Inflammatory Bowel Disease in Children

Inflammatory bowel disease (IBD) is a term for a group of conditions that involve chronic inflammation of the digestive tract, including Crohn’s disease and ulcerative colitis. Children account for 25% of all IBD cases. Although IBD is most common in children ages 10 to 18, it can develop at any age, including during infancy and toddlerhood.

Without proper management of these diseases, patients can suffer from abdominal pain, anemia, diarrhea, weight loss, malnutrition, obstruction, perforation, and cancer.

Comprehensive Care for All Types of IBD

Inflammation of the intestinal tract, which often leads to ulcers, fistulae, or obstructions, characterizes IBD. Crohn’s disease and ulcerative colitis are the two most common types of IBD. Crohn’s disease can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus, while ulcerative colitis strikes the inner lining of the large intestine or the rectum.

AT UT Southwestern, we use well-informed, shared decision-making tools to personalize treatment for each of our patients to improve short- and long-term outcomes. We provide comprehensive care to optimize the physical and psychological well-being of patients and their families.

Our Southwestern Pediatric IBD Program – the first of its kind in Texas – features a collaborative team of pediatric gastroenterologists, physician assistants, immunologists, pediatric surgeons, pathologists, psychologists, dietitians, imaging specialists, and nurses. Our basic science researchers continually seek new information about the nature of these diseases and new ways to improve treatment outcomes for patients.

The program is led by pediatric gastroenterologists who have specific expertise in the diagnosis and treatment of chronic inflammatory conditions of the intestines, including Crohn’s disease, ulcerative colitis, and indeterminate colitis.

The Southwestern Pediatric IBD Program is one of the largest IBD centers in the country. We care for more than 500 children a year and provide consultations to patients throughout the world. We are also pioneers in the field – UT Southwestern research identified novel genes that play a role in early-onset IBD.

We work closely with immunologists in the multidisciplinary Pediatric Intestinal Immunology Clinic (PIIC), specifically for very early-onset IBD children (younger than 6 years old) and those with IBD that doesn’t respond to conventional IBD treatments. We do a comprehensive evaluation employing advanced diagnostics for underlying immune dysregulation and immune deficiency states.

Among the conditions we routinely help manage are:

• Crohn’s disease, including ileal, colonic, perianal, and upper GI
• Ulcerative colitis
• Ulcerative proctitis
• Very early-onset IBD and infantile-onset IBD
• Intestinal strictures
• Fistulas in the GI tract
• Pouch disorders/pouchitis
• Microscopic colitis
• Collagenous colitis
• Lymphocytic colitis

To best treat our patients, we hold regular monthly multidisciplinary case conferences to discuss particularly challenging cases. We also have several clinic trials in which we can enroll patients with IBD.

Symptoms of IBD

Symptoms of IBD can vary, depending on the type of disease, the location of the inflammation, and the individual patient. Common symptoms include:

• Frequent and persistent abdominal pain
• Frequent and persistent diarrhea
• Rectal bleeding
• Weight loss
• Growth failure
• Perianal fistulae and fissures
• Fatigue
• Anemia

Diagnosing IBD

If our team suspects inflammatory bowel disease, we first obtain a symptom assessment and conduct a thorough physical examination. We talk with the patient and his or her family about other medical and family history. Then, depending on the examination results, we might perform any of several diagnostic tests, including blood work, stool testing, and endoscopic evaluation.

Endoscopic tests might include:

• Colonoscopy
• Upper endoscopy
• Flexible sigmoidoscopy
• Enteroscopy
• Pouchoscopy
• Video capsule endoscopy

Treating IBD

The goal of treatment is to reduce inflammation, which can in turn reduce immediate symptoms and prevent long-term complications. Treatment varies depending on the severity of the inflammation, the location of the inflammation, and the patient’s unique needs.

Medications that are used to treat IBD include:

• Aminosalicylates: Anti-inflammatory medications that can be given either orally or rectally
• Corticosteroids: Steroids that help to keep the immune system in check and reduce inflammation; while effective in the short-term, these are not recommended for long-term use
• Immunomodulators: Medications that change how the immune system functions so it can no longer cause inflammation
• Antibiotics: Sometimes used if an infection is also present with IBD
• Therapeutic antibodies and novel small molecules: Sometimes called biologics, these new treatments help people with moderate or severe IBD
• Nutritional support (also called nutritional therapy) can also be useful for patients with IBD.

Surgery is sometimes used in severe cases that do not respond to medication. Surgical treatments for IBD include:

• Hand-assisted surgeries
• J-pouch procedures
• Laparoscopic proctocolectomies
• Laparoscopic total colectomy
• Large and small bowel resection
• Minimally invasive laparoscopic surgery

Clinical Trials

Our patients have access to promising new treatments through phase III clinical trials, and a specially trained IBD research coordinator assists them throughout their participation.