Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) includes two classic entities, Crohn’s disease (CD) and ulcerative colitis (UC), and a third undetermined form (IBD-U). Ulcerative colitis is an idiopathic IBD affecting primarily the mucosal layer of the colon. UC is more frequent between ages 15 and 35. The disease extent is variable; inflammation can be restricted either to the distal rectum or to the entire colon. According to Scandinavian, North American, and UK studies, UC incidence in children ranges from 2.1 to 4.2 cases/year/100,000 population. Most common symptoms include rectal bleeding, abdominal pain, and diarrhea. Pediatric UC activity evaluation is evaluated with a sixth variable which is the pediatric UC activity index (PUCAI). Diagnosis is based on laboratory assessment and endoscopic and histologic evaluation. Treatment options depend on the extent and severity of disease. Medical treatment should be proposed first. Surgery should be reserved to patients with severe and/or refractory disease or with serious pharmacological side effects. Crohn’s disease is a chronic, relapsing, inflammatory disorder which could develop in any part of the gastrointestinal tract. The incidence of CD in children is increasing worldwide, ranging from 2.5 to 11.4 per 100,000, with an estimated prevalence of 58/100,000 which is rising in both developed and developing countries. In genetically predisposed children, an interaction between luminal contents and the mucosa leads to a dysregulated inflammation, which is the most recognized mechanism of pediatric CD. Classical symptoms and signs are abdominal pain, diarrhea, weight loss, fever, and failure to thrive. Diagnosis is based on serologic tests, fecal markers, and endoscopic findings. Conventional therapy is based on the shift from drugs with a better safety profile but lower efficacy (mesalazine, sulfasalazine, antibiotics) to those with improved efficacy but a greater risk of side effects (steroids, immunomodulators, biologicals, surgery).