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INFLAMMATORY BOWEL DISEASE IN CHILDREN

INFLAMMATORY BOWEL DISEASE IN CHILDREN. Abdulwahab Telmesani FRCPC, FAAP Associate Prof. of Pediatrics Umm Al-Qura University. INFLAMMATORY BOWEL DISEASE IN CHILDREN. CROHN’S DISEASE ULCERATIVE COLITIS INDETERMENANT (non specific) COLITIS. INFLAMMATORY BOWEL DISEASE IN CHILDREN.

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INFLAMMATORY BOWEL DISEASE IN CHILDREN

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  1. INFLAMMATORY BOWELDISEASE IN CHILDREN Abdulwahab Telmesani FRCPC, FAAP Associate Prof. of Pediatrics Umm Al-Qura University

  2. INFLAMMATORY BOWELDISEASE IN CHILDREN CROHN’S DISEASE ULCERATIVE COLITIS INDETERMENANT (non specific) COLITIS

  3. INFLAMMATORY BOWELDISEASE IN CHILDREN 1/3 of the incidence of IBD occurs in < 20 years of Age

  4. INFLAMMATORY BOWELDISEASE IN CHILDREN Highest in Scandinavian Western European North American Jews > Non Jews Urban > Rural Lowest in Asian African South American

  5. STRONG GENETIC PREDISPOSITION 10-25% in first degree relatives 7% in siblings Linkage with chromosome 16, 12, 14, 19, 6 & 1

  6. IBD IN SAUDI ARABIA Not Uncommon Adult > Children UC > CD Milder than the west

  7. PATHOPHYSILOLOGY Proinflammatory Cytokines & Eicosanoids Active inflammation Increase permeability & vasodilatation Symptoms & Signs Cont.#

  8. PATHOPHYSIOLOGY SYMPTOMS / SIGNS: Diarrhea Abdominal pain Protein Loss Bleeding Electrolyte Loss Stricture Formation

  9. EXPRESSION & DISTRIBUTION CROHN’S DISEASE 90% of patients have small bowel affected Classically terminal ileum 10-15% Only colon affected 60% Ileocolitis 20% have perirectal disease Cont.#

  10. EXPRESSION & DISTRIBUTION Trans mural inflammation Fistulas arise when inflammation extends through the serosa (Bladder, Vagina, Perineum) Granuloma is the Hallmark of Chron’s disease, found in 30% of all cases.

  11. EXPRESSION & DISTRIBUTION ULCERATIVE COLITIS 5% Proctitis 10-15% proctosigmoiditis 30-40% up to splenic flexure 50% pancolitis Almost always starts at the rectum Pathology limited to the mucosa Crypt abscesses, distorted architecture & goblet cell depletion, are typical

  12. PRESENTATION ULCERATIVE COLITIS Commonly Bloody mucoid diarrhea frequent loose stool lower abdominal pain more with defecation • Fulminant disease (10-15% of PT’s) • > 6 Bloody stools per day • Abdominal tenderness • Fever, tachycardia • Anemia HypoalbuminemiaCont.#

  13. PRESENTATION{CONTD} Constipation in proctitis Colonic carcinoma 1% by 10 years 1-2%per year thereafter Anorexia &Weight loss < Crohn’s Disease

  14. PRESENTATION • CROHN’S DISEASE • Abdominal pain ( awakens patient from sleep) • Site of disease dictates the nature & site of pain • Ileum RT quadrant pain • Gastroduodinal dyspeptic pain • Diarrhea & Rectal Bleeding may resemble U.C. • Cont.#

  15. PRESENTATION • Perianal disease(Fissures, fistulas & skin tags) • Intestinal obstruction is common • Abscesses (Interloop, intramesentric, • retroperitoneal, iliopsoas or subdiaphragmatic) • Carcinoma (Crohn’s Colitis)

  16. EXTRAINTESTINAL MANIFESTATIONS SYSTEMICLOCALISED Fever Eyes {C.D. > U.C. } Joints Malaise Skin Anorexia + wt loss Liver {C.D. 40% > U.C. 10%} Bone Delayed Growth & Kidneys Sexual Development Vascular {C.D. > U.C.} Hematological Heart

  17. EXTRAINTESTINAL MANIFESTATIONS EYE Uveitis, Episcleritis, Keratitis, RetinalVasculitis LIVER Sclerosing cholangitis U.C.>C.D. SKIN Erythema nodosum C.D.>U.C. Pyoderma gangrenosum U.C.> C.D.

  18. EXTRAINTESTINAL MANIFESTATIONS - JOINTS Arthralgia or Arthritis, Knees > Ankles > Hips> Wrists> Elbow Most common localised manifestations {ankylosing spondylitis, sacroilitis}U.C.>C.D. - BONE Demineralization {Steroid+Rest+Vit D def,Decreased Protein} - KIDNEYS Ca oxalate,Ca phosphate,Uric acid. Inflammation

  19. EXTRAINTESTINAL MANIFESTATIONS -VASCULAR Thrombocytosis Thrombophlebitis Activation of clotting cascade - HEMATOLOGICAL Anemia {B12 +Folic Acid def.} Effect of chemotherapy - HEART Perimyocarditis (good prognosis)

  20. DIAGNOSIS • Hx & P/E: • Stool Analysis + C/S • WBC N or slightly elevated • ESR Elevated 70 % • Thrombocytosis 60% • Albumin

  21. DIAGNOSIS Endoscopy Vs Radiology

  22. ENDOSCOPY Sigmoidoscopy Colonoscopy Ileum Upper endoscopy

  23. ULCERATIVE COLITIS Mucosa: Erythematus Granular Friable Loss of normal vascular

  24. CROHN’S Aphus Lesions Psudopolyps Patchy Distribution Bx normal mucosa

  25. RADIOLOGY -Upper G.I. Series Irrigular nodular and thickend bowel loops stenosis, ulcers & fistulas -Abdominal U/S & C.T. for complication of Crohn’s Disease

  26. TREATMENT AIM: Relief of symptoms Improve quality of life Improve growth

  27. TREATMENT Pharmacotherapy Nutrition Surgery

  28. TREATMENT Pharmacotherapy: 5- Aminosalicylate (P.O. Knema) Sulfasalzine

  29. TREATMENT Corticosteroids: Prednisone Budesonide

  30. TREATMENT Antibiotics: Metronidazol Ciprofloxacin

  31. TREATMENT Immunomodulators: 6- mercaptopurine Asathioprine Cyclosporine

  32. TREATMENT • Anti-tumer necrosis factor -Alpha • Infliximab • CDP571 • Thalidomide • Others

  33. TREATMENT • Clonidine (better than Sulfasulazine) • Na chromoglycate (No favorable effect)

  34. ANTIDIARRHEAL DRUGS Loperamide : Frequency of Diarrhea Contraindicated in sever colitis

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