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Unique Challenges in the Diagnosis and Management of the Pediatric IBD Patient

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Inflammatory Bowel Disease

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Pediatric inflammatory bowel disease (PIBD) has its own unique diagnostic and management challenges. As with adults, the differential diagnosis is broad but is made based on clinical signs, symptoms, laboratory testing, imaging, and endoscopy. Growth failure/poor weight gain is a frequent presentation in pediatric IBD and is multifactorial in etiology, resulting from malabsorption at the inflammatory site, direct effects of cytokines, and hormone imbalances. The Paris Classification system for PIBD takes growth delay into account, as well as disease location and behavior. Treatment consists of medical, surgical, and (unique to PIBD) nutritional. Several diets have been used in the treatment of PIBD with varying degrees of success. These include exclusive enteral nutrition (EEN), specific carbohydrate diet (SCD), IBD-AID, and Crohn’s disease elimination diet (CDED). A number of health maintenance issues must be addressed in the pediatric IBD population. Immunizations are important to this group and should generally be given, although live vaccines must be avoided for those on immunosuppressive medications. Psychosocial well-being is an important part of overall health, and PIBD patients are particularly vulnerable to adjustment issues, drugs and alcohol, and psychopathology including anxiety and depression. The transition process from pediatric to adult gastroenterology usually occurs in the early twenties. Despite evidence of their utility, transition clinics and transition readiness questionnaires are still underutilized. Very early-onset IBD (VEO-IBD) is a subset of IBD occurring in children under age 6; it is frequently aggressive, more often has a genetic basis, and may require distinct treatments.

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  1. Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA

    Jeffrey A. Morganstern & Alexander Schosheim

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  1. Jeffrey A. Morganstern
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Correspondence to Jeffrey A. Morganstern .

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  1. Zucker School of Medicine at Hofstra/Northwell, Mather Gastroenterology, Port Jefferson, NY, USA

    Ramona Rajapakse

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Morganstern, J.A., Schosheim, A. (2021). Unique Challenges in the Diagnosis and Management of the Pediatric IBD Patient. In: Rajapakse, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana, Cham. https://doi.org/10.1007/978-3-030-81780-0_9

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