Inflammatory bowel disease in children: current trends

Once considered rare in the East, inflammatory bowel disease (IBD) is now recognized to be an emerging entity in that region. East or West, the clinical features of and treatment options for IBD are the same, but it is possible that the exact pathogeneses or the initiating events differ. In this review, existing knowledge of IBD and new discoveries in the epidemiology, genetics and treatment of IBD are discussed in detail. The diagnosis and management of IBD in children has changed dramatically over the last decade, mainly due to increased awareness, the availability of newer diagnostic modalities such as MRI and video capsule endoscopy, and newer, more powerful treatments such as biologics. It is hoped that the combination of innovative research and advances in drug discoveries will change the natural history of IBD and make a major difference in children who are suffering from this unfortunate lifelong chronic inflammatory disorder.     

Inflammatory bowel disease

These experiments have shown that the ability of sera, from patients with chronic ulcerative colitis (CUC) or granulomatous colitis (GC), to convey cytotoxicity for human colonic epithelial cells to normal peripheral blood lymphocytes in vitro seems to be a property of the IgM fraction, and that the antibody is cytophilic. Treatment of peripheral blood lymphocytes from patients with CUC or GC with goat antihuman whole serum proteins serum or antihuman IgM serum inhibited their cytotoxicity for human colonic epithelial cells, suggesting that a similar cytophilic antibody may be acting. These findings indicate that the cytotoxicity of lymphocytes for colonic cells involves an immune mechanism and, taken together with the results of previous studies, we have speculated that colonic bacteria, or their products, may be significant in the development of this cytotoxicity and in the pathogenesis of inflammatory bowel disease.Supported in part by NIH Grant AM 12808, USPHS.The authors wish to thank Mrs. V. Knopf for technical assistance; the volunteers whose collaboration made these experiments possible; and Mr. H. Brumfield for assistance with the analytic ultracentrifugation.     

Inflammatory bowel disease

Although inflammatory bowel disease (IBD) usually presents in adolescents and young adults, both ulcerative colitis and Crohn's disease can also present in older adults. The diagnosis of IBD in the elderly is often difficult and can easily be confused with diverticulitis or ischaemic colitis. The symptoms and complications of IBD in the elderly are similar to those found in younger patients. However, when IBD presents later in life the disease is often less extensive and milder. Older IBD patients are treated with the same medications as younger patients, although the risk for drug toxicity is greater, especially with corticosteroid therapy. Comorbid illness in older patients often has a significant impact on the outcome of medical and surgical therapy for IBD but, in the absence of significant co-morbid disease, most elderly IBD patients can expect a good response to therapy.     

Inflammatory bowel disease

Abstract

Scandinavian researchers have contributed to the present understanding of inflammatory bowel disease (IBD). Important epidemiological data and family risk factors have been reported from all the Nordic countries, original twin studies mainly from Denmark and Sweden, and relationships to cancer and surgery mostly from Sweden. In collaboration with the industry, development of medical compounds was for a long time in the front line of international research, and the Scandinavian countries participated in the clinical breakthrough of biologic treatment. At present, many Nordic centers are working in the forefront of IBD research. An increasing number of young investigators have entered the scene along with the extended distribution of University clinics and research laboratories in these countries. This presentation of IBD gives a brief overview in the fields of clinical epidemiology and molecular biology. Many areas are covered by International collaborations with partners from Nordic centers. IBD was a topic focused by the founders of Scandinavian Journal of Gastroenterology. After 50 years one may state that the journal’s history reflects important pieces of scientific knowledge within these diseases. The early scope of Johannes Myren for IBD was shown through his work in the original World Association of Gastroenterology (OMG), and after 50 years we can clearly support the view that global perspectives in IBD are increasingly important.     

Inflammatory bowel disease

Cell-free supernatants, derived either from incubates of lymphocytes from patients with chronic ulcerative colitis or Crohn's disease of the colon (inflammatory bowel disease) with colonic epithelial cells or from incubates of colonic epithelial cells with normal lymphocytes pretreated with inflammatory bowel disease serum (cytophilic antibody), were studied for their cytotoxic and physicochemical properties. These cell-free supernatants were cytotoxic for various human and murine tissue cells; their cytotoxicities and physicochemical properties conformed to those of human lymphotoxin from stimulated (phytohemagglutinin-P) human lymphocytes. We suggest that the cytotoxicity of inflammatory bowel disease lymphocytes for colonic epithelial cells involves aspecific recognition mechanism, possibly mediated by cytophilic antibody. However, the actual destruction of target cells isnonspecific and is effected by the release of lymphotoxic factor which is triggered by the recognition mechanism.Supported in part by Grant No. AM12808 from the National Institutes of Health, USPHS.     

Inflammatory bowel disease in pregnancy

Fertility is affected in ulcerative colitis after surgery and in active Crohn's disease. Adverse fetal outcomes are not increased when IBD is quiescent. Active disease at conception increases the risk of adverse fetal outcomes. Most medications for IBD are safe during pregnancy and breastfeeding, with notable exceptions. Active disease is usually more deleterious than maintaining medical therapy.     

Inflammatory bowel disease in pregnancy

Women and men with inflammatory bowel disease (IBD) frequently express concerns about fertility and pregnancy. The evidence suggests that women with IBD can expect to have a normal pregnancy outcome provided they have inactive disease. They have an increased risk of having a small or premature baby but the majority will have a normal outcome of pregnancy. The commonly used drugs appear to be safe and well tolerated in pregnancy. There remains a need for further studies in this area to help in the difficult decisions about the management of IBD around the time of conception and during pregnancy.     

Inflammatory bowel disease in pregnancy

Crohn’s disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient. Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the b...     

Inflammatory bowel disease in pregnancy

Crohn disease and ulcerative colitis commonly affect women in their childbearing years. Fortunately, advances in the field of inflammatory bowel disease have made successful pregnancy outcomes a reality for many women. These advances have led to family planning as a common discussion between gastroenterologists and inflammatory bowel disease patients. Common discussion topics are fertility, conception, medication safety, pregnancy, delivery, and breastfeeding although there are limited available data. Education and patient awareness have become vital factors in successful pregnancy outcomes.     

Inflammatory bowel disease emergencies

Emergency complications of IBD are rare, but may be life-threatening, require surgery, and result in permanent end organ damage. The most common complications associated with UC are fulminant colitis, toxic megacolon, and bleeding. Each of these complications may resolve with aggressive medical therapy but often result in a total proctocolectomy. The most common complications associated with CD are abscesses and intestinal obstruction. Although initial treatment includes medical treatment, these Crohn's-related complications usually require a surgical intervention and intestinal resection. Finally, the most common extraintestinal manifestations that present as an emergency include thromboembolic events, ocular complications, and hepatobiliary disease. Some of these complications may parallel the course of the underlying disease and respond to IBD treatment, but thromboemboli, uveitis, and PSC do not. In the last decade there has been an explosion of knowledge and discovery into the pathogenesis of IBD. These findings have led to better and earlier treatment of IBD that it is hoped will alter the natural course of disease and prevent many of the complications outlined in this article.