There are a variety of medications available to treat both ulcerative colitis and Crohn’s disease. Important pediatric considerations for medical therapy include long term side effects of the medications especially with regards to growth, bone disease such as osteoporosis (decreased calcium in the bone), development of cataracts in the eyes from medications such as steroids and a small risk of developing certain types of cancer with some medications or as a result of having chronic inflammatory bowel disease over a long period of time.
Medications used for pediatric patients with inflammatory bowel disease include the following:
||How it is given
|Aminosalicylate or 5-ASA products
||by mouth, as a suppository or an enema
||by mouth, in the vein, or as an enema
|Immunosuppressants (Imuran, 6-MP)
||by mouth or by injection
||by mouth or in the vein
||by mouth, in the vein
|Immune-modulators (Infliximab, Adalimumab)
||in the vein or by injection
There are a variety of nutritional options also available for patients with Crohn’s disease and it has been shown that disease activity appears to decrease if patients are able to significantly increase their caloric intake through the use of standard or specialized diets. Supplementation with folic acid, calcium and Vitamin D in patients with decreased bone calcium is also helpful in pediatric patients with inflammatory bowel disease.
What is the role of surgery in ulcerative colitis or Crohn's disease?
Colorectal surgery is curative for ulcerative colitis, but not for Crohn's disease. Surgery is usually performed for disease that does not get better despite medications, if severe medication side effects develop or for other complications of the underlying inflammatory bowel disease. Children undergoing removal of their colon for ulcerative colitis can have a pouch fashioned of small intestine that serves as a reservoir for stool and takes the place of the rectum. Children undergoing surgery for Crohn’s disease generally do so for development of a specific complication of their disease or their medication. Because Crohn’s disease always comes back following surgery given a long enough period of follow up, patients are usually continued on maintenance medications to cut down how quickly or how severely the disease comes back. Also the amount of bowel removed is limited in patients with Crohn’s disease in order to prevent additional problems with absorption of nutrients after surgery. Patients still require regular follow up with their gastroenterologist after surgery for either ulcerative colitis or Crohn’s disease.
The development of colon cancer appears to be a long term risk of having either ulcerative colitis or Crohn’s disease and in some cases appears to relate to the number of years of disease. (i.e. number of years following diagnosis) Disease starting in childhood may be a particular risk factor and therefore pediatric patients with both UC and Crohn’s disease require regular follow up with a gastroenterologist throughout their life to help reduce the risk of developing serious complications including colon cancer.
Author(s) and Publication Date(s)
Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Annette E. Whitney, MD, Digestive Health Associates of Texas, Dallas, TX – Updated December 2012.
Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Vasundhara Tolia, MD, Children's Hospital Of Michigan, Detroit, MI – Published September 2004.
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