Pediatric Gastroenterology

Ulcerative Colitis

Children often get stomachaches, diarrhea, and abdominal pains, and a variety of causes, most of which resolve on their own in a short period of time, can be the culprit. A small number of these children, however, have symptoms that do not go away and, upon further investigation, turn out to be a form of inflammatory bowel disease known as ulcerative colitis. Ulcerative colitis can affect children and adults and is a chronic disease that can be controlled with medication in many cases.

What is Ulcerative Colitis?

Ulcerative colitis is a disease that affects the large intestine, otherwise known as the bowel or colon. When a patient has ulcerative colitis, the bowel becomes inflamed and can often wear away the top layer of cells causing sores, or ulcers within the intestine. This can cause abdominal pain for the patient as well as frequent diarrhea or other issues.

Ulcerative colitis can cause a number of complications. For example, children may not get enough protein, calories, or nutrients when they have this type of disease. This is due to the low food intake, pain in the abdomen or because the intake is not well absorbed. In turn, this can cause retarded growth or failure to thrive. In addition, toxic megacolon is a definite possibility with these children. This occurs when an infection in the colon causes it to enlarge to the point where it may burst, thus causing further complications.

Causes of Ulcerative Colitis

The cause of ulcerative colitis in children is unknown though research has shown that there are likely three main factors including genetics, immune system issues, and environmental factors. Approximately five to 20 percent of people with ulcerative colitis have a family member with the disease, indicating a possible genetic link.

Many factors have been ruled out as causes of ulcerative colitis including tension, emotional upset, and some viruses and bacteria. Evidence does also suggest that the immune systems of people with ulcerative colitis are abnormal; scientists do not yet know whether this is a cause or result of the disease. Much research continues and some promising studies may be on the horizon.

Symptoms of Ulcerative Colitis

The ulcerative colitis symptoms of each child may be very different. Some children have mild symptoms that progress slowly while others experience sudden, serious symptoms that require immediate attention. The most common symptoms include frequent diarrhea and abdominal pains and cramping. In addition, some children experience excess and unexplained tiredness and weight loss, as well as blood in the stool. Additionally, anemia and low iron levels are likely to be discovered upon blood testing. While not all symptoms are present to the same degree, most will appear at some point in pediatric patients with ulcerative colitis.

Diagnosing Ulcerative Colitis

After a complete medical exam and history are taken, a doctor will likely order some diagnostic tests to determine if a child has ulcerative colitis. Blood tests can help look for such problems as anemia or low iron, as well as infection or low blood counts. Stool samples may also be studied to check for infection in the colon, blood in stool, or for inflammation. In addition, X-ray studies including CT scans can determine where inflammation is located within the colon. Endoscopy studies can use a lighted probe to study the inside of the bowel and take samples of cells for further testing. Colonoscopy is the most important factor in the diagnosis of ulcerative colitis.

Treatments for Ulcerative Colitis

The goals of treatment are to control the inflammation in addition to increasing the nutritional deficits. To do this, doctors often offer the first course of action with medications and nutritional supplementation. Medication can often reduce symptoms to the point where the disease is well controlled. In some cases, however, surgery may be required. Surgery can actually cure the disease for some pediatric patients. Nonetheless, it is usually not the first choice for most patients.

To treat symptoms of ulcerative colitis, diet is another important factor to consider. Different people find that different foods contribute to flare-ups of inflammation. Other foods may actually be beneficial. Foods high in omega-3 fatty acids have been shown to reduce inflammation; yogurt-containing probiotics may also be beneficial. There are a large number of foods, which may cause trouble in some people. The list of problematic foods includes foods or drinks high in caffeine, carbonated drinks, dairy, beans, dried fruit, raw fruits and vegetables, nuts, foods containing sorbitol, popcorn, and refined sugar. Since not all foods will affect all people, it is a good idea to keep a food diary to detect which foods cause problems. Remember to eat a balanced diet as much as possible.

What is the Difference Between Ulcerative Colitis and Crohn's Disease?

While both ulcerative colitis and Crohn's disease are inflammatory bowel diseases, there are differences. In ulcerative colitis, the entire bowel is inflamed, but in Crohn's disease, there are areas of healthy tissue mixed with areas of inflammation. In addition, ulcerative colitis only affects the uppermost layer of colon tissue while Crohn's disease can affect all layers. The proper tests can help in diagnosing the proper disease for the best treatment.

Ulcerative colitis in pediatric patients may seem overwhelming, but, with patience and adherence to medical advice, it can be controlled. A regular, full lifestyle can be obtained once symptoms are alleviated. Nonetheless, ulcerative colitis is a chronic disease and flares may happen at any time. Making a treatment plan in advance with your child's doctor can be beneficial for quick response and treatment of symptoms.