Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis (UC) and Crohn's disease (CD). UC affects the colon and is characterized by inflammation of the mucosal layer. CD can involve any component of the gastrointestinal tract from the oral cavity to the anus and is characterized by transmural inflammation. These disorders have distinct pathologic and clinical characteristics, but their pathogenesis remains poorly understood. (See "Definition, epidemiology, and risk factors in inflammatory bowel disease" and "Immune and microbial mechanisms in the pathogenesis of inflammatory bowel disease".)
The peak incidence of IBD occurs in patients between the ages of 15 and 25 years. Approximately 25 to 30 percent of patients with CD and 20 percent of patients with UC present before the age of 20 years . Adults and children with IBD may present with similar clinical features; however, children can develop unique complications, including growth failure and delayed puberty. Thus, clinicians caring for children and adolescents with one of these disorders must treat the underlying disease and its complications and also must carefully monitor linear growth, skeletal development, and puberty. (See "Epidemiology and environmental factors in inflammatory bowel disease in children and adolescents" and "Growth failure and poor weight gain in children with inflammatory bowel disease".)
The suspicion of IBD typically arises from a combination of symptoms and screening laboratory data. The diagnosis is established by radiographic studies and endoscopy. These studies also help to localize the disease and to differentiate between UC and CD. The diagnosis of IBD in children is reviewed here. The clinical manifestations of CD, and the treatment of CD and UC are presented separately. (See "Clinical manifestations of Crohn's disease in children and adolescents" and "Overview of the management of Crohn's disease in children and adolescents" and "Treatment of ulcerative colitis in children and adolescents".)
Inflammatory bowel disease (IBD) should be suspected based upon suggestive features in the history and clinical presentation (table 1). Patients typically present in late childhood or adolescence with one or several of the following features:
- Gastrointestinal symptoms – Loose stools or bloody diarrhea, abdominal pain, or tenesmus
- Growth – Growth failure (subnormal gains in height or weight, or weight loss), and/or delayed puberty. Although growth failure is a common feature, a substantial number of children are overweight when they present with IBD (particularly those with UC) . Thus, obesity or lack of growth failure should not preclude a diagnosis of IBD.
- Physical findings – Abdominal tenderness (especially in the right lower quadrant), perianal disease (fistulae, anal skin tags, or fissures), or occult blood in stool
- Extraintestinal manifestations – Oral ulcerations (aphthous stomatitis), clubbing, rash (erythema nodosum or pyoderma gangenosum), eye inflammation (uveitis), or arthritis (See 'Extraintestinal manifestations' below.)