Inflammatory bowel disease (IBD) is comprised of two major disorders, ulcerative colitis (UC) and Crohn disease (CD). These disorders have distinct pathologic and clinical characteristics (table 1), but their pathogenesis remains poorly understood. (See "Definition, epidemiology, and risk factors in inflammatory bowel disease".)
Approximately 20 percent of patients with IBD develop symptoms as children or teenagers (younger than age 18). The development of IBD early in life has implications that are not encountered in adults. Clinicians caring for children and adolescents with CD or UC not only must treat the underlying disease and its complications but must also carefully monitor linear growth, skeletal development, and puberty. In addition, many children are unable to swallow pills or refuse topical enema therapy, rendering compliance with therapies typically used for older patients unfeasible.
The treatment of UC in children and adolescents is reviewed here. The clinical manifestations and diagnosis of inflammatory bowel disease, differentiation between UC and CD, and the treatment of ulcerative colitis in adults are discussed separately. (See "Clinical features and diagnosis of inflammatory bowel disease in children and adolescents" and "Management of severe ulcerative colitis".)
Ulcerative colitis (UC) in children principally occurs in teenagers but can also occur earlier in life . The presentation in children is similar to that in adults. Affected patients usually present with a subacute illness characterized by diarrhea frequently containing blood, weakness, anemia, abdominal pain, and sometimes weight loss. Those with a more fulminant presentation (acute severe UC) also may have severe abdominal pain, frankly bloody diarrhea, tenesmus, fever, leukocytosis, and hypoalbuminemia. Some children have more insidious onset of symptoms, with non-bloody diarrhea and sometimes poor weight gain prior to the development of more overt symptoms or signs . (See "Growth failure and poor weight gain in children with inflammatory bowel disease" and "Clinical features and diagnosis of inflammatory bowel disease in children and adolescents", section on 'Clinical manifestations'.)
Extraintestinal manifestations of inflammatory bowel disease may precede the gastrointestinal symptoms and are somewhat different in UC as compared with Crohn’s disease (CD), as is described in detail separately . (See "Clinical features and diagnosis of inflammatory bowel disease in children and adolescents", section on 'Extraintestinal manifestations'.)