Ulcerative Colitis in Children
Overview
Ulcerative colitis is an
inflammatory bowel disease (IBD). In this condition, the inner lining of your child’s
large intestine (colon or bowel) and rectum gets inflamed. This inflammation often
starts in the rectum and lower (sigmoid) intestine. Then it may spread to the whole
colon.
This causes diarrhea or frequent emptying of the colon. As cells on the surface of
the lining of the colon die and fall off, open sores (ulcers) form. This causes pus,
mucus, and bleeding.
Causes
Healthcare providers don't know what causes this condition. It may be triggered by
a virus or bacteria. This interacts with your child’s immune system and causes an
inflammatory reaction in the intestinal wall.
Children with ulcerative colitis
often have problems with their immune system. It's not clear if these issues are a
cause
or a result of the disease.
There’s no known cure for this
condition. But there are medical treatments and surgery if needed.
Risk Factors
People between the ages of 15 and
30 are at greatest risk of developing this condition. This issue can also start in
children and older adults. It also seems to run in some families.
Symptoms
Symptoms can happen a bit
differently in each child. They can include:
- Stomach pain
- Bloody diarrhea
- Fatigue
- Weight loss
- Loss of appetite
- Rectal bleeding
- Loss of body fluids and nutrients
- Anemia caused by severe bleeding
Some children also have the
following symptoms:
- Skin sores (lesions)
- Joint pain
- Inflammation of the eyes
- Liver problems
- Osteoporosis
- Rashes
- Kidney stones
Many of these symptoms may be caused by other health problems. Make sure your child
sees their healthcare provider for a diagnosis.
Diagnosis
Your child's healthcare provider
will ask about your child's health history. They will also give your child an exam.
Your child will have blood tests.
These tests can tell if your child has anemia. They can also tell if your child has
a
high white blood cell count. This can be a sign of inflammation or infection. Your
child’ may also have other tests.
Stool sample
This test checks for infection
or inflammation in your child’s digestive tract. A small sample of stool is collected
from your child and sent to a lab.
Upper endoscopy
In this test, a small, flexible
tube (endoscope) is used to look at the inside of your child’s upper digestive tract.
This tube has a light and a camera lens at the end of it. During the test, the
healthcare provider may take tissue samples from your child's digestive tract. The
provider will test these samples.
Colonoscopy
This test lets the provider look
at the length of your child’s colon (the large intestine). This can spot abnormal
growths, inflamed tissue, ulcers, and bleeding. In this test, the provider puts a
special tool (colonoscope) in through the rectum up into the colon. This tool is a
long, flexible, and lighted tube. During the test, the provider may take out tissue
to look at it more closely. They may also treat some problems.
Biopsy
The provider may take tissue
samples to be checked under a microscope. These samples may be taken from the lining
of the colon during a colonoscopy. Or they may be taken from the end of the small
intestine during an upper endoscopy.
Barium enema (lower GI series)
This test looks at the large
intestine. Your child will get barium in their rectum as an enema. This is a metallic
liquid that coats the inside of their organs. This helps them show up on an X-ray
better. Your child’s healthcare provider will take X-rays of their belly. This can
show narrowed areas (strictures), blockages (obstructions), and other issues.
Treatment
Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on the specific cause
and
how severe the condition is.
Diet
No specific diet causes or cures
this condition. If certain foods upset your child’s stomach, staying away from those
foods may help ease your child’s symptoms. A healthy diet is always advised.
Medicine
Your child’s healthcare provider
may prescribe medicines that reduce colon inflammation. These can include
aminosalicylates, corticosteroids, and immunomodulators. Some medicines are given
into the rectum as a suppository or enema. If your child’s condition is severe, they
may also need steroids, antibiotics, or medicines that affect the body's immune
system. These are called biologics and small molecules.
Hospital stay
If your child’s symptoms are
severe, they may need to stay in the hospital for monitoring and treatment. This can
help make sure your child is getting the nutrition and fluids they need. Treatment
will be given to help stop diarrhea and the loss of blood, fluids, and minerals. Your
child may need a special diet, feeding, and fluids or medicines through a vein. Some
children may also need surgery.
Surgery
About 10% to 20% of children
with this condition eventually need surgery. This is done because of heavy bleeding,
tear (perforation) of the colon, cancer risk, or severe illness. In surgery, your
child’s colon is removed. This may also be done if other treatments don’t work. Or
if
your child has side effects.
Your child may have 1 of the
following surgeries:
-
Proctocolectomy with ileostomy. This is the most common
surgery. In a proctocolectomy, the whole colon and rectum are taken out. In an
ileostomy, your child’s surgeon makes a small opening of the abdominal wall. The
tip of the lower small intestine (ileum) is brought to the surface of your child’s
skin. This allows waste to drain out into a bag.
-
Ileoanal anastomosis. In this surgery, just the
affected part of your child’s colon is taken out. The outer muscles of the rectum
aren’t removed. Your child’s surgeon attaches the ileum to the inside of the
rectum. This forms a pouch to hold the waste. This allows your child to pass stool
through their anus in a normal way. But your child’s bowel movements may happen
more often and be more watery than normal. This is sometimes done in 2 or 3
surgeries.
Complications
In rare cases, this condition can
cause death. If your child’s condition affects more than just their rectum and lower
colon, your child has a higher risk for colon cancer. They're also at risk for a tear
(perforation) of the bowel wall. This needs surgery. Your child may also have severe
bleeding at times.
Living with
Children with this condition need
long-term care. Your child may have times when symptoms go away (remission). This
can
sometimes last for months or years. But symptoms often come back. Medicines are often
needed for the long term.
Your child should learn what foods
trigger their symptoms and stay away from these foods. You and your child’s healthcare
provider should make sure your child gets enough nutrients to grow and develop well.
Support groups can help you and your child. Work with the provider to create a care
plan
for your child.
When to Call a Healthcare Provider
If your child has any symptoms of
ulcerative colitis, call their provider.
If your child is being treated for
ulcerative colitis and has new symptoms, call their provider. You should also call
if
you’re worried about your child’s growth.
Key Points
- Ulcerative colitis is an inflammatory bowel disease. In this condition, the inner
lining of your child’s large intestine and rectum gets inflamed.
- This inflammation causes diarrhea or frequent emptying of the colon. Your child may
also have stomach pain and diarrhea.
- Treatment may include staying away
from foods that cause symptoms, taking medicine, and having surgery.
- Children with this condition need long-term care. Your child may have times when symptoms
go away. But symptoms usually come back.
Next Steps
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects are
and when they should be reported.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is
advised and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.