In most cases, inflammatory bowel disease is a lifelong disease. At Children's Hospital & Medical Center's Pediatric Gastroenterology Department, we follow your child throughout the duration of their childhood and teenage years. We use a multi-disciplinary, multi-faceted approach that includes a combination of medications, nutritional guidance and medical management of symptoms and side effects that may occur due to medications and complications of the disease. Effective management of IBD requires a team approach that includes the family, primary care provider, pediatric gastroenterologist, nutritionist, psychologist, social worker, surgeon and school teachers. Usually, our clinic will see you every six months once your child's condition has been controlled. In more difficult cases, we may want to see your child every one to two months.
Treatment for inflammatory bowel disease over the last 10 years has improved tremendously due to improved medications. Medications are the primary treatment for relieving the symptoms of both ulcerative colitis and Crohn's disease. These usually include a combination of anti-inflammatory drugs to reduce inflammation and immunosuppressive agents to help restrain the immune system from attacking the body's own tissues and causing further inflammation. If the condition stabilizes, most patients can make the change to less potent drugs after about three months of treatment. You will also meet with our medical nutritionists who will develop a nutrition plan to meet your child's needs.
Eating a balanced diet with adequate calories is very important for children with inflammatory bowel disease. The symptoms of inflammatory bowel disease such as diarrhea, loss of nutrients and side effects of medications can all lead to malnutrition. A pediatric clinical dietitian from the Pediatric Gastroenterology Department will meet with you and your child to provide nutritional education. The nutritionist will also evaluate and assess your child's diet, intake patterns and caloric needs, and develop a plan to meet your child's individual nutritional needs.
A child who does not respond to medicine may be a candidate for surgery. However, with Crohn's disease, surgery is usually avoided whenever possible because of the recurring nature of the disease. An aggressive surgery approach to Crohn's disease could also cause further complications such as short bowel syndrome. This can lead to problems with the absorption of nutrients and growth failure.
In severe cases of ulcerative colitis, the colon (large intestine) may need to be removed. Surgery may be recommended for children who have had little success with medications and have been carefully evaluated. Nationally, one-third to one-half of colitis patients undergo surgery.
The surgery performed in children with ulcerative colitis is called ileal pouch-anal anastomosis. This surgery requires removal of the entire colon and rectum. In this procedure, the surgeon usually constructs a pouch from the end of the small intestine that attaches directly to the anus. Waste is then expelled normally, although bowel movements frequently are watery.