Challenges in Pediatric Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract comprising of two entities: Crohn disease (CD) and Ulcerative colitis (UC). Considered rare in children in the past, inflammatory bowel disease is nowadays more frequently found, raising diagnostic and treatment challenges.

In our study, we have taken into consideration all children diagnosed with inflammatory bowel disease, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta, from 2016 to 2019.

14 children were diagnosed with inflammatory bowel disease during this timeframe, 8 with Crohn disease (57,14%) and 6 with Ulcerative colitis (42,86%). The mean age at onset was 8.2 years for Crohn disease patients, varying between 20 months to 15 years, and 12.8 years for Ulcerative colitis patients, varying between 8 to 14 years.

After a positive diagnosis, different types of induction therapy was implemented, depending on the activity and severity of the disease, as well as on the type of inflammatory bowel disease. 12 patients received iv corticosteroids for an average of five days, followed by oral corticosteroids for 4-8 weeks. Aminosalicylates (Mesalazine) was used as a sole induction treatment in children with UC, or in association with corticosteroids in severe cases (4 cases). Immunomodulatory treatment (Azathioprine) was used for maintaining remission in 5 children with Crohn disease for an average period of 6 months. In 3 cases of CD, antibiotics, such as Metronidazole, were used in the initial treatment.

Biological therapy, such as Adalimumab (ADA), was administered as an induction therapy in patients with refractory to conventional treatment forms, in 5 cases, with a favourable outcome.