Ulcerative Colitis

What is ulcerative colitis in children?

Ulcerative colitis is a long-term (chronic) condition and belongs to a category of disease known as Inflammatory Bowel Disease. In Ulcerative colitis, 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 spreads 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.

What causes ulcerative colitis?

Researchers believe that Ulcerative colitis is caused by a combination of several factors. Certain susceptibility genes have already been identified for IBD. Most IBD researchers believe that something in the environment (such as a virus) triggers an inflammatory response in the gut. In people who may not have the genetic predisposition, this inflammatory response is self- limited, meaning it resolves on its own. However, in people with Ulcerative colitis, there is genetic influence that maintains the inflammatory response.

There's no cure for this condition, except to take out your child's colon with surgery. However, the symptoms can be managed medically.

Who is at risk for ulcerative colitis?

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 affects males and females equally. It also seems to run in some families.

What are the symptoms of ulcerative colitis?

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

The symptoms of ulcerative colitis may look like symptoms of other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ulcerative colitis diagnosed?

Your child's healthcare provider will ask about your child's health history. He or she will also give your child an exam. Other tests for Ulcerative colitis may include:

• Blood tests. These are done to see if your child has fewer healthy red blood cells because of blood loss. This is called anemia. These tests also check if your child has a higher number of white blood cells. That might mean there is an inflammation problem. Some of the tests can also check for signs of acute (current) and chronic inflammation in the blood stream. Sometimes long term gut inflammation can lead to poor absorption or protein loss in the gut, which can also be checked in the blood.

• Stool studies. This could be done to see if there is any blood in the stool, even if it is not visible to the human eye. Some studies can check for infection by a parasite or bacteria. Other tests could look for inflammation in the stool.

• Upper Endoscopy. This test checks the inside of part of the digestive tract. It uses a small, flexible tube called an endoscope. The tube has a light and a camera lens at the end. Tissue samples or biopsies from inside the digestive tract may also be taken for testing.

• Colonoscopy. This test looks at the full length of the large intestine. It can help check for abnormal growths, inflamed tissue, sores or ulcers, and bleeding. It uses a long, flexible, lighted tube called a colonoscope. The tube is put into your child's rectum up into the colon. This tube lets the provider see the lining of the colon and take out a tissue sample or biopsy to test it. Your child's provider may also be able to treat some problems that may be found. Tissue samples or biopsies from inside the digestive tract may also be taken for testing.

• Lower GI series or barium enema. This test checks the large intestine, including the colon and rectum. A thick, chalky fluid called barium is put into a tube. It is inserted into your child's rectum as an enema. Barium coats the organs, so they can be seen on an X-ray. An X-ray of your child's belly will show if there are any narrowed areas called strictures. It will also show any blockages or other problems.

How is ulcerative colitis treated?

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is.

Diet

Changing diets generally does not help this condition. But if certain foods upset your child's stomach, avoiding those foods may help ease your child's symptoms.

Medicine

Medicines are often used reduce the inflammation in the colon. Examples of medications include steroids, antibiotics, or drugs that affect the body's immune system.

Hospital stay

If your child's symptoms are severe, he or she may need to stay in the hospital. This can help make sure your child is getting the nutrition he or she needs. It can also stop diarrhea and the loss of blood, fluids, and minerals. Your child may need a special diet, feeding through a vein, or medicines. Some children may also need surgery.

Surgery

About 1 in 4 to 2 in 50 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 one 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.

• 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 the rectum. This forms a pouch to hold the waste. This allows your child to pass stool through his or her anus in a normal way. But your child's bowel movements may happen more often and be more watery than normal.

What are the complications of ulcerative colitis?

In rare cases, this condition can cause death. If your child's condition affects more than just his or her rectum and lower colon, your child has a higher risk for colon cancer.

Living with ulcerative colitis

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 usually come back.

Your child should learn what foods trigger his or her symptoms and avoid 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 your child's healthcare provider to create a care plan for your child.

When should I call my child's healthcare provider?

If your child has any symptoms of ulcerative colitis, call his or her healthcare provider.

If your child is being treated for ulcerative colitis and has new symptoms, call his or her healthcare provider. You should also call if you're worried about your child's growth.

Key points about ulcerative colitis

• 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 avoiding 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.

Online Medical Reviewers:

• Adler, Liora C., MD
• Chan, Albert, MD
• Freeborn, Donna, PhD, CNM, FNP