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:
Some children also have the following symptoms:
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Skin sores (lesions)
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Joint pain
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Inflammation of the eyes
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Liver problems
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Osteoporosis
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Rashes
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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:
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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.
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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.
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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.
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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.
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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:
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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.
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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
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Ulcerative colitis is an inflammatory bowel disease. In this condition, the inner
lining of your child's large intestine and rectum gets inflamed.
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This inflammation causes diarrhea or frequent emptying of the colon. Your child may
also have stomach pain and diarrhea.
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Treatment may include avoiding foods that cause symptoms, taking medicine, and having
surgery.
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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