Inflamed by inflammatory bowel disease in children

A combination of genetics, environmental triggers and the immune system can cause parts of the intestine in kids to get inflamed leading to IBD that lasts a long time or constantly comes and goes, warns Dr Srikanth K P

Inflammatory Bowel Disease (IBD) is a chronic ailment of the intestine. It can occur both, in adults and children. Nearly 25% of all patients with IBD fall in the paediatric age group. It is associated with prolonged inflammation of the digestive or gastrointestinal (GI) tract, affecting one or both the intestines together. In this condition, the body’s immune system starts attacking the intestinal tissue and causes ulcers, swelling, inflammation, and other issues.

A few decades ago, IBD was a very rare condition. However, there has been an increase in the incidence of IBD since the Covid-19 pandemic. While only about one case of IBD per year used to be reported earlier, now doctors are witnessing one to two cases in the paediatric age group every month.

Types of IBD

There are two subcategories of IBD Crohn’s Disease and Ulcerative Colitis. In ulcerative colitis, only the colon is affected, whereas, in Crohn’s disease, the whole gastrointestinal tract is affected, starting from the mouth to the colon. Crohn’s disease is more prevalent in South India, whereas North and other parts of India witness a higher prevalence of ulcerative colitis.

As IBD is an auto-immune disorder where the immune system damages the intestine, the body’s immunity goes haywire, and the immune system starts attacking the intestine. Along with immunity, it may also be driven by multiple factors, such as genetics, environmental factors (modern diet and lifestyle), nutritional deficiency, and changes in the gut microbiome.

Symptoms

Usually, most children have stomach pain, loose stools, weight loss, fever, loss of appetite, blood in the stool, and sometimes unexplained fever. Endoscopy and colonoscopy can show ulcers, swelling, and redness of the inner intestinal wall.

Treating children with IBD

IBD is a chronic disease that requires long-term treatment. The treatment plan for IBD consists of two stages. The initial phase aims at reducing inflammation and the lesion while boosting immunity. This phase lasts for up to 2 to 3 months when remission is achieved. This includes diet modification, certain dietary restrictions, lifestyle habits, and standard medications.

Once remission is achieved, it must be maintained for an extended period of time. At this point, some immunomodulator or biological drugs are prescribed, depending on the severity, type of condition and age of the child. Children must continue to take these medications for a long period of time before stopping them if symptoms do not recur for three to five years. However, in a very small percentage of cases, there is no recurrence and maintaining remission is difficult for years.

Prevention

Since this condition originated during industrialisation in western Europe, it is believed to be heavily influenced by modern lifestyles and eating habits, especially the increased consumption of processed foods. Thus, avoiding processed foods and opting for a healthy diet rich in nutrients can help lower the risk of IBD in children. In addition, leading a physically-active life is necessary to keep oneself healthy and away from not only IBD but also other diseases. Even though there is no permanent cure for IBD, children can still live a life of good quality by being aware of all aspects of preventing IBD and following the doctor’s recommended treatment plan.

(The author is a consultant in paediatric gastroenterology & hepatology.)