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Pediatric Ulcerative Colitis

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What is ulcerative colitis? 

Ulcerative colitis (UC) causes ulcers and inflammation in the inner lining of the child’s colon and rectum.

Expanded Overview

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD), along with Crohn’s disease. UC causes tiny sores in the large intestine lining, which bleed and produce mucus and pus.

Ulcerative colitis is a chronic (reoccurring) condition. The symptoms and their severity can vary — often, children will experience periods of remission where their symptoms are gone. UC often begins slowly, but eventually, becomes more severe.

What is the main cause of ulcerative colitis? 

Ulcerative colitis is most likely to develop in children and young adults between the ages of 15 to 25; however, it can occur at any age. Having a family member with inflammatory bowel disease also increases the likelihood of getting UC.

What are the symptoms of ulcerative colitis? 

Most ulcerative colitis patients have mild to moderate symptoms including:

  • Abdominal pain or cramping
  • Anemia (blood loss)
  • Bloody stools
  • Diarrhea with blood or pus
  • Fatigue
  • Fecal incontinence
  • Fever
  • Intense cramping
  • Joint pain
  • Skin rash
  • Sudden urges to use the bathroom

Symptoms vary along with the severity of the disorder. Problems related to UC extend beyond the GI tract, including:

  • Ophthalmic conditions
  • Joint pain
  • Hepatobiliary disease (of the liver, gall bladder and bile ducts)

How is ulcerative colitis treated?

Medical treatment aims to contain and control intestinal inflammation, limit extra-intestinal involvement and make it possible for patients to lead as active and normal a life as possible.

Outpatient treatment includes the use of anti-inflammatory therapy. Corticosteroids are effective in subduing acute bouts of inflammation, but long-term steroid treatment is not advised due to its harmful side effects.

A minority of patients, between 5 and 10 percent, do not respond to medical therapy and will require surgery. A total proctocolectomy (removal of the large intestine and rectum) can cure UC and remove the increased risk of future colonic adenocarcinoma (cancer) associated with it.

Are there complications associated with ulcerative colitis? 

Severe complications can arise in patients with ulcerative colitis during acute exacerbations of the disease, or as the disease progresses.

Toxic megacolon, an acute form of colon distention, is rare in children, but when it does occur, it is a medical and surgical emergency. Toxic megacolon is thought to be caused when overwhelming inflammation interferes with motility. The ensuing bacterial buildup leads to necrosis and peritonitis.

Children diagnosed with UC have an increased risk for colonic malignancy as they get older. The earlier the onset of the disease, the greater the eventual risk for malignancy:

  • The onset of UC before the age of 14 is associated with a 40 percent incidence of a colonic malignancy by the age of 35
  • The onset between ages 15 and 39 is associated with a 30 percent incidence of a colonic malignancy by the age of 35

Because of this strong association, children who have been diagnosed with UC should be scheduled for yearly screenings with surveillance colonoscopy, and a biopsy should be performed to identify any precursor evidence of epithelial dysplasia.

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