Pediatric inflammatory bowel disease

Table 1 Frequency of presenting symptoms in IBD[2,12]

Symptom	CD (%)	UC (%)
Abdominal pain	62-95	33-76
Diarrhea	52-78	67-93
Weight loss	43-92	22-55
Hematochezia	14-60	52-97
Delayed growth	30-33	6
Fever	11-48	4-34
Perianal disease	25	0
Extraintestinal manifestations	15-25	2-16

Table 2 Manifestations of IBD[2,4,5,12,13]

System	Manifestation
Generalized	Fever Weight loss Malaise Anorexia Fatigue Nausea/vomiting
Ocular	Uveitis Episcleritis Iritis Conjunctivitis
Oral	Cheilitis Stomatitis Apthae
Pulmonary	Pulmonary vasculitis Fibrosing alveolitis
Vascular	Vasculitis Thrombosis
Hepatobiliary	Primary Sclerosing Cholangitis Hepatitis Cholelithiasis Jaundice
Pancreatic	Pancreatitis
Gastrointestinal	Abdominal pain Nausea/vomiting Diarrhea Hematochezia
Renal/Urinary	Nephrolithiasis Obstructive hydronephrosis Enterovesical fistula UTI Amyloidosis
Hematologic	Iron deficiency anemia Anemia of chronic disease Thrombocytosis Vit B12 deficiency Autoimmune hemolytic anemia
Endocrine	Decreased growth velocity Delayed sexual maturation
Integumentary	Erythema nodosum Pyoderma gangrenosum Perianal disease
Musculoskeletal	Osteopenia and osteoporosis Arthritis/Arthralgias Ankylosing spondylitis

Table 3 Medications for IBD[4,12,19]

Class	Generic (Trade)	Use	Side Effects
Aminosalicylates	Mesalamine (Asacol, Pentasa) Sulfasalazine (Azulfadine) Olsalazine (Dipentum) Balsalazide (Colazal)	May be used to induce remission in mild CD or UC May be used to maintain remission in moderate CD or UC	Headache Nausea Anorexia Leukopenia Diarrhea
Corticosteroids	Prednisone Budesonide	Used for induction of remission in CD and UC, not effective in maintenance of remission	Increased risk of infection Hypertension Weight gain Acne Hirsuitism
Immunomodulators	Azathioprine (Imuran, Azasan) 6-mercaptopurine (Purinethol)	Used for maintenance of remission in moderate to severe CD or UC	Nausea/vomiting Diarrhea Pancreatitis Hepatitis Myelosuppression
	Methotrexate (Rheumatrex, Trexall)	May be used to maintain remission in moderate to severe CD or UC that does not respond to azathioprine or 6-mercaptopurine	Myelosuppression Oral ulcers Hepatitis
	Cyclosporine (Neoral, Sandimmune)	Has been used to induce and maintain remission in refractory cases of UC	Renal toxicity Hypertension Gingival hyperplasia Hirsuitism
Biologic Agents	Infliximab (Remicade)	May be used for refractory CD or steroid-dependent patients to induce and maintain remission	Infusion reaction (chest pain, Hyper- or hypotension, And shortness of breath) Nausea Fever/Chills Hives Fatigue

Table 4 Medical management of IBD[4,12,19]

	CD	UC
Mild	Aminosalicylates Antibiotics	Aminosalicylates
Moderate	Corticosteroids→Aminosalicylates or AZA or 6-MP or Methotrexate	Corticosteroids→Aminosalicylates or AZA or 6-MP or Methotrexate
Severe	Corticosteroids→AZA or 6-MP or Methotrexate or Infliximab	Corticosteroids→AZA or 6-MP or Methotrexate or Cyclosporine
All cases	Nutritional support Monitor growth closely	Nutritional support Monitor growth closely