IBD increasing in children, diagnosis often delayed

The incidence of inflammatory bowel disease (IBD) among children is increasing, but diagnosis often is delayed because symptoms can develop gradually, according to researchers from the Pediatric Inflammatory Bowel Disease Center at Johns Hopkins Children’s Center.

Although as many as 25% of patients are diagnosed by the age of 20 years, IBD often is considered an adult condition and rarely is on pediatricians’ radars. Children are being diagnosed at a younger age than ever before, with a growing number of cases in children younger than 5 years of age.

Many children are referred to gastroenterologists only after months of repeated visits to their primary care physicians for symptoms mistakenly attributed to viral gastritis or other common gastrointestinal (GI) ailments.

The researchers believe it is likely that changing environmental factors are triggering new cases in genetically predisposed children. According to the Crohn’s and Colitis Foundation of America, more than 100,000 children are living with IBD-Crohn’s disease or ulcerative colitis-in the United States. Crohn’s disease is seen more often than ulcerative colitis in children, but it tends to be diagnosed later because the most common symptom is vague abdominal pain rather than the more suggestive bloody stools seen in children with ulcerative colitis.

Delay in initiating treatment can make IBD worse and lead to severe anemia from GI bleeding, poor food absorption, malnutrition, and stunted growth. In advanced cases, serious damage to the colon and small intestine can require surgery. Symptoms such as abdominal pain, bloody stools, diarrhea, nausea/vomiting, weight loss, fatigue, dizziness, rapid heartbeat, and a family history of IBD should prompt referral to a specialist.

If IBD is suspected, pediatricians should obtain blood tests to check for anemia and inflammatory markers like C-reactive protein and elevated sedimentation rate, the Hopkins researchers advise. The diagnosis can be confirmed by endoscopy and colonoscopy.

Doctors see more children with inflammatory bowel disease [press release]. Baltimore, MD: Johns Hopkins Children’s Center; March 28, 2011.