Unraveling Pediatric IBD

Elyanne M. Ratcliffe, MD, FRCPC Division of Gastroenterology and Nutrition McMaster Children’s Hospital Current Concepts in Pediatrics October 16th, 2009

Objectives

• Clinical presentation of IBD • Diagnostic evaluation • Crohn’s vs Ulcerative Colitis • Management • Quality of life

Many Faces of IBD…

• 10 year old girl with urinary tract infection and constipation • 9 year boy with growth failure and constipation • 16 year old boy with weight loss, vomiting and abdominal pain • 12 year old girl with failure to thrive and severe anemia • 15 year old boy with arthritis and loose stools

Is it just me, or are we seeing A LOT of IBD these days?

QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.

Yes, there IS more!

Yes, there IS more!

• Health administrative data from 1991-2008 used to describe incidence and prevalence of IBD in Ontario • Prevalence increased from 42.1 (1994) to 56.3 (2005) per 100,000 • Incidence increased from 9.5 (1994) to 11.4 (2005) per 100,000 • Statistically significant increases in incidence in 0-4 and 5-9 year olds but not 10-14 and 15-17 year olds

Ontario has one of the highest rates of childhood-onset IBD in the world AND there is an accelerated increase in incidence in younger children

Touch Pad Question (1)

The incidence of IBD in Ontario has significantly increased in: A. 0-4 and 5-9 year olds B. 10-14 and 15-17 year olds C. Both A and B D. None of the above

Touch Pad Question (1)

The incidence of IBD in Ontario has significantly increased in:

A. 0-4 and 5-9 year olds

B. 10-14 and 15-17 year olds C. Both A and B D. None of the above

Step-Up Approach Biologics Steroids, immunomod 5 ASA’s, antibiotics, nutritional therapy

Step-Down Approach Biologics Nutritional Therapy?

Immunomodulators 5 ASA’s, antibiotics Steroids for failures

Touch Pad Question (2)

Nutrition therapy for IBD works by: A.

Boosting the patient’s nutritional status B. Decreasing inflammation C. Both A and B D. None of the above QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.

Touch Pad Question (2)

Nutrition therapy for IBD works by: A.

Boosting the patient’s nutritional status B. Decreasing inflammation

C. Both A and B

D. None of the above QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.

Quality of Life

Well-Adjusted Children with IBD

Gold N, Issenman R, Roberts J, Watt W. IBD 2000 6:1-7 • • 62 Children seen in Pediatric GI Clinic 36 IBD, 26 Functional GI complaints • • • Depression FGI

>

IBD Behaviour problems IBD

<

FGI

Only 19% kids with IBD described it as “a problem”

Touch Pad Question (3)

When compared to their siblings, kids with IBD: A. Were just as involved with activities B. Achieved as much as their siblings C. Were less involved with contact sports D. All of the above

Touch Pad Question (3)

When compared to their siblings, kids with IBD: A. Were just as involved with activities B. Achieved as much as their siblings C. Were less involved with contact sports

D. All of the above

Questions/Discussion