Journal Mobile

PM Gillett, PM Rogers, DC Wilson
Journal Issue: 
Volume 39: Issue 1: 2009




Paediatric inflammatory bowel disease (IBD) most usually evolves during adolescence,  a  time  of  great  challenge.  For  the  adolescent,  the  disease  should  be thoroughly  assessed  by  upper  gastrointestinal  endoscopy  and  ileo-colonoscopy, preferably  performed  under  general  anaesthetic  or  conscious  sedation,  with relevant  radiological  examination. This  will  enable  the  determination  of  diagnosis, IBD subtype and extent. Growth also needs to be assessed and the effect of disease on academic and social functioning must be explored. Unlike adult IBD, there is a poor evidence base for the medical and nutritional management of adolescent IBD. However, within the UK it is common practice to use exclusive enteral nutrition rather  than  corticosteroids  for  the  induction  of  Crohn’s  remission,  and  to  have early  recourse  to  immunomodulation  with  azathioprine  (and  methotrexate  for azathioprine/6MP intolerance or non-response) unless remission is rapidly induced and maintained. There should be close collaboration with paediatric and colorectal surgeons. Adolescents need higher relative drug doses than the literature suggests for adult IBD patients. Transition clinics are vital for adolescent care and provide a helpful source of second opinion for the paediatric gastroenterologist. Adolescents with IBD are best looked after by the paediatric gastroenterology multidisciplinary team  (or  in  shared  care  with  that  team).  In  this  overview  we  highlight  these  key areas of assessment, treatment and transition.