Inflammatory Bowel Disease

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Clinical manifestations

CD and UC have overlapping clinical features including abdominal pain, diarrhea, weight loss, hematochezia, malnutrition, anemia, fatigue, fevers, mouth ulcers, joint pain or swelling, and characteristic skin lesions such as erythema nodosum or pyoderma gangrenosum. Other extra intestinal manifestations seen in both UC and CD include uveitis, sclerosing cholangitis, gallstones, and renal stones. Although CD and UC share many symptoms and characteristics, there are numerous genetic, anatomic,

Epidemiology

The prevalence of CD in North America ranges from 26.0 to 198.5 per 100,000 persons and that of UC varies from 37.5 to 229 cases per 100,000. Incidence rates of CD are 3.1 to 14.6 per 100,000 patient-years and for UC are 2.2 to 14.3 cases per 100,000 person-years.13 About 1.4 million Americans suffer from inflammatory bowel disease.6 Approximately 25% of new cases of IBD are diagnosed during childhood and adolescence, and peak incidence of diagnosis occurs in the second and third decades. The

Treatment

The treatment paradigm in IBD has shifted from symptom control to mucosal healing, which is likely to result in prevention of disease progression, fewer complications, and reduction in the need for surgery. Other considerations in the treatment of children with IBD are optimization of nutrition, achievement of normal pubertal development and growth spurt, facilitation of emotional and social development, and prevention of long-term complications and disability while minimizing unwanted side

Adjustment Disorder/Depression and Anxiety

The diagnosis of a chronic illness such as IBD during childhood can involve a grieving process that begins with shock and disbelief and proceeds through feelings of anguish (sadness) and protest (anger) toward the gradual assimilation of illness information and adjustment to the implications of the disease. In both children and adolescents, the diagnosis of IBD can involve a sense of loss in any one of the following areas: independence, sense of control, privacy, body image, healthy self, peer

Medication Adherence

Because medications are critical to the management of IBD, medical adherence is particularly important for children with IBD. Although having to take daily medication can adversely affect QOL, the consequences of nonadherence can lead to more severe disease and QOL outcomes, including an increase risk for surgery.46 Adherence can be especially problematic during adolescence. One study found that medication adherence rates in pediatric IBD were 38% according to parents and 48% according to the

Medication

Psychotropic medications are often used to treat patients with IBD, although they should only be considered after a thorough psychological assessment has been completed and behavioral therapy has been deemed inadequate or unavailable. In a survey of 18 gastroenterologists, Mikocka-Walus and colleagues77 found that 78% had prescribed antidepressants for their IBD patients for the purpose of treating pain, depression, anxiety, and insomnia. In a review by Mikocka-Walus and colleagues,78 10 of 12

Summary

Pediatric-onset IBD is a lifelong chronic illness with high medical morbidity and associated psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors and psychosocial stress. Youth with active IBD or receiving treatment with steroids, social isolation, family conflict, or showing impaired social or academic functioning would particularly benefit from screening for psychiatric comorbidities,

Acknowledgments

The authors would like to thank Maggie Kirshner for her administrative assistance with the manuscript and David Benhayon, MD, PhD, Christine Karwowski, MD, Melissa Newara, MS, Patricia Delaney, LCSW, and Amy Levine, MSW, PhD for their editorial comments.

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References (105)

  • P. Mamula et al.

    Inflammatory bowel disease in early childhood and adolescence: special considerations

    Gastroenterol Clin North Am

    (2003)
  • P. Burke et al.

    Depression and anxiety in pediatric inflammatory bowel disease and cystic fibrosis

    J Am Acad Child Adolesc Psychiatry

    (1989)
  • P. Burke et al.

    Determinants of depression in recent onset pediatric inflammatory bowel disease

    J Am Acad Child Adolesc Psychiatry

    (1990)
  • D. Raymer et al.

    Psychological problems in children with abdominal pain

    Lancet

    (1984)
  • E. Szigethy et al.

    Case study: longitudinal treatment of adolescents with depression and inflammatory bowel disease

    J Am Acad Child Adolesc Psychiatry

    (2006)
  • G. Guyatt et al.

    A new measure of health status for clinical trials in inflammatory bowel disease

    Gastroenterology

    (1989)
  • T.M. Tojek et al.

    Maternal correlates of health status in adolescents with inflammatory bowel disease

    J Psychosom Res

    (2002)
  • I. Engstrom

    Parental distress and social interaction in families with children with inflammatory bowel disease

    J Am Acad Child Adolesc Psychiatry

    (1991)
  • A.K. Varghese et al.

    Antidepressants attenuate increased susceptibility to colitis in a murine model of depression

    Gastroenterology

    (2006)
  • S. Kane et al.

    Crohn's disease remission on bupropion

    Gastroenterology

    (2003)
  • E. Garcia-Vega et al.

    A stress management program for Crohn's disease

    Behav Res Ther

    (2004)
  • E. Szigethy et al.

    Cognitive behavioral therapy for adolescents with inflammatory bowel disease and subsyndromal depression

    J Am Acad Child Adolesc Psychiatry

    (2007)
  • M.U. Bers et al.

    Use of a computer-based application in a pediatric hemodialysis unit: a pilot study

    J Am Acad Child Adolesc Psychiatry

    (2003)
  • D.R. De Maso et al.

    Depression experience journal: a computer-based intervention for families facing childhood depression

    J Am Acad Child Adolesc Psychiatry

    (2006)
  • J.P. Achkar et al.

    The expanding universe of inflammatory bowel disease genetics

    Curr Opin Gastroenterol

    (2008)
  • D.Q. Shih et al.

    Recent advances in IBD pathogenesis: genetics and immunobiology

    Curr Gastroenterol Rep

    (2008)
  • M.S. Silverberg et al.

    Ulcerative colitis-risk loci on chromosomes 1p36 and 12q15 found by genome association-wide study

    Nat Genet

    (2009)
  • C. Abraham et al.

    Inflammatory bowel disease

    N Engl J Med

    (2009)
  • T. Kanai et al.

    Homeostatic (IL-7) and effector (IL-17) cytokines as distinct but complementary target for an optimal therapeutic strategy in inflammatory bowel disease

    Curr Opin Gastroenterol

    (2009)
  • R.J. Xavier et al.

    Unravelling the pathogenesis of inflammatory bowel disease

    Nature

    (2007)
  • C. Abraham et al.

    Interleukin-23/Th17 pathways and inflammatory bowel disease

    lnflamm Bowel Dis

    (2009)
  • A. Sawczenko et al.

    Presenting features of inflammatory bowel diseases in children

    Arch Dis Child

    (2003)
  • P. Turunen et al.

    Incidence of inflammatory bowel disease in Finnish children, 1987–2003

    Inflamm Bowel Dis

    (2006)
  • P.A. Smith

    Nutritional therapy for active Crohn's disease

    World J Gastroenterol

    (2008)
  • M. Zachos et al.

    Enteral nutritional therapy for induction of remission in Crohn's disease

    Cochrane Database Syst Rev

    (2007)
  • M. Schwartz et al.

    Optimizing conventional therapy for inflammatory bowel disease

    Curr Gastroenterol Rep

    (2008)
  • H. Lindfred et al.

    IBD and self-esteem in adolescence

    Acta Paediatr

    (2008)
  • L.M. Mackner et al.

    Psychosocial functioning in pediatric inflammatory bowel disease

    Inflamm Bowel Dis

    (2006)
  • I. Engstrom

    Mental health and psychological functioning in children and adolescents with inflammatory bowel disease: a comparison with children having other chronic illnesses and with healthy children

    J Child Psychol Psychiatry

    (1992)
  • I. Engstrom

    Inflammatory bowel disease and social interaction in families with children with inflammatory bowel disease

    J Pediatr Gastroenterol Nutr

    (1999)
  • A.K. Akobeng et al.

    Quality of life in children with Crohn's disease: A Pilot Study

    J Pediatr Gastroenterol Nutr

    (1999)
  • A.M. Griffiths et al.

    Development of a quality-of-life index for pediatric inflammatory bowel disease: dealing with differences related to age and IBD type

    J Pediatr Gastroenterol Nutr

    (1999)
  • H. Rabbett et al.

    Quality of life in children with Crohn's disease

    J Pediatr Gastroenterol Nutr

    (1996)
  • J.V. Lavigne et al.

    Psychological adjustment to pediatric physical disorders: a meta-analytic review

    J Pediatr Psychol

    (1992)
  • E. Szigethy et al.

    Depressive symptoms and inflammatory bowel disease in children and adolescents: a cross-sectional study

    J Pediatr Gastroenterol Nutr

    (2004)
  • L.M. Mackner et al.

    Psychological factors affecting pediatric inflammatory bowel disease

    Curr Opin Pediatr

    (2007)
  • E. Szigethy et al.

    Cytokines and depression

  • C. Karwowski et al.

    Characterizing depression in children with inflammatory bowel disease

    J Pediatr Gastroenterol Nutr

    (2009)
  • L.M. Mackner et al.

    Long-term psychosocial outcomes reported by children and adolescents with inflammatory bowel disease

    Am J Gastroenterol

    (2005)
  • C. Mrakotsky et al.

    Impact of acute steroid treatment on memory, executive function, and mood in pediatric inflammatory bowel disease

    J Pediatr Gastroenterol Nutr

    (2005)
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      UC is predominantly associated with symptoms such as abdominal pain, (bloody) diarrhea, weight loss, anemia, fatigue and fevers. Extracolonic features involving organs and systems such as joints, skin, liver, eye and mouth can also occur.2 The course of the disease is unpredictable including frequent exacerbations and remissions.3

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    A version of this article was previously published in the Child and Adolescent Psychiatric Clinics of North America, 19:2.

    Funding support: Dr Szigethy's research is funded by an NIH Director's Innovator Award, 1DP2OD001210, and NIMH-funded R01, MH077770.

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