Inflammatory Bowel Disease
Section snippets
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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Inflammatory bowel disease and cognitive behavioral therapy (CBT) in the young
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2013, Journal of Crohn's and ColitisCitation Excerpt :Therefore, psychotherapies targeting stress management, enhancing coping strategies, and decreasing detrimental behaviours (e.g. medical noncompliance) may improve psychological wellbeing and disease course of IBD patients. Six reviews concerning the role of psychotherapy for IBD have been published since 2006.26,44–49 Four of these were systematic reviews,44,47–49 including a Cochrane review.48
The Patient Simple Clinical Colitis Activity Index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission: A comparison of the P-SCCAI with clinician-based SCCAI and biological markers
2013, Journal of Crohn's and ColitisCitation Excerpt :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.