Disease Location
Inflammatory bowel disease tends to affect the large intestine more in adults than in children. For example, in ulcerative colitis, a disease that mostly affects the large intestine, around 70-80% of cases occur in adults compared to about 20-30% in children. Similarly, Crohn's disease, which can affect both the large and small intestine, is found in about one-third of children but in less than 10% of adults.
Disease Severity
Inflammatory bowel disease appearing at a young age tends to be more severe than the one appearing in adulthood. Even within the pediatric population, the disease tends to be more severe in infants compared to adolescents. However, it is important to note that there are cases of mild disease in children and severe disease in adults. On average, children are more likely to experience more complications and have a more active disease.
Response to Treatment
Studies show that children tend to respond better to various medications compared to adults, which may be due to a shorter duration of disease before starting treatment, resulting in higher treatment efficacy. It is advisable to treat the disease aggressively at an early stage rather than waiting for complications, as early intervention increases the chances of successful treatment.
Growth Impairment
One of the significant features in children with inflammatory bowel disease is growth impairment. Impaired growth occurs in about half of children with Crohn's disease who develop the condition before adolescence. In contrast, normal growth is observed in most children with ulcerative colitis. Growth impairment is primarily caused by inflammation affecting the growth hormone. Other factors include prolonged steroid treatment (not standard treatment), malnutrition due to absorption issues, or a decreased appetite. Some children may catch up on their growth during adolescence, but on average, children with Crohn's disease do not reach their expected height.
Quality of Life
Children and adolescents diagnosed with inflammatory bowel disease are at a higher risk of emotional problems, including anxiety, social stress, loneliness, and guilt. In adolescents, the disease may negatively affect body image due to slow growth, weight loss, different physical symptoms, and delayed sexual development. Coping with uncertainty, side effects of medications, hospitalizations, and treatments can also impact their overall quality of life. Supportive mechanisms, such as support groups, can significantly improve the adherence to treatment and reduce negative emotions.
Nutritional Therapy
Nutritional therapy, involving providing formula-based nutrition (e.g., Elecare, Modulen, PediaSure, Neocate, Ensure) without any other food additions, can be as effective as steroid therapy if given for 7-10 weeks. Additionally, this therapy can help reduce inflammation in the gut in many cases, which is not as frequently achieved with steroids (even if there is significant clinical improvement). Nutritional therapy is more effective in children than in adults, especially for those with small bowel rather than large bowel disease. This approach serves as an alternative to steroids and is more attractive, particularly when there is impaired growth and nutritional deficiencies.
Conclusion
Children and adolescents with Crohn's disease and ulcerative colitis are not just small adults. Unique considerations require personalized treatment for each individual based on chronological, physiological, and developmental age. Therefore, there is a significant advantage in providing specialized care for these conditions at centers dedicated to pediatric inflammatory bowel disease, where experienced multidisciplinary teams can cater to the unique needs of each patient and their families.