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IBD in Children: Answers from a Pediatric Gastroenterologist Maria-Oliva Hemker

Featured Expert:

Pediatric gastroenterologist Dr. Maria Oliva-Hemker provides answers to top questions about inflammatory bowel disease (IBD) in children. IBD is a chronic inflammatory disorder that can affect different parts of the gastrointestinal (GI) tract. Under IBD there are two principal diagnoses — Crohn’s disease and ulcerative colitis. Here’s what parents need to know.

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Does IBD present quality of life issues for my child?

Yes. IBD is a chronic illness so children do have to learn how to cope with it. They often struggle with going to school, taking medications and paying attention to their diet. As an IBD center, our team includes not only gastroenterologists, dieticians and surgeons who treat and study IBD, but also behavioral psychologists who help children cope with the condition.

At the end of the day children with IBD tend to be high achievers in both academics and sports. Our goal is to make children’s lives as normal as possible so they can achieve their goals.

How important is early detection?

The reason we want to detect early is because we want patients to feel better, get their GI tracts healthy, and make sure they do not develop delays in growth or puberty because they go undiagnosed. The other thing is that we’re not meant to be walking around with inflammation in our GI tract, which over time can increase risk for colon cancer and other serious conditions.

How well are pediatricians picking up IBD?

Children with colitis tend to be picked up earlier because they’re presenting with diarrhea or blood in the stool which they cannot hide. Unfortunately, children with Crohn’s may experience a year or more delay in diagnosis because the symptoms, such as abdominal pain, may be more subtle, more chronic and brewing, and it might take a while for parents to notice that something is wrong.

Is family history relevant?

Most people with IBD do not have a family member with IBD. But if you do have a family member with IBD, that may increase your risk of getting the disease.

Can pediatricians manage IBD?

In the United States, if a child is diagnosed with IBD, he or she should be followed by a pediatric gastroenterologist. However, once the diagnosis is made, gastroenterologists work closely with pediatricians to ensure total child care. But the medications and treatment are taken over by GI specialists.

What happens when my child sees a GI specialist?

If the specialist agrees with the pediatrician that the suspicion for IBD is high, then the child undergoes diagnostic endoscopy, which involves evaluation of both the upper and lower GI tract. The diagnosis of IBD is made by putting together a number of clues—the child’s history, physical examination, laboratory tests, endoscopic findings, and abdominal MRI or CT findings. The specialist will also try to pinpoint whether it’s Crohn’s or ulcerative colitis.

Are there any new treatments for IBD?

So-called biologics, now routinely used in both children and adults, are the biggest class of medicines that have had the most impact in terms of healing the lining of the GI tract. It’s important that we not only get symptoms under control but also heal the GI tract. That’s the advantage of these biologics — they minimize the effects of chronic inflammation on the body so that the GI tract can be as healthy as possible.

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