IBD targets children too
Contrary to what people believed in the past, Inflammatory Bowel Disease (IBD) is a condition that does not discriminate against age. In a long-term study, a team of researchers in Italy has found that the number of children affected by IBD has increased over the years. Their results were recently published in the European Journal of Pediatrics. Based at the Pediatric Clinic of the University of Trieste at the Institute for Maternal and Child Health Burlo Garofolo (IMCHBG), the researchers found that not only does IBD affect the general paediatric population (under 16 years of age), but it plays havoc on the lives of children under 2 years of age. Launched in 1984, the study ran for 20-year period. Their findings showed that the paediatric population aged two and under make up approximately 9% of the entire paediatric population affected by IBD. Early forms of the disease, said the researchers, are particularly severe versions and may hide an underlying inborn error of the immune system. Because of this, the children may be forced to undergo more invasive therapy instead of the usual immunosuppressive or surgical therapies. Another problem is misdiagnosis of the disease; patients sometimes are told they have a food allergy when the fact remains that they do not. Using a sample of 184 patients affected by IBD for a minimum of 2 years, the research team found that 8.6% of the participants (16 children) were diagnosed with IBD within their second year of life. Physicians had diagnosed up to 12 children with IBD before they turned 1. The researchers said that additional investigations confirmed IBD in 12 out of 16 cases. Immune system-related conditions were identified in the four remaining cases, they said. Allergies to cow's milk proteins were found in nearly 50% of the sample. The researchers put these patients on an exclusion diet for a long period, despite the absence of any clinical benefit. It was found that these cases were more severe when compared with patients that were diagnosed with IBD at a later age. They underwent surgical and aggressive immunosuppressive treatments. 'We were in a privileged position to serve as a reference centre following more than 300 IBD paediatric cases in the last 2 decades,' explained Professor Alessandro Ventura, head of the Pediatric Clinic at the University's IMCHBG. 'We realised that IBD can have a very precocious onset: if this is the case, the disease tends to be particularly severe,' he added. 'In the past, IBD was long considered specific to the adult population; therefore paediatricians rarely looked for it within the paediatric groups. Even today, IBD symptoms are often misclassified as cow's milk protein allergy, which causes a severe diagnostic delay.' Professor Ventura remarked that because of the misclassification, paediatricians should consider inflammatory intestinal disorder. 'If an intestinal problem such as bloody-mucous diarrhoea persists after three or four weeks, especially if in presence of fever, impaired growth, weight loss, perianal fistulas or abscesses, one should include IBD in the differential diagnosis.' There is no definite treatment for IBD, but experts say sufferers can use so-called biological drugs made by monoclonal antibodies. Treatment regimens can be individualised to fit each patient's needs.
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