Inflammatory bowel diseases (IBD)
IBD (Crohn’s disease, ulcerative and other colitis) continue to be a common cause of morbidity which impact on the child’s quality of life. Crohn's disease tends to present in older children and young adults, with another peak incidence in the fifties to seventies, although the disease can occur at any age.[1,2] Crohn's disease affects between 400,000 to 600,000 people in North America. Prevalence estimated for Northern Europe have ranged from 27–48 per 100,000. Ulcerative colitis occurs in 35–100 people in every 100,000 in the United States.[5,6]
The underlying aetiology and pathogenesis of IBD remains largely unknown, but is thought to result from an interaction between genetic susceptibility, environmental factors and the host immune response.
The nutritional consequences of IBD can be very impactful; affected children present with abdominal pain and diarrhoea and often with a very poor nutritional status due to reduced intakes. Combined with increased loss of protein and micronutrients such as zinc, the result is weight loss, reduced growth rate, delayed puberty, and anaemia, often unresponsive to dietary iron. This is further complicated when IBD occurs during puberty, when nutritional needs for growth are increased.
The American Academy of Pediatrics advises a diet well balanced in all nutrients and following the references dietary intakes for gender and age for all paediatric patients with IBD. Enteral nutrition is most commonly used to introduce remission in children with active Crohn’s disease. In a meta-analysis that was limited to randomised clinical trials involving only paediatric patients (5 trials with 127 patients), exclusive enteral nutrition was as effective as corticosteroid use in inducing clinical remission.
- Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007 12;369(9573):1641-57.
- Wu, GY; Marcy LC, Senthil N. Crohn Disease. eMedicine. Retrieved 2010-04-15.
- Loftus, EV, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America: a systematic review. Alimentary Pharmacology & Therapeutics. 2002;16:51–60.
- Bernstein CN, Wajda A, Svenson LW. et al. The epidemiology of inflammatory bowel disease in Canada: a population-based study. Am J Gastroenterol 2006;101:1559–68.
- Garland CF, Lilienfeld AM, Mendeloff AI, et al. Incidence rates of ulcerative colitis and Crohn's disease in fifteen areas of the United States. Gastroenterology 1981;81:1115-24.
- Cotran RS, Collins T, Robbins SL, et al. Pathologic Basis of Disease. WB Saunders, Philadelphia, PA, 1998.
- Niriella MA, De Silva AP, Dayaratne AH, et al. Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey. BMC Gastroenterol 2010;10:32-9.
- Kleinman RE (ed). Chronic diarrheal disease. In: Pediatric Nutrition Handbook. Policy of the American Academy of Pediatrics. Elk Grove Village, 6th edition 2009.
- Heuschkel RB, Menache CC, Megerian JT, et al. Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children. J Pediatr Gastroenterol Nutr 2000;31:8-15.