Pediatric ulcerative colitis (UC)

What is pediatric ulcerative colitis (UC)?

Pediatric ulcerative colitis is a gastrointestinal condition that causes redness, swelling (inflammation) and tiny sores in the large intestine (colon). It prevents the large intestine from working properly, causing mild to severe symptoms and complications.

Ulcerative colitis is usually diagnosed in patients between the ages of 15 to 20 but can be found in younger patients as well. It’s one of two leading types of inflammatory bowel diseases (IBD), the other being Crohn’s disease.

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What are the different types of pediatric ulcerative colitis?

The type of pediatric ulcerative colitis is determined by where the inflammation happens in the colon. The three main types of UC are:

Pediatric ulcerative proctitis

Inflammation happens in the final section of the large intestine (rectum).

Pediatric left-sided colitis (distal colitis)

Inflammation occurs in the left side of the large intestine (colon).

Pediatric pancolitis

Inflammation affects the entire colon.

What are the signs and symptoms of pediatric ulcerative colitis?

• Abdominal pain, especially on the left side of the belly

• Pain in the rectum

• Cramping

• Bloody stool

• Sudden urge to go to the bathroom

• Fatigue

• Loss of appetite

• Weight loss

UC can also affect other parts of the body, which can cause:

• Redness, pain and itchiness in the eyes

• Swelling and pain in the joints

• Rashes or changes in skin

• Mouth sores

• Bone loss (osteoporosis)

• Liver disorders

How is pediatric ulcerative colitis diagnosed?

Ulcerative colitis in pediatric patients is diagnosed via a variety of exams and tools, including:

• Physical exam. We will perform a physical exam of the abdomen to identify areas of discomfort.

• Blood test. This checks for anemia (low red blood cells) and signs of inflammation (high white blood cell count).

• Stool sample. This checks the stool for traces of blood, infection and inflammation.

• Upper endoscopy (EGD) and Colonoscopy. This is a procedure that uses a special tool with a camera to look inside the upper part of the GI tract, colon and last part of the small intestine (ileum).

• Sigmoidoscopy. This is similar to a colonoscopy, but it only examines the rectum and lower (sigmoid) colon.

What causes pediatric ulcerative colitis?

The immune system is responsible for attacking harmful bacteria, viruses and fungi. It also protects harmless bacteria that naturally exist in the large intestine. With ulcerative colitis, the immune system mistakenly attacks the healthy bacteria and tissue in the large intestine, which causes inflammation. The exact reason for this isn’t known but there are several things that can play a role, such as:

• Family history. Having a family member with inflammatory bowel disease can increase the risk of developing UC.

• Lifestyle. Eating a diet that is high in fat, low in fiber and processed foods can increase inflammation in the intestines.

• Medications. Taking certain medications, like antibiotics, ibuprofen, naproxen and diclofenac can irritate the colon and make UC symptoms worse.

How is pediatric ulcerative colitis treated?

Treatment for ulcerative colitis will depend on the severity of your child’s symptoms. Typically, UC can be treated with medications, like anti-inflammatory drugs, corticosteroids, immune system suppressors and biologics. We will also recommend a change in diet to help reduce inflammation.

If diet and medications don’t help, we may recommend surgery. While most children do well with noninvasive treatment, about 20% of children with UC require surgery. There are several surgical options:

• Proctocolectomy with ileostomy. This surgery removes the entire colon and rectum and creates an opening in the belly to pass stool. A bag will be attached to the opening to collect stool.

• Ileonanal anastomosis (J-pouch surgery). The colon is removed and the small intestine is connected to the anus to pass stool. This option doesn’t require a bag to be attached to the belly.

Removing all or part of the colon will affect your child’s digestion and stool. Bowel movements will happen more often and be more liquid or mushy in consistency. Colon surgery can also impact your child’s emotional state and cause some social difficulties. Our team at Children’s Health is here to give medical and emotional support to you and your family.