Pediatric Inflammatory Bowel Disease Conditions

Inflammatory bowel disease (IBD) includes conditions that cause chronic inflammation of the bowel. IBD is caused by an interaction of environmental and genetic factors leading to the body having an overly active immune system response to a disturbed gut microbiome. IBD affects everyone differently just like no two children are alike. Though there is presently no cure for IBD, there are highly effective treatments which allow most children with these diseases to feel well and have excellent outcomes. We are highly skilled at finding just the right combination of treatments to address your child’s IBD and help him or her step into a brighter future.

We diagnose and treat the following conditions:

• Ulcerative colitis. A disease of the large intestine (colon) that causes inflammation and ulcers that can produce pus, bleeding, and mucus. The most common symptoms are bloody stools or diarrhea and abdominal cramping, but it can also cause weight loss, fatigue, anemia, skin lesions, joint pains, rashes, and other symptoms. It most commonly affects teenagers but can also be seen in infants and very young children.
• Crohn’s disease. An inflammatory bowel disease that usually involves the lower part of the small intestine and/or the colon, though it may involve any part of the gastrointestinal tract including the colon. Symptoms may include abdominal pain, diarrhea, rectal bleeding, fatigue, anemia, weight loss, poor growth, fever, mouth ulcers, joint pain, and rashes. In children, it can cause delayed puberty and result in failure to grow.
• IBD unclassified (Indeterminate colitis). A form of IBD that cannot clearly be distinguished as ulcerative colitis or Crohn’s disease due to mixed features.
• Very early onset IBD (VEO-IBD). A term used for IBD when it is diagnosed in children under 6 years of age. In infants, it is referred to as infantile IBD. The symptoms can be similar to IBD in an older child or adult, though they tend to have involvement of the colon more frequently.
• Lymphocytic colitis. A form of IBD where specific immune cells called “lymphocytes” are seen in the inner lining of the large intestine (colon). The most common symptom is diarrhea.
• Eosinophilic gastroenteritis (EGID). A digestive inflammatory disease that may or may not evolve into IBD over time. It can also have similar symptoms including abdominal pain, occasional diarrhea, constipation, nausea, and vomiting.

Diagnostic tools

To diagnose IBD, it is vital evaluate (by camera under the microscope) the tissue lining of your child’s intestines and colon to determine the type of IBD and thereby customize the best treatment plan. These tests also allow us to measure the extent and severity of inflammation and track improvement. We use the following diagnostic and imaging tools:

• Esophagogastroduodenoscopy (EGD) or upper endoscopy. Using a flexible tube with a camera to visually examine for any redness, swelling, bleeding, ulcers, infections or other damage and then obtaining biopsies from the lining of the esophagus, stomach, and duodenum to further evaluate it under the microscope by a pathologist.
• Colonoscopy. A flexible tube with a camera and light that is advanced through the rectum so that the doctor can inspect the lining and obtain biopsies from the large intestine (colon) and the last few inches of the small intestine (ileum).
• Sigmoidoscopy. Works in much the same way as a colonoscopy but examines only the last portion of the colon.
• Advanced endoscopy. A name for more advanced diagnostic tools that are sometimes necessary to diagnose certain IBD conditions. The Stanford Medicine Children’s Health IBD Center houses the most advanced diagnostic tools available, including enteroscopies, to visualize and obtain biopsies of those parts of the small bowel that are beyond the reach of an EGD and colonoscopy.
• Small bowel capsule endoscopy. A noninvasive procedure in which a capsule containing a small camera is swallowed so that doctors can see the appearance of the inside lining of the entire small intestine to look for ulcers, bleeding or polyps. It does not allow us to obtain biopsies.
• Fecal biomarkers. This is a stool test to check for certain proteins and is used for evaluating the presence and severity of inflammation of the intestines.
• State-of-the-art imaging. Our radiology team uses the latest imaging technology and noninvasive techniques to capture images of your child’s bowel and abdomen with the highest level of detail while minimizing radiation. Our technologies include the following:
  • Magnetic resonance enterography (MRE). This technique protects from radiation exposure while allowing us to obtain detailed pictures of your child’s small and large intestine. It helps in assessing the extent, severity and complications from IBD and also used for monitoring your child’s response to treatment.
  • Contrast enhanced ultrasound (CEUS). We are one of just a few centers in the United States to use this specialized ultrasound imaging used to evaluate the small intestines with greater detail than a regular ultrasound while protecting the children from radiation exposure. It is useful for diagnosis and monitoring the response to treatment. Since ultrasounds are noninvasive, safer and sometimes can even avoid the need for an endoscopy, CT or MRE, they allow us to monitor and adjust your child’s care plan quickly and more frequently, making treatment more effective.
  • CT scans and other radiological exams. Additional tests may be needed in acute situations, or to assess your child’s IBD when an MRI or ultrasound is not possible. We have developed protocols that minimize the radiation exposure from such studies.
• Genetic testing. When your child is not responding to treatment, or we suspect an underlying genetic condition, we may perform genetic testing, which allows us in some patients to pinpoint the likely cause of the disease more precisely and thereby customize treatment when possible.