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 that 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 them step into a brighter future.

We diagnose and treat the following conditions:

• Ulcerative colitis (UC). A type of IBD that involves inflammation found only in the large intestine (colon). 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. A type of IBD that can involve any part of the gastrointestinal tract, including the esophagus, stomach, or small and large intestines. Symptoms may include abdominal pain, diarrhea, rectal bleeding, fatigue, anemia, weight loss, poor growth, fever, mouth ulcers, joint pain, or rashes. In children, it can cause delayed puberty and result in failure to grow.
• IBD unclassified. A form of IBD that cannot clearly be distinguished as UC 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.

Diagnostic tools

To diagnose IBD, it is vital to 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. A flexible tube with a camera is used to visually examine for any redness, swelling, bleeding, ulcers, infections, or other damage and then obtain 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 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 Center for Inflammatory Bowel Disease (IBD) and Celiac Disease 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 intestines. It helps in assessing the extent, severity, and complications from IBD and also is used for monitoring your child’s response to treatment.
  • 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 is diagnosed with VEO-IBD, 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.