Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, April 19, 2017

Another Medical Puzzle Afflicting Children

"The number of children under five being diagnosed with IBD [inflammatory bowel disease] is alarming because it was almost unheard of twenty years ago, and it is now much more common."
"We are seeing more of it."
"The numbers are huge -- much bigger than they were ten or twenty years ago. When you talk to some of the older doctors, they never saw it [in children] under five years old, it was completely unheard of and extremely rare under ten."
"Unfortunately, we don't know [why]. It is probably multiple factors. We still have to figure out how to prevent it."
"The psycho-social impact on the family of caring for a young child with a chronic illness is significant."

Dr. Eric Benchimol, pediatric gastroenterologist, Children's Hospital of Eastern Ontario

"[Crohn’s and colitis] aren’t talked about, they’re very much like invisible diseases. You may look at somebody and they look completely healthy, but internally there’s a war raging inside in their intestines."
"[The new study confirms the incidence of Crohn’s and colitis is climbing in Canada.] Families new to Canada are developing Crohn’s and colitis for the very first time, often within the first generation. So this type of research is really important because we really want to find out why this is happening."
Mina Mawani, president and CEO, Crohn’s and Colitis Canada
Inflammatory Bowel Disease
Kids Health -- Nemours Foundation

Canada is cited as having one of the highest rates of childhood inflammatory bowel disease world-wide. That fact along with the swift increase of the disease among children under five years of age is cause for great concern in the medical community, let alone for the parents of children diagnosed with IBD. A study published in the American Journal of Gastroenterology points out the very issue of children diagnosed with inflammatory bowel disease annually at a young age, a puzzling phenomenon that science is yet to clarify.

The latest study had researchers identify instances of IBD in children under age five increased by 7.2 percent annually between 1999 and 2010. IBD includes Crohn's disease and ulcerative colitis, affecting the digestive tract and the cause of chronic diarrhea, blood in the stool, abdominal pain, and loss of weight. All symptoms that would be frightening to the children experiencing them, and beyond alarming to the parents attempting to cope with their vulnerable children's condition and their therapeutic needs.

The study was carried out by research members of the Canadian Gastro-Intestinal Epidemiology Consortium who analyzed five provinces' health records identifying children under age 16 diagnosed with IBD between 1999 and 2010. Alberta, Manitoba, Ontario, Quebec and Nova Scotia, the five provinces for which medical records were perused represent between them 80 percent of the Canadian population. Over the close to two decades the study covered, an incremental annual increase in IBD resulted in a 60 percent increase of children living with Crohn's or colitis.
Kids Health -- Nemours Foundation

What precisely is the cause of IBD and its steady growth is a puzzle, but one that researchers believe reflects a number of issues, from predisposing genetics to environmental factors. The leading theory is that bacterial composition of the gut (microbiome) has altered as a result of early exposure to antibiotics, as well as the consumption of a typical high-fat, sugar-rich North American diet, and the issue of low levels of vitamin D common to a northern climate; all of which can be seen as potential triggers setting off the onset of the disease.

Each year in Canada an estimated 600 to 650 children are diagnosed with IBD, leaving close to three thousand children under age 16 living with the disease, at the present time. The Children's Hospital of Eastern Ontario alone diagnoses 60 to 70 children a year, with IBD. Rates for children under 16 appear to have stabilized across the country while Ontario realized a 5.8 percent annual increase in diagnoses during the same period for all children under 16.


Children with IBD must take medication and be given a special diet protocol to prevent flare-ups which in turn can cause chronic diarrhea and other uncomfortable and often painful symptoms. Normal childhood activity is brought to a screeching halt when these situations arise. Even eating certain foods meant to be avoided can ignite inflammation, creating cramping, bloating and gas and the inevitable frequent trips to the bathroom.

An estimated quarter-million Canadians suffer from irritable bowel syndrome. Difficult enough for adults, as it interrupts normal life, but critical for children whose lives are just beginning, and they face the necessity to adjust expectations, become alert to triggers, and resign themselves to a life of complications resulting from an often embarrassing and certainly hampering condition that will follow them all the days of their lives.

Dr. Benchimol pointed out that immigrant populations from South Asia: India, Pakistan and Sri Lanka, appear to develop high rates of IBD after arriving in Canada. He feels the genetic inheritance is there, and once they adopt a western diet and lifestyle, that becomes the tipping point for the disease onset.

Inflammatory bowel disease primarily includes Crohn’s disease and ulcerative colitis — conditions that affect the digestive tract and cause chronic diarrhea, blood in the stool and abdominal pain.
Inflammatory bowel disease primarily includes Crohn’s disease and ulcerative colitis — conditions that affect the digestive tract and cause chronic diarrhea, blood in the stool and abdominal pain.  (dreamstime file photo)

What is inflammatory bowel disease (IBD)?

Inflammatory bowel disease (IBD) refers to several related illnesses that affect the digestive tract. In these cases, the digestive tract becomes swollen and red (inflamed) and the gut tissue can be broken or damaged.
Crohn’s disease and ulcerative colitis are two forms of IBD. Both are ongoing (chronic) diseases. They are alike in some ways, but they also have some important differences.
In Crohn’s disease, all layers of the digestive tract can become inflamed and get sores, or ulcers. Crohn’s disease can affect any part of the digestive tract from the mouth to the anus. Usually, it affects the end of the small intestine and the large intestine (colon). There can be healthy patches in between inflamed patches.
In ulcerative colitis, only the inner lining (mucosa) of the colon becomes inflamed and gets ulcers. Most of the time, ulcerative colitis affects the whole length of the colon. Some children have healthy patches of intestine between inflamed patches, but this might not be true for your child.
Children with IBD can have features of both Crohn’s disease and ulcerative colitis.
IBD sometimes affects other parts of the body, too, such as the joints, liver, eyes or skin.
Most people diagnosed with IBD are 10 to 40 years old. However, some children younger than 5 years old get IBD.
IBD tends to run in families. About 1 in 5 people with either Crohn’s disease or ulcerative colitis has a close relative with some form of IBD. But IBD is not only genetic. We know this because if 1 identical twin has IBD, there’s less than a 50% chance that the other twin will have it too — even though they have the exact same genetic makeup.
Doctors believe that IBD happens because something goes wrong between a child’s genetic makeup, their immune system and their microbiome. It’s not clear why this happens. Doctors are studying IBD to learn more about the causes.
Immune deficiencies can cause severe IBD in children younger than 5, even in babies.


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