Pediatric and Inflammatory Bowel Disease: Perspective and Consequences

Pediatric and Inflammatory Bowel Disease: Perspective and Consequences

Pediatric and Adolescent Medicine Vol. 14 Series Editors David Branski Jerusalem Wieland Kiess Leipzig

Pediatric and Inflammatory Bowel Disease Perspective and Consequences Volume Editors John A. Walker-Smith London Emanuel Lebenthal Jerusalem David Branski Jerusalem 51 figures, 24 in color, and 14 tables, 2009 Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney

Pediatric and Adolescent Medicine John A. Walker-Smith The Wellcome Trust Centre for History of Medicine at University College of London London NW1 1AD UK Emanuel Lebenthal Hadassah-Hebrew University Medical Center PO Box 12000 91120 Jerusalem Israel David Branski Hadassah-Hebrew University Medical Center PO Box 12000 91120 Jerusalem Israel Library of Congress Cataloging-in-Publication Data Pediatric and inflammatory bowel disease : perspective and consequences / volume editors, John A. Walker-Smith, Emanuel Lebenthal, David Branski. p. ; cm. -- (Pediatric and adolescent medicine, ISSN 1017-5989 ; v. 14) Includes bibliographical references and indexes. ISBN 978-3-8055-9134-8 (hard cover : alk. paper) 1. Inflammatory bowel diseases. 2. Pediatric gastroenterology. I. Walker-Smith, John A. II. Lebenthal, Emanuel, 1939- III. Branski, D. IV. Series: Pediatric and adolescent medicine ; v. 14. [DNLM: 1. Inflammatory Bowel Diseases. 2. Adolescent. 3. Child. 4. Infant. W1 PE163HL v.14 2009 / WI 420 P3717 2009] RC862.I53P43 2009 618.92 33--dc22 2009012979 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2009 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 1017 5989 ISBN 978 3 8055 9134 8 e-isbn 978 3 8055 9135 5

Contents VII Preface Walker, J.A. (London); Lebenthal, E.; Branski, D. (Jerusalem) 1 Pathogenesis of Inflammatory Bowel Disease di Nardo, G.; Cucchiara, S. (Rome) 19 Epidemiology in Pediatric Inflammatory Bowel Disease Koletzko, S. (München) 29 Genetics of Inflammatory Bowel Disease Cooney, R.; Jewell, D. (Oxford) 51 Pathology of Inflammatory Bowel Disease in Children Harpaz, N. (New York, N.Y.) 67 Early-Onset Inflammatory Bowel Disease: Infant, Toddler, and Pre-School Lebenthal, E.; Branski, D. (Jerusalem); Walker-Smith, J.A. (London) 76 Radiological and Imaging Features Laghi, A.; Paolantonio, P.; Rengo, M.; Vasselli, F. (Polo Pontino); Di Mizio, V. (Latina/Chieti); Di Mizio, R. (Penne) 100 Endoscopic Modalities in Pediatric Inflammatory Bowel Disease Venkatesh, K.; Thomson, M. (Sheffield) 123 Approach to Clinical Diagnosis of Inflammatory Bowel Disease Bousvaros, A. (Boston, Mass.) 138 Growth and Puberty in Inflammatory Bowel Disease Savage, M.O.; Mark Beattie, R. (Southampton); Sanderson, I.R.S. ( London) 146 Treatment by Enteral Nutrition in Inflammatory Bowel Disease Köglmeier, J.; Heuschkel, R. (London) 158 Medical Therapy for Inflammatory Bowel Disease in Children and Adolescents Kappelman, M.D. (Chapel Hill, N.C.); Rufo, P.A. (Boston, Mass.) 172 Surgical Therapy McCrudden Erickson, K.; Teitelbaum, D.H.; Coran, A.G. (Ann Arbor, Mich.) V

191 Transition to Adult Care Hait, E.J.; Arnold, J.H.; Sands, B.E.; Fishman, L. (Boston, Mass.) 199 Author Index 200 Subject Index VI Contents

Preface Chronic inflammatory bowel disease (IBD) encompasses Crohn's disease, ulcerative colitis and indeterminate colitis. These disorders are induced by interactions between genetic, host, environmental and immune regulatory factors. The etiology of IBD is still obscure; however, a growing body of evidence suggests a dysfunctional mucosal immune system overacting with constituents of the commensal flora. The disease is not uncommon in the pediatric population. The clinical presentation and therapeutic considerations including nutritional support and disease complications especially failure to gain weight and short stature are more specific for pediatric and adolescent patients suffering from IBD. Early-onset IBD has a distinct phenotype and the difference from adult IBD makes it a unique subgroup, with the possibility of a wide range of causes. The aim of this book is to increase the knowledge and understanding of pediatricians and physicians on IBD in infants, toddlers, children, adolescents and young adults. This book covers most of the relevant topics related to pediatric IBD. Experts and leaders in the field of pediatric IBD from the USA, various European countries and Israel have contributed to this volume. Derek Jewell from the UK presented new data on the genetics of IBD. Koletzko from Germany discussed the epidemiology of IBD. Cucchiara from Italy reported on the evolving topic of the pathogenesis of IBD. The clinical aspects of pediatric IBD included the following: Bouvaros from the USA described an approach to the clinical diagnosis of IBD, and Lebenthal and Branski from Israel and Walker-Smith from the UK presented early-onset IBD as a distinct topic. The third clinical chapter by Sanderson from the UK was dedicated to an important issue in pediatric IBD, namely growth and puberty. VII

The fourth clinical chapter by Sands from the USA highlights an important and relevant topic, i.e. the transition of the pediatric patient to the care of the adult gastroenterologist. The book then continues with some very informative chapters which deal with considerations that need to be taken when forming a diagnosis. The first is by Laghi from Italy on radiological and imaging features, the second is by Thomson from the UK on endoscopic findings, and the third is by Harpaz from the USA on pathology in pediatric IBD. The concluding part of the book includes disease management. The first by Rufo from the USA concentrates on pharmacological therapy, the second by Heuschkel from the UK on the important therapeutic role of nutrition in IBD, and the third written by Coran s group from the USA is on surgical considerations. The editors wish to thank all the contributors to this book who are well-known authorities in the field and who invested their time and efforts into realizing this project. The editors wish to express their appreciation to the professional team from Karger Publishing House who accompanied us all the way through the production of this book. Last but not least, the editors wish to thank their wives Elizabeth Walker-Smith, Effie Branski and Chana Lebenthal for their patience and continuous support. J.A. Walker, London E. Lebenthal, Jerusalem D. Branski, Jerusalem VIII Preface