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Inflammatoryboweldisease(IBD)referstoseveralrelatedillnessesthataffectthedigestivetract.In
thesecases,thedigestivetractbecomesswollenandred(inflamed)andtheguttissuecanbe
brokenordamaged.

CrohnsdiseaseandulcerativecolitisaretwoformsofIBD.Bothareongoing(chronic)diseases.
Theyarealikeinsomeways,buttheyalsohavesomeimportantdifferences.

InCrohnsdisease,alllayersofthedigestivetractcanbecomeinflamedandgetsores,orulcers.
Crohnsdiseasecanaffectanypartofthedigestivetractfromthemouthtotheanus.Usually,it
affectstheendofthesmallintestineandthelargeintestine(colon).Therecanbehealthypatchesin
betweeninflamedpatches.

Inulcerativecolitis,onlytheinnerlining(mucosa)ofthecolonbecomesinflamedandgetsulcers.
Mostofthetime,ulcerativecolitisaffectsthewholelengthofthecolon.Somechildrenhavehealthy
patchesofintestinebetweeninflamedpatches,butthismightnotbetrueforyourchild.

ChildrenwithIBDcanhavefeaturesofbothCrohnsdiseaseandulcerativecolitis.

IBDsometimesaffectsotherpartsofthebody,too,suchasthejoints,liver,eyesorskin.

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Inthisvideo,Dr.DennisChristieexplainsthedifferenttypesofIBD.

What is IBD, Crohn's and Ulcerative Colitis?

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SeattleChildrenshasaspecialIBDCentertocareforchildrenwiththiscomplexcondition.

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TheprogramprovidesaccesstomanyIBDexperts.Wecanscheduleyourvisitsoyourchildsees
manyofthemin1placeonthesameday.Wetreatyourwholechildbycombiningcarefrom
specialistsindigestivehealth,immunehealth,nutrition,surgeryandpsychology.

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SeattleChildrensoffersadvancedtreatmentsforchildrenwithIBDthatarenotoffered
everywhere.Theseinclude:

TheSpecificCarbohydrateDiet(SCD)
Themedicinesnatalizumab,vedolizumabandustekinumab
Researchstudiesforfecalmicrobiotatransplanttherapy(alsoknownasstooltransplantor
fecestransplant)
StemcelltransplantforchildrenwithsevereCrohnsdiseasewhenassociatedwithspecific
geneticabnormalities
Surgery

Oursurgeonshavethemostexperienceintheregiondoingthehighlytechnicalsurgeriesthat
somechildrenwithIBDneed.

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TheIBDCenterteamalsoconductsresearchtofindbettertreatmentsandimprovethequalityof
lifeforchildrenwithIBD.WerepartofImproveCareNow,agroupofmorethan80centersworking
togethertostudyandrefineIBDcareforchildren.

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MostpeoplediagnosedwithIBDare10to40yearsold.However,somechildrenyoungerthan5
yearsoldgetIBD.
IBDtendstoruninfamilies.About1in5peoplewitheitherCrohnsdiseaseorulcerativecolitishasa
closerelativewithsomeformofIBD.ButIBDisnotonlygenetic.Weknowthisbecauseif1identical
twinhasIBD,thereslessthana50%chancethattheothertwinwillhaveittooeventhoughthey
havetheexactsamegeneticmakeup.

DoctorsbelievethatIBDhappensbecausesomethinggoeswrongbetweenachildsgenetic
makeup,theirimmunesystemandtheirmicrobiome.Itsnotclearwhythishappens.Doctorsare
studyingIBDtolearnmoreaboutthecauses.

ImmunedeficienciescancausesevereIBDinchildrenyoungerthan5,eveninbabies.

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ThemostcommonsymptomsofIBDare:

Crampingpaininthebelly
Ongoingdiarrhea
Bloodinstool(feces)
Weightloss

Thesymptomsrangefrommildmildpain,loosestoolsorgassybellytosevere,wherea
childdoublesoverwithpain,losesweight,passesstoolsmorethan8timesadayandpasses
blood.Symptomscanvaryovertime.Itsnormalforachildtogowithoutsymptomsformonthsor
evenyearsandthenhavesymptomsreappear.Thiscansometimesmakeithardfordoctorsto
makeadiagnosis.

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IBDcanleadtootherhealthproblems.Thesecanincludeslowedgrowth,delayedpuberty,
weakenedbonesorlowerbonedensity,anxiety,depressionandemotionalchallenges.Readmore
aboutthecomplicationsofCrohnsdiseaseorulcerativecolitis.

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Diagnosisalwaysstartswithadetailedhealthhistory.Todiagnoseinflammatoryboweldisease,the
IBDCenterteamwillaskyouforadetailedhistoryofyourchildsillness.Yourchildsdoctorsand
otherteammemberswillexamineyourchild.

Yourchildmightalsohavetests,includinglabwork,bodyimaging(radiology)andendoscopy.

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 Doctorsusetheselabteststolearnmoreaboutyourchild:

Bloodtests.Bloodtestscheckforanemia,whichcanbeasignofheavyinternalbleedingin
thegut,andhighlevelsofwhitebloodcellsandplatelets,whichcanbesignsofinflammation.
Bloodproteinlevelscantelltheteamifyourchildisnteatingenoughprotein,isntabsorbing
enoughproteinorislosingtoomuchproteinbecauseofinflammation.Othertestslookfor
substancesinthebloodthataresignsofinflammation(Creactiveproteintest,sedimentation
rate).
Testsonastoolsample.Theteamusestheseteststolookforbloodorsignsofinfection.
Certainstooltestscantelltheteamifyourchildhasactiveinflammation.

IfyourchildhasIBDanditstartedbeforeage5,theIBDCenterteammightsuggesttestingfor
immunedeficiencies.ImmunologistsatSeattleChildrenscandothistesting.

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Picturesthatshowtheinsideofyourchildsbellyorpelvicareacanhelptheteamlearnmore
aboutyourchildscondition.AtSeattleChildrens,wetrytousemethodsthatuseloworno
radiation,suchasultrasoundandMRI(magneticresonanceimaging).

SomechildrenmightneedanupperGI(PDF)(gastrointestinal)seriesofXrayswithasmallbowel
followthroughoraCT(computedtomography)scan.

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Oneofthebestwaystotellwhatshappeninginyourchildsintestineisforthedoctortolookatit.
Doctorscandothisbyinsertingathin,flexible,lightedtube(endoscope)throughyourchilds
mouthoranus.

ThetubehasacamerathatsconnectedtoacomputerandaTVmonitor.Usingthecamera,
doctorscanlookforswelling,redness,soresandbleeding.Theycaneventakeatinysample
(biopsy)oftheintestinefortesting.ThiscanhelpyourchildsteamdiagnoseIBD,figureoutthe
typeofIBDandtellhowmuchoftheintestineisaffected.

Yourchildmighthave1ormoreofthesetypesofendoscopy(pronouncedendOSScopeee):

Upperendoscopy.Thedoctorputstheendoscopethroughyourchildsmouthtolookattheir
stomachandthefirstpartoftheirsmallintestine.

Sigmoidoscopy(pronouncedsigmoidOSScopeee).Thedoctorputstheendoscope
throughyourchildsanustolookatonlytheirlowercolon.

Colonoscopy(pronouncedcoalunOSScopeee).Thedoctorputstheendoscopethrough
yourchildsanustolookattheirwholecolon.

Beforetheseprocedures,wegiveyourchildmedicinethatmakesthemfallasleep(anesthesia).
Theywillnotfeelanypainandwillnotmove.
 Sometimes,doctorsaskchildrentoswallowapilllikedevicethatcarriesatinycamera(capsule
endoscopy).Thedoctormightalsoplacethecapsuleinyourchildsdigestivetractusingan
endoscope.Thisdevicetakespicturesoftheintestine.Itpassesoutofyourchildsbodyinstool.
Doctorsviewthepicturesonacomputer.Thisletsthemseepartsoftheintestinetheycannotsee
usingaregularendoscope.

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FormostchildrenwithIBD,treatmentisabalanceofmedicinesandnutritionalsupport(seebelow).If
thesearenotenough,orifyourchildhasaseriouscomplication,yourchildmayneedsurgery.

TheIBDCenteratSeattleChildrensbringsateamofspecialiststogetherinoneplacetogiveyour
childandfamilythemostcompletecare.Thecentercombinescarefromexpertsindigestivehealth,
immunehealth,nutrition,surgeryandpsychology.Youandyourchildareactivepartnersinmaking
treatmentchoices.

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AttheIBDCenter,ourgoalsfortreatingyourchildareto:

Restorebalanceandhealthtoyourchildsbody
RelieveanypainorothersymptomscausedbyIBD

Decreaseinflammationandhealulcersinyourchildsintestines
Makesureyourchildisgettinggoodnutrition

Restoreyourchildsgrowthanddevelopment
Ensureyourchildbuildsthebestbonedensity

Helpyourchildandfamilywiththemental,emotionalandsocialeffectsofIBD

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WestarttreatmentforIBDwithmedicinesandnutritionalsupport.Medicinesaremainlyaimedat
calmingtheimmunesystem,whichistooreactive,andreducinginflammation.

Wetrytoavoidusingcorticosteroids(medicinesthatsuppresstheimmunesystem)becausethey
cancauselonglastingsideeffectsifusedagainandagain.

Severalothermedicinescanhelp.Theyincludeanewermedicinecallednatalizumab.Itlimitsthe
movementofoveractiveimmunecells.ItsusedinadultswithCrohnsdiseaseandisavailablefor
childrenthroughtheIBDCenter.

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 Inthisvideo,Dr.GhassanWahbeh,directorofSeattleChildrensIBDCenter,discussesthe
downsidesoftreatmentwithsteroids.

Side Effects of Treating Your Child's IBD With Steroids

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Dr.GhassanWahbehdiscussesthreetreatmentstrategiesthatavoidrepeateduseofsteroidsand
promotehealing.

Medications to Treat Your Child's IBD Without Steroid Use

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Theintestinesjobistobreakdownfoodsonutrientscanbeabsorbedintothebloodstream.
InflammationfromIBDcanmakeithardforyourchildtogetenoughnutrientstogrowand
develop.Nutritionalsupportcanhelpcorrectanyshortfalls.Intimeswheninflammationisunder
control,nutritionalsupportisstillimportanttomaintainahealthyandbalanceddiet.
 Nutritionalsupportcanmeanchangingwhatorhowyourchildeatsorusingnutritionaltherapies
(formulasorspecialdiets).

TheIBDCenterteamdesignsacompletenutritionplanforyourchildsotheygetenoughcalories
andeatarangeoffoods,includingfruitsandvegetables.

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TheresmountingevidencethatcertainnutritionaltherapiescanreduceinflammationinIBD.Atthe
IBDCenter,weembracenutritionaltherapiesandhelpfamiliesdecidewhetherthistypeof
treatmentisrightfortheirchildandhowtouseit.

Thecenterteamcangiveyoudetailsandresourcesabouttheoptions.Weworkwithyouto
decidethebestwaystotrackyourchildsprogressandtellwhetherthetherapyisworkingfor
them.

SpecificCarbohydrateDiet(SCD)

SeattleChildrensoffersinnovativetherapiesthatarenotofferedeverywhere.Asaleaderin
nutritionaltherapies,weofferdiettherapy,includingtheSpecificCarbohydrateDiet(SCD).

Thisdietremovesallgrains,dairy(exceptforyogurtfermented24hours),processedfoods,
sugarsandsweetenersexceptforhoney.Itpromotesonlynatural,nutrientrichfoods,which
includesvegetables,fruits,meatsandnuts.

Inadditiontobeingofferedbothasasole(primary)andadjuncttreatmentforIBD,theSCDdietis
beingresearchedforitseffectonIBDandthefecalmicrobiomethetrillionsofbacterialivingin
ourdigestivetract.Talktoyourchildsdoctortoseeifyourchildmaybeeligibletoparticipateina
study.

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AbalanceddietcanhelpmanageyourchildsIBDsymptoms.Dr.DavidSuskindexplainshow
eachchildsnutritionalneedsandproblemfoodsareunique.Creatingadietthatworksfor
yourchildplaysanimportantroleintreatment.

Nutritional Tips for Kids With IBD

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Yourchildmightneedsurgeryif:

Theyhaveseriousinflammationthatdoesntgetbetterwithmedicinesandnutritionalsupport.
TheirintestinegetsverynarroworscarredbecauseofIBD.Thiscanblocktheintestine.

Crohnsdiseaseaffectstheareaaroundtheiranus.Thiscancausepain,infectionsandpockets
ofpus(abscesses).

SurgeryisverydifferentforCrohnsdiseaseandforulcerativecolitis.

ForCrohnsdisease,surgeonsrepairorremovetheaffectedpartoftheintestineandpreserveas
muchofthehealthyintestineaspossible.Surgeonsusemanytechniquestodothis.

Forulcerativecolitis,surgeonsremovetheentirelargeintestine(colon)andtheliningofthe
rectum(or,rarely,thewholerectum).Inmostcases,theycreateapouchinsidethebodyfromthe
endofthesmallintestine(ileum)totheanus.(Thisbypassesthelargeintestine.)Thenthey
connectthesmallintestinetoanoutsideopeningmadeintheskinofthebellysowastecanpass
toabag.Thisbag(anileostomybag)isattachedontheoutside.Later,whentheinsidepouchcan
takeover,surgeonsclosetheileostomy.Rarely,achildsdigestivetractisnothealthyenoughto
makeapouchinsidethatworksinthiscase,thechildkeepstheileostomy.

OursurgeonsarehighlyexperiencedatoperationsforbothCrohnsdiseaseandulcerativecolitis.
Theyareskilledinbothlaparoscopicsurgery,orminimallyinvasivetechniques,andinopen
methods(usingalargercut).Yourchildssurgeonwillhelpyoudecidewhichtechniqueisbestfor
yourchild.

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SeattleChildrensoffersinnovativetherapiesthatarenotofferedeverywhere.Asaleaderin
nutritionaltherapies,SeattleChildrensHospitalInflammatoryBowelDiseaseCenteroffersdiet
therapyincludingtheSpecificCarbohydrateDiet(SCD).Thisdietremovesallgrains,dairy(except
foryogurtfermented24hours),processedfoods,sugarsandsweetenersexceptforhoney.It
promotesonlynatural,nutrientrichfoods,whichincludesvegetables,fruits,meatsandnuts.In
additiontobeingofferedbothasasole(primary)andadjuncttreatmentforIBD,theSCDdietisalso
beingresearchedforitseffectonIBDandthefecalmicrobiomethetrillionsofbacterialivinginour
digestivetract.Talktoyourchildsdoctortoseeifyourchildmaybeeligibletoparticipateinastudy.

CalltheIBDCenterat2069872521torequestanappointment,asecondopinionormore
information.

SeattleChildrenscomplieswithapplicablefederalandothercivilrightslawsanddoesnot
discriminate,excludepeopleortreatthemdifferentlybasedonrace,color,religion(creed),sex,
genderidentityorexpression,sexualorientation,nationalorigin(ancestry),age,disability,orany
otherstatusprotectedbyapplicablefederal,stateorlocallaw.Financialassistanceformedically
necessaryservicesisbasedonfamilyincomeandhospitalresourcesandisprovidedtochildren
underage21whoseprimaryresidenceisinWashington,Alaska,MontanaorIdaho.

19952017SeattleChildrensHospital
4800SandPointWayNESeattleWA98105
2069872000 8669872000(tollfree)