Ulcerative Colitis in Children and Adolescents

Ulcerative colitis (UC) is a chronic gastrointestinal inflammatory disorder and is one of the inflammatory bowel diseases (IBD) along with Crohn disease (CD). CD can involve any area of the gastrointestinal (GI) tract and has features of transmural disease, skip lesions and mucosal granulomata. UC, on the other hand, principally involves the colon for a variable length, and comprises confluent superficial inflammation. In addition, some individuals may be termed to have IBD unclassified (IBDU): a situation where there are clear diagnostic features of IBD, but no definitive features of either UC or CD. Over time many individuals with IBDU are reclassified as UC or CD. At present CD and UC are considered to be incurable, although colectomy can be seen as a surgical cure for UC. Furthermore, the pathogenesis of these conditions remains unclear, although understanding is increasing rapidly. The onset of UC can be in any age, from the first year of life. The peak age of onset, however, is between 15 and 35 years of age. Overall rates of UC climbed through the last decades of the 20th century. Recent paediatric data suggests that rates of UC have been static in a number of countries. In some, however, UC incidence has continued to increase. In countries where IBD was previously uncommon, UC incidence rates are also noted to be increasingly recently. When diagnosed in children of any age, these individuals face a longterm condition with remitting-relapsing features. Children may have significant interruption to daily activities and consequent impact upon quality of life (QOL). A number will have complications of disease and some will require colectomy during childhood. Because of the multiple aspects of UC and the various adverse impacts, children and adolescents with UC should be considered separately to adults with UC and require a multidisciplinary approach to management to ensure that all aspects are considered in optimal fashion.