Paeds GI - IBD and Constipation

Question 1

What lab tests and results are indicative of inflammatory bowel disease?

Answer 1

Stool calprotectin (inflammatory marker in the stool)
Raised CRP
Low albumin
(Plus no pathogens in the stool)
Raised ESR
Anaemia
Thrombocytosis

Question 2

What investigations are required to definitively diagnose IBD?

Answer 2

Radiology (especially for Crohn’s)
- MRI, barium meal/follow-through
Endoscopy/colonoscopy
Mucosal biopsy (done with endo/colonoscopy)

Question 3

Describe the aims of management in IBD

Answer 3

Induce and maintain remission
Correct nutritional deficiencies
Maintain normal growth and development

Question 4

Describe the medical management options for IBD

Answer 4

Anti-inflammatories (but avoid steroids if possible in children)
Immunosuppressive drugs - azathioprine
Biologics - infliximab (TNF-antagonist)

Question 5

What is the mainstay of IBD treatment in children?

Answer 5

Immune modulation (requires inpatient treatment)
Nutritional supplementation

Question 6

How long does it take for malabsorption and reduced appetite (e.g. due to IBD symptoms) to result in growth problems?

Answer 6

at least 6 months

Question 7

How many types of stool are described in the bristol stool chart? which types are normal?

Answer 7

7 types

Types 3 and 4 are normal

Question 8

What are the possible causes of chronic constipation in children?

Answer 8

Rarely due to a severe underlying medical problem -usually multifactorial
Social
- Poor diet - Insufficient fluids, excessive milk
- Potty training/school toilet
Physical
- Intercurrent illness e.g Bad cold/flu – little intake for a few days
- Medication
Family history
Psychological (secondary)
Organic - Hirschsprung’s disease, anatomical rectum abnormalities (rare)

Question 9

What is Hirschsprung’s disease?

Answer 9

Failure of the enteric nervous system in the gut (very rare)

Question 10

What are the non-pharmacological management strategies for chronic constipation in children?

Answer 10

Manage social factors and diet
- more fibre, fruit/veg, less milk
Reduce aversive factors
- make toilet a pleasant experience
- soften stool, remove pain (more fluid and fibre)
- reward good behaviour rather than punishing “bad” behaviour

Removal of impacted faeces from the rectum

Question 11

What are the pharmacological management options for constipation in children?

Answer 11

Laxatives to soften stool and stimulate peristalsis:
- osmotic laxatives e.g. lactulose
- stimulant laxatives e.g. senna, picolax
- isotonic laxatives e.g. movicol (softens stool)
Disimpaction: an intensive course of laxatives are given (primarily movicol) to clear out the colon.