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Care of Adults with Chronic Childhood Conditions pp 183–201Cite as

Inflammatory Bowel Disease

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Abstract

The incidence of inflammatory bowel disease has increased in pediatric populations over the last decade. Patients diagnosed in childhood survive well into adulthood, and therefore healthcare requires transfer to an adult gastroenterologist. The interplay of the primary care provider and gastroenterologist can help foster the delivery of comprehensive disease management for the patient with inflammatory bowel disease. This chapter will focus on the complexities involved in transition to adult care along with issues with which the primary care provider can assist the subspecialist in the co-management of patients with inflammatory bowel disease.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Mt. Sinai Hospital, 17 East 102nd Street, 5th Floor, New York, NY, 10029, USA

    Elana Maser

  2. Department of Gastroenterology/Hepatology, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Ft. Hood, TX, 76544, USA

    Anish Patel

Authors
  1. Elana Maser
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  2. Anish Patel
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Corresponding author

Correspondence to Anish Patel .

Editor information

Editors and Affiliations

  1. School of Medicine, Hofstra North Shore-LIJ School of Medicine, LAKE SUCCESS, New York, USA

    Mariecel Pilapil

  2. Mount Sinai School of Medicine , NEW YORK, New York, USA

    David E. DeLaet

  3. University of California Los Angeles , SANTA MONICA, California, USA

    Alice A. Kuo

  4. Baylor Clinic , HOUSTON, Texas, USA

    Cynthia Peacock

  5. Brigham and Women's Hospital , BOSTON, Massachusetts, USA

    Niraj Sharma

Appendix

Appendix

Inflammatory bowel disease (IBD) fact sheet

Definition

Inflammatory Bowel Disease (IBD) is characterized by chronic, relapsing inflammation within the gastrointestinal tract. IBD consists of Crohn’s disease (CD) and ulcerative colitis (UC).

∙ UC: affects the mucosal layer of the colon and rectum

∙ CD: affects all layers of the bowel and can occur in any part of the gastrointestinal tract from mouth to anus.

Prevalence

∙ Affects more than 5 million people worldwide, with more than 1.7 million in the United States

∙ Lifetime risk of development is 1 %

∙ ¼ of patients are diagnosed in childhood or adolescence

Pathophysiology

Inflammation is a result of inappropriate and ongoing activation of the innate immune system of the gut mucosa, driven by the commensal luminal flora in a genetically susceptible host

∙ Unclear as to specific flora responsible for activation

∙ Limited variation in gut bacteria is typically seen in an IBD host

Symptoms

Symptoms can overlap between CD and UC but each has distinctive attributes that can help differentiate:

∙ Abdominal pain, diarrhea

∙ Perianal fistulas (CD)

∙ Weight loss

∙ Anemia, vitamin deficiencies

∙ Bloody stools (higher risk in UC)

Challenges in transition

The transition from pediatric to adult care can be complicated due to the complexity of disease management.

∙ Complications related to the underlying disease and advanced therapies in IBD can be difficult to assess.

∙ Limited scope on routine health maintenance, to include vaccinations and cancer screening (for example, annual colon cancer screening with colonoscopy)

∙ Compliance of medication therapy

∙ Access to therapy and care if college-bound

∙ Discussions in intimacy and pregnancy

∙ Gaining trust in new provider

∙ Dietary management

Helpful resources

∙ Crohn’s and Colitis Foundation of America (resources for patients and family members, may include local chapters in communities throughout the US): http://www.ccfa.org

∙ American College of Gastroenterology Guidelines on Crohn’s disease and Ulcerative Colitis management (developed by expert panel): http://gi.org/clinical-guidelines/clinical-guidelines-sortable-list/

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Maser, E., Patel, A. (2016). Inflammatory Bowel Disease. In: Pilapil, M., DeLaet, D., Kuo, A., Peacock, C., Sharma, N. (eds) Care of Adults with Chronic Childhood Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-43827-6_12

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