Ulcerative colitis in Child
The pathophysiology of this disease has not been fully elucidated; however, it is believed to be in part related to an atypical Th2 immune response resulting in increased natural killer T cells and IL-13 in the colonic mucosa leading to epithelial cell cytotoxicity, apoptosis, and epithelial barrier dysfunction. Autoimmunity and genetic factors may play a role in UC.
Clinical manifestations include relapsing episodes of bloody diarrhea, abdominal pain, fever, malaise, and weight loss. Patients may be anemic.
Cutaneous involvement manifests as aphthous stomatitis or perianal disease. The most commonly associated dermatologic conditions are erythema nodosum and pyoderma gangrenosum.
Although 83% of patients will suffer from at least one relapse during the first 10 years after initial onset, the prognosis for UC in general is good. Over half of patients report remission or only mild intestinal symptoms.
On endoscopy, UC almost always presents with continuous involvement of the rectum and/or colon. During the active phase of disease, the mucosa can appear erythematous and friable. Pseudopolyps and inflammatory polyps may also be present.
UC has been linked with a Westernized lifestyle including high-fat and high-sugar diets, medication use, stress, and high socioeconomic status. Twenty-five percent of UC cases also possess a familial component.
The course of UC is often random and unpredictable. The initial presentation can vary from mild / asymptomatic to severe (toxic hemorrhagic colitis). Patients can then present with variable episodes of exacerbation as well as complete remission.
Pediatric Patient Considerations:
The mean age at time of diagnosis of IBD among children is 10.3 years. Pediatric-onset disease has a worse course, with more extensive disease, a higher colectomy rate (30%-40% at 10 years compared with 20% in adult-onset disease), and more frequent hospitalizations.
K51.919 – Ulcerative colitis, unspecified with unspecified complications
64766004 – Ulcerative colitis
- Infectious colitis (eg, Clostridium difficile colitis, amebic colitis, strongyloidiasis)
- Medication-induced colitis
- Ischemic colitis
- Segmental (diverticular disease-associated) colitis (see diverticulitis)
- Bile acid diarrhea
- Crohn disease
- Erythema nodosum
- Recurrent aphthous stomatitis
- Herpes simplex virus
- Other diseases with oral ulcers, including cytomegalovirus infection, erosive lichen planus, and pemphigus vulgaris
- Hidradenitis suppurativa
- Behçet disease
- Cyclic neutropenia
- Vitamin B12 deficiency
- Folate deficiency
- Human immunodeficiency virus disease
- Pilonidal disease
- Sexual abuse
- Allergic colitis