Ulcerative colitis (UC) is an Inflammatory Bowel Disease (IBD) in which chronic inflammation of the large intestine (the rectum and colon) leads to digestive and extra-intestinal symptoms.
Although largely diagnosed in early adulthood, UC has become increasingly common in adolescents and children. It’s important to know that even though an early diagnosis presents unique challenges, your child can absolutely lead a normal, healthy life. The research on IBD is constantly developing, leading to novel therapies that offer more gentle and natural ways of managing ulcerative colitis.
Here’s what you need to know as a parent of a child or teen with UC.
What are the symptoms of Ulcerative Colitis in children and teens?
Ulcerative colitis is characterized by courses of relapse and remission, meaning the symptoms can remain dormant for long periods of time, then ‘flare up’ and require management. The aim of IBD treatment is to achieve long-lasting symptom relief and sustainable clinical remission.
Pediatric UC does present differently from later onset UC. This is because children with UC are more likely to present with pancolitis (inflammation of the entire colon), whereas in adults the disease is generally confined to the rectum or left side of the colon. Children with UC are more likely to suffer abdominal pain and bloody diarrhea than rectal bleeding, which is more commonly reported in adults.
Common symptoms of pediatric UC:
- Abdominal pain
- Chronic diarrhea (with or without blood)
- Weight loss
- Rectal bleeding
Children with UC are also more likely to show extraintestinal manifestations and impaired nutrition, and these areas will need extra healthcare attention.
How do I know if my child has ulcerative colitis?
If your child shows any of the above symptoms, especially abdominal pain, diarrhea, and urgency, take them to a doctor for a diagnosis.
What causes ulcerative colitis in children and teens?
Researchers are not sure exactly what causes UC to develop initially but beleive it emerges from an interaction between:
- Genetic predisposition
- Immune system irregularity
- Gut bacteria imbalance
- Environmental factors
Environmental factors refer to exposure to certain diets, drugs, stress, air and water pollution, and additives that could contribute to the development of IBD.
Who is at risk for developing ulcerative colitis?
The risk of developing UC increases if someone:
- Has a close relative with UC
- Are white or of Ashkenazi Jewish descent
- Smoke when they’re young or are exposed to regular secondhand smoke
Studies also show that patients with ulcerative colitis had more exposure to processed foods before developing their conditions, especially high consumption of fats, omega-6 fatty acids, and meat.
How is ulcerative colitis diagnosed?
First, the doctor will take your child’s medical history and family history, then conduct a physical examination to reveal any signs of anemia, malnutrition, or extra-intestinal manifestations such as skin abnormalities or arthritis.
The doctor will also run blood and stool tests to check:
- Blood count
- C-reactive protein
- Serum levels
- Liver function
- Microbial factors
- The presence of celiac
- Fecal markers of intestinal inflammation (such as fecal calprotectin)
- The presence of bacterial infections such as Salmonella or Clostridium difficile toxins
It is highly recommended, if not essential, to conduct the following procedures when diagnosing pediatric UC. These procedures will be done while your child is under anesthetic.
Ileocolonscopy with biopsies
This is a colonoscopy that includes the intubation of the ileum, and biopsies of the tissue from all parts of the lower intestinal tract.
This is an endoscopy of the upper GI tract (the esophagus, stomach, and the first segment of the small intestine) to exclude Crohn’s disease or determine an atypical subtype of UC.
Magnetic Resonance Enterography (MRE)
This is a radiological investigation of the small bowel which helps determine disease activity and the extent of extraluminal complications such as fistulas or sinus tracts.
How is ulcerative colitis treated and managed in children & teens?
As of yet, there is no confirmed single ‘cause’ or ‘cure’ for IBD. Rather, treatment aims to induce remission and maintain remission for as long as possible, both in terms of symptom relief and clinical markers of the underlying inflammation, as well as manage disease complications.
In children with IBD, the long-term goals are to:
- Control the inflammation
- Prevent long-term tissue injury and complications
- Support physical and psychological growth
- Address nutritional needs and quality of life
Dietary and nutritional support is essential for all IBD patients for several reasons, so it is highly, highly recommended to work with a registered dietician.
Not only do certain pharmaceuticals deplete vitamin and mineral levels, but UC itself can impact the body’s absorption of nutrients (malnutrition), or flush them out altogether (malabsorption). A dietician will help make sure your child is getting their nutritional and calorie needs met and address any deficiencies. This is crucial for children with UC, who have a high risk of potential growth delays.
Nutritional Deficiencies with UC:
- Vitamin A, B12, D, E & K
Aside from meeting nutritional needs, diet plays a large role in the development and management of IBD, and a poor, overly processed diet may contribute to flare-ups.
As difficult as it may be, eliminating especially inflammatory foods is always beneficial. The general rule is the less processed, the better. The Mediterranean diet is one of the healthiest diets in the world, packed with anti-inflammatory food, and is a good reference for clean eating that’s not too limited.
Supplements & Natural Therapies for UC
There are many natural therapies available for UC, but curcumin shows the best results for induction and maintenance therapy for UC. Curcumin is a natural anti-inflammatory and antioxidant extracted from turmeric root. A 2013 study on children with IBD found that up to 2 grams, twice a day, was tolerable in children with UC.
Curcumin works by regulating inflammatory cytokines through several mechanisms and pathways. It’s been found to positively impact the gut microbiome and contribute to healing impaired intestinal barrier function – two factors that drive intestinal inflammation in IBD. In fact, a 2015 study found that some patients taking curcumin for induction therapy showed complete mucosal healing after just 4 weeks.
Although curcumin works wonders for inflammation and maintaining remission long-term, there is another natural therapy that induces remission much more quickly, but can only be taken short-term. Qing Dai is a Traditional Chinese herbal formula extracted from various Indigo plants.
Human studies show that Qing Dai can quickly relieve UC symptoms (especially bleeding) by inhibiting NF-κB signals and suppressing proinflammatory cytokines such as TNF-α, IL-1, and IL-6. TNF-α and IL-6 are also linked to linear growth issues in children with UC, meaning Qing Dai may be beneficial for this specific complication. Research shows that Qing Dai can induce the production of interleukin 22, which promotes the regeneration of the mucosa.
If your child is over the age of 8, it’s highly worth exploring a dual treatment with Qing Dai and Curcumin, as the two compounds combined to address all states of disease and phases of healing.
Medication for UC
The right pharmaceutical therapy for your child largely depends on their age, the extent of their disease, and your child’s tolerance to certain medications. Drug therapy for UC does have side effects, so this should be discussed thoroughly with your child’s doctor to find the best option.
The first-line treatment for UC is generally oral 5-aminosalicylate (5-ASA) medication. In cases of pediatric UC, higher doses are recommended as the disease presents more severely in children. 5-ASA, such as mesalazine, reduces inflammation in the intestine by preventing the production of chemicals involved in the inflammatory process.
Corticosteroids lower immune system activity and restrict inflammation in the digestive tract. This is a short-term therapy to control flare-ups, and shouldn’t be taken long-term due to the high likelihood of adverse effects. They also weaken the immune system, so your child may need extra monitoring while on this type of therapy.
Immunomodulators may be recommended if your child does not respond to either 5-ASA or corticosteroids. They work to regulate the activity of the immune system, but also have significant side effects.
How to support your child
Children and teens with UC may struggle with feeling different, or not being able to engage in the same activities as their peers. There is a high association between IBD and mental health issues, as well as poor self-image.
Seek out mental health support for your child if they show signs of anxiety or depression, and guide them towards stress-relief tools like yoga, music, art, writing, or spending time with their friends. The best thing they can do to heal is to limit stress and listen to their body’s needs. It may also help to seek extra support and stress relief for yourself, as the burden of IBD does take a toll.
UC is a huge challenge, but with the right tools and information, your child still has a happy, healthy, and full life ahead.