Ulcerative colitis is a type of inflammatory bowel disease (IBD) that involves ongoing (chronic) inflammation of the gastrointestinal tract. Ulcerative colitis inflammation affects the colon (large intestine). In children, the condition often affects the entire colon.
View Child-Friendly Explanation
There isn’t anything you or your parents did to get the disease, so you don’t have to feel guilty about it. It is not contagious, which means it can’t be “caught” by someone else.Pediatric GI doctor
The cause of ulcerative colitis is unknown. There is likely an interaction between a child's genetic makeup and their environment that triggers the condition. Many factors can cause ulcerative colitis flare-ups, including infections and physical stress.
Symptoms of ulcerative colitis can vary and may include:
- Abdominal pain or cramping
- Blood in the stool
- Constant feeling of needing to empty the bowels
- Joint pains
- Poor appetite
- Weight loss
- Failure to thrive
- Delayed puberty
Diagnosis of Ulcerative Colitis
If your child shows signs of ulcerative colitis, a pediatric gastroenterologist can perform the following exams and tests to make a diagnosis:
- Blood tests. A pediatric specialist may order a variety of blood tests to check for ulcerative colitis. Examples of blood tests include:
- Complete blood count (CBC), which measures red and white blood cells and platelet count
- Erythrocyte sedimentation rate (ESR), which shows if there is inflammation in the body
- C-reactive protein (CRP), which shows if there is inflammation in the body
- Chemistry panel to check liver and kidney function and nutritional status
- IBD antibody panel test to check for antibodies that may support a diagnosis of ulcerative colitis
- Stool tests. A sample of your child's stool can be tested to search for the presence of blood, inflammation and bacteria. Types of stool tests include:
- Hemoccult to detect unseen blood in the stool
- Calprotectin, which indicates inflammation in the intestine
- Culture to check for bacterial infection in the intestine
- Clostridium difficile (C. diff), which detects a specific bacteria in the colon known to cause diarrhea
- Upper gastrointestinal (GI) endoscopy and colonoscopy. All children who are suspected to have ulcerative colitis will undergo both an upper GI endoscopy and a colonoscopy. The upper GI endoscopy examines the esophagus (swallowing tube), stomach and upper small intestine. A colonoscopy examines the end of the small intestine and the entire large intestine. Your child will feel no pain or discomfort during these procedures, which are performed under general anesthesia.
- Imaging studies. A pediatric gastroenterologist may use several imaging studies to take pictures and X-rays of your child’s gastrointestinal tract. Imaging studies for ulcerative colitis include:
- Fluoroscopy. The doctor may perform a type of fluoroscopy procedure called small bowel barium X-ray. Your child will be asked to drink a small amount of barium, and several X-rays will be done to follow the barium as it passes through the small intestine. This study looks for disease in the areas of the small intestine which may not be reached and examined during the endoscopy procedure.
- Special imaging studies. The doctor may perform special imaging studies to look for problems with other organs (liver, pancreas, gallbladder, kidneys). An IV may be required. These tests should not be painful to your child. They include:
- Capsule endoscopy. Capsule endoscopy may be used to examine areas in the digestive tract that cannot be visualized during standard endoscopic examination. An older child will be asked to swallow a capsule containing a camera that takes pictures throughout the small intestine. The capsule may be placed with the endoscope in very young children or children who have trouble swallowing. The capsule transmits a radio signal to a belt which is worn for eight hours following ingestion of the capsule.
Treatments for ulcerative colitis include:
- Medicines. Medicine is the best treatment option for ulcerative colitis. The following medicines are the most common, but other medications may be prescribed as needed:
- Aminosalicylates (5-ASAs). Aminosalicylates are medicines that help control mild to moderate inflammation. Some forms are taken by mouth; others must be given rectally.
- Corticosteroids. Corticosteroids, including prednisone and methylprednisolone, are used to treat moderate to severe ulcerative colitis. They may be taken by mouth or inserted into the rectum. Entocort (budesonide) is an oral corticosteroid that works on the lining of the lower small intestine and upper colon without much absorption into the bloodstream.
- Immunomodulators. Immunomodulators, such as azathioprine, 6-mercaptopurine and methotrexate, help reduce the need for corticosteroids and can help heal some fistulas (abnormal connections between organs).
- Antibiotics. Antibiotics may be prescribed for abscesses (sores) or fistulas.
- Biologic therapy. Biologic therapy is used to treat patients with severe ulcerative colitis that does not respond to any other types of medication. These medicines (called monoclonal antibodies) help block an immune system chemical that promotes inflammation. They include:
- Infliximab (Remicade)
- Adalimumab (Humira)
- Certolizumab (Cimzia)
- Surgery. If medicines do not work, a bowel resection may be needed (colectomy). A bowel resection removes the damaged or diseased part of the intestine. After the resection, your child's surgeon will perform an anastomosis to reconnect the bowel.
- Nutrition. No specific diet has been shown to improve or worsen ulcerative colitis. However, eating a healthy amount of calories, vitamins and protein is important to avoid malnutrition and weight loss. Children with ulcerative colitis frequently lose weight and growth may slow down before they are diagnosed. Our pediatric gastroenterology team believes growth is a critical outcome in treating pediatric patients with IBD. We tailor our treatment with medicines to help children regain lost weight and promote growth. However, many children require more intense nutritional therapy to improve their growth. We regularly examine and meet with you and your child. At each clinic appointment, we measure your child's height and weight. We work carefully with our dietitians to find the most appropriate nutrition plan for our patients with IBD. We help children regain lost weight and begin growing taller with the following nutritional therapies:
- Oral nutritional supplements. Supplements like Pediasure®, Boost® or Ensure® provide excellent nutrition in addition to a regular diet. Modulen® was designed specifically for patients with IBD. Any of these can be taken once or more daily with meals or as a snack.
- Calcium and vitamin D. IBD can lead to premature thinning of the bones. This can be worsened by steroids. Patients with ulcerative colitis must receive an adequate amount (above what a normal child would require) of calcium and vitamin D. Your pediatric gastroenterologist will recommend a specific amount of calcium and vitamin D based upon the age of your child. Some children may require a calcium supplement such as Tums®, Viactiv® or Caltrate®.
- Parenteral nutrition. Parenteral nutrition is sugar, fat and protein given through an IV. This is only rarely required in children with severe ulcerative colitis who are unable to take enough nutrition by eating and drinking or have had severe weight loss prior to their diagnosis. If parenteral nutrition is required, your physician will carefully manage the ingredients in the parenteral nutrition by following the results of several blood tests.
- Coping. Some children may become overwhelmed with the thought of having a lifelong illness. They will need the support of family, friends and, sometimes, a professional counselor.
Key Points to Remember
Key Points to Remember
- Ulcerative colitis is a form of IBD that causes inflammation in the colon (large intestine).
- Symptoms vary and can come and go with periods of flare-ups. Some of the most common symptoms include abdominal pain, diarrhea and blood in the stool.
- Ulcerative colitis is a lifelong condition but can often be treated with medicines.
- Eating a healthy diet is important to avoid malnutrition and weight loss.
Support Services & Resources
Support Services & Resources
Visit the websites below to find support groups and services and learn more about ulcerative colitis.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The Crohn's and Colitis Foundation of America (CCFA) sponsors support groups and summer camps for children living with ulcerative colitis and provides extensive information about the condition on its website.
The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition provides patient outreach and education for children and families living with ulcerative colitis.
Ulcerative Colitis Research
Ulcerative Colitis Research
Our pediatric specialists actively participate in a large variety of local and national research studies for ulcerative colitis. These studies are examining new treatments and new tests to help with diagnosis. We are also participating in studies about the quality of life in children with IBD. Your physician may ask you about your interest in participating in these studies.
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
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