Differences in the management of inflammatory bowel disease in children and adolescents compared to adults.

Managing IBD in children and adolescents requires attention to issues unique to these age groups. The spectrum of presenting signs and symptoms is broad and often, subtle. Physician awareness of intestinal and extra-intestinal features prompts earlier diagnosis and intervention. The focus of treatment is not limited to intestinal symptoms, but also involves assessing weight and height gains, sexual maturation, extra-intestinal manifestations and psychosocial well-being. Differences in selecting drugs for pediatric versus adult patients are based on: 1. lack of prospective trials establishing effective doses for different ages; 2. inability to swallow capsules; 3. importance of nutrition in promoting growth; 4. paucity of data regarding the long-term safety of medications; 5. untoward cosmetic effects of corticosteroids, and 6. the need to develop coping mechanisms for a chronic illness. While sulfasalazine and mesalamine are useful in mild disease, corticosteroids are necessary for moderate and severe disease. Metronidazole and ciprofloxacin are effective in perianal CD. Elemental and polymeric formulas induce and maintain remission in active CD and reverse growth failure. Immunomodulatory agents (azathioprine and 6-mercaptopurine) enable physicians to reduce steroids and hospitalization. In practice, combination therapy is recommended to control symptoms and limit drug-induced side effects.