Introduction

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that is associated with mucosal ulceration of the colon and rectum, leading to bloody diarrhea, abdominal pain, tenesmus, and other gastrointestinal symptoms. While the exact cause is unknown, UC is an autoimmune condition that may be influenced by environmental factors, genetic predisposition, and the balance of the gut microbiome, among other unknown influences.[1][2] Ulcerative colitis often presents in childhood,[3] and thus the pediatric surgeon remains an essential team member in the diagnosis and management of children with UC. In children, where the incidence of IBD is increasing, approximately 40% will require a total colectomy within 10 years,[1] and therefore, a multidisciplinary team approach is crictical to the management and wellbeing of the pediatric patient with UC.

What is different about ulcerative colitis in children?

Up to 25% of patients affected by UC will present in childhood.[4][5] UC is often a more severe disease process in children and many present with pancolitis leading to a higher percentage requiring colectomy.[3][6] While most children present with typical symptoms of abdominal pain and rectal bleeding, it is important for clinicians to recognize atypical symptoms such as growth failure and anorexia as diagnosis can often be delayed.[7] The disease presentation was once thought to correlate with the clinical outcome for ulcerative colitis, but in young children, even a severe disease presentation can lead to a mild disease course.[8][9] UC can affect the linear growth and physiologic health of a child as well as social and emotional development. Children who have UC may miss school and social activities and are prone to behavioral disturbances and depression.[8]

Content in this topic is referenced in SCORE Inflammatory Bowel Disease overview