Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6101
Peer-review started: February 10, 2015
First decision: March 10, 2015
Revised: March 30, 2015
Accepted: April 9, 2015
Article in press: April 9, 2015
Published online: May 28, 2015
Inflammatory bowel disease (IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn’s disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid (distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum (pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice.
Core tip: Approximately 25% of patients with inflammatory bowel disease have onset of symptoms in childhood or adolescence. The unique and often severe features of childhood presentation make treatment decisions challenging. The dogma of surgical conservatism in Crohn's disease is challenged in the specific instance of left sided colitis. Furthermore we argue that the separation of adult and paediatric inflammatory bowel disease practice may disadvantage children, delaying adaption of innovative treatments and timely transition.