Inflammatory bowel disease (IBD) is a condition characterized by inflammation in the digestive tract. It includes one of two conditions: Crohn's disease and ulcerative colitis. Crohn's disease can involve any part of the digestive tract, from the mouth to the anus. However, the most commonly affected areas are the lower section of the small intestine and colon. Healthy areas are sometimes found between sections of diseased tissue. The inflammation can penetrate to all layers of the intestinal wall.

Ulcerative colitis occurs in the large intestine and affects only the inner lining of the intestinal wall. Tiny sores develop on the surface of the affected area of the lining, causing bleeding and production of pus and mucus. The diseased sections follow a continuous pattern (rather than a break with healthy tissue, as in Crohn's disease).

The most common symptoms associated with IBD are diarrhea, rectal bleeding, abdominal pain or cramps, fever and weight loss. Inflammation in the small intestine can interfere with the ability to absorb nutrients and cause malnourishment.

Crohn's disease can also cause some very serious complications. Inflammation can lead to narrowing of the small intestine (called a stricture). Sometimes blockages occur. Fissures, or tears, can develop in the lining of the anus. As the inflammation eats away at the lining, patients may also develop fistulas, or abnormal tunnels between one loop of intestine and another. Sometimes fistulas develop between the intestine and bladder, vagina or skin.

The Crohn's and Colitis Foundation of America estimates about 1.4 million Americans have IBD. About 30,000 new cases are diagnosed every year. IBD leads to about 700,000 visits to physicians each year and 100,000 hospitalizations.

Helping Children with IBD

IBD is most commonly diagnosed in adults, but can occur at any age. Researchers report in 25 percent of adults with IBD, symptoms begin during childhood. The Crohn's and Colitis Foundation of America estimates as many as 100,000 children under 18 have IBD.

IBD in childhood leads to some specific complications. It can cause nutritional deficiencies that affect a child's growth and development. During peak periods of illness, children may be very fatigued and have difficulty sleeping. Symptoms can cause frequent school absences that interfere with education and achievement. In addition, children with IBD may be embarrassed by their symptoms and often feel different from their peers.

Researchers believe stress can cause flare ups of IBD symptoms and worsen the disease. Children's Hospital of Pittsburgh has developed a "Coping Clinic" for children with IBD to help young patients deal with the effects of their disease. The program integrates behavioral therapy with medical therapy to help children control their stress levels and remain active, despite their symptoms.

Child Psychiatrist Eva Szigethy, M.D., Ph.D., says when children are first diagnosed with IBD, they are often very angry, frustrated or depressed. She helps children to understand that these emotions are part of the normal coping process. Then she looks for ways IBD may be causing impairment at school or in social relationships. An individualized program is developed to help the child recognize stress triggers and develop skills (such as hypnosis) to offset the problem.

Research suggests that stress reduction may help reduce symptoms and help patients control flare-ups of IBD. Currently, Szigethy is doing a study to measure the effects of stress reduction on a child's ability to function. The researchers will also measure the effects of the Coping Clinic on levels of inflammatory proteins associated with IBD.

For general information about inflammatory bowel disease:

American College of Gastroenterology

Crohn's and Colitis Foundation of America

Growing Up with IBD is a website designed for children with IBD. It can be accessed at http://www.growingupibd.org.