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Korean J Pediatr
Inflammatory bowel disease (IBD) is a chronic relapsing disorder of unknown etiology, which is believed
to be multifactorial. Recently, the incidence of pediatric IBD has steeply increased in Korea since 2000.
Poorly controlled disease activity can result in complications such as intestinal fistulae, abscess,
and stricture, as well as growth retardation and delayed puberty in children. Because of a lack of
confirmative tests, various diagnostic modalities must be used to diagnose IBD. Onset age, location,
behavior, and activity are important in selecting treatments. Monogenic IBD must be excluded among
infantile and refractory very-early-onset IBD. Early aggressive therapy using biologics has recently
been proposed for peripubertal children to prevent growth failure and malnutrition.
Key words: Inflammatory bowel disease, Child, Crohn disease, Ulcerative colitis
Introduction
Pediatric inflammatory bowel disease (IBD) was previously rare in Korea1); therefore,
most general pediatricians in Korea may have encountered a few cases of pediatric IBD
during their training program. However, the incidence of IBD has risen in adults since
19902) and in children in the 2000s3,4), and its incidence continues to increase without
having reached a peak. The incidence of IBD has been rapidly increasing in the last 5 years.
General pediatricians are expected to encounter children with IBD more frequently in the
near future. To improve the understanding of pediatric IBD among Korean pediatricians,
we have written this review focusing on the issues that may pertain to clinical practice in
Korea.
What is IBD?
IBD is a chronic relapsing disorder of unknown etiology that encompasses the two
distinct disorders of Crohn disease (CD) and ulcerative colitis (UC). In CD, inflammation
can occur anywhere in the gastrointestinal tract. CD, although rarely fatal, is refractory
and causes abdominal pain, diarrhea, anorexia, and weight loss (Table 1)3-5). The
clinical presentations of Korean children with CD were similar that observed in Western
countries6-8). In our study, weight loss, growth retardation, lower bone mineral density, and
nutritional deficiencies were also observed9) (Table 2). Importantly, growth failure is one
of the most important aspects in pediatric CD10). Unlike in the adult population, disease
onset in children is uniquely associated with growth retardation and delayed puberty. Poor
control of disease activity can result in serious complications such as intestinal fistulae,
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Variable
Male female ratio
UC (n=54)5,13)
2.1:1
1:1
Abdominal pain
95 (77)
44 (81)
Diarrhea
76 (62)
40 (74)
Hematochezia
36 (29)
50 (93)
Weight loss
68 (55)
22 (41)
Growth failure
17 (14)
1 (2)
Perianal symptoms
67 (54)
0 (0)
Extraintestinal symptoms
28 (23)
9 (17)
16 (23)
3 (4)
Weight-for-height
39 (55)
20 (28)
35 (49)
19 (27)
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468
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Conclusions
Understanding the unique features of pediatric IBD is impor
tant for its diagnosis and management. First, some clues to the
pathogenesis of the disease can be uncovered when we under
stand the reasons of the current change in the incidence or
prevalence between different regions and ethnic backgrounds.
Second, we must consider different management strategy when
pediatric patients have different characteristics compared to
adults.
Poorly controlled disease activity can result in inevitable
surgery and growth retardation in children with IBD. Various
Hemoglobin (g/dL)*
44/71 (62)
43/70 (61)
49/64 (77)
46/64 (72)
45/65 (69)
24/68 (35)
6/61 (10)
25/63 (40)
1/62 (2)
26/51 (51)
Conflict of interest
No potential conflict of interest relevant to this article was
reported.
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