Recognising the red flags: When to consult a gastroenterologist for adolescent IBD

Inflammatory bowel disease (IBD) is a chronic condition that affects the digestive system, posing unique challenges for adolescents during the crucial years of growth and development. Recognising the red flags early and consulting a gastroenterologist can lead to better outcomes.

Dr Ioanna Parisi, distinguished consultant gastroenterologist, explains the key warning signs, the diagnostic process, and the importance of timely intervention for adolescent IBD.

What is IBD, and how do adolescent presentations differ from those in adults?

IBD is a chronic condition that affects the gastrointestinal (GI) tract, leading to persistent inflammation. It includes two main disorders: Crohn’s disease and ulcerative colitis. For adolescents, IBD involves the same underlying chronic inflammation as in adults but often presents with additional concerns.

Adolescents with IBD may not only experience abdominal pain, diarrhoea, or rectal bleeding but also systemic symptoms, including growth delays, malnutrition, and intestinal damage, due to the impact of chronic inflammation during the critical adolescent growth period.

Furthermore, IBD onset during adolescence can also coincide with development milestones like academic pressure, exacerbating the psychological burden of living with a chronic illness. This makes timely diagnosis and treatment not only about symptom control but also about ensuring proper growth and emotional wellbeing.

What are the red flags that signal the need for specialist consultation?

Recognising the signs that differentiate common digestive issues from potential IBD is crucial. The following signs warrant a consultation with your gastroenterologist as soon as possible:

• Chronic diarrhoea that lasts more than a few weeks, especially if it contains blood.
• Abdominal pain that is severe, recurring, or impacts daily life.
• Significant and unexplained weight loss, which could signal malnutrition.
• Fatigue or weakness, often due to anaemia caused by intestinal bleeding or poor nutrient absorption.
• Blood or mucus in the stool, indicating possible intestinal inflammation.
• Delayed growth and puberty, which can result from prolonged inflammation and inadequate nutrition.

Additionally, it’s also important to consider a family history of IBD or autoimmune conditions, as these can increase the likelihood of the disease in adolescents. While occasional stomach aches can be attributed to infections or dietary intolerances, persistent and severe symptoms should raise concerns.

What diagnostic tests might be used to confirm IBD in adolescents?

Diagnosing IBD requires a combination of medical history, physical examinations, and specific diagnostic tests. The first step typically includes blood tests to detect inflammation markers, anaemia, or nutrient deficiencies. Stool tests may also be used to rule out infections and measure markers of intestinal inflammation.

To confirm the diagnosis and assess the extent of IBD, imaging and endoscopic procedures will then be performed. Endoscopy and colonoscopy allow direct visualisation of the GI tract and the collection of tissue biopsies, whereas sometimes non-invasive capsule endoscopy may be advised. Meanwhile, imaging techniques such as MRI scans or ultrasounds provide detailed views of the digestive tract to help identify complications like abscesses or strictures.

How is IBD in adolescents treated?

Treatment for adolescent IBD is multifaceted and aims to control inflammation, manage symptoms, and promote healthy growth and development. The specific approach is tailored to the severity of the disease, its location in the GI tract, and the individual needs of the patient.

Medications

Corticosteroids and anti-inflammatory drugs, such as 5-aminosalicylic acid, are often used as a first line to reduce inflammation in mild cases. For moderate to severe cases, immune-modulating drugs and biologics, such as anti-TNF agents, may be prescribed to target the underlying immune response and maintain long-term remission. There are currently several advanced medical therapies to achieve and sustain a good control of the chronic inflammation.

Nutritional therapy

In some cases, a liquid-only diet or supplemental nutrition can induce remission of IBD whilst helping to address nutritional deficiencies and growth delays.

Surgery

In certain cases, usually if medical treatments are insufficient or complications arise, surgery may be necessary to remove damaged sections of the intestine and treat complications such as strictures or fistulas.

How often should adolescents with IBD follow-up with their gastroenterologist?

Regular follow-up is essential for managing IBD effectively. During periods of active disease, appointments will occur every 4 to 6 weeks to monitor progress and adjust medications as needed.

Once the condition stabilises, follow-up intervals will extend to every 3 to 6 months. These appointments will often include blood and stool tests to control inflammation and ensure that medications are safe and effective.

In addition, routine assessments of growth, puberty, and bone health will be required to ensure healthy growth and development and to detect and manage any complications related to IBD or its treatment.

If you would like to book an appointment with Dr Ioanna Parisi, head on over to her Top Doctors profile today.