Treatment and Diet
There are various treatments available for children with Crohn’s Disease and Ulcerative Colitis. The aim of any treatment is to get the child into a full remission and back to a normal life style. However, at present there is no way of preventing a relapse in all those affected, though some newer treatments can help some patients for weeks or months. In some the remission may last for years so this is one area currently where further personalised medicines research is also being undertaken to tailor treatments to the person depending on the location and severity of their inflammatory bowel disease.
Over the last 2 decades enteral feeding has been the first choice of treatment for children with Crohn’s Disease. This is a special liquid feed containing all the nutrients and has no side effects. This special feed can sometimes be taken as a drink or if really unpalatable to the child can be given through a naso-gastric tube. This special feed will usually be given for six weeks and no food will be taken during this time. At the end of the six weeks foods will be introduced very gradually. Sometimes this feed is continued as a supplement to the normal food.
However drugs, including steroids and other options, such a range of immunosuppressants and biologic treatments, may be needed to suppress the inflammation and bring about a remission.
Surgery is sometimes necessary and the type of surgery performed will depend on what part of the bowel is affected. There are several types of operation and your paediatric gastroenterologist or paediatrician and the paediatric surgeon will discuss these with you. It may be just a straight forward resection of part of the bowel but in more severe cases it may mean making a stoma and bringing the bowel out on to the surface of the stomach and fitting a bag to collect body waste.
An acute attack of Ulcerative Colitis is usually treated with a combination of drugs including steroids or other treatments taken by mouth, and/or drugs in the form of an enema into the rectum. This may be followed by a prolonged or indefinite period of maintenance treatment with a much less powerful drug.
Increasingly a range of the newer biological treatments may be used. In severe cases an urgent, or planned, operation may be necessary to remove all or part of the colon. Total Colectomy, if necessary, completely cures Ulcerative Colitis but the patient is left with a permanent ileostomy (an artificial opening on the stomach).
Poor diet and inflammation in the bowel leads to rapid weight loss and it is important therefore to counteract this. There is no one diet that will help all young patients but generally a well balanced diet containing essential nutrients should be encouraged.
When unwell, children often feel as if they have just eaten a big meal so a normal sized meal will be refused. Gentle encouragement with small amounts may help. If a particular food upsets the child then it should be omitted from the diet. However it is dangerous to try dietary manipulations without the supervision of a doctor or dietitian as avoiding too many foods will lead to further malnutrition.
There are several drinks obtainable from the chemist that contains all the nutrients. These ‘milk-shake’ type drinks may help when there is a loss of appetite but again advice should be sought from the doctor, IBD nurse or dietician.
Your doctor can also discuss other Crohn’s and colitis (ibd) treatments or surgical options