DEAR MAYO CLINIC: My 16-year-old daughter has been diagnosed with ulcerative colitis. Are the treatments safe for her growing body? Will the condition most likely remain mild, or will it get worse as she gets older?
ANSWER: Ulcerative colitis is a lifelong disease that usually requires medication to control. All medications have some risks that you, your daughter and her doctor should consider and discuss when making treatment decisions. In a child or teenager, however, the disease itself is more likely to impair growth and development than the medications used to treat it. Controlling ulcerative colitis with effective treatment is critical to ensure your daughter's proper growth.
The medical care of people who have ulcerative colitis typically is managed by a gastroenterologist -- a doctor who specializes in diseases that affect the stomach and intestines. Your child's gastroenterologist will consider the severity of her disease and the extent of its involvement in the colon when making treatment suggestions. Many medications are available that can effectively control ulcerative colitis symptoms.
One type of medication in particular that you should talk about with your daughter's doctor is corticosteroids (steroids), as they can have an effect on growth. Steroids such as prednisone or methylprednisolone can be used in children and adolescents to control the symptoms of ulcerative colitis. But this group of medications may have a negative impact on bone development, as well as other significant side effects when used long-term.
Though helpful for quickly reducing inflammation, the use of steroids should be minimized in children with ulcerative colitis. When used, steroids are typically considered a short-term medication bridge to control symptoms until another, slower-acting medication can exert its full effect.
Even if your daughter does not take steroids, or takes them for only a short time, it's important to have her bone density monitored regularly, as the disease itself also can cause problems with bone development. When ulcerative colitis is well-controlled, the risk of bone problems in young people is lowered considerably.
It's hard to predict whether your daughter's disease will get worse as she gets older. Ulcerative colitis often follows what's called a relapsing and remitting course. That means the disease generally has periods when symptoms flare-up and periods without symptoms, called remission. The goal of medical therapy for ulcerative colitis is to bring about a period of remission, and then maintain that remission with a medication that prevents flare-ups.
Many experts in pediatric ulcerative colitis have observed that when remission is achieved soon after diagnosis in children, remission tends to be easier to maintain in the long term. Unfortunately, that's not the case for everyone with this disease. So it is important to work with your daughter's gastroenterologist to find the safest medication that will control her disease over time.
Finally, it's important to note that surgery may be the best answer for some children with ulcerative colitis. Because ulcerative colitis inflammation is limited to the colon, removing the colon can provide an effective long-term solution. This is usually done with two to three operations. An internal pouch is created from the small intestine to serve as a new reservoir for stool. The procedure is called total colectomy with ileo-anal pouch anastomosis. It's usually reserved for people who have not responded to medical therapy. Those who have this surgery usually can stop taking medications to control ulcerative colitis. -- Michael Stephens, M.D., Pediatric Gastroenterology, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to firstname.lastname@example.org. For more information, visit http://www.mayoclinic.org.)
Treatment for ulcerative colitis in children critical to ensure proper growth
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