Abdominal pain? You may have inflamed guts

Cigarette smoke can trigger an ongoing immune system response or aggravate inflammatory bowel disease.

Although inflammatory bowel disease (IBD) is more common in the West, it has been on the rise in Asia over the past four decades. Most cases usually occur in those aged 15 to 30 years old.

In childhood, the peak incidence is between 11 and 13 years, but it can also occur in younger children.

In general, this long-term disease leads to inflammation of the intestines and damages the intestinal lining. Ulcers may form, which result in bleeding. The various types of IBD are Crohn's disease (CD), ulcerative colitis (UC), and allergic colitis (AC).

Sometimes, the term indeterminate colitis (IC) is used to refer to cases that are impossible to accurately categorise. In a worldwide context, however, it is important to note that infection, and not IBD, is the most common cause of gastrointestinal inflammation.

In general, CD can affect any part of the gastrointestinal tract, from the mouth to the anus, whereas UC affects only the colon and rectum. UC is more common than CD in Asian countries, but the incidence of CD appears to be rising.

CD is more common in men, while the incidence of UC is equal in both genders. In Malaysia, IBD affects Indians more than other ethnic groups.

On the other hand, AC mostly occurs in infants and young children. It is due to allergies to foods like cow's milk, egg, soy or wheat. It usually occurs concurrently with other conditions such as asthma, eczema and hay fever, but children with minor immunodeficiency may also get it.

Causes of IBD

The underlying cause of IBD is still unknown despite a large amount of research into it, but experts believe that IBD is caused by a combination of factors such as:

·Genetics: Research suggests that for people with IBD, there is a gene which mutates, causing the body to react abnormally to microbes like bacteria, viruses or protein in food. If your child has a blood relative with IBD, he or she is at a slightly higher risk of developing the disease.

·Immune system: Many immunological abnormalities have been described in patients with IBD, but none have yet to be convincingly shown to be the main causative factor.

·Environment: Cigarette smoke or the spread of bacteria or viruses can trigger an ongoing immune system response, or aggravate the disease. These environmental factors can damage the intestinal lining directly, triggering the start of the disease or accelerate its development.

·Diet: An unhealthy diet can worsen symptoms.

Does your child have IBD?

Pay attention if he or she displays various combinations of these symptoms:

·Diarrhoea (can be as often as 20 times a day, or more)

·Abdominal pain

·Rectal bleeding (blood in the stools)

·Skin pallor (anaemia caused by blood loss through stools, or the intestinal inflammation itself)

·Loss of appetite

·Lethargy

·Weight loss

·Fever

·Recurrent mouth ulcers that are difficult to heal

·Inflammation in the eyes or skin

Those with IBD do not necessarily experience symptoms all the time. A child may go through periods of flare-ups and periods of no symptoms.

Nonetheless, proper treatment must be given, especially since IBD might delay puberty, or stunt a child's growth, due to nutrient loss.

In some cases, complications from CD can develop, including:

·Fistulas (abnormal openings between parts of the intestine, or between the intestine and another organ, such as the bladder or skin)

·Obstruction or rupture in the small intestine or colon

·Skin rashes

·Arthritis

If you think your child might have IBD, please consult a doctor. The doctor might perform several tests to determine the diagnosis, including blood tests, colonoscopy, gastroscopy, barium X-ray and tissue biopsy.

Helping your child cope with IBD

Because there is no telling when symptoms may resurface after remission, managing the disease can be difficult.

Your child may feel tired, uncomfortable and irritable, so do your best to help your child receive the right treatment, and adopt a suitable diet for his or her needs.

Here are some tips:

·If your child has been prescribed medication by his or her paediatrician, make sure he or she takes them as instructed. Usually, anti-inflammatory drugs and immunosuppressive drugs are prescribed for IBD.

·Talk to the doctor about any queries you might have. Discuss your child's symptoms. Don't be afraid to ask what you need to know from the doctor.

·Ask the doctor about foods to avoid giving your child. Over time, your child should also find out which foods in particular provoke their symptoms, and make a note to abstain from eating them. Discourage intake of junk food as these can exacerbate IBD symptoms. To help control symptoms, try giving your child smaller meals throughout the day. Prepare healthy lunches and snacks for him or her to bring to school.

·Encourage your child to exercise regularly as this helps to give him or her more energy and reduce stress.

With proper treatment and management of IBD, there is no reason why a child cannot lead a normal, active life.

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