William Spivak, M.D.
Inflammatory bowel disease (IBD)
IBD should be suspected in patients with chronic GI blood loss, diarrhea, abdominal pain, anorexia, fever and weight loss. In any given patient, some or most of these symptoms may be absent. An occasional child with IBD will have none of these symptoms and may present with growth failure or an extraintestinal manifestation of IBD such as arthritis. Barium enema is rarely indicated since it is neither very sensitive nor specific when compared to colonoscopy. Children with persistent rectal bleeding or guaiac posive stool should have a colonoscopy performed once infectious etiologies and anal fissure have been excluded. Pediatric patients with possible Crohn’s disease should have an upper GEndoscopy performed at the time of their initial Colonoscopy, since about 1 of 3 children with Crohn's disease will have upper intestinal involvement at the time of initial presentation. Occasionally, the colonoscopy will be negative or show non-specific inflammatory changes, but the upper intestinal tract will have granuloma present, confirming the diagnosis. Type your paragraph here.