About 30% of individuals with inflammatory bowel disease present before the age of 21 years (1). Despite this prevalence, most therapeutic agents are tested in adults with inflammatory bowel disease and pharmacokinetics, safety, and efficacy may never be studied in children and adolescents. In this review, data from the pediatric population will be reported when available, and data from studies obtained in adults will be used when appropriate.
The goals of therapy for the child and adolescent with Crohn's disease or ulcerative colitis are to control mucosal inflammation and to prevent delays in growth and sexual maturation. These objectives are met by pharmacological therapy, nutritional intervention, psychological support, and surgery. Mucosal inflammation can be modulated by pharmacological and nutritional therapy or ultimately by resection of involved areas of the bowel. Delays in growth and sexual maturation are best managed by meeting caloric and nutritional requirements as well as providing psychosocial support.
PHARMACOLOGIC APPROACHES TO MUCOSAL INFLAMMATION Pharmacological Therapy in Ulcerative Colitis
In ulcerative colitis, mucosal inflammation is limited to the colon. Although some individuals may have mild ileal inflammation, commonly called "backwash ileitis," therapy is directed toward control of the areas of the colon that are inflamed. Clinical manifestations (Table ) frequently correlate with the degree of mucosal