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Diagnosing Ulcerative Colitis in Children

At Hassenfeld Children’s Hospital at NYU Langone, doctors in the Pediatric Gastroenterology Program diagnose ulcerative colitis in children. In this form of inflammatory bowel disease, or IBD, the lining of the colon, or large intestine, becomes chronically inflamed. This condition can occur in any part of the colon.

Signs and symptoms include bloody stools, abdominal pain, ulcers in the colon, diarrhea, and weight loss. Without treatment, symptoms can worsen over time. Children with ulcerative colitis often experience flare-ups between periods of remission, which is an absence of symptoms.

The causes of ulcerative colitis in children aren’t fully understood, but genetics, environment, and an autoimmune response are all thought to play a role.

Ulcerative colitis is not the same as irritable bowel syndrome, or IBS. In IBS, a collection of symptoms occurs together. These may include abdominal cramping, constipation, and diarrhea. Unlike with inflammatory bowel disease, IBS does not lead to inflammation that damages the gastrointestinal tract.

Another form of IBD is Crohn’s disease, which mainly affects the small intestine and colon but can affect any part of the gastrointestinal tract. The symptoms of these two types of IBD can be similar. For this reason, our doctors perform a physical exam and extensive testing when diagnosing ulcerative colitis in children.

Medical History

Your child’s doctor asks about the symptoms your child has been experiencing as well as the frequency and severity of these symptoms. The doctor may ask about the foods your child eats and whether your child’s diet has changed recently.

Physical Exam

Doctors conduct a physical exam to determine if your child is showing signs and symptoms of ulcerative colitis. Your child’s doctor may check the abdomen, pressing gently to determine if your child feels pain or tenderness. He or she may check for eye inflammation, joint swelling or irritation, skin rashes, and inflammation and bleeding in the anus.

Because children with this condition can experience weight loss and slowed growth, doctors also check your child’s weight and height.

Diagnostic Tests

A variety of tests may then be conducted to assist the doctor in making a diagnosis.

Blood Tests

Your child’s doctor may recommend blood testing to check for elevated levels of white blood cells and platelets, which may indicate inflammation. He or she is also looking for a reduced amount of red blood cells, a sign of anemia, which can occur with this condition.

Liver function tests may be performed, because inflammation caused by ulcerative colitis can affect the liver’s ability to break down nutrients and eliminate waste.

Stool Tests

Because ulcerative colitis can affect bowel movements, your child’s doctor may test the stool for the presence of blood and signs of bacteria that cause infection, such as salmonella. Infection can cause diarrhea and other symptoms similar to those of ulcerative colitis.

For this test, you are given a small plastic container to take home, where you collect a sample of your child’s stool. You then return this sample to the doctor’s office or mail it to a laboratory, where it is analyzed.

Digital Rectal Exam

A digital rectal exam can help the doctor look for signs of ulcerative colitis, such as bleeding, inflammation, pain, or tenderness. In this brief exam, a doctor inserts a gloved finger into the rectum.

Magnetic Resonance Enterography

Magnetic resonance enterography, which is a type of MRI scan, may be used to produce detailed images of the small intestine. This test uses a magnetic field and radio waves to create two- and three-dimensional images.

Before the test, your child drinks a flavored contrast agent or a dye to make the small intestine more visible during the scan.

Magnetic resonance enterography typically takes 45 to 60 minutes.

Upper Endoscopy

An upper endoscopy allows doctors to examine the lining of the esophagus, stomach, and small intestine for inflammation, bleeding, obstructions, and ulcers. It is performed with general anesthesia.

During this test, a doctor inserts a thin, flexible instrument with a camera embedded in its tip—called an endoscope—into the throat and advances it to the esophagus, stomach, and small intestine. The images appear on a monitor. An upper endoscopy usually takes 10 to 20 minutes.

Colonoscopy

At Hassenfeld Children’s Hospital, gastroenterologists usually perform a colonoscopy to diagnose ulcerative colitis. During this test, live images of the colon and rectum are viewed on a monitor to help the doctor to examine the intestinal lining for inflammation and ulcers.

Your child eats no solid food for 24 hours prior to the test. Until four hours before the procedure, he or she may have clear liquids, such as apple juice or broth. Babies under 12 months may have breast milk or baby formula. Your child’s doctor supplies a laxative solution to drink the night before the test to empty the bowels.

During the test, a doctor inserts a colonoscope, a long, thin, flexible instrument with a camera and light embedded in the tip into the anus and slowly moves it through the rectum and colon. The camera sends images of the colon to a nearby computer monitor. The procedure takes about 30 minutes and requires general anesthesia.

The doctor may perform biopsies during this test, removing small tissue samples and sending them to a laboratory for analysis. These results may help doctors differentiate between ulcerative colitis and Crohn’s disease.

Capsule Endoscopy

Your child’s doctor may perform a capsule endoscopy to examine the small intestine. It can help doctors determine whether symptoms are caused by ulcerative colitis or Crohn’s disease.

In this test, a child swallows a capsule, which is the size of a multivitamin. This capsule has a tiny camera inside that takes pictures of the small intestine as it passes through. Radio waves transmit these images to a small receiver that is worn around on a belt around the waist. A doctor downloads the images for review.

If a child cannot swallow the capsule, it is placed in the duodenum located at the top of the small intestine during an upper endoscopy.

The capsule passes through the gastrointestinal tract, leaving the body during a bowel movement. It can be flushed down the toilet.

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