Cases of IBD rising in young Canadian kids: What you need to know

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• Cases of IBD are rising in Canada, especially in kids under the age of six.

• Experts don’t know why cases are rising, but recognition of IBD in children and environmental factors could be at play.

• Symptoms of IBD in children include: bloody stool or diarrhea, abdominal pain, weight loss, fatigue, delayed growth, fissures or bleeding.

• Expert advice to parents: Don't panic, but stay informed and seek medical advice if needed.

A report released earlier this month found the highest rising demographic of patients being diagnosed with inflammatory bowel disease (IBD) in Canada are children under the age of six.

Crohn’s and Colitis Canada's June 1 report outlined rates of IBD in children are rising slightly, especially in Ontario and Quebec. But across the country, children under six made up the highest-rising group.

Dr. Eric Benchimol, a pediatric gastroenterologist at the SickKids Inflammatory Bowel Disease Centre in Toronto, was the chair of the research committee.

Benchimol told Yahoo Canada he wasn't "particularly surprised to find that in our research, because we're seeing that in our clinic."

Benchimol said when he trained 15 years ago, it was nearly unheard of to see toddlers in his clinic. Meanwhile, he had two young patients on Monday alone.

"It's a regular thing now that we're seeing it in young young kids," he said.

However, there are many things we do know about IBD and getting diagnosed. Read on to learn more.

What is IBD?

Benchimol said it's important to distinguish between IBS and IBD, the latter being more severe.

"Sometimes people mix those up — it's not the irritable bowel syndrome, it's inflammatory bowel disease," Benchimol said, adding it’s an immune-mediated disease.

The immune system usually causes inflammation to fight off infections or illnesses like cancer. But in those with IBD, the immune system has "gone out of control” and is causing inflammation even when there’s no illness to fight off, Benchimol explained.

This causes damage to the bowel.

"You get a hyper-inflammation in the bowel, which causes ulcers and bleeding and pain."

There are two types of IBD that affect different parts of the bowel: Crohn’s disease and ulcerative colitis.

According to Crohn’s and Colitis Canada, here’s the difference:

Ulcerative colitis is localized in the colon, including the rectum and anus, and only invades the inner lining of bowel tissue. It always starts at the rectum, extending upwards through the colon.

Crohn’s disease strikes in the gastrointestinal tract, anywhere from mouth to anus, but usually in the lower part of the small bowel and upper colon. With this disease, patches of inflammation are spread out and can invade both inner and outer lining of the intestine.

Some people are also diagnosed with indeterminate colitis, when it is unclear whether the patient has Crohn’s or ulcerative colitis.

Benchimol said inflammation from IBD can spread to different parts of the body, causing inflammation of joints, skin and liver among others.

"It's a chronic disease, there's really no cure for it," he claimed.

What causes IBD and how is it diagnosed?

According to Benchimol, there are more than 200 genes that have been identified as increasing your risk of IBD. However, they increase it by a tiny amount.

"What we think is going on is in somebody who might be genetically at risk, they're exposed to some environmental factors (risk factors), which then probably change the gut microbiome — the balance of good and bad bacteria in the gut," he explained, "which then later in life, triggers an immune system response."

Benchimol said most people who have that gene will either get IBD later in life or not at all, depending on environmental exposures.

Symptoms are more easily detectable with ulcerative colitis, including: blood in your poop; and often in kids: bloody diarrhea.

"It's usually diagnosed pretty quickly. Once you rule out infection, which is the most common cause of bloody diarrhea, you then get a colonoscopy, and that makes a diagnosis," Benchimol said.

With Crohn’s, however, it’s not always obvious.

"You might get some belly aches, you may lose weight for no reason, you may have fevers for no reason, you may have decreased appetite, and often it can be missed," the doctor said. He added it's diagnosed based on colonoscopy, ultrasound MRI and bloodwork.

Why are IBD rates in Canadian children rising?

Benchimol explained though there isn't a definite answer, a part of the increase is likely higher recognition of cases; people are more aware of IBD in kids now, so kids are more likely to get diagnosed earlier. But, that's not all.

"I think there's something going on in our environment, which is bringing the age of onset lower, that we're seeing more of it in these very young children," he claimed.

Living in a Western culture, he said, is believed to increase the risk of IBD. These factors could include:

• Western diet (high in animal fats, less fish oils)

• Early-life use of antibiotics

• Potentially lack of vitamin D (sunlight)

Living in a city can also increase chances of IBD, especially in northern areas, he said, like in Canada.

"What all of those things have in common is that those things change your gut microbiome," Benchimol explained. "Your gut microbiome is very hard to change permanently after the age of about five."

What does life with IBD look like for kids?

According to Benchimol, the first six months after diagnosis is typically a "rough go" for patients and parents, as specialists work to find appropriate medicines and treatment.

But, those who go into remission after a round of treatment will "live completely healthy, normal lives," he said.

"They'll go through school and play whatever sports they want to play, go to university... or embark on whatever career they want to take — that's the majority of patients."

However, about 10 to 15 per cent of patients do struggle long-term.

"That means frequent hospital admissions, visits to the doctor, a lot of infusions with medications, and then even potentially surgery because of complications like bowel obstructions."

One aspect Benchimol often advocates for is interdisciplinary solutions for treating youth with IBD, as the chronic disease can impact mental health.

"It means medicine lifelong, it means being worried about having pain or having a flare-up, or needing to find a washroom, and that can cause a lot of stress on both the child and the family," the doctor said.

He added children and teens with IBD have double the rate of anxiety and depression compared to their peers without IBD.

In addition, transitioning from pediatric care to adult care for IBD can also be a challenge, the doctor highlighted. "We've even described that after transfer, they have a lot more emergency room visits than they did before transfer. And that's probably because they don't know how to access the resources they need in order to keep their disease in remission."

Expert's advice to parents

For parents who may be concerned about the latest data, Benchimol has a message: "Don't panic."

He said tummy pain is very common in young children, even up to 25 per cent of them have abdominal pain, that's not IBD.

"If you're worried that your child might have something like this, or if there's more red flags, like they're not growing well, they're not gaining weight well, or they've got blood in their poop, see your doctor," Benchimol advised.

"They can do some tests to see whether this might be IBD or they can refer to a pediatric gastroenterologist to get checked out."

As for preventative measures, the researcher said there aren't any as of now, but work is being done.

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