الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 306 |  |  |
| | | from | 306 | | |
Abstract
Pediatric Inflammatory Bowel Disease (IBD )is one of the most significant chronic disorder in Pediatric Gastroenterology. Recent studies find an increasing frequency both in pediatric and adult populations.
IBD is an immune-mediated disorder resulting in chronic, relapsing inflammation of the gastrointestinal tract. Current theory suggests its origin is likely multi-factorial i.e in genetically predisposed individuals, environmental factors and maladaptive immune responses to gastrointestinal flora generate a dysregulated inflammatory cascade creating mucosal injury.
Chronic inflammatory bowel disease (IBD) typically refers to two major entities, Crohn’s disease (CD) and ulcerative colitis (UC). CD features segmental intestinal involvement, with thickening of the bowel wall consequent to transmural inflammation and fibrosis, resulting in obstructive strictures, especially in the ileo-cecal area. In contrast to CD, UC is classically defined as diffuse chronic mucosal inflammation limited to the colon, which invariably affects the rectum, and extends proximally in a symmetric uninterrupted pattern to involve part or all of the large intestine. However, a subset of patients with IBD involving the colon will have certain “non-classical” features, these patients are known to have indeterminate colitis (IC).
In a patient suspected to have IBD. No single diagnostic method alone allows unequivocal diagnosis, so the ESPGHAN IBD working group defined consensus-based criteria for the diagnosis of IBD in children that involves history taking, physical examination, laboratory investigations, endoscopy with biopsies and radiology.
Generally IBD presents with abdominal pain, diarrhea (sometimes bloody), weight loss, and growth disturbance in addition to extraintestinal manifestations which are more common in CD than in UC.
On conclusion, the multimodality imaging is the cornerstone of investigation in IBD and “in pediatrics” the relapsing nature of the diseases put the children in great risk of radiation and complications of repeated imagings and colonoscopies. Although in suspected IBD patients, diagnosis is reached mainly by ileo-colonoscopy combined with biopsy,the radiology plays a complementary role in visualizing the small intestine(mostly non accessible by endoscopies),detecting the disease extension, activity and complications, extraintestinal diseases and differentiating between inflammatory and fibrotic strictures. But in pathologically proved IBD, recent imaging modalities (especially which do not carry a radiation burden) should replacing endoscopies in the follow up of the disease to evaluate response to therapy, detect relapse and development of complications. This means that US could be used as fist imaging modality for screening and follow up the patients, and the MRI should be the primarycross-sectional imaging modality for evaluation and follow up. CT should be considered only if there are absolute contraindications for an MRI examination (e.g., pacemaker) or in emergent situations (e.g., acute intestinal obstruction).