Mimickers and concurrent disease in pediatric IBD

Irritable bowel disease (IBD) is a highly common diagnosis for pediatric gastroenterologists, but it can be described by one specialist as having “very nonspecific features.”

in an interview with hcplive During the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2023 annual meeting in San Diego this week, session presenter Riha Bhatt, MD, assistant professor of pediatrics, pediatric gastroenterology, hepatology and nutrition at Vanderbilt University Medical Center, Discussed. Barriers to pediatric IBD diagnosis—and some key features that physicians should consider.

“A lot of (diagnoses) are made on symptoms — especially growth failure in children, sometimes arthritis and additional GI manifestations like mouth sores — and radiographically, you’ll definitely see inflammation on biopsy,” Bhatt said. ” “We’ll see long-term changes, and sometimes in Crohn’s disease you might see granulomas — but you can see a lot of those symptoms in other diseases.”

Bhatt stressed the importance of keeping an eye out for “mimickers” of IBD, which can be distinguished by biopsy-based pathology and the patient’s clinical history. Adversely, pediatric IBD may be fraught with any number of concurrent diseases; Clinicians looking to eliminate the diagnosis should perhaps consider co-conspirators instead.

“One thing I would note in my point is that sometimes we have to part with Occam’s razor – it’s not the simplest answer, but instead we have to go with Hickam’s statement where Dr. (John ) Hickam said, ‘A patient can have this please cure multiple diseases,'” Bhatt said. “So, we have to keep an open mind about it, especially when our IBD patients don’t respond that way. Have been doing as we think they should.”

Bhatt highlighted 3 common concurrent diseases that his colleagues should be aware of in pediatric IBD cases:

celiac disease

“If you have an IBD patient who has new symptoms, or a new type of rash and they’re not responding to their medications, you’re wondering, ‘Hey, have we checked celiac serology here recently? ‘” Bhatt explained.

Meckel’s diverticulum

“You know, interestingly, there have been some small studies that have shown that in Crohn’s patients, the risk of Meckel’s diverticulum may be increased 2-3 (fold),” Bhatt said. “If you have an IBD patient who is having new-on-painless bleeding, and his hemoglobin is dropping, that’s something to keep our eye on.”


“Remember that many of our IBD patients are immunocompromised because we have given them medications to suppress their immune system, so they may be at risk for certain infections,” Bhatt said. “Histoplasmosis is one that, you know, we just think about in the Ohio River Valley, but CDC information is showing that it’s actually moving westward, it’s moving southward. So it’s something we want to think about in our IBD population.”

Leave a Comment

“The Untold Story: Yung Miami’s Response to Jimmy Butler’s Advances During an NBA Playoff Game” “Unveiling the Secrets: 15 Astonishing Facts About the PGA Championship”