Preface

In the United States, an estimated 250,000 children and young adults suffer from inflammatory bowel disease—a number that has steadily risen over the past few decades. Some of these patients have been cured by surgery, but the vast majority are only palliated and in the worse of circumstances are forced to endure chronic debilitating symptoms. The good news is that there has been significant progress in our understanding and management of this disease.

In this edition of Seminars in Pediatric Surgery, our goal is to review the progress in basic and applied research as well as medical and surgical practice that has been made since this topic was last presented in this journal 14 years ago (Volume 3, Number 1, February 1994).

In this edition, Dr. Claudio Fiocchi, Professor of Medicine at the Cleveland Clinic Lerner College of Medicine and physician in the Department of Patholbiology and Department of Gastroenterology and Hepatology at the Cleveland Clinic, and Dr. Subra Kugathasan, Associate Professor of Pediatrics in the Department of Pediatrics at the Medical College of Wisconsin, who are coinvestigators of the National Pediatric IBD Study Project, discuss progress in basic research including exciting new work in molecular genetics and adaptive immunity.

Dr. Terry Gramlich, Director of Hepatopathology, and Dr. Robert Petras, National Director for Gastrointestinal Pathology Services at AmeriPath Inc., discuss the pathology of Inflammatory Bowel Disease, including the sometimes difficult distinction between Mucosal Ulcerative Colitis and Crohn’s colitis as well as the relatively new entity called Indeterminate Colitis.

Dr. Jeffrey Hyams, Head of the Division of Digestive Disease and Nutrition at The Connecticut Children’s Medical Center and a leading authority in the diagnosis and medical treatment of Inflammatory Bowel Disease, with his colleague, Dr. Ryan Carvalho, discuss the value of the new serologic biomarkers that may be used to distinguish Ulcerative Colitis from Crohn’s disease as well as the indications and precautions for the use of video-capsule endoscopy, CT, and MRI, which are being used more frequently as a diagnostic tool. They also describe novel treatment modalities including the newer biologic agents and probiotic therapy.

The surgical treatment of Crohn’s disease is subdivided into three separate topics. First, Dr. Stephen Dolgin, Chairman of Pediatric Surgery at the Schneider Children’s Hospital and Clinical Professor of Surgery at Mt. Sinai Medical School, discusses upper GI and small bowel Crohn’s disease. Next, Dr. Christopher Moir, Chair of Pediatric Surgery at the Mayo Clinic, discusses Crohn’s Colitis. Finally, Dr. Scott Strong, a colorectal surgeon and basic research scientist in IBD at the Cleveland Clinic, discusses the management of perianal Crohn’s Disease. All three surgeons have a wealth of experience in the field and discuss principles of conservative therapy as well as old and new techniques in the surgeons’ armamentarium, including strictureplasty, ileorectal anastomosis, and anorectal advancement flaps for recalcitrant fistulae.

Dr. Craig Lillehei discusses the indications, technical considerations, and expected functional outcome of the ileopouch anal anastomosis for Ulcerative Colitis. Dr. Lillehei is a pediatric surgeon at Boston Children’s Hospital who is well known for his many publications in the field. Dr. Lillehei’s article is followed by a cautionary tale in which I discuss the management of pouchitis, pouch failure, and related complications of ileal pouch anal anastomosis.

Finally, Dr. Mark Kayton, a pediatric surgeon at the Memorial Sloan-Kettering Cancer Center, provides an extensive discussion concerning the risks of cancer in children and adults with Inflammatory Bowel Disease.

The foregoing collection of articles presents one of the most detailed and up-to-date descriptions of the current state-of-the-art and should prove to be a valuable resource for pediatric gastroenterologists and pediatric surgeons alike. I would like to thank all of the contributors who did a tremendous job in bringing this edition to fruition and also to Dr. Jay Grosfeld for giving us the opportunity to present our work and the work of others who share a common interest in this field.