Inflammatory bowel disease can strike during puberty

Q: My neighbor's 14-year-old daughter was recently diagnosed with inflammatory bowel disease. Isn't she kind of young to develop this problem? What causes it?

A: Unfortunately, inflammatory bowel disease (IBD) is not at all uncommon among adolescents. In fact, many diseases that we think of as occurring in adults first manifest themselves during puberty. The reasons for this are unclear, but the association has fascinated medical researchers for decades.

There are two major types of inflammatory bowel disease: ulcerative colitis, which mainly affects the large intestine, and regional enteritis (also known as Crohn's disease), which can affect any portion of the intestinal tract from the mouth to the rectum. Both can produce symptoms such as weight loss, loss of appetite, abdominal cramps and bloody diarrhea. These symptoms can be very mild or very severe. Both diseases can involve organ systems other than the intestines.

Despite intensive research, the cause of IBD remains uncertain. Scientists are not sure whether they are dealing with only one or two diseases or with many diseases that share similar symptoms. Suggested causes include genetics (the disease can occur in families and is more common among certain groups of individuals), some kind of infection, diet and an altered immune system. It may be a combination of factors which result in the disease.

Even though the cause of inflammatory bowel disease is unclear, significant progress has been made in treating it with a number ** of different medications. Occasionally a special diet or surgery is required for difficult-to-manage cases.

Dr. Wilson is director of pediatric primary care of the Johns

Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.