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Inflammatory Bowel Diseases (IBD) - Crohn's Disease and Ulcerative Colitis


Our focus on IBD:

Crohn’s disease and Ulcerative Colitis are Dr. Kunde’s areas of clinical and research interest and he strives hard to help children with these conditions. It is Dr. Kunde’s goal to achieve remission in every child with IBD in his practice. An internal analysis done at WakeMed Hospitals showed an excellent remission rate for Dr. Kunde’s patients at 87%.

We at Wake Pediatric Gastroenterology offer comprehensive care for children with inflammatory bowel disease. Dr. Kunde and staff work closely with a team of experts in surgery, radiology, pathology, infusion centers, and endoscopy center. We ensure your child gets the very best care available, including access to pediatric infusion services – which is critical in providing care for patients with IBD.

What is IBD:

IBD is a group of lifelong conditions where the gut immune system is hyperactive leading to ongoing inflammation and damage to the gastrointestinal tract. If your child is diagnosed with inflammatory bowel disease, it is either Crohn’s Disease Ulcerative Colitis (or indeterminate colitis when the diagnosis is not well defined). These diseases impact the stomach and small and large intestines, causing pain and discomfort for your child. While the diseases are often diagnosed in adults, studies suggest that up to 30 percent of adult cases can begin in childhood. Nearly 1.5 million Americans have IBD

Understanding Crohn’s Disease and Ulcerative Colitis

While the two diseases are classified as inflammatory bowel disorders, Crohn’s disease can affect any region of the digestive system, while ulcerative colitis is confined to the large intestine (colon). In both diseases, immune cells are dysfunctional and damage the lining of the digestive system. While it is sometimes difficult to distinguish between the two if the inflammation is confined to the large intestines, but if other regions are involved, it is clearly Crohn’s disease.

Children often have more severe symptoms or flare-ups when they are under stress or when exposed to certain environmental conditions. IBD can develop at any age but is most commonly diagnosed in children during early adolescence. The most common symptoms of inflammatory bowel disease in kids include:

  • Abdominal pain or cramping

  • Diarrhea, sometimes with blood

  • Failure to gain weight or grow

  • Fatigue

  • Fever

  • Rectal bleeding

  • Relapsing gastrointestinal illness over several months

  • Weight loss

Symptoms can range from mild to severe, and they come and go. During periods of time when your child has no symptoms, the condition is “in remission.” When symptoms are present, it’s called having “a relapse” or “a flare-up.”

How is Inflammatory Bowel Disease diagnosed?

When inflammatory bowel disease is suspected in children, our pediatric gastroenterologist will order tests that may include:

  • Complete Blood Count (CBC) and other blood tests that can confirm an inflammation in the body and antibodies (proteins) found with IBD

  • Stool tests to look for blood, bacteria, and inflammation

  • Upper endoscopy that looks at the esophagus, stomach, and upper portion of the small intestine

  • The colonoscopy visualizes the lower small intestine, colon, and anus

  • X-rays, ultrasound, CT scan, MRI, or capsule endoscopy (depending on if previous test results are inconclusive)

How is IBD treated?

The treatment options are vast and discussing them here is outside the scope of this educational material. Each patient is different and therefore treatment cannot be standardized. If your child is diagnosed with IBD, rest assured that Dr. Kunde will discuss this in detail and provide all the support you need.

We will create an individualized treatment plan based on his or her diagnosis and the severity of symptoms. We also consider your child’s age and manage symptoms in ways that won’t negatively affect growth and development. Your child’s treatment plan may include:

  • Nutrition or dietary therapy

  • Medications, such as antibiotics, anti-inflammatory medications, immune-suppressing medication, or biologics

  • Surgery to repair or remove parts of the intestine

  • Specialized psychological support to help children and families cope with emotional challenges and manage stress

Children sometimes experience weight loss and stop getting taller. These children are often at higher risk for premature thinning of bones. In these cases, your child’s gastroenterologist may recommend intense nutritional therapy, additional calcium and vitamin D supplements, and in extreme cases, IV therapy.

Living with IBD:

Since IBD is a lifelong condition, many children and parents are upset at the diagnosis and acceptance is difficult. It’s important to remember that these diseases can be controlled by working with your pediatric gastroenterologist who will recommend the best treatments based on the severity and status of the disease. Since these conditions are worse during flare-ups, education, along with following a healthy diet and taking medication to control symptoms and prevent distress, are all important.

Learning how to live and thrive with IBD takes a commitment from the entire family. At first, it can be overwhelming, so having a strong support system is critical to help everyone cope with the disease. We can offer nutritional and counseling support to children and families living with Crohn’s disease or ulcerative colitis.


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