Pediatric Crohns Disease
Crohn's disease is chronic inflammatory disease of the bowel and has only recently been recognized as a significant disease in children and adolescents. It’s a form of inflammatory bowel disease (IBD).
In a child with Crohn's disease, the immune system attacks healthy tissue in the digestive tract. The tissue becomes swollen and inflamed, causing the intestine walls to thicken.
The digestive system goes from the mouth to the anus, and Crohn's disease can affect any part of it, including the mouth, esophagus (the tube connecting the mouth and stomach), stomach, and rectum, as well as both the small intestine and large intestine. Crohn's disease most frequently occurs at the end of the small intestine and the beginning of the large intestine.
Children and young adults are most commonly diagnosed with Crohn's disease between the ages of 15 and 25; however, it can occur at any age.
Genetics, environmental factors and risk factors – like a parent smoking – can all have a role in the diagnosis of Crohn's disease. However, the exact cause of Crohn's disease remains unproven but it is understood to be a disorder of the immune system. Viral or bacterial agents are suspected as being the triggers behind the response.
Symptoms of Chron's disease include:
- Cramping or pain in the abdomen
- Lack of appetite
- Needing to pass stool even when bowels are empty
- Watery or bloody diarrhea
- Weight loss
Symptoms during a flare-up may include:
- Bloody stools
- Eye swelling
- Fistula (an abnormal connection between two organs)
- Joint pain
- Joint swelling
- Mouth ulcers
- Nodules (bumps) under the skin that are red and tender
- Rectal bleeding
- Swollen gums
Testing and Diagnosis
- Complete blood count
- Stool studies
- X-ray: A single-contrast upper GI radiologic series
- Magnetic resonance enterography (MRE), MRI, abdominal ultrasonography
- Endoscopy, including a colonoscopy with biopsy, upper endoscopy, or esophagogastroduodenoscopy (EGD) and video capsule endoscopy
Medical treatment aims to control the inflammatory progress of the disease, while minimizing any potential side effects caused by medications. Goals are to allow normal physical development and to provide as near a normal lifestyle as possible for the patient.
- Antibiotic therapy
- Corticosteroid therapy or immunomodulatory therapy if the disease persists
Patients might require surgery if they fail to respond to medical treatment or do not thrive.
Complications, such as abscesses, obstructions, hemorrhages or perforations of the bowel or intestine also require surgical treatment or repair. Surgery is effective, but not curative, and flare ups of the disease will likely recur.
Laparascopic surgery can be performed in many cases, with more minimally invasive procedures being performed every year.