Crohn's disease in a child is a non-specific inflammatory chronic granulomatous disease of the digestive tract with a predominant location of the affected foci in the small intestine. The main symptoms are diarrhea and abdominal pain. During periods of exacerbation, general inflammatory symptoms are observed - weakness, fever. In children, symptoms of Crohn's disease cause developmental delays and other signs of malabsorption. The formation of fistulas, fistulas, the development of intestinal obstruction is also characteristic. It is clinically diagnosed, confirmed by the results of an instrumental comprehensive examination. The goal of treatment is to achieve and maintain a state of remission.
The manifestation of the disease in children
Crohn's disease is often called terminal ileitis, since it is precisely this arrangement of inflammatory foci that is especially characteristic of this pathology. The frequency of occurrence is not more than 0.1%. Diagnosed mainly in adolescence. In pediatrics, Crohn's disease has a very high relevance, which is associated with the chronic nature of the pathology, and therefore all treatment is palliative. It should be noted that now the reasons for the development of the disease have not yet been clarified, therefore it is impossible to carry out measures for prevention. Life expectancy and quality are significantly reduced; in children, Crohn's disease contributes to disability and mortality statistics.
Classification and causes in pediatrics
At present, the etiology of the disease continues to be investigated. Viruses and bacteria, drugs, features of the functioning and structure of the intestines are of particular importance. Along with a hereditary predisposition, these factors can trigger acute intestinal inflammation with the development in the submucosal layer of granulomas characteristic of this disease in adults and children.
The causes of Crohn's disease should be determined by the doctor.
Patients have an imbalance in cytokine regulation, in which pro-inflammatory cytokines predominate. The permeability of the intestinal wall is increased, which contributes to a significant increase in the antigenic load on the human body.
In a child, Crohn's disease can affect all digestive departments. By location, terminal ileitis, which is especially common, ileocolitis, colitis, damage to the upper gastrointestinal tract, anorectal zone, is distinguished. Mixed forms may also be. Inflammatory-infiltrative, stricture-forming and fistulo-forming forms are anatomically distinguished. The clinic of the first variety is characterized by stool disorders, signs of malabsorption, fever, associated with this decrease in body weight and developmental delay. In the second case, in children, Crohn's disease is manifested by signs of intestinal obstruction and a condition close to it, provoked by stenosis of the intestinal lumen. In the third case, pathological manifestations are due to the formation of fistulas.
Symptoms of pathology
Crohn's disease in a child is characterized by a wavy course with alternating remission and exacerbation. Most often, the pathology is low-symptom, periods of an absolute absence of clinical manifestations are less common. There are typical extraintestinal and intestinal symptoms of Crohn's disease in children. The most common signs of gastrointestinal tract, which are found in almost all patients, are abdominal pain and diarrhea. Cramping pains, as a rule, their intensity is negligible. If the inflammatory foci are localized in the esophagus and stomach, there is a feeling of heaviness, vomiting, and nausea. As the pathology progresses in children, it is possible to attach to the pain of bloating. Tenesmus is rare.
Diarrhea
Also one of the main symptoms is diarrhea. A disease can begin with just stool changes. Different frequency of emptying, there is a connection with the localization of granulomatous foci - the higher the defeat of the gastrointestinal tract, the more pronounced diarrhea. In the stool, there is rarely a small amount of blood (usually during an exacerbation with the formation of crack-ulcers). Prolonged diarrhea in Crohn's disease is accompanied in children by signs of malabsorption. The child has a deficiency of fat-soluble vitamins, iron, calcium and other micronutrients. Because of this, physical development lags behind. Inflammation manifests itself as general weakness, fever, weight loss. The most common manifestations of the extraintestinal type are aphthous stomatitis, arthralgia, iridocyclitis, erythema nodosum, sacroileitis, etc.
Diagnosis of Crohn's disease in children
Individual symptoms of the disease are characteristic of a large number of intestinal pathologies. In children, Crohn's disease, in addition, is rare, and in combination with nonspecific symptoms, difficulties in diagnosing pathology appear. Clinically, a doctor may suspect Crohn's disease by the presence of pain and diarrhea, for which there are no other explanations. The diagnosis may also indicate a developmental delay, the presence of intestinal inflammatory pathologies in relatives, weight loss. To exclude other nosologies, a set of instrumental survey methods is performed.
Survey radiography of the abdominal organs is performed with double contrast. Due to this, the intestinal lumen, the structure and width of the organ are evaluated. For example, it often turns out to visualize the inflamed areas like “cobblestone pavement”. Such a pattern is observed only with this disease and is provoked by a large number of intersecting cracks in the intestinal wall. In children, Crohn's disease often appears in the form of internal and external fistulas, which is also detected radiologically or during examination if a fistula opens on the skin. Often, with the disease, there is a perianal arrangement of fistulas and other violations of this area: pararectal infiltrates, ulcers, fissures.
Irrigoscopy
Irrigoscopy is carried out. To exclude diseases of the large intestine, sigmoidoscopy is performed with a biopsy. Even if there are no granulomas, inflammatory signs characteristic of pathology in children are often detected histologically. Both colonoscopy and sigmoidoscopy make it possible to visualize the intestinal mucosa, which may be in the period of infiltration in the form of a “quilt” and “cobblestone pavement” at the stage of ulcer-cracks.
Separate areas of irreversible stenosis and erosion are noted. General blood tests show an acceleration of ESR and other inflammatory signs. A fecal analysis is required to determine other causes of diarrhea.
The following is a treatment protocol for Crohn's disease in children.
Key clinical guidelines
Adolescents and children with a dominance in the clinical picture of puberty and growth retardation (excluding familial forms) should initially perform a contrast radiography of the large and small intestines. The traditional radiographic symptoms of Crohn's disease are: intermittent type of lesion, the small intestine is involved in the process; bowel obstruction and fistula; the presence of nodularity and ulceration of the mucosa, as well as stricture in the area of ​​the cecum and ileum.
What are the clinical recommendations for Crohn's disease in children?
Children with diarrhea and the presence of blood in the stool with marked laboratory changes (excluding infectious causes) are recommended first of all to conduct a biopsy with a colonoscopy. When carrying out a colonoscopy, an endoscopist should try to examine the terminal ileum, and take biopsy samples from him and from all parts of the large intestine.
For Crohn’s disease, the following endoscopic symptoms are characteristic: intermittent type of finely knotted lesion (in the form of a “cobblestone bridge”) of the mucous membrane with the presence of its unchanged sections, a linear type of ulceration, small aphthous ulcers, a relative decrease in the level of the inflammatory process towards the rectum, narrowing and ulceration ileocecal valves, strictures and intestinal fistulas. Histological findings that distinguish between chronic and acute colitis include basal lymphoplasmacytosis, defects in the architecture of crypts. Typical histological symptoms are noncaseating granulomas that are not adjacent to destroyed crypts, lymphoid transmural aggregates.
In Crohn's disease in children, clinical guidelines should be strictly followed.
Therapy, prevention and prognosis in children
Therapeutic manipulations are aimed at achieving and maintaining remission. A special diet is prescribed. It is aimed at enhancing the digestibility of nutrients for the proper physical development of the patient. Special high molecular weight mixtures are prescribed. The main type of medication in the medical treatment of Crohn's disease in pediatrics is aminosalicylates. Anti-inflammatory treatment is carried out with the use of corticosteroids, including drugs of local functioning in the small intestine.
The use of biological agents, including TNFα inhibitors, is becoming a relatively new way.
For children in the treatment of Crohn's disease, cytostatics are sometimes used. If there are bowel complications, antibiotics are prescribed. Surgical intervention is mandatory for the development of fistulas, intestinal abscesses and obstruction. The indication for surgery is also the lack of effectiveness of conservative methods. Resection of the intestinal lobe is carried out only in extreme cases, carried out as carefully as possible. This often holds back remission, but the inflammation process in any case reappears in another section of the gastrointestinal tract. In the period after surgery, they undergo course therapy with antibiotics and corticosteroids.
Symptoms and treatment of Crohn's disease in children are interrelated.
In children, the prevention of the disease is based on a balanced diet in accordance with the patient’s age, prevention and treatment of inflammatory bowel infections, parasitic and other digestive pathologies. The prognosis and consequences for the life of the child are determined by the severity of the course and the existing complications. There may be prolonged remissions, but you need to be aware that Crohn's disease is chronic in children, so she has a poor prognosis for recovery. Parents need to be consulted, they are informed on all possible methods to improve the quality of life and alleviate the symptoms of the child.
How are Crohn’s disease and UC associated in children?
Nonspecific ulcerative colitis and its differences
In children, ulcerative colitis is a chronic inflammatory bowel disease of unknown origin, which characterizes ulcerative-destructive changes in the mucous membrane of the colon.
Two forms of inflammatory bowel disease - ulcerative colitis and Crohn's disease - seem very similar at first glance. But they have a number of properties that make it possible to distinguish them from each other.
The main difference between these pathologies is the site of inflammation and the nature of the lesion. Crohn's disease can affect any part of the gastrointestinal tract: from the oral cavity to the anus, however, most of the disorders originate in the terminal region of the ileum. Conversely, ulcerative colitis is limited only to colon damage. It is microscopically limited to inflammation of the colon mucosa, and Crohn’s disease affects the entire intestinal wall.
Due to the similar clinical picture, Crohn's disease and ulcerative colitis are included in the number of inflammatory intestinal diseases. Diagnosis is difficult due to the partial coincidence of signs with symptoms of other pathologies, in particular, chronic enteritis, dysentery, salmonellosis, systemic lupus erythematosus and non-ulcer colitis.
Ulce, or ulcerative colitis, is a common disease and is observed almost worldwide. Its frequency is also very high in children, moreover, in recent years there has been a “rejuvenation” of the pathology.
Reviews of Crohn's disease in children
Reviews of real people allow us to conclude about the features of Crohn's disease. People say that both UC and Crohn's disease are incurable and unpleasant pathologies, but with proper therapy and diet you can achieve a long, stable remission. It is recommended that you find a competent proctologist.
The diagnosis of Crohn’s disease is often observed from birth; it is difficult to diagnose it due to its similarity with other diseases. At the same time, antibiotics help temporarily. The Remicade drug, which is administered to a child, copes well. It is quite expensive, but the patient’s life is really changing for the better.
Sometimes a diagnosis is made in adolescence, for example, after acute sudden pain. After surgery, the patient lives a normal life, at first he adheres to a diet.
Parents also note that children can live as they are used to, but they need to monitor their nutrition more.