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, the symptoms of Crohn's disease cause developmental delays and other signs of malabsorption. Also characteristic is the formation of fistulas, fistulas, the development of intestinal obstruction. Clinically diagnosed, confirmed by the results of an instrumental comprehensive examination. The goal of treatment is to achieve and maintain a state of remission.
Manifestation of illness in children
Crohn's disease is often called terminal ileitis, since it is this arrangement of inflammatory foci that is especially characteristic of this pathology. The frequency of occurrence is not more than 0.1%. It is diagnosed mainly in adolescence. In pediatrics, Crohn's diseasehas a very high relevance, which is associated with the chronic nature of the pathology, and therefore all ongoing treatment is palliative. It should be noted that now the causes of the development of the disease have not yet been clarified, therefore it is impossible to carry out measures for prevention. Life expectancy and its quality are significantly reduced, in children Crohn's disease contributes to the statistics of disability and mortality.
Classification and causes in pediatrics
Currently, the etiology of the disease continues to be investigated. Viruses and bacteria, medicines, features of the functioning and structure of the intestine are of some importance. Simultaneously with hereditary predisposition, these factors can trigger acute intestinal inflammation with the development of granulomas in the submucosal layer, which are characteristic of this disease in adults and children.
Causes of Crohn's disease should be determined by a doctor.
Patients show an imbalance in cytokine regulation, which is dominated by pro-inflammatory cytokines. 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 is distinguished, which is especially common, ileocolitis, colitis, lesions of the upper gastrointestinal tract, anorectal zone. There may also be mixed forms. Anatomically, inflammatory-infiltrative, stricture-forming and fistula-formingforms. The clinic of the first variety is characterized by stool disorders, signs of malabsorption, fever, associated weight loss and developmental delay. In the second case, Crohn's disease in children 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 an undulating course with alternating remission and exacerbation. Most often, the pathology is oligosymptomatic, periods of absolute absence of clinical manifestations are less common. There are typical extraintestinal and intestinal symptoms of Crohn's disease in children. The most common gastrointestinal symptoms, which occur in almost all patients, are abdominal pain and diarrhea. The pains are cramping, as a rule, their intensity is insignificant. 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, abdominal distention may be added to the pain. Tenesmus is rare.
Diarrhea
Also one of the main symptoms is diarrhea. The disease can begin just with changes in the stool. Different frequency of emptying, there is a connection with the localization of granulomatous foci - the higher the lesion of the gastrointestinal tract, the more pronounced diarrhea. There is rarely a small amount of blood in the stool (usually during an exacerbation with the formation of cracked ulcers). Chronic diarrhea in Crohn's diseaseaccompanied by signs of malabsorption in children. The child has a lack of fat-soluble vitamins, iron, calcium and other micronutrients. Because of this, physical development lags behind. Inflammation is manifested by general weakness, fever, weight loss. The most common manifestations of the extraintestinal type are aphthous stomatitis, arthralgia, iridocyclitis, erythema nodosum, sacroiliitis, etc.
Diagnosis of Crohn's disease in children
Some 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 the 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 be indicated by developmental delay, the presence of intestinal inflammatory pathologies in relatives, and weight loss. To exclude other nosologies, a set of instrumental examination methods is carried out.
Plain 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 is often possible to visualize inflamed areas like a "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 radiographically or duringtime of examination if a fistula opens on the skin. Often with the disease, there is a perianal location of fistulas and other disorders of this area: pararectal infiltrates, ulcers, cracks.
Irrigoscopy
Irrigoscopy is being carried out. To exclude diseases of the large intestine, sigmoidoscopy with biopsy is performed. 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 can be in the period of infiltration in the form of a "quilt" and "cobblestone pavement" at the stage of ulcers-cracks.
There are separate areas of irreversible stenosis and erosion. General blood tests show an acceleration of ESR and other inflammatory signs. A stool test is required to determine other causes of diarrhea.
Below is the treatment protocol for Crohn's disease in children.
Key clinical guidelines
Adolescents and children with a predominance of puberty and growth retardation in the clinical picture (excluding familial forms) should initially be given a contrast radiography of the large and small intestines. The traditional radiographic symptoms of Crohn's disease are: an 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 blind and ileum.
What are the clinical guidelines for Crohn's disease in children?
Children with diarrhea andin the blood stool with pronounced laboratory changes (excluding infectious causes), it is recommended first of all to conduct a biopsy with colonoscopy. When performing a colonoscopy, the endoscopist should try to examine the terminal ileum, take biopsies both from it and from all parts of the large intestine.
Crohn's disease is characterized by the following endoscopic symptoms: an intermittent type of small-nodular lesion (in the form of a "cobblestone pavement") 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 straight bowel, narrowing and ulceration of the ileocecal valves, strictures and intestinal fistulas. Histological findings that distinguish chronic from acute colitis include basal lymphoplasmocytosis and crypt architectural defects. Typical histological findings are non-caseating granulomas that are not adjacent to collapsed crypts, lymphoid transmural aggregates.
Clinical guidelines should be strictly followed for children with Crohn's disease.
Therapy, prevention and prognosis in children
Therapeutic manipulations are aimed at achieving and maintaining remission. A special diet is prescribed. It aims to enhance the absorption of nutrients for the correct physical development of the patient. Special high-molecular mixtures are prescribed. The main type of drugs in the drug therapy of Crohn's disease in pediatrics areaminosalicylates. Anti-inflammatory treatment with corticosteroids, including topical drugs in the small intestine.
Relatively new is the use of biological agents, including TNFα inhibitors.
Cytostatic drugs are sometimes used in the treatment of Crohn's disease for children. If there are bowel complications, antibiotics are prescribed. Surgical intervention is mandatory in the development of fistulas, intestinal abscesses and obstruction. The indication for the operation is also the lack of effectiveness of conservative methods. Resection of the intestinal lobe is carried out only in extreme cases, it is carried out as carefully as possible. This often keeps remission, but the process of inflammation in any case appears again in another part of the gastrointestinal tract. In the period after the operation, they undergo course therapy with antibiotics and corticosteroids.
Symptoms and treatment of Crohn's disease in children are interrelated.
In children, disease prevention is based on rational nutrition in accordance with the age of the patient, prevention and treatment of inflammatory bowel infections, parasitic and other digestive pathologies in time. 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 long remissions, but one must be aware that in children, Crohn's disease is chronic, so it 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 relatedCrohn's disease and UC in children?
Ulcerative colitis and its differences
In children, ulcerative colitis is a chronic inflammatory bowel disease of unknown origin that characterizes ulcerative-destructive changes in the colonic mucosa.
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 allow them to be distinguished from each other.
The main difference between these pathologies is the location of the 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, but most disorders originate in the terminal ileum. Conversely, ulcerative colitis is limited to only affecting the colon. It is microscopically limited to inflammation of the colonic mucosa, while Crohn's disease affects the entire intestinal wall.
Because of their similar clinical presentation, Crohn's disease and ulcerative colitis are included among inflammatory bowel diseases. Diagnosis is difficult due to the overlap of signs with symptoms of other pathologies, in particular, chronic enteritis, dysentery, salmonellosis, systemic lupus erythematosus and non-ulcerative colitis.
UC, or non-specific ulcerative colitis, is a common disease and occurs almost all over the world. Its frequency is also very high in children, moreover, recently there has been a "rejuvenation"pathology.
Reviews on Crohn's disease in children
Reviews of real people allow us to draw a conclusion 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, a long-term stable remission can be achieved. Finding a competent proctologist is recommended.
Diagnosis Crohn's disease is often present at birth and is difficult to diagnose due to its similarity to other diseases. In this case, antibiotics help temporarily. The Remicade drug, which is dripped to the child, is doing well. It is quite expensive, but the patient's life really changes for the better.
Sometimes the diagnosis is made during adolescence, for example, after acute, sudden pain. After the operation, 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 you need to monitor their nutrition more.
