Clinical manifestations of Crohn disease in children and adolescents
- Mala Setty, MD
Mala Setty, MD
- Assistant Professor, UCSF Department of Pediatrics;
- Associate Gastroenterologist, UCSF Benioff Children's Hospital Oakland
- George H Russell, MD, MS
George H Russell, MD, MS
- Research staff (Assistant professor)
- Harvard Medical School
- Athos Bousvaros, MD
Athos Bousvaros, MD
- Associate Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
Crohn disease (CD, also known as regional enteritis) is an immune-mediated inflammatory disease that can affect any portion of the intestinal tract from the mouth to the anus. The disease typically involves the ileum, ileum and cecum, or ileum and entire colon. In some cases, the disease is found only in the colon, making it difficult to distinguish from ulcerative colitis (UC). Gastritis and upper intestinal tract inflammation are present in 30 percent of patients and may or may not be related to the underlying inflammatory bowel disease (IBD). (See "Definition, epidemiology, and risk factors in inflammatory bowel disease".)
The incidence of CD is approximately 5 to 10 new cases per 100,000 individuals/year and appears to be rising . Approximately 20 to 25 percent of these cases are diagnosed in children younger than age 18 years [2-4]. Although the exact pathophysiology has not been fully defined, there is both a genetic and environmental component. It is likely that inherited gene mutations may predispose individuals with CD to an inflammatory response directed against intraluminal antigens (including intestinal bacteria, dietary antigens, and environmental antigens such as tobacco smoke). Environmental risk factors under investigation include geographic trends, early exposures (breastfeeding, antibiotics), infections, and diet. (See "Epidemiology and environmental factors in inflammatory bowel disease in children and adolescents" and "Genetic factors in inflammatory bowel disease".)
The clinical manifestations of CD in children and adolescents are reviewed here. The diagnosis of CD, including the differentiation from UC and the management of CD are discussed separately. (See "Clinical presentation and diagnosis of inflammatory bowel disease in children" and "Overview of the management of Crohn disease in children and adolescents".)
Children with CD may present with intestinal and/or extraintestinal manifestations (table 1). Intestinal manifestations are more common. In one of the largest series, which included 891 children ages 6 to 17 years, the most common presenting symptoms were :
●Abdominal pain – 44 percent
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- PRESENTING SYMPTOMS
- INTESTINAL DISEASE
- Disease location and classification
- ORAL AND PERIANAL LESIONS
- Perianal lesions
- Oral lesions
- Isolated orofacial and perianal findings
- ESOPHAGEAL AND GASTRIC DISEASE
- Growth failure
- Micronutrient deficiencies
- EXTRAINTESTINAL MANIFESTATIONS