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Clinical manifestations of Crohn disease in children and adolescents

Mala Setty, MD
George H Russell, MD, MS
Athos Bousvaros, MD
Section Editors
Kathleen J Motil, MD, PhD
Melvin B Heyman, MD, MPH
Deputy Editor
Alison G Hoppin, MD


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 [1]. 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 [5]:

Abdominal pain – 44 percent

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2016.
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