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Clinical manifestations of Crohn's disease in children and adolescents

INTRODUCTION

Crohn's 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 usually is localized, most commonly to the ileum, ileum and cecum, or ileum and entire colon. Gastritis and upper intestinal tract inflammation are present in 30 percent of patients. (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. Approximately 20 to 25 percent of these cases are diagnosed in children younger than age 18 years [1]. 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). (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 Ulcerative Colitis, and the management of CD are discussed separately. (See "Clinical features and diagnosis of inflammatory bowel disease in children and adolescents" and "Overview of the management of Crohn's disease in children and adolescents".)

OVERVIEW

Children with CD may present with intestinal and/or extraintestinal manifestations (table 1). Intestinal manifestations are more common. In one of the largest series of children who were younger than 10 years of age, the most common presenting symptoms were [2]:

  • Abdominal pain (95 percent)
  • Weight loss (80 percent)
  • Diarrhea (77 percent)
  • Hematochezia (60 percent)
  • Growth failure (30 percent)
  • Extraintestinal manifestations (20 percent)

           

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Literature review current through: Apr 2013. | This topic last updated: Jan 16, 2013.
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