Related Experiment Videos
Inflammatory bowel disease in children--clinical, endoscopic, radiologic and histopathologic investigation
1Department of Pediatrics, Seoul National University College of Medicine, Korea.
Insights
This study reviews 22 pediatric inflammatory bowel disease (IBD) cases, highlighting diagnostic delays and distinct clinical features of Crohn's disease and ulcerative colitis in children. Early diagnosis and tailored treatment are crucial for managing pediatric IBD effectively.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Clinical Case Review
Background:
- Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC), chronic inflammatory conditions affecting the gastrointestinal tract.
- Pediatric IBD presents unique diagnostic and management challenges compared to adult populations.
- Timely diagnosis is critical to prevent disease progression and long-term complications in children.
Purpose of the Study:
- To review a five-year clinical experience with pediatric inflammatory bowel disease (IBD) patients.
- To analyze the diagnostic delays, clinical presentations, and treatment outcomes for Crohn's disease and ulcerative colitis in children.
- To compare the specific gastrointestinal and extraintestinal manifestations between pediatric CD and UC.
Main Methods:
- Retrospective review of 22 pediatric patients diagnosed with IBD between 1987 and 1991.
- Data collection included patient demographics, clinical symptoms, diagnostic intervals, endoscopic findings, and treatment modalities.
- Comparison of clinical features and disease characteristics between Crohn's disease and ulcerative colitis cohorts.
Main Results:
- The study included 12 patients with Crohn's disease and 10 with ulcerative colitis, with a mean age at diagnosis of 8.7 years.
- Significant diagnostic delays were observed, averaging 18 months from symptom onset, with Crohn's disease diagnosis delayed longer (67% >13 months).
- Diarrhea, abdominal pain, and rectal bleeding were common presenting symptoms. Ulcerative colitis showed higher rates of hematochezia and severe diarrhea, while Crohn's disease presented more frequently with severe abdominal pain.
Conclusions:
- Pediatric inflammatory bowel disease (IBD) often experiences considerable diagnostic delays, necessitating increased awareness among clinicians.
- Distinct clinical and endoscopic features differentiate Crohn's disease and ulcerative colitis in children, aiding in diagnosis.
- Medical management was initiated for most patients, with a significant proportion of Crohn's disease patients requiring surgical intervention.
Abstract:
This paper reviews our five years' clinical experience (1987 to 1991) of 22 patients with inflammatory bowel disease (IBD). There were 12 patients with Crohn's disease and 10 patients with ulcerative colitis. The mean age at diagnosis was 8.7 years (2 to 14 years). Clinical impressions before referral were chronic diarrhea in 11, irritable bowel syndrome in 5, colon polyp in 4, lymphoma in 3, intestinal tuberculosis in 2, amoebic colitis in 2, ulcerative colitis in 2 children and other diseases. The mean interval from the onset of symptoms to the diagnosis of IBD was 18 months. Diagnosis of Crohn's disease was delayed for more than 13 months in 8 (67%), whereas that of ulcerative colitis was delayed for more than 13 months in 4 (40%). Diarrhea (50%), abdominal pain (36%) and rectal bleeding (36%) were the three most frequent presenting complaints of IBD. Moderately severe abdominal pain was a more common chief complaint in Crohn's disease (58%) than in ulcerative colitis (10%). Hematochezia (90% vs 17%) and moderately severe diarrhea (90% vs 75%) were more common gastrointestinal manifestations in ulcerative colitis than in Crohn's disease. The associated extraintestinal manifestations were oral ulcer in 7, arthralgia in 11 and arthritis in 4, skin lesions in 2, eye lesions in 2 and growth failure in 9 patients. Of 12 children with Crohn's disease, granuloma was found in 5, aphthous ulcerations in 8, cobble stone appearance in 8, skip area or asymmetric lesions in 6, transmural involvement in 7, and perianal fistula in 3. Among 10 children with ulcerative Colitis, there were crypt abscess in 8, granularity or friability in 10 and rectosigmoid ulcerations with purulent exudate in 8 children. The main sites of involvement in children with Crohn's disease were both the small and large bowels in 7 (58%), small bowel only in 2 (16%), and colon only in 3 (25%). Terminal ileum involvement was seen in 75% of Crohn's disease cases. The main sites of involvement in children with ulcerative colitis were total colon in 4 (40%), up to the splenic flexure in 2 (20%), rectosigmoid in 3 (30%) and rectum only in one (10%). Medical treatment including sulfasalazine, and systemic or topical steroid was administered initially in most patients. Seven of 12 patients with Crohn's disease and 2 of 10 patients with ulcerative colitis were operated on.(ABSTRACT TRUNCATED AT 400 WORDS)