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Updated: Aug 17, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Ileal involvement is age dependent in pediatric Crohn's disease
Ulrich Meinzer1, Maja Ideström, Corinne Alberti
1Department of Paediatric Gastroenterology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
Insights
Pediatric Crohn's disease (CD) ileal lesions appear later than colonic lesions, supporting the role of Peyer's patches. CARD15/NOD2 mutations influence ileal disease onset and severity in children.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Immunology of Gut Disorders
Background:
- Lymphoid follicles (LFs) are implicated in early Crohn's disease (CD) pathogenesis.
- Peyer's patches in the small intestine differ in development and involution from isolated colonic LFs.
- This suggests potential differences in ileal versus colonic lesion distribution in pediatric CD.
Purpose of the Study:
- To investigate the age-dependent probability of ileal lesions in pediatric Crohn's disease.
- To explore the influence of CARD15/NOD2 genotype on ileal lesion development and age of onset.
Main Methods:
- Retrospective review of medical records from French (n=136) and Swedish (n=55) pediatric CD cohorts.
- Analysis of disease sites, age of onset, and CARD15/NOD2 genotype (n=99).
- Computation of age-dependent probability for developing ileal lesions.
Main Results:
- Disease occurrence curves differed significantly between CD with and without ileal lesions (P < 0.0001).
- Probability of small bowel involvement at age 8 was 19%, increasing to 61% by age 16.
- CARD15/NOD2 mutations were associated with a higher probability (75%) and earlier onset of ileal disease.
Conclusions:
- Ileal CD lesions in children are delayed relative to colonic lesions.
- This supports the hypothesis of Peyer's patches playing a pathophysiological role in ileal CD.
- Caution is advised when diagnosing chronic colitis in young children due to the rarity of small bowel lesions.
Background:
Lymphoid follicles (LFs) have been suggested to play a role at the early stage of Crohn's disease (CD) lesions. In the small bowel, LFs are grouped, forming Peyer's patches, which develop early in fetal life, grow in size and number until puberty, and undergo involution. In contrast, colonic LFs are isolated and undergo little change during life. As a result, if LFs play a role in the occurrence of CD lesions, the distribution of ileal and colonic lesions is expected to be altered in small children.
Methods:
Medical records of 2 independent French (n = 136) and Swedish (n = 55) cohorts of consecutive pediatric CD were reviewed. Disease sites and age of onset were recorded, and the age-dependent probability to develop ileal lesions was computed. The CARD15/NOD2 genotype was also analyzed when available (n = 99).
Results:
The curves of disease occurrence were significantly different in case of CD with or without ileal lesions (P < 0.0001). At the age of 8 years, the probability (95% confidence interval) of small bowel involvement was 0.19 (0.07-0.39). It increased until 16 years of age to 0.61 (0.54-0.68). It was slightly higher in patients carrying 1 or more CARD15/NOD2 mutations [0.75 (0.55-0.89)] than in wild-type patients [0.46 (0.34-0.58)]. CARD15 mutations also influenced the age of onset of ileal disease (P < 0.02).
Conclusions:
In children, ileal CD lesions are delayed compared with colonic lesions. This observation is in agreement with the previously proposed hypothesis of a pathophysiological role of Peyer's patches in ileal CD. The rarity of small bowel lesions should be a warning to be cautious when classifying chronic colitis in small children.
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