[When to think about Crohn's disease when facing with chronic abdominal pain in children and adolescents?]
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1Service de gastroentérologie, hépatologie et nutrition pédiatriques, hôpital Necker-Enfants malades, 75015 Paris. olivier.goulet@nck.aphp.fr
Insights
Crohn
Area of Science:
- Gastroenterology and immunology, focusing on inflammatory bowel diseases (IBD).
Context:
- Inflammatory bowel diseases, including Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), show increasing incidence and prevalence globally.
- CD diagnosis is becoming more common in younger populations, with 15-20% of cases presenting before age 20 and a rise in early-onset pediatric cases.
- Geographical variations exist, with higher IBD rates in Northern Europe compared to Southern Europe.
Purpose:
- To summarize the current understanding of Crohn's disease pathogenesis, diagnosis, and treatment strategies.
- To highlight the epidemiological trends and increasing prevalence of CD, particularly in pediatric populations.
- To outline diagnostic criteria and therapeutic approaches for managing CD.
Summary:
- Crohn's disease (CD) is a type of inflammatory bowel disease (IBD) characterized by discontinuous inflammation in the GI tract.
- Diagnosis involves clinical, biochemical, radiological, endoscopic, and histological evidence, with symptoms including chronic abdominal pain and failure to thrive.
- Treatment focuses on reducing inflammation and promoting growth, utilizing enteral feeding, azathioprine for remission, and anti-TNF therapy for refractory cases.
Impact:
- Enhanced understanding of CD pathogenesis involving immune responses and gut microbiota.
- Improved diagnostic accuracy through a multimodal approach.
- Advancements in treatment, including nutritional therapy and targeted immunosuppression, leading to better disease management and remission rates.
Abstract:
Crohn's disease (CD) together with ulcerative colitis (UC) and indeterminate colitis (IC) are the so called inflammatory bowel diseases (IBD). Epidemiological data show an increased incidence of both UC and CD and, especially in North America and in Europe, an increased prevalence of CD. European data show that northern countries present higher rates of IBD than southern ones. It is estimated that 15%-20% of CD patients experience onset of their symptoms under 20 years of age. An increasing number of children enter disease before 8 years of age. The pathogenesis of CD has became more documented involving both the immune system and changes in intestinal microbiota. Chronic abdominal pain associated with failure to thrive and inflammatory syndrome with or without intestinal transit disorders suggest CD. Onset of a anoperineal disease is also suggestive of CD and is a severity sign. The diagnosis is based on clinical history, physical examination, radiological studies, endoscopy, and histology. CD is defined by evidence of a discontinuous chronic inflammation of the gastrointestinal tract with or without granulomas and supported by clinical, biochemical, and radiological evidence. Treatment aims to reducing inflammation and restauring growth. Enteral feeding has become a key issue in allowing to avoid steroids. Immunosuppressive treatment based on azathioprine is increasingly used for maintaining remission. Anti-TNF treatment is a rescue therapy in case of refractory, frequently relapsing disease especially those with ano-perineal disease.
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