Related Experiment Videos
The distribution of small bowel Crohn's disease in children compared to adults
S Halligan1, S Nicholls, C I Bartram
1Department of Radiology, St Mark's Hospital, London.
Insights
Barium follow-through (BaFT) is crucial for diagnosing pediatric Crohn's disease (CD) affecting the small bowel. This imaging technique helps identify CD in children, particularly in the upper gastrointestinal tract, where it may be missed otherwise.
Area of Science:
- Gastroenterology
- Pediatric Radiology
- Diagnostic Imaging
Background:
- Crohn's disease (CD) is a chronic inflammatory condition affecting the gastrointestinal tract.
- Small bowel involvement is common in CD, but diagnostic challenges exist, especially in pediatric populations.
- Barium follow-through (BaFT) is an established imaging modality for evaluating the small bowel.
Purpose of the Study:
- To evaluate the utility of Barium follow-through (BaFT) examinations in diagnosing small bowel Crohn's disease (CD) in children and adults.
- To compare the patterns of small bowel CD involvement between pediatric and adult patients.
- To determine if BaFT is essential for detecting small bowel CD in children.
Main Methods:
- Retrospective review of BaFT examinations performed on 67 children and 114 adults with confirmed Crohn's disease (CD).
- Analysis of the frequency and location (proximal, mid, distal small bowel) of CD findings on BaFT.
- Statistical comparison of disease distribution between pediatric and adult cohorts.
Main Results:
- Small bowel CD was detected by BaFT in 68.7% of children and 54.4% of adults.
- Children showed significantly more disease in the duodenal/jejunal regions (proximal small bowel) compared to adults (P < 0.05).
- Adults had significantly more disease in the terminal ileum (distal small bowel) compared to children (P < 0.05).
- A notable proportion of children (19.6%) had small bowel CD with a normal terminal ileum, highlighting proximal disease.
Conclusions:
- Barium follow-through (BaFT) is an essential imaging tool for diagnosing small bowel Crohn's disease (CD) in children.
- Pediatric patients exhibit a distinct pattern of small bowel CD, with a higher prevalence in the proximal segments compared to adults.
- BaFT examination is critical to avoid missing cases of small bowel CD in the pediatric population, especially when the terminal ileum appears normal.
Abstract:
Barium follow-through (BaFT) examinations in 67 children and 114 adults with proven Crohn's disease (CD) were reviewed. Forty-six (68.7%) children and 62 (54.4%) adults had evidence of small bowel CD on BaFT. The frequency of CD in the proximal, mid and distal small bowel was 30.4%, 45.7% and 80.4%, respectively for children and 14.5%, 59.7% and 93.5% for adults. Children had significantly more duodenal/jejunal disease than adults (chi 2 = 3.99, P < 0.05) and significantly less terminal ileal disease (chi 2 = 4.29, P < 0.05). There was no significant difference in mid ileal disease. Nine (19.6%) children had small bowel CD with a normal terminal ileum compared with four (6.5%) adults. Ileoscopy-negative children have more proximal small bowel CD than adults and less distal disease. BaFT examination is essential if small bowel CD is not to be missed in children.