Crohn's Disease in Children
Joyce D. Gryboski MD1
1 Professor of Pediatrics and Director of Gastroenterology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
Once considered rare in children, Crohn's disease (CD) is being recognized with increasing frequency.1-3 This is due not only to physical awareness but to an alarming increase in the incidence of the disease in young people. Although early descriptions of CD localized the site of involvement to the terminal ileum, it is now recognized that all organs of the alimentary tract may be affected, and in some unfortunate patients involvement extends proximally as far as the stomach, esophagus, or oropharynx and distally, to involve even perianal tissue.
Unlike ulcerative colitis which is rather clear-cut in its presentation, CD is often insidious with solitary symptoms of anorexia, weight loss, short stature, or fever of unknown origin being its only manifestation. The presenting symptoms and longterm course vary with the site of disease, and although each patient must be evaluated and treated individually, some overall predictions may be offered as to the victim's future quality of life.4-6
Significant advances have been made during the last decade in understanding the pathophysiology of the disease and in methods of its treatment, although as yet the etiology remains to be defined. Although CD has many features in common with ulcerative colitis and the two are often combined in the terminology, "inflammatory bowel disease," the pathologic findings, course, and complications are distinctive enough that they should be considered as two distinct diseases.
