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- Jeffrey S. Hyams, MD*
- *Head, Division of Digestive Diseases and Nutrition, Connecticut Children’s Medical Center; Professor of Pediatrics, University of Connecticut School of Medicine, Hartford, CT. Dr Hyams is a Consultant, National Treatment Registry for Remicade for Centocor, Inc.
OBJECTIVES
After completing this article, readers should be able to:
Describe the primary clinical difference between Crohn disease and ulcerative colitis.
List the greatest single risk factor for developing inflammatory bowel disease.
Delineate the primary presentation of children and adolescents who have Crohn disease.
Explain the effects of prolonged daily use of high-dose corticosteroids.
Describe the primary risk factor for intestinal cancer associated with both ulcerative colitis and Crohn disease.
Introduction
Inflammatory bowel disease (IBD) is a generic term used to describe two idiopathic disorders that are associated with gastrointestinal inflammation: Crohn disease (CD) and ulcerative colitis (UC). These disorders need to be distinguished from other conditions that may display similar clinical and laboratory findings, such as infection, allergy, and neoplasm. Because IBD also may be associated with a large array of extraintestinal manifestations, a knowledge of the clinical spectrum of these disorders is important to the clinician who may encounter associated pediatric problems such as growth delay, arthritis, hepatitis, and anemia. Once IBD is diagnosed, newer medical and surgical treatment modalities allow most affected children to lead relatively normal lives.
Definitions
The ultimate definition of UC and CD rests with the location and characteristics of inflammation within the gastrointestinal tract. In UC, a relatively homogeneous inflammatory process is confined to the mucosa, which starts in the rectum and involves a variable extent of colon proximally. Crypt abscesses are common. Contrary to historical belief, patients may have discontinuous inflammation at diagnosis or even rectal sparing, but over the course of the illness the inflammation becomes more confluent. Inflammation limited to the rectum, observed in 10% of patients, is termed ulcerative proctitis. In about 30% of cases, the disease is limited to the left side of the colon; in 40% to 50%, there is pancolitis.
The inflammation associated with CD may involve any portion …
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