Crohn's disease is a chronic inflammatory disease of the digestive tract. It causes inflammation of the small intestine, which is made up of the duodenum, jejunum and ileum. Along with ulcerative colitis, it is part of a larger classification of illnesses called inflammatory bowel diseases. While Crohn's disease does occur at any age and is most often diagnosed in adults in their 20s and 30s, approximately 20 to 30 percent of patients with Crohn's disease present before 20 years of age. Crohn's disease in children can delay puberty, stunt growth and weaken the bones.
Causes
The cause of Crohn's disease is currently unknown. However, the current theory is that a virus, bacteria or other unknown event triggers an immune response that causes inflammation of the intestines in a child who is genetically predisposed to the disease. Crohn's disease is familial in about 15 to 20 percent of people.
Judy Cho, M.D., and her team at Yale University School of Medicine have identified a mutation in the receptor gene associated with the IL-23 pathway, which can target organ-specific inflammatory responses such as the one in Crohn's disease. "This finding is particularly intriguing because we appear to have identified a gene variant that protects against development of inflammatory bowel disease," said Cho. "It causes us to think about the genetics of health as well as about the genetics of the disease."
Symptoms
Symptoms of Crohn's disease can vary in each child depending on the location and extent of inflammation of the small intestine. The most common symptoms include abdominal pain, watery diarrhea, fatigue, weight loss, loss of appetite, painful defecation, rectal bleeding with bowel movements, nausea and vomiting.
Furthermore, patients can also have manifestations outside of the intestine. These include delayed sexual development, stunted growth, arthritis, painful nodules on the legs known as erythema nodosum, mouth ulcers, and inflammation and pain of the eyes.
Diagnosis
After a complete history is taken and a physical exam is performed by a pediatrician, there are several tests that can be done to further establish a diagnosis of Crohn's disease.
Blood tests can be done to look for evidence of anemia or inflammation in the body.
Stool cultures can be done to look for evidence of parasites, bacteria or viruses. Also, stool can be tested for blood, indicating rectal bleeding.
An endoscopy procedure is performed. A flexible tube with a light and camera at the end is inserted through the mouth or rectum to examine the upper and lower parts of the digestive tract. A tissue sample is taken for further examination, known as a biopsy. An endoscopy is necessary to make the diagnosis of Crohn's disease.
Treatment
Currently, there is no cure for Crohn's disease. Treatment is conducted by a multidisciplinary team consisting of a gastroenterologist, nutritionist, pediatrician, counselor and social worker. The goals of treatment are to induce and maintain remission, allow the child to grow through proper nutrition, and prevent the complications of Crohn's disease.
Several drugs used in the treatment of Crohn's disease. These include anti-inflammatory medications, steroids, antibiotics and immunomodulators (drugs that suppress the immune system).
When medical therapy cannot adequately control the symptoms, surgical treatment is required. This can involve removing a part of the small intestine and/or creating an ostomy, when the tip of the bowel is brought to the skin's surface to allow waste to leave the body into a bag.
Prognosis
Although Crohn's disease is a serious illness in children with several complications, it is not fatal. With proper treatment and follow up, children can lead healthy and active lives. There are several groups and organizations helping children affected by Crohn's disease both emotionally and physically.
