Crohn's disease is inflammation and ulceration of the digestive tract and can appear in one or more parts of the tract from the mouth to the anus. Though usually thought of as an adult disease, Crohn's has become more prevalent in children
Warren Bishop, MD, gastroenterologist at University of Iowa Children's talks about Chron's disease:
What child is most likely to develop Crohn's disease?
Almost any child can develop Crohn's disease, but we know that if there is already a family history of Crohn's disease, children from those families are more likely to be affected. However, of all the cases of Crohn's disease that we follow and treat University of Iowa Children's Hospital, only about 30 percent have a family history.
At what age do children first show symptoms of Crohn's disease?
The age that children present at can vary quite a bit. For example, I've seen children under two years of age with Crohn's disease, but if you look at population studies, the most common age of onset is actually in the mid to late teenage years.
What are some of the symptoms a child with Crohn's disease might develop?
Typical symptoms of Crohn's disease include diarrhea, cramping abdominal pain, blood in the stool, weight loss, poor weight gain, and sometimes children even will present with symptoms outside of the intestines, such as an unusual skin rash or arthritis.
Do children with Crohn's disease have symptoms parents might not recognize as part of the disease?
Yes, that's definitely a possibility, particularly those children I mentioned who don't have symptoms that necessarily point you directly to the intestines. For example, a child who grew well until he was maybe 8 or 9 years of age, and then gradually his peers are getting larger, and he's becoming one of the smaller kids in the classroom. That's when a growth failure is a sneaky way Crohn's can present and parents may miss this entirely for several years before they realize something is significantly wrong.
Is Crohn's disease often misdiagnosed as another illness?
Crohn's can be misdiagnosed as another illness, particularly if the child is having symptoms that are not necessarily in the intestine. I've seen children diagnosed with rheumatoid arthritis, for example, who turned out to have Crohn's disease with its associated arthritis. Perhaps a child might be thought to have irritable bowel syndrome, or spastic colon as it's commonly referred to. When, in fact they have a more serious process going on that may not be recognized until the symptoms become more obvious.
Why should children suspected of having Crohn's disease be seen by a pediatric gastroenterologist?
The primary reason is that children are different from adults and there are many different concerns related to medications that should be used and shouldn't be used in children ,or the dose of medication that should or shouldn't be used in children.
A primary example of this would be prednisone. Prednisone is commonly used to treat Crohn's disease in adult patients, but we feel we need to avoid this in children for long-term use because of its negative effects on growth and bone calcium content, for example.
So we take alternative approaches in children. The physician familiar with treating this disease in adults may not have the same perspective and may not fully understand how, particularly medicine, should be dosed for children.
An adult dose of any medicine is not going to be appropriate for a younger child.
How is Crohn's disease treated in children?
Crohn's disease is treated in children in many different ways. We have a layered approach with patients who are not particularly ill. We start with medications that aren't particularly strong, but very protective. If the disease becomes more severe or if it's already quite severe, we're going to use a stronger medication. We're going to consider cost in our decision-making. But primarily, we need to be sure that we're fitting the treatment to that particular patient's problem.
Do symptoms go away as a child ages?
Symptoms in Crohn's disease can be deceiving. The disease itself, which I think is the question you're really asking, does not go away. It's very much like rheumatoid arthritis or other autoimmune diseases in which people can have good months and bad months. It's important for people not to interpret having a good month as meaning that the disease has gone away.
We keep our patients on medications that suppress the inflammation and prevent, as much as possible, serious long-term consequences of the disease.
If your intestines are constantly inflamed, you're at risk for developing scarring and narrow spots in the intestine, even though you're feeling good. Therefore we like to control that inflammation throughout the patient's life. And since children have many decades of living in front of them, we take this approach pretty aggressively and do our very best to prevent complications as they get older and leave pediatric care.
Is there currently a cure for Crohn's disease?
At the present time, unfortunately there is no cure for Crohn's disease. However, Crohn's disease is very treatable; people do not die of Crohn's disease. You can actually have serious complications from Crohn's disease if it is not treated well, and so our goal is to prevent serious complications and to keep our kids healthy with the help of our community physicians and the parents. |
