Crohn's disease in a child

Crohn's disease was given the name of a gastroenterologist from the United States, who first described it as a separate nosology in 1932.Also known under the names: granulomatous enteritis, transmural ileitis, regional enteritis, region-terminal ileitis.

"Peak" incidence falls on the age of 12 to 20 years. Crohn's disease in preschool children is a rare occurrence. The greatest number of cases is registered among white people in the countries of northern Europe and America. There is a significant prevalence of Ashkenazi Jews by ethnicity. Boys are sick more often than girls.

What is known about the causes of the disease?

Reasons are still being studied. A common opinion about the nature of the disease does not exist yet. Proponents of the genetic theory argue that their version is confirmed by the more frequent detection of Crohn's disease in homozygous twin brothers and blood relatives, a combination with Bekhterev's disease. An increased mutational activity of the gene CARD15( NOD2) was detected.

Influence of infection is indicated by the study of the connection with the consequence of infection of experimental animals with paratuberculous mycobacteria. There is no other viral or bacterial etiology.

The role of the immune status is confirmed by a high content in patients with T-lymphocytes, the presence of antibodies to the E. coli, milk protein, lipopolysaccharides, immune complexes in the blood during exacerbations. However, there was no specific antigen, which causes pathological changes.

Changes in the disease

Crohn's disease in a child and adult does not differ in morphological and anatomical features. The entire digestive tract serves as the area of ​​damage, but in 75% of cases the main localization is the terminal part of the jejunum and the beginning of the thick( ileocolitis).

Segmental alternation of affected and healthy parts of the mucosa

. Pathological changes consist in thickening of the wall, presence of transverse ulcers and cracks, the formation of nodes( granulomas), because of which specialists called the intestines "cobblestone pavement".
Ulcers penetrate the intestinal wall, form fistulous passages into adjacent intestinal loops, urinary bladder, abscessed.

The lymph nodes are necessarily involved in the process. They also find specific granulomas. The result of chronic course - the formation of dense scars, deformation and narrowing of individual areas of the intestine, damage to microflora.

Phases of development of inflammation

Sections of affected intestinal tissue undergo 3 phases of changes:

• Infiltration of - all cellular elements accumulate in the submucosal layer, the vascular pattern disappears( matte shade of the mucous membrane).Surface erosions are formed, surrounded by fibrinous plaque, which restrains the spread and absorption of toxins.
• The phase of ulceration - erosions deepen and turn into ulcers reaching to the muscle layer. Ulcers join each other with cracks, the intestinal wall in the place of lesion swells and thickens, the lumen narrows.
• Scarring - healing of ulcers forms coarse connective-tissue scars. They narrow and deform the intestine. Stenosis acquires an irreversible organic basis.

Cobblestone and gut contraction contribute to partial obstruction

Symptoms of Crohn's disease in children depend on the localization of the disease, often mimic appendicitis and ulcerative colitis. Pathology develops gradually with periods of exacerbations and remissions. The latent current can last from several months to three years. The more foci on the mucosa, the heavier the course of the disease.

In half of children, nodular inflammation affects the blind and ileum intestines( ileocecal version), less often - the small and large intestines are isolated. In 5% of cases, Crohn's disease reveals areas of inflammation in the mouth, on the mucosa of the esophagus, in the stomach.

The most common childhood symptoms are:

• diarrhea - a loose stool up to ten times a day;
• cramping and aching pains in the abdomen, worse after eating and defecating;
• nausea with vomiting on pain;
• lag in physical development;
• weight loss due to impaired intestinal absorption;
• facial swelling;
• prolonged low-grade fever( 37.2-37.5);
• later appearance of sexual characteristics in adolescence.

The defeat of the small intestine leads to hypovitaminosis and anemia due to a lack of vitamin B12.The child is coping heavily with the school load.

Babe is constantly pale, complains of weakness, is not active

With ileocecal version, pains appear in the right ileal region, similar to an attack of appendicitis. The temperature is kept, the characteristic leukocytosis in the blood. If the lesions are located in the large intestine, the child complains of cramping pain before defecation, blood appears in the feces.

In the case of a protracted form of Crohn's disease, extraintestinal symptoms appear:

• pains and a feeling of aches in the joints of the hands and feet;
• tenderness along the spine;
• inflammation of the ocular membranes;
• erythema nodosum on the skin;
• aphthous ulcers in the oral cavity.

In connection with diarrhea, additional painful symptoms are possible:

• irritation of the skin and around the anus;
• puffiness of the anus folds;
• cracks and ulcers at the exit of the rectum;
• formation of fistulous passages.

If Crohn's disease develops in the first year of life, then the beginning is judged on a liquid diarrhea with bloody impurities, lagging behind the baby in weight gain and development. Extraintestinal symptoms are usually added to 7 years. Before school the child lags noticeably in growth from peers, thin, suffers from periodic abdominal pains and frequent fever.

Diagnostic features of

Laboratory signs are not the main ones in diagnostics, but they allow one to judge the massiveness of the inflammatory reaction, the phase of the course of the disease, complications. The strength of inflammation is indicated by leukocytosis, high ESR, the presence of C-reactive protein. Signs of iron deficiency anemia are detected by reducing the number of red blood cells, the level of hemoglobin, transferrin, iron in the blood of the child.

Biochemical tests show a low protein content, an increase in transaminases, alkaline phosphatase. In this case, the relationship between albumins and globulins is disturbed by the growth of α-globulins. In the immunological laboratory, an increase in IgG is confirmed against a background of IgA deficiency.

With the help of stool tests, it is necessary not only to confirm the decrease in the ability of the intestine to digest food and inflammation over the remains of mucus, leukocytes, bloody inclusions, but also to exclude the various infectious causes of enterocolitis.

To this end, the tank is planted for the detection of shigella, clostridium, salmonella, iersinia, campylobacteria, mycobacterium tuberculosis, dysentery amoeba, tests for helminths and parasites are tested.

Determination of calprotectin level in feces is a reaction that allows to identify specific inflammation. This protein is synthesized by cells of the intestinal mucosa. The increase is detected with Crohn's disease, ulcerative colitis, a tumor.

Colonoscopy for children Colonoscopy is performed under anesthesia

The use of a colonoscopy with examination of the entire colon and the transition to the skin can reveal a specific picture of the disease, take material for histological examination. In biopsy trials, the main diagnostic criterion is the detection of granulomas without curdled necrosis in the central zone.

A huge help is provided by video surveillance. This method helps to inspect all parts of the small intestine. Unfortunately, so far it is only used in private clinics and is quite expensive.
On the review radiograph of the intestine after the barium mixture is taken, there are places of constriction, deformity, ulcers, fistulas.

How do symptoms of complications appear?

Timely detection of complications of Crohn's disease is important, because they require emergency surgical intervention. Perforation of the intestinal ulcer - clinically looks like a shock state of the patient after sharp "dagger" pain. Symptoms of peritonitis are evident, and the stomach becomes strained.

The perforation is possibly covered, when the contents of the intestine do not enter the abdominal cavity, but into the neighboring organs( bladder, girls to the uterus).However, there are no bright symptoms. But the next examination reveals fistulous passages. There are signs of illness of the organs involved.

Cicatricial deformity of the intestine and swelling contribute to the development of partial or complete obstruction. The child has severe pain, there is no stool, the gases do not escape, and the abdomen is swollen. Intestinal bleeding is caused by damage to the vessels of the inflammation zone. In the stool, blood is detected, the patient's pressure decreases, pallor, tachycardia, cold sweat.

Bleeding from the upper intestine is manifested by the dark stool

How is Crohn's disease treated?

Treatment of children with Crohn's disease must include:

• dietary and parenteral( intravenous) nutrition in order to minimize bowel movement;
• therapy with medicines;
• according to indications surgical methods;
• teens need counseling psychologist to learn how to live with their disease.

Food

The diet for a child is built according to the scheme of table number 4 according to Pevzner. It provides for high caloric content, exclusion of dairy products, rye bread, oatmeal, wheat, barley cereals, fatty meat, fried foods, legumes, fresh vegetables and fruits, as well as making menus from boiled fish, seafood, chicken, soups, cerealson water, fresh juices, jelly.

Medication treatment

The scheme of drug therapy is developed by the attending physician individually for each patient. It includes:

• sulfonamide preparations( sulfasalazine, mesalazine);
• glucocorticoids( Hydrocortisone, Prednisolone, Dexamethasone);
• immunosuppressants( Cyclosporine, Azathioprine);
• if necessary, antibiotics and metronidazole are used;
• probiotics and enzymes for facilitating digestion;
• multivitamins, necessarily B12 and folic acid for the prevention of anemia;
• enterosorbents help to remove inflammation products from the intestine;
• for anesthesia is prescribed antispasmodics.

The maximum dosages are calculated by the weight and age of the child, they are applied only to the stage of exacerbation. With remission, the process subsides, but the doctor prescribes maintenance treatment. It is strictly forbidden to use the people's means alone.

Dosage adjustment is only possible with the participation of a physician.

If prompted by complications, surgical intervention is urgently needed. The affected area of ​​the intestine is surgically removed, the ends are joined, the bleeding vessels are bandaged. Fistulous moves are replaced with plastic.

Forecast

Until a method is found for getting rid of Crohn's disease, it is impossible to completely cure the child. Parents should constantly monitor the performance of appointments, the observance of proper nutrition. In such conditions, the disease passes into a state of prolonged remission, the children develop normally and do not differ from their peers.

A child with Crohn's disease requires much more attention from parents. The proposed methods of examination and treatment can not be ignored. This threatens the development of severe complications and is life-threatening.