ethnoscience

Diagnosis of Crohn's disease in children. Symptoms of Crohn's disease in children and methods of treating inflammation of the digestive tract

Today there is a sad picture: more and more children are susceptible to inflammatory bowel diseases.

Often, parents do not attach any importance to the child’s words when he says that his stomach hurts.

Because of such negligent attitude towards health, very serious problems sometimes arise.

In this article, a Russian gastroenterologist will talk about Crohn's disease in adolescents, why it occurs and how to treat it.

1. Crohn's disease as an oncology...

- People help children with cancer because they know that treatment is not cheap. How often does society help with diseases of this type? Do they know that these diseases can end in tragedy?

Yes, most charitable foundations help children with cancer, but in gastroenterology I I equate Crohn's disease with oncology.

This disease is life-threatening if not treated carefully. It progresses every day, so it is necessary to start treatment immediately from the moment the diagnosis was made.

May even require surgery, since there is inflammation of the entire wall of the colon and rectum, it can affect the esophagus and in advanced cases lead to death.

Working with children and teenagers is especially challenging for me. After all, it is difficult for teenagers to accept their illness; they may develop depression, but we don’t need that. This only interferes with treatment and recovery, which is why you can always find psychological help in our hospital.

- Parents may not notice the symptoms that indicate the onset of the disease, because there is nothing supernatural about the child having a stomach ache. But how do you still get through to your parents? What symptoms should they look out for first?

Firstly, this diarrhea with blood in the stool that has lasted more than 5 weeks. Significant weight loss, constant abdominal pain. The main thing is to make an accurate diagnosis in time, but with Crohn's disease, unfortunately, this takes a lot of time.

Video: "Crohn's disease: chronic intestinal inflammation"

– How does Crohn’s disease differ from ulcerative colitis? How not to confuse them?

– Yes, these diseases are often confused. They also highlight undifferentiated colitis– a disease that has features of both diseases. In this case, it is very difficult to prescribe the necessary therapy.

Ulcerative colitis is an inflammatory bowel disease that affects the lining of the colon. Crohn's disease affects the entire gastrointestinal tract from the mouth to the anus. Surgeries are performed only in the most extreme cases, because after surgery the disease relapses quite quickly and often.

Crohn's disease is on par with cancer because it is very difficult to identify. And this disease, unfortunately, is incurable. In this case, it is only possible to go into remission, and then after that you will have to follow clear instructions so that a relapse does not occur.

This disease leads to severe disability, so it is better to make a diagnosis as early as possible and begin treatment. In practice, it is noticeable that Crohn's disease in children occurs in a much more aggressive form than in adults. It is very important to support them during treatment.

- Why does Crohn's disease and other inflammatory bowel diseases, such as ulcerative colitis, occur?

There may be many reasons, but primarily influenced by genetics. At the moment, doctors know about more than 200 so-called loci in which these genes can be stored.

But for these genes to manifest themselves, some other factors are needed, for example:

Environmental quality. Polluted air, radiation, radiation. The higher the level of development of a country, the higher the level of development of these diseases.
Improper unbalanced diet: constant consumption of food with the addition of preservatives, flavoring fillers, emulsifiers, dyes can significantly affect the health of each person. Nowadays, fast food is especially popular among young people - tasty and quick food that can satisfy your hunger, but by doing this you are only making things worse for yourself. It's better to watch your diet. It is known that, for example, in Asia, where they mainly ate rice and seafood, there was not even a popularization of these diseases until the moment when many people began to switch to European food.
Smoking. Smoking poisons the entire body, so people who smoke are always on the risk list.
Stress. Unfortunately, every modern person is exposed to stress every day. Because of this, a malfunction occurs in our body and the immune system is weakened.

- How are Crohn's disease and ulcerative colitis diagnosed?

There are many ways. You can find these diseases for tests such as complete blood count, stool test. If the analyzes show elevated leukocytes, red blood cells and an increase in ESR, then a thorough examination should be taken seriously.

– Are genetic studies necessary and their effectiveness?

– There are cases when the patient’s body does not respond to the prescribed therapy, then we are dealing with monogenic diseases. It's already quite another type of therapy, up to bone marrow transplantation. If the correct diagnosis is not made in time, it can lead to death. Therefore, you need to be very careful.

2. Drug therapy is the last hope

- What effective treatments exist for Crohn's disease and ulcerative colitis?

Drug therapy for Crohn's disease and ulcerative colitis contains aminosalicylates, cytostatics and anticytokine drugs, which block the inflammatory focus of the disease and help heal the mucosa. As a result, relapses of the disease can be stopped.

Recently, a new but very effective drug, Vedolizumab (Entyvio), was registered in Russia. It is not yet intended for the treatment of children, since the drug has not yet been fully tested, but research is being conducted on its use. But not everything is so hopeless: this drug has already been used in children in Norway and Canada, and it has shown good results.

– Do you know children who need this drug?

- Yes. We have two very serious patients. Both of them have not yet been fully diagnosed and require serious therapy. The girl went through a lot: at first she simply had a stomach ache, and after some time she was diagnosed with severe intestinal damage, life-threatening.

Both the boy and the girl have damage to the oral cavity and high inflammatory activity in the blood. We closely monitor their condition, since it is impossible to predict the course of Crohn's disease in them, since these are rare cases.

We are afraid that the disease will become more damaging, narrowing the intestine. In this case, surgical intervention will be immediately required, children will become disabled, and the disease may progress further.

We are consulting with foreign clinics and their experience, as we are thinking about using the drug Vedolizumab, which can save children. If all else fails, we will consider the option of bone marrow transplantation.

– And what decision do you think you will come to?

– Of course, the first option, namely taking a new drug, is a safer option for children and maintaining their health. Bone marrow transplantation can have serious consequences and complications.

The state is currently purchasing the drug exclusively for adults, but there is the possibility of using it for children for particularly important indications. We are confident that we will be able to bring children to remission and minimize the risk of complications. We really hope that everything will work out and that in the future all regions of the country will be able to use this drug.

Video: "Ulcerative colitis: causes and symptoms"

– How possible is a full life for a child with such a disease and in remission?

– To show this, I have a folder with drawings of patients, where they depicted how they saw their lives before and after therapy with special drugs. The difference is noticeable to the naked eye. In the drawings before therapy, black and gray colors predominated, anxiety and despondency were felt.

Afterwards - a more positive picture, some paint the sun, flowers, rainbows, some paint their family, their goals, dreams, desires.

It is by comparing these pictures that you fleetingly realize how the patients’ lives change after therapy. Undoubtedly, the use of new drugs is like a breath of life-saving air for patients.

Our the main task after therapy is to adapt the child to a new life, teach him to live with Crohn's disease, ulcerative colitis, because sometimes the disease can worsen.

You can learn to live fully, even despite such a terrible disease. You need to follow the right diet, moderate exercise and a positive attitude, and that’s when everything will work out! We wish all our patients unlimited health and patience in overcoming such a difficult disease.

Crohn's disease in children (syn. granulomatous ileitis, regional enteritis) is a disease with a chronic course, which is characterized by the development of an inflammatory granulomatous process localized in the large or small intestine. The incidence rate is 0.1%.

The pathogenesis and causes of the disease currently remain unclear. It is assumed that the culprits may be genetic predisposition, viral or bacterial infections, and a decrease in the resistance of the immune system.

The main clinical manifestations are considered to be pain in the abdominal area, fever, profuse diarrhea and weakness. During diagnosis, the occurrence of fistulas and fistulas is detected.

The diagnostic process is based on the results of instrumental procedures, but also includes laboratory tests and primary diagnostic measures performed by a pediatric gastroenterologist.

Treatment of the pathology is aimed at achieving stable remission, which is achieved using conservative therapeutic methods, including following a gentle diet and taking medications.

Etiology

The main causes of its occurrence are currently a blank spot for specialists in the field of pediatrics and pediatric gastroenterology. Crohn's disease in children is an autoimmune process when the immune system produces specific antibodies against its own cells (in this case, the intestines), which destroy them.

It is believed that the following factors may act as a trigger for the disease:

the presence of illness in one of the close relatives;
pathological influence of microscopic bacteria, which in structure resemble the causative agent of tuberculosis (Koch's bacillus);
changes in intestinal microflora;
decreased immune system resistance;
poor nutrition that does not correspond to the child’s age category;
influence of toxic and toxic substances on the children's body;
severe course of disorders of a bacterial or viral nature;
long-term influence of stressful situations or regular psycho-emotional stress;
side effects from uncontrolled use of certain groups of medications;
adverse environmental influences;
addiction to bad habits - applies to teenagers.

The possibility cannot be ruled out that the pathology arises due to the influence of not one, but several possible causes: the disease may have a polyetiological nature.

It is most often diagnosed in children aged 10 to 17 years; the disease occurs equally in boys and girls.

Classification

Based on the focus of the inflammatory process, clinicians talk about the existence of several types of disease:

Type 1. Can occur in 3 variants. The first is that the affected area is limited to one area of the small intestine, for example, the duodenum. The second - localization is noted in the area of the transition of the large intestine to the small intestine. Third, the focus is limited to any segment of the large intestine.
Type 2. Has several different forms. The first is that several segments of both the large and small intestine are involved in the pathological process. The second is that changes affect organs such as the stomach, esophagus and oral mucosa.

Separation according to the nature of the course indicates the existence of such forms of the disease:

acute (at first diagnosis) - onset can be abrupt or gradual, duration exceeds 6 months;
chronic or continuous - characterized by the absence of remission or its duration of less than six months;
recurrent - frequently recurring occurrence of symptoms with periods of absence of clinical manifestations for more than 6 months.

According to the clinical picture, the disease occurs:

acute or inflammatory lesion of the ileum;
jejunoileitis, accompanied by - inflammation is localized in the ileum or jejunum, and the passage of feces through the intestine is disrupted;
chronic form of jejunoileitis with malabsorption syndrome of nutrients;
granulomatous - the formation of a large number of small-sized neoplasms in the walls of the large intestine;
granulomatous - the formation of granulomas in the rectum.

As Crohn's disease progresses in children, it goes through several stages:

Infiltration. Inflammation affects only the submucosal layer, followed by the appearance of superficial erosions, deep aphthae and fibrin inclusions.
The appearance of ulcers or cracks. The pathological process reaches the muscle layer. The ulcers are connected by cracks, against which the mucous layer swells, causing a narrowing of the intestines.
Scarring. As the ulcers heal, rough connective tissue forms, the growth of which is fraught with intestinal stenosis.

Symptoms

The time of appearance and severity of clinical signs of the disease in a child are influenced by the following factors:

localization of the inflammatory focus;
time of development of the disease;
age category.

The main signs of this disorder:

violation of the act of defecation - rare or abundant, persistent or scanty diarrhea;
pain in the abdominal area - the pain can be dull and long-lasting or sharp and short-term;
redness and swelling of the anal tissue;
weakness and fatigue;
insufficient weight gain in infants and weight loss in adolescents;
temperature increase to 39 degrees;
and esophagus;
nausea leading to vomiting;
anterior wall of the abdominal cavity;
appearance;
lagging behind peers in physical development.

In addition to general clinical signs, symptoms of Crohn's disease in children can be specific:

anemia;
yellowness of the sclera;
decreased visual acuity;
severe pain in the abdomen in the navel area;
complete aversion to food;
severe fatigue;
ulceration of the perianal area;
muscle and joint pain;
formation of aphthae on the oral mucosa;
change in urine color;
joint inflammation;
increased urge to empty the bladder.

In some children, remission - a complete absence or reduction in the severity of symptoms - can last for years. It is not possible to find out the reasons influencing the occurrence of exacerbations.

Diagnostics

Even an experienced pediatrician or pediatric gastroenterologist will not be able to make a correct diagnosis based on the clinical picture alone. The diagnostic process must take an integrated approach.

Primary diagnosis:

family history analysis;
studying the patient's medical history - to search for the most characteristic predisposing factor that has a pathological basis;
collection and analysis of the child’s life history - information regarding eating behavior, medication use and the influence of stressful situations;
assessment of the condition of the skin and sclera;
measuring body temperature;
palpation and percussion of the anterior wall of the abdominal cavity;
a detailed survey of the child or his parents - to find out the time of onset of symptoms and the degree of their severity.

The most informative laboratory tests in the process of diagnosing the problem:

general blood and urine analysis;
blood chemistry;
coprogram;
immunological tests.

Among the instrumental examinations, it is worth highlighting the following procedures:

radiography of the peritoneum;
irrigoscopy;
abdominal ultrasonography;
sigmoidoscopy;
colonoscopy;
EFGDS;
capsule endoscopy;
computer colonography.

Treatment

After confirming the diagnosis, attempts are made to cure the child from Crohn's disease using conservative methods: bed rest and rest, both physical and emotional, are necessary.

Drug therapy involves taking the following medications:

combination anti-inflammatory drugs;
hormonal substances;
leukotriene receptor antagonists;
antispasmodics;
immunosuppressants;
antibacterial drugs;
mineral and vitamin complexes;
aminosalicylates;
corticosteroids;
enzyme substances;
probiotics and prebiotics;
enterosorbents;
iron supplements.

Nutrition is of great importance - diet therapy involves following the rules of gentle menu No. 4c according to Pevzner.

Surgical intervention is performed only for individual indications:

with the formation of suppuration;
spicy;
the occurrence of fistulas;
internal hemorrhage;
lack of positive dynamics from the use of conservative methods.

The essence of surgical treatment is excision of the affected area of the intestine.

Possible complications

If parents ignore the symptoms of the disease and completely refuse qualified help, there is a high risk of developing life-threatening complications for the child:

formation of fistulas, strictures and abscesses;
intestinal bleeding;
anemia;
intestinal obstruction;
rupture of the wall of the affected organ;
urolithiasis disease;
retardation in growth and physical development.

Prevention and prognosis

To prevent the development of the disease, parents must strictly monitor or independently follow simple rules of prevention:

complete refusal of adolescents from harmful addictions;
proper and nutritious nutrition appropriate for the child’s age;
compliance with the work, nutrition and rest regime;
avoiding physical and psycho-emotional fatigue;
competent use of medications prescribed by the attending physician;
regular examination by a pediatrician and an annual visit to a pediatric gastroenterologist.

Symptoms and treatment of Crohn's disease in children affect the prognosis. Conscientious adherence to therapeutic and preventive measures provides a favorable prognosis - achieving stable remission, but it is impossible to completely cure the disease.

Pathology significantly reduces the quality of life and affects its duration. contributes to the number of disabled children and child mortality.

Similar materials

Esophageal diverticula are a pathological process that is characterized by deformation of the esophageal wall and protrusion of all its layers in the form of a pouch towards the mediastinum. In the medical literature, esophageal diverticulum also has another name - esophageal diverticulum. In gastroenterology, this particular localization of saccular protrusion accounts for about forty percent of cases. Most often, the pathology is diagnosed in males who have crossed the fifty-year mark. But it is also worth noting that usually such individuals have one or more predisposing factors - gastric ulcer, cholecystitis and others. ICD 10 code – acquired type K22.5, esophageal diverticulum – Q39.6.

Achalasia cardia is a chronic disorder of the esophagus, which is characterized by impaired swallowing. At this moment, relaxation of the lower sphincter is observed. As a result of such a disorder, food particles accumulate directly in the esophagus, causing an expansion of the upper parts of this organ. This disorder is quite common. It affects both sexes almost equally. In addition, cases of detection of the disease in children have been recorded. In the international classification of diseases - ICD 10, this pathology has its own code - K 22.0.

Distal esophagitis is a pathological condition that is characterized by the progression of the inflammatory process in the lower part of the esophageal tube (located closer to the stomach). This disease can occur in both acute and chronic forms, and is often not the main, but a concomitant pathological condition. Acute or chronic distal esophagitis can develop in any person - neither age category nor gender plays a role. Medical statistics are such that pathology most often progresses in people of working age, as well as in the elderly.

Crohn's disease is a chronic progressive inflammatory disease of various parts of the digestive tract from the mouth to the anus. The essence of the pathology is inflammation of all layers of the intestinal wall, the formation of deep ulcers, in place of which granulomas then grow, narrowing the lumen of the affected part of the intestine.

The prevalence of the disease among the child population is 10-15 cases per 100 thousand children. In children, the disease can develop at any age, but children from 11 to 18 years of age are predominantly affected. There is practically no difference in the prevalence of the disease among boys and girls.

The final section of the small intestine is most often affected, which is why the disease is sometimes called “terminal ileitis.” In children, the jejunum and duodenum may be affected. Difficulties with early diagnosis of the disease lead to the spread of the pathological process to other parts of the gastrointestinal tract.

Causes

Experts believe that the most likely cause of Crohn's disease is a failure in the immune system, resulting in the formation of antibodies to the cells of one's own body.

Scientists have not established the exact cause of the disease.

Possible reasons include:

infectious origin (bacterial or viral nature);
exposure to toxins;
psycho-emotional overload;
poor quality food;
side effects of certain medications;
adverse environmental influences.

Hereditary predisposition to the disease matters. But the largest number of supporters is with the immunogenic theory, according to which the occurrence of Crohn’s disease is associated with a malfunction in the immune system and the formation of autoimmune antibodies against the body’s own tissues.

It is possible that the development of Crohn’s disease is associated not with one, but with a complex of causative factors, that is, any of them is a trigger for the occurrence of gene mutations and the development of the disease.

Classification

Depending on the prevalence of the process, Crohn's disease can occur in the form of:

terminal ileitis (damage to the small intestine);
colitis (the process is localized in the large intestine);
ileocolitis (both the small and large intestines are involved in the process);
anorectal (predominantly affecting the anus and rectum).

The course of the disease is undulating, with alternating periods of exacerbation and remission.

Symptoms

In children, Crohn's disease may be hidden for some period, almost asymptomatic, or masked behind extraintestinal manifestations. This latent period can last up to 3 years, which makes timely diagnosis of the pathology difficult. But then the disease still manifests itself.

Clinical signs of Crohn's disease are varied:

Persistent diarrhea up to 10 bowel movements per day. The frequency and volume of stool depend on the level of damage to the digestive tract: the higher the affected area is located, the stronger the diarrhea. Blood may occasionally be present in the stool. When the small intestine is damaged, the absorption of nutrients is impaired - malabsorption syndrome develops. This leads to loss of body weight. In babies, stool may become profuse, mixed with mucus, pus, and light in color.
All children experience abdominal pain. At the initial stages, they can be insignificant and intermittent, and as the disease progresses they become strong, cramping, accompanying food intake and acts of defecation. The cause of pain is a narrowing of the intestinal lumen, making it difficult for food to pass through.
Often the pain is accompanied by flatulence (bloating).
If the gastric mucosa is damaged, the child may experience nausea, a feeling of heaviness in the epigastric region, and vomiting.
Temperature increase within 37.5 ° C, general weakness, lack of appetite.

With total damage to the intestines, the disease may manifest itself in the form of a symptom complex characteristic of an “acute abdomen” when children are admitted to the surgical department.

Extraintestinal symptoms of Crohn's disease are manifested by lesions:

joints in the form of monoarthritis (inflammation of one of the joints) and arthralgia (pain in the joints);
oral mucosa – aphthous stomatitis;
eye – uveitis, iridocyclitis, episcleritis (inflammation of the membranes of the eye);
biliary tract – cholestasis (stagnation of bile), cholangitis (inflammation of the bile ducts).

As a result of impaired absorption in the intestines, hypovitaminosis develops, deficiency of microelements (, etc.), and the electrolyte composition of the blood is disrupted. As a result of a lack of proteins in the body, edema appears. Vascular disorders are possible.

Features of the course of Crohn's disease in children are significant developmental delay (physical and sexual), increased temperature to high levels, and severe joint pain. In girls, the menstrual cycle is disrupted (secondary amenorrhea is noted).

Of the extraintestinal manifestations of the disease, children most often develop damage to the eyes, oral mucosa and skin in the form of eczema, dermatitis, and long-term non-healing ulcers.

Complications

The most significant symptoms of Crohn's disease in children are abdominal pain and frequent (up to 10 times a day or more) loose stools.

In Crohn's disease, complications are often associated with severe intestinal damage. Anal fissures, perianal abscesses, and fistulas often occur. Due to a sharp narrowing of the intestinal lumen, intestinal obstruction may develop. Perforation (perforation of the wall) of the intestine and the development of an inflammatory process of the peritoneum (peritonitis) cannot be ruled out. The lumen of the small intestine may become pathologically dilated (toxic dilatation).

Diagnostics

In addition to interviewing the child and parents and examining the patient, the results of laboratory and instrumental studies are important for diagnosing Crohn’s disease.

Clinical and biochemical blood tests in Crohn's disease reveal the following changes:

decrease in hemoglobin, red blood cells and reticulocytes (young cells, precursors of red blood cells);
increase in the number of leukocytes;
accelerated ESR;
hypoproteinemia (decrease in total protein in the blood);
violation of the ratio of protein fractions (decreased albumin and increased alpha globulin);
increased alkaline phosphatase activity;
the appearance of C-reactive protein;
decrease in the content of potassium and other trace elements.

The severity of changes in biochemical parameters corresponds to the severity of the disease.

A coprogram and stool analysis for dysbacteriosis, and stool culture for pathogenic microflora are also prescribed to exclude another cause of diarrhea.

An endoscopic examination of the intestine is mandatory - colonoscopy (examination of the intestine from the inside using a flexible endoscope equipped with fiber optics and a microcamera).

Endoscopic changes in the mucosa can vary depending on the extent of intestinal damage and stage.

According to the endoscopic picture, the following phases of Crohn's disease are distinguished:

The infiltration phase, in which inflammation invades the submucosal layer of the intestinal wall. In this case, the mucous membrane has a matte surface, the vascular pattern is not visible. Small erosions resembling aphthae with a fibrinous coating may be detected.
The ulcer-fissure phase is characterized by the appearance of individual or multiple deep ulcers (involving the muscular layer of the intestinal wall). Cracks in the mucous membrane intersect with each other, creating a “cobblestone street” picture. The intestinal lumen in the affected area is narrowed due to pronounced edema not only of the submucosal layer of the intestinal wall, but also of its deep layers.
The scarring phase is characterized by the presence of granulomas and the formation of an irreversible narrowing of the intestinal lumen.

During endoscopy, material is taken for biopsy - its histological examination allows to confirm the diagnosis.

When X-ray examination (with double contrast), characteristic signs of Crohn's disease are segmental lesions of the intestine, uneven, wavy contours. Ulcers may be found in the colon. Haustration (ring-shaped protrusions of the wall of the large intestine) below the lesion segment is preserved.

CT, MRI, ultrasound, and immunological studies can also be used.

Crohn's disease must be differentiated from a protracted course of intestinal infection, malabsorption syndrome, and intestinal tumors. It also has many similar manifestations to Crohn's disease. But there are also differences. With Crohn's disease, the pain syndrome is more pronounced, but there is less blood in the stool, there are no painful spasms during defecation, the rectum is less often affected, and the volume of feces during bowel movements is more abundant.

Treatment

The intestinal mucosa in this pathology resembles a “cobblestone street.”

For Crohn's disease, conservative and surgical treatment is used. During the period of exacerbation, children are hospitalized in the gastroenterology department and are prescribed bed rest. Outside of exacerbation, a gentle regimen with minimal physical activity is recommended.

Conservative treatment is selected individually, taking into account the age of the child and the severity of the disease. Treatment is aimed at suppressing inflammation and eliminating intoxication, transferring the disease into remission.

The components of complex conservative treatment are:

diet therapy;
use of 5-aminosalicylic acid derivatives;
antibiotic therapy;
corticosteroid drugs (for severe forms of the disease);
probiotics;
enterosorbents;
enzyme preparations;
vitamin and mineral complexes;
iron supplements (with ).

Diet therapy

In the acute phase of the disease, the diet corresponds to table No. 1 according to Pevzner. In case of severe exacerbation, a semi-starvation diet may be prescribed for 1-2 days: it is allowed to drink acidophilus milk, low-fat kefir, slightly sweetened tea, grated or baked apple.

You need to feed your baby in small portions 5-6 times a day. Food should be pureed and warm. As the exacerbation subsides, new products are gradually introduced with the permission of the attending physician, and the child is transferred to table No. 4 according to Pevzner.

Dishes are prepared by boiling, baking or steaming. The ratio of proteins, carbohydrates and fats, the volume of meals and liquid consumed per day is calculated by the doctor depending on the age of the child.

Allowed:

pureed mucous soups in a second broth (meat or fish);
mashed in water (except millet, buckwheat, pearl barley, corn);
e puree;
chicken and rabbit meat in the form of soufflé or minced meat, steamed meatballs (without seasonings or gravy);
crackers (from white bread);
mashed (or in the form of casseroles);
steam omelette;
jelly and jelly (from blueberries, bird cherry, pears).

Stewed vegetables (cauliflower), small noodles, low-fat fermented milk products, mild cheese (preferably grated) are gradually introduced. Casseroles should not have a crispy crust. A new product is introduced every three days and the child’s condition is monitored. If pain, bloating or diarrhea occurs, the irritant is excluded from the diet. Another product is then introduced no earlier than 3-5 days later. Any expansion of the diet must be agreed with a doctor.

The following should be excluded from the diet:

fatty meat (lamb, pork, goose, duck);
sausages;
fish and meat, canned vegetables;
smoked;
pickle, okroshka;
milk soup;
raw vegetables;
, radish, horseradish, radish, ;
legumes;
sour berries;
grape juice;
ice cream;
chocolate.

The consumption of sweets should be minimal.

Drug therapy

Among antibiotics, broad-spectrum drugs and antibacterial agents (Metronidazole) are used. The most pronounced effect is obtained when prescribing 5-aminosalicylic acid drugs (Sulfasalazine, Mesalazine, etc.).

In the acute phase, corticosteroids (Dexamethasone, Prednisolone, Hydrocortisone) are used in severe cases. In rare cases, cytostatics are used (Cyclosporine, Azathioprine).

In severe cases of the disease, severe electrolyte imbalances and the development of hypoproteinemia (severe protein deficiency in the body), intravenous drips of electrolyte solutions, plasma, amino acid solutions, and albumin are used.

To improve food digestion, enzyme preparations (Pancreatin, Creon, etc.) are used. To restore microflora imbalance, probiotics (Bifidumbacterin, Bifiform, Bifikol, etc.) are prescribed. Enterosorbents (Smecta, Enterosgel) are prescribed as symptomatic treatment.

Surgery

If complications develop, surgical treatment is performed - the affected area of the intestine is removed, its patency is restored by performing an anastomosis, and the fistulas are excised. But, unfortunately, surgery will not protect against the development of relapse of the disease.

Prevention

It is difficult to prevent the occurrence of Crohn's disease without knowing the exact cause of its development. Acute intestinal infections should be prevented or treated correctly. It is important to strengthen the child’s immunity, eliminate psychological trauma, and ensure regular medical supervision of the child’s development. If Crohn's disease occurs, every effort should be made to prevent exacerbations.

Forecast

It is impossible to cure a child from Crohn's disease. With proper and persistent treatment, remission can be achieved, sometimes long-term, improving the child’s quality of life. The prognosis for life depends on the severity of the disease and the complications that develop.

Summary for parents

Crohn's disease is a serious and incurable disease. Attentive attention to the child’s health and regular medical supervision will help prevent the severe development of the disease. Lifelong adherence to the diet and treatment under the supervision of a gastroenterologist will ease the course of the disease and put it into remission.

– chronic nonspecific granulomatous inflammatory disease of the digestive tract with predominant localization of foci of inflammation in the small intestine. The main symptoms are abdominal pain and diarrhea. During periods of exacerbation, general signs of inflammation are present (fever, weakness). Crohn's disease in children leads to developmental delays and other manifestations of malabsorption. The formation of fistulas, fistulas, and the development of intestinal obstruction are typical. It is diagnosed clinically and confirmed by the results of a comprehensive instrumental examination. Treatment is aimed at achieving and maintaining remission.

General information

Crohn's disease in children is often called terminal ileitis, since it is this localization of inflammation that is most characteristic of this disease. The frequency of occurrence in the population does not exceed 0.1%. Most often diagnosed in adolescence. The relevance of Crohn's disease in pediatrics is very high. This is due to the chronic course of the pathology; for this reason, all therapy provided is palliative. In addition, at present, the causes of the development of the disease remain unclear, so preventive measures are impossible. The quality and life expectancy are significantly reduced; Crohn's disease in children contributes to the structure of child mortality and disability.

Causes and classification of Crohn's disease in children

The etiology of the disease continues to be studied. A certain role is assigned to bacteria and viruses, medications, and the structure and functioning of the intestines. Along with genetic predisposition, all of these factors can trigger acute inflammation in the intestine with the development of granulomas in the submucosal layer, characteristic of Crohn's disease in children and adults. Patients have an imbalance of cytokine regulation with a predominance of pro-inflammatory cytokines. The permeability of the intestinal wall is increased, which contributes to a significant increase in the antigenic load on the body.

Crohn's disease in children can affect all parts of the digestive tract. According to localization, terminal ileitis (occurs most often), colitis, ileocolitis, damage to the anorectal region, and upper gastrointestinal tract are distinguished. Mixed forms are also possible. Anatomically, fistula-forming, stricture-forming and inflammatory-infiltrative forms are distinguished. In the first case, clinical manifestations are associated with the formation of fistulas. In the second case, Crohn's disease in children is manifested by symptoms of intestinal obstruction and a related condition caused by stenosis of the intestinal lumen. The clinical picture of the inflammatory-infiltrative form of the disease is dominated by stool disturbances, fever, symptoms of malabsorption, associated developmental delays and weight loss.

Symptoms of Crohn's disease in children

The disease is characterized by an undulating course with alternating periods of exacerbation and remission, often asymptomatic; periods of complete absence of clinical signs are less common. There are typical intestinal and extraintestinal manifestations of Crohn's disease in children. The most common gastrointestinal symptoms, occurring in almost all patients, are diarrhea and abdominal pain. The pain is cramping and its intensity is usually insignificant. When foci of inflammation are localized in the stomach and esophagus, there is a feeling of heaviness, nausea, and vomiting. As Crohn's disease progresses in children, the pain may be accompanied by bloating. Tenesmus is rare.

Diarrhea is also one of the main symptoms. The disease can begin with changes in stool. The frequency of bowel movements varies, and there is a connection with the location of the foci of granulomatous inflammation - the higher the gastrointestinal tract lesion is localized, the more severe the diarrhea. Rarely, small amounts of blood are found in the stool (usually in the acute phase with the formation of fissure ulcers). Prolonged diarrhea in Crohn's disease in children is accompanied by symptoms of malabsorption. The child has a deficiency of fat-soluble vitamins (A, D, E), calcium, iron and other micronutrients. This is due to the lag in physical development. Inflammation is manifested by fever, general weakness, and loss of body weight. The most common extraintestinal manifestations are arthralgia, aphthous stomatitis, sacroiliitis, erythema nodosum, iridocyclitis, etc.

Diagnosis of Crohn's disease in children

Certain signs of the disease are characteristic of many other intestinal pathologies. In addition, Crohn's disease is rare in children, which, together with nonspecific symptoms, causes difficulties in diagnosing the disease. A pediatrician can clinically suspect Crohn's disease by the presence of diarrhea and pain, for which there are no other explanations. Developmental delays, weight loss, and the presence of inflammatory bowel diseases in relatives can also indicate a diagnosis. To exclude other nosologies, a complex of instrumental examination methods is carried out.

Plain radiography of the abdominal organs is performed with double contrast. This allows you to evaluate the intestinal lumen, its width and structure. Thus, it is often possible to visualize areas of inflammation in a “cobblestone” type. A similar pattern occurs only with this disease and is caused by many intersecting cracks in the intestinal wall. Crohn's disease in children is often manifested by fistulas (external and internal), which can also be detected x-ray or noticed during examination if the fistula opens onto the skin. The disease often involves perianal localization of fistulas, as well as other pathologies in this area: cracks, ulcers, perirectal infiltrates.

Irrigoscopy is performed. To exclude pathologies of the large intestine, sigmoidoscopy with biopsy is performed. Even in the absence of granulomas, signs of inflammation characteristic of Crohn's disease in children are often detected histologically. Colonoscopy, like sigmoidoscopy, allows you to visualize the intestinal mucosa, which may look like a “quilt” in the infiltration phase and a “cobblestone pavement” in the ulcer-crack phase. Individual erosions and areas of irreversible stenosis can be seen. General blood tests confirm an acceleration of ESR and other signs of inflammation. A stool examination is required to identify other causes of diarrhea.

Treatment, prognosis and prevention of Crohn's disease in children

Therapeutic measures are aimed at achieving and maintaining remission. A special diet is indicated. The goal is to increase the absorption of nutrients for the normal physical development of the child. Special high-molecular mixtures are prescribed. Aminosalicylates are the main group of drugs in the drug treatment of Crohn's disease in children. Anti-inflammatory therapy is carried out using corticosteroids, including local agents in the small intestine. One of the relatively new methods is the use of biological drugs, in particular TNF-α inhibitors.

Sometimes cytostatics are used in the treatment of Crohn's disease in children. In the presence of intestinal complications, antibiotics are indicated. Surgical treatment is mandatory in case of development of intestinal obstruction, fistulas, or intestinal abscesses. Indication for surgery is also the ineffectiveness of conservative therapy methods. Resection of part of the intestine is carried out only in extreme cases and is performed as sparingly as possible. This often leads to the maintenance of remission, but the inflammatory process inevitably resumes in another part of the gastrointestinal tract. In the postoperative period, a course of treatment with corticosteroids and antibiotics is carried out.

Crohn's disease is a chronic inflammatory disease of an autoimmune nature. It affects the entire gastrointestinal tract, causing the patient a lot of inconvenience. Traditionally, the disease occurs in adolescents aged 12 to 18 years, less often in children under 7 years of age. Crohn's disease in children has many symptoms, but it can and should be treated.

Collapse

This disease has a chronic nonspecific granulomatous nature. In other words, it is an inflammatory process in the gastrointestinal tract. The disease primarily affects the terminal portion of the small intestine. Despite the chronic process, the disease progresses relatively quickly. With its development, characteristic nodular changes and granules on the walls appear in the intestine. Lesions can form in all parts of the gastrointestinal tract, including the stomach, although they are predominantly found in the small intestine.

The disease is characterized by an inflammatory process in the intestines

The disease is distinguished by the fact that it reduces the resistance of local microflora to various pathogenic pathogens. As a result, an uncontrolled inflammatory process develops, and this is already dangerous not only for the child’s health, but also for his life.

Crohn's disease provokes a gradual narrowing of the intestinal lumen, which makes the passage of feces more difficult. Lack of neuromuscular coordination leads to constant diarrhea. Severe pain appears and the intestinal microflora is disrupted. The inflamed tissues of the affected organ are unable to absorb water and electrolytes in the required quantities, which threatens the body with dehydration.

This disease is quite simple to diagnose only when the inflammatory process has already developed. This is due to the fact that in latent form it successfully disguises itself as other diseases of the digestive tract. The disease can remain in this kind of suspended animation from several months to three years.

Crohn's disease is difficult to diagnose until the inflammatory process begins

Lack of timely treatment is a guarantee of rapid spread of the inflammatory process to all organs of the gastrointestinal tract.

Symptoms intensify, the patient’s well-being deteriorates significantly. In addition, advanced cases are much more difficult to treat.

To date, the exact cause in children has not been fully studied. What is certain is that there is a corresponding predisposition for this. In general, young patients who:

bad genetics (someone in your family has already had this disease);
nutrition is incorrect, unbalanced or of poor quality;
microorganisms were found in the intestines that are similar in structure to Koch bacilli - these are bacteria that cause tuberculosis;
problems were identified with the native flora, including opportunistic ones, which negatively affect the state of the child’s immune system.

Course of the disease

Crohn's disease has three phases that logically follow each other.

Stage	Phase name	Description
First	Infiltration	In other words, it is a process of infection. Inflammation occurs in the submucosal layer. Outwardly, it is almost invisible, and therefore does not cause any negative symptoms. The surface of the mucosa becomes matte, the vascular pattern disappears. As the inflammatory process progresses, superficial erosions, nodules, and granulomas appear here. Their distinctive feature is that the contents include fibrins - special blood proteins responsible for localizing inflammation and preventing the spread of toxins throughout the body
Second	Formation of ulcers and cracks	Damage to the mucous layer becomes deeper, as a result of which the muscles of the affected organ are also affected. Ulcers and cracks appear, tissues swell. All this leads to the fact that the lumen in the intestine narrows
Third	Scarring	Ulcers and other structural damage to the mucosa begin to scar. As a result, rough connective tissue lacking elasticity is formed. When it grows, stenosis occurs - a narrowing of the walls of the organ, which cannot be corrected. Characteristic irregularities and bumps form on the inner walls of the colon.

Symptoms of Crohn's disease in children depend on where exactly the inflammatory process is localized. However, there are also general symptoms that, first of all, parents should pay attention to, since the child, due to the specificity of the problem, can hide it from prying eyes.

These symptoms include:

severe diarrhea. The more the intestines are affected, the more often the child visits the restroom. He can go there ten times a day. All this negatively affects the state of the gastrointestinal tract, irritates the small intestine, and also worsens the psychological state of the patient. Minor traces of blood can also be observed in the stool - this indicates that ulcers and cracks have already formed on the mucous membrane;
sudden loss of body weight. The reason is a significant decrease in the intestines’ ability to absorb nutrients. In a short period, a child can lose up to ten kilograms of live weight;
stomach ache. This is a classic symptom for almost all diseases of the gastrointestinal tract, including Crohn's disease. Pain can be localized in different places, depending on which organ is affected by the disease. The painful syndrome is characterized by paroxysmal episodes and can be severe or minor. As the disease progresses, the pain intensifies. It manifests itself especially strongly when the patient eats or visits the toilet. If the stomach is affected, the child also feels nausea, heaviness in the stomach, and sometimes vomits. If the problem is not treated, the pain syndrome becomes unbearable, and bloating occurs;
general weakness, increased temperature to subfebrile levels - approximately 37.5 degrees;
due to damage to the intestinal mucosa, its ability to absorb beneficial substances such as magnesium, iron, zinc, as well as water and electrolytes, is impaired. Against this background, iron deficiency anemia and vitamin B12 deficiency develop. Swelling appears, the patient experiences delays in growth and development. The metabolic process of proteins, fats and carbohydrates is disrupted.

Extraintestinal symptoms are also present, that is, those that are not related to problems with the gastrointestinal tract. As a rule, they appear only during exacerbations of the disease, or when it is at the extreme stage of its development.

Main symptoms: loss of weight and appetite, abdominal pain, general malaise

These symptoms include:

inflammation of the mucous membrane of the eyes;
a feeling of body aches, especially in the spine;
development of aphthous stomatitis;
skin lesions, predominantly expressed in erythema nodosum.

It is important to understand that visiting the toilet so often will inevitably lead to negative symptoms in the rectum. Diarrhea provokes the development of problems such as irritation of the skin around the anus and rectal mucosa, swelling of the anal folds, the formation of fistulas, etc.

Treatment of this disease is extremely complex. It is impossible to achieve a positive result using only one technique. In fairness, it should be noted that the prognosis, subject to timely initiation of therapy and its adequacy, in the vast majority of cases is positive. This is facilitated by a young, healthy body, growing, and therefore striving to get rid of the annoying problem.

Drug treatment of the disease

Therapy should include:

drug treatment;
psychological assistance;
good nutrition;
surgical intervention (only if necessary).

How to eat properly with this disease? Considering that it affects the digestive system, there is nothing strange in the fact that food must be safe, high-quality and healthy. This is the basis for successful treatment; accordingly, the diet is developed with the direct participation of the attending physician. The choice of products may vary, but the general principles always remain the same:

calorie content should be normal - not low and not high;
fish and other seafood should be included in the diet;
meat can be consumed, but it should be of medium fat content;
It is strongly recommended to give up grains - wheat, rye, barley, corn, oats, etc.;
Do not consume any dairy products.

As for drug therapy, preference is given to glucocorticosteroids and antibiotics. In the case of children, drugs such as Dexamethasone, Hydrocortisone, and Metronidazole have demonstrated the greatest effectiveness. Therapy should include probiotics and enzymes, for example, Pancreatin, immunosuppressants (Cyclosporine and others), various painkillers and antispasmodics.

It is also important to successfully combat diarrhea, as it entails dehydration. To do this, it is recommended to take antidiarrheal drugs and especially sorbents that absorb toxins released during the inflammatory process.

Surgery is prescribed only if drug therapy along with proper nutrition does not give the desired result. The purpose of the operation is to excise the inflammatory focus in the gastrointestinal tract, expand the narrowed lumen and completely restore the functionality of the affected organ.