Inflammatory Bowel Disease in Infants and Young Children

Abstract

Gastroenterology and Nutrition| November 01 2002 Inflammatory Bowel Disease in Infants and Young Children AAP Grand Rounds (2002) 8 (5): 54–55. https://doi.org/10.1542/gr.8-5-54-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Inflammatory Bowel Disease in Infants and Young Children. AAP Grand Rounds November 2002; 8 (5): 54–55. https://doi.org/10.1542/gr.8-5-54-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: inflammatory bowel disease Source: Mamula P, Telega G, Markowitz J, et al. Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol. 2002;97:2005–2010. Inflammatory bowel disease (IBD) is a chronic disorder with unclear etiology. The prevalence of IBD appears to be increasing in both adults and children.1,2 Recent data suggest that a gene mutation on chromosome 16 (Nod2) is associated with an increased likelihood of Crohn’s disease.3 While genetic factors clearly contribute to IBD, environmental factors and altered immune response are also important in pathogenesis.4 Because of the life-long implications of IBD, it is important to diagnose and treat children early to improve their short- and long-term health. In order to identify clinical symptoms and presenting patterns, the authors reviewed the records of all children age 5 years and younger diagnosed with IBD at Children’s Hospital of Philadelphia between 1977 and 2000. A total of 94 children were identified with Early Onset (<5 years) IBD (EO-IBD); 82 of these children had complete charts for review and confirmation of IBD. Clinical symptoms at presentation included diarrhea in 81% of children with Crohn’s disease (CD), 79% of children with ulcerative colitis (UC), and 89% of children with indeterminate colitis (IC). Children with UC were more likely to have hemoccult positive stools (94%) than children with CD (67%) or IC (67%) (P=.0002). Failure to thrive (FTT) was more common in CD (44%) or IC (39%) than in those with UC (11%) (P=.004). In addition, vomiting was present in CD (15%) or IC (22%) but not in UC (P=.01). Chronic fever was associated with CD (11%) but not with UC or IC (P=.015). Most children with CD presented with colonic involvement (89%). All 4 patients initially diagnosed with UC who presented with FTT had their diagnosis changed to IC or CD (P<.0001). Testing for the presence of antisaccharomyces cerevisiae antibody (ASCA) and perinuclear antineutrophil cytoplasmic antibody (p-ANCA) was done in 15 children. None of the children with IBD tested positive for ASCA. However, 10 children tested positive for p-ANCA: 3 of 5 CD patients, 5 of 7 UC patients, and 2 of 3 IC patients. As in adult populations, IBD in children has been increasing in prevalence. It is important for the practicing pediatrician to know that EO-IBD does occur and that its clinical presentation is often subtle when compared to IBD presentation in adolescents and adults. Serological markers of ASCA and p-ANCA have been shown to be very useful in the diagnosis of IBD in adults,5 the former being more specific for Crohn’s disease and the latter for UC. These markers are used in conjunction with endoscopy, laboratory tests, and clinical symptoms and help categorize patients into Crohn’s, ulcerative colitis, or indeterminate colitis. The authors point out that these antibody markers lack specificity in EO-IBD in children when compared with adults. Whether the ASCA antibody in Crohn’s patients takes years to develop,... You do not currently have access to this content.