What is it about ?
The two main chronic inflammations of the lining of the intestines in children are:
- Crohn’s disease,
- ulcerative colitis.
The cause of these conditions is not yet clear. It is presumed that these are autoimmune diseases, in which the immune system turns against its own tissues.
Crohn’s disease is inherited in 20% of cases. Environmental factors and lifestyle also play a role. It is a characteristic disease of civilization. It is more common in Western Europe and North America.
What is their frequency?
These conditions affect about 15 in 100,000 children, but the number is increasing. Crohn’s disease is more common than ulcerative colitis.
Where do we meet them?
Illnesses can start at any age. When they start in childhood, it is usually at the onset of puberty.
How to recognize them?
Both diseases mainly affect the large intestine (colon). But Crohn’s disease can affect all the mucous membranes of the digestive system, from the mouth to the anus, including the small intestine and the large intestine. Ulcerative colitis remains limited to the large intestine.
The conditions often begin insidiously and the first signs are mainly intestinal symptoms:
- diarrhea,
- increased number of stools,
- nocturnal bowel movements,
- occasional presence of blood in the stool,
- stomach aches,
- gurgling in the stomach.
These signs can be accompanied by weight loss and sometimes fever. The child often looks pale. A child’s growth may be slowed down and puberty delayed.
In Crohn’s disease, canker sores can form in the mouth, redness of the lining of the mouth, and growths in the anus that look like warts.
How is the diagnosis made?
If you have persistent abdominal symptoms, your doctor will do a physical examination, then usually order a blood and stool test. The presence of bacteria, blood (residues) and the calprotectin protein is thus tested in the stool. Testing for calprotectin is not, however, reimbursed for disease screening. Its reimbursement is only foreseen within the framework of the follow-up of an established Crohn’s disease.
If the doctor suspects a disease of the intestines, he refers the child to a specialist (gastroenterologist) for an endoscopy of the intestine and stomach. In children, this examination is performed under general anesthesia. The examination makes it possible to visualize the characteristic inflammatory lesions.
If necessary, the specialist can do a biopsy. He then takes a small piece of mucous membrane from the intestines to analyze it under the microscope.
Sometimes the doctor will also do an exam of the small intestine using a CT scan or video capsule endoscopy.
What can your doctor do?
In children, ulcerative colitis is usually severe. The treatment is based on the treatment for adults, but adapted to the child. Medicines (immunosuppressants) are given to suppress (slow down) the immune system.
If there is chronic blood in the stool, iron supplements may need to be given. If the child does not respond well to treatment, tube feeding may be given temporarily. Sometimes an operation is necessary to loosen a narrowing or to remove a portion of the large intestine.
Source
Foreign clinical practice guide ‘Inflammatory bowel disease in children’ (2014), updated on 1.12.2016 and adapted to the Belgian context on 21.05.2018 – www.ebpnet.be