Crohn’s Disease in Children and Adolescents
What is Crohn’s disease?
Crohn’s disease is a form of inflammatory bowel disease (IBD) that affects the gastrointestinal (GI) tract, causing inflammation in one or more parts of the intestine. Crohn’s disease can affect any one or multiple parts of the GI tract, causing inflammation anywhere from the mouth to the anus. It most commonly affects the lower part of the small intestine (ileum) and the colon, which is part of the large intestine.
Because the immune system improperly attacks the GI tract, Crohn’s disease is considered an autoimmune condition. It is chronic (ongoing), and if not properly controlled in young patients, it can lead to permanent damage of the intestine as well as affecting growth, puberty, and bone health. There is no cure for Crohn’s disease but with medical management, diet and lifestyle changes, and surgery, many children with Crohn’s live active lives and sometimes achieve long-term remission.
Anyone can develop Crohn’s disease, but it is more common in some families. Many people develop the disease during adolescence. Crohn’s disease affects the whole family because it impacts a child’s ability to eat and have bowel movements.
How does Crohn’s disease affect the intestine?
Inflammation caused by Crohn’s disease interrupts the intestine’s normal functioning in a number of ways. Crohn’s disease can cause:
- Malabsorption, or the inability for the intestine to absorb nutrients
- Ulcers, or raw areas and sores which develop in deep layers of the intestinal tissue.
- Intestinal stricture, or a narrowing of the intestine which can develop and lead to a blockage
- Intestinal fistula, or an abnormal passageway which forms between two parts of the intestine or between one part of the intestine and nearby tissues
What causes Crohn’s disease?
There is no single cause of Crohn’s disease, but research shows that it is caused by a combination between genetics and environmental factors. Some of the genetic contributions to Crohn’s disease are known, but not everyone with these genetic changes develops the condition.
Scientists believe that environment and diet play a role as well. The specific environmental factors that cause Crohn’s disease are currently unknown.
What are the symptoms of Crohn’s disease?
Many symptoms of Crohn’s disease are similar to symptoms of other GI issues. Symptoms often develop gradually although in some cases they develop more suddenly. Children with Crohn’s disease can experience periods of symptoms followed by periods of remission (no symptoms). If your child is actively experiencing symptoms of Crohn’s disease, they may include:
- Belly pain
- Low appetite
- Diarrhea or loose stools
- Blood in the stool
- Unexplained fevers or fatigue
- Weight loss
- Inability to gain height
Less common symptoms include:
- Joint pain
- Eye pain
- Delayed growth
How is Crohn’s disease diagnosed?
To diagnose Crohn’s disease your child’s physician will conduct a full medical examination and family history. Your child will also be scheduled for some tests, which may include:
- Blood tests to check for anemia and inflammation.
- Stool sample to check for blood in the stool.
- Imaging studies may include magnetic resonance enterography (MRE), CT scan, barium X-ray, DEXA scan and/or bone age assessment.
- Colonoscopy examines the colon and the small intestine.
- Endoscopy uses a tiny camera to examine the small intestine.
- Biopsy tests tissue samples that are taken during a colonoscopy or endoscopy.
If you or your child has received a diagnosis of Crohn's disease and would like a second opinion or opportunity to discuss treatment options, please make an appointment with the Pediatric Inflammatory Bowel Disease Center.
How is Crohn’s disease treated?
With advances in knowledge about IBD over the past decades, there are now many treatment options for Crohn’s disease, including nutritional therapy, medications that suppress the immune system, and surgery. With proper treatment and long-term monitoring, many people with Crohn’s disease are able to live full and active lives.
The goal of treatment is to reduce symptom flareups, maintain nutrition, and relieve symptoms during flares.
Medications will most likely be part of your child’s long-term treatment plan. Medications are sometimes used in combination with each other, and they may be given orally, by injection, or intravenously.
- Antibiotics may be prescribed when infection is a concern, or in combination with other medications.
- Steroids help reduce inflammation during a flareup of symptoms. They can also relieve symptoms such as rectal bleeding, fever, and joint pain. Steroids may be given orally, topically, or intravenously.
- Immunomodulators decrease immune system activity. They are generally used for patients who are not responding to other treatments.
- Biologics target specific proteins that are known to cause inflammation. They are generally given intravenously to children in whom traditional medical therapy is not working or is causing side effects.
Children need proper nutrition in order to grow and develop strong bones, and intestinal inflammation caused by Crohn’s disease can prevent the absorption of key nutrients. Nutritional therapy is an important component of treatment and may be used in combination with one or more medications. Nutritional therapy may include:
- Specialized diets: Research has shown that certain diets may reduce intestinal inflammation and promote healing.
- Enteral nutrition therapy: A form of treatment in which all nutrition and calories are taken in liquid form, either orally or through a tube, for six to 12 weeks, to treat inflammation and ensure proper nutrition. Learn more about enteral nutrition therapy.
- Nutrition support: Your family will work with a nutritionist to monitor your diet, make sure you are is getting proper nutrition for your growth, and navigate the challenges of restricting diets in children and adolescents.
For some people, surgery is an option, especially for those who do not respond to medications or when medications stop working. Surgery for Crohn’s disease is called resection. A portion of the intestine that is damaged is removed and the remaining parts are reconnected. Resection can help you respond to medications or provide important relief from symptoms. Resection is generally a temporary solution, because symptoms tend to recur.
People with Crohn’s disease require lifetime monitoring by a gastroenterologist with expertise in inflammatory bowel conditions. In children and adolescents, this is particularly important because they are still growing. Monitoring will be a key component of your treatment plan, so that we can help make sure treatment is leading to normal growth and development.