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.

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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 has begun

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:

• caloric 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.

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Conservative treatment

Most children with Crohn's disease can receive long-term outpatient treatment, one of the main components of which is a high-calorie diet with a high protein content and the exclusion of roughage. If you are intolerant to milk, it is also excluded. In cases of steatorrhea, a diet low in fat and supplemented with triglycerides is indicated. It is useful to eat a light snack between regular meals.

Sulfasalazine (azulfidine) is used, although it is less effective for Crohn's disease than for UC. Steroids are prescribed in the following cases:

• when conservative therapy does not allow the condition to improve, but there are no indications for surgical treatment yet;
• when a patient is admitted to the hospital in a state of severe exacerbation with symptoms of toxicosis; (3) in patients suffering from extraintestinal manifestations of the disease (arthralgia, skin lesions) that are not amenable to conservative treatment by other methods; (4) in patients with severe widespread inoperable enteritis.

Azathioprine (Imuran) is used to treat the chronic form of the disease, although controlled studies suggest that this drug may be only slightly more effective than placebo. In addition, 5% of patients receiving long-term azathioprine and prednisone develop neoplasms, which is 80 times higher than the incidence in the general population. Cyclosporine was also used when other methods of conservative therapy were ineffective and, moreover, with a slightly more pronounced effect than azathioprine.

With long-term use of these drugs, serious side effects may occur, in particular toxic kidney damage and increased susceptibility of patients to infectious diseases. In some patients, during exacerbations, it is possible to use low doses of antibiotics, such as metronidazole (Flagyl), which have minimal side effects. After ileal resection, cholesterol may be used to treat diarrhea.

In case of severe Crohn's disease or an increase in eating disorders, despite outpatient therapy, the child must be hospitalized. Parenteral nutrition, abolition of feedings, elimination of electrolyte disturbances, deficiency of vitamins and microelements allow in most cases to achieve an improvement in the condition of patients.

Surgical treatment

Although surgical treatment of Crohn's disease rarely leads to recovery and, in addition, is associated with a high rate of relapse of the disease, in some patients the operation provides significant clinical improvement and allows reducing the dose of medications or stopping their use altogether. Surgical treatment is indicated for complications of Crohn's disease (including intestinal obstruction), growth retardation, failure of conservative therapy, the presence of intestinal (external or internal) fistulas, perirectal fistulas or abscesses, intestinal bleeding, abdominal pain and abdominal abscesses. Complete abolition of feeding and total parenteral nutrition both before and after surgery help reduce the incidence of postoperative complications and allow the majority of patients to restore their health to such an extent that they can lead a normal active life.

During a 23-year period (1967–1990) at the UCLA Medical Center, 70 patients (49 males and 21 females) under the age of 19 years underwent surgery for Crohn's disease and its complications. The average duration of illness before surgery was 3.2 years (range 3 months to 12 years). Inflammatory bowel diseases in the immediate next of kin of patients (siblings, parents, aunts and uncles) were observed in 11 cases out of 70 (16%). 7 of these relatives had Crohn's disease. During the same 23-year period, another 56 children with Crohn's disease were treated conservatively without surgery other than venous access.

Although Crohn's disease primarily affects the small intestine and cecum, in 70 operated patients it seemed appropriate to distinguish three variants of the pathology. In 39 patients, the ileocecal form was identified - damage to the terminal ileum and cecum (sometimes involving the ascending colon). In 24 patients, the changes were localized in the colon and rectum—colorectal form.

In 7 cases, only the small intestine was affected. At the time of the first operation, the average age of patients with the ileocecal form was 17.3 years, while patients with colorectal lesions tended to be somewhat younger (average age 15.2 years).

The most common indication for surgery in children with the ileocecal form was intestinal obstruction (90%), while in patients with colorectal lesions this complication required surgery in only three cases (13%). Prolonged diarrhea was the main and most pronounced symptom in only 8 of 39 children with the ileocecal form and in almost all patients with colorectal lesions. Bleeding from the rectum was observed only in the colorectal form (5 patients). Stunted growth and delayed development of secondary sexual characteristics were noted in 32% of children with the ileocecal form and in 46% of children with the colorectal form. Since almost half of the patients received steroid therapy for more than 2 years before surgery, it is difficult to say definitively whether the growth delay was due to chronic inflammation (i.e., Crohn's disease itself), to drug therapy, or both these factors.

Primary or secondary external intestinal fistulas occurred in 8 of 39 patients with the ileocecal form of the disease and in 3 of 24 with the colorectal form. In two cases, these fistulas appeared 2 years after appendectomy. 6 children with the ileocecal form had internal (interintestinal) fistulas; in one of these patients the fistula was between the intestine and the bladder. In colorectal lesions, internal fistula occurred in only one case.

Often the first manifestations of Crohn's disease were anal abscesses, fistulas or sluggish fissures, which were almost 17 times more common in patients with the colorectal form than in patients with ileocecal lesions.

In 19 of 23 patients, perirectal abscesses were opened and drained or perineal ulcers were excised, but local surgical treatment was effective in only two cases. One patient underwent perineal surgery three times before the diagnosis of Crohn's disease was made. Perineal drainage operations (before bowel resection or reduction surgery) were performed repeatedly in most patients (on average 1.6 interventions per patient).

9 of 39 children with the ileocecal form (23%) and 8 of 24 with colorectal lesions (33%) suffered from arthralgia of the knee, hip, elbow, or shoulder joints before surgery. Eight of the 70 patients had erythema nodosum, three had mild uveitis, and three had nephrolithiasis (oxalate).

In the small intestinal form of the disease, in 3 out of 7 cases the operation was performed due to intestinal obstruction and consisted of resection of a limited area of ​​the ileum. Another three patients with lesions in the ileum due to Crohn's disease developed acute abdominal pain, and the children were operated on with a diagnosis of appendicitis. The operation revealed inflammation of the ileum without signs of intestinal obstruction, and an appendectomy was performed. All patients received conservative treatment with good effect.

Indications for primary surgery in 70 patients are presented in the table. In some cases, not one, but several indications arose. Most often (38 operations out of 138), intervention was undertaken due to intestinal obstruction, accompanied by pain, eating disorders and fever. Growth retardation, usually with persistent diarrhea, pain and fever, was an indication for surgical treatment in 26 cases. 23 patients were operated on for perianal fistulas or abscesses, accompanied by constant inflammation of the rectum, and therefore the patients constantly experienced extremely unpleasant sensations.

All but two of these patients ultimately underwent ileostomy or proctocolectomy. In case of internal interintestinal fistulas (11 children) with local abscesses and intestinal obstruction (or without these complications), resection of the part of the intestine bearing the fistula was performed. Laparotomy with excision of external intestinal fistulas was performed in 5 children: in two cases as a primary intervention and in three cases after previous operations complicated by anastomotic failure.

Intravenous hyperalimentation was carried out in 59 of 70 patients and in the last 16 years it has been mandatory in absolutely all children both in the pre- and postoperative period. 17 patients received home parenteral nutrition for varying periods of time. Adrenocorticosteroids, azulfidine, or a combination of these drugs were included in the complex of drug therapy in the preoperative period in 68 of 70 children. Most patients were admitted for surgery while already receiving steroid treatment.

Over a 23-year period, a total of 138 operations were performed on 70 children. The most common intervention was drainage or excision of perianal fistulas or abscesses, performed in 36 cases. Of the abdominal operations, resection of the ileum (distal section) and ascending colon with anastomosis was most often performed - 38 patients.

K.U. Ashcraft, T.M. Holder

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.

Reasons

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:

1. 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.
2. All children experience abdominal pain. At the initial stages, they can be insignificant and unstable, 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.
3. Often the pain is accompanied by flatulence (bloating).
4. If the gastric mucosa is damaged, the child may experience nausea, a feeling of heaviness in the epigastric region, and vomiting.
5. 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:

1. 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.
2. 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.
3. 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 you 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 the imbalance of microflora, probiotics are prescribed (Bifidumbacterin, Bifiform, Bifikol, etc.). Enterosorbents (Smecta, Enterosgel) are prescribed as symptomatic treatment.

Surgical treatment

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.

Crohn's disease- chronic nonspecific progressive transmural granulomatous inflammation of the gastrointestinal tract.

The terminal part of the small intestine is most often affected, therefore there are such synonyms for this disease as “terminal ileitis”, “granulomatous ileitis”, etc. Any part of the digestive tract from the root of the tongue to the anus can be involved in the pathological process. The frequency of intestinal lesions decreases in the following sequence: terminal ileitis, colitis, ileocolitis, anorectal form, etc. Focal, multifocal and diffuse forms are also distinguished. The course of Crohn's disease is undulating, with exacerbations and remissions.

Crohn's disease is detected in children of all age groups. The peak incidence occurs between 13 and 20 years of age. Among the sick, the ratio of boys to girls is 1:1.1.

Etiology and pathogenesis

The etiology and pathogenesis of the disease are unknown. The role of infection (mycobacteria, viruses), toxins, food, and some medications, considered as a trigger for the development of acute inflammation, is discussed. Immunological, dysbiotic, and genetic factors are of great importance. A connection has been established between the HLA histocompatibility system and Crohn's disease, in which the DR1 and DRw5 loci are often identified.

Clinical picture

The clinical picture of the disease is very diverse. The onset of the disease is usually gradual, with a long-term course with periodic exacerbations. Acute forms are also possible.

The main clinical symptom in children is persistent diarrhea (up to 10 times a day). The volume and frequency of stool depend on the level of damage to the small intestine - the higher it is, the more frequent the stool and, accordingly, the more severe the disease. Damage to the small intestine is accompanied by malabsorption syndrome. An admixture of blood periodically appears in the stool.

Abdominal pain is a mandatory symptom in all children. The intensity of pain varies from minor (at the beginning of the disease) to intense cramping associated with eating and defecation. When the stomach is affected, they are accompanied by a feeling of heaviness in the epigastric region, nausea, and vomiting. In the later stages, the pain is very intense and is accompanied by bloating.

General symptoms of the disease: general weakness, weight loss, fever. With significant damage to the small intestine, the absorption and metabolism of proteins, carbohydrates, fats, vitamin B 12, folic acid, electrolytes, iron, magnesium, zinc, etc. are impaired. Hypoproteinemia is clinically manifested by edema. Characterized by delayed growth and sexual development.

The most common extraintestinal manifestations of Crohn's disease are arthralgia, monoarthritis, sacroiliitis, erythema nodosum, aphthous stomatitis, iridocyclitis, uveitis, episcleritis, pericholangitis, cholestasis, and vascular disorders.

Complications in Crohn's disease are most often associated with the formation of fistulas and abscesses of various locations, intestinal perforation, and peritonitis. Intestinal obstruction and acute toxic dilatation of the colon are possible.

Laboratory and instrumental studies

A general blood test reveals anemia (decreased red blood cells, hemoglobin, hematocrit), reticulocytosis, leukocytosis, and increased ESR. A biochemical blood test reveals hypoproteinemia, hypoalbuminemia, hypokalemia, a decrease in the content of microelements, an increase in the level of alkaline phosphatase, β-globulin and C-reactive protein. The severity of biochemical changes correlates with the severity of the disease.

The endoscopic picture of Crohn's disease is characterized by great polymorphism and depends on the stage and extent of the inflammatory process. Endoscopically, three phases of the disease are distinguished: infiltration, ulcers-fissures, scarring.

In the infiltration phase (the process is localized in the submucosa), the mucous membrane has the appearance of a “quilt” with a matte surface, the vascular pattern is not visible. Subsequently, aphthae-type erosions appear with isolated superficial ulcerations and fibrinous deposits.

In the phase of fissure ulcers, individual or multiple deep longitudinal ulcerative defects are detected, affecting the muscular layer of the intestinal wall. The intersection of cracks gives the mucous membrane a “cobblestone” appearance. Due to significant swelling under the mucous membrane, as well as damage to the deep layers of the intestinal wall, the intestinal lumen narrows.

During the scarring phase, areas of irreversible intestinal stenosis are detected. Characteristic radiological signs (the study is usually carried out with double contrast) are segmented lesions, wavy and uneven contours of the intestine. In the large intestine, irregularities and ulcerations are determined along the upper edge of the segment with preservation of haustration along the lower edge. At the stage of ulcers-cracks - the appearance of a “cobblestone pavement”.

Diagnosis and differential diagnosis

The diagnosis is established on the basis of clinical and anamnestic data and the results of laboratory, instrumental, and morphological studies.

Differential diagnosis of Crohn's disease is carried out with acute and protracted intestinal infections of bacterial and viral etiology, diseases caused by protozoa, worms, malabsorption syndrome, tumors, ulcerative colitis, etc.

Differential diagnosis of inflammatory bowel diseases

Clinical symptom	Disease
	Nonspecific ulcerative colitis	Crohn's disease
Stool with blood
Stomach ache
		None
Stool volume	Moderate	Excess
Rectal lesion	Always expressed
Perianal lesions
Relapses after surgery

Treatment

The most effective drugs are 5-aminosalicylic acid (mesalazine) and sulfasalazine. At the same time, it is necessary to take folic acid and multivitamins with microelements in an age-specific dose. In the acute phase of the disease and in case of severe complications (anemia, cachexia, joint damage, erythema, etc.), glucocorticoids (hydrocortisone, prednisolone, dexamethasone) are prescribed, and less often - immunosuppressants (azathioprine, cyclosporine).

In addition, broad-spectrum antibiotics, metronidazole, probiotics, enzymes (pancreatin), enterosorbents [diosmectite (smecta)], antidiarrheal drugs (for example, loperamide), and symptomatic agents are used to treat patients with Crohn's disease. In severe cases of the disease with the development of hypoproteinemia and electrolyte disturbances, intravenous infusions of solutions of amino acids, albumin, plasma, and electrolytes are performed. According to indications, surgical treatment is carried out - removal of the affected parts of the intestine, excision of fistulas, anastomosis to restore patency.

Prevention

Forecast

The prognosis for recovery is unfavorable; for life, it depends on the severity of the disease, the nature of its course, and the presence of complications. It is possible to achieve long-term clinical remission.