Original paper
Crohn’s disease in children and youth – clinical observations

Crohn’s disease is more frequently diagnosed in children and teenagers. The clinical symptoms depend on localisation, extension and disease stage in the gastrointestinal tract and they are less characteristic in comparison with ulcerative colitis. The aim of the study is the analysis concerning clinical picture in children and teenagers that are actually treated due to Crohn’s disease in our Department. Patients and methods: Medical documentation was retrospectively analysed and concerned 22 children and teenagers that were diagnosed on the base of clinical, endoscopic, radiologic and histologic criteria to suffer from Crohn’s disease. The majority of patients (63,6%) comprised boys and children from agglomeration containing over 100.000 of inhabitants (54,5%). The average patients’ age at the time of establishing diagnosis was 12,8 years (from 5 years to 18 years). Results: The symptoms duration time before establishing diagnosis was from 1 month to 48 months (the average – 11 months). The following symptoms occurred as predominant: stomach-aches (81,8%), fever (63,6%), diarrhoea (59%) including half patients with periodic blood addition, malnutrition (50%). These symptoms were accompanied by anaemia (54,5%), hypoproteinaemia (45%), dysproteinaemia (22,7%). The perianal lesions were observed in 9 children (41%). The segmental lesions were found in majority of patients (72%) in the large intestine, including 4 children (18%) with coexisting inflammatory changes in the ileum and these patients presented rather insidious course of the disease, but the diagnosis was established only several months from the first symptoms manifestation. Malnutrition and periodically diarrhoea dominated as the first symptoms of Crohn’s disease. The inflammatory lesions were found in 8 children in the upper part of the gastrointestinal tract (36,6%). These lesions coexisted with segmental changes in the large intestine in 5 children, but one child additionally presented changes in the ileum. Aphthae in the oral cavity were observed in 5 children (22,7%). The parenteral symptoms were observed rarely and they usually preceded manifestation of typical symptoms; 3 children showed articular symptoms (13,6%) and 2 children presented dermatic symptoms (erythema nodosum and gangrenous dermatitis). Typical symptoms were preceded with cholestasis in two children, but primary sclerosing cholangitis or autoimmunological hepatitis were not diagnosed. Cholestasis withdrew during the treatment. Results: Clinical picture of Crohn’s disease in children is various, but the most common symptoms are stomach-aches, fever, diarrhoea and malnutrition.