Crohn disease in children

The incidence of Crohn disease in children is increasing. Children may have an insidious presentation with any combination of:

• gastrointestinal symptoms (eg pain, altered bowel habits, mouth ulcers)
• perianal symptoms (eg perianal abscess, perianal fissure)
• extra-intestinal symptoms (eg fatigue, recurrent fevers, arthritis, arthralgia, pathognomonic skin manifestations)
• growth or nutritional problems (eg weight loss, short stature, delayed puberty).

Symptoms of Crohn disease in children younger than 6 years may be the presenting symptoms of a variety of monogenic disorders.

Useful biomarkers in children with Crohn disease (in the absence of infection) include elevated C-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR), thrombocytosis and hypoalbuminaemia. In children older than 4 years, faecal calprotectin testing is a useful screening test for Crohn disease because it indicates whether an endoscopy is required.

Management of Crohn disease in children varies according to the severity and distribution of inflammation. Induction therapy may include metronidazole, a 5-aminosalicylate, exclusive enteral nutrition, corticosteroids (eg budesonide, prednisolone) or a tumour necrosis factor (TNF) inhibitor. Maintenance therapy may include a thiopurine (eg azathioprine), methotrexate or a TNF inhibitor.