Crohn's Disease

• Regional enteritis; involves any region of GI tract from mouth to anus
• Transmural; granulomas
• Segmental, “skip lesions”
• Initial presentation in children often involves ileum and colon, but may involve small bowel alone
• Diarrhea: less frequently bloody
• Fever, weight loss, anorexia, abdominal pain (colicky & worse after meals); growth failure common
• Extra-intestinal manifestations more common than in UC; include:
  • GI related (mucocutaneous): oral aphthous ulcers, perianal fistulae
  • Rheumatologic: arthritis, uveitis
  • Derm: erythema nodosum
• vs Ulcerative colitis' possible extra-intestinal manifestations: mnemonic My uncle is not a cronie, he brought a liver pie (not crohns=UC, anklyosing..., liver-related, pie-oderma)
  • GI related (liver): sclerosing cholangitis, chronic active hepatitis
  • Rheum (HLA-B27): ankylosing spondylitis
  • Derm: pyoderma gangrenosum

Labs may include

• anemia
• Fe deficiency
• elevated ESR
• elevated platelet count
• low albumin
• elevated stool alpha-1-antitrypsin.
• ASCA (anti-saccharomyces cerevisiaeantibodies) in 55% of children (only 5% in UC)

Radiological findings: ulcers, thumb printing, skip areas

Therapy:

• Aim of treatment is to alleviate symptoms
• steroids, aminosalicylates, sulfasalizine, azathioprine, 6-MP
• nutritional support
• Additional therapy:Abx (metronidazole or ciprofloxacin) for perineal lesions of Crohn’s
• Surgery usually not indicated since up to 50% recurrence rate and potential complications

CHLA Board review 2005