Clinical Features and Extraintestinal Manifestations of Crohn Disease in Children

Abstract

PurposeThe aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients.MethodsThe medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding baseline demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classification, and clinical features and course of EIMs were investigated.ResultsFifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean follow-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileocolonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary thromboembolism in 1 (1.4%).ConclusionPerianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD.

Dermatological Manifestations in Pediatric Inflammatory Bowel Disease

“…Korean authors report the case of a 10-year-old girl who presented with vulvitis as the initial symptom; skin biopsy set the diagnosis of MCD [ 19 ]. Anal skin tags have been described in both adult and pediatric CD as flesh-colored, waxy, painless, raised, firm, narrow or broad anal malformations that usually appear in group and may sometimes present granulomatous tissue [ 20 ].…”

COMPLICATED Crohn's disease IN ADOLESCENTS: FEATURES, INDICATIONS FOR SURGICAL TREATMENT, DIFFICULTY OF TRANSITION of care (review article)

“…Так, в доказательном консенсусе Европейского общества по изучению БК и язвенного колита (ЕССО) имеется указание, что плановая хирургия может быть показана детям при резистентности к консервативному лечению, особенно в препубертатном или пубертатном возрасте, с задержкой роста и при локальном поражении кишечника [55,61]. Экстраполяция рекомендаций для лечения взрослых пациентов не всегда применима у детей, так как есть весомые различия между течением БК во взрослом и детском возрасте, например, дети имеют тенденцию к более тяжелому течению болезни и обширным по протяженности поражениям [44,36,70,71]. В начале 90-х годов Griffiths A.M. и соавт.…”

Current issues of pediatric inflammatory bowel disease in Korea

“…In CD, inflammation can occur anywhere in the gastrointestinal tract. CD, although rarely fatal, is refractory and causes abdominal pain, diarrhea, anorexia, and weight loss ( Table 1 ) 3 , 4 , 5) . The clinical presentations of Korean children with CD were similar that observed in Western countries 6 , 7 , 8) .…”

“…This population-based study did not include a national sample; however, it clearly revealed that the incidence of IBD is on the rise in Korean adults. The onset of IBD is reported to be extremely rare in Korean children 1) ; however, recent single-center studies confirmed that the number of pediatric patients newly diagnosed with CD has increased since 2000 3 , 4) . A population-based study in children is essential to accurately determine whether the incidence of IBD is rising continuously in Korea.…”

“…Pediatric inflammatory bowel disease (IBD) was previously rare in Korea 1) ; therefore, most general pediatricians in Korea may have encountered a few cases of pediatric IBD during their training program. However, the incidence of IBD has risen in adults since 1990 2) and in children in the 2000s 3 , 4) , and its incidence continues to increase without having reached a peak. The incidence of IBD has been rapidly increasing in the last 5 years.…”