Crones Disease in young children

[Gary-Anderson]

Posted By  HFHSM.D.-bb on February 26, 1998 at 23:48:15:

In Reply to: Crones Disease in young children  posted by Gary Anderson on February 11, 1998 at 01:49:42:

: Our 5 year old grandson has recently been diagnosed as having Crones Disease.  We are not able to find much information about the disease, it's prognosis, how it is controlled.  He seems to have a mild case with frequent upset stomach after he eats.  He has recently  had an endoscopy and colonoscopy;  although there is no visual indication of disease a biopsy indicates that the disease is present.  He has infrequent diarrhea.  He does not vomit.  He is small (height & weight) for his age.  Will the disease affect his growth?  Will he "out-grow" the disease?  Will it be a lifetime problem that he will have to adjust to?  Is it fatal?  Can it be controlled by medication or resolved by surgery? Are there any support groups in the Northwest or available through Email?  We have lots of questions but not many answers and there doesn't seem to be much written about it.  Can you help us and our son's family find more information or share what you can?  Any help would be greatly appreciated.  Responses from readers who have or live with someone who has the disease would also be appreciated.   **Gary Anderson

[HFHSM.D.-bb]

February 21, 1997
Re:  Crones (Crohn’s) disease in young children
Dear Gary Anderson:
     Crohn’s disease is one of the two most common types of chronic inflammatory bowel
disease.  This disease most commonly begins from fifteen to twenty years of age but can occur
in the first ten years of life, as you have found in your grandson.  The disease can affect any area
of the bowel, from the mouth to the very end.  The affected areas are usually at the location  where
the small intestine meets the large intestine or in the large intestine.  The disease usually involves
the full width of the bowel in the affected areas but may begin on the inner lining only and later progress.
The inflammation or injury of the bowel results in local swelling and redness that later causes ulcers
in those areas like canker sores (i.e. aphthous ulcers).  In some cases, the disease will then cause
scars to form which may cause a bowel obstruction in extreme examples.  Another possible occurrence
is an abnormal communication or opening  between segments of the bowel known as a fistula which can occur in severe cases.  The specific cause of Crohn’s disease is not known, although a tendency to occur
in families has long been recognized and a disease gene(s) has been located on a specific chromosome.
The disease appears to be be triggered by some agent in the environment but a specific infection has never been isolated as the cause.  It is well known that certain individuals seem to be more susceptible than others.  
     If untreated, Crohn’s disease will lead to the complications referred in the above paragraph.  In
children, there is the added complication of a reduced rate of growth.  Because Crohn’s disease is
a life-long condition and never goes away on its own, prompt measures must be taken to treat this disease
as soon as the diagnosis is firmly established.  The medical therapy usually begins with the use of the drug
prednisone, a type of cortisone, or other related drugs.  Prednisone is not permanent therapy since it may
also reduce the growth rate and cause other side effects but is ideal as a starting medication.  Drug therapy
also includes 5-aminosalicylic acid compounds which are particularly useful when Crohn’s disease affects the colon or large intestine.  In cases where a patient responds to prednisone but the effect does not last
when the medication is slowly removed, alternative medication can be tried to reduce the dependency on
the prednisone.  Of all the possible choices, azathioprine (Imuran) appears to provide the best benefit in
keeping the disease quiet and allowing the child to conduct a normal life in such extreme cases.  In the
situations where drugs are not sufficient or bowel complications occur, surgery becomes an option in select
cases.  Surgery is most useful when the disease is confined to one single location such as where the small
intestine joins to the large intestine but may be necessary in any case if there is a blockage or a rupture.
Unfortunately, surgery is not a cure and the disease can be expected to eventually come back but surgery
commonly results in marked improvement, particulary in the child with growth delay.  Lastly, good
nutrition is a firm foundation for treatment in anyone with Crohn’s disease and under the right conditions
may actually cause a temporary remission of the disease.
     If Crohn’s disease is properly recognized and treated, complications can generally be avoided and
the individual can lead a normal life.  Since complications can and do occur, careful ongoing evaluation
is necessary in every case.  In cases involving children,  a pediatric gastoenterologist is required because
of the above issues.  In addition, support groups exist at either local or national levels to assist in
answering your very good questions.   A particularly useful group is the Crohn’s & Colitis Foundation
of America, Inc., whose national office is located at 386 Park Avenue South, 17th Floor, New York,
N. Y., 10016-8804.  This organization has plentiful brochures and other information and they can also
be reached by phone at [phone].  
If you are in the Detroit area and wish to have your grandson evaluated, please contact [phone] and request an evaluation with William M. Belknap, M.D, one of our experts in pediatric
gastroenterology  
This information is presented for informational purposes only and should not be interpreted as a formal medical consultation.  If you have specific questions, please contact a physician and request evaluation.
HFHSM.D.-bb
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keywords: crohn’s disease, pediatrics