Crohn's Disease in Children: A Case Report

Authors

  • Nicodemus Nicodemus Pediatric Intensive Care Unit, Mayapada Hospital, South Jakarta, Indonesia
  • Nuraini Irma Susanti Pediatric Gastroenterologist, Mayapada Hospital, South Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.2.2.2023.32-45

Keywords:

Crohn’s disease, inflammatory bowel disease, pediatric

Abstract

Background: Crohn's disease in children is a chronic inflammatory bowel disease (IBD). The incidence of this disease has tended to increase in recent decades. This case report aimed to increase clinician insight into Crohn's disease.

Case: We reported a case of Crohn's disease, one of the inflammatory bowel disease (IBD) type in a 16-year-old boy. The patient came with complaints of loose stools without mucus and blood, accompanied by heartburn, nausea, vomiting, and decreased appetite. The patient had a history of changes in defecation patterns in the last 4 months and decreased appetite and weight loss in the last 1 month. There was epigastric tenderness on physical examination. Inflammatory markers and fecal calprotectin values were increased. Gastrointestinal endoscopy results found pangastritis and pancolitis with histopathological examination showing results appropriate to IBD. The patient received corticosteroid methylprednisolone 1 mg/kg/day as induction therapy and experienced improvement in symptoms and laboratory results after 7 days of therapy.

Discussion: There are characteristic differences between Crohn's disease and ulcerative colitis. A definite diagnosis is made by endoscopy and histopathological examination. The current goal of Crohn's disease therapy is no longer limited to improving symptoms or optimizing growth and development, but also targeting the improvement of the gastrointestinal mucosa. Remission induction therapy can be carried out with exclusive enteral nutrition or corticosteroids which are gradually reduced.

Conclusion: This case report increases clinician insight into the characteristics, approaches to IBD diagnosis, and remission induction therapy in Crohn's disease in children.

References

Oliveira SB. Diagnosis and management of inflammatory bowel disease in children. BMJ. 2017; 357:2083. https://doi.org/10.1136/bmj.j2083

Moon JS. Clinical aspects and treatments for pediatric inflammatory bowel disease. Pediatr Gastroenterol Hepatol Nutr. 2019;22(1):50-6. https://doi.org/10.5223/pghn.2019.22.1.50

Ghione S, Sarter H, Fumery M, Armengol-Debeir L, Savoye G, Ley D, et al Dramatic increase in incidence of ulcerative colitis and Crohn’s disease [1988-2011]: a population-based study of French adolescents. Am J Gastroenterol. 2018;113:265–72. https://doi.org/10.1038/ajg.2017.228

Ong C, Aw MM, Liwanag MJ, Quak SH, Phua KB. Rapid rise in the incidence and clinical characteristics of pediatric inflammatory bowel disease in a South-East Asian cohort in Singapore, 1994-2015. J Dig Dis. 2018;19:395-403. https://doi.org/10.1111/1751-2980.12641

Hong SJ, Cho SM, Choe BH, Jang HJ, Choi KH, Kang B, et al. Characteristics and incidence trends for pediatric inflammatory bowel disease in Daegu-Kyungpook province in Korea: a multi-center study. J Korean Med Sci. 2018;33:e132. https://doi.org/10.3346/jkms.2018.33.e132

Rinawi F, Assa A, Hartman C, Mozer Glassberg Y, Friedler VN, Rosenbach Y, et al. Incidence of bowel surgery and associated risk factors in pediatric-onset Crohn's disease. Inflamm Bowel Dis. 2016;22:2917-23.https://doi.org/10.1097/MIB.0000000000000937

Gevers D, Kugathasan S, Denson LA, Vazquez-Baeza Y, Treuren WV, Ren B, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe. 2014;15(3):382-92. https://doi.org/10.1016/j.chom.2014.02.005

Morgan XC, Kabakchiev B, Waldron L, Tyler AD, Tickle TL, Milgrom R, et al. Associations between host gene expression, the mucosal microbiome, and clinical outcome in the pelvic pouch of patients with inflammatory bowel disease. Genome Biol. 2015;16(1):67. https://doi.org/10.1186/s13059-015-0637-x

Hong J, Yang HR, Moon JS, Chang JY, Ko JS. Association of IL23R variants with Crohn’s disease in Korean children. Front Pediatr. 2019;7:472. https://doi.org/10.3389/fped.2019.00472

Arai K, Kunisaki R, Kakuta F, Hagiwa S, Murakoshi T,Yanagi T, et al . Phenotypic characteristics of pediatric inflammatory bowel disease in Japan: results from a multicenter registry. Intest Res. 2020;18:412-420. https://doi.org/10.5217/ir.2019.00130

Ashton JJ, Ennis S, Beattie RM. Early-onset pediatric inlammatory bowel disease. Immunol Allergy Clin North Am. 2019;39(1):63–79. https://doi.org/10.1016/S2352-4642(17)30017-2

Aloi M, Lionetti P, Barabino A,Guariso G, Costa S, Fontana M, et al. Phenotype and disease course of early-onset pediatric inflammatory bowel disease. Inflamm Bowel Dis 2014;20:597–605. https://doi.org/10.1097/01.MIB.0000442921.77945.09

Banerjee R, Pal P, Mak JWY, Ng SC. Challenges in the diagnosis and management of inflammatory bowel disease in resource-limited settings in Asia. Lancet Gastroenterol Hepatol. 2020;5:1076–88. https://doi.org/10.1016/S2468-1253(20)30299-5

Holtman GA, Lisman-van Leeuwen Y, Reitsma JB, Berger MY. Noninvasive Tests for Inflammatory Bowel Disease: A Meta-analysis. Pediatrics 2016;357. https://doi.org/10.1542/peds.2015-2126

Saha A, Tighe MP, Batra A. How to use faecal calprotectin in management of paediatric inflammatory bowel disease. Arch Dis Child Educ Pract Ed .2016; 101: 124–28. https://doi.org/10.1136/archdischild-2014-307941

Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. The ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;58: 795–806. https://doi.org/10.1097/MPG.0000000000000239

Anupindi SA, Podberesky DJ, Towbin AJ, Courtier J, Gee MS, Darge K, et al. Pediatric inflammatory bowel disease: imaging issues with targeted solutions. Abdom Imaging. 2015;357:975-92. https://doi.org/10.1007/s00261-015-0423-y

Van Rheenen PF, Aloi M, Assa A, Bronsky J, Escher JC, Fagerberg UL, et al. The medical management of pediatric crohn’s disease: an ECCO-ESPGHAN guideline update. Journal of Chrohn’s and Collitis. 2021;171-194. https://doi.org/10.1093/ecco-jcc/jjaa161

Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bryant RV, D’Haens G, et al. Selecting Therapeutic Targets in Inflammatory Bowel Disease [STRIDE]: determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110:1324–38. https://doi.org/10.1038/ajg.2015.233

Turner D, Riccuito A, Lewis A, D’Amico F, Dhaliwal J, Griffiths AM, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organisation for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021;160:1570-1583. https://doi.org/10.1053/j.gastro.2020.12.031

Lee WS, Arai K, Alex G, Treepongkaruna S, Kim KM, Choong CL, et al. Medical management of pediatric inflammatory bowel disease (PIBD) in the Asia Pasific Region: A position paper by the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD working group. JGHF. 2023. https://doi.org/10.1111/jgh.16097

Levine A, Kori M, Kierkus J, Boneh RS, Sladek M, Escher JC, et al. Azithromycin and metronidazole versus metronidazole-based therapy for the induction of remission in mild to moderate paediatric Crohn’s disease: a randomised controlled trial. Gut. 2019;68:239–47. https://doi.org/10.1136/gutjnl-2017-315199

Kadim M. Efektivitas pemberian nutrisi enteral eksklusif terhadap induksi remisi penyakit crohn. Sari Pediatri. 2019;21(1):57-65. http://dx.doi.org/10.14238/sp21.1.2019.57-65

Ong C, Lim PT, Logarajah V, Liwanag MJ, Ang BX, Cher Y, et al. Exclusive enteral nutrition with concomitant early thiopurine use was effective in maintaining steroid-free remission in a Southeast Asian cohort of children with Crohn’s disease. BMC Gastroenterol. 2018;18:185. https://doi.org/10.1186/s12876-018-0907-7

Chan KJ, Song ZL, Chew KS, Ng RT, Taib SHW, Lee WS. Exclusive enteral nutrition is effective and feasible as primary induction and re-induction therapy in Asian children with Crohn’s disease. J Paediatr Child Health. 2021;57:239-245. https://doi.org/10.1111/jpc.15184

Hisamatsu T. Enteral nutrition in the biologic era: learn from yesterday, live for today, hope for tomorrow. Intest Res. 2020;18:139-140. https://doi.org/10.5217/ir.2019.09192

Kang Y, Park S, Kim SY, Koh H. Therapeutic efficacy of exclusive enteral nutrition with specific polymeric diet in pediatric Crohn’s disease. Pediatr Gastroenterol Hepatol Nutr. 2019;22:72–9. https://doi.org/10.5223/pghn.2019.22.1.72

Levine A, Wine E, Assa A, Boneh RS, Shaoul R, Kori M, et al. Crohn’s disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology. 2019;157:440–50. https://doi.org/10.1053/j.gastro.2019.04.021

Chan KJ, Song ZL, Chew KS, Ng RT, Taib SHM, Lee WS. Exclusive enteral nutrition is effective and feasible as primary induction and re-induction therapy in Asian children with Crohn’s disease. J Paediatr Child Health. 2021;57:239-245. https://doi.org/10.1111/jpc.15184

Kuenzig ME, Rezaie A, Kaplan GG, Otley AR, Steinhart AH, Griffiths AM, et al. Budesonide for the induction and maintenance of remission in Crohn’s Disease: systematic review and meta-analysis for the Cochrane Collaboration. J Can Assoc Gastroenterol. 2018;1:159–73. https://doi.org/10.1093/jcag/gwy018

Wang XQ, Xiao Y, Xu X, Yu Y, Shan CY, Guo L, et al. Study of disease phenotype and its association with prognosis of paediatric inflammatory bowel disease in China. BMC Pediatr. 2018;18:229. https://doi.org/10.1186/s12887-018-1212-x

Carnovale C, Maffioli A, Zaffaroni G, Mazhar F, Battini V, Mosini G, et al. Efficacy of tumour necrosis factoralpha therapy in paediatric Crohn's disease patients with perianal lesions: a systematic review. Expert Opin Biol Ther. 2020;20:239-251. https://doi.org/10.1080/14712598.2020.1718096

Lee WS, Arai K, Alex G, Treepongkaruna S, Kom KM, Choong CL, et al. Management and monitoring of pediatric inflammatory bowel disease (PIBD) the Asia Pasific Region: A position paper by the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD working group: Surgical management, disease monitoring and special considerations. https://doi.org/10.1111/jgh.16097

Published

2023-05-31

How to Cite

1.
Crohn’s Disease in Children: A Case Report. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2023 May 31 [cited 2024 Dec. 3];2(2):32-45. Available from: https://apghn.com/index.php/journal/article/view/38