What is Crohn's Disease

Male1: Sometimes adolescents especially say girls, the period is a little delayed, they get stomachaches for a long period of time and he does a blood test, and he finds a thing called the sed rate is high and he sends it to you because he thinks that the kid could have a possible disease called Crohn’s disease? Male2: Crohn’s disease is a serious illness. This is another category of what we call an inflammatory bowel disease, an ulcerative colitis, what we just discussed is one of this category. The other category is called Crohn’s disease. The difference is that Crohn’s disease might involve any area of the gastrointestinal tract and colitis involves only the colon. Crohn’s disease may involve any segment of the gastrointestinal tract. Male1: They also get something like fistulas or something like that. Male2: Yes, Crohn’s disease is what you call transmural disease—an inflammation of the intestine, small intestine or large intestine. It may unfortunately cause complications when a fistula or an opening of the intestine may occur. Male1: If you do see a kid, what is your general approach to the problem? Male2: Well, the treatment should be provided surely and quite aggressively because of the fear of this complications. The approach to the therapy of Crohn’s disease is similar to therapy of ulcerative colitis, however, some modifications are made. Male1: Which are? Male2: The Crohn’s disease is a condition that may involve the small bowel only with a sparing of colon in other words, the colon is not involved, in this case, biologic therapy, which I mentioned in regards to ulcerative colitis is frequently the first therapy of choice. Male1: What is the prognosis for something like Crohn’s disease? Male2: The prognosis of someone with Crohn’s disease—the prognosis again at least half or 50% of patients is quite good and therapy is quite efficient. In somewhere around 30% of patients, the treatment becomes extremely difficult. Male1: What is your prognosis of a complicated case? Male2: The quite significant proportion of children with Crohn’s disease who do not have good response to therapy eventually have surgery when they become of adult age and sometimes even with the adolescents. Male1: So general rule is, Crohn’s is a little more difficult to handle generally? Male2: Crohn’s disease is kind of a less straightforward condition because it involves any area of gastrointestinal tract and the approach to Crohn’s disease which involve the small bowel already proximal small intestine, sometimes is extremely difficult. Male1: Are there any newer drugs coming down the grape vine soon? Male2: Well, at this point, it is a combination of immunosuppressive drugs and biologic treatment is becoming more and more conventional for therapy of small bowel Crohn. Male1: And what is the usual age that you see Crohn’s disease. Male2: The majority of children who develop Crohn’s disease are over the age of ten, however, there is a significant percent of children who develop Crohn under ten. Male1: Is it more boys or more girls? Male2: It is very, very similar proportion of boys and girls in Crohn’s disease. Male1: Unsexless disease? Male2: Not really, there is some predominance of boys over girls in any of this category, but I would say about 50/50. Male1: Is there a time that it is difficult to diagnose between the two type of colitis? Male2: Sometimes it is because Crohn’s disease may involve any area of the gastrointestinal tract and sometimes it involves the colon only and then differentiation between Crohn colitis or ulcerative colitis may become very difficult. Male1: So a biopsy of the area involved will differentiate easily? Male2: Well, the differential diagnosis is made usually based on colonoscopy and then the picture on the colonoscope. An endoscope is placed inside the colon, usually allow us to differentiate Crohn colitis versus ulcerative colitis. Male1: But pediatrics, we have sort of a problem because a lot of drugs come out that are not fully tested on pediatrics, is that true? Male2: Well most of the drugs are less tested in pediatrics simply because it is difficult to design a good study when the children may be involved, most of the parents would not allow the children to take drugs for the study for testing. Most of the adults will just do that for whatever reason, an infant, infants especially very young children are very difficult to test. Male1: What is the youngest age you have seen a kid with Crohn’s disease? Male2: Well the youngest child with Crohn’s disease that I have seen is somewhere around two years. The youngest child with Crohn’s disease is described in the world literature, I believe is just under one year of age.