Modern principles of Crohn's disease diagnosis in children

Authors

DOI:

https://doi.org/10.14739/2310-1210.2020.3.204957

Keywords:

Crohn’s disease, children, diagnosis

Abstract

The aim of our work is to review and analyze scientific literature to highlight the world experience in diagnosing Crohn’s disease (CD) in children, given the need to maintain a unified strategy in diagnostic tactics for this pathology.

CD is an autoimmune disease with a chronic progressive transmural inflammatory process of unknown etiology, which can affect the entire gastrointestinal tract from the oral cavity to the anal canal in patients of any age. Approximately 20–25 % of CD cases manifest in patients under the age of 18 years. The pathogenesis of CD is a multifocal process in which genetic mutations of more than 50 genes take place. Morphological changes are diverse and not fully understood. CD is characterized by systemic, local manifestations and the presence of surgical complications. The main diagnostic methods are endoscopic, radiological, morphological and MRI. Differential diagnosis of CD should include ulcerative colitis, inflammatory and autoimmune intestinal diseases in children, congenital malformations of the gastrointestinal tract. Today, the diagnosis of CD in children remains debatable.

Conclusions. In the lack of a clear idea of the etiological factors, pathogenesis of CD in children and its consequences, finding diagnostic tactics for this pathology determines the urgency of the issue in pediatrics and pediatric surgery. Diagnostic search in children with CD is a lengthy and materially expensive, requiring powerful facilities and equipment as well as fundamental competencies of a physician. The cascade approach to the diagnosis of CD proposed by the World Gastroenterology Organization (WGO) is the best option for determining the optimal targeted diagnostic algorithm for each patient, taking into account the existing logistic support at a hospital and the financial capacity of a patient.

References

Bernstein, C. N., Eliakim, A., Fedail, S., Fried, M., Gearry, R., Goh, K.-L., Hamid, S., Khan, A. G., Khalif, I., Ng, S. C., Ouyang, Q., Rey, J.-F., Sood, A., Steinwurz, F., Watermeyer, G., & LeMair, A. (2016). World Gastroenterology Organisation Global Guidelines Inflammatory Bowel Disease. Journal of Clinical Gastroenterology, 50(10), 803-818. https://doi.org/10.1097/mcg.0000000000000660

Kornienko, E. A., Krupina, A. N., Gabrusskaya, T. V., & Kalinina, N. M. (2016). Vospalitel'nye zabolevaniya kishechnika s ochen' rannim nachalom. [Inflammatory bowel disease with very early onset]. Al'manakh klinicheskoi meditsiny, 44(6), 719-733. https://doi.org/10.18786/2072-0505-2016-44-6-719-733 [in Russian].

Duricova, D., Fumery, M., Annese, V., Lakatos, P. L., Peyrin-Biroulet, L., & Gower-Rousseau, C. (2017). The natural history of Crohn’s disease in children. European Journal of Gastroenterology & Hepatology, 29(2), 125-134. https://doi.org/10.1097/meg.0000000000000761

Malchow, H., Ewe, K., Brandes, J. W., Goebell, H., Ehms, H., Sommer, H., & Jesdinsky, H. (1984). European Cooperative Crohn's Disease Study (ECCDS): results of drug treatment. Gastroenterology, 86(2), 249-266.

Keighley, M. R. B., & Allan, R. N. (1986). Current Status and Influence of Operation on Perianal Crohn's Disease. International Journal of Colorectal Disease, 1(2), 104-107. https://doi.org/10.1007/bf01648416

Lourenço, R., Azevedo, S., & Lopes, A. I. (2016). Surgery in Pediatric Crohn Disease: Case Series from a Single Tertiary Referral Center. GE Portuguese Journal of Gastroenterology, 23(4), 191-196. https://doi.org/10.1016/j.jpge.2016.03.007

Bailey, J. (2017). Editorial: Factors Promoting Development of Fibrosis in Crohn’s Disease. Frontiers in Medicine, 4, Article 160. https://doi.org/10.3389/fmed.2017.00160

Magro, F., Barreiro-de Acosta, M., Lago, P., Carpio, D., Cotter, J., Echarri, A., Gonçalves, R., Pereira, S., Carvalho, L., Lorenzo, A., Barros, L., Castro, J., Dias, J. A., Rodrigues, S., Portela, F., Dias, C., & da Costa-Pereira, A. (2010). Clinical practice in Crohn’s disease in bordering regions of two countries: Different medical options, distinct surgical events. Journal of Crohn’s and Colitis, 4(3), 301-311. https://doi.org/10.1016/j.crohns.2009.12.004

Fedulova, E. N., Potekhin, P. P., Lukoyanova, G. M., Rozhdenkin, E. A., Tutina, O. A., Fedorova, O. V., Bogomolov, A. R., Abramov, S. A., Lobanova, E. V., & Shumilova, O. V. (2010). Slozhnost' diagnosticheskogo poiska v verifikatsii bolezni Krona u detei. Klinicheskii sluchai [Difficulty in diagnostics to verify Crohn’s disease in children. Clinical case study]. Pediatricheskaya farmakologiya, 7(2), 115-122. [in Russian].

Benchimol, E. I., Kaplan, G. G., Otley, A. R., Nguyen, G. C., Underwood, F. E., Guttmann, A., Jones, J. L., Potter, B. K., Catley, C. A., Nugent, Z. J., Cui, Y., Tanyingoh, D., Mojaverian, N., Bitton, A., Carroll, M. W., deBruyn, J., Dummer, T. J. B., El-Matary, W., Griffiths, A. M., … Bernstein, C. N. (2017). Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease: A Population-Based Inception and Birth Cohort Study. American Journal of Gastroenterology, 112(9), 1412-1422. https://doi.org/10.1038/ajg.2017.208

Benchimol, E. I., Bernstein, C. N., Bitton, A., Carroll, M. W., Singh, H., Otley, A. R., Vutcovici, M., El-Matary, W., Nguyen, G. C., Griffiths, A. M., Mack, D. R., Jacobson, K., Mojaverian, N., Tanyingoh, D., Cui, Y., Nugent, Z. J., Coulombe, J., Targownik, L. E., Jones, J. L., … Kaplan, G. G. (2017). Trends in Epidemiology of Pediatric Inflammatory Bowel Disease in Canada: Distributed Network Analysis of Multiple Population-Based Provincial Health Administrative Databases. American Journal of Gastroenterology, 112(7), 1120-1134. https://doi.org/10.1038/ajg.2017.97

Jostins, L., Ripke, S., Weersma, R. K., Duerr, R. H., McGovern, D. P., Hui, K. Y., Lee, J. C., Schumm, L. P., Sharma, Y., Anderson, C. A., Essers, J., Mitrovic, M., Ning, K., Cleynen, I., Theatre, E., Spain, S. L., Raychaudhuri, S., Goyette, P., Wei, Z., Abraham, C., … Cho, J. H. (2012). Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature, 491(7422), 119-124. https://doi.org/10.1038/nature11582

Uhlig, H. H., Schwerd, T., Koletzko, S., Shah, N., Kammermeier, J., Elkadri, A., Ouahed, J., Wilson, D. C., Travis, S. P., Turner, D., Klein, C., Snapper, S. B., & Muise, A. M. (2014). The Diagnostic Approach to Monogenic Very Early Onset Inflammatory Bowel Disease. Gastroenterology, 147(5), 990-1007.e3. https://doi.org/10.1053/j.gastro.2014.07.023

Khatsko, V. V., Dudin, A. M., Mezhakov, S. V., Potapov, V. V., & Parkhomenko, A. V. (2012). Sovremennye aspekty etiopatogeneza, diagnostiki i lecheniya bolezni Krona (nauchnyi obzor). [Modern aspects of etiopathogenesis, diagnosis and treatments of Crohn’s disease (scientific review)]. Ukrainskyi zhurnal khirurhii, (4), 133-136. [in Russian].

Tymkiv, M. Z. (2016). Biolohichni vlastyvosti E.coli, vydilenykh vid khvorykh z neinfektsiinymy zakhvoriuvanniamy tovstoi kyshky arterii. (Avtoref. dis. … kand. med. nauk). [Biological properties of E. coli isolated from patients with non-infectious diseases of the large intestine]. (Extended abstract of candidate’s thesis). Vinnytsia. [in Ukrainian].

Rehal, S., & von der Weid, P.-Y. (2017). TNFΔARE Mice Display Abnormal Lymphatics and Develop Tertiary Lymphoid Organs in the Mesentery. The American journal of pathology, 187(4), 798-807. https://doi.org/10.1016/j.ajpath.2016.12.007

Rusyn, V. I., Chobei, S. M., Shkriba, I. I., Tokach, N. H., & Kobal, M. M. (2013). Morfolohichna diahnostyka khvoroby Krona [Morphological diagnosis of Crohn's disease]. Ukrainskyi zhurnal khirurhii, (1), 13-17. [in Ukrainian].

Fabian, O., Hradsky, O., Potuznikova, K., Kalfusova, A., Krskova, L., Hornofova, L., Zamecnik, J., & Bronsky, J. (2017). Low predictive value of histopathological scoring system for complications development in children with Crohn’s disease. Pathology - Research and Practice, 213(4), 353-358. https://doi.org/10.1016/j.prp.2017.01.009

Satsangi, J., Silverberg, M. S., Vermeire, S., & Colombel, J. F. (2006). The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut, 55(6), 749-753. https://doi.org/10.1136/gut.2005.082909

Amil-Dias, J., Kolacek, S., Turner, D., Pærregaard, A., Rintala, R., Afzal, N. A., Karolewska-Bochenek, K., Bronsky, J., Chong, S., Fell, J., Hojsak, I., Hugot, J.-P., Koletzko, S., Kumar, D., Lazowska-Przeorek, I., Lillehei, C., Lionetti, P., Martin-de-Carpi, J., Pakarinen, M., … Kolho, K.-L. (2017). Surgical Management of Crohn Disease in Children. Journal of Pediatric Gastroenterology and Nutrition, 64(5), 818-835. https://doi.org/10.1097/mpg.0000000000001562

Singer, A. A. M., Gadepalli, S. K., Eder, S. J., & Adler, J. (2016). Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion. Pediatrics, 137(3), Article e20152878. https://doi.org/10.1542/peds.2015-2878

Kantor, N., Wayne, C., & Nasr, A. (2017). What is the optimal surgical strategy for complex perianal fistulous disease in pediatric Crohn’s disease? A systematic review. Pediatric Surgery International, 33(5), 551-557. https://doi.org/10.1007/s00383-017-4067-6

Levine, A., Koletzko, S., Turner, D., Escher, J. C., Cucchiara, S., de Ridder, L., Kolho, K. L., Veres, G., Russell, R. K., Paerregaard, A., Buderus, S., Greer, M. L., Dias, J. A., Veereman-Wauters, G., Lionetti, P., Sladek, M., Martin de Carpi, J., Staiano, A., Ruemmele, F. M., Wilson, D. C., … European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. (2014). ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. Journal of pediatric gastroenterology and nutrition, 58(6), 795-806. https://doi.org/10.1097/MPG.0000000000000239

Van Assche, G., Dignass, A., Reinisch, W., van der Woude, C. J., Sturm, A., De Vos, M., Guslandi, M., Oldenburg, B., Dotan, I., Marteau, P., Ardizzone, A., Baumgart, D. C., D’Haens, G., Gionchetti, P., Portela, F., Vucelic, B., Söderholm, J., Escher, J., Koletzko, S., … Lindsay, J. (2010). The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Special situations. Journal of Crohn’s and Colitis, 4(1), 63-101. https://doi.org/10.1016/j.crohns.2009.09.009

Gklavas, A., Dellaportas, D., & Papaconstantinou, I. (2017). Risk factors for postoperative recurrence of Crohn's disease with emphasis on surgical predictors. Annals of gastroenterology, 30(6), 598-612. https://doi.org/10.20524/aog.2017.0195

Gomollón, F., Dignass, A., Annese, V., Tilg, H., Van Assche, G., Lindsay, J. O., Peyrin-Biroulet, L., Cullen, G. J., Daperno, M., Kucharzik, T., Rieder, F., Almer, S., Armuzzi, A., Harbord, M., Langhorst, J., Sans, M., Chowers, Y., Fiorino, G., Juillerat, P., Mantzaris, G. J., … ECCO. (2017). 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. Journal of Crohn's & colitis, 11(1), 3-25. https://doi.org/10.1093/ecco-jcc/jjw168

Gionchetti, P., Dignass, A., Danese, S., Magro Dias, F. J., Rogler, G., Lakatos, P. L., Adamina, M., Ardizzone, S., Buskens, C. J., Sebastian, S., Laureti, S., Sampietro, G. M., Vucelic, B., van der Woude, C. J., Barreiro-de Acosta, M., Maaser, C., Portela, F., Vavricka, S. R., Gomollón, F., & ECCO. (2017). 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations. Journal of Crohn's & colitis, 11(2), 135-149. https://doi.org/10.1093/ecco-jcc/jjw169

Koriche, D., Gower-Rousseau, C., Chater, C., Duhamel, A., Salleron, J., Tavernier, N., Colombel, J. F., Pariente, B., Cortot, A., & Zerbib, P. (2017). Post-operative recurrence of Crohn's disease after definitive stoma: an underestimated risk. International journal of colorectal disease, 32(4), 453-458. https://doi.org/10.1007/s00384-016-2707-2

He, X., Chen, Z., Huang, J., Lian, L., Rouniyar, S., Wu, X., & Lan, P. (2014). Stapled Side-to-Side Anastomosis Might Be Better Than Handsewn End-to-End Anastomosis in Ileocolic Resection for Crohn’s Disease: A Meta-Analysis. Digestive Diseases and Sciences, 59(7), 1544-1551. https://doi.org/10.1007/s10620-014-3039-0

Zimmerman, L. A., Saites, C. G., Bairdain, S., Lien, C., Zurakowski, D., Shamberger, R. C., Linden, B. C., & Bousvaros, A. (2016). Postoperative Complications in Children With Crohn Disease Treated With Infliximab. Journal of pediatric gastroenterology and nutrition, 63(3), 352-356. https://doi.org/10.1097/MPG.0000000000001151

Downloads

How to Cite

1.
Soleiko DS, Horbatiuk O, Soleiko NP, Soleiko VV. Modern principles of Crohn’s disease diagnosis in children. Zaporozhye medical journal [Internet]. 2020Jun.10 [cited 2024Apr.19];22(3). Available from: http://zmj.zsmu.edu.ua/article/view/204957

Issue

Vol. 22 No. 3 (2020)

Section

Review

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)