Clinical Manifestations of Crohn's Disease in Children and Adolescents

Abstract

Crohn's disease (regional enteritis) is a chronic disorder which usually appears in adolescence or early adulthood.1-8 The average age of onset reported in the adult literature is 27 years.9 Although it has not been reported frequently in children, Van Patter et al., found that 14% of 600 patients observed at the Mayo Clinic had an onset of symptoms occurring before the age of 15.10 Rogers et al.,11 utilizing a computerized analysis of their files, found that 21% of 489 patients with the diagnosis of Crohn's disease had the onset before age 15. In fact, the first patient that attracted Dr. Crohn's attention to this entity was a 16-year-old boy.12 Among the patients in the 7 to 15-year-age range at the Mount Sinai Hospital in New York, the maximum incidence was at 10 to 14 years of age.5 The current communication summarizes the clinical features of 58 patients with Crohn's disease of the small intestine and/or of the colon whose disease appeared before they were 15 years of age and emphasizes the prominence of the extra-intestinal manifestations. The mode of presentation of these younger patients was often such that the clinician's attention was diverted from the gastrointestinal tract. PATIENTS STUDIED During a 20-year period (1952 to 1972) at the Johns Hopkins Hospital, 376 patients were discharged with the diagnosis of regional enteritis or Crohn's disease. Forty-eight of them, or 12.7%, were under the age of 15. The diagnosis was based on pathological and/or roentgenographic cnteria. The study group included these 48 patients plus 10 others seen in the outpatient department or at other Baltimore hospitals (Sinai Hospital and the Greater Baltimore Medical Center).