Ulcerative Colitis and Crohn Disease in Children

Once considered rare in pediatric practice, chronic inflammatory bowel disease is now recognized with increasing frequency in children. Ulceractive colitis and Crohn disease constitute the two major entities, and it is still not clear whether these are two separate entities or different portions of the spectrum of one disease. Abdominal pain, diarrhea, rectal bleeding, weight loss, and anemia are prominent findings in both ulcerative colitis and Crohn disease; however, extraintestinal manifestations may dominate the clinical findings, masquerading as juvenile rheumatoid arthritis, idiopathic growth failure, or even anorexia nervosa. Often, it is not until intestinal manifestations are recognized that a correct diagnosis is made.1 EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE Since 1950, there has been an increase, in the incidence of Crohn disease, ranging from 100% to 400% in all age groups.2 In contrast, the incidence of ulcerative colitis has not changed significantly. Ulcerative colitis is diagnosed in 15% of patients before the age of 20 years, usually in adolescence. Although ulcerative colitis may occur in infancy, inflammatory disease of the colon during the first year of life is more often due to food allergy3 or infectious disease. Certain groups of children are at greater risk for the development of inflammatory bowel disease. Ulcerative colitis and Crohn disease occur more commonly among Northern European, Anglo-Saxon races, in urban rather than rural dwellers, and in Jewish individuals living in Europe and North America.