Crohn's and colitis in children and adolescents
Crohn's and colitis in children and adolescents
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DOI：
10.3748/wjg.v18.i41.5862
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发表时间：
2012-11-07
影响因子：
4.3
通讯作者：
Lemberg, Daniel A.
中科院分区：
文献类型：
--
作者：
Day, Andrew S.;Ledder, Oren;Lemberg, Daniel A.
克罗恩病和溃疡性结肠炎可被归类为炎症性肠病（IBD）。近年来，这些情况越来越普遍，包括儿童和青年。虽然对这些疾病的发病机制方面了解很多，但确切的病因尚未了解，并且仍然没有治愈方法。最近的数据已经说明了一些基因的重要性，其中一些基因在生命早期（包括婴儿期）IBD的发病中是重要的。疼痛、腹泻和体重减轻是小儿克罗恩病的典型症状，而血性腹泻更是儿童结肠炎的典型症状。然而，在这两种情况下都可能出现非典型症状：这些症状包括孤立的线性生长障碍或肠外表现，如结节性红斑。克罗恩病和结肠炎在诊断时生长和营养通常受到损害。考虑可能的IBD和完成适当的调查是必不可少的，以确保及时诊断，从而避免诊断延误的后果。儿童期IBD的发病模式（包括发病部位和进展）与成人期IBD有很大不同。各种治疗方案可用于IBD儿童和青少年。单纯肠内营养在诱导活动性克罗恩病缓解中起着重要作用。内科和外科治疗需要在儿童成长和发育的背景下考虑。儿童这些慢性疾病的整体管理应包括多学科的专业知识，重点是保持肠道炎症的控制，优化营养，生长和生活质量，同时预防疾病或治疗相关的并发症。(C)2012年百世登。All rights reserved.
Crohn's disease and ulcerative colitis can be grouped as the inflammatory bowel diseases (IBD). These conditions have become increasingly common in recent years, including in children and young people. Although much is known about aspects of the pathogenesis of these diseases, the precise aetiology is not yet understood, and there remains no cure. Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life, including in infancy. Pain, diarrhoea and weight loss are typical symptoms of paediatric Crohn's disease whereas bloody diarrhoea is more typical of colitis in children. However, atypical symptoms may occur in both conditions: these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythema nodosum. Growth and nutrition are commonly compromised at diagnosis in both Crohn's disease and colitis. Consideration of possible IBD and completion of appropriate investigations are essential to ensure prompt diagnosis, thereby avoiding the consequences of diagnostic delay. Patterns of disease including location and progression of IBD in childhood differ substantially from adult-onset disease. Various treatment options are available for children and adolescents with IBD. Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn's disease. Medical and surgical therapies need to considered within the context of a growing and developing child. The overall management of these chronic conditions in children should include multi-disciplinary expertise, with focus upon maintaining control of gut inflammation, optimising nutrition, growth and quality of life, whilst preventing disease or treatment-related complications. (C) 2012 Baishideng. All rights reserved.