Hépato-Gastro & Oncologie Digestive


Specific features of childhood-onset Crohn's disease Volume 22, supplement 2, Octobre 2015

Université Paris-Descartes,
Sorbonne Paris-Cité ;
Hôpital Necker-Enfants Malades,
service de gastroentérologie,
hépatologie et nutrition pédiatriques
149 rue de Sèvres, 75743 Paris cedex 15
* Tirés à part

The incidence of pediatric-onset Crohn's disease (CD) is increasing in developed countries for several decades now. According to recent studies, the natural history of pediatric CD is comparable to adult-onset disease, but children and adolescent are more likely to have a severe disease, and show age-specific characteristics. Growth retardation impacting on final adult height is one of the major challenge of pediatric-onset CD. In contrast to adult patients, exclusive enteral nutrition is the recommended first-choice induction therapy in luminal CD. Evolution of the disease is marked by a high risk of disease extension, thus an immunosuppressive therapy is frequently required. The tolerance of these treatments must be closely monitored, especially the risk of infections or intolerance. Use of surgery also occurs earlier in children with CD than in adults. The introduction of biological therapy allowed an improved control and quality of life especially in pediatric-onset CD. In conclusion, childhood-onset CD is a factor of severity due to greater disease activity and longer disease duration. An aggressive therapeutic approach should be considered in these patients in order to control disease and inflammation and to allow optimal growth.