Crohn's disease in children and adolescents increased 2.5 times over 10 years. Suspicious of diarrhea and weight loss for more than 2 weeks
Jul 21, 2024
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Crohn's disease is still an unfamiliar disease. However, some famous celebrities recently revealed their disease and began to become known gradually. Crohn's disease, along with ulcerative colitis, is a representative chronic inflammatory bowel disease. Inflammatory bowel disease is a chronic inflammatory disease that occurs in the intestine (臟) due to various factors such as heredity, individual immune response, composition of intestinal microorganisms, and environment, and is largely divided into Crohn's disease and ulcerative colitis.
The name Crohn's disease comes from the first report by American physician Burrill Bernard Crohn in 1932. It is also called a CD after the first letter. Although the incidence rate was high mainly in the West, the incidence rate in Korea has been increasing rapidly due to recent changes in eating habits. It is especially common among young people.
Professor Kim Yu-yi of the Department of Pediatrics and Adolescents at the Catholic University of Korea's Incheon St. Mary's Hospital said, `Inflammatory bowel diseases, including Crohn's disease, have been reported to have increased by 2.5 times in the last 10 years among children and adolescents in Korea, and the most important cause is changes in eating habits.' In particular, in the case of children and adolescents with Crohn's disease, nutrition is not well absorbed, which can lead to growth disorders such as low weight or low height, he warned.
▶Increased 2.1x faster over the past 10 years...Half of patients under their 20s
The number of Crohn's disease patients in Korea is increasing rapidly. According to data from the Health Insurance Review and Assessment Service, 33,238 patients visited hospitals with Crohn's disease in Korea last year (2023), up 2.1 times over 10 years from 16,138 in 2013. By age group, △20s accounted for 31.2%, followed by △30s 25.1% △40s 15.3% △10s 15.1%.
Typical symptoms of Crohn's disease are abdominal pain, diarrhea, and weight loss. If these symptoms persist for more than two weeks, Crohn's disease can be suspected. Along with these symptoms, bloody excrement, fever, fatigue, pain or discharge around the anus, tooth decay that does not heal well, vomiting, nausea, oral pain, growth retardation, anemia, etc. may appear.
Occasionally, it is compared with similar symptoms of ulcerative colitis, but there are differences in the location, extent, and features of the lesion. Ulcerative colitis occurs only in the large intestine, has shallow inflammation, and is characterized by continuous distribution. On the other hand, Crohn's disease can occur anywhere in the digestive tract from the mouth to the anus, but it mainly occurs in the small and large intestine, has deep inflammation, and is distributed in a sparse manner.
Professor Kim Yu-yi "When 10% of Crohn's disease patients are diagnosed, up to 20% to 30% may be accompanied by extraintestinal manifestation in the oral cavity, skin, joints, liver, eyes, etc. within one year of diagnosis."Inflammation of the entire intestinal wall of Crohn's disease can cause intestinal fibrosis and stenosis, causing intestinal obstruction, pustules, and fine intestinal perforation or fistula, requiring surgical treatment. "
▶ Representative symptom is abdominal pain, diarrhea, weight loss...Estimating the cause of immune system changes
Not much is known about the cause of Crohn's disease. However, it is estimated that various environmental and social factors such as genetic factors, breastfeeding, westernized diet, antibiotic abuse, smoking, drugs, and stress are caused by changes in the immune system. The clinical features change with age. In particular, Crohn's disease, where genetic abnormalities are found, develops at a very young age, and the prognosis is usually very poor.
In addition, the intestinal microbial environment is also considered one of the causes. Intestinal microbes play a very important role in our bodies. It protects against harmful substances from the outside and synthesizes necessary substances that our body cannot synthesize from food. However, if intestinal microorganisms lose their balance, the barrier breaks down and the number of beneficial bacteria decreases, preventing them from protecting harmful substances, which can cause various diseases. Recently, research on intestinal microorganisms has been actively conducted in various fields such as diabetes, obesity, and ADHD (attention deficiency, hyperactivity disorder) in addition to intestinal diseases.
Professor Kim Yu-yi said, "In the case of Crohn's disease, changes in intestinal microorganisms reduce beneficial bacteria, increase relatively harmful bacteria, and lose the balance of intestinal microorganisms." "This can break down the barrier and increase intestinal permeability, causing toxic substances or harmful bacteria to penetrate the intestines and cause inflammation."
▶ Treatment focuses on medication...Normal life is possible with continuous treatment and management
If Crohn's disease is suspected, fecal tests including various serological tests, fecal calprotectin tests reflecting intestinal inflammation, and fecal culture tests are conducted to exclude the possibility of bacterial infection. Then, MRI (magnetic resonance imaging) or capsule endoscopy is performed to check for invasion of the small intestine, and mucous membranes are observed with colonoscopy and upper gastrointestinal endoscopy and biopsy is performed.
Professor Kim Yu-yi "Imaging tests for the diagnosis of Crohn's disease are to identify the small intestine and differ from general CT (computerized tomography) or MRI tests."The small intestine is usually attached without inflating the lumen of the intestine, but in order to indirectly identify lesions such as fistulas and stenosis in the small intestine, a contrast agent is taken before an MRI examination to inflate the intestinal lumen. Through this, it is possible to indirectly check the narrowed part of the small intestine, side streets, and swelling of the intestine.'
Treatment usually proceeds with medication. In particular, the treatment of Crohn's disease in children and adolescents aims to alleviate symptoms and make growth as good as possible, and to improve the quality of life by minimizing the toxicity of therapeutic drugs. Treatment is divided into two types depending on the timing: at the time of first diagnosis or at the time of deterioration. During the active period, remission induction therapy is performed to induce remission (寬解), which is a state in which symptoms are reduced. Unlike adults, children undergo full enteral nutrition, in which they consume beverages with chopped nutrients for eight weeks as much as necessary calories in mild and moderate cases. If remission is induced through this, drugs such as anti-inflammatory drugs or immunomodulators should be taken steadily depending on the condition of the disease to maintain the remission.
Drugs are divided into three stages, mild, moderate, and severe, depending on the patient's condition, and are divided into remission induction treatment and remission maintenance treatment drugs, respectively. In general, complete enteral nutrition is performed to induce remission, but if symptoms are severe from the beginning, or if complete enteral nutrition fails or recurs, steroids and biological agents are used to induce remission. After that, remission maintenance treatment is performed with anti-inflammatory drugs, immunomodulators, and biological agents.
If you are first diagnosed with Crohn's disease, you must induce remission even if you continue to raise the level of the drug. In some cases, the disease worsens during maintenance treatment, and after that, treatment to induce remission is performed again, and maintenance treatment is planned again after remission is induced. In general, Crohn's disease is rarely continuously active, but if it recurs frequently, complications such as stenosis may be accompanied.
Professor Kim Yu-yi said, "Cron's disease occurs frequently in adolescent children, so when diagnosed, not only children but also their parents are very embarrassed and upset due to the burden of taking medicine for life due to an unfamiliar disease name. It is important for family members, school teachers, and friends around them to understand and be considerate of the disease together."
There is no special prevention method for Crohn's disease in children and adolescents because the cause or pathogenesis of Crohn's disease has not yet been identified. However, it is estimated that it can be prevented to some extent by complete breastfeeding, healthy eating, and refraining from abusing antibiotics. Professor Kim Yu-yi "In principle, Crohn's disease is not a cure to this day, but it is possible to live close to normal with continuous and thorough treatment and management."
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