Overview

• Crohn’s
  • More common in children.
  • Location → anywhere in GI tract, terminal ileum (40%) is most common.
  • Thickness → transmural.
  • Histology → skip lesions, cobble-stoning, rose-thorn ulcers.
  • Extra-Intestinal Features → mouth ulcers, uveitis, erythema nodosum, ankylosing spondylitis.
  • Complications → nutritional deficiencies, anaemia, strictures, abdoman wall fistulae.
• UC
  • Sx → abdominal pain, PR bleeding.
  • Location → continuous lesions starting from the rectum to the ileocaecal valve.
  • Thickness → mucosa and submucosa only.
  • Histology → pseudopolyps, continuous inflammation, ulceration with loss of haustra, crypt damage.
  • Extra-Intestinal Features → PSC, pyoderma gangrenosum, erythema nodosum, enteric arthritis.
  • Complications → nutritional deficiencies, anaemia, toxic megacolon, colonic perforation, haemorrhage.

Making Diagnosis

Clinical Features

Investigations

• Bedside → stool sample: faecal calprotectin.
• Bloods > inflammation (raised ESR/CRP), anaemia, B12 deficiency (crohn’s as terminal ileum affected).
• Imaging → colonoscopy and biopsy.
  • Crohns → non-caseating granulomas.
  • Ulcerative Colitis → 90% of children have pancolitis. Crypt abscesses and goblet cell depletion.
• UC → scoring systems: Paediatric Ulcerative Colitis Activity Index (PUCAI) and Truelove and Witts score. Be aware of co-existing depression.

Management Plan

Overview → induce remission, maintain remission, consider need for surgery, complications.

• Crohn’s
  • Inducing Remission → enteral (NG/NJ) feeding to not tolerating food. Steroids: first-line is prednisolone. 5-ASAs can be used if steroids are not tolerated.
  • Maintaining Remission → stop smoking, immunosuppressants (azathioprine/mercaptopurine/anti-TNFa), vaccinations (as are immunosuppressed).
• Ulcerative Colitis
  • Inducing Remission → main drug: 5-ASAs (mesalazine).
    • Proctitis → topical 5-ASAs.
    • Proctosigmoiditis / Left-Sided UC → topical 5-ASAs.
    • Extensive UC → topical + oral 5-ASAs.
  • Maintaining Remission → 5-ASAs.
  • Severe (Fulminating) Colitis → IV corticosteroids to induce remission. Assess need for surgery.

Complications →