Wann muss man an eine chronisch-entzündliche Darmerkrankung bei Kindern und Jugendlichen denken?

Zusammenfassung

Die Inzidenz der chronisch-entzündlichen Darmerkrankungen (CED), v. a. des Morbus Crohn, im Kindesalter nimmt zu. Zwischen 20 und 30 % der CED-Patienten befinden sich im Kindes- oder Jugendalter.

Typisch für die Colitis ulcerosa ist eine blutige Diarrhö. Beim M. Crohn zeigen sich häufig unspezifische Bauchschmerzen, Diarrhö, Anämie, Fieber, Gewichtsverlust und Wachstumsverzögerung. Wachstumsverzögerungen durch eine verzögerte Diagnose oder unzureichenden Behandlung einer CED sind eine besondere Komplikation im Kindes- und Jugendalter. Weitere extraintestinale Manifestationen sind Müdigkeit, Anorexie sowie Gelenk-, Haut-, Augen-, Leber-, Gallengangs- und Pankreasbeteiligung. Nach dem Ausschluss von gastrointestinalen Infektionen helfen Entzündungsmarker im Blut sowie Calprotectin und Laktoferrin im Stuhl für die Diagnose. Für die endgültige Diagnose und Klassifizierung sind die Ileokoloskopie und Ösophagogastroduodenoskopie notwendig. Weitere Bildgebung (z. B. MRT, Videokapselendoskopie) wird empfohlen.

Summary

The incidence of inflammatory bowel diseases (IBD), especially Crohn’s disease, in children and adolescents is on the rise. Between 20 and 30 % of IBD patients are children or adolescents.

Bloody diarrhea is the most common presenting symptom in ulcerative colitis. Crohn’s disease may present with vague abdominal pain, diarrhea, anemia, fever, weight loss, and growth retardation. Growth retardation is a unique complication due to delayed diagnosis of or uncontrolled inflammation in IBD in children and adolescents. Further extraintestinal manifestations are fatigue, anorexia, and joint, skin, eye, hepatobiliary and pancreatic manifestations.

After exclusion of gastrointestinal infections blood and fecal inflammatory markers are helpful for the diagnosis. The final diagnosis and classification relies on ileocolonoscopy and esophagogastroduodenscopy. Further imaging (such as MRI and video capsule endoscopy) is recommended.

Schlüsselwörter

Chronisch-entzündliche Darmerkrankung - Kinder - Jugendliche - Symptome - Diagnostik

Keywords

Inflammatory bowel disease - children - adolescents - symptoms - diagnostics

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