Pediatric Crohn Disease Differential Diagnoses

  • Author: Andrew B Grossman, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: May 21, 2012
 
 

Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis (see below), other problems to be considered include the following:

  • Infection
  • Celiac disease
  • Immunodeficiency
  • Chronic granulomatous disease
  • Radiation enteritis
  • Ischemic enterocolitis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Andrew B Grossman, MD  Clinical Assistant Professor, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine

Andrew B Grossman, MD is a member of the following medical societies: American Gastroenterological Association, Crohns and Colitis Foundation of America, and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

Petar Mamula, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine

Petar Mamula, MD, is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Additional Contributors

Robert Baldassano, MD Director, Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Associate Professor, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania

Robert Baldassano, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Stefano Guandalini, MD Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Tysk C, Lindberg E, Jarnerot G, Floderus-Myrhed B. Ulcerative colitis and Crohn's disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking. Gut. Jul 1988;29(7):990-6. [Medline].

  2. Kugathasan S, Loizides A, Babusukumar U, et al. Comparative phenotypic and CARD15 mutational analysis among African American, Hispanic, and White children with Crohn's disease. Inflamm Bowel Dis. Jul 2005;11(7):631-8. [Medline].

  3. Kugathasan S, Judd RH, Hoffmann RG, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr. Oct 2003;143(4):525-31. [Medline].

  4. Griffiths AM, Buller HB. Inflammatory bowel diseases. In: Walker WA, Durie P, eds. Textbook of Pediatric Gastrointestinal Diseases. 3rd ed. 2000.

  5. Zholudev A, Zurakowski D, Young W, Leichtner A, Bousvaros A. Serologic testing with ANCA, ASCA, and anti-OmpC in children and young adults with Crohn's disease and ulcerative colitis: diagnostic value and correlation with disease phenotype. Am J Gastroenterol. Nov 2004;99(11):2235-41. [Medline].

  6. Fagerberg UL, Loof L, Myrdal U, et al. Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr. Apr 2005;40(4):450-5. [Medline].

  7. Frokjaer JB, Larsen E, Steffensen E, et al. Magnetic resonance imaging of the small bowel in Crohn's disease. Scand J Gastroenterol. Jul 2005;40(7):832-42. [Medline].

  8. Lee SS, Kim AY, Yang SK, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. Jun 2009;251(3):751-61. [Medline].

  9. Guilhon de Araujo Sant'Anna AM, et al. Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial. Clin Gastroenterol Hepatol. Mar 2005;3(3):264-70. [Medline].

  10. D'Haens G, Baert F, van Assche G, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet. Feb 23 2008;371(9613):660-7. [Medline].

  11. Kim MJ, Lee JS, Lee JH, Kim JY, Choe YH. Infliximab therapy in children with Crohn's disease: a one-year evaluation of efficacy comparing 'top-down' and 'step-up' strategies. Acta Paediatr. Mar 2011;100(3):451-5. [Medline].

  12. Akobeng AK, Gardener E. Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn's Disease. Cochrane Database Syst Rev. 2005;(1):CD003715. [Medline].

  13. Beattie RM. Enteral nutrition as primary therapy in childhood Crohn's disease: control of intestinal inflammation and anabolic response. JPEN J Parenter Enteral Nutr. Jul-Aug 2005;29(4 Suppl):S151-5; discussion S155-9, S184-8. [Medline].

  14. Borrelli O, Cordischi L, Cirulli M, et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol. Jun 2006;4(6):744-53. [Medline].

  15. Turner D, Grossman AB, Rosh J, et al. Methotrexate following unsuccessful thiopurine therapy in pediatric Crohn's disease. Am J Gastroenterol. Dec 2007;102(12):2804-12; quiz 2803, 2813. [Medline].

  16. Alfadhli AA, McDonald JW, Feagan BG. Methotrexate for induction of remission in refractory Crohn's disease. Cochrane Database Syst Rev. 2005;CD003459. [Medline].

  17. Stephens MC, Baldassano RN, York A, et al. The bioavailability of oral methotrexate in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. Apr 2005;40(4):445-9. [Medline].

  18. Uhlen S, Belbouab R, Narebski K, et al. Efficacy of methotrexate in pediatric Crohn's disease: a French multicenter study. Inflamm Bowel Dis. Nov 2006;12(11):1053-7. [Medline].

  19. Hyams J, Crandall W, Kugathasan S, et al. Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children. Gastroenterology. Mar 2007;132(3):863-73; quiz 1165-6. [Medline].

  20. Jacobstein DA, Markowitz JE, Kirschner BS, et al. Premedication and infusion reactions with infliximab: results from a pediatric inflammatory bowel disease consortium. Inflamm Bowel Dis. May 2005;11(5):442-6. [Medline].

  21. Colombel JF, Sandborn WJ, Rutgeerts P, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial. Gastroenterology. Jan 2007;132(1):52-65. [Medline].

  22. Hyams JS, Griffiths A, Markowitz J, Baldassano RN, Faubion WA Jr, Colletti RB, et al. Safety and Efficacy of Adalimumab for Moderate to Severe Crohn's Disease in Children. Gastroenterology. May 2 2012;[Medline].

  23. [Guideline] Strong SA, Koltun WA, Hyman NH, Buie WD. Practice parameters for the surgical management of Crohn's disease. Dis Colon Rectum. Nov 2007;50(11):1735-46. [Medline]. [Full Text].

  24. von Allmen D, Markowitz JE, York A, Mamula P, Shepanski M, Baldassano R. Laparoscopic-assisted bowel resection offers advantages over open surgery for treatment of segmental Crohn's disease in children. J Pediatr Surg. Jun 2003;38(6):963-5. [Medline].

 
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Colonoscopic image of large ulcer and inflammation of descending colon in 12-year-old boy with Crohn disease.
Histologic features of chronic colitis with crypt atrophy and branching and lymphocytic infiltrate. Hematoxylin-eosin staining. Image courtesy of Dr E Ruchelli.
Colonic granuloma in patient with Crohn disease. Hematoxylin-eosin staining. Image courtesy of Dr E Ruchelli.
Image obtained during upper gastrointestinal series with small-bowel follow-through shows narrowing and irregularity in distal ileum in 16-year-old male adolescent with Crohn disease.
Inflamed terminal ileum in 10-year-old girl with Crohn disease.
Small abscess on right side of anal sphincter in 9-year-old boy with Crohn disease.
Table. Characteristics and Presentations Differentiating Crohn Disease From Ulcerative Colitis
Crohn DiseaseUlcerative Colitis
Characteristic
DistributionEntire GI tractColon only, although gastritis recognized
Skip lesionsContinuous involvement proximally from rectum
PathologyFull thicknessMucosa only
Granulomas (30%)No granulomas
RadiologyEntire GI tractColon only
Skip lesionsContinuous involvement proximally from rectum
Fistulas, abscesses, fibrotic stricturesMucosal disease only
Cancer riskIncreasedEstimated 1%/y, starting 10 y after diagnosis
Presentation
BleedingCommonVery common
ObstructionCommonUncommon
FistulaCommonNone
Weight lossCommonUncommon
Perianal diseaseCommonRare
GI = gastrointestinal.
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