Chronic inflammatory bowel disease in children: a complex problem in management

Children with chronic inflammatory bowel disease in the UK are still often cared for by general paediatricians with the assistance of adult gastroenterologists or surgeons. This is not the case in North America or much of Europe. Juvenile onset Crohn's disease is an increasing problem as a recent report from Scotland indicates.1 Both diagnosis and management are complex and the time has come for all children with these disorders to be at least reviewed in a tertiary centre for paediatric gastroenterology2 in order to improve the delivery of care. There is clearly an important genetic aspect to inflammatory bowel disease. There is some evidence that genetic anticipation may occur to explain the tendency for children to be younger than their parents at diagnosis but some relate this to ascertainment.3 Delay in diagnosis is a common feature in these children.4It is often considered that partial or inadequate diagnosis is enough. Children deserve the same comprehensive diagnostic approach as is available to adults in order to plan rational management. After all, these disorders are likely to be life long. When cared for initially by adult physicians or gastroenterologists, vital measurement of height and grading of puberty are often not done. Accurate diagnosis and effective treatment are both essential for ideal management. Smooth transfer to adult clinics in due course is essential. Until the 1970s Crohn's disease was thought to be uncommon in children, although ulcerative colitis had been recognised in children from the 1920s. The diagnosis of Crohn's disease is more difficult in children than in adults because systemic manifestations such as growth failure and delayed puberty may dominate the early clinical picture. As a result, diagnosis can be delayed.5 However, the modern approach of fibreoptic ileocolonoscopy with multiple mucosal biopsies, coupled with high quality barium …