Revista de enfermedades y trastornos inflamatorios del intestino

Management Challenges in Adolescents with Crohn’s Disease-Current Practice

Abstract

Yair Kasirer, Liron Birimberg-Schwartz, Shelly Ben Harush Negari and Dan Turner

The incidence and prevalence of Crohn's disease (CD) in adolescents is rising. The clinical course differs in several aspects from that of adults. Pediatric-onset disease is more extensive and its course is somewhat more aggressive. In addition to the common manifestation of CD, adolescents with CD may present with pubertal delay, growth retardation and osteopenia. These unique aspects of adolescence CD should impact the treatment paradigm. In cases of growth impairment and osteopenia, treatment should be intensive aiming at promoting complete mucosal healing and, in turn, improved growth and bone formation. The use of enteral nutrition should be thus encouraged both for induction and maintenance of remission. However, adolescent CD carries implications that go beyond the physical manifestations of the disease. Children diagnosed with IBD are at increased risk of emotional distress and decreased social functioning. The use of support groups and other psychosocial interventions is advocated as a mean to enhance coping skills and improve quality of life. As many as half of adolescents are non-compliant with the recommended treatment hence, a particular emphasis should be placed on engaging the adolescent in the treatment plan, using several intervention strategies. Adolescence is a time of dynamic physical changes and growth along with emotional maturation. This review highlights some of the unique aspects that should come into play while managing CD during this sensitive period of life.