Changing concepts of inflammatory disease of the colon in children

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Recent experience with inflammatory disease of the colon in adults has shown a striking increase in the number of patients with transmural colitis (Crohn’s disease of the colon, granulomatous colitis) and a decrease in the number of patients with ulcerative colitis.1 A review of cases of inflammatory bowel disease in children examined at the Cleveland Clinic from 1965 to 1970 documents this trend. Until recently, there has been much confusion concerning the differential diagnosis between ulcerative colitis and Crohn’s disease and, thus some patients may have been misclassified. In children, the variable natural history of the disease, the hesitance to do repeated roentgenographic studies of the gastrointestinal tract, and the reluctance to subject children to proctosigmoidoscopy have contributed to misclassification of these two diseases. Disregarding the incidence of cancer, it is not known whether the long-term prognosis in the two diseases is widely different. Previous studies have indicated that the prognosis is poor for children who have the onset of inflammatory bowel disease before age 14. The condition frequently requires operations, and there is a greatly increased risk of cancer and a higher mortality than among patients in whom inflammatory bowel disease develops at a later age.2, 3 A recent study from the Mayo Clinic of the long-range prognosis of Crohn’s disease following onset in childhood seems to indicate a poor prognosis, and an even higher risk of cancer than was originally thought.4 Other investigators have not duplicated these results and the controversy continues. However, there does appear to be



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