Crohn's disease: the Melbourne experience

Abstract

During the years 1979–1988, 63 children (38 male: 25 female) were first diagnosed as having Crohn's disease on the basis of histological findings. Twenty-nine per cent were less than 10 years old at the onset of symptoms; 40% of these cases took more than 1 year to diagnose. Most patients (59%) presented with abdominal pain and diarrhoea, but 40% presented with: a non-specific illness (14%); upper gastro-intestinal tract symptoms (14%); growth failure (6%); systemic disease (5%), or peri-anal disease (1%). There were signs of abdominal tenderness, distension, or an abdominal mass in over 50% of cases. Peri-anal Crohn's disease was present in 41% and a height less than the 10th centile was recorded at diagnosis in 45%. Children were treated with a combination of prednisolone and sulphasalazine. In 16 cases a bowel resection was performed. Surgery was indicated for localised stricture formation causing obstruction and for persistence of severe disease poorly responsive to steroids, particularly in the prepubertal child with growth failure. The extent and distribution of disease influenced outcome. Twenty-four of 39 children followed for more than 3 years are either well-controlled or disease-free at present.