Levine Arie
Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Tel Aviv University, Tel Aviv 58100, Israel.
Dig Dis. 2009;27(3):212-4. doi: 10.1159/000228552. Epub 2009 Sep 24.
The clinical manifestations of Crohn's disease (CD) and ulcerative colitis (UC) are highly variable, with significant diversity in phenotypes of the diseases. This diversity may manifest as a difference in age of onset. Pediatric-onset disease may present differently and have a different natural history, with ramifications for disease management. Clear evidence exists at present that pediatric-onset UC may be different than adult-onset UC. The primary difference in disease phenotype is extent of disease. Approximately 60-70% of patients with pediatric-onset UC present with pancolitis, as opposed to approximately 20-30% in adults. Patients are more likely to have severe disease and become steroid-dependent. CD may be affected by an age gradient. There is an inverse linear relationship between age and colonic CD, the younger the patient, the more likely is the patient to have colonic CD. This inverse relationship is true through age 10. In addition, pediatric patients are more likely to have upper gastrointestinal involvement than their adult peers. Comparing adult and pediatric phenotypes is fraught with methodological obstacles. Disease behavior, with the exception of growth failure, seems to parallel disease behavior in adults. Patients with growth retardation are a high risk group for complications and should be managed as such.
克罗恩病（CD）和溃疡性结肠炎（UC）的临床表现高度多变，疾病表型存在显著差异。这种差异可能表现为发病年龄的不同。儿童期发病的疾病可能表现不同，自然病程也不同，这对疾病管理有影响。目前有明确证据表明，儿童期发病的UC可能与成人期发病的UC不同。疾病表型的主要差异在于疾病范围。约60 - 70%的儿童期发病的UC患者表现为全结肠炎，而成人患者中这一比例约为20 - 30%。儿童患者更易患重症疾病并对类固醇产生依赖。CD可能受年龄梯度影响。年龄与结肠型CD之间存在负线性关系，患者年龄越小，患结肠型CD的可能性越大。这种负相关关系在10岁之前都成立。此外，儿童患者比成年同龄人更易出现上消化道受累。比较成人和儿童的表型存在诸多方法学上的障碍。除生长发育迟缓外，疾病行为似乎与成人的疾病行为相似。生长发育迟缓的患者是并发症的高危人群，应按此进行管理。
