Griffiths A M
Division of Gastroenterology/Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.
Baillieres Clin Gastroenterol. 1998 Mar;12(1):115-32. doi: 10.1016/s0950-3528(98)90088-4.
The clinical features of Crohn's disease manifest during adolescence are varied as in adults. The potential complication of growth impairment and concomitant delay in pubertal development is unique to this population. Cytokines released from the inflamed bowel and chronic nutritional insufficiency are the major factors in the pathophysiology of growth inhibition. Hence reduction of intestinal inflammation and consistent provision of adequate nutrition are of paramount importance in management. Drug treatment mirrors that of adults; few specifically paediatric clinical trials have been conducted. Enteral nutrition is an important therapeutic alternative for young patients. There is evidence that it constitutes both a primary therapy of inflammation and a means of providing the calories needed for growth. In the setting of extensive disease, dependency on corticosteroids should be minimized through judicious administration of immunosuppressive drugs. For an adolescent with localized stenotic disease, optimal management includes a timely referral for intestinal resection as a means of providing an asymptomatic interval during which growth and pubertal development can normalize.
青少年期克罗恩病的临床特征与成人一样多种多样。生长发育受损以及随之而来的青春期发育延迟这一潜在并发症是该人群所特有的。炎症肠道释放的细胞因子和慢性营养不足是生长抑制病理生理学中的主要因素。因此，减轻肠道炎症和持续提供充足营养在治疗中至关重要。药物治疗与成人相似；很少有专门针对儿科的临床试验。肠内营养是年轻患者重要的治疗选择。有证据表明，它既是炎症的主要治疗方法，也是提供生长所需热量的一种手段。在广泛性疾病的情况下，应通过合理使用免疫抑制药物尽量减少对皮质类固醇的依赖。对于患有局限性狭窄疾病的青少年，最佳治疗方法包括及时转诊进行肠道切除，以提供一个无症状期，在此期间生长和青春期发育可以恢复正常。
