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Diagnosis of inflammatory bowel disease
Last reviewed: 06.07.2025
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Diagnosis of inflammatory bowel diseases in children is based on clinical, laboratory, X-ray endoscopic and histological signs. The studied laboratory parameters are necessary both for assessing the severity of the underlying process and for differential diagnosis. Blood tests may reveal anemia due to iron and folic acid deficiency, thrombocytosis, increased ESR and acute phase protein levels. In long-term disease, protein loss and malabsorption lead to hypoalbuminemia, deficiency of vitamins, electrolytes and microelements. Studies of specific markers of inflammatory diseases of the colon are underway: antineutrophil cytoplasmic antibodies (pANCA) are more often detected in nonspecific ulcerative colitis, antibodies to Saccharomyces cerevisiae fungi (ASCA) are more typical for Crohn's disease.
X-ray methods are minimally invasive and allow one to evaluate the structure and function of the intestine, wall rigidity, and detect submucosal edema, pseudodiverticula, fistulas, stenosis, ulcerative and erosive defects.
Endoscopy is of great auxiliary importance, it is indicated when it is necessary to take material for biopsy from the colon and terminal ileum. The endoscopic picture has features in various variants of inflammatory bowel diseases, but does not always allow to verify the diagnosis. In children, lymphoid hyperplasia of the terminal ileum is often detected - this is a normal variant.
Although the biopsy of the mucous membrane is superficial, the study allows us to establish some histological signs of various types of inflammatory bowel disease in children. Crohn's disease is characterized by focality, discontinuity of the lesion, accumulation of histiocytes and lymphocytes (the so-called microgranulomas), true granulomas in the submucosa and lamina propria. Nonspecific ulcerative colitis is more characterized by continuity and superficiality of the lesion, atrophy of the mucous membrane and a significant decrease in the number of goblet cells. With an increase in the number of biopsies, the information content of the histological diagnostic method increases significantly.
Indications for consultation with other specialists
Children with inflammatory bowel diseases should be managed and observed together with a gastroenterologist; in case of complications, a mandatory consultation with a proctologist surgeon is necessary to decide on timely surgical treatment.
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