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Diagnosis of inflammatory bowel diseases
Last reviewed: 23.04.2024
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Diagnosis of inflammatory bowel diseases in children is based on clinical, laboratory, X-ray-endoscopic and histological signs. The laboratory indicators to be studied are necessary both for assessing the severity of the main process and for differential diagnosis. In blood tests, anemia due to deficiency of iron and folic acid, thrombocytosis, increased ESR and the content of acute phase proteins can be detected. With a long-term disease, protein loss and malabsorption lead to hypoalbuminemia, a deficiency of vitamins, electrolytes and microelements. Studies of specific markers of inflammatory bowel diseases are being conducted: antineutrophil cytoplasmic antibodies (pANCA) are more often detected with ulcerative colitis, antibodies to fungi of Saccharomyces cerevisiae (ASCA) are more characteristic of Crohn's disease.
X-ray methods are minimally invasive, allow to assess the structure and function of the intestine, the rigidity of the wall, to detect submucous edema, pseudodiverticles, fistulas, stenoses, ulcerous and erosive defects.
Endoscopy has a large auxiliary value, shown when it is necessary to take material for biopsy from the thick and terminal ileum. The endoscopic pattern has peculiarities in various variants of inflammatory bowel diseases, but it does not always allow to verify the diagnosis. Children often have lymphoid hyperplasia of the terminal ileum - this is a variant of the norm.
Although the biopsy of the mucosa is superficial, the study makes it possible to establish some histological signs of various variants of inflammatory bowel diseases in children. Crohn's disease is characterized by foci, discontinuity of the lesion, accumulation of histiocytes and lymphocytes (the so-called microgranules), true granulomas in the submucosa and its own plate. For non-specific ulcerative colitis, the continuity and superficiality of the lesion, atrophy of the mucosa and a significant decrease in the number of goblet cells are more characteristic. With an increase in the number of biopsies, the informative value of the histological diagnostic method increases noticeably.
Indications for consultation of other specialists
Children with inflammatory bowel disease should be observed and observed together with a gastroenterologist; in case of complications, a compulsory consultation of the surgeon-coloproctologist is necessary to resolve the issue of timely surgical treatment.
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