Când suspectăm boala inflamatorie intestinală la copil? Semne de alarmă și diagnostic precoce

Abstract

Inflammatory bowel diseases (IBD) represent a heterogeneous group of chronic, relapsing, immune-mediated inflammatory disorders characterized by persistent inflammation of the gastrointestinal tract. This category includes Crohn’s disease (CD), ulcerative colitis (UC), and inflammatory bowel disease unclassified (IBD-U), forms that do not meet the complete criteria for classification into one of the first two clinical entities [1]. Over the last two decades, inflammatory bowel diseases have become one of the most important chronic digestive disorders in children and adolescents. Although they were previously regarded as conditions specific to young adults, current epidemiological data demonstrate a steady increase in the number of cases diagnosed during childhood, including in children younger than 10 years and even younger than 6 years [2]. Pediatric-onset disease has distinct features compared with adult-onset disease. Children frequently develop more extensive and more aggressive forms of disease, with major effects on linear growth, pubertal development, bone mineralization, and quality of life. In addition, the longer disease duration exposes these patients to a higher cumulative risk of complications, surgical interventions, and repeated hospitalizations [3]. One of the most important clinical challenges remains early diagnosis. Initial symptoms are often nonspecific and may be mistaken for much more common pediatric conditions, such as gastroenteritis, functional gastrointestinal disorders, food intolerances, or irritable bowel syndrome. Consequently, the interval between symptom onset and diagnosis may range from several months to several years [4]. Numerous studies have shown that diagnostic delay is associated with severe growth impairment, delayed pubertal development, increased risk of stricturing and fistulizing complications, need for early surgery, impaired psychological status, and reduced quality of life [5]. For these reasons, recognition of alarm signs and increased clinical suspicion among pediatricians, family physicians, and other specialists involved in childcare are essential objectives of modern medical practice.