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DIAGNOSTIC CHALLENGENS AND MANAGEMENT OF EARLY CROHN'S DISEASE IN A PEDIATRIC PATIENT: THE VALUE OF CAPSULE ENDOSCOPY
Samone Alexander
*1, Iyawnna Hazzard
1, Arleigh-Ann Byer
1, Yinka Davies
1,21College of Medicine, California Northstate University College of Medicine, Elk Grove, CA; 2Sacramento Pediatric Gastroenterology, Sacramento, CA
Crohn's Disease (CD) is a chronic inflammatory bowel disease commonly affecting the terminal ileum. Typical symptoms include right lower quadrant pain, diarrhea, and weight loss. In pediatric and adolescent populations, CD may also present with growth and puberty delays. Often the diagnosis of CD is made using a combination of clinical symptoms, endoscopic findings, and biopsy results that show signs of inflammation. However, diagnostic challenges arise when traditional methods, such as esophagogastroduodenoscopy (EGD), colonoscopy, and magnetic resonance enterography (MRE), fail to provide definitive evidence of disease.
This report discusses a 28-year-old male referred to the Gastroenterology clinic at age 16 for a continuation of right lower quadrant abdominal pain and weight loss following an appendectomy. Despite multiple traditional evaluations, including normal biopsy results of the small bowel, the patient's symptoms persisted. However, capsule endoscopy performed two years later revealed distal small bowel inflammation, leading to a preliminary diagnosis of CD. Treatment with mesalamine and adherence to a specific carbohydrate diet resulted in symptom resolution and normal follow-up imaging.
After six years without progression of disease, the patient discontinued treatment. The patient, less than one year later, consequently developed a small bowel obstruction due to complications of his Crohn’s disease and MRE showed disease progression despite normal biopsies in the distal ileum.. This case highlights the limitations of traditional diagnostic methods in detecting early CD, emphasizing the importance of early diagnosis with capsule endoscopy and consistent treatment and follow up to prevent complications.
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