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News

Crohn's disease in thin adolescents mistaken for anorexia

Children and adolescents who are painfully thin and failing to thrive properly are sometimes being wrongly diagnosed as anorexic when they actually have Crohn's disease, a leading professor of paediatrics and child health warns at this week's Annual Scientific Meeting of the British Society of Gastroenterology.

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Professor Booth, Leonard Parsons Professor of Paediatrics and Child Health, The Medical School, Edgbaston, Birmingham, told the Annual Scientific Meeting of the British Society of Gastroenterology how treatment of youngsters with extreme growth failure can be delayed for months if a mistaken diagnosis of anorexia nervosa is made.

The children actually have difficulty in eating and digesting food because of Crohn’s disease – inflammation of the digestive tract, usually of the small intestine.

Professor Booth reports that an important, but uncommon way in which Crohn’s disease can present is with growth failure and no gastrointestinal symptoms.

Adolescents with Crohn’s disease need careful handling and encouragement to stick to their treatment regime
Annual Scientific Meeting of the British Society of Gastroenterology, Birmingham

Growth failure in the absence of intestinal symptoms can be an important presentation of Crohn’s in adolescents.

The other important presentation is in wasting or malnutrition, so much so that presenting this way in adolescence, it is sometimes confused with anorexia nervosa.

Concerns about making the wrong diagnoses were first raised forty years ago, but cases are still seen.

Professor Booth cited the case of one girl who had suffered from low grade intestinal symptoms for several years, but the particularly prominent symptom was her refusal to eat as well as growth failure.

This patient was diagnosed by psychiatrists as anorexic and was admitted for in-patient treatment.

Professor Booth reported that the young girl was exposed to a fairly punitive style management of anorexia and it was eventually recognized after about six months in hospital that she had small bowel Crohn’s disease.

Crohn’s disease can present as growth failure or sometimes masquerade as anorexia nervosa.

Professor Booth told how adolescents with Crohn’s disease need careful handling to encourage them to stick to their treatment regime.

The presenter stated that adolescents are at an age when they want to rebel and take risks, and identify with their friends, thinking that they are bullet-proof and want to dissociate themselves from their parents, which makes life difficult for their doctor.

Professor Booth advises doctors to see young people by themselves as well as with their parents because young people want you to be their doctor, not their friend.

Professor Booth concludes, “Growth is all important to adolescents and about 33% of adolescents with Crohn’s disease will exhibit linear growth failure and pubertal delay.”

“Boys are more concerned about this than girls.”

Annual Scientific Meeting of the British Society of Gastroenterology, Birmingham Paper presented by Professor IW Booth on Monday 14th March 2005: Growing pains: IBD in adolescence
18 March 2005

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