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Crohn disease — RACP Paediatrics MCQ

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HardGastroenterologyCrohn diseaseRACP Paediatrics

A 13-year-old has six months of abdominal pain, mouth ulcers, weight loss and delayed puberty. Examination shows perianal skin tags and right iliac fossa tenderness; CRP and faecal calprotectin are elevated. What is the most appropriate investigation?

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Correct answer: A — Ileocolonoscopy and upper endoscopy with biopsies

Growth failure, perianal disease, raised inflammatory markers and elevated calprotectin suggest Crohn disease, requiring endoscopic assessment with biopsies. IBS does not cause delayed puberty, elevated CRP or perianal tags. The pearl is that poor growth may precede gastrointestinal symptoms in paediatric inflammatory bowel disease.

Reference: RCH Clinical Practice Guidelines; ECCO/ESPGHAN paediatric IBD guidance