Exclusive and Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) is a well-establised primary therapy in active pediatric Crohn’s disease (CD). EEN promotes mucosal healing, restores bone mineral density, and improves growth. On the contrary, treatment of active CD with corticosteroids (CS) has a strong negative impact on the linear growth and bone density. Therefore, EEN is recommended as a first-line therapy in children with active CD. EEN has been evaluated in a number of clinical studies including randomized controlled trials. While meta-analyses of adult studies suggest superiority of CS, pediatric studies have shown that EEN is at least as effective as CS in inducing remission. The mechanisms by which EEN suppresses inflammation are not yet fully elucidated. Hypotheses include improvement in nutritional status, decreasing of the inflammatory cascade mechanism, limiting luminal antigen exposure, improving intestinal permeability, and modification of intestinal microbiota

Nutritional Therapy for Inflammatory Bowel Disease

The components of a diet influence intestinal microbiota, epithelial barrier function, immune system, and many other factors that play important role in both development and treatment of inflammation in gastrointestinal tract. We briefly review potential role of specific dietary compounds as a risk or protective factor, but we predominantly concentrate on nutritional status and nutritional intervention in patients with inflammatory bowel disease. Besides exclusive enteral nutrition as a potential first-line treatment in active Crohn’s disease, other nutritional therapeutic modalities such as partial enteral nutrition, parenteral nutrition, diets based on carbohydrate modifications, anti-inflammatory diet, and the use of specific dietary compounds with anti-inflammatory properties, known as pharmaconutrition, are presented

Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) has proven to be a highly effective treatment option in inducing remission in active Crohn’s disease (CD) in the paediatric population. In adults with CD, the results of meta-analyses demonstrated that therapy with corticosteroids was more effective in comparison with EEN. The most important limitation of the success of EEN treatment is patients’ compliance. Exclusivity of enteral nutrition and its substantial impact on the quality of life are the main reasons why EEN is not acceptable to many patients. Therefore, the treatment with partial enteral nutrition (PEN), where patients are allowed to eat some ordinary food besides enteral formulas, is becoming an important treatment option, not only in inducing, but also in maintaining remission in CD. However, strong evidence on the efficacy of PEN for induction and maintenance of CD remission is still lacking. Due to the excellent safety profile of the treatment with enteral nutrition in comparison with other treatment modalities, further well-designed, randomised, controlled studies are necessary to elucidate the exact role of PEN in inducing and maintaining of remission in CD patients. Herein, the most relevant studies on the efficacy and the role of PEN in active and quiescent CD are reviewed

Non-alcoholic fatty liver disease in a pediatric patient with heterozygous familial hypobetalipoproteinemia due to a novel APOB variant: a case report and systematic literature review

BackgroundFamilial hypobetalipoproteinemia (FHBL) is an autosomal semi-dominant disorder usually caused by variants in the APOB gene that frequently interferes with protein length. Clinical manifestations include malabsorption, non-alcoholic fatty liver disease, low levels of lipid-soluble vitamins, and neurological, endocrine, and hematological dysfunction.MethodsGenomic DNA was isolated from the blood samples of the pediatric patient with hypocholesterolemia and his parents and brother. Next-generation sequencing (NGS) was performed, and an expanded dyslipidemia panel was employed for genetic analysis. In addition, a systematic review of the literature on FHBL heterozygous patients was performed.Case reportGenetic investigation revealed the presence of a heterozygous variant in the APOB (NM_000384.3) gene c.6624dup[=], which changes the open reading frame and leads to early termination of translation into the p.Leu2209IlefsTer5 protein (NP_000375.3). The identified variant was not previously reported. Familial segregation analysis confirmed the variant in the mother of the subject, who also has a low level of low-density lipoprotein and non-alcoholic fatty liver disease. We have introduced therapy that includes limiting fats in the diet and adding lipid-soluble vitamins E, A, K, and D and calcium carbonate. We reported 35 individuals with APOB gene variations linked to FHBL in the systematic review.ConclusionWe have identified a novel pathogenic variant in the APOB gene causing FHBL in pediatric patients with hypocholesterolemia and fatty liver disease. This case illustrates the importance of genetic testing for dyslipidemias in patients with significant decreases in plasma cholesterol as we can avoid damaging neurological and ophthalmological effects by sufficient vitamin supplementation and regular follow-ups

Comparison of partial and exclusive enteral nutrition in the treatment of active childhood-onset Crohn\u27s disease

Kljub temu, da so številne raziskave in metaanalize pokazale, da je zdravljenje otrok in mladostnikov z aktivno Crohnovo boleznijo (CB) s popolno enteralno prehrano (PEP) primerljivo učinkovito s kortikosteroidi (KS) in bolj uspešno v vzpostavitvi sluznične remisije ter ima po smernicah Evropskega združenja za pediatrično gastroenterologijo, hepatologijo in prehrano ESPGHAN-a prednost pred zdravljenjem s KS, se v klinični praksi še vedno premalo uporablja. Najpomembnejši vzrok je v nesodelovanju bolnikov, za katere je vzdrževanje zahtevnega protokola zdravljenja, brez uživanja običajne hrane, težka naloga. Zato je vse bolj aktualno raziskovanje učinkovitosti zdravljenja z delno enteralno prehrano (DEP), kjer lahko bolniki poleg enteralne formule zaužijejo tudi nekaj običajne hrane. Dosedanje raziskave zdravljenja z DEP so ocenjevale le klinični odziv na zdravljenje, nobena raziskava do sedaj še ni raziskala učinka DEP na sluznično vnetje. Zato je bil primarni namen naše raziskave oceniti ne le klinični, temveč tudi endoskopski odziv na 6-tedensko zdravljenje z novim protokolom zdravljenja z DEP in ga primerjati s standardnim zdravljenjem s PEP. Nov protokol zdravljenja smo zasnovali z namenom izboljšanja sodelovanja bolnikov in dovoljuje, da bolniki poleg enteralne formule (75% energijskega vnosa) zaužijejo en obrok hrane dnevno s protivnetno dieto. Od začetka junija 2017 do konca februarja 2021 smo na Kliničnem oddelku za gastroenterologijo, hepatologijo in nutricionistiko (KOGHN) obravnavali 54 otrok in mladostnikov s klinično in endoskopsko potrjeno aktivno CB, ki so bili kandidati za zdravljenje z enteralno prehrano. Petnajst bolnikov smo izključili na podlagi izključitvenih kriterijev, 3 so odklonili prehransko zdravljenje in so bili zdravljeni s KS, 3 so bili zdravljeni z drugo vrsto enteralne formule, ker jim ni ustrezal okus formule, ki smo jo zaradi lastnosti in uradne registracije, da je namenjena za zdravljenje CB, izbrali kot testno. V »intention to treat« (ITT) analizo smo vključili 33 bolnikov z aktivno CB, 14 bolnikov v skupino z zdravljenjem z DEP in 19 v skupino s PEP. V skupini bolnikov z DEP je 13 bolnikov in v skupini s PEP 16 bolnikov zaključilo 6-tedensko prehransko zdravljenje in so bili vključeni v »per protocol« (PP) analizo. V PEP skupini so bili bolniki zdravljeni s polimerično enteralno formulo (Alicalm, Nutricia, Nizozemska) po standardnem protokolu s 100% energijskim vnosom, v DEP skupini pa s 75% energijskim vnosom v obliki iste enteralne formule v kombinaciji z enim obrokom dnevno s protivnetno dieto. Protivnetno dieto (PVD) smo zasnovali na podlagi CDED (angl. »Crohn’s Disease Exclusion Diet«), ki smo jo prilagodili slovenskim razmeram. CDED temelji na hipotezi, da je najpomembnejši mehanizem delovanja PEP v izključitvi določenih sestavin hrane, ki negativno vplivajo na vnetje črevesa, predvsem na črevesno pregrado in mikrobioto. Naša PVD se od CDED razlikuje po tem, da vključuje uživanje lokalno pridelane zelenjave in sadja. CDED dovoljuje uživanje riža in krompirja, naša PVD dodatno tudi ajde in prosa. PVD za razliko od CDED izključuje ocvrte jedi ter vzpodbuja uživanje zdravih rastlinskih olj, predvsem olivnega olja. Klinično remisijo, opredeljeno s kliničnim kazalcem aktivnosti CB (angl. »Pediatric CD Activity Index« (PCDAI)) < 10, je imelo v DEP skupini po ITT analizi 78,5% in v PEP skupini 68,4% bolnikov, med skupinama ni bilo statistično pomembne razlike (p = 0,698). Po PP analizi je bilo po končanem 6-tedenskem zdravljenju z DEP protokolom 84,6% bolnikov v klinični remisiji in v PEP skupini 81,3% (p = 0,999). Endoskopsko remisijo, opredeljeno z endoskopskim kazalcem aktivnosti CB (angl. »Simple Endoscopic Score-for Crohn’s Disease« (SES-CD)) ? 2, je po 6-tedenskem zdravljenju doseglo 53,8% bolnikov v DEP in 50,0% v PEP skupini (p = 0,999). Sluznično remisijo (SES-CD = 0) smo po končanem zdravljenju ugotovili pri 38,5% bolnikov v DEP in pri 43,8% v PEP skupini (p = 0,999). Povprečne vrednosti PCDAI in SES-CD so od začetka do konca 6-tedenskega zdravljenja statistično pomembno upadle v obeh skupinah, med skupinama ni bilo statistično značilne razlike v upadu PCDAI (p = 0,881) in SES-CD (p = 0,750). Od laboratorijskih izvidov so se tekom zdravljenja v obeh skupinah statistično pomembno znižale povprečne vrednosti sedimentacije eritrocitov, CRP, povprečne vrednosti trombocitov in povprečne koncentracije fekalnega kalprotektina. Med skupinama bolnikov, zdravljenih z DEP in s PEP, ni bilo statistično pomembnih razlik v upadu omenjenih laboratorijskih parametrov. Po 6-tedenskem zdravljenju pa nismo ugotovili pomembnega povišanja povprečnih vrednosti koncentracije hemoglobina v krvi in povprečnih vrednosti antropometričnih parametrov v nobeni od skupin. Rezultati naše raziskave so pokazali, da je bilo zdravljenje z novim protokolom zdravljenja z DEP primerljivo učinkovito v vzpostavitvi klinične in endoskopske remisije v primerjavi s standardnim zdravljenjem s PEP. Nov protokol zdravljenja je enostaven in dovoljuje bolnikom, da poleg enteralne formule dnevno zaužijejo en obrok hrane z manjšimi prehranskimi omejitvami, kar doprinese k boljši kakovosti življenja. Raziskovalno delo kot prispevek k znanosti vključuje zasnovo novega protokola zdravljenja z DEP s 75% energijskim vnosom z enteralno formulo in enim obrokom dnevno s protivnetno dieto. Naša raziskava je do sedaj prva in edina, ki je ugotavljala ne le klinični, temveč tudi endoskopski odziv na zdravljenje z DEP.NNumerous clinical studies and meta-analysis have confirmed that exclusive enteral nutrition (EEN) is as effective as corticosteroids (CS) for induction of remission in active pediatric Crohn’s disease (CD). Moreover, EEN was shown to be more effective than CS in achieving mucosal healing (MH), therefore consensus guidelines of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend EEN as a first-line therapy in children with active CD. Despite the numerous benefits of EEN, this treatment strategy is still underused in clinical practice. The most important barrier, preventing widespread use of EEN, is patient compliance. Adhering to the EEN regimen is difficult for most patients as they are only allowed to consume liquid enteral formula during the 6–8-week treatment period. Recently, partial enteral nutrition (PEN) has come into the forefront of pediatric CD treatment research, as it allows patients to consume some solid food alongside the enteral formula, improving the quality of life and patient compliance. So far, all previous studies on PEN have only evaluated the clinical response to PEN treatment, furthermore, no study has evaluated the effect of PEN on mucosal healing in CD. Therefore, the primary goal of our study was to evaluate not only the clinical outcomes of PEN, but the endoscopic remission and mucosal healing rates after a 6-week treatment course with PEN, as well as to compare the outcomes of PEN treatment to the standard EEN treatment protocol. At our Department of Pediatric Gastroenterology, Hepatology and Nutrition, from June 2017 until the end of February 2021, 54 children and adolescents with clinically and endoscopically confirmed active CD were screened for inclusion into our study. Fifteen patients were excluded based on the exclusion criteria. Additionally, three patients were excluded as they chose CS over nutritional treatment and another 3 patients due to being treated with a different enteral nutrition formula which wasn’t part of the treatment protocol. Finally, 33 patients were included into our study on intention to treat (ITT) analysis. Nineteen patients were included into the EEN and 14 into the PEN group. Thirteen patients in the PEN group and 16 patients in the EEN group concluded 6 weeks of nutritional treatment and were therefore included into per protocol (PP) analysis. All patients in the EEN group were treated with the same polymeric enteral formula (Alicalm, Nutricia, Nehterlands) in accordance with the standard treatment protocol, where 100% of daily energy requirements are covered with an enteral formula. In the PEN group, 75% of daily energy requirements were supplied by an enteral formula, while children were allowed one meal per day from an anti-inflammatory diet (AID). The AID was based on the CD Exclusion Diet (CDED), which was modified to fit the Slovenian dietary habits. CDED is grounded on recent scientific findings and excludes dietary components that negatively affect either intestinal permeability or the microbiome. Our AID differs from CDED in that it allows patients to consume locally sourced fruit and vegetables. CDED permits the consumption of rice and potatoes, our AID additionally allows buckwheat and millet, but excludes fried foods and promotes the use of healthy vegetables oils, especially olive oil. On ITT analysis, clinical remission (Pediatric CD Activity Index < 10) was achieved in 78.5% of patients in the PEN and 68.4% of patients in the EEN group (p=0.698), respectively. On per protocol analysis 84.6% of patients in the PEN and 81.3% of patients in the EEN group achieved clinical disease remission (p = 0.999). Endoscopic remission, defined as Simple Endoscopic Score for CD (SES-CD) ⡤ 2, was observed in 53.8% of patients in the PEN and in 50.0% of patients in the EEN group (p = 0.999) and mucosal healing (SES-CD = 0) was found in 38.5% of patients in the PEN and in 43.8% of patients in the EEN group (p = 0.999). Mean PCDAI and SES-CD index values significantly decreased in both groups and no difference between groups was observed (p = 0.881 for PCDAIp = 0.750 for SES-CD). Furthermore, a statistically significant decrease in mean erythrocyte sedimentation rate, C-reactive protein, mean thrombocyte count and fecal calprotectin was found in both groups with no significant differences between the two groups in the change of the abovementioned parameters during a 6-week treatment course. During the treatment period, no statistically significant increases in the patients’ mean blood hemoglobin levels or anthropometric parameters were observed for either group. In our study, our novel PEN treatment protocol, allowing one meal per day from an anti-inflammatory diet, was comparable in effectiveness to standard EEN treatment in inducing clinical and endoscopic remission in pediatric patients with active CD. Our PEN protocol allows patients to consume one meal per day alongside the enteral nutrition formula, which positively impacts the patients’ quality of life. Our research project contributes to scientific research with the development of a novel nutritional treatment protocol, which combines 75% of daily required energy intake from an enteral formula with one allowed meal per day from an anti-inflammatory diet. Furthermore, our study is the first to assess not only clinical but also endoscopic remission and mucosal healing rates in the treatment of CD with partial enteral nutrition

Modern diagnostic aproach to celiac disease

Izhodišča: Celiakija je imunsko pogojena bolezen tankega črevesa, ki nastane kot posledica uživanja glutena pri genetsko predisponiranih osebah. Bolezen prizadene okoli 1 % prebivalstva in ni le bolezen otroške dobe, saj v različnih kliničnih oblikah prizadene ljudi vseh starosti. Diagnostika bolezni temelji na merilih, ki jih je sprejelo in nato revidiralo Evropsko združenje za pediatrično gastroenterologijo, hepatologijo in prehrano (ESPGHAN). Kot zlati standard predvidevajo dokaz reverzibilne okvare sluznice tankega črevesa. Revidirana merila predvidevajo manjše število biopsij za postavitev dokončne diagnoze, kar je predvsem posledica uporabe seroloških testov. V diagnostiki celiakije igrajo pomembno vlogo tudi genetske preiskave, predvsem določanje prisotnosti zapisa za HLA-DQ2 in HLA-DQ8. Najnovejši testi, ki omogočajo določanje prisotnosti protiteles proti tkivni transglutaminazi v kapilarni krvi ob obisku bolnika v ambulanti, bodo verjetno zelo olajšali diagnostiko bolezni. Nova dognanja, ki kažejo, da gre pri celiakiji za sistemski patološki imunski odgovor na gluten pri genetsko predisponiranih osebah, pa že kažejo na to, da v prihodnje biopsija sluznice tankega črevesa morda ne bo več imela primarne vloge. Zaključki: Sodobna diagnostika celiakije temelji na uporabi bolezensko specifičnih seroloških testov in dokazu povratne okvare sluznice tankega črevesa. V diagnostiki se v zadnjem času uspešno uporabljajo tudi genetski testi in novi hitri serološki testi. Intenzivne raziskave patogeneze in klinične slike celiakije pa bodo pokazale, ali bo v prihodnje moč postaviti zanesljivo diagnozo bolezni tudi brez biopsije sluznice tankega črevesa.Background: Celiac disease, also known as genetic gluten intolerance is a chronic disease that affects genetically predisposed individuals after the gluten ingestion. It affects about 1 % of population regardless of the age, and can manifest with diverse clinical picture. Diagnosis of celiac disease is based on criteria adopted and later revised by European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). These criteria consider intestinal biopsy as a gold standard. The number of biopsies has decreased after the introduction of serological tests, which are considered in revised criteria. Genetic tests have also proven to be very valuable in diagnostic procedure, especially HLA-DQ2 and HLA-DQ8 determination. Bedside or point-of-care tests, which enable quick determination of anti tissue transglutaminase antibodies in capillary blood, are a promising new tool. Many reports have shown that adverse immunological response to gluten in genetically predisposed individuals is systemic, which can lead to a decreased importance of intestinal biopsy in future. Conclusions: Diagnosis of celiac disease is based on specific serological markes and reversible mucosal changes of small intestine. Lately developed genetic tests and new quick serological tests are also used. Intensive research focused on pathogenesis and manifestations of celiac disease will show whether definite diagnosis could be confirmed without the use of intestinal biopsy in future

Klinična uporabnost seroloških označevalcev v diagnostiki kronične vnetne črevesne bolezni v pediatriji

Background: Among children and adolescents, the diagnosis of inflammatory bowel disease (IBD) is often missed or delayed because of the nonspecific nature of the clinical symptoms. In such instances noninvasive and accurate diagnostic tests that would accurately distinguish IBD from functional disorders would be most valuable to clinicians. Several serological markers have been used as non-invasive diagnostic tools in IBD pediatric patients. The aim of our study was to determine the prevalence and diagnostic accuracy of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), anti-exocrine pancreatic antibodies (PAB) and anti-goblet cells antibodies (GAB) alone and in combination in children and adolescents with IBD. Patients and methods: Serum specimens were analyzed for p-ANCA, ASCA IgG, ASCA IgA, PAB and GAB antibodies in 49 children and adolescents with confirmed IBD and 53 non-IBD controls. P-ANCA, PAB and GAB antibodies were determined by indirect immunofluorescent test and ASCA by enzyme-linked immunosorbent assay. All patients with Crohn\u27s disease (CD) had genotyping performed using a sequence specific PCR directed against the wild type and the three principal mutations of NOD2/CARD15 gene. Disease location, body mass index (BMI) and disease activity by pediatric Crohn\u27s disease activity index (PCDAI) at the time of diagnosis were determined in CD patients. Results: The prevalence of p-ANCA in patients with UC and ASCA in CD patients was high (82.3 % and 67.9 %, respectively). Positivity for PAB antibodies in CD and GAB in UC was lower (35.7 % and 23.5 %, respectively). Accuracy data (sensitivity, specificity, PPV, NPV, respectively) for differentiating IBD from non-IBD controls were as follows: p-ANCA: 82 %, 100 %, 100 %, 94 %ASCA IgG: 68 %, 94 %, 86 %, 84 %ASCA IgA: 54 %, 100 %, 100 %, 80 %PAB: 36 %, 98 %, 91 %, 74 %GAB: 23 %, 100 %, 100 %, 80 %. In distinguishing CD from UC we found out the following accuracy data (sensitivity, specificity, PPV, NPV, respectively): p-ANCA: 82 %, 82 %, 74 %, 88 %ASCA IgG: 68 %, 100 %, 100 %, 65 %ASCA IgA: 54 %, 100 %, 100 %, 57 %PAB: 36 %, 100 %, 100 %, 49 %GAB: 23 %, 100 %, 100 %, 68 %. There were no significant association between ASCA positivity and the three major mutations of NOD2/CARD15 gene, disesase location and family history in CD patients, however an association between BMI and disease activity at the time of diagnosis was found out. Conclusions: Specificity and positive predictive value of serological markers p-ANCA, ASCA IgG, ASCA IgA, PAB and GAB for IBD alone and in combination are high and which make them useful in diagnosis of inflammatory bowel disease in day-to-day clinical practice, particulary in making decision about performing invasive diagnostic procedures. Because of low sensitivity they are less useful as screening tests for inflammatory bowel disease in pediatric population.Izhodišča: Kronična vnetna črevesna bolezen (KVČB) pri otrocih in mladostnikih pogosto poteka z nespecifičnimi kliničnimi znaki, ki so lahko podobni funkcionalnim motnjam, zato je diagnoza KVČB pogosto postavljena pozno ali pa celo spregledana. V pediatriji so v klinični praksi še posebno zaželjeni zanesljivi neinvazivni diagnostični testi, ki ločijo KVČB od funkcionalnih motenj. Številni serološki označevalci se že uporabljajo kot neinvazivni diagnostični testi v diagnostiki KVČB v pediatriji. Namen naše raziskave je bil določiti prevalenco ter diagnostično uporabnost seroloških označevalcev - protiteles proti citoplazemskim antigenom nevtrofilcev (Antineutrophil Cytoplasmic Antibodies - ANCA), protiteles proti kvasovki Saccharomyces cerevisiae (Anti-Saccharomyces Cerevisiae Antibodies - ASCA), protiteles proti eksokrinemu delu pankreasa (Pancreas Antibodies - PAB) in protiteles proti čašastim celicam (Goblet cells Antibodies - GAB) posamezno in v kombinaciji pri otrocih in mladostnikih s KVČB. Bolniki in metode: V vzorcih serumov 49 otrok in mladostnikov s KVČB in 53 otrok in mladostnikov kontrolne skupine, ki niso imeli KVČB, smo ugotavljali prisotnost protiteles p-ANCA, ASCA IgG, ASCA IgA, PAB and GAB. Protitelesa p-ANCA, PAB in GAB smo določali z metodo indirektne imunofluorescence, protitelesa ASCA IgG in IgA pa z encimsko-imunsko metodo ELISA. Dodatno smo vsem bolnikom s Crohnovo boleznijo določali morebitno prisotnost treh najpomembnejsih mutacij v genu NOD2/CARD15 z metodo polimerazne verižne reakcije (PCR), opredelili umestitev vnetja, določili indeks telesne mase in stopnjo aktivnosti vnetja s pediatričnim indeksom aktivnosti bolezni (PCDAI) ob postavitvi diagnoze. Rezultati: Ugotovili smo visoko prevalenco p-ANCA protiteles pri bolnikih z ulceroznim kolitisom (UK) (82,3 %), medtem ko je bila prevalenca ASCA protiteles pri bolnikih s Crohnovo boleznijo (CB) nekoliko nižja (67,9 %). Prevalenca PAB protiteles pri CB in GAB pri bolnikih z UK je bila še nižja (35,7 % za PAB pri CB in 23,5 % za GAB protitelesa pri UK). Občutljivost, specifičnost, pozitivna napovedna vrednost (PPV) in negativna napovedna vrednost (NPV) omenjenih seroloških označevalcev v diagnostičnem razlikovanju KVČB od zdravih preiskovancev so bile sledeče: za p-ANCA: 82 %, 100 %, 100 %, 94 %za ASCA IgG: 68 %, 94 %, 86 %, 84 %za ASCA IgA: 54 %, 100 %, 100 %, 80%za PAB: 36 %, 98 %, 91 %, 74 % in za GAB: 23 %, 100 %, 100 %, 80 %. V razlikovanju med CB in UK pa so občutljivost, specifičnost, pozitivna napovedna vrednost (PPV) in negativna napovedna vrednost (NPV) znašale: za p-ANCA: 82 %, 82 %, 74 %, 88 %za ASCA IgG: 68 %, 100 %, 100 %, 65 %za ASCAIgA: 54 %, 100 %, 100 %, 57 %za PAB: 36 %, 100 %, 100 %, 49 % in za GAB:23 %, 100 %, 100 %, 68 %. V naši študiji nismo potrdili statistično pomembne povezave med prisotnostjo ASCA protiteles in treh najpogostejših mutacij v genu NOD2/CARD15 pri bolnikih s CB. Prav tako nismo potrdili povezave med ASCA pozitivnim serološkim statusom in ilealno umestitvijo vnetja ter pozitivno družinsko anamnezo. Ugotovili pa smo statistično pomembno povezavo med prisotnostjo ASCA protiteles z večjo aktivnostjo CB in nižjim indeksom telesne mase pri bolnikih s CB. Zaključki: Zaradi visoke specifičnosti ter pozitivne napovedne vrednosti so serološki označevalci p-ANCA, ASCA IgG, ASCA IgA, PAB in GAB tako samostojno kot v kombinaciji pomembni neinvazivni diagnostični testi. V vsakodnevni klinični praksi nam koristijo predvsem v diagnostični razmejitvi med kronično vnetno črevesno boleznijo in funkcionalnimi motnjami ter pri odločitvi za invazivne diagnostične metode. Zaradi prenizke občutljivosti pa niso primerni za uporabo kot presejalni testi za kronično vnetno črevesno bolezen v pediatrični populaciji

Incidence Trends and Geographical Variability of Pediatric Inflammatory Bowel Disease in Slovenia: A Nationwide Study

Background. The aims of the study were to determine the incidence rate of pediatric inflammatory bowel disease (PIBD) and its trends for the period of 2002-2010 and to assess the geographical distribution of PIBD in Slovenia. Materials and Methods. Medical records of patients (0-18 years) with newly diagnosed IBD during the study period were retrospectively reviewed. Results. The mean incidence rate for IBD in 2002-2010 was 7.6 per 100,000 children and adolescents per year, 4.5 for Crohn&apos;s disease (CD), 2.9 for ulcerative colitis (UC), and 0.2 for IBD-unclassified, respectively. The incidence rate increased from 5.8 per 100,000 per year in 2002-2004 to 8.6 in 2005-2007 and remained stable afterwards. Statistically significant difference in the incidence rate between the Northeastern and Southwestern parts of the country was observed ( = 0.025). Conclusion. This nationwide study demonstrates that Slovenia is among the European countries with the highest PIBD incidence. During the study period a substantial rise of PIBD incidence was observed during the first half of the study and it seems to have stabilized in the second half. The significant difference in PIBD incidence between Northeastern and Southwestern parts of the country merits further exploration of the possible environmental factors

Incidence Trends and Geographical Variability of Pediatric Inflammatory Bowel Disease in Slovenia: A Nationwide Study

Background. The aims of the study were to determine the incidence rate of pediatric inflammatory bowel disease (PIBD) and its trends for the period of 2002–2010 and to assess the geographical distribution of PIBD in Slovenia. Materials and Methods. Medical records of patients (0–18 years) with newly diagnosed IBD during the study period were retrospectively reviewed. Results. The mean incidence rate for IBD in 2002–2010 was 7.6 per 100,000 children and adolescents per year, 4.5 for Crohn’s disease (CD), 2.9 for ulcerative colitis (UC), and 0.2 for IBD-unclassified, respectively. The incidence rate increased from 5.8 per 100,000 per year in 2002–2004 to 8.6 in 2005–2007 and remained stable afterwards. Statistically significant difference in the incidence rate between the Northeastern and Southwestern parts of the country was observed (p=0.025). Conclusion. This nationwide study demonstrates that Slovenia is among the European countries with the highest PIBD incidence. During the study period a substantial rise of PIBD incidence was observed during the first half of the study and it seems to have stabilized in the second half. The significant difference in PIBD incidence between Northeastern and Southwestern parts of the country merits further exploration of the possible environmental factors