Inflammatoriska tarmsjukdomar hos barn - ett växande problem

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Concentration of fecal calprotectin in 11,255 children aged 0-18 years

Objectives Fecal calprotectin is a valued surrogate marker for intestinal inflammation. It has been argued that calprotectin levels are higher in early age than in later life hampering the use of calprotectin in young children. Subjects and methods To study age-related variation, we used data from our laboratory information system on consecutive, unselected fecal calprotectin measurements from 2014 to 2017 in all children aged 0 to 18 years. From each individual, the first measurement was included and repeated measurements were excluded. Fecal calprotectin was quantitated in the major clinical laboratory in southern Finland, HUSLAB with an ELISA kit from Calpro AS (Calpro/Calprolab, Oslo, Norway). Currently, the assay is performed on two automatic pipetting analysers (Dynex DS2, Chantilly, USA) according to the instructions of the manufacturer. Results There were altogether 11,255 fecal calprotectin results from as many children. The median level of fecal calprotectin was 51 mg/kg in infants 100 mg/kg increased with increasing age. Conclusions Fecal calprotectin values in children beyond the first year of life are in general low and comparable in children and adolescents.Peer reviewe

Exposure to proton pump inhibitors is associated with the development of pediatric autoimmune diseases

Proton pump inhibitors (PPIs) have been associated with decreased gut microbiota diversity. Disrupted gut microbiota composition has been reported in several autoimmune diseases (ADs), such as type 1 diabetes mellitus (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), and inflammatory bowel diseases (IBD). We investigated whether PPIs are associated with the development of ADs in children and concluded that PPI exposures could be related to the onset of ADs, especially IBD and potentially AIT as well

Fecal calprotectin in juvenile idiopathic arthritis patients related to drug use

Background: Patients with juvenile idiopathic arthritis (JIA) on non-steroidal anti- inflammatory drugs (NSAIDs) may experience abdominal pain. In adults, NSAID use has been linked to an increase in fecal calprotectin (FC) levels, a surrogate marker for gut inflammation. In JIA, data on gut inflammation related to drug use is scarce. Methods: JIA patients followed up at the outpatient pediatric rheumatology clinic in Children's Hospital, Helsinki University Hospital, Helsinki, Finland were routinely assessed for FC if they complained about abdominal pain, had an elevated erythrocyte sedimentation rate (ESR) or used NSAIDs on a daily basis. The FC levels were related to the presence of abdominal pain, to ESR, and to the presence of HLA-B27. Results: Of the total group of 90 patients (median age 9.1 years; 45 JIA patients with disease modifying antirheumatic drugs (DMARDs), 25 without DMARD medication, and 20 arthralgia patients as controls), approximately 50% used NSAIDs, of whom 40% complained about abdominal pain. In patients with abdominal pain, one-third had elevated FC values (>100 mu g/g). The FC values, for the most part, declined along with the discontinuation or reduction of NSAIDs and after intensifying the DMARD medication, where after the pain disappeared. In patients with an elevated ESR, the FC values and ESR normalized in parallel. The presence of HLA-B27 was not associated with FC levels. Conclusion: In patients with JIA and abdominal pain, it may be useful to determine the FC when evaluating the need for further gastrointestinal examinations.Peer reviewe

Clustering of pediatric onset inflammatory bowel disease in Finland : a nationwide register-based study

Peer reviewe

Lääketieteen opiskelijoiden näkemyksiä potilaan kohtaamisesta ja työssä jaksamisesta

Lääketieteen 5. vuoden opiskelijat raportoivat monipuolisia havaintoja potilaiden kohtaamisesta ja ratkaisumalleja haastaviin vuorovaikutustilanteisiin. Tulevan työpaikan valinnassa opiskelijat arvostavat erityisesti työyhteisön hyvää ilmapiiriä, kollegiaalisuutta ja vaivatonta konsultaatiomahdollisuutta

IBD-hoitajasta hyötyä tulehduksellisten suolistosairauksien hoidossa

Suolistosairauksien hoitoon koulutetun sairaanhoitajan tulisi olla kiinteä osa moniammatillista tiimiä, joka vastaa tulehduksellisia suolistosairauksia (IBD) sairastavien potilaiden hoidosta. ¬Toistaiseksi tämä on tilanne vain joka toisessa näitä potilaita ¬hoitavista keskuksis

Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis

Peer reviewe

Tulehdukselliset suolistosairaudet - mikä vialla?

Teema : autoimmuunitaudit. English summar

Infliksimabin aloitushoidon vaikutus tulehduksellista suolistosairautta sairastavien lasten kalprotektiiniarvoihin

Vertaisarvioitu. Englsih abstract.Lähtökohdat : Tavoitteena oli tarkastella TNF-α:n salpaaja infliksimabin aloitushoidon aikaansaamaa vastetta tulehduksellista suolistosairautta sairastavilla lapsilla. Menetelmät : Tutkimuksessa oli mukana 20 Crohnin tautia, 5 haavaista koliittia ja 5 välimuotoista koliittia sairastavaa lasta. Kuuden viikon aloitushoidon aikana potilaat saivat kolme infliksimabi-infuusiota. Hoitovastetta mitattiin ulosteen kalprotektiinin avulla. Tulokset : Kalprotektiinin mediaani hoitojakson alussa oli 908 µg/g, kahden viikon kuluttua mediaani oli laskenut merkitsevästi tasolle 295 µg/g (p = 0,005). Kuuden viikon jälkeen mediaani oli 256 µg/g, eikä ero kahden viikon arvoon ollut tilastollisesti merkitsevä. Vain Crohnin tautia sairastavilla kalprotektiinin mediaani laski tilastollisesti merkitsevästi (p = 0,0057). Potilaista 87 % jatkoi ylläpitohoitoon infliksimabilla. Päätelmät : Infliksimabi laski osalla potilaista tehokkaasti kalprotektiinitasoa jo kahden viikon jälkeen hoidon aloittamisesta. Crohnin tautia sairastaville saatiin parempi vaste kuin haavaisessa tai välimuotoisessa koliitissa.Peer reviewe