20 research outputs found
Guidelines for the diagnosis and treatment od chronic constipation in children ā Recommendations from Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association
Uvod i cilj: KroniÄna opstipacija, prvenstveno funkcijska, jedna je od najÄeÅ”Äih gastrointestinalnih tegoba u djece i jedan od najÄeÅ”Äih razloga posjeta gastroenterologu. S ciljem adekvatne dijagnoze i lijeÄenja Hrvatsko druÅ”tvo za pedijatrijsku gastroenterologiju, hepatologiju i prehranu (HDPGHP) revidiralo je smjernice za dijagnostiku i lijeÄenje kroniÄne opstipacije u djece. Metode: Prilikom kreiranja novih smjernica pretražena je dostupna
znanstvena i struÄna literatura, ukljuÄujuÄi i smjernice relevantnih europskih druÅ”tava. Rezultati: U detalje su razraÄene smjernice za dijagnostiku i lijeÄenje kroniÄne opstipacije u djece s predloženim postupnicima i praktiÄnim savjetima o dozama lijekova. ZakljuÄci: Dijagnoza funkcijske opstipacije postavlja se na temelju kliniÄke slike i fizikalnog pregleda i vrlo dobro lijeÄi osmotskom laksativnom terapijom.Introduction and aim: Chronic constipation, primarily functional, is one of the most common gastrointestinal problems in children and one of the most common reasons for referral to gastroenterologist. With the aim to promote adequate diagnosis and treatment, the Croatian Society of Pediatric Gastroenterology, Hepatology and Nutrition (HDPGHP) has revised guidelines for the diagnosis and treatment of constipation in children. Methods:
The available scientific and clinical literature, including the guidelines of relevant European societies, was searched before creating the guidelines. Results: This manuscript represents guidelines for the diagnosis and treatment of chronic constipation in children and contains detailed algorithm and practical advice on therapy including doses. Conclusions: Functional constipation is diagnosed based on clinical symptoms and physical examination
and can be adequately managed with osmotic laxative therapy
Vegetarijanska i veganska prehrana u djeÄjoj dobi - smjernice Hrvatskog druÅ”tva za pedijatrijsku gastroenterologiju, hepatologiju i prehranu Hrvatskog lijeÄniÄkog zbora [Vegetarian and vegan diet in children - guidelines of the Croatian society for pediatric gastroenterology, hepatology and nutrition of the Croatian Medical Association]
The influence of vegetarian and vegan diet on childrenās health has been discussed not only by pediatricians
but also by other professionals who take care of children. Therefore, the aim of this recommendations, based on presented
and summarized scientific evidences on the effect of vegetarian and vegan diet on childrenās and adolescentsā health,
was to state the instructions of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the
Croatian Medical Association. Vegetarian, and especially vegan diet, is not only the omission of meat and other food of
animal origin, but has to represent balanced nutrition adjusted for children. Such a child requires continuous supervision
not only by primary health physician but also by pediatric nutritionist, who both have to be specially educated in the
field. As restrictions in diet significantly increase the risk for nutritional deficiencies, parents who decide to follow such
a diet, and all professionals who take care of such children, have to be aware of possible nutritional risks that are much
bigger than in adulthood
MĆ¢nÄ de mĆ¢nÄ cu Boala CeliacÄ (BC)
Proiectul CD SKILLS PP13 a UniversitÄČii de Stat de MedicinÄ Či Farmacie
āNicolae TestemiČanuā din Republica Moldova Či permisÄ spre traducere din limba englezÄ cu suportul tehnic al echipei de implementare: Tatiana Raba, Olesea Nicu, Anton Pivtora
Diagnostic algorithm for coeliac disease in children younger than two years of age
U djece mlaÄe od dvije godine dijagnoza celijakije postavlja se na temelju tri
biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom
bezglutenske prehrane) je uredna i treÄa (nakon optereÄenja glutenom) ponovno
pokazuje oÅ”teÄenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je
postavljena sljedeÄa hipoteza: u djece mlaÄe od dvije godine dijagnoza celijakije
može se postaviti na osnovu jedne biopsije, pozitivnih seroloŔkih nalaza i oporavka
na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost
dijagnostiÄkih parametara, definirati dijagnostiÄki postupnik za bolesnike mlaÄe od
dvije godine te usporediti skupinu kojoj je treÄa biopsija potvrdila (A1) i skupinu
kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 znaÄajno ÄeÅ”Äe
su se oÄitovali nenapredovanjem i proljevom i ÄeÅ”Äe su imali Marsh 3C leziju
sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u
bolesnika mlaÄih od dvije godine s tipiÄnim nalazom biopsije (Marsh 3C) i
pozitivnom serologijom, treba zapoÄeti bezglutensku prehranu i ako uslijedi
oporavak i negativizacija seroloÅ”kih nalaza postavlja se konaÄna dijagnoza celijakije.
U 71% naŔih bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i
pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poŔtedio
bi dijete od ponavljanih biopsija, skratio postupak i smanjio troŔkove.In children under two years coeliac disease is diagnosed with three small
bowel biopsies: the first shows destructive lesion, second (during gluten-free diet) is
normal and third (after gluten challenge) again shows mucosal damage. Such a
procedure is long-lasting and invasive, so following hypothesis was set: in children
under two years coeliac disease can be diagnosed with one biopsy, positive
serological markers and clinical remission to gluten-free diet. Aims were: to
determine predictive value of diagnostic parameters, to define algorithm in children
under two years and to compare groups with confirmed diagnosis (A1) vs those with
diagnosis not confirmed by the third biopsy (A2). More patients in group A1
presented with failure to thrive and diarrhoea, had more Marsh 3C lesions and
positive serology results. Based on results a new algorithm was proposed: in children
under two years with Marsh 3C lesion and positive serology, gluten-free diet should
be commenced and if there is clinical remission and serology tests become negative,
diagnosis of coeliac disease is final. In 71% of our patients diagnosis could have
been made with one biopsy and not even one patient would be missed. This would
spare a child from repeating biopsies, shorten the procedure and save expenses
Razrada dijagnostiÄkog postupnika za celijakiju u djece mlaÄe od dvije godine starosti [Diagnostic algorithm for coeliac disease in children younger than two years of age]
In children under two years coeliac disease is diagnosed with three small
bowel biopsies: the first shows destructive lesion, second (during gluten-free diet) is
normal and third (after gluten challenge) again shows mucosal damage. Such a
procedure is long-lasting and invasive, so following hypothesis was set: in children
under two years coeliac disease can be diagnosed with one biopsy, positive
serological markers and clinical remission to gluten-free diet. Aims were: to
determine predictive value of diagnostic parameters, to define algorithm in children
under two years and to compare groups with confirmed diagnosis (A1) vs those with
diagnosis not confirmed by the third biopsy (A2). More patients in group A1
presented with failure to thrive and diarrhoea, had more Marsh 3C lesions and
positive serology results. Based on results a new algorithm was proposed: in children
under two years with Marsh 3C lesion and positive serology, gluten-free diet should
be commenced and if there is clinical remission and serology tests become negative,
diagnosis of coeliac disease is final. In 71% of our patients diagnosis could have
been made with one biopsy and not even one patient would be missed. This would
spare a child from repeating biopsies, shorten the procedure and save expenses
Diagnostic algorithm for coeliac disease in children younger than two years of age
U djece mlaÄe od dvije godine dijagnoza celijakije postavlja se na temelju tri
biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom
bezglutenske prehrane) je uredna i treÄa (nakon optereÄenja glutenom) ponovno
pokazuje oÅ”teÄenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je
postavljena sljedeÄa hipoteza: u djece mlaÄe od dvije godine dijagnoza celijakije
može se postaviti na osnovu jedne biopsije, pozitivnih seroloŔkih nalaza i oporavka
na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost
dijagnostiÄkih parametara, definirati dijagnostiÄki postupnik za bolesnike mlaÄe od
dvije godine te usporediti skupinu kojoj je treÄa biopsija potvrdila (A1) i skupinu
kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 znaÄajno ÄeÅ”Äe
su se oÄitovali nenapredovanjem i proljevom i ÄeÅ”Äe su imali Marsh 3C leziju
sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u
bolesnika mlaÄih od dvije godine s tipiÄnim nalazom biopsije (Marsh 3C) i
pozitivnom serologijom, treba zapoÄeti bezglutensku prehranu i ako uslijedi
oporavak i negativizacija seroloÅ”kih nalaza postavlja se konaÄna dijagnoza celijakije.
U 71% naŔih bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i
pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poŔtedio
bi dijete od ponavljanih biopsija, skratio postupak i smanjio troŔkove.In children under two years coeliac disease is diagnosed with three small
bowel biopsies: the first shows destructive lesion, second (during gluten-free diet) is
normal and third (after gluten challenge) again shows mucosal damage. Such a
procedure is long-lasting and invasive, so following hypothesis was set: in children
under two years coeliac disease can be diagnosed with one biopsy, positive
serological markers and clinical remission to gluten-free diet. Aims were: to
determine predictive value of diagnostic parameters, to define algorithm in children
under two years and to compare groups with confirmed diagnosis (A1) vs those with
diagnosis not confirmed by the third biopsy (A2). More patients in group A1
presented with failure to thrive and diarrhoea, had more Marsh 3C lesions and
positive serology results. Based on results a new algorithm was proposed: in children
under two years with Marsh 3C lesion and positive serology, gluten-free diet should
be commenced and if there is clinical remission and serology tests become negative,
diagnosis of coeliac disease is final. In 71% of our patients diagnosis could have
been made with one biopsy and not even one patient would be missed. This would
spare a child from repeating biopsies, shorten the procedure and save expenses
Diagnostic algorithm for coeliac disease in children younger than two years of age
U djece mlaÄe od dvije godine dijagnoza celijakije postavlja se na temelju tri
biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom
bezglutenske prehrane) je uredna i treÄa (nakon optereÄenja glutenom) ponovno
pokazuje oÅ”teÄenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je
postavljena sljedeÄa hipoteza: u djece mlaÄe od dvije godine dijagnoza celijakije
može se postaviti na osnovu jedne biopsije, pozitivnih seroloŔkih nalaza i oporavka
na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost
dijagnostiÄkih parametara, definirati dijagnostiÄki postupnik za bolesnike mlaÄe od
dvije godine te usporediti skupinu kojoj je treÄa biopsija potvrdila (A1) i skupinu
kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 znaÄajno ÄeÅ”Äe
su se oÄitovali nenapredovanjem i proljevom i ÄeÅ”Äe su imali Marsh 3C leziju
sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u
bolesnika mlaÄih od dvije godine s tipiÄnim nalazom biopsije (Marsh 3C) i
pozitivnom serologijom, treba zapoÄeti bezglutensku prehranu i ako uslijedi
oporavak i negativizacija seroloÅ”kih nalaza postavlja se konaÄna dijagnoza celijakije.
U 71% naŔih bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i
pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poŔtedio
bi dijete od ponavljanih biopsija, skratio postupak i smanjio troŔkove.In children under two years coeliac disease is diagnosed with three small
bowel biopsies: the first shows destructive lesion, second (during gluten-free diet) is
normal and third (after gluten challenge) again shows mucosal damage. Such a
procedure is long-lasting and invasive, so following hypothesis was set: in children
under two years coeliac disease can be diagnosed with one biopsy, positive
serological markers and clinical remission to gluten-free diet. Aims were: to
determine predictive value of diagnostic parameters, to define algorithm in children
under two years and to compare groups with confirmed diagnosis (A1) vs those with
diagnosis not confirmed by the third biopsy (A2). More patients in group A1
presented with failure to thrive and diarrhoea, had more Marsh 3C lesions and
positive serology results. Based on results a new algorithm was proposed: in children
under two years with Marsh 3C lesion and positive serology, gluten-free diet should
be commenced and if there is clinical remission and serology tests become negative,
diagnosis of coeliac disease is final. In 71% of our patients diagnosis could have
been made with one biopsy and not even one patient would be missed. This would
spare a child from repeating biopsies, shorten the procedure and save expenses