Guidelines for the diagnosis and treatment od chronic constipation in children – Recommendations from Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Uvod i cilj: Kronična opstipacija, prvenstveno funkcijska, jedna je od najčešćih gastrointestinalnih tegoba u djece i jedan od najčešćih razloga posjeta gastroenterologu. S ciljem adekvatne dijagnoze i liječenja Hrvatsko društvo za pedijatrijsku gastroenterologiju, hepatologiju i prehranu (HDPGHP) revidiralo je smjernice za dijagnostiku i liječenje kronične opstipacije u djece. Metode: Prilikom kreiranja novih smjernica pretražena je dostupna znanstvena i stručna literatura, uključujući i smjernice relevantnih europskih društava. Rezultati: U detalje su razrađene smjernice za dijagnostiku i liječenje kronične opstipacije u djece s predloženim postupnicima i praktičnim savjetima o dozama lijekova. Zaključci: Dijagnoza funkcijske opstipacije postavlja se na temelju kliničke slike i fizikalnog pregleda i vrlo dobro liječi 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 dječjoj dobi - smjernice Hrvatskog društva za pedijatrijsku gastroenterologiju, hepatologiju i prehranu Hrvatskog liječničkog 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 children’s 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 children’s and adolescents’ 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

Mână de mână cu Boala Celiacă (BC)

Proiectul CD SKILLS PP13 a Universității de Stat de Medicină și Farmacie “Nicolae Testemițanu” din Republica Moldova și permisă spre traducere din limba engleză 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 mlađe od dvije godine dijagnoza celijakije postavlja se na temelju tri biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom bezglutenske prehrane) je uredna i treća (nakon opterećenja glutenom) ponovno pokazuje oštećenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je postavljena sljedeća hipoteza: u djece mlađe od dvije godine dijagnoza celijakije može se postaviti na osnovu jedne biopsije, pozitivnih seroloških nalaza i oporavka na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost dijagnostičkih parametara, definirati dijagnostički postupnik za bolesnike mlađe od dvije godine te usporediti skupinu kojoj je treća biopsija potvrdila (A1) i skupinu kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 značajno češće su se očitovali nenapredovanjem i proljevom i češće su imali Marsh 3C leziju sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u bolesnika mlađih od dvije godine s tipičnim nalazom biopsije (Marsh 3C) i pozitivnom serologijom, treba započeti bezglutensku prehranu i ako uslijedi oporavak i negativizacija seroloških nalaza postavlja se konačna dijagnoza celijakije. U 71% naših bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poštedio bi dijete od ponavljanih biopsija, skratio postupak i smanjio troškove.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 dijagnostičkog postupnika za celijakiju u djece mlađe 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 mlađe od dvije godine dijagnoza celijakije postavlja se na temelju tri biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom bezglutenske prehrane) je uredna i treća (nakon opterećenja glutenom) ponovno pokazuje oštećenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je postavljena sljedeća hipoteza: u djece mlađe od dvije godine dijagnoza celijakije može se postaviti na osnovu jedne biopsije, pozitivnih seroloških nalaza i oporavka na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost dijagnostičkih parametara, definirati dijagnostički postupnik za bolesnike mlađe od dvije godine te usporediti skupinu kojoj je treća biopsija potvrdila (A1) i skupinu kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 značajno češće su se očitovali nenapredovanjem i proljevom i češće su imali Marsh 3C leziju sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u bolesnika mlađih od dvije godine s tipičnim nalazom biopsije (Marsh 3C) i pozitivnom serologijom, treba započeti bezglutensku prehranu i ako uslijedi oporavak i negativizacija seroloških nalaza postavlja se konačna dijagnoza celijakije. U 71% naših bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poštedio bi dijete od ponavljanih biopsija, skratio postupak i smanjio troškove.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 mlađe od dvije godine dijagnoza celijakije postavlja se na temelju tri biopsije tankog crijeva: prva pokazuje destruktivnu leziju, druga (tijekom bezglutenske prehrane) je uredna i treća (nakon opterećenja glutenom) ponovno pokazuje oštećenje sluznice. Ovakav postupak dugotrajan je i invazivan pa je postavljena sljedeća hipoteza: u djece mlađe od dvije godine dijagnoza celijakije može se postaviti na osnovu jedne biopsije, pozitivnih seroloških nalaza i oporavka na bezglutensku prehranu. Glavni ciljevi rada bili su: odrediti prediktivnu vrijednost dijagnostičkih parametara, definirati dijagnostički postupnik za bolesnike mlađe od dvije godine te usporediti skupinu kojoj je treća biopsija potvrdila (A1) i skupinu kojoj nije potvrdila dijagnozu celijakije (A2). Bolesnici skupine A1 značajno češće su se očitovali nenapredovanjem i proljevom i češće su imali Marsh 3C leziju sluznice te pozitivna protutijela. Na osnovu rezultata predložen je novi postupnik: u bolesnika mlađih od dvije godine s tipičnim nalazom biopsije (Marsh 3C) i pozitivnom serologijom, treba započeti bezglutensku prehranu i ako uslijedi oporavak i negativizacija seroloških nalaza postavlja se konačna dijagnoza celijakije. U 71% naših bolesnika dijagnoza se mogla postaviti na temelju jedne biopsije i pritom niti jedan bolesnik ne bi ostao nedijagnosticiran. Ovakav postupnik poštedio bi dijete od ponavljanih biopsija, skratio postupak i smanjio troškove.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