Chronic inflammatory bowel disease in children

U grupu bolesti zajednickog naziva kronicna upalna bolest crijeva ubrajamo ulcerozni kolitis i Crohnovu bolest. Incidencija i prevalencija ovih bolesti , posebice M. Crohn svakodnevno raste. Etiologija nije jasna, a najvjerojatnije se radi o imunološki posredovanoj bolesti. Na kronicnu upalnu bolest crijeva valja posumnjati u djece s ucestalim stolicama koje traju duže od 6 tjedana, cesto udružene s bolovima u trbuhu, gubitkom na težini, zastojem u rastu ili febrilitetom nepoznate etiologije. Sumnja na bolest se postavlja na osnovi klinicke slike, fizikalnog pregleda, laboratorijskih pretraga, a dokazuje se endoskopskim, rendgenološkim i histološkim pregledom sluznice crijeva. Cilj terapije kronicne upalne bolesti crijeva je indukcija remisije, sprijecavanje relapsa, poboljšanje nutricijskog manjka te osiguranje normalnog rasta i razvoja djeteta. S obzirom da je etiologija nepoznata, gore navedene ciljeve postižemo razlicitim lijekovima, što ovisi o težini bolesti, te u slucaju komplikacija i kirurškim lijecenjemUlcerative colitis and Crohn disease represent a group of inflammatory disorders of the colon and small intestine whose etiology and interrelationships remain unknown. While the incidence of Crohn disease continues to increase, the incidence of ulcerative colitis has stabile. The usual symptoms are rectal bleeding, abdominal cramping, diarrhea, fever, anorexia, weight loss, and by many local and systematic complications. Diagnostic procedures supplement a throught history and physical examination in the evaluation of symptoms suggestive to inflammatory bowel disease. Multiple technologies are available, including contrast radiolography, gastrointestinal endoscopy with biopsy, ultrasonography, computed tomography, and radioisotope studies. Because the cause of inflammatory bowel disease has not been established, current medical therapy is facilitative and supportive rather than currativ

PAEDIATRIC ENTERAL FEEDING

Visoka zastupljenost malnutricije u bolesnika primljenih u bolnicu zbog bolesti nastalih akutno, bez podležeće kronične bolesti, te u još većem broju onih s kroničnim bolestima bilo kojega sustava, nalaže brzo dijagnosticiranje i liječenje tog poremećaja. Prikazane su osnovne karakteristike malnutricije, s posebnim osvrtom na dječju dob, indikacije za prehrambenom potporom, način provođenja enteralne prehrane te praćenje i moguće komplikacij

Chronic inflammatory bowel disease in children

U grupu bolesti zajednickog naziva kronicna upalna bolest crijeva ubrajamo ulcerozni kolitis i Crohnovu bolest. Incidencija i prevalencija ovih bolesti , posebice M. Crohn svakodnevno raste. Etiologija nije jasna, a najvjerojatnije se radi o imunološki posredovanoj bolesti. Na kronicnu upalnu bolest crijeva valja posumnjati u djece s ucestalim stolicama koje traju duže od 6 tjedana, cesto udružene s bolovima u trbuhu, gubitkom na težini, zastojem u rastu ili febrilitetom nepoznate etiologije. Sumnja na bolest se postavlja na osnovi klinicke slike, fizikalnog pregleda, laboratorijskih pretraga, a dokazuje se endoskopskim, rendgenološkim i histološkim pregledom sluznice crijeva. Cilj terapije kronicne upalne bolesti crijeva je indukcija remisije, sprijecavanje relapsa, poboljšanje nutricijskog manjka te osiguranje normalnog rasta i razvoja djeteta. S obzirom da je etiologija nepoznata, gore navedene ciljeve postižemo razlicitim lijekovima, što ovisi o težini bolesti, te u slucaju komplikacija i kirurškim lijecenjemUlcerative colitis and Crohn disease represent a group of inflammatory disorders of the colon and small intestine whose etiology and interrelationships remain unknown. While the incidence of Crohn disease continues to increase, the incidence of ulcerative colitis has stabile. The usual symptoms are rectal bleeding, abdominal cramping, diarrhea, fever, anorexia, weight loss, and by many local and systematic complications. Diagnostic procedures supplement a throught history and physical examination in the evaluation of symptoms suggestive to inflammatory bowel disease. Multiple technologies are available, including contrast radiolography, gastrointestinal endoscopy with biopsy, ultrasonography, computed tomography, and radioisotope studies. Because the cause of inflammatory bowel disease has not been established, current medical therapy is facilitative and supportive rather than currativ

IMA LI MEĐU RODITELJIMA DJECE S UPALNIM BOLESTIMA CRIJEVA VIŠE OBILJEŽJA OPSESIVNO-KOMPULZIVNOG POREMEĆAJA LIČNOSTI NEGO MEĐU RODITELJIMA ZDRAVE DJECE?

Obsessive traits, neuroticism, as well as obsessive-compulsive personality disorder (OCPD) may be notably found among adult patients with inflammatory bowel disease (IBD), while the results are not so clear among children with IBD. However, according to published data, all children with IBD who also have a psychiatric diagnosis have at least one parent with psychopathology. The majority of parents of children with IBD have a psychiatric diagnosis, predominantly personality disorder. Children with parental psychopathology differ from children without parental psychopathology in anxious and depressive features. Parents of children with “compulsive neurosis” or obsessive-compulsive disorder have a significant level of anancastic characteristics or OCPD. In the light of published data, we hypothesize that OCPD will be more prevalent in parents of children with IBD than in parents of healthy children. Findings regarding the presence of personality disorder in parents of children with IBD may help in the process of developing and implementing treatment interventions, which would include children with IBD, as well as their parents, in order to improve their relationship, since pathological personality is linked with interpersonal impairment and this relationship can further be stressed by the demands of IBD itself.Među odraslima oboljelima od upalnih bolesti crijeva (IBD) u značajnoj mjeri mogu biti prisutne karakteristike opsesivnosti, neuroticizma, ali i opsesivno kompulzivnog poremećaja ličnosti (OCPD), dok za djecu s IBD jasni rezultati o učestalosti nisu pronađeni. Prema dosadašnjim podacima sva djeca s IBD koja su ujedno imala psihijatrijski poremećaj imala su barem jednog roditelja s prisutnom psihopatologijom. U većine roditelja djece s IBD ustanovljen je psihijatrijski poremećaj. Pretežno se radilo o poremećaju ličnosti (PD). Djeca u čijih je roditelja prisutna psihopatologija razlikuju se od djece bez roditeljske psihopatologije u anksioznim i depresivnim obilježjima. Roditelji djece s “kompulzivnom neurozom” ili opsesivno kompulzivnim poremećajem imaju značajnu razinu anankastičnih karakteristika ili OCPD. U svjetlu dosada poznatih podataka iz literature moglo bi se pretpostaviti da će OCPD biti prisutniji u roditelja djece s IBD nego u roditelja zdrave djece. Utvrđivanje prisutnosti poremećaja ličnosti u roditelja djece s IBD moglo bi pomoći u razvoju i provedbi strategija liječenja koje bi uključivale djecu s IBD kao i njihove roditelje. Svrha takvih intervencija bila bi poboljšanje njihovog međusobnog odnosa s obzirom na to da je patološka osobnost povezana s interpersonalnim oštećenjem, a odnos između roditelja i djeteta može biti dodatno izložen stresu zbog zahtjeva koje donosi sama upalna bolest crijeva

Gastroparesis in childhood: fiction or daily problem?

Gastropareza je poremećaj obilježen povraćanjem, epigastričnom boli, osjećajem nadutosti, ranim osjetom sitosti, distenzijom abdomena i gubitkom tjelesne mase. Nastaje kao posljedica otežanog pražnjenja želučanog sadržaja u duodenum, a u odsutnosti mehaničke zapreke. U djece se gastropareza najčešće javlja kao posljedica gastroenteritisa uzrokovanog rotavirusom. U većini slučajeva simptomi prolaze spontano unutar 6-24 mjeseca. Pri dijagnostici gastropareza u svakodnevnom radu primjenjuju se ultrazvuk abdomena, radiološka pasaža želuca, endoskopske pretrage, scintigrafija i elektrogastrografija. Mogućnosti liječenja su brojne: liječenje specifičnih poremećaja, izobrazba uz psihološku pomoć, prilagođena prehrana, lijekovi, enteralna i parenteralna nutritivna potpora. Od lijekova najkorisniji su prokinetici i antiemetici. U dječjoj dobi se zbog djelotvornosti i sigurnosti preporuča upotrebu eritromicina. Od novijih načina liječenja električna stimulacija želuca (stomach „pace maker“) daje najbolje rezultate.Gastroparesis, or delayed gastric emptying without obstruction, is a chronic disorder caused by stomach pump failure. The prevalence and etiology of gastroparesis in children has not been extensively examined, though postviral gastroparesis (rotavirus) is thought to be the most com mon identifiable cause in children. Typical symptoms of gastroparesis are abdominal fullness or bloating, early satiety, epigastric pain and distress, heartburn, anorexia, nausea, vomiting and weight loss. Several methods have been proposed for quantification of gastric emptying: abdominal ultrasonography, radiographic contrast techniques, gastric emptying scintigraphy, electrogastrography and breath testing for gastroparesis. Initial therapy should be guided by underlying diseases, if existent. Treatment is based on psychological and dietary support and pharmacotherapy. Pharmacotherapy includes prokinetic and antiemetic agents. From a paediatric perspective, prokinetic erythromycin is more efficient, has mild and transient side effects after long-term, low-dose administration. Gastric electrical stimulation seems to be the most promising therapeutic option available at present

Endoscopic Features of Gastric Mucosa in Children Having Pathohistological Evidence of Helicobacter Pylori Infection

Infection with Helicobacter pylori (Hp) is common in children from developing countries, particularly in adolescents. It is associated with chronic gastritis and stomach cancer. A characteristic endoscopic finding in children is nodular gastritis. The aim of this study was to assess and confirm association of nodular gastritis, mainly of anthral mucosa, with Hp infection in children. A total of 195 children 1 to 15 years of age were studied during a two-year period (2004–2006). There were 107 girls (54.9%) and 88 boys (45.1%). The patients presented with recurrent epigastric pain, nausea, vomiting, heartburn, sour mouth, regurgitation, bloating or other dyspeptic symptoms. The complaints were recorded by a structured interview with parents and older children. Upper endoscopy was performed in all children. The presence and degree of mucosal granulation was recorded and two samples of mucousa from the antrum and the small curvature were taken. Biopsy material was processed for histology as usual, stained with 2% Giemsa and examined by a pathologist for the presence of Hp. A total of 40 of 195 children (20.5%) have had positive Hp infection and a 27 of 40 (67.5%) have had a granular aspect of anthral mucosa at the endoscopy. Sensitivity of the finding was 87.5%, specificity 93.5%, positive predictive value 73%, negative predictive value 91.8%, p<0.05. Average age of those patients was 11.5±3.0 years. Subjective symptoms of dyspepsia (as recorded by the questionnaire) were often associated with Hp positivity, but short of statistical significance. No difference between boys and girls was noted. Endoscopic finding of nodular gastritis, especially in areas of antrum and small curvature, showed a highly positive correlation with Hp infection

ENTERAL FEEDING IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Uloga enteralne prehrane u liječenju kronične upalne bolesti crijeva još uvijek nije jasno definirana. U radu su prikazane posljedice malnutricije kao jednog od osnovnih simptoma kronične upalne bolesti crijeva te, sukladno tome, njihovo liječenje. Iz prikazanog jasna je potreba suportivne terapije adekvatnim enteralnim pripravcima. To se posebice odnosi na dječju populaciju oboljelih budući da poremećaj rasta i razvoja ima dalekosežne posljedice. Važnost potpune enteralne prehrane kao inicijalne terapije još nema adekvatnog odgovora i zahtijeva daljnje prospektivne analize. Prikazane su i neke nove mogu}nosti prehrane u liječenju kronične upalne bolesti crijeva, koje predstavljaju moguću budć}nost u terapiji tih bolestiThe purpose of enteral feeding in the inflammatory bowel diseases (IBD) has not been well defined yet. This article presents the consequences of malnutrition, as one of the basic symptoms of IBD and its therapy, respectively. As it is shown here, a supportive therapy with adequate enteral feeding is of great value, especially in pediatric patients due to long-term consequences of the growth failure and the failure to thrive. A complete enteral feeding as a primary and the only therapy in IBD has not been established completely yet and needs further analyses. We have shown some new ways of the enteral treatment of IBD that could be a future therapy of these illnesse

ENTERAL FEEDING IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Uloga enteralne prehrane u liječenju kronične upalne bolesti crijeva još uvijek nije jasno definirana. U radu su prikazane posljedice malnutricije kao jednog od osnovnih simptoma kronične upalne bolesti crijeva te, sukladno tome, njihovo liječenje. Iz prikazanog jasna je potreba suportivne terapije adekvatnim enteralnim pripravcima. To se posebice odnosi na dječju populaciju oboljelih budući da poremećaj rasta i razvoja ima dalekosežne posljedice. Važnost potpune enteralne prehrane kao inicijalne terapije još nema adekvatnog odgovora i zahtijeva daljnje prospektivne analize. Prikazane su i neke nove mogu}nosti prehrane u liječenju kronične upalne bolesti crijeva, koje predstavljaju moguću budć}nost u terapiji tih bolestiThe purpose of enteral feeding in the inflammatory bowel diseases (IBD) has not been well defined yet. This article presents the consequences of malnutrition, as one of the basic symptoms of IBD and its therapy, respectively. As it is shown here, a supportive therapy with adequate enteral feeding is of great value, especially in pediatric patients due to long-term consequences of the growth failure and the failure to thrive. A complete enteral feeding as a primary and the only therapy in IBD has not been established completely yet and needs further analyses. We have shown some new ways of the enteral treatment of IBD that could be a future therapy of these illnesse