BACKGROUND: Mucosal healing (MH) has become a perspective treatment target in patients with Crohn's disease (CD). Data about the impact of MH on long-term outcome in pediatric patients are still scarce. METHODS: Seventy-six pediatric patients with CD were evaluated retrospectively (2000-2015) in a tertiary care center. Based on MH achievement, they were divided into two groups (MH, N.=17; and No MH, N.=59). The primary endpoint was to assess the association of MH and the need for CD-related hospitalizations or surgery in pediatric patients with CD. RESULTS: The number of hospitalized patients was 24% in the MH group and 42% in the No MH group (P=0.26). The total number of CD-related hospitalizations was not significant between the MH group and the No MH group (5 vs. 41, P=0.15). The time to the first hospitalization was 24 months in MH and 21 months in No MH (P>0.99). About 24% of the patients in the MH group and 39% patients in the No MH group underwent CD-related operation (P=0.39). Time to the first operation was 43 months for MH and 19 months for the No MH group (P=0.13). The follow-up period was 91 months in the MH group and 80 months in the No MH group (P=0.74). The use of infliximab was positively associated with MH (P=0.002). CONCLUSIONS: MH was not associated with fewer CD-related hospitalizations or operations in pediatric patients with CD during seven years of follow-up.
- MeSH
- časové faktory MeSH
- centra terciární péče MeSH
- Crohnova nemoc * terapie MeSH
- dítě MeSH
- hojení ran MeSH
- hospitalizace * statistika a číselné údaje MeSH
- infliximab terapeutické užití MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- střevní sliznice * patologie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Over the past few years, mucosal healing (MH) has emerged as a promising goal in the treatment of pediatric patients with Crohn's disease (CD). We aimed to assess whether combination therapy with infliximab (IFX) + azathioprine (AZA) was more effective than AZA therapy alone in achieving mucosal healing in pediatric patients with CD. METHODS: Newly diagnosed pediatric patients with CD at the Department of Pediatrics in University Hospital in Hradec Králové were retrospectively recruited (2000-2014). The patients were divided into two groups according to the therapy: (a) IFX + AZA ± corticosteroids ± 5-aminosalicylic acid (5-ASA) (n = 16); and (b) AZA ± corticosteroids ± 5-ASA (n = 40). The patients were also divided into two groups: "MH" and "no MH," according to their MH status. MH was defined as the complete endoscopic disappearance of all mucosal ulcerations (including aphthous ulcerations) and the absence of any sign of mucosal inflammation in the terminal ileum and the large bowel. RESULTS: Of 56 patients, MH was observed in 56% (9/16) treated with combined therapy in comparison with 15% (6/40) of patients in the AZA group (P = 0.006). The median dose of AZA in both groups was 2.1 mg/kg per day. We observed eight adverse events in seven patients from the IFX + AZA group. Adverse effects were less common in the AZA group (P = 0.002). CONCLUSION: Combined therapy (IFX + AZA) was more effective in achieving MH in pediatric CD than treatment with AZA alone.
- MeSH
- azathioprin terapeutické užití MeSH
- Crohnova nemoc * farmakoterapie MeSH
- dítě MeSH
- imunosupresiva MeSH
- infliximab terapeutické užití MeSH
- lidé MeSH
- pediatrie * MeSH
- retrospektivní studie MeSH
- synergismus léků MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
A two-year-old girl with two weeks of abdominal pain, vomiting, and food refusal, ten months after percutaneous endoscopic gastrostomy insertion because of inadequate peroral intake, was admitted to a tertiary centre hospital. On admission, the extracorporeal part of the gastrostomy was much shortened. X-ray examination revealed migration of the end of the gastrostomy tube with a left-shifted course of the tube through the duodenum. Gastroscopy and subsequently laparotomy were performed. A longitudinal pressure necrosis was identified under the tube, with two perforations in the duodenojejunal region. Ten centimeters of that duodenojejunal region were resected, and end-to-end anastomosis was made. The migration of the gastrostomy was probably caused by insufficient care by the parents. Pathophysiologically, the tube caused the pressure necrosis in the duodenojejunal area; this was supported by histology. This is a hitherto undescribed complication of a percutaneous endoscopic gastrostomy, showing that migration of the gastrostomy to the deeper part of the small bowel can lead to pressure necrosis, a potentially life-threatening condition in children which cannot be treated without invasive procedures.
- MeSH
- duodenum patologie MeSH
- enterální výživa MeSH
- gastroskopie MeSH
- gastrostomie škodlivé účinky MeSH
- lidé MeSH
- nekróza etiologie MeSH
- nemoci duodena etiologie chirurgie MeSH
- odstranění implantátu MeSH
- perforace střeva etiologie chirurgie MeSH
- předškolní dítě MeSH
- selhání protézy škodlivé účinky MeSH
- tlak škodlivé účinky MeSH
- zaváděcí katétry škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Popisujeme kazuistiky dvou dětí ve věku 15, resp. 17 měsíců s anamnézou průjmového onemocnění následovaného náhle vzniklou neurologickou symptomatologií. Podle klinických projevů a provedených vyšetření jsme stanovili diagnózu benigních křečí asociovaných s norovirovou gastroenteritidou. Benigní infantilní křeče asociované s gastroenteritidou představují relativně novou jednotkou popisovanou hlavně v Asii. K nejčastějším vyvolavatelům patří noroviry. Postihuje dosud zdravé jedince ve věku kolem 15–21 měsíců. K hlavním klinickým projevům patří několik málo dnů trvající afebrilní gastroenteritida následována atakou křečí, nejčastěji generalizovaných tonicko-klonických. Křeče mají velkou tendenci k rekurenci v prvních 24 hodinách a jsou relativně rezistentní k antikonvulzivní léčbě. Noroviry bývají prokázány ve stolici. Základní biochemické parametry séra, vyšetření likvoru i zobrazovací vyšetření mozku bývají v mezích normy. Interiktální EEG záznam může být normální nebo se záchytem abnormity s úpravou v čase. Prognóza, i přes závažně vypadající stav, bývá excelentní. Děti se dál vyvíjejí zcela normálně a jsou bez potřeby antikonvulzivní léčby.
Case reports of two children with the case history of diarrhea disease followed by suddenly developed neurological symptomatology at the age of 15 and 17 months are described. The clinical, manifestations and examinations performed made it possible to establish the diagnosis of benign seizures associated with noroviral gastroenteritis. Benign infantile seizures associated with noroviral gastroenteritis represent a relatively new unit described mainly in Asia. Noroviruses belong to the most frequent provoking agents. The disease affects so far healthy individuals at the age of 15–21 months. The main clinical manifestations include several although not many says lasting afebrile gastroenteritis, followed by seizure attacks, most often generalized tonic clonic seizures. The seizures tend to be rather recurrent in the first 24 hours and are rather resistant to anticonvulsant therapy. Noroviruses are often demonstrated in the stools. The basic biochemical parameters of serum, examination of liquor and imaging examination of the brain are often normal. Interictal EEG record may be normal or detecting abnormities which adjust in time. The prognosis despite apparently serious condition is usually excellent. The children further develop in a normal way and do not need anticonvulsant therapy.
- Klíčová slova
- noroviry, křeče, rotaviry,
- MeSH
- Adenoviridae izolace a purifikace MeSH
- anamnéza MeSH
- antigeny virové diagnostické užití MeSH
- chromatografie afinitní využití MeSH
- gastroenteritida virologie MeSH
- klinický obraz nemoci MeSH
- kojenec MeSH
- křeče u dětí diagnóza terapie virologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- Norovirus izolace a purifikace patogenita MeSH
- polymerázová řetězová reakce s reverzní transkripcí využití MeSH
- prognóza MeSH
- Rotavirus izolace a purifikace MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
