İnflamatuvar barsak hastalığı olan çocuk hastalarımızın değerlendirilmesi

Year 2017, Volume: 25 Issue: 2, 35 - 39, 29.08.2017

Eylem Sevinç

https://doi.org/10.17940/endoskopi.337911

Cited By: 2

Abstract

Giriş ve Amaç: Görülme sıklığı çocuklarda son yıllarda giderek artan inflamatuvar barsak hastalığı tanısı almış olgularımızın demografik, klinik ve laboratuar bulguları ve izlem sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada Sağlık Bilimleri Üniversitesi Kayseri Eğitim ve Araştırma Hastanesi Çocuk Gastroenteroloji bölümünde, 2014 - 2017 yılları arasındaki süreçte izlenen yaşları 4-18 yaş arasında değişen, 16’sı erkek (%50), 32 inflamatuvar barsak hastalığı olan olguların başvuru şikayetleri, fizik muayene bulguları, laboratuvar ve endoskopik verileri ve aldıkları tedavileri retrospektif olarak değerlendirildi. Bulgular: Çalışmaya alınan 32 olgunun yaş ortalaması 15 yıl ve 16’sı (%50) erkek idi. Olguların 22’sinde ülseratif kolit (%68), 10’nunda Crohn hastalığı (%32) saptandı. Ülseratif kolitli olgularımızın en sık başvuru şikayeti kanlı dışkılama (%95), Crohn hastalıklı olgularımızn ise karın ağrısıydı (%90). Olgularımızda batın hassasiyeti en sık görülen fizik muayene bulgusuydu. İnflamatuvar barsak hastalıklı olgularımızın kolonoskopik bakılarında, Ülseratif kolitli olgularımızın 12’sinde (%55) pankolit, Crohn hastalıklı olgularımızın 6’sında (%60) ileokolonik tutulum gözlendi. İnflamatuvar barsak hastalıklı olgularımızın izlem sırasında 30’nun (%96) mesalazin, 24 (%77)’ünün steroid ve 23’ünün (%72) azatiopurin aldığı saptanırken, diğer taraftan6 (%18) olgumuzun biyolojik ajan aldığı, 1 (%3,1) olgunun da metotreksat aldığı, 3’üne (%9.3) cerrahi girişim uygulandığı saptandı. Sonuç: İnflamatuvar barsak hastalıkları çocukluk çağının önemli kronik hastalıklarından biridir. Uzun dönemli takip gerektiren çocuk olgularda gerek hastalığa gerekse uygulanan tedavilere bağlı olarak gelişen komplikasyonların sıklığı giderek artmaktadır.

Keywords

Ülseratif kolit, Crohn hastalığı, çocuk

Clinical evaluation of children with inflammatory bowel disease

Abstract

Background and Aims: The aim of this study was to evaluate the demographics, clinical, laboratory findings, and results of follow-up of our cases with inflammatory bowel disease increasing incidence of in children. Materials and Methods: This study was carried out in the Department of Pediatric Gastroenterology of Kayseri Education and Research Hospital of Health Sciences University between the years 2014 and 2017 and included 32 cases of Inflammatory bowel disease,16 cases (50%) of men aged between 4 and 18 years. Physical examination findings, laboratory and endoscopic results as well as treatments of our cases, were evaluated retrospectively. Results: The mean age of the 32 cases enrolled in this study was 15 years, and 16 cases (50%) were male. Ulcerative colitis was found in 22 cases (68%), Crohn’s disease was found in 10 cases (32%). The most frequent complaints of our patients with ulcerative colitis were bloody stool (95%), and patients with Crohn’s disease were abdominal pain (90%). In our cases, the most common physical examination finding was the abdominal tenderness. In our colonoscopic assessment, we detected pancolitis in 12 ulcerative colitis cases (55%), and found ileocolonic involvement in 6 Crohn’s disease cases (60%). During the follow-up of our cases with inflammatory bowel disease, we identified 30 (96%) cases received mesalazine, 24 (77%) cases received steroids, and 23 (72%) cases received azathioprine. In addition, we learned 6 (18%) cases received biochemical agents, 1 (3.1%) case received methotrexate, and 3 (9.3%) cases had surgery. Conclusion: Inflammatory bowel disease is one of the most important chronic diseases of childhood. In children who require long-term follow-up, the frequency of complications due to illness or treatment is increasing.

Keywords

Ulcerative colitis, Crohn’s disease, child

References

• 1. Satsangi J, Silverberg MS, Vermeire S, et al The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749-753. 2. Ye Y, Pang Z, Chen W et al. The epidemiology and risk factors of inflammatory bowel disease.Int J Clin Exp Med. 2015;8(12):22529-22542. 3. Beşer ÖF, Kutlu T, Çokuğraş FÇ, ve ark. İnflamatuvar Barsak Hastalığı Tanılı Çocukların Uzun Süreli İzlemi: 53 Olgunun Değerlendirilmesi. Güncel Pediyatri Dergisi 2015;13:81-88. 4. MKoma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013;6:33–47. 5. Agrawal D, Rukkannagari S, Kethu S. Pathogenesis and clinical approach to extraintestinal manifestations of inflammatory bowel disease. Minerva Gastroenterol Dietol. 2007 Sep. 53(3):233-48. 6. Hyams JS. Treating Inflammatory Bowel Disease in Children and Adolescents. Gastroenterol Hepatol. 2014;10(7):444-446. 7. Reid G, Carey AF. Pathology of idiopathic inflammatory bowel disease. Surgery. 2011;29(8):362-365. 8. Auvin S, Molinie F, Gower-Rousseau C, et al. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988-1999). J Pediatr Gastroenterol Nutr 2005;41:49-55. 9. Al-Qabandi WA, Buhamrah EK, Hamadi KA, et al. Inflammatory bowel disease in children, an evolving problem in Kuwait. Saudi J Gastroenterol. 2011;17(5):323-327. 10. Kugathasan S, Judd RH, Hoffman RG, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: A statewide population-based study. J Pediatr. 2003;143:525–531. 11. Dimakou K, Pachoula I, Panayotou I, et al.Pediatric inflammatory bowel disease in Greece: 30-years experience of a single center. Ann Gastroenterol. 2015;28(1):81-86. 12. Griffiths AM. Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin Gastroenterol 2004;18:509-523. 13. Bernstein CN, Blanchard JF, Rawsthorne P, et al. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001;96:1116–1122. 14. Kulnigg-Dabsch S, Schmid W, Howaldt S, et al. Iron deficiency generates secondary thrombocytosis and platelet activation in IBD: the randomized, controlled thromboVIT trial. Inflamm Bowel Dis. 2013;19(8):1609-1616. 15. Goodhand JR, Kamperidis N, Rao A, et al. Prevalence and management of anemia in children, adolescents, and adults with inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:513–519. 16. Birimberg-Schwartz L, Wilson DC, Kolho KL, et al. pANCA and ASCA in Children with IBD-Unclassified, Crohn's Colitis, and Ulcerative Colitis-A Longitudinal Report from the IBD Porto Group of ESPGHAN. Inflamm Bowel Dis. 2016 Aug;22(8):1908-1914. 17. Ruemmele FM, Veres G, Kolho KL et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis. 2014 ;8(10):1179-1207. 18. Turner D, Levine A, Escher JC, et al. Management of pediatric ulcerative colitis: joint ECCO and ESPGHAN evidence-based consensus guidelines J Pediatr Gastroenterol Nutr. 2012;55(3):340-361. 19. Ben-Horin S, Kopylov U, Chowers Y. Optimizing anti-TNF treatments in inflammatory bowel disease. Autoimmun Rev. 2014;13(1):24-30. 20. Baillie CT, Smith JA. Surgical strategies in paediatric inflammatory bowel disease. World J Gastroenterol. 2015;21(20):6101-6116.