Peculiarities of the course of ulcerative colitis in children at the present stage

M.F. Denisova, N.M. Muzyka, N.V. Cherneha, T.D. Zadorozhna, T.M. Archakova, N.Yu. Bukulova

Abstract


Background. As to severity of the course, the incidence of complications and mortality rate, ulcerative colitis hold a position within the top of the gastrointestinal system diseases in children. Goal of research — to study peculiarities of the course of ulcerative colitis at the present stage. Materials and methods. The retrospective analysis was conducted of 184 clinical records of the children, who were on examination and treatment at the Department of the diseases of gastrointestinal system of the State Institution “Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine” between 2004 and 2014. Results and discussion. Ulcerative colitis is common in the children of all ages, among which the preschool children and teenagers are at greater risk than others. The risk factors include both the antenatal and the postnatal ones: gestational toxicosis and miscarriage threat, weight deficit at birth, artificial feeding, intestinal infections. Ulcerative colitis is characterized by chronic relapse, slow progression of the disease, and the typical clinical symptoms are: diarrhea, hemorrhagic colitis, abdominal pain syndrome, toxic syndrome, late physical development. In terms of localization, the inflammation process most often affects the entire large bowel (59.6 %), left-sided colitis (28.5 %), and proctosigmoiditis (accounts for 11.9 %) are less common. The informative criteria of ulcerative colitis activity are the Pediatric Ulcerative Colitis Activity Index (PUCAI), fecal calprotectin level, a number of complete blood count values (hemoglobin, leucocytes, platelets, erythrocyte sedimentation rate) and biochemical studies (C-reactive protein, alpha-2 globulins). The modern combined baseline therapy is efficient in 22 % of patients suffering from total colitis, in 42–58 % — from left-sided colitis according to the follow-up study results. Monotherapy with 5-aminosalicylic acid medications was efficient in 68 % of patients with the least active segmental colitis and in 100 % of patients with proctosigmoiditis. Conclusion. Analysis of the clinical records of the children with ulcerative colitis has showed the current age pattern of the disease, the gender difference depending on localization and severity of the inflammation and destructive processes in the bowel, incongruity of the clinical and the laboratory findings, efficiency of the treatment patterns suggested by ECCO and ESPGAN, relevance of the use of new criteria to assess the inflammation process in the bowel. The findings received can be used for substantiation of the research and practice program on the problem of ulcerative colitis in the children aimed at the development of the relevant branches, such as epidemiology, pathogenesis, age clinical features, optimization of clinical practice guidelines.

Keywords


ulcerative colitis; peculiarities of the course; children

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DOI: https://doi.org/10.22141/2224-0551.12.2.2017.99769

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