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Objective@#To investigate the incidence and risk factors of extraintestinal manifestations (EIMs) in children with inflammatory bowel disease (IBD).@*Methods@#The clinical data of 161 children with IBD was collected from the electronic medical records in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine from January 2012 to December 2017. These patients were divided into Crohn′s disease (CD) group and ulcerative colitis (UC) group, accounting for 82.0% (132 cases) and 18.0%(29 cases), respectively. The incidence of EIMs in each group was analyzed. The potential risk factors of EIMs including the IBD phenotype, gender, age, location of the CD lesion, disease activity of CD, and the presence of perianal lesion were analyzed with logistic regression model.@*Results@#Eighty-eight patients (54.7%) had EIMs. The main EIMs were immune-mediated EIMs and growth retardation, accounting for 41.0% (66/161) and 24.2% (39/161), respectively. Aphthous ulcer (39/161, 23.0%) was the most common symptom among immune-mediated EIMs, followed by arthropathy (20/161, 12.4%) and skin lesions (19/161, 11.8%). Forty-three patients (26.7%) had EIMs before being diagnosed as IBD. Fifty-eight (65.9%) patients had only one EIM during the whole course of IBD. By logistic regression analysis, CD (OR=5.536, 95%CI:1.825-16.788) and perianal disease (OR=1.969, 95%CI:1.035-3.746) were the risk factors of immune-mediated EIMs. Meanwhile, CD (OR=11.319, 95%CI: 1.487-86.179), younger than six-year-old at diagnosis (OR=8.556, 95%CI: 3.109-23.545), moderate to severe activity of CD (OR=3.447, 95%CI: 1.196-9.934) and perianal disease (OR=3.361, 95%CI: 1.720-7.793) increased the risk of growth retardation.@*Conclusions@#The children with IBD have a high incidence of EIMs, which were more common in CD than in UC. The risk factors of developing EIMs include CD, perianal diseases, younger than six-year-old at diagnosis and moderate to severe activity of CD.
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Objective@#To analyze the clinical characteristics of chronic pancreatitis (CP) and evaluate its impact on growth of children.@*Methods@#A retrospective study was conducted in 94 children (male 49 cases, female 45 cases) who were diagnosed with CP in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from August 2008 to July 2015. Clinical characteristics, such as features of abdominal pain, etiologies, image data, levels of serum amylase and lipase, and physical development data were extracted from electronic medical records. The comparison between groups based on etiology or with normal control was performed with student′s t test.@*Results@#The age of first episode was (8.2±3.7) years. There were 61 (65%) children diagnosed with idiopathic CP, and 25 (27%) with anatomic abnormalities. The age of onset in the group with anatomic abnormalities was lower than that in the idiopathic CP group ((6.3±3.5) vs. (8.9±3.4) years, t=3.211, P=0.002). There were 51 (54%) patients with serum amylase elevation, 41(44%) patients with lipase elevation, and 35 (37%) with elevation in both. The questionnaire showed that 28 out of 30 children had moderate to severe abdominal pain. The patients′ weight standard score (SDS) was significantly lower than the overall average in normal control (-0.4±1.1 vs. 0, t=-3.308, P=0.001). Meanwhile, the mean level of insulin like growth factor-1 (IGF-1) SDS of 35 children was significantly decreased (-1.8±1.8 vs. 0, t=-6.136, P<0.01). There were 69% (37/54) patients diagnosed by magnetic resonance cholangiopancreatography (MRCP) combined with magnetic resonance imaging (MRI), higher than that diagnosed by abdominal ultrasound (29%, 27/94).@*Conclusions@#Idiopathic CP and anatomic abnormalities were the two main etiologies. Normal level of serum amylase and lipase or negative finding of ultrasound cannot exclude CP, while MRCP and MRI should be considered to improve CP diagnostic rate. It is noteworthy that growth delay would happen in children with CP history.
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Objective To evaluate the clinical value and safety of endoscopic retrograde cholangiopancreatog-raphy(ERCP)in children with pancreaticobiliary diseases. Methods Retrospective review was conducted for the data of 196 patients younger than 18 years old who underwent ERCP between January 2008 and June 2016 at Shanghai Rui-jin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University. The data of indications,pathogenesis,thera-py,complications were collected and the relationship between ERCP treatment methods and post - operation complica-tions was analyzed. Results A total of 314 ERCP procedures were performed on 196 patients,with the success rate of 99. 0％ . There were 94 boys and 102 girls with the median age of (8. 7 ± 3. 7)years old(ranged 1. 1 - 16. 8 years old) at time of procedure. Indications included pancreatic diseases(156 cases)and bile duct diseases(40 cases). The ERCP findings were classified as follows:chronic pancreatitis(114 cases),acute recurrent pancreatitis(28 cases),bile duct stone(19 cases),acute pancreatitis(12 cases),cholangiectasis(8 cases),cholangitis(5 cases),congenital biliary dila-tion(5 cases)and other pancreaticobiliary. Furthermore,45. 9％ of the patients were proved to have structural abnor-malities after operation. The most common bile duct diseases were malfusion of pancreatobiliary ducts(60. 0％),and pancreas cleavage was the most common cause of recurrent pancreatitis,accounting for 22. 4％ . The total post - ERCP complication rate was 14. 3％,including 41 cases(13. 0％)mild to moderate post - ERCP pancreatitis,4 cases(1. 3％) gastrointestinal bleeding. All cases were cured by medical treatment except that one cases with duodenal minor papilla wound bleeding underwent emergent endoscopic hemostasis. No other serious complications occurred such as bile duct in-fection,postoperative perforation and severe pancreatitis related to ERCP. Statistical analysis showed that multiple repeated operations were the protective factor for post - ERCP pancreatitis and pancreatic stone removal was the risk factor. Conclusions The diagnostic and therapeutic utility of ERCP for pediatrics with pancreaticobiliary diseases is effective and safe.
ABSTRACT
Celiac disease(CD) is a chronic intestinal malabsorption syndrome by ingestion of wheat bran material in a susceptible population which is immune-mediated.At present,the incidence of CD in North America and Europe has reached about 1％-3％,the disease is considered to be very rare in China,but now some studies have confirmed the existence of the disease.Children suffering from CD can lead to failure in growth and development,and patients can be significantly improved by gluten-free diet.Therefore,early diagnosis and timely treatment is great significance.