Nutritional status and its influencing factors in children with newly diagnosed inflammatory bowel disease / 中国当代儿科杂志

OBJECTIVES@#To investigate the nutritional status and its influencing factors in children with newly diagnosed inflammatory bowel disease (IBD).@*METHODS@#A retrospective analysis was conducted on the clinical data of children who were diagnosed with IBD for the first time in Hunan Children's Hospital from January 2015 to December 2021. Diagnostic delay was defined as the time from the symptom onset to IBD diagnosis being in the upper quartile (P76-P100) of all IBD children in the study. Multivariate logistic regression analysis was used to explore the risk factors for emaciation and growth retardation.@*RESULTS@#A total of 125 children with newly diagnosed IBD were included, with Crohn's disease being the main type (91.2%). The rates of emaciation and growth retardation were 42.4% (53 cases) and 7.2% (9 cases), respectively, and the rate of anemia was 77.6% (97 cases). Diagnostic delay was noted in 31 children (24.8%), with the time from the symptom onset to IBD diagnosis of 366 to 7 211 days. Multivariate logistic regression analysis showed that diagnostic delay was a risk factor for emaciation and growth retardation (OR=2.73 and OR=4.42, respectively; P<0.05) and that age was positively associated with emaciation (OR=1.30, P<0.05).@*CONCLUSIONS@#Children with newly diagnosed IBD have poor nutritional status, and the rates of anemia, emaciation, and growth retardation are high. Diagnostic delay is associated with malnutrition in children with IBD.

Bilateral uveitis in silent ulcerative colitis: case report

Silent or subclinical inflammatory bowel diseases (IBD) is a relatively new term that has been used to describe individuals with asymptomatic active mucosal bowel inflammation, often unaware of their disease due to either the lack of or mild inflammatory symptoms. These patients are at risk for gastrointestinal and extra-gastrointestinal manifestations, with more advanced complications. In this article we intend to describe a case report of a patient with chronic history of many organ involvements including ocular, skin, and musculoskeletal, which was later placed under the umbrella of silent ulcerative colitis. (AU)

Improved Mayo Endoscopic Score has a higher value for evaluating clinical severity of ulcerative colitis / 南方医科大学学报

OBJECTIVE@#To assess the value of Improved Mayo Endoscopic Score (IMES) for evaluation of the clinical severity of ulcerative colitis (UC).@*METHODS@#We retrospectively analyzed the clinical and endoscopic data of 167 patients diagnosed with UC in Beijing Tsinghua Changgung Hospital from January, 2015 to November, 2021. The severity of endoscopic lesions was determined by Mayo Endoscopic Score (MES, 0-3 points) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score (0-8 points), and the scope of endoscopic lesions was evaluated based on the Montreal classification system. The IMES was established by combining the MES with the Montreal classification.@*RESULTS@#The IMSE showed stronger correlations with modified Truelove and Witts Disease Severity, Mayo score and partial Mayo score (r=0.712, 0.784, and 0.703, respectively) than MES (r=0.642, 0.754, and 0.604, respectively), Montreal classification (r=0.598, 0.628, and 0.603, respectively) and UCEIS (r= 0.670, 0.767, and 0.677, respectively). ROC curve analysis showed that IMES was superior to MES, Montreal and UCEIS in diagnosis of severe and moderate- to-severe UC. IMES also showed stronger correlations with the laboratory indicators including CRP (r=0.583), WBC (r=0.235), HB (r=-0.280), PLT (r=0.352), ALB (r=-0.396) and ESR (r=0.471) than MES and Montreal classification. An IMES score of 5 was of greater value than a MES score of 3, E3, and UCEIS≥6 for predicting the administration of systemic hormones, immunosuppressants, or surgery in the near future.@*CONCLUSION@#IMES can better reflect the clinical severity of UC and has good correlations with the laboratory indicators of the patients.

Infección comunitaria por Clostridium difficile asociada a colitis ulcerativa idiopática / Community Clostridium difficile infection associated to idiopathic ulcerative colitis

RESUMEN Clostridium difficile es una bacteria relacionada con la colitis, asociada a antibióticos y a la diarrea adquirida en pacientes hospitalizados. Sin embargo, su comportamiento ha cambiado en los últimos años, hasta el punto de ser considerada un problema de salud mundial. Su curso clínico varía desde casos asintomáticos, colitis, hasta complicaciones que ponen en peligro la vida del paciente. Dentro de los factores de riesgo descritos se encuentra la enfermedad inflamatoria intestinal, especialmente la colitis ulcerativa idiopática. El caso reportado versa sobre la presentación de esta infección asociada a un brote de colitis ulcerativa en un paciente joven, sin antecedentes de enfermedad inflamatoria intestinal, consumo de antibióticos ni hospitalización (AU).

ABSTRACT Clostridium difficile is a bacterium related to antibiotic-associated colitis and to diarrhea acquired in hospitalized patients. However, its behavior has changed in recent years to the point of being considered as a global health problem. Its clinical course ranges from asymptomatic cases, colitis, to complications with risk for the patient's life. The inflammatory bowel disease, especially idiopathic ulcerative colitis is found among the described risk factors. The case reported deals with the presentation of this infection associated to an outbreak of ulcerative colitis in a young patient, with no previous history of inflammatory bowel disease, consumption of antibiotics or hospitalization (AU).

Colitis ulcerosa: a propósito de un caso pediátrico / Ulcerative colitis: about a pediatric case / Colite ulcerativa: sobre um caso pediátrico

RESUMEN Se presentó el caso de un paciente masculino de 8 años de edad con antecedentes de salud anterior, referido a la consulta externa de Gastroenterología del Hospital Nacional Guido Valadares, de Timor Oriental, por episodios recurrentes de diarreas mucosanguinolentas acompañadas de dolor abdominal en hipogastrio de cuatro meses de evolución. Se realizaron exámenes de laboratorio, ultrasonido abdominal y videocolonoscopia con citología y biopsia de la mucosa del colon. El estudio endoscópico informó una colitis ulcerativa extensa y la histología arrojó el diagnóstico de una enfermedad inflamatoria crónica intestinal del tipo colitis ulcerosa. La colitis ulcerosa es un proceso inflamatorio intestinal de origen desconocido que causa inflamación crónica, difusa y continua, en la mucosa y submucosa. Su incidencia en los niños está aumentando y afecta, incluso, a los lactantes. Se indicó tratamiento dietético y medicamentoso. Actualmente se encuentra asintomático y lleva seguimiento mensual en la consulta de Digestivo.

ABSTRACT The case of an 8-year-old male patient with a previous health history was presented, referred to the Gastroenterology outpatient clinic of the Guido Valadares National Hospital, East Timor, for recurrent episodes of mucosanguineous diarrhea accompanied by abdominal pain in the hypogastrium with four months of evolution. Laboratory tests, abdominal ultrasound and video colonoscopy with cytology and biopsy of the colon mucosa were performed. The endoscopic study reported extensive ulcerative colitis and the histology gave the diagnosis of a chronic inflammatory bowel disease of the ulcerative colitis type. Ulcerative colitis is an inflammatory intestinal process of unknown origin that causes chronic, diffuse and continuous inflammation in the mucosa and submucosa. Its incidence in children is increasing and affects even infants. Dietary and drug treatment was indicated. He is currently asymptomatic and undergoes monthly follow-up in the Digestive Clinic.

RESUMO Foi apresentado o caso de um paciente do sexo masculino, 8 anos, com antecedentes de saúde, encaminhado ao ambulatório de Gastroenterologia do Hospital Nacional Guido Valadares, Timor Leste, por episódios recorrentes de diarreia mucosanguínea acompanhada de dor abdominal em hipogástrio de quatro meses de evolução. Foram realizados exames laboratoriais, ultrassonografia abdominal e videocolonoscopia com citologia e biópsia da mucosa do cólon. O estudo endoscópico relatou colite ulcerativa extensa e a histologia deu o diagnóstico de doença inflamatória intestinal crônica do tipo colite ulcerativa. A colite ulcerosa é um processo inflamatório intestinal de origem desconhecida que causa inflamação crônica, difusa e contínua na mucosa e na submucosa. Sua incidência em crianças está aumentando e afeta até mesmo bebês. Foi indicado tratamento dietético e medicamentoso. Ele atualmente é assintomático e tem acompanhamento mensal na consulta Digestiva.

Epidemiological profile and hospitalization data of patients with inflammatory bowel disease / Perfil epidemiológico e caráter de internação dos pacientes portadores de doença inflamatória intestinal

Abstract Objective: This study's objective was to understand the epidemiologic profile of the patients with inflammatory bowel disease in the state of Tocantins, Brazil. Methods: This is a descriptive study of secondary data, which was gathered by using the Informatics Department of the Brazilian Health System, and it corresponds to the cases registered from January of 2010 to December of 2017. The data of interest were those related to the total number of admissions, age range, gender, ethnicity, city of hospitalization, and type of care. Results: There were 340 hospital admissions due to inflammatory bowel diseases in Tocantins, of which 204 (60%) were female patients and 136 (40%), male patients; the predominant age group was between 20 and 59 years old (65.88%). These hospitalizations lasted an average of 4.7 days and 98.23% of them occurred as a matter of urgency. Conclusion: The study demonstrated that the epidemiological profile of the inflammatory bowel disease in the state of Tocantins consists of female patients, aged between 20 and 59 years, with hospitalizations lasting 4.7 days and mainly urgent, demonstrating that it is necessary to implement screening measures in order to make the diagnosis earlier, thus preventing possible complications.

Resumo Objetivo: Conhecer o perfil epidemiológico dos pacientes portadores da doença inflamatória intestinal no estado do Tocantins. Metodologia: Trata-se de estudo descritivo de dados secundários obtidos a partir do Sistema de Internações Hospitalares do Sistema Único de Saúde, que se compreendem entre Janeiro de 2010 e Dezembro de 2017. Os dados de interesse foram aqueles relacionados ao número total de internações, à faixa etária, sexo, raça, município de internação dos pacientes e caráter dos atendimentos. Resultados: Houve 340 internações hospitalares em razão das doenças inflamatórias intestinais em Tocantins, das quais 204 (60%) foram pacientes femininos e 136 (40%) pacientes masculinos, e a faixa etária predominante foi entre 20 e 59 anos (65,88%). Essas internações duraram em média 4,7 dias e 98,23% delas ocorreram com caráter de urgência. Conclusão: O estudo demonstrou que o perfil epidemiológico da doença inflamatória intestinal no Tocantins constitui-se por pacientes femininos, tendo de 20 a 59 anos, internações de 4,7 dias e predominantemente de urgência, o que torna necessário a implantação de medidas de rastreio de forma a tornar o diagnóstico mais precoce, prevenindo, então, possíveis complicações.

Hemophagocytic lymphohistiocytosis as a presentation of inflammatory bowel disease / Linfohistiocitosis hemofagocítica como presentación de la enfermedad inflamatoria intestinal

Abstract Background: Hemophagocytic lymphohistiocytosis (HLH) is considered a medical emergency that should be recognized in patients with fever, splenomegaly, and progressive deterioration of the general condition. Laboratory findings include cytopenia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. For HLH diagnosis, it is essential, although not mandatory, to perform a bone marrow biopsy. Given its nature, secondary causes of HLH should be sought, mainly infections, hemato-oncological disorders, autoimmune diseases, and auto-inflammatory conditions. Case report: We present the case of a female adolescent who presented with fever and lower gastrointestinal bleeding. Upon admission, acute liver failure and pancytopenia were documented. A bone marrow aspirate was performed, which revealed hemophagocytosis; other tests confirmed HLH diagnosis. During the diagnostic approach, inflammatory bowel disease was diagnosed. The patient received first-line treatment with an adequate response. Conclusions: Inflammatory bowel disease can be considered a cause of secondary HLH, particularly in patients with suggestive symptoms, such as digestive bleeding in the absence of other secondary causes of HLH.

Resumen Introducción: La linfohistiocitosis hemofagocítica (LHH) es considerada una urgencia médica que debe reconocerse en pacientes con deterioro progresivo del estado general, fiebre, pancitopenia y esplenomegalia. Los hallazgos de laboratorio incluyen citopenia, hipertrigliceridemia, hipofibrinogenemia e hiperferritinemia. Para su diagnóstico es importante, aunque no obligatoria, la realización de aspirado de médula ósea. Dada su naturaleza, se deben buscar causas secundarias de LHH, principalmente enfermedades infecciosas, hematooncológicas, autoinmunitarias y autoinflamatorias. Caso clínico: Se presenta el caso de una adolescente que inició con fiebre y sangrado digestivo bajo. A su ingreso, se documentó falla hepática aguda y pancitopenia. Se realizó aspirado de médula ósea y se encontró hemofagocitocis; el resto de los exámenes concluyeron LHH. Durante su abordaje se diagnosticó enfermedad inflamatoria intestinal. La paciente recibió tratamiento de primera línea con adecuada respuesta. Conclusiones: La enfermedad inflamatoria intestinal puede considerarse como una causa secundaria de LHH, en particular en pacientes con clínica sugestiva, como es el sangrado digestivo, en ausencia de otras causas secundarias de LHH.

Colitis ulcerativa extensa severa presentación caso / Severe extensive ulcerative colitis. Case presentation

RESUMEN La colitis ulcerativa es una enfermedad crónica recidivante del tracto gastrointestinal, que evoluciona por recaídas formando parte de las enfermedades inflamatorias intestinales (EII). Afecta la mucosa y submucosa del colon, caracterizada por un proceso ulcerativo y supurado de la mucosa. La diarrea crónica con sangre es el síntoma más importante. En su curso alternan periodos de remisión y de crisis. No existe un criterio patognomónico para su definición, su diagnóstico se basa en una serie de criterios clínicos, endoscópicos e histológicos. Esta entidad infrecuente en su forma extensa severa. Aparece en un paciente, que llega a la institución de salud refiriendo que hace aproximadamente dos años, presenta cuadros de diarreas intermitentes con sangre, tratadas en el área de salud. Se le realizó Rx y colonoscopia constatando presencia de eritema, granularidad mucosa, friabilidad, pérdida de la vascularización submucosa, erosiones y ulceraciones extensas, profundas, signos de edema, pseudopólipos, pérdida de haustras, rigidez, sangrado, tractos fibrosos y presencia de exudado luminal. Se diagnosticó colitis extensa ulcerativa severa y se orientó tratamiento médico endovenoso y se continuó por via oral, obteniendo la remisión del cuadro clínico desde el punto de vista clínico y endoscópico (AU).

ABSTRACT Ulcerative colitis is a chronic recidivist disease of the gastrointestinal tract, evolving by relapses and is one of the intestinal inflammatory diseases. It affects the colon mucosa and sub-mucosa, characterized for an ulcerative process and mucosa exudation. Chronic diarrhea with blood is the most important symptom. Periods of crisis and remission alternated in its course; there is not a pathognomonic criteria for its definition and its diagnosis is based in a series of clinical, endoscopic and histological criteria. This entity, infrequent in extensive severe form, appears in a patient arriving to the hospital referring having intermittent diarrheas with blood for two years, treated in the health area. He undergone a radiography and colonoscopy, showing the presence of an erythema, mucosa granularity, friability, lost of submucosa vascularization, deep extensive erosions and ulcerations, edema signs, pseudo polyps, haustras lost, stiffness, bleeding, fibrous tracts and presence of luminal exudates. Severe ulcerative extensive colitis was diagnosed and was prescribed an endovenous medical treatment, continued orally, achieving the disease remission from the clinical and endoscopic point of view (AU).

Fístula perianal compleja: Tratamiento con plasma rico en plaquetas / Complex perianal fistula: Treatment with platelet-rich plasma

Paciente masculino con diagnóstico de enfermedad inflamatoria intestinal (colitis ulcerosa), corticodependiente, que consulta en nuestro servicio por fístula perianal compleja con extenso compromiso inflamatorio crónico de la región perianal, el cual fue tratado exitosamente con la aplicación local de plasma rico en plaquetas como única terapéutica. Se presentan los beneficios que se podrían obtener mediante la aplicación de plasma rico en plaquetas autólogo en el tratamiento de este tipo de fístulas. De ese modo se evitan los procedimientos quirúrgicos en un terreno inflamatorio crónico que implican altas tasas de complicaciones y recurrencia, afectando la calidad de vida.

A male patient with a diagnosis of steroid dependent inflammatory bowel disease (ulcerative colitis) sought medical care due to complex perianal fistula with extended chronic inflammation of the perianal region that was successfully treated with platelet-rich plasma as a single therapy. The benefits of autologous platelet-rich plasma for the treatment of this type of fistulas are presented. In this way, there is no need to perform surgery in a chronic inflammatory territory with high rate of complications and recurrence affecting patients' quality of life.

Fecal calprotectin role in diagnosis of ulcerative colitis and treatment follow-up / Papel da calprotectina fecal no diagnóstico de colite ulcerativa e no acompanhamento do tratamento

ABSTRACT Objective: Ulcerative colitis usually affects the rectum and potentially can involve the whole colon. Noninvasive methods such as fecal calprotectin measurement may be considered as a reliable and inexpensive approach in assessing disease severity or treatment change strategy. Methods: In this retrospective cross-sectional study, records of 56 ulcerative colitis patients who hospitalized with exacerbation between May 2016 and April 2017 were assessed based on IBD Data Bank Software in Gastrointestinal and Liver Diseases and Research Center (GLDRC), Guilan province, Iran between. A questionnaire of demographic characteristics, clinical findings and fecal calprotectin level was completed. Montreal classification severity of ulcerative colitis and Mayo disease activity index were scored. Data were analyzed for descriptive and analytical analysis. Results: Fecal calprotectin was significantly different in terms of disease severity based on both Mayo score (p = 0.007) and Montreal classification (p = 0.001). In patients with mild symptoms, no increase in fecal calprotectin was observed, but in patients with moderate and severe elevations in fecal calprotectin levels was significant. Also, C-Reactive Protein surge was related to disease severity (p = 0.02). Furthermore, regression comparison among high-chance patients based on fecal calprotectin was significantly related to higher Erythrocyte Sedimentation Rate levels and smoking, p = 0.01 and p = 0.05, respectively. Conclusion: It seems fecal calprotectin levels are related to the disease severity. Non-invasive methods, such as fecal calprotectin assay, may seem to be an alternative to aggressive, costly and time-consuming methods, such as colonoscopy and biopsy, to reduce the suffering of patients and ultimately help improve the patients' life quality.

RESUMO Objetivo: A colite ulcerativa geralmente afeta o reto, podendo acometer todo o cólon. Métodos não invasivos, como a dosagem de calprotectina fecal, podem ser uma abordagem confiável e barata para a avaliação da gravidade da doença ou da estratégia de mudança de tratamento. Métodos: Neste estudo transversal retrospectivo, os registros de 56 pacientes com colite ulcerativa que foram hospitalizados devido a exacerbação entre maio de 2016 e abril de 2017 foram avaliados usando o software IBD Data Bank no Centro de Pesquisa e Doenças Gastrointestinais e Hepáticas (GLDRC), na província de Guilan, Irã. Foi aplicado um questionário de características demográficas, achados clínicos e nível de calprotectina fecal. Foram usados o escore de Mayo de atividade da doença e a classificação de Montreal da gravidade da colite ulcerativa. Os dados foram analisados de forma descritiva e analítica. Resultados: A calprotectina fecal apresentou diferença significativa em termos de gravidade da doença com base no escore de Mayo (p = 0,007) e na classificação de Montreal (p = 0,001). Em pacientes com sintomas leves, nenhum aumento na calprotectina fecal foi observado. Entretanto, em pacientes com sintomas moderados e severos, o aumento nos níveis de calprotectina fecal foi significativo. Além disso, o aumento nos níveis de proteína C reativa foi associado à gravidade da doença (p = 0,02). A análise da regressão entre pacientes considerados de alto risco com base na calprotectina fecal indicou uma associação significativa com níveis elevados da taxa de sedimentação de eritrócitos e tabagismo (p = 0,01 e p = 0,05, respectivamente). Conclusão: Os níveis de calprotectina fecal parecem estar relacionados com a gravidade da doença. Métodos não invasivos, como o estudo de calprotectina fecal, podem ser uma alternativa a métodos agressivos, caros e demorados, tais como colonoscopia e biópsia, reduzindo o sofrimento e ajudando a melhorar a qualidade de vida dos pacientes.

Manifestações clínicas iniciais em pacientes com doença inflamatória intestinal / The onset of clinical manifestations in inflammatory bowel disease patients

ABSTRACT BACKGROUND: The diagnosis of inflammatory bowel disease is often delayed because of the lack of an ability to recognize its major clinical manifestations. OBJECTIVE: Our study aimed to describe the onset of clinical manifestations in inflammatory bowel disease patients. METHODS: A cross-sectional study. Investigators obtained data from interviews and the medical records of inflammatory bowel disease patients from a reference centre located in Brazil. RESULTS: A total of 306 patients were included. The mean time between onset of symptoms and diagnosis was 28 months for Crohn's disease and 19 months for ulcerative colitis. The main clinical manifestations in Crohn's disease patients were weight loss, abdominal pain, diarrhoea and asthenia. The most relevant symptoms in ulcerative colitis patients were blood in the stool, faecal urgency, diarrhoea, mucus in the stool, weight loss, abdominal pain and asthenia. It was observed that weight loss, abdominal pain and distension, asthenia, appetite loss, anaemia, insomnia, fever, nausea, perianal disease, extraintestinal manifestation, oral thrush, vomiting and abdominal mass were more frequent in Crohn's patients than in ulcerative colitis patients. The frequencies of urgency, faecal incontinence, faeces with mucus and blood, tenesmus and constipation were higher in ulcerative colitis patients than in Crohn's disease patients. The mean time from the onset of clinical symptoms to the diagnosis of Crohn's disease was 37 months for patients with ileocolonic location, 26 months for patients with ileum location and 18 months for patients with colon location. In ulcerative colitis patients, the mean time from the onset of symptoms to diagnosis was 52 months for proctitis, 12 months for left-sided colitis and 12 months for extensive colitis. CONCLUSION: Ulcerative colitis presented a high frequency of intestinal symptoms, and Crohn's disease showed a high frequency of systemic manifestations at the onset of manifestation. There was a long delay in diagnosis, but individuals with more extensive disease and more obvious symptoms showed a shorter delay.

RESUMO CONTEXTO: O diagnóstico da doença inflamatória intestinal é frequentemente retardado pela falta de capacidade para reconhecer as suas principais manifestações clínicas. OBJETIVO: Nosso estudo teve como objetivo descrever as manifestações clínicas iniciais em pacientes com doença inflamatória intestinal. MÉTODOS: Estudo transversal. Os pesquisadores obtiveram dados por entrevistas e registros médicos de pacientes com doença inflamatória intestinal em um centro de referência localizado na Bahia. RESULTADOS: Foram incluídos 306 pacientes. O tempo entre o início dos sintomas e o diagnóstico foi de 28 (±48) meses para doença de Crohn e 19 (±46) meses para colite ulcerativa. O tempo médio desde o início dos sintomas clínicos até o diagnóstico de doença de Crohn foi de 37 meses para pacientes com localização do ileocolon, 26 meses para a localização do íleo e 18 meses para a localização do cólon. Nos doentes com colite ulcerativa, o tempo médio desde o início dos sintomas até ao diagnóstico foi de 52 meses para proctite, 12 meses para colite no lado esquerdo e 12 meses para colite extensa. As principais manifestações clínicas em pacientes com doença de Crohn foram perda de peso, dor abdominal, diarreia e astenia. Os sintomas mais relevantes da colite ulcerativa foram sangue nas fezes, urgência fecal, diarreia, muco nas fezes, perda de peso, dor abdominal e astenia. Observou-se que a perda de peso, dor abdominal e distensão, astenia, perda de apetite, anemia, insônia, febre, náusea, doença perianal, manifestação extraintestinal, afta oral, vômitos e massa abdominal foram mais frequentes na doença de Crohn. A frequência de urgência e incontinência fecal, fezes com muco e sangue, tenesmo e constipação foram maiores na colite ulcerativa. CONCLUSÃO: A colite ulcerativa apresentou alta frequência de sintomas intestinais e a doença de Crohn mostrou alta frequência de manifestações sistêmicas. Houve um grande atraso no diagnóstico, mas indivíduos com doença mais extensa e sintomas mais exuberantes mostraram um atraso menor.

Colitis ulcerosa en un niño de 20 meses: a propósito de un caso / Ulcerative colitis in an infant aged 20 months: A case report

La disentería es un problema frecuente en la primera infancia y, normalmente, es causada por fisuras anales, enteritis infecciosa, proctocolitis alérgica, ingestión de sangre materna e invaginación intestinal. En ocasiones muy poco frecuentes, también puede ser provocada por un vólvulo, por coagulopatías, enterocolitis necrosante, pólipos, diverticulitis de Meckel o enfermedades intestinales inflamatorias (EII). La incidencia de EII en los niños está aumentando y afecta, incluso, a los lactantes. Los subtipos más comunes son la enfermedad de Crohn (EC) y la colitis ulcerosa (CU). Si bien el máximo de ocurrencia de EII se produce entre la segunda y la tercera décadas de vida, la EII pediátrica representa entre el 7% y el 20% de todos los casos. Dentro de este grupo etario, las tasas más elevadas se observan en la adolescencia; sin embargo, hay casos de inicio muy temprano de la EII, incluso antes de los seis años de edad. Los síntomas característicos de la EC incluyen dolor abdominal, diarrea y pérdida de peso, mientras que la CU en general se asocia con diarrea hemorrágica. El informe describe el caso de un niño de 20 meses con disentería, al que finalmente se le diagnosticó CU.

Bloody diarrhea is a common problem in early childhood, typically caused by anal fissures, infectious enteritis, allergic proctocolitis, swallowed maternal blood and intussusception. More rarely, it can also be caused by volvulus, coagulopathies, necrotizing enterocolitis, polyps, Meckel diverticulitis and inflammatory bowel disease (IBD). The incidence of IBD is on the rise in children, even affecting infants. The most common subtypes are Crohn's disease (CD) and ulcerative colitis (UC). While IBD occurrence peaks in the second to third decades of life, paediatric IBD accounts for 7-20% of all cases. Within this age group, the highest rates are seen in the teenage years; however, very early onset IBD can be seen before six years of age. The classic symptoms of CD include abdominal pain, diarrhea and weight loss, while UC is typically associated with bloody diarrhea. The report describes the case of a 20-month-old boy with bloody diarrhea who was ultimately diagnosed with UC.

Factores pronósticos en colitis ulcerosa de reciente diagnóstico / Prognostic factors of ulcerative colitis at the moment of diagnosis

The clinical presentation of ulcerative colitis at the moment of diagnosis is variable, and its clinical course is difficult to predict. It can range from a quiescent to a refractory chronic course that may require hospitalization and surgical procedures. It can also have complications such as colorectal cancer. In this review we discuss the role of demographic, clinical, endoscopic, histological and associated factors, which can help to predict the clinical course of the disease at the moment of diagnosis, and to individualize therapy according to this clinical risk. Accurate identification of patients with a newly diagnosed ulcerative colitis who are at high risk of an unfavorable outcome is still a challenge. However, an effective evaluation allows an early diagnosis, a timely and effective treatment.

Frequency of Oral Manifestation in Patients with Inflammatory Bowel Disease in Chile / Frecuencia de Manifestaciones Orales en Pacientes con Enfermedad Inflamatoria Intestinal en Chile

SUMMARY: Inflammatory bowel disease (IBD) is an autoinflammatory chronic disorder of the gastrointestinal tract with a dysregulated immune response, being Crohn's Disease (CD) and Ulcerative Colitis (UC) the two main conditions. In literature the extra intestinal manifestations associated with IBD have been well documented. However, in our country, there are no studies about the oral manifestations. Having this information, is fundamental in order to optimize resources involved in diagnosis and treatment in a multidisciplinary level. Descriptive observational cross-sectional study, with a non-probabilistic sample for convenience with patients diagnosed with IBD belonging to the "CD-UC Group". In a period of four months the intraoral exam, diagnosis, and description of the lesions according location, type of illness, age, and sex were carried out. Thirty (30) patients (23 UC and 7 CD) filled the criteria of inclusion, 30 % men and 70 % women. 11 patients presented at least one oral lesion, being recurrent oral ulcer the most frequent, and two more specific lesions (macrocheilia and corrugated lesion). Of these patients, 37 % presented at least one oral lesion, being the most frequent one recurrent oral ulcer (ROU).

RESUMEN: La Enfermedad Inflamatoria Intestinal (EII) es un desorden inmunitario autoinflamatorio crónico del tracto gastrointestinal, siendo la Enfermedad de Crohn (EC) y la Colitis Ulcerativa (CU) sus dos condiciones principales. Se ha documentado en la literatura acerca de las manifestaciones extraintestinales asociadas a EII. Sin embargo, en nuestro país, no existen estudios acerca de las manifestaciones orales. Contar con esta información es fundamental para optimizar los recursos involucrados en el diagnóstico y tratamiento a nivel multidisciplinario. Se realizó un estudio observacional descriptivo de corte transversal, con un muestreo no probabilístico por conveniencia con pacientes diagnosticados de EII pertenecientes a la "Agrupación EC-CU". En un periodo de 4 meses se realizó el examen intraoral, diagnóstico y descripción de lesiones según localización, tipo de enfermedad, edad y sexo. Resultados: 30 pacientes (23 CU y 7 EC) cumplieron con los criterios de inclusión, 30 % hombres y 70 % mujeres. De los sujetos, 11 pacientes presentaron al menos una lesión oral, la úlcera recurrente oral fue la lesión más frecuente y se encontraron dos lesiones específicas (macroqueilia y lesión de aspecto corrugado). Un 37 % de los pacientes presentaron al menos una lesión oral, en donde la lesión más frecuente fue la úlcera recurrente oral.

Evaluation of fecal protein S100A12 in patients with inflammatory bowel disease / Avaliação da proteína fecal s100q12 em pacientes com doença inflamatória intestinal

BACKGROUND AND OBJECTIVE: The diagnosis and evaluation of inflammatory bowel disease is quite complex. An ideal, noninvasive marker for this disease is quite urgently needed. Fecal S100A12 is a member of the S100 protein family and is secreted by activated neutrophils. We aim to evaluate it as a biomarker for inflammatory bowel disease patients in China. METHODS: Fecal S100A12 was measured in 18 Crohn's disease, 21 ulcerative colitis, and 17 healthy controls. Diagnostic value was evaluated by receiver operating characteristic (ROC) analysis in comparison with C-reactive protein and erythrocyte sedimentation rate. The correlation between fecal S100A12 and clinical characteristics was also evaluated. RESULTS: We found significant increases (p<0.01) in the diagnostic value of S100A12 in both Ulcerative Colitis and Crohn's Disease when compared to healthy controls. In ulcerative colitis, fecal S100A12 correlated with fecal occult blood (p=0.02, r=0.55); in Crohn's disease, it correlated with disease duration, albumin and platelet levels (p=0.01, r=-0.53; p<0.01, r=-0.65; p=0.04, r=0.45. respectively). No correlation occurred between fecal S100A12 and other clinical conditions. CONCLUSION: Fecal S100A12 is valuable in distinguishing inflammatory bowel disease patients versus healthy controls. However, the sensitivity and specificity are limited when compared with that described in western countries. The correlation between S100A12 and clinical characteristics is limited as well. More research is need to better explore this interaction in Chinese patients.

JUSTIFICATIVA E OBJETIVO: O diagnóstico e avaliação da doença inflamatória intestinal é bastante complexo. Um marcador ideal, não invasivo para esta doença é urgentemente necessário. O S100A12 fecal é um membro da família de proteínas S100 e é secretado por neutrófilos ativados. Pretendemos avaliá-lo como biomarcador para pacientes com doença inflamatória intestinal na China. MÉTODOS: a proteína fecal S100A12 foi medida em 18 pacientes com Moléstia de Crohn, 21 pacientes com Colite Ulcerativa e 17 voluntários saudáveis (controles). O valor diagnóstico foi avaliado através da análise da característica de operação do receptor (ROC) em comparação com a proteína C reativa e com a taxa sedimentação eritrocitária. A correlação entre S100A12 fecal e características clínicas também foi avaliada. RESULTADOS: Observamos aumentos significativos (p < 0.01) no valor diagnóstico de S100A12 tanto na Colite Ulcerativa quanto na Doença de Crohn quando comparados aos controles saudáveis. Na colite ulcerativa, a proteína S100A12 fecal correlacionou com sangue oculto fecal (p = 0,02, r = 0,55); Na doença de Crohn, correlacionou com a duração da doença, albumina e níveis de plaquetas (p = 0,01, r = -0,53; p <0,01, r = -0,65; p = 0,04, r = 0,45, respectivamente). Não houve correlação entre S100A12 fecal e outras condições clínicas. CONCLUSÃO: O S100A12 fecal é valioso para distinguir pacientes com doença inflamatória intestinal versus controles saudáveis. No entanto, a sensibilidade e especificidade é limitada quando comparada com a descrita nos países ocidentais. A correlação entre S100A12 e características clínicas é limitada. Mais pesquisas são necessárias para explorar melhor essa interação em pacientes chineses.

Paediatric inflammatory bowel disease: Clinical presentation and disease location

Objective: To determine different clinical presentations and disease location demarcated by upper and lower gastrointestinal endoscopy and relevant histopathology in children diagnosed with inflammatory bowel disease [IBD]

Methods: This is 5 years [2010 to 2015] retrospective study conducted at the Aga Khan University Hospital enrolling 65 admitted children between 6 months to 15 years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower [up to the terminal ileum] endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by paediatric gastroenterologists at endoscopy suite of the hospital and all specimens were reported by the pathology department. ESPGHAN revised criteria for the diagnosis of inflammatory bowel disease in children and an adolescent was used to standardize our diagnosis. Extent of disease on endoscopy and relevant histopathology of the biopsy samples were noted at the time of diagnosis. Data was summarized using mean, standard deviation, numbers and percentages for different variables

Results: Total 56 children were enrolled according to inclusion criteria. There were 34 children [61.53%]diagnosed with ulcerative colitis [UC] 10 patients [16.92%] had Crohn's Disease [CD] and 11 [21.53%] patients were labeled as Indeterminate colitis [1C]. Mean age at onset of symptoms was10.03+/-2.44 and mean age at diagnosis was11.10+/-2.36. Abdominal pain [80%] and chronic diarrhea [70%] were common symptoms in CD whereas bloody diarrhea [79.41%] and rectal bleeding [64.70%] were common presentation in UC. Patients diagnosed with indeterminate colitis [IC] had similar clinical features as in UC patients. Only 7% patients had some extra-intestinal features in the form of joint pain and /or uveitis. Aspartate aminotransferase level [95.18 +/-12.89] was relatively high in patients with CD in comparison with other categories of IBD. Endoscopic findings and relevant histopathology of biopsy samples in UC showed 65% patient had pan-colitis and 13% with disease restricted to rectum only whereas in CD 70% patient had| disease in ileo-colon and only 10% had involvement of ileum at the time diagnosis

Conclusion: Patients with UC dominated in our cohort. The most common clinical presentation in UCJ was bloody diarrhea and rectal bleeding and patients with CD had abdominal pain and chronic diarrhea i as predominant clinical features. Extraintestinal features were uncommon in our cohort. In endoscopicl findings, pan-colitis was the most frequent finding in UC and ileo-colon was common location in CD. 1C and UC shared common clinical features and disease location on endoscopy