RESUMO
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Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.
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El síndrome de intestino corto constituye una entidad con alteración en la superficie de absorción y en la funcionalidad del sistema gastrointestinal. En estos pacientes se ha descrito mayor predisposición de alergias alimentarias a la proteína de la leche de vaca y al huevo. Se describen los casos de 2 lactantes menores con síndrome de intestino corto y reacciones alérgicas a fórmulas de aminoácidos libres. En el primer caso la paciente presentó una respuesta no mediada por inmunoglobulina E (IgE) manifestada clínicamente con una colitis eosinofílica, que mejoró con uso de esteroides sistémicos, cambio a otra fórmula elemental. En el segundo caso se presenta una paciente con intolerancia inicial a la leche materna y fórmula extensamente hidrolizada. Con primera fórmula de aminoácidos libres presenta sangrado gastrointestinal y manifestaciones cutáneas, por lo que se hace cambio a otra fórmula de aminoácidos libres con tolerancia transitoria. Subsecuentemente, en el contexto de un cuadro viral no especificado con compromiso respiratorio y gastrointestinal, presenta reacción anafiláctica a la fórmula de aminoácidos libres que venía tolerando previamente, por lo que se hace necesario cambio a dieta modular con tolerancia adecuada. No se encontraron reportes previos en la literatura de reacciones alérgicas a fórmulas elementales a base de aminoácidos, por lo cual se reportan los casos descritos. Aún no hay consenso en cuanto a la fórmula ideal para iniciar la alimentación en los pacientes con intestino corto para evitar sensibilización alergénica.
Short bowel syndrome (SBS) is characterized by alterations in the absorption surface and in the functionality of the gastrointestinal system. Patients with SBS are more prone to allergies the protein in cow's milk and eggs. We report two cases of infants with SBS and allergic reactions to amino acid based formulas. In the first case, the patient's response was not IgE-mediated. It manifested clinically with eosinophilic colitis that improved with the use of systemic steroids and a change to another elemental formula. In the second case, the patient initially presented intolerance to breast milk and extensively hydrolyzed formula. After feeding with the first free amino acid formula, the patient developed gastrointestinal bleeding and skin manifestations. Another free amino acid formula was substituted. The patient had transient tolerance to the new formula. Later, in the context of an unspecified viral infection with respiratory and gastrointestinal involvement, the patient presented an anaphylactic reaction to the formula which had previously been tolerated. This necessitated a change to a modular diet which was adequately tolerated. We have presented this case report because no previous reports were found in the literature about allergic reactions to basic amino acid-based formulas. There is still no consensus on the ideal formula for preventing allergic sensitization in patients with SBS.
Assuntos
Humanos , Feminino , Lactente , Aminoácidos , Hipersensibilidade Alimentar , Alimentos Formulados , Síndrome do Intestino CurtoRESUMO
La atresia traqueal es una condición poco frecuente en el recién nacido y su asociación con otras malformaciones ha sido reportada en la literatura en no mas de 100 casos, entre estas asociaciones las malformaciones cardiacas complejas se registran con frecuencia. Se reporta un recién nacido de sexo femenino con diagnóstico de atresia traqueal acompañada de anomalías que sugieren Síndrome de CHARGE y una sobrevida de 13 días...