RESUMO
OBJECTIVES: Although ursodeoxycholic acid has been used to treat various cholestatic liver diseases in children, few data are available about its efficacy in biliary atresia. The aim of this study was to assess the effect of ursodeoxycholic acid treatment on liver function in children who underwent successful surgery for biliary atresia. PATIENTS AND METHODS: We prospectively studied 16 children with biliary atresia who underwent successful portoenterostomies (postoperative conjugated bilirubin concentration: <34 micromol/L) and were treated with ursodeoxycholic acid for at least 18 months after surgery. Ursodeoxycholic acid treatment was then discontinued. Clinical and biological assessment was performed at the time of discontinuation of ursodeoxycholic acid treatment (T0), at follow-up (T1) and, if the clinical or biological status worsened, after resumption of ursodeoxycholic acid treatment (T2). RESULTS: Ursodeoxycholic acid treatment was resumed in 13 cases. In 1 patient, jaundice recurred after ursodeoxycholic acid therapy was discontinued but abated after resumption of treatment. In 13 children, liver function worsened significantly when ursodeoxycholic acid was discontinued. T1 versus T0 concentrations expressed as multiples of the upper limit of the normal range (in parentheses) were as follows: alanine aminotransferase, 3.0 xN (0.8-7.0) vs 1.5 xN (0.5-5.4); gamma glutamyl transpeptidase, 8.0 xN (1.8-30.2) vs 4.2 xN (0.5-27.4); and aspartate aminotransferase, 1.7 xN (0.7-6.0) vs 1.3 xN (0.6-3.4). When ursodeoxycholic acid treatment was resumed, liver function had improved in all patients by T2. Concentrations of endogenous bile acids tended to be elevated at T1 (not significant) and were significantly decreased at T2. CONCLUSION: Our study demonstrates the beneficial effect of ursodeoxycholic acid on liver function in children after successful surgery for biliary atresia.
Assuntos
Atresia Biliar/tratamento farmacológico , Atresia Biliar/cirurgia , Colagogos e Coleréticos/administração & dosagem , Ácido Ursodesoxicólico/administração & dosagem , Atresia Biliar/diagnóstico , Atresia Biliar/mortalidade , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Lactente , Recém-Nascido , Fígado/efeitos dos fármacos , Fígado/enzimologia , Testes de Função Hepática , Masculino , Portoenterostomia Hepática/métodos , Probabilidade , Estudos Prospectivos , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
OBJECTIVES: Experience with pediatric home-based enteral nutrition (HEN), in particular series including children only, has been reported only rarely. We investigated the evolution of pediatric HEN activity during an 11-year period. METHODS: All patients aged 17 years or younger who started HEN between January 1990 and December 2000 were included in this retrospective study. RESULTS: The annual number of patients treated with HEN increased dramatically from 16 in 1990 to 200 in 2000, with more than 65 new patients every year since 1999 (P < 0.0001). The mean age at the commencement of HEN decreased from 6.2 +/- 1.4 (SEM) to 4.8 +/- 0.7 years (P = 0.006). The use of nasogastric tubes decreased from 63% in 1990 to 35% in 1998 (P = 0.009), and the use of gastrostomy increased from 50% to 60% from 1994 onward. The proportion of patients with digestive diseases commencing HEN in each year decreased from more than 40% before 1996 to less than 32% in 2000 (P = 0.009). Commercially manufactured pediatric diets were used increasingly (P = 0.0006). CONCLUSIONS: The evolution of HEN was marked by changes in the population treated and the modes of treatment after the emergence of gastrostomy and commercial diets. This justified the creation of a multidisciplinary, pediatric artificial nutrition unit.
