Lavados colónicos anterógrados para el estreñimiento refractario en niños sin encefalopatía / Antegrade colonic enemas for intractable constipation in non-mentally retarded children

Revisión retrospectiva de las cecostomías realizadas para lavados anterógrados colónicos. Doce apendicocecostomías desde enero de 2002 a febrero de 2008, 9 apendicostomías en pacientes con mielomeningocele y 3 cecostomías en niños con estreñimiento crónico no orgánico sin encefalopatía ni retraso mental. De los 9 primeros pacientes, de entre 3 y 13 años, 8 tuvieron muy buena evolución y uno requirió retirada por mal empleo familiar. A un niño de 7 años, por lo demás sano, con estreñimiento crónico desde los 10 meses, pese a laxantes múltiples (varias tandas de desimpactación y dilatación anal bajo anestesia), con estudio morfofuncional normal, se le realizó, hace 5 años, cecostomía; persistió cierta tendencia a impactación pero con buena calidad de vida. Otro niño, previamente sano, de 12 años de edad, presentaba incontinencia fecal diaria asociada a estreñimiento desde los 3 años, con manometría anorrectal normal y biopsia con leve displasia neuronal; se le realizó cecostomía hace 3 años, con mejoría evidente y menor trastorno emocional secundario. El último caso de cecostomía tenía 8 años, con cuadro similar al anterior y se realizó procedimiento endoscópico con botón de Chait, con lo que mejoró francamente el cuadro. La progresión del estreñimiento rebelde a edad adulta tiene un impacto negativo en la adaptación social y el estado emocional del paciente, y puede alterar la vida familiar. Los lavados anterógrados colónicos proporcionan independencia y mejoran la calidad de vida. Se necesitan realizar en más pacientes para poder establecer verdaderos datos de efectividad (AU)

A descriptive review of 12 patients who underwent appendicocecostomy or caecostomy for antegrade colonic lavage from January 2002 to February 2008. There were 9 appendicocecostomies performed patients from 3 to 13 years suffering from myelomeningocele, of which 8 of them had a very good outcome, with one case with drawn due to poor use by the family. Three caecostomies were performed in non-mentally retarded constipated children. One was an otherwise healthy 7 year-old boy with hards tools since he was 10 months old, in spite of multiple laxative treatments, with normal morphology and function. He had a percutaneous caecostomy five years ago, with some improvement and a good quality of life, but still some occasional partial impactions. Another healthy 12 year-old boy with daily constipation associated faecal incontinence since he was 3 years old (normal manometry and rectal biopsy with signs of mild neuronal dysplasia)had a percutaneous caecostomy performed three years ago, with improvement in the faecal incontinence and better psychological out come. The last caecostomy patient was an 8 year-old boy, with a similar clinical history and good progress in last three years after placing a Chait’s button using an endoscopic procedure. Stubborn constipation continuing in to adult life has a negative impact on the social and emotional adaptation of the paediatric patient, affecting family interactions. Antegrade colonic lavage allows independence and improves the quality of life in patients affected by recurrent faecal impactions. This technique needs to be performed on more patients to find out its true effectiveness (AU)

[Antegrade colonic enemas for intractable constipation in non-mentally retarded children]. / Lavados colónicos anterógrados para el estreñimiento refractario en niños sin encefalopatía.

A descriptive review of 12 patients who underwent appendicocecostomy or caecostomy for antegrade colonic lavage from January 2002 to February 2008. There were 9 appendicocecostomies performed patients from 3 to 13 years suffering from myelomeningocele, of which 8 of them had a very good outcome, with one case withdrawn due to poor use by the family. Three caecostomies were performed in non-mentally retarded constipated children. One was an otherwise healthy 7 year-old boy with hard stools since he was 10 months old, in spite of multiple laxative treatments, with normal morphology and function. He had a percutaneous caecostomy five years ago, with some improvement and a good quality of life, but still some occasional partial impactions. Another healthy 12 year-old boy with daily constipation associated faecal incontinence since he was 3 years old (normal manometry and rectal biopsy with signs of mild neuronal dysplasia) had a percutaneous caecostomy performed three years ago, with improvement in the faecal incontinence and better psychological outcome. The last caecostomy patient was an 8-year-old boy, with a similar clinical history and good progress in last three years after placing a Chait's button using an endoscopic procedure. Stubborn constipation continuing into adult life has a negative impact on the social and emotional adaptation of the paediatric patient, affecting family interactions. Antegrade colonic lavage allows independence and improves the quality of life in patients affected by recurrent faecal impactions. This technique needs to be performed on more patients to find out its true effectiveness.

Eficacia del tratamiento nutricional primario en la enfermedad de Crohn pediátrica / Efficacy of exclusive enteral feeding as primary therapy for paediatric Crohn´s disease

Introducción: El tratamiento nutricional primario (TNP), que consiste en la administración de dieta exclusiva con fórmula enteral (polimérica, semielemental o elemental) durante un período no inferior a 6-8 semanas, ha demostrado ser efectivo para inducir la remisión clínica en niños afectados de enfermedad de Crohn. La remisión clínica no siempre conlleva la remisión histológica o la curación de la mucosa. La calprotectina fecal es un excelente marcador de la actividad inflamatoria intestinal y sus concentraciones se correlacionan estrechamente con el grado de inflamación de la mucosa intestinal. Pacientes y métodos: Se ha realizado un estudio prospectivo observacional en el que se incluyeron todos los pacientes menores de14 años diagnosticados de enfermedad de Crohn entreenero de 2002 y octubre de 2007 que recibieron alimentación exclusiva con fórmula polimérica (Modulen IBD, Nestlé, Vevey, Suiza) durante su primer brote de enfermedad. Se establecieron controles clínicos (peso, talla, índice de masa corporal, índice de actividad de la enfermedad de Crohn pediátrica [PCDAI]) y determinaciones de calprotectina fecal al inicio, y a las 4 y 8 semanas de tratamiento. La remisión clínica se definió cuando el PCDAI era igual o inferior a 10. Se consideraron normales valores de calprotectina fecal inferiores a 50 mg/g de heces. Resultados: Se incluyeron 14 pacientes (9 varones), con una edad media en el momento del diagnóstico de 10,74 +/- 2,56 años. A las 4 semanas, el 71 % de los pacientes alcanzaron la remisión clínica, que se acompañó de un descenso no significativo de las cifras de calprotectina fecal. A las 8 semanas, el 85 % de los pacientes logró la remisión clínica y los valores de calprotectina fecal habían descendido de forma significativa, aunque sin alcanzar concentraciones normales. Conclusión: El TNP administrado durante un período de 8 semanas puede inducir la remisión clínica y mejorar el grado de inflamación de la mucosa intestinal (AU)

Introduction: The primary nutritional therapy (PNT), which consists in the administration of exclusive enteral formula feeds(polymeric, semi-elemental or elemental formula) for a period of no less than 6-8 weeks, has proven to be effective in inducing clinical remission in children with Crohn’s disease. The clinical remission does not always include histological remission or cure of the mucosa. Faecal calprotectin is closely correlated with endoscopic and histological findings but is slightly associated with clinical activity scores. Patients and methods: An observational prospective study including all patients under 14 years of age diagnosed with Crohn’s disease between January 2002 and October 2007, and who were fed exclusively with polymeric formula (Modulen IBD, Nestle, Vevey, Switzerland) during the onset of the disease. Clinical controls were carried out (weight, height, body mass index [BMI) and the Paediatric Crohn’s Disease Activity Index [PCDAI)) and faecal calprotectin was measured at the beginning and at weeks 4 and 8 of treatment. The clinical remission was defined as having a PCDAI less than or equal to 10. Faecal calprotectin values below 50 mg/g faeces were considered as normal. Results: There were 14 patients (9 males), mean age at diagnosis of 10.74 +/- 2.56 years. At week 4, 71 % of patients (10/14)had achieved clinical remission and a decrease in faecal calprotectin levels that was not significant. After 8 weeks, 85 % of our patients were in clinical remission and faecal calprotectin values had declined significantly without treaching normal levels. Conclusion: Primary nutritional therapy administered over a period of 8 weeks is capable of inducing clinical remission and improving the degree of inflammation of the intestinal mucosa (AU)

[Efficacy of exclusive enteral feeding as primary therapy for paediatric Crohn's disease]. / Eficacia del tratamiento nutricional primario en la enfermedad de Crohn pediátrica.

INTRODUCTION: The primary nutritional therapy (PNT), which consists in the administration of exclusive enteral formula feeds (polymeric, semi-elemental or elemental formula) for a period of no less than 6-8 weeks, has proven to be effective in inducing clinical remission in children with Crohn's disease. The clinical remission does not always include histological remission or cure of the mucosa. Faecal calprotectin is closely correlated with endoscopic and histological findings but is slightly associated with clinical activity scores. PATIENTS AND METHODS: An observational prospective study including all patients under 14 years of age diagnosed with Crohn's disease between January 2002 and October 2007, and who were fed exclusively with polymeric formula (Modulen IBD, Nestle, Vevey, Switzerland) during the onset of the disease. Clinical controls were carried out (weight, height, body mass index [BMI) and the Paediatric Crohn's Disease Activity Index [PCDAI)) and faecal calprotectin was measured at the beginning and at weeks 4 and 8 of treatment. The clinical remission was defined as having a PCDAI less than or equal to 10. Faecal calprotectin values below 50 microg/g faeces were considered as normal. RESULTS: There were 14 patients (9 males), mean age at diagnosis of 10.74 +/- 2.56 years. At week 4, 71 % of patients (10/14) had achieved clinical remission and a decrease in faecal calprotectin levels that was not significant. After 8 weeks, 85 % of our patients were in clinical remission and faecal calprotectin values had declined significantly without reaching normal levels. CONCLUSION: Primary nutritional therapy administered over a period of 8 weeks is capable of inducing clinical remission and improving the degree of inflammation of the intestinal mucosa.