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1.
J Pediatr Gastroenterol Nutr ; 64(5): 818-835, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28267075

RESUMO

The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.


Assuntos
Colectomia , Doença de Crohn/cirurgia , Intestino Delgado/cirurgia , Assistência Perioperatória/métodos , Anastomose Cirúrgica , Anti-Inflamatórios/uso terapêutico , Terapia Biológica , Quimioterapia Adjuvante , Criança , Colectomia/métodos , Doença de Crohn/tratamento farmacológico , Procedimentos Cirúrgicos Eletivos , Humanos , Imunossupressores/uso terapêutico , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Recidiva , Prevenção Secundária/métodos
2.
Clin Nutr ; 24(5): 775-9, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15904998

RESUMO

BACKGROUND AND AIMS: Long-term effects of using enteral feed therapy to induce remission in paediatric Crohn's disease are poorly documented. The aim of this study is to examine the short and long-term impact of enteral nutrition as primary therapy for children with newly diagnosed Crohn's disease. METHODS: Since 1994, a data base was set up in Bristol for all children with inflammatory bowel diseases. The data of newly diagnosed patients with Crohn's disease in whom enteral nutrition was used as the primary therapy (44 children) was analysed, with particular reference to time to remission, to first and subsequent relapse, and to first steroid usage. RESULTS: Forty out of 44 patients (90%) responded to enteral nutrition, with a median time to remission of 6 weeks. 25 of these 40 (62%) relapsed, with a median duration of remission of 54.5 weeks (range 4-312). 15 (38%) have not relapsed. 21 of the 44 (47%) have not received steroids. In those who eventually required steroids, their use was postponed for a median 68 weeks (range 6-190). Site of disease activity had no impact on response to enteral nutrition, but there was a trend towards earlier relapse in those with isolated colonic involvement. CONCLUSIONS: This data suggests that there are long-term benefits to the use of enteral nutrition to induce remission in children with Crohn's disease Steroids may be avoided in nearly half the cases and, in others, their use postponed by 68 weeks.


Assuntos
Doença de Crohn/terapia , Nutrição Enteral/métodos , Crescimento , Esteroides/uso terapêutico , Adolescente , Criança , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Estudos Longitudinais , Masculino , Recidiva , Indução de Remissão , Fatores de Tempo , Resultado do Tratamento
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