Serotype-Specific Pneumococcal Status prior to PCV 13 Administration in Children and Adolescents with Inflammatory Bowel Disease.

The aim of this study was to evaluate the serotype-specific pneumococcal status of children and adolescents with inflammatory bowel disease (IBD) who were naïve to pneumococcal vaccination before administering the 13-valent pneumococcal conjugate vaccine (PCV 13). This was an open, prospective study on children and adolescents aged 5-18 years who had IBD and were naïve to pneumococcal vaccination. A single dose of PCV 13 was administered to each patient. The geometric mean concentrations (GMCs) were measured for all 13 serotypes. A total of 122 subjects completed the study. Prevaccination GMCs ranged from 0.55 µg/ml (serotype 4) to 4.26 µg/mI (serotype 19A). Prior to the administration of PCV 13, high GMCs were detected in older children and adolescents who had IBD and were naïve to pneumococcal vaccination.

[Intramural duodenal hematoma and acute pancreatitis as a complication of diagnostic biopsy of a duodenal 6-year-old boy]. / Krwiak sródscienny dwunastnicy I ostre zapalenie trzustki jako powiklanie diagnostycznej biopsji dwunastnicy u 6-letniego chlopca.

Hematoma duodenum is a very rare complication of diagnostic endoscopy of the upper gastrointestinal tract when biopsy of the duodenum is performed (average frequency is estimated as 1:1,250 biopsies). Most often, it affects children and young adults without any risk factors. Symptoms result from obstruction of the duodenum and compression of the adjacent structures. Conservative treatment, which consists of parenteral nutrition and aspiration of gastric contents until the absorption of hematoma and patency of the gastrointestinal tract returns, is preferred. This paper describes a 6-year-old boy diagnosed due to short stature and low weight in whom the diagnostic biopsy of the duodenum caused formation of a hematoma in the descending duodenum and led to total ileus and acute pancreatitis. The boy was treated conservatively with good result and complete resolution of symptoms was achived.

Deep Vein Thrombosis of the Left Lower Limb in a 12 Year-Old Female Child with Ulcerative Colitis - Case Report.

BACKGROUND: Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. CASE REPORT: This case report presents a patient with ulcerative colitis, with thrombotic complication of the left common iliac vein that occurred at the age of 11, two years after diagnosis. After a year of anticoagulation and compression therapy, although exacerbations of underlying disease occurred in the first 6 months of treatment, there was no recurrence of deep venous thrombosis, partial recanalization within affected venous system has been achieved and the patient is remission of ulcerative colitis for the last six months. CONCLUSIONS: In children, thromboembolic complications occur about 7 times less often than in adults, but increases in the case of hospitalized children. In children with IBD this complication can occur independently og disease activity even in patients with any other risk factors.

Monotherapy with infliximab versus combination therapy in the maintenance of clinical remission in children with moderate to severe Crohn disease.

OBJECTIVES: The aim of the present study was to compare the efficacy and safety of 2 protocols of maintenance therapy with infliximab (IFX) and an immunomodulatory agent in pediatric patients with Crohn disease (CD): withdrawal of immunomodulators versus continuation of immunosuppressants. METHODS: The present multicenter randomized open-label trial included 99 patients with CD (ages 14.5 ±â€Š2.6 years) who were administered IFX (5 mg/kg body weight) along with an immunomodulatory agent (azathioprine 1.5-3 mg/kg body weight per day, methotrexate 10-25 mg/week). After 10 weeks of the induction therapy, 84 responders were centrally randomized into 1 of the following groups: group I (n = 45) in which IFX and an immunomodulatory agent were continued up to week 54 and group II (n = 39) in which the immunomodulatory agent was discontinued after 26 weeks. RESULTS: The induction therapy was reflected by a significant decrease in Pediatric Crohn's Disease Activity Index (PCDAI) and Simplified Endoscopic Activity Score for Crohn's Disease (SES-CD) values. After the maintenance phase, the analyzed groups did not differ significantly in terms of the clinical response loss rates and final PCDAI and SES-CD scores. Furthermore, no significant intragroup differences were documented between mean PCDAI scores determined at the end of induction and maintenance phases. Intensification/modification of the treatment was required in 13 of 45 (29%) and 11 of 39 (28%) patients of groups I and II, respectively. A total of 9 serious adverse events were documented; none of the patients died during the trial. CONCLUSIONS: Twenty-six weeks likely represent the safe duration of combined IFX/immunomodulatory therapy in our sample of pediatric patients with CD.

[Biological treatment of inflammatory bowel diseases in children in the years 2004-2013 in Poland]. / Leczenie biologiczne nieswoistych zapalen jelit u dzieci w latach 2004-2013 w Polsce.

UNLABELLED: In the last years an increase in Crohn's disease morbidity in children is observed together with constant morbidity of ulcerative colitis. The course of these diseases is severe, younger children are affected and the diseases are resistant to conventional treatment. Biological drugs are a chance for a longer remission and healing of the intestinal mucosa. OBJECTIVE OF THE WORK: Assessment of the use of biological drugs in treatment of inflammatory bowel disease in Poland was the objective of the work. MATERIAL AND METHODS: Gastroenterological centers treating inflammatory bowel disease during the years 2004-2013 were invited to a questionnaire retrospective study. RESULTS: The questionnaires of biological treatment of Crohn's disease and ulcerative colitis in children were received from 12 centers. In the years 2004-2013 the number of children aged 4 months to 18 years with Crohn's disease treated with biological drugs was 424. In the years 2004-2008--69 children were treated with infliximab and in the years 2009-2013--299 children, which was a four-fold increase. 56 children were treated with adalimumab in the years 2008-2013. In the years 2005-2013--72 children with ulcerative colitis were treated with infliximab and 11 with adalimumab. The age of the children ranged from 2 years to 18 years. The higher number of children treated was in the years 2009-2013: 59 with infliximab and 10 with adalimumab. CONCLUSIONS: In the last decade a significant increase on the number of children with Crohn's disease and ulcerative colitis treated with biological drugs was observed. It is connected not only to greater morbidity but above all to the introduction of a treatment program by the National Health Insurance Fund for children with Crohn's disease. There is an expectation that the introduction of biological treatment in inflammatory bowel disease will prolong clinical and endoscopic remission and diminish the number of surgeries.

[Anemia in selected diseases of the gastrointestinal tract in children]. / Niedokrwistosc w wybranych chorobach przewodu pokarmowego u dzieci.

Anemia is a frequent symptom of diseases of alimentary tract, also in children. Among others, inflammatory bowel disease, celiac disease and Helicobacter pylori are most often complicated by anemia. Not infrequently these disorders are accompanied by more than one type of anemia and moreover its pathogenesis may be complex. In children with inflammatory bowel disease iron deficiency anemia is predominant, which is caused by the loss and insufficient supply of iron, but also in this group of diseases anemia of chronic diseases pose a problem. In patient with celiac disease, especially in small children, the main cause of anemia is malabsorption of iron, also its loss due to microdamage of the intestine mucosa has also been observed. In Helicobacter pylori infection the origin of anemia is still being discussed. The treatment of iron deficiency anemia (most frequent in the diseases of the alimentary tract) consists mainly of the treatment of underlying disease, supply of iron in food and in the form of drugs. Transfusions of blood ingredients are done only in severe anemia leading to hemodynamic disturbances. Iron may be supplemented either by oral or intravenous route.

[A case of a 16.5-year-old boy with myelosis funicularis caused by secondary vitamin B12 deficiency associated with dietary deficiencies - case report]. / Zwyrodnienie sznurów tylnych rdzenia kregowego z powodu wtórnego niedoboru witaminy B12 w przebiegu diety niedoborowej u 16,5-letniego chlopca - opis przypadku.

Vitamin B12 deficiency can manifest with many illness symptoms, among which dominate those of the hematology, digestive and nervous system. The illness symptoms of vitamin B12 deficiency are often atypical and the early cause diagnosis might be difficult. Hereby it is described a case of a 16.5-year-old boy with myelosis funicularis caused by vitamin B12 deficiency.

[Frequency of anemia in ulcerative colitis in children]. / Ocena czestosci wystepowania niedokrwistosci we wrzodziejacym zapaleniu jelita grubego u dzieci.

UNLABELLED: Anemia is one of most frequent complication of ulcerative colitis. It affects patients in the exacerbation of the disease as well as in the remission. It may be caused by the loss of the blood, the disturbances of intestinal absorption or deficient diet. The aim of the study was to estimate the rate of anemia in children with ulcerative colitis during first hospitalization. MATERIAL AND METHODS: The study comprised 36 children aged 2.5 to 18 years, 23 girls and 13 boys in whom ulcerative colitis was diagnosed based on the Porto criteria. Anemia in children was assessed depending on the age, period between first symptoms and diagnosis of the disease and on the activity of the disease according to PUCAI scale. RESULTS: Anemia was diagnosed in 72.2% of the children. Hemoglobin concentration ranged from 6.3 to 12.4 g/dl, average 10.05 g/dl depending on age. Activity of the disease according to PUCAI scale amounted to 5 to 80 points, average 51.9 points. Time from first symptoms to the diagnosis of the disease extended from one week to 12 months, average 3.6 months. In children without anemia the average concentration of hemoglobin was 13.2 g/dl, the activity of the disease 33.5 points and average time before diagnosis - 1.7 months. CONCLUSIONS: Anemia is a frequent symptom of ulcerative colitis in children. The presence of anemia depends on the disease activity and on the time between first symptoms and diagnosis of the disease. There is a necessity of iron supplementation in children with anemia despite effective anti-inflammatory treatment.

[Blue rubber bleb naevus syndrome]. / Zespól naczyniaków gumiastych.

Blue rubber bleb nevus syndrome (Bean syndrome) is a rare disease characterized by the presence of multiple vascular malformation of rubber-like consistence. This disease is of a genetic origin and most often is caused by sporadic mutation, however, exist reports on autosomal dominant type of heritance. Nevi are most frequently met in the skin and alimentary tract but may be present in all organs and tissues. The most frequent symptom of Bean syndrome is anaemia due to ferrum deficiency, which is a result of chronic hemorrhagia from vascular malformations in the alimentary tract. Vascular anomalies on the skin are usually asymptomatic. Other symptoms are less frequent and depend on the localisation of vascular changes and therefore patients with Bean syndrome require meticulous analysis of reported multiple - specialistic medical care.

[Blue rubber bleb naevus syndrome--a rare cause of bleeding from the gastrointestinal tract--case report]. / Zespól naczyniaków gumiastych--rzadka przyczyna krwawienia z przewodu pokarmowego--opis przypadku.

Blue rubber bleb nevus syndrome (BRBNS or Bean's syndrome) is a rare disease characterized by the interaction of hemangiomas of rubber-like tenacity in the skin and gastrointestinal tract, rarely in other organs. Cutaneous malformations are usually asymptomatic and not require any treatment. The most common symptoms of gastrointestinal tract are iron deficiency anemia and bleeding. Hemangiomas can occur in any organ and cause a wide spectrum of symptoms. BRBNS can cause massive bleeding and even death. In this article we present a case of Bean's syndrome in a 7,5-year-old girl with bleeding from the lower gastrointestinal tract, which has been caused by hemangiomas located in the skin, large intestine, chest and armpit.

Selective Forms of Therapy in the Treatment of Inflammatory Bowel Diseases.

Selective interference with the functioning of the immune system consisting of the selective blockade of pro-inflammatory factors is a modern, promising, and developing strategy for the treatment of diseases resulting from dysregulation of the immune system, including inflammatory bowel disease. Inhibition of the TNF alpha pathway, group 12/23 cytokines, and lymphocyte migration is used in the treatment of severe or moderate ulcerative colitis and Crohn's disease. Intracellular signal transduction by influencing the phosphorylation of SAT (signal transducer and activator of transcription) proteins remains in clinical trials.

The Incidence of Inflammatory Bowel Disease in the Paediatric Population in the District of Lower Silesia, Poland.

The incidence of IBD has been rising over the last decades. The trend applies not only to well-developed countries but also to the regions with limited number of cases so far, e.g., Asia or Middle East. AIM: The aim of the study was to determine the incidence of paediatric IBD in the district of Lower Silesia, Poland, between 2016 and 2018. METHODS: The number of newly diagnosed IBD per 100,000 children, living in the region, was calculated. The characteristics of the group were established. RESULTS: There were 81 cases of paediatric IBD diagnosed between the 1st of January 2016 and 31st of December 2018. The diagnosis of ulcerative colitis (UC) was made for 42 children. In the same period of time 39 cases of Crohn disease (CD) were recognised. The incidences were calculated as 2.57 for UC, and 2.38 for CD. The total incidence of IBD between 2016 and 2018 was 4.96/100,000/year which is rise in the last 20 years. CONCLUSION: An increase in incidence of IBD in the district of Lower Silesia has been observed.

Determinants of disease-specific knowledge among children with inflammatory bowel disease and their parents: A multicentre study.

BACKGROUND: Disease knowledge is associated with increased treatment compliance and improvement of symptoms in inflammatory bowel disease (IBD). IBD-knowledge inventory device (IBD-KID) was developed and validated specifically as a tool to measure disease-related knowledge in children with IBD and their parents. AIM: To prospectively assess the determinants of disease-related knowledge regarding paediatric IBD patients and their parents, using the IBD-KID. METHODS: A questionnaire-based survey was carried out in paediatric patients and their parents. The determinants of patients' and parents' IBD-KID scores were assessed according to hierarchical linear regression models. RESULTS: The study group consisted of 269 IBD patients and 298 parents. The patients' mean (standard deviation, SD) IBD-KID score was 10.87 (± 3.97), while the parents' was 11.95 (± 3.97). Both groups exhibited poor knowledge of the side effects of steroid therapy, the role of surgical treatment in IBD, dietary restrictions and the risks associated with the use of herbal medicines. The patients' IBD-KID scores were statistically associated with patient sex [B coefficient (standard error, SE) = 1.03 (0.44), P = 0.021] and patient age [B (SE) = 0.03 (0.01), P < 0.001]. The parents' IBD-KID scores were significantly related to patient age [B (SE) = 0.02 (0.01), P = 0.003], and treatment with immunosuppressive agent [B (SE) = 1.85 (0.48), P < 0.001]. The final models explained 26.9% of the variance of patients' IBD-KID scores and 18.5% of the variance of parents' scores. CONCLUSION: The variables originating from parents' knowledge were significantly associated with patients' IBD-KID scores. The study results indicate the need to implement better education programmes for patients and parents.

[Assessment of fecal calprotectin concentration as inflammatory marker in inflammatory bowel diseases in children--preliminary report]. / Ocena stezenia kalprotektyny w kale jako markera stanu zapalnego w nieswoistych zapaleniach jelit u dzieci--doniesienie wstepne.

UNLABELLED: Among patients with inflammatory bowel disease children constitute about 15-20%. Still is ongoing search for the perfect marker for this large group of patients which will help in the diagnosis of the disease, in determination of its activity, in monitoring the treatment and in predicting the relapse, while the test for that marker would be simple, cheap and noninvasive. One of the antimicrobial peptide-calprotectin, which is present in feces and is dependent on the number of migrating granulocytes into the intestinal lumen, is a promising marker of the severity of inflammation. The aim of the study was to evaluate the usefulness of the application of calprotectin measurement in stool in children with inflammatory bowel disease, as a marker of the severity of inflammation. MATERIAL AND METHODS: We analyzed 115 patients: 32 with ulcerative colitis (UC), 44 with Crohn's disease (CD), 9 with hemorrhagia from the lower part of the digestive tract, but without inflammatory bowel disease and 30 from the control group. In all patients were measured the concentration of calprotectin in the sample of feces using CALPRO (Calprotectin ELISA test) and markers of inflammation: erythrocyte sedimentation rate (ESR), CRP protein, leukocytosis in the peripheral blood counts (L), concentration of seromucoid and the number of platelets (Tr) and hemoglobin (Hb). RESULTS: Concentration of calprotectin in feces of patients with inflammatory bowel diseases was above the norm I (> 50 mg/kg b.w.) in all patients with moderate and severe disease and in the majority of patients with mild disease or in remission. In contrast it was normal in all from control group. Fecal calprotectin concentration was higher than normal in connection with abnormal results of laboratory parameters such as inflammatory markers in serum and haemoglobin concentration. Laboratory abnormalities were more frequent in patients with IBD and with fecal calprotectin level above the norm than in all patients with IBD. CONCLUSIONS: 1. Calprotectin concentration in stool above of norm was observed in the majority of patients with inflammatory bowel disease, and in none from the control group. 2. The number of patients with IBD and higher fecal calprotectin concentration increased with disease activity 3. Fecal calprotectin concentration was higher in patients with severe and moderate disease activity than in those with mild disease activity or in remission. 4. Calprotectin fecal concentration in patients with inflammatory bowel disease was associated with increased other inflammatory markers in serum and decreased haemoglobin. 5. Measurement of fecal calprotectin concentration can be an noninvasive method of assessment disease activity in inflammatory bowel diseases.

Value of magnetic resonance enterography in diagnosis and treatment follow up in Crohn's disease in children.

PURPOSE: Crohn's disease (CD) is a chronic inflammatory disease which can affect all parts of the gastrointestinal tract. Magnetic resonance enterography (MRE) enables detection of pathologic changes in the small intestine, which are not accessible by conventional endoscopy. The aim of the study was to assess the value of MRE in imaging of small bowel lesions, their location and extent, in CD patients and its correlation with clinical and endoscopic activity. MATERIALS AND METHODS: MRE was performed in 108 children with CD, aged 5.5 to 18 years. The diagnosis was based on the Porto criteria. Location and clinical manifestation was evaluated according to the Paris classification. Clinical CD activity was assessed with PCDAI and endoscopic activity with SES-CD. In 36 children, control MRE was performed. RESULTS: The most common endoscopic location of the disease was the colon (41.7%), terminal ileum and colon (24.1%). Inflammation as the main clinical manifestation was dominant (81.5%). In MRE, inflammatory changes were found in 40.8% of children, strictures in 11.1%. The EIA value (activity in MRE) increased along with PCDAI score and SES-CD. MRE performed during follow up, showed transmural healing in 16.7% of patients and improvement in 55.5%. CONCLUSIONS: MRE is an efficient diagnostic tool in proper characterization of disease location in pediatric CD. As positive correlation of the results of MRE with the endoscopic and clinical activity has been found, taking into account good tolerance and non-invasiveness of the procedure it can be recommended to be used in reassessment.

Correlation between biomarkers (calprotectin, seromucoid, metalloproteinase-3 and CRP) and clinical and endoscopic activity of ulcerative colitis in children.

PURPOSE: The aim of the study was to compare the clinical activity and inflammatory markers with the endoscopic activity of ulcerative colitis (UC) and mucosal healing. PATIENTS AND METHODS: The study included 50 children aged 2-18 years (27 girls, 23 boys) diagnosed with UC at various stages of the disease; 8 children were assessed twice. In 20 children, colonoscopy revealed pancolitis, in 24 - left-sided colitis, and in 6 - ulcerative proctitis. The clinical activity of UC was assessed according to the Pediatric Ulcerative Colitis Activity Index (PUCAI). Endoscopic index of the colon inflammation was assessed according to the Rachmilewitz scoring. We assessed the clinical activity of UC, the concentration of fecal calprotectin (FC), seromucoid, metalloproteinase-3 (MMP-3) and C-reactive protein (CRP). RESULTS: The study demonstrated significant decrease in the clinical activity, FC, seromucoid and MMP-3 in endoscopic remission. We found a strong positive correlation between PUCAI, FC, serum seromucoid and serum MMP-3 with the endoscopic activity. However, we found no relationship between the concentration of CRP and the endoscopic activity of the disease. Among the studied markers, seromucoid exhibited the best performance in distinguishing between patients with endoscopic remission and endoscopically active disease. CONCLUSIONS: The examined inflammatory markers such as FC, as well as serum seromucoid and MMP-3 levels may be helpful in the assessment of large intestine mucosal healing.

Immunogenicity of Diphtheria Booster Vaccination in Adolescents With Inflammatory Bowel Disease.

The aim of this prospective study was to assess the immunogenicity and safety of booster vaccine against diphtheria in children with inflammatory bowel disease on and without immunosuppression treatment. Immunoprotection was achieved in 93% of the children. No significant differences depending on the treatment used and no serious adverse events or flares of inflammatory bowel disease were observed.

Epidemiology of inflammatory bowel disease among children in Poland. A prospective, population-based, 2-year study, 2002-2004.

BACKGROUND/AIMS: The incidence of pediatric inflammatory bowel disease (IBD) in Western countries is on the rise. No prospective studies have been conducted on the epidemiology of pediatric IBD in Poland. The aim of the study was to define the characteristics of new pediatric IBD and assess the incidence of new IBD among children in Poland between 2002 and 2004. METHODS: Patient records from 24 pediatric gastroenterology centers servicing the whole population of Poland were collected. IBD diagnosis was based on clinical, radiological, endoscopic and histological features. RESULTS: There were 491 new IBD patients, representing an overall incidence of IBD of 2.7 cases/100,000 children/year. The incidence of Crohn's disease (CD) was 0.6, ulcerative colitis (UC) 1.3, and indeterminate colitis (IC) 0.8. The age-related incidence of IBD was 1.8 in the 0- to 10-year-old age group, rising to 3.7 for the 11- to 18-year age group. CONCLUSIONS: The overall incidence of IBD (as well as CD, UC and IC) in Poland is lower than that in Western countries. The relative contribution of UC and IC to the overall IBD incidence is higher in Poland than in most Western countries. These findings may suggest a tendency towards under- or misdiagnosis.

[Complications of endoscopy in children]. / Powiklania endoskopowego badania przewodu pokarmowego u dzieci.

Endoscopic examination is a valuable procedure both in the diagnostics and in the treatment of alimentary tract diseases. It is usually safe, however, it is invasive and therefore burdened by complications risk, particularly when it is performed as a therapeutic procedure. Taking into consideration the causative agent, complications of endoscopy can be divided into these occurring already before examination being the result of preparation to the examination and directly connected with the procedure of examination. The occurrence of complication may require other, additional diagnostic procedures, treatment including surgical, moreover it can be a cause of patient death. The prevention of complications of endoscopy includes proper qualification to the examination, detailed history of concomitant diseases, proper preparation for the examinations, experienced staff conducting the examination and proper technical setting.

[Assessment of bone mineral density in children with celiac disease]. / Ocena gestosci mineralnej kosci u dzieci chorujacych na chorobe trzewna.

UNLABELLED: To the reasons of disturbances of bone mineralization in celiac disease belong: absorption impairment due to the changes in mucosa including calcium and vitamin D adsorption, the activation of osteoclasts by proinflammatory cytokines and the decrease in concentration of growth hormone and IGF-1 in the serum. THE AIM OF THE STUDY was to analyze mineral bone density in children with celiac disease. MATERIAL AND METHODS: Analysis included 37 children aged 5 to 17 years, treated in our clinic since November 2004 to June 2007 with diagnosed celiac disease. In all children examination of total body bone mineral density (TBMD) was performed using DPX(+) densitometer (Lunar). RESULTS: The disturbances of mineral bone density were observed in 15 out of 37 children with diagnosed celiac disease which amounted to 40.5%. In patients with celiac disease diagnosed de novo such disturbances were present in 75%. CONCLUSIONS: The reduction of mineral bone density was present in 40.54% of children with diagnosed celiac disease and in 75% of patients with celiac disease diagnosed de novo. The decrease of BMD correlated with nutritional status and was present only in 30% of properly nourished children and in much higher percent in severely malnourished children. Reduced bone mineral density was observed in 50% of children with mucosa villous atrophy and merely in 8% with proper small intestine mucosa. There is a need of diagnostic scheme for early diagnosis (screening) and treatment of mineral bone density disturbances in children with celiac disease.