Воспалительные заболевания кишечника у детей: алгоритмы диагностики и современные стратегии терапии

Abstract

Inflammatory bowel disease (IBD) is a chronic immune-mediated disease including Crohn's disease and ulcerative colitis. In about 10% of cases, the disease manifests itself in childhood. The clinical picture of IBD with rectal bleeding or perianal inflammation requires immediate endoscopic examination. In the absence of red-flag symptoms, a combination of patient history, blood and stool biomarkers may help differentiate IBD from other causes of abdominal pain or diarrhea. Treatment of IBD in children is carried out taking into account predictors of adverse outcome, which justifies the preliminary use of anti-tumor necrosis factor therapy for patients with a high risk of developing complications of the disease. In the treatment of patients with IBD, biochemical or endoscopic remission, rather than clinical remission, is the therapeutic goal because intestinal inflammation often persists despite resolution of abdominal symptoms. In pediatric practice, IBD is associated with additional problems, such as impaired growth and physical development, delayed puberty and mental maturation in adolescents. Even after remission has been achieved, many patients with IBD continue to experience nonspecific symptoms like abdominal pain and fatigue. Transfer to adult care is a well-recognized risk for disease relapse, which highlights patient vulnerability and the need for a transition program that is continued by the adult-oriented IBD team. The general pediatrician is an invaluable link in integrating these challenges in the clinical care of patients with IBD and optimizing their outcomes. This state-of-the-art review aims to provide general pediatricians with an update on pediatric IBD to facilitate interactions with pediatric gastrointestinal specialists. Key words: inflammatory bowel diseases, Crohn's disease, ulcerative colitis, children, diagnosis, treatment