Introduction: Primary immune thrombocytopenia (ITP) is the most frequent cause of thrombocytopenia in pediatric population, with a reported incidence of 1.1-12.5 cases per 100 000 children. However, currently there are different definitions of ITP, as well as diagnostic and therapeutic approaches. Objective: To develop an evidence-based clinical practice guideline (CPG) to unify ITP definitions, and this way, reduce the variability of its diagnosis, and to provide indications for the treatment of acute, persistent, and chronic ITP in patients under 18 years of age Materials and methods: The CPG was developed by a multidisciplinary group that followed the standard methods of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the development of CPGs, formulated PICO clinical questions, and conducted systematic reviews. GRADE evidence profiles were created and recommendations, with their respective level of evidence and strength, were made after a panel of experts assessed the benefit-risk balance, the quality of evidence, the patients’ values and preferences and the context in which they should be implemented. Results: A total of 23 recommendations for the treatment of acute, persistent and chronic ITP by pediatricians, hematologist and health professionals working in emergency services were made. Overall, the evidence of the GPC is of low quality and the recommendations were formulated in order to improve the treatment success rate of ITP and the prognosis of children with this condition. Conclusions: Despite ITP is the main cause of thrombocytopenia in pediatric population, so far there is not enough high quality evidence supporting the recommendations presented here for its proper classification and treatment in children. Thus, further studies providing high quality evidence on this issue are required.
Objetivo: desde 2015, la Asociación Colombiana de Gastroenterología, con el apoyo del Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia, realizó la guía de práctica clínica para el diagnóstico y tratamiento de colitis ulcerativa. Desde la publicación de esta guía, han aparecido nuevas alternativas terapéuticas y nuevos conceptos sobre los objetivos del tratamiento, por lo cual se consideró necesaria su actualización. Materiales y métodos: esta actualización fue realizada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas relevantes a nuevos tratamientos y vigilancia endoscópica de los pacientes adultos con colitis ulcerativa y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías fueron evaluadas en términos de calidad y aplicabilidad. El Grupo Cochrane llevó a cabo la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE. Resultados: se realizó una actualización de la guía para el tratamiento de la colitis ulcerativa en adultos en Colombia y se diseñaron nuevos algoritmos de tratamiento, teniendo en cuenta la extensión y la actividad de la enfermedad y los diferentes niveles de atención. Conclusiones: se estableció la importancia para el tratamiento de la evaluación clínica y endoscópica y se especificaron las indicaciones para el adecuado tratamiento de los pacientes con colitis ulcerativa. Adicionalmente, se dieron recomendaciones de vigilancia endoscópica de cáncer colorrectal y la importancia de la cromoendoscopia.
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