Relapsing and Refractory Ulcerative Colitis in Children

Abstract

Approximately half of the children with ulcerative colitis (UC) have refractory, relapsing or steroid-dependent disease. UC in children is more extensive than in adults, presents more often with severe attacks and carries a more aggressive disease course. Therefore, although a step-up approach is usually recommended in UC, aggressive therapy will often be indicated in children since steroid dependency should never be tolerated. It is vital to ensure that in every resistant case, the symptoms are truly related to the inflammatory disease activity and not to other conditions such as poor adherence to treatment, infections, adverse reactions to drugs, irritable bowel syndrome, lactose intolerance, celiac disease and bacterial overgrowth. The clinician should be ready to escalate therapy in a timely manner but only after ensuring optimization of current treatments. Optimization may include, among others, appropriate dosage, utilization of assays that determine thiopurine, calcineurin inhibitors and anti-tumor necrosis factor levels, introduction of combination therapy when indicated (enemas and immunomodulators) and a long enough time for treatment to become effective. Colectomy is always a valid option and should be discussed before major treatment escalations. Experimental therapies can be considered when all else fails and the family prefers to avoid colectomy. The management of refractory and relapsing disease is particularly challenging in children, and this review summarizes the available evidence to guide treatment decisions in this setup.

Computed Tomographic Anatomy of the Ascending and Descending Colon in Children and Adolescents

“…В работе Ю.В. Сафроновой [1] показано, что расстояние от восходящей ободочной кишки до 3,6±0,4 5,4±0,4 12 5,4±0,1 2,9,12 4,7±0,2 9,12 3,9±0,2 6,9,12 3,7±0,2 6,9,12 Всего 4.…”

“…На сегодняшний день в литературе встречается достаточно большое количество работ, содержащих сведения о патологии ободочной кишки у детей и подростков [3,6,8,11,12], что диктует необходимость детального изучения и уточнения имеющихся сведений об анатомии и топографии данного органа.…”

Transición del adolescente con enfermedad inflamatoria intestinal desde la atención pediátrica a la del adulto

“…En la EC, esta estrategia tiene como objetivo el manejo de las complicaciones (estenosis, fístulas, enfermedad perianal o refractariedad a terapia farmacológica), describiéndose tasas de cirugías de 20% a los 3 años del debut y 34% a los 5 años 18 . En CU, si bien la colectomía remueve por completo el foco de la enfermedad, mejorando la calidad de vida y evitando los potenciales riesgos del tratamiento inmunosupresor, cabe mencionar que otras complicaciones pueden desarrollarse, como el compromiso del reservorio, incontinencia o afectación de la fertilidad 19 . El éxito de la terapia depende de mantener el tratamiento por largo tiempo.…”

Transcriptomic analyses of treatment-naïve pediatric ulcerative colitis patients and exploration of underlying disease pathogenesis

“…Adults with UC often experience abdominal pain and bloody diarrhea [ 1 , 2 ]. In pediatric UC patients, the presentation of UC can differ from that in adults and is generally more severe, with rapid progression and a poorer prognostic outlook [ 3 , 4 ]. Multicenter studies of European pediatric cohorts have suggested that pediatric-onset UC cases, which comprise 15–20% of all cases, affect 1–4 per 100,000 children per year in Europe and North America [ 5 ].…”