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IZAZOVI U LEČENJU HRONIČNE INFLAMATORNE BOLESTI CREVA KOD DECE U SRBIJI
CHALLENGES IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASE IN CHILDREN IN SERBIA

Authors

 

Mirjana Stojšić1,2 , Olgica Latinović2,3, Tatiana Jocić3, Alesandar Knežević3

1Institut za zdravstvenu zaštitu dece i omladine Vojvodine, Novi Sad, Srbija
2Medicinski fakultet Univerziteta u Novom Sadu, Srbija
3Klinički centar Vojvodine, Novi Sad, Srbija

 


Rad je primljen 06.11.2017. / Prihvaćen 08.11.2017.

 


Correspondence to


Mirjana Stojšić, MD, PhD,
pediatrician-gastroenterohepatologist
Chief of Cabinet for GI endoscopy
Department of gastroenterology, hepatology and nutrition
Institute of Child and Youth Health Care of Voyvodina
Hajduk Veljkova 10, 21000 Novi Sad, Serbia
mobil : +381 62 20 33 40
e-mail: drstojsic@gmail.com

 

 

Sažetak

 

Hronične inflamatorne bolesti creva (HIBC) uključuju hronične upale celog ili dela digestivnog trakta, a prvenstveno podrazumevaju ulcerozni kolitis i Kronovu bolest. HIBC kod male dece se razlikuje fenotipski, genetski i prognostički. Pre svega jer je nasleđe dominantan etiološki faktor.Etiologija HIBC je primer složene zapaljenske bolesti. Kod većine pacijenata HIBC se razvija zbog dejstva uglavnom nepoznatih faktora spoljne sredine, uključujući crevnu mikrofloru, koji deluju na genetski predisponiranog domaćina. Što se bolest javi u ranijem uzastu dominantniji su genetski faktori (familijarno javljanje bolesti), a ako se kasnije javi prediminirantni su faktori spoljne sredine (sporadični slučajevi). Najveća učestalost oboljevanja od HIBC je između 15 i 25 godine života. HIBC kod dece ima svoje specifičnosti. Karakteristike HIBC kod dece, za razliku od obolelih adultnih osoba su: teža forma bolesti, ekstenzivnija bolest, poremećaji rasta i razvoja, seksualno sazrevanje, manja psihosocijalna uklopljenost i proces tranzicije.
Izazovi u lečenju HIBC kod dece u Srbiji možemo podeliti na nekoliko oblasti :
• Dijagnostički izazovi: nepoznati epidemiološki podaci, pridržavanje Porto dijagnostičkih kriterijuma, kao i klasifikacija bolesti, otkrivanje HIBC u najmanjem uzrastu.
• Terapijski izazovi: usvajanje terapijskih vodiča i nepoznata adherencija pacijenta.
• Problemi prilikom praćenja obolelih: poremećaji rasta i razvoja, procenjivanje kvaliteta života, poteškoće u pohađanju škole,procena psihosocijalnog statusa, aktivnosti organizacije obolelih i vakcinacija obolelih.
• Izazovi vezani za timski rad: organizovan multidisciplinarni pristup, tranzicija punoletnih ka adultnim ustanovama, i nacionalni registar obolelih.
• Izazovi u budućnosti: standardizacija lečenja HIBC dece, telemedicina, upotreba probiotika i biomarkera.
Broj obolelih od HIBC je u stalnom porastu u celom svetu, pa i u Srbiji. sa tim u vezi se očekuje i veći broj dece obolele od HIBC. Poteškoće koje se javljaju prilikom lečenja dece sa hroničnom inflamatornom bolesti creva možemo shvatati kao probleme ili kao izazove, sa tendecijom ka njihovom rešavanju. Ovim radom pokušano je da se pristupi ovim poteškoćama u lečenju dece obolele od HIBC kao izazovima i da se za njih ponude neka konkretna rešenja.

 

 

Abstract

 

Inflammatory bowel disease (IBD) include chronic inflammation of the entire or part of the digestive tract, and primarily involves ulcerative colitis and Crohn's disease. IBD in small children differs phenotypically, genetically and prognostically. First of all, because the heritage is the dominant etiological factor. The etiology of IBD is an example of a complex inflammatory disease. In most patients, IBD develops due to the effects of largely unknown external factors, including the intestinal microflora, which act on the genetically-predicted host. The more common the disease occurs, the more genetic factors (familiary apparance) are dominant, and if the lateral pre-emptive factors of the external environment (sporadic cases) appear. The highest incidence of IBD is between 15 and 25 years of age. HIBC in children has its own specificities. The characteristics of IBD in children, unlike adult adults, are: severe disease, more extensive disease, growth and developmental disorders, sexual maturation, minor psychosocial involvement and the transition process.
The challenges in the treatment of HIBC in children in Serbia can be divided into several areas:
• Diagnostic challenges: unknown epidemiological data, adherence to Porto diagnostic criteria, as well as classification of diseases, detection of HIBC at the youngest age.
• Therapeutic challenges: acceptance therapeutic guidelines and unknown patient adherence.
• Problems in monitoring the patients: growth and development disorders, assessment of quality of life, difficulties in attending school, assessment of psychosocial status, activities of the organization of patients and vaccinations of the diseased.
• Challenges related to team work: organized multidisciplinary approach, adult transition to adult institutions, and national registry of patients.
• Challenges in the future: standardization of the treatment of HIBC children, telemedicine, use of probiotics and biomarkers.
The number of patients with IBD is increasing steadily throughout the world, including in Serbia. In this regard, a greater number of children with IBD are expected to be involved. Difficulties that arise in the treatment of children with inflammatory bowel disease can be seen as problems or challenges, with a tendency towards their resolution. This work was attempted to address these difficulties in treating children with IBD as challenges and to offer some concrete solutions for them.

 

 

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PDF Stojšić M. et al • MD-Medical Data 2017;9(4): 239-244

 

 

 

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