1,721,036 research outputs found
Immunomodulatori
No full textGli immunomodulatori, intesi come farmaci in grado di modulare (e più
precisamente di ridurre) la risposta immune, trovano ampio spazio di utilizzo
in gastroenterologia pediatrica, principalmente nel trattamento delle
malattie infiammatorie croniche intestinali e nella prevenzione del rigetto
nel trapianto di organo.
Conoscere il loro meccanismo d’azione, gli effetti avversi, i corretti dosaggi
e le indicazioni è indispensabile per il pediatra gastroenterologo (ma anche
per il pediatra generalista), sia ospedaliero che di libera scelta, per l’elevato
numero di bambini che ne fanno utilizzo e per prevenire o trattare gli effetti
avversi, primo fra tutti l’aumentato rischio di infezioni, con una corretta
prevenzione vaccinale
Celiac disease in children
No full textCeliac disease is a common immune-mediated disease, that may present, after gluten ingestion, with various and heterogeneous symptoms that can vary according to patients' age. The diagnostic screening test is serum anti tissue transglutaminase IgA level. In doubt cases, anti-endomysium IgA and the anti-deamidated gliadin peptides IgG could be useful to confirm the suspicion, before a biopsy will be perform. Since 2012, guidelines have made it possible to avoid the biopsy in symptomatic pediatric patients with high levels of anti transglutaminase IgA, positivity to antiendomysium IgA, and with HLA DQ2 or DQ8. In all other cases duodenal biopsy is still mandatory to confirm the diagnosis. The therapy of celiac disease is a lifelong gluten free diet. In children prognosis of celiac disease is good, without complications. Here we review and discuss the present literature about celiac disease in childhood
Reply to thalidomide treatment of pediatric ulcerative colitis: A new use for an old drug
No full textN/
Bannayan-Riley-Ruvalcaba Syndrome (BRRS): An Uncommon Case of Haematochezia in a 3-year-old-boy.
No full textN/
Isolati, multipli, ereditari: Le tante facce dei polipi intestinali
No full textThis article provides a critical review of the clinical presentation, pathology, genetics and management of the polyposis in childhood starting from the isolated juvenile polyp to the hereditary polyposis syndromes. These include the juvenile polyposis syndrome, Peutz-Jeghers syndrome, PTEN hamartoma tumor syndromes and familial adenomatous polyposis (FAP). These conditions typically outbreak in the second decade of life but early
detection and proper screening and surveillance can minimize the risk of intestinal and extracolonic cancers. While juvenile polyp could be easily removed, the amartomatosis syndromes will require a specific endoscopic surveillance and a periodic polypectomy. In the case of FAP, the paediatrician has a decisive role in defining the colonscopic follow-up and the timing of the total colectomy
Ulcerative Colitis of the Neovagina in a Toddler with Cloaca and Chronic Kidney Disease
Full text linkThe case of a toddler with long-channel cloaca, mild chronic kidney disease (CKD) due to renal dysplasia, and early onset of ulcerative colitis (UC) is herein reported. The patient underwent definitive repair of cloaca, that included vaginal elongation with colon, at 5 months of age and was admitted for episodes of vaginal bleeding at 22 months of age. A vaginoscopy revealed a severe inflammation of the colonic neovagina. As rectal bleeding was also noticed, she underwent a colonscopy that showed the same macroscopic inflammatory picture. Neovaginal and colonic biopsies confirmed UC. The mother turned out to be affected by UC since adolescence. The patient is now on oral therapy with mesalazine and topical steroid and mesalazine in the neovagina. The association between cloaca and inflammatory bowel disease (IBD) is anecdotal, but the family history of IBD should be considered when planning the surgical reconstruction of patients with cloaca. In this patient, the occurrence of UC may require a new neovagina in the future and the concomitance of CKD may complicate the overall management due to the potential nephrotoxicity of drugs used for UC therapy
Thalidomide for inflammatory bowel disease: Systematic review
No full textBACKGROUND:
Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases.
METHODS:
CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events.
RESULTS:
The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3%) patients. Clinical remission was achieved in 220/427 (51.5%) cases. Maintenance of remission was reported in 128/160 (80.0%) patients at 6 months and in 96/133 (72.2%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7%) patients. Fistulas improved in 49/81 (60.5%) cases and closed in 28/81 (34.6%). Endoscopic improvement was observed in 46/66 (69.7%) and complete mucosal healing in 35/66 (53.0%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3%) adverse events and were the most frequent cause of drug withdrawal.
CONCLUSION:
Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments
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