Showing papers by "Jarosław Kierkuś published in 2014"

Fecal calprotectin is a good biomarker of mucosal healing in monitoring of children with IBD

Abstract: Summary Introduction. Fecal calprotectin (FC) concentrations of patients with inflammatory bowel diseases (IBD) are much higher than those of healthy controls or patients with func- tional disorders or other gastrointestinal diseases. Thus FC is a good biomarker of gut inflammation in differential diagnosis of IBD as well as mucosal healing in monitoring of IBD in adults. There is shortage of data concerning predictive value of FC in mucosa status assessment in children with IBD. Aim. The aim of the study was to assess the usefulness of FC as a biomarker of endos- copy proven mucosal healing in monitoring of children with IBD. Material and methods. 46 patients (25M, 21F; aged 13.7 ± 3.8) with IBD (24 ulcerative colitis - UC, and 22 Crohn's disease - CD) were involved to the study and had elective co- lonoscopy performed and FC within a week before endoscopy measured. Mucosa status during endoscopy were assessed with SES-CD in case of CD and with Baron score in case of UC. Full mucosal healing was defined as SES-CD = 0 or Baron score = 0. The ROC curves was used as a statistical method to establish cut off points and AUC (area under curve) was regarded as assessment of discrimination between subgroup with full mucosal healing vs. subgroup with mucosal inflammation present. Results. The AUC was 0.95. The optimal cut-off level of discrimination between sub- group with full mucosal healing vs. subgroup with mucosal inflammation present was 233 μg/g with sensitivity 1 and specificity 0.79. When specificity was outweighed over sensitivity the cut-off point was 54 μg/g with sensitivity 0.77 and specificity 0.97. Conclusions. FC is a good biomarker of mucosal healing in monitoring of children with IBD. Values below 54 μg/g enable to select 77% patients with full mucosal healing.

[Biological treatment of inflammatory bowel diseases in children in the years 2004-2013 in Poland].

Abstract: In the last years an increase in Crohn's disease morbidity in children is observed together with constant morbidity of ulcerative colitis. The course of these diseases is severe, younger children are affected and the diseases are resistant to conventional treatment. Biological drugs are a chance for a longer remission and healing of the intestinal mucosa. OBJECTIVE OF THE WORK: Assessment of the use of biological drugs in treatment of inflammatory bowel disease in Poland was the objective of the work.Gastroenterological centers treating inflammatory bowel disease during the years 2004-2013 were invited to a questionnaire retrospective study.The questionnaires of biological treatment of Crohn's disease and ulcerative colitis in children were received from 12 centers. In the years 2004-2013 the number of children aged 4 months to 18 years with Crohn's disease treated with biological drugs was 424. In the years 2004-2008--69 children were treated with infliximab and in the years 2009-2013--299 children, which was a four-fold increase. 56 children were treated with adalimumab in the years 2008-2013. In the years 2005-2013--72 children with ulcerative colitis were treated with infliximab and 11 with adalimumab. The age of the children ranged from 2 years to 18 years. The higher number of children treated was in the years 2009-2013: 59 with infliximab and 10 with adalimumab.In the last decade a significant increase on the number of children with Crohn's disease and ulcerative colitis treated with biological drugs was observed. It is connected not only to greater morbidity but above all to the introduction of a treatment program by the National Health Insurance Fund for children with Crohn's disease. There is an expectation that the introduction of biological treatment in inflammatory bowel disease will prolong clinical and endoscopic remission and diminish the number of surgeries.

Cohort profile: pediatric patients with Crohn's disease qualified to biologic therapy

Abstract: Summary Introduction. Treatment with modern therapies is an economic problem in every coun- try. Therefore, there are therapeutic programs of National Health Fund (NHF) in Poland which enable to apply such expensive treatment. Currently, Polish NHF programs include biologic therapy with infliximab (IFX) for pediatric patients aged 6-18 years with severe Crohn's disease (CD). Aim. The aim of this study was to describe the clinical profile of pediatric patients hos- pitalized in the Department of Gastroenterology, Hepatology and Feeding Disorders, Chil- dren's Memorial Health Institute in Warsaw, who have been qualified to biologic therapy with either infliximab (IFX) or adalimumab (ADA). Material and methods. We have performed a retrospective analysis of 107 children age 13.0 ± 9.3 years diagnosed with CD and treated with IFX and/or ADA within the period of 8 year; time between 2005 and 2013. The data on patient's demographics, including age, sex, and age at disease onset as well as on the course and behavior of CD have been collected. Results. One hundred and seven CD patients (M: 54, F: 53) aged 13.0 ± 9.3 years were analyzed. Eighty one children (75.7%) received IFX, 26 (24.3%) ADA, and 8 (7.5%) were treated with both agents. Mean disease duration was 5.5 ± 0.83 years. The most frequently found location of lesions was L3 (56.1%). Extraintestinal manifestations were reported in 18 patients (16.8%), and arthralgia/arthritis was the most frequently found con- dition among them (77.8%). The most frequently found complication were nutritional and growth disorders, observed in 10 patients (9.3%). Mean PCDAI score at qualification was (median± ) 52.5)±27.5. Mean SES-SD (median (interquartile range)) score at qualification was 1 (1.0-22.0). Conclusions. Pediatric patients qualified to biologic therapy have rather severe than moderate course of disease with high PCDAI score.

Biological therapy for pediatric ulcerative colitis

Abstract: Ulcerative colitis is a chronic inflammatory bowel disease of unknown etiology. Actually, the main pathogenic role is attributed to pro-inflammatory cytokines, the major one is Tumour Necrosis Factor alpha (TNF-α). The advances in understanding the pathogenesis of inflammatory bowel disease have led to the introduction of new therapeutic options, biological agents. Till now U.S. Food and Drug Administration (FDA) approved three monoclonal antibodies against TNF-α to treat adults with moderate to severe ulcerative colitis with an inadequate response to conventional therapy, or who are intolerant, or have medical contraindications for such therapy. These are: infliximab, adalimumab and golimumab. Only infliximab has been approved by the agency to treat children, nonetheless adalimumab is also used in treatment of pediatric patients with ulcerative colitis. The purpose of this review is to summarize the current knowledge on the use of biologics in pediatric ulcerative colitis. Currently, this new therapeutic options are the integral part of the pediatric ulcerative colitis treatment algorithm and with time probably will be used more extensively.

Adalimumab in pediatric ulcerative colitis

Abstract: Summary Introduction. Adalimumab (ADA) has been shown to be effective in adult patients with moderately to severely active ulcerative colitis. Unfortunately, data about its role in pediat- ric patients are sparse. Aim. The aim of our study was to summarize the experience with adalimumab (ADA) used in therapy of pediatric patients with ulcerative colitis (UC) in our center. Material and methods. We retrospectively analyzed data of six children with active UC who have been treated with ADA in our hospital. Data about treatment history, concomitant therapy, and biochemical parameters were collected. We evaluated short term response to ADA as well as long term outcomes. PUCAI index was used to assess clinical condition of the subjects. Endoscopic features were classified according to Baron scale.

A case of pediatric patient with ulcerative colitis and extraintestinal skin manifestation – pyoderma gangrenosum

Abstract: Summary Ulcerative colitis (UC) is an inflammatory disease of the intestines (inflammatory bowel disease – IBD) which is typically characterized by abdominal pain, diarrhea, vomiting, or weight loss. Manifestations such as skin rashes, arthritis, iritis, primary sclerosing cholangitis, pyoderma gangrenosum or erythema nodosum may also occur. They are rare and develop in approximately one-quarter to one-third of patients with IBD. Skin involvement is a fairly common problem, and may affect up to 25 percent of patients. Extra-intestinal symptoms can either precede intestinal disorders or they can be connected with exacerbation of bowel disease. All of them can either precede intestinal disorders or be connected with exacerbation of already diagnosed UC. Extra-intestinal symptoms preceding intestinal disorders may delay proper diagnosis and treatment which cause a lot of dangerous complications. We report a case of 9-years old boy with severe UC and pyoderma gangrenosum who was diagnosed primary as Schonlein-Henoch Purpura. Misdiagnosis appeared to be life-threatening in this patient.

Aktualne wytyczne klasyfikacji i diagnostyki nieswoistych zapaleń jelit u dzieci

Abstract: During the past years incidence of Inflammatory Bowel Disease (IBD) in pediatric population is increasing. The aim of this study is to facilitate diagnosis. Authors presented the clinical characteristics and current diagnostic guidelines. The work also describes the Paris classification, currently used in children.

Monitoring Crohn’s disease activity: clinical, endoscopic and histological indices

Abstract: Crohn’s disease (CD) together with ulcerative colitis (UC) belong to chronic gastrointestinal condition called inflammatory bowel disease (IBD). The clinical course of both disorders is similar and is characterized by exacerbations and spontaneous or drug-induced remissions but their histopathological features are different. Moreover, the various clinical patterns are reflected in the microscopic features observed in biopsies obtained during endoscopy, which is used for monitoring of disease activity. However, endoscopic mucosal biopsies do not show all the characteristic features of CD. In the last years, many disease-specific instruments, especially complex numeric activity indices to measure activity have been created. Therefore, the review of biopsies, in combination with clinical, laboratory, radiographic and endoscopic observations, is needed for both diagnosis and monitoring of IBD, and for the differentiation CD and UC from other conditions. The aim of this article is to make a revision of available clinical, endoscopic and histopathological scales used in common practice for diagnosis and monitoring of CD.

Endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreatic diseases

Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is nowadays a valuable method for detailed diagnostic evaluation and minimally invasive therapy for biliary and pancreatic diseases in pediatric population. The technique of ERCP is no more difficult in children than in adults, and except infants, there is no need for use a special pediatric endoscope. In children ERCP is usually performed with the patient under general anesthesia. Routine antibiotic prophylaxis is controversial, because there is no pediatric data regarding this problem. Pediatric indications for ERCP are similar to those for adults, though with a much lower incidence of malignant diseases. Among children with pancreatic diseases a common indications are: acute or recurrent acute pancreatitis, chronic pancreatitis, abdominal pain suspected to be of pancreaticobiliary origin, suspicion of pancreatic ductal anomaly, pancreatic trauma, differential diagnosis of focal pancreatic lesions and preoperative evaluation. Therapeutic ERCP constitutes 30-78% of all ERCPs and has a significant impact on the management of patients with pancreatic diseases, offering an alternative to surgical treatment in some cases. Pediatric studies demonstrates that ERCP has a high degree of technical success and a low rate of complications when performed by experienced endoscopists. MRCP nowadays has become the first-line diagnostic tool for biliopancreatic diseases and in the future ERCP may play a role mainly as a therapeutic intervention.

Czy mikroskopowe zapalenie jelita grubego należy do nieswoistych chorób zapalnych jelit

Abstract: Najnowszy konsensus histopatologiczny Europejskiej Organizacji ds. nieswoistych chorob zapalnych jelit (ECCO), wydany w 2013 roku, obejmuje opis i wytyczne diagnozowania mikroskopowego zapalenia jelita grubego (MZJG). W związku z tym powstaje pytanie, czy MZJG nalezy zaliczyc do nieswoistych chorob zapalnych jelit, wraz z chorobą Leśniowskiego-Crohna oraz wrzodziejącym zapaleniem jelita grubego. Zagadnienie to bylo rowniez dyskutowane podczas 9. Kongresu ECCO, ktory odbyl sie w Kopenhadze w lutym 2014 roku.