II Katedra i Klinika Pediatrii


II Katedra i Klinika Pediatrii

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Jamer T.,II Katedra i Klinika Pediatrii | Iwanczak B.,II Katedra i Klinika Pediatrii
Developmental period medicine | Year: 2016

Acute recurrent pancreatitis is not common in children. The epidemiology, etiology and clinical presentation of pediatric acute recurrent pancreatitis are not well understood. The etiology is diverse and multifactorial, with many cases being idiopathic. The most common etiology of acute recurrent pancreatitis in children are genetic factors, biliary duct disorders, anatomic anomalies of the pancreatobiliary system and metabolic diseases. Mutations are most commonly found in the cationic trypsynogen gene (PRSS1), the pancreatic secretory trypsin inhibitor gene (SPINK1) and the cystic fibrosis transmembrane conductance regulator gene (CFTR). The case described here is that of a 6-year-old boy, without a family history of pancreatitis, who was hospitalized several times over 5 years, with epigastric pain and high serum levels of amylase and lipase. Genetic testing showed a heterozygous variation, c.194+2T>C (IVS3+2T>C) in the SPINK1 gene and variation c.1210-34TG(11) T(5) (IVS8-5T+(TG)11) in the CFTR gene. Other etiological factors also occurred leading to the initiation and relapses of the disease.

Pawlowska K.,II Katedra i Klinika Pediatrii
Developmental period medicine | Year: 2014

Frequency of inflammatory bowel diseases (Crohn's disease and ulcerative colitis) tends to increase in developing countries. Nearly 25% of cases affects pediatric patients. Inflammatory bowel diseases are often associated with weight loss and stunting in children. Moreover, weight and height deficiencies are often early symptoms. Initially, nonspecific or latent course of disease delays the diagnostic process. Malnutrition in inflammatory bowel diseases can be caused by disorders of digestion and nutrients' absorption, intestinal loss, increased energy expenditure and appetite impairment. Nutritional deficiencies and inflammatory agents lead to disturbance of tissue metabolism - muscle and bone - and retardation of somatic development of affected children. Thus, deficiencies of muscle mass, bone mineral density and body height are observed. Insufficient normalization of somatic features may be the consequence of recurrent nature of disease and specificity of pharmacological treatment. Present work deals with the current state of knowledge concerning the somatic development disorders of children with inflammatory bowel diseases. Abnormal nutritional status, bone mineral density deficits and growth failure of patients have been discussed in the context of their relations and dependencies on inflammatory, nutritional and therapeutic factors.

Introduction: Treatment of inflammatory bowel diseases is very expensive, because of costs of chronic medication, special formulas and vitamins. Surgical complications are specially expensive. Aim of the study was to evaluate costs of treatment in children with inflammatory bowel diseases. Material and methods: The study included 65 children (35 girls and 30 boys) aged from 5 to 18 years (mean age 12.8 years) with inflammatory bowel diseases (IBD), treated in the 2nd Department and Clinic of Pediatrics, Gastroenterology and Nutrition. These children were divided into 3 groups depending on the clinical diagnosis: group 1 - 30 children with Crohn's disease (CD), group 2 - 19 children with ulcerative colitis (UC), and group 3 - 16 children with indeterminate colitis (IC). In all patients a detailed questionnaire was performed. Those patients were asked about their place of living and living conditions, parental education, possession of domestic and farm animals. We also asked about their access to the health care system (GP, pharmacy, gastroenterological unit). Based on the questionnaire we assessed the direct monthly cost of the treatment including the cost of specific medicines, nutritional formulas and transportation to the department. The obtained results were statistically analyzed. Results: 77.2% of IBD children live in the countryside and small towns, only 6.8% are Wrocław citizens. The average living area of their flats was 94 m2 with concentration of 3.9 person/flat. All of the houses are equipped with water, 88.6% possess toilet and 93.1% have central heating system. 68.2% of IBD children possess pets, 6.8% raise farm animals. The average distance from the place of living of IBD children were: 5.5 km to GP practice, 91.2 km to our department and 3.1 km to pharmacy. Inflammatory bowel diseases were the reason for 37.5 days/year of school truancy and 12.5 days/year of parental absence at the place of work. 79.9% of the patients' mothers and 72.7% of the patients' fathers have academic or secondary education, primary education adequately 20.1% and 27.3%. In children with inflammatory diseases very high direct monthly costs were observed, middling 880.25 PLN for children with Crohn's disease and 755.2 PLN for the whole group of children with IBD. The costs of particular medicines and enteral nutrition were significantly higher for children with Crohn's disease, adequately 264.25 PLN and 279.0 PLN. One third of all expenditures were the costs of transportation. Cost analysis of medical treatment which combined specific drugs, vitamins, additives, probiotics and other medicines revealed that the costs were significantly higher for children with Crohn's disease - 67.2% than for ulcerative colitis - 56.1% and indeterminate colitis - 44.0%. Conclusions: 1. In children with inflammatory diseases very high direct monthly cost were observed, middling 880.25 PLN for children with Crohn's disease and 755.2 PLN for whole group of children with IBD. 2. To optimize therapy of children with inflammatory bowel diseases the authors postulate significantly bigger financial support from the health care system. © 2011 Cornetis.

Various scales of localization of clinical activity, and of endoscopic as well as histological activity of ulcerative colitis were presented in this review. Most of the cited scales were elaborated based on clinical symptoms in adults. In 2007, a non-invasive pediatric scale of ulcerative colitis was elaborated, and in 2010 Paris classification of extension and activity of ulcerative colitis in children was prepared. The presented non-invasive scale of the disease activity is of great practical value, since it is based on clinical symptoms, therefore, allows daily assessment of the disease activity and course which enables modification of the treatment. © 2011 Cornetis.

Reich M.,II Katedra I Klinika Pediatrii | Iwanczak B.,II Katedra I Klinika Pediatrii
Przeglad Gastroenterologiczny | Year: 2010

Introduction: Constipation is a frequent problem in the ge - neral population; it could be a functional dysfunction or a symptom of a serious medical condition. Objective: The aim of the study was to assess the commonest causes and symptoms of chronic constipation in Polish children and adolescents. Materials and methods: A total of 137 patients (72 boys and 65 girls) with chronic constipation were included. Every patient underwent careful physical examination. Based on the obtained information a specially designed questionnaire was completed. All results were analysed statistically. Results: Functional constipation was the commonest cause of chronic constipation diagnosed in 126 (92%) children. Less commonly, Hirschsprung's disease (6 patients - 4.4%), hypothyroidism (4 patients - 2.9%) or a consequence of surgery for anal atresia (1 patient - 0.7%) was found to be a cause of constipation. In all children with Hirschsprung's disease the symptoms appeared before the end of the 6th month of their life, which was significantly earlier than in patients with functional constipation. The most common concomitant disorders were other gastrointestinal diseases, including food allergy, irritable bowel syndrome, lactose intolerance and problems with intestinal absorption. Conclusions: The most common cause of chronic constipation in children is functional constipation. It seems that food allergy may predispose children to chronic constipation. Symptoms of Hirschsprung's disease occur early, most commonly before the age of 6 months.

Iwanczak F.,II Katedra I Klinika Pediatrii | Iwanczak B.,II Katedra I Klinika Pediatrii
Przeglad Gastroenterologiczny | Year: 2011

In the present review the influence of certain factors on the effectiveness of treatment course and new possibilities of medication of Helicobacter pylori infections are outlined. Increasing resistance against clarithromycin and high resistance against metronidazole pose the greatest challenge. Therefore, the choice of the proper set of antibiotics and chemotherapeutics is of the greatest importance. The authors present the results of eradication depending on treatment schemas. The authors also direct attention at the importance of the duration of the treatment and compliance of patients in fulfilment of medical advice. Results of treatment effectiveness with tetracycline, bismuth, levofloxacin, moxifloxacin, and other medicaments are presented. Sequence therapy and recommendations for the treatment of H. pylori infection of the Working Group of the Polish Society of Gastroenterology are discussed.

Here, we present a 12-year-old girl, who complained of severe abdominal pain, defecated hard stools every 2-4 days, and subsequently noticed soiling, which was incorrectly diagnosed as diarrhea. Loss of appetite and decrease of body weight within 6 months was also noted. Based on clinical presentation an inflammatory bowel disease was suspected and the child was transferred to gastroenterological department for further diagnosis and treatment. Retentive stool masses were noted during physical examination, the anal region was contaminated with stool, and abnormal defecation rhythm was observed with manometry. Finally, functional constipation has been diagnosed as the underlying cause of all complaints. Lack of defecation for several days may cause in children abdominal pain, lack of appetite, and with time loss of weight and inhibition of somatic development. Soiling and fecal incontinence may appear due to extension of rectum wall by retentive stool masses. This unintentional encopresis may be incorrectly handled as diarrhea and may hinder making the correct diagnosis. © 2011 Cornetis.

Hutyra T.,II Katedra i Klinika Pediatrii | Iwanczak B.,II Katedra i Klinika Pediatrii
Pediatria Wspolczesna | Year: 2010

Overgrowth of intestinal bacterial flora is the excessive growth of nonpathogenic bacteria, which usually live in the large intestine, in the upper part of the small intestine. Hypochlorhydria, anatomic anomalies, motor disorders, disturbances in communication between various segments of the alimentary tract and immunodeficiency predispose to the excessive proliferation of the small intestine flora. The syndrome of intestine bacterial overgrowth may significantly disturb digestion and absorption of food ingredients leading to disturbances of physical development in children. The diagnostic methods of bacterial overgrowth consist of direct, namely, quantitative and qualitative assessment of the content of the intestine, and indirect methods, which are based on the metabolism of bacteria and among the indirect ones- hydrogen breath test, which is widely used in children. The treatment is based on antibiotics active against Gram-negative bacteria and supplementation of nutritional deficiencies. © 2010 Almamedia Press.

Gastrointestinal tract bleeding in children is an alarm symptom. It is imperative to establish quickly, if possible, the etiology and localization of bleeding and its proper treatment. The aim of this study was to present the most common causes of lower gastrointestinal tract bleeding in children and the diagnostic investigations that are required. © 2010 Almamedia Press.

Krzesiek E.,II Katedra i Klinika Pediatrii | Pytrus T.,II Katedra i Klinika Pediatrii | Iwanczak B.,II Katedra i Klinika Pediatrii
Pediatria Wspolczesna | Year: 2011

Introduction: Different perianal manifestations in the course of Crohn's disease like condylomas, fissures, fistulas, abscesses, strictures and malignancies are observed. Aim of the study was to evaluate the prevalence of perianal lesions in pediatric Crohn's disease and its correlation with the activity and duration of the disease and response to the treatment. Material and methods: The study included 79 children aged from 14 months to 18 years with diagnosis of Crohn's disease, treated in the 2nd Department and Clinic of Pediatrics, Gastroenterology and Nutrition between 2006 and 2010. Perianal lesions were observed in 23 cases. Age of the onset of clinical symptoms, type of the perianal lesions, activity of the disease according to the PCDAI score, location of endoscopic changes and therapeutic effects were analyzed. The obtained results were statistically examined. Results: Perianal lesions were observed in 23 cases (29.1%) of pediatric Crohn's disease. Most frequently condylomas and fissures, less frequently abscesses and fistulas. In 10 (43.5%) of children we observed more than one perianal manifestation, in 39.1% of children perianal disease preceded diagnosis of Crohn's disease and in 21.8% accompanied symptoms of IBD. In 13 (56.5%) of pediatric Crohn's patients only colonic involvement in ileocolonoscopy was noticed. Perianal lesions in the course of Crohn's disease require biological treatment more frequently than those without perianal manifestation, adequately 47.8% and 12.5%. Perianal changes were noticed both at a time of the exacerbation of the disease (abscesses, fistulas, painful condylomas) and during the clinical remission (condylomas, fissures, fistulas). In 17.4% of children total clinical remission of perianal lesions was observed, in the rest 74% of children perianal lesions were benign and did not disturbe normal activity of these children. Conclusions: 1.The most common perianal manifestations of pediatric Crohn's disease were condylomas and fissures. Those lesions have not been treated successfully. 2. Perianal fistulas were noticed in 5% of children with Crohn's disease. 3. In 39.1% of patients with Crohn's disease perianal lesions preceded diagnosis of the disease. 4. In most of the children perianal lesions were benign and did not disturbe normal activity of these children. © 2011 Cornetis.

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