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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. Source


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. Source


Introduction: Gastroesophageal reflux disease in children may assume a laryngological mask where classical symptoms from the alimentary tract may not appear. Aim of the study: Determination of frequency of selected laryngological symptoms occurrence in school age children with gastroesophageal reflux disease and their dependence on intensity of acid reflux and its presence in the lower and upper part of the esophagus as well as videostroboscopic assessment of inflammatory process in the larynx. Material and methods: Analysis comprised 194 children aged 6 to 18 years hospitalized in the clinic due to gastroesophageal reflux disease. In each patient a detailed history pertaining to laryngological symptoms was collected and 24-hours pH-metry was performed. Basing on pH-metry all patients were divided into three groups with various severity of reflux and control group with normal pH recording. Additionally groups with and without acid reflux in the upper part of the esophagus were delineated. In 34 children videostroboscopy was conducted. Results: To the laryngological symptoms most frequently reported by the patients with gastroesophageal reflux disease belong: hoarseness (31.8%), feeling of foreign body (28.6%) and sore throat (27.4%). Along with severity of gastroesophageal reflux disease increased frequency of hawking in children from 25% in mild form to 31.5% in severe form. Sore throat and sensation of a foreign body was more often reported by patients with mild gastroesophageal reflux disease than with severe form. In patients in whom gastroesophageal reflux was present in the upper part of the esophagus (subgroup B) symptoms such as hawking, hoarseness, dry cough, foreign body feeling in the throat were more frequently reported. Inflammatory changes in the larynx in the form of laryngeal cords edema and contact ulceration were observed only in children with gastroesophageal reflux disease. The presence of reflux in the upper part of the esophagus predisposed to edema of laryngeal cords and contact ulceration within the larynx and trachea. Conclusions: 1. Laryngological symptoms are frequently observed in gastroesophageal reflux disease in school age children. 2. Hoarsneness, hawking and sore throat were the most frequent symptoms. 3. The frequency of laryngological symptoms increases in the presence of high gastroesophageal reflux. 4. Laryngeal cord edema and contact ulceration in videostroboscopy study were observed solely in children with gastroesophageal reflux disease. © 2010 Almamedia Press. Source


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. Source


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. Source

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