View More View Less
  • 1 Fővárosi Önkormányzat Heim Pál Gyermekkórháza Gasztroenterológiai és Nefrológiai Osztály Budapest Üllői út 86. 1089
Restricted access

Purchase article

USD  $25.00

1 year subscription (Individual Only)

USD  $1,070.00

Célkitűzés: A gyermekkori Crohn-betegség magyarországi jellegzetességeinek és lefolyásának vizsgálata. Módszer: 1984 és 2006 között diagnosztizált és 18 éves korig legalább egy éven át kezelt 81 beteg adatainak retrospektív értékelése. Eredmények: 62%-os fiúdominancia, 12,5% familiaritás észlelhető. A diagnosztikus késedelem 11,36 (1–96) hónap volt. A diagnóziskor az átlagéletkor 13,6 (4–17) év, az aktivitási index 37,88 (5–80), ilealis érintettség 87%-ban, stricturaképző és penetráló forma 27%-ban, perianalis manifesztáció 26%-ban, óriássejt-, illetve granulomaképződés 47%-ban, malnutritio 23,5%-ban, hyposomia 11%-ban volt jelen. Szteroidkezelést a betegek 84%-a, azathioprinterápiát 62%-a kapott. Biológiai terápia a vizsgált időszakban nem volt lehetséges. A műtéti arány 31% (bélműtétek: 20%, perianalis műtétek: 11%). 18 éves korra az átlagos aktivitási index 6,63-ra (0–35), a malnutritiós betegek aránya 9,9%-ra, a hyposomiásoké 2,5%-ra csökkent. A változások mértéke statisztikailag szignifikáns. Következtetések: A gyermekkori Crohn-betegség magyarországi jellegzetességei hasonlóak az európai adatokhoz. A hosszú diagnosztikus késedelem, a magas kezdeti aktivitási index, a granulomák, valamint a stricturaképző és penetráló formák jelenléte későbbi szövődményeket, illetve műtéti igényt jelezhetnek, ezért erőteljes iniciális terápiát indokolnak. Az immunmoduláns terápia korai bevezetése a lefolyást kedvezően befolyásolja. Orv. Hetil., 2011, 152, 546–554.

  • Veres G.: A gyermekkori krónikus gyulladásos bélbetegség (IBD) sajátosságai. Magy. Belorv. Arch., 2008, 61, 452–459.

    Veres G. , 'A gyermekkori krónikus gyulladásos bélbetegség (IBD) sajátosságai ' (2008 ) 61 Magy. Belorv. Arch. : 452 -459.

    • Search Google Scholar
  • Vernier-Massouille, G., Balde, M., Salleron, J. és mtsai: Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology, 2008, 135, 1106–1113.

    Salleron J. , 'Natural history of pediatric Crohn’s disease: a population-based cohort study ' (2008 ) 135 Gastroenterology : 1106 -1113.

    • Search Google Scholar
  • Pigneur, B., Seksik, P., Viola, S. és mtsai: Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm. Bowel Dis., 2010, 16, 953–961.

    Viola S. , 'Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease ' (2010 ) 16 Inflamm. Bowel Dis. : 953 -961.

    • Search Google Scholar
  • Hyams, J. S., Ferry, G. D., Mandel, F. S. és mtsai: Development and validation of a pediatric Crohn’s disease activity index. J. Pediatr. Gastroenterol. Nutr., 1991, 12, 439–447.

    Mandel F. S. , 'Development and validation of a pediatric Crohn’s disease activity index ' (1991 ) 12 J. Pediatr. Gastroenterol. Nutr. : 439 -447.

    • Search Google Scholar
  • Joubert K., Darvay S., Ágfalvi R.: Az országos longitudinális gyermeknövekedés-vizsgálat testmagasság (testhossz) és testtömeg referenciaértékei születéstől 18 éves korig. Anthrop. Közl., 2004, 45, 81–88.

    Ágfalvi R. , 'Az országos longitudinális gyermeknövekedés-vizsgálat testmagasság (testhossz) és testtömeg referenciaértékei születéstől 18 éves korig ' (2004 ) 45 Anthrop. Közl. : 81 -88.

    • Search Google Scholar
  • Pintér A. (szerk.): 3. sz. Módszertani Levél. Útmutató és táblázatok a gyermekkori tápláltság megítéléséhez. Országos Gyermekegészségügyi Intézet, Budapest, 2004.

    '', in 3. sz. Módszertani Levél. Útmutató és táblázatok a gyermekkori tápláltság megítéléséhez , (2004 ) -.

  • De Matos, V., Russo, P. A., Cohen, A. B. és mtsai: Frequency and clinical correlations of granulomas in children with Crohn disease. J. Pediatr. Gastroenterol. Nutr., 2008, 46, 392–398.

    Cohen A. B. , 'Frequency and clinical correlations of granulomas in children with Crohn disease ' (2008 ) 46 J. Pediatr. Gastroenterol. Nutr. : 392 -398.

    • Search Google Scholar
  • Satsangi, J., Silverberg, M. S., Vermeire, S. és mtsa: The Montreal classification of IBD: controversies, consensus, and implications. Gut, 2006, 55, 749–753.

    Vermeire S. , 'The Montreal classification of IBD: controversies, consensus, and implications ' (2006 ) 55 Gut : 749 -753.

    • Search Google Scholar
  • Veres, G., Papp, M., Lakatos, P. és mtsai: First 2-year analysis of prospectively diagnosed patients with inflammatory bowel disease (IBD) in the Hungarian Paediatric IBD Registry (HUPIR). J. Pediatr. Gastroenterol. Nutr., 2009, 48, Suppl. 3, E42–E43.

    Lakatos P. , 'First 2-year analysis of prospectively diagnosed patients with inflammatory bowel disease (IBD) in the Hungarian Paediatric IBD Registry (HUPIR) ' (2009 ) 48 J. Pediatr. Gastroenterol. Nutr. : E42 -E43.

    • Search Google Scholar
  • Sagiv-Friedgut, K., Karban, A., Weiss, B. és mtsai: Early-onset Crohn disease is associated with male sex and a polymorphism in the IL-6 promoter. J. Pediatr. Gastroenterol. Nutr., 2010, 50, 22–26.

    Weiss B. , 'Early-onset Crohn disease is associated with male sex and a polymorphism in the IL-6 promoter ' (2010 ) 50 J. Pediatr. Gastroenterol. Nutr. : 22 -26.

    • Search Google Scholar
  • Gupta, N., Bostrom, A. G., Kirschner, B. S.: Gender differences in presentation and course of disease in pediatric patients with Crohn disease. Pediatrics, 2007, 120, e1418–e1425.

    Kirschner B. S. , 'Gender differences in presentation and course of disease in pediatric patients with Crohn disease ' (2007 ) 120 Pediatrics : e1418 -e1425.

    • Search Google Scholar
  • Escher, J. C.: Diagnostic work-up and disease phenotype in pediatric IBD: 2-year results from the ESPGHAN Registry. J. Pediatr. Gastroenterol. Nutr., 2006, 43, Suppl. 2, S8–S10.

    Escher J. C. , 'Diagnostic work-up and disease phenotype in pediatric IBD: 2-year results from the ESPGHAN Registry ' (2006 ) 43 J. Pediatr. Gastroenterol. Nutr. : S8 -S10.

    • Search Google Scholar
  • Sawczenko, A., Ballinger, A. B., Savage, M. O. és mtsa: Clinical features affecting final adult height in patients with pediatric-onset Crohn’s disease. Pediatrics, 2006, 118, 124–129.

    Savage M. O. , 'Clinical features affecting final adult height in patients with pediatric-onset Crohn’s disease ' (2006 ) 118 Pediatrics : 124 -129.

    • Search Google Scholar
  • Wine, E., Reif, S. S., Leshinsky-Silver, E. és mtsai: Pediatric Crohn’s disease and growth retardation: the role of genotype, phenotype, and disease severity. Pediatrics, 2004, 114, 1281–1286.

    Leshinsky-Silver E. , 'Pediatric Crohn’s disease and growth retardation: the role of genotype, phenotype, and disease severity ' (2004 ) 114 Pediatrics : 1281 -1286.

    • Search Google Scholar
  • Wong, S. C., MacRae, V. E., McGrogan, P. és mtsa: The role of pro-inflammatory cytokines in inflammatory bowel disease growth retardation (invited review). J. Pediatr. Gastroenterol. Nutr., 2006, 43, 144–155.

    McGrogan P. , 'The role of pro-inflammatory cytokines in inflammatory bowel disease growth retardation (invited review) ' (2006 ) 43 J. Pediatr. Gastroenterol. Nutr. : 144 -155.

    • Search Google Scholar
  • Freeman, H. J.: Comparison of long-standing pediatric-onset and adult-onset Crohn’s disease. J. Pediatr. Gastroenterol. Nutr., 2004, 39, 183–186.

    Freeman H. J. , 'Comparison of long-standing pediatric-onset and adult-onset Crohn’s disease ' (2004 ) 39 J. Pediatr. Gastroenterol. Nutr. : 183 -186.

    • Search Google Scholar
  • Balde, M., Vernier-Masouille, G., Gower-Rousseu, C. és mtsai: Natural history of Crohn’s disease in children: a population-based cohort study in northern France. J. Pediatr. Gastroenterol. Nutr., 2006, 43, Suppl. 2, S11.

    Gower-Rousseu C. , 'Natural history of Crohn’s disease in children: a population-based cohort study in northern France ' (2006 ) 43 J. Pediatr. Gastroenterol. Nutr. : S11 -.

    • Search Google Scholar
  • Meinzer, U., Ideström, M., Alberti, C. és mtsai: Ileal involvement is age dependent in pediatric Crohn’s disease. Inflamm. Bowel Dis., 2005, 11, 639–644.

    Alberti C. , 'Ileal involvement is age dependent in pediatric Crohn’s disease ' (2005 ) 11 Inflamm. Bowel Dis. : 639 -644.

    • Search Google Scholar
  • Levine, A.: Pediatric inflammatory bowel disease: is it different? Dig. Dis., 2009, 27, 212–214.

    Levine A. , 'Pediatric inflammatory bowel disease: is it different? ' (2009 ) 27 Dig. Dis. : 212 -214.

    • Search Google Scholar
  • Gasche, C., Scholmerich, J., Brynskov, J. és mtsai: A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm. Bowel Dis., 2000, 6, 8–15.

    Brynskov J. , 'A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998 ' (2000 ) 6 Inflamm. Bowel Dis. : 8 -15.

    • Search Google Scholar
  • Shaoul, R., Karban, A., Reif, S. és mtsai: Disease behavior in children with Crohn’s disease: the effect of disease duration, ethnicity, genotype and phenotype. Dig. Dis. Sci., 2009, 54, 142–150.

    Reif S. , 'Disease behavior in children with Crohn’s disease: the effect of disease duration, ethnicity, genotype and phenotype ' (2009 ) 54 Dig. Dis. Sci. : 142 -150.

    • Search Google Scholar
  • Lakatos, P. L., Szalay, F., Tulassay, Z. és mtsai: Clinical presentation of Crohn’s disease. Association between familial disease, smoking, disease phenotype, extraintestinal manifestations and need for surgery. Hepatogastroenterology, 2005, 52, 817–822.

    Tulassay Z. , 'Clinical presentation of Crohn’s disease. Association between familial disease, smoking, disease phenotype, extraintestinal manifestations and need for surgery ' (2005 ) 52 Hepatogastroenterology : 817 -822.

    • Search Google Scholar
  • Shaoul, R., Karban, A., Weiss, B. és mtsai: NOD2/CARD15 mutation and presence of granulomas in pediatric and adult Crohn’s disease. Inflamm. Bowel Dis., 2004, 10, 709–714.

    Weiss B. , 'NOD2/CARD15 mutation and presence of granulomas in pediatric and adult Crohn’s disease ' (2004 ) 10 Inflamm. Bowel Dis. : 709 -714.

    • Search Google Scholar
  • Heresbach, C. A., Orrego, A., Nesi, G. és mtsai: Frequency and significance of granulomas in a cohort of incident cases of Crohn’s disease. Gut, 2005, 54, 215–222.

    Nesi G. , 'Frequency and significance of granulomas in a cohort of incident cases of Crohn’s disease ' (2005 ) 54 Gut : 215 -222.

    • Search Google Scholar
  • Rubio, C. A., Orrego, A., Nesi, G. és mtsa: Frequency of epitheloid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis. J. Clin. Pathol., 2007, 60, 1268–1272.

    Nesi G. , 'Frequency of epitheloid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis ' (2007 ) 60 J. Clin. Pathol. : 1268 -1272.

    • Search Google Scholar
  • Molnár, T., Tiszlavicz, L., Gyulai, C. és mtsai: Clinical significance of granuloma in Crohn’s disease. World J. Gastroenterol., 2005, 11, 3318–3321.

    Gyulai C. , 'Clinical significance of granuloma in Crohn’s disease ' (2005 ) 11 World J. Gastroenterol. : 3318 -3321.

    • Search Google Scholar
  • Ideström, M., Rubio, C., Granath, F. és mtsai: CARD15 mutations are rare in Swedish pediatric Crohn disease. J. Pediatr. Gastroenterol. Nutr., 2005, 40, 456–460.

    Granath F. , 'CARD15 mutations are rare in Swedish pediatric Crohn disease ' (2005 ) 40 J. Pediatr. Gastroenterol. Nutr. : 456 -460.

    • Search Google Scholar
  • Polgár M., Galántai I., Szigetváry I. és mtsai: Immunmoduláns kezelés tapasztalatai serdülőkori Crohn-betegségben. Gyermekgyógyászat, 2002, 53, 353–361.

    Szigetváry I. , 'Immunmoduláns kezelés tapasztalatai serdülőkori Crohn-betegségben ' (2002 ) 53 Gyermekgyógyászat : 353 -361.

    • Search Google Scholar
  • Escher, J. C., Taminiau, J. A. J. M., Nieuwenhuis, E. E. S. és mtsai: Treatment of inflammatory bowel disease in childhood: best available evidence. Inflamm. Bowel Dis., 2003, 9, 34–58.

    Nieuwenhuis E. E. S. , 'Treatment of inflammatory bowel disease in childhood: best available evidence ' (2003 ) 9 Inflamm. Bowel Dis. : 34 -58.

    • Search Google Scholar
  • Mossop, H., Davies, P., Murphy, M. S.: Predicting the need for azathioprine at first presentation in children with inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr., 2008, 47, 123–129.

    Murphy M. S. , 'Predicting the need for azathioprine at first presentation in children with inflammatory bowel disease ' (2008 ) 47 J. Pediatr. Gastroenterol. Nutr. : 123 -129.

    • Search Google Scholar
  • Markowitz, J., Grancher, K., Kohn, N. és mtsai: A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease. Gastroenterology, 2000, 119, 895–902.

    Kohn N. , 'A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease ' (2000 ) 119 Gastroenterology : 895 -902.

    • Search Google Scholar
  • Markowitz, J., Grancher, K., Kohn, N. és mtsa: Immunmodulatory therapy for pediatric inflammatory bowel disease: changing pattern of use, 1990–2000. Am. J. Gastroenterol., 2002, 97, 928–932.

    Kohn N. , 'Immunmodulatory therapy for pediatric inflammatory bowel disease: changing pattern of use, 1990–2000 ' (2002 ) 97 Am. J. Gastroenterol. : 928 -932.

    • Search Google Scholar
  • Banerjee, S., Bishop, W.: Evolution of thiopurine use in pediatric inflammatory bowel disease in an academic center. J. Pediatr. Gastroenterol. Nutr., 2006, 43, 324–330.

    Bishop W. , 'Evolution of thiopurine use in pediatric inflammatory bowel disease in an academic center ' (2006 ) 43 J. Pediatr. Gastroenterol. Nutr. : 324 -330.

    • Search Google Scholar
  • Punati, J. B., Markowitz, J., Lerer, T. és mtsai: Early immunmodulator use improves 18-month outcomes in pediatric Crohn’s disease. Gastroenterology, 2006, 130, A11.

    Lerer T. , 'Early immunmodulator use improves 18-month outcomes in pediatric Crohn’s disease ' (2006 ) 130 Gastroenterology : A11 -.

    • Search Google Scholar
  • Jaspers, G. J., Verkade, H. J., Escher, J. C. és mtsai: Azathioprine maintains first remission in newly diagnosed pediatric Crohn’s disease. Inflamm. Bowel Dis., 2006, 12, 831–836.

    Escher J. C. , 'Azathioprine maintains first remission in newly diagnosed pediatric Crohn’s disease ' (2006 ) 12 Inflamm. Bowel Dis. : 831 -836.

    • Search Google Scholar
  • Rutgeerts, P., Vermeire, S., Van Assche, G.: Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target? Gut, 2007, 56, 453–455.

    Assche G. , 'Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target? ' (2007 ) 56 Gut : 453 -455.

    • Search Google Scholar
  • Colletti, R. B. (editorial): Next steps on the thiopurine methyltransferase 6-thioguanine nucleotide pathway. J. Pediatr. Gastroenterol. Nutr., 2006, 43, 282–283.

    Colletti R. B. , 'Next steps on the thiopurine methyltransferase 6-thioguanine nucleotide pathway ' (2006 ) 43 J. Pediatr. Gastroenterol. Nutr. : 282 -283.

    • Search Google Scholar
  • Derijks, L. J. J., Gilissen, L. P. L., Hooymans, P. M. és mtsa: Thiopurines in inflammatory bowel disease. Aliment. Pharmacol. Ther., 2006, 24, 715–729.

    Hooymans P. M. , 'Thiopurines in inflammatory bowel disease ' (2006 ) 24 Aliment. Pharmacol. Ther. : 715 -729.

    • Search Google Scholar
  • Bousvaros, A.: Common errors in the management of children with IBD. J. Pediatr. Gastroenterol. Nutr., 2006, 43, Suppl. 2, S15–S16.

    Bousvaros A. , 'Common errors in the management of children with IBD ' (2006 ) 43 J. Pediatr. Gastroenterol. Nutr. : Suppl. 2, S15 -S16.

    • Search Google Scholar
  • Sandhu, B. K., Fell, J. M. E., Beattie, R. M. és mtsai: Guidelines for the management of inflammatory bowel disease in children in the United Kingdom. J. Pediatr. Gastroenterol. Nutr., 2010, 50, Suppl. 1, S1–S13.

    Beattie R. M. , 'Guidelines for the management of inflammatory bowel disease in children in the United Kingdom ' (2010 ) 50 J. Pediatr. Gastroenterol. Nutr. : S1 -S13.

    • Search Google Scholar
  • Mamula, P., Baldassano, R. N.: Postsurgical recurrences in Crohn’s disease: why, when and how to prevent. J. Pediatr. Gastroenterol. Nutr., 2000, 30, 557–559.

    Baldassano R. N. , 'Postsurgical recurrences in Crohn’s disease: why, when and how to prevent ' (2000 ) 30 J. Pediatr. Gastroenterol. Nutr. : 557 -559.

    • Search Google Scholar
  • Kiss L. S., Lakatos P. L.: A betegség lefolyásának előrejelzése gyulladásos bélbetegségekben. Orv. Hetil., 2010, 151, 293–301.

    Lakatos P. L. , 'A betegség lefolyásának előrejelzése gyulladásos bélbetegségekben ' (2010 ) 151 Orv. Hetil. : 293 -301.

    • Search Google Scholar
  • Solberg, I. C., Vatn, M. H., Høie, O. és mtsai: Clinical course in Crohn’s disease: results of a Norvegian population-based ten-year follow-up study. Clin. Gastroenterol. Hepatol., 2007, 5, 1430–1438.

    Høie O. , 'Clinical course in Crohn’s disease: results of a Norvegian population-based ten-year follow-up study ' (2007 ) 5 Clin. Gastroenterol. Hepatol. : 1430 -1438.

    • Search Google Scholar
  • Gupta, N., Cohen, S. A., Bostrom, A. G. és mtsai: Risk factors for initial surgery in pediatric patients with Crohn’s disease. Gastroenterology, 2006, 130, 1069–1077.

    Bostrom A. G. , 'Risk factors for initial surgery in pediatric patients with Crohn’s disease ' (2006 ) 130 Gastroenterology : 1069 -1077.

    • Search Google Scholar
  • Pacilli, M., Eaton, S., Fell, J. M. és mtsai: Surgery in children with Crohn disease refractory to medical therapy. J. Pediatr. Gastroenterol. Nutr., 2010 Oct 20. [Epub ahead of print.]

  • Newby, E. A., Croft, N. M., Green, M. és mtsai: Natural history of paediatric inflammatory bowel disease over a 5-year follow-up: a retrospective review of data from the register of paediatric inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr., 2008, 46, 539–545.

    Green M. , 'Natural history of paediatric inflammatory bowel disease over a 5-year follow-up: a retrospective review of data from the register of paediatric inflammatory bowel disease ' (2008 ) 46 J. Pediatr. Gastroenterol. Nutr. : 539 -545.

    • Search Google Scholar
  • Ben-Horin, S., Avidan, B., Yanai, H. és mtsai: Familial clustering of Crohn’s disease in Israel: prevalence and association with disease severity. Inflamm. Bowel Dis., 2009, 15, 171–175.

    Yanai H. , 'Familial clustering of Crohn’s disease in Israel: prevalence and association with disease severity ' (2009 ) 15 Inflamm. Bowel Dis. : 171 -175.

    • Search Google Scholar
  • Auvin, S., Molinié, F., Gower-Rousseau, C. és mtsai: Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in Northern France (1988–1999). J. Pediatr. Gastroenterol. Nutr., 2005, 41, 49–55.

    Gower-Rousseau C. , 'Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in Northern France (1988–1999) ' (2005 ) 41 J. Pediatr. Gastroenterol. Nutr. : 49 -55.

    • Search Google Scholar
  • Markowitz, J., Kahn, E., Daum, F.: Prognostic significance of epitheloid granulomas found in rectosigmoid biopsies at the initial presentation of pediatric Crohn’s disease. J. Pediatr. Gastroenterol. Nutr., 1989, 9, 182–186.

    Daum F. , 'Prognostic significance of epitheloid granulomas found in rectosigmoid biopsies at the initial presentation of pediatric Crohn’s disease ' (1989 ) 9 J. Pediatr. Gastroenterol. Nutr. : 182 -186.

    • Search Google Scholar