За даними співробітників кафедри педіатрії №1 НМАПО, в останні 20 років спостерігається зростання кількості госпіталізацій дітей із запальними захворюваннями кишечника (ЗЗК). Однак в Україні немає єдиного центру спостереження за дітьми із ЗЗК, тому збір статистичних даних є досить складною проблемою. Цьому сприяла й відсутність єдиного підходу до діагностики. У статті викладено оновлені рекомендації ECCO та ESPGHAN (2018) щодо класифікації ЗЗК у дітей, алгоритму їх діагностики з використанням критеріїв PIBD класів. Надано статистичні дані щодо реєстрації ЗЗК у дітей у педіатричному відділенні НДСЛ «ОХМАТДИТ». У якості прикладу застосування критеріїв диференціальної діагностики різних форм ЗЗК у дітей, оцінки важкості хвороби наведено клінічний випадок та надано схему ведення пацієнтів з цією патологією. Висновки. Оновлені рекомендації ECCO та ESPGHAN полегшують проведення диференціальної діагностики різних варіантів ЗЗК, надають чітку схему спостереження за дітьми з цією патологією, що покращує результати лікування та якість життя маленьких пацієнтів. Автори заявляють про відсутність конфлікту інтересів. Ключові слова: запальні захворювання кишечника, клінічні рекомендації, схема ведення пацієнтів, PIBD класи, педіатричний індекс активності виразкового коліту, діти.

Modern outpatient management of ulcerative colitis (UC) continues to be a difficult task, as 20% of children still need colectomy (there are no official statistics for Ukraine). Therefore, the European Organization for the Study of Crohn's Disease and Colitis (ECCO) and the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN), seeking to standardize the daily treatment of inflammatory bowel disease (IBD), have developed a protocol for the management and treatment of children with VC. Based on the analysis of medical research, followed by an evidentiary assessment of each provision, the 2012 recommendations were updated. The aim is to present the provisions of the updated protocol on therapeutic management of children with ulcerative colitis and to consolidate the material on a clinical case. Materials and methods. The article presents updated recommendations of ECCO and ESPGHAN (2018) on the treatment of COPD in children, the algorithm of induction and maintenance of remission of UC and COPD unclassified. A clinical case is given for an example of application of the algorithm of induction and support of remission of IBD at children, assessment of severity and the scheme of management of patients with this pathology is provided. Results and conclusions. The updated recommendations of ECCO and ESPGHAN facilitate the treatment of unclassified UC and IBD, provide a clear scheme for monitoring children with this pathology, which improves treatment outcomes and quality of life of young patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ulcerative colitis, recommendations. children, anti-TNF, calprotectin, unclassified inflammatory bowel disease, monitoring, activity index, treatment.

Inflammatory bowel disease (IBD) is a chronic inflammatory disease that affects the gastrointestinal tract and includes ulcerative colitis (ulcerative colitis) and Crohn's disease. Symptoms often include abdominal pain, weight loss, hematochezia, and diarrhea, although some patients may experience more insidious gastrointestinal and extraintestinal manifestations. Allergic proctocolitis caused by dietary protein (FPIAP) is a condition characterized by inflammatory changes in the distal parts of the colon in response to one or more foreign dietary proteins due to immune-mediated reactions. Clinically similar to IBD. Delay in the diagnosis of IBD, especially Crohn's disease, remains common in children, and potential complications due to these delays require effective differential diagnosis. Purpose - on the example of a clinical case to show the features of the differential diagnosis of IBD and FPIAP. Clinical case. Child A., 2 months old, has a green stool of liquid consistency, sometimes with mucus, abdominal pain. According to laboratory tests, high levels of fecal calprotectin and eosinophilic cationic protein were detected. Diet diagnostics in the form of an elimination diet and provocative tests were used. Due to which significant allergens have been identified and excluded from the mother’s diet. Conclusions. Determination of fecal calprotectin levels, fecal occult blood analysis, and serum IgE are important in the differential diagnosis of IBD and FPIAP. Timely diagnosis and rational therapy, prevents the development of severe consequences and improves the condition of patients. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: inflammatory bowel disease, allergic proctocolitis, diet diagnostics, differential diagnosis, rectal bleeding.

Chronic urticaria is a common disease that also occurs against the background of inflammatory bowel disease. This case draws attention to the common pathophysiology between autoimmune and autoinflammatory diseases and the need for careful differential diagnosis and further research, which can significantly influence the choice of treatment tactics. Clinical case. An 9-year-old girl with chronic urticaria from birth and recurrent episodes of fever and conjunctivitis was examined at the pediatric ward of the National Children's Specialized Hospital «OKHMATDYT». On the basis of negative results of determination of serum level of immunoglobulins A to gliadin and endomysia celiac disease is excluded, and also by means of modern methods of allergodiagnostics (skin prick-tests, cold test, molecular allergodiagnostics, elimination dietodiagnostics) influence of various is excluded. The girl was diagnosed with chronic idiopathic urticaria with inflammatory bowel disease with trial treatment with ketatifen, bilastine and mesalazine. Due to complaints of recurrent rashes and fever on the background of this therapy, the anamnesis of the disease was re-analyzed and the material was sent for genetic sequencing, which allowed to change the diagnosis to auto-inflammatory disease and prescribed therapy — daily administration of anakinra. Since then, she no longer has recurrent febrile fever or urticaria, and the level of markers of inflammation has returned to normal. Conclusions. This clinical example is interesting for a complex diagnostic search, when a combination of chronic urticaria and inflammatory bowel disease was observed without effect on therapy, which forced to reconsider the diagnosis, which turned out to be even rarer and was finally confirmed by genome sequencing. But despite the fact that the diagnosis was different, it is interesting that on the background of taking mesalazine the girl's condition still improved slightly: became less likely to bother urticarial rash and fever on the background of the rash, which may indicate some common pathogenetic features of inflammation in intestines and chronic idiopathic urticaria, which has an indisputable scientific and practical interest. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: urticaria, inflammatory bowel disease, autoinflammatory diseases, interleukinE1, Biologics, anakinra.