No abstract

Background -Approximately 25% of patients with inflammatory bowel disease (IBD) develop the disease during childhood or adolescence and treatment aims to control active symptoms and prevent long-term complications. The management of Crohn's disease (CD) and ulcerative colitis (UC) can be especially challenging in children and adolescents, related to particularities that may affect growth, development, and puberty. Objective -This consensus aims to provide guidance on the most effective medical and surgical management of pediatric patients with CD or UC. Methods -Experts in Pediatric IBD representing Brazilian gastroenterologists (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]) developed this consensus. A rapid review was performed to support the recommendations/statements. Medical and surgical recommendations were structured and mapped according to the disease type, disease activity, and indications and contraindications for medical and surgical treatment. After structuring the statements, the modified Delphi Panel methodology was used to conduct the voting. The process took place in three rounds: two using a personalized and anonymous online voting platform and one face-to-face. Whenever participants did not agree with a specific recommendation, an option to explain why was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations in each round was accepted when reached ≥80% agreement. Results and conclusion -The recommendations are presented according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/ patient monitoring after initial treatment, follow-up/ patient monitoring after initial treatment. Surgical recommendations were grouped according to disease type and recommended surgery. The target audience for this consensus was general practitioners, gastroenterologists, and surgeons interested in the treatment and management of pediatric CD and UC. Additionally, the consensus aimed to support the decision-making of health insurance companies, regulatory agencies, and health institutional leaders and/or administrators.

Avaliar as repercussões nutricionais mais frequentes em crianças com alergia à proteína do leite de vaca. Estudo transversal, com pacientes com diagnóstico clínico de APLV atendidos no ambulatório de um hospital de referência de abril a dezembro de 2019 com crianças de 0 a 5 anos. Foram reunidos história clínica, sociodemográfica, avaliação antropométrica, dados bioquímicos e características alimentares. Os dados foram digitados no software Excel 2010 (Windows®) e analisados pelo SPSS 2010.Para verificar normalidade foi usado o teste de Kolmogorov Smirnov, variáveis com distribuição não Gaussiana apresentadas sob a forma de medianas e dos respectivos intervalos interquartílicos. As de distribuição normal foram comparadas pelos testes de “t” e ANOVA , quando necessário utilizamos os testes de MannWhitney e Kruskal Wallis . Foi utilizado o nível de significância de 5% (P< 0,05). As crianças apresentaram maior percentual de eutrofia na amostra (87,9 %). A média das concentrações séricas de vitamina D foi de 33 ng/ml (DP= 10,42), observou-se maior prevalência de insuficiência dessa vitamina nos que estavam em dieta de exclusão (82,6% vs. 17,4%; p = 0,07). Na avaliação da variedade alimentar foi visto que mesmo com bom apetite o perfil alimentar das crianças não apresenta variedade em relação aos grupos de alimentos. Foi observado que as crianças com APLV apresentavam em sua maioria estado nutricional de eutrofia, os que estavam em dieta de exclusão apresentaram uma maior prevalência de insuficiencia de vitamina D e não apresentavam variedade alimentar.