tailieunhanh - Refractory Inflammatory Bowel Disease in Children

Opportunity: Cancer is the leading cause of death in Canadian children beyond the neonatal period. One in 400 Canadian adults are survivors of childhood cancer, and more than two-thirds experience chronic and/or late-occurring health problems, that often are not clinically apparent until decades after treatment. 10 Non-random molecular or cytogenetic events are found in 50% of childhood cancers, and many types of childhood cancers are associated with congenital anomalies, or family cancer history, suggesting a strong genetic basis for the etiology of cancer in children. All Canadian children with cancer are treated in 17 networked paediatric centres, offering. | Journal of Pediatric Gastroenterology and Nutrition 47 266-272 2008 by European Society for Pediatric Gastroenterology Hepatology and Nutrition and North American Society for Pediatric Gastroenterology Hepatology and Nutrition Refractory Inflammatory Bowel Disease in Children RIBD Working Group M. Oliva-Hemker . Escher ÍD. Moore M. Dubinksy ll. Hildebrand . Koda S. Murch yyB. Sandhu . Seo . Tanzi and B. Warner Johns Hopkins University School of Medicine Baltimore MD Erasmus Medical Center-Sophia Children s Hospital Rotterdam The Netherlands ÍChildren Youth and Women s Health Service Adelaide Australia Cedars-Sinai Medical Center David Geffen School of Medicine at UCLA Los Angeles CA fAstrid Lindgren Children s Hospital Stockholm Sweden IlChild Institute-Hospital das Clinicas Faculty of Medicine of Sao Paulo University Sao Paulo Brazil Warwick Medical School Coventry UK Bristol Royal Hospital for Children Bristol UK ÍÍSeoul National University Children s Hospital Seoul Korea Centro Hospitalario Pereira Rossell Montevideo Uruguay and Washington University School of Medicine St Louis MO Crohn disease CD and ulcerative colitis UC are 2 chronic relapsing inflammatory bowel diseases IBDs of unknown etiology. Approximately 25 of patients are diagnosed by the age of 20 years. Originally the highest incidence rates were reported in northern and Western Europe and in North America. However the gap that previously existed between areas of high and low incidence rates is shrinking because IBD is now being reported with increasing frequency in Africa South America and Asia 1 . In children the incidence of CD appears to have risen above that of UC 1 2 . CD and UC can follow an active and remitting course and their response to therapies can be highly variable. In severe disease inducing and maintaining remission can be difficult. The purpose of this report is to highlight 3 refractory IBD phenotypes for which medical and surgical management can be particularly