Koniushevska A. A., Sydorenko N. V., Vaizer N. V., Kramarenko I. E., Yakovenko D. V., Bokholdin Yu. О.

LITERATURE REVIEWS

Scentific article

Abstract. The article is devoted to the problem of diagnosis and treatment of nonspecific ulcerative colitis in children. A literature review of the modern understanding of the etiology, pathogenesis, classification, course, clinical picture, observation and treatment of nonspecific ulcerative colitis, based on international guidelines. The etiology of the disease remains unknown, and the pathogenesis is insufficiently studied, many questions about this remain debatable. The modern classification of nonspecific ulcerative colitis distinguishes not only the length of the process, the nature of the course, severity of the disease, phases of the course, response to steroid therapy, but also there is an international age classification, which distinguishes neonatal, infant options, options , pediatric options. The criteria of assessment of the disease severity on the clinical pediatric activity index of activity – PUCAI (Pediatric Ulcerative Colitis Activity Index). The literature review for the treatment of nonspecific ulcerative colitis in children provides recommendations for the appointment of drugs of 5-amino-salicylic acid, topical and systemic glucocorticoids, immunosuppressants, drugs of biological therapy. Own clinical observation for 6 years of a child with severe nonspecific ulcerative colitis is given. The peculiarity of the clinical case was the development of the disease at an early age (at the age of 1 year), already in the onset of the disease there was a violation of physical development, persistent anemia. The disease had a recurrent severe and aggressive course, was complicated by intestinal bleeding, the development of extraintestinal manifestations: hepatitis, pancreatitis, severe posthemorrhagic anemia, severe necrotizing vasculitis. Skin changes in ulcerative colitis are more common in children with a greater prevalence of intestinal lesions, with high activity and significant severity of the disease. This has made it difficult to diagnose and treat the child.

nonspecific ulcerative colitis, children, clinic, diagnosis, assessment of activity and severity, treatment.

1. Zaprudnov AM, Grigorev KI, Haritonova LA, Bogomaz LV, Yudina TM. Problemy i perspektivy izucheniya sovremennoj detskoj gastroenterologii. Pediatriya. 2016;95(6):10–8. [in Russian].
2. Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Limbergen JV, Griffiths AM. Epidemiology of Pediatric Inflammatory Bowel Disease: A Systematic Review of International Trends. Inflamm Bowel Dis. 2011;17(1):423–39. doi: 10.1002/ibd.21349.
3. Kushnir IE. Terapevticheskie strategii lecheniya yazvennogo kolita: realii i perspektivy. Suchasna gastroenterologiya. 2016;90(4):108-15. [in Ukrainian].
4. Glavnov PV, Lebedeva NN, Kashenko V A, Varzin S A. Yazvennyj kolit i bolezn Krona. Sovremennoe sostoyanie problemy etiologii, rannej diagnostiki i lecheniya (Obzor literatury). Vestnik Sankt-Peterburgskij gosudarstvennyj universitet. 2015;11(4):48-72. [in Russian].
5. Markova AA, Kashkina EI. Sovremennye metody diagnostiki i ocenki tyazhesti techeniya nespecificheskogo yazvennogo kolita. Vestnik TGU. 2012;17(3):915-9. [in Russian].
6. Denisova MF, Chernega NV, Muzyka NN, Reminnaya NT, Palkina IS, Zadorozhnaya TD, et al. Sravnitelnaya kliniko-paraklinicheskaya harakteristika yazvennogo kolita i bolezni Krona u detej. Zdorov’ya ditini. 2016;70(2):10-5. [in Ukrainian].
7. Kornienko EA, Krupina AN, Gabrusskaya TV, Kalinina NM. Vospalitelnye zabolevaniya kishechnika s ochen rannim nachalom. Almanah klinicheskoj mediciny. 2016;44 (6):719–33. doi: 10.18786/2072-0505-2016-44-6-719-733. [in Russian].
8. Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature. 2011;474(7351):307–17. doi: 10.1038/ nature10209.
9. Kanshina AA. Narushenie gemostaza u detej s vospalitelnymi zabolevaniyami kishechnika [avtoreferat dissertacii]. Moskva: Pervyj Moskovskij gosudarstvennyj medicinskij universitet im. I.M. Sechenova; 2020. 25 s.
10. Uhlig HH, Schwerd T, Koletzko S, Shah N, Kammermeier J, Elkadri A, et al. The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology. 2014;147(5):990–1007. doi: 10.1053/ j.gastro.2014.07.023.
11. Yablokova EA, Gorelov AV, Sichinava IV, Borisova EV, Polotnyanko EYu, Grammatopulo M I, et al. Techenie vnekishechnyh proyavlenij vospalitelnyh zabolevanij kishechnika u detej. Eksperimentalnaya i klinicheskaya gastroenterologiya. 2016;132(8):62-6. [in Russian].
12. Nikonov EL, Aksyonov VA, Skvorcova TA, Zharova ME. Immunoterapiya vospalitelnyh zabolevanij kishechnika. Doktor. Ru. 2019;10(165):31–7. doi: 10.31550/1727-2378-2019-165-10-31-37. [in Russian].
13. Limbergen JV, Russell RK, Drummond HE, Aldhous MC, Round NK, Nimmo ER, et al. Definition of phenotypic characteristics of childhoodonset inflammatory bowel disease. Gastroenterology. 2008;135(4):1114–22. doi: 10.1053/j.gastro.2008.06.081.
14. Ohotnikova OM, Tkachova TM, Romanchuk AA, Grishenko OM, Voronyak DI. Suchasnij algoritm diagnostiki virazkovogo kolitu u ditej vidpovidno do ostannih rekomendacij Yevropejskoyi organizaciyi z vivchennya hvorobi Krona i kolitu ta Yevropejskogo tovaristva dityachih gastroenterologiv, gepatologiv ta nutriciologiv. Sovremennaya pediatriya. 2019;103(7):33-43. doi: 10.15574/SP.2019.103.33. [in Ukrainian].
15. Sandhu BK, Fell JME, Beattie RM, Mitton SG, Wilson DC, Jenkins H, et al. Guidelines for the management of inflammatory bowel disease in children in the United Kingdom. J Pediatr Gastroenterol Nutr. 2010;1(50):1-13. doi: 10.1097/MPG.0b013e3181c92c53
16. Beketova GV, Soldatova OV. Yazvennyj kolit u detej i podrostkov. Pediatriya. Vostochnaya Evropa. 2017;2(5):177-98. [in Ukrainian].
17. Anushenko AO, Potapov AS, Cymbalova EG, Gordeeva OB. Anemiya pri vospalitelnyh zabolevaniyah kishechnika u detej. Voprosy sovremennoj pediatrii. 2016;15(2):128–140. doi: 10.15690/vsp.v15i2.1530. [in Russian].
18. Ivashkin VT, Lapina TL. Gastroenterologiya: nacionalnoe rukovodstvo. Moskva: GEOTAR Media; 2008. 704 s. [in Russian].
19. Baranov AA, Potapov AS, Gabruzskaya TV, Gorelov AV, Zaharova IN, Kornienko EA, et al. Federalnye klinicheskie rekomendacii po okazaniyu medicinskoj pomoshi detyam s yazvennym kolitom. Moskva; 2016; 53 s. [in Russian].
20. Sovalkin VI, Bikbavova GR, Emelyanova YuA. Sovremennyj vzglyad na patogenez i laboratornuyu diagnostiku yazvennogo kolita (Obzor literatury). Arhiv vnutrennej mediciny. 2017;7(4):252-9. doi: 10.20514/2226-6704-2017-7-4-252-259. [in Russian].
21. Denisova MF, Muzika NM, Chernega NV, Zadorozhna TD, Archakova TM, Bukulova NYu. Osoblivosti perebigu virazkovogo kolitu v ditej na suchasnomu etapi. Zdorov’ya ditini. 2017;12(2):10-5. doi: http://dx.doi. org/10.22141/2224-0551.12.2.2017.99769. [in Ukrainian].
22. Zaharova IN, Zajdenvarg GE, Berezhnaya IV, Tatarkina OV. Medikamentoznaya terapiya hronicheskih vospalitelnyh zabolevanij kishechnika u detej. Medicinskij Sovet. 2011;11-12:41-7. [in Russian].
23. Abdulhakov SR, Abdulhakov RA. Nespecificheskij yazvennyj kolit: sovremennye podhody k diagnostike i lecheniyu. Vestn. sovrem. klinich. mediciny. 2009;2(1):32–41. [in Russian].
24. Yablokova EA, Gorelov AV, Ratnikova MA, Sichinava IV, Grammatopulo MI, Polotnyanko EYu., et al. Vospalitelnye zabolevaniya kishechnika u detej. Pediatriya. 2006;5:99–105. [in Russian].
25. Strober W, Fuss I, Mannon P. The fundamental basis of inflammatory bowel disease. J. Clin. Investigation. 2007;117(3):514–21.
26. Bellavia M, Tomasello G, Romeo M, Damiani P, Monte A I L, Lozio L,
27. et al. Gut microbiota imbalance and chaperoning system malfunction are central to ulcerative colitis pathogenesis and can be counteracted with specifically designed probiotics: a working hypothesis. Med. Microbiol. Immunol. 2013 Dec; 202(6):393–406. doi: 10.1007/s00430- 013-0305-2.
28. Gosiewski T, Strus M, Fyderek K, Kowalska-Duplaga K,Wedrychowecz A, Jedynak-Wasowicz U, et al. Horizontal distribution of the fecal microbiota in adolescents with inflammatory bowel disease. JPGN. 2012;54(1):20–7. doi: 10.1097/MPG.0b013e31822d53e5.
29. Khan MW, Kale AA, Bere P, Vajjala S, Gounaris E, Pakanati K.C. Microbes, intestinal inflammation and probiotics. Expert Review of Gastroenterology and Hepatology. 2012;6(1):81–94. doi: doi.org/10. 1586/egh.11.94.
30. Fujita H, Eishi Y, Ishige I, Saitoh K, Takizawa T, Arima T, et al. Quantitative analysis of bacterial DNA from Mycobacteria spp., Bacteroides vulgatus, and Escherichia coli in tissue samples from patients with inflammatory bowel diseases. J. Gastroenterol. 2002;37:509-16. doi: doi.org/10.1007/s005350200079.
31. Rhodes JM. The role of Escherichia coli in inflammatory bowel disease. Gut. 2007 May;56(5):610-612. doi: 10.1136/gut.2006.111872.
32. Duffy M, O’Mahony L, Coffey JC, Collins JK, Shanahan F, Redmond HP, et al. Sulfate-reducing bacteria colonize pouches formed for ulcerative colitis but not for familial adenomatous polyposis. Dis. Colon. Rectum. 2002;45:384–388. doi: 10.1007/s10350-004-6187-z
33. Kamalova AA, Safina ER, Nizamova RA, Zajnetdinova MSh, Kvitko EM. Pitanie pri vospalitelnyh zabolevaniyah kishechnika u detej. Ros vestn perinatol i pediatr. 2020;65(5):145–151. doi: 10.21508/1027–4065–2020–65–5–145–15. [in Russian].
34. Levin GYa, Popovicheva AN, Sosnina LN, Fedorova OV, Sheremetev YuA. Rol narushenij reologicheskih svojstv eritrocitov v patogeneze vospalitelnyh zabolevanij kishechnika u detej. Tromboz, gemostaz i reologiya. 2017;72(4):45-52. [in Russian].
35. Volosnikov DK, Sabirova AV, Kalatina YuE, Sorokin DV. Vospalitelnye zabolevaniya kishechnika u detej Chelyabinskoj oblasti. Pediatricheskij vestnik Yuzhnogo Urala. 2016;2:24-27. [in Russian].
36. Klimov LYa, Zaharova IN, Abramskaya LM, Stoyan MV, Kuryaninova VA, Dolbnya SV, et al. Vitamin D i hronicheskie zabolevaniya kishechnika: rol v patogeneze i mesto v terapii. Prakticheskaya medicina. 2017;106(5):59-64. [in Russian].
37. Burisch J, Munkholm P. Inflammatory bowel disease epidemiology. Curr Opin Gastroenterol. 2013 Jul;4(29):357-62. doi: 10.1097/ MOG.0b013 e32836229fb.
38. Shtajn DDzh, Shejker R, redaktor .Vospalitelnye zabolevaniya kishechnika. Klinicheskoe rukovodstvo. Moskva: GEOTAR-Media; 2021. 256 s. [in Russian].
39. Stepanov YuM, Skirda IYu, Petishko OP. Hronichni zapalni zahvoryuvannya kishechnika: osoblivosti epidemiologiyi v Ukrayini. Gastroenterologiya. 2017;2(51):97-105. doi: 10.22141/2308-2097.51.2. 2017.101703. [in Ukrainian].
40. Shepherd B, Schwartz DA. Inflammatory bowel disease: diagnostic and treatment options. Hosp. Physician. 2005;10(41):11–9.
41. Shapkina OA, Fedulova EN, Lavrova AE, Shabunina EI. Nauchno-prakticheskie aspekty epidemiologicheskih issledovanij vospalitelnyh zabolevanij kishechnika u detej Privolzhskogo Federalnogo okruga. Pediatriya. 2016;95 (6):50–55. [in Russian].
42. Denisova MF. Sovremennye podhody k diagnostike yazvennogo kolita u detej. Sovremennaya pediatriya. 2014;3:113-5. [in Ukrainian].
43. Turner D, Otley AR, Mack D, Hyams J, de Bruijne J , Uusoue K, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007;133(2):423-32. doi: 10.1053/j.gastro.2007.05.029.
44. Ahrieva HM, Zajratyanc OV, Maev IV, Makarova OV, Tertychnyj AS. Patologicheskaya anatomiya vospalitelnyh zabolevanij kishechnika. Yazvennyj kolit. Bolezn Krona: Rukovodstvo dlya vrachej. Moskva: Gruppa MDV; 2019. 128 s. [in Russian].
45. de Bie CI, Buderus S, Sandhu BK, de Ridder L, Paerregaard A, Veres JG, et al. Escher, and the EUROKIDS Porto IBD Working Group of ESPGHAN Diagnostic workup of paediatric patients with inflammatory bowel disease in Europe: results of a 5-year audit of the EUROKIDS registry. J. Pediatr. Gastroent. Nutr. 2012;54:374–380. doi: 10.1097/MPG.0b013e318231d984.
46. Belousova OYu, Pavlenko NV, Voloshin KV, Slobodyanyuk AL. Neinvazivnye metody diagnostiki vospalitelnyh zabolevanij kishechnika u detej. Dityachij likar. 2016;1(46):58-62. [in Ukrainian].
47. Kryuchko TO, Nesina IM, Poda OA, Kolenko IO. Algoritm diferencijnoyi diagnostiki zahvoryuvan kishechnika u ditej. Dityachij likar. 2016;48(3):21-24. [in Ukrainian].
48. Mihajlova EI, Danchenko MN. Vospalitelnye zabolevaniya kishechnika: Sovremennyj vzglyad na problemy diagnostiki (Obzor). Problemy zdorovya i ekologii. 2007;3:32-8. [in Russian].
49. Birimberg-Schwartz L, Wilson DC, Kolho K-L, Karolewska-Bochenek K, Afzal NA, Spray C, et al. pANCA and ASCA in Children with IBD-Unclassified, Crohn’s Colitis, and Ulcerative Colitis-A Longitudinal Report from the IBD Porto Group of ESPGHAN. Inflamm Bowel Dis. 2016 Aug; 22(8):1908-14. doi: 10.1097/MIB.0000000000000784.
50. Solberg IC, Lygren I, Cvancarova M, Jahnsen J, Stray N, Sauar J, et al. Predictive Value of Serologic Markers in a Population-based Norwegian Cohort with Inflammatory Bowel Disease. Inflamm. Bowel dis. 2009;15(3):406–14. doi: 10.1002/ibd.20781.
51. Turner D, Levine A, Escher JC, Griffiths AM, Russel RK, Dignass A, et al Management of Pediatric Ulcerative Colitis: Joint ECCO and ESPGHAN Evidence based Consensus Guidelines. JPGN. 2012;3(55):340-61. doi: 10.1097/MPG.0b013e3182662233.
52. Turner D, Travis SP, Griffiths AM, Ruemmele FM, Levine A, Benchimol EI, et al. Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBDWorking Group of ESPGHAN. Am. J. Gastroenterol. 2011 Apr;4(106):574-88. doi: 10.1038/ajg.2010.481.
53. Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel Je-F, Allez M, et al. Second EUROPEAN evidence-based Consensus on the diagnosis and management of ulcerative colitis part 2: Current management. J Crohns Colitis. 2012 Dec;6(10):991-1030. doi: 10.1016/j. crohns.2012.09.002.
54. Ford AC, Khan KJ, Sandborn WJ, Hanauer SB, Moayyedi P. Efficacy of topical 5-aminosalicylates in preventing relapse of quiescent ulcerative colitis: a meta-analysis. Clin. Gastroenterol. Hepatol. 2012;5(10):513–9. doi: 10.1016/j.cgh.2011.10.043.
55. Denisova MF, Chernega NV, Beba YuV. Novye vozmozhnosti v lechenii hronicheskih nespecificheskih zabolevanij kishechnika u detej. Sovremennaya pediatriya. 2012;4(44):153-5. [in Ukrainian].
56. Khan KJ, Dubinsky MC, Ford AC, Ullman TA, Talley NJ, Moayyedi P, et al. Efficacy of immunosuppressive therapy for inflammatory bowel disease: a systematic review and meta-analysis. Am. J. Gastroenterol. 2011;4(106):630–42. doi: 10.1038/ajg.2011.64.
57. Pozler O, Chladek J, Maly J, Hroch M, Dědek P, Beránek M, et al. Steady state of azathioprine during initiation treatment of pediatric inflammatory bowel disease. Journal Crohns Colitis. 2010;4:623–8. doi: doi.org/ 10.1016/j.crohns.2010.06.005
58. .Hyams J, Damaraju L, Blank M, Johanns J, Guzzo C, Winter HS, et al. Induction and maintenance therapy with infliximab for children with moderate to severe ulcerative colitis. Clin. Gastroenterol. Hepatol. 2012;4(10):391-9. doi: 10.1016/j.cgh.2011.11.026.
59. Panaccione R, Ghosh S, Middleton S, Márquez JR, Scott BB, Flint L, et al. Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology. 2014 Feb;2(146):392-400. doi: 10.1053/j.gastro.2013.10.052.
60. Bernstein CN, Fried M, Krabshuis JH, Cohen H, Eliakim R, Fedail S, et al. World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010. Inflamm Bowel Dis. 2010;1(16):112–24. doi: 10.1002/ibd.21048.

«Bulletin of problems biology and medicine» Issue 1 (159), 2021 year, 278-286 pages, index UDK 616.348-002.44-02-092-07-053.2

10.29254/2077-4214-2021-1-159-278-286