Utredning och diagnostik av PIBD Petter Malmborg ALB.

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Presentation transcript:

Utredning och diagnostik av PIBD Petter Malmborg ALB

Portokriterierna II

Inflammatory bowel disease in children and adolescents: recommendations for diagnosis-the Porto criteria. IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr Jul;41(1):1-7. Portokriterierna I

Diagnosis of IBD is based on Clinical signs and symptoms Endoscopy and histology and radiology Every child suspected of IBD should undergo Colonoscopy with ileal intubation Upper gastrointestinal endoscopy Radiologic contrast imaging of the small bowel (except in definite ulcerative colitis). Portokriterierna I

Gold standards for the diagnosis of CD or UC is not yet available. ECCO statements 2009 & 2012

För att ställa diagnosen IBD skall annan orsak till den påvisade tarminflammationen ha uteslutits: Infektion Malignitet Ischemi Lennard-Jones-kriterierna Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2-6

Diagnostic criteria for UC (all 3 criteria must be present) 1. History of diarrhoea and/or rectal bleeding and pus for more than 1 week or repeated episodes. 2. Characteristic endoscopic findings of continuous ulceration, vulnerability, or granulated mucosa. 3. Histopathology consistent with UC Infection and cancer must have been ruled out. Köpenhamnskriterierna Ulcerative colitis. An epidemiological study based on a regional inception cohort, with special reference to disease course and prognosis. Langholz E. Dan Med Bull 1999;46(5):400 ‐ 15.

Diagnostic criteria for CD (2 of 4 criteria must be present) 1. History of abdominal pain, weight loss, and/or diarrhoea for more than 3 months. 2. Characteristic endoscopic or radiologic findings of ulceration, cobblestoning or stricture. 3. Histopathology consistent with CD. 4. Fistulas and/or abscesses in addition to an affected bowel segment. Infection and cancer must have been ruled out. Köpenhamnskriterierna Crohn's disease ‐ occurrence, course and prognosis. Munkholm P. Dan Med Bull 1997;44(3):287 ‐ 302.

Portokriterierna II

Antal barn-ungdomar som insjuknar i IBD per innevånare och år Northern Stockholm South-Eastern Norway Eastern Denmark Southern Finland 2003 UC CD

Differentiating ulcerative colitis from Crohn disease in children and young adults North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; Colitis Foundation of America, Bousvaros A, Antonioli DA, Colletti RB, et al J Pediatr Gastroenterol Nutr May;44(5):