Doença inflamatória intestinal: abordagem e tratamento das crianças e adolescentes

Abstract

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disorder of the gastrointestinal tract, comprising ulcerative colitis and Crohns disease. The cause(s) of these disorders remain unknown but likely involves some interplay between genetic vulnerability and environmental factors. Children and adolescents with IBD present often with a more complicated disease course compared to adult patients. The most common clinical manifestations are abdominal pain, diarrhea, weight loss and blood in the stool. The intestinal inflammation reduces the absorption of nutrients. Extra-intestinal manifestations may be present. Treatment is difficult because it is a chronic disease with phases of relapse and remission. The most current view of IBD therapy is based on the modification of the natural history of the disease, with the goal of achieving mucosal healing, reducing complications of the disease and improve the patient's quality of life. The main issues that arise with the use of infliximab, and other immunobiologicals, is the time of its introduction, as well as the role of concomitant immunomodulators. Clinical management of IBD requires long-term treatment based on a combination of drugs to control the disease. It is important to value the possible interactions between the drugs and their side effects. It is essential to monitor the linear growth, pubertal development, and bone health. Outpatient follow-up and complementary tests should be judicious and individualized.