• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권3호
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• pp.214-220
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• 2016

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (${\times}2$) and via a nasoduodenal tube (${\times}4$) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.

• 대한한방소아과학회지
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• 제36권3호
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• pp.19-34
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• 2022

Objectives To investigate the effect of Jakyakgamcho-tang (JGT) on Dextran sulfate sodium (DSS) induced ulcerative colitis. Methods Experimental animals were divided into six groups; group 1, normal group; group 2, DSS-induced colitis group; group 3, 5-aminosalicylic acid (5-ASA)-treated group; group 4, Glycyrrhiza Uralensis (Gamcho, GC)-treated group; group 5, Paeoniae Radix (Jakyak, JY)-treated group; group 6, JGT-treated group. Inflammatory cytokines and their metabolites were detected. Result In the JGT group, the levels of tumor necrosis factor alpha (TNF-α), prostaglandin E2 (PGE2) were significantly decreased, whereas that of Interleukin-10 (IL-10) were significantly increased. In addition, the metabolite profile changed in the JGT group with most metabolites increasing. Conclusion This study demonstrates that the therapeutic potential of JGT in ulcerative colitis. Further studies should be conducted to confirm our findings.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권2호
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• pp.240-245
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• 2009

만성 염증성 장 질환에서 유발되는 드문 피부 병변인 괴저 농피증은 초기에는 홍반으로 둘러싸인 농포로 시작하지만 빠르게 주변부로 확장되고 염증이 진피 내로 파급 되면서 깊은 궤양이 생겨 피부 함몰을 일으킨다. 초기에 감염성 연부조직염 등으로 오인하여 절개 배농이나 강한 압박 배농을 하게 되면 이 질환의 이상초과민현상 때문에 병변이 악화되는 경향이 있다. 따라서 조기 진단과 습윤-비밀폐 드레싱으로 상처에 가하는 충격을 최소화하면서 상처 부위를 보존하고 2차 세균 감염을 예방하는 것이 초기 치료에 매우 중요하다. 저자들은 궤양성 대장염을 가진 15세 여자에서 발생한 괴저 농피증을 초기 에 압박 배농하여 병변이 빠르게 악화된 증례의 치료 경험을 보고하면서 조기 진단과 초기 치료 대응의 중요성을 강조하고자 한다.

• Child Health Nursing Research
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• 제29권3호
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• pp.218-228
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• 2023

Purpose: This study aimed to identify clinical characteristics of South Korean pediatric inflammatory bowel disease (IBD) in a children's hospital over the past 5 years, with a specific focus on comparing the features observed between Crohn's disease (CD) and ulcerative colitis (UC). Additionally, it aimed to examine the nursing diagnoses given to patients. Methods: This retrospective study analyzed the medical records of Korean pediatric patients under 18 years of age who were diagnosed with IBD and hospitalized at a children's hospital in Seoul, South Korea, from January 2017 to December 2021. Results: The number of pediatric patients diagnosed with IBD steadily increased. This finding was particularly prominent for CD patients, the majority of whom were male. Pediatric patients with CD had significantly higher rates of abdominal pain and perianal lesions, while pediatric patients with UC had a higher rate of bloody stool. Laboratory findings indicated that CD patients had higher levels of inflammatory markers and lower albumin levels than UC patients. The nursing diagnoses given during hospitalization mostly related to safety and protection, physical comfort, and gastrointestinal function. Conclusion: This study provides insights into Korean pediatric IBD patients, enabling early detection and the development of nursing intervention strategies. From a comprehensive perspective, nursing care should not only address patients' physical needs but also their psychosocial needs.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권3호
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• pp.297-303
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• 2020

The musculoskeletal system can be involved as an extra-intestinal manifestation of inflammatory bowel disease. Among these, myositis in ulcerative colitis (UC) is very rare. A 14-year-old girl was admitted due to severe shoulder tenderness. She had complained of left jaw pain and swelling for the past 10 days. Inflammatory markers were elevated with no evidence of infectious etiology. Myositis was suspected by shoulder magnetic resonance imaging. Three days after admission, she developed hematochezia. Muscle biopsy and colonoscopy was performed due to worsening left mandibular area pain and persistent hematochezia. Colonoscopy showed consistent findings with UC. She was finally diagnosed with UC with myositis as an extra-intestinal manifestation. She showed a dramatic response to UC treatment. Gastrointestinal symptoms were well-controlled. After 14 months, UC symptoms and muscle pain were aggravated, which were relieved after steroid and cyclosporin treatment. We report a unique case of UC initially presented with myositis, preceding gastrointestinal symptoms.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권4호
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• pp.357-365
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• 2021

Purpose: A change in diagnosis from ulcerative colitis (UC) to Crohn's disease (CD) has been reported in pediatric inflammatory bowel disease; however, only a few clinical characteristics and predictors of this diagnostic change have been reported. We aimed to describe the clinical characteristics of patients with UC who underwent a change in diagnosis to CD and identify variables associated with the change. Methods: The medical records of pediatric patients with UC who were followed up at the National Center for Child Health and Development between 2006 and 2019 were retrospectively reviewed. Clinical data on disease phenotype, laboratory parameters, endoscopic findings, and treatment of patients whose diagnosis changed to CD (cCD) were compared to those of patients whose diagnosis remained UC (rUC). Results: Among the 111 patients initially diagnosed with UC, 11 (9.9%) patients were subsequently diagnosed with CD during follow-up. There was no significant difference between the cCD and rUC groups in terms of sex, age at initial diagnosis, and the extent and severity of disease at initial diagnosis. Albumin and hemoglobin levels were significantly lower in the cCD group than in the rUC group. The proportion of patients who required biologics was significantly higher in the cCD group than in the rUC group (p<0.05). Conclusion: Approximately 10% children initially diagnosed with UC were subsequently diagnosed with CD. Hypoalbuminemia and anemia at initial diagnosis and use of biologics could be predictors of this diagnostic change.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권2호
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• pp.171-176
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• 2009

목 적: 최근 우리나라 소아에서 염증장병이 꾸준히 증가추세에 있으나 이들의 혈액학적 특징에 대해서는 알려진 바가 없다. 국내 염증장병 환아들의 장기간 관리에 도움이 되고자 혈액학적 소견을 분석하여 보았다. 방 법: 가천의대 길병원 소아청소년과에서 2002년 9월부터 2008년 9월 사이에 대장경과 생검으로 확진된 염증장병 환자 중 18세 이하인 25명의 염증장병 환아를 대상으로 하였다. 진단 당시의 혈색소, 적혈구용적률, 백혈구 수, 혈소판 수, 평균적혈구용적, 평균적혈구 혈색소량을 조사했다. 환아의 빈혈 빈도, 혈색소와 질병 이환기간과의 관계, 혈색소와 활동도지수와의 관계에 대하여 알아보았다. 결 과: 빈혈은 전체적으로 76% (19/25)에서 있었으며, 크론병 환아에서는 88% (14/16), 궤양결장염 환아에서는 56% (5/9)였다. 백혈구증가와 혈소판증가는 크론병 환아에서만 있었으며 빈도는 각각 56% (9/16), 25% (4/16)였다. 증상의 이환기간과 혈색소치는 크론병과 궤양결장염 모두에서 통계적인 유의성이 없었다. 활동도지수와 혈색소치도 크론병과 궤양결장염 모두에서 통계적인 유의성이 없었다. 결 론: 본 연구에서 염증장병 환아의 혈액학적 소견은 외국 문헌의 보고 내용과 큰 차이는 없었으나 빈혈의 빈도가 높았으며 질병의 이환기간 또는 활동도지수와 빈혈은 상관관계가 없었다. 이러한 사실은 염증장병환아를 장기간 관리하는 동안 빈혈에 대한 관리 역시 포함해야 하는 것을 시사하였다. 백혈구증가와 혈소판증가는 크론병에서만 관찰되어 궤양성장염과 감별진단하는데 도움이 될 수 있음을 제시하였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.7-18
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• 2021

Purpose: The long-term efficacy and safety of infliximab (IFX) in children with ulcerative colitis (UC) have not been well-evaluated. Here, we reviewed the long-term durability and safety of IFX in our single center pediatric cohort with UC. Methods: This retrospective study included 20 children with UC who were administered IFX. Results: For induction, 5 mg/kg IFX was administered at weeks 0, 2, and 6, followed by every 8 weeks for maintenance. The dose and interval of IFX were adjusted depending on clinical decisions. Corticosteroid (CS)-free remission without dose escalation (DE) occurred in 30% and 25% of patients at weeks 30 and 54, respectively. Patients who achieved CS-free remission without DE at week 30 sustained long-term IFX treatment without colectomy. However, one-third of the patients discontinued IFX treatment because of a primary nonresponse, and one-third experienced secondary loss of response (sLOR). IFX durability was higher in patients administered IFX plus azathioprine for >6 months. Four of five patients with very early onset UC had a primary nonresponse. Infusion reactions (IRs) occurred in 10 patients, resulting in discontinuation of IFX in four of these patients. No severe opportunistic infections occurred, except in one patient who developed acute focal bacterial nephritis. Three patients developed psoriasis-like lesions. Conclusion: IFX is relatively safe and effective for children with UC. Clinical remission at week 30 was associated with long-term durability of colectomy-free IFX treatment. However, approximately two-thirds of the patients were unable to continue IFX therapy because of primary nonresponse, sLOR, IRs, and other side effects.

• Clinical and Experimental Pediatrics
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• 제52권4호
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• pp.504-507
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• 2009

자가면역성 간염, 원발성 담관성 간경화증, 원발성 경화성 담관염은 대표적인 자가 면역성 간질환이다. 이 각 질환의 임상적, 조직학적, 혈청학적 특징이 혼재되어 어느 한 질환으로 진단하기 어려운 경우를 중복증후군(overlap syndrome)이라 하고, 최근 소아에게서도 드물게 보고되고 있다. 한편 경화성 담관염은, 염증성 장질환에서 가장 흔히 동반되는 간담도계질환으로 알려져 있다. 저자들은 궤양성 대장염으로 진단된 환아에게서 간조직 검사, 혈청 검사, 방사선 검사 등을 통해 자가면역성 간염-원발성 경화성 담관염의 중복증후군을 진단하였기에 보고하는 바이다. 염증성 장질환 환아에게서 자가 면역성 간질환 또는 중복증후군 동반여부를 염두에 두어 임상적, 조직학적, 혈청학적 검사를 통해 적절한 진단과 치료가 필요하겠다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권sup2호
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• pp.72-79
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• 2008

The incidence of inflammatory bowel disease is increasing rapidly in Korea and one quarter of the new patients present in childhood. Crohn's disease and ulcerative colitis are incurable conditions associated with significant morbidity, therefore the focus of treatment in children should be to reduce or eliminate symptoms, optimize nutritional status and growth, prevent complications. This review will deal with the evidence supporting the treatments currently used in children with inflammatory bowel disease.