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首页> 外文期刊>The American Journal of Gastroenterology >Repeat endoscopy affects patient management in pediatric inflammatory bowel disease.
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Repeat endoscopy affects patient management in pediatric inflammatory bowel disease.

机译：重复内窥镜检查会影响小儿炎症性肠病的患者管理。

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OBJECTIVES: Endoscopy is commonly performed in the diagnosis of children with inflammatory bowel disease (IBD). The utility of repeat endoscopy for the management of pediatric IBD has not been subject to investigation. The frequency and determinants of changes in medical management resulting from endoscopy are unknown. METHODS: We conducted a cross-sectional cohort study to assess the frequency and determinants of management change in all children (0-21 years) who underwent endoscopy for the surveillance or evaluation of established IBD between July 2002 and July 2006 at 2 referral centers in the United States. Patients were sampled from the Pediatric Endoscopy Database System Clinical Outcomes Research Initiative and a chart review was performed to identify demographic features (age, gender), blood work (hemoglobin, albumin, erythrocyte sedimentation rate, C-reactive protein), and endoscopy results (endoscopic and histologic). An endoscopic score was used to assess mucosal injury. Subjects were divided into two groups for comparative analysis: (i) patients with management changes based on endoscopic or histologic findings, and (ii) patients without changes. RESULTS: We analyzed 285 endoscopic procedures (137 colonoscopies, 109 esophagogastroduodenoscopy (EGD) with colonoscopy, 25 sigmoidoscopies, 8 EGDs, 6 EGDs with sigmoidoscopy) performed in 230 children (mean age 14.5) with established IBD, including 147 with Crohn's disease, 80 with ulcerative colitis, and 3 with indeterminant colitis. Management changes were documented in 119 (42%) procedures, including 58 (20%) immediately after endoscopy, 52 (18%) after histology review, and 9 (3%) after both. Management changes included new medications in 86 cases, discontinuation of a medication in 3 cases, hospital admission in 11, and surgical consult in 14. No significant differences between groups occurred with regard to age, gender, endoscopy type, or infliximab use. The presence of anemia, hypoalbuminemia, or elevated markers of inflammation (ESR, CRP) did not correlate with management outcome. Management changes after endoscopy were more frequent in patients with Crohn's disease as compared to patients with ulcerative colitis. Patients with mucosal injury were more likely to have a management change than those with mucosal healing (80% vs. 20%; P<0.001). CONCLUSIONS: The overall rate of management change after endoscopic evaluation in children with IBD is approximately 42%. Addition of a new medication is the most common intervention. Blood work and patient symptoms before the procedure did not predict management outcome; however, mucosal healing may be an important end point. Our findings suggest that endoscopy is valuable for the evaluation of children with IBD.
机译：目的：内镜检查通常用于诊断儿童炎症性肠病（IBD）。重复内窥镜检查在儿科IBD治疗中的应用尚未受到研究。内窥镜检查导致医疗管理变化的频率和决定因素尚不清楚。方法：我们进行了一项横断面队列研究，以评估2002年7月至2006年7月在美国2个转诊中心接受内窥镜检查以监测或评估既定IBD的所有儿童（0-21岁）的管理变化频率和决定因素。美国。从儿科内窥镜数据库系统临床结果研究计划中对患者进行了抽样，并进行了图表审查，以确定人口统计学特征（年龄，性别），血液工作（血红蛋白，白蛋白，红细胞沉降率，C反应蛋白）和内窥镜检查结果（内镜和组织学）。内窥镜评分用于评估粘膜损伤。将受试者分为两组进行比较分析：（i）根据内窥镜检查或组织学检查发现管理改变的患者，以及（ii）没有改变的患者。结果：我们分析了230例已确诊IBD的儿童（平均年龄14.5）的285例内窥镜检查程序（137例结肠镜检查，109例食管胃十二指肠镜检查（EGD）与结肠镜检查，25例乙状结肠镜检查，8例EGD，6例乙状结肠镜检查），其中包括147例克罗恩病，80例溃疡性结肠炎，3例不确定性结肠炎。管理变更记录在119（42％）个步骤中，包括在内镜检查后立即进行58（20％），组织学检查后52（18％）和两者后9（3％）。管理上的变化包括86例使用新药物，3例停用药物，11例入院，14例接受手术咨询。两组在年龄，性别，内窥镜检查类型或英夫利昔单抗使用方面均无显着差异。贫血，低白蛋白血症或炎症标志物（ESR，CRP）的存在与治疗结果无关。与溃疡性结肠炎患者相比，克罗恩病患者内镜检查后的管理变化更为频繁。黏膜损伤的患者比黏膜愈合的患者更有可能发生管理上的改变（80％比20％; P <0.001）。结论：经内镜评估的IBD患儿的整体管理变化率约为42％。最常见的干预是添加新药。手术前的血液检查和患者症状不能预测治疗结果;但是，粘膜愈合可能是重要的终点。我们的发现表明，内窥镜检查对于评估IBD儿童具有重要价值。

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