Inflammatory bowel disease in children is usually more severe than in adults. In addition, young patients often do not respond to standard treatment. The solution to this problem is modern biological treatment, but it is still very limited or not available at all, especially for the youngest - emphasized specialists at the conference "Stop discrimination in access to biological treatment! Let it be he alth, not age, that decides ", organized by the Polish Society for the Support of People with IBD" J-elita "on May 19, which is the World Day of IBD.

IBD(IBD) are chronic autoimmune diseases. They include, among others ulcerative colitis (UC) and Crohn's disease (L-C) and microscopic colitis. People between the ages of 20 and 40 develop IBD most often, although an increase in the incidence of young children is also observed. It is the youngest who are in the worst situation, because the disease is usually more severe in them than in adult patients. The hope for remission (the time when symptoms of the disease have milder or completely disappear), avoid surgery and improve quality of life is biological therapy to reduce inflammation. Unfortunately, in Poland, young patients have more limited access to modern and effective treatment than adults. In some cases it is even impossible.

Inflammatory bowel disease in children - causes

The causes of IBD have not been known so far. It is known that the disease is not caused by an allergy or food intolerance. It was also established that three factors (each equally) play a role in its development - genetic, immunological and environmental, i.e. - as a result of environmental factors, people with genetic predisposition and immune disorders develop chronic inflammation of the intestinal wall - explains prof. Witold Bartnik from the Department of Gastroenterology and Hepatology, CMKP at the Oncology Center in Warsaw. It is a bit different with the youngest. - The younger the child, the greater the role of genetic predisposing factors - notes Dr. n. med. Piotr Albrecht, head of the Department of Gastroenterology, NutritionChildren and Paediatrics of the Independent Public Children's Teaching Hospital in Warsaw.

IBD in children - symptoms

IBD in children is more severe than in adults, Dr. Albrecht notes. For example, in the course of Crohn's disease, abdominal pain occurs in 87% of people. the youngest. For comparison - only 53 percent. sick adults complain of this ailment.

The youngest more often (33% of cases) than adults (13%) develop severe relapses

However, fever occurs in 74 percent of small patients and only in 35 percent. adults. Only diarrhea (sometimes with an admixture of mucus and blood) is more common in adults (80% of patients) than in children (55%). The characteristic triad of symptoms, such as abdominal pain, diarrhea and weight loss, occurs in 25% of patients. sick children.

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In addition, diseases accompanying IBD (including liver disease, eye diseases, pain and / or arthritis) appear more often in children than in adults.

IBD in children - treatment

There is currently no treatment that can cure IBD, but there are medications that can control the symptoms of the disease. In Poland, the level of reimbursement of basic drugs (mesalazine, immunosuppressants, glucocorticosteroids) is at a satisfactory level.

People diagnosed with IBD up to the age of 19 have a high risk of developing bowel cancer, over 40%.

Unfortunately, standard treatment is often ineffective in children due to side effects or difficulties in achieving remission. Little patients need modern, more effective therapy. An example is biological treatment that relieves symptoms and prevents their recurrence in most patients. It is an alternative to surgery and a chance to avoid dangerous complications. Thanks to such treatment, sick children have a chance to develop properly, go to school normally, and play with their peers.

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What are biological drugs?

Biologics work by reacting against the molecules of the immune system: cytokines, cytokine receptors or cells. Most drugsbiological, it is the so-called monoclonal antibodies. The molecule against which most drugs are directed is TNF-alpha (tumor necrosis factor). Its increased concentration is found in the altered intestinal mucosa, where it causes inflammatory reactions. Depending on the structure of antibodies, several preparations are known to lower its concentration. Two drugs are registered in Poland - infliximab and adalimumab (the latter in Poland is not available for children, only for adults). Biological treatment is to bring into remission for the longest possible time, and even permanently. This can only be achieved if biological treatment is introduced as soon as possible (within the first two years of illness).

Unfortunately, currently in Poland biological treatment is still difficult to access for patients with IBD - especially for children - due to too restrictive criteria for qualifying for the drug program. According to prof. Bartnik is a large system error resulting from the legal regulations in force in Poland. - In most countries, such treatment can be used by milder patients, unfortunately not in our country - emphasizes prof. Beekeeper.

In Poland, access to biological treatment has 2.8 percent. sick. In Europe it is worse only in Romania, Bulgaria and Latvia

In adult ulcerative colitis patients, biological therapy is limited to three doses. Children with UC do not have access to it. In contrast, biological treatment of patients (adults and children) suffering from Crohn's disease is financed only for 12 months (it cannot be extended or restarted at the first symptoms of an exacerbation), and the inclusion criteria for the therapeutic program are too strict and excessive. They show that only a patient who is extremely exhausted by the disease, when it leads to a serious condition and exhaustion of the organism, has a chance of receiving standard treatment in the EU. In addition, adults have access to both biological drugs used in the treatment of C. L-C (the first is infliximab, the second - adalimumab), and children only to the first. Adalimumab is dedicated to be used at home, which means your child must come to the hospital to receive adalimumab. Thus, they are unnecessarily exposed to hospital infections that may worsen his he alth.

- We are working on making the scoring of qualifications for treatment in Poland conducive to treatment, less restrictive. As an environment, we can appeal on this matter. Everything is in the hands of the Minister of He alth - says prof. Beekeeper. - I believe that the need for changes in this matter will be noticed -he adds. Whereas dr hab. Małgorzata Mossakowska - the founder and long-time president of the Polish Society for Supporting People with IBD "J-elita" - emphasized that the Society repeatedly appealed to the Minister of He alth to improve the situation of patients with IBD, but to no avail.

More information on IBD can be found on the website of the Polish Society for Supporting People with IBD "J-elita".

Category:

Gastrology