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Revisão terapêutica da doença de Crohn em contexto de caso clínico pediátrico
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Introdução: A incidência de doença de Crohn (D. Crohn) em idade pediátrica tem vindo a aumentar nos últimos anos. O correto diagnóstico e caracterização inicial da doença são fundamentais para uma boa orientação terapêutica.
Caso clínico: JFPD, D. Crohn, [A1aL1B1G0], com antecedentes familiares positivos para a D. Crohn. Após quatro internamentos no último ano, surge com quadro de dor abdominal, tipo cólica, com mais de 5 dejeções/dia pastosas e líquidas, com presença de muco, sem sangue e com agravamento três dias antes do internamento, às quais se associam falsas vontades e diarreia. Medicado com azatioprina, messalazina, adalimumab e suplemento peptisorb®/fortimel®. Após discussão médico-cirúrgica realizou cirurgia passando 17,5 para 2,5 PCDAI após o procedimento cirúrgico. Atualmente em monoterapia com adalimumab, com boa evolução estado ponderal.
Discussão: De entre a terapêutica farmacológica, os novos agentes biológicos em monoterapia sobressaem com melhores outcomes clínicos e crescimento linear no primeiro ano quando comparados com terapêuticas como monoterapia com imunomodeladores.
Conclusão: As indicações terapêuticas são ainda extrapoladas de estudos realizados em adultos ou de estudos com número reduzido de doentes. Deste modo, sublinha-se a necessidade de mais investigação, para uma abordagem terapêutica adequada.
Introduction: The incidence of the Crohn disease in pediatric age has been increasing over the last few years. The initial correct diagnosis and description of the disease are crucial for a good therapeutic guidance. Clinical case: JFPD, Crohn disease, [A1aL1B1G0], having a positive family history as regards Crohn disease, and after four hospitalization episodes over the previous year, comes up with abdominal pain, cramp-like, with more than 5 pasty and liquid excretions per day (alternatively), with mucus, no blood, worsening three days prior to hospitalization, defecation overnight (around 5 times but in small quantity), associated with false need to defecate and diarrhea. Medicated with azathioprine, mesalazine, adalimumab and peptisorb®/fortimel® supplement. After medical-surgical discussion the surgery took place going from 17.5 to 2.5 PCDAI after surgical procedure. The patient is currently under monotherapy with adalimumab, evolving quite well. Discussion: Among the pharmacological therapy, the new biological agents in monotherapy stand out with better clinical outcomes and linear growth in the first year when compared to other therapeutics such as monotherapy with immunomodulators. Conclusion: The therapeutic indications are still extrapolated from studies carried out in adults or studies with a limited number of patients. The need for further studies is thus underlined in order to improve the therapeutic approach.
Introduction: The incidence of the Crohn disease in pediatric age has been increasing over the last few years. The initial correct diagnosis and description of the disease are crucial for a good therapeutic guidance. Clinical case: JFPD, Crohn disease, [A1aL1B1G0], having a positive family history as regards Crohn disease, and after four hospitalization episodes over the previous year, comes up with abdominal pain, cramp-like, with more than 5 pasty and liquid excretions per day (alternatively), with mucus, no blood, worsening three days prior to hospitalization, defecation overnight (around 5 times but in small quantity), associated with false need to defecate and diarrhea. Medicated with azathioprine, mesalazine, adalimumab and peptisorb®/fortimel® supplement. After medical-surgical discussion the surgery took place going from 17.5 to 2.5 PCDAI after surgical procedure. The patient is currently under monotherapy with adalimumab, evolving quite well. Discussion: Among the pharmacological therapy, the new biological agents in monotherapy stand out with better clinical outcomes and linear growth in the first year when compared to other therapeutics such as monotherapy with immunomodulators. Conclusion: The therapeutic indications are still extrapolated from studies carried out in adults or studies with a limited number of patients. The need for further studies is thus underlined in order to improve the therapeutic approach.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Doença de Crohn pediátrica Aimentação entérica Corticoterapia Azatioprina Infliximab Adalimumab