Page 68 - Proceeding of Plenary Abstract of Parallel Symposim

GASTROHEPATOLOGI

Inflammatory Bowel Disease and Long Term Adolecent Health

Hasri Salwan
Department of Child Health, Medical Faculty, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
Abstract
Background Inflammatory Bowel Disease (IBD), which consists of Crohn's disease and ulcerative colitis,
is a chronic inflammatory disease of the gastrointestinal tract (GIT). This disease is rare, but the incidence
is recently increasing in developed countries. This disease generally affects adults and adolescents, but does
not rule out children. Discussion The multifactorial roles in etiology and pathogenesis of IBD are genetic,
immunological, and environmental factors, make difficult to eliminate. The clinical picture does not only
occur in the GIT but also involves other organs. The GIT pathology in the Crohn's disease occur from the
mouth to the anus, from the mucous to serous layer, whereas Ulcerative Colitis occurs only in the mucosa
and submucosa layer of colon. The treatment is both supportive and symptomatic. Symptomatic treatment
is given depending on the symptoms and response to the therapy. The therapeutic approach ranges from
aminosalicylate to immunosuppression. Therapeutic approach in severe cases is progressive until full remission
is achieved. The prognosis of IBD is characterized by periods of remission and exacerbation. Almost all cases
of IBD will experience relapse after initial diagnosis and treatment. The long-term sequel of IBD may differ
between children and adults. IBD in children tend to have more extensive and severe disease than adults.
IBD presenting in childhood interferes with growth, education, and employment as well as psychosocial
and sexual development, frequently delaying adolescent development milestones. At 8 years from diagnosis,
most patients have active disease and quality of life is slightly lower than in the rest of population. Long-term
outcome majority of patients evolved to complicated behavior. The surgery rate has decrease over time, and
early use modern medication was related to its decrease.
Keywords: IBD, multifactorial; symptomatic treatment; long-term effect

Social Changes Leading to New Challenges in Pediatric Gastrohepatology

Hanifah Oswari
Department of Child Health, Faculty of Medicine Universitas Indonesia /Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Abstract
Background Several social changes have a high impact and provide important challenges in pediatric
gastrohepatology. These changes may lead to diseases or disorders such as Non-alcoholic fatty liver disease
(NAFLD), inflammatory bowel diseases (IBD), and functional abdominal pain disorders (FAPD).
Objective This presentation will focus on diagnosis strategy and therapeutic option available for these 3
challenges in pediatric gastroenterology and hepatology. Discussion Increasing rates of childhood obesity
led to higher rates of NAFLD in developing country. NAFLD has now become the most frequent cause of
chronic liver disease in children. NAFLD comprises a broad spectrum of liver damage, from simple steatosis,
which is benign and reversible, to more severe forms of the disease, such as non-alcoholic steatohepatitis
(NASH), which can lead to liver fibrosis, cirrhosis, hepatic failure, and hepatocellular carcinoma. However,
NAFLD is still under diagnosed in children. Therapy for NAFLD in children are still limited. IBD comprises
Crohn disease (CD), ulcerative colitis (UC), and IBD unclassified. Higher rates of IBD have been seen in
many countries. IBD is a chronic immune disorder of unclear etiology. The introduction of the Western diet
which is high in fat and protein and low in fruits and vegetables have been proposed as an explanation for
the increase in IBD incidence in previously low incidence countries. These changes of IBD pattern mean
that many children are being diagnosed as IBD and need therapy. Pediatric FAPD comprises irritable bowel
syndrome (IBS), functional dyspepsia (FD), abdominal migraine (AM), and functional abdominal pain not
otherwise specified (FAP-NOS). Around 93% FAPD patient was identified at least one food and/or food
type as worsening gastrointestinal symptoms. Up to 50% of children with FAPD are also reported to have
clinically relevant anxiety or depression. IBS was found to be the highest prevalence in Asia. Many patients
with FGID report gastrointestinal symptoms to be meal related. Diagnosis FAPD is challenging. The available
pharmacological interventions are limited in children. However, there are many options available to treat these
disorders, including non-pharmacological interventions.

Kongres Nasional Ilmu Kesehatan Anak XVIII 53