CROHN'S DISEASE IN THE 21ST CENTURY: IMMUNOPATHOPHYSIOLOGY AND MODERN HORIZONS OF DIAGNOSTICS

Abstract

Over the past twenty years, up to 15 cases of Crohn's disease were recorded at the Iashvili Children's Central Clinic. The study aimed to analyze 5 clinical instances registered in the recent past, determining gender and ethnic preferences, assessing patients using the Pediatric Crohn's Disease Severity Index, Montreal Classification, and Lehman Index, and to identify prognostic criteria.

Based on the analysis of the medical histories of five patients, we found that the disease was more common in females (3:2). Two patients had mild to moderate Crohn's disease (PCDAI score range - 10 - 37.5), their assessment according to the Montreal classification was A1L2 and A2L2. The Lehman Index, which shows the degree of damage to the digestive tract in Crohn's disease, was not determined due to the absence of surgical intervention. Three patients had a relatively severe form of Crohn's disease (PCDAI score range - >40), we confirmed the presence of fistula in two of them, and stricture in one of them by the Montreal classification. The Lehman index was approximately in the middle of the internationally recognized border - 0.2-12.6. Extraintestinal clinical manifestations such as anemia and arthritis were detected in the latter patients.

Conclusions. Our study showed that Crohn's disease is actively progressing in pediatric age. In the patients we studied who required surgical intervention, the disease was accompanied by various extraintestinal clinical manifestations. A high score of pediatric Crohn's disease severity, assessment of patients by the Montreal classification (various ALB variants) and a high Lehman index indicate a relatively more severe course of the disease and require careful treatment. The main line of treatment in patients with mild disease was prednisolone, and in patients with severe disease was infliximab.