vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i3.677vsp-326Research ArticleНЕПРЕРЫВНОЕ ПРОФЕССИОНАЛЬНОЕ ОБРАЗОВАНИЕPROFESSIONAL DEVELOPMENTКЛИНИЧЕСКАЯ КАРТИНА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЯЗВЕННОГО КОЛИТА У ДЕТЕЙ: РОССИЙСКИЙ ПЕДИАТРИЧЕСКИЙ КОНСЕНСУСCLINICAL MANIFESTATION, DIAGNOSTICS AND TREATMENT OF ULCERATIVE COLITIS IN CHILDREN: RUSSIAN PEDIATRIC CONSENSUSПотаповА. С.PotapovA. S.

Potapov Aleksandr Sergeevich, PhD, professor, Head ofthe Department of Gastroenterology and Hepathology of Scientific Center of Children’s Health, RAMS Address: Lomonosovskii prospect, 2, building 1, Moscow, RF, 119991, Tel.: (499) 134-06-93, email: potapov@nczd.ru

potapov@nczd.ruАлиеваЭ. И.AlievaE. I.potapov@nczd.ruГабрузскаяТ. В.GabruzskayaT. V.potapov@nczd.ruГореловА. В.GorelovA. V.potapov@nczd.ruЗахароваИ. Н.ZakharovaI. N.potapov@nczd.ruКорниенкоЕ. А.KornienkoE. А.potapov@nczd.ruПанфиловаВ. Н.PanfilovaV. N.potapov@nczd.ruПечкуровД. В.PechkurovD. V.potapov@nczd.ruРатниковаМ. А.RatnikovaM. A.potapov@nczd.ruРевноваМ. О.RevnovaM. O.potapov@nczd.ruСитниковаЕ. П.SitnikovaE. P.potapov@nczd.ruУрсоваН. И.UrsovaN. I.potapov@nczd.ruФедуловаЭ. Н.FedulovaE. N.potapov@nczd.ruЦимбаловаЕ. Г.TsimbalovaE. G.potapov@nczd.ruШумиловП. В.ShumilovP. V.potapov@nczd.ruЩербаковаО. В.ShcherbakovaO. V.potapov@nczd.ruЩиголеваН. Е.ShchigalevaN. E.potapov@nczd.ruНаучный центр здоровья детей РАМН, Москва,; Первый Московский государственный медицинский университет им. И.М. Сеченова,РоссияScientific Centre of Children Health of RAMS, Moscow; I.M. Sechenov First Moscow State Medical University,Russian FederationИзмайловская детская городская клиническая больница, МоскваРоссияIzmailovo Children Municipal Clinical Hospital, MoscowRussian FederationСанкт-Петербургская государственная педиатрическая медицинская академияРоссияSt. Petersburg State Pediatric Medical AcademyRussian FederationПервый Московский государственный медицинский университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian FederationРоссийская медицинская академия последипломного образования, МоскваРоссияRussian Medical Academy of Post-Graduate Education, MoscowRussian FederationСанкт-Петербургская государственная педиатрическая медицинская академияРоссияSt. Petersburg State Pediatric Medical Academy,Russian FederationКрасноярский государственный медицинский университет им. проф. В.Ф. Войно-ЯсенецкогоРоссияV.F. Voino-Yasenetsky Krasnoyarsk State Medical UniversityRussian FederationСамарский государственный медицинский университетРоссияYaroslavl State Medical AcademyRussian FederationСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian FederationМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияM.F. Vladimirsky Rostov Regional Scientific-Research Clinical InstituteRussian FederationНижегородский научно-исследовательский институт детской гастроэнтерологииРоссияNizhny Novgorod Scientific-Research Institute of Pediatric GastroenterologyRussian FederationНаучный центр здоровья детей РАМН, МоскваРоссияScientific Centre of Children Health of RAMS, MoscowRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова, МоскваРоссияN.I. Pirogov Russian National Research Medical University, MoscowRussian FederationРоссийская детская клиническая больница, МоскваРоссияRussian Children Clinical Hospital, MoscowRussian Federation201314052013123Вопросы современной педиатрии1830Copyright © Потапов А.С., Алиева Э.И., Габрузская Т.В., Горелов А.В., Захарова И.Н., Корниенко Е.А., Панфилова В.Н., Печкуров Д.В., Ратникова М.А., Ревнова М.О., Ситникова Е.П., Урсова Н.И., Федулова Э.Н., Цимбалова Е.Г., Шумилов П.В., Щербакова О.В., Щиголева Н.Е., 20132013Потапов А.С., Алиева Э.И., Габрузская Т.В., Горелов А.В., Захарова И.Н., Корниенко Е.А., Панфилова В.Н., Печкуров Д.В., Ратникова М.А., Ревнова М.О., Ситникова Е.П., Урсова Н.И., Федулова Э.Н., Цимбалова Е.Г., Шумилов П.В., Щербакова О.В., Щиголева Н.Е.Potapov A.S., Alieva E.I., Gabruzskaya T.V., Gorelov A.V., Zakharova I.N., Kornienko E.А., Panfilova V.N., Pechkurov D.V., Ratnikova M.A., Revnova M.O., Sitnikova E.P., Ursova N.I., Fedulova E.N., Tsimbalova E.G., Shumilov P.V., Shcherbakova O.V., Shchigaleva N.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/326

(Авторы: А.С. Потапов, Э.И. Алиева, Т.В. Габрузская, А.В. Горелов, И.Н. Захарова, Е.А. Корниенко, В.Н. Панфилова, Д.В. Печкуров, М.А. Ратникова, М.О. Ревнова, Е.П. Ситникова, Н.И. Урсова, Э.Н. Федулова, Е.Г. Цимбалова, П.В. Шумилов, О.В. Щербакова, Н.Е. Щиголева)

Язвенный колит — хроническое рецидивирующее воспалительное заболевание толстой кишки с распространением поражения непрерывно, от прямой кишки в проксимальном направлении. Язвенный колит у детей, несмотря на имеющиеся сходные признаки с таковым у взрослых больных, имеет ряд особенностей и отличий по характеру течения и ответу на терапию, в связи с чем в подходах к ведению детей нужно также учитывать эти особенности. В 2012 г. Европейской организацией по изучению болезни Крона и язвенного колита и Европейским обществом педиатрической гастроэнтерологии, гепатологии и питания на основе принципов доказательной медицины были разработаны совместные рекомендации по диагностике и лечению язвенного колита у детей. На основе Европейских рекомендаций группой ведущих детских гастроэнтерологов, занимающихся проблемой воспалительных заболеваний кишечника, с учетом российских особенностей и опыта ведения детей с язвенным колитом, был разработан и 15.02.2013 г. принят на Экспертном совете по разработке Российского консенсуса, прошедшем в рамках работы XVII съезда педиатров России, Российский консенсус по язвенному колиту у детей. В рекомендациях предложены стандартизированные протоколы, которые позволят проводить своевременную и эффективную диагностику, лечение и наблюдение детей с язвенным колитом. В то же время необходимо отметить, что данный консенсус не является догмой, и всегда следует учитывать индивидуальные особенности больного, а также новые научно обоснованные данные.а.

Ulcerative colitis is recurrent inflammatory disorder of the large intestine characterized by continuous expansion of bowel involvement, from the rectum to the proximal parts. Despite certain similar sign with adults, ulcerative colitis in children has a number of special features and distinctions to disease course and therapy response, therefore such peculiarities should be considered while choosing the management strategy. In 2012 European Crohn’s and Colitis Organisation and European Society for Pediatric Gastroenterology, Hepatology and Nutrition developed collaborated recommendations on diagnostics and treatment of ulcerative colitis in children based on the evidence-based medicine. On the base of European recommendations and with regard to Russian peculiarities and experience of management of children with ulcerative colitis the Russian Consensus on Ulcerative Colitis in children was developed by the group of the chief pediatric gastroenterologists specializing in inflammatory bowel diseases in children. This Consensus was approved on the 15th of February 2013 at the Expert Counsel on Development of the Russian Consensus, which took place during the XVII Summit of Pediatricians of Russia. These recommendations contain standardized protocols, which allow to provide timely and efficient diagnostics, treatment and follow-up of children with ulcerative colitis. It is necessary to mention, that this Consensus is not a doctrine and individual features of each patient and modern scientifically based data must be taken into account.

язвенный колитдетиклинические рекомендациидиагностика и лечениепедиатрический индекс активности язвенного колитаulcerative colitisclinical recommendationsdiagnosticstreatmentpediatric ulcerative colitis activity indexReferencesBenchimol E. I., Fortinsky K. J., Gozdyra P. et al. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm. Bowel. Dis. 2011; 17: 423–439.Benchimol E. I., Fortinsky K. J., Gozdyra P. et al. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm. Bowel. Dis. 2011; 17: 423–439.Henderson P., Hansen R., Cameron F. L. et al. Rising incidence of pediatric inflammatory bowel disease in Scotland. Inflamm. Bowel. Dis. 2012; 18: 999–1005.Henderson P., Hansen R., Cameron F. L. et al. Rising incidence of pediatric inflammatory bowel disease in Scotland. Inflamm. Bowel. Dis. 2012; 18: 999–1005.Heyman M. B., Kirschner B. S., Gold B. D. et al. Children with earlyonset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J. Pediatr. 2005; 146: 35–40.Heyman M. B., Kirschner B. S., Gold B. D. et al. Children with earlyonset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J. Pediatr. 2005; 146: 35–40.Van Limbergen J., Russell R. K., Drummond H. E. et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008; 135: 1114–1122.Van Limbergen J., Russell R. K., Drummond H. E. et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008; 135: 1114–1122.Gower-Rousseau C., Dauchet L., Vernier-Massouille G. et al. The natural history of pediatric ulcerative colitis: a population-based cohort study. Am. J. Gastroenterol. 2009; 104: 2080–2088.Gower-Rousseau C., Dauchet L., Vernier-Massouille G. et al. The natural history of pediatric ulcerative colitis: a population-based cohort study. Am. J. Gastroenterol. 2009; 104: 2080–2088.Travis S. P. L., Stange E. F., Leґmann M. et al. European evidencebased consensus on the management of ulcerative colitis: current management. J. Crohn Colitis. 2008; 2: 24–62.Travis S. P. L., Stange E. F., Leґmann M. et al. European evidencebased consensus on the management of ulcerative colitis: current management. J. Crohn Colitis. 2008; 2: 24–62.Turner D., Travis S. P., Griffiths A. M. et al. Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBDWorking Group of ESPGHAN. Am. J. Gastroenterol. 2011; 106: 574–588.Turner D., Travis S. P., Griffiths A. M. et al. Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBDWorking Group of ESPGHAN. Am. J. Gastroenterol. 2011; 106: 574–588.Glickman J. N., Bousvaros A., Farraye F. A. et al. Pediatric patients with untreated ulcerative colitis may present initially with unusual morphologic findings. Am. J. Surg. Pathol. 2004; 28: 190–197.Glickman J. N., Bousvaros A., Farraye F. A. et al. Pediatric patients with untreated ulcerative colitis may present initially with unusual morphologic findings. Am. J. Surg. Pathol. 2004; 28: 190–197.Levine A., de Bie C. L., Turner D. et al. Atypical disease phenotypes in paediatric ulcerative colitis: 5-year analyses of the EUROKIDS registry. Inflamm. Bowel. Dis. 2012 [Epub ahead of print].Levine A., de Bie C. L., Turner D. et al. Atypical disease phenotypes in paediatric ulcerative colitis: 5-year analyses of the EUROKIDS registry. Inflamm. Bowel. Dis. 2012 [Epub ahead of print].Robert M. E., Tang L., Hao L. M. et al. Patterns of inflammation in mucosal biopsies of ulcerative colitis: perceived differences in pediatric populations are limited to children younger than 10 years. Am. J. Surg. Pathol. 2004; 28: 183–189.Robert M. E., Tang L., Hao L. M. et al. Patterns of inflammation in mucosal biopsies of ulcerative colitis: perceived differences in pediatric populations are limited to children younger than 10 years. Am. J. Surg. Pathol. 2004; 28: 183–189.Haskell H., Andrews C. W., Jr., Reddy S. I. et al. Pathologic features and clinical significance of «backwash» ileitis in ulcerative colitis. Am. J. Surg. Pathol. 2005; 29: 1472–1481.Haskell H., Andrews C. W., Jr., Reddy S. I. et al. Pathologic features and clinical significance of «backwash» ileitis in ulcerative colitis. Am. J. Surg. Pathol. 2005; 29: 1472–1481.de Bie C. I., Buderus S., Sandhu B. K. et al. Diagnostic workup of paediatric patients with inflammatory bowel disease in Europe: results of a 5-year audit of the EUROKIDS registry. J. Pediatr. Gastroenterol. Nutr. 2012; 54: 374–380.de Bie C. I., Buderus S., Sandhu B. K. et al. Diagnostic workup of paediatric patients with inflammatory bowel disease in Europe: results of a 5-year audit of the EUROKIDS registry. J. Pediatr. Gastroenterol. Nutr. 2012; 54: 374–380.Koletzko S., Niggemann B., Arato A. et al. Diagnostic approach and management of cow’s milk protein allergy in infants and children: a practical guideline of the GI-committee of ESPGHAN. J Pediatr Gastroenterol Nutr. 2012; 55: 221–229.Koletzko S., Niggemann B., Arato A. et al. Diagnostic approach and management of cow’s milk protein allergy in infants and children: a practical guideline of the GI-committee of ESPGHAN. J Pediatr Gastroenterol Nutr. 2012; 55: 221–229.Glocker E. O., Frede N., Perro M. et al. Infant colitis — it’s in the genes. Lancet. 2010; 376: 1272. 15. Glocker E. O., Kotlarz D., Boztug K. et al. Inflammatory bowel disease and mutations affecting the interleukin-10 receptor. N. Engl. J. Med. 2009; 361: 2033–2045.Glocker E. O., Frede N., Perro M. et al. Infant colitis — it’s in the genes. Lancet. 2010; 376: 1272. 15. Glocker E. O., Kotlarz D., Boztug K. et al. Inflammatory bowel disease and mutations affecting the interleukin-10 receptor. N. Engl. J. Med. 2009; 361: 2033–2045.Begue B., Verdier J., Rieux-Laucat F. et al. Defective IL10 signaling defining a subgroup of patients with inflammatory bowel disease. Am. J. Gastroenterol. 2011; 106: 1544–1555.Begue B., Verdier J., Rieux-Laucat F. et al. Defective IL10 signaling defining a subgroup of patients with inflammatory bowel disease. Am. J. Gastroenterol. 2011; 106: 1544–1555.Beattie R. M., Nicholls S. W., Domizio P. et al. Endoscopic assessment of the colonic response to corticosteroids in children with ulcerative colitis. J. Pediatr. Gastroenterol. Nutr. 1996; 22: 373–379.Beattie R. M., Nicholls S. W., Domizio P. et al. Endoscopic assessment of the colonic response to corticosteroids in children with ulcerative colitis. J. Pediatr. Gastroenterol. Nutr. 1996; 22: 373–379.Mack D. R., Langton C., Markowitz J. et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics. 2007; 119: 1113–1119.Mack D. R., Langton C., Markowitz J. et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics. 2007; 119: 1113–1119.Weinstein T. A., Levine M., Pettei M. J. et al. Age and family history at presentation of pediatric inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 2003; 37: 609–613.Weinstein T. A., Levine M., Pettei M. J. et al. Age and family history at presentation of pediatric inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 2003; 37: 609–613.Henderson P., Casey A., Lawrence S. J. et al. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease. Am. J. Gastroenterol. 2012; 107: 941–949.Henderson P., Casey A., Lawrence S. J. et al. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease. Am. J. Gastroenterol. 2012; 107: 941–949.Venediktova M. M., Tsimbalova E. G., Potapov A. S., Mayanskii N. A. Voprosi diagnostiki v pediatrii — Diagnostics in pediatrics. 2011; 3 (6): 23–26.Venediktova M. M., Tsimbalova E. G., Potapov A. S., Mayanskii N. A. Voprosi diagnostiki v pediatrii — Diagnostics in pediatrics. 2011; 3 (6): 23–26.Turner D., Leach S. T., Mack D. et al. Faecal calprotectin, lactoferrin, M2-pyruvate kinase and S100A12 in severe ulcerative colitis: a prospective multicentre comparison of predicting outcomes and monitoring response. Gut. 2010; 59: 1207–1212.Turner D., Leach S. T., Mack D. et al. Faecal calprotectin, lactoferrin, M2-pyruvate kinase and S100A12 in severe ulcerative colitis: a prospective multicentre comparison of predicting outcomes and monitoring response. Gut. 2010; 59: 1207–1212.Sylvester F. A., Turner D., Draghi A., 2nd et al. Fecal osteoprotegerin may guide the introduction of second-line therapy in hospitalized children with ulcerative colitis. Inflamm. Bowel. Dis. 2011; 17: 1726–1730.Sylvester F. A., Turner D., Draghi A., 2nd et al. Fecal osteoprotegerin may guide the introduction of second-line therapy in hospitalized children with ulcerative colitis. Inflamm. Bowel. Dis. 2011; 17: 1726–1730.Harris M. S., Lichtenstein G. R. Review article: delivery and efficacy of topical 5-aminosalicylic acid (mesalazine) therapy in the treatment of ulcerative colitis. Aliment. Pharmacol. Ther. 2011; 33: 996–1009.Harris M. S., Lichtenstein G. R. Review article: delivery and efficacy of topical 5-aminosalicylic acid (mesalazine) therapy in the treatment of ulcerative colitis. Aliment. Pharmacol. Ther. 2011; 33: 996–1009.Lichtenstein G. R., Kamm M. A. Review article: 5-aminosalicylate formulations for the treatment of ulcerative colitis — methods of comparing release rates and delivery of 5-aminosalicylate to the colonic mucosa. Aliment. Pharmacol. Ther. 2008; 28: 663–673.Lichtenstein G. R., Kamm M. A. Review article: 5-aminosalicylate formulations for the treatment of ulcerative colitis — methods of comparing release rates and delivery of 5-aminosalicylate to the colonic mucosa. Aliment. Pharmacol. Ther. 2008; 28: 663–673.Sutherland L., Macdonald J. K. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2006: CD000543.Sutherland L., Macdonald J. K. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2006: CD000543.Sutherland L., Macdonald J. K. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2006: CD000544.Sutherland L., Macdonald J. K. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2006: CD000544.Odera G., Giuliani B., Santini B. et al. Topical treatment with 5-SA and hydrocortisone. Riv. Ital. Pediatr. 1986; 12: 674–678.Odera G., Giuliani B., Santini B. et al. Topical treatment with 5-SA and hydrocortisone. Riv. Ital. Pediatr. 1986; 12: 674–678.Ford A. C., Khan K. J., Sandborn W. J. et al. Efficacy of topical 5-aminosalicylates in preventing relapse of quiescent ulcerative colitis: a meta-analysis. Clin. Gastroenterol. Hepatol. 2012; 10: 513–519.Ford A. C., Khan K. J., Sandborn W. J. et al. Efficacy of topical 5-aminosalicylates in preventing relapse of quiescent ulcerative colitis: a meta-analysis. Clin. Gastroenterol. Hepatol. 2012; 10: 513–519.Kolho K. L., Raivio T., Lindahl H. et al. Fecal calprotectin remains high during glucocorticoid therapy in children with inflammatory bowel disease. Scand. J. Gastroenterol. 2006; 41: 720–725.Kolho K. L., Raivio T., Lindahl H. et al. Fecal calprotectin remains high during glucocorticoid therapy in children with inflammatory bowel disease. Scand. J. Gastroenterol. 2006; 41: 720–725.Powell-Tuck J., Bown R. L., Lennard-Jones J. E. A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis. Scand. J. Gastroenterol. 1978; 13: 833–837.Powell-Tuck J., Bown R. L., Lennard-Jones J. E. A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis. Scand. J. Gastroenterol. 1978; 13: 833–837.Uchida K., Araki T., Toiyama Y. et al. Preoperative steroid-related complications in Japanese pediatric patients with ulcerative colitis. Dis. Colon Rectum. 2006; 49: 74–79.Uchida K., Araki T., Toiyama Y. et al. Preoperative steroid-related complications in Japanese pediatric patients with ulcerative colitis. Dis. Colon Rectum. 2006; 49: 74–79.Gionchetti P., Rizzello F., Ferrieri A. et al. Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroidtreatment: a double-blind, placebo-controlled trial. Dig. Dis. Sci. 1999; 44: 1220–1221.Gionchetti P., Rizzello F., Ferrieri A. et al. Rifaximin in patients with moderate or severe ulcerative colitis refractory to steroidtreatment: a double-blind, placebo-controlled trial. Dig. Dis. Sci. 1999; 44: 1220–1221.Ohkusa T., Kato K., Terao S. et al. Newly developed antibiotic combination therapy for ulcerative colitis: a double-blind placebo-controlled multicenter trial. Am. J. Gastroenterol. 2010; 105: 1820–1829.Ohkusa T., Kato K., Terao S. et al. Newly developed antibiotic combination therapy for ulcerative colitis: a double-blind placebo-controlled multicenter trial. Am. J. Gastroenterol. 2010; 105: 1820–1829.Timmer A., McDonald J. W., Macdonald J. K. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2007: CD000478.Timmer A., McDonald J. W., Macdonald J. K. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2007: CD000478.Gisbert J. P., Linares P. M., McNicholl A. G. et al. Meta-analysis: the efficacy of azathioprine and mercaptopurine in ulcerative colitis. Aliment. Pharmacol. Ther. 2009; 30: 126–137.Gisbert J. P., Linares P. M., McNicholl A. G. et al. Meta-analysis: the efficacy of azathioprine and mercaptopurine in ulcerative colitis. Aliment. Pharmacol. Ther. 2009; 30: 126–137.Khan K. J., Dubinsky M. C., Ford A. C. et al. Efficacy of immunosuppressive therapy for inflammatory bowel disease: a systematic review and meta-analysis. Am. J. Gastroenterol. 2011; 106: 630–642.Khan K. J., Dubinsky M. C., Ford A. C. et al. Efficacy of immunosuppressive therapy for inflammatory bowel disease: a systematic review and meta-analysis. Am. J. Gastroenterol. 2011; 106: 630–642.Barabino A., Torrente F., Ventura A. et al. Azathioprine in paediatric inflammatory bowel disease: an Italian multicentre survey. Aliment. Pharmacol. Ther. 2002; 16: 1125–1130.Barabino A., Torrente F., Ventura A. et al. Azathioprine in paediatric inflammatory bowel disease: an Italian multicentre survey. Aliment. Pharmacol. Ther. 2002; 16: 1125–1130.Kader H. A., Mascarenhas M. R., Piccoli D. A. et al. Experiences with 6-mercaptopurine and azathioprine therapy in pediatric patients with severe ulcerative colitis. J. Pediatr. Gastroenterol. Nutr. 1999; 28: 54–58.Kader H. A., Mascarenhas M. R., Piccoli D. A. et al. Experiences with 6-mercaptopurine and azathioprine therapy in pediatric patients with severe ulcerative colitis. J. Pediatr. Gastroenterol. Nutr. 1999; 28: 54–58.Verhave M., Winter H. S., Grand R. J. Azathioprine in the treatment of children with inflammatory bowel disease. J. Pediatr. 1990; 117: 809–814.Verhave M., Winter H. S., Grand R. J. Azathioprine in the treatment of children with inflammatory bowel disease. J. Pediatr. 1990; 117: 809–814.Pozler O., Chladek J., Maly J. et al. Steady-state of azathioprine during initiation treatment of pediatric inflammatory bowel disease. J. Crohns Colitis. 2010; 4: 623–628.Pozler O., Chladek J., Maly J. et al. Steady-state of azathioprine during initiation treatment of pediatric inflammatory bowel disease. J. Crohns Colitis. 2010; 4: 623–628.Sandborn W. J. A review of immune modifier therapy for inflam matory bowel disease: azathioprine, 6-mercaptopurine, cyclosporine, and methotrexate. Am. J. Gastroenterol. 1996; 91: 423–433.Sandborn W. J. A review of immune modifier therapy for inflam matory bowel disease: azathioprine, 6-mercaptopurine, cyclosporine, and methotrexate. Am. J. Gastroenterol. 1996; 91: 423–433.De Greef E., Vandenplas Y., Veereman-Wauters G. Opportunistic infections in paediatric inflammatory bowel disease patients. Arch. Dis. Child. 2011; 91: 5–7.De Greef E., Vandenplas Y., Veereman-Wauters G. Opportunistic infections in paediatric inflammatory bowel disease patients. Arch. Dis. Child. 2011; 91: 5–7.Russell R. K., Wilson M. L., Loganathan S. et al. A British Society of Paediatric Gastroenterology, Hepatology and Nutrition survey of the effectiveness and safety of adalimumab in children with inflammatory bowel disease. Aliment. Pharmacol. Ther. 2011; 33: 946–953.Russell R. K., Wilson M. L., Loganathan S. et al. A British Society of Paediatric Gastroenterology, Hepatology and Nutrition survey of the effectiveness and safety of adalimumab in children with inflammatory bowel disease. Aliment. Pharmacol. Ther. 2011; 33: 946–953.Turner D., Griffiths A. M. Acute severe ulcerative colitis in children: a systematic review. Inflamm. Bowel. Dis. 2011; 17: 40–449.Turner D., Griffiths A. M. Acute severe ulcerative colitis in children: a systematic review. Inflamm. Bowel. Dis. 2011; 17: 40–449.Lawson M. M., Thomas A. G., Akobeng A. K. Tumour necrosis factor alpha blocking agents for induction of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2006: CD005112.Lawson M. M., Thomas A. G., Akobeng A. K. Tumour necrosis factor alpha blocking agents for induction of remission in ulcerative colitis. Cochr. Database Syst. Rev. 2006: CD005112.Rutgeerts P., Sandborn W. J., Feagan B. G. et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N. Engl. J. Med. 2005; 353: 2462–2476.Rutgeerts P., Sandborn W. J., Feagan B. G. et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N. Engl. J. Med. 2005; 353: 2462–2476.Hyams J., Damaraju L., Blank M. et al. Induction and maintenance therapy with infliximab for children with moderate to severe ulcerative colitis. Clin. Gastroenterol. Hepatol. 2012; 10: 391–399.Hyams J., Damaraju L., Blank M. et al. Induction and maintenance therapy with infliximab for children with moderate to severe ulcerative colitis. Clin. Gastroenterol. Hepatol. 2012; 10: 391–399.Baranov A. A., Potapov A. S., Tsimbalova E. G. Vestnik Rossiiskoi akademii meditsinskikh nauk — Annals of the Russian Academy of Medical Sciences. 2011; 6: 36–41.Baranov A. A., Potapov A. S., Tsimbalova E. G. Vestnik Rossiiskoi akademii meditsinskikh nauk — Annals of the Russian Academy of Medical Sciences. 2011; 6: 36–41.Hyams J. S., Lerer T., Griffiths A. et al. Outcome following infliximab therapy in children with ulcerative colitis. Am. J. Gastroenterol. 2010; 105: 1430–1436.Hyams J. S., Lerer T., Griffiths A. et al. Outcome following infliximab therapy in children with ulcerative colitis. Am. J. Gastroenterol. 2010; 105: 1430–1436.Panaccione R., Ghosh S., Middleton S. et al. Infliximab, azathioprine or infliximabюazathioprine for treatment of moderate to severe ulcerative colitis. The UC SUCCESS trial. J. Crohns Colitis. 2011; 5: 13.Panaccione R., Ghosh S., Middleton S. et al. Infliximab, azathioprine or infliximabюazathioprine for treatment of moderate to severe ulcerative colitis. The UC SUCCESS trial. J. Crohns Colitis. 2011; 5: 13.Lichtenstein G. R., Diamond R. H., Wagner C. L. et al. Clinical trial: benefits and risks of immunomodulators and maintenance infliximab for IBD-subgroup analyses across four randomized trials. Aliment. Pharmacol. Ther. 2009; 30: 210–226.Lichtenstein G. R., Diamond R. H., Wagner C. L. et al. Clinical trial: benefits and risks of immunomodulators and maintenance infliximab for IBD-subgroup analyses across four randomized trials. Aliment. Pharmacol. Ther. 2009; 30: 210–226.Chaparro M., Guerra I., Munoz-Linares P. et al. Systematic review: antibodies and anti-TNF-alpha levels in inflammatory bowel disease. Aliment. Pharmacol. Ther. 2012; 35: 971–986.Chaparro M., Guerra I., Munoz-Linares P. et al. Systematic review: antibodies and anti-TNF-alpha levels in inflammatory bowel disease. Aliment. Pharmacol. Ther. 2012; 35: 971–986.Bernstein C. N., Fried M., Krabshuis J. H. et al. World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010. Inflamm. Bowel. Dis. 2010; 16: 112–124.Bernstein C. N., Fried M., Krabshuis J. H. et al. World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010. Inflamm. Bowel. Dis. 2010; 16: 112–124.Gonzalez-Huix F., Fernandez-Banares F., Esteve-Comas M. et al. Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis. Am. J. Gastroenterol. 1993; 88: 227–232.Gonzalez-Huix F., Fernandez-Banares F., Esteve-Comas M. et al. Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis. Am. J. Gastroenterol. 1993; 88: 227–232.McIntyre P. B., Powell-Tuck J., Wood S. R. et al. Controlled trial of bowel rest in the treatment of severe acute colitis. Gut. 1986; 27: 481–485.McIntyre P. B., Powell-Tuck J., Wood S. R. et al. Controlled trial of bowel rest in the treatment of severe acute colitis. Gut. 1986; 27: 481–485.Dickinson R. J., Ashton M. G., Axon A. T. et al. Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology. 1980; 79: 1199–1204.Dickinson R. J., Ashton M. G., Axon A. T. et al. Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology. 1980; 79: 1199–1204.Barabino A., Tegaldo L., Castellano E. et al. Severe attack of ulcerative colitis in children: retrospective clinical survey. Dig. Liver Dis. 2002; 34: 44–49.Barabino A., Tegaldo L., Castellano E. et al. Severe attack of ulcerative colitis in children: retrospective clinical survey. Dig. Liver Dis. 2002; 34: 44–49.Bechtold S., Alberer M., Arenz T. et al. Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease. Inflamm. Bowel Dis. 2010; 16: 216–225.Bechtold S., Alberer M., Arenz T. et al. Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease. Inflamm. Bowel Dis. 2010; 16: 216–225.Werkstetter K. J., Pozza S. B., Filipiak-Pittroff B. et al. Long-term development of bone geometry and muscle in pediatric inflammatory bowel disease. Am. J. Gastroenterol. 2011; 106: 988–998.Werkstetter K. J., Pozza S. B., Filipiak-Pittroff B. et al. Long-term development of bone geometry and muscle in pediatric inflammatory bowel disease. Am. J. Gastroenterol. 2011; 106: 988–998.Gokhale R., Favus M. J., Karrison T. et al. Bone mineral density assessment in children with inflammatory bowel disease. Gastroenterology. 1998; 114: 902–911.Gokhale R., Favus M. J., Karrison T. et al. Bone mineral density assessment in children with inflammatory bowel disease. Gastroenterology. 1998; 114: 902–911.Sylvester F. A., Wyzga N., Hyams J. S. et al. Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease. Inflamm. Bowel. Dis. 2007; 13: 42–50.Sylvester F. A., Wyzga N., Hyams J. S. et al. Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease. Inflamm. Bowel. Dis. 2007; 13: 42–50.Walther F., Fusch C., Radke M. et al. Osteoporosis in pediatric patients suffering from chronic inflammatory bowel disease with and without steroid treatment. J. Pediatr. Gastroenterol. Nutr. 2006; 43: 42–51.Walther F., Fusch C., Radke M. et al. Osteoporosis in pediatric patients suffering from chronic inflammatory bowel disease with and without steroid treatment. J. Pediatr. Gastroenterol. Nutr. 2006; 43: 42–51.Pappa H., Thayu M., Sylvester F. et al. Skeletal health of children and adolescents with inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 2011; 53: 11–25.Pappa H., Thayu M., Sylvester F. et al. Skeletal health of children and adolescents with inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 2011; 53: 11–25.Greenley R. N., Stephens M., Doughty A. et al. Barriers to adherence among adolescents with inflammatory bowel disease. Inflamm. Bowel. Dis. 2010; 16: 36–41.Greenley R. N., Stephens M., Doughty A. et al. Barriers to adherence among adolescents with inflammatory bowel disease. Inflamm. Bowel. Dis. 2010; 16: 36–41.Hommel K. A., Denson L. A., Baldassano R. N. Oral medication adherence and disease severity in pediatric inflammatory bowel disease. Eur. J. Gastroenterol. Hepatol. 2011; 23: 250–254.Hommel K. A., Denson L. A., Baldassano R. N. Oral medication adherence and disease severity in pediatric inflammatory bowel disease. Eur. J. Gastroenterol. Hepatol. 2011; 23: 250–254.Hommel K. A., Baldassano R. N. Barriers to treatment adherence in pediatric inflammatory bowel disease. J. Pediatr. Psychol. 2010; 35: 1005–1010.Hommel K. A., Baldassano R. N. Barriers to treatment adherence in pediatric inflammatory bowel disease. J. Pediatr. Psychol. 2010; 35: 1005–1010.Reed-Knight B., Lewis J. D., Blount R. L. Association of disease, adolescent, and family factors with medication adherence in pediatric inflammatory bowel disease. J. Pediatr. Psychol. 2011; 36: 308–317.Reed-Knight B., Lewis J. D., Blount R. L. Association of disease, adolescent, and family factors with medication adherence in pediatric inflammatory bowel disease. J. Pediatr. Psychol. 2011; 36: 308–317.Cassinotti A., Actis G. C., Duca P. et al. Maintenance treatment with azathioprine in ulcerative colitis: outcome and predictive factors after drug withdrawal. Am. J. Gastroenterol. 2009; 104: 2760–2767.Cassinotti A., Actis G. C., Duca P. et al. Maintenance treatment with azathioprine in ulcerative colitis: outcome and predictive factors after drug withdrawal. Am. J. Gastroenterol. 2009; 104: 2760–2767.Actis G. C., Fadda M., Pellicano R. et al. The 17-year singlecenter experience with the use of azathioprine to maintain remission in ulcerative colitis. Biomed. Pharmacother. 2009; 63: 362–365.Actis G. C., Fadda M., Pellicano R. et al. The 17-year singlecenter experience with the use of azathioprine to maintain remission in ulcerative colitis. Biomed. Pharmacother. 2009; 63: 362–365.Turner D., Otley A. R., Mack D. et al. Development and evaluation of a Pediatric Ulcerative Colitis Activity Index (PUCAI): a prospective multicenter study. Gastroenterology. 2007; 133: 423–432.Turner D., Otley A. R., Mack D. et al. Development and evaluation of a Pediatric Ulcerative Colitis Activity Index (PUCAI): a prospective multicenter study. Gastroenterology. 2007; 133: 423–432.

The authors declare that there are no conflicts of interest present.