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Background Recently published paediatric guidelines for diagnosing coeliac disease do not include recommendations on the follow-up of coeliac disease patients. Goal The aim of this study was to assess the management practices and experience of coeliac disease patients with their follow-up appointments in Central Europe. Study Gastroenterologists and coeliac disease patients in five Central European countries were asked to complete the web-based questionnaire focusing on coeliac disease management practices. Results Answers from 147 gastroenterologists and 2041 coeliac disease patients were available for the analysis. More than half of the gastroenterologists (58.5%) schedule the first follow-up visit within 3 months after the diagnosis. At follow-up, tissue transglutaminase antibodies are checked in almost all patients (95.9%). Approximately two-thirds (60.7%) of gastroenterologists refer all of their patients to the dietitian at diagnosis. Similarly, 42.8% of coeliac disease patients reported that they had not been appointed to a dietitian. Almost one-third of coeliac disease patients (30.8%) reported that they had no follow-up appointments with gastroenterologist at all. Conclusions Follow-up of coeliac disease patients is suboptimal in Central Europe. Many patients are not followed regularly. A lot of patients are not referred to a dietitian. The recommendations on the optimal follow-up of coeliac disease patients are needed in order to improve patient care.

The influence of vegetarian and vegan diet on children’s health has been discussed not only by pediatricians but also by other professionals who take care of children. Therefore, the aim of this recommendations, based on presented and summarized scientific evidences on the effect of vegetarian and vegan diet on children’s and adolescents’ health, was to state the instructions of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association. Vegetarian, and especially vegan diet, is not only the omission of meat and other food of animal origin, but has to represent balanced nutrition adjusted for children. Such a child requires continuous supervision not only by primary health physician but also by pediatric nutritionist, who both have to be specially educated in the field. As restrictions in diet significantly increase the risk for nutritional deficiencies, parents who decide to follow such a diet, and all professionals who take care of such children, have to be aware of possible nutritional risks that are much bigger than in adulthood.

Cilj: Osvijestiti o mogućnosti postojanja sindroma Rapunzel u adolescentica s akutnim pankreatitisom. Prikaz slučaja: U hitnu pedijatrijsku ambulantu javila se petnaestogodišnja djevojka zbog povremenih bolova u gornjem dijelu abdomena koji su se intenzivirali par dana pred dolazak. Prilikom fizikalnog pregleda nađena je u epigastriju i lijevom hipohondriju bolna rezistencija veličine otprilike 10 cm u promjeru. Opsežnom laboratorijskom analizom našle su se povišene koncentracije enzima gušterače te se postavila dijagnoza akutnog pankreatitisa. Daljnjom obradom indicirala se gastroskopija kojom se prikazala masa kose na ulazu u želudac. Kompjutoriziranom tomografijom uočilo se da ona seže sve do bulbusa duodenuma. Nakon provedenog konzervativnog liječenja pankreatitisa abdominalni bolovi su regredirali, došlo je do normalizacije enzima gušterače te je bilo indicirano operativno liječenje. Učinila se eksplorativna laparotomija i gastrotomija. Ekstirpirao se trihobezoar težine 1 kg i dužine 25 cm oblika odljeva lumena želuca i početnog dijela duodenuma. Postavila se dijagnoza sindroma Rapunzel. Dječji psihijatar potvrdio je prisutnu trihotilomaniju i trihofagiju te se djevojku uključilo u psihoterapijski tretman. Zaključak: Sindrom Rapunzel vrlo je rijetko stanje, ali treba biti uključeno u diferencijalnu dijagnozu akutnog pankreatitisa u adolescenata. Specifični simptomi trihotilomanije i trihofagije u kombinaciji s nespecifičnim simptomima, poput dugotrajnog bola u abdomenu, trebali bi pobuditi sumnju na razvoj trihobezoara., Aim: To raise awareness about the existence of Rapunzel syndrome in female adolescents with acute pancreatitis. Case report: A 15-year-old girl came to the emergency pediatric clinic due to the occasional pain in the upper abdomen, which had intensified a few days before her arrival. During physical examination, a painful resistance of approximately 10 cm in diameter was palpated in the epigastrium and the right hypochondrium. Extensive laboratory analysis revealed raised concentrations of pancreatic enzymes so a diagnosis of acute pancreatitis was made. Further examination indicated gastroscopy, which showed a mass of hair at the entrance to the stomach. Computed tomography revealed that the mass reached all the way to the duodenal bulbus. After the conservative treatment of pancreatitis, the abdominal pain regresses and the pancreatic enzymes returned to normal so the operative treatment was indicated. Exploratory laparotomy and gastrotomy were performed. A kilogram heavy and 25 cm long trichobezoar in the shape of the gastric lumen and the initial part of the duodenum were exploited. Rapunzel syndrome was diagnosed. The child psychiatrist confirmed the presence of trichotillomania and trichophagia, so the girl was referred to the psychotherapy treatment. Conclusion: Rapunzel syndrome is a very rare condition but should be included in the differential diagnosis of acute pancreatitis in adolescents. Specific symptoms of trichotillomania and trichophagia in combination with non-specific symptoms such as prolonged abdominal pain should raise the suspicion of the development of trichobezoars.

OBJECTIVES: During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to nonclassical, oligosymptomatic, and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe. METHODS: Paediatric gastroenterologists in 5 countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analyzed and the differences among very young (

Pediatric inflammatory bowel disease (IBD) presents with extensive phenotype. The aim of this study was to determine the phenotype of pediatric IBD patients in Croatia at diagnosis and follow-up.Children were prospectively recruited into Croatian IBD national registry. Data on diagnostic evaluation, therapy and 1-year follow-up were collected.A total of 51 newly diagnosed patients were recruited (19 Crohn's disease (CD), 28 ulcerative colitis (UC) and 4 IBD-unclassified (IBD-U)). Most common location in CD was ileocolonic disease (52.6%), and pancolitis in UC (53.6%). The recommended complete diagnostic algorithm was performed only in 29.4% of patients. First-line therapy used in CD was exclusive enteral nutrition for remission induction (84.2%) and azathioprine for maintenance (73.7%). In patients with UC, aminosalicylates were the most common drug used (89.3%). By the end of the first year 41.2% of CD and 53.9% of UC patients had one or more relapses and required treatment escalation.Our data confirm extensive intestinal involvement in pediatric IBD and relatively high relapse rate during the first year of follow-up. More effort should be invested on the national level to implement more stringent adherence to the current European guidelines.The key message of our article is that pediatric IBD in Croatia shows extensive intestinal involvement with high relapse rates in first year of follow-up. It is the first cohort study reporting on the phenotype of pediatric IBD in Croatia, but also investigates adherence to diagnostic and therapeutic European guidelines which is not commonly reported. The study is national based, thus having the greatest impact on Croatian health care,stressing out that more effort should be invested on the national level to implement more stringent adherence to the current European guidelines.

Background: Pediatric inflammatory bowel disease (IBD) presents with extensive phenotype. The aim of this study was to determine the phenotype of pediatric IBD patients in Croatia at diagnosis and follow-up. Methods: Children were prospectively recruited into Croatian IBD national registry. Data on diagnostic evaluation, therapy and 1-year follow-up were collected. Results: A total of 51 newly diagnosed patients were recruited (19 Crohn's disease (CD), 28 ulcerative colitis (UC) and 4 IBD-unclassified (IBD-U)). Most common location in CD was ileocolonic disease (52.6%), and pancolitis in UC (53.6%). The recommended complete diagnostic algorithm was performed only in 29.4% of patients. First-line therapy used in CD was exclusive enteral nutrition for remission induction (84.2%) and azathioprine for maintenance (73.7%). In patients with UC, aminosalicylates were the most common drug used (89.3%). By the end of the first year 41.2% of CD and 53.9% of UC patients had one or more relapses and required treatment escalation. Conclusion: Our data confirm extensive intestinal involvement in pediatric IBD and relatively high relapse rate during the first year of follow-up. More effort should be invested on the national level to implement more stringent adherence to the current European guidelines. Impact: The key message of our article is that pediatric IBD in Croatia shows extensive intestinal involvement with high relapse rates in first year of follow-up. It is the first cohort study reporting on the phenotype of pediatric IBD in Croatia, but also investigates adherence to diagnostic and therapeutic European guidelines which is not commonly reported. The study is national based, thus having the greatest impact on Croatian health care,stressing out that more effort should be invested on the national level to implement more stringent adherence to the current European guidelines.

Cilj: prikaz 15-godišnjeg pacijenta upućenog u našu Kliniku radi kroničnog kašlja i ezofagitisa. Prikaz slučaja: Petnaestogodišnji mladić patio je od dugotrajnog kašlja uz koji su se javljale i poteškoće gutanja. Dijagnostičkom obradom postavljena je dijagnoza gastroezofagealne refluksne bolesti (engl. gastroesophageal reflux disease, GERD) i patohistološki dokazanog ezofagitisa koji se na provedeno liječenje značajno smanjuju, ali kašalj ostaje nepromijenjen. Pulmološkom i psihijatrijskom obradom postavljena je dijagnoza psihogenog kašlja te je započeto psihoterapijsko liječenje na što dolazi do smanjenja mladićevih tegoba. Zaključak: GERD se prezentira širokim spektrom ezofagealnih i ekstraezofagealnih simptoma od kojih je značajan i kronični kašalj. Međutim, kašalj druge etiologije poput psihogenog kašlja može biti i uzrok GERD-u što diferencijalnodijagnostički moramo razmotriti kod bolesnika u kojih medikamentozna terapija nije dovela do poboljšanja., Aim: Presentation of 15-year-old patient admitted to our Clinic because of chronic cough and esophagitis. Case report: A 15-year-old boy suffers from chronic cough along with swallowing difficulties. Diagnostic workup has been performed and a diagnosis of gastroesophageal reflux disease (GERD) with pathohistologically proven esophagitis has been made with significant improvement after completion of therapy, but cough stayed unchanged. The boy was examined by pulmologist and psychiatrist and they made a diagnosis of habitual cough; psychotherapy was started and resulted in improvement of symptoms. Conclusion: GERD presents with a broad spectrum of esophageal and extraeosphageal symptoms with chronic cough as an important one. Nevertheless, a cough from different origin, such as habitual cough, may cause GERD which must be included in differential diagnosis of patients to whom pharmacological treatment failed to help.

Komplementarne i alternativne metode (KAM) liječenja koriste se kao zamjena ili kao nadopuna metoda medicine zasnovane na dokazima. One prolaze provjeru sigurnosti i djelotvornosti, ali, za razliku od konvencionalnih metoda, u nedostatno kvalitetno dizajniranim istraživanjima. Sve je više pacijenata koji se odlučuju za KAM, posebice onih koji boluju od kroničnih, rekurirajućih ili fatalnih bolesti. Incidencija upalnih bolesti crijeva (UBC) u stalnom je porastu, a patogeneza i, posljedično, terapija ostaju nedovoljno spoznate. U liječenju UBC-a nastoji se koristiti sigurne i jeftine lijekove koji se primijenjuju samostalno ili kombinirano. Konvencionalni lijekovi za UBC umanjuju simptome, ali su često nedostatni za uspješno liječenje ili pak imaju značajne nuspojave. U današnjoj kliničkoj praksi nameće se potreba edukacije liječnika o primjeni KAM-a, posebice u kroničnih bolesti kao što je UBC. Najčešće spominjani oblici KAM-a u djece oboljele od UBC-a su: ljekovite biljke (kurkuma, kanabis), probiotici, riblja ulja, hiperbarična oksigenoterapija, akunpunktura, dijetne prehrane te multivitaminske terapije., Complementary and alternative treatment methods (CAM) are used instead of, or as a supplement to, methods of evidence based medicine. CAM treatments undergo verification of safety and efficacy, but in not sufficiently well-designed studies. Increasing number of patients is opting for CAM, especially those suffering from chronic, recurrent or fatal diseases. The incidence of inflammatory bowel disease (IBD) has been growing steadily and pathogenesis and, consequently, the therapy remains insufficiently defined. In the treatment of IBD there is a tendency towards using safe and cheap drugs, which may be applied independently or combined. Conventional medications for IBD reduce symptoms, but are often insufficient for successful treatment or have significant side effects. In everyday's clinical practice, there is a need for educating physicians on the use of CAM, especially in chronic diseases, such as IBD. The most commonly reported forms of CAM in children with IBD are: herbs (turmeric, cannabis), probiotics, fish oils, hyperbaric oxygen therapy, acupuncture, diet nutrition and multivitamin therapy.

Objectives. The current European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines introduced the option to diagnose coeliac disease (CD) in children and adolescents without upper endoscopy if the defined criteria are met. The aim of our study was to evaluate how frequently paediatric gastroenterologists in Central Europe used the “no-biopsy” approach and how often the duodenal biopsy could have been omitted. Methods. Medical records of patients aged<19 years diagnosed with CD in 2016 from five European countries were analysed, focusing on levels of transglutaminase antibodies (TGA) at the time of diagnosis and on whether the diagnosis was confirmed using duodenal biopsy or “no-biopsy” approach. Clinical presentation and delays until final diagnosis were analysed according to diagnostic approach. Results. Data from 653 children (63.9% female, median age: 7 years, range: 7 months-18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. One fifth (n=134) of included children were asymptomatic at diagnosis. Of 519 symptomatic children, 107 (20.6%) were diagnosed by the “no-biopsy” approach. Out of the remaining 412 children who underwent duodenal biopsies, 214 (51.9%) had TGA≥10 times upper level of normal (ULN) and would have been eligible for the “no-biopsy” approach. Signs and symptoms of malabsorption were more frequent in children diagnosed without duodenal biopsies. There were no differences in diagnostic delays with respect to the diagnostic approach. Conclusion. In this cohort, about 60% of symptomatic CD patients could have been diagnosed without duodenal biopsies. The aim of the “no-biopsy” approach was to make the diagnostic procedure less challenging without compromising its reliability. However, this option was applied only in 20%, in spite of fewer burdens to the family and reduced costs. The reasons for this discrepancy are unknown. Physicians should be made more aware about the reliability of CD diagnosis without biopsies when the ESPGHAN guidelines for CD diagnosis are followed.

Introduction. Celiac disease (CD) is an autoimmune disease triggered by gluten in genetically predisposed individuals. Despite the increasing prevalence of CD, many patients remain undiagnosed. Standard serology tests are expensive and invasive, so several point-of-care tests (POC) for CD have been developed. We aimed to determine the prevalence of CD in first-grade pupils in Primorje-Gorski Kotar County, Croatia, using a POC test. Methods. A Biocard celiac test that detects IgA antibodies to tissue transglutaminase in whole blood was used to screen for celiac disease in healthy first-grade children born in 2011 and 2012 who consumed gluten without restrictions. Results. 1478 children were tested, and none of them were tested positive with a rapid test. In 10 children (0,6%), IgA deficiency has been suspected; only 4 of them agreed to be tested further for total IgA, anti-tTG, and anti-DGP antibodies. IgA deficiency was confirmed in 3 patients, and in all 4 children, CD has been excluded. Conclusion. Our results have not confirmed the usefulness of the POC test in screening the general population of first-grade schoolchildren. Further research is needed to establish the true epidemiology of CD in Primorje-Gorski Kotar County and to confirm the value of the rapid test in comparison with standard antibody CD testing.

Objectives: Coeliac disease (CD) is a systemic autoimmune disorder affecting about 1% of the population. Many patients remain undiagnosed or are diagnosed with substantial delay. We assessed diagnostic delays in symptomatic CD children in Central Europe (CE). Methods: Paediatric gastroenterologists in 5 CE countries retrospectively reported data of their patients diagnosed in 2016. Age at first CD-related symptom(s), first visit to paediatric gastroenterologist and confirmed diagnosis were used to determine diagnostic delays. Results: Data from 393 children (65% girls, median age 7 years, range 7 months to 18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. Median duration from first symptom(s) to visit to paediatric gastroenterologist was 5 months (range 0–10 years ; preschool 4 months, school-aged 5 months), and further duration until final diagnosis was 1 month (range 0–5 years) with significant regional differences (P < 0.001). Median diagnostic delay was 6 months (range 0–10 years ; preschool 5 months, school-aged 7 months). Type of clinical presentation had little, however, significant effect on delays. Reduced body mass in delays longer than 3 years compared with delays shorter than 1 year was found (z score −0.93 vs −0.39, P < 0.05). Conclusions: Time from first symptoms to CD diagnosis in children in 5 CE countries is slightly shorter compared with few other small paediatric studies, and significantly shorter than reported for adults. Nevertheless, delays of more than 3 years in 6.6% of children are worrisome. Raising awareness about the variable symptoms and implementation of reliable diagnostic tools will further reduce diagnostic delays

Edema is defi ned as abnormal accumulation of fl uid in the interstitium. Differential diagnosis of generalized edema is very broad. Most often, renal and cardiac causes lead to generalized edema. The potential gastrointestinal causes of edema are liver failure and protein losing enteropathy including celiac disease and protein malnutrition. Generalized edema is rarely an initial manifestat ion of celiac disease. Hereby, we present a case of a 3-year-old boy with celiac disease, initially presented with generalized edema and hypoproteinemia.

Edema is defi ned as abnormal accumulation of fl uid in the interstitium. Diff erential diagnosis of generalized edema is very broad. Most often, renal and cardiac causes lead to generalized edema. The potential gastrointestinal causes of edema are liver failure and protein losing enteropathy including celiac disease and protein malnutrition. Generalized edema is rarely an initial manifestation of celiac disease. Hereby, we present a case of a 3-year-old boy with celiac disease, initially presented with generalized edema and hypoproteinemia., Edemi nastaju zbog abnormalnog nakupljanja tekućine u intersticiju. Diferencijalna dijagnoza edema je vrlo široka. Bubrežni i srčani uzroci su najčešći uzroci generaliziranih edema. Mogući gastrointestinalni uzroci edema su zatajenje jetre, enteropatija uzrokovana gubitkom proteina, uključujući celijakiju i proteinsku neishranjenost. Generalizirani edemi su rijetka prva manifestacija celijakije. Prikazujemo slučaj trogodišnjeg dječaka s celijakijom koji se inicijalno prezentirao generaliziranim edemima i hipoproteinemijom.

Akutni pankreatitis je bolest koja se sve češće dijagnosticira u dječjoj dobi. Postoje značajne razlike između akutnog pankreatitisa u djece i odraslih; bolesti se razlikuju u etiologiji,prirodnom tijeku i prognozi. Ipak, današnji pristup bolesti i njenom liječenju zasniva se uglavnom na istraživanjima u odraslih osoba. U tijeku su brojna istraživanja koja za cilj imaju rasvijetliti značajke bolesti dječje dobi. U ovom članku donosimo današnje spoznaje o etiopatogenezi, dijagnostici, liječenju i prognozi akutne upale gušterače u dječjoj dobi., Acute pancreatitis is a disease that is becoming increasingly recognized in the pediatric population. There are numerous differences between the pediatric and adult disease, including etiology, natural history and prognosis. Nevertheless, the current approach to the disease and its treatment is mostly based on adult studies. Currently, many studies are aimed at finding the characteristics of the pediatric type of the disease. In this review we summarize the current concepts on the etiopathogenesis, diagnosis, treatment and prognosis of pediatric acute pancreatitis.

It has been generally recognized that the prevalence of bacterial resistance among bacteria is an unavoidable consequence of antibiotic use and is positively linked to the overall use of antibacterial drugs. The purpose of this study was to investigate the extent of antimicrobial usage and to evaluate the antimicrobial resistance at three different hospital settings in Croatia: a clinical hospital, a general hospital and a specialized clinic for infectious diseases. In this survey the antimicrobial drug consumption and antimicrobial susceptibility test results were analyzed for the first 6 months of 1997 in three different hospitals in Croatia: the University Hospital Center (UHC), Rijeka, the Clinic for Infectious Diseases 'Dr Fran Mihaljevic', Zagreb and the Dubrovnik General Hospital. The data were collected from corresponding hospital pharmacy records and microbiology laboratories. Antimicrobial drug utilization was expressed in number of defined daily doses (DDDs) per 100 bed days. High antimicrobial utilization and high resistance rates were found in all three hospitals. At the Clinic for Infectious Diseases, the most frequently used antimicrobials where those of narrow spectrum while at the UHC Rijeka and the Dubrovnik General Hospital the broad spectrum antimicrobials were mostly used. The highest antimicrobial consumption was noted at the Susak locality of the UHC, Rijeka, where the highest resistance rates of bacteria to antimicrobials were also found. Results of this observational study indicate that attempts should be made to reduce the influence of factors that may lead to emergent resistance. The most effective approach to the prevention of transmission of multidrug-resistant pathogens is preventing the initial emergence of resistance. A rational and strict antibiotic policy is thus of great importance for the optimal use of these agents.

The purpose of the present study was to investigate the antibiotics utilization in the University Hospital Center of Rijeka (UHC), with capacity of 1566 beds, during the period of 4 years (1990-1994). The data concerning the antibiotics utilization were collected from a hospital pharmacy record and calculated as the defined daily dose (DDD) per 100 bed days. Total antibiotics use decreased continually from 1990 through 1994. According to our study, metronidazole became the most frequently prescribed antibiotic. Comparing the 1994 to the 1990 antibiotics utilization, we may notice an outstanding decrease in cotimoxazole, ampicillin and cefalexin utilization and an increase in amoxicillin + clavulanic acid, gentamycin and cefuroxime (there are no tetracyclines among the 10 most frequently prescribed antibiotics). The changes noticed in the use of antibiotics are partly caused by changes in therapeutic principles, but we consider drug donations as the most important factor. Drug donations have retained the treatment quality of our patients in very difficult conditions in Croatia during the war period.

Cilj: Kronična upalna bolest crijeva (KUBC) spada među najteže kronične bolesti dječje i adolescentne dobi. KUBC je zajednički naziv za Crohnovu bolest (CB), ulcerozni kolitis (UK) i nediferencirani kolitis. Točan uzrok nije poznat, ali se smatra da su u nastanak kronične upalne crijevne reakcije uključeni i funkcionalno integrirani utjecaji okoline, bolesnikovo genetsko nasljeđe, bolesnikova crijevna mikrobiološka flora te imunološki sustav. Obilježena nepredvidljivim egzarcebacijama neujednačene jačine, bolest se najčešće manifestira probavnim smetnjama, ali nisu rijetke ni izvancrijevne tegobe. Izvancrijevne smetnje puno su izrazitije u CB. Psihičke smetnje u te su djece brojne, a učestalije su u aktivnim fazama bolesti. Prikaz slučaja: U prikazu je opisan dječak obolio od ulceroznog kolitisa s pridruženim psihičkim smetnjama. Osobita pažnja posvećena je obiteljskim odnosima. Rasprava: Iako su psihološki i tjelesni čimbenici povezani, prihvaćenije je mišljenje da su psihički poremećaji u KUBC posljedica, a ne uzrok bolesti. Uobičajeno funkcioniranje i kvaliteta života obitelji djece s KUBC mogu biti ozbiljno narušeni. Reakcija obitelji na bolest djeteta ovisi o dobi djeteta, prirodi, težini i prognozi bolesti. Cijela obitelj mora se udruženo suočiti s bolesti te na taj način ostaje zajedno. Otvoreno obiteljsko komuniciranje o simptomima i liječenju KUBC mora biti prilagođeno dobi bolesnika. Time se osnažuje bolesnikova percepcija o mogućnostima savladavanja svakodnevnih problema. Zaključak: Osnova liječenja KUBC mora biti holistički pristup kojim se uvažavaju sve posebnosti djetetova stanja., Aim: Inflammatory bowel diseases are considered to be amongst the most severe chronic diseases in childhood and adolescence. They are marked by unpredictable relaps with uneven intensity. The most recognizable are gastrointestinal disturbances, but extraintestinal ones are numerous as well. It’s not rare that those affected develop psychological disturbances which then can lead to further complications to the diseases course and treatment. Case report: We described a case of a boy with colitis ulcerosa and psychological disturbances. Special attention was paid to relationship with closed family. Discussion: Normal functioning and the quality of life of families with children with IBD can be seriously disturbed. Coping with the disease of the child depends on the child’s age, nature, severity and prognosis of the illness. Both, the individual and the whole family should face the disease united and in that way they remain together. Open family communication about symptoms and treatment of IBD must be adapted to the patient’s age. This reinforces the patient’s perception of the possibilities of overcoming everyday problems. Conclusion: The basis of treating IBD must be a holistic approach that takes into consideration all the specifics of the child’s condition.

Djeca koja boluju od recidivirajućih abdominalnih bolova vrlo su raznolika skupina bolesnika. Organski, psihogeni i funkcionalni uzroci poremećaja preklapaju se u većoj ili manjoj mjeri, otežavajući dijagnozu i liječenje. Doprinos Rimskih kriterija je u definiranju simptoma koji pomažu pri dijagnostici funkcionalnih poremećaja i na taj način smanjuju broj nepotrebnih pretraga. Svrha ovog postupnika je pomoći liječnicima u dijagnostici i liječenju djece s recidivirajućim abdominalnim bolovima., Children who suffer from recurrent abdominal pain are a very heterogeneous group of patients. The organic, psychological and functional causes of this disorder overlap, making both the diagnosis and the treatment more difficult. The contribution of Rome criteria is in defining symptoms that helps in diagnosing functional disorders and thus lessen the number of unnecessary diagnostic procedures. The purpose of this algorithm is to help physicians diagnose and treat children with recurrent abdominal pain.

A point-prevalence survey of five European university hospitals was performed to benchmark antimicrobial drug use in order to identify potential problem areas in prescribing practice and to aid in establishing appropriate and attainable goals. All inpatients at the university hospitals of Rijeka (Croatia), Tartu (Estonia), Riga (Latvia), Vilnius (Lithuania) and Karolinska-Huddinge (Sweden) were surveyed for antimicrobial drug use during a single day. The frequency of antimicrobial drug use was 24% in Rijeka, 30% in Tartu, 26% in Riga, 14% in Vilnius and 32% in Huddinge. Surgical patients were treated with antimicrobial agents more often than medical patients in Riga (53% vs. 31%), Tartu (39% vs. 26%) and Vilnius (54% vs. 25%). Two-thirds of patients in Rijeka, Tartu, Riga and Vilnius, and fewer than half of the patients in Huddinge, received antimicrobial agents intravenously. Broad-spectrum antimicrobial agents were used most commonly in Rijeka. The prevalence of nosocomial infections treated with antibiotics was 9% at Huddinge, and 3–5% at the other centres. Benchmarking antimicrobial drug use at five university hospitals identified differences and problem areas. The high rates of intravenous administration, poor compliance with guidelines, and prolonged surgical prophylaxis were general problems that deserved specific attention at all centres. A change in prescription practices may reduce unnecessary drug use and decrease antimicrobial resistance.