Levine Arie, Koletzko Sibylle, Turner Dan, Escher Johanna C, Cucchiara Salvatore, de Ridder Lissy, Kolho Kaija-Leena, Veres Gabor, Russell Richard K, Paerregaard Anders, Buderus Stephan, Greer Mary-Louise C, Dias Jorge A, Veereman-Wauters Gigi, Lionetti Paolo, Sladek Malgorzata, Martin de Carpi Javier, Staiano Annamaria, Ruemmele Frank M, Wilson David C
*Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel †Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany ‡Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel §Pediatric Gastroenterology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands ||Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy ¶Children's Hospital, University of Helsinki, Helsinki, Finland #Semmelweis University, Budapest, Hungary **Department of Paediatric Gastroenterology and Nutrition, Yorkhill Children's Hospital, Glasgow, UK ††Department of Paediatrics, Hvidovre University Hospital, Copenhagen, Denmark ‡‡St.-Marien-Hospital, Department of Pediatrics, Bonn, Germany §§Department of Diagnostic Imaging, The Hospital for Sick Children ||||Department of Medical Imaging, University of Toronto, Toronto Canada ¶¶Hospital S. João, Porto, Portugal ##Pediatric Gastroenterology and Nutrition, UZ Brussels, Brussels, Belgium ***Departement Neurofarba, University of Florence, Meyer Children Hospital, Florence, Italy †††Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Cracow, Poland ‡‡‡Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain §§§Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II," Naples, Italy ||||||Université Sorbonne Paris Cité, Université Paris Descartes, INSERM U989, AP-HP, Hôpital Necker Enfants Malades, Service de Gastroentérologie Pédiatrique, Paris, France ¶¶¶Child Life and Health, University of Edinburgh, Edinburgh, UK.
J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):795-806. doi: 10.1097/MPG.0000000000000239.
BACKGROUND: The diagnosis of pediatric-onset inflammatory bowel disease (PIBD) can be challenging in choosing the most informative diagnostic tests and correctly classifying PIBD into its different subtypes. Recent advances in our understanding of the natural history and phenotype of PIBD, increasing availability of serological and fecal biomarkers, and the emergence of novel endoscopic and imaging technologies taken together have made the previous Porto criteria for the diagnosis of PIBD obsolete. METHODS: We aimed to revise the original Porto criteria using an evidence-based approach and consensus process to yield specific practice recommendations for the diagnosis of PIBD. These revised criteria are based on the Paris classification of PIBD and the original Porto criteria while incorporating novel data, such as for serum and fecal biomarkers. A consensus of at least 80% of participants was achieved for all recommendations and the summary algorithm. RESULTS: The revised criteria depart from existing criteria by defining 2 categories of ulcerative colitis (UC, typical and atypical); atypical phenotypes of UC should be treated as UC. A novel approach based on multiple criteria for diagnosing IBD-unclassified (IBD-U) is proposed. Specifically, these revised criteria recommend upper gastrointestinal endoscopy and ileocolonscopy for all suspected patients with PIBD, with small bowel imaging (unless typical UC after endoscopy and histology) by magnetic resonance enterography or wireless capsule endoscopy. CONCLUSIONS: These revised Porto criteria for the diagnosis of PIBD have been developed to meet present challenges and developments in PIBD and provide up-to-date guidelines for the definition and diagnosis of the IBD spectrum.
背景：儿童期起病的炎症性肠病（PIBD）的诊断在选择最具信息量的诊断测试以及将PIBD正确分类为不同亚型方面可能具有挑战性。我们对PIBD自然史和表型的理解取得了新进展，血清学和粪便生物标志物的可及性不断提高，以及新型内镜和成像技术的出现，这些因素共同使得先前用于诊断PIBD的波尔图标准过时。 方法：我们旨在采用循证方法和共识流程修订原始的波尔图标准，以得出PIBD诊断的具体实践建议。这些修订后的标准基于PIBD的巴黎分类和原始的波尔图标准，同时纳入了新数据，如血清和粪便生物标志物的数据。所有建议和总结算法均达成了至少80%参与者的共识。 结果：修订后的标准与现有标准不同，它定义了2种溃疡性结肠炎（UC，典型和非典型）类别；UC的非典型表型应按UC治疗。提出了一种基于多种标准诊断未分类炎症性肠病（IBD-U）的新方法。具体而言，这些修订后的标准建议对所有疑似PIBD患者进行上消化道内镜检查和回结肠镜检查，对于小肠成像（除非内镜检查和组织学检查后为典型UC），采用磁共振肠造影或无线胶囊内镜检查。 结论：这些修订后的PIBD诊断波尔图标准是为应对PIBD当前的挑战和发展而制定的，为IBD谱系的定义和诊断提供了最新指南。
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