Pediatric Hepatology: Present and Future

Extract

Pediatric Gastroenterology was born as specialism within Pediatrics during the 1960s, and its younger sister, Hepatology, gradually acquired respect as an autonomous field early in the 1970s, with the formation of the Pediatric group for Gastroenterology, and more recently in 1992 with the creation of the Italian Society for Pediatric Gastroenterology and Hepatology in the Italian Society of Pediatrics. My aim in this paper is to review the most significant developments that have taken place in Pediatric Hepatology over the past decade, and to indicate how the field is likely to develop in the future. I will make particular reference here to HBV infection, cholelithiasis, extrahepatic biliary atresia, and liver transplants.

In Italy, this remains one of the most common causes of chronic hepatitis in children. (HCV infection in children without an underlying illness is still uncommon). Since the 1960s, we have gained an understanding of the risk factors, pathogenesis and natural history of infection, and an awareness of the strong tendency for the condition to become chronic in children. Moreover, with the increase in knowledge of the biology of the virus, an efficacious programme of preventive medicine has been implemented, which 3 years ago culminated in obligatory vaccination for newborns and 12-year-old children. These measures have resulted in a change in the epidemiology of the infection, which is now found above all in foreign children residing in Italy, who have been usually adopted.

Over the last 10 years, the phenomenon of international adoption represents a new socio-sanitary reality in the industrialized countries. A number of important studies report that, more than 50 percent of foreign children adopted present serious medical condition (irrespective of the area of the world from which they come, be it Asia, Africa, South America, or Eastern Europe). If routine screening is not carried out, these disorders go undetected by medical tests performed in the children's countries of origin, as well as by medical examinations carried out in their adoptive countries [4]. The most frequent diseases are infections, and amongst these HBV infection, besides TBC and CMV infection, making those children in whom such infections go undetected veritable spring of disease [3].