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Paediatric Crohn's

Christina Ong, Poh Ting Lim, Veena Logarajah, Maria Janelle Liwanag, Bi Xia Ang, Yuqin Cher, Fang Kuan Chiou, Ajmal Kader
BACKGROUND: Exclusive enteral nutrition (EEN) is as effective as corticosteroids in inducing remission in children with Crohn's disease (CD). However, over 50% of these children relapse by 12 months of diagnosis. Thiopurines are commonly prescribed as maintenance therapy for CD, but evidence for its efficacy is controversial. Data on the effectiveness of EEN in Southeast Asian (SEA) children with CD is scarce. This study aims to evaluate the efficacy of EEN induction therapy in a cohort of SEA children with newly diagnosed CD...
December 12, 2018: BMC Gastroenterology
Mallory Chavannes, Christine Martinez-Vinson, Lara Hart, Nicole Kaniki, Che-Yung Chao, Sally Lawrence, Kevan Jacobson, Jean-Pierre Hugot, Jérome Viala, Colette Deslandres, Prevost Jantchou, Ernest G Seidman
Background: Ustekinumab (UST) is effective in the treatment of adults with moderate to severe Crohn's disease (CD). There is a paucity of data on its use in children. Aim: To evaluate the response to UST in children with moderate to severe CD. Methods: This multi-centre retrospective cohort study identified children under 18 years old with CD who received open-labelled subcutaneous UST. The primary outcome was changes in mean abbreviated PCDAI (aPCDAI) between baseline and 3 and 12 months, and rate of clinical remission at 3 and 12 months...
December 12, 2018: Journal of Crohn's & Colitis
Jeffrey S Hyams, Marla Dubinsky, Joel Rosh, Frank M Ruemmele, Samantha F Eichner, Jen-Fue Maa, Andreas Lazar, Gabriela Alperovich, Nael M Mostafa, Anne M Robinson
BACKGROUND: In the IMAgINE 1 study, adalimumab induced and maintained remission of moderate-to-severe Crohn's disease in children. AIM: To assess the efficacy, pharmacokinetics, immunogenicity and safety of immunomodulator and adalimumab combination therapy vs adalimumab monotherapy in paediatric patients with Crohn's disease. METHODS: Patients 6-17 years old with moderate-to-severe Crohn's disease (n = 192) received weight-based adalimumab induction at baseline and week 2...
December 2, 2018: Alimentary Pharmacology & Therapeutics
Liselotte C de Kloet, Sebastian E E Schagen, Anemone van den Berg, Agnes Clement-de Boers, Mieke E C A M Houdijk, Daniëlle C M van der Kaay
BACKGROUND: Growth failure can be a unique manifestation of untreated intestinal inflammation in children with inflammatory bowel disease (IBD). It can, however, be difficult to diagnose IBD in the absence of symptoms or in the presence of aspecific gastrointestinal symptoms. A delay in diagnosis is a risk factor for lower adult height. CASE DESCRIPTION: A 15--year-old boy was referred to a paediatric endocrinologist for growth failure and delayed puberty. Additional investigations were performed and he was diagnosed with Crohn's disease...
November 19, 2018: Nederlands Tijdschrift Voor Geneeskunde
Adel Alghamdi, Konstantinos Gerasimidis, Gavin Blackburn, Didem Akinci, Christine Edwards, Richard K Russell, David G Watson
Metabolomic profiling using high resolution mass spectrometry with hydrophilic interaction chromatography was applied to 11 faecal extracts from eleven healthy children and to 43 faecal extracts from eleven children undergoing exclusive enteral nutrition for the treatment of active Crohn's disease (CD) at timepoints before, during (15, 30, and 60 days), and after treatment. Differences between the control and CD samples were identified at each timepoint. An orthogonal partial least square-discriminant analysis (OPLS-DA) model identified eight metabolites that were normally distributed according to Q-Q plots...
November 22, 2018: Metabolites
Ben Kang, So Yoon Choi, Young Ok Choi, Soo-Youn Lee, Sun-Young Baek, Insuk Sohn, Byung-Ho Choe, Hae Jeong Lee, Yon Ho Choe
Background and Aims: Mucosal healing is an important treatment goal in Crohn's disease. We investigated the association between serum infliximab trough levels and mucosal healing, and the infliximab cut-off levels required for mucosal healing in paediatric patients. Methods: In this multicentre, retrospective, cross-sectional study, medical records and electronic data of paediatric patients with luminal Crohn's disease, who had received infliximab for ≥1 year, were examined...
November 19, 2018: Journal of Crohn's & Colitis
Tomer Ziv-Baran, Séamus Hussey, Malgorzata Sladek, Jorge Amil Dias, Javier Martin de Carpi, Erasmo Miele, Gabor Veres, Paolo Lionetti, Sibylle Koletzko, Federica Nuti, Anders Paerregaard, Kaija-Leena Kolho, Richard K Russell, Ron Shaoul, Dror Weiner, Rotem Sigall Boneh, Johanna Escher, Lenne Finnby, Dan Turner, Arie Levine
BACKGROUND: Paediatric Crohn's disease is characteried by frequently relapsing disease which may lead to hospitalisations and complications. AIM: To develop predictive models for early relapse following first remission. METHODS: The GROWTH CD prospective inception cohort was designed to predict risk for early disease relapse and poor outcomes. Newly diagnosed children underwent endoscopies and imaging. They were phenotyped and followed at scheduled visits through 78 weeks for relapses...
November 18, 2018: Alimentary Pharmacology & Therapeutics
Andrea Brusaferro, Elena Cavalli, Edoardo Farinelli, Rita Cozzali, Nicola Principi, Susanna Esposito
OBJECTIVES: The main objective of this manuscript is to discuss our present knowledge of the relationships between dysbiosis and paediatric Crohn's disease (CD). The therapeutic role of the methods currently used to re-establish normal gut microbiota composition is also analysed. METHODS: PubMed was used to search for all of the studies published from January 2008 to June 2018 using the key words: "Crohn's disease" and "gut dysbiosis" or "microbiota" or "microbioma" or "probiotic" and "children" or "paediatric"...
October 15, 2018: Journal of Infection
Haiming Fang, Lian Fu, Jiajia Wang
Background: Fecal microbiota transplantation (FMT) is an emerging treatment approach for inflammatory bowel disease (IBD). The donor selection, the separation of fecal bacteria, the frequency of FMT, the way of infusion, the long-term safety, and efficacy are still uncertain. Aim: To further study the efficacy and safety and protocol of FMT for IBD. Methods: A systematic review and meta-analysis were conducted until February, 2018. Clinical remission was established as the primary outcome...
2018: BioMed Research International
Zaina T Al-Salama
PF-06438179/GP1111 (Zessly® ; Ixifi® ) [hereafter referred to as GP1111] is a biosimilar of the reference monoclonal anti-TNF-α antibody infliximab, and is approved in the EU and USA for the same indications as the reference drug, including rheumatoid arthritis (RA), Crohn's disease, ulcerative colitis (including paediatric ulcerative colitis in the EU), ankylosing spondylitis, psoriatic arthritis and plaque psoriasis; GP1111 is also approved in Japan. GP1111 has similar physicochemical characteristics and pharmacodynamic properties to those of reference infliximab, and the pharmacokinetic similarity of the agents has been shown in healthy volunteers and patients with moderate-to-severe RA despite methotrexate therapy...
October 4, 2018: BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy
Karen van Hoeve, Erwin Dreesen, Ilse Hoffman, Gert Van Assche, Marc Ferrante, Ann Gils, Séverine Vermeire
Background: The role of therapeutic drug monitoring for infliximab [IFX] therapy in children with inflammatory bowel disease [IBD] is poorly investigated. We determined if IFX exposure correlates with long-term remission in children. Methods: In this retrospective study, all children with Crohn's disease [CD] and ulcerative colitis [UC], receiving maintenance IFX at our centre, were included. Serum trough levels and cumulative drug exposure were correlated with clinical, biological, and endoscopic remission...
November 15, 2018: Journal of Crohn's & Colitis
Giovanni Di Nardo, Carlo Calabrese, Roberto Conti Nibali, Arianna De Matteis, Emanuele Casciani, Luigi Martemucci, Giuseppe Pagliaro, Nico Pagano
Introduction: Device-assisted enteroscopy is a new endoscopic technique for the evaluation of small bowel in adults and children. Data in pediatric population are limited. This review aims to identify diagnostic and therapeutic benefits of enteroscopy in children. Methods: We have analysed paediatric literature on device-assisted enteroscopy focusing on indications, technical aspects and complications, with attention given to adult publications that may be applicable to the paediatric population...
August 2018: United European Gastroenterology Journal
Catherine L Wall, Richard B Gearry, Andrew S Day
Background and Aim: Enteral nutrition (EN) is not commonly used for the treatment of adults with active Crohn's disease (CD), despite patient interest in nutrition-based alternatives to corticosteroids and evidence of efficacy in paediatric CD. The aim of this study was to assess the impact of 2 different EN regimens on disease symptoms, nutrition and inflammatory markers in young adults with active CD. Methods: A prospective non-randomized pilot study of adults aged 16-40 years with active CD on endoscopy or imaging was undertaken...
July 2018: Inflammatory Intestinal Diseases
Anna-Maria Schneider, Daniel Weghuber, Benjamin Hetzer, Andreas Entenmann, Thomas Müller, Georg Zimmermann, Sebastian Schütz, Wolf-Dietrich Huber, Judith Pichler
BACKGROUND: Vedolizumab is safe and effective in adult patients with Crohn's disease (CD) and ulcerative colitis (UC); however, data in children with inflammatory bowel disease (IBD) are scarce. Therefore, we evaluated vedolizumab use in a cohort of Austrian paediatric patients with IBD. METHODS: Twelve patients (7 female; 7 CD; 5 UC), aged 8-17 years (median, 15 years), with severe IBD who received vedolizumab after tumour necrosis factor α antagonist treatment were retrospectively analysed...
September 15, 2018: BMC Gastroenterology
J Gavin, L V Marino, J J Ashton, R M Beattie
AIM: Maintenance enteral nutrition (MEN) is routinely used in Paediatric Crohn's Disease (CD) to prolong remission although there is limited evidence for efficacy and a lack of formal guidelines. This study surveyed patients', parents' and professional experience with MEN. METHODS: Two questionnaires were developed to survey the experience of MEN; (i) Patients/Parents (children >10 years of age aimed to complete independently) and (ii) Dietitians. Questionnaires were sent to families prescribed MEN after exclusive enteral nutrition (EEN) between 2015-17 (n = 77) and dietitians working in paediatric regional centres in UK (n = 23)...
December 2018: Acta Paediatrica
James J Ashton, Sarah Ennis, R Mark Beattie
The incidence of early-onset paediatric inflammatory bowel disease is increasing worldwide. Defined as a diagnosis of Crohn's disease, ulcerative colitis, or inflammatory bowel disease unclassified before the age of 10 years, the disease is complex, multifactorial, and lifelong, and affects nutrition and psychological wellbeing. Over 200 genes have been implicated and a further 52 genes are known to cause monogenic disease, often presenting in infancy. Heritability of early-onset inflammatory bowel disease is hypothesised to be between that of infantile-onset (ie, <6 years old) and adult-onset disease, with genetic cause characterised by a few genes with modest or large effect size...
October 2017: The lancet child & adolescent health
T G J de Meij, E F J de Groot, C F W Peeters, N K H de Boer, C M F Kneepkens, A Eck, M A Benninga, P H M Savelkoul, A A van Bodegraven, A E Budding
BACKGROUND & AIMS: Intestinal microbiota is considered to play a crucial role in the aetiology of inflammatory bowel disease (IBD). We aimed to describe faecal microbiota composition and dynamics in a large cohort of children with de novo (naïve) IBD, in comparison to healthy paediatric controls (HC). METHODS: In this prospective study, performed at two tertiary centres, faecal samples from newly diagnosed, treatment-naïve paediatric IBD patients were collected prior to bowel cleansing for colonoscopy (t0) and 1, 3 and 6 weeks and 3 months after initiation of therapy...
2018: PloS One
Dan Turner, Frank M Ruemmele, Esther Orlanski-Meyer, Anne M Griffiths, Javier Martin de Carpi, Jiri Bronsky, Gabor Veres, Marina Aloi, Caterina Strisciuglio, Christian P Braegger, Amit Assa, Claudio Romano, Séamus Hussey, Michael Stanton, Mikko Pakarinen, Lissy de Ridder, Konstantinos H Katsanos, Nick Croft, Víctor Manuel Navas-López, David C Wilson, Sally Lawrence, Richard K Russell
BACKGROUND AND AIM: Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. METHODS: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)...
August 2018: Journal of Pediatric Gastroenterology and Nutrition
Dan Turner, Frank M Ruemmele, Esther Orlanski-Meyer, Anne M Griffiths, Javier Martin de Carpi, Jiri Bronsky, Gabor Veres, Marina Aloi, Caterina Strisciuglio, Christian P Braegger, Amit Assa, Claudio Romano, Séamus Hussey, Michael Stanton, Mikko Pakarinen, Lissy de Ridder, Konstantinos Katsanos, Nick Croft, Victor Navas-López, David C Wilson, Sally Lawrence, Richard K Russell
BACKGROUND: The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with ∼20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of pediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. METHODS: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)...
August 2018: Journal of Pediatric Gastroenterology and Nutrition
Dominika Wilczyńska, Kamila Mielniczuk, Anna Szaflarska-Popławsk, Aneta Krogulska
Bloody diarrhea is a common problem in early childhood, typically caused by anal fissures, infectious enteritis, allergic proctocolitis, swallowed maternal blood and intussusception. More rarely, it can also be caused by volvulus, coagulopathies, necrotizing enterocolitis, polyps, Meckel diverticulitis and inflammatory bowel disease (IBD). The incidence of IBD is on the rise in children, even affecting infants. The most common subtypes are Crohn's disease (CD) and ulcerative colitis (UC). While IBD occurrence peaks in the second to third decades of life, paediatric IBD accounts for 7-20% of all cases...
August 1, 2018: Archivos Argentinos de Pediatría
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