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Paediatric Ulcerative Colitis

Peter C Church, Shaun Ho, Ajay Sharma, Diane Tomalty, Karen Frost, Aleixo Muise, Thomas D Walters, Anne M Griffiths
Background: Infliximab pharmacokinetics in steroid-refractory ulcerative colitis (UC) suggest a need for higher dosing, but data concerning efficacy of intensification in this setting are lacking in children and inconsistent overall. Methods: Paediatric patients (N=125) treated with infliximab for steroid-refractory or steroid-dependent UC were retrospectively reviewed. Outcomes (clinical response and remission, colectomy, mucosal healing, safety) with standard vs...
January 23, 2019: Journal of Crohn's & Colitis
Tarah Rigterink, Laura Appleton, Andrew S Day
BACKGROUND: Vitamin D deficiency is highly prevalent in children with inflammatory bowel disease (IBD). This may contribute to an increased risk of poor bone health and may also influence the course of disease. An optimal treatment strategy of vitamin D therapy in children with IBD has not yet been established. AIM: To analyse the published intervention studies of vitamin D therapy in children with IBD. METHODS: A systematic review was conducted of clinical studies involving children with IBD (including Crohn disease or ulcerative colitis) who had received vitamin D therapy...
January 22, 2019: World Journal of Clinical Pediatrics
Viktor Wintzell, Henrik Svanström, Ola Olén, Mads Melbye, Jonas F Ludvigsson, Björn Pasternak
BACKGROUND: Studies have shown an association between use of azathioprine and increased risk of acute pancreatitis in adult inflammatory bowel disease. However, whether an association exists among paediatric patients is not known. We aimed to investigate whether use of azathioprine is associated with the risk of acute pancreatitis in children with inflammatory bowel disease. METHODS: We did a nationwide register-based cohort study in Sweden (2006-16) and Denmark (2000-16)...
January 23, 2019: Lancet Child & Adolescent Health
Jiri Bronsky, Lissy de Ridder, Frank M Ruemmele, Anne Griffiths, Stephan Buderus, Ondrej Hradsky, Almuthe Christina Hauer
OBJECTIVES: Despite existence of international guidelines for diagnosis and management of inflammatory bowel diseases (IBD) in children, there might be differences in the clinical approach. METHODS: A survey on clinical practice in paediatric IBD was performed among members of the ESPGHAN Porto IBD working group and interest group, PIBD-NET, and IBD networks in Canada and German speaking countries (CIDsCANN, GPGE), using a web-based questionnaire. Responses to 63 questions from 106 paediatric IBD centres were collected...
January 17, 2019: Journal of Pediatric Gastroenterology and Nutrition
Karen van Hoeve, Erwin Dreesen, Ilse Hoffman, Gert Van Assche, Marc Ferrante, Ann Gils, Séverine Vermeire
OBJECTIVES: Therapeutic drug monitoring has been proposed as a useful tool in the management of infliximab (IFX) treated patients with inflammatory bowel disease (IBD). The aim of this retrospective study was to determine whether IFX trough levels after induction therapy are predictive for outcome at week 52. METHODS: All paediatric IBD patients receiving maintenance IFX at our centre, with IFX trough level available at their first maintenance infusion and a follow-up of at least 52 weeks were included...
January 8, 2019: Journal of Pediatric Gastroenterology and Nutrition
James J Ashton, Florina Borca, Enrico Mossotto, Tracy Coelho, Akshay Batra, Nadeem A Afzal, Hang T T Phan, Michael Stanton, Sarah Ennis, Robert Mark Beattie
BACKGROUND: Anti-tumour necrosis factor-α (anti-TNF) therapy use has risen in paediatric-onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti-TNF-therapy and surgery. DESIGN: All patients diagnosed with PIBD within Wessex from 1997 to 2017 were assessed. The prevalence of anti-TNF-therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact)...
January 9, 2019: Alimentary Pharmacology & Therapeutics
Yael Haberman, Rebekah Karns, Phillip J Dexheimer, Melanie Schirmer, Judith Somekh, Ingrid Jurickova, Tzipi Braun, Elizabeth Novak, Laura Bauman, Margaret H Collins, Angela Mo, Michael J Rosen, Erin Bonkowski, Nathan Gotman, Alison Marquis, Mason Nistel, Paul A Rufo, Susan S Baker, Cary G Sauer, James Markowitz, Marian D Pfefferkorn, Joel R Rosh, Brendan M Boyle, David R Mack, Robert N Baldassano, Sapana Shah, Neal S Leleiko, Melvin B Heyman, Anne M Grifiths, Ashish S Patel, Joshua D Noe, Bruce J Aronow, Subra Kugathasan, Thomas D Walters, Greg Gibson, Sonia Davis Thomas, Kevin Mollen, Shai Shen-Orr, Curtis Huttenhower, Ramnik J Xavier, Jeffrey S Hyams, Lee A Denson
Molecular mechanisms driving disease course and response to therapy in ulcerative colitis (UC) are not well understood. Here, we use RNAseq to define pre-treatment rectal gene expression, and fecal microbiota profiles, in 206 pediatric UC patients receiving standardised therapy. We validate our key findings in adult and paediatric UC cohorts of 408 participants. We observe a marked suppression of mitochondrial genes and function across cohorts in active UC, and that increasing disease severity is notable for enrichment of adenoma/adenocarcinoma and innate immune genes...
January 3, 2019: Nature Communications
Huey Miin Lee, Maesha Deheragoda, Phil Harrison, John Devlin, Maria Sellars, Nedim Hadzic, Anil Dhawan, Tassos Grammatikopoulos
OBJECTIVES: Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis and data is limited in the paediatric population. We aim to describe in detail a cohort of paediatric patients with AIP including their presentation, investigations that led to their diagnosis, management and long-term follow up. METHODS: We retrospectively reviewed the data of 6 patients diagnosed with AIP over an 10-year period. Data including demographics, clinical information, laboratory parameters, serological markers, radiological and histological findings as well as longitudinal follow up were collected...
November 14, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
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
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
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
Marco Gasparetto, Vivien Wong-Spracklen, Franco Torrente, Kate Howell, Mary Brennan, Gabriele Noble-Jamieson, Robert Heuschkel, Matthias Zilbauer
The disease course of children with ulcerative colitis (UC) varies substantially. Published data on predictors of disease outcomes in children remain scarce. We validate clinical predictors of outcomes in 93 children with UC in a single centre (age range: 2-18 years, minimum follow-up: 18 months). We stratified children into 3 groups according to their disease course, that is, 1 = mild (38/93, 40.9%), 2 = moderate (38/93, 40.9%), 3 = severe (17, 18.2%). Comparison of clinical and biochemical parameters was performed between groups using Chi-square, Mann-Whitney, and log-rank tests...
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
Xin-Qiong Wang, Yuan Xiao, Xu Xu, Yi Yu, Cheng-Yan Shan, Yan Guo, Ling Gong, Tong Zhou, Shen-Shen Gao, Yao-Zong Yuan, Xiao-Jin Wang, Chun-Di Xu
BACKGROUND: To investigate the unique features of inflammatory bowel disease (IBD) in children, we wanted to identify whether there might be a strong correlation between the disease phenotype and its prognosis at various ages in paediatric patients. METHODS: We collected data from patients diagnosed with IBD (ulcerative colitis (UC) or Crohn's disease (CD)) from 2002 to 2016. The diagnosis was made according to the Porto criteria and Paris Classification. Patient characteristics, clinical manifestations and treatments were collected...
July 12, 2018: BMC Pediatrics
Eva Karaskova, Jana Volejnikova, Dusan Holub, Maria Velganova-Veghova, Lucie Sulovska, Vladimír Mihal, Monika Horvathova, Dagmar Pospisilova
AIM: Hepcidin is a central regulator of iron homeostasis. Its production is also influenced by systemic inflammation. The aims of this study were to compare hepcidin levels in paediatric patients newly diagnosed with Crohn's disease (CD) and ulcerative colitis (UC) and to determine the association of hepcidin levels with laboratory and clinical parameters of inflammatory bowel disease (IBD) activity. METHODS: Children with newly diagnosed IBD between January 2012 and September 2016 were enrolled in this comparative cross-sectional study...
June 20, 2018: Journal of Paediatrics and Child Health
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