Bowel Disease In Children Research Articles

Czech Working Group for Paediatric Gastroenterology and Nutrition guidelines for diagnostics and treatment of inflammatory bowel diseases in children – 1st edition update

Czech Working Group for Paediatric Gastroenterology and Nutrition guidelines for diagnostics and treatment of inflammatory bowel diseases in children – 1st edition update

Autoimmune and inflammatory manifestations occur frequently in patients with primary immunodeficiencies

Primary immunodeficiencies (PIDs) are inherited diseases associated with a considerable increase in susceptibility to infections. It is known that PIDs can also predispose to cancer and immune diseases, including allergy, autoimmunity, and inflammation. We aimed at determining the incidence of autoimmunity and inflammation in patients with PIDs. We have retrospectively screened 2183 consecutive cases of PID in the Centre de Référence Déficits Immunitaires Héréditaires registry (CEREDIH; the French national PID registry) for the occurrence of autoimmunity and inflammation. One or more autoimmune and inflammatory complications were noted in 26.2% of patients, with a risk of onset throughout the patient's lifetime. The risk of autoimmune cytopenia was at least 120 times higher than in the general population, the risk of inflammatory bowel disease in children was 80 times higher, and the risk of other autoimmune manifestations was approximately 10 times higher. Remarkably, all types of PIDs were associated with a risk of autoimmune and inflammatory complications, although the greatest risk was associated with T-cell PIDs and common variable immunodeficiency. The occurrence of autoimmune disease is a negative prognostic factor for survival. Our results provide the basis for a detailed prospective evaluation of autoimmunity and inflammation in the context of PIDs, with a view to accurately assessing these risks and describing the possible effect of medical intervention.

P219 Inflammatory bowel disease in children is a challenging diagnosis when overlaps with coeliac disease

P219 Inflammatory bowel disease in children is a challenging diagnosis when overlaps with coeliac disease

Paediatric Inflammatory Bowel Disease: Clinical Presentation and Disease Location.

Objective:To determine different clinical presentationsand disease location demarcatedby upper and lower gastrointestinal endoscopyand relevant histopathologyin children diagnosed with inflammatory bowel disease (IBD).Methods:This is 5 years (2010 to 2015) retrospective studyconducted at the Aga Khan University Hospitalenrolling65admitted children between 6 months to 15years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by paediatric gastroenterologists at endoscopy suite of the hospital and all specimens were reported by the pathology department. ESPGHAN revised criteria for the diagnosis of inflammatory bowel disease in children and an adolescent was used to standardize our diagnosis. Extent of disease on endoscopy and relevant histopathology of the biopsy samples were noted at the time of diagnosis. Data was summarized using mean, standard deviation, numbers and percentages for different variables.Results:Total 56 children were enrolled according to inclusion criteria. There were 34children (61.53%) diagnosed with ulcerative colitis (UC), 10 patients (16.92%) had Crohn’sDisease (CD) and 11 (21.53%) patients were labeled as Indeterminate colitis (IC). Mean age at onset of symptoms was10.03±2.44 and mean age at diagnosis was11.10±2.36. Abdominal pain (80%) and chronic diarrhea (70%) were common symptoms in CD whereas bloody diarrhea (79.41%) and rectal bleeding(64.70%)were common presentation in UC. Patients diagnosed with indeterminate colitis(IC) had similar clinical features as in UC patients. Only 7% patients had some extra-intestinal features in the form of joint pain and/or uveitis. Aspartate aminotransferase level (95.18 ±12.89) was relatively high in patients withCD in comparison with other categories of IBD. Endoscopic findings and relevant histopathology of biopsy samples in UC showed 65% patient had pan-colitis and 13 % with disease restricted to rectum only whereas in CD 70% patient had disease in ileo-colon and only 10 % had involvement of ileum at the time diagnosis.Conclusion:Patients with UC dominated in our cohort. The most common clinical presentation in UC was bloody diarrhea and rectal bleeding and patients with CDhad abdominal pain and chronic diarrhea as predominant clinical features. Extraintestinal features were uncommon in our cohort. In endoscopic findings, pan-colitis was the mostfrequentfinding in UC and ileo-colonwas common location in CD. IC and UC shared common clinical features and disease location on endoscopy.

The role of adhesion molecules in inflammatory bowel disease in children. Assessment of the possible risk of cardiovascular complications.

IntroductionInflammatory bowel diseases (IBD) are chronic diseases that proceed with exacerbation and remission phases. Adhesion molecules play a significant role in inflammatory processes. The same adhesion molecules play an important role in atherogenesis.AimTo assess the risk of atherosclerosis in IBD in children.Material and methodsThe study included 40 patients with IBD (25 with Crohn’s disease – CD and 15 with ulcerative colitis – UC) aged 4–17 years. In the study group, concentrations of selected adhesion molecules (intracellular adhesion molecule – ICAM, vascular cell adhesion molecule – VCAM, E-selectin) and selected parameters of lipid metabolism in serum were assessed.ResultsNo statistically significant differences between CD and UC patients and in the control group, in mean values of selected adhesins were obtained. Average variable VCAM was significantly lower in patients with CD than in patients with UC in the active stage of the diseases. Significantly higher average levels of triglycerides (TG) and high density lipoproteins (HDL) were found in the control group than in patients with CD. Significantly higher levels of total cholesterol (CHL) and HDL were noticed in the control group patients than in the patients with UC. The HDL/CHL was significantly higher in controls than in patients with UC.ConclusionsNo increased risk of developing atherosclerosis was found in children with IBD. Decreased risk in patients during exacerbation of inflammatory bowel disease was revealed, which may result from malnutrition typical for acute disease phase.

P-175B 器質的病変による小児腸重積症に対し回盲部切除術を要した4例(結腸,直腸,肛門, 第44回日本小児外科学会学術集会)

P-175B 器質的病変による小児腸重積症に対し回盲部切除術を要した4例(結腸,直腸,肛門, 第44回日本小児外科学会学術集会)

Complementary and alternative therapies for inflammatory bowel diseases in children

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.

Double balloon enteroscopy in children: diagnosis, treatment, and safety.

To assess the feasibility and utility of double balloon enteroscopy (DBE) in the management of small bowel diseases in children. Fourteen patients (10 males) with a median age of 12.9 years (range 8.1-16.7) underwent DBE; 5 for Peutz-Jeghers syndrome (PJ syndrome), 2 for chronic abdominal pain, 4 for obscure gastrointestinal (GI) bleeding, 2 with angiomatous malformations (1 blue rubber bleb nevus syndrome) having persistent GI bleeding, and 1 with Cowden's syndrome with multiple polyps and previous intussusception. Eleven procedures were performed under general anesthesia and 3 with deep sedation. The entire small bowel was examined in 6 patients, and a length between 200 cm and 320 cm distal to pylorus in the remaining 8. Seven patients had both antegrade (trans-oral) and retrograde (trans-anal and via ileostomy) examinations. One patient underwent DBE with planned laparoscopic assistance. The remaining 6 had trans-oral examination only. The median examination time was 118 min (range 95-195). No complications were encountered. Polyps were detected and successfully removed in all 5 patients with PJ syndrome, in a patient with tubulo-villous adenoma of the duodenum, in a patient with significant anemia and occult bleeding, and in a patient with Cowden's syndrome. A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy, and in 1 with a discrete angioma which was treated with argon plasma coagulation. The source of bleeding was identified in a further patient with varices. DBE was normal or revealed minor mucosal friability in the remaining 3 patients. Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children, allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents

ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents

Paediatric reference ranges for faecal calprotectin: a UK study

Background Faecal calprotectin has been shown to be a useful non-invasive marker for the diagnosis and monitoring of inflammatory bowel disease in children and adults. Although there are well-established reference ranges for the diagnosis of inflammatory bowel disease in adults, these have been less well studied in children. The objective was to establish reference ranges in our local population. Method All faecal calprotectin results from 2011 to 2014 were retrospectively collated and grouped according to patient age. Probability plots were used to determine expected upper limit of normal for each age group, and Mann-Whitney test was used to determine statistical difference between groups. Results Upper limit of normal for age groups 1-3.9 years, 4-17.9 years and 18 years plus were 77, 62 and 61 µg/g, respectively. There was a significant difference ( P = 0.0013) between the median calprotectin concentration for the age group 1-3.9 years ( n = 87) and 4-17.9 years ( n = 636) and between the age group 1-3.9 years and 18 years plus ( n = 7953, P = 0.0001), but there was no significant difference between the age groups 4-17.9 years and 18 years plus ( P = 0.4206). Conclusions In our local population, faecal calprotectin varies with age. Children aged 1-3.9 years had higher concentrations of faecal calprotectin than adults, but there was no significant difference in faecal calprotectin between older children and adults. This is in agreement with other published studies; however, the faecal calprotectin upper limit of normal calculated for children aged 1-3.9 years was lower than has been observed elsewhere.

Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease.

Studies testing the efficacy of behavioral interventions to modify psychosocial sequelae of inflammatory bowel disease in children are limited. This report presents outcomes through a 6-month follow-up from a large randomized controlled trial testing the efficacy of a cognitive behavioral intervention for children with inflammatory bowel disease and their parents. One hundred eighty-five children aged 8 to 17 years with a diagnosis of Crohn's disease or ulcerative colitis and their parents were randomized to one of two 3-session conditions: (1) a social learning and cognitive behavioral therapy condition or (2) an education support condition designed to control for time and attention. There was a significant overall treatment effect for school absences due to Crohn's disease or ulcerative colitis (P < 0.05) at 6 months after treatment. There was also a significant overall effect after treatment for child-reported quality of life (P < 0.05), parent-reported increases in adaptive child coping (P < 0.001), and reductions in parents' maladaptive responses to children's symptoms (P < 0.05). Finally, exploratory analyses indicated that for children with a higher level of flares (2 or more) prebaseline, those in social learning and cognitive behavioral therapy condition experienced a greater reduction in flares after treatment. This trial suggests that a brief cognitive behavioral intervention for children with inflammatory bowel disease and their parents can result in improved child functioning and quality of life, and for some children may decrease disease activity.

The association of sleep with inflammatory bowel disease in children and adolescents

Aim To systematically review literature investigating sleep quality in children and adolescents with inflammatory bowel disease (IBD).

CT and MRI of Rare Extraintestinal Manifestations of Inflammatory Bowel Disease in Children and Adolescents.

Inflammatory bowel disease (IBD) is associated with a spectrum of extraintestinal manifestations (EIMs) affecting many organ systems. EIMs can occur in more than 40% of patients with IBD and are associated with significant morbidity. They occur at any time point in the course of disease, often during an active phase of bowel inflammation, but sometimes preceding bowel disease. Prompt recognition of EIMs enables timely and more effective therapy. Physicians who image patients with IBD should be aware of the myriad extraintestinal conditions that may be detected on imaging studies, both within and outside of the abdomen, as they may predate the diagnosis of IBD. Cross-sectional imaging of unusual conditions associated with IBD will be presented, including pathology in the hepatobiliary, pancreatic, genitourinary, musculoskeletal, mucocutaneous, vascular, neurologic, and pulmonary systems.

Anemia in Inflammatory Bowel Diseases in Children

Anemia is one of the most frequent complications of inflammatory bowel diseases, which occur, according to various sources, in 6–74% of patients with these forms of pathology. The pathogenesis and treatment of anemia in inflammatory bowel diseases have a number of peculiarities. Thus, for example, not every anemia — iron deficiency and, accordingly, its correction is limited to only iron administration. The review analyzed the multifactorial nature of anemia in inflammatory bowel diseases, its influence on the course, and prognosis of the main disease; modern therapeutic agents are described.

Diffusion-weighted imaging in pediatric body magnetic resonance imaging.

Diffusion-weighted MRI is being increasingly used in pediatric body imaging. Its role is still emerging. It is used for detection of tumors and abscesses, differentiation of benign and malignant tumors, and detection of inflamed bowel segments in inflammatory bowel disease in children. It holds great promise in the assessment of therapy response in body tumors, with apparent diffusion coefficient (ADC) value as a potential biomarker. Significant overlap of ADC values of benign and malignant processes and less reproducibility of ADC measurements are hampering its widespread use in clinical practice. With standardization of the technique, diffusion-weighted imaging (DWI) is likely to be used more frequently in clinical practice. We discuss the principles and technique of DWI, selection of b value, qualitative and quantitative assessment, and current status of DWI in evaluation of disease processes in the pediatric body.

Clinical course and outcomes of diagnosing Inflammatory Bowel Disease in children 10 years and under: retrospective cohort study from two tertiary centres in the United Kingdom and in Italy.

BackgroundMost children with Inflammatory Bowel Disease (IBD) are diagnosed between 11 and 16 years of age, commonly presenting with features of typical IBD. Children with onset of gut inflammation under 5 years of age often have a different underlying pathophysiology, one that is genetically and phenotypically distinct from other children with IBD. We therefore set out to assess whether children diagnosed after the age of 5 years, but before the age of 11, have a different clinical presentation and outcome when compared to those presenting later.MethodsRetrospective cohort study conducted at two European Paediatric Gastroenterology Units. Two cohorts of children with IBD (total number = 160) were compared: 80 children diagnosed between 5 and 10 years (Group A), versus 80 children diagnosed between 11 and 16 (Group B). Statistical analysis included multiple logistic regression.ResultsGroup A presented with a greater disease activity (p = 0.05 for Crohn’s disease (CD), p = 0.03 for Ulcerative Colitis (UC); Odds Ratio 1.09, 95 % Confidence Interval: 1.02–1.1), and disease extent (L2 location more frequent amongst Group A children with CD (p = 0.05)). No significant differences were observed between age groups in terms of gastro-intestinal and extra-intestinal signs and symptoms at disease presentation, nor was there a difference in the number of hospitalisations due to relapsing IBD during follow-up. However, children in Group A were treated earlier with immunosuppressants and had more frequent endoscopic assessments.ConclusionWhile clinicians feel children between 5 and 10 years of age have a more severe disease course than adolescents, our analysis also suggests a greater disease burden in this age group. Nevertheless, randomized trials to document longer-term clinical outcomes are urgently needed, in order to address the question whether a younger age at disease onset should prompt per se a more “aggressive” treatment. We speculate that non-clinical factors (e.g. genetics, epigenetics) may have more potential to predict longer term outcome than simple clinical measures such as age at diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0455-y) contains supplementary material, which is available to authorized users.

P540. Efficacy and safety of adalimumab in the treatment of inflammatory bowel disease in children

P540. Efficacy and safety of adalimumab in the treatment of inflammatory bowel disease in children

Obesity and inflammatory bowel disease in children

Obesity and inflammatory bowel disease in children

Seasonal variations in onset and exacerbation of inflammatory bowel diseases in children.

BackgroundStudies have suggested that inflammatory bowel diseases (IBD) follow a seasonal pattern with regard to their onset and exacerbations. The aim of this study is to determine if there is any seasonal pattern to the onset and exacerbation of IBD in the pediatric population and if the birth of children diagnosed with IBD follows a seasonal pattern.MethodsPatients between the ages of 1 and 21 years and with a diagnosis of IBD established between July 1992 and July 2012 were included. Their onset and exacerbations of IBD (year and season) were recorded. The birth dates of the patients were aggregated to determine whether a seasonal birth pattern existed amongst them.ResultsA total of 170 children were included in this study; 34 % of patients had their onset in the fall and 19 % of them had their onset in the summer. The total number of documented exacerbations was 358 and the median number of exacerbations was two, with a range of 1–11. IBD exacerbations were generally uniformly distributed throughout the year. We did not observe any specific season where children with IBD tended to be born.ConclusionsOur data suggests that the onset of symptoms of IBD tends to have a seasonal trend with the highest incidence in the fall. However, we did not observe any association between seasonality and exacerbations in the pediatric population. Moreover, there was no specific season in which children with IBD tended to be born in greater numbers.

Inflammatory Bowel Disease in Children and Adolescents.

The inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn disease, are chronic inflammatory disorders of the gastrointestinal tract most often diagnosed in adolescence and young adulthood, with a rising incidence in pediatric populations. These disorders are common enough in children that most pediatricians and other pediatric clinicians will encounter children with IBD in their general practice. Inflammatory bowel disease is caused by a dysregulated mucosal immune response to the intestinal microflora in genetically predisposed hosts. Although children can present with the classic symptoms of weight loss, abdominal pain, and bloody diarrhea, many present with nonclassic symptoms of isolated poor growth, anemia, or other extraintestinal manifestations. Once IBD is diagnosed, the goals of therapy consist of eliminating symptoms, normalizing quality of life, restoring growth, and preventing complications while minimizing the adverse effects of medications. Unique considerations when treating children and adolescents with IBD include attention to the effects of the disease on growth and development, bone health, and psychosocial functioning. The purpose of this review is to provide a contemporary overview of the epidemiologic features, pathogenesis, diagnosis, and management of IBD in children and adolescents.