Inflammatory Bowel Disease In Children Research Articles

Psychological interventions for inflammatory bowel disease: a systematic review and component network meta-analysis protocol

IntroductionPatients with inflammatory bowel diseases (IBD) often report psychological problems, unemployment, disability, sick leave and compromised quality of life. The effect of psychological interventions on health-related outcomes in IBD is...

Neutrophil-to-Lymphocyte Ratio: An Easy Marker for the Diagnosis and Monitoring of Inflammatory Bowel Disease in Children.

The neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive inflammation biomarker that reflects systemic inflammation based on complete blood count values. In our study, we aimed to compare the NLR values in pediatric inflammatory bowel disease (IBD) and in healthy controls, and to define NLR levels in children with IBD during diagnosis, active disease, and remission. NLR values of patients with IBD at diagnosis, remission, and active disease of the patients were recorded retrospectively. Age- and sex-matched healthy subjects enrolled as the control group. Sixty-three patients with IBD and 92 healthy subjects as the control group enrolled. The mean age of the patients with IBD was 9.31 ± 5.24years, and 57.1% were males. The mean NLR values of the patients with IBD at diagnosis and remission were significantly higher than that of healthy controls (p < 0.001). The mean NLR values of the patients at diagnosis and active disease were significantly higher than that of during remission (p < 0.001). The best cutoff of NLR for prediction of diagnosis of IBD in children was 1.46 with a sensitivity of 86.2% and specificity of 93.5%. There was no significant difference regarding NLR between patients with IBD with and without associated diseases. At diagnosis the mean NLR level of patients with Crohn's disease was significantly higher than that of ulcerative colitis (p = 0.019). It was shown for the first time that NLR levels were significantly increased at diagnosis and active disease of childhood IBD, compared to the remission period. We believe that NLR can be a non-invasive inflammatory biomarker that should be used in the initial evaluation and follow-up of the disease activity in children.

Association of autoimmune hepatobiliary pathology with inflammatory bowel diseases in children

Introduction. Hepatobiliary pathology (HBP) occurs in approximately 30% of patients with inflammatory bowel disease (IBD). However, the features of its course in the pediatric cohort of patients remain insufficiently studied. Purpose: to study the features of the course of autoimmune forms of HBD in children with IBD. Materials and methods. A comprehensive clinical, laboratory and instrumental examination was carried out in 84 children with autoimmune forms of HBP in combination with IBD (HBP+IBD), which made up the main group, and 79 patients with isolated forms of IBD included in the comparison group. Results. The prevalence of autoimmune HBP in IBD children was 10.2%. Primary sclerosing cholangitis (PSC) was diagnosed in 64.3% of cases, which was mainly associated with ulcerative colitis. The incidence of autoimmune hepatitis (AIH) was 8.3%. In the structure of the overlap syndrome, the most frequent combination was AIH+PSC (15.5%). The debut of the disease was manifested by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, haemicolitis. With HBP+IBD, there was an increase in serum concentrations of alanine (ALT) and aspartate aminotransferases (AST), total protein, γ-glutamyl transferase (GGT), alkaline phosphatase, direct bilirubin and IgG. Approximately with the same frequency in PSC, antibodies to saccharomycetes (ASCA) - 80% and antibodies to the cytoplasm of neutrophils (ANCA) - 75% were detected. In AIH, antinuclear antibodies (ANA) and antibodies to liver and kidney microsomes (anti-LKM1) were detected in 100%. HBP-IBD equally (28.6%) revealed moderate fibrosis and cirrhosis, no fibrosis in 20.6%, moderate fibrosis in 15.9% of cases, mild fibrosis in 6,3%. Cirrhosis of the liver in 55.6% of cases was the outcome of the course of PSC, in 16.7% - AIH, in 27.8% was associated with the course of the overlap syndrome. Conclusion. Various forms of autoimmune HBP occur in 10.2% of cases, are more often associated with UC, are represented by PSC and AIH, occur in males, at the onset signs are clinically presented by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, and haemicolitis.

Inflammatory bowel disease in children – from the diagnosis to the treatment Recommendations from Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Inflammatory bowel disease in children – from the diagnosis to the treatment Recommendations from Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Draft clinical guidelines for endoscopic diagnosis of ulcerative colitis in children

The article summarizes clinical guidelines for endoscopic examinations (esophagogastroduodenoscopy, ileocolonoscopy, video capsule endoscopy) in children with ulcerative colitis (UC). Such issues of endoscopic examinations and monitoring of UC as indications for primary and repeated examinations, technical aspects of examinations, biopsy, endoscopic activity indices and endoscopic semiotics of UC, the role of video capsule endoscopy are considered.

Environmental Risk Factors for Childhood Inflammatory Bowel Diseases: A Multicenter Case-Control Study.

Objective: Multiple environmental factors can be linked to the development of inflammatory bowel disease (IBD). With an increase in the cases of IBD, the objective of this research is to investigate environmental risk factors for IBD in the Saudi population. Methods: A retrospective multicenter case–control study was performed among IBD children from 2009 to 2021.The variables analyzed to be the possible risk factors included their socioeconomic status, living and demographic characteristics, and lifestyle related to IBD. The questionnaire included a list of IBD risk factors that was given to the control and the patient group. For every variable, the 95% confidence interval (CI) and odds rations were also estimated. Results: There were 335 individuals considered in this study: 168 controls (50.1%) and 167 IBD patients (49.9%). Of these, 93 IBD patients (56%) had CD and 74 patients (44%) had UC. Most of participants were female (72.1%) and were aged above 10 years (51.5%). Vaginal delivery (OR 0.551, 95% CI: 1.59–4.14), age above 10 years (OR 1.040, 95% CI: 1.012–1.069), deficient fruit intake (OR 2.572, 95% CI: 1.59–4.14), no exposure to antibiotics (OR 2.396, 95% CI: 1.51–3.81), appendectomy (OR 2.098, 95% CI: 1.87–2.35), less physical activity (OR 2.033, 95% CI: 1.05–3.93) and gastroenteritis admissions > 2 times/year (OR 0.107, 95% CI: 0.037–0.311) were the risk factors for IBD. These factors depicted a more significant link with CD than UC (p < 0.05). Interestingly, sleep disturbance was estimated to be a CD risk factor (adjusted OR: 3.291, 95% CI = 0.97–11.22). Pets in house was risk factor for UC (p < 0.001). Conclusions: This study highlights association between vaginal delivery, age above 10 years, deficient fruit intake, low physical activity, exposure to antibiotics, appendectomy, and frequent gastroenteritis admissions as risk factors for IBD. Knowledge of these risk factors can help pediatricians to prospectively identify patients at risk of environmental exposure.

Indian Academy of Pediatrics Consensus Guidelines for Probiotic Use in Childhood Diarrhea

Several probiotic species and strains, single or combined, have been evaluated in childhood diarrheal disorders, and recommendations have ever been changing as newer trials are published. Therefore, there is a need to develop a guideline for Indian children describing the current role of probiotics in clinical practice. To develop a guideline for the use of probiotics in children with diarrhea. A national consultative group (NCG) was constituted by the Indian Academy of Pediatrics (IAP), consisting of subjects experts. Sub-topics were allotted to various experts as paired groups for detailed review. Members reviewed the international and Indian literature for existing guidelines, systematic reviews, meta-analyses and trials. Thereafter, two virtual structured meetings of the group were held on 2nd and 22nd August, 2020. The management guidelines were formulated by the group and circulated to the participants for comments. The final guidelines were approved by all experts, and adopted by the IAP executive board. The NCG suggests Lactobacillus GG as a conditional recommendation with low-to-moderate level evidence or Saccharomyces boulardii as a conditional recommendation with very low-to-low level evidence as adjuvant therapy in acute diarrhea. The NCG also recommends the use of combination probiotics in neonatal necrotizing enterocolitis (NEC), as these reduce the risk of NEC stage II and above, late-onset sepsis, mortality and also time to achieve full feeds. The NCG does not recommend the use of any kind of probiotics in the therapy of acute dysentery, persistent diarrhea, Clostridium difficile diarrhea and chronic diarrheal conditions such as celiac disease, diarrhea-predominant irritable bowel syndrome and inflammatory bowel disease in children. Risk of antibiotic-associated diarrhea (AAD) is high with some antibiotics and most of these cases present as mild diarrhea. The NCG recommends probiotics only in special situations of AAD. L. rhamnoses GG or S. boulardii may be used for the prevention of AAD. VSL#3, a combination probiotic, may be used as an adjuvant in active pouchitis, prevention of recurrences and maintenance of remission in pouchitis.

Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease.

In the course of inflammatory bowel disease (IBD) malabsorption may lead to a vitamin D deficiency and calcium–phosphate misbalance. However, the reports on the vitamin D status in children with IBD are few and ambiguous. Here, we are presenting complex analyses of multiple factors influencing 25OHD levels in IBD children (N = 62; Crohn’s disease n = 34, ulcerative colitis n = 28, mean age 14.4 ± 3.01 years, F/M 23/39) and controls (n = 47, mean age 13.97 ± 2.57, F/M 23/24). Additionally, calcium–phosphate balance parameters and inflammatory markers were obtained. In children with IBD disease, activity and location were defined. Information about therapy, presence of fractures and abdominal surgery were obtained from medical records. All subjects were surveyed on the frequency and extent of exposure to sunlight (forearms, partially legs for at least 30 min a day), physical activity (at least 30 min a day) and diet (3 days diary was analyzed with the program DIETA 5). The mean 25OHD level was higher in IBD patients compared to controls (18.1 ng/mL vs. 15.5 ng/mL; p = 0.03). Only 9.7% of IBD patients and 4.25% of controls had the optimal vitamin D level (30–50 ng/mL). Despite the higher level of 25OHD, young IBD patients showed lower calcium levels in comparison to healthy controls. There was no correlation between the vitamin D level and disease activity or location of gastrointestinal tract lesions. Steroid therapy didn’t have much influence on the vitamin D level while vitamin D was supplemented. Regular sun exposure was significantly more common in the control group compared to the IBD group. We found the highest concentration of vitamin D (24.55 ng/mL) with daily sun exposure. There was no significant correlation between the vitamin D level and frequency of physical activity. The analysis of dietary diaries showed low daily intake of vitamin D in both the IBD and the control group (79.63 vs. 85.14 IU/day). Pediatric patients, both IBD and healthy individuals, require regular monitoring of serum vitamin D level and its adequate supplementation.

High Rates of Serious Infections in Childhood IBD

High Rates of Serious Infections in Childhood IBD

Regional features of the course of ulcerative colitis: clinical observations (on the example of Rostov-on-Don)

The aim of the study was to identify the clinical, epidemiological and therapeutic features of ulcerative colitis in children in Rostov-on-Don. Under the observation were 34 children aged 1 to 14 years with a diagnosis of ulcerative colitis, which was based on anamnesis, clinical picture, laboratory results, and colonoscopy. The activity of ulcerative colitis was assessed taking into account the PUCAI index. To determine the reliability of the compared indicators (%), the χ2 criterion was used. Clinical and epidemiological studies have shown an increase in the incidence of ulcerative colitis in children in Rostov-on-Don over the past 10 years. In the clinic of ulcerative colitis, mild, erased forms of the course of the disease dominated, which determined the later diagnosis at the prehospital stage. There was a «rejuvenation» of the disease: ulcerative colitis was more often detected in the preschool group of children. The incidence of ulcerative colitis in boys was higher than in girls. In the treatment of mild and moderate forms of ulcerative colitis, the use of basic drugs is very effective, taking into account the principle of «step up».

P549 Oxidative stress and antioxidant capacity biomarkers in adults and children with IBD: current update from OxIBDiet trial

Abstract Background Oxidative stress takes part in the pathogenesis of inflammatory bowel disease (IBD). The OxIBDiet (NCT04513015) is a multicentre ongoing project designed to evaluate oxidative status of IBD children and adults and to estimate the effects of an antioxidant diet in a subgroup of IBD patients. Methods The total antioxidant capacity, measured through the ferric reducing ability of plasma (FRAP, µmol/equivalent FeSO4) and oxygen radical absorbance capacity (ORAC, plasma trolox equivalents), lipid peroxidation, as serum levels of the thiobarbituric acid reactive substances (TBARs, µmol MDA) and the degree of protein oxidation, as advanced Oxidation Protein Products (AOPP, µmol/g protein), were measured. Activities (nmol/min/mg of protein) of the main antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione reductase (GR), glutathione S-Transferase (GST) and catalases (CAT) were evaluated in PMNs cells and plasma. Oxidative biomarkers were correlated with clinical parameters. Results Twenty-three adults (mean age: 33,7, IQR 20,5 years, 42% male, 63% in remission) and 41 children with IBD (mean age: 12, IQR 4 years, 52% male, 61% in remission) were enrolled and compared respectively to 29 adults and 23 children controls. FRAP was significantly reduced in IBD children compared to adults (202 vs 277 mcmol/eq FeSO4, p&amp;lt;0.0001) and was correlated with age (r=0.5718; p&amp;lt;0.0001). Plasmatic ORAC was significantly higher in IBD children compared to controls and adults with IBD (Figure 1). ORAC in IBD subjects resulted inversely correlated to age (r= -0.4417, p=0.0004) and use of biologics (r= -0.4246, p=0.0006). AOPP were elevated in paediatric IBD versus controls (p=0.0049) and correlated to the diagnosis of Crohn at the multiple regression analysis (r=-0.732; p=0.023). The main antioxidant enzymes plasmatic activities are shown in table 1. Conclusion The antioxidant system and therefore the antioxidant capacity is significantly different in IBD compared to controls and evolve from paediatric to adult age, maybe as an effort to compensate the persistent redox imbalance and inflammation. Involvement of antioxidant cascade in IBD pathogenesis and role in therapeutic approach will be better outlined by the final results.

Primary sclerosing cholangitis in children with inflammatory bowel disease

Introduction. Currently, in pediatric practice, there are no clear data on the features of the onset of primary sclerosing cholangitis (PSC) in inflammatory bowel diseases (IBD), the frequency of detection of markers of cytolysis and cholestasis, the nature of the lesion of the hepatobiliary system and changes in the endoscopic picture. Purpose: assessment of clinical, laboratory, and instrumental features of PSC course in IBD children (PSC+IBD). Materials and methods. For the period 2015-2021, a comprehensive examination of 54 children with PSC+IBD (main group) and 79 patients with isolated IBD (comparison group): ulcerative colitis (UC) or Crohn’s disease (CD) was carried out. Results. In 54 children of the main group, the combination of PSC+UC was detected in 48 (88.9%) patients with a predominance of boys. At the onset of the disease, the most frequent manifestations in children with PSC+IBD were diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, and hemocolitis. In children with PSC+IBD, compared with patients with IBD, there was a statistically significant increase in serum concentrations of ALT, AST and total protein, indicating an increase in hepatitis activity; GGT, alkaline phosphatase and direct bilirubin - about an increase in the severity of cholestasis syndrome; IgG - as a marker of the severity of mesenchymal-inflammatory syndrome in the framework of liver damage. According to the endoscopic data, with PSC+UC, pancolitis with more pronounced involvement of the right colon or isolated proctitis prevails, and with PSC+CD, ileocolitis is more common. Indices PUCAI (p &lt; 0.001) and PCDAI (p = 0.027) were statistically significantly lower in the PSC+IBD group than in the isolated IBD. According to the data of transient liver elastometry, no statistically significant difference was obtained between the medians of the parameters of the biochemical blood test at different stages of fibrosis. According to the results of magnetic resonance imaging of the abdominal organs and MR-cholangiopancreatography, the most characteristic changes in PSC+IBD are heterogeneity of the liver parenchyma, unevenness of the intra- and extrahepatic bile ducts, the presence of areas of expansion and narrowing of their diameter. Conclusions. The phenotype of PSC+IBD in children is manifested mainly by intestinal symptoms, more often UC with involvement of the right parts of the intestine in boys and a lower activity index than the isolated course of IBD, in combination with laboratory syndromes and cholestasis.

Consanguinity and Positive Family History of Inflammatory Bowel Diseases in Children: A Multicenter Case–Control Study

AbstractInflammatory bowel diseases (IBD), which comprise Crohn's disease (CD) and ulcerative colitis (UC), are rising trend in Saudi population. We aim to examine the association between consanguinity and family history and the risk of childhood IBD in Saudi children. A multicenter case–control study conducted in three tertiary hospitals in Jeddah and Riyadh, Saudi Arabia, during periods 2009 to 2021. Data about demographics, consanguinity, family history of IBD, and type of IBD were collected using a structured questionnaire. The same questionnaire was applied in matched case–control. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression analysis that was performed to compare both groups. The study population included 335 children: 167 IBD patients (49.9%) and 168 controls (50.1%). Of these IBD, 93 patients (56%) were CD and 74 patients (44%) were UC. Most of participants were females (72.1%) and their age more than 10 years (51.5%). There was first-degree consanguinity in 66 IBD patients (49.6%). No significant difference in first-degree consanguinity between cases and controls was noted (49.6% in cases vs. 50.4% in controls; OR = 1.02; 95% CI = 0.66–1.57). The consanguinity showed a more significant association with CD than UC (p &lt; 0.05). Family history of IBD (father, siblings, and grandparents) as risk factors for IBD was identified: paternal history of IBD (OR = 0.25, 95% CI = 0.08–0.76), siblings' history of IBD (OR = 2.16, 95% CI = 1.92–2.43), and grandparent's history of IBD (OR = 0.22, 95% CI = 0.07–0.65). Family history of IBD showed a more significant association with CD than UC (p &lt; 0.05). Consanguinity is strongly associated with IBD with more significant association with CD than UC and may possibly explain IBD rise in Saudi Arabia. The greatest risk of family history of IBD is in first-degree relatives, especially in siblings' rather than parents and grandparents.

Extraintestinal Manifestations in Children Diagnosed with Inflammatory Bowel Disease.

We aimed to evaluate the frequency of extraintestinal manifestations (EIM) in children with inflammatory bowel disease (IBD) and the correlation of EIM with disease activity index, disease type and disease age. Records of patients who were under the 18 years of age and followed up with the diagnosis of IBD were included in the study. The demographic characteristics of the patients, the age of the patients, the sex of the patients, the type of disease and the age of the disease were recorded. When patients were enrolled in the study disease activity indexes were calculated by examining the physical examination and laboratory values of the patients in their last visits, by using the Pediatric Ulcerative Colitis Activity Index (PUCAI) in Ulcerative Colitis (UC) and the Pediatric Crohn's Disease Activity Index (PCDAI) in Crohn's Disease (CD). It was conducted with a total of 44 patients, 40.9% (n=18) females and 59.1% (n=26) males diagnosed with IBD. The ages of the patients participating in the study ranged from 8 to 19 and the mean was found to be 14.64±3.19 years. According to the type of disease; 27.3% of the patients were CD and 72.7% were UC. When the disease activity is examined; 37.2% were in remission, 37.2% were mild, 16.3% moderate and 9.3% severe. The incidence of EIM in females is 77.8% and 65.4% in males. The incidence of EIM is 75% in CD and 68.8% in UC. Hepatobiliary involvement was detected in 41.5% (n=17) of the patients, joint involvement in 29.5% (n=13), osteopenia in bone in 16.3% (n=7), osteoporosis in 7% (n=3), ocular involvement (uveitis) in 2.3% (n=1) and skin involvement (erythema nodosum) in 2.3% (n=1). EIM are common in childhood IBD patients. It should be kept in mind that EIM are as common in UC as CD.

Azathioprin v terapii idiopatických střevních zánětů u dětí – díl I: indikace, dávkování a nežádoucí účinky léčby thiopuriny

Background: Thiopurines (in Europe mainly azathioprine) are widely used in the treatment of inflammatory bowel diseases in children. Due to a prolonged time until the onset of therapeutic effect, those drugs are aimed to be used in the maintenance phase of the therapy rather than for induction of remission. Thiopurines are sometimes used in combination therapy (with aminosalicylates or biological treatment agents). The adverse events of these drugs occur as often as in 15–40% cases and may lead to treatment cessation in a significant number of patients. Aims: To overview available information on (mainly) children suffering from inflammatory bowel disease. Conclusion: Genetic examination accompanied with laboratory monitoring of blood count parameters (specifically at the beginning of therapy) and biochemistry can help prevent some of the severe adverse events. Keywords Crohn’s disease, ulcerative colitis, pediatrie, merkaptopurin, thiopuriny

P072 Non-invasive Vagal Nerve Stimulation to Treat Crohn Disease and Ulcerative Colitis in Children and Young Adults: A Proof-of-Concept Clinical Trial.

Current inflammatory bowel disease (IBD) therapies are limited by incomplete efficacy, loss of response, side effects and high costs. Vagal nerve stimulation (VNS) is an investigational Bioelectronic Medicine therapy targeting the nervous system to treat IBD through an 'inflammatory reflex' that reduces systemic inflammation. Data in humans with IBD are promising but limited to two small studies using a cervically implanted VNS device in adults with Crohn disease (CD); no data exist to date using a non-invasive VNS modality in IBD. This study aimed to evaluate the efficacy and safety of transcutaneous auricular VNS (ta-VNS) in children and young adults with CD or ulcerative colitis (UC). IBD patients 10-21 years of age with mild/moderate CD or UC who did not achieve remission with conventional therapy, and a fecal calprotectin (FC) >200 ug/g within 4 weeks of study entry were enrolled. Subjects were randomized to receive either ta-VNS using a transcutaneous electrical nerve stimulator unit targeting the cymba conchae of the external left ear, or sham stimulation of the posterior lower leg, for 5 minutes once daily for a 2-week duration followed by a switch to the alternative stimulation for an additional 2 weeks. At week 4, all subjects were assigned to receive active ta-VNS for 5 minutes twice daily until week 16 so that all received 14 weeks of active ta-VNS by the end of the study. Primary study endpoint was defined as ∆FC ≥50% reduction from baseline to week 16. Secondary endpoints included improvement in weighted Pediatric Crohn Disease Activity Index (wPCDAI) or Pediatric Ulcerative Colitis Activity Index (PUCAI). Twenty-two subjects were enrolled (12 UC, 10 CD; median age 14.4 years [range 10-21] 54.5% male). Median baseline FC was 587 (range 18 - 3828, SD 1074). 5 subjects (4 UC, 1 CD) had FC levels 12.5 at baseline, 3 (50%) achieved clinical remission (wPCDAI ≤ 10) at week 16. In the full UC cohort (n = 12), baseline PUCAI ranged from 0-45. In the 6 with PUCAI > 10 at baseline, 2 (33%) achieved clinical remission at week 16. There were no safety concerns. Non-invasive ta-VNS reduced FC levels and improved symptoms in a pediatric cohort with mild/moderate IBD. Further research is needed to identify optimal electrical dose and settings to achieve peak anti-inflammatory effect and to identify the mechanistic principles for this therapy.

P073 Joint manifestations of IBD: about 9 cases

Abstract Background Joint manifestations during chronic inflammatory bowel diseases (IBD) represent the most frequent extra digestive manifestations, dominated by spondylarthropathy, isolated sacroillitis and peripheral rheumatism. We conducted a retrospective study of 9 cases of IBD collected in the pediatric services of the CHU MOHAMMED VI of Oujda over a 4 year period from July 2017 to March 2021.The objective of our study is to describe the joint manifestations in inflammatory bowel diseases in children. Materials and methods This is a retrospective study of 9 cases of IBD collected in the pediatric services of the CHU MOHAMMED VI of Oujda over a 4-year period from June 2017 to March 2021. All these parameters were collected on operating sheets and reported on ExcelThe data were collected from the files registered in a pediatric hospitalization register Results Our study includes 9 patients with male predominance in 60% of cases, the prevalence of joint manifestations was 45% of which 3/4 of cases are in Crohn's disease and 1/4 of cases in UC.Axial joint involvement was 25% in Crohn's disease while joint involvement was peripheral in 75% of which 2/3 in Crohn's and 1/3 in UC.Peripheral involvement affects the large joints in all patients with a bilateral character. With a biological inflammatory syndrome in which the CRP was &amp;gt;50 mg/l and the VS more than 30All patients received corticotherapy and analgesics in 25% of cases. The evolution was marked by a good clinical and biological improvement with an average delay of 10 days. Discussion Ulcerative colitis (UC) and Crohn's disease (CD) are chronic cryptogenetic inflammatory bowel diseases (IBD). In addition to intestinal involvement, these IBDs are associated in 20% to30% of cases with extra digestive manifestations, with joint manifestations being the most frequent. There are essentially two types: Peripheral attacks which are the most frequent (8–20% of patients) especially during Crohn's disease; All joints can be affected, but most often asymmetric oligoarthritisAxial involvement includes sacroiliitis (SI) and ankylosing spondylitis (SpA) SI is more prevalent than SpA in both UC and CD Treatment of joint manifestations involves rest and exercise% tocontrol spinal stiffening in axial involvement; and analgesics Close collaboration between gastro-pediatricians and pediatric rheumatologists is the key to optimal management of the extra-digestive manifestations of IBD. Conclusion Joint involvement plays an important role in the extra digestive manifestations of IBD. It should be systematically screened in IBD patients, especially if they present a biological inflammatory syndrome, thus enabling early diagnosis and better management.

Environmental risk factors for inflammatory bowel disease: A case control study in Southeast Asian children

Early-life environmental exposure, which has important implications in the pathogenesis of inflammatory bowel disease (IBD), is not well understood in Asian children. We examined environmental factors prior to the development of childhood IBD in a Southeast Asian population. We conducted a case control study in IBD diagnosed before 18 years of age and controls matched by gender, age and ethnicity. A questionnaire recording medical, family, dietary and social histories, home environment, childhood diseases and immunisation status was used. In a multivariate analysis involving 70 children with IBD (Crohn's disease (CD)=38; ulcerative colitis (UC)=32) and 140 controls, childhood acute gastroenteritis (odds ratio (OR): IBD 6.9; CD 7.8; UC 5.8) and excessive antibiotic usage in early childhood (OR: IBD 5.3; CD 4.2; UC 4.8) were significantly associated with IBD, CD and UC. Having a fish or turtle aquarium (OR 6.0), major stressful life events (OR 5.6) and attending the same school concurrently with a sibling (OR 2.9) were significant risk factors for IBD. Duration of breastfeeding >6months (OR: IBD 0.4; UC 0.2) and safe water consumption (OR: IBD 0.2; UC 0.2) reduced the odds of having IBD and UC, respectively. Being vaccinated for rotavirus reduced the odds of developing IBD (OR 0.1). Several risk and protective factors were identified in this environmental risk study in Southeast Asian children with IBD. This knowledge has important implications in understanding disease aetiology and future prevention strategies to reduce the development of IBD in Southeast Asian children.

The condition of the oral cavity at the time of\xa0diagnosis of\xa0inflammatory bowel disease in pediatric patients

Changes in the oral mucosa can appear in the course of inflammatory bowel disease in both children and adults. They often precede the appearance of gastrointestinal symptoms. The aim of the study was to determine the nature of changes in the oral cavity at the time of diagnosis of inflammatory bowel disease in children compared to children without systemic diseases. 49 children diagnosed with inflammatory bowel disease and 60 children without systemic diseases were examined. The prevalence of the aphthae stomatitis and angular cheilitis was 24.5% in the examined group and 10% in the control group (p = 0.0772). Changes in the oral mucosa occurred more frequently in children with Crohn's disease 35.3% than with ulcerative colitis 18.7%. In children with Crohn's disease, the most frequently observed lesion was aphthous stomatitis 23.5%, and in ulcerative colitis, angular cheilitis 12.5%. Changes in the oral mucosa are a therapeutic problem requiring in general diseases patients both local and systemic treatment and interdisciplinary cooperation between dentists, paediatricians and gastroenterologists. The finding of repeated changes in the oral mucosa during a dental examination should be the reason for referring the patient to a paediatrician for the foreclosure or make a diagnosis of inflammatory bowel diseases.

Nutritional Impact of Medical Management and Operation in Responsive and Refractory Ulcerative Colitis in Children

Nutritional Impact of Medical Management and Operation in Responsive and Refractory Ulcerative Colitis in Children