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Demonstrates additional beneficial clinical outcomes from conventional medication through supplementation with oral intake of cereals in adults with ulcerative colitis or Crohn's disease. Observation of increased plasma activity of the protein antisecretory factor after cereal intake; Potential influence of cereal in pediatric patients suffering from inflammatory bowel diseases.

BACKGROUND: An increased incidence of paediatric Crohn's disease was reported recently by our group. AIMS: To assess the incidence and characteristics of inflammatory bowel disease (IBD) in northern Stockholm between 1990 and 2001. METHODS: All records of individuals 0-15 years of age with suspected IBD in the population based catchment area of 180 000 individuals were scrutinised using defined diagnostic criteria. Patient files were searched for relatives with IBD, and for concomitant autoimmune diseases. RESULTS: A total of 152 children were diagnosed with IBD, corresponding to an overall incidence (per 100 000) of IBD of 7.4. The incidence of Crohn's disease (CD) was 4.9, ulcerative colitis (UC) 2.2, and indeterminate colitis 0.2. Between 1990 and 2001, there was a marked increase in the incidence of CD while the incidence of UC was almost unchanged, leading to a net increase in the overall occurrence of IBD. There was a male dominance of CD. Fourteen per cent and 11% of patients with CD and UC, respectively, had a first or second degree relative with IBD. Eighteen per cent and 10% of patients with CD and UC, respectively, had a concomitant autoimmune disease. Ten patients with CD (10%) underwent surgery. CONCLUSIONS: The incidence of CD has increased in northern Stockholm. The current incidence is higher than that reported from other areas. Our results suggest a shift in presentation and diagnosis from UC towards CD, but also a net increase in IBD. Concomitant autoimmune disorders and family history are common in paediatric IBD. [ABSTRACT FROM AUTHOR]

Thirty-eight children with Helicobacter pylori gastritis diagnosed by histopathology, and/or bacteriological culture were treated with omeprazole, amoxicillin and clarithromycin. Follow-up endoscopy was performed in 34 children. Outcome was measured by negative histology and culture for H. pylori. Six patients were excluded. Of the 32 remaining children eradication was achieved in 75% (95% confidence interval 60-90%). [ABSTRACT FROM AUTHOR]

OBJECTIVES:Infl ammatory bowel disease (IBD), e.g., Crohn's disease (CD) and ulcerative colitis (UC), is a complex genetic disorder. Tumor necrosis factor (ligand) superfamily, member 15 (TNFSF15) has been previously identified as a susceptibility gene for CD in Japanese and UK cohorts. This replication study was designed in order to confirm and further validate the role of TNFSF15 in IBD.METHODS:A total of 666 IBD families (corresponding to 2,982 relatives) with European ancestry were genotyped for the rs6478108 and rs7869487 polymorphisms, which define the main TNFSF15 haplotypes previously associated with CD. An association between the main haplotypes and CD, UC and IBD was tested using the Genehunter TDT and Unphased statistics. Caspase recruitment domain 15 (CARD15)/TNFSF15 interaction and genotype/phenotype correlations were also studied.RESULTS:The previously reported “high-risk” haplotype (A) was associated with IBD (P=0.001) (OR=1.25 (1.05–1.50)) and CD (P=0.02) (OR=1.31 (1.03–1.67)) whereas the “protective” (B) haplotype was significantly less transmitted to IBD and CD patients. No interaction between CARD15 and TNFSF15 was detected. We also failed to define a clinical subgroup of CD patients specifically associated with TNFSF15 haplotype A.CONCLUSIONS:This study confirms that TNFSF15 or a closely linked gene is involved in the genetic predisposition to CD.Am J Gastroenterol 2009; 104:384–391; doi:10.1038/ajg.2008.36; published online 13 January 2009 [ABSTRACT FROM AUTHOR]

Aims: To test the assumption that epithelioid granulomas found in colonoscopic biopsy specimens in patients with Crohn's colitis are markers of a different clinical behaviour. Methods: Sections from colonoscopic biopsy specimens from 352 consecutive patients (119 children and 233 adults) were investigated. Results: A total of 1117 colonoscopies were performed: 293 in children (mean 2.46 per patient) and 824 in adults (mean 3.53 per patient) (p<0.05). Granulomas at initial colonoscopy were recorded in 67.2% (43/ 64) of children and 65.9% (27/41) of adults (p>0.6), and at subsequent colonoscopies in 53.8% (64/119) of children and 17.6% (41/233) of adults (p<0.05). Surgical intervention was required in 6.3% (4/64) of the children having previous granuloma, but also in 14.5% (8/55) of those without previous granuloma, the rate for operated adults being 26.8% (11/41) and 24.5% (47/192), respectively (p>0.6). Conclusions: Granulomas in entry and/or in subsequent colonoscopic biopsy specimens in patients with Crohn's colitis did not predict the need for subsequent surgical intervention. The fact that the frequency of granulomas was significantly higher in children than in adults with Crohn's colitis (despite a higher mean number of colonoscopic biopsies in adults), and that granulomas were present in colonoscopic biopsy specimens but not in the subsequent surgical specimens from 50% of the paediatric and 36% of the adult patients strengthen the conviction that granulomas in Crohn's colitis might evolve or regress at different time intervals during the course of the disease. This behaviour would reflect a particular immunological reaction, an epiphenomenon from immature tissues--as in children--when challenged by the so far elusive aetiological agent responsible for Crohn's disease. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether radiological findings and healing time in children with pneumonia are correlated to etiologic agent. Material and Methods: A total of 346 children with radiologically verified acute pneumonia, and with accomplished serological tests for bacteria and viruses, were included in the study. Five etiological groups were analysed: children with bacterial etiology only, with viral etiology only, with mixed bacterial and viral etiology, with Mycoplasma only, and children with no etiology. Results: The chest films of each etiological group were analysed and the findings were correlated to the children's age. The radiological findings did not differ between the etiological groups. Radiological findings correlated significantly with the patient's age. The radiological healing frequency at check-up X-ray was found to be significantly lower in children with mixed bacterial and viral etiology compared to children in each of the other groups and to the material as a whole. Conclusion: Conclusions about the etiology could not be drawn from the chest X-ray findings. [ABSTRACT FROM AUTHOR]

Background and aims: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are complex genetic disorders. CARD15/NOD2, a member of the Ced4 superfamily which includes Apaf-1 and CARD4/NOD1, has recently been associated with genetic predisposition to CD but additional genetic factors remain to be identified. Because CARD4/NOD1 shares many structural and functional similarities with CARD15, we tested its putative role in IBD. Patients and methods: The 11 exons of CARD4 were screened for the presence of variants in 63 unrelated IBD patients. The only non-private genetic variation encoding for a substitution in the peptidic chain was genotyped in 381 IBD families (235 CD, 58 UC, 81 mixed, and seven indeterminate colitis families) using a polymerase chain reaction-restriction fragment length polymorphism procedure. Genotyping data were analysed by the transmission disequilibrium test. Results: Five of nine sequence variations identified in the coding sequence of the gene encoded for non-conservative changes (E266K, D372N, R705Q, T787M, and T787K). Four were present in only one family. The remaining variant (E266K), which exhibited an allele frequency of 0.28, was not associated with CD, UC, or IBD. Furthermore, IBD patients carrying sequence variations in their CARD4 gene had a similar phenotype to those with a normal sequence. Conclusion: Our results suggest that CARD4 does not play a major role in genetic susceptibility to IBD. [ABSTRACT FROM AUTHOR]

Background: Nitric oxide (NO) production is increased in inflammatory bowel disease (IBD). Measurements of luminal NO in Crohn disease and ulcerative colitis have revealed that levels are increased during active disease. We aim to evaluate whether rectal measurements of NO can reveal active disease of the colon as well as ileum. Methods: Sixteen children with active Crohn disease in the ileocaecal or colorectal regions of the gut and 6 children with active ulcerative colitis were compared to a group of 14 healthy children. Gaseous samples for analysis of luminal NO were collected using a Foley catheter inserted into rectum. The balloon of the catheter was filled with NO-free air and incubated for 10 min. After aspiration, samples were analysed using chemiluminescence. Values are expressed as median and range. Results: In healthy children, rectal NO values were 60 (0-275) ppb. In children with Crohn disease of the colorectal region, NO concentrations were 5,675 (300-49,350) ppb (P < 0.001), while those with Crohn disease of the ileocaecal region had NO levels of 2,625 (300-15,000) ppb (P < 0.01). In children with ulcerative colitis, NO values of 5,500 (950-34,000) ppb were found (P < 0.001). Conclusion: Rectal NO levels are greatly increased in children with IBD. Highest values were found in patients with colorectal engagement, but rectal NO was increased also in ileocaecal disease. Rectal sampling of luminal NO is a simple and minimally invasive method and should be considered a diagnostic tool for intestinal inflammatory activity in children regardless of primary disease location. [ABSTRACT FROM AUTHOR]