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Background and Aim: Serum leucine‐rich alpha‐2 glycoprotein (LRG) and calprotectin have been studied as disease activity markers in adults with inflammatory bowel disease (IBD). We evaluated them in pediatric IBD patients. Methods: Subjects under 17 years old undergoing care at 11 Japanese pediatric centers were retrospectively assigned to 3 groups representing Crohn's disease (CD), ulcerative colitis (UC), and normal controls (NC) with irritable bowel syndrome or no illness. Serum LRG and calprotectin were measured using commercial enzyme‐linked immunosorbent assay kits. Results: We enrolled 173 subjects, including 74 with CD, 77 with UC, and 22 NC. Serum LRG concentrations in active CD (median, 200 μg/mL) were significantly greater than in remission (81 μg/mL; P < 0.001) or NC (69 μg/mL; P < 0.001). Serum calprotectin concentrations in active CD (2941 ng/mL) also were significantly greater than in remission (962 ng/mL; P < 0.05) or NC (872 ng/mL; P < 0.05). Serum LRG concentrations in active UC (134 μg/mL) were significantly greater than in remission (65 μg/mL; P < 0.01) but not significantly greater than in NC (69 μg/mL); serum calprotectin concentrations in active UC (1058 ng/mL) were not significantly different from those in remission (671 ng/mL) or NC (872 ng/mL). In receiver operating characteristic analyses of LRG, calprotectin, C‐reactive protein, and erythrocyte sedimentation rate for ability to distinguish active IBD from remission, CD and UC showed areas under receiver operating characteristic curves for LRG (0.77 and 0.70, respectively), exceeding those for calprotectin, C‐reactive protein, or erythrocyte sedimentation rate. Conclusions: In pediatric IBD, serum LRG may better reflect disease activity than serum calprotectin, particularly in CD. [ABSTRACT FROM AUTHOR]

Background and Aim: Serologic markers such as myeloperoxidase (MPO) antineutrophil cytoplasmic antibodies (ANCA) (MPO‐ANCA) have been used to screen patients for ulcerative colitis (UC). However, MPO‐ANCA shows limited accuracy in Asians. Proteinase 3 ANCA (PR3‐ANCA) has performed better at UC diagnosis in Japanese adults than MPO‐ANCA. The present study aimed to evaluate usefulness of PR3‐ANCA for diagnosis of UC in Japanese pediatric practice. Methods: Patients under 17 years old undergoing assessment at 12 Japanese pediatric centers between November 2016 and February 2018 were prospectively enrolled and divided into groups with UC, Crohn's disease (CD), intestinal disease control (IC), and healthy control (HC). Serum PR3‐ANCA and MPO‐ANCA were analyzed using chemiluminescence enzyme immunoassay kits. Results: Sera from 367 patients (148 with UC at a median age of 12 years; 120 with CD, 13 years; 56 with IC, 10.5 years; and 43 with HC, 10 years) were examined. Median PR3‐ANCA values in UC (1.6 U/mL) were greater than in CD (0.2; P < 0.001), IC (0.15; P < 0.001), and HC (0.1; P < 0.001). In receiver operating characteristic curve analyses, the area under the curve for PR3‐ANCA was 0.79, significantly greater than for MPO‐ANCA (0.58; P < 0.001). Using a cut‐off value of 0.8 U/mL determined from the receiver operating characteristic analyses, PR3‐ANCA showed significantly greater sensitivity (64.9%) than MPO‐ANCA (cut‐off, 0.2 U/mL; sensitivity, 19.6%; P < 0.001) and good specificity (83.6%). Conclusions: In Japanese children and adolescents, PR3‐ANCA performed better as a serologic marker for diagnosis of UC than MPO‐ANCA. To our knowledge, this is the first report of such a comparison. [ABSTRACT FROM AUTHOR]

Background Long-term effectiveness of enteral nutrition for maintaining remission in pediatric Crohn's disease (CD) is poorly documented. The aim of this study was therefore to examine the long-term effectiveness of enteral nutrition with aminosalicylates as maintenance therapy for those in whom remission was primarily induced by total parenteral nutrition or exclusive enteral nutrition with aminosalicylates. Methods We retrospectively analyzed data for 58 pediatric patients with newly diagnosed CD during a median follow-up period of 50 months (range, 12-216 months). Data for remission-induced patients in whom enteral nutrition with aminosalicylates was used as maintenance therapy were analyzed with particular reference to time to first relapse and time to first intestinal surgery. Results Twenty-five (43.1%) of the patients relapsed with a median duration of remission of 32.4 months (range, 6-73.2 months). The cumulative rates of continuous remission were 0.88 (95% CI: 0.79-0.96) at 1 year, 0.73 (95% CI: 0.61-0.85) at 2 years, and 0.52 (95% CI: 0.35-0.68) at 5 years. None of the patients received corticosteroids, immunomodulators or anti-tumor necrosis factor agents until relapse. Disease location had no impact on timing of relapse, but with regard to disease behavior there was a trend towards earlier relapse in patients with penetrating type. Only six of the 58 patients (10.3%) needed intestinal surgery. There was a trend towards need for surgery in patients with ileal disease and with stricturing type. Conclusions Enteral nutrition therapy with aminosalicylates is effective for maintaining remission and decreasing the rate of intestinal surgery in pediatric CD. [ABSTRACT FROM AUTHOR]