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1. Differences in Outcomes Over Time With Exclusive Enteral Nutrition Compared With Steroids in Children With Mild to Moderate Crohn’s Disease: Results From theGROWTH CDStudy

Author

Ron Shaoul, Malgorata Sladek, Sibylle Koletzko, Jorge Amil Dias, Javier Martín de Carpi, Annamaria Staiano, Rotem Sigall Boneh, Gábor Veres, Federica Nuti, Arie Levine, N. Cohen-Dolev, Seamus Hussey, Sivan Ben Avraham Shulman, Dan Turner, Tomer Ziv-Baran, Richard K. Russell, Anders Paerregaard, Tamar Pfeffer Gik, Paolo Lionetti, Chen Sarbagili Shabat, Cohen-Dolev, Noa, Sladek, Malgorata, Hussey, Seamu, Turner, Dan, Veres, Gabor, Koletzko, Sibylle, Martin de Carpi, Javier, Staiano, Annamaria, Shaoul, Ron, Lionetti, Paolo, Amil Dias, Jorge, Paerregaard, Ander, Nuti, Federica, Pfeffer Gik, Tamar, Ziv-Baran, Tomer, Ben Avraham Shulman, Sivan, Sarbagili Shabat, Chen, Sigall Boneh, Rotem, Russell, Richard K, and Levine, Arie

Subjects
Male, medicine.medical_specialty, Pediatrics, Adolescent, Constriction, Pathologic, Severity of Illness Index, Gastroenterology, Inflammatory bowel disease, 03 medical and health sciences, Enteral Nutrition, 0302 clinical medicine, Crohn Disease, Adrenal Cortex Hormones, Recurrence, Internal medicine, Severity of illness, medicine, Humans, Rectal Fistula, Prospective Studies, 030212 general & internal medicine, Child, Propensity Score, Prospective cohort study, Biological Products, Crohn's disease, business.industry, Remission Induction, Mean age, General Medicine, medicine.disease, Abscess, Body Height, Treatment Outcome, Parenteral nutrition, Propensity score matching, Female, 030211 gastroenterology & hepatology, business, Complication
Abstract

Background: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. Methods: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. Results: A total of 147 children [mean age 12.9 +/- 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 +/- 1 months with CS, 16.05 +/- 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 +/- 1.1 to -0.51 +/- 1.2, p = 0.01], but not with EEN [-0.32 +/- 1.1 to -0.22 +/- 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.

Published
2017
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2. Corrigendum to: Diagnostic Yield of Next-Generation Sequencing in Very Early-Onset Inflammatory Bowel Diseases: A Multicenter Study

Author

Olivier Alibeu, P. Tounian, Nadia Siala, Michela Tempia-Caliera, Jean-Pierre Hugot, Sabine Rakotobe, Christelle Lenoir, Anne Breton, Caterina Strisciuglio, Víctor Manuel Navas-López, Jan Melek, Alain Fischer, Frédéric Rieux-Laucat, Marie-Claude Stolzenberg, Eric Jeziorski, Yago González-Lama, Bénédicte Pigneur, Mongi Ben Hariz, Marina Aloi, Sylvain Latour, Fabienne Mazerolles, Christian Breuer, Julie Bruneau, Clara Crémilleux, Cecile Pelatan, Vaidotas Urbonas, Alexandre Fabre, Nadine Cerf-Bensussan, Frank M. Ruemmele, Luisa Mearin, Capucine Picard, Georgia Malamut, Neslihan Gurcan, Anders Paerregaard, Isabel Pinto Pais, Dan Turner, István Máttyus, Julie Rebeuh, Jiri Bronsky, Sylvain Hanein, Peter Lewindon, Rémi Duclaux-Loras, Graziella Guariso, Anne Bourrier, Odul Egritas Gurkan, Janos Major, Stéphanie Willot, Mara Cananzi, Marianna Parlato, Claudio Romano, Alain Lachaux, Matjaz Homan, Jorge Amil Dias, Eva Lévy, A Fischer, Stéphanie Coopman, Jan Krzysztof Nowak, Fernando Magro, Clémentine Dumant-Forest, Stephan Buderus, Bernadette Bègue, Fabienne Charbit-Henrion, Olivier Goulet, Evi Karanika, Alain Dabadie, Emmanuel Mas, Marta German Diaz, Cécile Fourrage, Rosa Lima, Charbit-Henrion, Fabienne, Parlato, Marianna, Hanein, Sylvain, Duclaux-Loras, Rémi, Nowak, Jan, Begue, Bernadette, Rakotobe, Sabine, Bruneau, Julie, Fourrage, Cécile, Alibeu, Olivier, Rieux-Laucat, Frédéric, Lévy, Eva, Stolzenberg, Marie-Claude, Mazerolles, Fabienne, Latour, Sylvain, Lenoir, Christelle, Fischer, Alain, Picard, Capucine, Aloi, Marina, Dias, Jorge Amil, Hariz, Mongi Ben, Bourrier, Anne, Breuer, Christian, Breton, Anne, Bronsky, Jiri, Buderus, Stephan, Cananzi, Mara, Coopman, Stéphanie, Crémilleux, Clara, Dabadie, Alain, Dumant-Forest, Clémentine, Gurkan, Odul Egrita, Fabre, Alexandre, Fischer, Aude, Diaz, Marta German, Gonzalez-Lama, Yago, Goulet, Olivier, Guariso, Graziella, Gurcan, Neslihan, Homan, Matjaz, Hugot, Jean-Pierre, Jeziorski, Eric, Karanika, Evi, Lachaux, Alain, Lewindon, Peter, Lima, Rosa, Magro, Fernando, Major, Jano, Malamut, Georgia, Mas, Emmanuel, Mattyus, Istvan, Mearin, Luisa M, Melek, Jan, Navas-Lopez, Victor Manuel, Paerregaard, Ander, Pelatan, Cecile, Pigneur, Bénédicte, Pais, Isabel Pinto, Rebeuh, Julie, Romano, Claudio, Siala, Nadia, Strisciuglio, Caterina, Tempia-Caliera, Michela, Tounian, Patrick, Turner, Dan, Urbonas, Vaidota, Willot, Stéphanie, Ruemmele, Frank M, and Cerf-Bensussan, Nadine

Subjects
VEO-IBD, business.industry, Yield (finance), monogenic IBD, next generation sequencing, very early onset IBD, Gastroenterology, Inflammatory Bowel Diseases, Genetics and molecular epidemiology, Original Articles, General Medicine, monogenic disorders, Bioinformatics, Very early onset, DNA sequencing, paediatrics, Editor's Choice, Multicenter study, TNGS, Medicine, genetics and molecular epidemiology, business
Abstract

Background and Aims An expanding number of monogenic defects have been identified as causative of severe forms of very early-onset inflammatory bowel diseases [VEO-IBD]. The present study aimed at defining how next-generation sequencing [NGS] methods can be used to improve identification of known molecular diagnosis and to adapt treatment. Methods A total of 207 children were recruited in 45 paediatric centres through an international collaborative network [ESPGHAN GENIUS working group] with a clinical presentation of severe VEO-IBD [n = 185] or an anamnesis suggestive of a monogenic disorder [n = 22]. Patients were divided at inclusion into three phenotypic subsets: predominantly small bowel inflammation, colitis with perianal lesions, and colitis only. Methods to obtain molecular diagnosis included functional tests followed by specific Sanger sequencing, custom-made targeted NGS, and in selected cases whole exome sequencing [WES] of parents-child trios. Genetic findings were validated clinically and/or functionally. Results Molecular diagnosis was achieved in 66/207 children [32%]: 61% with small bowel inflammation, 39% with colitis and perianal lesions, and 18% with colitis only. Targeted NGS pinpointed gene mutations causative of atypical presentations, and identified large exonic copy number variations previously missed by WES. Conclusions Our results lead us to propose an optimised diagnostic strategy to identify known monogenic causes of severe IBD.

Published
2020

3. Diagnostic yield of next-generation sequencing in very early-onset inflammatory bowel diseases: A multicentre study

Author

Charbit-Henrion, Fabienne, Parlato, Marianna, Hanein, Sylvain, Duclaux-Loras, Remi, Nowak, Jan, Bègue, Bernadette, Rakotobe, Sabine, Bruneau, Julie, Fourrage, Cécile, Alibeu, Olivier, Rieux-Laucat, Frédéric, Lévy, Eva, Stolzenberg, Marie-Claude, Mazerolles, Fabienne, Latour, Sylvain, Lenoir, Christelle, Fischer, Alain, Picard, Capucine, Aloi, Marina, Amil Dias, Jorge, Ben Hariz, Mongi, Bourrier, Anne, Breuer, Christian, Breton, Anne, Bronski, Jiri, Buderus, Stephan, Cananzi, Mara, Coopman, Stéphanie, Crémilleux, Clara, Dabadie, Alain, Dumant-Forest, Clémentine, Egritas Gurkan, Odul, Fabre, Alexandre, Fischer, Aude, German Diaz, Marta, Gonzalez-Lama, Yago, Goulet, Olivier, Guariso, Graziella, Gurcan, Neslihan, Homan, Matjaz, Hugot, Jean-Pierre, Jeziorski, Eric, Karanika, Evi, Lachaux, Alain, Lewindon, Peter, Lima, Rosa, Magro, Fernando, Major, Janos, Malamut, Georgia, Mas, Emmanuel, Mattyus, Istvan, Mearin, Luisa, Melek, Jan, Navas-Lopez, Victor Manuel, Paerregaard, Anders, Pelatan, Cecile, Pigneur, Bénédicte, Pinto Pais, Isabel, Rebeuh, Julie, Romano, Claudio, Siala, Nadia, Strisciuglio, Caterina, Tempia-Caliera, Michela, Tounian, Patrick, Turner, Dan, Urbonas, Vaidotas, Willot, Stéphanie, Ruemmele, Frank, Cerf-Bensussan, Nadine, Charbit-Henrion, Fabienne, Parlato, Marianna, Hanein, Sylvain, Duclaux-Loras, Rémi, Nowak, Jan, Begue, Bernadette, Rakotobe, Sabine, Bruneau, Julie, Fourrage, Cécile, Alibeu, Olivier, Rieux-Laucat, Frédéric, Lévy, Eva, Stolzenberg, Marie-Claude, Mazerolles, Fabienne, Latour, Sylvain, Lenoir, Christelle, Fischer, Alain, Picard, Capucine, Aloi, Marina, Dias, Jorge Amil, Hariz, Mongi Ben, Bourrier, Anne, Breuer, Christian, Breton, Anne, Bronski, Jiri, Buderus, Stephan, Cananzi, Mara, Coopman, Stéphanie, Crémilleux, Clara, Dabadie, Alain, Dumant-Forest, Clémentine, Gurkan, Odul Egrita, Fabre, Alexandre, Fischer, Aude, Diaz, Marta German, Gonzalez-Lama, Yago, Goulet, Olivier, Guariso, Graziella, Gurcan, Neslihan, Homan, Matjaz, Hugot, Jean-Pierre, Jeziorski, Eric, Karanika, Evi, Lachaux, Alain, Lewindon, Peter, Lima, Rosa, Magro, Fernando, Major, Jano, Malamut, Georgia, Mas, Emmanuel, Mattyus, Istvan, Mearin, Luisa M, Melek, Jan, Navas-Lopez, Victor Manuel, Paerregaard, Ander, Pelatan, Cecile, Pigneur, Bénédicte, Pais, Isabel Pinto, Rebeuh, Julie, Romano, Claudio, Siala, Nadia, Strisciuglio, Caterina, Tempia-Caliera, Michela, Tounian, Patrick, Turner, Dan, Urbonas, Vaidota, Willot, Stéphanie, Ruemmele, Frank M., Cerf-Bensussan, Nadine, Laboratory of Intestinal Immunity (Equipe Inserm U1163), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), The Clinical Bioinformatics laboratory (Equipe Inserm U1163), Immunité et cancer (U932), Université Paris Descartes - Paris 5 (UPD5)-Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Immunogenetics of pediatric autoimmune diseases (Equipe Inserm U1163), Chaire Médecine expérimentale (A. Fischer), Collège de France (CdF (institution)), GENIUS Group, Service de Gastroentérologie et nutrition [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Pédiatrie, Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de pédiatrie médicale et médecine de l'adolescent [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Hospital Universitario Puerta de Hierro-Majadahonda [Madrid, Spain], Gastroentérologie-Hépatologie et Nutrition Pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Hospital de São João [Porto], Service de gastroenterologie [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Recherche Agronomique (INRA)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Le Mans (CH Le Mans), University of Messina, Department of Pediatrics, Centre Hospitalier Universitaire Mongi Slim [La Marsa], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Gastroentérologie, d'hépatologie et nutrition pédiatrique [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5)-Institut Curie-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut National de la Recherche Agronomique (INRA)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), CHU Le MAns, Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Curie-Université Paris Descartes - Paris 5 (UPD5), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), and Institut Curie-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, paediatric, VEO-IBD, Adolescent, monogenic disorder, Gastroenterology, High-Throughput Nucleotide Sequencing, Infant, Genetics and molecular epidemiology, Inflammatory Bowel Diseases, monogenic disorders, Corrigenda, Cohort Studies, paediatrics, Predictive Value of Tests, Child, Preschool, TNGS, Humans, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, Age of Onset, Child, Genetics and molecular epidemiology, monogenic disorders, paediatrics, TNGS, VEO-IBD, Gastroenterology, AcademicSubjects/MED00260
Abstract

Background and Aims An expanding number of monogenic defects have been identified as causative of severe forms of very early-onset inflammatory bowel diseases [VEO-IBD]. The present study aimed at defining how next-generation sequencing [NGS] methods can be used to improve identification of known molecular diagnosis and to adapt treatment. Methods A total of 207 children were recruited in 45 paediatric centres through an international collaborative network [ESPGHAN GENIUS working group] with a clinical presentation of severe VEO-IBD [n = 185] or an anamnesis suggestive of a monogenic disorder [n = 22]. Patients were divided at inclusion into three phenotypic subsets: Predominantly small bowel inflammation, colitis with perianal lesions, and colitis only. Methods to obtain molecular diagnosis included functional tests followed by specific Sanger sequencing, custom-made targeted NGS, and in selected cases whole exome sequencing [WES] of parents-child trios. Genetic findings were validated clinically and/or functionally. Results Molecular diagnosis was achieved in 66/207 children [32%]: 61% with small bowel inflammation, 39% with colitis and perianal lesions, and 18% with colitis only. Targeted NGS pinpointed gene mutations causative of atypical presentations, and identified large exonic copy number variations previously missed by WES. Conclusions Our results lead us to propose an optimised diagnostic strategy to identify known monogenic causes of severe IBD.

Published
2018
Full Text
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4. Response to treatment is more important than disease severity at diagnosis for prediction of early relapse in new-onset paediatric Crohn’s disease

Author

Gábor Veres, Jorge Amil Dias, Anders Paerregaard, Johanna C. Escher, Dror Weiner, Dan Turner, Richard K. Russell, Erasmo Miele, Javier Martín de Carpi, Rotem Sigall Boneh, Tomer Ziv-Baran, Kaija-Leena Kolho, Sibylle Koletzko, Ron Shaoul, Seamus Hussey, Arie Levine, Federica Nuti, Malgorzata Sladek, Paolo Lionetti, L. Finnby, Ziv-Baran, Tomer, Hussey, Séamu, Sladek, Malgorzata, Amil Dias, Jorge, Martin de Carpi, Javier, Miele, Erasmo, Veres, Gabor, Lionetti, Paolo, Koletzko, Sibylle, Nuti, Federica, Paerregaard, Ander, Kolho, Kaija-Leena, Russell, Richard K., Shaoul, Ron, Weiner, Dror, Sigall Boneh, Rotem, Escher, Johanna, Finnby, Lenne, Turner, Dan, Levine, Arie, and Pediatrics

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Adolescent, Disease, Klinikai orvostudományok, Logistic regression, Severity of Illness Index, Feces, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Predictive Value of Tests, Recurrence, Internal medicine, Severity of illness, medicine, Humans, Immunologic Factors, Pharmacology (medical), Prospective Studies, Child, Prospective cohort study, Crohn's disease, Hepatology, business.industry, Remission Induction, Gastroenterology, Orvostudományok, medicine.disease, Faecal calprotectin, Treatment Outcome, 030104 developmental biology, Child, Preschool, Predictive value of tests, Female, 030211 gastroenterology & hepatology, Calprotectin, business, Leukocyte L1 Antigen Complex, Biomarkers
Abstract

Background Paediatric Crohn's disease is characteried by frequently relapsing disease which may lead to hospitalisations and complications. Aim To develop predictive models for early relapse following first remission. Methods The GROWTH CD prospective inception cohort was designed to predict risk for early disease relapse and poor outcomes. Newly diagnosed children underwent endoscopies and imaging. They were phenotyped and followed at scheduled visits through 78 weeks for relapses. Twenty-eight dichotomous and continuous variables were assessed at baseline and week 12, including phenotype, inflammatory markers, disease activity (PCDAI) and other markers. Clinical relapses defined as PCDAI >10 after remission were recorded using a relapse form. Logistic regression & risk modelling was performed. Results We enrolled 282 eligible patients of whom 178 (63.6%) patients achieved steroid free remission by week 12. Disease complications developed in 22/76(29%) of patients with relapse compared to 20/206 (9.7%) without relapse (P = 0.01). Multivariable analysis demonstrated that while variables from age/gender at diagnosis were not predictive, week 12 variables including PCDAI >5 (P = 0.02), CRP >20 mg/L (P = 0.02), and faecal calprotectin >400 µg/g (P = 0.03) as optimal cut-offs were associated with increased risk of relapse. A prediction model for patients in remission including gender, age, week 12 PCDAI, calprotectin and CRP had sensitivity 43%, specificity 92%, PPV 78%, NPV 71% for relapse. Conclusions Early relapses were associated with a higher risk for disease complications at followup. Relapse prediction based on week 12 disease activity or inflammation is superior to prediction using data from diagnosis.

Published
2018

5. Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN

Author

Mikko P. Pakarinen, Frank M. Ruemmele, Javier Martín-de-Carpi, Christine Spray, Iva Hojsak, Ian D. Sugarman, Sanja Kolaček, Dan Turner, Annamaria Staiano, Sibylle Koletzko, Ron Shaoul, Sonny K. F. Chong, Paolo Lionetti, Devinder Kumar, John Fell, Harland S. Winter, Anders Paerregaard, Risto Rintala, David C. Wilson, Jean-Pierre Hugot, Nadeem A. Afzal, Craig W. Lillehei, Kaija-Leena Kolho, Izabella Lazowska-Przeorek, Katarzyna Karolewska-Bochenek, Jiri Bronsky, Jorge Amil-Dias, Amil Dias, Jorge, Kolacek, Sanja, Turner, Dan, Pærregaard, Ander, Rintala, Risto, Afzal, Nadeem Ahmad, Karolewska Bochenek, Katarzyna, Bronsky, Jiri, Chong, Sonny, Fell, John, Hojsak, Iva, Hugot, Jean Pierre, Koletzko, Sibylle, Kumar, Devinder, Lazowska Przeorek, Izabella, Lillehei, Craig, Lionetti, Paolo, Martin de Carpi, Javier, Pakarinen, Mikko, Ruemmele, Frank M, Shaoul, Ron, Spray, Christine, Staiano, Annamaria, Sugarman, Ian, Wilson, David C, Winter, Harland, and Kolho, Kaija Leena

Subjects
medicine.medical_specialty, Placebo-controlled study, MEDLINE, Anti-Inflammatory Agents, Inflammatory bowel disease, Perioperative Care, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, Crohn Disease, law, Recurrence, Intestine, Small, Secondary Prevention, Medicine, Humans, Elective surgery, Intensive care medicine, Child, Colectomy, business.industry, Incidence (epidemiology), Patient Selection, Anastomosis, Surgical, Gastroenterology, Perioperative, medicine.disease, Surgery, Biological Therapy, Chemotherapy, Adjuvant, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, 030211 gastroenterology & hepatology, business, Elective Surgical Procedure, Immunosuppressive Agents
Abstract

The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.

Published
2017

6. Clostridium difficile and pediatric inflammatory bowel disease: A prospective, comparative, multicenter, ESPGHAN study

Author

Dan Turner, Erasmo Miele, Gábor Veres, Marina Aloi, Massimo Martinelli, Mariassunta Del Pezzo, Ana Močić Pavić, Anders Paerregaard, Arie Levine, Javier Martín-de-Carpi, Annamaria Staiano, Caterina Strisciuglio, Martinelli, Massimo, Strisciuglio, Caterina, Veres, Gabor, Paerregaard, Ander, Pavic, Ana M., Aloi, Marina, Martín De Carpi, Javier, Levine, Arie, Turner, Dan, Del Pezzo, Mariassunta, Staiano, Annamaria, and Miele, Erasmo

Subjects
Male, medicine.medical_specialty, Proton Pump Inhibitor, Adolescent, Prognosi, MEDLINE, Clostridium Infection, Disease, digestive system, Gastroenterology, Inflammatory bowel disease, Follow-Up Studie, Disease course, Internal medicine, Anti-Bacterial Agent, medicine, Humans, Immunology and Allergy, Prospective Studies, Child, Prospective cohort study, Crohn's disease, Ulcerative coliti, Clostridium difficile, Ulcerative colitis, Anti-Bacterial Agents, Celiac Disease, Child, Preschool, Clostridium Infections, Female, Follow-Up Studies, Inflammatory Bowel Diseases, Prognosis, Proton Pump Inhibitors, Medicine (all), Clostridioides difficile, business.industry, Inflammatory Bowel Disease, medicine.disease, digestive system diseases, Prospective Studie, business, Human
Abstract

Background: Clostridium difficile infection is associated with pediatric inflammatory bowel disease (IBD) in several ways. We sought to investigate C. difficile infection in pediatric patients with IBD in comparison with a group of children with celiac disease and to evaluate IBD disease course of C. difficile infected patients. Methods: In this prospective, comparative, multicenter study, 211 pediatric patients with IBD were enrolled from October 2010 to October 2011 and tested for the presence of C. difficile toxins A and B in their stools at 0, 6, and 12 months. During the same study period, stool specimens for C. difficile toxins analysis were collected from 112 children with celiac disease as controls. Results: Clostridium difficile occurrence was significantly higher in patients with IBD compared with patients with celiac disease (7.5% versus 0.8%; P = 0.008). Clostridium difficile was associated with active disease in 71.4% of patients with IBD (P = 0.01). Colonic involvement was found in 85.7% of patients with C. difficile. Antibiotics, proton pump inhibitors, hospitalization, and IBD therapies were not associated with increased C. difficile detection. At 12 months, a higher number of C. difficile-positive patients at the enrollment started immunosuppressant/biological therapy compared with patients without C. difficile (P = 0.01). At 6 and 12 months, patients with C. difficile were more frequently in active disease than patients without C. difficile (P = 0.04; P = 0.08, respectively). Hospitalizations were higher at 6 months in C. difficile group (P = 0.05). Conclusions: In conclusion, this study demonstrates that pediatric IBD is associated with increased C. difficile detection. Patients with C. difficile tend to have active colonic disease and a more severe disease course. Copyright © 2014 Crohn's & Colitis Foundation of America, Inc.

Published
2014

7. Management of pediatric ulcerative colitis : joint ECCO and ESPGHAN evidence-based consensus guidelines

Author

Gábor Veres, Ulrika L. Fagerberg, David C. Wilson, Brian Sweeny, Johanna C. Escher, Kaija-Leena Kolho, Annamaria Staiano, Alexander Potapov, Jorge Amil Dias, Frank M. Ruemmele, Jean-Pierre Hugot, Sanja Kolaček, Seamus Hussey, Daniela Elena Serban, Salvatore Cucchiara, Risto Rintala, Richard K. Russell, Dan Turner, Anne M. Griffiths, Paolo Lionetti, Jiri Bronsky, Anders Paerregaard, Christian Braegger, Axel Dignass, Lissy de Ridder, Arie Levine, Gigi Veerman, Pediatrics, Turner, Dan, Levine, Arie, Escher, Johanna C, Griffiths, Anne M, Russell, Richard K, Dignass, Axel, Dias, Jorge Amil, Bronsky, Jiri, Braegger, Christian P, Cucchiara, Salvatore, de Ridder, Lissy, Fagerberg, Ulrika L, Hussey, Séamu, Hugot, Jean Pierre, Kolacek, Sanja, Kolho, Kaija Leena, Lionetti, Paolo, Paerregaard, Ander, Potapov, Alexander, Rintala, Risto, Serban, Daniela E, Staiano, Annamaria, Sweeny, Brian, Veerman, Gigi, Veres, Gabor, Wilson, David C, Ruemmele, Frank M., and University of Zurich

Subjects
Placebo-controlled study, european society for paediatric gastroenterology, Disease, Inflammatory bowel disease, law.invention, 0302 clinical medicine, Clinical Protocols, Randomized controlled trial, law, Child, Societies, Medical, Pediatric, Gastroenterology, Ulcerative colitis, 3. Good health, Europe, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, management, Human, medicine.medical_specialty, and nutrition, Consensus, Evidence-based practice, pediatrics, MEDLINE, 610 Medicine & health, Consensu, Primary sclerosing cholangitis, ulcerative colitis, clinical guidelines, inflammatory bowel disease, children, pediatric ulcerative colitis activity index, hepatology, european crohn's and colitis organization, 03 medical and health sciences, medicine, Humans, 2715 Gastroenterology, 2735 Pediatrics, Perinatology and Child Health, Intensive care medicine, Clinical Protocol, business.industry, medicine.disease, Surgery, 10036 Medical Clinic, Pediatrics, Perinatology and Child Health, Colitis, Ulcerative, business
Abstract

Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations ; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). A group of 27 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to ESPGHAN and ECCO members. A list of 23 predefined questions were addressed by working subgroups based on a SR of the literature. A total of 40 formal recommendations and 68 practice points were endorsed with a consensus rate of at least 89% regarding initial evaluation, how to monitor disease activity, the role of endoscopic evaluation, medical and surgical therapy, timing and choice of each medication, the role of combined therapy, and when to stop medications. A management flowchart, based on the Pediatric Ulcerative Colitis Activity Index (PUCAI), is presented. These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.

Published
2012
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