101
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Cao Y, Chan AT. Vitamin D and Early-Onset Colorectal Cancer-Rays of Hope? Gastroenterology 2023; 165:831-833. [PMID: 37544414 PMCID: PMC10726952 DOI: 10.1053/j.gastro.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Yin Cao
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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102
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Waschmann M, Stuart A, Trieschmann K, Lin HC, Hunter AK. Assessing the Impact of the COVID-19 Pandemic on the Severity of Pediatric Inflammatory Bowel Disease Admissions and New Diagnoses. CROHN'S & COLITIS 360 2023; 5:otad062. [PMID: 37941600 PMCID: PMC10629215 DOI: 10.1093/crocol/otad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction The COVID-19 pandemic has introduced new challenges to the diagnosis and management of pediatric inflammatory bowel disease (IBD). Many patients have had only limited access to their providers through telemedicine, and many chose to delay nonemergent treatment. Methods A retrospective chart review of patients with IBD seen by the Pediatric Gastroenterology Division at Doernbecher Children's Hospital from January 2018 to August 2021 was conducted. The study cohort was divided into 2 groups: those presenting before the onset of the COVID-19 pandemic (January 1, 2018 to February 28, 2020) and those presenting during the pandemic (March 1, 2020 to August 1, 2021). Variables collected included: age, sex, race, ethnicity, IBD type, insurance type, location of residence. Primary outcome measures selected focused on disease severity, initial type of treatment, or surgical intervention offered. A subgroup analysis of the new diagnosis patients was performed. Data were analyzed using independent t-tests, chi-squared analysis, and Wilcoxon rank sum tests. Results Two hundred and eleven patients met inclusion criteria, 107 (72 new diagnoses, 35 admissions) within the pre-COVID epoch and 104 (67 new diagnoses, 37 admissions) within the during-COVID epoch. Patients in the during-COVID epoch had higher fecal calprotectin level and were more likely to be started on a biologic as initial treatment. Patients admitted during COVID for IBD flare were more likely to require surgical intervention. Subgroup analysis of newly diagnosed patients revealed higher incidence of comorbid depression and anxiety. Conclusions Our review identified increased disease severity in newly diagnosed pediatric patients with IBD as well as pediatric patients admitted for flare during COVID. Increases in anxiety and depression rates during COVID may have contributed to worsened disease severity.
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Affiliation(s)
- Malika Waschmann
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, USA
| | - Ariana Stuart
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kimberly Trieschmann
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, USA
- Division of Pediatric Gastroenterology, Doernbecher Children’s Hospital, Portland, OR, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Henry C Lin
- Division of Pediatric Gastroenterology, Doernbecher Children’s Hospital, Portland, OR, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Anna K Hunter
- Division of Pediatric Gastroenterology, Doernbecher Children’s Hospital, Portland, OR, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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103
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Bouhuys M, Mian P, van Rheenen PF. Ustekinumab trough levels in children with Crohn's disease refractory to anti-tumor necrosis factor agents: a prospective case series of off-label use. Front Pharmacol 2023; 14:1180750. [PMID: 37818191 PMCID: PMC10561290 DOI: 10.3389/fphar.2023.1180750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background: Ustekinumab is used off-label in pediatric Crohn's disease refractory to anti-tumor necrosis factor. Data on optimal dosing, target trough levels, and potential benefit of therapeutic drug monitoring in children treated with ustekinumab are limited. Materials and Methods: We describe a series of six adolescents who consented to be treated with ustekinumab. We measured their trough levels, C-reactive protein, and fecal calprotectin before every administration. Results: Standard adult dosing was effective to achieve biochemical remission (fecal calprotectin < 250 mg/kg) in one patient and clinical remission (resolution of symptoms) in another. The other four patients failed to respond on standard dosing and underwent intravenous re-induction and interval shortening to increase ustekinumab trough levels. This resulted in biochemical remission in one patient and clinical remission in another, suggesting an exposure-response relationship. The remaining two patients had no therapeutic benefit, and ustekinumab was discontinued. Conclusion: In this report, we show that ustekinumab can induce remission in pediatric patients with anti-tumor necrosis factor refractory Crohn's disease. It is worth escalating the dose before abandoning the drug as ineffective. Prospective studies in children are needed to determine long-term efficacy of ustekinumab, usefulness of therapeutic drug monitoring strategies, and, if applicable, optimal target trough levels.
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Affiliation(s)
- Marleen Bouhuys
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Paola Mian
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, Netherlands
| | - Patrick F. van Rheenen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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104
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Alorfi NM, Alourfi MM, Bokhari GA, Alkhattabi A, Ibrahim NA, Alsabban AM, Almatrafi MJ, Zakri YA, Almahmoud AJ, Al-ghamdi KMA, Alsharif SN. Comprehensive Review of Ustekinumab Utilization in Inflammatory Bowel Diseases: Insights from the ClinicalTrials.gov Registry. Int J Gen Med 2023; 16:4283-4294. [PMID: 37750106 PMCID: PMC10518143 DOI: 10.2147/ijgm.s433636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
Background Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic inflammatory conditions affecting the gastrointestinal tract. To achieve and sustain remission, effective treatment strategies are necessary. Ustekinumab, a biologic agent targeting interleukin-12 and interleukin-23, has emerged as a significant therapeutic option for moderate to severe IBD. Aim To gain insights into the utilization of Ustekinumab for IBD, we conducted a comprehensive review of the ClinicalTrials.gov registry. Methods A comprehensive search of the ClinicalTrials.gov was conducted to find all clinical trials involving the use of Ustekinumab in IBD patients. As of December 30th, 2022, 69 clinical trials were identified that included IBD and Ustekinumab. The study list was saved, and those clinical trials that fitted the definition of targeted therapy were included in the review. Results The results showed that Ustekinumab was associated with significant improvements in the clinical response and remission rates, in both Crohn's disease and ulcerative colitis patients. Additionally, the safety profile of Ustekinumab was generally favourable, with low rates of adverse events reported. In terms of study design, most of the relevant studies found in the database were interventional studies. The investigation focused on completed studies and found that there were a limited number of clinical trials with interventional measures. Conclusion Ustekinumab appears to be a promising treatment option for patients with IBD, with the potential to provide significant clinical benefits and a favourable safety profile. Further research is warranted to confirm these findings and explore optimal dosing and treatment regimens.
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Affiliation(s)
- Nasser M Alorfi
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mansour M Alourfi
- Internal Medicine Department, King Faisal Medical City for Southern Region, Abha, Saudi Arabia
- Department of Gastroenterology, East Jeddah Hospital, Jeddah, Saudi Arabia
| | | | | | | | | | - Mohammad J Almatrafi
- Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Yaser Abdulaziz Zakri
- Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdullah Jasem Almahmoud
- Gastroenterology Section, Internal Medicine Department, King Fahad Hospital, Jeddah, Saudi Arabia
| | | | - Saeed Nasser Alsharif
- Gastroenterology Department, Armed Force Hospital of Southern Region, Khamis Mushait, Saudi Arabia
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105
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Godala M, Gaszyńska E, Walczak K, Małecka-Wojciesko E. Role of Serum Interleukin-6, Interleukin-1β and Interleukin-10 in Assessment of Disease Activity and Nutritional Status in Patients with Inflammatory Bowel Disease. J Clin Med 2023; 12:5956. [PMID: 37762896 PMCID: PMC10532332 DOI: 10.3390/jcm12185956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Inflammatory bowel diseases (IBD) are characterised by multifactorial and chronic inflammation. Much attention has been paid to immune dysfunction in inflammatory bowel diseases. The aim of this study was to assess the usefulness of serum IL-6, IL-1β and IL-10 in determining the activity and nutritional status in IBD patients. The case-control study was carried out on 82 patients with IBD; the control group consisted of 25 clinically healthy subjects. The serum concentrations of IL-6, IL-1 β and IL-10 were determined by the quantitative sandwich enzyme-linked immunosorbent assay. There were no significant differences in IL-6 and IL-1β levels in UC and CD patients according to disease activity as assessed by the Montreal classification, Partial Mayo Score and CDAI. Significantly higher IL-6 levels were found in patients with low body fat in comparison to patients with normal body fat. Furthermore, significantly higher mean IL-6 levels were observed in patients with excess body fat in comparison to patients with normal body fat, and also in comparison to patients with deficient body fat. IL-6 and IL-1β may provide extra information regarding the nutritional status of IBD patients. IL-10 can be considered a non-invasive biomarker of IBD activity.
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Affiliation(s)
- Małgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Konrad Walczak
- Department of Internal Medicine and Nephrodiabetology, Medical University of Lodz, 90-549 Lodz, Poland;
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-419 Lodz, Poland;
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106
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Spina R, Ropars A, Bouazzi S, Dadi S, Lemiere P, Dupire F, Khiralla A, Yagi S, Frippiat JP, Laurain-Mattar D. Screening of Anti-Inflammatory Activity and Metabolomics Analysis of Endophytic Fungal Extracts; Identification and Characterization of Perylenequinones and Terpenoids from the Interesting Active Alternaria Endophyte. Molecules 2023; 28:6531. [PMID: 37764307 PMCID: PMC10534442 DOI: 10.3390/molecules28186531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Patients suffering from inflammatory chronic diseases are classically treated with anti-inflammatory drugs but unfortunately are highly susceptible to becoming resistant to their treatment. Finding new drugs is therefore crucial and urgent and research on endophytic fungi is a promising way forward. Endophytic fungi are microorganisms that colonize healthy plants and live within their intercellular tissues. They are able to produce a large variety of secondary metabolites while allowing their host to stay healthy. A number of these molecules are endowed with antioxidant or antimicrobial as well as cytotoxic properties, making them very interesting/promising in the field of human therapy. The aim of our study was to investigate whether extracts from five endophytic fungi isolated from plants are endowed with anti-inflammatory activity. Extracts of the endophytic fungi Alternaria alternata from Calotropis procera leaves and Aspergillus terreus from Trigonella foenum-graecum seeds were able to counteract the lipopolysaccharide (LPS) pro-inflammatory effect on THP-1 cells differentiated into macrophages. Moreover, they were able to induce an anti-inflammatory state, rendering them less sensitive to the LPS pro-inflammatory stimulus. Taken together, these results show that these both endophytic fungi could be interesting alternatives to conventional anti-inflammatory drugs. To gain more detailed knowledge of their chemical richness, phytochemical analysis of the ethyl acetate extracts of the five endophytic fungi studied was performed using HPTLC, GC-MS and LC-MS with the Global Natural Products Social (GNPS) platform and the MolNetEnhancer tool. A large family of metabolites (carboxylic acids and derivatives, steroid derivatives, alkaloids, hydroxyanthraquinones, valerolactones and perylenequinones) were detected. The purification of endophytic fungus extract of Alternaria alternate, which diminished TNF-α production of 66% at 20 µg/mL, incubated one hour before LPS addition, led to the characterization of eight pure compounds. These molecules are altertoxins I, II, III, tricycloalternarenes 3a, 1b, 2b, anthranilic acid, and o-acetamidobenzoic acid. In the future, all these pure compounds will be evaluated for their anti-inflammatory activity, while altertoxin II has been shown in the literature as the most active mycotoxin in terms of anti-inflammatory activity.
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Affiliation(s)
- Rosella Spina
- Université de Lorraine, INRAE, LAE, F-54000 Nancy, France;
| | - Armelle Ropars
- Université de Lorraine, SIMPA, F-54000 Nancy, France; (A.R.); (J.-P.F.)
| | - Sihem Bouazzi
- Université de Lorraine, CNRS, L2CM, F-54000 Nancy, France; (S.B.); (S.D.); (P.L.); (F.D.)
| | - Safa Dadi
- Université de Lorraine, CNRS, L2CM, F-54000 Nancy, France; (S.B.); (S.D.); (P.L.); (F.D.)
| | - Pascal Lemiere
- Université de Lorraine, CNRS, L2CM, F-54000 Nancy, France; (S.B.); (S.D.); (P.L.); (F.D.)
| | - François Dupire
- Université de Lorraine, CNRS, L2CM, F-54000 Nancy, France; (S.B.); (S.D.); (P.L.); (F.D.)
| | - Afra Khiralla
- Botany Department, Faculty of Sciences and Technologies, Shendi University, Shendi 11111, Sudan;
| | - Sakina Yagi
- Department of Botany, Faculty of Science, University of Khartoum, Khartoum 11115, Sudan;
| | - Jean-Pol Frippiat
- Université de Lorraine, SIMPA, F-54000 Nancy, France; (A.R.); (J.-P.F.)
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107
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Coward S, Benchimol EI, Kuenzig ME, Windsor JW, Bernstein CN, Bitton A, Jones JL, Lee K, Murthy SK, Targownik LE, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Im JHB, Davis T, Weinstein J, Goddard Q, Gorospe J, Bennett J, Caplan L, Bergevin M, Yang XY, Mason K, Sanderson R, Brass C, Kaplan GG. The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD. J Can Assoc Gastroenterol 2023; 6:S9-S15. [PMID: 37674492 PMCID: PMC10478802 DOI: 10.1093/jcag/gwad004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Inflammatory bowel disease (IBD), consisting of Crohn's disease and ulcerative colitis, is recognized across the world, though Canada has among the highest burdens of IBD in the world. The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) led a six-province study that demonstrated the compounding prevalence of IBD in Canada from 400 per 100,000 in 2002 to 636 per 100,000 in 2014. The prevalence in 2023 is estimated at 825 per 100,000, meaning that over 320,000 people in Canada are living with IBD. Prevalence is forecasted to rise by 2.44% per year such that 1.1% of the population, 470,000 Canadians, will live with IBD by 2035. The overall incidence of IBD in 2023 is 30 per 100,000 person-years, indicating that over 11,000 Canadians will be newly diagnosed with IBD in 2023. Incidence is forecasted to rise by 0.58% per year up to 32.1 per 100,000 by 2035. The rising incidence of IBD is propelled by pediatric-onset IBD, which is rising by 1.23% per year from 15.6 per 100,000 in 2023 to 18.0 per 100,000 in 2035. In contrast, incidence rates among adults and seniors are relatively stable. Understanding the determinates of IBD has expanded through prospective cohort studies such as the Crohn's and Colitis Canada Genetic, Environmental, Microbial (CCC-GEM) project. Consensus recommendations towards diet, lifestyle, behavioural and environmental modifications have been proposed by international organizations with the goal of optimizing disease control and ultimately preventing the development of IBD. Despite these efforts, Canadian healthcare systems will need to prepare for the rising number of people living with IBD.
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Affiliation(s)
- Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Léa Caplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maxime Bergevin
- École de kinésiologie et des sciences de l’activité physique, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Xin Yu Yang
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Kate Mason
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | | | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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108
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Atia O, Benchimol EI, Ledderman N, Greenfeld S, Kariv R, Weisband YL, Matz E, Ollech J, Dotan I, Assa A, Shouval DS, Uhlig HH, Muise AM, Olén O, Kuenzig ME, Kaplan GG, Turner D. Incidence, Management, and Outcomes of Very Early Onset Inflammatory Bowel Diseases and Infantile-Onset Disease: An Epi-IIRN Study. Clin Gastroenterol Hepatol 2023; 21:2639-2648.e6. [PMID: 36336312 DOI: 10.1016/j.cgh.2022.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS In this nationwide study from the Israeli Inflammatory Bowel Disease Research Nucleus, we aimed to describe the incidence of very early onset inflammatory bowel diseases (VEOIBDs) with a focus on infantile-onset disease and to compare management and disease course with older children. METHODS Data were retrieved from the 4 Israeli Health Maintenance Organizations covering 98% of the population. Pediatric-onset IBD was categorized as follows: adolescent onset (10 to <18 y), early onset (6 to <10 y), VEOIBD (0 to <6 y), toddler onset (2 to <6 y), and infantile onset (<2 y). RESULTS A total of 5243 children with 35,469 person-years of follow-up evaluation, were diagnosed with IBD during 2005 to 2020: 4444 (85%) with adolescent onset, 548 (10%) with early onset, and 251 (4.8%) with VEOIBD, of whom 81 (1.5%) had infantile onset. The incidence of pediatric-onset IBD increased from 10.8 per 100,000 in 2005 to 15.3 per 100,000 in 2019 (average annual percentage change, 2.8%; 95% CI, 2.2%-3.4%), but that of VEOIBD remained stable (average annual percentage change, 0%; 95% CI, -2.5% to 2.6%). The infantile-onset and toddler-onset groups were treated less often with biologics (36% and 35%, respectively) vs the early onset (57%) and adolescent-onset groups (53%; P < .001). The time to steroid dependency was shorter in infantile-onset (hazard ratio [HR], 2.1; 95% CI, 1.5-2.9) and toddler-onset disease (HR, 1.6; 95% CI, 1.2-2.0) vs early onset and adolescent-onset disease, but time to hospitalizations, time to surgery, and growth delay were worse only in infantile-onset disease. In a multivariable model, infantile-onset patients had a higher risk for surgery (HR, 1.4; 95% CI, 1.1-1.9) and hospitalization (HR, 1.7; 95% CI, 1.2-2.4) than the toddler-onset group. CONCLUSIONS The incidence of VEOIBD remained stable. Infantile-onset IBD had worse outcomes than older children, while toddler onset had mostly similar outcomes, despite less frequent use of biologics.
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Affiliation(s)
- Ohad Atia
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Natan Ledderman
- Meuhedet Health Services, Meuhedet Research Institue, Tel-Aviv, Israel
| | - Shira Greenfeld
- Maccabi Health Services, Maccabi Research Institue, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Revital Kariv
- Maccabi Health Services, Maccabi Research Institue, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Eran Matz
- Leumit Health Services, Leumit Research Institue, Tel-Aviv, Israel
| | - Jacob Ollech
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Iris Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Amit Assa
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dror S Shouval
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Schneider Children's Hospital, Petah Tikva, Israel
| | - Holm H Uhlig
- Translational Gastroenterology Unit, Biomedical Research Center, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Aleixo M Muise
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ola Olén
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
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109
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Khan R, Kuenzig ME, Benchimol EI. Epidemiology of Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am 2023; 52:483-496. [PMID: 37543395 DOI: 10.1016/j.gtc.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Inflammatory bowel disease (IBD), including subtypes Crohn disease and ulcerative colitis is a chronic inflammatory disorder most often diagnosed in young adulthood. The incidence and prevalence of pediatric-onset IBD is increasing globally. IBD is likely caused by an interplay of multiple environmental factors resulting in a dysregulated mucosal response to the commensal intestinal microbiota in genetically predisposed individuals. This article provides an overview of pediatric IBD epidemiology and environmental risk factors associated with its development, such as the Hygiene Hypothesis, air pollution, greenspace and blue space, neonatal factors, antibiotics, and diet.
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Affiliation(s)
- Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON M5G 1X8, Canada; Child Health Evaluative Sciences, SickKids Research Institute
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON M5G 1X8, Canada; Child Health Evaluative Sciences, SickKids Research Institute; ICES, Toronto, Canada; Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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110
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Zhang X, Rosh JR. Safety Summary of Pediatric Inflammatory Bowel Disease Therapies. Gastroenterol Clin North Am 2023; 52:535-548. [PMID: 37543398 DOI: 10.1016/j.gtc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Therapeutic options for the treatment of pediatric inflammatory bowel disease include aminosalicylates, enteral nutrition, corticosteroids, immunomodulators, biologics, and emerging small molecule agents. Infectious risk due to systemic immunosuppression should be mitigated by appropriate screening before therapy initiation. Rare but serious malignancies have been associated with thiopurine use alone and in combination with anti-tumor necrosis factor agents, often in the setting of a primary Epstein-Barr virus infection. Potential agent-specific adverse events such as cytopenias, hepatotoxicity, and nephrotoxicity warrant regular clinical and laboratory monitoring.
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Affiliation(s)
- Xiaoyi Zhang
- Pediatric Gastroenterology, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Indiana University, 705 Riley Hospital Drive, ROC 4210, Indianapolis, IN 46202, USA. https://twitter.com/xtzhang
| | - Joel R Rosh
- Pediatric Gastroenterology, Division of Pediatric Gastroenterology, Liver Disease, and Nutrition, Cohen Children's Medical Center of New York, 1991 Marcus Avenue, Suite M100, Lake Success, NY 11042, USA.
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111
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Marderfeld L, Guz Mark A, Biran N, Shamir R. Can We Rely on Resting Metabolic Rate Equations? Large Variance in Crohn Disease Pediatric Patients. J Pediatr Gastroenterol Nutr 2023; 77:389-392. [PMID: 37378956 DOI: 10.1097/mpg.0000000000003878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Inadequate caloric intake is common in Crohn disease (CD) and nutrition support plays an important role in remission induction and in meeting nutritional needs. For nutritional planning, determining resting metabolic rate (RMR) is essential in pediatric patients with CD. STUDY AIM To measure RMR in CD pediatric patients using indirect calorimetry, and compare it with estimated RMR (eRMR) calculated by Schofield equation. METHODS Children with CD treated in a tertiary pediatric inflammatory bowel disease center in Israel participated in the cross-sectional study. At study visits, weight, height, clinical and laboratory assessments, bioelectrical impedance, and RMR measured by indirect calorimetry were done. Additionally, disease severity was determined by the Pediatric Crohn Disease Activity Index and eRMR was calculated using the Schofield equation. The ratio of the measured RMR to eRMR was performed in addition to the Spearman correlation test. RESULTS The study group included 73 children (49 boys) with mean age of 13.9 ± 2.3 years. Children with moderate or severe disease had lower weight for age z score, lower BMI- z , and lower RMR compared to children with mild disease. However, when RMR was adjusted for fat free mass (n = 50), the association between RMR and disease severity disappeared. Variance in RMR was high between subjects. CONCLUSIONS Our data suggest that the Schofield equation is inadequate for determining RMR in pediatric CD and that RMR should be measured to guarantee the most appropriate nutritional intervention.
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Affiliation(s)
- Luba Marderfeld
- From Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- the Nutrition and Dietetics Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Anat Guz Mark
- From Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Biran
- From Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- the Nutrition and Dietetics Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Raanan Shamir
- From Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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112
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Windsor JW, Kuenzig ME, Murthy SK, Bitton A, Bernstein CN, Jones JL, Lee K, Targownik LE, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Im JHB, Davis T, Weinstein J, Goddard Q, Gorospe J, Benchimol EI, Kaplan GG. The 2023 Impact of Inflammatory Bowel Disease in Canada: Executive Summary. J Can Assoc Gastroenterol 2023; 6:S1-S8. [PMID: 37674500 PMCID: PMC10478799 DOI: 10.1093/jcag/gwad003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
The burden of inflammatory bowel disease (IBD) (i.e., associated direct and indirect costs, prevalence of disease, personal impact to the individual and to caregivers) continues to increase in Canada. The prevalence of IBD has increased since Crohn's and Colitis Canada's 2018 Impact of IBD report from an estimated 270,000 Canadians living with IBD in 2018 to an estimated 322,600 Canadians living with IBD today in 2023. Consequently, associated costs of IBD have also dramatically increased from an estimated $2.57 billion in 2018 to an estimated $5.38 billion in 2023; this increase is due to multiple factors including increased prevalence of disease, inflation, and additional identified factors (e.g., presenteeism, costs of childcare). Beyond the economic impact of IBD, these diseases have a significant impact on people living with the disease and their caregivers, including different presentations of disease, different commonly associated extra-intestinal manifestations or comorbid conditions, and different barriers to accessing care. In this supplementary issue, we review: Evolving trends in the epidemiology of IBD; updated estimates of indirect and direct costs (including out-of-pocket costs) associated with IBD; information specific to IBD in children, adolescents, and seniors; issues related to IBD pertaining to sex and gender; information specific to risks associated with COVID-19 and cancer related to IBD; an overview of current treatments for IBD; and evolving care models, including access to care.
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Affiliation(s)
- Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Quebec, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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113
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El-Matary W, Carroll MW, Deslandres C, Griffiths AM, Kuenzig ME, Mack DR, Wine E, Weinstein J, Geist R, Davis T, Chan J, Khan R, Matthews P, Kaplan GG, Windsor JW, Bernstein CN, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Targownik LE, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Im JHB, Goddard Q, Gorospe J, Verdugo J, Morin SA, Morganstein T, Banning L, Benchimol EI. The 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-Children and Adolescents with IBD. J Can Assoc Gastroenterol 2023; 6:S35-S44. [PMID: 37674497 PMCID: PMC10478811 DOI: 10.1093/jcag/gwad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Rates of inflammatory bowel disease (IBD) in Canadian children and adolescents are among the highest in the world, and the incidence is rising most rapidly in children under five years of age. These young children may have either a typical form of IBD with multi-factorial aetiology, or they may have a monogenic form. Despite the growing number of children in Canada living with this important chronic disease, there are few available medical therapies approved by Health Canada due to the omission of children from most clinical trials of newly developed biologics. As a result, off-label use of medications is common, and physicians have learned to use existing therapies more effectively. In addition, most Canadian children are treated in multidisciplinary, specialty clinics by physicians with extra training or experience in IBD, as well as specialist nurses, dietitians, mental health care providers and other allied health professionals. This specialized clinic approach has facilitated cutting edge research, led by Canadian clinicians and scientists, to understand the causes of IBD, the optimal use of therapies, and the best ways to treat children from a biopsychosocial perspective. Canadians are engaged in work to understand the monogenic causes of IBD; the interaction between genes, the environment, and the microbiome; and how to address the mental health concerns and medical needs of adolescents and young adults transitioning from paediatric to adult care.
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Affiliation(s)
- Wael El-Matary
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology and Nutrition, University of Alberta, Edmonton, Alberta, Canada
| | - Colette Deslandres
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David R Mack
- CHEO IBD Centre and Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Eytan Wine
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, Alberta, Canada
- Edmonton Pediatric IBD Clinic, Edmonton, Alberta, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin Chan
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jules Verdugo
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Samantha A Morin
- Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Taylor Morganstein
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Lisa Banning
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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114
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Schaumleffel C. Inflammatory Bowel Disorders in Children and Adolescents: Management of Care for Students at School. NASN Sch Nurse 2023; 38:230-235. [PMID: 37222457 DOI: 10.1177/1942602x231171329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Inflammatory bowel disease (IBD) is an umbrella term for two chronic and recurrent digestive conditions, Crohn's disease (CD) and ulcerative colitis (UC). Both are characterized by chronic inflammation of the gastrointestinal tract but not caused by infection or other identifiable causes. Childhood IBD often leads to a more extensive disease and a more aggressive course than adult-onset disease. Since children spend a lot of time at school, children with IBD may experience symptoms while at school. As a result, school nurses play a crucial role in identifying and managing students with IBD within their school or school district. It is important for a school nurse to understand the etiology, symptoms, and management of IBD to provide management of care at school.
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Affiliation(s)
- Carol Schaumleffel
- School of Nursing College of Health Sciences and Professions Ohio University Athens, OH
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115
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Dufrusine B, Di Lisio C, Maurizio A, Sallese M, De Laurenzi V, Dainese E. Influence of food emulsifiers on cellular function and inflammation, a preliminary study. Front Nutr 2023; 10:1197686. [PMID: 37599692 PMCID: PMC10434242 DOI: 10.3389/fnut.2023.1197686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Emulsifiers are extensively used as food additives and their consumption is increasing in Western countries. However, so far only few studies examined their potential effects on intestinal cellular functions and gut inflammation. The aim of this preliminary analysis was to study the emulsifiers and their concentrations capable of causing cellular damage compared to extra virgin olive oil (EVOO). We tested two commonly used emulsifiers (EMI, EMII) and EVOO on Caco-2 cells, derived from a colon carcinoma and widely used as a model of the intestinal inflammation. The diphenyltetrazolium bromide test MTT and clonogenic assay were used to study the effect of emulsifiers on cell viability. Cell migration was determined by the wound-healing assay. The inflammation was studied by measuring the levels of interleukin 6 (IL-6) and monocyte chemoattractant protein-1/C-C motif chemokine ligand 2 (CCL2), multifunctional cytokines with a major role in the acute-phase response. Furthermore, we analyzed the effect of conditioned media of Caco-2 cells treated with EMs on macrophages activation. In conclusion, our preliminary data provide evidence that EMs increase the proliferation and migration rate of Caco-2 cells. Moreover, Caco-2 cells treated with EMs enhance the IL-6 and CCL2 release and activated macrophages, supporting their role as proinflammatory molecules.
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Affiliation(s)
- Beatrice Dufrusine
- Department of Bioscience and Technology for Food Agriculture and Environment, University of Teramo, Teramo, Italy
| | | | | | - Michele Sallese
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Vincenzo De Laurenzi
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Enrico Dainese
- Department of Bioscience and Technology for Food Agriculture and Environment, University of Teramo, Teramo, Italy
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116
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Alsarhan A, Aljasmi R, Ajaka N, Krishnamurthy B, Kader A, Aljasmi M, Nahdi N, Malik E, Murbati B, Aljabri E, Tzivinikos C. Challenges in Managing Paediatric Crohn's Disease With Crohn's Disease Exclusion Diet (CDED): The First Single-Center Study in the United Arab Emirates. Cureus 2023; 15:e43970. [PMID: 37746457 PMCID: PMC10515460 DOI: 10.7759/cureus.43970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease has been increasing significantly. For that, many modalities of treatment have shown promising results including a special diet. In our study, we looked at Crohn's disease dietary management for induction and subsequently maintenance of treatment. The research question was how feasible was applying this approach and what difficulties the patients and their parents faced. METHODOLOGY We reviewed the electronic medical system. We had 32 paediatric patients who were diagnosed with Crohn's disease and used the special diet plan (Crohn's disease exclusion diet or exclusion enteral nutrition) to induce remission or maintenance. Then, we used a questionnaire to identify the difficulties they faced while using the special diet. RESULTS AND DISCUSSION We have found that the cohort had used the special diet for a variable duration. The majority of patients opted to start with Crohn's disease exclusion diet. The clinical response was inconsistent due to poor compliance. Only 57 % of the patients were able to bear with the dietary plan beyond 12 weeks. Patients reported the following factors which caused non-compliance: intolerance/difficulty to follow (40%), cost (19%), poor clinical response (19%), and others. CONCLUSIONS In managing Crohn's disease, a multidisciplinary approach, including dietary interventions, is crucial. However, adherence to specialized diets poses several challenges identified in this study based on patient feedback. Addressing barriers and prioritizing dietitians' role is essential for improved patient outcomes in inflammatory bowel disease management.
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Affiliation(s)
- Ali Alsarhan
- Pediatric Gastroenterology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Rehab Aljasmi
- Medical Affairs, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Natacha Ajaka
- Nutrition, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Balaji Krishnamurthy
- Pediatric Gastroenterology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Ajmal Kader
- Pediatric Gastronetrology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Masooma Aljasmi
- Nutrition, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Noor Nahdi
- Nutrition, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Ehsan Malik
- Pediatric Gastroenterology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Buthaina Murbati
- Pediatric Gastroenterology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Eiman Aljabri
- Pediatric Gastroenterology, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Christos Tzivinikos
- Pediatric Gastroenterology, Al Jalila Children's Speciality Hospital, Dubai, ARE
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117
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Rubín de Célix C, Martín-de-Carpi J, Pujol-Muncunill G, Palomino LM, Velasco Rodríguez-Belvís M, Martín-Masot R, Navas-López VM, Ricart E, Casanova MJ, Rodríguez-Martínez A, Leo-Carnerero E, Alcaraz A, Mañosa M, Hernández V, Cobelas Cobelas MC, Sánchez C, Menchén L, Mesonero F, Barreiro-De Acosta M, Martinón-Torres N, Tejido Sandoval C, Rendo Vázquez A, Corsino P, Vicente R, Hernández-Camba A, Alberto Alonso JR, Alonso-Abreu I, Castro Millán AM, Peries Reverter L, Castro B, Fernández-Salgado E, Busto Cuiñas MM, Benítez JM, Madero L, Clemente F, Riestra S, Jiménez-Treviño S, Boscá-Watts M, Crehuá-Gaudiza E, Calvo Moya M, Huguet JM, Largo-Blanco EM, González Vives L, Plaza R, Guerra I, Barrio J, Escartín L, Alfambra E, Cruz N, Muñoz MC, Muñoz Pino MG, Van Domselaar M, Botella B, Monfort Miquel D, Rodríguez Grau MC, De La Mano A, Ber Y, Calvo Iñiguez M, Martínez-Pérez TDJ, Chaparro M, Gisbert JP. Benefits of Paediatric to Adult Transition Programme in Inflammatory Bowel Disease: The BUTTERFLY Study of GETECCU and SEGHNP. J Clin Med 2023; 12:4813. [PMID: 37510928 PMCID: PMC10381381 DOI: 10.3390/jcm12144813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017-2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients' outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes.
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Affiliation(s)
- Cristina Rubín de Célix
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Laura María Palomino
- Paediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | | | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Alejandro Rodríguez-Martínez
- Paediatric Gastroenterology, Hepatology and Nutrition, UGC de Pediatría, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | | | - Alba Alcaraz
- Department of Paediatric Gastroenterology, Nutrition and Hepatology, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain
| | - Miriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 08916 Badalona, Spain
| | - Vicent Hernández
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, SERGAS, Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | | | - César Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Hospital General Universitario Gregorio Marañón, 28018 Madrid, Spain
| | - Luis Menchén
- Gastroenterology Department-CEIMI, Hospital General Universitario Gregorio Marañón, Departamento de Medicina, Universidad Complutense de Madrid, 28018 Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Manuel Barreiro-De Acosta
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Nazareth Martinón-Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Coral Tejido Sandoval
- Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Alicia Rendo Vázquez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Pilar Corsino
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Raquel Vicente
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Alejandro Hernández-Camba
- Gastroenterology Department, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - José Ramón Alberto Alonso
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - I Alonso-Abreu
- Gastroenterology Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Ana María Castro Millán
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Laia Peries Reverter
- Gastroenterology Department, Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain
| | - Beatriz Castro
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Estela Fernández-Salgado
- Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - M Mercedes Busto Cuiñas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - José Manuel Benítez
- Gastroenterology Department, Hospital Universitario Reina Sofía, IMIBIC, 14004 Córdoba, Spain
| | - Lucía Madero
- Gastroenterology Department, Hospital Universitario de Alicante, Instituto de Investigación Sanitaria y Biomedica (ISABIAL), 03010 Alicante, Spain
| | - Fernando Clemente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Alicante, 03010 Alicante, Spain
| | - Sabino Riestra
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Santiago Jiménez-Treviño
- Paediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Maia Boscá-Watts
- Gastroenterology Department, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Marta Calvo Moya
- Inflammatory Bowel Disease Unit, Department of Gastroenterology and Hepatology, Hospital Puerta de Hierro, 28222 Madrid, Spain
| | - José María Huguet
- Gastroenterology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Ester-María Largo-Blanco
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Leticia González Vives
- Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Rocío Plaza
- Gastroenterology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Josefa Barrio
- Paediatric Gastroenterology Unit, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Laura Escartín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Erika Alfambra
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Noelia Cruz
- Gastroenterology Department, Hospital Doctor José Molina Orosa, 35500 Las Palmas, Spain
| | - M Carmen Muñoz
- Gastroenterology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain
| | | | | | - Belén Botella
- Gastroenterology Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - David Monfort Miquel
- Gastroenterology Department, Centro Consorci Sanitari Terrassa, 08227 Terrassa, Spain
| | | | - Agustín De La Mano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Henares, 28822 Madrid, Spain
| | - Yolanda Ber
- Gastroenterology Department, Hospital de San Jorge, 22004 Huesca, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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周 娟, 肖 雄, 夏 雨, 游 洁, 赵 红. [Nutritional status and its influencing factors in children with newly diagnosed inflammatory bowel disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:745-750. [PMID: 37529958 PMCID: PMC10414168 DOI: 10.7499/j.issn.1008-8830.2212066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To investigate the nutritional status and its influencing factors in children with newly diagnosed inflammatory bowel disease (IBD). METHODS A retrospective analysis was conducted on the clinical data of children who were diagnosed with IBD for the first time in Hunan Children's Hospital from January 2015 to December 2021. Diagnostic delay was defined as the time from the symptom onset to IBD diagnosis being in the upper quartile (P76-P100) of all IBD children in the study. Multivariate logistic regression analysis was used to explore the risk factors for emaciation and growth retardation. RESULTS A total of 125 children with newly diagnosed IBD were included, with Crohn's disease being the main type (91.2%). The rates of emaciation and growth retardation were 42.4% (53 cases) and 7.2% (9 cases), respectively, and the rate of anemia was 77.6% (97 cases). Diagnostic delay was noted in 31 children (24.8%), with the time from the symptom onset to IBD diagnosis of 366 to 7 211 days. Multivariate logistic regression analysis showed that diagnostic delay was a risk factor for emaciation and growth retardation (OR=2.73 and OR=4.42, respectively; P<0.05) and that age was positively associated with emaciation (OR=1.30, P<0.05). CONCLUSIONS Children with newly diagnosed IBD have poor nutritional status, and the rates of anemia, emaciation, and growth retardation are high. Diagnostic delay is associated with malnutrition in children with IBD.
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Huang C, Hao W, Wang X, Zhou R, Lin Q. Probiotics for the treatment of ulcerative colitis: a review of experimental research from 2018 to 2022. Front Microbiol 2023; 14:1211271. [PMID: 37485519 PMCID: PMC10358780 DOI: 10.3389/fmicb.2023.1211271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Ulcerative colitis (UC) has become a worldwide public health problem, and the prevalence of the disease among children has been increasing. The pathogenesis of UC has not been elucidated, but dysbiosis of the gut microbiota is considered the main cause of chronic intestinal inflammation. This review focuses on the therapeutic effects of probiotics on UC and the potential mechanisms involved. In animal studies, probiotics have been shown to alleviate symptoms of UC, including weight loss, diarrhea, blood in the stool, and a shortened colon length, while also restoring intestinal microecological homeostasis, improving gut barrier function, modulating the intestinal immune response, and attenuating intestinal inflammation, thereby providing theoretical support for the development of probiotic-based microbial products as an adjunctive therapy for UC. However, the efficacy of probiotics is influenced by factors such as the bacterial strain, dose, and form. Hence, the mechanisms of action need to be investigated further. Relevant clinical trials are currently lacking, so the extension of animal experimental findings to clinical application requires a longer period of consideration for validation.
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Affiliation(s)
- Cuilan Huang
- Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi Children’s Hospital, Wuxi, China
| | - Wujuan Hao
- Department of Digestive, Affiliated Children’s Hospital of Jiangnan University, Wuxi, China
| | - Xuyang Wang
- Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi Children’s Hospital, Wuxi, China
| | - Renmin Zhou
- Department of Digestive, Affiliated Children’s Hospital of Jiangnan University, Wuxi, China
| | - Qiong Lin
- Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi Children’s Hospital, Wuxi, China
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Jo SY, Bang KS. Clinical characteristics and nursing diagnoses of pediatric patients hospitalized with inflammatory bowel disease: a single-center retrospective study in South Korea. CHILD HEALTH NURSING RESEARCH 2023; 29:218-228. [PMID: 37554089 PMCID: PMC10415836 DOI: 10.4094/chnr.2023.29.3.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE This study aimed to identify clinical characteristics of South Korean pediatric inflammatory bowel disease (IBD) in a children's hospital over the past 5 years, with a specific focus on comparing the features observed between Crohn's disease (CD) and ulcerative colitis (UC). Additionally, it aimed to examine the nursing diagnoses given to patients. METHODS This retrospective study analyzed the medical records of Korean pediatric patients under 18 years of age who were diagnosed with IBD and hospitalized at a children's hospital in Seoul, South Korea, from January 2017 to December 2021. RESULTS The number of pediatric patients diagnosed with IBD steadily increased. This finding was particularly prominent for CD patients, the majority of whom were male. Pediatric patients with CD had significantly higher rates of abdominal pain and perianal lesions, while pediatric patients with UC had a higher rate of bloody stool. Laboratory findings indicated that CD patients had higher levels of inflammatory markers and lower albumin levels than UC patients. The nursing diagnoses given during hospitalization mostly related to safety and protection, physical comfort, and gastrointestinal function. CONCLUSION This study provides insights into Korean pediatric IBD patients, enabling early detection and the development of nursing intervention strategies. From a comprehensive perspective, nursing care should not only address patients' physical needs but also their psychosocial needs.
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Affiliation(s)
- Sung-Yoon Jo
- Graduate Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Kyung-Sook Bang
- Professor, College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Baldwin K, Grossi V, Hyams JS. Managing pediatric Crohn's disease: recent insights. Expert Rev Gastroenterol Hepatol 2023; 17:949-958. [PMID: 37794692 DOI: 10.1080/17474124.2023.2267431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Children and adolescents with Crohn's disease present unique challenges due to extensive disease at diagnosis and the effect of bowel inflammation on growth. Historical approaches with corticosteroids and immunomodulators are far less effective than early treatment with anti-TNF biologics. AREAS COVERED This review covers recent literature delineating the crucial role of early anti-TNF therapy in the treatment of moderate- to- severe Crohn's disease in children and adolescents. The potential risks and benefits of concomitant immunomodulators are discussed, along with therapeutic anti-TNF drug monitoring, and reassessment by endoscopy and cross-sectional imaging to evaluate success beyond symptom control. EXPERT OPINION Standard of care therapy for moderate-to-severe pediatric Crohn's disease now entails precision dosing of anti-TNF therapy with periodic reassessment of bowel inflammation. The role of dietary modification continues to evolve. Current and future efforts need to be directed to elucidating ways to predict response to anti-TNF therapy and quickly changing to agents with other mechanisms of action when needed. Inordinate regulatory delays in approval of new therapies approved for adults continue to handicap pediatric clinicians and frequently limits their treatment choices, or forces them to give medications "off label." Only a concerted effort by clinicians, pharma, and regulators will improve this situation.
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Affiliation(s)
- Katherine Baldwin
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Victoria Grossi
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
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Jijón Andrade MC, Pujol Muncunill G, Lozano Ruf A, Álvarez Carnero L, Vila Miravet V, García Arenas D, Egea Castillo N, Martín de Carpi J. Efficacy of Crohn's disease exclusion diet in treatment -naïve children and children progressed on biological therapy: a retrospective chart review. BMC Gastroenterol 2023; 23:225. [PMID: 37386458 PMCID: PMC10311743 DOI: 10.1186/s12876-023-02857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Recent trials suggested that the Crohn's disease (CD) exclusion diet (CDED) plus partial enteral nutrition (PEN) is a safe and effective strategy in remission induction of paediatric-onset CD. However, real-world evidence regarding the safety and efficacy of the CDED plus PEN approach is still lacking. The present case-series study reported our experience with the outcomes of CDED plus PEN in the paediatric-onset CD at disease onset and after the loss of response to biologics. METHODS We conducted a retrospective chart review on children who were treated with CDED plus PEN through the period from July 2019 and December 2020. Clinical and laboratory data were retrieved and compared at baseline, 6, 12, and 24 weeks of treatment. The primary endpoint of the present study was the rate of clinical remission. RESULTS The present study retrieved the data from 15 patients. Of them, nine patients were treatment naïve at the time of initiation of CDED plus PEN (group A) and the remaining patients relapsed on biologics before treatment. All patients in groups A and B exhibited clinical remission in week six, which was sustained until week 12. At the end of the follow-up, the clinical remission rate was 87% and 60% in groups A and B, respectively. No side effects were observed in both groups. In group A, the faecal calprotectin (FC) and albumin improved at week six, week 12, and week 24 (p < 0.05). The erythrocyte sedimentation rate (ESR) improved significantly at week 12 (p = 0.021) and week 24 (p = 0.027). At the same time, the haemoglobin and iron levels showed significant improvement only at week 24. For group B, only FC showed numerical reductions over time that did not reach the level of statistical significance. CONCLUSION Treatment with CDED plus PEN was well tolerated and achieved an excellent clinical remission rate in treatment-naive patients. However, the benefit of CDED plus PEN was less in patients who initiated the strategy after losing the response to biologics.
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Affiliation(s)
- María Clara Jijón Andrade
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain.
| | - Gemma Pujol Muncunill
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Ana Lozano Ruf
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Laura Álvarez Carnero
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Victor Vila Miravet
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Dolores García Arenas
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Natalia Egea Castillo
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Javier Martín de Carpi
- Unit for the Comprehensive Care of Paediatric IBD, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, Barcelona, Spain
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Dong F, Kern I, Weidner J, Kügler K, Rothe U, Amin M, Laaß MW, Flemming G, Winkler U, Richter T, Kugler J, Manuwald U. Clinical course of new-onset Crohn's disease in children and adolescents in dependency of age, initial location, initial severity level and therapy over the period 2000-2014 based on the Saxon Pediatric IBD-Registry in Germany. PLoS One 2023; 18:e0287860. [PMID: 37384664 PMCID: PMC10309614 DOI: 10.1371/journal.pone.0287860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE In Saxony, the incidence of Crohn's disease (CD) in children and adolescents increased significantly from 3.3 per 100,000 person-years in 2000 to 5.1 in 2014. The aim of this study was to describe the initial characteristics and the clinical course of CD in children and adolescents and to identify drug treatment options associated with an advantage for a mild course or remission. METHODS Clinical data were collected from patients who suffered from inflammatory bowel disease (IBD) and were recruited in the Saxon Pediatric IBD-Registry. All children newly diagnosed with CD in this registry in Saxony between 2000 and 2014 were included in this registry study. Characteristics such as age, disease location and extra-intestinal manifestations at diagnosis were accessed. The severity level of the disease at diagnosis as well as at follow-up were analysed by PCDAI index. Patients were divided into 3 groups according to length of follow-up: 1-3 years, 4-6 years and 7-9 years after diagnosis. A logistic regression model was conducted to examine which baseline parameters are associated with disease progression. RESULTS There were 338 children and adolescents with CD included in this registry study. At diagnosis, the median age of patients was 12.0 (0.7-14.9), 61.5% (n = 208) of the patients were male. The most common disease location observed in pediatric CD patients was the L3 (55%, n = 176). Patients aged 10-14 years were significantly more likely to present an L2 than patients aged 0-4 years (80.3%, n = 53 vs. 19.7%, n = 13, p = 0.01). During the follow-up, data from 71.3% (n = 241) othe patients were available. Disease activity measured by PCDAI decreased in 47.7% (n = 115) of the patients, 40.7% (n = 98) of the patients were stable and increased in 11.6% (n = 28) of the patients. Patients with intermediate/severe disease at onset were more likely to have an active disease at the end of follow up, too (p = 0.00). Logistic regression analysis of the initial characteristics showed that the age at diagnosis, gender, initial location and initial extra-intestinal manifestation are not associated with the progression of the disease (p>0.05). Furthermore, drug treatment options could be identified from our data, which are associated with benefits for a milder course or remission. CONCLUSION From 2000 to 2014, the health status of most pediatric patients with CD had improved or remained stable. Initial characteristics including age at diagnosis, initial localization and initial extra-intestinal manifestation are not associated with the progression of the disease, only the initial activity by PCDAI.
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Affiliation(s)
- Fan Dong
- Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Ivana Kern
- Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Jens Weidner
- Center for Medical Informatics, Institute for Medical Informatics and Biometry, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | | | | | - Makan Amin
- Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
- Department for Trauma Surgery and Orthopedics, Hospital “Park-Klinik Weissensee”, Berlin, Germany
| | - Martin W. Laaß
- University Hospital for Children and Adolescents, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Gunter Flemming
- Department of Gastroenterology, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Ulf Winkler
- Clinic for Children and Adolescents, Hospital Bautzen, Oberlausitz-Kliniken gGmbH, Bautzen, Germany
| | | | - Joachim Kugler
- Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Ulf Manuwald
- Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
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Leiz M, Knorr M, Moon K, Tischler L, Sohrabi K, Cantez S, Däbritz J, de Laffolie J, van den Berg N. How can patient registries facilitate guideline-based healthcare? A retrospective analysis of the CEDATA-GPGE registry for pediatric inflammatory bowel disease. BMC Health Serv Res 2023; 23:648. [PMID: 37330476 DOI: 10.1186/s12913-023-09639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/03/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Early diagnosis is mandatory for the medical care of children and adolescents with pediatric-onset inflammatory bowel disease (PIBD). International guidelines ('Porto criteria') of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend medical diagnostic procedures in PIBD. Since 2004, German and Austrian pediatric gastroenterologists document diagnostic and treatment data in the patient registry CEDATA-GPGE on a voluntary basis. The aim of this retrospective study was to analyze whether the registry CEDATA-GPGE reflects the Porto criteria and to what extent diagnostic measures of PIBD according to the Porto criteria are documented. METHODS Data of CEDATA-GPGE were analyzed for the period January 2014 to December 2018. Variables representing the Porto criteria for initial diagnostic were identified and categorized. The average of the number of measures documented in each category was calculated for the diagnoses CD, UC, and IBD-U. Differences between the diagnoses were tested by Chi-square test. Data on possible differences between data documented in the registry and diagnostic procedures that were actually performed were obtained via a sample survey. RESULTS There were 547 patients included in the analysis. The median age of patients with incident CD (n = 289) was 13.6 years (IQR: 11.2-15.2), of patients with UC (n = 212) 13.1 years (IQR: 10.4-14.8) and of patients with IBD-U (n = 46) 12.2 years (IQR: 8.6-14.7). The variables identified in the registry fully reflect the recommendations by the Porto criteria. Only the disease activity indices PUCAI and PCDAI were not directly provided by participants but calculated from obtained data. The category 'Case history' were documented for the largest part (78.0%), the category 'Imaging of the small bowel' were documented least frequently (39.1%). In patients with CD, the categories 'Imaging of the small bowel' (χ2 = 20.7, Cramer-V = 0.2, p < 0.001) and 'Puberty stage' (χ2 = 9.8, Cramer-V = 0.1, p < 0.05) were documented more often than in patients with UC and IBD-U. CONCLUSION The registry fully reproduces the guideline's recommendations for the initial diagnosis of PIBD. The proportion of documented diagnostic examinations varied within the diagnostic categories and between the diagnoses. Despite technological innovations, time and personnel capacities at participating centers and study center are necessary to ensure reliable data entry and to enable researchers to derive important insights into guideline-based care.
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Affiliation(s)
- M Leiz
- Institute for Community Medicine, University Medicine, Greifswald, Germany.
| | - M Knorr
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - K Moon
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - L Tischler
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - K Sohrabi
- Technical University of Applied Sciences, Giessen, Germany
| | - S Cantez
- General Pediatrics & Neonatology, Justus-Liebig-University, Giessen, Germany
| | - J Däbritz
- Department of Pediatrics, Greifswald University Medical Center, Greifswald, Germany
| | - J de Laffolie
- General Pediatrics & Neonatology, Justus-Liebig-University, Giessen, Germany
| | - N van den Berg
- Institute for Community Medicine, University Medicine, Greifswald, Germany
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Hua H, Pan C, Chen X, Jing M, Xie J, Gao Y, Huang J, Chen X, Gao Y, Xu C, Li P. Probiotic lactic acid bacteria alleviate pediatric IBD and remodel gut microbiota by modulating macrophage polarization and suppressing epithelial apoptosis. Front Microbiol 2023; 14:1168924. [PMID: 37396394 PMCID: PMC10308112 DOI: 10.3389/fmicb.2023.1168924] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/24/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The incidence of pediatric inflammatory bowel disease (PIBD) continues to rise. It was reported that the probiotic lactic acid bacteria Pediococcus pentosaceus (P. pentosaceus) can interfere with intestinal immunity, but it is still unknown whether it can alleviate PIBD and the concrete mechanism of immune regulation is unclear. Methods For this study, 3-week-old juvenile mice were selected for modeling the development of PIBD. The mice treated with 2% DSS were randomly divided into two groups, which were given P. pentosaceus CECT8330 and equal amounts of solvent, respectively. The feces and intestinal tissue were collected for the mechanism exploration in vivo. THP-1 and NCM460 cells were used to investigate the effects of P. pentosaceus CECT8330 on macrophage polarization, epithelial cell apoptosis, and their crosstalk in vitro. Results P. pentosaceus CECT8330 obviously alleviated colitis symptoms of juvenile mice, including weight loss, colon length shortening, spleen swelling, and intestinal barrier function. Mechanistically, P. pentosaceus CECT8330 could inhibit intestinal epithelial apoptosis by suppressing the NF-κB signaling pathway. Meanwhile, it reprogramed macrophages from a pro-inflammatory M1 phenotype to an anti-inflammatory M2 phenotype, leading to a decreased secretion of IL-1β which contributes to the reduction in ROS production and epithelial apoptosis. Additionally, the 16S rRNA sequence analysis revealed that P. pentosaceus CECT8330 could recover the balance of gut microbiota, and a significantly increased content of Akkermansia muciniphila was particularly observed. Conclusion P. pentosaceus CECT8330 shifts macrophage polarization toward an anti-inflammatory M2 phenotype. The decreased production of IL-1β leads to a reduction in ROS, NF-κB activation, and apoptosis in the intestinal epithelium, all of which help to repair the intestinal barrier and adjust gut microbiota in juvenile colitis mice.
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Affiliation(s)
- Huiying Hua
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Pan
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xixi Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengxia Jing
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinfang Xie
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanqi Gao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebin Huang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuehua Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujing Gao
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Chundi Xu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pu Li
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ravikumara M. Helicobacter pylori in children: think before you kill the bug! Therap Adv Gastroenterol 2023; 16:17562848231177610. [PMID: 37361453 PMCID: PMC10285598 DOI: 10.1177/17562848231177610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/06/2023] [Indexed: 06/28/2023] Open
Abstract
Since the discovery of Helicobacter pylori (H. pylori) as the causative organism for gastric and duodenal ulcers four decades ago and subsequent recognition as class 1 gastric carcinogen, countless numbers of studies have been conducted and papers published, on the efficacy of various management strategies to eradicate the infection. In adults, a global consensus by the experts in the field concluded that H. pylori gastritis is an infectious disease and requires treatment irrespective of the presence or absence of symptoms due to the potential for serious complication like peptic ulcer disease and gastric neoplasia. However, although more than half the world's population harbors H. pylori, these serious complications occur only in a small minority of the infected population, even less so in childhood. More importantly, there is accumulating evidence for beneficial role of H. pylori against many chronic health conditions, from several epidemiological and laboratory studies. No doubt, eradication therapy is indicated in children with H. pylori-related peptic ulcer disease. Even though the pediatric guidelines from various learned societies recommend against a "test and treat" strategy, this is not always adhered to. With the accumulating evidence of the possible beneficial role of H. pylori, it is time to pause and think, are we causing more harm than good by eradicating H. pylori in every child who has this bug?
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Martín-García P, Alonso-Arroyo A, Catalá-López F. Tumour necrosis factor (TNF) antagonist therapy for paediatric inflammatory bowel disease: A systematic review. Med Clin (Barc) 2023; 160:501-516. [PMID: 36967304 DOI: 10.1016/j.medcli.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 06/07/2023]
Abstract
Inflammatory bowel disease includes two chronic inflammatory diseases, ulcerative colitis and Crohn's disease. The burden of disease is increasing worldwide. A few reviews evaluating the paediatric use of tumour necrosis factor (TNF) antagonists have been published, although these mostly include observational studies and do not consider economic evaluations. This systematic review evaluated the available evidence regarding the efficacy, safety, and cost-effectiveness of TNF antagonist therapy for paediatric inflammatory bowel disease. We searched PubMed/MEDLINE, Embase, and Cochrane Central (up to May 2022). Nine randomized clinical trials and four economic evaluations that examined any anti-TNF drugs (e.g., infliximab, adalimumab, golimumab, and certolizumab) against different alternatives were included. In studies evaluating the efficacy of anti-TNF drugs in Crohn's disease, most assessed the efficacy of maintenance regimen in patients who had previously responded to induction (response=28%-63%, and clinical remission=17%-83% depending on dose, drug, and follow-up). In ulcerative colitis, maintenance treatment with anti-TNF drugs reported clinical remission rates between 17% and 44%. Nine studies reported information on adverse events. No clinical trials comparing different anti-TNF drugs were found. The findings from this review suggest that maintenance treatment with anti-TNF drugs (such as infliximab and adalimumab) in paediatric inflammatory bowel disease is probably effective and safe. However, the economic evaluations reported contradictory results of the cost-effectiveness ratios. Protocol registry: Open Science Framework: https://osf.io/wjmvf.
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Affiliation(s)
- Paula Martín-García
- Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Adolfo Alonso-Arroyo
- Departamento de Historia de la Ciencia y Documentación, Universidad de Valencia, Valencia, España
| | - Ferrán Catalá-López
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Universidad de Valencia/Instituto de Investigación Sanitaria INCLIVA y CIBERSAM, Valencia, España; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canadá
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128
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Östensson M, Björkqvist O, Guo A, Størdal K, Halfvarson J, Mårild K, Ludvigsson J. Epidemiology, validation, and clinical characteristics of inflammatory bowel disease: the ABIS birth cohort study. BMC Gastroenterol 2023; 23:199. [PMID: 37291531 DOI: 10.1186/s12876-023-02840-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Birth cohort studies with linked register-based data on inflammatory bowel disease (IBD) provide opportunities to prospectively study early-life determinants of the disease. However, register-based data often lack information on clinical characteristics and rely on diagnostic algorithms. Within the All Babies in Southeast Sweden (ABIS) cohort, we examined the validity of a register-based definition of IBD, its incidence, and clinical and therapeutic characteristics at diagnosis. METHODS We followed 16,223 children from birth (1997-1999) until the end of 2020 for the diagnosis of IBD as defined by a minimum of two diagnostic codes for IBD in the Swedish National Patient Register (NPR). We described the incidence and cumulative incidence of IBD. Through a medical record review of cases diagnosed by the end of 2017, we examined the positive predictive value (PPV) for IBD and described its clinical characteristics and treatment. RESULTS By 2020, at an average age of 22.2 years, 113 participants (0.74%, 95% confidence interval [CI] = 0.61-0.89) had a register-based diagnosis of IBD, corresponding to an incidence of 31.3 per 100,000 person-years of follow-up; the incidence for Crohn's disease (CD) was 11.1 per 100,000 person-years and 15.8 for ulcerative colitis (UC). Of 77 participants with a register-based definition of IBD by the end of 2017, medical records were identified for 61 participants, of whom 57 had true IBD (PPV = 93%; 95%CI = 0.87-1.00). While oral 5-aminosalicylic acid treatment was equally common in newly diagnosed CD and UC patients, biologics were more often used for newly diagnosed CD. The median faecal calprotectin levels were 1206 mg/kg at diagnosis and 93 mg/kg at the last follow-up (P < 0.001). CONCLUSIONS In this population-based sample of Swedish children and young adults the cumulative IBD incidence was 0.74. The validity of register-based definition of IBD was high and supports using such data to identify IBD patients in cohort studies.
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Affiliation(s)
- Malin Östensson
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olle Björkqvist
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Annie Guo
- Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
| | - Ketil Størdal
- Department of Paediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Children's Centre, Oslo University Hospital, Oslo, Norway
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karl Mårild
- Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden.
- Department of Paediatrics, Queen Silvia Children's Hospital, 416 78, Gothenburg, Sweden.
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Region Östergötland, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Division of Paediatrics, Linköping University, Linköping, Sweden
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Lin Q, Hao WJ, Zhou RM, Huang CL, Wang XY, Liu YS, Li XZ. Pretreatment with Bifidobacterium longum BAA2573 ameliorates dextran sulfate sodium (DSS)-induced colitis by modulating gut microbiota. Front Microbiol 2023; 14:1211259. [PMID: 37346749 PMCID: PMC10280014 DOI: 10.3389/fmicb.2023.1211259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives Inflammatory bowel disease (IBD) is a chronic lifelong inflammatory disease. Probiotics such as Bifidobacterium longum are considered to be beneficial to the recovery of intestinal inflammation by interaction with gut microbiota. Our goals were to define the effect of the exclusive use of BAA2573 on dextran sulfate sodium (DSS)-induced colitis, including improvement of symptoms, alleviation of histopathological damage, and modulation of gut microbiota. Methods In the present study, we pretreated C57BL/6J mice with Bifidobacterium longum BAA2573, one of the main components in an over-the-counter (OTC) probiotic mixture BIFOTO capsule, before modeling with DSS. 16S rDNA sequencing and liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based non-targeted metabolomic profiling were performed with the collected feces. Results We found that pretreatment of Bifidobacterium longum BAA2573 given by gavage significantly improved symptoms and histopathological damage in DSS-induced colitis mice. After the BAA2573 intervention, 57 genera and 39 metabolites were significantly altered. Pathway enrichment analysis demonstrated that starch and sucrose metabolism, vitamin B6 metabolism, and sphingolipid metabolism may contribute to ameliorating colitis. Moreover, we revealed that the gut microbiome and metabolites were interrelated in the BAA2573 intervention group, while Alistipes was the core genus. Conclusion Our study demonstrates the impact of BAA2573 on the gut microbiota and reveals a possible novel adjuvant therapy for IBD patients.
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Affiliation(s)
- Qiong Lin
- Nephrology and Immunology Department, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Digestive, Affiliated Children's Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Wu-Juan Hao
- Department of Digestive, Affiliated Children's Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ren-Min Zhou
- Department of Digestive, Affiliated Children's Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | | | - Xu-Yang Wang
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan-Shan Liu
- Department of Pediatric Laboratory, Affiliated Children's Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xiao-Zhong Li
- Nephrology and Immunology Department, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
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130
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Röckert Tjernberg A, Malmborg P, Mårild K. Coronavirus disease 2019 and gastrointestinal disorders in children. Therap Adv Gastroenterol 2023; 16:17562848231177612. [PMID: 37305380 PMCID: PMC10243097 DOI: 10.1177/17562848231177612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
During the past 3 years, the coronavirus disease 2019 (COVID-19) pandemic has had a great impact on people all over the world. However, it has become evident that disease manifestations and severity differ across age groups. Most children have a milder disease course than adults but possibly more pronounced gastrointestinal (GI) symptoms. Given the child's developing immune system, the impact of COVID-19 on disease development may differ compared to adults. This study reviews the potential bi-directional relationship between COVID-19 and GI diseases in children, focusing on common pediatric conditions such as functional GI disorders (FGID), celiac disease (CeD), and inflammatory bowel disease (IBD). Children with GI diseases, in general, and CeD and IBD, in particular, do not seem to have an increased risk of severe COVID-19, including risks of hospitalization, critical care need, and death. While infections are considered candidate environmental factors in both CeD and IBD pathogenesis, and specific infectious agents are known triggers for FGID, there is still not sufficient evidence to implicate COVID-19 in the development of either of these diseases. However, given the scarcity of data and the possible latency period between environmental triggers and disease development, future investigations in this field are warranted.
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Affiliation(s)
- Anna Röckert Tjernberg
- Department of Pediatrics, Kalmar County Hospital, Region Kalmar County, Kalmar S-391 85, Sweden
| | - Petter Malmborg
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karl Mårild
- Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
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Rajasekaran V, Evans HM, Andrews A, Bishop JR, Lopez RN, Mouat S, Han DY, Alsweiler J, Roberts AJ. Rising Incidence of Inflammatory Bowel Disease in South Asian Children in New Zealand-A Retrospective Population-Based Study. J Pediatr Gastroenterol Nutr 2023; 76:749-755. [PMID: 36800276 DOI: 10.1097/mpg.0000000000003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVES High rates of inflammatory bowel disease (IBD) are reported in children of South Asian (SA) descent in some western countries. This population-based study describes the incidence and clinical course of IBD in SA children compared to non-South Asian (NSA) children in New Zealand (NZ). METHODS Children (≤15 years) with new-onset IBD presenting to a centralized tertiary referral center in Auckland, NZ from 2010 to 2020 were identified. Disease phenotype, clinical characteristics, response to exclusive enteral nutrition, clinical remission rates at 3 and 12 months, biologic use, corticosteroid exposure, and disease complications were compared by ethnicity; IBD incidence was calculated. RESULTS There were 127 (26 SA; 101 NSA) children with Crohn disease, 41 (10 SA; 31 NSA) with ulcerative colitis, and 10 (3 SA; 7 NSA) with IBD-unclassified. IBD incidence in SA and NSA children was 14.1 per 100,000 and 4.3 per 100,000 respectively ( P < 0.001). IBD incidence increased by 5.6% per year ( P = 0.022), due to a greater rise in incidence in SA (SA 16.8% per year, P = 0.015; NSA 4.5% per year, P = 0.317). At presentation, SA children had worse biochemical parameters, severe colitis, and vitamin D deficiency. SA children had lower rates of remission following exclusive enteral nutrition (28.5% vs 65.0%, P < 0.001) or biologic induction (35.7% vs 70.8%, P = 0.020), at 3-month (35.3% vs 69.8%, P < 0.001) and 12-month follow-up (29.4% vs 55.0%, P = 0.005). No significant differences were found in disease location or corticosteroid burden. CONCLUSIONS Increasing incidence of IBD was disproportionately represented by SA children with more severe disease and lower remission rates following exclusive enteral nutrition or biologic therapy.
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Affiliation(s)
- Vivek Rajasekaran
- From the Department of Paediatric Gastroenterology & Hepatology, Starship Child Health, Auckland, New Zealand
- the Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Helen M Evans
- From the Department of Paediatric Gastroenterology & Hepatology, Starship Child Health, Auckland, New Zealand
- the Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amy Andrews
- the Department of Clinical Nutrition, Te Toko Tumai, Auckland, New Zealand
| | - Jonathan R Bishop
- From the Department of Paediatric Gastroenterology & Hepatology, Starship Child Health, Auckland, New Zealand
| | - Robert N Lopez
- From the Department of Paediatric Gastroenterology & Hepatology, Starship Child Health, Auckland, New Zealand
| | - Stephen Mouat
- From the Department of Paediatric Gastroenterology & Hepatology, Starship Child Health, Auckland, New Zealand
| | - Dug Yeo Han
- the Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- the Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amin J Roberts
- From the Department of Paediatric Gastroenterology & Hepatology, Starship Child Health, Auckland, New Zealand
- the Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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132
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Aboud Syriani L, Parsana R, Durazo‐Arvizu RA, Michail S. Differences in gut microbiota and fecal bile acids between Caucasian and Hispanic children and young adults with ulcerative colitis. Physiol Rep 2023; 11:e15752. [PMID: 37344396 PMCID: PMC10284820 DOI: 10.14814/phy2.15752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
Ulcerative Colitis (UC) is an inflammatory bowel disease (IBD) that has been associated with gut dysbiosis. Changes in the gut microbiome lead to changes in bile acids (BA) metabolism, which changes the BA profiles in patients with UC. We conducted this study to investigate the differences in bile acids and gut microbiota between Hispanic and Caucasian children and young adults with UC. Twenty-seven Caucasian and 20 Hispanic children and young adults with UC were enrolled in the study. BAs were extracted from the subjects' stool samples and analyzed by liquid chromatography-mass spectrometry. Microbial DNA was also extracted from the stool samples to perform 16s rRNA amplicon sequencing. The median levels of cholic acid and taurolithocholic acid were found to be significantly higher in Hispanic children and young adults with UC compared to their Caucasian counterparts. The abundance of the gut microbiota that metabolizes BAs such as Proteobacteria, Pseudomonadaceae, Pseudomonas, Ruminococcus gnavus, and Escherichia coli were also all significantly higher in Hispanic children and young adults as well. The distinct BA profile that we found in Hispanic children and young adults with UC, in addition to the unique composition of their gut microbiome, provide them with a protective gut environment against inflammation, which is contrary to the common believe that Hispanics have worse IBD.
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Affiliation(s)
- Lara Aboud Syriani
- College of Osteopathic Medicine of the PacificWestern University of Health SciencesPomonaCaliforniaUSA
| | - Riddhi Parsana
- Children's Hospital of Los AngelesLos AngelesCaliforniaUSA
| | - Ramón A. Durazo‐Arvizu
- Children's Hospital of Los AngelesLos AngelesCaliforniaUSA
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sonia Michail
- Children's Hospital of Los AngelesLos AngelesCaliforniaUSA
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Wang K, Olén O, Emilsson L, Khalili H, Halfvarson J, Song M, Ludvigsson JF. Association of inflammatory bowel disease in first-degree relatives with risk of colorectal cancer: A nationwide case-control study in Sweden. Int J Cancer 2023; 152:2303-2313. [PMID: 36760205 PMCID: PMC11221413 DOI: 10.1002/ijc.34470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
This study aims to assess the association between inflammatory bowel disease (IBD) history in first-degree relatives (FDRs) and colorectal cancer (CRC) risk. We conducted a nationwide case-control study in Sweden among 69 659 CRC cases and 343 032 non-CRC controls matched on age, sex, birth year and residence county. Through linkage of multi-generation register and the nationwide ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, we ascertained IBD diagnoses among parents, full siblings and offspring of the index individuals. Odds ratios (ORs) of CRC associated with IBD family history were calculated using conditional logistic regression. 2.2% of both CRC cases (1566/69659) and controls (7676/343027) had ≥1 FDR with IBD history. After adjusting for family history of CRC, we observed no increased risk of CRC in FDRs of IBD patients (OR, 0.96; 95%CI, 0.91-1.02). The null association was consistent according to IBD subtype (Crohn's disease or ulcerative colitis), number of FDRs with IBD (1 or ≥ 2), age at first IBD diagnosis in FDRs (<18, 18-39, 40-59 or ≥60 years), maximum location/extent of IBD or FDR relation (parent, sibling or offspring). The null association remained for early-onset CRC (diagnosed at age <50 years). In conclusion, IBD history in FDRs was not associated with an increased risk of CRC. Our findings suggest that extra screening for CRC may not be needed in the offspring, siblings or parents of IBD patients, and strengthen the theory that it is the actual inflammation or atypia of the colon in IBD patients that confers the increased CRC risk.
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Affiliation(s)
- Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ola Olén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
| | - Louise Emilsson
- Department of General Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Vårdcentralen Nysäter and Center for Clinical Research, County Council of Värmland, Värmland, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hamed Khalili
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Institute of Environmental Medicine, Nutrition Epidemiology, Karolinska Institutet, Solna, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Gladkikh M, Benchimol EI, Mack DR, Mojaverian N, Highmore K, Miller E, Davila J. MR Enterography Scores Correlate with Degree of Mucosal Healing in Pediatric Crohn's Disease: A Pilot Study. J Can Assoc Gastroenterol 2023; 6:125-130. [PMID: 37273972 PMCID: PMC10235592 DOI: 10.1093/jcag/gwad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Objectives MR enterography (MRE) Index of Activity (MaRIA) and Clermont are validated scores that correlate with Crohn's disease (CD) activity; however, the Clermont score has not been validated to correlate with the degree of change in mucosal inflammation post induction treatment in children. This pilot study evaluated if MaRIA and Clermont scores can serve as surrogates to ileocolonoscopy for assessing interval change in mucosal inflammation in pediatric CD post-induction treatment. Methods Children with known or newly diagnosed ileocolonic CD starting or changing therapy underwent ileocolonoscopy, scored with simple endoscopic score for Crohn's disease (SES-CD), and MRE on the same day at two time points (Week 0 and 12). Accuracy of global MaRIA and Clermont indices relative to ileocolonoscopy in detecting degree of post-treatment interval change in mucosal inflammation was assessed through correlational coefficients (r). Inter-reader agreement was calculated for imaging scores through intraclass correlation (ICC). Results Sixteen children (mean age 11.5 ± 2.8) were evaluated. Global MaRIA/Clermont correlated with SES-CD in detecting the degree of change in mucosal inflammation (r = 0.676 and r = 0.677, P < 0.005, respectively). Correlation for pooled timepoint assessments between SES-CD and global MaRIA/Clermont was moderate (r = 0.546, P < 0.001 and r = 0.582, P < 0.001, respectively). Inter-rater reliability for global MaRIA and Clermont was good (ICC = 0.809 and ICC = 0.768, respectively, P < 0.001). Conclusions MRE-based global scores correlate with endoscopic indices and may be used to monitor disease changes in children with CD undergoing induction treatment, which can advise the physician if treatment changes should be made.
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Affiliation(s)
- Maria Gladkikh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Imaging, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nassim Mojaverian
- Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kerri Highmore
- Department of Medical Imaging, CHEO, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elka Miller
- Department of Medical Imaging, CHEO, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Davila
- Correspondence: Jorge Davila, MD, FRCPC, Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada, e-mail:
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135
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Dhaliwal J, Benchimol EI. The Incidence of IBD Among South Asian Children is Rising-But are the Phenotype and Outcomes Distinct? J Pediatr Gastroenterol Nutr 2023; 76:697-698. [PMID: 36917835 DOI: 10.1097/mpg.0000000000003767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Jasbir Dhaliwal
- From the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- the Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Eric I Benchimol
- the SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- the Child Health Evaluative Sciences, SickKids Research institute, The Hospital for Sick Children, Toronto, ON, Canada
- the Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
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136
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Wu CY, Liang LL, Ho HJ, Hsu CT, Hsu HT, Ao CK, Wu CY, Lin YH, Chuang YF, Hsu YC, Chen YJ, Ng SC. Physical Fitness and Inflammatory Bowel Disease Risk Among Children and Adolescents in Taiwan. JAMA Pediatr 2023; 177:608-616. [PMID: 37126317 PMCID: PMC10152374 DOI: 10.1001/jamapediatrics.2023.0929] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/01/2023] [Indexed: 05/02/2023]
Abstract
Importance The incidence of inflammatory bowel disease (IBD) is increasing in newly industrialized countries but disease etiologies remain unclear. Objective To investigate the association between physical fitness and subsequent IBD risk among children and adolescents in Taiwan. Design, Setting, and Participants This nationwide cohort study was conducted between January 1, 2010, and December 31, 2018. Data sources included the Taiwan National Health Insurance Research Database, the National Student Fitness Tests Database, and the Air Quality Monitoring System Database. This study included students who were aged 10 years, completed physical fitness tests between grades 4 and 13, and had at least 1 year of follow-up. Data analysis was last performed on January 15, 2023. Exposures Physical fitness tests included cardiorespiratory endurance (CE; number of minutes to complete an 800-m run), musculoskeletal endurance (ME; number of bent-leg curl-ups in 1 minute), musculoskeletal power (MP; standing broad jump distance), and flexibility fitness (FF; 2-leg sit-and-reach distance). Main Outcomes and Measures Subsequent risk of IBD was compared among students based on physical fitness test results. Six-year cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality. Performance was reported in quantiles, ranging from 1 (best) to 4 (poorest). Results There were 4 552 866 students who completed physical fitness tests between grades 4 and 13; among these students, 1 393 641 were aged 10 years and were included in the analysis. Six-year cumulative incidence of IBD risk was lowest among students in the best-performing quantile of CE (quantile 1, 0.74% [95% CI, 0.63%-0.86%]; P < .001), ME (0.77% [0.65%-0.90%]; P < .001), and MP (0.81% [0.68%-0.93%]; P = .005) compared with students in quantiles 2 through 4, respectively; however, no association was observed for quantiles of FF. After adjusting for competing HRs for mortality and other confounders, better CE was inversely associated with IBD risk (adjusted HR, 0.36 [95% CI, 0.17-0.75]; P = .007). Other measures of physical fitness were not independently associated with IBD risk. Conclusions and Relevance The results of this study suggest that CE was inversely associated with IBD risk among children and adolescents, but ME, MP, and FF were not independently associated with IBD risk. Future studies that explore the mechanisms are needed.
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Affiliation(s)
- Chun-Ying Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Lin Liang
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu J. Ho
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Te Hsu
- Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
| | - Hsiu-Tao Hsu
- Center for Physical and Health Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chon-Kit Ao
- Department of Economics, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yi Wu
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsian Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Fang Chuang
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yao-Chun Hsu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Ju Chen
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Siew C. Ng
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Microbiota I-Center, Hong Kong, China
- State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
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137
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Jagt JZ, van Rheenen PF, Thoma SMA, Gower J, Reimering-Hartgerink PB, van der Wielen HJHL, van Steenbergen EJ, Goutbeek AM, van Dijk-Lokkart EM, Vlietstra S, Reinders D, den Otter Y, Schoonderwoert I, Schoonderwoert B, Schoonderwoert H, van der Weide G, van Harten S, Mouthaan K, Benninga MA, de Boer NKH, van der Horst D, Scherpenzeel M, de Meij TGJ. The top 10 research priorities for inflammatory bowel disease in children and young adults: results of a James Lind Alliance Priority Setting Partnership. Lancet Gastroenterol Hepatol 2023:S2468-1253(23)00140-1. [PMID: 37230110 DOI: 10.1016/s2468-1253(23)00140-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Jasmijn Z Jagt
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands; Paediatric Gastroenterology, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, Netherlands.
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Sophia M A Thoma
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, and Faculty of Medicine, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Esther J van Steenbergen
- Department of Paediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Anne-Marije Goutbeek
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| | | | | | | | | | | | | | | | | | | | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, Netherlands
| | | | | | - Tim G J de Meij
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
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138
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Day AS. Editorial: Insights in pediatric gastroenterology, hepatology and nutrition: 2022. Front Pediatr 2023; 11:1210986. [PMID: 37252039 PMCID: PMC10213724 DOI: 10.3389/fped.2023.1210986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
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139
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Wu R, Yang J, Cao J, Wang P, Wang C, Chen W, Wu Y, Zheng X, Jin Y, Yang H. Efficacy of short-chain polypeptide-based EEN formulas in alleviating intestinal injury in children with Crohn's disease: a single-center study in China. Front Nutr 2023; 10:931004. [PMID: 37215203 PMCID: PMC10198436 DOI: 10.3389/fnut.2023.931004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/03/2023] [Indexed: 05/24/2023] Open
Abstract
Short-chain polypeptides are composed of three to nine amino acids, which can be absorbed by the intestinal tract without digestive enzymes and ATP energy. Crohn's disease (CD) is a chronic non-specific disease derived from inflammation and damage of the gastrointestinal tract. In this study, we aim to investigate the effect of short-chain polypeptide-based exclusive enteral nutrition (EEN) formulas on intestinal injury in Chinese children with active CD. From January 2013 to January 2019, a total of 84 consecutive children with a diagnosis of Crohn's disease (CD) in the Department of Pediatric Gastroenterology, Children's Hospital of Nanjing Medical University, were divided into mild and moderate-to-severe active CD groups. Each group was further divided into two subgroups: drug group and short-chain polypeptide plus drug group. Tests were carried out on the levels of intestinal fatty acid binding protein (I-FABP) in the blood, fecal calprotectin (FC), and occludin protein in the intestinal mucosa 1 day before treatment and 8 weeks after treatment. Endoscopic and histopathological observations were detected to compare the changes in intestinal injury in children with active CD. After 8 weeks of treatment, the SES-CD scores and Chiu scores of the ileocecal area and terminal ileum of children with mild active CD and the ileocecal area of children with moderate-to-severe active CD in short-chain polypeptide plus drug group were significantly lower than those in the drug group. The OD value of occludin in the terminal ileum and ileocecal area of children with mild active CD and the ileocecal area of children with moderate-to-severe active CD after short-chain polypeptide-based EEN formulas and drug treatment was significantly higher than those in the drug group (p < 0.05). Meanwhile, the levels of FC and I-FABP were significantly decreased (p < 0.05). The results showed that short-chain polypeptide-based EEN formulas effectively alleviate intestinal injury in children with active CD.
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Affiliation(s)
- Runqiu Wu
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jin Yang
- Department of Pediatric Anesthesiology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jinjin Cao
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Chenhui Wang
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Wenxin Chen
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yanling Wu
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xinguo Zheng
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Jin
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Yang
- Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
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140
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Yoo L, Tsai CS, Heitkemper M, Kamp K. Systematic review: Individual-level factors and social determinants of health impacting sleep health in individuals with inflammatory bowel disease. J Adv Nurs 2023; 79:1650-1663. [PMID: 36756952 PMCID: PMC10182249 DOI: 10.1111/jan.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
AIM To examine the individual-level factors and social determinants of health (SDOH) linked to sleep health among individuals with inflammatory bowel disease (IBD). DESIGN Systematic review without meta-analysis. DATA SOURCES Four databases (PubMed, Web of Science, CINAHL and PsycINFO) were searched in February 2022. REVIEW METHODS Databases were searched with keywords related to IBD and sleep. The review was conducted per the PRISMA protocol. The checklist for analytical cross-sectional studies published by the Joanna Briggs Institute was used for quality appraisal. Factors were organized by individual, social and societal levels according to the social-ecological model of sleep health. RESULTS In the review, 45 studies were identified and synthesized. All studies examined individual-level factors with sleep, with age being the most common factor studied. Only nine studies considered a social determinant of health which included marital status, number of children, education level, annual income, employment status, work tenure, type of employment, area of residence, minority status/ethnicity and COVID-19. However, the source of information for the social determinant of health was not clearly defined for more than half of these studies. CONCLUSION Although IBD sleep research has explored individual-level factors (i.e. age) that impact sleep health, there is a lack of information on the SDOH that can contribute to sleep health. IMPACT This review provides insight into the different factors that have been examined in IBD sleep research. By determining the SDOH that impact sleep, nursing research can inform sustainable and tailored interventions that focus on changing behaviour and improving sleep of individuals of varying backgrounds and life experiences. There is a continued need for nurses in practice and research to explore the SDOH that influence health outcomes and the daily lives of those with IBD.
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Affiliation(s)
- Linda Yoo
- University of Washington, Seattle, Washington, USA
| | | | | | - Kendra Kamp
- University of Washington, Seattle, Washington, USA
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141
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Ji J, Wu X, Li X, Zhu Y. Effects of microplastics in aquatic environments on inflammatory bowel disease. ENVIRONMENTAL RESEARCH 2023; 229:115974. [PMID: 37088319 DOI: 10.1016/j.envres.2023.115974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/03/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
The incidence of inflammatory bowel disease (IBD) has been increasing in recent years, particularly in newly industrialized nations. Environmental factors have been identified as playing a crucial role in IBD pathogenesis. Microplastics (MPs), a novel class of environmental pollutants, are a significant global pollution concern. MPs are found in almost all aquatic environments. MPs in the environment may pose health risks, specifically concerning the intestinal system, due to prolonged exposure through the consumption of aquatic foods and drinking water. In this review, we aimed to provide a comprehensive overview of the current knowledge on the impact of MPs in water resources on the occurrence and progression of IBD. Our systematic analysis of in vitro and in vivo studies found that MPs induce intestinal barrier dysfunction, imbalance in the intestinal microbiome, and metabolic abnormalities, ultimately leading to IBD. In addition, MP exposure causes greater harm to individuals with preexisting gastrointestinal disorders than those without them. Our analysis of this literature review highlights the need for further research to improve the understanding of the complex relationship between MP exposure and IBD.
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Affiliation(s)
- Jiali Ji
- The Affiliated Kangning Hospital, School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325035, China
| | - Xinyue Wu
- Zhejiang Provincial Key Laboratory of Organic Pollution Process and Control, Department of Environmental Science, Zhejiang University, Hangzhou, 310058, China
| | - Xi Li
- The Affiliated Kangning Hospital, School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325035, China
| | - Ya Zhu
- The Affiliated Kangning Hospital, School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325035, China.
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142
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Vernon-Roberts A, Musto F, Aloi M, Day AS. Italian Cross-Cultural Adaptation of a Knowledge Assessment Tool (IBD-KID2) for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2023; 5:187-197. [DOI: 10.3390/gidisord5020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Background: For children with inflammatory bowel disease (IBD), understanding their condition may lead to better outcomes. Knowledge assessment is imperative to identify where education may be required. An IBD knowledge assessment tool (IBD-KID2) is available in English; the aim of this study was to translate IBD-KID2 in to Italian and assess its validity/reliability among children with IBD. Methods: IBD-KID2 has fifteen items, scoring one point per correct answer. IBD-KID2 items were assessed for cultural comprehension/relevance by Italian gastroenterologists using a content validity index; those items with a maximum score proportion <0.78 were reviewed. IBD-KID2 was then translated using ‘forward–backward’ process and reviewed for content/meaning. A prospective study among Italian children with IBD enabled score comparisons with established populations (z test), and reliability was assessed using test–retest completion (Pearson correlation (r), paired t-test). Results: Twenty-five children participated: 16 (64%) male, mean age 14.9 years (SD2.4), Crohn’s disease 13 (52%). The mean IBD-KID2 score was 8.8 (SD2.8), with no association with independent variables. Test–retest showed strong correlation between scores (r = 0.78, p < 0.001), with no mean difference (p = 0.39). Comparison with other pediatric IBD populations (NZ/Australia/Canada) showed no score difference (p = 0.62, CI −0.9 to 1.5). Conclusions: The translation of IBD-KID2 to Italian used a rigorous methodology. Scores showed the translated tool has equivalence and generalizability to Italian children with IBD.
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Affiliation(s)
| | - Francesca Musto
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Umberto I Hospital, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Umberto I Hospital, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand
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Sun Q, Chen J, Zhao Q, He Z, Tang L, Pu Y, He B. Bio-adhesive and ROS-scavenging hydrogel microspheres for targeted ulcerative colitis therapy. Int J Pharm 2023; 639:122962. [PMID: 37068716 DOI: 10.1016/j.ijpharm.2023.122962] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
Ulcerative colitis (UC) as an important type of inflammatory bowel disease is a chronic disease characterized by intestinal dyshomeostasis. The UC treatment is challenged by the insufficiency of drug delivery and retention. Herein, we fabricated an intrarectal formulation of olsalazine (Olsa)-loaded hydrogel microspheres (LDKT/Olsa) with good bio-adhesiveness and reactive oxygen species (ROS)-scavenging ability to enhance drug retention and therapeutic effect. Low methoxy pectin-dopamine conjugate/konjac glucomannan composite hydrogel microspheres (LDKT) with a size ranging from 10 to 100 μm were prepared by using Zn2+ and ROS-sensitive thioketal as crosslinkers. Upon intrarectal administration, the negatively charged and dopamine-functionalized hydrogel microspheres efficiently adhered to cationic surface of inflammatory mucosa, scavenging ROS and releasing Zn2+ and Olsa for antibacterial and anti-inflammatory effects. In the dextran sodium sulfate (DSS)-induced mouse UC model, the microspheres significantly reduced the levels of colonic ROS and pro-inflammatory cytokines, improved gut mucosal barrier integrity, and remarkably relieved colitis. Overall, the LDKT microspheres are promising carriers to deliver drugs for UC treatment.
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Affiliation(s)
- Qiqi Sun
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Jun Chen
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Quan Zhao
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Ziyun He
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Lei Tang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Yuji Pu
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China
| | - Bin He
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, China.
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Hu X, Liu W, He M, Qiu Q, Zhou B, Liu R, Wu F, Huang Z. Comparison of the molecular mechanisms of Fuzi Lizhong Pill and Huangqin decoction in the treatment of the cold and heat syndromes of ulcerative colitis based on network pharmacology. Comput Biol Med 2023; 159:106870. [PMID: 37084637 DOI: 10.1016/j.compbiomed.2023.106870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/21/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The aim of this study was to illuminate the similarities and differences of two prescriptions as "cold" and "heat" drugs for treating ulcerative colitis (UC) with the simultaneous occurrence of heat and cold syndrome via network pharmacology. METHODS (1) Active compounds of Fuzi-Lizhong Pill (FLP) and Huangqin Decoction (HQT) were retrieved from the TCMSP database, and their common active compounds were compared using the Venn diagram. (2) Potential proteins targeted to three sets of compounds either (i) shared by FLP and HQT, (ii) unique to FLP or (iii) unique to HQT were screened from the STP, STITCH and TCMSP databases, and three corresponding core compound sets were identified in Herb-Compound-Target (H-C-T) networks. (3) Targets related to UC were identified from the DisGeNET and GeneCards databases and compared with the FLP-HQT common targets to identify potential targets of FLP-HQT compounds related to UC. (4) Three potential target sets were imported into the STRING database for protein‒protein interaction (PPI) analysis, and three core target sets were defined. (5) The binding capabilities and interacting modes between core compounds and key targets were verified by molecular docking via Discovery Studio 2019 and molecular dynamics (MD) simulations via Amber 2018. (6) The target sets were enriched for KEGG pathways using the DAVID database. RESULTS (1) FLP and HQT included 95 and 113 active compounds, respectively, with 46 common compounds, 49 FLP-specific compounds and 67 HQT-specific compounds. (2) 174 targets of FLP-HQT common compounds, 168 targets of FLP-specific compounds, and 369 targets of HQT-specific compounds were predicted from the STP, STITCH and TCMSP databases; six core compounds specific to FLP and HQT were screened in the FLP-specific and HQT-specific H-C-T networks, respectively. (3) 103 targets overlapped from the 174 predicted targets and the 4749 UC-related targets; two core compounds for FLP-HQT were identified from the FLP-HQT H-C-T network. (4) 103 FLP-HQT-UC common targets, 168 of FLP-specific targets and 369 of HQT-specific targets had shared core targets (AKT1, MAPK3, TNF, JUN and CASP3) based on the PPI network analysis. (5) Molecular docking demonstrated that naringenin, formononetin, luteolin, glycitein, quercetin, kaempferol and baicalein of FLP and HQT play a critical role in treating UC; meanwhile, MD simulations revealed the stability of protein‒ligand interactions. (6) The enriched pathways indicated that most targets were related to anti-inflammatory, immunomodulatory and other pathways. Compared with the pathways identified using traditional methods, FLP-specific pathways included the PPAR signaling pathway and the bile secretion pathway, and HQT-specific pathways included the vascular smooth muscle contraction pathway and the natural killer cell-mediated cytotoxicity pathway etc. CONCLUSION: In this study, we clarified the common mechanisms of FLP and HQT in treating UC and their specific mechanisms in treating cold and heat syndrome in UC through compound, target and pathway distinction and a literature comparison based on network pharmacology; these results provide a new perspective on the detailed mechanism of "multidrugs and single-disease" thought in traditional Chinese medicine.
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Affiliation(s)
- Xiyun Hu
- Key Laboratory of Computer-Aided Drug Design of Dongguan City, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, China; Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China
| | - Weidong Liu
- Key Laboratory of Computer-Aided Drug Design of Dongguan City, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, China; Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China
| | - Meiqi He
- Key Laboratory of Computer-Aided Drug Design of Dongguan City, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, China; Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China
| | - Qimiao Qiu
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China
| | - Bingjie Zhou
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China
| | - Ruining Liu
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China
| | - Fengxu Wu
- Hubei Key Laboratory of Wudang Local Chinese Medicine Research, School of Pharmaceutical Sciences, Hubei University of Medicine, Shiyan, 442000, China.
| | - Zunnan Huang
- Key Laboratory of Computer-Aided Drug Design of Dongguan City, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523710, China; Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, 523808, China; Marine Biomedical Research Institute of Guangdong Zhanjiang, Zhanjiang, 524023, China.
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145
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Wetwittayakhlang P, Tselekouni P, Al-Jabri R, Bessissow T, Lakatos PL. The Optimal Management of Inflammatory Bowel Disease in Patients with Cancer. J Clin Med 2023; 12:jcm12062432. [PMID: 36983432 PMCID: PMC10056442 DOI: 10.3390/jcm12062432] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) have an increased risk of cancer secondary to chronic inflammation and long-term use of immunosuppressive therapy. With the aging IBD population, the prevalence of cancer in IBD patients is increasing. As a result, there is increasing concern about the impact of IBD therapy on cancer risk and survival, as well as the effects of cancer therapies on the disease course of IBD. Managing IBD in patients with current or previous cancer is challenging since clinical guidelines are based mainly on expert consensus. Evidence is rare and mainly available from registries or observational studies. In contrast, excluding patients with previous/or active cancer from clinical trials and short-term follow-up can lead to an underestimation of the cancer or cancer recurrence risk of approved medications. The present narrative review aims to summarize the current evidence and provide practical guidance on the management of IBD patients with cancer.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Paraskevi Tselekouni
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Reem Al-Jabri
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, 1085 Budapest, Hungary
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146
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Chen X, Gao Y, Xie J, Hua H, Pan C, Huang J, Jing M, Chen X, Xu C, Gao Y, Li P. Identification of FCN1 as a novel macrophage infiltration-associated biomarker for diagnosis of pediatric inflammatory bowel diseases. J Transl Med 2023; 21:203. [PMID: 36932401 PMCID: PMC10022188 DOI: 10.1186/s12967-023-04038-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/05/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The incidence of pediatric inflammatory bowel disease (PIBD) has been steadily increasing globally. Delayed diagnosis of PIBD increases the risk of complications and contributes to growth retardation. To improve long-term outcomes, there is a pressing need to identify novel markers for early diagnosis of PIBD. METHODS The candidate biomarkers for PIBD were identified from the GSE117993 dataset by two machine learning algorithms, namely LASSO and mSVM-RFE, and externally validated in the GSE126124 dataset and our PIBD cohort. The role of ficolin-1 (FCN1) in PIBD and its association with macrophage infiltration was investigated using the CIBERSORT method and enrichment analysis of the single-cell dataset GSE121380, and further validated using immunoblotting, qRT-PCR, and immunostaining in colon biopsies from PIBD patients, a juvenile murine DSS-induced colitis model, and THP-1-derived macrophages. RESULTS FCN1 showed great diagnostic performance for PIBD in an independent clinical cohort with the AUC of 0.986. FCN1 expression was upregulated in both colorectal biopsies and blood samples from PIBD patients. Functionally, FCN1 was associated with immune-related processes in the colonic mucosa of PIBD patients, and correlated with increased proinflammatory M1 macrophage infiltration. Furthermore, single-cell transcriptome analysis and immunostaining revealed that FCN1 was almost exclusively expressed in macrophages infiltrating the colonic mucosa of PIBD patients, and these FCN1+ macrophages were related to hyper-inflammation. Notably, proinflammatory M1 macrophages derived from THP-1 expressed high levels of FCN1 and IL-1β, and FCN1 overexpression in THP-1-derived macrophages strongly promoted LPS-induced activation of the proinflammatory cytokine IL-1β via the NLRP3-caspase-1 axis. CONCLUSIONS FCN1 is a novel and promising diagnostic biomarker for PIBD. FCN1+ macrophages enriched in the colonic mucosa of PIBD exhibit proinflammatory phenotypes, and FCN1 promotes IL-1β maturation in macrophages via the NLRP3-caspase-1 axis.
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Affiliation(s)
- Xixi Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Yuanqi Gao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Jinfang Xie
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Huiying Hua
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Chun Pan
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Jiebin Huang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Mengxia Jing
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Xuehua Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China
| | - Chundi Xu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China.
| | - Yujing Gao
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 750004, China.
| | - Pu Li
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Er Rd.197, Shanghai, 200025, China.
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147
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Nambu R, Arai K, Kudo T, Murakoshi T, Kunisaki R, Mizuochi T, Kato S, Kumagai H, Inoue M, Ishige T, Saito T, Noguchi A, Yodoshi T, Hagiwara SI, Iwata N, Nishimata S, Kakuta F, Tajiri H, Hiejima E, Toita N, Mochizuki T, Shimizu H, Iwama I, Hirano Y, Shimizu T. Clinical outcome of ulcerative colitis with severe onset in children: a multicenter prospective cohort study. J Gastroenterol 2023; 58:472-480. [PMID: 36884071 DOI: 10.1007/s00535-023-01972-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND As best practices for treating children with severe-onset ulcerative colitis remain controversial in the era of biologic agents, we prospectively investigated treatments and outcomes in a multicenter cohort. METHODS Using a Web-based data registry maintained in Japan between October 2012 and March 2020, we compared management and treatment outcomes in an S1 group defined by a Pediatric Ulcerative Colitis Activity Index of 65 or more points at diagnosis with those in an S0 group defined by an index value below 65. RESULTS Three hundred one children with ulcerative colitis treated at 21 institutions were included, with follow-up for 3.6 ± 1.9 years. Among them, 75 (25.0%) were in S1; their age at diagnosis was 12.3 ± 2.9 years, and 93% had pancolitis. Colectomy free rates in S1 were 89% after 1 year, 79% after 2, and 74% after 5, significantly lower than for S0 (P = 0.0003). Calcineurin inhibitors and biologic agents, respectively, were given to 53% and 56% of S1 patients, significantly more than for S0 patients (P < 0.0001). Among S1 patients treated with calcineurin inhibitors when steroids failed, 23% required neither biologic agents nor colectomy, similarly to the S0 group (P = 0.46). CONCLUSIONS Children with severe ulcerative colitis are likely to require powerful agents such as calcineurin inhibitors and biologic agents; sometimes colectomy ultimately proves necessary. Need for biologic agents in steroid-resistant patients might be reduced to an extent by interposing a therapeutic trial of CI rather than turning to biologic agents or colectomy immediately.
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Affiliation(s)
- Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-Ku, Saitama, 3308777, Japan.
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takatsugu Murakoshi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sawako Kato
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Mikihiro Inoue
- Department of Pediatric Surgery, Fujita Health University, Aichi, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takeshi Saito
- Division of Pediatric Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Shin-Ichiro Hagiwara
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shigeo Nishimata
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Fumihiko Kakuta
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Miyagi, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Eitaro Hiejima
- Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan
| | - Nariaki Toita
- Department of Pediatrics, Sapporo Kosei General Hospital, Hokkaido, Japan
| | | | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-Ku, Saitama, 3308777, Japan
| | - Yuri Hirano
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Vernon-Roberts A, Aluzaite K, Khalilipour B, Day AS. Systematic Review of Diagnostic Delay for Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2023; 76:304-312. [PMID: 36730088 DOI: 10.1097/mpg.0000000000003670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Pediatric inflammatory bowel disease (IBD) is a complex inflammatory condition of the gut. Diagnosing IBD involves distinct longitudinal periods from first symptoms to primary care assessment, tertiary care referral, and then endoscopic confirmation. The term diagnostic delay (DD) is used if these periods are prolonged. The aim of this review was to amalgamate DD data for children with IBD, and identify factors associated with prolonged DD. METHODS Six health literature databases were searched (December 2020). Inclusion criteria for papers were children diagnosed with IBD before the age of 18 years, DD central tendency data, and to report a central tendency of their DD data, cohort >10 children. For analysis, all data were weighted by cohort sample size. RESULTS Searches identified 236 papers, and 26 were included in the final analysis with a pooled cohort of 7030 children. The overall DD periods were IBD 4.5 months [Interquartile range (IQR) 3.6-8.7 months], Crohn disease (CD) 5 months (IQR 4-7.2 months), and ulcerative colitis/indeterminate colitis/IBD-unclassified (UC/IC/IBDU) 3 months (IQR 2.2-4.9 months). The difference between subtypes was significant ( P < 0.001), with shorter DD for UC/IC/IBDU than CD ( P < 0.001) and IBD ( P < 0.001). DD periods were longer for CD than IBD ( P < 0.001). DD decreased over time for IBD ( P < 0.001) and UC ( P < 0.001) but the trend suggested an increase for CD ( P 0.069). CONCLUSIONS This data can be used to benchmark DD for children with IBD. Individual centers could determine whether improvements to awareness or infrastructure may reduce DD in order to minimize the risk of poor outcomes.
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Affiliation(s)
| | - Kristina Aluzaite
- the Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Andrew S Day
- From the Department of Pediatrics, University of Otago, Christchurch, New Zealand
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149
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Räisänen LK, Kääriäinen SE, Sund R, Engberg E, Viljakainen HT, Kolho KL. Antibiotic exposures and the development of pediatric autoimmune diseases: a register-based case-control study. Pediatr Res 2023; 93:1096-1104. [PMID: 35854091 PMCID: PMC10033398 DOI: 10.1038/s41390-022-02188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/27/2022] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Antibiotics have been associated with several individual autoimmune diseases (ADs). This study aims to discover whether pre-diagnostic antibiotics are associated with the onset of ADs in general. METHODS From a cohort of 11,407 children, 242 developed ADs (type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis (JIA), or inflammatory bowel diseases) by a median age of 16 years. Antibiotic purchases from birth until the date of diagnosis (or respective date in the matched controls n = 708) were traced from national registers. RESULTS Total number of antibiotic purchases was not related to the onset of ADs when studied as a group. Of specific diagnoses, JIA was associated with the total number of antibiotics throughout the childhood and with broad-spectrum antibiotics before the age of 3 years. Intriguingly, recent and frequent antibiotic use (within 2 years before diagnosis and ≥3 purchases) was associated with the onset of ADs (OR 1.72, 95% CI 1.08-2.74). Regardless of frequent use in childhood (40% of all antibiotics), penicillin group antibiotics were not related to any ADs. CONCLUSIONS Use of antibiotics was relatively safe regarding the overall development of ADs. However, broad-spectrum antibiotics should be used considerately as they may associate with an increased likelihood of JIA. IMPACT Increasing numbers of antibiotic purchases before the age of 3 years or throughout childhood were not associated with the development of pediatric autoimmune diseases. Broad-spectrum antibiotics were related to the development of autoimmune diseases, especially juvenile idiopathic arthritis in children, while penicillin group antibiotics were not. The use of broad-spectrum antibiotics in children should be cautious as they may carry along a risk for autoimmune disease development.
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Affiliation(s)
- Laura K Räisänen
- Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | | | - Reijo Sund
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Elina Engberg
- Folkhälsan Research Center, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heli T Viljakainen
- Folkhälsan Research Center, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kaija-Leena Kolho
- Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland.
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
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150
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Has the Incidence of Inflammatory Bowel Disease Peaked? Evidence From the Population-Based NorDIBD Cohort 1978-2020. Am J Gastroenterol 2023; 118:501-510. [PMID: 36728238 DOI: 10.14309/ajg.0000000000002187] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION While the incidence of inflammatory bowel disease (IBD) is rising globally, it has been suggested to stabilize in westernized countries, but this has not yet been shown in exhaustive and large cohorts. We generated an IBD cohort in North Denmark (NorDIBD) of 6,158 patients with IBD diagnosed from 1978 to 2020, based on all recorded and verified IBD diagnoses in the region. While describing the establishment of this cohort, we aimed to present the accurate incidence and prevalence of IBD over 4 decades. METHODS The NorDIBD cohort covered all pediatric and adult patients with an IBD diagnosis dated between January 1, 1978, and December 31, 2020, and living in North Denmark, hence forming an unselected population-based patient cohort. IBD incidence rates between 1978 and 2020 and IBD point prevalences between 2003 and 2020 were calculated. RESULTS We observed a 4-fold increase in the incidence of IBD from 11.5 per 100,000 persons (95% confidence interval [CI] 8.4-14.6) in the year 1978 to 51.3/100,000 (95% CI 45.5-57.1) in the year 2014, whereas in 2020, this rate stabilized. The overall prevalence of IBD more than doubled from 2003 to 2020, from 424 (95% CI 407-443) in 2003 to 872 (95% CI 849-896) IBD cases per 100,000 persons in 2020. DISCUSSION Our population-based NorDIBD cohort suggests stabilizing of the incidence of IBD in Denmark, whereas the prevalence continues to rise. Because the data represent a 10% sample of the entire Danish IBD population, we believe that data can be extrapolated to the IBD population in general and used for healthcare planning.
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