Besonderheiten der Therapie chronisch-entzündlicher Darmerkrankungen im Kindes- und Jugendalter

Predictors of improvement in disease activity in childhood and adolescent Crohn's disease: an analysis of age, localization, initial severity and drug therapy - data from the Saxon Registry for Inflammatory Bowel Disease in Children in Germany (2000-2014)

The escalating worldwide prevalence of Crohn's disease (CD) among children and adolescents, coupled with a trend toward earlier onset, presents significant challenges for healthcare systems. Moreover, the chronicity of this condition imposes substantial individual burdens. Consequently, the principal objective of CD treatment revolves around rapid inducing remission. This study scrutinizes the impact of age, gender, initial disease localization, and therapy on the duration to achieve disease activity amelioration. Data from the Saxon Pediatric IBD Registry in Germany were analyzed over a period of 15 years. In addition to descriptive methods, logistic and linear regression analyses were conducted to identify correlations. Furthermore, survival analyses and Cox regressions were utilized to identify factors influencing the time to improvement in disease activity. These effects were expressed as Hazard Ratios (HR) with 95% confidence intervals. Data on the clinical course of 338 children and adolescents with CD were available in the registry. The analyses showed a significant correlation between a young age of onset and the severity of disease activity. It was evident that treatment with anti-TNF (Infliximab) was associated with a more favorable prognosis in terms of the time required for improvement in disease activity. Similarly, favorable outcomes were observed with the combination therapies of infliximab with enteral nutrition therapy and Infliximab with immunosuppressants.Conclusion: Our analysis of data from the Saxon Pediatric IBD Registry revealed that the timeframe for improvement of disease activity in pediatric Crohn's disease is influenced by several factors. Specifically, patient age, treatment modality, and initial site of inflammation were found to be significant factors. The study provides important findings that underline the need for individualized treatment.

The Care of Children and Adolescents with Chronic Inflammatory Bowel Disease: A Cluster-Randomized Trial on Improving the Guideline Conformity of Treatment by the Use of the CEDATA-GPGE Patient Registry

BACKGROUND

For children and adolescents with chronic inflammatory bowel disease (IBD), treatment that is not in adequate conformity with the guidelines can adversely affect both the course of disease and the patients' development. The targeted use of digital patient registries may improve real-life adherence to the recommendations of evidence-based guidelines.

METHODS

In a cluster-randomized, controlled trial (DRKS00015505), treatment providers for the intervention group (IG) documented the treatment of children and adolescents with IBD in the CEDATA-GPGE patient registry; they received automated feedback on the data they entered and on potential deviations of the documented treatment from recommendations contained in the guidelines (care deficits). Treatments providers for the control group (CG) documented treatments as previously, i.e., only in the patients' charts. At the end of a twelve-month observation period, the data from both groups at baseline and on follow-up were analyzed in an intergroup comparison. The primary endpoint was the number of care deficits at twelve months.

RESULTS

319 patients were recruited from 47 pediatric gas troen tero logical centers in Germany (IG: 21 centers and 160 subjects; CG: 26 centers and 159 subjects). Among the 146 subjects in the IG who were followed up at 12 months, there were an average (mean) of 0.17 care deficits per patient (95% confidence interval [0.10; 0.24]). Among the 134 subjects in the CG who were followed up at 12 months, there were an average (mean) of 0.55 [0.43; 0.66] identified care deficits per patient (p < 0.0001).

CONCLUSION

Registry-based feedback can help bring treatment and its documentation into better con for - mity with the relevant guidelines and thereby reduce or prevent care deficits in children and adolescents with IBD.

[KARLOTTA (Kids + Adolescents Research Learning On Tablet Teaching Aachen) - randomized controlled pilot study for the implementation of a digital educational app with game of skill for pediatric patients with inflammatory bowel disease]

OBJECTIVES

Improvement of disease-specific knowledge in pediatric patients with inflammatory bowel disease (IBD) using a digital app and individualized teaching from physician to patient.

METHODS

We developed an app for Android Software called KARLOTTA (Kids + Adolescents Research Learning On Tablet Teaching Aachen) with a game of skill and IBD questionnaire with visual feedback and high scores. Randomized controlled study as a pilot project with 30 IBD patients, aged 10-18 years. The intervention group used the KARLOTTA app on a tablet before every consultation during a 12-month period. Outcome parameters were an increase in knowledge, changes in quality of life and analysis of the feedback questionnaires for patient and physician. The statistical analysis was carried out with the X2 -test, Mann-Whitney-U test and descriptive analysis.

RESULTS

KARLOTTA was played 55 times by 14 patients. In all patients (100%) gaps in knowledge could be discovered and specific teaching took place. In the KARLOTTA group, 11 of 14 patients (79%) had an increase in knowledge, in the control group 7 of 15 patients (47%), p-value of 0.08 with the X2 -test. There were no differences in results for quality of life. The app could be used without any problems in 87% of the appointments.

CONCLUSIONS

The KARLOTTA app reveals individual gaps in knowledge, provides tailor-made physician-patient teaching and can be easily implemented in the outpatient clinic.