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Dipasquale V, Cicala G, Spina E, Romano C. Biosimilars in Pediatric Inflammatory Bowel Diseases: A Systematic Review and Real Life-Based Evidence. Front Pharmacol 2022; 13:846151. [PMID: 35370732 PMCID: PMC8970685 DOI: 10.3389/fphar.2022.846151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Many pediatric inflammatory bowel disease (IBD) patients are now using biosimilars of anti-tumor necrosis factor-α (TNF-α), with increasing trends in recent years. This study reviewed all available data regarding the use of biosimilars in children with IBD. Methods: PubMed, Google Scholar, Scopus, and CENTRAL databases were searched through keywords; inflammatory bowel diseases, Crohn's disease, ulcerative colitis, biosimilar and child were combined using "AND" and "OR." Original research articles involving pediatric patients receiving one of the biosimilar medications based on the anti-TNF-α biologic drugs approved for pediatric IBD treatment, independently from efficacy and drug response, were included. Results: Nine studies were included in the evidence synthesis. CT-P13 was the biosimilar used in all studies. Four studies assessed the induction effectiveness of CT-P13. Clinical response and remission rates of biosimilar treatment were 86-90% and 67-68%, respectively, and they were not significantly different to the originator group. Five prospective studies on patients elected to switch from originator IFX to CT-P13 yielded similar results. Adverse events related to CT-P13 were mostly mild. The most frequently reported were upper respiratory tract infections. The switch from the originator had no significant impact on immunogenicity. Conclusion: The current review showed reported CT-P13 effectiveness as measured by clinical response and/or remission rates after induction or during maintenance and suggest that there is no significant difference with that of the originator IFX. Further studies are warranted, including clinical, and pharmacovigilance studies.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Abstract
Biological therapies, especially blocking tumor necrosis factor-α (TNFα) agents have radically changed the therapeutic approach and disease course of pediatric inflammatory bowel disease (IBD). In particular, drugs such as infliximab (IFX) and adalimumab (ADA) have been demonstrated to be effective in inducing and maintaining corticosteroid-free remission in both adult and pediatric patients with Crohns Disease (CD) and Ulcerative colitis (UC). Biosimilar biological (BioS) therapy is increasingly being used in pediatric age even though most knowledge on the safety and efficacy of these agents is based on IFX in adult IBD data. Studies show high rates of clinical response and remission in both IFX naïve patients and in patients switched from originator to BioS with similar risks of adverse events (AEs) as those reported with IFX originator. In the present review indications, efficacy and AEs of biological therapy in pediatric IBD will be discussed, as well as the role of other biological agents such as Golimumab, Vedolizumab and Ustekinumab, the role of BioS biological therapy and utility of therapeutic drug monitoring in clinical practice.
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Dipasquale V, Romano C. Biosimilar infliximab in paediatric inflammatory bowel disease: Efficacy, immunogenicity and safety. J Clin Pharm Ther 2020; 45:1228-1234. [PMID: 32743840 DOI: 10.1111/jcpt.13239] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Based on extrapolation, biosimilar infliximab (IFX) was approved to treat inflammatory bowel disease (IBD). The first studies in adults have shown similar efficacy and safety in comparison with reference drug. The aim of this review was to collect and evaluate all the literature data regarding the use of biosimilar IFX in paediatric IBD. METHODS This article reviewed efficacy, immunogenicity and safety profile of biosimilar IFX in IBD paediatric patients through a comprehensive search of the published literature. RESULTS AND DISCUSSION Eight papers were extracted and critically reviewed. Four paediatric studies (prospective, n = 3; retrospective, n = 1) assessed the induction efficacy of the biosimilar IFX. Clinical response and remission rates reported were 86%-90% and 67%-68%, respectively. No significant difference in clinical response and remission rates between the reference and biosimilar IFX groups was found at follow-up (range: 3-13 months). Similar findings were shown in the prospective studies (n = 4) conducted on patients elected to switch from reference IFX to its biosimilar. The most frequently reported adverse events (AEs) of biosimilar IFX were mild upper respiratory tract infections. Taking into account of all AEs coming from published data, biosimilar IFX seems to be as safe as its originator. Immunogenicity has not been significantly impacted by the switch from the reference drug. WHAT IS NEW AND CONCLUSION To date, treatment with (or switch to) biosimilar IFX in paediatric patients with IBD have been successful, without affecting efficacy, immunogenicity or safety. However, further studies are warranted, including clinical trials and pharmacovigilance studies.
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Affiliation(s)
- Valeria Dipasquale
- Unit of Pediatric Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood 'G. Barresi', University of Messina, Messina, Italy
| | - Claudio Romano
- Unit of Pediatric Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood 'G. Barresi', University of Messina, Messina, Italy
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Abstract
The incidence of paediatric Crohn's disease (CD) and ulcerative colitis (UC) is increasing. Surgical intervention is required during childhood in approximately 25% of children diagnosed with CD, and for 10% of those diagnosed with UC. Although there is evidence that the rate of surgical intervention undertaken in children is decreasing since the introduction of biologic therapy, this may only represent a delay rather than true reversal of the risk of surgery. Surgery for CD is not curative and limited resection is the key principle thus preserving bowel length. For UC, subtotal colectomy is relatively curative; ileo-anal pouch anastomosis can be performed to restore bowel continuity.
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Affiliation(s)
- Arun Kelay
- Department of Paediatric Surgery, University Hospital Southampton, Southampton, UK
| | - Lucinda Tullie
- Department of Paediatric Surgery, University Hospital Southampton, Southampton, UK
| | - Michael Stanton
- Department of Paediatric Surgery, University Hospital Southampton, Southampton, UK
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Chanchlani N, Mortier K, Williams LJ, Muhammed R, Auth MKH, Cosgrove M, Fagbemi A, Fell J, Chong S, Zamvar V, Hyer W, Bisset WM, Morris MA, Rodrigues A, Mitton SG, Bunn S, Beattie RM, Willmott A, Wilson DC, Russell RK. Use of Infliximab Biosimilar Versus Originator in a Pediatric United Kingdom Inflammatory Bowel Disease Induction Cohort. J Pediatr Gastroenterol Nutr 2018; 67:513-519. [PMID: 29697550 DOI: 10.1097/mpg.0000000000002011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to summarize short-term effectiveness, safety, and cost of using infliximab biosimilar (IFX-B) drugs, (Inflectra [Hospira] and Remsima [NAAP]) compared to originator infliximab (IFX-O) (Remicade [MSD]) in biologic naive pediatric inflammatory bowel disease in the United Kingdom. METHODS Prospective audit of patients starting anti-tumour necrosis factor (TNF) therapy. Disease severity, response to treatment, and remission rate was measured by Pediatric Crohn's Disease Activity Index (PCDAI) and/or Physician Global Assessment. RESULTS Between March 2015 and February 2016, 278 patients (175 IFX-O, 82 IFX-B, and 21 Adalimumab) were started on anti-TNF therapy. This was compared with collected data on 398 patients started on IFX-O from 2011 to 2015. At initiation, median PCDAI was 36 (20,48) (n = 42) in the IFX-O group and 28 (20,40) (n = 29) in the IFX-B group, (P = 0.08). Immunosuppression rates were similar: 150/175 (86%) for IFX-O and 65/82 (79%) for IFX-B (P > 0.05). Post induction, median PCDAI score was 5 (0,11) (n = 19) and 0 (0,8) (n = 15) in the IFX-O and IFX-B groups, respectively (P = 0.35). There was no difference in response to treatment using Physician Global Assessment 85% (n = 28) in IFX-O group and 86% (n = 19) in IFX-B group (P > 0.05). Adverse events at initiation and post induction were not different between both groups (P > 0.05). Using conservative calculations, £875,000 would have been saved for a 1-year period with universal adoption of biosimilars in patients who were instead treated with IFX-O. CONCLUSIONS IFX-B is likely as effective as IFX-O in treating IBD in comparable pediatric populations. Sites should adopt infliximab biosimilar for new starts due to cost reduction with no difference in other parameters.
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Affiliation(s)
| | | | - Linda J Williams
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Edinburgh
| | - Rafeeq Muhammed
- Birmingham Children's Hospital, Birmingham, Birmingham Children's Hospital, Birmingham
| | - Marcus K H Auth
- Alder Hey Children's Hospital and University of Liverpool, Liverpool
| | - Mike Cosgrove
- Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Wales
- Children's Hospital for Wales, Heath Park, Cardiff
| | | | - John Fell
- Chelsea and Westminster Hospital, London
| | - Sonny Chong
- Queen Mary's Hospital for Children (Epsom and St Helier University Hospitals), Sutton, Carshalton
| | - Veena Zamvar
- Clarendon Wing, Leeds General Infirmary, Leeds, West Yorkshire
| | - Warren Hyer
- Northwick Park and St Mark's Hospital, Harrow, Middlesex
| | | | - Mary-Anne Morris
- Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital, Norwich
| | - Astor Rodrigues
- Children's Hospital, John Radcliffe Hospital, Headley Way, Oxford
| | | | - Su Bunn
- Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne
| | - R Mark Beattie
- Southampton Children's Hospital, Tremona Road, Southampton
| | - Anne Willmott
- Leicester Royal Infirmary, Infirmary Square, Leicester
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Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, de Carpi JM, Bronsky J, Veres G, Aloi M, Strisciuglio C, Braegger CP, Assa A, Romano C, Hussey S, Stanton M, Pakarinen M, de Ridder L, Katsanos KH, Croft N, Navas-López VM, Wilson DC, Lawrence S, Russell RK. Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis-An Evidence-based Consensus Guideline From the European Crohn's and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018; 67:292-310. [PMID: 30044358 DOI: 10.1097/mpg.0000000000002036] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Acute severe colitis (ASC) is one of the few emergencies in pediatric gastroenterology. Tight monitoring and timely medical and surgical interventions may improve outcomes and minimize morbidity and mortality. We aimed to standardize daily treatment of ASC in children through detailed recommendations and practice points which are based on a systematic review of the literature and consensus of experts. METHODS These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Fifteen predefined questions were addressed by working subgroups. An iterative consensus process, including 2 face-to-face meetings, was followed by voting of the national representatives of ECCO and all members of the Paediatric Inflammatory Bowel Disease (IBD) Porto group of ESPGHAN (43 voting experts). RESULTS A total of 24 recommendations and 43 practice points were endorsed with a consensus rate of at least 91% regarding diagnosis, monitoring, and management of ASC in children. A summary flowchart is presented based on daily scoring of the Paediatric Ulcerative Colitis Activity Index. Several topics have been altered since the previous 2011 guidelines and from those published in adults. DISCUSSION These guidelines standardize the management of ASC in children in an attempt to optimize outcomes of this intensive clinical scenario.
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Affiliation(s)
- Dan Turner
- Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Frank M Ruemmele
- Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France
| | | | - Anne M Griffiths
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Gabor Veres
- Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Napoli, Italy
| | | | - Amit Assa
- Schneider Children's Hospital, Petach Tikva (affiliated to the Sackler Faculty of Medicine), Tel Aviv University, Tel Aviv, Israel
| | - Claudio Romano
- Pediatric Department, University of Messina, Messina, Italy
| | - Séamus Hussey
- National Children's Research Centre, Royal College of Surgeons of Ireland and University College Dublin, Ireland
| | | | - Mikko Pakarinen
- Helsinki University Children's Hospital, Department of Pediatric Surgery, Helsinki, Finland
| | - Lissy de Ridder
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Nick Croft
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | | | - David C Wilson
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Sally Lawrence
- BC Children's Hospital, University of British Columbia, Vancouver BC, Canada
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Auth MKK, Bunn SK, Protheroe AL, Williams LJ, Fell JM, Muhammed R, Croft NM, Beattie RM, Willmott A, Spray C, Vadamalayan B, Rodrigues A, Puntis J, Pigott AJ, Wilson DC, Mitton S, Furman M, Charlton C, Chong SKF, Russell RK. Improved Medical Treatment and Surgical Surveillance of Children and Adolescents with Ulcerative Colitis in the United Kingdom. Inflamm Bowel Dis 2018; 24:1520-1530. [PMID: 29668982 DOI: 10.1093/ibd/izy042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 12/20/2022]
Abstract
Background Pediatric ulcerative colitis (UC) presents at an earlier age and increasing prevalence. Our aim was to examine morbidity, steroid sparing strategies, and surgical outcome in children with active UC. Methods A national prospective audit was conducted for the inpatient period of all children with UC for medical or surgical treatment in the United Kingdom (UK) over 1 year. Thirty-two participating centers recruited 224 children in 298 admissions, comparisons over 6 years were made with previous audits. Results Over 6 years, recording of Paediatric Ulcerative Colitis Activity Index (PUCAI) score (median 65)(23% to 55%, P < 0.001), guidelines for acute severe colitis (43% to 77%, P < 0.04), and ileal pouch surgery registration (4% to 56%, P < 0.001) have increased. Corticosteroids were given in 183/298 episodes (61%) with 61/183 (33%) not responding and requiring second line therapy or surgery. Of those treated with anti-TNFalpha (16/61, 26%), 3/16 (18.8%) failed to respond and required colectomy. Prescription of rescue therapy (26% to 49%, P = 0.04) and proportion of anti-TNFalpha (20% to 53%, P = 0.03) had increased, colectomy rate (23.7% to 15%) was not significantly reduced (P = 0.5). Subtotal colectomy was the most common surgery performed (n = 40), and surgical complications from all procedures occurred in 33%. In 215/224 (96%) iron deficiency anemia was detected and in 51% treated, orally (50.2%) or intravenously (49.8%). Conclusions A third of children were not responsive to steroids, and a quarter of these were treated with anti-TNFalpha. Colectomy was required in 41/298 (13.7%) of all admissions. Our national audit program indicates effectiveness of actions taken to reduce steroid dependency, surgery, and iron deficiency. 10.1093/ibd/izy042_video1izy042.video15769503407001.
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Affiliation(s)
| | - Su K Bunn
- Great North Children's Hospital, Newcastle upon Tyne
| | | | - Linda Jane Williams
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh
| | - John M Fell
- Chelsea and Westminster Hospital, Chelsea, London
| | | | | | - R Mark Beattie
- Southampton Children's Hospital, University Hospital Southampton
| | - Anne Willmott
- Leicester Royal Infirmary Children's Hospital, Infirmary Square, Leicester
| | - Christine Spray
- Bristol Royal Hospital for Sick Children, Upper Maudlin St, Bristol
| | | | | | - John Puntis
- Leeds General Infirmary, Great George Street, Leeds
| | | | | | | | - Mark Furman
- Royal Free Hospital, Pond St, Hampstead, London
| | | | - Sonny K F Chong
- Queen Mary's Hospital for Children, Wrythe Lane, Carlshalton Surrey, Sutton
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Real-life Anti-tumor Necrosis Factor Experience in More Than 500 Patients: High Co-immunosuppression Rates But Low Rates of Quantifying Treatment Response. J Pediatr Gastroenterol Nutr 2018; 66:274-280. [PMID: 29356768 DOI: 10.1097/mpg.0000000000001679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to measure the effectiveness, safety, and use of anti-tumor necrosis Factor (TNF) therapy in pediatric inflammatory bowel disease in the United Kingdom (UK). METHODS Prospective UK audit of patients newly starting anti-TNF therapy. Disease severity was assessed using Physician Global Assessment +/or the Paediatric Crohn Disease Activity Index. RESULTS A total of 37 centers participated (23/25 specialist pediatric inflammatory bowel disease sites). A total of 524 patients were included: 429 with Crohn disease (CD), 76 with ulcerative colitis (UC), and 19 with IBD unclassified (IBDU). Eighty-seven percent (488/562) of anti-TNF was infliximab; commonest indication was active luminal CD 77% (330/429) or chronic refractory UC/IBDU 56% (53/95); 79% (445/562) had concomitant co-immunosuppression. In CD (267/429 male), median time from diagnosis to treatment was 1.42 years (interquartile range 0.63-2.97). Disease (at initiation) was moderate or severe in 91% (156/171) by Physician Global Assessment compared to 41% (88/217) by Paediatric Crohn Disease Activity Index (Kappa (κ) 0.28 = only "fair agreement"; P < 0.001.Where documented, 77% (53/69) of patients with CD responded to induction; and 65% (46/71) entered remission. A total of 2287 infusions and 301.96 years of patient' follow-up (n = 385) are represented; adverse events affected 3% (49/1587) infliximab and 2% (2/98) adalimumab infusions (no deaths or malignancies). Peri-anal abscess drainage was less common after anti-TNF initiation (CD), that is 26% (27/102) before, 7% (3/42) after (P = 0.01); however, pre and post anti-TNF data collection was not over equal time periods. CONCLUSIONS Anti-TNFs are effective treatments, usually given with thiopurine co-immunosuppression. This study highlights deficiencies in formal documentation of effect and disparity between disease severity scoring tools, which need to be addressed to improve ongoing patient care.
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Turner D, Carle A, Steiner SJ, Margolis PA, Colletti RB, Russell RK, Levine A, Kolho KL, Ruemmele FM. Quality Items Required for Running a Paediatric Inflammatory Bowel Disease Centre: An ECCO Paper. J Crohns Colitis 2017; 11:981-987. [PMID: 28789473 DOI: 10.1093/ecco-jcc/jjx036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/07/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The importance of a holistic approach with a comprehensive multidisciplinary team, including nutritional and psychosocial support, is becoming well recognised as a key contributor to optimal care in paediatric inflammatory bowel disease [IBD]. The Paediatric committee of ECCO [P-ECCO] aimed to determine important components that would contribute to quality of care in a paediatric IBD centre [henceforth 'quality items']. METHODS First, a list of items has been generated by a Delphi group of 111 international paediatric IBD experts. Through an iterative process, the group graded and ranked the items according to their perceived relative contribution to quality care. We then surveyed 101 paediatric IBD centres affiliated with the Porto and Interest groups of ESPGHAN in Europe and with the ImproveCareNow registry in North America, exploring the availability of the retained items in their centres. RESULTS A total of 68 items were generated and reduced to a list of 60 ranked order items, grouped in six domains: Facility, Personnel, Management, Supportive Services, Patient Support and Accessibility, and Academia and Communications. Of the retained items, 52 [88%] were present in most of the 101 high-performing paediatric IBD centres, and there was a trend for increased availability with increased patient volume at the centres. CONCLUSION In this P-ECCO study, we attempted to tabulate, for the first time in paediatrics, 60 quality items that paediatric IBD referral centres may wish to include.
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Affiliation(s)
- Dan Turner
- Shaare Zedek Medical Centre, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adam Carle
- James M. Anderson Centre for Health Systems Excellent, Cincinnati Children's Hospital Medical Centre; University of Cincinnati College of Medicine; University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
| | - Steven J Steiner
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter A Margolis
- James M. Anderson Centre for Health Systems Excellent, Cincinnati Children's Hospital Medical Centre; University of Cincinnati College of Medicine; University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
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10
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Hansen R, Russell RK. Steroid Limbo in Acute Severe Ulcerative Colitis: How Low Can You Go? J Pediatr Gastroenterol Nutr 2016; 63:2-3. [PMID: 26825763 DOI: 10.1097/mpg.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Richard Hansen
- Department of Paediatric Gastroenterology, The Royal Hospital for Children, Glasgow, United Kingdom
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11
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Olsen IØ, Jensen S, Larsen L, Sørensen EE. Adolescents' Lived Experiences While Hospitalized After Surgery for Ulcerative Colitis. Gastroenterol Nurs 2016; 39:287-96. [PMID: 26425861 PMCID: PMC4969068 DOI: 10.1097/sga.0000000000000154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/04/2014] [Indexed: 01/17/2023] Open
Abstract
Adolescents are in a transitional phase of life characterized by major physical, emotional, and psychological challenges. Living with ulcerative colitis is experienced as a reduction of their life quality. Initial treatment of ulcerative colitis is medical, but surgery may be necessary when medical treatment ceases to have an effect. No research-based studies of adolescents' experience of the hospital period after surgery for ulcerative colitis exist. The objective of the study was to identify and describe adolescents' lived experiences while hospitalized after surgery for ulcerative colitis. This qualitative study was based on interviews with eight adolescents. Analysis and interpretation were based on a hermeneutic interpretation of meaning. Three themes were identified: Body: Out of order; Seen and understood; and Where are all the others? The adolescents experience a postoperative period characterized by physical and mental impairment. Being mentally unprepared for such challenges, they shun communication and interaction. The findings demonstrate the importance of individualized nursing care on the basis of the adolescent's age, maturity, and individual needs. Further study of adolescent patients' hospital stay, focusing on the implications of being young and ill at the same time, is needed.
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Affiliation(s)
- Ida Østrup Olsen
- Correspondence to: Ida Østrup Olsen, MScN, RN, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark ()
| | - Susanne Jensen
- Ida Østrup Olsen, MScN, RN, is Clinical Nurse Specialist, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Susanne Jensen, SD, RN, is Clinical Teaching Nurse, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Lene Larsen, RN, is Clinical Nurse, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Erik Elgaard Sørensen, PhD, MScN, RN, is Head of Research, Clinical Nursing Research Unit, Aalborg Hospital Science and Innovation Center, Aalborg University Hospital; and Associate Professor, Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Lene Larsen
- Ida Østrup Olsen, MScN, RN, is Clinical Nurse Specialist, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Susanne Jensen, SD, RN, is Clinical Teaching Nurse, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Lene Larsen, RN, is Clinical Nurse, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Erik Elgaard Sørensen, PhD, MScN, RN, is Head of Research, Clinical Nursing Research Unit, Aalborg Hospital Science and Innovation Center, Aalborg University Hospital; and Associate Professor, Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Erik Elgaard Sørensen
- Ida Østrup Olsen, MScN, RN, is Clinical Nurse Specialist, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Susanne Jensen, SD, RN, is Clinical Teaching Nurse, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Lene Larsen, RN, is Clinical Nurse, Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Erik Elgaard Sørensen, PhD, MScN, RN, is Head of Research, Clinical Nursing Research Unit, Aalborg Hospital Science and Innovation Center, Aalborg University Hospital; and Associate Professor, Clinical Institute, Aalborg University, Aalborg, Denmark
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12
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Fell JM, Muhammed R, Spray C, Crook K, Russell RK. Management of ulcerative colitis. Arch Dis Child 2016; 101:469-74. [PMID: 26553909 PMCID: PMC4853583 DOI: 10.1136/archdischild-2014-307218] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 12/12/2022]
Abstract
Ulcerative colitis (UC) in children is increasing. The range of treatments available has also increased too but around 1 in 4 children still require surgery to control their disease. An up-to-date understanding of treatments is essential for all clinicians involved in the care of UC patients to ensure appropriate and timely treatment while minimising the risk of complications and side effects.
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Affiliation(s)
- John M Fell
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rafeeq Muhammed
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Chris Spray
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| | - Kay Crook
- Department of Paediatric Gastroenterology, Northwick Park Hospital, London, UK
| | - Richard K Russell
- Department of Paediatric Gastroenterology, The Royal Hospital for Children, Glasgow, UK
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13
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Clostridium difficile infection in newly diagnosed pediatric inflammatory bowel disease in the mid-southern United States. J Pediatr Gastroenterol Nutr 2013; 57:487-8. [PMID: 23783013 PMCID: PMC3970838 DOI: 10.1097/mpg.0b013e3182a027c5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clostridium difficile is an emerging opportunistic pathogen that infects patients with underlying chronic disorders such as inflammatory bowel diseases (IBD) at high rates. An extremely high prevalence of Clostridium difficile infection (CDI) was noted recently in new-onset pediatric IBD from eastern Europe (Poland). We examined the rate of CDI in our new pediatric IBD patients (123 tested) from 2010 to 2012. The overall prevalence of CDI at disease onset was 8.1%, significantly (P < 0.0001) lower than in Poland, but much higher than in the general population. This work supports the testing for Clostridium difficile in suspected cases of new-onset pediatric IBD.
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