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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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Martin NG, Roberts AJ, Evans HM, Bishop J, Day AS. Adherence to the New Zealand Pediatric Guideline for the Assessment and Diagnosis of Inflammatory Bowel Disease. JPGN REPORTS 2022; 3:e266. [PMID: 37168484 PMCID: PMC10158400 DOI: 10.1097/pg9.0000000000000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/08/2022] [Indexed: 05/13/2023]
Abstract
New Zealand (NZ) guidelines for the approach to diagnosis and management of inflammatory bowel disease (IBD) in children were developed in 2014. Objectives This study aimed to assess the application of the guidelines in a group of children diagnosed with IBD in regards to baseline investigations. Methods This retrospective observational study analyzed the application of recommended baseline investigations included in the NZ guidelines in a group of children aged <16 years diagnosed consecutively with IBD at the 2 NZ tertiary pediatric gastroenterology centers. Results Fifty children were included from each center. Seventy-two were diagnosed with Crohn's disease (CD), 15 with ulcerative colitis (UC), and 13 were with IBD unclassified. The children with CD had a mean Pediatric Crohn's Disease Activity Index score of 31 and almost half had ileocolonic involvement (47%). The 15 children with UC had a mean PUCAI score of 42, and 13 had pancolonic involvement. All 100 children underwent upper and lower gastrointestinal endoscopy with biopsies, and 92% had magnetic resonance enterography at diagnosis. Iron studies, folate, and vitamin B12 were measured in >70 children. Serum zinc, magnesium, and phosphate were infrequently measured. Current anthropometry was recorded in all children but historical growth data were variably recorded. Vaccination status was also inconsistently recorded. Conclusion Most of this group of children diagnosed with IBD in 2 NZ centers underwent key recommended investigations at diagnosis including gastrointestinal endoscopy and small bowel imaging. Other baseline assessments, including measurement of micronutrient levels, were completed variably. Measures to enhance consistent baseline assessments are required.
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Affiliation(s)
- Natalie G. Martin
- From the Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Amin J. Roberts
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Helen M. Evans
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Jonathan Bishop
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Andrew S. Day
- From the Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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Bronsky J, Copova I, Kazeka D, Lerchova T, Mitrova K, Pospisilova K, Sulovcova M, Zarubova K, Hradsky O. Adalimumab vs Infliximab in Pediatric Patients With Crohn's Disease: A Propensity Score Analysis and Predictors of Treatment Escalation. Clin Transl Gastroenterol 2022; 13:e00490. [PMID: 35363628 PMCID: PMC9132518 DOI: 10.14309/ctg.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Two antitumor necrosis factor therapies (infliximab [IFX] and adalimumab [ADA]) have been approved for the treatment of pediatric Crohn's disease (CD) but have not been compared in head-to-head trials. The aim of this study was to compare the efficacy and safety of ADA and IFX by propensity score matching in a prospective cohort of pediatric patients with luminal CD and at least a 24-month follow-up. METHODS Among 100 patients, 75 met the inclusion criteria, and 62 were matched by propensity score. We evaluated time to treatment escalation as the primary outcome and primary nonresponse, predictors of treatment escalation and relapse, serious adverse events, pharmacokinetics, and effect of concomitant immunomodulators as secondary outcomes. RESULTS There was no difference between ADA and IFX in time to treatment escalation (HR = 0.63 [95% CI 0.31-1.28] P = 0.20), primary nonresponse (P = 0.95), or serious adverse events. The median (interquartile range) trough levels at the primary outcome were 14.05 (10.88-15.40) and 6.15 (2.08-6.58) µg/mL in the ADA and IFX groups, respectively. On a multivariate analysis, the combination of anti-Saccharomyces cerevisiae antibody negativity and antineutrophil cytoplasmic antibody positivity was a strong independent predictor of treatment escalation (HR 5.19, [95% CI 2.41-11.18], P < 0.0001). The simple endoscopic score for CD, L3 disease phenotype, and use of concomitant immunomodulators for at least the first 6 months revealed a trend toward significance on a univariate analysis. DISCUSSION Propensity score matching did not reveal substantial differences in efficacy or safety between ADA and IFX. The anti-S. cerevisiae antibody negativity and antineutrophil cytoplasmic antibody positivity combination is a strong predictor of treatment escalation.
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Affiliation(s)
- Jiri Bronsky
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Ivana Copova
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Denis Kazeka
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Tereza Lerchova
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Katarina Mitrova
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.
| | - Kristyna Pospisilova
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Miroslava Sulovcova
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Kristyna Zarubova
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
| | - Ondrej Hradsky
- Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic;
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Claßen M, de Laffolie J, Claßen M, Schnell A, Sohrabi K, Hoerning A. Significant advantages for first line treatment with TNF-alpha inhibitors in pediatric patients with inflammatory bowel disease - Data from the multicenter CEDATA-GPGE registry study. Front Pediatr 2022; 10:903677. [PMID: 36304532 PMCID: PMC9595023 DOI: 10.3389/fped.2022.903677] [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: 03/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS In recent years, biological agents, such as anti-TNF-α blockers, have been introduced and have shown efficacy in pediatric patients with inflammatory bowel disease (IBD). Here, the prescription mode differentiated into a first/second line application, and efficacy and side effects are evaluated beginning from 2004 until today. METHODS Statistical analyses of the prospective and ongoing CEDATA multicenter registry data from the Society of Pediatric Gastroenterology and Nutrition (GPGE) were performed for patients receiving a biological agent at least once during the period from June 2004 until November 2020 (n = 487). The analyzed parameters were patient demographics, disease extent and behavior, prior or concurrent therapies, duration and outcome of biological therapy, disease-associated complications, drug-related complications, laboratory parameters and treatment response as determined by the Physician's Global Assessment. RESULTS Crohn's disease (CD) was present in 71.5% of patients, and 52% were boys. Patients showed high disease activity when receiving a first-line TNF-α blocker. After 2016, patients who failed to respond to anti-TNF-α induction therapy were treated with off-label biologics (vedolizumab 4.3% and ustekinumab 2.1%). Propensity score matching indicated that patients with CD and higher disease activity benefitted significantly more from early anti-TNF-α therapy. This assessment was based on a clinical evaluation and lab parameters related to inflammation compared to delayed second-line treatment. Additionally, first-line treatment resulted in less treatment failure and fewer extraintestinal manifestations during TNF-α blockade. CONCLUSION First-line treatment with anti-TNF-α drugs is effective and safe. An earlier start significantly reduces the risk of treatment failure and is associated with fewer extraintestinal manifestations during longitudinal follow-up.
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Affiliation(s)
- Merle Claßen
- Clinic for Children and Adolescent Medicine, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Jan de Laffolie
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Justus Liebig University Gießen, Gießen, Germany
| | - Martin Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Bremen-Mitte, Bremen, Germany
| | - Alexander Schnell
- Clinic for Children and Adolescent Medicine, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Keywan Sohrabi
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Justus Liebig University Gießen, Gießen, Germany
| | - André Hoerning
- Clinic for Children and Adolescent Medicine, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Moriczi M, Pujol-Muncunill G, Martín-Masot R, Jiménez Treviño S, Segarra Cantón O, Ochoa Sangrador C, Peña Quintana L, González Santana D, Rodríguez Martínez A, Rosell Camps A, Armas H, Barrio J, González de Caldas R, Rodríguez Salas M, Balmaseda Serrano E, Donat Aliaga E, Bodas Pinedo A, Vaquero Sosa E, Vecino López R, Solar Boga A, Moreno Álvarez A, Sánchez Sánchez C, Tolín Hernani M, Gutiérrez Junquera C, Martinón Torres N, Leis Trabazo MR, Eizaguirre FJ, García Peris M, Medina Benítez E, Fernández Caamaño B, Vegas Álvarez AM, Crespo Valderrábano L, Alonso Vicente C, Rubio Santiago J, Galera-Martínez R, García-Romero R, Ros Arnal I, Fernández Cebrián S, Lorenzo Garrido H, Viada Bris JF, Velasco Rodríguez-Belvis M, Bartolomé Porro JM, Blanco Rodríguez M, Barros García P, Botija G, Chicano Marín FJ, La Orden Izquierdo E, Crehuá-Gaudiza E, Navas-López VM, Martín-de-Carpi J. Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP. Nutrients 2020; 12:nu12041012. [PMID: 32272604 PMCID: PMC7231252 DOI: 10.3390/nu12041012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/21/2022] Open
Abstract
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.
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Affiliation(s)
- Melinda Moriczi
- Paediatric Gastroenterology and Nutrition Unit, Hospital Complex Torrecárdenas, 04009 Almeria, Spain; (M.M.); (R.G.-M.)
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Esplugues del Llobregat, 08950 Barcelona, Spain; (G.P.-M.); (J.M.-d.-C.)
| | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Malaga, 29011 Málaga, Spain;
| | - Santiago Jiménez Treviño
- Gastroenterology Unit, Hepatology and Nutrition, Central University Hospital of Asturias, 33011 Oviedo, Spain;
| | - Oscar Segarra Cantón
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carlos Ochoa Sangrador
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Virgen de la Concha, 49022 Zamora, Spain;
| | - Luis Peña Quintana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital, 35016 Las Palmas of Gran Canaria, Spain; (L.P.Q.); (D.G.S.)
| | - Daniel González Santana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital, 35016 Las Palmas of Gran Canaria, Spain; (L.P.Q.); (D.G.S.)
| | | | - Antonio Rosell Camps
- Paediatric Gastroenterology and Nutrition Unit, University Hospital Son Espases, 07010 Palma de Mallorca, Spain;
| | - Honorio Armas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital of the Canary Islands, 38320 Tenerife, Spain;
| | - Josefa Barrio
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Fuenlabrada, Fuenlabrada, 28942 Madrid, Spain;
| | - Rafael González de Caldas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Reina Sofía, 14004 Cordoba, Spain; (R.G.d.C.); (M.R.S.)
| | - Mónica Rodríguez Salas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Reina Sofía, 14004 Cordoba, Spain; (R.G.d.C.); (M.R.S.)
| | - Elena Balmaseda Serrano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Complex, University of Albacete, 02008 Albacete, Spain;
| | - Ester Donat Aliaga
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital La Fe, 46009 Valencia, Spain;
| | - Andrés Bodas Pinedo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Esther Vaquero Sosa
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Raquel Vecino López
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Alfonso Solar Boga
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital Teresa Herrera, 15004 A Coruña, Spain; (A.S.B.); (A.M.Á.)
| | - Ana Moreno Álvarez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital Teresa Herrera, 15004 A Coruña, Spain; (A.S.B.); (A.M.Á.)
| | - César Sánchez Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, General University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.S.S.); (M.T.H.)
| | - Mar Tolín Hernani
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, General University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.S.S.); (M.T.H.)
| | - Carolina Gutiérrez Junquera
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Puerta de Hierro, 28220 Majadahonda, Madrid, Spain;
| | - Nazareth Martinón Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Clinic of Santiago, 15706 Santiago de Compostela, Spain; (N.M.T.); (M.R.L.T.)
| | - María Rosaura Leis Trabazo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Clinic of Santiago, 15706 Santiago de Compostela, Spain; (N.M.T.); (M.R.L.T.)
| | - Francisco Javier Eizaguirre
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital of Donostia, 20006 San Sebastian, Spain;
| | - Mónica García Peris
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Lluís Alcanyís, Xátiva, 46800 Valencia, Spain;
| | - Enrique Medina Benítez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Beatriz Fernández Caamaño
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain;
| | - Ana María Vegas Álvarez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Laura Crespo Valderrábano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Carmen Alonso Vicente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Javier Rubio Santiago
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Jerez, 11408 Jerez de la Frontera, Cádiz, Spain;
| | - Rafael Galera-Martínez
- Paediatric Gastroenterology and Nutrition Unit, Hospital Complex Torrecárdenas, 04009 Almeria, Spain; (M.M.); (R.G.-M.)
| | - Ruth García-Romero
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Paediatric Hospital Miguel Servet, 50009 Zaragoza, Spain; (R.G.-R.); (I.R.A.)
| | - Ignacio Ros Arnal
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Paediatric Hospital Miguel Servet, 50009 Zaragoza, Spain; (R.G.-R.); (I.R.A.)
| | - Santiago Fernández Cebrián
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Complex Ourense, 32616 Ourense, Spain;
| | - Helena Lorenzo Garrido
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Basurto, Bilbao, 48013 Vizcaya, Spain;
| | - Javier Francisco Viada Bris
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Niño Jesús, 28009 Madrid, Spain; (J.F.V.B.); (M.V.R.-B.)
| | - Marta Velasco Rodríguez-Belvis
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Niño Jesús, 28009 Madrid, Spain; (J.F.V.B.); (M.V.R.-B.)
| | | | - Miriam Blanco Rodríguez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Jiménez Díaz Foundation, 28040 Madrid, Spain;
| | - Patricia Barros García
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital San Pedro de Alcántara, 10003 Cáceres, Spain;
| | - Gonzalo Botija
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Alcorcón Foundation, 28922 Alcorcón, Madrid, Spain;
| | - Francisco José Chicano Marín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Los Arcos del Mar Menor, 30739 Pozo Aledo, Murcia, Spain;
| | - Enrique La Orden Izquierdo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Infanta Sofía, 28709 San Sebastián de los Reyes, Madrid, Spain;
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Clinical Hospital, 46010 Valencia, Spain;
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Malaga, 29011 Málaga, Spain;
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-292-191
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Esplugues del Llobregat, 08950 Barcelona, Spain; (G.P.-M.); (J.M.-d.-C.)
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