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Gao F, Shen Y, Wu H, Laue HE, Lau FK, Gillet V, Lai Y, Shrubsole MJ, Prada D, Zhang W, Liu Z, Bellenger JP, Takser L, Baccarelli AA. Associations of Stool Metal Exposures with Childhood Gut Microbiome Multiomics Profiles in a Prospective Birth Cohort Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:22053-22063. [PMID: 39630952 DOI: 10.1021/acs.est.4c09642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Metal exposures are closely related to childhood developmental health. However, their effects on the childhood gut microbiome, which also impacts health, are largely unexplored using microbiome multiomics including the metagenome and metatranscriptome. This study examined the associations of fecal profiles of metal/element exposures with gut microbiome species and active functional pathways in 8- to 12-year-old children (N = 116) participating in the GESTation and Environment (GESTE) cohort study. We analyzed 19 stool metal and element concentrations (B, Na, Mg, Al, K, Ca, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Mo, Cd, Ba, and Pb). Covariate-adjusted linear regression models identified several significant microbiome associations with continuous stool metal/element concentrations. For instance, Zn was positively associated with Turicibacter sanguinis (coef = 1.354, q-value = 0.039) and negatively associated with Eubacterium eligens (coef = -0.794, q-value = 0.044). Higher concentrations of Cd were associated with lower Eubacterium eligens (coef = -0.774, q-value = 0.045). Additionally, a total of 490 significant functional pathways such as biosynthesis and degradation/utilization/assimilation were identified, corresponding to different functions, including amino acid synthesis and carbohydrate degradation. Our results suggest links among metal exposures, pediatric gut microbiome multiomics, and potential health implications. Future work will further explore their relation to childhood health.
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Affiliation(s)
- Feng Gao
- Department of Environmental Health Sciences, Fielding School of Public Health, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California 90095, United States
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Yike Shen
- Department of Earth and Environmental Sciences, University of Texas at Arlington, Arlington, Texas 76019, United States
| | - Haotian Wu
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Hannah E Laue
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts 01003, United States
| | - Fion K Lau
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Virginie Gillet
- Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Yunjia Lai
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Martha J Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Diddier Prada
- Institute for Health Equity Research - IHER, Department of Population Health Science and Policy and the Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Zhonghua Liu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York 10032, United States
| | | | - Larissa Takser
- Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Andrea A Baccarelli
- Office of the Dean, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
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Marrero J, Jerson B, Brimacombe M, Hopkins D, Hinderer KA, Hyams JS. Partnering With School Nurses for Continuing Education in Inflammatory Bowel Disease. J Contin Educ Nurs 2024; 55:589-595. [PMID: 39361537 DOI: 10.3928/00220124-20240927-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
BACKGROUND With the rising incidence of inflammatory bowel disease (IBD) in pediatric populations, school nurses are increasingly called on to care for and support these students. METHOD The research team surveyed Connecticut school nurses about their experiences, knowledge, and confidence in addressing IBD in the school setting. The team also developed and implemented an online education intervention to improve knowledge and confidence gaps during the 2022-2023 academic year. RESULTS Most participants have cared for one to two (46%, n = 66) or several (30%, n = 44) students with IBD. However, 24% (n = 35) have not cared for any students with IBD. School nurses shared their perspectives with three themes identified from the qualitative feedback: (a) limited knowledge and experience with IBD, (b) importance of support at school, and (c) need for interprofessional collaborative practice. CONCLUSION The online education significantly improved school nurses' knowledge (p < .001) and confidence scores (p < .001). Participants found this intervention beneficial to their work. [J Contin Educ Nurs. 2024;55(12):589-595.].
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Kohler D, Freid H, Cholewka J, Miller M, Gold SL. The use of parenteral nutrition in patients with inflammatory bowel disease: A detailed guide on the indications, risks, and benefits. Nutr Clin Pract 2024; 39:1026-1036. [PMID: 38922984 DOI: 10.1002/ncp.11178] [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] [Received: 03/17/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
Malnutrition is estimated to affect roughly 30%-80% of patients with inflammatory bowel disease (IBD). In those patients who cannot tolerate sufficient oral nutrition or there is no possibility for placing an enteral nutrition tube, parenteral nutrition offers a lifesaving alternative. However, this is not without risk. For patients with IBD, understanding the indications, contraindications, and complications associated with parenteral nutrition is crucial. In this review, we will discuss the indications and contraindications for parenteral nutrition in patients with IBD, the common complications associated with intravenous nutrition, the use of parenteral nutrition in special populations, such as in pediatric and perioperative patients, and the impact of parenteral nutrition on IBD-related outcomes.
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Affiliation(s)
- David Kohler
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Freid
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Jennifer Cholewka
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Megan Miller
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Stephanie L Gold
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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McLaughlin JF, Linville T, Jester TW, Marciano TA, Lazare F, Dotson JL, Samson C, Niklinska-Schirtz B, Cabrera J, Leibowtiz I, Batra S, Ammoury R, Strople JA, Saeed S, Sandberg KC, Tung J, Verstraete SG, Cox RF, Na S, Steiner SJ, Ali SA, Israel EJ, Dorsey J, Adler J, Rekhtman Y, Egberg MD, Waduge ER, Savas J, Brensinger CM, Lewis JD, Kappelman MD. Travel Time to Treating Center is Associated With Diagnostic Delay in Pediatric Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00761-4. [PMID: 39181423 DOI: 10.1016/j.cgh.2024.07.027] [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: 02/21/2024] [Revised: 06/23/2024] [Accepted: 07/10/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND & AIMS Delayed diagnosis of inflammatory bowel disease (IBD) leads to prolonged symptoms and worse long-term outcomes. We sought to evaluate whether race, ethnicity, disease type, and social factors are associated with delayed diagnosis of pediatric IBD. METHODS We performed a cross-sectional study of newly diagnosed pediatric patients with IBD at 22 United States sites from 2019 to 2022. Parents/guardians reported race, ethnicity, time between symptom onset and diagnosis, and other social determinants of health. Through bivariate and multivariable analyses using generalized estimating equations, we evaluated associations between these factors and diagnosis time defined as ≤60 days, 61 to 180 days, 181 to 365 days, and >365 days. RESULTS We enrolled 869 participants (mean age at diagnosis, 13.1 years; 52% male; 57% Crohn's disease [CD]; 34% ulcerative colitis [UC]; 8% Hispanic; 30% non-White). Overall, the mean time to diagnosis was 265.9 days. After adjustment, factors associated with longer diagnosis time included CD vs UC (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.9-3.5), 2 or more other health conditions (OR, 1.7; 95% CI, 1.1-2.7), and longer travel time to clinic (>1 hour [OR, 1.7; 95% CI, 1.2-2.4], >2 hours (OR, 1.8; 95% CI, 1.2-2.9] each vs <30 minutes). There was no association with race, ethnicity, birth country, gender, parent education, household income, insurance type, health literacy, and health system distrust. CONCLUSIONS Consistent with prior literature, diagnostic delay is longer for CD than UC. Reassuringly, time to diagnosis is equitable across racioethnic groups. New models of diagnostic care are needed for communities affected by longer travel times.
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Affiliation(s)
- Joi F McLaughlin
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Tiffany Linville
- Division of Pediatric Gastroenterology, Levine Children's Hospital, Charlotte, North Carolina
| | - Traci W Jester
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tuvia A Marciano
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, NYU Langone - Long Island School of Medicine, Mineola, New York
| | - Farrah Lazare
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, NYU Long Island, Lake Success, New York
| | - Jennifer L Dotson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, Ohio; The Center for Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Charles Samson
- Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Jose Cabrera
- Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ian Leibowtiz
- Division of Pediatric Gastroenterology, Children's National, Washington, DC
| | - Suruchi Batra
- Division of Pediatric Gastroenterology, Children's National, Washington, DC
| | - Rana Ammoury
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of the King's Daughter, Norfolk, Virginia
| | - Jennifer A Strople
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shehzad Saeed
- Department of Medical Affairs and Division of Pediatric Gastroenterology, Dayton Children's Hospital, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly C Sandberg
- Division of Pediatric Gastroenterology, Dayton Children's Hospital, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, Oklahoma City, Oklahoma
| | - Sofia G Verstraete
- Division of Pediatric Gastroenterology, UCSF Benioff Children's Hospital San Francisco, San Francisco, California
| | - Ryan F Cox
- Division of Pediatric Gastroenterology, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Sera Na
- Division of Pediatric Gastroenterology, Nemours Children's Hospital, Wilmington, Delaware
| | - Steven J Steiner
- Division of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sabina A Ali
- Division of Pediatric Gastroenterology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Esther J Israel
- Division of Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill Dorsey
- Division of Pediatric Gastroenterology, Nemours Children's Health, Jacksonville, Florida
| | - Jeremy Adler
- Susan B. Meister Child Health Evaluation and Research Center, Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Matthew D Egberg
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emmala Ryan Waduge
- Division of Pediatric Gastroenterology, Atrium Health Levine Children's Hospital, Charlotte, North Carolina
| | - Jen Savas
- ImproveCareNow, Inc, Burlington, Vermont
| | - Colleen M Brensinger
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Division of Gastroenterology and Hepatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael D Kappelman
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Florou M, Diamantopoulos C, Anastasiadis K, Mouravas V, Tramma D, Tsopozidi M, Kkoumourou E, Lambropoulos V. Bilateral Ureteral Obstruction in Children With Ulcerative Colitis and Oliguria: When and Why? Cureus 2024; 16:e67031. [PMID: 39280558 PMCID: PMC11402509 DOI: 10.7759/cureus.67031] [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: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
Inflammatory bowel disease (IBD) is an inflammatory clinical entity with many extraintestinal symptoms, including urinary tract manifestations. However, the bilateral ureteral obstruction is extremely rare. We report a case of bilateral ureteral obstruction in a 12-year-old male patient with ulcerative colitis (UC). Ultrasonography in the context of sudden anuria revealed bilateral ureterovesical junction (UVJ) obstruction, and the following cystoscopy verified the presence of fragile calculi in both edematous ureteral orifices. The literature data on UC in the pediatric population are scarce. Sudden deteriorating oliguria in an UC patient may result from secondary obstructive uropathy. Immediate diagnosis and treatment are essential to prevent acute kidney injury.
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Affiliation(s)
- Maria Florou
- Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Christos Diamantopoulos
- Department of Urology, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Kleanthis Anastasiadis
- Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital Papageorgiou of Thessaloniki, Thessaloniki, GRC
| | - Vassileios Mouravas
- Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital Papageorgiou of Thessaloniki, Thessaloniki, GRC
| | - Despoina Tramma
- Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Maria Tsopozidi
- Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hosital, Thessaloniki, GRC
| | - Elena Kkoumourou
- Department of Pediatric Surgery, Asritotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, GRC
| | - Vassileios Lambropoulos
- Department of Pediatric Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC
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Chen G, Deng H, Li M, Fang X, He C, Shu Y, Wang F. The role of long non-coding RNA in Crohn's disease. Heliyon 2024; 10:e32606. [PMID: 38961978 PMCID: PMC11219967 DOI: 10.1016/j.heliyon.2024.e32606] [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: 02/19/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
Emerging evidence has illuminated the pivotal role of long noncoding RNAs (lncRNAs) in orchestrating immunological functions and autoimmune responses. In the context of Crohn's disease (CD), an array of novel lncRNAs has been identified in the plasma and intestinal tissues of afflicted individuals, suggesting a dualistic influence on the disease progression, either exacerbating or mitigating its course. Current research has demonstrated the involvement of lncRNAs in competitive endogenous RNA, the inflammation process, epithelial barrier function, gut microbiota imbalance, and epigenetic regulation. This review aims to encapsulate the current knowledge on the lncRNA contribution to CD and underscore potential avenues for future research. LncRNAs are increasingly recognized as significant biomarkers and potential therapeutic targets, holding a key position in the pathogenesis of CD. Furthermore, the unique attributes of circulating lncRNAs, such as minimal side effects, combinational therapy potential, and personalized medicine, render them as promising therapeutic tools for individual health management in CD.
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Affiliation(s)
- Guo Chen
- Department of Internal Medicine, Anhui Hospital affiliated Shanghai Shuguang Hospital, Hefei, Anhui, China
| | - Heng Deng
- Department of Anorectal Surgery, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Ming Li
- Department of Anorectal Surgery, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Xiaoli Fang
- Department of Anorectal Surgery, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Chunrong He
- Hefei Haiheng Health Service Center, Hefei, Anhui, China
| | - Yingzi Shu
- Department of Anorectal Surgery, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Feifei Wang
- Department of Anorectal Surgery, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China
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Wan Z, Jiang Q, Zhou R, Li X, Han W, Xu B, Guo M, Ruan G, Bai X, Li G, Yang H. Consistent efficacy outcomes between phase 2 and phase 3 trials in Crohn's disease or ulcerative colitis in adults: a meta-analysis. Inflamm Res 2024; 73:915-928. [PMID: 38587530 DOI: 10.1007/s00011-024-01874-9] [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: 12/26/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The approval of novel biologic agents and small molecules for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) is dependent on phase 3 randomized controlled trials (RCTs). However, these trials sometimes fail to achieve the expected efficacy outcomes observed in phase 2 trials. METHODS We conducted a systematic review of RCTs that evaluated biologic agents and small molecules using paired regimens in both phase 2 and phase 3. We searched Medline, EMBASE, and Cochrane databases up until February 13, 2024. The revised Cochrane tool was utilized to assess the risk of bias. A generalized linear mixed-effects model (GLMM) was employed to estimate the odds ratios (ORs) for efficacy outcomes in phase 2 trials compared to phase 3. RESULTS We identified a total of 23 trials with 10 paired regimens for CD and 30 trials with 11 paired regimens for UC. The GLMM analysis revealed that phase 2 CD trials had higher outcomes measured by the Crohn's Disease Activity Index (CDAI) by 9-13% without statistical significance: CDAI-150: OR, 1.12 (95% CI 0.83-1.51, p = 0.41); CDAI-100: OR, 1.09 (95% CI 0.88-1.35, p = 0.40); or CDAI-70: OR, 1.13 (95% CI 0.61-2.08, p = 0.66). For UC, two efficacy outcomes were estimated to be equally reported in phase 2/phase 3 pairs: clinical remission: OR, 1.00 (95% CI 0.83-1.20, p = 0.96); endoscopic improvement: OR, 0.98 (95% CI 0.83-1.15, p = 0.79). However, the rate of clinical response was underestimated in phase 2 by 19%: OR, 0.81 (95% CI 0.70-0.95, p = 0.03). The inclusion criterion for the type of Mayo score for UC had a significant interaction with the study phase to influence the difference in clinical response (p = 0.002). CONCLUSIONS Our findings suggest that the main efficacy outcomes for CD and UC remain consistent between phase 2 and phase 3 trials, except for UC response rates. The efficacy data obtained from phase 2 trials can be considered reliable for the design of subsequent phase 3 trials. REGISTRATION PROSPERO (CRD42023407947).
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Affiliation(s)
- Ziqi Wan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Eight-Year Program, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qingwei Jiang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Runing Zhou
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiang Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wei Han
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bing Xu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mingyue Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gechong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Guanqiao Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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David JG, Dotson J, Mackner L. Is it "all in the bag?" Multidisciplinary perspectives on ostomy surgery in pediatric IBD across the ImproveCareNow network. JPGN REPORTS 2024; 5:101-109. [PMID: 38756109 PMCID: PMC11093923 DOI: 10.1002/jpr3.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 05/18/2024]
Abstract
Objectives Pediatric inflammatory bowel disease (IBD) is a chronic illness with various treatments, including ostomy surgery. Ostomy-related medical decision-making (MDM) is complex for multidisciplinary healthcare professionals (HCPs). This study sought to understand national multidisciplinary HCPs' perceptions about pediatric IBD ostomy surgery in the United States. Methods This cross-sectional REDCap survey recruited HCPs in pediatric IBD HCP roles from the ImproveCareNow (ICN) Learning Health System. The survey gathered data on, (1) demographics, (2) participants' perspectives on patients/families' ostomy perceptions, (3) participants' own perspectives on ostomies, and (4) participants' perspectives on multidisciplinary collaboration in ostomy surgery. Results Participants (n = 69, across n = 30 American ICN sites) were 84% White, 62% female, and 54% gastroenterologists. In reflecting on patients/families' perceptions, participants endorsed most (86%) view ostomies as a "failure," various psychosocial concerns (e.g., 97% endorsed body image concerns), and most (81%) have moderate to significant stigma about ostomies. In reflecting on their own perceptions, nearly half (44%) endorsed some to moderate stigma about ostomies and felt ostomy discussions were difficult when families had negative perceptions (88%). Over half (54%) endorsed currently having multidisciplinary care for pediatric IBD surgery. Most (70%) endorsed variability in the amount and/or quality of multidisciplinary collaboration. Conclusion MDM related to pediatric IBD ostomy surgery presents nuanced clinical complexities for HCPs. This work underscores interest in multidisciplinary care, notable ostomy-related psychosocial needs, and ostomy-related stigma. Future work should develop systematic approaches to multidisciplinary pediatric IBD ostomy care, bolster psychosocial support, and evaluate how systematic care may impact psychosocial, and healthcare utilization outcomes.
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Affiliation(s)
- Jennie G. David
- Department of PediatricsThe Ohio State Wexner Medical CenterColumbusOhioUSA
- Nationwide Children's HospitalColumbusOhioUSA
| | - Jennifer Dotson
- Department of PediatricsThe Ohio State Wexner Medical CenterColumbusOhioUSA
- Nationwide Children's HospitalColumbusOhioUSA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's HospitalColumbusOhioUSA
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's HospitalColumbusOhioUSA
| | - Laura Mackner
- Department of PediatricsThe Ohio State Wexner Medical CenterColumbusOhioUSA
- Nationwide Children's HospitalColumbusOhioUSA
- Center for Biobehavioral Health, Nationwide Children's HospitalColumbusOhioUSA
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Kaul K, Schumann S, Sander C, Däbritz J, de Laffolie J. Health Literacy of Children and Adolescents with Inflammatory Bowel Disease (IBD) and Parents of IBD Patients-Coping and Information Needs. CHILDREN (BASEL, SWITZERLAND) 2024; 11:481. [PMID: 38671698 PMCID: PMC11048777 DOI: 10.3390/children11040481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The number of children and adolescents with inflammatory bowel disease (IBD) is increasing. Many chronically ill children and adolescents have low health literacy. Patient empowerment (PE) enables positive changes and control over one's disease through specific activities, information, and counseling. The CEDNA (IBD Needs Assessment) Survey aimed to provide the necessary data to improve PE in pediatric IBD (PIBD). METHODS Questionnaires were distributed to adolescent IBD patients and parents of children and adolescents with IBD throughout Germany. The answers were given anonymously. Based on the available data, a subgroup analysis was conducted in relation to the age of the patients and the period since diagnosis. For the parents' responses, the same age groups were analyzed for comparison with the patients' responses. RESULTS From October 2021 to April 2022, 2810 questionnaires were distributed and 1158 questionnaires were completed (n = 708 parents [61.1%], n = 450 patients [38.9%]). The results indicate that health literacy in children with IBD is low. Significant gaps in knowledge of important IBD topics were identified, and a comparison of responses regarding preferred methods and timing of obtaining information revealed differences between patient and parent preferences. The greatest need for knowledge on IBD topics was found in the group of 16-17-year-old patients on transition (n = 214, 31.8%) and in the group of patients diagnosed 1-2 years ago on the causes of IBD (n = 288, 17.4%). The willingness to seek advice was unexpectedly low. CONCLUSIONS The analysis of all findings according to the patient's age structure and duration since diagnosis can be used to enable age-appropriate communication at certain stages of the disease. This tailored information should increase patients' health literacy, improve their management of the disease, and reduce the burden on their families.
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Affiliation(s)
- Kalina Kaul
- Department of General Pediatrics and Neonatology, University Children’s Hospital, University Giessen, 35392 Giessen, Germany; (K.K.); (J.d.L.)
| | - Stefan Schumann
- Department of General Pediatrics and Neonatology, University Children’s Hospital, University Giessen, 35392 Giessen, Germany; (K.K.); (J.d.L.)
| | - Cornelia Sander
- German Crohn’s Disease and Ulcerative Colitis Association, DCCV, National Association for Chronic Inflammatory Diseases of the Digestive Tract, 10179 Berlin, Germany;
| | - Jan Däbritz
- Department of Pediatrics, Greifswald University Medical Center, 17475 Greifswald, Germany;
| | - Jan de Laffolie
- Department of General Pediatrics and Neonatology, University Children’s Hospital, University Giessen, 35392 Giessen, Germany; (K.K.); (J.d.L.)
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10
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Trandafir LM, Spoiala EL, Ghiga G, Gimiga N, Budescu PD, Lupu VV, Butnariu L, Cojocaru E, Paduraru G. Impact of COVID-19 on Pediatric Inflammatory Bowel Diseases-From Expectations to Reality. J Pers Med 2024; 14:399. [PMID: 38673026 PMCID: PMC11051136 DOI: 10.3390/jpm14040399] [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: 02/29/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Viral infections have always been considered a threat to global health, with numerous outbreaks across time. Despite the relative recent experience with coronavirus-associated diseases such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), severe acute respiratory syndrome-2's (SARS-CoV-2) continuous evolution displays a different behavior. With a tropism for both respiratory and digestive mucosa, coronavirus disease 2019 (COVID-19) and inflammatory bowel disease (IBD) seem to share a particular common background. Current literature offers evidence that viral alteration of the immune system, inflammatory intestinal tissue damage, increased intestinal permeability, incomplete viral clearance with viral antigen persistence, and intestinal dysbiosis, might explain SARS-CoV-2-IBD relationship in terms of etiopathogenesis and evolution. The hyperinflammatory state that both entities have in common explains the lack of success of current IBD therapy, raising the need for new personalized therapeutic options, with better outcomes for IBD and COVID-19 as well. This review aims to summarize the current available data on pediatric IBD evolution, management, and outcomes in the post-COVID period, with an emphasis on the particular aspects of the SARS-CoV-2-IBD relationship in children.
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Affiliation(s)
- Laura Mihaela Trandafir
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Elena Lia Spoiala
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Gabriela Ghiga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Nicoleta Gimiga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Paula-Diana Budescu
- Saint Mary Children Hospital, Vasile Lupu Street, no 62-64, 700309 Iasi, Romania;
| | - Vasile Valeriu Lupu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
| | - Lacramioara Butnariu
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Elena Cojocaru
- Morpho-Functional Sciences II Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Gabriela Paduraru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (L.M.T.); (E.L.S.); (V.V.L.); (G.P.)
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11
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Tanpowpong P, Jitwongwai S, Kijmassuwan T, Sriphongphankul H, Osatakul S, Damrongmanee A, Ukarapol N, Treepongkaruna S. Multicenter registry of pediatric inflammatory bowel disease from a developing country. BMC Pediatr 2024; 24:225. [PMID: 38561705 PMCID: PMC10983750 DOI: 10.1186/s12887-024-04698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite the rising incidence of pediatric inflammatory bowel disease (PIBD) globally, multicenter collaborative studies of PIBD children among developing countries remain sparse. We therefore aimed to define the initial presentation and short-term outcomes of Thai children with PIBD from a multicenter registry. METHODS Four teaching hospitals participated in this study. A diagnosis of PIBD requires gastrointestinal endoscopy and histopathology in children aged < 19 years. Besides demographics, we collected clinical information and treatment with the data at 1-year follow up. RESULTS We included 35 Crohn's disease (CD), one IBD-unclassified, and 36 ulcerative colitis (UC) children (total n = 72 with 60.6% males). The mean age at diagnosis was 7.9 years (SD 4.1) with 38% being very early onset IBD (VEO-IBD). When compared with UC, the CD children were more likely to exhibit fever (42.3 vs. 13.9%), weight loss/failure to thrive (68.6 vs. 33.3%), and hypoalbuminemia (62.9 vs. 36.1%) but less likely to have bloody stools (51.4 vs. 91.7%) (all P < 0.05). No significant differences in demographics, clinical data and medications used with regards to VEO-IBD status. At 1 year after diagnosis (n = 62), 30.7% failed to enter clinical remission and 43.7% remained on systemic corticosteroids. Diarrhea (OR 9.32) and weight issues (OR 4.92) at presentation were independent predictors of failure to enter clinical remission; and females (OR 3.08) and CD (vs. UC) (OR 3.03) were predictors of corticosteroids use at 1-year follow-up. CONCLUSIONS A high proportion of VEOIBD is noted, and CD was more likely to present with significant inflammatory burden. Diarrhea and weight issues at presentation were independent predictors of failure to enter clinical remission; and females and CD (vs. UC) were predictors of corticosteroids use at 1-year follow-up.
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Affiliation(s)
- Pornthep Tanpowpong
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Settapong Jitwongwai
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teera Kijmassuwan
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hansa Sriphongphankul
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Seksit Osatakul
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Alisara Damrongmanee
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuthapong Ukarapol
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suporn Treepongkaruna
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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12
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Pasternak B. Medical management of pediatric inflammatory bowel disease. Semin Pediatr Surg 2024; 33:151398. [PMID: 38582057 DOI: 10.1016/j.sempedsurg.2024.151398] [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: 04/08/2024]
Abstract
Management of inflammatory bowel disease, both Crohn's disease (CD) and ulcerative colitis (UC), has seen a seismic shift over the past decade. Over the past five years, there has been the introduction of many new therapies with differing mechanisms of action and a goal of achieving mucosal healing, as well as clinical and biochemical remission (1,2). In addition, management is aimed at restoring normal growth and normalizing quality of life. The ultimate goal is to individualize medical management and determine the right drug for the right patient by identifying which inflammatory pathway is predominant and avoiding unwarranted lack of efficacy or side effects through biomarkers and risk prognostication. Patient's age, location of disease, behavior (inflammatory vs. penetrating/structuring), severity and growth delay all play into deciding on the best treatment approach. Ultimately, early intervention is key in preventing complications. The therapeutic approaches to management can be broken down to nutritional therapy, biologic agents, immunomodulators (including corticosteroids), aminosalicylates and antibiotics. There are numerous other therapies, such as small molecule agents recently approved in adults, which are garnering a great deal of interest.
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Affiliation(s)
- Brad Pasternak
- Division of Pediatric Gastroenterology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona, USA.
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13
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Hudson AS, Wahbeh GT, Zheng HB. Imaging and endoscopic tools in pediatric inflammatory bowel disease: What's new? World J Clin Pediatr 2024; 13:89091. [PMID: 38596437 PMCID: PMC11000065 DOI: 10.5409/wjcp.v13.i1.89091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024] Open
Abstract
Pediatric inflammatory bowel disease (IBD) is a chronic inflammatory disorder, with increasing incidence and prevalence worldwide. There have been recent advances in imaging and endoscopic technology for disease diagnosis, treatment, and monitoring. Intestinal ultrasound, including transabdominal, transperineal, and endoscopic, has been emerging for the assessment of transmural bowel inflammation and disease complications (e.g., fistula, abscess). Aside from surgery, IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation, injection, and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe. Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn's disease or those with IBD with new upper gastrointestinal symptoms. Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection. Artificial intelligence and machine learning is a rapidly evolving field, with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication. This review summarized these advancements, focusing on pediatric patients with IBD.
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Affiliation(s)
- Alexandra S Hudson
- Department of Pediatrics, University of Washington, Seattle, WA 98109, United States
| | - Ghassan T Wahbeh
- Department of Pediatrics, University of Washington, Seattle, WA 98109, United States
| | - Hengqi Betty Zheng
- Department of Pediatrics, University of Washington, Seattle, WA 98109, United States
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14
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Nambu R, Kudo T, Tachibana N, Shimizu H, Mizuochi T, Kato S, Inoue M, Kumagai H, Ishige T, Kunisaki R, Noguchi A, Yodoshi T, Hagiwara SI, Nishimata S, Kakuta F, Saito T, Iwama I, Hirano Y, Shimizu T, Arai K. Prognosis of pediatric ulcerative colitis after infliximab failure: A multicenter registry-based cohort study. J Gastroenterol Hepatol 2024; 39:312-318. [PMID: 38058020 DOI: 10.1111/jgh.16431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Even with increasing numbers of biologic agents available for management of ulcerative colitis (UC), infliximab (IFX) retains an important place in treatment of pediatric patients with this disease. As few reports have addressed outcomes in pediatric UC patients who had to discontinue IFX, we examined clinical course and prognosis after IFX failure in pediatric UC. METHODS A prospective cohort study of pertinent cases enrolled in the Japanese Pediatric Inflammatory Bowel Disease Registry between 2012 and 2020 was conducted to determine outcomes for pediatric UC patients who received IFX but required its discontinuation during follow-up (IFX failure). RESULTS Of the 301 pediatric UC patients in the registry, 75 were treated with IFX; in 36 of these, IFX was discontinued during follow-up. Severity of UC at onset and absence of concomitant immunomodulator therapy were significant risk factors for IFX failure (P = 0.005 and P = 0.02, respectively). The cumulative colectomy rate after IFX failure was 41.3% at 1 year and 47.5% at 2 years. Colectomy was significantly more frequent when IFX was discontinued before June 1, 2018, than when IFX was discontinued later (P = 0.013). This difference likely involves availability of additional biologic agents for treatment of UC beginning in mid-2018 (P = 0.005). CONCLUSION In pediatric UC patients, approximately 50% underwent colectomy during a 2-year interval following IFX failure. Prognosis after IFX failure appeared to improve with availability of new biologic agents and small-molecule drugs in mid-2018.
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Affiliation(s)
- Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Nao Tachibana
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Fukuoka, Japan
| | - Sawako Kato
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University, Tsu, Japan
- Department of Pediatric Surgery, Fujita Health University, Toyoake, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Takashi Ishige
- Department of Pediatrics, School of Medicine, Gunma University Graduate, Maebashi, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, 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
| | - 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, Sendai, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
- Division of Pediatric Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, 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
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
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15
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Klemenak M, Zupan M, Riznik P, Krencnik T, Dolinsek J. Evolving Landscape of Paediatric Inflammatory Bowel Disease: Insights from a Decade-Long Study in North-East Slovenia on Incidence, Management, Diagnostic Delays, and Early Biologic Intervention. Diagnostics (Basel) 2024; 14:188. [PMID: 38248065 PMCID: PMC10813920 DOI: 10.3390/diagnostics14020188] [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: 12/15/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND In the past decade, significant progress has been achieved in the care of children with inflammatory bowel disease (IBD). Our study concentrated on assessing the incidence and management of IBD in children in North-Eastern Slovenia over a 10-year period. METHODS Medical data from children and adolescents diagnosed with IBD in North-Eastern Slovenia (2014-2023) was analysed. Disease incidence and management of children were assessed. Findings were compared between two periods (2014-2019 and 2020-2023, coinciding with the COVID-19 pandemic). RESULTS 87 patients (median age 15.5 year; 50.6% male) with IBD (43.7% Crohn's disease (CD)), diagnosed between 2014 and 2023 were included. Extraintestinal manifestations were more common in CD than ulcerative colitis (UC) (15.8% vs. 2.4%, p < 0.05). Median delay from symptom onset to diagnosis was 2 months, lower in UC than CD (NS). Mean annual IBD incidence per 100,000 children aged 0 to 19 years was 6.4 (95% CI 4.4-8.3), slightly lower for CD than UC (2.8/100,000 vs. 3.1/100,000). In the second period, IBD incidence significantly rose (9.1 vs. 4.6, p < 0.05). During this period, 53% of CD patients transitioned to biological treatment within three months of diagnosis. CONCLUSION IBD incidence rose among children in North-Eastern Slovenia over the past decade. Additionally, more children with CD underwent biological therapy in the second period.
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Affiliation(s)
- Martina Klemenak
- Department of Gastroenterology, Hepatology and Nutrition, Pediatric Clinic, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Manca Zupan
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Petra Riznik
- Department of Gastroenterology, Hepatology and Nutrition, Pediatric Clinic, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Tomaz Krencnik
- Department of Gastroenterology, Hepatology and Nutrition, Pediatric Clinic, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Jernej Dolinsek
- Department of Gastroenterology, Hepatology and Nutrition, Pediatric Clinic, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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16
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Kaul K, Schumann S, Sander C, Däbritz J, de Laffolie J. A Nationwide Survey on Patient Empowerment in Pediatric Inflammatory Bowel Disease in Germany. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1904. [PMID: 38136106 PMCID: PMC10741601 DOI: 10.3390/children10121904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The incidence/prevalence of pediatric inflammatory bowel disease (IBD) is increasing. IBD places a significant burden on young patients during important developmental stages and affects their families. Children and adolescents with IBD require increased support from health care services. However, little is known about the additional support needed and how to provide it. Therefore, a large survey was conducted with a focus on patient empowerment. METHODS For the anonymous survey, called CEDNA, a patient questionnaire for adolescents with IBD and a questionnaire for parents of children and adolescents with IBD were made available throughout Germany (distributed n = 2810). Questions covered various aspects of coping with the disease, utilization of care, use and need of information and communication services, and how information should be provided. RESULTS From October 2021 to April 2022, 1158 (n = 708 parents (61.1%), n = 450 patients (38.9%)) questionnaires were completed. The results show a deficit in pediatric IBD care and revealed a large gap in knowledge about core IBD topics (e.g., 74.8% of patients feel poorly informed about transition, 62.4% know little about patient organizations and self-help groups, and 54.7% have little information about preventive health measures), indicating a low level of health literacy among affected children and adolescents. CONCLUSION Pediatric IBD poses significant challenges for patients, their families, and healthcare teams. By empowering patients and families, and providing targeted information and communication tailored to the age of the child or adolescent and the needs of the parents, care can be improved and better adapted to the needs of patients. Actions would include providing quality information online through scientific societies and patient organizations and facilitating self-management in adolescents.
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Affiliation(s)
- Kalina Kaul
- Department of General Pediatrics and Neonatology, University Children’s Hospital, University Giessen, 35392 Giessen, Germany; (K.K.); (J.d.L.)
| | - Stefan Schumann
- Department of General Pediatrics and Neonatology, University Children’s Hospital, University Giessen, 35392 Giessen, Germany; (K.K.); (J.d.L.)
| | - Cornelia Sander
- German Crohn’s Disease and Ulcerative Colitis Association (DCCV), National Association for Chronic Inflammatory Diseases of the Digestive Tract, 10179 Berlin, Germany;
| | - Jan Däbritz
- Greifswald University Medical Center, Department of Pediatrics, 17475 Greifswald, Germany;
| | - Jan de Laffolie
- Department of General Pediatrics and Neonatology, University Children’s Hospital, University Giessen, 35392 Giessen, Germany; (K.K.); (J.d.L.)
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17
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Pivac I, Jelicic Kadic A, Despot R, Zitko V, Tudor D, Runjic E, Markic J. Characteristics of the Inflammatory Bowel Disease in Children: A Croatian Single-Centre Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1677. [PMID: 37892340 PMCID: PMC10605261 DOI: 10.3390/children10101677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Inflammatory bowel diseases (IBDs), encompassing ulcerative colitis (UC) and Crohn's disease (CD), are chronic gastrointestinal disorders often diagnosed in youth, presenting unique features compared to adult-onset cases. We aimed to profile pediatric IBD patients in Croatia through a retrospective analysis of children up to 18 years old diagnosed with IBD at the University Hospital of Split from 1 January 2012, to 31 December 2021, utilizing data collected during hospitalization for diagnosis. Over a decade, 107 children were diagnosed, with 43.9% having UC, 55.1% CD, and 0.9% IBD-unclassified. Median age at diagnosis was 14.1 years, with UC patients being older (14.8 vs. 13.7 years, p = 0.044). Males constituted 60.7% of patients. Median symptom duration was 2.0 months, with CD patients experiencing a longer diagnostic delay (3.0 vs. 2.0 months, p = 0.003). The median incidence rate was 9.89 (95% CI 5.93-13.84) per 100,000 children/year, varying across age groups. Median (IQR) BMI z-score was -0.34 (-0.97-0.45). Common symptoms included diarrhea (60.7%) and abdominal pain (50.5%), with rectal bleeding more prevalent in UC (72.3% vs. 32.2%, p < 0.001). While our study offers valuable insights into pediatric IBD in Croatia, further prospective research is needed to clarify disease progression and development.
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Affiliation(s)
- Ivan Pivac
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia;
| | - Antonia Jelicic Kadic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (A.J.K.); (R.D.); (D.T.); (E.R.)
| | - Ranka Despot
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (A.J.K.); (R.D.); (D.T.); (E.R.)
| | - Vanda Zitko
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (A.J.K.); (R.D.); (D.T.); (E.R.)
| | - Darija Tudor
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (A.J.K.); (R.D.); (D.T.); (E.R.)
| | - Edita Runjic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (A.J.K.); (R.D.); (D.T.); (E.R.)
| | - Josko Markic
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia;
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (A.J.K.); (R.D.); (D.T.); (E.R.)
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18
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Zapata-Cobo P, Salvador-Martín S, Velasco M, Palomino LM, Clemente S, Segarra O, Moreno-Álvarez A, Fernández-Lorenzo A, Pérez-Moneo B, Montraveta M, Sánchez C, Tolín M, Loverdos I, Fobelo MJ, Navas-López VM, Magallares L, García-Romero R, Sánchez-Hernández JG, Rodríguez A, Bossacoma F, Balboa MJ, Salcedo E, Sanjurjo-Sáez M, López-Fernández LA. Polymorphisms indicating risk of inflammatory bowel disease or antigenicity to anti-TNF drugs as biomarkers of response in children. Pharmacol Res 2023; 194:106859. [PMID: 37473877 DOI: 10.1016/j.phrs.2023.106859] [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: 03/13/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Few genetic polymorphisms predict early response to anti-TNF drugs in inflammatory bowel disease (IBD), and even fewer have been identified in the pediatric population. However, it would be of considerable clinical interest to identify and validate genetic biomarkers of long-term response. Therefore, the aim of the study was to analyze the usefulness of biomarkers of response to anti-TNFs in pediatric IBD (pIBD) as long-term biomarkers and to find differences by type of IBD and type of anti-TNF drug. The study population comprised 340 children diagnosed with IBD who were treated with infliximab or adalimumab. Genotyping of 9 selected SNPs for their association with early response and/or immunogenicity to anti-TNFs was performed using real-time PCR. Variants C rs10508884 (CXCL12), A rs2241880 (ATG16L1), and T rs6100556 (PHACTR3) (p value 0.049; p value 0.03; p value 0.031) were associated with worse long-term response to anti-TNFs in pIBD. DNA variants specific to disease type and anti-TNF type were identified in the pediatric population. Genotyping of these genetic variants before initiation of anti-TNFs would enable, if validated in a prospective cohort, the identification of pediatric patients who are long-term responders to this therapy.
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Affiliation(s)
- Paula Zapata-Cobo
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Salvador-Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Velasco
- Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | | | | | | | | | | | | | | | - Cesar Sánchez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mar Tolín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - María Jesús Fobelo
- Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain
| | | | | | | | | | | | - Ferrán Bossacoma
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Sant Joan de Dèu, Barcelona, Spain
| | | | | | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis A López-Fernández
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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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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Yadav J, Philpott DJ. A gut bacterial strain rescues stunted growth. Science 2023; 379:756-757. [PMID: 36821690 DOI: 10.1126/science.adg6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Lactiplantibacillus plantarum promotes growth in undernourished mice.
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Affiliation(s)
- Jitender Yadav
- Department of Immunology, Medical Sciences Building, University of Toronto, Toronto, ON, Canada
| | - Dana J Philpott
- Department of Immunology, Medical Sciences Building, University of Toronto, Toronto, ON, Canada
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