Summary
Background
It is reported that 27–54% of paediatric patients with perianal Crohn's disease (CD) do not respond to infliximab (IFX).
Aim
To identify predictors of response to IFX in paediatric ...perianal CD.
Methods
A retrospective cohort study of 101 paediatric patients treated with IFX between 2000 and 2011 for perianal CD in 22 French hospitals of the GETAID pédiatrique network was performed. Response was monitored after induction therapy and at 1 year. Complete response was defined by closure of all fistulas and complete healing of ulcers. Associations between baseline characteristics and (i) 1‐year response and (ii) time of first relapse among initial responders were tested by logistic regression and Cox model respectively.
Results
Eighty‐nine patients (88%) responded to induction therapy (36 partial/53 complete). At 1 year, 76 patients (75%) were responders (22 partial/54 complete). Predictors of 1‐year response were: number of fistulas ≤1 (OR: 3.76, 95% CI: 1.20–11.77, P = 0.03) and baseline Harvey–Bradshaw index <5 (OR: 3.72, 95% CI: 1.10–12.60, P = 0.03). Predictors of relapse among initial responders were: CD duration <10 months (OR: 3.31, 95% CI: 1.34–8.19, P = 0.0097) and number of fistulas >1 (OR: 2.79, 95% CI: 1.12–6.95, P = 0.028). Combined therapy with an immunomodulator was not associated with 1‐year response or time of relapse.
Conclusion
Those patients with perianal Crohn's disease have better outcomes if they have less fistulas, a low baseline Harvey–Bradshaw Index or a longer duration of Crohn's disease.
Background
Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn’s disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the ...gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn’s disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie (SNFCP). They report a consensus on the management of perianal Crohn’s disease lesions, including fistulas, ulceration and anorectal stenosis and propose an appropriate treatment strategy, as well as sphincter-preserving and multidisciplinary management.
Methodology
A panel of French gastroenterologists and colorectal surgeons with expertise in inflammatory bowel diseases reviewed the literature in order to provide practical management pathways for perianal CD. Analysis of the literature was made according to the recommendations of the Haute Autorité de Santé (HAS) to establish a level of proof for each publication and then to propose a rank of recommendation. When lack of factual data precluded ranking according to the HAS, proposals based on expert opinion were written. Therefore, once all the authors agreed on a consensual statement, it was then submitted to all the members of the SNFCP. As initial literature review stopped in December 2014, more recent European or international guidelines have been published since and were included in the analysis.
Results
MRI is recommended for complex secondary lesions, particularly after failure of previous medical and/or surgical treatments. For severe anal ulceration in Crohn’s disease, maximal medical treatment with anti-TNF agent is recommended. After prolonged drainage of simple anal fistula by a flexible elastic loop or loosely tied seton, and after obtaining luminal and perineal remission by immunosuppressive therapy and/or anti-TNF agents, the surgical treatment options to be discussed are simple seton removal or injection of the fistula tract with biological glue. After prolonged loose-seton drainage of the complex anal fistula in Crohn’s disease, and after obtaining luminal and perineal remission with anti-TNF ± immunosuppressive therapy, surgical treatment options are simple removal of seton and rectal advancement flap. Colostomy is indicated as a last option for severe APL, possibly associated with a proctectomy if there is refractory rectal involvement after failure of other medical and surgical treatments. The evaluation of anorectal stenosis of Crohn’s disease (ARSCD) requires a physical examination, sometimes under anesthesia, plus endoscopy with biopsies and MRI to describe the stenosis itself, to identify associated inflammatory, infectious or dysplastic lesions, and to search for injury or fibrosis of the sphincter. Therapeutic strategy for ARSCD requires medical–surgical cooperation.
Collagenous gastritis in children: A national cohort Illan Montero, Jonathan; Viala, J.; Rebeuh, J. ...
Archives de pédiatrie : organe officiel de la Société française de pédiatrie,
July 2023, 2023-Jul, 2023-07-00, 20230701, Letnik:
30, Številka:
5
Journal Article
Recenzirano
Collagen gastritis is a rare disease that manifests in children mainly as isolated gastric involvement associated with martial deficiency anemia. There are no recommendations for the management and ...follow-up of these patients. We aimed to describe the clinical data, endoscopic findings, and treatments deployed in France's children with collagenous gastritis.
All French pediatric gastroenterology centers and pediatric centers for rare digestive diseases (Centres de Maladies Rares Digestives) were contacted to collect cases of collagenous gastritis, defined on gastric biopsies and diagnosed before 18 years of age.
A total of 12 cases diagnosed (4 males and 8 females) between 1995 and 2022 could be analyzed. The median age at diagnosis was 12.5 years (7–15.2). The most frequent clinical presentation was abdominal pain (6/11) and/or nonspecific symptomatology attributed to anemia (8/10). Anemia was present in all children (11/11; Hb 2.8–9.1 g/dL). Nodular gastritis was present in 10 patients (antrum: 2; fundus: 4; in antrum and fundus: 4). All patients had a basement membrane thickening (from 19 to 100 μm). The treatments received were PPI (11), oral or intravenous martial supplementation (12), budesonide (1), and prednisone (1). Martial supplementation improved anemia in all cases. At discontinuation, nine of 10 patients had a recurrence of anemia.
Collagenous gastritis is an exceptional condition, clinically manifested in children as abdominal pain and iron deficiency anemia probably of hemorrhagic origin. Patients require long-term follow-up and monitoring of their disease to describe the risk of progression better.
Abstract Objectives To evaluate the added value of fetal magnetic resonance imaging (MRI) in diagnosing and assessing isolated orofacial clefts and compare MRI with second-line diagnostic ultrasound. ...Materials and methods In a two-year prospective bicenter study, fetuses with isolated orofacial clefts were reassessed using second-line diagnostic ultrasound and MRI. The results of second line ultrasound and those MRI were compared to each other. The gestational age at the time of ultrasound and MRI, and the final diagnosis for each of the imaging modalities were recorded. Finally, the results of second line ultrasound and those of MRI were compared to the results of neonatal clinical examination after delivery that served as standard of reference. Results Twenty-two women were included after informed consent was obtained. On average, diagnostic ultrasound was performed at 25.5 weeks of gestation (range: 24–34 weeks) and MRI at 29.5 weeks of gestation (range: 27–34 weeks). The results of ultrasound and those of MRI findings were strictly consistent in 20 women (20/22; 91%) but differed in 2 women (2/22; 9%). For all fetuses, the final radiological diagnosis was confirmed by clinical examination after delivery. Conclusion If ultrasound examination proves technically challenging, fetal MRI can be used to obtain the same diagnostic information in 91% of cases and can help surgeons and interdisciplinary teams provide appropriate antenatal counseling.
Abstract Purpose The purpose of this study was to evaluate the effectiveness of ethylene vinyl alcohol copolymer ( Onyx) as a single embolic agent for percutaneous arterial treatment of hemorrhage ...due to uterine arteriovenous malformations (AVMs). Materials and methods Twelve women (mean age, 33 years) with metrorrhagia due to uterine AVMs who were treated by percutaneous arterial embolization using Onyx as a single embolic agent were retrospectively included. The diagnosis of uterine AVM was suggested by pelvic ultrasound and/or magnetic resonance imaging findings and further confirmed by angiography. Clinical files and angiographic examinations were reviewed for angiographic findings, technical and clinical success, procedure complication and further pregnancies. Clinical success was defined by absence of metrorrhagia at 1 month following embolization. Results Sixteen arterial embolization procedures were performed. Angiographically, 6 women had high flow AVM and 6 had low flow AVM. The rate of technical and clinical success was 92% (11/12 patients). One woman with early repeat hemorrhage underwent two embolization procedures and further hysterectomy. No severe complications were observed after embolization. Three women (3/12; 25%) became pregnant following embolization including one full term pregnancy. Conclusion In women with metrorrhagia due to AVM, arterial embolization with Onyx is effective and safe. Additional research is needed to confirm the possibility of future pregnancy after Onyx embolization.
The purpose of this study was to evaluate the dose-dependent effect of human milk fortifier (HMF) on the osmolality of various preterm human milks (PHMs) at different gestational and lactation ...stages, and with different storage and treatment conditions that are routinely used in neonatal intensive care units (NICUs).
Twenty-four mothers who had given birth to their baby before 28 or between 29 and 31 weeks of pregnancy participated in the study after 1–2 weeks or 3–4 weeks breastfeeding after delivery. The study was a prospective, multicenter, comparative, and noninterventional study. Osmolality of fresh or pasteurized human milk stored at 4°C was measured (cryoscopy) at baseline, and 24hours after adding Suppletine® Human Milk fortifier (SHMF) at 3%, 4%, 4.5%, and 5% (w/v).
PHM without supplementation had an osmolality (mean±SD) of 301±8 mOsm/kgH2O (n=40; 95% CI: 298; 303). Adding 3–5% SHMF induced a linear increase of osmolality (P<0.001; r2=0.975). With 4% SHMF, the osmolality measure was 443±13mOsm/kg H2O (95% CI: 439–447). Neither a 24-hour storage at 4°C nor pasteurization induced a modification of osmolality compared to the fresh samples.
Whatever the origin and quality of milk as well as hospital practices, adding up to 4% (w/v) SHMF to PHM increases its nutritional quality and osmolality without exceeding 450mOsm/kgH2O, which is generally recognized as safe.
Assess the transition of children followed for inflammatory bowel disease (IBD) to the adult gastroenterology care unit and the development of joint medical visits (JMVs).
This study was conducted at ...the Rennes University Hospital (Brittany, France). All patients with IBD and relayed to an adult gastroenterologist (GE) between 2000 and 2014 were included. The following medical data were collected: age, gender, clinical status, disease activity, type of follow-up (freelance or at hospital), medical history, disease locations, and treatments received. Patients who were relayed in the same hospital attended a JMV with both the pediatric and adult gastroenterologists. Patients and parents were interviewed with a questionnaire sent by mail. They were asked how they had perceived the transition with questionnaires containing specific items about the JMV. The answers of the patients who attended JMVs were compared to those who did not attend.
Eighty-two patients were included. The patient response rate was 56 % (parents, 59 %). The average age at transition was 18±0.8years. Fifty patients were relayed in the same hospital with 30 attending a JMV. These patients suffered from more severe disease than other patients. Thirty-nine patients felt ready to transition (87 %). The JMV was deemed beneficial or very beneficial (74 %) for both follow-up and the benefits of the GE's knowledge of the medical file. The parents' responses did not differ from the patients'.
Development of the JMV enables a successful transition for pediatric patients with IBD. It could be improved by developing specific therapeutic education sessions based on transition training.
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