Summary
Background Nutritional therapy has an established role as induction therapy in paediatric Crohn’s disease. However, compliance is the main difficulty and may be greatly influenced by the ...administration route.
Aim To analyse the efficiency of exclusive nutrition to induce remission in children with Crohn’s disease comparing fractionated oral vs. continuous enteral feeding.
Methods The medical records of 106 patients treated by exclusive nutritional therapy Modulen IBD (R) by either oral or continuous enteral route were reviewed retrospectively. Comparative analyses of remission rates, changes in anthropometry, Paediatric Crohn’s disease Activity Index (PCDAI), laboratory indices and compliance rates were performed.
Results On exclusive enteral nutrition, at 8 weeks, 34/45 patients achieved remission in the oral group (75% on intention‐to‐treat analysis) and 52/61 (85%) in the enteral nutrition group (P = 0.157). All patients showed a significant decrease in disease severity assessed by PCDAI (P < 0.0001) and significant improvements in anthropometric measures and inflammatory indices. No difference was observed whether Modulen IBD was administered orally or by continuous enteral feeding, apart from weight gain, which was greater in the enteral group (P = 0.041). In a subgroup of patients, mucosal healing was evidenced on follow‐up endoscopies showing a clear correlation to remission. Compliance rates (87% and 90%) were similar. Nevertheless, noncompliant patients had lower mucosal healing and remission rates.
Conclusions These retrospective data suggest that the use of fractionated oral nutritional therapy might be as efficacious as continuous enteral administration to induce remission and mucosal healing in children with Crohn’s disease. However, appropriate prospective clinical trials are needed to confirm these findings.
Summary
Background
Risk benefit strategies in managing inflammatory bowel diseases (IBD) are dependent upon understanding the risks of uncontrolled inflammation vs those of treatments. Malignancy and ...mortality in IBD have been associated with disease‐related inflammation and immune suppression, but data are limited due to their rare occurrence.
Aim
To identify and describe the most common causes of mortality, types of cancer and previous or current therapy among children and young adults with paediatric‐onset IBD.
Methods
Information on paediatric‐onset IBD patients diagnosed with malignancy or mortality was prospectively collected via a survey in 25 countries over a 42‐month period. Patients were included if death or malignancy occurred after IBD diagnosis but before the age of 26 years.
Results
In total, 60 patients were identified including 43 malignancies and 26 fatal cases (9 due to cancer). Main causes of fatality were malignancies (n = 9), IBD or IBD‐therapy related nonmalignant causes (n = 10; including 5 infections), and suicides (n = 3). Three cases, all fatal, of hepatosplenic T‐cell lymphoma were identified, all were biologic‐naïve but thiopurine‐exposed. No other haematological malignancies were fatal. The 6 other fatal cancer cases included 3 colorectal adenocarcinomas and 3 cholangiocarcinomas (CCAs). Primary sclerosing cholangitis (PSC) was present in 5 (56%) fatal cancers (1 colorectal carcinoma, 3 CCAs and 1 hepatosplenic T‐cell lymphoma).
Conclusions
We report the largest number of paediatric‐onset IBD patients with cancer and/or fatal outcomes to date. Malignancies followed by infections were the major causes of mortality. We identified PSC as a significant risk factor for cancer‐associated mortality. Disease‐related adenocarcinomas were a commoner cause of death than lymphomas.
Celiac disease diagnosis in 2008 Schmitz, J; Garnier-Lengliné, H
Archives de pédiatrie : organe officiel de la Société française de pédiatrie
15, Številka:
4
Journal Article
Recenzirano
Since the 1990's, the widespread use of very sensitive and specific serological tests has completely changed the conditions of the diagnosis of celiac disease (CD). The active form of the disease is ...now only the tip of the iceberg representing it. Currently, CD is evoked either in front of mild digestive symptoms at the usual age or in the course of screening in siblings of an index case or in patients at risk (insulin dependent diabetes for example) at a later age using IgA anti-endomysium or anti-tissue transglutaminase antibodies, the sensitivities and specificities of which exceed 90%. In some cases, HLA typing is helpful in allowing to exclude a patient who is neither DQ2 nor DQ8. The intestinal biopsy remains the "gold standard" of the diagnosis showing villous atrophy; the latter, however, is less and less often severe as the disease is milder and milder. The diagnosis of CD then rests on the confrontation of the clinical, biological and histological data. Once CD has been diagnosed, it can be classified either as active or silent (positive serology with isolated villous atrophy), or latent (positive serology with a normal mucosa) and the appropriate therapeutic decision can be taken.
Diagnostic de la maladie cœliaque en 2008 Schmitz, J.; Garnier-Lengliné, H.
Archives de pédiatrie : organe officiel de la Société française de pédiatrie,
4/2008, Letnik:
15, Številka:
4
Journal Article
Recenzirano
La mise au point et l’utilisation généralisée, depuis les années 1990, de tests sérologiques de plus en plus spécifiques et sensibles ont complètement transformé les conditions du diagnostic de la ...maladie cœliaque (MC) dont la forme active, symptomatique, n’est plus que le sommet émergé de l’iceberg qui la représente. Cliniquement, la maladie est soit évoquée devant des symptômes digestifs mineurs à l’âge habituel, soit dépistée dans la fratrie d’un cas index ou chez un enfant à risque (diabétique par exemple) à un âge plus avancé grâce à l’utilisation des anticorps anti-endomysium et antitransglutaminase tissulaire d’isotype IgA dont la sensibilité et la spécificité dépassent 90 %. Dans certains cas, le typage HLA apporte une aide au diagnostic en excluant un malade qui n’est ni DQ2 ni DQ8. L’« étalon or » du diagnostic demeure la biopsie intestinale qui le confirme en mettant en évidence l’atrophie villositaire de moins en moins souvent sévère, en particulier chez les malades dépistés. La confrontation des données cliniques, biologiques et histologiques est alors nécessaire pour affirmer la MC. Une fois le diagnostic établi, la maladie pourra être classée en MC active, silencieuse (sérologies positives et lésions histologiques isolées) ou latente (sérologies positives mais histologie normale) et l’attitude thérapeutique adaptée.
Since the 1990's, the widespread use of very sensitive and specific serological tests has completely changed the conditions of the diagnosis of celiac disease (CD). The active form of the disease is now only the tip of the iceberg representing it. Currently, CD is evoked either in front of mild digestive symptoms at the usual age or in the course of screening in siblings of an index case or in patients at risk (insulin dependent diabetes for example) at a later age using IgA anti-endomysium or anti-tissue transglutaminase antibodies, the sensitivities and specificities of which exceed 90%. In some cases, HLA typing is helpful in allowing to exclude a patient who is neither DQ2 nor DQ8. The intestinal biopsy remains the “gold standard” of the diagnosis showing villous atrophy; the latter, however, is less and less often severe as the disease is milder and milder. The diagnosis of CD then rests on the confrontation of the clinical, biological and histological data. Once CD has been diagnosed, it can be classified either as active or silent (positive serology with isolated villous atrophy), or latent (positive serology with a normal mucosa) and the appropriate therapeutic decision can be taken.
Alcohol and pregnancy Seror, E; Chapelon, E; Bué, M ...
Archives de pédiatrie : organe officiel de la Société française de pédiatrie
16, Številka:
10
Journal Article
Recenzirano
Alcohol consumption during pregnancy is a major cause of mental retardation in Western countries. Fetal alcohol syndrome (FAS) is mainly characterized by pre- and postnatal stunted growth, ...neurocognitive disorders, and facial dysmorphism. It compromises the intellectual and behavioral prognosis of the child. Prevention tools exist, through better information of health professionals, for optimal care of high-risk women before, during, and after pregnancy, which would decrease the incidence of SAF in the future.
Alcool et grossesse Seror, E.; Chapelon, E.; Bué, M. ...
Archives de pédiatrie : organe officiel de la Société française de pédiatrie,
10/2009, Letnik:
16, Številka:
10
Journal Article
Recenzirano
L’alcool pendant la grossesse est un problème majeur de santé publique. Il représente la première cause de déficit intellectuel d’origine non génétique dans les pays occidentaux. Le syndrome ...d’alcoolisation fœtale (SAF) est principalement caractérisé par un retard de croissance pré- et postnatal, des troubles neurocognitifs et une dysmorphie faciale. Il menace le pronostic intellectuel et comportemental de l’enfant à long terme. Des outils de prévention primaire et secondaire existent et passent par une meilleure information des professionnels de santé, pour une prise en charge optimale des patientes à risque avant, pendant et après la grossesse, ce qui devrait permettre de constater une diminution de l’incidence du SAF dans les années à venir.
Alcohol consumption during pregnancy is a major cause of mental retardation in Western countries. Fetal alcohol syndrome (FAS) is mainly characterized by pre- and postnatal stunted growth, neurocognitive disorders, and facial dysmorphism. It compromises the intellectual and behavioral prognosis of the child. Prevention tools exist, through better information of health professionals, for optimal care of high-risk women before, during, and after pregnancy, which would decrease the incidence of SAF in the future.
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the ...article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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