Share Facebook
Crohn's Disease Forum » Parents of Kids with IBD » Paediatric IBD - Articles and Research


 
12-02-2012, 08:48 PM   #31
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Childhood Crohn's disease presenting as chronic constipation.




AuthorsD'Aleo CM, et al. Show all Journal
Pediatr Med Chir. 2009 Jul-Aug;31(4):168-71.
Affiliation
Deparment of Pediatric, Ospedale "M Raimondi", San Cataldo, CL, Italy. [email protected]
Abstract
Inflammatory bowel disease (IBD) include Crohn's disease (CD) and ulcerative colitis (UC). In children signs and symptoms of IBD are often non-specific, diagnosis is more difficult than in adults and systemic manifestation as growth failure and delayed puberty are common. While abdominal pain, rectal bleeding and diarrhoea are usual symptoms, constipation represents an unusual presentation of CD or UC. We report a 9-years-old girl with severe constipation, worsening abdominal pain, intermittent fever, diagnosed as CD. To our knowledge, this is a rare case of CD presenting as chronic constipation in children; we can find, in reviewed recent literature, only few report of similar condition.
__________________
DS - -Crohn's -Stelara

Last edited by DustyKat; 08-18-2013 at 12:50 AM. Reason: Added to list
12-02-2012, 09:25 PM   #32
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Faecal calprotectin in children with chronic gastrointestinal symptoms

Alan Bremner*, Sohere Roked, Rebecca Robinson, Ian Phillips, Mark Beattie
Article first published online: 2 JAN 2007

DOI: 10.1111/j.1651-2227.2005.tb01870.x


Abstract
Aims: Faecal calprotectin, a neutrophil cytosolic protein, is raised in inflammatory bowel disease. We assessed this investigation in evaluating children with chronic intestinal symptoms. Methods: Stool samples from 100 children aged 5–17 years (referrals to the regional paediatric gastroenterology service) were tested using a commercially available kit. Results: Calprotectin was higher in inflammatory bowel disease than normal children (p<0.0001) or in those with functional constipation (p<0.0001). The overall specificity for organic bowel disorders was 85%. Calprotectin correlated with C-reactive protein in inflammatory bowel disease (p=0.001), and clinical disease activity in ulcerative colitis (p=0.017), but not with disease activity in Crohn's disease.

Conclusion: Raised faecal calprotectin should prompt further assessment in children with chronic intestinal symptoms, since an organic bowel disorder is likely. However, calprotectin cannot be regarded as a specific test for idiopathic inflammatory bowel disease.

Last edited by DustyKat; 08-18-2013 at 12:52 AM. Reason: Added to list
12-02-2012, 09:30 PM   #33
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Osteoporosis: An Unusual Presentation of Childhood Crohn’s Disease1
M. Thearle, M. Horlick, J. P. Bilezikian, J. Levy, J. M. Gertner, L. S. Levine, M. Harbison, W. Berdon and S. E. Oberfield


Abstract

Osteoporosis is known to be associated with Crohn’s disease. We report a 12-yr-old boy without a history of steroid use, in whom severe osteoporosis and multiple collapsed vertebrae were the presenting manifestations of Crohn’s disease. After treatment of the Crohn’s disease, he resumed normal growth and progressed through puberty. Concomitantly, he demonstrated a substantial recovery of vertebral bone mineral density and structure. Possible pathophysiological mechanisms underlying the osteoporosis and the subsequent improvement in bone density are discussed.

Last edited by DustyKat; 08-18-2013 at 12:56 AM. Reason: Added to list
12-02-2012, 10:52 PM   #34
Crohn's Mom
Moderator
 
Crohn's Mom's Avatar
 
Join Date: Mar 2011
Location: Florida

My Support Groups:
wow...that is really interesting about the Osteoporosis as a presenting symptom !

Thanks MLP
12-03-2012, 07:32 AM   #35
Farmwife
Forum Monitor
 
Farmwife's Avatar
 
Join Date: Apr 2012
Location: Michigan

My Support Groups:
Childhood Crohn's disease presenting as chronic constipation.



Uh-oh


Thanks mlp
__________________
I'm mom to............... Little Farm Girl 8 yr old
Ibd (microscopic)
(12/28/12),
dx Juvenile Arthritis
(12/13/13)
dx Erthema Nodosum
(8/13/14)
Bladder and Bowel Dysfunction
(10/14/13)
Ehlers-Danlos Syndrome dx (1/26/17)
Remicade started on (9/8/14)Every 4 wks
Azathroprine started on 10/9/15
EN/EEN- since (1/12/13)
Past Meds- LDN, Humira, Pred, MTX, Sulfasalazine
12-03-2012, 12:22 PM   #36
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Chronic constipation for Ibd is very very rare that is why it made a paper.
12-03-2012, 03:11 PM   #37
Farmwife
Forum Monitor
 
Farmwife's Avatar
 
Join Date: Apr 2012
Location: Michigan

My Support Groups:
Good, now I have hope mlp!
12-03-2012, 04:08 PM   #38
DustyKat
Super Moderator
 
DustyKat's Avatar
 
Join Date: May 2010
Location: New South Wales, Australia
While abdominal pain, rectal bleeding and diarrhoea are usual symptoms, constipation represents an unusual presentation of CD or UC.
I would like to see more studies into IBD and constipation. Although I fully understand that it is not the common presentation, even on this forum alone it isn't a rare occurrence. Of course my interest stems from the fact that neither of my children suffered with bleeding or diarrhoea. Matt was diagnosed very quickly but given Sarah's lengthier diagnosis period she tended to constipation.

Dusty.
__________________
Mum of 2 kids with Crohn's.
12-03-2012, 08:15 PM   #39
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Dusty- I am looking since that is how DS presented and no one 2nd or 3rd opinion took his constipation as a sign that his crohn's not still under control until it ceased with remicade.
12-03-2012, 11:08 PM   #40
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
http://www.nejm.org/search?q=pediatr...s+constipation


Case studies from New England journal of medicine on constipation and Ibd.
12-03-2012, 11:11 PM   #41
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
A 17-year-old boy was admitted to the hospital because of a 6-week history of abdominal pain, constipation, and weight loss. Gastrointestinal radiographs showed narrowing of the cecum. CT scans showed peritoneal implants and a mediastinal mass.

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
Case 27-2011 — A 17-Year-Old Boy with Abdominal Pain and Weight Loss



From:
http://www.nejm.org/doi/full/10.1056/NEJMcpc1102200

Last edited by DustyKat; 08-18-2013 at 02:37 AM. Reason: Added to list
12-04-2012, 05:17 AM   #42
DustyKat
Super Moderator
 
DustyKat's Avatar
 
Join Date: May 2010
Location: New South Wales, Australia
Thanks mlp!

The time and effort that you put into sourcing and posting these articles is very much appreciated.
12-07-2012, 02:53 PM   #43
DustyKat
Super Moderator
 
DustyKat's Avatar
 
Join Date: May 2010
Location: New South Wales, Australia
Effect of EEN on gut microflora function in children with Crohn's disease.

2012 Dec

Tjellström B, Högberg L, Stenhammar L, Magnusson KE, Midtvedt T, Norin E, Sundqvist T.

Department of Microbiology, Karolinska Institute, Sweden

Objective. Exclusive enteral nutrition (EEN) is a first-line treatment in children with active Crohn's disease (CD) but is seldom used in adults with active disease. The mode of action of EEN in suppressing mucosal inflammation is not fully understood, but modulation of intestinal microflora activity is one possible explanation. The aim of this study was to investigate the effect of 6-week EEN in children with active CD, with special reference to intestinal microflora function.

Materials and methods. Fecal samples from 18 children (11 boys, 7 girls; median age 13.5 years) with active CD (13 children with small bowel/colonic and 5 with perianal disease) were analyzed for short chain fatty acid (SCFA) pattern as marker of gut microflora function. The children were studied before and after EEN treatment. Results from 12 healthy teenagers were used for comparison.

Results. Eleven (79%) of the children with small bowel/colonic CD responded clinically positively to EEN treatment showing decreased levels of pro-inflammatory acetic acid as well as increased concentrations of anti-inflammatory butyric acids and also of valeric acids, similar to the levels in healthy age-matched children. In children with active perianal CD, however, EEN had no positive effect on clinical status or inflammatory parameters.

Conclusions. The authors present new data supporting the hypothesis that the well-documented anti-inflammatory effect of EEN in children with active small bowel/colonic CD is brought about by modulation of gut microflora activity, resulting in an anti-inflammatory SCFA pattern. By contrast, none of the children with perianal disease showed clinical or biochemical improvement after EEN treatment.

http://www.ncbi.nlm.nih.gov/pubmed/23016828

Thank you kiny!

Last edited by DustyKat; 08-18-2013 at 02:38 AM. Reason: Added to list
12-09-2012, 12:51 AM   #44
Tesscorm
Moderator
 
Tesscorm's Avatar
 
Join Date: Jun 2011
Location: Ontario

My Support Groups:
Not sure if this is the right thread to post this in (link is not even specifically related to IBD) but it's a definition/explanation of SIR (Standardized Incidence Ratio) and CI (confidence interval). With no medical, scientific, etc. background, I'm often stumped at some of the terminology in studies and/or reports, ie (SIR 1.03, 95% CI 0.4–2.2) and thought others might have the same problem. The link gives a relatively understandable explanation of the SIR and CI.

http://www.state.nj.us/health/eohs/p...kes_fs_sir.pdf
__________________
Tess, mom to S, 22
Diagnosed May 2011

Treatment:
May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil

Last edited by DustyKat; 08-18-2013 at 02:40 AM. Reason: Added to list
12-09-2012, 02:55 AM   #45
DustyKat
Super Moderator
 
DustyKat's Avatar
 
Join Date: May 2010
Location: New South Wales, Australia
Thanks for posting Tess.

I am happy to leave it here.
12-11-2012, 08:54 PM   #46
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Women with inflammatory bowel disease (IBD) have similar rates of fertility to the general population, but have an increased rate of adverse pregnancy outcomes compared with the general population, which may be worsened by disease activity. Infertility is increased in those undergoing ileal pouch–anal anastomosis. Anti-tumor necrosis factor therapy in pregnancy is considered to be low risk and compatible with use during conception in men and women and during pregnancy in at least the first two trimesters. Infliximab (IFX) and certolizumab pegol are also compatible with breastfeeding, but safety data for adalimumab (ADA) are awaited. The safety of natalizumab during pregnancy is unknown. For children with Crohn's disease (CD), IFX is effective at inducing and maintaining remission. Episodic therapy is not as effective as scheduled infusions. Disease duration in children does not appear to affect the efficacy of IFX. IFX promotes growth in prepubertal and early pubertal Crohn's patients. It is also effective for the treatment of extraintestinal manifestations. ADA is effective for children with active CD and for maintaining remission, even if they have lost response to IFX, although there are fewer data. Vaccination of infants exposed to biological therapy in utero should be given at standard schedules during the first 6 months of life, except for live-virus vaccines such as rotavirus. Inactivated vaccines may be safely administered to children with IBD, even when immunocompromised.
From:
http://www.nature.com/ajg/journal/v1...g2010464a.html


Am J Gastroenterol 2011;106:214–223; doi:10.1038/ajg.2010.464; published online 14 December 2010

The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD With the European Crohn's and Colitis Organisation: Pregnancy and Pediatrics



Last edited by DustyKat; 08-18-2013 at 02:41 AM. Reason: Added to list
12-11-2012, 11:48 PM   #47
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
DDW: Methotrexate Adds No Benefit to Infliximab (Remicade) in Crohn's Disease
By John Gever, Staff Writer, MedPage Today
Published: May 23, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine
Action Points
Explain to interested patients that the study found no benefit from adding methotrexate to infliximab (Remicade) therapy in Crohn's disease.
Explain that infliximab and methotrexate are each approved individually for Crohn's disease.
Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
SAN DIEGO, May 23 -- Although both methotrexate and infliximab (Remicade) are known to be effective against Crohn's disease, combining them provides no extra benefit, a researcher said here.


Patients receiving the combination had the same treatment success rate as others treated with infliximab alone in a 50-week, placebo-controlled trial, reported Brian Feagan, M.D., of the Robarts Research Institute in London, Ontario, at Digestive Disease Week.


"Triple induction therapy with methotrexate was not more effective than dual induction therapy followed by infliximab maintenance therapy," he said.


Treatment success was defined by three criteria: score of less than 150 on the Crohn's Disease Activity Index and no clinical need for prednisone supplements at week 14, and no relapse though week 50.


At week 14, 76.2% of patients receiving the combination met the success definition, compared with 77.8% of those taking infliximab and placebo (P=0.83). There were 63 patients in each arm.


Relapse rates were also nearly identical, with 55.6% of combination-treated patients meeting the final success definition at week 50 versus 57.1% of those receiving infliximab and placebo (P=0.86).


Disease duration had no bearing on responses to the combination versus infliximab alone. There were no differences in response rates in patients whose disease onset was less than two years earlier, nor in patients with disease duration of more than 12 years.


Patients in the study were adults with an established Crohn's diagnosis and active symptoms requiring 15 to 40 mg/day of prednisone. Lactating or pregnant women and patients with risk factors for toxicity from the study drugs or recent serious infections were excluded.


Infliximab was given at 5 mg/kg by infusion at weeks one, three, and seven, and every eight weeks thereafter through week 50, with 200 mg of hydrocortisone prior to each infusion. Methotrexate was started at 10 mg weekly by subcutaneous injection, then increased to 25 mg by week seven and continued until week 14. Prednisone was gradually withdrawn over the 14-week induction phase.


Median disease activity scores over the first 14 treatment weeks suggested that the methotrexate-infliximab combination was actually inferior to infliximab alone, although the difference did not reach statistical significance.


Dr. Feagan said that if any advantage for the combination was going to be evident, it would most likely have been in this measure. In fact, the mean score in the combination group at week 14 was about 125, compared with about 100 with infliximab.


Secondary measures of effectiveness, such as scores on the SF-36 health survey instrument, also showed no significant differences between treatments.


There were no major differences in adverse effects in the study, Dr. Feagan said. The most important was that 14 patients in the combination group had disease exacerbations versus four in the infliximab-only group. Infection rates were nearly identical.


Despite the lack of benefit for the combination in the trial, Dr. Feagan said it deserves additional research.


"In my opinion, future studies should concentrate on combination therapy in patients with early disease and in steroid-resistant patients," he said.


Gary Lichtenstein, M.D., of the University of Pennsylvania in Philadelphia, commented that the findings were no surprise.


Earlier studies in his own lab and elsewhere had suggested that combinations of drugs do not add benefit to individual biologic therapies in Crohn's disease, he said.


"In most patients you don't need to add anything. These biologic agents are wonderful drugs by themselves. By adding drugs such as methotrexate or steroids you are just increasing the risk of serious adverse events," he said.


The study was investigator-initiated with support from Schering Canada.

Dr. Feagan reported relationships with Abbott, UCB Pharma, Centocor, Schering-Plough, Novartis, Celgene, Chemocentryx, Procter & Gamble Pharmaceuticals, Otsuka America, Berlex, Santarus, Synta, Genentech, PDL Biopharma, and Elan.


Dr. Lichtenstein reported relationships with Salix, Procter & Gamble, Shire, Axcan, Centocor, UCB, Schering-Plough, Abbott, AstraZeneca, GlaxoSmithKline, Bristol-Myers Squibb, Elan, Serono, Wyeth, Millennium, and Protein Design Labs.

Primary source: Digestive Disease Week
Source reference:
Feagan B, "A randomized trial of methotrexate in combination with infliximab for the treatment of Crohn's disease" Digestive Disease
From:
http://www.medpagetoday.com/MeetingCoverage/DDW/9598

Last edited by DustyKat; 08-18-2013 at 02:43 AM. Reason: Added to list
12-18-2012, 07:17 PM   #48
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Quality Improvement in Gastroenterology Clinical Practice
Rakhi Kheraj, Sumeet K. Tewani, Gyanprakash Ketwaroo, Daniel A. Leffler Disclosures
Clin Gastroenterol Hepatol. 2012;10(12):1305-1314.

Inflammatory Bowel Disease
Bone mineral density (BMD) tests, vaccinations, and dysplasia screens are important components of quality outpatient care for patients with inflammatory bowel disease (IBD).

Osteoporosis and Osteopenia
Patients with IBD are at increased risk for developing osteoporosis and osteopenia; about 15% of patients with IBD also have osteoporosis. [26] Several risk factors for osteoporosis have been identified and include a course of steroid therapy longer than 3 months or recurring use of steroids, age >50 years, postmenopausal status, history of low-impact fracture, and hypogonadism. Using these risk factors to identify patients who should be tested for BMD led to the finding that 69% of patients with IBD were prescribed specific therapy. [27] Currently, the AGA recommends dual-energy x-ray absorptiometry screening for high-risk patients (grade D). [26] However, despite these recommendations and their validation in a prospective cohort, only 23% of patients with risk factors at a representative tertiary institution were tested. [28]

Vaccinations
Although immunosuppressive agents have significantly improved medical management of Crohn's disease and ulcerative colitis, they increase the risk of infection, so vaccinations are important. [29,30] Appropriate routine vaccinations are recommended by the Advisory Committee for Immunization Practices ( Table 1). [31,32] Live vaccines, such as varicella, generate concern among patients with IBD, who are likely to receive immunosuppressive therapy. Consideration of vaccination at initial visit could allow for safe vaccination before initiation of immunosuppressive therapy. Many common vaccines, such as hepatitis A virus, hepatitis B virus (HBV), pneumococcal, injectable influenza, and human papillomavirus, are recommended for individuals on or being considered for immunosuppressive regimens. Despite recommendations, vaccination of patients with IBD is underutilized in general practice. [30]

On the basis of major society guidelines, adequate bone health and infection prevention through appropriate testing and vaccination are considered important parts of outpatient IBD QI. An example of QI initiatives in these areas could include the following steps: (1) development of an evidence-based practice standard for BMD testing and vaccination in patients with IBD; (2) retrospective evaluation of appropriately tested or vaccinated patients; and (3) development or enhancement of a mechanism that increases rates of BMD testing or vaccination in appropriate individuals. Possibilities include patient-completed forms and templated notes in patients' charts to serve as reminders to ordering physicians. Potential initiatives include automated reminder letters for vaccinations, such as influenza, that are needed on a recurring basis. For BMD testing, patients could receive a standardized test referral when they check out from the clinic. QI initiatives should also include (4) a prospective audit of IBD patients to assess rates of appropriate vaccination or referral for BMD testing and (5) evaluations for any potential shortcomings of the system. After this step, healthcare workers should return to step 3.

Screening for Dysplasia
The risk of colorectal cancer and dysplasia is increased in patients with ulcerative and Crohn's colitis, compared with the general population. This risk of colorectal cancer is estimated to be 2% for patients who have had ulcerative colitis for 10 years or more and as high as 18% for those with the disease for 30 years. [33] To reduce the risk of colorectal cancer in patients with IBD, the AGA recommends that all patients undergo surveillance colonoscopy a maximum of 8 years after onset of IBD symptoms [34] (grade B*). Surveillance schedules can then be based on family history, extent and activity of disease, and the presence of primary sclerosing cholangitis or abnormal findings such as polyps and strictures. [19,35,36] The sensitivity of endoscopic screening for dysplasia can be increased by including chromoendoscopy, performance by an experienced endoscopist, and adequate sampling of the colon. [37] When dysplasia or cancer is found, it should be confirmed by a histology analysis by an expert gastrointestinal pathologist. [36,38]

An example of a QI initiative in dysplasia screening would involve the following steps: (1) establish an evidence-based practice guideline for dysplasia screening in patients with longstanding colitis; (2) evaluate the tests performed in a cohort of at-risk IBD patients to identify those who have been screened for dysplasia, have had an adequate number of biopsies analyzed, and those who are undergoing appropriate surveillance; (3) identify patient-based and system-based risk factors for insufficient dysplasia screening and develop a mechanism to improve screening by addressing these risk factors (possible approaches include sending reminder letters, which are generated at initial visit and at each procedure for surveillance colonoscopy and mailed before the suggested appointment); and (4) audit patients who are receiving dysplasia screening under the new quality intervention to evaluate any potential shortcomings and assure that the QI initiative has been modified appropriately.

Medications in Inflammatory Bowel Disease
Infliximab and other anti–tumor necrosis factor-alpha therapies increase the risk of infection and reactivation of tuberculosis (TB) and HBV. [39,40] The ACG therefore recommends routine testing for TB and HBV before anti–tumor necrosis factor therapy begins. [41] Although the rate of screening is increasing, there is a substantial need for QI efforts to improve these rates. [42]

Before patients are treated with 6-mercaptopurine or azathioprine, AGA guidelines recommend thiopurine methyltransferase testing by activity or genotype to identify patients at risk for developing severe bone marrow suppression (grade B). [43] Likewise, it is equally important to monitor patients while they are receiving therapy; systems to ensure appropriate interval laboratory tests and routine follow-up examinations could be included in QI plans.

An example of a QI project to promote the safe use of appropriate medications, such as infliximab, would involve the following steps: (1) an initial retrospective review of patients who are receiving infliximab to ensure documentation of appropriate tests for TB and HBV; (2) implementation of interventions to ensure that patients were tested for these diseases before therapy began (such as a checklist for the ordering physician or the pharmacist to confirm that tests for TB and HBV have been completed before they dispense infliximab); and (3) confirmation of the efficacy of the quality initiative via prospective audit of patients who are receiving infliximab and room for further modification of the initiative to achieve 100% compliance with prescreening for HBV and TB.



From:
http://www.medscape.com/viewarticle/775859_3

Last edited by DustyKat; 08-18-2013 at 02:45 AM. Reason: Added to list
12-25-2012, 12:47 PM   #49
David
Co-Founder
 
David's Avatar
 
Join Date: Feb 2006
Location: Naples, Florida
Magnesium deficiency and proton pump inhibitors. Not pediatric specific, but I know many of your kids are on PPIs.

Last edited by DustyKat; 08-18-2013 at 02:47 AM. Reason: Added to list
12-27-2012, 04:38 PM   #50
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
San Diego, October 22, 2012 – Prometheus Laboratories Inc., a specialty pharmaceutical and diagnostic company, will present five abstracts at the American College of Gastroenterology 2012 Scientific Meeting taking place this week in Las Vegas, NV. These data add to the compelling body of evidence that supports standardized use of liquid phase assays in helping to identify potential causes for loss of treatment response among inflammatory bowel disease (IBD) patients using infliximab (IFX).
PROMETHEUS Anser IFX is a proprietary, new generation monitoring test that helps guide patient management decisions – potentially saving IBD patients and their treating physicians valuable time and effort. This liquid phase assay, launched earlier this year, measures drug (infliximab) and drug antibody levels in the presence of drug (infliximab) at anytime in the course of therapy. Prometheus intends to use this platform for subsequent introductions of additional tests targeted to other biologic agents being used to treat a variety of autoimmune diseases.
In one abstract "Comparison of techniques for monitoring infliximab and antibodies to infliximab in Crohn's disease patients with infliximab treatment failure" (Steenholdt et al), the PROMETHEUS Anser IFX diagnostic demonstrated superiority over ELISA, a commonly used solid phase assay for measuring both IFX and antibodies-to-infliximab (ATI) levels. The development of ATIs can shorten the duration of clinical response to IFX and decrease the likelihood of an IBD patient remaining in remission.
In the study, IFX and ATI levels were measured among 67 patients with infliximab treatment failure. PROMETHEUS Anser IFX proved more sensitive than ELISA in detecting absolute trough IFX concentrations (mean difference of 0.60 µg/ml). In addition, ATIs were detectable in only 6 (9%) of ELISA patients, as compared to 23 (35%) of the PROMETHEUS Anser IFX patients. Of the 17 samples for which ATI were detected by PROMETHEUS Anser IFX and missed by ELISA, 14 had detectable IFX levels that were likely missed due to interference from serum IFX, a common shortcoming of the solid phase ELISA assay and further support for the use of the new liquid test.


New Data Support Use of Prometheus® Anser™ IFX Assay in Managing Infliximab Treatment Failure Among Inflammatory Bowel Disease Patients



From:
http://phoenix.corporate-ir.net/phoe...cle&ID=1747863

Last edited by DustyKat; 08-18-2013 at 02:49 AM. Reason: Added to list
12-31-2012, 10:18 AM   #51
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
http://www.cincinnatichildrens.org/W....aspx?id=87937


Evidence-Based Care Guideline
Management of Pediatric
Moderate / Severe Inflammatory
Bowel Disease (IBD):


This guideline is subdivided into selected medication options, such that the following will be addressed:
• recommended care prior to treatment
• induction and maintenance with the following
medications
• 6-mercaptopurine (6-MP) or azathioprine (AZA)
(Imuran®/Azasan®) with or without prednisone
OR
• methotrexate (MTX) OR
• infliximab (Remicade®)
• other treatment related interventions
• patient / family education.
Target Population
Children 0 to 22 years of age diagnosed with Inflammatory Bowel Disease (IBD) [either Crohn’s Disease (CD) or Ulcerative Colitis (UC)].
Target Users
Include but are not limited to (in alphabetical order):
• clinicians caring for patients diagnosed with IBD
• patient care staff, including:
• nurse practitioners
• nurses
• patients and families
• physicians in training
• primary care providers
01-11-2013, 07:11 PM   #52
DustyKat
Super Moderator
 
DustyKat's Avatar
 
Join Date: May 2010
Location: New South Wales, Australia
Why 40mg of Prednisone?

Corticosteroids can be administered as oral (cortisone, prednisone, prednisolone, budesonide), intravenous (prednisolone, methylprednisolone, corticotropin), or rectal (beclomethasone, tixicortol, budesonide, prednisolone metasulfobenzoate) formulations. Truelove and Witts reported the efficacy of cortisone 100 mg per day in UC in 1955.8 Baron and colleagues then reported that 40 mg of prednisone was more effective than 20 mg and equally effective as 60 mg, but with fewer side effects.50 Finally, single daily dosing of prednisone 40 mg daily was equally effective as 10 mg four times a day.51 It is from these early studies that the current maxim of prednisone 40 mg per day for moderate to severe UC originated. No maintenance benefit of corticosteroids in UC has been found.52

http://www.ncbi.nlm.nih.gov/pmc/arti...0076/#r17007-8
My musings...did this maxim for UC become the standard for all IBD?

(Interesting that 40mg was equally as effective as 60mg)

Dusty.

Last edited by DustyKat; 08-18-2013 at 02:55 AM. Reason: Added to list
01-17-2013, 05:30 PM   #53
kiny
Senior Member
 
kiny's Avatar
 
Join Date: Apr 2011
http://www.cincinnatichildrens.org/W....aspx?id=87937


Evidence-Based Care Guideline
Management of Pediatric
Moderate / Severe Inflammatory
Bowel Disease (IBD):
Only commented I wanted to make about this is that it is severly outdated, combination therapy is something that is rarely done anymore because of the increased risks and lack of clinical significance. It is sometimes used when biologics are started, but it is rarely used together anymore because they know the risks are much higher on combo therapy than monotherapy.

Even the top-down approach that came after 2007, while it was a popular theme a few years ago, with the increased recognition of side effects especially in children, people have come back from that a bit.
02-07-2013, 03:15 AM   #54
Patricia56
Senior Member
 
Patricia56's Avatar
 
Join Date: Jul 2012
Location: Northern California, USA
Hey Penguin Lady -

have you seen this series of articles regarding the nosebo effect? I don't have access to full text, if you do I am very interested in reading these articles. I always like to get a glimpse of things from the doctors side of the room. Helps level the playing field you know?

Thanks My little penguin

Nocebo phenomena in medicine: their relevance in everyday clinical practice.

http://www.ncbi.nlm.nih.gov/pubmed/22833756

To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent.

http://www.ncbi.nlm.nih.gov/pubmed/22416745

and then there is at least 5 (FIVE) comments/responses to this article which run 1 to 3 pages long each.
__________________
Badger, 18, CD, overall great guy
Dxd age 10, 2006 after nearly 1 year of active sx
Current CD meds: Remicade, Methotrexate and Omeprazole, Vit. D, Calcium, Folic Acid, Probiotic

Nothing I say here should be construed as medical advice. I am not a doctor. These are just my opinions.
02-07-2013, 12:37 PM   #55
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
I haven't seen it yet
But doesn't surprise me.
Everything has an effect .
Even studying something has an effect.
"Hawthorne effect "
02-08-2013, 03:14 AM   #56
Patricia56
Senior Member
 
Patricia56's Avatar
 
Join Date: Jul 2012
Location: Northern California, USA
I am interested in seeing the ethical aspects of this issue as debated by the docs. When and how much to tell patients about side effects is a big deal from my perspective.
02-09-2013, 04:07 PM   #57
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
http://www.advancesinibd.com/assets/...gics_print.pdf


Good slides on biologics
Trough levels
Biologics:
Indications and Optimizing Therapy
Bruce E. Sands, MD, MS
Mount Sinai School of Medicine New York, NY


Last edited by DustyKat; 08-18-2013 at 02:57 AM. Reason: Added to list
02-09-2013, 08:04 PM   #58
my little penguin
Forum Monitor
 
Join Date: Apr 2012

My Support Groups:
Infliximab (Remicade®; Schering-Plough, Kenilworth, NJ, U.S.A.) is a chimeric monoclonal antibody (75% human, 25% mouse) that acts as a tumour necrosis factor-α inhibitor. Infliximab is registered for treatment of rheumatoid arthritis (RA), psoriatic arthritis, Crohn disease, ulcerative colitis, ankylosing spondylitis and plaque-type psoriasis. In dermatology it is also used for off-label indications such as hidradenitis suppurativa and pyoderma gangrenosum among others.[1] Infliximab has proven to be very effective in the treatment of moderate to severe chronic plaque-type psoriasis. In several randomized controlled trials (RCTs) around 80% of patients showed an improvement of at least 75% in the Psoriasis Area and Severity Index (PASI 75) after 10weeks of treatment, and more than half of the patients even showed an improvement of more than 90% (PASI 90).[2-4]

During and after the intravenous administration of infliximab infusion reactions can occur, comparable with what happens when using other foreign protein-derived treatments. Infusion reactions during the infusion or in the first 24h afterwards are defined as acute reactions.[5,6] The majority occurs during or in the first 2h after the infusion. Symptoms include 'flushing', chest tightness, dizziness, shortness of breath, headache, hypo/hypertension, nausea, sweating, rise in temperature and (other) symptoms of anaphylaxis, like urticaria and bronchospasms.[3,5,7] Delayed reactions are reactions that occur between 24h and 14days after an infusion, the majority occurring after 5-7days.[5] In most cases symptoms include arthralgia, myalgia, influenza-like symptoms, headache, tiredness and 'rash' or urticaria.[4,5,8]

Infusion reactions appear in 3-22% of patients with psoriasis who are treated with infliximab;[7] in placebo arms this is approximately 0-2%.[3,4] The reactions can be subdivided into mild, moderate or severe reactions. Most reactions are mild or moderate and only few are severe.[3] The severity of infusion reactions is assigned by the physician based on the patient's signs and symptoms; however, they do not always fit neatly into the definition of mild, moderate or severe reactions.[6] Mild reactions can be defined as reactions that are self-limiting and resolve spontaneously after temporary cessation of the infusion or reduction of the infusion speed. Moderate reactions are those that require closer attention and an extended observation period and often discontinuation of the infusion. Serious reactions involve respiratory symptoms or a symptomatic blood pressure drop and need for close monitoring, often for 24h and occasionally requiring hospital admission.[9] A severe infusion reaction can be anaphylactic or anaphylactoid and should be treated as such (Fig. 1). In these cases infliximab should be stopped immediately.[5]

The British Journal of Dermatology
Review and Expert Opinion on Prevention and Treatment of Infliximab-related Infusion Reactions
L.L.A. Lecluse, G. Piskin, J.R. Mekkes, J.D. Bos, M.A. de RieDisclosures
The British Journal of Dermatology. 2008;159(3):527-536.



From:
http://www.medscape.com/viewarticle/580215

Last edited by DustyKat; 08-18-2013 at 02:59 AM. Reason: Added to list
03-15-2013, 07:30 PM   #59
Tesscorm
Moderator
 
Tesscorm's Avatar
 
Join Date: Jun 2011
Location: Ontario

My Support Groups:
MRI of the Small Bowel in Patients with Crohn's Disease

http://www.medscape.com/viewarticle/738939

Abstract

Purpose of review To highlight the advances in MRI of the small intestine in patients with Crohn's disease. MRI of the gut has become more feasible with improved spatial resolution and speed of the MR sequences allowing parallel evaluation for both disease activity and extra-enteric complications.

Recent findings Recent literature highlights excellent diagnostic accuracy of MR enterography (MRE) that is comparable to computed tomography enterography (CTE). Compared to CTE the image quality is not quite as good, and there is slightly more interobserver variability in interpretation. Despite these performance characteristics, the overall diagnostic yield of MRE is comparable to CTE. The lack of radiation exposure related to MRE is a significant strength, especially in Crohn's population that by virtue of their younger age, body habitus and potential need for repeated imaging, is at highest risk of potential cancer from radiation exposure due to diagnostic imaging. MRE should not be viewed as a 'safer' version of a CTE. The physics of MRI allows the application of unique sequences that add novel insights not possible with other imaging modalities.

Summary MRE is a highly effective technique for assessing Crohn's disease. We are only starting to explore new MRI sequences and the future of this technology is extremely exciting.

Last edited by DustyKat; 08-18-2013 at 03:00 AM. Reason: Added to list
03-16-2013, 08:41 AM   #60
Tesscorm
Moderator
 
Tesscorm's Avatar
 
Join Date: Jun 2011
Location: Ontario

My Support Groups:
Thought this was a great link that vtfamily posted.

Clinical Imaging of the Small Intestine

http://books.google.com/books?id=sOr...0bowel&f=false
Reply

Crohn's Disease Forum » Parents of Kids with IBD » Paediatric IBD - Articles and Research
Thread Tools


All times are GMT -5. The time now is 06:02 PM.
Copyright 2006-2017 Crohnsforum.com