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


 
11-06-2012, 05:51 AM   #1
DustyKat
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Paediatric IBD - Articles and Research

As the name suggests, this is a thread in which to post any articles/research related primarily to paediatric IBD. If you find an item that does relate to children but is of general interest then please post as well.

Thank you so much to all that have posted items it is very much appreciated. I have been through the forum and have gathered up all I could find. If anyone has posted an item and I have missed it please let me know. Thanks, Dusty.


GENERAL PAEDIATRIC IBD ARTICLES:


*Vaccination Issues In Patients With Inflammatory Bowel Disease Receiving Immunosuppression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533208/

*Vaccines And recommendations For Their Use In Inflammatory Bowel Disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602494/

*New Therapies For IBD: From Bench To The Bedside: Abstract And Introduction
http://www.medscape.com/viewarticle/763862?src=nl_topic

*Presentation Powerpoint - Pediatric IBD
http://www.naspghan.org/user-assets/...2ndEdition.pdf

*Skin Cancer In IBD
http://www.medscape.com/viewarticle/767304?src=nl_topic

*Pediatric IBD Manifestations
http://www.wjgnet.com/1007-9327/12/3204.pdf

*EIM's In Children
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245880/

*Power Point Presentation - EIM's
http://www.powershow.com/view/b0f88-...t_presentation

*Child Friendly Bristol Stool Chart
http://www.eric.org.uk/assets/Childr...April08%20.pdf

*Role Of MAST Cells In IBD
http://www.wjgnet.com/1007-9327/10/309.asp

*Immune Disorders And Children With IBD
http://www.medscape.com/viewarticle/752420

*IBD In Infancy
http://www.iagh.org/Portals/44fa7561...afi-13-1-1.pdf

*Ileal Lesions Rarity In Crohn's Disease Under Age 8 - Paper
http://www.rima.org/web/medline_pdf/...Dis_639-44.pdf

*Presentation And Disease Course In Early Compared To Later Onset Paediatric Crohn’s Disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258513/

*Bone Age
http://www.ucsf.edu/news/2012/05/120...ement-bone-age

*GEM Project. CCFC Study of Siblings Of People With Crohns.
http://www.ccfc.ca/site/c.ajIRK4NLLhJ0E/b.6446493/

*Podcast Sylviane Forget: Crohn’s Disease In Canada: Environment Or Genetics?
http://podcasts.mcgill.ca/health-2/s...t-or-genetics/

*Pediatric Inflammatory Bowel Disease:Highlighting Paediatric Differences in IBD
http://www.meteo.mcgill.ca/~manyan/T...20in%20IBD.pdf

*Iliopsoas Bursitis Presenting As Hip Pain Secondary To Crohn's Fistula
http://archive.ispub.com/journal/the....ILJVj8Xs.dpbs

*Pediatric Crohn's Disease And Growth Retardation: The Role Of Genotype, Phenotype, And Disease Severity
http://pediatrics.aappublications.or.../1281.abstract

*Immune Responses Predict Disease Progression In Pediatric Crohn's
http://www.gastrohep.com/news/news.asp?id=4060

*Variation In Care In Pediatric Crohn’s Disease
http://c3nproject.org/news/variation...rohn’s-disease

*Primary Care Considerations In The Management Of Inflammatory Bowel Disease Patients
http://mobileservices.texterity.com/...icle_id=166917

*Growth Retardation In Pediatric Crohn's Disease: Pathogenesis And Interventions
http://onlinelibrary.wiley.com/doi/1...ibd.20115/full

*Protein Metabolism In Inflammatory Bowel Disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434623/

*Growth Failure In Pediatric Inflammatory Bowel Disease: Prevalence, Risk Factors, And Treatment
http://www.practicalgastro.com/pdf/J...ionArticle.pdf

*Dysbiosis In The Pathogenesis Of Pediatric Inflammatory Bowel Diseases
http://www.hindawi.com/journals/iji/2012/687143/

*Childhood Crohn's Disease Presenting As Chronic Constipation.
http://www.ncbi.nlm.nih.gov/pubmed/19839400

*Osteoporosis: An Unusual Presentation Of Childhood Crohn’s Disease
http://www.ncbi.nlm.nih.gov/pubmed/10852438

*Case Records Of The Massachusetts General Hospital
Case 27-2011 — A 17-Year-Old Boy with Abdominal Pain and Weight Loss

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

*Fact Sheet: Explanation Of Standardized Incidence Ratios
http://www.state.nj.us/health/eohs/p...kes_fs_sir.pdf

*Pregnancy And Pediatrics
http://www.nature.com/ajg/journal/v1...g2010464a.html

*Quality Improvement In Gastroenterology Clinical Practice
http://www.medscape.com/viewarticle/775859_3

*Reaching Students With Chronic Illness
http://www.insidehighered.com/news/2007/11/08/chronic

*Opportunistic Infection In immunocompromised IBD Patients
http://www.naspghan.org/user-assets/...20NASPGHAN.pdf

*A Review Of Postoperative Crohn’s Disease
http://www.practicalgastro.com/pdf/M...insArticle.pdf

*The Pediatric Pouch In Inflammatory Bowel Disease
http://www.medscape.com/viewarticle/781002_2

*Crohns Disease - First Visit With GI (checklist)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079145/

*Gut Bacteria We Pick Up As Kids Stick With Us For Decades
http://www.npr.org/blogs/health/2013...us-for-decades

*Inflammatory Bowel Disease: Heat Waves Linked To Flares
http://www.medscape.com/viewarticle/809363

*Definition Of Phenotypic Characteristics Of Childhood Onset Inflammatory Bowel Disease.
http://www.ncbi.nlm.nih.gov/m/pubmed...644819/related

*How To Cope With A Sick Child
http://robingoldstein.net/articles/p...-a-sick-child/

*The Pediatric Pouch in Inflammatory Bowel Disease
http://www.medscape.com/viewarticle/781002

*Growth, Body Composition, And Nutritional Status In Children And Adolescents With Crohn's Disease
http://journals.lww.com/jpgn/Fulltex..._Status.9.aspx

*Update On Nutritional Status, Body Composition And Growth In Paediatric Inflammatory Bowel Disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964391/

*Change In The Treatment Strategy For Pediatric Crohn's Disease
http://synapse.koreamed.org/DOIx.php...830&vmode=FULL

*Mucus Useful In Treating IBD
http://www.sciencedaily.com/releases...0926143147.htm

*Mucus Enhances Gut Homeostasis And Oral Tolerance By Delivering Immunoregulatory Signals
http://www.sciencemag.org/content/34...urce=shortener

*Discussing The Latest Advances In Crohn’s Disease And Ulcerative Colitis
http://ibdblog.mayoclinic.org

*Current Therapy Of Crohn's Disease (2006) (go to page 59 if the link doesn't take you there directly)
http://www.hgd.hr/AdminLite/FCKedito...CI.pdf#page=59

*What’s Hot In IBD Research “Future Therapies For IBD”
http://www.chop.edu/export/download/...D_Research.pdf

*Crohn’s Disease Severity Depends On Type Of Immune Cells Behind Patient’s Inflammation
http://www.medicaldaily.com/crohns-d...mmation-270366

*What Is Ferritin?
http://highferritin.imppc.org/hiperferritin.php?lang=en

*Crohn’s Disease Hits Kids With Family Roots In South Asia
http://www.vancouversun.com/health/C...766/story.html

*Enthesitis Is An Extraintestinal Manifestation Of Pediatric Inflammatory Bowel Disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860180/

*Changing Paradigms For Assessing Response To Therapy In Crohn’s Disease
http://www.naspghan.org//files/docum...EB_4-25-14.pdf

*Improving Health Supervision In Pediatric And Young Adult PatIents With IBD
http://www.naspghan.org/files/docume...Newsletter.pdf

*Monitoring Disease Activity In Paediatric IBD Patients
http://www.naspghan.org/files/docume...BDPatients.pdf

*23 and Me: Genetics and IBD Testing
https://www.23andme.com/IBD/

*Transitioning A Patient With IBD From Paediatric To Adult Care
http://www.naspghan.org/files/docume...PedtoAdult.pdf

*Crohn’s Disease Linked To Imbalance In Gut Microbiota
http://www.medicaldaily.com/crohns-d...robiota-271073

*Bile-making microbe fights off germ behind chronic diarrhoea - C Diff
http://news.sciencemag.org/biology/2...ronic-diarrhea

*Consensus guidelines of ECCO/ESPHGAN on the mefical management of pediatric Crohn's disease
http://www.sciencedirect.com/science...73994614001482

*Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease
https://www.youtube.com/watch?v=xqWW1azBTNk&app=desktop

*Health-Related Quality of Life in Youth with Crohn's Disease: The Role of Disease Activity and Parenting Stress.
http://www.ncbi.nlm.nih.gov/pubmed/25564807

*The course of anaemia in children and adolescents with Crohn’s disease included in a prospective registry
http://link.springer.com/article/10....384-014-2042-4

*Chronic Granulomatous Disease and Crohn's Disease Histopathological Distinctive Features: A Pediatric Study
http://www.ghrnet.org/index.php/jogh...e/view/529/571

*Combinatorial Effects of Diet and Genetics on Inflammatory Bowel Disease Pathogenesis
http://journals.lww.com/ibdjournal/F...ics_on.26.aspx

*Maintaining Intestinal Health: The Genetics and Immunology of Very Early Onset Inflammatory Bowel Disease
http://www.sciencedirect.com/science...52345X15001228

*CHOP Researchers Discover Genetic Variants Linked to Very Early Onset IBD in Children
http://ibdnewstoday.com/2015/09/10/c...-ibd-children/

*Gut bacteria could predict asthma in kids
http://www.sciencemag.org/news/2015/...paign=facebook

*Detection of Small Bowel Mucosal Healing and Deep remission in Patients With Known Small Bowel Crohn's Disease Using Biomarkers, Capsule Endoscopy, and Imaging.
http://www.ncbi.nlm.nih.gov/pubmed/26215531

*Study Identifies New Genetic Defects that Cause Rare Cases of Very Early Onset IBD
http://www.gastro.org/news_items/201...arly-onset-ibd

*NOD2 Induces Autophagy to Control AIEC Bacteria Infectiveness in Intestinal Epithelial Cells
https://link.springer.com/article/10...8?view=classic

*Evidence Suggests Early Exposure to Antibiotics Might Lead to Long-Term Behavioural Changes
http://www.sciencealert.com/antibiot...ur-study-finds

*Mucosal healing and deep remission: What does it mean?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837253/


DIAGNOSTIC RELATED ARTICLES:


*New Type Of IBD Test For Those Undiagnosed
http://www.plosone.org/article/info%...l.pone.0039242

*Diagnostic Considerations In Paediatric IBD Management
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886370/

*Faecal Markers Of Gastrointestinal Inflammation
http://www.medscape.com/viewarticle/773411?src=nl_topic

*Terminal Ileal Biopsy, Small Bowel Imaging And Upper GI Endoscopy Are All Required For The Efficient Diagnosis Of Paediatric Crohn's Disease
http://m.adc.bmj.com/content/96/Suppl_1/A20.2.abstract

*Faecal Calprotectin In Children With Chronic Gastrointestinal Symptoms
http://www.ncbi.nlm.nih.gov/pubmed/16421055

*MRI Of The Small Bowel In Patients With Crohn's Disease
http://www.medscape.com/viewarticle/738939

*Clinical Imaging Of The Small Intestine
http://books.google.ca/books?id=sOrK...0bowel&f=false

*Faecal Calprotectin Limitations For Diagnosing Paediatric Crohn's
http://www.gesa.org.au/news.asp?id=332

*Diagnosis And Treatment Of Perianal Crohn Disease
http://www.naspghan.org/user-assets/...isease_.27.pdf

*Role Of Fecal Calprotectin As A Biomarker Of Intestinal Inflammation In Inflammatory Bowel Disease
http://onlinelibrary.wiley.com/doi/1...000-00013/full

*Interpretation Of Biochemical Tests For Iron Deficiency: Diagnostic Difficulties Related To Limitations Of Individual Tests
http://www.australianprescriber.com/magazine/20/3/74/6

*The Diagnostic Approach to Monogenic Very Early Onset Inflammatory Bowel Disease
http://www.gastrojournal.org/article...919-6/fulltext

*SICUS, MRE, CE effective for imaging small bowel in pediatric IBD
http://www.healio.com/gastroenterolo...-pediatric-ibd

*Occult Blood and Perianal Exam: Value Added in Pediatric Inflammatory Bowel Disease Screening.
http://journals.lww.com/jpgn/Abstrac...ampaign=buffer


MEDICATION RELATED ARTICLES, INCLUDING ASSOCIATED RISKS:


*Balancing Risks And Benefits of Treatment
http://www.ccfa.org/assets/pdfs/risk...transcript.pdf

*Addressing Risks And Benefits In IBD - Slideshow
http://online.ccfa.org/site/DocServe...df?docID=19022

*Remicade And Growth
http://www.drbozo.com/library/1842.pdf

*Optimizing Biologics: Remicade
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002580/

*Biologics in Paediatric Crohn's Disease
http://www.hindawi.com/journals/grp/2011/287574/

*A SONIC Boom: Making Sense Of Top Down Therapy For Crohn’s Disease
http://boards.medscape.com/forums?12...5721!comment=1

*PSC - The Case Of The Disappearing Liver Disease
http://stanmed.stanford.edu/2011spring/article6.html

*Hepatosplenic T-Cell Lymphoma In Patients Receiving TNF-α inhibitor Therapy: Expanding The Groups At Risk
http://mobile.journals.lww.com/euroj...&article=00009

*Is There A Benefit From The Concomitant Use Of Immunosuppression With Anti-TNF In Crohn's Disease; Heads Or Tails?
http://www.ncbi.nlm.nih.gov/m/pubmed...20methotrexate

*Lymphoma Risk In Children And Young Adults With Inflammatory Bowel Disease: Analysis Of A Large Single-Center Cohort.
http://www.ncbi.nlm.nih.gov/pubmed/21887728

*Methotrexate Adds No Benefit To Infliximab (Remicade) In Crohn's Disease
http://www.medpagetoday.com/MeetingCoverage/DDW/9598

*Magnesium Deficiency And Proton Pump Inhibitors (PPIs)
http://www.crohnsforum.com/showthread.php?t=44940

*New Data Supports Use Of Prometheus® Anser™ IFX Assay In Managing Infliximab Treatment Failure Among Inflammatory Bowel Disease Patients
http://phoenix.corporate-ir.net/phoe...cle&ID=1747863

*Why 40mg Of Prednisone?
http://www.ncbi.nlm.nih.gov/pmc/arti...0076/#r17007-8

*Biologics:Indications And Optimizing Therapy
http://www.advancesinibd.com/assets/...gics_print.pdf

*Review And Expert Opinion On Prevention And Treatment Of Infliximab-Related Infusion Reactions
http://www.medscape.com/viewarticle/580215

*Adalimumab (Humira) For Children With Crohn’s Disease
http://gutsandgrowth.wordpress.com/2...rohns-disease/

*Efficacy Of Adalimumab In Moderate-to-Severe Pediatric Crohn's Disease
http://www.nature.com/ajg/journal/v1...g2009372a.html

*Fighting Cancer And Other Diseases Naturally With Immune Stimulators; Qu Biologics Clinical Trial Revives Old Theory
http://blogs.vancouversun.com/2013/0...an-old-theory/

*Interview With Dr. Hal Gunn, The Founding CEO Of Qu Biologics And Developer Of "Site Specific Immunomodulation" (SSI)
http://www.crohnsforum.com/showthread.php?t=43965

*Drug Therapies And The Risk Of Malignancy In Crohn's Disease: Results From The TREAT™ Registry
http://www.nature.com/ajg/journal/v1...g2013441a.html

*Use Of biologics Within 3 Months Of Diagnosis Appears To Produce Better Outcomes At 1 Year Than Step Up With Immunomodulators (Aza and Mtx)
http://www.globalacademycme.com/clic...ee9134a23.html

*Effect Of An Enteric Coated Fish Oil Preparation On Relapses In Crohn's Disease
http://www.nejm.org/doi/full/10.1056...99606133342401

*Evaluating Lymphoma Risk in Inflammatory Bowel Disease
http://cdn.intechopen.com/pdfs-wm/35455.pdf

*Efficacy And Safety Of Treatment For Pediatric IBD
http://www.chop.edu/export/download/...4_Grossman.pdf

*Optimizing 6-Mercaptopurine And Azathioprine Therapy In The Management Of Inflammatory Bowel Disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208360/

*Effect Of A Probiotic Preparation (VSL#3) On Induction And Maintenance Of remission In Children With Ulcerative Colitis
http://www.nature.com/ajg/journal/v1...g2008118a.html

*Infliximab Maintains Durable Response And Facilitates Catch Up Growth In Luminal Pediatric Crohn's Disease
http://www.ncbi.nlm.nih.gov/pubmed/24865777

*The Use Of Sirolimus (Rapamycin) In The Management Of Refractory Inflammatory Bowel Disease In Children
http://www.ecco-jccjournal.org/artic...266-9/abstract

*Restarting infliximab for IBD after a drug holiday
http://www.medicalnewstoday.com/releases/282165.php

*Next-Generation Therapeutics for IBD - (including Entyvio and Simponi)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451973/

*Patient factors that increase infliximab clearance and shorten half-life in inflammatory bowel disease: a population pharmacokinetic study.
http://www.ncbi.nlm.nih.gov/m/pubmed/25358062/

*'Biosimilars' for children with IBD need more research, ESPGHAN expert panel states
http://www.medicalnewstoday.com/releases/296726.php

*Concomitant Use of Immunomodulators Affects the Durability of Infliximab Therapy in Children With Crohn's Disease.
http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract

*A new type of drug that could save the US billions of dollars just got one step closer to approval
http://www.businessinsider.com.au/fd...16-2?r=US&IR=T

*Efficacy and Safety of Escalation of Adalimumab Therapy to Weekly Dosing in Pediatric Patients with Crohn's Disease
http://journals.lww.com/ibdjournal/F...imumab.13.aspx

FDA Approves Lower Cost Alternative to Biotech Drug Humira
http://www.chicagotribune.com/busine...926-story.html


EEN & NUTRITION RELATED ARTICLES:


*Nutrition in Paediatric IBD - Paper
http://www.medicine.virginia.edu/cli...ril%202012.pdf

*Use of Enteral Nutrition for the Control of Intestinal Inflammation in Pediatric Crohn Disease
http://www.naspghan.org/user-assets/....29%5B1%5D.pdf

*Enteral Nutrition in Paediatric Crohn's Disease - Slide Show
http://www.ibdcme.tv/library/ppts/EnteralNutrition.pdf

*Nutrition in Pediatric Inflammatory Bowel Disease
http://mobileservices.texterity.com/...icle_id=166918

*Effect Of EEN On Gut Microflora Function In Children With Crohn's Disease
http://www.ncbi.nlm.nih.gov/pubmed/23016828

*Treatment Of Active Crohn's Disease In Children Using Partial Enteral Nutrition With Liquid Formula: A Randomised Controlled Trial
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856067/

*Effectiveness Of Concomitant Enteral Nutrition Therapy And Infliximab For Maintenance Treatment Of Crohn's Disease In Adults.
http://www.crohnsforum.com/showthread.php?t=55580

*Physician Attitudes And Practices Of Enteral Nutrition As Primary Treatment Of Paediatric Crohn Disease In North America
http://journals.lww.com/jpgn/Fulltex...Enteral.9.aspx

*Enteral Nutrition: The Neglected Primary Therapy of Active Crohn's Disease
http://journals.lww.com/jpgn/Fulltex...Therapy.3.aspx

*Enteral Nutrition and Corticosteroids in the Treatment of Acute Crohn's Disease in Children
http://journals.lww.com/jpgn/Fulltex..._in_the.5.aspx

*Definitions Of Different Types Of Enteral Formulas
http://www.thriverx.net/PDFs/Adult%2...20Formulas.pdf

*A Retrospective Study Showing Maintenance Treatment Options For Paediatric CD In The First Year Following Diagnosis After Induction Of remission With EEN: Supplemental Enteral Nutrition Is Better Than Nothing!
http://www.biomedcentral.com/1471-230X/14/50/abstract

*Enteral Nutrition in Crohn’s Disease: An Underused Therapy
http://www.hindawi.com/journals/grp/2013/482108/

*Enteral Nutrition as First-line Therapy in Treating Children and Adolescents with Crohn’s Disease
http://www.naspghan.org/files/docume...ewsltr_WEB.pdf
__________________
Mum of 2 kids with Crohn's.

Last edited by DustyKat; 09-11-2017 at 07:04 AM.
11-06-2012, 11:47 AM   #2
Tesscorm
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Great idea!! With all the great posts/links lately, I was thinking that it would be nice to have all of them in one location!

Just an idea, and I'll tag David here... would it be possible to set up a 'library' of sorts? As with all my 'tech' ideas, have absolutely no clue how it's possible but I'm thinking that if someone's post includes a link or an article, they could 'click' a button that would duplicate the post in the library. Once the button is 'clicked', that could bring up a prompt with common IBD key words and the poster could select key words that apply to that link/article. The library could act as a depository of information from all members (not just the parents) about all topics and the 'key words' could facilitate searches.

Another approach would be to still have the 'button' that would allow the duplication of the post but, instead of going into a library and selecting key words, the button would bring up a listing of all Wiki items and the poster would then select which Wiki items apply to their post. Their post would then be copied into those Wiki postings (using plural as a link may apply to a number of subjects).

Just a suggestion...
__________________
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
11-06-2012, 12:09 PM   #3
Clash
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Woohoo!! Way to go Dusty!! Thanks so much for this. I lose track of all the links and have been saving them to the computer but I like the idea of having this readily available!!! Dusty the Superhero...I'd vote for that!
__________________
Clash
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara


Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
11-06-2012, 03:59 PM   #4
crohnsinct
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DUSTY YOU ROCK! I almost feel bad about my pointy hat comment earlier.

This is awsome as I have been away for a whille and needing to get caught up...you spoil me so!
__________________
Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Remicade
Methotrexate (12.5mg wkly - oral)
Vit d 2000IU
Multi vitamin plus iron
Calcium
Folic Acid
Previously used - Prednisone, Prevacid, Enteral Nutrition

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohns
Methotrexate (15mg weekly oral)
Enteral Nutrition
Entocort
IBD-AID Diet
Vit d 1000IU
Calcium
Folic Acid
Previously used: Mtx injections
11-06-2012, 09:31 PM   #5
David
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Very interesting idea Tesscorm. I'll assign a few neurons to ponder how we might implement something like that.
11-09-2012, 02:22 PM   #6
my little penguin
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http://www.medscape.com/viewarticle/773411?src=nl_topic

Fecal markers
__________________
DS - -Crohn's -Stelara

Last edited by DustyKat; 08-17-2013 at 09:57 PM. Reason: Added to list
11-10-2012, 08:59 PM   #7
my little penguin
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Results: Twenty-five cases of HSTCL were identified. Twenty-two (88%) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16%) were in women and four patients were above 65 years of age. Twenty-four cases (96%) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone.

From:
http://mobile.journals.lww.com/euroj...&article=00009


Remicade(biologics & immunosuppressants )
So no longer just a young male risk
And per above includes all immunosuppressants ( including Mtx )
Conclusion: HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-α inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.
A lot to think about

Last edited by DustyKat; 08-17-2013 at 09:58 PM. Reason: Added to list
11-10-2012, 10:38 PM   #8
my little penguin
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Pediatric Inflammatory
Bowel Disease:
Highlighting Pediatric
Differences in IBD
Cary G. Sauer, MD,MSca, Subra Kugathasan, MDb,*


Inflammatory bowel disease (IBD) includes Crohn disease (CD) and ulcerative colitis
(UC), and is often diagnosed in late childhood and early adulthood. IBD is thought
to develop as a result of dysregulation of the immune response to normal gut flora
in a genetically susceptible host. Approximately 25% of incident cases of IBD occur
during childhood and the rest occur throughout adulthood, peaking in the second
and third decades of life. What determines the age of onset remains unexplained.
Studying early-onset presentation and epidemiology of complex predominately adult
diseases such as IBD is particularly necessary, as the early onset may represent the
‘‘pure’’ form of the disease process and hence may hold secrets of the initiating events
of IBD pathogenesis. Basic, translational, and clinical scientists continue to focus on
pediatric IBD, because it may shed light not only on the cause but also the prevention
of this lifelong disease. Over the last decade, data from pediatric IBD studies have
demonstrated many similarities and differences between pediatric and adult onset,
which continue to add pieces to an increasingly complex IBD puzzle. The mechanism
responsible for these similarities and differences remains unanswered.
The purpose of this article is to discuss clinically relevant epidemiology and treatment
aspects of pediatric IBD, with a special focus on similarities and differences in
pediatric and adult IBD. Epidemiologic similarities and differences may ultimately
provide the link to a better understanding of the pathogenesis of IBD. This article
also highlights evidence-based treatment algorithms, with special focus on pediatric
studies and care for children.

from:
http://www.meteo.mcgill.ca/~manyan/T...20in%20IBD.pdf

Last edited by DustyKat; 08-17-2013 at 09:58 PM. Reason: Added to list
11-11-2012, 02:55 AM   #9
DustyKat
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Two excellent articles mlp! Thanks for posting.

Dusty.
11-11-2012, 10:41 AM   #10
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Over the last some years the increasing knowledge on the pathogenesis of Crohn's disease led to the development of a number of biological agents targeting specific molecules involved in gut inflammation, first of all TNF-alpha and its receptors. Infliximab, adalimumab and certolizumab have been successful in inducing and maintaining remission in Crohn's disease at both short and long term. This was recently confirmed by a Cochrane meta-analysis and also open label extension follow-up and cohort studies. Emerging new data however indicate that combination therapy with infliximab-azathioprine appears to have added benefit in inducing steroid-free remission and mucosal healing than either infliximab or azathioprine alone in azathioprine-naďve patients with early disease. Similarly the combination of steroids induction and infliximab was efficacious in luminal Crohn's disease. In contrast, there seems to be no synergism between methotrexate and infliximab. It is also less clear whether it is beneficial to use short or long-term infliximab-azathioprine combination in patients who previously failed therapy with azathioprine. In contrast, combination may potentially be associated with increased risk for infection and cancer. In case control-studies, especially the combination of steroids and anti-TNF and older age increased the risk for infectious complications, while scattered case reports point to the potentially increased risk of a rare form of non-Hodgkin's lymphoma (Hepatosplenic T cell lymphoma) with the use of azathioprine-anti-TNF combination. The aim of this review is to summarize the benefits and risks for the use combination therapy with TNF-alpha inhibitors in the treatment of Crohn's disease.
From:
http://www.ncbi.nlm.nih.gov/m/pubmed...20methotrexate

So no benefit seen by adding Mtx to remicade...

Last edited by DustyKat; 08-17-2013 at 09:58 PM. Reason: Added to list
11-12-2012, 11:19 AM   #11
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Thought this might be of interest as so many seem to have hip pains.



Iliopsoas Bursitis Presenting as Hip Pain Secondary to Crohn's Fistula

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http://www.ispub.com/journal/the-int....eCaGqUXg.dpbs

Last edited by DustyKat; 08-17-2013 at 09:59 PM. Reason: Added to list
11-16-2012, 08:20 PM   #12
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Conclusions: More than half of children diagnosed with CD present with ileocolonic disease. Patients with disease involvement of the terminal ileum are more likely to present with stricturing disease complications, indicating a particular surveillance and treatment strategy. The Paris classification is a useful tool to capture the variety of phenotypic characteristics of paediatric CD.
From:
https://www.nvge.nl/uploads/nF/qt/nF...ering-2012.doc


Disease phenotype at diagnosis in paediatric Crohn’s disease:
5-year analyses of the EUROKIDS registry

C.I. de Bie1, A. Paerregaard2, S. Kolacek3, F.M. Ruemmele4, S. Koletzko5, J.M.E. Fell6,
J.C. Escher1, and the EUROKIDS Porto IBD Working Group of ESPGHAN
11-16-2012, 08:34 PM   #13
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Background: Jejunoileitis (JI) is an unusual manifestation of Crohn’s disease (CD) that has been associated with high morbidity and the frequent need for surgical intervention. Although the disease has been well-described in adults, the true prevalence and clinical phenotype in children is unknown.
Aim: To compare the clinical course and nutritional impact of CD in children with and without proximal small bowel involvement.
Methods: Patients with either Crohn’s jejunitis or JI with or without colonic involvement were identified through a clinical database (1996–2002). All radiologic studies were reviewed by an experienced radiologist blinded to the clinical diagnosis. Thirty-six patients with CD without histologic or radiologic signs of proximal small bowel involvement were used for comparison. All medical, surgical, and hematologic parameters were compared in both disease groups.
Results: Among the 134 patients with CD, 23 (17%) had radiologic signs of JI, including intestinal fold thickening (57%), luminal nar- rowing (31%), and skip lesions (13%). Enteric fistula (6%) and stric- tures (6%) were less common. Patients with JI were likely to be stunted at the time of diagnosis, require surgical intervention (P < 0.03) and nutritional therapy in the form of nasogastric tube feeds (P < 0.03). Nutritional therapy was also associated with an improvement in height in patients with proximal small bowel disease (OR:5.87).
Discussion: JI is a relatively common disease phenotype in children with CD that requires aggressive nutritional and surgical intervention. Future studies are required to determine if the early detection and use of immune modulators may lessen the morbidity associated with proximal small bowel disease

From:
http://onlinelibrary.wiley.com/store...1xq6z&ad3f5a3d

Pediatric Jejunoileitis:
A Severe Crohn’s Disease Phenotype That Requires Intensive Nutritional Management
T. M. Attard,* K. M. Horton,† K. DeVito,* A. Darbari,* M. Oliva-Hemker,* R. Thompson,‡ and C. Cuffari*

Last edited by DustyKat; 08-17-2013 at 10:01 PM. Reason: Added to list
11-16-2012, 08:37 PM   #14
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Background. Delayed growth is a well-established feature of pediatric Crohn's disease. Several factors have been shown to affect growth, including disease location, severity, and treatment. The recently discovered NOD2 gene has been correlated to ileal location of Crohn's disease and subsequently could affect growth through the resulting phenotype or as an independent risk factor. The aim of our study was to determine if growth retardation is affected by genotype independently of disease location or severity.

From:
http://pediatrics.aappublications.or.../1281.abstract

Pediatric Crohn's Disease and Growth Retardation: The Role of Genotype, Phenotype, and Disease Severity


Last edited by DustyKat; 08-17-2013 at 10:01 PM. Reason: Added to list
11-16-2012, 08:52 PM   #15
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Terminal ileal biopsy, small bowel imaging and upper GI endoscopy are all required for the efficient diagnosis of paediatric crohn's disease



Differentiating Crohn's disease from UC and IBDU is vital for children. Appreciable phenotypic differences exist between adult and paediatric-onset Crohn's disease (PCD) at diagnosis. Guidelines (JPGN 2010;50:S1–S13) for PCD diagnosis recommend assessment by upper-gastrointestinal endoscopy (UGIE), colonoscopy with terminal ileal (TI) biopsy and small-bowel imaging (SBI). We aimed to establish the relative contribution of each part of evaluation to PCD diagnosis
From:
http://m.adc.bmj.com/content/96/Suppl_1/A20.2.abstract

Last edited by DustyKat; 08-17-2013 at 10:03 PM. Reason: Added to list
11-16-2012, 08:55 PM   #16
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Immune responses to microbial antigens are associated with more aggressive disease phenotypes among children with Crohn's disease, reports the latest issue of the American Journal of Gastroenterology.

From:
http://www.gastrohep.com/news/news.asp?id=4060

Immune responses predict disease progression in pediatrics Crohn's



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11-16-2012, 09:08 PM   #17
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Variation in care in pediatric Crohn’s disease




Objectives: Variation in medical care can be a barrier to improving clinical outcomes. We aim to describe the variation in care of Crohn disease as provided by a broad sample of pediatric gastroenterologists.

Methods: Two hundred forty-six Crohn disease patients of 93 pediatric gastroenterologists from 48 practice sites starting treatment with either thiopurine or infliximab were studied. We assessed variation in diagnostic testing that had been performed to establish the diagnosis of Crohn disease and to assess the phenotype, extent, and severity of disease. We also assessed variation in initial thiopurine and infliximab dosage and in nutritional therapy.

Results: Diagnostic studies in which care was uniform included complete blood count, performed in 100% of patients, erythrocyte sedimentation rate and colonoscopy in 96%, and upper endoscopy in 89%. However, imaging of the small bowel had not been performed in 19%, and a stool test for pathogens had not been performed in 29%. Thiopurine methyltransferase (TPMT) had been measured in 61% of patients before treatment with a thiopurine; in 85%, TPMT was normal. Nonetheless, even when TPMT was normal, 40% of patients received an initial dose of thiopurine that was lower than recommended. Testing for tuberculosis before initiating treatment with infliximab was not performed in 30%. In addition, 36% of severely underweight patients were not receiving a multivitamin supplement, supplemental formula, or tube feeding.

Conclusions: There is variation in diagnostic and therapeutic interventions in the management of pediatric Crohn disease, and gaps exist between recommended and actual care. JPGN 49:297–303, 2009. "

From:
http://c3nproject.org/research/varia...80%99s-disease

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11-16-2012, 09:16 PM   #18
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http://www.ibdcme.tv/library/ppts/EnteralNutrition.pdf

EEN
Study slides

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11-16-2012, 09:22 PM   #19
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Gastroenterol Hepatol (N Y). 2009 November; 5(11): 775–783.
PMCID: PMC2886370
Diagnostic Considerations in Pediatric Inflammatory Bowel Disease Management

Carmen Cuffari, MD



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Abstract
Approximately 20% of all inflammatory bowel disease (IBD) first presents in childhood or adolescence, and approximately 10% of the estimated 1.4 million Americans with IBD are under age 17. Diagnosis in pediatric patients may be complicated at presentation due to atypical symptoms and/or extraintestinal manifestations (eg, short stature, chronic anemia, unexplained fever, arthritis, mouth ulcers). Pediatric IBD is traditionally diagnosed using endoscopic evaluations of the upper and lower gastrointestinal tract with mucosal biopsies for histologic confirmation. Less invasive serologic testing for IBD may be particularly valuable in pediatric patients, particularly given the association between serum immune reactivity and severe disease phenotypes that is drawing increasing attention. These serologic markers may help stratify risk and identify appropriate pediatric candidates for early aggressive therapy. Serologic testing in pediatric patients includes traditional IBD serologic markers such as anti–Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibody, as well as newer antimicrobial antibodies, including antibodies to outer membrane porin C; I2, a bacterial sequence derived from Pseudomonas fluorescens; and CBir1 flagellin, a colitogenic antigen of the enteric microbial flora in C3H/HeJBir mice strain. Given recent data associating seropositivity with aggressive clinical phenotypes and rapid disease progression, serologic testing may allow early initiation of therapy, maintenance of remission, reduction of corticosteroid exposure, facilitation of mucosal healing, and restoration of normal growth velocity.
Keywords: Inflammatory bowel disease, diagnosis, serologic markers, pediatric, phenotypes, prognostic, biologic therapy
From:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886370/

Last edited by DustyKat; 08-18-2013 at 12:32 AM. Reason: Added to list
11-22-2012, 08:40 AM   #20
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Lymphoma Risk in Children with Inflammatory Bowel Disease

Due to the early age of immune suppression exposure in children with inflammatory bowel disease (IBD), there is concern that such medication may lead to an increased risk of malignancy. This possibility is especially concerning as there is an increased risk of hepatosplenic T-cell lymphoma in children with IBD in young males who are receiving thiopurines with or without the addition of anti-tumor necrosis factor (TNF) antibodies.

The authors of this study retrospectively evaluated a large IBD data set over a 30-year period to determine actual patient risk. This study was comprised of 1560 study subjects from 1979 to 2009 who were treated at a single-pediatric tertiary care center with expertise in IBD. Follow-up time of all patients after an initial diagnosis of IBD was calculated in months up until their current visit or until they left the practice. The amount of time of treatment for IBD for all medication classes, including thiopurines and anti-TNF antibodies was also calculated.

In order to determine medication risk, “Patient-years taking medications” was used to determine the total number of years that patients were treated with specific medical therapies. “Patient-years observed” was used to determine the aggregate number of months a patient was exposed to a specific medical therapy.

In total, 1374 patient charts qualified for analysis. There was a mean follow-up of 4.8 ± 3.4 years per patient with 58% of patients having Crohn disease, 39% having ulcerative colitis, and 3% having inflammatory bowel disease unclassified. A thiopurine agent was used in 61% of patients, and 22% of patients were treated with an anti-TNF antibody. When all patients were considered, only 2 cases of lymphoma were identified in follow up visits. Both patients were males (12 and 18 years of age), and both were receiving thiopurine treatment. Both patients were treated with chemotherapy and were alive after treatment. A third patient receiving thiopurine therapy was diagnosed with EBV-related hemophagocytic lymphohistiocytosis, and the disease was successfully treated with discontinuation of the thiopurine. This data helped determine a risk of two lymphomas per 2574 patient-years if patients were actually taking this medication, and a risk of two lymphomas per 4441 patient-years if a patient had ever taken a thiopurine. The absolute incidence rate of lymphoma in children receiving thiopurines was 3 per 10,000 patient-years. Of note, no lymphomas were noted in any patient receiving anti-TNF antibody therapy. This absolute incidence was compared to the National Cancer Institute Surveillance Epidemiology and End Results database which showed an incidence lymphoma rate of all children 19 years or younger of 4.5 per 10,000 patient-years in children receiving thiopurines and of 0.58 per 10,000 patient-years in all children.

This study suggests that the risk of lymphoma development was low in this study in a manner similar to other studies although the results were not statistically significant. There appears to be a slight risk of lymphoma development in children with IBD receiving thiopurines in which the causes (such as genetic risk factors) need to be further elucidated.

(Ashworth L, Billett A, Mitchell P, Nuti F, Siegel C, Bousvaros A. “Lymphoma risk in children and young adults with inflammatory bowel disease: analysis of a large single-center cohort.” Inflammatory Bowel Diseases. 2012: 18: 838-843).

Lymphoma risk Ibd children
11-22-2012, 10:34 AM   #21
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Prometheus Launches New Monitoring Test To Help Guide Inflammatory Bowel Disease Management

PROMETHEUS® Anser ™ IFX designed to help identify potential causes for loss of treatment response among

IBD patients using infliximab

SAN DIEGO, PRNewswire – Prometheus Laboratories Inc., a specialty pharmaceutical and diagnostic company, announced today the market launch of its proprietary new generation monitoring test, PROMETHEUS Anser IFX. This test measures drug (infliximab) and drug antibody levels in one sample among inflammatory bowel disease (IBD) patients using infliximab – helping physicians identify potential causes for loss of treatment response and helping to guide patient management decisions. This is the first commercial test utilizing Prometheus' proprietary homogenous mobility shift assay (HMSA) platform technology. 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.

The Crohn's and Colitis Foundation of America estimates that approximately 1.4 million Americans suffer from IBD. Approximately 50% of IBD patients using infliximab may eventually experience a loss of treatment response during their treatment. For some patients, this loss of treatment response may be the result of insufficient infliximab levels. For others, the loss may be due to the development of antibodies to infliximab (ATI). If the loss of treatment response is due to the development of ATI, increasing the infliximab dose – the most common first step for physicians – may be less effective than switching to another treatment agent. PROMETHEUS Anser IFX test was verified with more than 3,000 IBD clinical patient samples.

New remicade test from:
Practical Gastro sept 2012
11-24-2012, 03:35 PM   #22
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Nutrition in Pediatric Inflammatory Bowel Disease



Approximately 25% of patients with inflammatory bowel disease (IBD) have the onset of their disease within the first 2 decades of life. Malnutrition is frequent in patients with IBD, especially those with Crohn's Disease (CD). Various micronutrient deficiencies also contribute to morbidity in these patients. Liquid nutrition is frequently utilized to manage the group of patients with malnutrition. In pediatric CD, there is considerable evidence to support the use of polymeric formula as exclusive nutrition to induce remission in newly diagnosed patients, as well as in those with relapses. Exclusive enteral nutrition is an attractive alternative to corticosteroids in patients with CD. There is no evidence for using exclusive enteral nutrition for inducing or maintaining remission in patients with UC. We review the nutritional aspects of patients with IBD and the use of liquid enteral nutrition for remission induction in pediatric patients with IBD
From:

http://mobileservices.texterity.com/...mobileWeb=true



A definition of growth impairment in terms of a static height measurement may be misleading, since it is influenced by parental height and pubertal status. A patient may be normally short; conversely a previously tall child may not have grown for 2 years but may still be of average stature for age and gender. Serial measurements showing a fall from higher to lower percentiles and height velocity expressed as a z-score for age and gender should be used to define growth faltering. Height velocity z-score for age and gender is the most sensitive parameter to recognize impaired growth. One of the drawbacks of height velocity is that normal standards for height velocity throughout childhood are based on height increments during 12-month periods. It is recommended that height velocities be calculated over intervals no shorter than every 6 months. A height velocity z-score of-2 over a 12-month period equates to a reduction in height z-score of approximately 0.3 to 0.4. It should be noted that BMI may not be a reliable marker of nutrition status in pediatric IBD; it does not reflect alterations in body composition (i.e., decreased skeletal muscle). Thus, BMI can underestimate malnutrition in patients with inflammatory bowel disease (9). Recent evidence has shown that children with CD have decreased fat-free mass 2 years after diagnosis, even in those patients with clinical improvement (including weight gain), suggesting that weight gain was mainly due to an increase in fat mass.

Impaired linear growth is defined by at least one of the following criteria: (10)

1. Height z-score at diagnosis or subsequently significantly less than expected height z-score

• Difference between observed height z-score and predicted height z-score using the ‘Mid-parental Heights’ formula is >2.0 OR

• Difference between observed height z-score and the ‘pre-illness' height z-score is >1.0

2. Current height z-score significantly less than height z-score at diagnosis or reduction in height z-score since diagnosis is < 0.75

Assessment of pubertal status by Tanner staging should be an integral part of nutrition and growth assessment in patients with IBD. Self-assessment using line drawings and written descriptions of Tanner stages have been validated in children with CD (11). In girls, menarchal status should also be ascertained. Females enter the adolescent growth spurt relatively early in puberty, while in males it occurs late (Tanner 4). The growing phase could be considered final once they have entered Tanner stage 5 and they have demonstrated less than 0.5 cm linear growth in 12 months.

Last edited by DustyKat; 08-18-2013 at 12:39 AM. Reason: Added to list
11-24-2012, 08:13 PM   #23
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Asthma

The lifetime asthma prevalence in the United States per 2010 CDC survey is approximately 13.5% (18). Asthma therapy is typically based on the frequency, severity, and time of day of asthma symptoms. Mainstays in the therapy of asthma include both short and long acting inhaled beta 2 adrenergic receptor agonists (albuterol, salmeterol), anticholinergics (ipratropium), inhaled glucocorticoids (budesonide, fluticasone), leukotriene receptor antagonists (montelukast), theophylline, and anti IgE therapy (omalizumab). Using the Lexi-Comp and Epocrates databases interactions between Asthma and IBD medications were evaluated. Medications evaluated for IBD include prednisone, 5-ASA, mercaptopurine, azathioprine, infliximab, and methotrexate.

Interactions between these drug classes include an increased risk of hypokalemia with prednisone and either long or short acting beta 2 receptor agonists. The combination of infliximab and theophylline may lead to decreased levels of theophylline levels due to altered hepatic metabolism. Methotrexate should be avoided in these patients do to the increased risk of pulmonary fibrosis. Finally a significant side effect was noted between the combination of methotrexate and theophylline. Used in conjunction these medications may increase theophylline levels and decreases methotrexate levels.

From
http://mobileservices.texterity.com/...mobileWeb=true

Primary Care Considerations in the Management of Inflammatory Bowel Disease Patients

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11-25-2012, 09:43 PM   #24
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Abstract
Growth retardation (GR) may pose a significant challenge to the quality of life and the proper management of children and adolescents with Crohn's disease (CD). It can occur in a significant proportion of patients, and may precede clinical evidence of bowel disease. Current evidence suggests that GR is a complex interaction between nutritional status, inflammation, disease severity, and genotype, which causes resistance to the effects of growth hormone. Recent research has identified a key role for the inflammatory cytokines TNF alpha, IL-6, and IL1 beta. This review summarizes current knowledge as well as gaps in our understanding of the mechanisms involved and the usefulness of the different treatment modalities in promoting growth in CD patients.

(Inflamm Bowel Dis 2007)

Crohn's disease (CD) in children and adolescents is a complex disorder with a relapsing course that can be very difficult to manage for patients and physicians alike. Like adults, children and adolescents are prone to the same diverse array of complications stemming from the disease and its therapy, with the exception of growth failure and delayed puberty. These complications occur primarily in pediatric onset CD, and may pose a significant challenge to the quality of life and the proper management of these children. With our expanding therapeutic options for induction and maintenance of remission, GR often remains the most vexing and significant source of consternation for patients and care takers alike. This article provides a review of the physiologic determinants of normal growth and a literature-based review of potential risk factors for GR in children and adolescents with CD. These factors include the inflammatory process, disease severity and location, nutritional state, drugs, and genes. We will also discuss the evidence for medical, nutritional, and surgical interventions on growth.

Growth failure occurs in 15%–40% of children with inflammatory bowel disease (IBD)1 and growth failure may precede clinical evidence of bowel disease by a few years.2 Growth failure is less common in ulcerative colitis (UC) compared to CD both at diagnosis and during follow-up.1, 3 In CD, temporary growth failure occurs in 40%–50% of affected children2 and stunting into adulthood may persist in 15%–30% of patients.4, 5 In 1 study of 105 children with CD admitted to hospital during 1968–1983, it was shown that despite GR in the teenage years, most young people with IBD eventually achieved normal height.6 Many studies, however, have found that height at maturity is often compromised.3 Hildebrand et al,7 in a study following 128 IBD patients longitudinally from childhood to adulthood, suggested that up to 25% will not achieve their growth potential. Furthermore, final height remains below the 5th percentile in 7%–30% of patients.5, 7, 8–10 Sawczenko et al8 recently conducted a retrospective review of 123 adult patients with disease onset below age 16. They reported a more modest deficit, and found that 19% of these adults had achieved a final height below their target height.

Normal linear growth occurs via activation of the growth hormone (GH) insulin-like growth factor 1 (IGF-1) axis while supported by an adequate supply of nutrients. GH secreted from the pituitary gland stimulates the release of IGF-1. IGF-1 stimulates the proliferation and hypertrophy of chondrocytes in the epiphyseal growth plate, resulting in growth of the long bones (Fig. 1). Circulating IGF-1 is found in complexes with high-affinity IGF binding proteins (IGFBPs). There are at present 6 known IGFBPs. Most serum IGF-1 binds to IGFBP-3, which in turn is regulated by GH. The binding protein IGFBP-1 is regulated primarily by insulin levels, but also by corticosteroids. IGFBP-1 expression is increased in states of insulopenia and starvation and by corticosteroids in a dose-dependent manner.11, 12 Factors that increase IGFBP-1 may decrease the availability of bioactive IGF-1.
from:

http://onlinelibrary.wiley.com/doi/1...ibd.20115/full

Growth retardation in pediatric Crohn's disease: Pathogenesis and interventions

Raanan Shamir MD1,4, Moshe Phillip MD2,5, Arie Levine MD3,5,*


TREATMENT STRATEGIES
Enteral Nutrition and Growth
Enteral nutrition has been shown to promote and restore growth in pediatric CD. Sustained enteral nutrition (EN) may promote growth through several pathways: by inducing remission, by supply of micro- and macronutrients as well as calories required for growth, or by decreasing circulating cytokines. In an important study, Banerjee et al52 prospectively investigated the effect of polymeric EN on inflammatory markers and indices of nutritional restitution in children with active CD. They found a decrease in circulating IL-6 by day 3 of the study. A decrease in serum CRP, IL-6, and an increase in serum IGF-1 were noted by day 7, while measures of nutritional improvement occurred only from day 14. Of note, this important study included a small cohort that was not growth retarded, the baseline IGF-1 concentrations were not very low, and consistent marked improvement was noted from day 14. Given the small number of patients involved and fluctuations noted until day 14 in the median and range of IGF-1, more data are required before it can be established that an early elevation in IGF-1 is not due to an increase in protein and caloric delivery. Two additional studies evaluated the effect of EN on IGF-1. One supported a rise in IGF-1 by day 14 and the other did not.34, 53 Thus, at present, the mechanism by which EN affects growth remains to be determined.

A recent Cochrane review established that, despite the paucity of controlled, well-designed studies, current evidence indicates that EN may be superior to corticosteroids for achieving an increase in height velocity.1 In a small but randomized controlled study of 24 children with active CD, high-dose steroids (prednisolone 2 mg/kg/day for 2 weeks, maximum 60 mg/day, reduced based on clinical response) were compared to an elemental diet given exclusively for 4 weeks.54 In that study there was a similar improvement in disease activity and duration of remission in both groups, regardless of the site of disease. Nevertheless, subsequent growth velocity was significantly better in the group treated with the elemental diet (+0.3 ± 3.3) compared to the corticosteroid group (−3.1 ± 2.8), despite a greater and more sustained increase in energy intake in the group treated with steroids. Similar results were obtained in 2 more studies.55, 56, 57 In the only meta-analysis of pediatric studies58 including nonrandomized studies and abstracts, EN was found to have a significant effect on height velocity standard deviation scores compared to steroid treatment. One reason that sustained EN may lead to better short-term growth over steroids may have to do with a superior improvement in lean body mass (which is associated with an increase in IGF-1), while steroids may preferentially increase fat accretion.17 A single study has shown that corticosteroids increase circulating IGF-1 blood levels during treatment of active disease in an adult population.33 Of note, free IGF-1 did not return to levels noted in a control population. More data are required in order to evaluate or compare the effect of corticosteroids on IGF-1 and growth in children.

Enteral nutrition (polymeric or elemental formulas) can induce remission in CD patients.58, 59 In adults, remission rates are higher with steroids compared to EN, while in children data are conflicting,54, 58 with 1 meta-analysis showing that steroids and EN result in similar remission rates.58 EN may have an effect on growth even after remission was achieved.10, 60 Thus, the effect of EN on growth is most likely the result of the combined effects of improved nutrition on GH IGF-1 axis, effect of EN on inflammation, and direct effect that nutrition might have on linear growth.

Since low caloric intake often contributes to growth failure, it is reasonable to assume that oral nutrition supplementation increases caloric intake. However, oral supplements are not tolerated for a long period of time, and in most cases with GR and inadequate caloric intake tube feeding is needed. Children learn very quickly to swallow the feeding tube every night without interruption of daily activities.61 Another option is the use of percutaneous gastrostomy (PEG) tubes, and there are reports in children with CD demonstrating the efficacy and safety of using PEG for long-term nutrition support.62, 63

Since remission is a key goal for resumption of adequate growth, it is unknown whether total or partial EN have equivalent effects needed to achieve remission. One recent study addressing this question demonstrated that remission rate with partial EN (50% of daily calories as an elemental diet) was significantly lower than with total EN (100% of calories) given for a 6-week period (15% versus 42%). Furthermore, only total EN lead to a significant decrease in erythrocyte sedimentation rate (ESR).64 In that context, one must bear in mind that EN may be more likely to induce endoscopic and histologic improvement when the ileum is involved.65

Last edited by DustyKat; 08-18-2013 at 12:42 AM. Reason: Added to list
11-30-2012, 07:56 PM   #25
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Major loss of body protein mass in inflammatory bowel disease is much less common than weight loss, which is often attributable to losses of other body, particularly water and fat. It does occur, however, in a few patients, especially in those with compromised food intake. It is due principally to the combined effects of diminished intake and excessive intestinal losses of amino nitrogen. Nitrogen metabolism is influenced not only by protein nutritional state and net nitrogen intake but also by disease activity. There is some evidence for abnormally low secretion of growth hormone in adolescents with inflammatory bowel disease and growth failure. Low serum albumin concentrations are not necessarily related to protein undernutrition and are the combined result of relatively reduced albumin synthesis, increased intestinal losses, and maldistribution between intravascular and extravascular spaces. Concentrations in the plasma of IgG and acute phase reactants may be raised despite increased losses into the bowel lumen. The prevention of total body protein depletion is achieved principally by maintaining adequate and often not supranormal intakes of a balanced source of amino nitrogen in a balanced diet given orally, enterally, or parenterally, combined with a medical or surgical approach to reduce disease activity: supranormal energy intakes are not beneficial.
From:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434623/

Gut. 1986 November; 27(Suppl 1): 67–71.
PMCID: PMC1434623
Protein metabolism in inflammatory bowel disease.



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11-30-2012, 08:01 PM   #26
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Growth Failure in Pediatric Inflammatory Bowel Disease: Prevalence, Risk Factors, and Treatment


Caloric and Selected Nutrient Supplementation
The use of enteral/parenteral nutrition as primary ther- apy of active Crohn’s disease is beyond the subject of this review. What follows below is a review of recent data regarding treatment of growth failure, not active disease.
Children with quiescent Crohn’s disease do not have an elevated REE (11). Adaptation downward in REE in CD patients secondary to weight loss appears to be offset by mucosal inflammation (29). Short-and long-term refeeding studies demonstrate significant and sustainable catch-up growth (both height and weight) with aggressive enteral refeeding (29-31). Multiple studies have shown improved height velocity in patients with Crohn’s disease with enteral nutrition, irrespective of whether this was given as nocturnal supplementation, exclusive elemental feeds, or cycling. Many did not comment on pubertal status, and follow-up periods ranged from 6 weeks to 18 months (7,12,32–36).
Therefore,
From:
http://www.practicalgastro.com/pdf/J...ionArticle.pdf

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11-30-2012, 08:06 PM   #27
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Table 1
Accepted Definitions of Growth Failure
• Height below 3rd percentile
• Height velocity less than 3rd percentile for age
• Drop in trajectory of the growth curve >2 major
percentile lines
• Bone age greater than 2 standard deviations below
chronological age
Change in height velocity by pubertal staging
Prepubertal
Females (Tanner 2–3) Males (Tanner 3–4)
4.4 cm/yr 9 cm/yr 10.3 cm/yr

From paper above
11-30-2012, 08:40 PM   #28
Jmrogers4
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Thanks MLP, I didn't understand it all but I think I will print out and bring to Jack's GI (He's gone from 70% on charts in height to 17% and 50% in weight to 7% over the last 3 years
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Jacqui

Mom to Jack (18) dx Crohn's 2/2010
Vitamin D -2000mg
Remicade - started 1/9/14; 7.5ml/kg every 6 weeks
Centrum for Him teen multivitamin
Past meds: Imuran/Azathioprine; allopurinol; methotrexate; LDN; Prednisone; Apriso; Pentasa; EEN

Husband dx Crohn's 3/1993
currently none due to liver issues
11-30-2012, 10:38 PM   #29
my little penguin
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Gastroenterol Hepatol (N Y). 2009 November; 5(11): 775–783.
PMCID: PMC2886370
Diagnostic Considerations in Pediatric Inflammatory Bowel Disease Management

Carmen Cuffari, MD


From:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886370/

Approximately 20% of all inflammatory bowel disease (IBD) first presents in childhood or adolescence, and approximately 10% of the estimated 1.4 million Americans with IBD are under age 17. Diagnosis in pediatric patients may be complicated at presentation due to atypical symptoms and/or extraintestinal manifestations (eg, short stature, chronic anemia, unexplained fever, arthritis, mouth ulcers). Pediatric IBD is traditionally diagnosed using endoscopic evaluations of the upper and lower gastrointestinal tract with mucosal biopsies for histologic confirmation. Less invasive serologic testing for IBD may be particularly valuable in pediatric patients, particularly given the association between serum immune reactivity and severe disease phenotypes that is drawing increasing attention. These serologic markers may help stratify risk and identify appropriate pediatric candidates for early aggressive therapy. Serologic testing in pediatric patients includes traditional IBD serologic markers such as anti–Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibody, as well as newer antimicrobial antibodies, including antibodies to outer membrane porin C; I2, a bacterial sequence derived from Pseudomonas fluorescens; and CBir1 flagellin, a colitogenic antigen of the enteric microbial flora in C3H/HeJBir mice strain. Given recent data associating seropositivity with aggressive clinical phenotypes and rapid disease progression, serologic testing may allow early initiation of therapy, maintenance of remission, reduction of corticosteroid exposure, facilitation of mucosal healing, and restoration of normal growth velocity.
Keywords: Inflammatory bowel disease, diagnosis, serologic markers, pediatric, phenotypes, prognostic, biologic therapy

Last edited by DustyKat; 08-18-2013 at 12:46 AM. Reason: Added to list
11-30-2012, 10:57 PM   #30
my little penguin
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International Journal of Inflammation
Volume 2012 (2012), Article ID 687143, 7 pages
doi:10.1155/2012/687143
Review Article
Dysbiosis in the Pathogenesis of Pediatric Inflammatory Bowel Diseases
Donatella Comito and Claudio Romano
Pediatric Department, University of Messina, 98125 Messina, Italy
Received 10 November 2011; Revised 18 January 2012; Accepted 1 February 2012



From:
http://www.hindawi.com/journals/iji/2012/687143/

Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract that occur in genetically susceptible individuals. Crohn’s disease (CD) and ulcerative colitis (UC) are two major types of IBD. In about 20–25% of patients, disease onset is during childhood and pediatric IBD can be considered the best model for studying immunopathogentic mechanisms. The fundamentals of IBD pathogenesis are considered a defective innate immunity and bacterial killing with overaggressive adaptive immune response. A condition of “dysbiosis”, with alterations of the gut microbial composition, is regarded as the basis of IBD pathogenesis. The human gastrointestinal (GI) microbial population is a complex, dynamic ecosystem and consists of up to one thousand different bacterial species. In healthy individuals, intestinal microbiota have a symbiotic relationship with the host organism and carry out important metabolic, “barrier,” and immune functions. Microbial dysbiosis in IBD with lack of beneficial bacteria, together with genetic predisposition, is the most relevant conditions in the pathogenesis of the pediatric IBD.

Last edited by DustyKat; 08-18-2013 at 12:48 AM. Reason: Added to list
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