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


 
10-19-2013, 11:43 PM   #91
Tesscorm
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Change in the treatment strategy for pediatric Crohn's disease

Discusses top-down vs. bottom-up approaches

http://synapse.koreamed.org/DOIx.php...830&vmode=FULL
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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
10-29-2013, 01:56 PM   #92
Jenn
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Hi, just found this, thought it really interesting:

Mucus useful in treating IBD
http://www.sciencedaily.com/releases...0926143147.htm

and this:
http://www.sciencemag.org/content/34...urce=shortener

I thought about this when my son was first dx'ed, he was never a snot-nosed kid, know what I mean? Had trouble with ear infections and asthma too. Also had a lot of mucus in his stool as a baby, years before dx. Curious. Would also be a different kind of therapy for sure.
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Jennifer ~ son dx at age 8, Sep 2010
currently on Humira, Feb 2012+, MTX (20mg) Aug 2017+, folic acid
past use: 6mp for Sep 2010-Apr 2011 (not effective enough), then Remicade April 2011-Dec 2011 (built antibodies); additional 6MP Aug 2012-Sep 2013; Periactin for appetite Sep 2010-Sep 2013
other: Centrum chewable multi; calcium-vitD;
Derma-Smoothe for psoriasis rashes; Alrex, Zaditor eye drops for vernal conjunctivitis; history of asthma, ear infections

Last edited by Jenn; 10-29-2013 at 02:15 PM.
11-06-2013, 10:07 PM   #93
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Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease

http://onlinelibrary.wiley.com/doi/1...000-00013/full
11-06-2013, 10:43 PM   #94
my little penguin
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Role of Fecal Calprotectin as a Biomarker of Intestinal
Inflammation in Inflammatory Bowel Disease
Michael R. Konikoff, MD and Lee A. Denson, MD

http://www.google.com/url?sa=t&rct=j...56146854,d.aWc

same article but gives you the pdf version
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11-27-2013, 11:59 AM   #95
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Thalidomide May Help Kids With Crohn's Disease:

http://health.usnews.com/health-news...crohns-disease
11-27-2013, 12:11 PM   #96
my little penguin
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Yes but thalidomide can cause neuropathy as well


Anti-tumour necrosis factor-α antibodies are useful for the treatment of refractory Crohn's disease and ulcerative colitis. Thalidomide is another agent with tumour necrosis factor-α suppressive properties.

Aim
To investigate the long-term efficacy and safety of thalidomide in a group of children and young adults with refractory inflammatory bowel disease.

Methods
Twenty-eight patients with refractory moderate-severe inflammatory bowel disease (19 Crohn's disease, 9 ulcerative colitis) received thalidomide 1.5–2.5 mg/kg/day. Patients were assessed at baseline, at weeks 2, 4, 8 and 12, and then every 12 weeks by patient's diary, physical examinations, laboratory analyses and scoring on activity indexes. Primary outcomes were: (i) efficacy in inducing remission; and (ii) efficacy in maintaining remission.

Results
remission was achieved with thalidomide in 21 of 28 (75%) patients (17 with Crohn's disease, 4 with ulcerative colitis). Mean duration of remission was 34.5 months. Sixteen of 20 (80%) patients suspended steroids. Reversible neuropathy occurred in seven of 28 (25%) patients, but only with cumulative doses over 28 g. Other side effects requiring thalidomide suspension were vertigo/somnolence (one of 28), and agitation/hallucinations (one of 28).

Conclusions
Thalidomide seems to be effective in inducing long-term remission in children and adolescents with intractable inflammatory bowel disease. Neuropathy is the main adverse effect, but appears to be cumulative dose-dependent, thus allowing long-term remission before drug suspension.


From

http://onlinelibrary.wiley.com/doi/1...6.03211.x/full
01-06-2014, 11:36 AM   #97
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Video blog of IBD specialists from Mayo on various topics...

http://ibdblog.mayoclinic.org
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- Remicade, started Nov 2013, added Solumedrol June 2015
- added Methotrexate/Folate March 2016
- Multivitamins, Probiotics, Vit D
- Small bowel resection, Jan 2013
01-14-2014, 07:01 PM   #98
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Drug Therapies and the Risk of Malignancy in Crohn's Disease: Results From the TREAT™ Registry

Gary R Lichtenstein, Brian G Feagan, Russell D Cohen, Bruce A Salzberg, Robert H Diamond, Wayne Langholff, Anil Londhe and William J Sandborn

Abstract
OBJECTIVES:

We assessed potential associations between malignancy and antitumor necrosis factor therapy in patients with Crohn's disease (CD), as this relationship is currently poorly defined.

METHODS:

Utilizing data from the Crohn's Therapy, Resource, Evaluation, and Assessment Tool (TREAT™) Registry, a prospective cohort study examining long-term outcomes of CD treatments in community and academic settings, infl uences of baseline patient/disease characteristics and medications were assessed by survival analysis and multivariate models. Standardized incidence ratios and exact 95 % confi dence intervals were determined as the ratio of events observed (TREAT) vs. expected (general population of USA).

RESULTS:

As of 23 February 2010, 6,273 CD patients (infliximab during registry=3,420 (during or within 1 year before registry=3,764); other-treatments-only: 2,509), were enrolled and, on average, had been followed for 5.2/7.6 years, respectively, for all/currently active patients. Crude cancer incidences were similar between infliximab- and other-treatments-only-exposed patients. Multivariate Cox regression analysis demonstrated that baseline age (hazard ratio (HR)=1.59/10 years; P<0.001), disease duration (HR=1.64/10 years; P=0.012), and smoking (HR=1.38; P=0.045) but neither immunosuppressive therapy alone (HR=1.43; P=0.11), infliximab therapy alone (HR=0.59; P=0.16), nor their combination (HR=1.22, P=0.34) were independently associated with the risk of malignancy. When compared with the general population, no significant increase in incidence was observed in any malignancy category. In an exposure-based analysis, use of immunosuppressants alone (odds ratio=4.19) or in combination with infliximab (3.33) seemed to be associated with a numerically, but not significantly, greater risk of malignancy than did treatment with infliximab alone (1.96) relative to treatment with neither.

CONCLUSIONS:

In the TREAT Registry, age, disease duration, and smoking were independently associated with increased risk of malignancy. Although results for immunosuppressant use were equivocal, no significant association between malignancy and infliximab was observed.

http://www.nature.com/ajg/journal/va...g2013441a.html
01-27-2014, 04:05 AM   #99
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Thank you for gathering this great information in one place, lots to read when I get back from work today! Have a great week,
Rachel
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02-06-2014, 12:35 AM   #100
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Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement:

http://www.naspghan.org/user-assets/...isease_.27.pdf

*Brian’sMom.
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02-12-2014, 04:23 PM   #101
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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...T&ocid=1690525
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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.
02-13-2014, 04:16 AM   #102
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I don't know how many of you follow the Books, Multimedia, Research & News Forum but below a link into interesting discussion on the potential MAP vaccine:

http://www.crohnsforum.com/showthread.php?t=59071
02-22-2014, 01:16 PM   #103
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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
02-22-2014, 01:21 PM   #104
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Effect of an Enteric-Coated Fish-Oil Preparation on Relapses in Crohn's Disease

http://www.nejm.org/doi/full/10.1056...99606133342401
03-04-2014, 10:37 PM   #105
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Drugs in the pipeline for IBD for all of us anxious moms (and dads!) that can't help but worry about the future!
http://www.chop.edu/export/download/...D_Research.pdf
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
03-06-2014, 03:37 PM   #106
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From some of the doctors at SickKids in Toronto, Ontario like Dr. Walters & Dr. Griffiths is this article:

Increased Effectiveness of Early Therapy with Anti-Tumor Necrosis Factor vs. an Immunomodulator in Children with Crohn's Disease

http://www.medicaldaily.com/crohns-d...mmation-270366

Report link is here: http://www.deepdyve.com/lp/elsevier/...sis-eNSBl0XwBS
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Mom of 16 yr. girl w/Indeter.Colitis Sep. 2012(age 11) Nov.2012 Crohn's Sep. 2014 Crohn's Colitis, UC Nov 2015, Crohn's Feb. 2016

Ileostomy surgery July 2015

Current Meds: None!
Previous Meds: Humira, Remicade, Methotrexate, Cipro, Flagyl, Zofran, Cortifoam, 5-ASA suppository, Questran, Mezavant, EEN (Peptamen Jr. 1.5) by NG tube, Antibiotic Cocktail (Vancomycin, Metronidazole & Doxycycline), Simponi, Prevacid, Imuran, prednisone
ibdsupportivmom.wordpress.com ☆
03-09-2014, 10:36 PM   #107
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Very easy to read and informative report on EEN

(I may have posted this before but... just in case )

Enteral Nutrition in Crohn's Disease: An Underused Therapy

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870077/
03-23-2014, 03:00 PM   #108
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http://cdn.intechopen.com/pdfs-wm/35455.pdf
Evaluating Lymphoma Risk in Inflammatory Bowel Disease

massive review of the research available through 2011 published in 2013.
45 pages long
03-24-2014, 11:00 AM   #109
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http://www.biomedcentral.com/1471-230X/14/50/abstract

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!
04-16-2014, 10:13 AM   #110
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Interpretation of biochemical tests for iron deficiency: diagnostic difficulties related to limitations of individual tests

http://www.australianprescriber.com/magazine/20/3/74/6


What is ferritin?

http://highferritin.imppc.org/hiperferritin.php?lang=en

(There is a small section explaining the relationship between inflammation and ferritin.)

Last edited by Tesscorm; 04-16-2014 at 10:31 AM.
04-16-2014, 02:20 PM   #111
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Front page story today.

http://www.vancouversun.com/health/C...766/story.html
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Son (age 13) diagnosed with Crohn's Feb. 2012.
Currently on Imuran and Sulfasalazine.

Also taking: TuZen probiotic and following a low FODMAP diet (not very strictly).

Past Treatments: Prednisone, Flagyl, Cipro, Pentasa, exclusive EN via NG tube (6 weeks), Prevacid, Iberogast (20 drops twice a day) and high doses of vitamin B2.
04-29-2014, 08:01 PM   #112
Maya142
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For kids with joint pain without swelling:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860180/
05-11-2014, 12:39 AM   #113
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Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease.

CONCLUSION
Nutritional status, as indicated by compromised body composition (that is, reduced lean mass), is present in children with IBD and persists over time, irrespective of treatment. Further, alterations in body composition are expressed differently between boys and girls, and in response to treatment. Reports suggest girls present with wasting which morphs into cachexia with treatment. In contrast, boys present with cachexia, with resolution of lean mass with treatment, and excess of fat mass. It must be noted that literature in this area is relatively limited, and more studies are needed, particularly addressing responses to treatment.

As with compromised nutritional status, growth deficits are reported in children with IBD. Data are promising with respect to improvements in linear growth as a result of treatment with biologics, however, it is clear that further research is necessary in this area as the majority of studies conducted are retrospective in nature and subject numbers are small. Key features associated with improvements in growth appear to be successful clinical response to treatment, patients in early stages of puberty, thereby allowing a greater window of opportunity for growth potential, and the presence of growth failure at the onset of treatment, again allowing for greater growth potential. An area that is lacking for evidence is the impact of biologics on body composition, and more data are warranted in this area.
Full Article:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964391/
05-11-2014, 01:26 AM   #114
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mlp, do you have any articles that may be around that aren’t included here?
05-11-2014, 03:43 PM   #115
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Front page list updated.
05-13-2014, 05:52 PM   #116
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http://www.chop.edu/export/download/...4_Grossman.pdf

New chop pediatric Ibd meds slide
06-07-2014, 08:11 AM   #117
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Optimizing 6-mercaptopurine and azathioprine therapy in the management of inflammatory bowel disease

Abstract

The thiopurine drugs, 6-mercaptopurine (6-MP) and azathioprine, are efficacious in the arsenal of inflammatory bowel disease (IBD) therapy.

Previous reports indicate that 6-thioguanine nucleotide (6-TGN) levels correlate with therapeutic efficacy, whereas high 6-methylmercaptopurine (6-MMP) levels are associated with hepatotoxicity and myelotoxicity.

Due to their complex metabolism, there is wide individual variation in patient response therein, both in achieving therapeutic drug levels as well as in developing adverse reactions. Several strategies to optimize 6-TGN while minimizing 6-MMP levels have been adopted to administer the thiopurine class of drugs to patients who otherwise would not tolerate these drugs due to side-effects.

In this report, we will review different approaches to administer the thiopurine medications, including the administration of 6-mercaptopurine in those unsuccessfully treated with azathioprine; co-administration of thiopurine with allopurinol; co-administration of thiopurine with anti-tumor necrosis factor α; 6-TGN administration; desensitization trials; and split dosing of 6-MP.
Full Article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208360/

I have posted this in the research forum and also added it to the front page here. I did so as there is interesting discussion contained within as stated in the last paragraph of the abstract above.
06-07-2014, 08:47 AM   #118
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This article/radio report Malnutrition and the Microbiome talks about a child's gut microbiome, and how that can lead to malnutrition. Although they do not talk about "IBD", per se, it seems to me there might be a common solution: to provide the "right" microbiome through introduction of a "good" microbiome (i.e. Fecal Microbiota Transplant).

One of the tragedies of malnutrition in children is that the problems don't end when the hunger stops. A new study has shown that the microbial communities in the gut of children who experience malnutrition seem to be compromised over the long term, and don't recover even after therapy and a return to a normal diet.
06-07-2014, 10:48 AM   #119
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This paper Effect of a Probiotic Preparation (VSL#3) on Induction and Maintenance of remission in Children With Ulcerative Colitis shows that probiotics can be much better than placebo. My thought, though, is that it would be very expensive.

That study that indicated that VSL#3 was effective at inducing remission. After one year, 3 of the 14 VSL#3 patients relapsed and 11 of the 15 placebo patients relapsed. VSL#3 is a mix of a bunch of probiotics, and the paper says it doesn't know which of them is responsible for the improvement. The study had the kids stay on the probiotic for the length of the study (one year). Depending on the weight of the patient, it might cost $1,000 (45 lbs) to $4,000 (140 lbs) to pay for this probiotic in a year. But in another study, they only took the probiotic for 12 weeks, so maybe the dose could be reduced instead of the full dose 'forever'.

This is what the VSL3 web site says about how long to keep on the probiotic:
In general, VSL#3 takes up to 1 week to become established in the gut. A study conducted with VSL#3 confirms that maximum bacterial colonization of the gut occurs within 20 days. This high level of colonization remains stable throughout consumption. After daily intake is interrupted, the strains in VSL#3 will survive in the gut for up to 3 weeks.
Miele E, Pascarella F, Giannetti E, et al. Effect of a probiotic
preparation (VSL#3) on induction and maintenance of remission
in children with ulcerative colitis. Am J Gastroenterol. 2009;104:
437–443.

Last edited by 7vNH; 06-07-2014 at 11:04 AM.
06-07-2014, 12:20 PM   #120
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DS has been on vsl#3 DS( prescription ) for over a year.
His GI had him take a higher dose for a month .
He now takes a lower dose.
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