These postrationalisation data are disappointing. The emphasis for care will now focus on improved communication between, primary care, general paediatricians and surgical centres through regional and national managed clinical networks, aiming to improve future outcomes for Scottish children with BA.
Introduction
An altered colonic microbiota contributes to inflammatory bowel disease (IBD) pathogenesis. Adult studies suggest modification of the microbiota by synbiotics (probiotics+prebiotics) can improve ulcerative colitis (UC)1 and Crohn's disease (CD)2.
Aim
To assess the feasibility of using a synbiotic in children with IBD.
Methods
Patients with IBD aged 6 to 16 years were approached. Children were excluded if they used any prebiotic/probiotic agent in the preceding 14 days, were using antibiotics or had a severe IBD exacerbation. Patients were withdrawn if they started antibiotics or another prebiotic/probiotic or they wished to discontinue. Participation involved taking the probiotic (Bifidobacterium longum in a capsule) and prebiotic (3.5 g Synergy 1 inulin oligofructose) twice daily for 12 weeks. A pre-study questionnaire and physician's global assessment (PGA) were completed. Questionnaires were provided for return at 1, 4, 8 and 12 weeks. Trial completion involved finishing the synbiotic course and returning all questionnaires.
Results
23 children were recruited. 11 (48%) were male. Median age was 13.4 years (7.8–16.6 years). 11 had CD, 6 UC and 4 IBD-unspecified. Initial PGA was ‘inactive’ in 19, ‘mild’ in 3, ‘moderate’ in 1 and ‘severe’ in 1. Only 3 of the first 17 patients completed the study. Feedback indicated the prebiotic was poorly tolerated, therefore the last six participants undertook a tapered probiotic course: none in week 1, once daily in week 2, then twice daily from week 3. Only two of six completed the modified study. Completion overall was 5/23 (22%). Reasons for withdrawal were: six diarrhoea/IBD flare, six stopped returning questionnaires, four required antibiotics, one advised by GP because of rash, one unwell on prebiotic but completed probiotic and one parent stopped after noticing ‘no difference.
Conclusion
Although synbiotics have shown promise in adult IBD this feasibility study in fairly well paediatric IBD patients has shown poor tolerability. We suspect the drop-out rate was due to the prebiotic agent, but further studies are necessary to assess the tolerance of different prebiotics/probiotics in paediatric IBD before larger efficacy trials.
The four centres with the facilities and expertise to give prolonged PN beyond term and provide paediatric ( < 16 years of age) HPN are formalised within the Scottish HPN MCN. Scotland comprises 8.6 % of the UK paediatric population. We aimed to demonstrate incidence and prevalence of the need for paediatric HPN in Scotland, as a representative part of the UK. We report nationwide incidence and prevalence of paediatric HPN in Scotland, from the 4 centres. Extrapolation to the UK suggests that there are annual minimum paediatric incidences and period prevalence of 48 and 126 cases. Standardised 2010 point prevalence and incidence rates of 12.1 and 5.5 per million compare with and validate the 13.7 and 6.0 per million respectively from a recent UK survey (1) ; however our period prevalence data suggests a higher rate of 15.4 per million.
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