SUMMARY BackgroundAdalimumab is a second generation humanized anti-tumour necrosis factor (TNF) monoclonal antibody with established efficacy in Crohn's disease (CD).

SUMMARY BackgroundAdalimumab is efficacious therapy for adults with Crohn's disease (CD).

Clinical response to infliximab therapy is associated with an improvement in linear growth in the short term in children with CD. This increase in height may not be simply due to progress in pubertal status or reduction in GC dose.

Inflammatory bowel disease (IBD) is characterised by an inappropriate chronic immune response against resident gut microbes. This may be on account of distinct changes in the gut microbiota termed as dysbiosis. The role of fungi in this altered luminal environment has been scarcely reported. We studied the fungal microbiome in de-novo paediatric IBD patients utilising next generation sequencing and compared with adult disease and normal controls. We report a distinct difference in fungal species with Ascomycota predominating in control subjects compared to Basidiomycota dominance in children with IBD, which could be as a result of altered tolerance in these patients.

Background: Puberty is thought to be commonly affected in adolescents with inflammatory bowel disease (IBD). Aims: To determine the impact of Crohn’s disease (CD) and ulcerative colitis (UC) on the pubertal growth spurt. Methods: Retrospective study of 30 boys with CD (CD-M), 11 girls with CD (CD-F), 14 boys with UC (UC-M) and 12 girls with UC (UC-F). Pubertal growth was assessed by calculating peak height velocity SDS (PHV SDS), height SDS at diagnosis (Ht_Diag) and height SDS at PHV (Ht_PHV) and age at PHV (Age_PHV). Systemic markers of disease activity were also collected. Results: Altered parameters of pubertal growth were observed in the CD groups compared to the normal population: in the CD-M group, median Ht_Diag was –0.56 (p = 0.001) and median Age_PHV was 14.45 years (p = 0.004), and in the CD-F group, median Ht_Diag was –1.14 (p = 0.007) and Ht_PHV was –0.79 (p = 0.039). Individually, 8/30 CD-M cases had one or more parameter affected: 2 boys had Ht_Diag <–2, 3 boys had Ht_PHV <–2, 2 boys had an Age_PHV >2 years above population mean, and 2 boys had a PHV SDS <–2. In the whole group, Age_PHV showed an association with erythrocyte sedimentation rate (r = 0.4; p = 0.005) and an inverse association with BMI (r = 0.4; p = 0.001). Conclusion: Disorders of pubertal growth are more likely to occur in CD and, particularly, in boys.

CTE affects a proportion of pediatric IBD patients. Although resolution of physical impairment is the norm, significant morbidity exists. Our study suggests a secular trend toward CTE in CD. Primary prevention with the identification and amelioration of identifiable risk factors should be the clinical objective in future studies.

No abstract

SUMMARY BackgroundMethotrexate is increasingly used as a third line immunosuppression agent in children with Crohn's disease (CD). Methotrexate is traditionally administered in the hospital setting.