Evaluation of the Pediatric Crohn Disease Activity Index: A Prospective Multicenter Experience

Hyams, Jeffrey S.; Markowitz, James; Otley, Anthony; Rosh, Joel R.; Mack, David R.; Bousvaros, Athos; Kugathasan, Subra; Pfefferkorn, Marian; Tolia, Vasundhara; Evans, Jonathan; Treem, William R.; Wyllie, Robert; Rothbaum, Robert; Rosario, Fernando del; Katz, Aubrey J.; Mezoff, Adam; Oliva-Hemker, Maria; Lerer, Trudy; Griffiths, Anne M.

doi:10.1097/01.mpg.0000183350.46795.42

Cited by 285 publications

(218 citation statements)

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“…BMI was converted to BMI z-scores according to growth curves of the general Greek pediatric population. Disease activity was quantified using the Pediatric Crohn's Disease Activity Index (37) and Pediatric Ulcerative Colitis Activity Index (38). Both these indexes have been validated in pediatric populations with IBD, with higher values corresponding to higher disease activity.…”

Section: Methodsmentioning

confidence: 99%

Circulating leptin and adiponectin and their relation to glucose metabolism in children with Crohn’s disease and ulcerative colitis

et al. 2013

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Background: Crohn's disease (CD) and ulcerative colitis (UC) result in metabolic consequences. We assessed circulating leptin and adiponectin concentrations and examined their relations to glucose metabolism in children with CD and UC. Methods: Circulating morning fasting concentrations of leptin, adiponectin, glucose, and insulin were measured in 32 children with CD and 18 children with UC. Insulin resistance (IR) and β-cell function were evaluated by the updated homeostatic model assessments (HOMA2-IR and HOMA2-B). results: Leptin was positively related to BMI z-scores overall and in the CD and the UC subgroups (P < 0.001). A negative correlation between leptin and disease activity was observed in the entire population (P = 0.034) and in the UC (P = 0.03) group. None of the assessed parameters was related to adiponectin. Fourteen percent of the participants were insulin resistant (15.6% in the CD group and 11.1% in the UC group), significantly more than expected (P < 0.001). Leptin was associated with HOMA2-IR (overall: r = 0.29, P = 0.045). Pathway analysis suggested that, overall, disease activity and BMI significantly affect leptin, which in turn is the only correlate of HOMA2-IR. conclusion: Disease activity was significantly and inversely related to leptin in children with inflammatory bowel disease (IBD). A significant proportion of the patients had increased IR, which is positively related to circulating leptin. c rohn's disease (CD) and ulcerative colitis (UC) are inflammatory conditions of the intestines, often collectively referred to as inflammatory bowel diseases (IBDs). They are characterized by a chronic course with significant morbidity and require long-term medications and care. It is now recognized that IBDs are not just diseases of the bowels, but rather systemic disorders with frequent extraintestinal manifestations (1). In children, such complications include, among others, altered body composition, malnutrition, and metabolic disturbances, with the last being probably the least studied. Endocrine dysfunction in pediatric IBD, although recognized for more than 30 y (2), has not been extensively investigated. Growth impairment, being the most frequent endocrine disorder encountered

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Section: Methodsmentioning

confidence: 99%

Circulating leptin and adiponectin and their relation to glucose metabolism in children with Crohn’s disease and ulcerative colitis

et al. 2013

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“…The sPCDAI used 6 of the 11 components from the full PCDAI, 23 including abdominal pain, stools, weight loss, abdominal examination, extraintestinal manifestations, and general well-being. The sPCDAI has comparable discriminatory accuracy for categorizing disease severity as the full PCDAI.…”

Section: Disease Activitymentioning

confidence: 99%

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Studies on adult patients who have Crohn disease have shown a comparative benefit of antiTNFa versus placebo and thiopurines. These same studies have not been done in children, because of time, cost, and ethical (withholding an efficacious treatment) challenges. WHAT THIS STUDY ADDS:Anti-TNFa therapy administered in routine practice to children with Crohn disease was more effective than usual care at achieving clinical and corticosteroid-free remission. Using data from the ImproveCareNow learning health system for observational research is feasible and produces valuable evidence. abstract OBJECTIVES: ImproveCareNow (ICN) is the largest pediatric learning health system in the nation and started as a quality improvement collaborative. To test the feasibility and validity of using ICN data for clinical research, we evaluated the effectiveness of anti-tumor necrosis factor-a (anti-TNFa) agents in the management of pediatric Crohn disease (CD).METHODS: Data were collected in 35 pediatric gastroenterology practices (April 2007 to March 2012 and analyzed as a sequence of nonrandomized trials. Patients who had moderate to severe CD were classified as initiators or non-initiators of anti-TNFa therapy. Among 4130 patients who had pediatric CD, 603 were new users and 1211 were receiving anti-TNFa therapy on entry into ICN.RESULTS: During a 26-week follow-up period, rate ratios obtained from Cox proportional hazards models, adjusting for patient and disease characteristics and concurrent medications, were 1.53 (95% confidence interval [CI], 1.20-1.96) for clinical remission and 1.74 (95% CI, 1.33-2.29) for corticosteroid-free remission. The rate ratio for corticosteroid-free remission was comparable to the estimate produced by the adult SONIC study, which was a randomized controlled trial on the efficacy of anti-TNFa therapy. The number needed to treat was 5.2 (95% CI, 3.4-11.1) for clinical remission and 5.0 (95% CI, 3.4-10.0) for corticosteroid-free remission. CONCLUSIONS:In routine pediatric gastroenterology practice settings, anti-TNFa therapy was effective at achieving clinical and corticosteroidfree remission for patients who had Crohn disease. Using data from the ICN learning health system for the purpose of observational research is feasible and produces valuable new knowledge. Over thelastseveraldecades,therapeutic advances in the treatment of pediatric Crohn disease (CD) have included the widespread use of immunomodulators such as 6-mercaptopurine, azathioprine, and methotrexate. [1][2][3] More recently, the anti-tumor necrosis factor a (anti-TNFa) biological agents (eg, infliximab and adalimumab) have been adopted as a treatment of moderate to severe pediatric CD. 4 Although several studies on adult patients who have CD have shown a comparative benefit of anti-TNFa versus placebo 5 and thiopurines, 6 these same studies have not been done in children because of practical (time and cost) and ethical (withholding an efficacious treatment) challenges.The cost of anti-TNFa is in the range...

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“…A 4. táblázat mutatja a CD, az 5. táblázat pedig az UC megítélésére használt indexek kiszámításának módját. [37,38].…”

Section: Táblázatunclassified

“…A gyermekkori Crohn-betegség aktivitási index (Pediatric Crohn's Disease Activity Index = PCDAI) (0-100 pont) [37] legyen több, mint maximum két-három hónap, annak számos szövődménye és növekedést gátló hatása miatt. 5-aminoszalicilsav-(5-ASA-) tartalmú készítmények adása elsősorban a colonra lokalizálódó formákban javasoltak.…”

Section: Táblázatunclassified

Milestones in understanding of the pathogenesis of immunmediated intestinal disorders. Development of their diagnosis and therapy

Arató

2013

Orvosi Hetilap

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Az elmúlt évtizedekben nagymértékben gazdagodtak ismereteink a bél mucosalis immunrendszerének felépítésé-ről és működéséről. Kiderült, hogy az intestinalis mikrofl óra és a mucosa között igen szoros és fi noman szabályozott kapcsolat van. Ez a fi nom egyensúly biztosítja a mucosalis homeosztázist, aminek kulcsszerepe van abban, hogy a szervezet megfelelően védekezzen a kórokozókkal szemben, de az orális tolerancia révén ne alakuljon ki immunreakció a commensalis baktériumokkal és a táplálékantigénekkel szemben. Amennyiben ebben a pontosan szabá-lyozott folyamatban zavar támad, akkor könnyen alakulnak ki immunmediált bélbetegségek. A dolgozat első része a mucosalis immunrendszer struktúrájáról és működéséről ad áttekintést. A második rész pedig három immunmediált bélbetegség, így a coeliakia, a gyulladásos bélbetegség és a tejallergia enteralis formájának patomechanizmusát, diagnosztikáját és terápiáját tárgyalja. Orv. Hetil., 2013, 154, 1512-1523 Kulcsszavak: mucosalis immunrendszer, intestinalis mikrofl óra, coeliakia, gyulladásos bélbetegség, tejallergia Milestones in understanding of the pathogenesis of immunmediated intestinal disorders Development of their diagnosis and therapyIn the last decades our knowledge has been enormously broadened about the structure and function of the gut associated lymphoid system. It was recognized how intricate and fi nely tuned connection exists between the gut bacterial fl ora and the intestinal mucosa. This subtle balance ensures mucosal homeostasis, which has a key role in organ defence against pathogens. However, at the same time this system makes possible the development of oral tolerance toward the commensals and the food antigens. In case of any disturbances in this fi nely tuned process, immunmediated intestinal disorders may easily develop. The fi rst part of this paper reviews the structure and function of the mucosal immune system, while the second part surveys the pathogenesis, diagnosis and therapy of coeliac disease, infl ammatory bowel disease and cow's milk allergy induced enteropathy. Orv. Hetil., 2013, 154, 1512-1523 Keywords: mucosal immune system, intestinal microfl ora, coeliac disease, infl ammatory bowel disease, cow's milk allergy (Beérkezett: 2013. augusztus 6.; elfogadva: 2013. augusztus 22.) A szerkesztőség felkérésére készült közlemény. Rövidítések CD = Crohn-betegség; EMA = endomysium elleni antitest; GALT = (gut-associated lymphoid tissue) bélhez kapcsolt immunrendszer; IEL = intraepithelialis lymphocyták; PAMP = (pathogen-associated molecular patterns) patogének speciális molekuláris mintázata; TLR = Toll-like receptor; UC = colitis ulcerosa

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Evaluation of the Pediatric Crohn Disease Activity Index: A Prospective Multicenter Experience

Cited by 285 publications

References 16 publications

Circulating leptin and adiponectin and their relation to glucose metabolism in children with Crohn’s disease and ulcerative colitis

Circulating leptin and adiponectin and their relation to glucose metabolism in children with Crohn’s disease and ulcerative colitis

Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System

Milestones in understanding of the pathogenesis of immunmediated intestinal disorders. Development of their diagnosis and therapy

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