Guidelines for the Management of Inflammatory Bowel Disease in Children in the United Kingdom

Sandhu, Bhupinder; Fell, John; Beattie, R Mark; Mitton, Sally G.; Wilson, David C.; Jenkins, Huw

doi:10.1097/mpg.0b013e3181c92c53

Cited by 142 publications

(130 citation statements)

References 150 publications

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] La incidencia en la CABA alcanzó 2,4/100 000, más cercana a las reportadas, mientras la provincia de Buenos Aires reportó una incidencia muy baja, incluso, respecto a otras provincias del país. En el Gran Buenos Aires, que comprendió 24 partidos del conurbano, se registraron, durante el mismo período, igual número de pacientes que en la CABA, pero la tasa obtenida fue baja (0,4/100 000), debido al elevado número poblacional.…”

Section: Discussionunclassified

“…Todos estos resultados coincidieron con los publicados en el registro EUROKID del año 2012. 1,[23][24][25] El tránsito de intestino delgado, estudio radiológico disponible en casi todos los centros del país, fue realizado en 40% de los pacientes, valores muy por debajo de lo recomendado en los criterios Porto. 1 En cuanto a la extensión y gravedad de CU, la mayoría presentaron pancolitis; 70% fueron formas leves y 26%, moderadas.…”

Section: -16unclassified

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Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina

2017

Arch Argent Pediat

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RESUMENIntroducción. La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. Población y métodos. Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. Resultados. Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0,4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9,7 años y la demora diagnóstica, de 16,5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. Conclusiones. La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología. INTRODUCCIÓNLa enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Se reconoce una tercera forma llamada enfermedad inflamatoria intestinal no clasificable (EIINC). Los criterios diagnósticos s e b a s a n e n l o s c r i t e r i o s P o r t o que consideran aspectos clínicos, r a d i o l ó g i c o s , e n d o s c ó p i c o s e histológicos.

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Section: Discussionunclassified

Section: -16unclassified

Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina

2017

Arch Argent Pediat

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“…Significant factors play a role in its development such as the environmental factors, genetic variations, altered intestinal microbiota and the disturbances in the innate and adaptive immune response [3,4,21]. People living in the western countries are more susceptible to the disease and those living in underdeveloped countries might be protected from the disease due to the high exposure to the parasitic infestation [3].…”

Section: Discussionmentioning

confidence: 99%

“…Although upper gastrointestinal study with Small Bowel Follow-Through (SBFT) is the main radiological modality in IBD patients, its information on the presence or the extent of disease are limited [2]. CT and MRI can provide better visualization of the inflamed mucosa and peri-intestinal involvement [2,21,25]. Ideally, all pediatric patients suspected to have UC should have endoscopic procedure (upper and lower gastrointestinal endoscopy and biopsies) to confirm the diagnosis [21,25].…”

Section: Discussionmentioning

confidence: 99%

“…CT and MRI can provide better visualization of the inflamed mucosa and peri-intestinal involvement [2,21,25]. Ideally, all pediatric patients suspected to have UC should have endoscopic procedure (upper and lower gastrointestinal endoscopy and biopsies) to confirm the diagnosis [21,25]. Most of our patients had pancolitis (81.6%) on colonoscopy which is higher percentage than that reported by Al-Qabandi, et al [14], Docktor, et al [23] and AlSaleem, et al [16] which was 64%, 55% and 46.1% respectively.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Ulcerative Colitis from Prevalence to Outcome

Isa¹

2017

J Clin Gastroenterol Treat

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Effect of Thalidomide on Clinical Remission in Children and Adolescents With Refractory Crohn Disease

Lazzerini

Martelossi

Magazzù

et al. 2013

JAMA

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IMPORTANCE Pediatric-onset Crohn disease is more aggressive than adult-onset disease, has high rates of resistance to existing drugs, and can lead to permanent impairments. Few trials have evaluated new drugs for refractory Crohn disease in children.OBJECTIVE To determine whether thalidomide is effective in inducing remission in refractory pediatric Crohn disease. DESIGN, SETTING, AND PATIENTS Multicenter, double-blind, placebo-controlled, randomized clinical trial of 56 children with active Crohn disease despite immunosuppressive treatment, conducted August 2008-September 2012 in 6 pediatric tertiary care centers in Italy. INTERVENTIONS Thalidomide, 1.5 to 2.5 mg/kg per day, or placebo once daily for 8 weeks. In an open-label extension, nonresponders to placebo received thalidomide for an additional 8 weeks. All responders continued to receive thalidomide for an additional minimum 52 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were clinical remission at week 8, measured by Pediatric Crohn Disease Activity Index (PCDAI) score and reduction in PCDAI by Ն25% or Ն75% at weeks 4 and 8. Primary outcomes during the open-label follow-up were clinical remission and 75% response. RESULTS Twenty-eight children were randomized to thalidomide and 26 to placebo. Clinical remission was achieved by significantly more children treated with thalidomide (13/28 [46.4%] vs 3/26 [11.5%]; risk ratio [RR], 4.0 [95% CI, 1.2-12.5]; P = .01; number needed to treat [NNT], 2.86). Responses were not different at 4 weeks, but greater improvement was observed at 8 weeks in the thalidomide group (75% response, 13/28 [46.4%] vs 3/26 [11.5%]; RR, 4.0 [95% CI, 1.2-12.5]; NNT = 2.86; P = .01; and 25% response, 18/28 [64.2%] vs 8/26 [30.8%]; RR, 2.1 [95% CI,]; NNT = 2.99; P = .01). Of the nonresponders to placebo who began receiving thalidomide, 11 of 21 (52.4%) subsequently reached remission at week 8 (RR, 4.5 [95% CI, 1.4-14.1]; NNT = 2.45; P = .01). Overall, 31 of 49 children treated with thalidomide (63.3%) achieved clinical remission, and 32 of 49 (65.3%) achieved 75% response. Mean duration of clinical remission in the thalidomide group was 181.1 weeks (95% CI, 144.53-217.76) vs 6.3 weeks (95% CI, 3.51-9.15) in the placebo group (P < .001). Cumulative incidence of severe adverse events was 2.1 per 1000 patient-weeks, with peripheral neuropathy the most frequent severe adverse event.CONCLUSIONS AND RELEVANCE In children and adolescents with refractory Crohn disease, thalidomide compared with placebo resulted in improved clinical remission at 8 weeks of treatment and longer-term maintenance of remission in an open-label follow-up. These findings require replication to definitively determine clinical utility of this treatment.

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Guidelines for the Management of Inflammatory Bowel Disease in Children in the United Kingdom

Cited by 142 publications

References 150 publications

Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina

Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina

Pediatric Ulcerative Colitis from Prevalence to Outcome

Effect of Thalidomide on Clinical Remission in Children and Adolescents With Refractory Crohn Disease

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