Improved Outcomes With Quality Improvement Interventions in Pediatric Inflammatory Bowel Disease

Samson, Charles M.; Morgan, Pamela J.; Williams, Elizabeth; Beck, Lee R.; Addie-Carson, Ric Junette; Mcintire, Stacy; Booth, Andrea; Mendez, Eduardo; Luzader, Carolyn P.; Tomer, Gitit; Saeed, Shehzad Ahmed; Donovan, Edward F.; Bucuvalas, John C.; Denson, Lee A.

doi:10.1097/mpg.0b013e318262de16

Cited by 36 publications

(28 citation statements)

References 52 publications

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“…We were not able to perform a similar analysis for fecal calprotectin in our cohort given the small number of patients with the biomarker collected, but studies have shown that a fecal calprotectin >400 mcg/gm in those with clinically quiescent IBD is associated with increased risk of disease relapse in the following year. 44,45 …”

Section: Discussionmentioning

confidence: 99%

Utility of Neutrophil Fcγ Receptor I (CD64) Index as a Biomarker for Mucosal Inflammation in Pediatric Crohnʼs Disease

Minar

Haberman

Jurickova

et al. 2014

Inflammatory Bowel Diseases

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Background Neutrophil expression of the Fcγ receptor I (CD64) is upregulated in adult patients with clinically active inflammatory bowel disease (IBD). We tested the relationship of CD64 with mucosal inflammation and clinical relapse in pediatric Crohn's disease (CD). Methods In a cohort of 208 newly diagnosed CD and 43 non-IBD controls, ileal expression of FcγRI/S100A9 was determined by RNA sequencing from biopsies obtained at ileocolonoscopy. In a second cohort, we tested for the peripheral blood polymorphonuclear neutrophil (PMN) CD64 index from 26 newly diagnosed CD, 30 non-IBD controls and 83 children with established CD. Results Ileal FcγRIA mRNA expression was significantly elevated in CD at diagnosis compared with non-IBD controls (p<0.001), and correlated with ileal S100A9 (calprotectin) expression (r=0.83, p<0.001). The median(range) PMN CD64 index for newly diagnosed CD was 2.3(0.74-9.3) compared with 0.76(0.39-1.2) for non-IBD controls (p<0.001) with 96% sensitivity and 90% specificity at the cut point of 1.0. The PMN CD64 index significantly correlated with mucosal injury as measured by the Simple Endoscopic Score-CD (SES-CD, r=0.62, p<0.001). CD patients in clinical remission receiving maintenance therapy with a PMN CD64 index <1.0 had a sustained remission rate of 95% over the following 12 months compared with 56% in those with a PMN CD64 index >1.0 (p<0.01). Conclusions An elevated PMN CD64 index is associated with both mucosal inflammation and an increased risk for clinical relapse in pediatric CD. The PMN CD64 index is a reliable marker for sustained remission in CD patients receiving maintenance therapy.

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Section: Discussionmentioning

confidence: 99%

Utility of Neutrophil Fcγ Receptor I (CD64) Index as a Biomarker for Mucosal Inflammation in Pediatric Crohnʼs Disease

Minar

Haberman

Jurickova

et al. 2014

Inflammatory Bowel Diseases

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“…56 Children with low vitamin D levels are more likely to have disease recurrence, and maintaining serum vitamin D levels greater than 30 ng/mL increases the likelihood of maintaining clinical remission. 57 …”

Section: Long-term Sequelaementioning

confidence: 99%

Inflammatory Bowel Disease in Children and Adolescents

2015

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“…Optimization of vitamin D and calcium delivery is advisable as this may theoretically help decrease deficits in BMD—though it should be noted that treatment with vitamin D has not been shown to improve BMD in CD (69). The North American Society of Pediatric Gastroenterology Hepatology and Nutrition recommends yearly screening of vitamin D (in the spring) and treating levels <20 with courses such as 50,000 IU vitamin D /week x 6 weeks (70, 71). …”

Section: Prevention and Treatment Of Endocrine Co-morbiditiesmentioning

confidence: 99%

“…Close monitoring of disease symptomatology and testing of intestinal inflammation via measurement of fecal calprotectin may assist in diagnosis of occult increases in disease activity (71). Additional steps targeting puberty and growth can be added should disease severity and endocrine sequelae persist despite escalation in CD-specific treatment.…”

Section: Prevention and Treatment Of Endocrine Co-morbiditiesmentioning

confidence: 99%

Delays in Puberty, Growth, and Accrual of Bone Mineral Density in Pediatric Crohn’s Disease: Despite Temporal Changes in Disease Severity, the Need for Monitoring Remains

DeBoer

Denson

2013

The Journal of Pediatrics

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Improved Outcomes With Quality Improvement Interventions in Pediatric Inflammatory Bowel Disease

Abstract: Our results show that significant improvements in patient outcomes are associated with QI efforts that do not rely on new medication or therapies.

Cited by 36 publications

References 52 publications

Utility of Neutrophil Fcγ Receptor I (CD64) Index as a Biomarker for Mucosal Inflammation in Pediatric Crohnʼs Disease

Utility of Neutrophil Fcγ Receptor I (CD64) Index as a Biomarker for Mucosal Inflammation in Pediatric Crohnʼs Disease

Inflammatory Bowel Disease in Children and Adolescents

Delays in Puberty, Growth, and Accrual of Bone Mineral Density in Pediatric Crohn’s Disease: Despite Temporal Changes in Disease Severity, the Need for Monitoring Remains

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