Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study

OBJECTIVE: To define epidemiologic and clinical characteristics of newly diagnosed pediatric inflammatory bowel disease (IBD) in a large population-based model. STUDY DESIGN: All pediatric gastroenterologists providing care for Wisconsin children voluntarily identified all new cases of IBD during a 2-year period. Demographic and clinical data were sent to a central registry prospectively for analysis. RESULTS: The incidence of IBD in Wisconsin children was 7.05 per 100,000, whereas the incidence for Crohn's disease was 4.56, more than twice the rate of ulcerative colitis (2.14). An equal IBD incidence occurred among all ethnic groups, and children from sparsely and densely populated counties were equally affected. The majority (89%) of new IBD diagnoses were nonfamilial. CONCLUSIONS: This study provides novel, prospective, and comprehensive information on pediatric IBD incidence within the United States. The surprisingly high incidence of pediatric IBD, the predominance of Crohn's disease over ulcerative colitis, the low frequency of patients with a family history, the equal distribution of IBD among all racial and ethnic groups, and the lack of a modulatory effect of urbanization on IBD incidence collectively suggest that the clinical spectrum of IBD is still evolving and point to environmental factors contributing to the pathogenesis.     

Medical management of pediatric inflammatory bowel disease

Inflammatory bowel diseases (IBD) are chronic autoimmune conditions of the gut affecting both pediatric and adult patients. Medical therapy is often successful at inducing and maintaining remission and preventing disease complications. The mainstays of treatment are medications and other therapies that reduce inflammation and suppress the overactive immune system. Here we review current medical therapies for pediatric IBD, discuss future therapeutics, and present current treatment goals and approaches.     

儿童炎症性肠病53例临床分析

目的　探讨儿童炎症性肠病 (IBD)的临床特点 ,以提高儿童IBD的诊治和管理水平。方法　对 1992～2 0 0 2年 5 3例IBD患儿的临床资料进行回顾性分析。结果　IBD的患病率逐渐增加 ,5 3例IBD中克罗恩病 (CD)2 6例 ,溃疡性结肠炎 (UC) 2 7例。 2 7%的CD和 4 5 %的UC发病在 6岁以下 ,有 5例 (19% )UC发病在 1岁以内 ;男女性别无显著性差异 (P >0 0 5 ) ;发病至确诊平均时间CD为 5 0周 ,UC为 4 8周。临床表现CD以发热、腹痛为主要表现 ,UC以腹泻、便血为主要表现 ;胃肠外表现CD可见口腔溃疡、关节炎等 ,UC可见肛周病变、口腔溃疡等 ,两组患儿生长发育障碍的发生率均较高 (CD 6 5 % ,UC 5 9% ,P >0 0 5 )。病理改变CD以破坏和慢性增殖改变并存为特点 ,病灶均累及回肠末端及回盲部 ;而UC以急性炎症和渗出为主 ,病灶均累及直肠。外科合并症的发生率CD为 15 4 % ,UC为 14 8% ;儿童IBD治疗效果不满意 ,短期缓解率CD为 5 9% ,UC为 5 6 %。结论　IBD可以累及包括婴幼儿在内的各年龄组儿童 ,诊断的滞后以及缺乏系统的管理是临床亟待解决的问题。     

Use of C-reactive protein in children with newly diagnosed inflammatory bowel disease

C-reactive protein (CRP), a marker for inflammation, was evaluated with other routine blood tests in children with newly diagnosed inflammatory bowel disease. Evaluation of CRP level helped identify additional patients found to have inflammatory bowel disease at endoscopy, although a sizeable number of patients with mild ulcerative colitis had a normal CRP level.     

MICI-MINOTS: Linguistic and metric validation of a pediatric questionnaire on knowledge about inflammatory bowel disease

BackgroundTherapeutic education is an essential part of the treatment of chronic diseases, such as inflammatory bowel disease (IBD). The IBD-KID, developed in Canada in English, assesses children's and adolescents’ acquired knowledge about their condition and has been validated in Canadian and Australian populations. However, there is no pediatric questionnaire in French to assess patients’ knowledge about IBD.ObjectiveTo report the linguistic validation process and metric validity of the MICI-MINOTS, the French version of the IBD-KID.MethodThe translation process consisted of three consecutive steps: forward–backward translation, acceptability testing, and cognitive interviews. The IBD-KID consists of 23 questions, but a 24th question about immunomodulatory therapy was added in the MICI-MINOTS. Psychometric testing was conducted with five groups: children with IBD, their parents, children in a control group, their parents, and health workers recruited from the Timone Pediatric Hospital and the Saint-Sébastien Maternal and Child Protection Center, Marseille, France. A total of 15 individuals completed the tool twice, with a 15-day interval. Internal consistency, reliability, external validity, reproducibility, and sensitivity to change were tested.ResultsA total of 38 children with IBD (sex: 20 boys, 18 girls; age: 13.90 [± 2.88] years; 25 with Crohn's disease), 20 children in the control group, 58 parents (every child was included with one parent), and 62 health workers were included in the analysis. Intraclass correlation was 0.94 (95% confidence interval 0.83–0.98) for test–retest assessment. Readability using the Scolarius score corresponded to elementary school level. Among the children with IBD, 89.5% answered all 24 questions. For 23 questions, the mean score of children with IBD was higher than among children in the control group: 9.58 (± 3.01) versus 5.47 (± 3.56), respectively (P < 0.01). Parents of children with IBD scored higher than parents of children in the control group: 10.63 (± 3.16) versus 8.4 (± 3.07), respectively (P = 0.012). In the health workers’ group, pediatric residents (17.82 ± 3.46) scored higher than nurses 11.75 (± 3.4) and ward clerks (8.67 ± 2.40; P < 0.01). Patients’ knowledge score was significantly related to their parents’ knowledge score (r = 0.402, P = 0.012) for 23 questions.ConclusionThe French version of the IBD-KID showed satisfactory psychometric properties to assess knowledge about the disease in French-speaking children.     

NOD2/CARD15 mutation analysis and genotype-phenotype correlation in Jewish pediatric patients compared with adults with Crohn's disease

OBJECTIVES: The allelic variants in the NOD2/CARD15 gene G908R, R702W, and 1007fs are strongly and independently associated with susceptibility to Crohn's disease (CD). Our aim was to compare the NOD2/CARD15 genotype and the genotype-phenotype correlation in Jewish pediatric patients with CD (相似文献   

Inflammatory bowel diseases: the paediatric gastroenterologist's perspective

Inflammatory bowel diseases (IBDs), including Crohn disease (CD) and ulcerative colitis (UC), often affect children and adolescents. Their diagnosis is based on the integration of clinical, biological, endoscopic, histological and radiological data. The paediatric radiologist may help the clinician in many ways. In children presenting with symptoms compatible with IBD, gut exploration by US may identify those who will benefit from more invasive explorations including endoscopy. During the process of diagnosis, small bowel exploration has a crucial role in differentiating CD from UC and in classifying the disease into subphenotypes. Finally, new imaging methods are useful during patient follow-up for assessing disease activity and for the diagnosis of complications.     

新生儿炎症性肠病的临床特征及基因诊断研究

目的 分析2例新生儿期起病的炎症性肠病临床特点及基因诊断结果,以提高对该病的认识和临床诊疗水平.方法 2018年至2019年,解放军总医院第七医学中心八一儿童医院共收治2例新生儿期起病的炎症性肠病患儿.对2例诊断为新生儿炎症性肠病的患儿行结肠镜检查,并行病理活检,采用直接测序法对患儿进行白细胞介素-10受体A(inte...     

Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study

Background Children with inflammatory bowel disease (IBD) undergo invasive and repeated investigations, including contrast radiology and endoscopy.Objective To assess transabdominal sonography of the colon and distal ileum compared to colonoscopy and barium radiology in known or suspected IBD.Materials and methods A prospectively recruited cohort of 44 children (median age 12 years, range 3.5–16.5 years; 24 males) underwent transabdominal sonography prior to colonoscopy (n=33) or barium follow-through (n=25). Diagnoses were: Crohn disease (n=25), ulcerative colitis (n=12), indeterminate colitis (n=1), normal (n=6).Results Bowel wall thickness (BWT) and endoscopic severity were compared in 153 colonic segments. No difference was found between normal and mildly affected segments. BWT was less in normal bowel than moderate (P<0.001) or severe (P<0.001) lesions. Where BWT was >2.9 mm, sensitivity for moderate/severe disease was 48%, specificity 93%, positive predictive value 83% (likelihood ratio 7). Barium radiology showed terminal ileum abnormality in ten patients (40%). Where ileal BWT was >2.5 mm, comparative sensitivity was 75%, specificity 92%, positive predictive value 88% (likelihood ratio 9). Superior mesenteric artery Doppler did not correlate with disease severity.Conclusion Increased BWT has good positive predictive value for moderate/severe disease in the colon proximal to the rectum (>3 mm), and terminal ileum (>2.5 mm). BWT below this cannot exclude moderate/severe mucosal lesions.     

Long-term outcomes of pediatric inflammatory bowel disease

The incidence and prevalence of childhood-onset inflammatory bowel diseases (IBD), including subtypes Crohn's disease and ulcerative colitis, have risen dramatically in recent years, and have emerged globally as important pediatric chronic diseases. Therefore, health care providers are more frequently encountering very young children with IBD, a chronic and incurable condition requiring life-long therapy. These children are living long lives with IBD and therefore knowledge of long-term outcomes is increasingly important to better counsel families and determine the best course of treatment. This review summarizes the current knowledge and literature surrounding long-term outcomes of pediatric IBD, with emphasis on the following areas: need for surgery due to complicated disease behavior, risk of disease remission and recurrence, mental health and psychosocial well-being, educational outcomes, linear growth impairment, cancer risk, and mortality. In addition, we review recent research about predicting negative long-term outcomes in children with IBD.