The aetiology and impact of malnutrition in paediatric inflammatory bowel disease

Disease‐associated undernutrition of all types is very common in paediatric inflammatory bowel disease (IBD). Recent weight loss remains one of the triad of clinical manifestations and a cornerstone for the diagnosis of Crohn’s disease (CD), although significantly fewer patients now present as being underweight. Recent evidence suggests that the introduction of medical treatment will quickly restore body weight, although this does not reflect concomitant changes in body composition. CD children present with features of nutritional cachexia with normal fat stores but depleted lean mass. Poor bone health, delayed puberty and growth failure are additional features that further complicate clinical management. Suboptimal nutritional intake is a main determinant of undernutrition, although activation of the immune system and secretion of pro‐inflammatory cytokines exert additional independent effects. Biochemically low concentrations of plasma micronutrients are commonly reported in IBD patients, although their interpretation is difficult in the presence of an acute phase response and other indices of body stores adequacy are needed. Anaemia is a common extraintestinal manifestation of the IBD child. Iron‐deficient anaemia is the predominant type, with anaemia of chronic disease second. Decreased dietary intake, as a result of decreased appetite and food aversion, is the major cause of undernutrition in paediatric IBD. Altered energy and nutrient requirements, malabsorption and increased gastrointestinal losses are additional factors, although their contribution to undernutrition in paediatric CD needs to be studied further.     

Inflammatory bowel disease in young patients: challenges faced by black and minority ethnic communities in the UK

There is strong evidence indicating that inflammatory bowel disease (IBD) is increasing among black and minority ethnic (BME) communities. Despite this rise in prevalence, there is a paucity of research relating to ethnicity and IBD outside the USA. Furthermore, the symptoms of IBD are reported to start during childhood or adolescence in 20–25% of people with the condition. It is therefore important that young people's experiences of diagnosis, treatment and living with IBD are fully understood to ensure effective services and information provision. The study reported on in this paper was commissioned by a UK charity (Crohn's and Colitis UK) with the aim of increasing understanding of the specific issues and service needs of young people with IBD from BME communities. Empirical research entailed in‐depth semi‐structured interviews with 20 young people from BME groups accessed through gastroenterology departments at three collaborating NHS hospitals in England serving ethnically diverse populations. Interviews were carried out from June to December 2010 and sought to capture young people's views with IBD. A thematic analysis of their experiences identified many commonalities with other young people with IBD, such as the problematic route to formal diagnosis and the impact of IBD on education. The young people also experienced tensions between effective self‐management strategies and cultural norms and practices relating to food. Moreover, the ability of parents to provide support was hampered for some young people by the absence of culturally competent services that were responsive to the families’ communication needs. The findings highlight the need for more culturally appropriate information concerning IBD, and improved responsiveness to young people with IBD within primary care and the education system, as well as culturally competent messaging relating to the specific nature of the condition among the wider South Asian and black communities.     

儿童炎症性肠病病原菌分析

摘要:目的　分析某院炎症性肠病（Inflammatory Bbowel Disease,IBD）儿童患者粪便中的菌群分布,并与正常对照进行比较,探讨儿童IBD的发生与肠道菌群的关系。方法　选取2011年5月-2014年8月在该院确诊的IBD患儿共101例作为调查对象;同时选取该院同一时间段进行健康体检的健康儿童50例作为对照。收集调查样本新鲜粪便,通过荧光定量PCR检测肠道优势菌群的数量情况,比较溃疡性结肠炎（UC）患儿、克罗恩病（CD）患儿与正常对照组各优势菌种的数量差异。结果　根据菌群定量检测结果发现,拟杆菌属在3组人群中数量差异无统计学意义（F＝3.148,P＞0.05）,UC组及CD组双歧杆菌、缠绕杆菌、乳酸菌、脆弱杆菌、梭状芽胞杆菌比对照组显著减少（F值分别为15.331、17.453、21.479、18.521,27.658,P值均＜0.05）,UC组及CD组肠球菌比正常对照组明显增多（F＝23.457,P＜0.05）。结论　儿童肠道优势菌群与IBD的发生具有关联性,但优势菌群分布与IBD发生的因果关系还需要今后进行进一步的研究证实。     

活动性炎症性肠病与血小板参数的相关性及其临床意义

目的研究炎症性肠病(IBD)患者血液中血小板计数和平均血小板体积是否可以作为评价IBD活动性的参考指标。方法选取IBD病例160例,其中溃疡性结肠炎(UC)85例,克隆病(CD)75例;非IBD病例121例。摘录病例中的血小板计数和平均血小板体积。结果UC和CD病例中的血小板计数均比非IBD病例高,而平均血小板体积均比非IBD病例低,差异有统计学意义。血小板计数和平均血小板体积均与UC的炎症程度分级有相关关系,与CD的简易CD活性指数评分也有相关关系。结论血小板计数和平均血小板体积可作为评价IBD活动性的参考指标。     

活动性炎症性肠病与血小板参数的相关性及其临床意义

目的研究炎症性肠病（IBD）患者血液中血小板计数和平均血小板体积是否可以作为评价IBD活动性的参考指标。方法选取IBD病例160例，其中溃疡性结肠炎（UC）85例，克隆病（CD）75例；非IBD病例121例。摘录病例中的血小板计数和平均血小板体积。结果UC和CD病例中的血小板计数均比非IBD病例高，而平均血小板体积均比非IBD病例低，差异有统计学意义。血小板计数和平均血小板体积均与UC的炎症程度分级有相关关系，与CD的简易CD活性指数评分也有相关关系。结论血小板计数和平均血小板体积可作为评价IBD活动性的参考指标。     

小儿炎症性肠病23例临床分析

目的了解小儿炎症性肠病（inflammatory bowel disease,IBD）的临床、实验室检查、影像学检查和内镜检查特点,以提高对小儿炎症性肠病的诊断水平。方法对1992年3月至2007年10月复旦大学附属儿科医院消化科收治的23例炎症性肠病患儿的临床资料进行回顾性分析。结果小儿炎症性肠病以男童发病为多,腹痛、腹泻、便血为溃疡性结肠炎（ulcerative colitis,UC）与克罗思病（Crohn’s disease,CD）的共同表现,而血便以溃疡性结肠炎多见,腹痛多见于Crohn’s病,肠外表现Crohn’s病更为多见。病变部位,溃疡性结肠炎以乙状结肠分布为主,Crohn’s病以末端回肠、回盲部分布为主,与成年人炎症性肠病相比,病变累及范围更广。结论需建立统一的小儿炎症性肠病活动指标,对炎症性肠病进行系统管理,尽早做出诊断,避免小儿生长发育迟缓。     

112例炎症性肠病患者的营养风险筛查

目的 筛查炎症性肠病(IBD)患者营养风险的发生情况.方法 采用营养风险筛查2002(NRS2002)对在北京协和医院就诊的112例IBD患者进行营养风险筛查.体重指数(BMI)采用中国标准,以小于18.5 kg/m~2结合临床判定为营养不良,直接记录为3分.采用True-Love标准将溃疡性结肠炎(UC)分为轻型、中型和重型.采用Harvey和Bradshaw标准将克罗恩病(CD)分为缓解期(≤4分)、中度活动期(4-8分)和重度活动期(≥9分).结果 112例IBD患者中,UC为70例,CD为42例,总营养风险发生率为40.2%.CD组患者营养风险发生率为52.4%,明显高于UC组的32.9%(P<0.05).营养风险发生率与疾病严重程度相关.重型IBD患者营养不良(不足)发生率显著低于营养风险发生率(P=0.003).结论 IBD患者营养风险发生率较高,NRS2002有助于发现IBD患者的营养风险.     

Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease

Alcohol consumption is a potential trigger for flare in inflammatory bowel disease (IBD) flare because of alcohol's pro-oxidant effects and its deleterious effects on gut barrier function. The association with alcohol consumption and IBD flare is unclear. To test this hypothesis, we evaluated the pattern of alcohol consumption and its self-reported effect on gastrointestinal (GI) symptoms in patients with IBD. We recruited 129 consecutive patients: 52 patients with Crohn's disease, 38 patients with ulcerative colitis, and 39 patients with irritable bowel syndrome (IBS). All the participants completed a validated questionnaire on disease activity (the Crohn's disease activity index or ulcerative colitis clinical activity index, respectively) validated questionnaires to quantify alcohol consumption by National Institute of Alcohol Abuse and Alcoholism criteria, and two structured questionnaires we designed to access patients' perception of the effect of alcohol on their GI symptoms and on overall GI symptom severity. The pattern of current, light, moderate, and heavy alcohol consumption in inactive IBD was similar to the general U.S. population. Specifically, of the 90 inactive IBD patients, 56 (62%) were current drinkers, compared with 61% in the general U.S. population. Of current drinkers, 75% of IBD (N = 42) and 43% of IBS (N = 9) reported a worsening of GI symptoms with alcohol consumption (P = .01); however, overall GI symptom severity did not differ when compared with quantity of alcohol consumed. Patients with inactive IBD drink alcohol in quantities similar to the general population. Current drinkers with inactive IBD are more likely to report worsening of GI symptoms with alcohol than current drinkers with IBS.     

中西医结合治疗慢性盆腔炎性继发不孕症的疗效分析

目的:研究中西医结合方法治疗慢性盆腔炎所致继发不孕症的临床疗效。方法:研究慢性盆腔炎所致不孕症患者共206例,随机分为两组,中西医结合治疗组及单纯西医治疗组,各103例。中西医结合治疗组采用经期抗炎及经间期中药治疗;单纯西医治疗组采用经期抗炎,比较两组继发不孕症患者经治疗后其临床疗效、输卵管造影结果显示正常(双侧输卵管通畅)者以及妊娠率有无差别。结果:轻度、中度慢性盆腔炎患者其中西医结合治疗组(治疗组)的临床疗效、输卵管造影结果显示正常(双侧输卵管通畅)者以及妊娠率明显高于西医治疗组(对照组),有显著性差异(P<0.05),但重度慢性盆腔炎患者两组无显著性差异(P>0.05)。结论:中西医结合治疗轻度、中度慢性盆腔炎所致继发不孕症的疗效明显高于单纯西医治疗组。     

Perception of the Role of Food and Dietary Modifications in Patients with Inflammatory Bowel Disease: Impact on Lifestyle

Background: Diet has a relevant role in triggering symptoms in inflammatory bowel disease (IBD) from the patients’ perspective, but there is gap the between patients’ and doctors’ perceptions. Few studies have addressed this topic. The aim of this study was to evaluate food habits and nutrition knowledge in a homogeneous cohort of patients with IBD from southern Italy. Methods: 167 consecutive patients with IBD were recruited. The survey was based on the administration of a semi-structured questionnaire assessing demographics, disease features, dietary behavior, and food intolerance. Results: The majority of patients did not consider food a cause of their disease. However more than 80% changed their diet after the diagnosis and most report an improvement in symptoms. Spiced and seasoned foods, dairy products, vegetables, and fruit were often avoided. A dairy-free diet was adopted by 33.7%. Food choices were based on self-experience and not on medical counselling. Dietary modifications deeply impact on lifestyle. Conclusions: Most of the patients with IBD set diet and lifestyle on self-experience and give up many foods. This has an impact on psychosocial functioning and can lead to nutritional deficiencies. High quality studies are warranted to assess evidence-based dietary strategies and develop patient-targeted dietary recommendations.     

A population-based study of familial clustering of inflammatory bowel disease in Florence

In the frame of a population-based epidemiological study inthe metropolitan area of Florence in a 15 year period (1978–1992)all prevalent patients affected with ulcerative colitis (UC)or Crohn's disease (CD) (alive and resident in the area at theend of the study) were investigated in order to identify familialclustering. Only 45 patients (5.2%) reported at least 1 relativewith a diagnosis of inflammatory bowel disease (IBD). Amongthese, 25 patients reported a first-degree relative affectedwith IBD (2.9%). All the 28 families were contacted and detailedpersonal interviews were carried out in order to collect familytrees. The affected relatives living outside the study areawere also identified and their IBD diagnoses were verified.Fifteen families included only affected members with a diagnosisof UC; 5 had only CD, while 8 families had members affectedwith both forms. Two large families had 4 affected members and2 other families had 3. Overall 9 parent-child affected pairswere identified (1 out of every 3 families). The high concordancewithin families for the type of disease (p=0.015) suggests thatthe disease susceptibility is specific. The authors discussthese findings and a possible interpretation of the low proportionof familial cases in this area.     

The meaning of parental illness to children: the case of inflammatory bowel disease

BACKGROUND: Research on the impact of parental illness on children is sparse, and it remains unclear what kind of support, if any, families would value. This paper presents findings from the first investigation to explore the experiences of young people who have a parent with inflammatory bowel disease (IBD). DESIGN AND METHODS: This qualitative study involved interviews with 23 young people, aged between six and 20 years, who have a parent with IBD. A range of non-verbal techniques was used to facilitate interviews with young children. Data were analysed using the framework approach. RESULTS: Participants varied in their understanding and perception of their parent's condition and the extent to which they discussed it with family and friends. Some reported being unaffected by their parent's illness. The main negative effects on everyday life were restrictions on social activities, parents being unable to do housework, children having to be well-behaved and parents becoming withdrawn or irritable. Experiences could lead to feelings of sadness, worry, anger and guilt. The few who reported positive effects described spending time with the parent while ill, being allowed to be more independent and being close as a family. Relatives, friends, neighbours, service providers and young people all played a role in helping to manage the situation, and most participants felt that their family did not need additional support. However, some young people would value advice and information regarding the condition and opportunities to meet others in a similar situation. CONCLUSION: IBD is a highly variable condition, with substantial differences in the extent to which it impinges on the lives of family members. In addition to supporting patients, health professionals have an important role to play in offering advice and information to others affected by the illness, including children.     

112例炎症性肠病患者的营养风险筛查

Objective To assess the nutritional risk of patients with inflammatory bowel disease (IBD).Methods The nutritional status of 112 IBD patients from PUMC Hospital were evaluated by Nutritional Risk Screening 2002 (NRS 2002).Using Chinese standard,a body mass index (BMI) that was lowered than 18.5 kg/m~2 according to clinical material was regarded as malnutrition,and the score was recorded as 3.The se-verity of ulcerative colitis (UC) was evaluated using True-Love criteria as mild,moderate,and severe.Crohn's disease (CD) was evaluated using Harvey-Bradshaw Index as in remission stage (≤4),moderately active stage (4-8),and severely actively stage (≥9).Results All these 112 patients,including 70 UC cases and 42 CD cases,were evaluated by NRS2002.Forty-five patients (40.2%) were judged as at the risk of malnutrition.The incidence of malnutrition was significantly higher in CD patients than in UC patients (52.4% vs.32.9%,P<0.05).It was also significantly correlated with the severity of disease.In patients with severe IBD,the rate of mal-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk.Con-clusions The risk of malnutrition is high in IBD patients.NRS 2002 can be used for nutritional risk screening.     

The role of complementary medicine in European and Asian patients with inflammatory bowel disease

Three hundred and eighty-two patients with known inflammatory bowel disease (IBD) (190 European and 192 Asian) and 190 with coeliac disease were sent a previously validated questionnaire to investigate patients' use of alternative medicine and their views on its effectiveness. Details sought included whether they had ever consulted an alternative practitioner, whether they had followed a course of treatment and its clinical effects. Information about where patients had heard about such alternative practitioners and whether they were told to discontinue their current allopathic medication was also sought. Results were analysed after three consecutive mailings, including one in Gujurati to Asian patients. A randomly selected group was re-interviewed four months later. To validate the study alternative medicine practitioners were also interviewed to investigate what percentage of their attendees have IBD and how many of those clients were Asians.One hundred and fifty-eight questionnaires were returned from European patients with IBD (response rate = 83%), 145 from patients with coeliac disease (response rate = 76%) but only 81 Asian patients with IBD (response rate = 42%). Forty-seven European and Asian patients with inflammatory bowel disease sought advice or treatment from an alternative practitioner, compared with only 11 with coeliac disease (X² = 11.64, df = 12, P < 0.003). There was no significant difference in consultation rates between Asian and European patients with IBD (Yates corrected X² = 0.78, ns). The most common practitioners consulted by all groups were homeopaths (n = 23) and herbalists (n = 27) but 20 patients consulted more than one practitioner at a time. Patients with coeliac disease and European patients with IBD had consulted osteopaths (n = 6) and reflexologists (n = 7). Ten patients with IBD had also attended a spiritualist and five Asian patients a hakim. Common sources of information about alternative remedies included friends and relatives (n = 13), the media (n = 11), word of mouth (n = 11) and family practitioners (n = 6). Most patients were advised to continue their current medications, although two had been told to stop and 10 advised to reduce the dose of their allopathic medications. Twenty alternative medicine practitioners stated that overall between 2–5% of their attendees have IBD with 10% of those clients being Asian. Asians preferred to consult Asian practitioners rather than European practitioners. There was no clear consensus as to whether complementary therapies were felt beneficial, although many patients with IBD believed them to be helpful.     

Stigma,deviance and morality in young adults' accounts of inflammatory bowel disease

For young adults with inflammatory bowel disease (IBD), perceived stigma has been found to be a salient concern. Drawing on interviews with individuals with IBD aged 18–29 (n = 16), this article uses rhetorical discourse analysis to explore how stigma is discursively constructed by young adults, with a focus on the moral underpinnings of the participants' talk. Their representations showed both felt stigma and enacted stigma; principally related to the perceived taboo surrounding the symptoms of their condition, which often led to the non‐disclosure or concealment of the condition. The different ways in which stigma is manifested in the accounts present a challenge to recent arguments questioning the relevance of this concept in chronic illness research, though it was found that it is not adequate to look at stigma alone and, given the unstable nature of IBD, negotiating stigma in relation to possible charges of deviance is a pertinent issue for these young adults. For instance, non‐disclosure because of shame could result in individuals experiencing blame. Accounts were constructed through a range of discursive strategies, allowing the participants to present themselves in morally appropriate ways throughout. Suggestions are made about future directions in addressing stigma and deviance in relation to this cohort.     

Paediatric parenting stress in inflammatory bowel disease: application of the Pediatric Inventory for Parents

Background The psychosocial functioning of caregivers of adolescents managing inflammatory bowel disease (IBD) has been understudied; yet, poor caregiver functioning can place youth at risk for compromised disease management. The current study addressed this limitation by examining a sample of caregivers of adolescents with IBD. Study aims included (1) documenting rates of paediatric parenting stress; (2) identifying associated sociodemographic predictors of parenting stress; and (3) comparing previously published rates of parenting stress to those within other paediatric chronic conditions, including cancer, type 1 diabetes, obesity, sickle cell disease, bladder exstrophy. Methods Caregivers of adolescents with an IBD diagnosis (M_age= 15.4 ± 1.4, 44.4% female, 88.7% Caucasian) and receiving tertiary care within a gastroenterology clinic (n= 62) completed the Pediatric Inventory for Parents (PIP) as a measure of paediatric parenting stress with frequency and difficulty as PIP subscales. Paediatric gastroenterologists provided disease severity assessments. Results Adolescents with IBD were experiencing relatively mild disease activity. Bivariate correlations revealed that PIP‐difficulty was positively associated with Crohn's disease severity (r= 0.38, P < 0.01). Caregiver age was negatively associated with the frequency of parenting stress total (r=?0.25, P= 0.05) and communication scores (r=?0.25, P < 0.05). The frequency and difficulty of parenting stressors within the IBD sample were similar to rates within type 1 diabetes, but were significantly lower than rates identified in other paediatric chronic conditions. Conclusions Caregivers of adolescents with IBD seem to experience low rates of parenting stress when their adolescents are receiving outpatient care and during phases of IBD relative inactivity. The sociodemographic characteristics of IBD families (i.e. primarily Caucasian, well‐educated and higher socio‐economic status) likely encourage greater access to financial and psychosocial resources, which may aid in promoting more optimal stress management.     

Effects of Olive Oil and Its Components on Intestinal Inflammation and Inflammatory Bowel Disease

With the rising global burden of inflammatory bowel disease (IBD) and the rising costs of novel biological drugs, there is an increasing need for dietary approaches and functional foods that could modulate the course of IBD. The Mediterranean diet has proven to be efficacious in managing chronic inflammatory diseases, and recent studies have also shown its benefits in the setting of IBD. Since olive oil and its compounds have been shown to provide a considerable anti-inflammatory effect, in this review, we aim to discuss the latest evidence concerning the impact of olive oil and its bioactive compounds on IBD. Numerous preclinical studies have exhibited solid evidence on the mechanisms by which polyphenol-rich extra-virgin olive oil (EVOO) or specific polyphenols like hydroxytyrosol (HT) provide their anti-inflammatory, antioxidative, antitumour, and microbiota-modulation effects. Accordingly, several human studies that explored the effects of olive oil on patients with IBD further confirmed the evidence brought forward by preclinical studies. Nevertheless, there is a need for larger-scale, multicentric, randomized control trials that would finally elucidate olive oil’s level of efficacy in modulating the course of IBD.