Diagnostic imaging in inflammatory bowel disease in paediatric patients

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

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Prevalence of undernutrition in newly diagnosed paediatric patients with inflammatory bowel disease

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.605 ◽

2021 ◽

Vol 46 ◽

pp. S757-S758

Author(s):

D. Kofinova ◽

R. Shentova ◽

P. Hadzhiyski ◽

H. Naydenov ◽

P. Yaneva ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Newly Diagnosed ◽

Paediatric Patients ◽

Inflammatory Bowel

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P670 Usefulness of monitoring the concentration of azathioprine metabolites in the children with inflammatory bowel disease and autoimmune hepatitis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.798 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S549-S550

Author(s):

K Bąk-Drabik ◽

J Duda-Wrońska ◽

D Dąbrowska-Piechota ◽

P Adamczyk

Keyword(s):

Inflammatory Bowel Disease ◽

Side Effects ◽

Autoimmune Hepatitis ◽

Bowel Disease ◽

Immunosuppressive Drug ◽

Therapeutic Drug ◽

Paediatric Patients ◽

Inflammatory Bowel ◽

The Mean ◽

Dose Change

Abstract Background Azathioprine (AZA) is an immunosuppressive drug, which is metabolised in the liver and kidneys into 6-thioguanine- the form responsible for the therapeutic effect. Despite its anti-inflammatory, antibacterial and immunomodulating properties, azathioprine has also dose-related side effects, such as bone marrow suppression, liver damage and pancreatitis. The purpose of this study was to assess the usefulness of monitoring the concentration of azathioprine metabolites: 6-tioguanine (6-TG) and 6-methylmercaptopurine (6-MMP) in the group of paediatric patients with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH). Methods The clinical data of 46 paediatric patients (24 girls) with IBD and AIH, aged 8–17 years, hospitalised in the Department of Gastroenterology, who had undergone a blood examination for AZA metabolites concentration, were analysed. Results Initial mean dose of azathioprine was 1.23 mg/kg/day in IBD and 1.16 mg/kg/day in AIH. In 30% of patients, the concentrations of 6-TG and 6-MMP were within the normal range. Forty-eight per cent of patients required a dose change due to: elevated 6-TG concentration (32.6%) or underdosage (15.4%). After modification the mean dose was 1.16 mg/kg/day in IBD and 0.85 mg/kg/day in AIH. In 10.7 % of patients, the concentrations of 6-TG and 6 MMP were below the proper range, in the same percentage of patients metabolites were undetectable. Conclusion In a significant number of cases monitoring the concentration of AZA metabolites indicated the necessity to reduce the dose of AZA allowing to achieve the therapeutic optimum and prevent serious side effects. Receiving undetectable concentration of metabolites is a sign of non-compliance. The final doses of AZA were found to be lower than the recommended doses. Therapeutic drug monitoring (TDM), which involves measurement of drug or active metabolite levels is a good strategy that can be used to optimise IBD and AIH therapeutics.

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759 – Significant Variants in Monogenic Inflammatory Bowel Disease Genes Identified by Whole Exome Sequencing of 400 Paediatric Patients

Gastroenterology ◽

10.1016/s0016-5085(19)37187-2 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-157-S-158

Author(s):

James J. Ashton ◽

Enrico Mossotto ◽

Imogen Stafford ◽

Tracy Coelho ◽

Nadeem A. Afzal ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Exome Sequencing ◽

Whole Exome Sequencing ◽

Bowel Disease ◽

Disease Genes ◽

Paediatric Patients ◽

Whole Exome ◽

Inflammatory Bowel

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P262 Trends in the prevalence and severity of anaemia in paediatric patients with inflammatory bowel disease in the last decade

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.391 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S281-S281

Author(s):

S Y Geng ◽

Z Ridha ◽

B L Pham ◽

E Tran ◽

A Peixoto ◽

...

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Disease ◽

Iron Deficiency ◽

Disease Severity ◽

Bowel Disease ◽

Paediatric Patients ◽

Intestinal Involvement ◽

Inflammatory Bowel ◽

The Impact

Abstract Background Anaemia is one of the most common extraintestinal manifestations in patients with inflammatory bowel disease(IBD) at diagnosis. Studies have shown that anaemia was associated with low levels of quality of life, which improves with the correction of anaemia in adults. Recent data have shown an increase in the incidence and severity of paediatric IBD. We aim to investigate the trends in the prevalence of anaemia in children at diagnosis of IBD in the last decade. The secondary aim was to investigate the associations between haemoglobin (Hb) levels and disease characteristics. Methods Eligible patients (age ≤18 years, diagnosed with IBD from 2009 to 2018) were retrospectively identified through a prospective IBD database maintained at CHU Sainte-Justine, Montreal, Canada. Disease localisation and phenotype were defined according to the Paris Classification of IBD. Anaemia was defined by Hb levels according to WHO targets. The annual prevalence of anaemia was calculated according to subtype (inflammatory vs. iron deficiency). The Pediatric Crohn’s Disease Activity Index(PCDAI) and the Pediatric ulcerative colitis Activity(PUCAI) Index were used to assess the disease severity at diagnosis. Results We included 887 patients (439 females), mean(SD) age of 13.1 (3.4) years. Of these, 519 (58.5%) were identified with anaemia within 30 days of diagnosis. The median (IQR) Hb level at diagnosis was 108 (98 −114) g/dl. Severe anaemia(< 70 g/dl) was present in 1.8 % of patients. The prevalence of anaemia at diagnosis remained relatively stable ranging from 60.2% in 2009 to 60.4% in 2018. The annual proportion of inflammatory vs. iron-deficiency anaemia is displayed in Figure 1. Anaemia was more prevalent in CD (62.2%) than UC (57.9%) or IBD-U(39.6%). The median(IQR) PCDAI and PUCAI were respectively 37.5 (27.5–47.5) and 55.0 (40.0–65.0) in the anaemic group as compared with 27.5 (20.0–37.50) and 35.0 (25.0–55.0) in the non-anaemic group; p < 0.0001. Patients with anaemia had a lower BMI z-score [median(IQR) −0.84(−1.84–0.08)] than the non-anaemic patients[median(IQR) −0.38(−1.21–0.43)]; p < 0.001. The prevalence of anaemia correlated significantly with disease location: upper intestinal involvement [L4a(67.7%) L4b(63.6%) L4aL4b(60.7%) none (52.8%)] p = 0.024 for CD; for UC[E1(21.1%) E2(44.4%) E3(75.0%) E4 (71.1%)] p < 0.0001. A moderate correlation was found between Hb levels and C-reactive protein (r = −0.312, 95% CI: −0.378 to −0.243, p < 0.0001). Conclusion Anaemia remains a prevalent symptom in paediatric patients with IBD, and it is correlated with the extent of intestinal involvement and disease severity. The impact of anaemia at diagnosis and during follow-up on the levels of quality of life and physical activity is currently under investigation.

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Adequate Infliximab Exposure During Induction Predicts Remission in Paediatric Patients With Inflammatory Bowel Disease

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/mpg.0000000000002265 ◽

2019 ◽

Vol 68 (6) ◽

pp. 847-853 ◽

Cited By ~ 9

Author(s):

Karen van Hoeve ◽

Erwin Dreesen ◽

Ilse Hoffman ◽

Gert Van Assche ◽

Marc Ferrante ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Paediatric Patients ◽

Inflammatory Bowel

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P112 Long-term outcome of immunomodulators use in paediatric patients with inflammatory bowel disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjy222.236 ◽

2019 ◽

Vol 13 (Supplement_1) ◽

pp. S143-S144

Author(s):

K van Hoeve ◽

I Hoffman ◽

M Ferrante ◽

S Vermeire

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Paediatric Patients ◽

Inflammatory Bowel

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Protocol of a randomised controlled trial assessing the impact of physical activity on bone health in children with inflammatory bowel disease

BMJ Open ◽

10.1136/bmjopen-2019-036400 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036400

Author(s):

Jérémy Vanhelst ◽

Stéphanie Coopman ◽

Julien Labreuche ◽

Claire Dupont ◽

Valérie Bertrand ◽

...

Keyword(s):

Physical Activity ◽

Inflammatory Bowel Disease ◽

Randomised Controlled Trial ◽

Bone Health ◽

Bowel Disease ◽

Controlled Trial ◽

Whole Body ◽

Paediatric Patients ◽

Inflammatory Bowel ◽

Randomised Controlled

IntroductionLow bone mineral density (BMD) is a frequent issue in children and adolescents with inflammatory bowel disease (IBD). Several studies in healthy populations have reported a positive impact of physical activity (PA) on bone health. Recently, an observational study in paediatric patients with IBD showed a significant positive relationship between daily PA and BMD. However, intervention studies investigating a causal relationship between PA and BMD are warranted to confirm these results. The aim of this randomised controlled trial will be to investigate the effect of a PA programme on BMD in paediatric patients with IBD.Methods and analysisThis trial is a multicentre (four centres), randomised, controlled, blinded end-point study. Eighty children with IBD will be randomly assigned in a 1:1 ratio to receive a programme with adapted physical exercises (intervention group) or usual PA (control group) during a 9-month period. The primary outcome is the change from baseline at 9 months (the end of the study) in whole-body BMD assessed by dual-energy X-ray absorptiometry. Secondary efficacy outcomes include the changes from baseline at 9 months in: BMD assessed in the lumbar spine and trochanter; daily PA (time spent in moderate-to-vigorous PA); body composition (fat mass and fat-free mass); fatigue resistance; quality of life and activity of IBD.Ethics and disseminationThe study was approved by the Research Ethics Committee in France (Comité de Protection des Personnes, Sud-Ouest and Outre-Mer III, Bordeaux, France, No 2018/27). All procedures will be performed according to the ethical standards of the Helsinki Declaration of 1975, as revised in 2008, and the European Union’s Guidelines for Good Clinical Practice. Written informed consent will be obtained from the parents or legal guardian and from the children. Research findings will be disseminated in peer-reviewed journals and scientific meetings.Trial registration numberNCT03774329.

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