Is It Useful to Monitor Thiopurine Metabolites in Pediatric Patients with Crohn’s Disease on Combination Therapy? A Multicenter Prospective Observational Study

2021 ◽  
Vol 23 (2) ◽  
pp. 183-194
Author(s):  
Kristyna Pospisilova ◽  
Jitka Siroka ◽  
Eva Karaskova ◽  
Ondrej Hradsky ◽  
Tereza Lerchova ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Multicenter Prospective Observational Study

scholarly journals Clinical and Nutritional Impact of a Semi-Elemental Hydrolyzed Whey Protein Diet in Patients with Active Crohn’s Disease: A Prospective Observational Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3623
Author(s):  
Blanca Ferreiro ◽  
Silvia Llopis-Salinero ◽  
Beatriz Lardies ◽  
Carla Granados-Colomina ◽  
Raimon Milà-Villarroel
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Nutritional Status ◽  
Disease Activity ◽  
Prospective Observational Study ◽  
Elemental Diet ◽  
Stool Frequency ◽  
Nutritional Treatment ◽  
The Mean

Background: Malnourishment is a common complication in patients with Crohn’s disease. Methods: An observational, prospective study was conducted to assess the nutritional status, disease activity, and stool frequency at baseline and after 12 weeks of treatment with a semi-elemental diet in patients with active Crohn’s disease. Results: A total of 144 patients with Crohn’s disease were included. The nutritional status improved after treatment, resulting in 76.1% of patients at low risk of malnourishment, 20.4% moderately malnourished, and 8.5% severely malnourished after 12 weeks of treatment. Nutritional status improvement was associated with the number of nutritional supplements. Mean albumin levels and body mass index (BMI) improved after 12 weeks of nutritional treatment (from 3.0 g/dL to 3.7 g/dL and from 20.2 kg/m2 to 21.1 kg/m2, respectively). A significant decrease in HBI was found after 12 weeks of nutritional treatment (from 10.2 to 3.7). The mean number of stools per day decreased with the 12 week semi-elemental diet (from 4.6 stools/day to 1.7 stools/day). Conclusion: In this observational study, the semi-elemental diet seemed effective in improving the nutritional status, disease activity, and stool frequency in patients with active Crohn’s disease.

scholarly journals Discontinuation of Azathioprine Could Be Considered in Pediatric Patients with Crohn’s Disease who Have Sustained Clinical and Deep Remission

2021 ◽  
Author(s):  
Tae Jong Jeong ◽  
Eun Sil Kim ◽  
Yiyoung Kwon ◽  
Seonwoo Kim ◽  
Sang Won Seo ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Pediatric Patients ◽  
Proportional Hazards ◽  
Treatment Strategies ◽  
Cox Proportional Hazards ◽  
Clinical Relapse ◽  
Factors Affecting ◽  
Factors Associated

Abstract Few studies have demonstrated treatment strategies about the duration and cessation of medications in patients with Crohn’s disease (CD). We investigated factors affecting clinical relapse after infliximab (IFX) or azathioprine (AZA) withdrawal in pediatric patients with CD on combination therapy. Pediatric patients with moderate-to-severe CD receiving combination therapy were analyzed retrospectively and factors associated with clinical relapse were investigated. Discontinuation of IFX or AZA was performed in patients who sustained clinical remission (CR) for at least two years and achieved deep remission. A total of 75 patients were included. Forty-four patients (58.7%) continued with combination therapy and 31 patients (41.3%) discontinued AZA or IFX (AZA withdrawal 10, IFX withdrawal 15, both withdrawal 6). Cox proportional-hazards regression identified four factors associated with clinical relapse: IFX cessation (hazard ratio; HR 2.982, P=0.0081), formation of antibody-to-IFX (ATI) (HR=3.12, P=0.0373), IFX trough level (TL) (HR=0.581, P=0.003) and 6-thioguanine nucleotide (6-TGN) level (HR=0.978, P<0.001). However, AZA cessation was not associated with clinical relapse (P=0.9021). Even when applied in pediatric patients who meet stringent criteria, IFX cessation increased the relapse risk. However, withdrawal of AZA could be contemplated in pediatric patients with CD who have sustained CR for at least two years and achieved deep remission.

scholarly journals P221 Crohn’s disease patients unable to complete preoperative mechanical bowel preparation have increased risk of anastomotic complications: results of a prospective observational study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
L Kunovsky ◽  
F Marek ◽  
Z Kala ◽  
D Ivanecka ◽  
I Iesalnieks
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Anastomotic Leak ◽  
Prospective Observational Study ◽  
Mechanical Bowel Preparation ◽  
Oral Antibiotics ◽  
Increased Risk ◽  
Postoperative Anastomotic Leak ◽  
Colorectal Resections

Abstract Background To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centers in Germany and the Czech Republic. Methods Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole/Paramomycin or Metronidazole/Neomycine. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was the occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intra-abdominal septic complications (IASC) which were defined as anastomotic leak, intra-abdominal abscess, fistula or peritonitis. Results Between 6/2016 and 3/2021, 157 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Forty (26%) developed complications from the MBP, mostly vomiting; twenty-nine patients (18.5%) were not able to complete the MBP. Female sex (HR 4.2, p=0.016) was associated with an increased probability of not being able to complete the MBP. Postoperative anastomotic leak occurred in 5 patients (3%). In a multivariate analysis, the risk of anastomotic leak was significantly higher in patients unable to complete the MBP (10.5%), as compared to patients with complete MBP (1.6%, p=0.01, HR 21.0). Postoperative IASC occurred in 7 patients (7%). Patients unable to complete preoperative MBP were at higher risk of developing IASC. However, the difference was not statistically significant (14% vs. 5%, p=0.12). Conclusion The anastomotic leak rate was low when preoperative MBP and oral antibiotics were used. However, patients not able to complete MBP might be at an increased risk.

scholarly journals Discontinuation of Azathioprine could be considered in pediatric patients with Crohn’s disease who have sustained clinical and deep remission

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Tae Jong Jeong ◽  
Eun Sil Kim ◽  
Yiyoung Kwon ◽  
Seonwoo Kim ◽  
Sang Won Seo ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Pediatric Patients ◽  
Proportional Hazards ◽  
Treatment Strategies ◽  
Cox Proportional Hazards ◽  
Clinical Relapse ◽  
Internal Validation ◽  
Factors Associated

AbstractFew studies have demonstrated treatment strategies about the duration and cessation of medications in patients with Crohn’s disease (CD). We investigated factors affecting clinical relapse after infliximab (IFX) or azathioprine (AZA) withdrawal in pediatric patients with CD on combination therapy. Pediatric patients with moderate-to-severe CD receiving combination therapy were analyzed retrospectively and factors associated with clinical relapse were investigated. Discontinuation of IFX or AZA was performed in patients who sustained clinical remission (CR) for at least two years and achieved deep remission. A total of 75 patients were included. Forty-four patients (58.7%) continued with combination therapy and 31 patients (41.3%) discontinued AZA or IFX (AZA withdrawal 10, IFX withdrawal 15, both withdrawal 6). Cox proportional-hazards regression and statistical internal validation identified three factors associated with clinical relapse: IFX cessation (hazard ratio; HR 2.982, P = 0.0081), IFX TLs during maintenance therapy (HR 0.581, P = 0.003), 6-thioguanine nucleotide (6-TGN) level (HR 0.978, P < 0.001). However, AZA cessation was not associated with clinical relapse (P = 0.9021). Even when applied in pediatric patients who met stringent criteria, IFX cessation increased the relapse risk. However, withdrawal of AZA could be contemplated in pediatric patients with CD who have sustained CR for at least 2 years and achieved deep remission.

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