scholarly journals The Medical Management of Paediatric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update

2020 ◽  
Author(s):  
Patrick F van Rheenen ◽  
Marina Aloi ◽  
Amit Assa ◽  
Jiri Bronsky ◽  
Johanna C Escher ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Treatment Response ◽  
Medical Management ◽  
Therapeutic Drug ◽  
Close Monitoring ◽  
Faecal Calprotectin ◽  
Exclusive Enteral Nutrition ◽  
Medical Librarian ◽  
Paediatric Crohn’S Disease

Abstract Objective We aimed to provide an evidence-supported update of the ECCO-ESPGHAN guideline on the medical management of paediatric Crohn’s disease [CD]. Methods We formed 10 working groups and formulated 17 PICO-structured clinical questions [Patients, Intervention, Comparator, and Outcome]. A systematic literature search from January 1, 1991 to March 19, 2019 was conducted by a medical librarian using MEDLINE, EMBASE, and Cochrane Central databases. A shortlist of 30 provisional statements were further refined during a consensus meeting in Barcelona in October 2019 and subjected to a vote. In total 22 statements reached ≥ 80% agreement and were retained. Results We established that it was key to identify patients at high risk of a complicated disease course at the earliest opportunity, to reduce bowel damage. Patients with perianal disease, stricturing or penetrating behaviour, or severe growth retardation should be considered for up-front anti-tumour necrosis factor [TNF] agents in combination with an immunomodulator. Therapeutic drug monitoring to guide treatment changes is recommended over empirically escalating anti-TNF dose or switching therapies. Patients with low-risk luminal CD should be induced with exclusive enteral nutrition [EEN], or with corticosteroids when EEN is not an option, and require immunomodulator-based maintenance therapy. Favourable outcomes rely on close monitoring of treatment response, with timely adjustments in therapy when treatment targets are not met. Serial faecal calprotectin measurements or small bowel imaging [ultrasound or magnetic resonance enterography] are more reliable markers of treatment response than clinical scores alone. Conclusions We present state-of-the-art guidance on the medical treatment and long-term management of children and adolescents with CD.

scholarly journals Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1012
Author(s):  
Melinda Moriczi ◽  
Gemma Pujol-Muncunill ◽  
Rafael Martín-Masot ◽  
Santiago Jiménez Treviño ◽  
Oscar Segarra Cantón ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Disease Activity ◽  
Clinical Remission ◽  
Activity Index ◽  
Newly Diagnosed ◽  
Faecal Calprotectin ◽  
Exclusive Enteral Nutrition ◽  
Paediatric Crohn’S Disease

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.

scholarly journals A101 USTEKINUMAB LEVELS MEASURED DURING INDUCTION ARE ASSOCIATED WITH CLINICAL AND BIOCHEMICAL OUTCOMES AT WEEK 12 OF TREATMENT IN CROHN’S DISEASE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 117-118
Author(s):  
M Walshe ◽  
K Borowski ◽  
K Boland ◽  
S Rho ◽  
J Stempak ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Negative Correlation ◽  
Pearson Correlation ◽  
Significant Negative Correlation ◽  
Therapeutic Drug ◽  
Tertiary Referral Centre ◽  
Faecal Calprotectin ◽  
Drug Levels ◽  
Induction Dose

Abstract Background Therapeutic drug monitoring (TDM) helps guide use of anti-TNF drugs in IBD patients. In addition, higher anti-TNF levels during induction therapy have been shown to be associated with better clinical and endoscopic outcomes. The role of TDM for more novel biologics such as ustekinumab (an anti- IL-12/23 antibody used to treat Crohn’s disease) remains to be elucidated. Aims We set out to investigate correlations between ustekinumab drug levels measured during induction with clinical and biochemical outcomes in patients with Crohn’s disease. Methods Patients with Crohn’s disease commencing treatment with ustekinumab were recruited from a single tertiary referral centre. Standard weight-based induction dosing was used. TDM was performed at week 2 and week 6 following IV induction dose. A drug-tolerant assay (Prometheus) was used. Kruskal-Wallis test was used to examine association between induction dose and ustekinumab levels. CDAI, CRP, and faecal calprotectin (FCP) were measured at week 12. Pearson correlation co-efficient was used to assess the relationship between ustekinumab levels and i)CDAI ii)CRP and iii)FCP at week 12. Results A total of 38 ustekinumab levels in 21 patients were measured. Week 2 ustekinumab levels were available for 17 patients, 16 (94.1%) of whom had levels of greater or equal to 25μg/mL. (1 patient had a level of 19.5μg/mL.) Week 6 ustekinumab levels were available for 21 patients; median 15μg/mL (IQR 9.9–21.3). No patients had detectable antibodies to ustekinumab. There was no significant association between absolute induction dose and week 6 ustekinumab levels; p=0.46. Of the 21 patients with week 6 levels, CDAI, CRP and FCP were available for 18, 18 and 16 patients respectively; Median CDAI 103(IQR 42–249), median CRP 2.3mg/L(IQR 1.0–11.3), median FCP 269μg/g(IQR109-932). There was a significant negative correlation between week 6 ustekinumab levels and CDAI; r=-.609, p=0.007. A negative correlation between week 6 ustekinumab levels and FCP was also significant; r=-.526, p=0.037. There was no significant correlation between week 6 ustekinumab levels and CRP; r=-.259, p=0.298. Conclusions We have demonstrated inter-patient variation in drug pharmacokinetics at week 6 following induction dose of ustekinumab in patients with Crohn’s disease. Drug levels at week 6 are significantly associated with clinical and biochemical markers of disease activity (CDAI, faecal calprotectin) at week 12. Measurement of week 6 ustekinumab levels may aid early identification of patients at risk of primary non-response to ustekinumab. Funding Agencies Testing provided by Prometheus

scholarly journals P454 Serum oncostatin M predicts mucosal healing in Crohn’s disease patients treated with infliximab

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S406-S406
Author(s):  
L Bertani ◽  
L Antonioli ◽  
M Fornili ◽  
M Fornai ◽  
G Tapete ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Treatment Response ◽  
Predictive Marker ◽  
Mucosal Healing ◽  
Oncostatin M ◽  
Spearman Correlation ◽  
Drug Infusion ◽  
Serum Samples ◽  
Faecal Calprotectin

Abstract Background A number of Crohn’s Disease (CD) patients fail to respond to infliximab (IFX) treatment. For this reason, the identification of a biomarker suitable to predict treatment outcome represents one of the most intriguing challenges for gastroenterologists. Oncostatin M (OSM) is a member of the interleukin 6 cytokine family, which is upregulated significantly in CD inflamed intestinal mucosa. OSM has been suggested as a promising biomarker to predict the responsiveness to anti-TNF therapy in patients with inflammatory bowel diseases. The aim of the present study was to evaluate the suitability of the evaluation of OSM serum levels as a predictive marker of treatment response to IFX. Methods We included CD patients treated with IFX during 2017 and 2018. All patients underwent a colonoscopy at week 54, when treatment response was evaluated in terms of mucosal healing (MH, defined as disappearance of ulcers). At baseline and after 14 weeks of treatment, OSM was evaluated by ELISA on serum samples collected before drug infusion. We assessed also faecal calprotectin (FC) at baseline and week 14. Mann-Whitney test was used to evaluate the correlation between OSM and FC levels at baseline and week 14 with MH at week 54. Spearman correlation between OSM and FC values at baseline and week 14 was computed as well. Logistic regression models to predict MH at week 54 were carried out by the Akaike Information Criterion (AIC) and Area Under the Curve (AUC). Results In a cohort of 45 patients (24 males) included in the study, 27 displayed MH. At baseline, OSM levels were significantly lower in treatment responders than non-responders (p &lt; 0.001). Similar results were obtained at week 14, when FC levels also were lower in responders than non-responders (p &lt; 0.001 for both OSM and FC). OSM values at baseline and week 14 were significantly associated (Spearman correlation = 0.92, p &lt; 0.001). The diagnostic accuracy of binary OSM at baseline in predicting MH (AIC = 26, AUC = 0.93) was greater than that of binary FC at week 14 (AIC = 34.7, AUC = 0.89). Conclusion These preliminary data suggest that OSM and FC are able to predict the outcome of treatment with IFX. Of note, at variance with FC, the predictive capability of OSM was appreciable at baseline, thus allowing to propose OSM as a promising biomarker for driving therapeutic choices in Crohn’s disease patients.

scholarly journals P547 Inadequate vitamin C status and association with inflammatory biomarkers in adults with active Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S465-S466
Author(s):  
C Wall ◽  
K MacFarlane ◽  
A Carr ◽  
A Day ◽  
R Gearry
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Vitamin C ◽  
High Performance ◽  
Serum Vitamin ◽  
Water Soluble ◽  
Dietary Vitamin ◽  
Micronutrient Deficiencies ◽  
Faecal Calprotectin ◽  
Exclusive Enteral Nutrition

Abstract Background Micronutrient deficiencies are common in inflammatory bowel disease (IBD) due to the inflammatory burden and changes in dietary intake. Vitamin C, an essential water-soluble antioxidant required for tissue repair and immune function, is found primarily in fresh fruit and vegetables however, this food group is more often avoided by people with IBD compared with the general population. This research aimed to determine serum vitamin C status in subjects with active Crohn’s disease, measure urinary vitamin C excretion in healthy controls (HC) and Crohn’s disease patients before and after exclusive enteral nutrition (EEN) and assess associations between inflammatory markers and vitamin C. Methods Stored serum and random urine samples prospectively collected from adults with mild to moderately active Crohn’s disease and adult HC were analysed. Both HC and Crohn’s disease groups received EEN with a known vitamin C content for two weeks. Serum and urinary vitamin C were measured using high-performance liquid chromatography with electrochemical detection. Urinary vitamin C was standardised to urinary creatinine. Non-parametric t-tests and correlations were performed. Results EEN was initiated in 38 patients (aged 16 to 39 years old). Inadequate serum vitamin C (&lt;50 µmol/l) was present in 36/38 patients with active Crohn’s disease and 45% had hypovitaminosis C. Baseline C-reactive protein (CRP) was 12 mg/l (range, 3 to 158 mg/l) and faecal calprotectin was 1065 µg/g (range, 60 to 3838 µg/g). Serum vitamin C correlated weakly with CRP (r = −0.30 95% CI: −0.58 to 0.03, p = 0.06) but not with faecal calprotectin. Two weeks of EEN was completed by 30 (79%) patients and 17 (81%) HC. The average vitamin C intake was 168mg/day (range, 108–252 mg/day). Baseline urinary excretion of vitamin C was low in both Crohn’s disease and HC. Following EEN urinary vitamin C excretion increased significantly in both groups (Figure 1). Conclusion Patients with active Crohn’s disease had inadequate vitamin C status. EEN increased urinary vitamin C excretion in both Crohn’s disease and HC, suggesting low baseline dietary vitamin C intake and potentially enhanced utilisation. Further research with a larger patient cohort would provide a greater understanding of vitamin C metabolism in active Crohn’s disease.

scholarly journals Outcomes of exclusive enteral nutrition in paediatric Crohn’s disease

2016 ◽  
Vol 71 (2) ◽  
pp. 185-191 ◽  
Author(s):  
L Lafferty ◽  
M Tuohy ◽  
A Carey ◽  
S Sugrue ◽  
M Hurley ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Exclusive Enteral Nutrition ◽  
Paediatric Crohn’S Disease
Sign in / Sign up

Export Citation Format

Share Document