Crohn Disease in Childhood and Adolescence

10.2310/im.5604 ◽

2018 ◽

Author(s):

Lori Zimmerman

Keyword(s):

Weight Loss ◽

Gastrointestinal Tract ◽

Crohn Disease ◽

Signs And Symptoms ◽

Mucosal Healing ◽

Joint Disease ◽

Perianal Disease ◽

Childhood And Adolescence ◽

Chronic Inflammatory Condition ◽

And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

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Impact of Inflammatory Bowel Disease upon Growth in Children and Adolescents

ISRN Pediatrics ◽

10.5402/2011/365712 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

V. Moeeni ◽

A. S. Day

Keyword(s):

Inflammatory Bowel Disease ◽

Weight Loss ◽

Gastrointestinal Tract ◽

Children And Adolescents ◽

Linear Growth ◽

Delayed Puberty ◽

Childhood And Adolescence ◽

Bowel Diseases ◽

Inflammatory Processes ◽

Inflammatory Bowel

The inflammatory bowel diseases (IBDs) are chronic inflammatory processes affecting the gastrointestinal tract. When diagnosed in childhood and adolescence, IBD almost always impacts adversely upon the nutritional state of the patient. Weight loss and impaired linear growth may be present at diagnosis or subsequently. Further potential nutritional consequences in childhood IBD include malnutrition, anaemia, osteopaenia, and delayed puberty. Understanding the nutritional aspects of IBD is paramount in growing children, especially those entering and advancing through puberty. This paper focuses upon the nutritional impacts of IBD in children and adolescents.

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Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa083 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Zeinab Bakhshi ◽

Siddhant Yadav ◽

Bradley R Salonen ◽

Sara L Bonnes ◽

Jithinraj Edakkanambeth Varayil ◽

...

Keyword(s):

Weight Loss ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Crohn Disease ◽

Severe Disease ◽

Bloodstream Infections ◽

Home Parenteral Nutrition ◽

Average Weight ◽

Olmsted County ◽

Short Bowel

Abstract Background We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusions Less than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

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Assessment of small intestine mucosal healing by capsule endoscopy in pediatric Crohn disease after exclusive enteral nutrition treatment

Digestive and Liver Disease ◽

10.1016/j.dld.2008.07.261 ◽

2008 ◽

Vol 40 (10) ◽

pp. A91

Author(s):

C. Brondello ◽

E. Pozzi ◽

F. Mangiantini ◽

M. Lorusso ◽

S. Bevilacqua ◽

...

Keyword(s):

Small Intestine ◽

Enteral Nutrition ◽

Capsule Endoscopy ◽

Crohn Disease ◽

Mucosal Healing ◽

Exclusive Enteral Nutrition

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IRIDOCYCLITIS IN JUVENILE RHEUMATOID ARTHRITIS

PEDIATRICS ◽

10.1542/peds.44.1.92 ◽

1969 ◽

Vol 44 (1) ◽

pp. 92-100 ◽

Cited By ~ 1

Author(s):

Jane Schaller ◽

Carl Kupfer ◽

Ralph J. Wedgwood

Keyword(s):

Rheumatoid Arthritis ◽

Juvenile Rheumatoid Arthritis ◽

Signs And Symptoms ◽

Joint Disease ◽

Slit Lamp ◽

Patients At Risk ◽

Eye Involvement ◽

Eye Examination ◽

Systemic Manifestations ◽

Polyarticular Disease

Eight of 70 children with juvenile rheumatoid arthritis have developed iridocyclitis. This complication occurred more frequently in patients with monoarticular and pauciarticular disease (29%) than in patients with polyarticular disease (2%). Seven of eight patients with iridocyclitis have monoarticular or pauciarticular disease; none has had prominent systemic manifestations or evidence of ankylosing spondylitis. Iridocyclitis preceded joint manifestations in two of the patients and followed arthritis by 1 to 10 years in six of the patients. Activity of iridocyclitis and arthritis seemed unrelated; four patients developed iridocyclitis while arthritis was inactive. In seven children iridocyclitis began insidiously without acute symptoms. Eye involvement has remained unilateral in six patients. Six children have had significant decrease in visual acuity, and six continue to have active ocular inflammation despite therapy. Iridocyclitis is potentially a major cause of disability in juvenile rheumatoid arthritis. Early signs and symptoms may be minimal. Patients at risk are those with limited forms of joint disease. Early detection and therapy are crucial for prevention of permanent ocular damage. Careful eye examination should be a routine part of physical examination of children with rheumatoid arthritis, and periodic slit lamp examinations should be performed even when arthritis is in remission.

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Neuroendocrine regulation of energy balance: Implications on the development and surgical treatment of obesity

Nutrition and Health ◽

10.1177/0260106017719369 ◽

2017 ◽

Vol 23 (3) ◽

pp. 131-146 ◽

Cited By ~ 5

Author(s):

Gisele Farias ◽

Bárbara Dal Molin Netto ◽

Solange Cravo Bettini ◽

Ana Raimunda Dâmaso ◽

Alexandre Coutinho Teixeira de Freitas

Keyword(s):

Weight Loss ◽

Adipose Tissue ◽

Gastrointestinal Tract ◽

Energy Balance ◽

Public Health Problem ◽

Neuroendocrine Regulation ◽

Calorie Intake ◽

Hormone Signaling ◽

Sustained Weight Loss

Introduction: Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger–satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure. Objective: This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries. Conclusions: According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.

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Management of musculoskeletal complications in patients with hemophilia: literature review and expert recommendations

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x21666210427134232 ◽

2021 ◽

Vol 21 ◽

Author(s):

E. Carlos Rodriguez-Merchan

Keyword(s):

Ankle Arthrodesis ◽

Joint Disease ◽

Structural Defects ◽

Childhood And Adolescence ◽

Joint Degeneration ◽

Hemophilic Arthropathy ◽

Younger Age ◽

The Moment ◽

And Function ◽

Expert Recommendations

: In people with hemophilia, hematological prophylaxis during childhood and adolescence could elude the occurrence of musculoskeletal complications (in joints and muscles) if the concentration of the defective factor is averted from decreasing under 1% of normal. Prompt management is of capital significance as the juvenile skeleton is hypersensitive to the adverse events of the disease; intense structural defects might appear rapidly. Important articular bleeds and inveterate hypertrophy of the articular synovial membrane must be treated vigorously to preclude joint degeneration (hemophilic arthropathy). At the moment that extreme joint disease is in place with intense affliction, the goal must be to reestablish activity whilst at the same time reducing the peril to the patient. Articular debridement is an efficacious surgical technique to accomplish this goal, particularly around the knee or ankle, and may be contemplated to be a backup to ankle arthrodesis or ankle or knee replacement in patients of younger age. Eventually joint replacement can commonly reestablish both articular mobility and function in an unhealthy articulation.

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Medical Therapy for Crohn Disease

10.2310/gastro.5416 ◽

2015 ◽

Author(s):

Jessica R Allegretti ◽

Joshua R. Korzenik

Keyword(s):

Disease Activity ◽

Crohn Disease ◽

Clinical Symptoms ◽

Activity Index ◽

Severe Disease ◽

Treatment Options ◽

Injection Site Reaction ◽

Perianal Fistula ◽

Perianal Disease ◽

Aminosalicylic Acid

Crohn disease (CD) is an inflammatory condition that can affect any portion of the gastrointestinal tract from the mouth to the perianal area. The resulting transmural inflammation can lead to a spectrum of clinical presentations depending on disease location and severity. The treatment of CD depends on the severity of the disease, phenotype, presence of perianal disease, and response to previous therapies. This review examines the goals of therapy for CD, clinical symptoms and disease activity, treatment of disease based on mild to moderate to severe stages, treatment of refractory disease, perianal disease, postoperative CD, and noninflammatory treatment options. Figures show adalimumab injection-site reaction and perianal fistula with seton placement. Tables list the Crohn Disease Activity Index (CDAI), the Harvey Bradshaw Index, 5-aminosalicylic acid formulations, standard dosing of CD medications for moderate to severe disease, and rates of clinical response and remission in patients receiving anti–tumor necrosis factor agents versus placebo, by trial. This review contains 2 highly rendered figures, 5 tables, and 85 references.

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A Pathology Review of the Lower Gastrointestinal Tract in Relation to Ulcerative Colitis in Rats and Cynomolgus Macaques Treated With Ammonium Perfluorooctanoate

Toxicologic Pathology ◽

10.1177/0192623320911606 ◽

2020 ◽

Vol 48 (4) ◽

pp. 593-602 ◽

Cited By ~ 1

Author(s):

Sue Chang ◽

George A. Parker ◽

Sarah E. Kleinschmidt ◽

Geary W. Olsen ◽

Carol A. Ley ◽

...

Keyword(s):

Ulcerative Colitis ◽

Gastrointestinal Tract ◽

Laboratory Animals ◽

Ohio River ◽

Positive Trend ◽

Sprague Dawley ◽

Toxicological Studies ◽

Chronic Inflammatory Condition ◽

Cynomolgus Macaques ◽

Rigorous Treatment

Among many short-term, subchronic, and chronic toxicology studies with ammonium perfluorooctanoate (PFOA), the gastrointestinal tract has not been identified as a target organ for PFOA-related toxicity in laboratory animals where the corresponding serum PFOA concentrations typically approach several orders of magnitude higher than the general human population. These lack of gastrointestinal tract-related findings were in direct contrast to an epidemiological observation where a positive trend was observed for ulcerative colitis, an idiopathic chronic inflammatory condition of the gut, in a Mid-Ohio River community whose drinking water contained higher levels of PFOA. This study was conducted to perform a histological reevaluation of large intestine sections in laboratory animals from 2 long-term toxicological studies: one was with Sprague Dawley rats that received ammonium PFOA in their diet for 2 years and the other one was with cynomolgus macaques that received daily capsules of ammonium PFOA for 6 months. In both studies, there was a lack of histological evidence of treatment-related inflammatory lesions that was suggestive of the occurrence of ulcerative colitis in these laboratory animals even under the most rigorous treatment schedules. These findings do not offer support for the biological plausibility of the epidemiological associations reported.

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