Хвороба Крона в дітей раннього віку. Складний шлях до діагнозу

Use and Misuse of Small Bowel Video Capsule Endoscopy in Clinical Practice

: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. : Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids' Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids' Inpatient Database, and cost was calculated using the hospital's cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. : In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were $66.3 million and $10,176 (95% confidence interval [CI] $9647-$10,705), and for UC were $48.6 million and $11,836 (95% CI $10,760-$12,912). For CD, 0- to 5-year-old patients had the highest mean LOS (8.10, 95% CI 5.53-10.67, days) and mean cost ($13,894, 95% CI $9053-$18,735), whereas, for UC, 11- to 15-year-old patients had the highest mean LOS (7.49, 95% CI 6.88-8.10, 95% CI 5.53-10.67, days) and mean cost ($13,407, 95% CI $11,704-$15,110). : For a pediatric disease with a rather low prevalence rate, the estimated annual inpatient pediatric burden of IBD is a sizeable $152.4 million (2010 US$) and 64,985 days spent in the hospital. As medications and outpatient treatments improve for the treatment of IBD, there is an opportunity for significant reduction in inpatient burden.

Chronic inflammatory demyelinating polyradiculoneurophathy and Graves' disease in an adolescent with Crohn's disease.

Beyond Gene Discovery in Inflammatory Bowel Disease: The Emerging Role of Epigenetics

This study was designed to determine the outcome of patients with Crohn's disease and indeterminate colitis who have an ileal pouch-anal anastomosis. Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn's disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35-question survey mailed to all patients with a functioning pouch of at least six months duration. Pouch complications were significantly more common in patients with Crohn's disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn's disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn's disease, multivariate analysis revealed that the pathologist's initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn's disease were independently associated with pouch failure. The functional results in patients with Crohn's disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis. Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one-half of patients with Crohn's disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn's disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn's disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch-anal anastomosis is an acceptable alternative for patients with indeterminate colitis.

The Commensal Microbiota and Enteropathogens in the Pathogenesis of Inflammatory Bowel Diseases

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Bile acid malabsorption (BAM), clinically manifesting as hologenic diarrhea, is one of the common but often overlooked symptoms of inflammatory bowel diseases (IBD). Objective. To assess the level of fecal excretion of BA in patients with IBD and the possibility of using the determination of BA in feces in the diagnosis of diarrhea and the clinical course of Crohn’s disease (CD) and ulcerative colitis (UC). Material and methods. The study included 62 stool samples from clinically examined patients with CD, 26 — with UC, 20 — with IBD unclassified (IBDU), and 15 stool samples from healthy individuals, in which concentrations of fecal BA, fecal calprotectin (FC) and stool osmotic gap (SOG) were measured. The associations of these markers with diarrhea, localization, severity, disease phenotype, and surgical treatment of IBD were determined. Results. The mean concentration of fecal BA was significantly higher in patients with CD (113.3±303.1 µmol/g), UC (41.72±112.5 µmol/g) and IBDU (44.41±99, 6 µmol/g) compared with the control group (0.9±1.35 µmol/g) (p&lt;0.05). An increased concentration of fecal BA in 51.3% of cases was observed in the group of patients with CD with diarrheal syndrome compared with patients with CD without diarrhea (26%) with mean concentrations of 162±371.6 µmol/g vs. 30.8±70.84 µmol/g (p&lt;0.001). In 67.2% of IBD patients with diarrheal syndrome, low SOG values (23.16±12.64 mOsmol/kg) were noted, which had an inverse correlation with high concentrations of fecal BA (181.7±364.4.1 µmol/g) (r= –0.48, p=0.002). In 51.2% of patients with IBD with diarrhea and low values of SOG, high concentrations of fecal BA (134.7±321.8 µmol/g) and FC (1035±774.4 µg/g) were combined (r=0.29, p=0.03). The level of faecal excretion of fatty acids was significantly higher in patients with terminal ileitis (226±566.5 µmol/g) and stenosing CD phenotype (150±479.8 µmol/g) compared with patients with colitis, ileocolitis and involvement of the upper gastrointestinal tract and luminal CD phenotype, respectively. In CD patients with ileocecal resection, the frequency of detection and the mean concentration of fecal BA were higher compared with patients without removal of the terminal ileum — 85.7% (127.7±116.4 µmol/g) vs. 18.1% (21.82±53.13 µmol/g), respectively (p=0.01). Conclusions. Determination of the concentration of fecal BA allows diagnosing type BAM, as well as identifying subgroups of patients with chologenoic and chologeno-inflammatory types of diarrheal syndrome in IBD. Clinically significant BAM is associated with terminal ileitis, a stricture phenotype, and ileocecal resection in CD. Assessment of faecal FA excretion can serve as a potential therapeutic target for the development of new treatments for IBD.

Introduction/Objective A subset of patients with an established diagnosis of UC develops signs of CD (de novo CD) following IPAA. While the etiology and risk factors of de novo CD remain largely unknown, preliminary studies have shown controversial results regarding family history of inflammatory bowel disease (IBD) and smoking history. Methods Patients that underwent IPAA for UC, with at least 1 year of follow-up, were identified (n=161; 1996 to 2018). We retrospectively reviewed the electronic medical records. Patients that were diagnosed with de novo CD during the follow-up period were further identified. Smoking history and family history of IBD were evaluated. Chi square test was performed to compare the frequencies. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated by logistic regression model. P&amp;lt;0.05 was considered statistically significant. Results 29 de novo CD were identified. At the time of proctocolectomy, the family history of IBD and smoking history was documented in 152 UC patients including 27 that subsequently developed de novo CD. 23 of 152 had a family history of IBD (12 UC, 9 CD and 2 IBD, NOS). 19/129 (14.7%) UC patients without a family history of any type of IBD, 4/9 (44.4%) with a family history of CD, and 4/12 (33.3%) with a family history of UC developed de novo CD. Patients with a family history of CD were more likely to develop de novo CD post IPAA than those without a family history of any type of IBD (OR 4.63, 95% CI 1.14-18.82, p=0.03). Family history of UC did not correlate with development of de novo CD (OR 2.90; 95% CI 0.79-10.57, p=0.108). At the time of proctocoletomy, 11 were current smokers, 25 were former smokers, and 116 never smoked. In de novo CD group, there were 4/27 (14.8 %) former smokers and 23/27 (85.2 %) never smokers. No de novo CD patient was current smoker. In the UC group that remained as UC following IPAA, 11/125 (8.8%) were current smokers, 21/125 (16.8 %) former smokers, and 93/125 (74.4 %) were never smokers. Current smoking status was not associated with development of de novo CD (p = 0.214). Conclusion Family history of CD may be a risk factor for developing de novo CD following IPAA for UC. Current smoking status was not associated with development of de novo CD following IPAA for UC.

Crohn's disease is widely described in the Western literature, but it has not been widely observed in the Middle Eastern community. We diagnosed Crohn's disease in seven Arabs, three whom were Saudi Nationals. Their mean age was 32.4 years (range, 18-40 years) and duration of symptoms varied from three months to ten years. The site of the disease was ileocolic in five patients and colonic in two. Mass lesions in the abdomen were seen in three patients. Four cases were diagnosed from histological specimens obtained at laparotomy and resection and the other three were diagnosed from colonoscopic biopsy specimens. Extraintestinal manifestations were found in three patients. Surgery alone was the treatment in two patients, whereas the remaining required medical therapy, mainly steroids, with or without surgery. We conclude that Crohn's disease does occur in the Arab population, but with milder systemic effects.

Purpose: Diverticulosis of the colon is a common disease process of the Western world found in up to 50% of patients over age 60 presenting for screening colonoscopy. Studies have linked the condition to lack of dietary fiber intake in combination with the prolonged colonic transit time and increased intra-luminal pressure associated with low volume stools. Contrary to diverticulosis, chronic colitis seen in inflammatory bowel disease is characterized by liquid stools suggestive of low intra-colonic pressure and a thickened bowel wall. It is reasonable to hypothesize that these competing pathophysiologic events would produce an indirect correlation in disease prevalences. Methods: An electronic medical record database review was done selecting patients who carried a diagnosis of ulcerative colitis or Crohn's disease at our institution, who had undergone recent colonoscopy. Patients under age 50 or those who had undergone previous colonic surgery with resection of any portion of the distal transverse, descending, or sigmoid colon were excluded, due to the fact that the vast majority of patients with diverticular disease have evidence of disease in the distal colon. Endoscopically or pathologically proven active IBD was not necessary for inclusion. After initiation of the inclusion and exclusion criteria, there were 82 patients in the ulcerative colitis group and 63 in the Crohn's disease group. A control group of patients over age 50 who had recently undergone colonoscopy at our institution with no known diagnosis of either type of IBD, no post procedure diagnosis of IBD, no previous colonic surgery, and an indication not related to GI blood loss (melena, hematochezia, etc.) was selected. 101 patients were included in this group. Presence or absence of one or more diverticulum in any area of the colon was recorded. Results: Diverticulosis was less prevalent in patients with IBD. Of the 63 patients with known diagnosis of Crohn's disease, incidental diverticulosis was found in 12 (19%). Of the 82 patients with known diagnosis of ulcerative colitis, diverticulosis was found in 23 (28%). Of the control group of 101 patients, diverticulosis was found in 39 (38.6%). Of the 23 patients with ulcerative colitis found to have diverticulosis, further review showed that only 6 of these patients had evidence of active inflammation endoscopically. The majority (17) had endoscopically normal colons and presumed quiescent disease. Conclusion: Patients with inflammatory bowel disease have a lower prevalence of diverticulosis than the general population. This indirect correlation is probably less pronounced in those whose IBD is in remission.

Diagnosis and Management of Primary Sclerosing Cholangitis

Inflammatory Bowel Disease Clinical

P-049: Reproducibility of serologic antibody activity at diagnosis and after treatment in pediatric ulcerative colitis and Crohn’s disease

OBJECTIVE Benefit of antibiotic use in Inflammatory Bowel Disease (IBD) is unclear and has been a subject of research. This study investigated the association between antibiotic use and treatment outcomes among IBD patients using real-world data. METHODS Data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) of Crohn’s &amp; Colitis Foundation’s IBD Plexus program were used. Patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) since 2000 were included. The use of antibiotics (ciprofloxacin, metronidazole, rifaximin and vancomycin) for ≥7 days after enrollment was identified from electronic health records and case report forms. Disease activity scores were assessed at the time of enrollment (baseline) and during follow-up using 6-point Mayo score (6-pt MS) and short Clinical Disease Activity Index (sCDAI) for UC and CD, respectively. Patients’ demographic and clinical characteristics were also collected. Remission was defined as 6-pt MS of 0-1 for UC and sCDAI&amp;lt;150 for CD. The association between antibiotic use and outcome during follow-up was assessed in a subset of patients without remission at baseline using a multivariable Cox proportional hazards model. The model included the following covariates for adjustment: age, gender, race, family history of IBD, IBD surgery, disease activity at enrollment and other IBD drug use during follow-up. RESULTS A total of 2,959 IBD patients (UC=1,060; CD=1,899) were included. Mean age at diagnosis was 30±14 years (UC=32±15; CD=28±14). Forty-four percent of the patients were male (UC=49%; CD=41%) and 79% were White (UC=82%; CD=78%). Antibiotic use after enrollment was observed in 29% of the patients (UC=26%; CD=30%). About 60% of UC or CD patients were in remission at baseline. The antibiotic use group had significantly higher baseline disease activity (UC 6-pt MS: 1.7±1.8; CD sCDAI: 167±96) than patients without antibiotic use (UC 6-pt MS: 1.3±1.7; CD sCDAI: 137±89). In the subset of patients with mild, moderate or severe baseline IBD (6-pt MS&amp;gt;1 for UC; sCDAI≥150 for CD), the baseline disease activity scores were largely comparable between patients who used antibiotic and who did not (UC 6-pt MS: 3.6±1.3 vs 3.3±1.3, p-value=0.063; CD sCDAI: 248±83 vs 238±83, p-value=0.169), while patients who used antibiotics were less likely to experience remission during follow-up compared to those who did not use antibiotics (UC adjusted remission hazard ratio [aRHR] 0.39, 95% confidence interval [CI] 0.26-0.60; CD aRHR 0.60, 95% CI 0.46-0.79). CONCLUSION In this study, antibiotic use in patients with IBD was negatively associated with remission during follow-up. The effect of antibiotics on gut microbiome and optimal use of antibiotics in IBD patients need to be further explored.