Pub Date : 2019-12-01DOI: 10.1097/MPG.0000000000002508
R. Hoffman, M. Burns, S. Gosselin
{"title":"Corticosteroids for Caustic Esophageal Burns.","authors":"R. Hoffman, M. Burns, S. Gosselin","doi":"10.1097/MPG.0000000000002508","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002508","url":null,"abstract":"","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83135359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/MPG.0000000000002488
Daniella Ohnemus, K. Neighbors, Lisa G. Sorensen, J. Lai, E. Alonso
OBJECTIVES Despite the need for monitoring cognition for minimal hepatic encephalopathy (MHE) in children with portal hypertension, few screening methods exist. The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Cognitive Function (PedsPCF) item bank, a 43-item parent- and self-report questionnaire, could be a useful screening tool. This study aimed to evaluate the PedsPCF item bank as a screening tool and explore its correlation with other neurocognitive measures and clinical indicators of portal hypertension. METHODS Pediatric patients with portal hypertension were recruited at Lurie Children's Liver Clinic. A short battery of neuropsychological tests tapping attention, executive functioning, and fine motor speed was administered along with surveys of cognitive functioning (PedsPCF, Behavior Rating Inventory of Executive Function; BRIEF) and quality of life (PROMIS Pediatric-25 Profile). RESULTS 18 patients participated (ages 8 to 17). The PedsPCF correlated well with the BRIEF but did not correlate with neurocognitive testing. Qualitative heatmap analysis of the relationship between z-scores and clinical signs of portal hypertension suggests the PedsPCF is less sensitive than the BRIEF. The fine motor task (Grooved Pegboard) appears to offer the highest sensitivity of the tests administered and is also relatively quick and easy to administer. CONCLUSIONS Elements of the battery show promise in this small pilot sample. The BRIEF and the Grooved Pegboard may hold the most potential for screening in the clinical setting. Further study is necessary to examine this question in a larger multi-center sample.
{"title":"A Pilot Study of the pedsPCF Item Bank as a Screening Tool for Pediatric Minimal Hepatic Encephalopathy.","authors":"Daniella Ohnemus, K. Neighbors, Lisa G. Sorensen, J. Lai, E. Alonso","doi":"10.1097/MPG.0000000000002488","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002488","url":null,"abstract":"OBJECTIVES\u0000Despite the need for monitoring cognition for minimal hepatic encephalopathy (MHE) in children with portal hypertension, few screening methods exist. The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Cognitive Function (PedsPCF) item bank, a 43-item parent- and self-report questionnaire, could be a useful screening tool. This study aimed to evaluate the PedsPCF item bank as a screening tool and explore its correlation with other neurocognitive measures and clinical indicators of portal hypertension.\u0000\u0000\u0000METHODS\u0000Pediatric patients with portal hypertension were recruited at Lurie Children's Liver Clinic. A short battery of neuropsychological tests tapping attention, executive functioning, and fine motor speed was administered along with surveys of cognitive functioning (PedsPCF, Behavior Rating Inventory of Executive Function; BRIEF) and quality of life (PROMIS Pediatric-25 Profile).\u0000\u0000\u0000RESULTS\u000018 patients participated (ages 8 to 17). The PedsPCF correlated well with the BRIEF but did not correlate with neurocognitive testing. Qualitative heatmap analysis of the relationship between z-scores and clinical signs of portal hypertension suggests the PedsPCF is less sensitive than the BRIEF. The fine motor task (Grooved Pegboard) appears to offer the highest sensitivity of the tests administered and is also relatively quick and easy to administer.\u0000\u0000\u0000CONCLUSIONS\u0000Elements of the battery show promise in this small pilot sample. The BRIEF and the Grooved Pegboard may hold the most potential for screening in the clinical setting. Further study is necessary to examine this question in a larger multi-center sample.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83716597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/MPG.0000000000002509
A. Akobeng, I. Abdelgadir
{"title":"Response to Letter: Corticosteroids for Oesophageal Caustic Injuries.","authors":"A. Akobeng, I. Abdelgadir","doi":"10.1097/MPG.0000000000002509","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002509","url":null,"abstract":"","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82688793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-26DOI: 10.1097/MPG.0000000000002577
A. Palanica, M. Leier, Andrew Lee, Yan Fossat, Michael Docktor
The results of medical procedures can often be difficult to translate into comprehensible and engaging information for patients. This randomized controlled trial evaluated the satisfaction and perceived value of a technology, called HealthVoyager, which creates a personalized virtual reality (VR) experience of a patient's endoscopy or colonoscopy findings in comparison to the standard practice (i.e., reviewing printed reports). The platform allows gastroenterologists to create a customized VR patient report to help translate medical knowledge and procedural information to the patient. Forty-one patients (17 HealthVoyager [test]; 24 standard practice [control]) completed a self-report survey assessing their experience for receiving medical information. Results demonstrated that patients were significantly more satisfied in learning about their gastrointestinal condition and procedural results using HealthVoyager rather than with the standard of care. These results have implications for improving the knowledge translation of medical findings between healthcare providers and patients in various disease states and patient populations.
{"title":"Enhancing the Patient Experience for Individuals Undergoing Endoscopic Procedures Using Virtual Reality.","authors":"A. Palanica, M. Leier, Andrew Lee, Yan Fossat, Michael Docktor","doi":"10.1097/MPG.0000000000002577","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002577","url":null,"abstract":"The results of medical procedures can often be difficult to translate into comprehensible and engaging information for patients. This randomized controlled trial evaluated the satisfaction and perceived value of a technology, called HealthVoyager, which creates a personalized virtual reality (VR) experience of a patient's endoscopy or colonoscopy findings in comparison to the standard practice (i.e., reviewing printed reports). The platform allows gastroenterologists to create a customized VR patient report to help translate medical knowledge and procedural information to the patient. Forty-one patients (17 HealthVoyager [test]; 24 standard practice [control]) completed a self-report survey assessing their experience for receiving medical information. Results demonstrated that patients were significantly more satisfied in learning about their gastrointestinal condition and procedural results using HealthVoyager rather than with the standard of care. These results have implications for improving the knowledge translation of medical findings between healthcare providers and patients in various disease states and patient populations.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80601619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-26DOI: 10.1097/MPG.0000000000002572
R. Satherley, S. Coburn, Monique M. Germone
OBJECTIVES A diagnosis of celiac disease (CD) requires individuals to adopt a strict gluten-free diet (GFD). As children with CD must rely on their caregivers for guidance and support with managing the GFD, CD may challenge the caregiver's emotional and social well-being. The primary objective of this mixed-methods systematic review was to synthesize of research investigating the impact of CD on caregiver's well-being. METHODS Five databases were systematically searched from 1990-2018 to identify all empirical studies that assessed well-being in caregivers of children (0-18 years) with CD. Qualitative and quantitative data were extracted separately before being integrated to explore key themes across the studies. RESULTS 12 studies were identified that explored the well-being of caregivers of children with CD (3 qualitative, 9 quantitative), reporting on 665 caregivers. The quality of evidence was limited across studies. Synthesis of results revealed three themes (Caregiver Responsibility, Caregiver Well-Being and Concern for Child's Health, Implications for the Family) describing the impact of a child with CD on caregiver well-being. CONCLUSIONS Caregivers of children with CD may experience difficulties that impact their well-being; specific difficulties identified included the impact of caregivers' social activities, finances and anxiety. The findings detailed in this review point towards factors that may guide health care personnel to provide support for the caregivers of children with CD.
{"title":"The Impact of Celiac Disease on Caregivers' Well-Being: An Integrative Review.","authors":"R. Satherley, S. Coburn, Monique M. Germone","doi":"10.1097/MPG.0000000000002572","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002572","url":null,"abstract":"OBJECTIVES\u0000A diagnosis of celiac disease (CD) requires individuals to adopt a strict gluten-free diet (GFD). As children with CD must rely on their caregivers for guidance and support with managing the GFD, CD may challenge the caregiver's emotional and social well-being. The primary objective of this mixed-methods systematic review was to synthesize of research investigating the impact of CD on caregiver's well-being.\u0000\u0000\u0000METHODS\u0000Five databases were systematically searched from 1990-2018 to identify all empirical studies that assessed well-being in caregivers of children (0-18 years) with CD. Qualitative and quantitative data were extracted separately before being integrated to explore key themes across the studies.\u0000\u0000\u0000RESULTS\u000012 studies were identified that explored the well-being of caregivers of children with CD (3 qualitative, 9 quantitative), reporting on 665 caregivers. The quality of evidence was limited across studies. Synthesis of results revealed three themes (Caregiver Responsibility, Caregiver Well-Being and Concern for Child's Health, Implications for the Family) describing the impact of a child with CD on caregiver well-being.\u0000\u0000\u0000CONCLUSIONS\u0000Caregivers of children with CD may experience difficulties that impact their well-being; specific difficulties identified included the impact of caregivers' social activities, finances and anxiety. The findings detailed in this review point towards factors that may guide health care personnel to provide support for the caregivers of children with CD.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80245118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-26DOI: 10.1097/MPG.0000000000002576
R. Harris, R. Jackson, R. Russell
10. Weisbrod VM, Silvester JA, Raber C, et al. Preparation of gluten-free foods alongside gluten-containing food may not always be as risky for celiac patients as diet guides suggest. Gastroenterology 2019;158:273–5. 11. Hollon JR, Cureton PA, Martin ML, et al. Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients. BMC Gastroenterol 2013;13:40. 12. Shah S, Akbari M, Vanga R, et al. Patient perception of treatment burden is high in celiac disease compared with other common conditions. Am J Gastroenterol 2014;109:1304–11.
10. Weisbrod VM, Silvester JA, Raber C，等。对乳糜泻患者来说，将无麸质食物和含麸质食物一起准备并不总是像饮食指南所建议的那样危险。胃肠病学2019;158:273-5。11. Hollon JR, Cureton PA, Martin ML，等。微量麸质污染可能在饮食依从性无反应性乳糜泻患者亚组的粘膜和临床恢复中发挥作用。中华医学会胃肠病学杂志2013;13:40。12. Shah S, Akbari M, Vanga R，等。与其他常见疾病相比，乳糜泻患者对治疗负担的感知较高。[J] .中华肠胃病杂志，2014;39(1):1 - 4。
{"title":"Trough Measurements of Infliximab: The Earlier the Better?","authors":"R. Harris, R. Jackson, R. Russell","doi":"10.1097/MPG.0000000000002576","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002576","url":null,"abstract":"10. Weisbrod VM, Silvester JA, Raber C, et al. Preparation of gluten-free foods alongside gluten-containing food may not always be as risky for celiac patients as diet guides suggest. Gastroenterology 2019;158:273–5. 11. Hollon JR, Cureton PA, Martin ML, et al. Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients. BMC Gastroenterol 2013;13:40. 12. Shah S, Akbari M, Vanga R, et al. Patient perception of treatment burden is high in celiac disease compared with other common conditions. Am J Gastroenterol 2014;109:1304–11.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81492349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-19DOI: 10.1097/MPG.0000000000002562
P. Ngo, Ali Kamran, Susannah J. Clark, R. Jennings, Thomas E. Hamilton, C. Smithers, B. Zendejas, Jessica L Yasuda, D. Zurakowski, M. Manfredi
OBJECTIVES The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in esophageal atresia (EA) patients remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI. METHODS 158 EA patients with at least one ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI-) and dilation with steroid injection (ISI+). RESULTS A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1 mm (IQR 0, 3) vs. 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved diameter (P < 0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P = 0.0009, P = 0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% CI: 2.15-4.88) (P < 0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1 mm (IQR 0, 3) vs. 0.5 mm (IQR -1.25, 2) (P = 0.001). There was no difference in perforation incidence between ISI+ and ISI- groups (P = 0.82). CONCLUSIONS ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.
目的病灶内类固醇注射(ISI)在食管闭锁(EA)患者吻合口狭窄治疗中的作用尚不清楚。本研究的目的是评价ISI的有效性和安全性。方法选取2010 ~ 2017年间，应用至少一种ISI治疗食管吻合口狭窄的EA患者158例。比较单纯扩张术(ISI-)和类固醇注射扩张术(ISI+)的狭窄直径变化(ΔD)。结果共行球囊扩张1055例，其中ISI+ 452例。ISI+组的中位ΔD显著增大:1 mm (IQR 0,3) vs. 0 mm (IQR - 1,1.5) (P < 0.0001)。ISI+组在随后的内镜检查中，直径改善的百分比更高(P < 0.0001)，直径不变和减小的百分比更低(P = 0.0009, P = 0.003)。多变量logistic回归证实了ISI对提高狭窄直径改善可能性的显著性，校正比值比为3.24 (95% CI: 2.15-4.88) (P < 0.001)。前3次ISI+手术的ΔD大于后续ISI+手术的ΔD: 1 mm (IQR 0,3) vs. 0.5 mm (IQR -1.25, 2) (P = 0.001)。ISI+组与ISI-组穿孔发生率差异无统计学意义(P = 0.82)。结论sisi联合扩张术耐受性良好，比单纯扩张术更能改善吻合口狭窄直径。ISI优于单纯扩张的益处仅限于前3次ISI手术。
{"title":"Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair.","authors":"P. Ngo, Ali Kamran, Susannah J. Clark, R. Jennings, Thomas E. Hamilton, C. Smithers, B. Zendejas, Jessica L Yasuda, D. Zurakowski, M. Manfredi","doi":"10.1097/MPG.0000000000002562","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002562","url":null,"abstract":"OBJECTIVES\u0000The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in esophageal atresia (EA) patients remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI.\u0000\u0000\u0000METHODS\u0000158 EA patients with at least one ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI-) and dilation with steroid injection (ISI+).\u0000\u0000\u0000RESULTS\u0000A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1 mm (IQR 0, 3) vs. 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved diameter (P < 0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P = 0.0009, P = 0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% CI: 2.15-4.88) (P < 0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1 mm (IQR 0, 3) vs. 0.5 mm (IQR -1.25, 2) (P = 0.001). There was no difference in perforation incidence between ISI+ and ISI- groups (P = 0.82).\u0000\u0000\u0000CONCLUSIONS\u0000ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"117 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75761530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-19DOI: 10.1097/MPG.0000000000002565
O. Behairy, A. Elsadek, E. Behiry, Ibrahim A. Elhenawy, N. Shalan, Kamal R Sayied
OBJECTIVES This study aimed to estimate the value of serum IL-33 levels in infants with cholestasis, correlate serum IL-33 levels with the clinicopathological profile of infants with cholestasis and compare its level with that of healthy infants who served as control METHODS:: sixty infants with cholestasis were enrolled in this study and divided into biliary atresia group and non-biliary atresia group, in addition to thirty healthy infants as a control group. All infants were analyzed for their clinical, biochemical features, histopathological profile and serum level of IL- 33 by ELISA. RESULTS serum level of IL -33 in BA group (median 48.0, IQR: 28.9-106.2) was significantly higher than the non-BA group (median 17.3, IQR: 13.7-18.8 pg/ml) and both were higher than the control group. There was a positive correlation between serum IL-33 and AST, ALT, bilirubin (total and direct) levels and fibrosis stage among the BA group. Serum IL-33 at a cut-off value of 20.8 pg/ml can detect biliary atresia with a specificity of 95% and a sensitivity of 96.7%. CONCLUSION The significantly higher production of IL -33 in patients with BA compared to non-BA suggests a potential role of IL -33 for initiation and progression of the disease process. also, IL -33 may have a diagnostic role in infants with BA.
{"title":"Clinical Value of Serum Interleukin-33 Biomarker in Infants with Neonatal Cholestasis.","authors":"O. Behairy, A. Elsadek, E. Behiry, Ibrahim A. Elhenawy, N. Shalan, Kamal R Sayied","doi":"10.1097/MPG.0000000000002565","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002565","url":null,"abstract":"OBJECTIVES\u0000This study aimed to estimate the value of serum IL-33 levels in infants with cholestasis, correlate serum IL-33 levels with the clinicopathological profile of infants with cholestasis and compare its level with that of healthy infants who served as control METHODS:: sixty infants with cholestasis were enrolled in this study and divided into biliary atresia group and non-biliary atresia group, in addition to thirty healthy infants as a control group. All infants were analyzed for their clinical, biochemical features, histopathological profile and serum level of IL- 33 by ELISA.\u0000\u0000\u0000RESULTS\u0000serum level of IL -33 in BA group (median 48.0, IQR: 28.9-106.2) was significantly higher than the non-BA group (median 17.3, IQR: 13.7-18.8 pg/ml) and both were higher than the control group. There was a positive correlation between serum IL-33 and AST, ALT, bilirubin (total and direct) levels and fibrosis stage among the BA group. Serum IL-33 at a cut-off value of 20.8 pg/ml can detect biliary atresia with a specificity of 95% and a sensitivity of 96.7%.\u0000\u0000\u0000CONCLUSION\u0000The significantly higher production of IL -33 in patients with BA compared to non-BA suggests a potential role of IL -33 for initiation and progression of the disease process. also, IL -33 may have a diagnostic role in infants with BA.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81242604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-14DOI: 10.1097/MPG.0000000000002556
J. Jossen, B. Kiernan, N. Pittman, M. Dubinsky
BACKGROUND Vedolizumab (VDZ) is effective for treating both adult and pediatric onset IBD. Clinical outcomes, however, have been reported to be superior in patients naïve to anti-TNF. With the growing interest in endoscopic endpoints, we aimed to describe rates of mucosal healing in pediatric patients being treated with VDZ and examine the influence of anti-TNF on outcomes. METHODS We conducted a retrospective review of all IBD patients ≤21 years of age who initiated VDZ and underwent endoscopy. Primary outcome was mucosal healing (composite of endoscopic (SES-CD and Mayo score UC) and histological remission (Nancy index-UC and CD histologic activity). Descriptive statistics summarized the data. Comparisons were made for endpoints based on anti-TNF exposure using univariate testing. RESULTS Sixty-eight patients were included in the final analysis; 35 with UC and 33 with CD. Thirty-two patients (22 UC and 10 CD) were anti-TNF naïve and 36 patients (13 UC and 23 CD) were anti-TNF exposed. The median duration on VDZ prior to endoscopic assessment was 49 (IQR 32-73) weeks. A total of 38% (25/66) of patients met the primary outcome of mucosal healing and did not differ between anti-TNF naïve or exposed. Endoscopic remission was achieved by 51% with significantly more anti-TNF naïve patients reaching this endpoint (66% v. 40%, p = 0.03). Histologic remission was achieved by 42% of patients with a non-significant trend towards improved histologic remission rates in anti-TNF naïve patients (52% v. 33%, p = 0.13). CONCLUSION VDZ is associated with mucosal healing in pediatric IBD. Anti-TNF exposure significantly impacted endoscopic remission, but not histologic remission in children on VDZ.
背景:vedolizumab (VDZ)对成人和儿童IBD均有效。然而，据报道，naïve患者的临床结果优于抗tnf。随着对内镜终点的兴趣日益增长，我们旨在描述接受VDZ治疗的儿科患者的粘膜愈合率，并检查抗tnf对结果的影响。方法我们对所有≤21岁开始VDZ并接受内镜检查的IBD患者进行回顾性分析。主要结局是粘膜愈合(内镜下(SES-CD和Mayo评分)UC)和组织学缓解(Nancy指数-UC和CD的组织学活性)。描述性统计汇总了数据。使用单变量测试对基于抗tnf暴露的终点进行比较。结果68例患者纳入最终分析;35例合并UC, 33例合并CD。32例(22例合并UC, 10例合并CD)抗tnf naïve, 36例(13例合并UC, 23例合并CD)抗tnf暴露。内镜评估前VDZ的中位持续时间为49周(IQR 32-73)。共有38%(25/66)的患者达到了粘膜愈合的主要结局，抗tnf naïve和暴露tnf之间没有差异。内镜下缓解率为51%，达到这一终点的抗tnf naïve患者显著增加(66% vs 40%， p = 0.03)。42%的患者达到组织学缓解，抗tnf naïve患者的组织学缓解率改善趋势不显著(52% vs 33%， p = 0.13)。结论vdz与儿童IBD的黏膜愈合有关。抗tnf暴露显著影响VDZ患儿的内窥镜缓解，但不影响组织学缓解。
{"title":"Anti-TNF Exposure Impacts Vedolizumab Mucosal Healing Rates in Pediatric Inflammatory Bowel Disease.","authors":"J. Jossen, B. Kiernan, N. Pittman, M. Dubinsky","doi":"10.1097/MPG.0000000000002556","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002556","url":null,"abstract":"BACKGROUND\u0000Vedolizumab (VDZ) is effective for treating both adult and pediatric onset IBD. Clinical outcomes, however, have been reported to be superior in patients naïve to anti-TNF. With the growing interest in endoscopic endpoints, we aimed to describe rates of mucosal healing in pediatric patients being treated with VDZ and examine the influence of anti-TNF on outcomes.\u0000\u0000\u0000METHODS\u0000We conducted a retrospective review of all IBD patients ≤21 years of age who initiated VDZ and underwent endoscopy. Primary outcome was mucosal healing (composite of endoscopic (SES-CD and Mayo score UC) and histological remission (Nancy index-UC and CD histologic activity). Descriptive statistics summarized the data. Comparisons were made for endpoints based on anti-TNF exposure using univariate testing.\u0000\u0000\u0000RESULTS\u0000Sixty-eight patients were included in the final analysis; 35 with UC and 33 with CD. Thirty-two patients (22 UC and 10 CD) were anti-TNF naïve and 36 patients (13 UC and 23 CD) were anti-TNF exposed. The median duration on VDZ prior to endoscopic assessment was 49 (IQR 32-73) weeks. A total of 38% (25/66) of patients met the primary outcome of mucosal healing and did not differ between anti-TNF naïve or exposed. Endoscopic remission was achieved by 51% with significantly more anti-TNF naïve patients reaching this endpoint (66% v. 40%, p = 0.03). Histologic remission was achieved by 42% of patients with a non-significant trend towards improved histologic remission rates in anti-TNF naïve patients (52% v. 33%, p = 0.13).\u0000\u0000\u0000CONCLUSION\u0000VDZ is associated with mucosal healing in pediatric IBD. Anti-TNF exposure significantly impacted endoscopic remission, but not histologic remission in children on VDZ.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82711840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-14DOI: 10.1097/MPG.0000000000002563
S. Shankar, R. Bolia, H. Foo, C. D'Arcy, N. Hardikar, Martin Wensing, W. Hardikar
OBJECTIVES Gamma-glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of 'normal GGT' BA has not been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to 1) describe outcomes of a single-centre Australian cohort of infants with biliary atresia and 2) assess the impact of GGT level at presentation on outcomes in BA. METHODS Infants diagnosed with BA between 1991 - 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT) and death. Patients were categorised into normal (<200IU/L) or high GGT groups based on a mean of three consecutive GGT values done prior to Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice and outcomes were compared between the two groups. RESULTS 113 infants underwent KPE at median 61 (30-149) days. At a median follow-up of 14.2 (0.9-26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pre-transplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to clearance of jaundice were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18months, p = 0.02), underwent LT at a younger age (14 vs 20months, p = 0.04) and had poorer transplant-free survival (p = 0.04) than high GGT group. CONCLUSION 12.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in biliary atresia was associated with a poorer outcome.
{"title":"Normal Gamma Glutamyl Transferase Levels at Presentation Predict Poor Outcome in Biliary Atresia.","authors":"S. Shankar, R. Bolia, H. Foo, C. D'Arcy, N. Hardikar, Martin Wensing, W. Hardikar","doi":"10.1097/MPG.0000000000002563","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002563","url":null,"abstract":"OBJECTIVES\u0000Gamma-glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of 'normal GGT' BA has not been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to 1) describe outcomes of a single-centre Australian cohort of infants with biliary atresia and 2) assess the impact of GGT level at presentation on outcomes in BA.\u0000\u0000\u0000METHODS\u0000Infants diagnosed with BA between 1991 - 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT) and death. Patients were categorised into normal (<200IU/L) or high GGT groups based on a mean of three consecutive GGT values done prior to Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice and outcomes were compared between the two groups.\u0000\u0000\u0000RESULTS\u0000113 infants underwent KPE at median 61 (30-149) days. At a median follow-up of 14.2 (0.9-26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pre-transplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to clearance of jaundice were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18months, p = 0.02), underwent LT at a younger age (14 vs 20months, p = 0.04) and had poorer transplant-free survival (p = 0.04) than high GGT group.\u0000\u0000\u0000CONCLUSION\u000012.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in biliary atresia was associated with a poorer outcome.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75052734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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