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Otley A, Day AS, Zachos M. Nutritional Management of Inflammatory Bowel Disease. PEDIATRIC INFLAMMATORY BOWEL DISEASE 2023:355-383. [DOI: 10.1007/978-3-031-14744-9_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Gatti S, Del Baldo G, Catassi G, Faragalli A, Aloi M, Bramuzzo M, D'Arcangelo G, Felici E, Fuoti M, Lega S, Panceri R, Pastore M, Penagini F, Gesuita R, Catassi C. Factors associated with quality of life in Italian children and adolescents with IBD. Sci Rep 2021; 11:18076. [PMID: 34508152 PMCID: PMC8433211 DOI: 10.1038/s41598-021-97661-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Improving the quality of life (QoL) is crucial in the management of pediatric inflammatory bowel disease (IBD). We aimed to (1) Validate the IMPACT-III questionnaire in Italian IBD children; (2) explore factors associated to QoL in pediatric IBD. Internal consistency, concurrent validity, discriminant validity and reproducibility of the Italian version of the IMPACT-III questionnaire was measured in IBD children/adolescents in 8 centers. Associations between patient and disease characteristics and the IMPACT-III domains were analyzed through quantile regression analysis. The IMPACT-III questionnaire, collected in 282 children with IBD (median age: 14.8 years; IQR 12.4-16.4) showed a median total score of 76 (IQR 67-83). Female gender, active disease and age were negatively associated with the total IMPACT-III score. Specifically, female gender was negatively associated with the Bowel/Systemic Symptoms, Emotional and Treatment domain scores, while disease activity was significantly associated with Bowel Symptoms and Treatment/Interventions reported QoL. The IMPACT- III showed good internal consistency (Cronbach's alpha coefficient = 0.87, 95% CI 0.85-0.89) and reproducibility (Concordance Correlation Coefficient = 0.66, 95% CI 0.57-0.74). In Italian children with IBD active disease, female gender and adolescence are associated to a worse QoL, indicating the need of more attention in this subgroup of young patients. IMPACT-III questionnaire is a reliable instrument to measure QoL in Italian children.
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Affiliation(s)
- Simona Gatti
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy.
| | - Giada Del Baldo
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
| | - Giulia Catassi
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161, Rome, Italy
| | - Andrea Faragalli
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Via Tronto 10/a, 60126, Ancona, Italy
| | - Marina Aloi
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161, Rome, Italy
| | - Matteo Bramuzzo
- Digestive Endoscopy and Nutrition Unit, Institute of Child and Maternal Health, IRCCS "Burlo Garofolo", Via dell'Istria 65, 34137, Trieste, Italy
| | - Giulia D'Arcangelo
- Department of Maternal and Child Health, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161, Rome, Italy
| | - Enrico Felici
- Pediatrics and Pediatric Emergency Unit "U.Bosio" Center for Pediatric Digestive Diseases, The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Spalto Marengo 46, 15121, Alessandria, Italy
| | - Maurizio Fuoti
- Gastroenterology and GI Endoscopy, University Department of Pediatrics, Children's Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Sara Lega
- Digestive Endoscopy and Nutrition Unit, Institute of Child and Maternal Health, IRCCS "Burlo Garofolo", Via dell'Istria 65, 34137, Trieste, Italy
| | - Roberto Panceri
- Clinica Pediatrica, Università Milano Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Cadore, 20900, Monza, Italy
| | - Maria Pastore
- IRCCS Casa Sollievo della Sofferenza-Pediatria, Viale Padre Pio, 7d, 71013, San Giovanni Rotondo, Italy
| | - Francesca Penagini
- Clinica Pediatrica, Ospedale dei Bambini "V. Buzzi", Università degli Studi di Milano, Via Lodovico Castelvetro 32, 20154, Milano, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Via Tronto 10/a, 60126, Ancona, Italy
| | - Carlo Catassi
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy
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Touma N, Varay C, Baeza-Velasco C. Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease. J Psychosom Res 2021; 142:110354. [PMID: 33465493 DOI: 10.1016/j.jpsychores.2020.110354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. OBJECTIVE This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. METHOD Four international databases were consulted in March 2020: PubMed, PsychInfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. RESULTS One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. CONCLUSIONS Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.
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Affiliation(s)
- Nathalie Touma
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France.
| | - Caroline Varay
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France
| | - Carolina Baeza-Velasco
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France; Department of Psychiatric Emergency and Post-Emergency, Montpellier University Hospital Center, 371 Av du Doyen Gaston Giraud, 34090 Montpellier, France
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Clinical Remission and Psychological Management are Major Issues for the Quality of Life in Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2021; 72:74-79. [PMID: 32740538 DOI: 10.1097/mpg.0000000000002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Crohn disease (CD) can affect patient's quality of life (QOL) with physical, social, and psychological impacts. This study aimed to investigate the QOL of children with CD and its relationship with patient and disease characteristics. METHODS Children ages from 10 to 17 years with diagnosed CD for more than 6 months were eligible to this cross-sectional study conducted in 35 French pediatric centers. QOL was assessed by the IMPACT-III questionnaire. Patient and disease characteristics were collected. RESULTS A total of 218 children (42% of girls) were included at a median age of 14 years (interquartile range [IQR]: 13--16). Median duration of CD was 3.2 years (IQR: 1.7-5.1) and 63% of children were in clinical remission assessed by wPCDAI. Total IMPACT-III score was 62.8 (±11.0). The lowest score was in "emotional functioning" subdomain (mean: 42.8 ± 11.2). Clinical remission was the main independent factor associated with QOL of children with CD (5.74 points higher compared with those "with active disease", 95% confidence interval [CI] 2.77--8.70, P < 0.001). Age of patient at the evaluation was found negatively correlated with QOL (-0.76 per year, 95% CI: -1.47 to -0.06, P = 0.009). Presence of psychological disorders was associated with a lower QOL (-9.6 points lower to those without, 95% CI: -13.34 to -5.86, P < 0.0001). Total IMPACT-III and its subdomains scores were not related to sex, disease duration, or treatments. CONCLUSIONS These results not only confirm that clinical remission is a major issue for the QOL of patients, but also highlights the importance of psychological care.
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Stapersma L, van den Brink G, van der Ende J, Szigethy EM, Groeneweg M, de Bruijne FH, Hillegers MHJ, Escher JC, Utens EMWJ. Psychological Outcomes of a Cognitive Behavioral Therapy for Youth with Inflammatory Bowel Disease: Results of the HAPPY-IBD Randomized Controlled Trial at 6- and 12-Month Follow-Up. J Clin Psychol Med Settings 2020; 27:490-506. [PMID: 31506853 PMCID: PMC7462914 DOI: 10.1007/s10880-019-09649-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Youth with inflammatory bowel disease (IBD) often experience psychological difficulties, such as anxiety and depression. This randomized controlled study tested whether a 3-month disease-specific cognitive behavioral therapy (CBT) in addition to standard medical care versus standard medical care only was effective in improving these youth's psychological outcomes. As this study was aimed at prevention, we included 70 youth (10-25 years) with IBD and symptoms of subclinical anxiety and/or depression, and measured psychological outcomes at 6- and 12-month follow-up. In general, participants in both groups showed improvements in anxiety, depression, health-related quality of life, social functioning, coping, and illness perceptions, sustained until 12 months follow-up. Overall, we found no differences between those receiving additional CBT and those receiving standard medical care only. We assume that this can be explained by the perceived low burden (both somatically and psychologically) or heightened awareness of psychological difficulties and IBD. ClinicalTrials.gov NCT02265588.
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Affiliation(s)
- Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Gertrude van den Brink
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Eva M Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Groeneweg
- Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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Perito ER, Palermo TM, Pohl JF, Mascarenhas M, Abu-El-Haija M, Barth B, Bellin MD, Fishman DS, Freedman S, Gariepy C, Giefer M, Gonska T, Heyman MB, Himes RW, Husain SZ, Lin T, Liu Q, Maqbool A, McFerron B, Morinville VD, Nathan JD, Ooi CY, Rhee S, Schwarzenberg SJ, Shah U, Troendle DM, Werlin S, Wilschanski M, Zheng Y, Zimmerman MB, Lowe M, Uc A. Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2020; 70:106-114. [PMID: 31567889 PMCID: PMC6934913 DOI: 10.1097/mpg.0000000000002502] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP). METHODS Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report. RESULTS Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort. CONCLUSIONS In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.
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Affiliation(s)
- Emily R. Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - John F. Pohl
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Maria Mascarenhas
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley Barth
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Melena D. Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | - Cheryl Gariepy
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Matthew Giefer
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Tanja Gonska
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, ON, Canada
| | - Melvin B. Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ryan W. Himes
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Sohail Z. Husain
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Tom Lin
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Quin Liu
- Department of Pediatrics, Cedars-Sinai, Los Angeles, CA
| | - Asim Maqbool
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian McFerron
- Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Veronique D. Morinville
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Jaime D. Nathan
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chee Y. Ooi
- School of Women’s and Children’s Health, Medicine, University of New South Wales, New South Wales, Sydney, Australia
| | - Sue Rhee
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | | | - Uzma Shah
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - David M. Troendle
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Steven Werlin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Yuhua Zheng
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Mark Lowe
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Aliye Uc
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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Burgess CJ, Gillett P, Mitchell D, Hammond P, Henderson P, Wilson DC. Incidence of Paediatric Stricturing Duodenal Crohn Disease: A 19-Year Population-based Cohort Study. J Pediatr Gastroenterol Nutr 2019; 69:539-543. [PMID: 31335835 DOI: 10.1097/mpg.0000000000002444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Stricturing duodenal Crohn disease (CD) is a rare but serious presentation of CD causing significant morbidity. We aim to provide the first robust incidence data and case studies on this severe presentation in children. METHODS A regional cohort of prospectively acquired incident cases of paediatric CD diagnosed <16 years of age in South-East Scotland was captured over a 19-year period (1999-2018). A retrospective review was conducted on the medical records of all patients together with a review of the available literature and consensus guidelines. Incidence rates for all CD and for duodenal stricturing CD were calculated. RESULTS A total of 247 new cases of paediatric CD were diagnosed within the study period. Median age at diagnosis was 12.5 years with 62% male predominance. Overall paediatric CD incidence rate was 5.70/100,000/year with a specific duodenal B2 phenotype disease incidence rate of 0.05/100,000/year; representing 0.8% of incident cases at diagnosis. Two incident cases of stricturing duodenal CD presented with systemic symptoms of weight loss, abdominal pain, anorexia, and lethargy, together with persistent vomiting suggestive of obstruction. Both cases partially responded to intensive medical therapy but eventually required laparoscopic gastroduodenostomy. A detailed literature search confirmed there are no paediatric incidence data, guidelines, or case reports relating to duodenal stricture as either a presentation or complication of CD. CONCLUSIONS Duodenal structuring disease is a rare but serious presentation of CD causing significant morbidity and not currently covered in the paediatric literature or consensus guidelines. Best practice medical and surgical management remain uncertain and require further research.
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Affiliation(s)
- Christopher J Burgess
- Child Life and Health, University of Edinburgh
- Department of Paediatric Gastroenterology and Nutrition
| | - Peter Gillett
- Department of Paediatric Gastroenterology and Nutrition
| | | | - Philip Hammond
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Paul Henderson
- Child Life and Health, University of Edinburgh
- Department of Paediatric Gastroenterology and Nutrition
| | - David C Wilson
- Child Life and Health, University of Edinburgh
- Department of Paediatric Gastroenterology and Nutrition
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Stapersma L, van den Brink G, van der Ende J, Bodelier AG, van Wering HM, Hurkmans PCWM, Mearin ML, van der Meulen-de Jong AE, Escher JC, Utens EMWJ. Illness Perceptions and Depression Are Associated with Health-Related Quality of Life in Youth with Inflammatory Bowel Disease. Int J Behav Med 2019; 26:415-426. [PMID: 31183787 PMCID: PMC6652166 DOI: 10.1007/s12529-019-09791-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In youth with inflammatory bowel disease (IBD), health-related quality of life (HRQOL) has been shown to be affected by individual disease factors and specific psychological factors. The innovative aim of this study is to examine the combined impact of psychological factors (illness perceptions, cognitive coping, anxiety, and depression) on HRQOL, over and above the associations of demographic and disease factors with HRQOL in youth with IBD. METHOD Data on clinical disease activity, illness perceptions, cognitive coping, anxiety, depression, and HRQOL were prospectively collected in 262 consecutive youth (age 10-20, 46.6% male) with confirmed IBD. Multiple linear regression analyses tested the associations of demographic, disease, and psychological variables with HRQOL in separate groups for Crohn's disease (CD; N = 147) and ulcerative colitis and IBD unclassified (UC/IBD-U; N = 115), using age-specific validated instruments. RESULTS In both disease groups, more negative illness perceptions (ß = - .412; ß = - .438, p < .001) and more depression (ß = - .454; ß = - .279, p < .001) were related to lower HRQOL. In the UC/IBD-U group, more anxiety was related to lower HRQOL (ß = - .201, p = .001). The model with the psychological variables explained a large and significant amount of variance in both groups: 74% and 83%, respectively (p < .001). CONCLUSION In 10-20-year-old IBD patients, negative illness perceptions and depression were significantly and more strongly associated with lower HRQOL than demographic and disease factors. Thus, it is important to integrate psychological factors in the treatment for IBD patients. To improve HRQOL in young IBD patients, psychological interventions should be targeted at negative illness perceptions and depression.
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Affiliation(s)
- Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands
| | - Gertrude van den Brink
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands
| | | | | | | | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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Burgess CJ, Reilly C, Steward-Harrison L, Balouch F, Lewindon PJ. Utility of proactive infliximab levels in paediatric Crohn's disease. Arch Dis Child 2019; 104:251-255. [PMID: 29950353 DOI: 10.1136/archdischild-2018-315100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Infliximab (IFX) has an established role in Crohn's disease (CD), with serum trough levels of IFX (TLI) increasingly used to optimise dosing. We report the utility of routine, proactive TLI in children on combination therapy with immunosuppression (IS) from a single paediatric centre. METHODS This is a retrospective chart review of all children with CD receiving IFX therapy conducted betweenJanuary 2014-May 2017. Clinical phenotype, duration of therapy, TLI (µg/mL), drug antibodies, type of IS, biomarkers and changes in management were recorded. RESULTS 60 children (8-17 years; median 14.1 years) had 206 TLIs recorded. 56/60 (93%) were on IS, with 5/60 (8%) developing antidrug antibodies (ADAs). 63/206 TLIs were recorded duringan episode of relapse (median 3.0 µg/mL) vs 143/206 TLIs recorded in remission (median 5.2 µg/mL). For children with TLI <3 µg/mL, 31/63 (49%) were in relapse vs 30/143 (21%) in remission. For children with TLI >7 µg/mL, 7/63 (11%) were in relapse vs 46/143 (32%) in remission. Change in management resulted from 43/206 (21%) TLIs in 31/60 (52%) children: 21 dose escalations, 12 de-escalations and 10 changed to adalimumab. Of 31 postinduction TLIs, 15/17 (88%) children with TLI >7 µg/mL achieved clinical and biochemical remission for the duration of therapy (median 14 months), while 4/5 (80%) children with TLI <3 µg/mL required early dose escalation. Combination therapy with thiopurines (TP) (median TLI 4.9 µg/mL) versus methotrexate (MTX) (median TLI 5.2 µg/mL) achieved comparable levels with no difference in relapse frequency. CONCLUSIONS Routine, proactive TLIs guide optimal management in children with CD. Postinduction and during maintenance, levels <3 µg/mL were associated with relapse and levels >7 µg/mL with sustained remission. Combination IS with TP and MTX appears to offer comparable TLI and ADA rates.
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Affiliation(s)
- Christopher J Burgess
- Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
| | - Claire Reilly
- Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Lana Steward-Harrison
- Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Fariha Balouch
- Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Peter J Lewindon
- Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
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10
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Kim S, Park S, Kang Y, Kim JE, Kang B, Choe BH, Lee YJ, Park JH, Yang HR, Lee SH, Kim KM, Ryoo E, Tchah H, Shim JO, Koh H. Can We Estimate Quality of Life in Pediatric Inflammatory Bowel Disease Patients? An Asian Multicenter Study. J Pediatr Gastroenterol Nutr 2019; 68:45-49. [PMID: 30052570 DOI: 10.1097/mpg.0000000000002119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Inflammatory bowel disease (IBD) is a chronic lifelong condition and is related to poor quality of life (QoL). The aim of this study was to evaluate the QoL of Asian pediatric patients with IBD and to determine the clinical factors that can influence QoL. METHODS Children and adolescents aged 9 to 18 years diagnosed with IBD were enrolled from 7 hospitals. The patients completed the IMPACT-III questionnaire, and clinical data were collected. The results of the questionnaire and the correlation with clinical data were analyzed. RESULTS A total of 208 patients (Crohn disease: n = 166; ulcerative colitis: n = 42) were enrolled. There was no definite QoL difference according to the Paris classification. Female sex (-5.92 ± 2.97, P = 0.0347) and active disease status (-10.79 ± 3.11, P = 0.0006) were significantly associated with poor QoL. Extreme body weight z score and older age at diagnosis were also associated with worse QoL. CONCLUSIONS Various clinical factors may affect the QoL in patients with IBD, but determining the overall QoL of patients using only these clinical factors is difficult. Therefore, regular direct measurements of QoL are necessary to better understand patients with IBD.
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Affiliation(s)
- Seung Kim
- Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul
| | - Sowon Park
- Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul
| | - Yunkoo Kang
- Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul
| | - Jung Eun Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University, Yangsan
| | - Jae Hong Park
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University, Yangsan
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Sung Hee Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul
| | - Kyung Mo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul
| | - Eell Ryoo
- Department of Pediatrics, Gachon University, Gil Hospital, Incheon
| | - Hann Tchah
- Department of Pediatrics, Gachon University, Gil Hospital, Incheon
| | - Jung Ok Shim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hong Koh
- Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul
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F-calprotectin and Blood Markers Correlate to Quality of Life in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2017; 65:539-545. [PMID: 28169974 DOI: 10.1097/mpg.0000000000001540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our aim was to investigate predictors of health-related quality of life (HRQoL) with respect to changes in disease parameters over time in children with inflammatory bowel disease. METHODS This was a prospective longitudinal study examining the association between HRQoL (IMPACT III) and symptom scores (Pediatric Crohn Disease Activity Index, abbreviated Pediatric Ulcerative Colitis Activity Index), fecal calprotectin measures and blood analyses (C-reactive protein, erythrocyte sedimentation rate, orosomucoid, albumin, hemoglobin, and vitamin-D) in a cohort of 10- to 17-year-old patients with inflammatory bowel disease. Data were collected prospectively at 3-month intervals during a 2-year period. Associations were analyzed using linear mixed-effect models. Patients were divided into 2 groups, which received nonbiological oral treatment or biological parenteral treatment. RESULTS From 79 patients (39 Crohn disease/40 ulcerative colitis), representing a total of 43,132 days of observation, 572 IMPACT measurements were paired with variables. A decrease in the IMPACT III score was significantly associated with increased ulcerative colitis-symptom score in the biological group (P = 0.005), and a similar inverse tendency was found in the nonbiological group and for Crohn disease symptoms in both groups. We found in both treatment groups overall a significant (P < 0.05) inverse association between the IMPACT III and the levels of fecal calprotectin, erythrocyte sedimentation rate, and orosomucoid, whereas albumin, hemoglobin, and vitamin-D were directly significantly associated. CONCLUSIONS The IMPACT score, already known to correlate with disease activity, has now been shown to be associated with disease markers in feces and blood. This emphasizes that objective markers of disease activity indirectly can predict the patient's HRQoL.
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Changes in health-related quality of life over a 1-year follow-up period in children with inflammatory bowel disease. Qual Life Res 2017; 26:1617-1626. [DOI: 10.1007/s11136-017-1513-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 01/26/2023]
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Chouliaras G, Margoni D, Dimakou K, Fessatou S, Panayiotou I, Roma-Giannikou E. Disease impact on the quality of life of children with inflammatory bowel disease. World J Gastroenterol 2017; 23:1067-1075. [PMID: 28246481 PMCID: PMC5311096 DOI: 10.3748/wjg.v23.i6.1067] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/16/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
AIM
To assess the impact of disease characteristics on the quality of life (QOL) in children with inflammatory bowel diseases (IBD).
METHODS
This was a cross-sectional study conducted at the First Department of Pediatrics of the University of Athens at the “Aghia Sophia” Children’s Hospital. Children diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC), who were followed as outpatients or during a hospitalization, participated, after informed consent was obtained from their legal representative. QOL was assessed by the IMPACT-III questionnaire. Demographic data and disease characteristics were also collected. Statistical analyses included parametric (Student’s t-test and Pearson’s r) and non-parametric (Mann-Whitney test, Fisher’s test and Spearman’s rho) procedures.
RESULTS
Ninety-nine patients (UC: 37, 73.0% females, CD: 62, 51.6% females), aged 12.8 ± 2.6 years were included. Overall, as well as, sub-domain scores did not differ between UC and CD (overall score: 73.9 ± 13.3 vs 77.5 ± 11.2, respectively, P = 0.16). In the entire sample, total score was related to physician’s global assessment (PGA, patients classified as “mild/moderate” active disease had, on average, 14.8 ± 2.7 points lower total scores compared to those “in remission”, P < 0.001) and age at IMPACT completion (Pearson’s r = 0.29, P = 0.05). Disease activity assessed by the indices Pediatric Ulcerative Colitis activity index, Pediatric Crohn’s disease activity index or PGA was significantly associated with all subdomains scores. Presence of extraintestinal manifestations had a negative impact on emotional and social functioning domains.
CONCLUSION
Disease activity is the main correlate of QOL in children with IBD, underlining the importance of achieving and sustaining clinical remission
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Otley AR, Day AS, Zachos M. Nutritional Management of Inflammatory Bowel Disease. PEDIATRIC INFLAMMATORY BOWEL DISEASE 2017:333-356. [DOI: 10.1007/978-3-319-49215-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Tamara VDS. "Role of Psychosocial Factors on the Course of Inflammatory Bowel Disease and Associated Psychotherapeutic Approaches. A Fresh Perspective and Review". ACTA ACUST UNITED AC 2015. [DOI: 10.15406/ghoa.2015.02.00038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wu J, Niu JK, Miao YL. Impaired growth and puberty in pediatric patients with inflammatory bowel disease: Etiology and treatment. Shijie Huaren Xiaohua Zazhi 2015; 23:221-228. [DOI: 10.11569/wcjd.v23.i2.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Growth failure associated with delayed puberty is a unique feature in pediatric patients with inflammatory bowel disease (IBD), especially those with Crohn's disease, which has a negative effect on quality of life, emotional functioning, social functioning, and body image. Although the underlying mechanisms are not fully clear, the condition may be induced by the effects of malnutrition, inflammatory process and glucocorticoid on the growth hormone/insulin-like growth factor-1 axis or on the growth plate. Nutrition, biologic agents, intestinal resection and glucocorticoids are main treatments. Standards for monitoring and treatment of impaired growth and development in pediatric IBD patients need to be formulated. To achieve optimal growth, the efforts of hospitals, families and society are necessary.
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Szabó D, Kökönyei G, Arató A, Dezsőfi A, Molnár K, Müller KE, Lakatos PL, Papp M, Lovász BD, Golovics PA, Cseh A, Veres G. Autoregressive cross-lagged models of IMPACT-III and Pediatric Crohn's Disease Activity Indexes during one year infliximab therapy in pediatric patients with Crohn's disease. J Crohns Colitis 2014; 8:747-755. [PMID: 24434181 DOI: 10.1016/j.crohns.2013.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/20/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Quality of life (QoL) is an important outcome measure in the evaluation of therapies for inflammatory bowel disease. The primary aim of this study was to determine the effect of one year infliximab treatment on QoL and clinical parameters in pediatric patients with Crohn's diseases (CD). METHODS Our prospective study involved 51 children with conventional therapy resistant, severe CD (mean age: 15.25years, range: 11-18years). Infliximab was given according to the protocol (5mg/kg, at weeks 0, 2, 6 and every 8weeks). During the infliximab courses QoL of patients was evaluated by IMPACT-III questionnaire at weeks 0, 6, 30 and 53. At the same time, the Pediatric Crohn's Disease Activity Index (PCDAI) score was calculated. Moreover, serum C-reactive protein (CRP), serum platelets and serum albumin were followed up. Auto-regressive, cross-lagged models were used to assess relation between QoL and the clinical parameters. RESULTS The initial IMPACT-III scores [median, percentile 25-75 (pc 25-75) at week 0: 115, 102.5-130.25] increased significantly (p<0.001) following infliximab therapy at week 54 (median: 141.5, 124.5-153.75). Clinical and laboratory parameters also improved significantly (p<0.001). Auto-regressive regression coefficients (β value) were significant between each variable over time. The strongest cross-lagged relations were observed between IMPACT-III and serum albumin, IMPACT-III and platelets. Reliability test of IMPACT-III revealed an excellent level of internal consistency (Cronbach's alpha=0.931). CONCLUSION Infliximab treatment has beneficial clinical effect which is confirmed by decrease of PCDAI and increase of IMPACT-III. Autoregressive regression analysis showed regression relation between IMPACT-III and PCDAI and laboratory parameters.
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Affiliation(s)
- Dolóresz Szabó
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - András Arató
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Antal Dezsőfi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Kriszta Molnár
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | | | | | - Mária Papp
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Barbara D Lovász
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Petra A Golovics
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Aron Cseh
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gábor Veres
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
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Filipovic BR, Filipovic BF. Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease. World J Gastroenterol 2014; 20:3552-3563. [PMID: 24707138 PMCID: PMC3974522 DOI: 10.3748/wjg.v20.i13.3552] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 12/20/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis and Crohn’s disease, commonly known as inflammatory bowel disease (IBD), draw attention from specialists of various disorders, including gastroenterology, psychiatry, and radiology. The involvement of a cortical influence in the brain-gut axis as well as the interaction of the hypothalamic-pituitary-adrenal axis and the peripheral nervous system provide an initial explanation of the psychological symptoms associated with IBD. The involvement of structures the limbic system, such as the anterior cingulate cortex, the prefrontal cortex, and the amygdala, paves the way for the discovery of the mechanisms underlying depression depression, anxiety, alexithymia, personality traits, and other psychological impairments following the onset of IBD. Psychiatric therapy in IBD patients is almost as important as the gastroenterological approach and consists of pharmacological treatment and psychotherapy. Neither of the available psychiatric treatment methods is considered the golden standard because both methods have side effects, and psychotropic medication can provoke the worsening of IBD symptoms. Thus, both approaches must be applied with awareness of the possibility of side effects. We suggest that psychiatrists and gastroenterologists work together to reach a consensus on IBD therapy to ensure success and to reduce side effects and relapse to the lowest possible rates.
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Warschburger P, Hänig J, Friedt M, Posovszky C, Schier M, Calvano C. Health-related quality of life in children with abdominal pain due to functional or organic gastrointestinal disorders. J Pediatr Psychol 2013; 39:45-54. [PMID: 24055816 DOI: 10.1093/jpepsy/jst070] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Comparing health-related quality of life (HRQOL) in children suffering from functional and organic gastrointestinal disorders and to identify predictors for HRQOL. METHODS Children with functional (n = 70) and organic (n = 100) gastrointestinal disorders, aged 8-18 years and referred to a pediatric gastroenterologist, completed questionnaires assessing pain severity, coping, and HRQOL. RESULTS The sample reported low HRQOL scores, even significantly lower compared with reference values of chronically ill children, derived from normative data of KINDL-R, a generic QOL questionnaire. HRQOL was not significantly associated with age, gender, duration of pain, and diagnosis (functional gastrointestinal disorder vs. organic gastrointestinal disorder). Pain severity and catastrophizing were significantly associated with HRQOL, with catastrophizing fully mediating the relationship between pain and HRQOL. CONCLUSION The emotional burden associated with chronic abdominal pain-regardless of its cause-is enormous. Interventions should target the children's coping strategies, as catastrophizing seems to be the causal link between pain and HRQOL.
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Affiliation(s)
- Petra Warschburger
- Counseling Psychology, Department of Psychology, Potsdam University, Karl- Liebknecht- Str. 24/25, 14476 Potsdam, Germany.
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Castaneda AE, Tuulio-Henriksson A, Aronen ET, Marttunen M, Kolho KL. Cognitive functioning and depressive symptoms in adolescents with inflammatory bowel disease. World J Gastroenterol 2013; 19:1611-1617. [PMID: 23538788 PMCID: PMC3602478 DOI: 10.3748/wjg.v19.i10.1611] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/12/2012] [Accepted: 12/17/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate cognitive functioning and depressive symptoms in adolescents with inflammatory bowel disease (IBD).
METHODS: A neuropsychological test battery, including subtests of the Wechsler Adult Intelligence Scale-Revised and III, Wechsler Memory Scale-Revised, California Verbal Learning Test (CVLT), Stroop Color-Word Test, and Trail Making Test, which assessed verbal and visual short- and long-term memory, processing speed, logical reasoning, verbal intelligence, attention, and executive functioning, was administered to 13- to 19-year-old patients with IBD (n = 34; active disease n = 20). Depressive symptoms were measured with the Beck Depression Inventory. The findings were compared with peers with non-acute juvenile idiopathic arthritis (JIA; n = 23). Patients with coexisting psychiatric disorders were excluded.
RESULTS: The IBD group, especially patients in the acute phase, made more perseverative errors in the CVLT test that assessed verbal memory than the JIA group (6.0 ± 4.3 vs 3.3 ± 2.9, P < 0.01), but no other differences between the IBD and JIA groups were observed in the neuropsychological tests. The difference was close to statistical significance, even when glucocorticoid medication was controlled for (P < 0.052). The IBD group had more depressive symptoms than the JIA group (7.9 ± 7.6 vs 4.0 ± 4.0, P < 0.05). Approximately one third of the IBD group had at least mild depressive symptoms, and those with acute illness had the highest scores. However, depressive symptoms were not related to the difference in the verbal memory test (perseverative errors in the CVLT) between the IBD and JIA groups.
CONCLUSION: Adolescents with acute IBD may have mild verbal memory problems but no major cognitive deficits compared to peers with JIA.
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Cameron FL, Gerasimidis K, Papangelou A, Missiou D, Garrick V, Cardigan T, Buchanan E, Barclay AR, McGrogan P, Russell RK. Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with Crohn's disease. Aliment Pharmacol Ther 2013; 37:622-9. [PMID: 23360085 DOI: 10.1111/apt.12230] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 11/15/2012] [Accepted: 01/11/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is an effective first line treatment for active paediatric Crohn's disease (CD). AIM To examine the effect of EEN on short- and long-term clinical outcome together with anthropometric measurements. METHODS Retrospective case-note review in newly diagnosed CD (<16 years) who completed 8 weeks of EEN. Demographics, anthropometry, disease characteristics and inflammatory markers were collected at EEN initiation and at 1, 2, 6, 12 & 24 months post treatment initiation. EEN response was determined by a patient global assessment. RESULTS One hundred and nine patients were included (Males 68; Median age: 11.2 years). After 8 weeks EEN, 65 were in remission, 32 improved and 12 had no improvement. By 4 weeks, mean weight/BMI z-score (s.d.) increased (P < 0.02) and between 4 and 8 weeks (P < 0.05). Baseline inflammatory markers all improved significantly by week 4 (albumin, CRP and platelets; all P < 0.01) and ESR (P < 0.00001). 63/109(58%) relapsed during follow-up. 44/63(70%) patients completed a second course of EEN with similar response rate, but lower weight gain (3.3 vs. 5.1 kg, P < 0.05). Height z-score did not change significantly over the 24 months. Introduction of azathioprine within 6 months of diagnosis did not improve height outcomes at 24 months. CONCLUSIONS Weight and BMI z-score improved with EEN and changes are sustained to 2 years, but height z-score did not. Seventy per cent of patients who relapsed during 2-year follow-up managed a 2nd course of EEN. The optimal therapeutic strategies for length of EEN course and to improve linear growth are awaited.
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Affiliation(s)
- F L Cameron
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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Abstract
BACKGROUND AND AIM Crohn disease (CD) presents a range of physical, social, and psychological challenges, and can adversely affect the quality of life of those affected by it. The present study aimed to investigate the health-related quality of life of paediatric patients with CD in the Wellington region. Measuring health-related quality of life assists with resource allocation decisions and assesses various forms of interventions. METHODS Patients ages 9 to 18 years with CD in the Wellington region were assessed using the IMPACT-III inflammatory bowel disease-specific questionnaire (n = 16). Eight participants filled it out and returned it by post; the remaining 8 filled it out in a meeting with the researcher and then underwent cognitive debriefing as part of a cross-cultural adaptation of the questionnaire. RESULTS Of a maximum possible value of 175, the total health-related quality of life score had a mean value of 119.2 (standard deviation 30.7). Using Spearman rank correlation analysis, significant findings included a positive correlation between disease duration and quality of life (ρ = 0.534, sig. <0.05) and a negative correlation between disease activity and quality of life (ρ = -0.596, sig. <0.05). Qualitative information included difficulties in coping with long-term and unpleasant treatments and feelings of isolation. CONCLUSIONS Children with Crohn disease in the Wellington region may benefit from age-specific social and psychological support. Because there is limited information on quality of life in young patients with CD in New Zealand, the results of the present study may be used as baseline data for future studies.
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Abstract
OBJECTIVE Little is known of the psychological well-being of youths diagnosed as having inflammatory bowel diseases (IBDs). Much of the literature available focuses on adults with IBD and those that focus on youths tend to use generic measures of health-related quality of life (QOL). The primary aim of this research is to obtain a profile of the IBD-related QOL and levels of anxiety of youths of ages 9 to 17 years presenting with IBD to a national hospital. It is also intended to examine the clinical utility of the IMPACT-III questionnaire. PATIENTS AND METHODS A questionnaire battery containing the IMPACT-III questionnaire and the Spence Children's Anxiety Scale (SCAS) was posted to all of the patients on the database of the gastrointestinal clinic between the ages of 9 and 17 years (n = 215), resulting in an achieved sample size of 79 (response rate of 36.7%). RESULTS It was found that 63% (n = 50) of participants had total IMPACT-III scores below the cutoff of 143, previously established for remission. In addition, 5 participants reported being unhappy with their lives. Thirty-nine percent (n = 31) of participants had elevated anxiety symptoms on ≥ 1 of the SCAS subscales. Anxiety level was found to be a significant predictor of QOL (β = -0.616, P = 0.001). Qualitative feedback highlighted the variability of physical and psychological symptoms participants experience, feelings of anger or embarrassment around the condition, and posed numerous questions, indicating that there is a lack of knowledge among patients around IBD. CONCLUSIONS These findings support the utility of screening patients with IBD for psychological difficulties and estimates of QOL. Further research and group interventions are recommended.
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Ernährung und Chirurgie als Säulen der CED-Behandlung. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-010-2197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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