Gastroenterol Clin North Am. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study.
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J Pediatr. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France J Pediatr Gastroenterol Nutr. Inflammatory bowel diseases in pediatric and adolescent patients: clinical, therapeutic, and psychosocial considerations.
Indeterminate colitis: a significant subgroup of pediatric IBD. Inflammatory bowel disease in children 5 years of age and younger. Am J Gastroenterol. Chronic inflammatory bowel disease in children and adolescents in Sweden.
J Pediatr Gastroenterol Nutr. Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn's and Colitis Foundation of America. Nikolaus S, Schreiber S. Diagnostics of inflammatory bowel disease. Burakoff R.
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Indeterminate colitis: clinical spectrum of disease. J Clin Gastroenterol. Loftus EV. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Pediatric inflammatory bowel disease: clinical and molecular genetics. Serum immune responses predict rapid disease progression among children with Crohn's disease: immune responses predict disease progression.
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Haller CA, Markowitz J. IBD in children: lessons for adults. Curr Gastroenterol Rep. Polymorphisms of tumor necrosis factor-alpha but not MDR1 influence response to medical therapy in pediatric-onset inflammatory bowel disease. Diagnostic precision of anti-Saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibodies in inflammatory bowel disease. Diagnostic accuracy of serological assays in pediatric inflammatory bowel disease. IBD serological panels: facts and perspectives.
Antibodies to CBir1 flagellin define a unique response that is associated independently with complicated Crohn's disease. Utility of serum antibodies in determining clinical course in pediatric Crohn's disease. Clin Gastroenterol Hepatol. Increased immune reactivity predicts aggressive complicating Crohn's disease in children. Gershon MD, Tack J. The serotonin signaling system: from basic understanding to drug development for functional GI disorders.
Utility of serological markers in predicting the early occurrence of complications and surgery in pediatric Crohn's disease patients. Can we alter the natural history of Crohn disease in children? Inflammatory bowel disease in pediatric and adolescent patients. Crohn's disease: influence of age at diagnosis on site and clinical type of disease. Clinical patterns, natural history, and progression of ulcerative colitis. A long-term follow-up of patients.
Dig Dis Sci. The molecular classification of the clinical manifestations of Crohn's disease. Mutations in NOD2 are associated with fibrostenosing disease in patients with Crohn's disease. CARD15 gene mutations and risk for early surgery in pediatric-onset Crohn's disease. Dubinsky MC. New patients: should children be treated differently? Colorectal Dis.
Growth, body composition, and nutritional status in children and adolescents with Crohn's disease. Nutritional issues in pediatric inflammatory bowel disease. Risk factors for low bone mineral density in children and young adults with Crohn's disease. Total dose intravenous infusion of iron dextran for iron-deficiency anemia in children with inflammatory bowel disease.
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Engstrom I. Inflammatory bowel disease in children and adolescents: mental health and family functioning. Psychosocial functioning in pediatric inflammatory bowel disease. Psychological factors affecting pediatric inflammatory bowel disease. Curr Opin Pediatr. Coping strategies and quality of life of adolescents with inflammatory bowel disease. Qual Life Res.
Challenges and strategies of children and adolescents with inflammatory bowel disease: a qualitative examination. Health Qual Life Outcomes. Measuring quality of life in pediatric patients with inflammatory bowel disease: psychometric and clinical characteristics. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med. Guidelines for immunizations in patients with inflammatory bowel disease. Immune response to influenza vaccine in pediatric patients with inflammatory bowel disease. A consensus statement on health care transitions for young adults with special health care needs.
Studies in children are more controversial with results ranging from low through normal 70,71 and even high serum folate levels , Both sulfasalazine and MTX can cause folate deficiency, as both are inhibitors of dihydrofolate reductase and cellular uptake of folate A recent systematic review showed that folic acid supplementation in MTX-treated patients with rheumatoid arthritis reduces the incidence of abnormal liver function tests, gastrointestinal GI adverse effects, and rates of withdrawal from treatment The optimal dosage of supplementation has not been established though either a daily dose of 1 mg or a weekly dose of 5 mg seem to be sufficient ECCO guidelines recommend measuring folate level at least annually, or if macrocytosis is present in the absence of thiopurine use Vitamin B12 status is measured by either serum B12 levels or more accurately by methylmalonic acid and homocysteine levels The causes of vitamin B12 deficiency in patients with IBD include ileal disease or resection, fistulas, small bowel bacterial overgrowth and reduced intake , Vitamin B12 deficiency was also demonstrated in UC patients with ileoanal pouch Pediatric data are scarce with 2 small cohorts yielding contradictive results 70, ECCO guidelines recommend assessing cobalamin level at least annually or when macrocytosis is present, in the absence of thiopurine use Patients with clinical deficiency should be treated with scheduled intra-muscular injections Chronic intestinal failure necessitating the need for home PN is uncommon in CD and is observed mainly in adults due to resections of a significant portion of the small intestine If intestinal failure occurs and when EN is contraindicated hemodynamic instability, intestinal ischemia, intestinal obstruction, ileus, severe intestinal hemorrhage, and high-output fistulae , the individual nutrition goals should, however, be met by the provision of PN.
Preferably, this should be limited to a short period few weeks ; however, in cases of intestinal failure this may need to be done indefinitely. In 1 study, EN was as good as PN for induction of remission and the probability to remain in remission after 1 year In another study, elemental diet and PN were equally as effective in remission induction Overall, PN only has a role in children with or at risk of malnutrition and in children in need of nutrition support where the use of EN is contraindicated or is insufficient to maintain nutritional status and growth.
Although it was never adequately studied in children, clinical wisdom as well as costs and safety concerns, however, should limit the use of PN to its classical roles as stated above. After the publication of the last meta-analysis, 1 RCT and some other prospective studies were published replicating the previous results — The overall conclusion is that EEN has the same efficacy in the induction of remission as corticosteroids.
Recently, the efficacy of EEN has been confirmed in comparison to biological therapy. Lee et al enrolled 90 consecutive children with an active CD in a prospective study.