Is Fecal Calprotectin a Useful Marker for Small Bowel Crohn Disease?

OBJECTIVES: The identification of reliable non-invasive biomarkers of Crohn disease (CD) activity is crucial. Fecal calprotectin (FC) is the most promising one. We aimed to define whether its performance for isolated ileal CD could be as useful as for colonic and ileocolonic disease. METHODS: Retrospective observational study of all pediatric patients affected with CD with FC and inflammatory blood markers performed within one week from an ileocolonoscopy or magnetic resonance enterography. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of FC >50 mcg/g were evaluated for isolated ileal CD (L1), colonic CD (L2) and ilecolonic CD (L3) using ilecolonoscopy and magnetic resonance enterography as the reference standard. The best FC cut-off for each disease location was evaluated using receiver operating characteristic curves. RESULTS: One-hundred seventy-six FC measurements from a total of 98 patients were collected (14.3% L1, 10.2% L2, 75.5% L3). The sensitivity and specificity of FC for L1 CD were 36% and 91%, respectively, compared to 93% and 75% for L2 and 70% and 95% for L3. An FC of 95 mg/kg was identified as the best cut off for identification of active isolated ileal disease, with a sensitivity of 77% and a specificity of 56% [area under the curve (confidence interval [CI] 0.56- 0.97) 0.77, P = 0.02]. CONCLUSIONS: With a sensitivity of 36%, FC alone does not accurately reflect isolated L1 disease activity. A significantly lower threshold should be applied for increasing its performance for isolated small bowel CD monitoring.

Oral desensitization in IgE-mediated food allergy: Effectiveness and safety.

The avoidance of allergenic foods and emergency medications on accidental exposure are the only currently approved treatments in food allergy. EAACI guideline on allergen immunotherapy recommends oral immunotherapy as a therapeutic option to increase the threshold of the reaction during treatment in children with persistent IgE-mediated cow's milk, hen's egg, and peanut allergy from around 4-5 years of age, but the same recommendation cannot currently be made to achieve post-discontinuation effectiveness. Both systemic and local reactions during OIT have been frequently reported. For this reason, EAACI guideline suggests several recommendations on safety, including carefully monitoring patients for allergic reactions, especially during the up-dosing phase of OIT, and monitoring for symptoms of new-onset eosinophilic esophagitis. New approaches are certainly necessary to give priority not only to effectiveness but also to safety.

Short-term Psychodynamic Psychotherapy in Addition to Standard Medical Therapy Increases Clinical Remission in Adolescents and Young Adults with Inflammatory Bowel Disease: a Randomised Controlled Trial.

BACKGROUND: Inflammatory bowel diseases [IBD] are chronic and pervasive conditions of the gastrointestinal tract with a rising incidence in paediatric and young adult populations. Evidence suggests that psychological disorders might be associated with relapse of disease activity. This study aims to evaluate the efficacy of short-term psychodynamic psychotherapy [STPP] in addition to standard medical therapy [SMT] in maintaining clinical remission in adolescents and young adults [AYA] with quiescent IBD, compared with SMT alone. METHODS: A two-arm, single-centre, randomised, controlled trial was conducted in 60 IBD AYA in clinical remission. Patients were randomised to receive an 8-week STPP + SMT [n = 30] or SMT alone [n = 30]. The primary outcome was the steroid-free remission rate at 52 weeks after treatment. Secondary outcomes included the overall hospitalisation rate within 52 weeks after treatment, and medication adherence obtained from patient's electronic medical records. RESULTS: Intention-to-treat analysis showed significant improvement in maintaining disease remission rates in the 8-week STPP + SMT group compared with the control one. The proportion of patients maintaining steroid-free remission at 52 weeks was higher in patients in STTP group [93.1%] compared with patients randomised to control group [64.3%; p = 0.01]. There were no significant differences in secondary outcomes, except for depression reduction in STPP + SMT group. CONCLUSIONS: An 8-week STPP intervention in addition to SMT effectively increases the steroid-free remission rates in AYA with quiescent IBD. Results do not support effects for other secondary outcomes, except for depression reduction.

Endoscopic ultrasound-guided gastrojejunostomy with lumen-apposing metal stent in a boy with neurological impairment requiring jejunal feeding.

Video 1EUS-guided, LAMS-assisted gastrojejunostomy for re-routing a PEGJ tube in neurologically impaired children.

Direct visualization of biliary stump polyp in a boy with recurrent pancreatitis after surgery for pancreatobiliary maljunction associated with choledocal cyst.

Video 1Direct cholangioscopy for pancreatobiliary maljunction.