Transition Readiness in Youth with Inflammatory Bowel Disease.

OBJECTIVES: To examine readiness of adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) to transition to adult care. STUDY DESIGN: A cross-sectional multicenter study evaluating transition readiness in individuals with IBD 16-19 years old prospectively recruited from 8 Canadian IBD centers using the validated ON Taking Responsibility for Adolescent to Adult Care (ON TRAC) questionnaire. Secondary aims included (1) screening for depression and anxiety using the 8-item Personal Health Questionnaire Depression Scale and The Screen for Child Anxiety Related Emotional Disorders questionnaires, respectively; (2) evaluating the association between depression and anxiety with readiness and disease activity; and (3) subjectively evaluating AYA readiness based on physician and parent assessments. RESULTS: In total, 186 participants (139 adolescent, 47 young adult) were enrolled, mean age 17.4 years (SD, 0.87). ON TRAC scores determined that 26.6% of AYAs at pediatric and 40.4% at adult centers reached the threshold of readiness. On multivariable linear regression analysis age was positively (P = .001) and disease remission negatively (P = .03) associated with ON TRAC scores. No statistically significant differences were determined across centers. A significant percentage of AYAs reported moderate-to-severe depression (21.7%) and generalized anxiety (36%); however, neither were significantly associated with ON TRAC scores. Notably, physician and parental assessment of AYA readiness correlated poorly with ON TRAC scores (⍴ = 0.11, ⍴ = 0.24, respectively). CONCLUSIONS: Assessment of transition readiness in AYAs with IBD highlighted that a large proportion do not have adequate knowledge or behavior skills needed for transition to adult care. This study infers that readiness assessment tools are essential during transition to identify deficits in knowledge and behavior skills that could be specifically targeted by the youth, caregivers, and multidisciplinary team.

The Experience of a Gluten-free Diet in Children with Type 1 Diabetes and Celiac Disease.

OBJECTIVE: This study examined overall self-reported adherence to gluten-free diet (GFD) in children with type 1 diabetes and celiac disease (T1DCD) compared to children with celiac disease (CD). Secondary objectives included gaining insight into self-reported symptoms, barriers to adherence, and experience of a GFD between groups. METHODS: Children <18 years old who had been seen at BC Children's Hospital for T1DCD or CD were invited to participate in a web-based questionnaire and medical record review. RESULTS: A total of 26 children with T1DCD and 46 children with CD participated in the study. The groups' demographics and symptoms of CD were similar; however, a greater proportion of those with T1DCD were asymptomatic at diagnosis (T1DCD 27%; CD 7%; P = 0.016). Overall adherence to a GFD was high in both groups (T1DCD 92%; CD 100%; P = 0.38) but those with T1DCD reported a significantly less positive effect on their health (P = 0.006) and a significantly greater negative effect on activities from a GFD (P = 0.03). Children with T1DCD reported more significant barriers to eating gluten-free at home and at restaurants, specifically with social pressure, cost and taste compared to those with CD only. CONCLUSION: Children with T1DCD face specific barriers in adherence that are more impactful compared with children living with CD. These children are more often asymptomatic at diagnosis, and they go on to experience different impacts of a GFD spanning across home and social settings. Given the complexity of having a dual diagnosis, CD care should be tailored specifically to children living with T1DCD.

Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn's disease patients.

BACKGROUND: Asymptomatic children with Crohn's disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation. AIM: In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse. METHODS: In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo. RESULTS: 53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 µg/g (283-1758) vs 244 µg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 µg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937). CONCLUSION: Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 µg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

Changing incidence of inflammatory bowel disease: environmental influences and lessons learnt from the South asian population.

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disorder of the gastrointestinal tract associated with significant morbidity. While IBD occurs in genetically susceptible individuals, the etiology is multifactorial, involving environmental influences, intestinal dysbiosis, and altered immune responses. The rising incidence of IBD in industrialized countries and the emergence of IBD in countries with traditionally low prevalence underscore the importance of environmental influences in the pathobiology of the disease. Moreover the high incidence of IBD observed in the South Asian immigrant population in the United Kingdom and Canada further supports the influence of environmental factors.

Effects of host outcrossing on the interaction between an aquatic snail and its locally adapted parasite.

In this study, we investigated the interaction between host outcrossing and infection in the Biomphalaria glabrata-Schistosoma mansoni system. Snails collected from three susceptible isofemale lines were mated with either siblings or snails recently derived from a field site in Brazil. Resulting inbred and outcrossed progeny were then exposed to S. mansoni larvae and monitored for a 10-week period. Interestingly, all snails exhibited equal susceptibility whether they were the result of inbreeding or outcrossing. However, further examination of both host and parasite life-history traits uncovered significant differences between the groups. In uninfected snails, outcrossed progeny tended to exhibit greater fitness relative to inbred progeny. When snails were parasitized, these differences were magnified in certain life-history traits, particularly host reproduction and survival. As an extension of the work, we also investigated virulence within this host-parasite system. Estimates of parasite reproduction and host size were combined to generate a novel "exploitation index," and these indices were regressed with host survivorship. As predicted, there was a significant and negative correlation between the variables, but this was restricted to a single snail line. Results from this study demonstrate that infection outcomes (as measured by prevalence) may not differ between inbred and outcrossed hosts. However, outcrossing may enhance snail fitness through life-history trait expression.

Interplay between host genetic variation and parasite transmission in the Biomphalaria glabrata-Schistosoma mansoni system.

Genetic variability is often predicted to enhance host fitness in the face of parasitism, yet this idea is rarely tested in an experimental setting, particularly with animal hosts. To assess this question, we used a relatively resistant line of snail hosts (Biomphalaria glabrata) to generate inbred and outcrossed progeny that were then either exposed or sham-exposed to the trematode parasite, Schistosoma mansoni. Results showed no difference in prevalence between the groups; however, large differences appeared in other host life history traits, particularly reproduction. Outcrossed progeny produced large numbers of eggs relative to inbred progeny especially in the face of infection. Furthermore, eggs produced by outcrossed snails took less time to hatch and exhibited greater hatching success compared to their inbred counterparts. Parasite reproduction demonstrated the opposite trend, with fewer parasites emerging from outcrossed snails compared to inbred individuals. This work shows that the introduction of genetic variation into inbred snail populations can have important implications for the viability of host populations and disease transmission.