[Knowledge of adolescents with inflammatory bowel disease: Results of a multicenter cross-sectional survey]. / Connaissances des adolescents atteints de maladie inflammatoire chronique intestinale : résultats d'une enquête transversale multicentrique.

AIM: To assess knowledge acquired by adolescents about their inflammatory bowel disease (IBD). METHODS: An anonymous questionnaire was given during consultation to adolescents followed for IBD by pediatricians from 13 hospitals between 1 September 2012 and 1 July 2013. After parental consent, these physicians completed a form at the inclusion of each patient, in which the characteristics of IBD were detailed. The patients mailed back their questionnaire. RESULTS: A total of 124 patients from 12 to 19 years of age were included with a response rate of 82% (all anonymous); 23% of the patients thought that diet was a possible cause of IBD and 22% that one of the targets of their treatment was to cure their disease for good. Of the patients reported having Crohn disease, 46% knew the anoperineal location and 14% knew that Crohn disease can affect the entire digestive tract. Twenty-five percent of the patients were able to name one side effect of azathioprine (88% had already received this treatment), 24% were able to name one side effect of infliximab (54% had already received this treatment), 70% of the adolescents knew that smoking worsens Crohn disease, 68% declared they had learned about their IBD from their pediatrician, and 81% said they would like to receive more information. CONCLUSION: Adolescents with IBD have gaps in their general knowledge and the different treatments of their disease. Their main source of information is their pediatrician, warranting the implementation of customized patient education sessions.

[Congenital portosystemic shunts: experience of the western region of France over 5 years]. / Shunts porto-systémiques congénitaux : expérience du Grand-Ouest sur cinq ans.

INTRODUCTION: Congenital portosystemic shunts (CPS) are rare vascular malformations that lead to liver metabolic modifications. The aim of this study was to describe the management and outcome of CPS in children who were followed in the western region of France and to compare our experience to a literature review. PATIENTS AND METHODS: This retrospective study reports nine children with CPS who were followed in the western region of France between 2008 and 2013. RESULTS: Among these nine children, six were detected by prenatal ultrasonography, one had cholestatic jaundice during the postoperative period, one had cholestatic jaundice during the first days of life, and one had dyspnea and fatigue. Two children had liver tumors. The CPS was intrahepatic for four children and extrahepatic for two children. Three others had a patent ductus venosus. Among the intrahepatic shunts that were discovered before the age of 2 years, three closed spontaneously. The five other shunts were closed surgically or by interventional radiology techniques, after angiography for four children. After closure of eight shunts, the outcome was favorable for six children. Two children presented complications after surgery: portal hypertension and portal thrombus. CONCLUSION: When CPS is suspected, the diagnosis should be confirmed and complications should be investigated. Shunt closure restores portal flow and prevents complications.

Effect of a gluten-free diet on bone mineral density in children with celiac disease.

AIM: The aim of the study was to assess the evolution of bone mineral density (BMD) in children with celiac disease and to evaluate the effect of a gluten-free diet (GFD). METHODS: Altogether, 44 children (31 girls and 13 boys) were followed-up. BMD was measured by dual-energy X-ray absorptiometry of the lumbar spine (Hologic QDR 4500). Results are expressed as absolute values for BMD, and as Z scores for chronological age (BMD/CA) and bone age (BMD/BA). Patients were divided into two groups according to whether they followed a diet without (n=34) or with (n=10) gluten for at least 1 year. All patients were clinically free of symptoms at the end of the follow-up. RESULTS: At inclusion, 26 patients (59%) were delayed in bone age, 17 children (38%) had a BMD/CA< or =1 S.D. and six (13.6%) had a BMD/CA< or =2 S.D., whereas nine children (20%) had a BMD/BA< or =1 S.D. and three (6.8%) had a BMD/BA< or =2 S.D. During the follow-up, the BMD increase was greater in the GFD group, as determined by the BMD/CA/year (+0.05+/-0.3 vs -0.34+/-0.4 S.D.; P<0.01) and BMD/BA/year (-0.02+/-0.4 vs -0.4+/-0.6 S.D.; P<0.05). The gain in BMD/BA was smaller in the GFD group because of their need to catch up in bone maturation. CONCLUSION: Celiac children not following a GFD show delays in both bone maturation and mineralization. This prospective study confirms the importance of maintaining a GFD in children with celiac disease until the end of skeletal mineralization even in asymptomatic patients following a non-restricted diet.

[Breastfeeding and vegan diet]. / Allaitement maternel et végétalisme.

Vegan diet in lactating women can induce vitamin B12 deficiency for their children with risk of an impaired neurological development. A 9.5-month-old girl presented with impaired growth and severe hypotonia. She had a macrocytic anemia secondary to vitamin B12 deficiency. MRI showed cerebral atrophy. She was exclusively breastfed. Her mother was also vitamin B12 deficient, secondary to a vegan diet. She had a macrocytic anemia when discharged from the maternity. Vegan diet is a totally inadequate regimen for pregnant and lactating women, especially for their children. Prevention is based on screening, information and vitamin supplementation.

[Incidence of inflammatory bowel disease in children in Brittany (1994-1997). Breton association of study and research on digestive system diseases (Abermad)]. / Incidence des maladies inflammatoires du tube digestif chez l'enfant en Bretagne (1994-1997). Association bretonne d'étude et de recherche sur les maladies de l'appareil digestif (Abermad).

BACKGROUND: The aim of this work was to determine in Brittany the incidence and main clinical pattern of inflammatory bowel disease (IBD) occurring during childhood. These data are compared to the previous epidemiologic data available from the Northern France registry or around the world. METHODS: Private and public Brittany gastroenterologists (2,836,418 inhabitants including 618,049 children under 17 years of age) referred all patients consulting for inflammatory bowel disease from January 1994 to December 1997. An interviewer-practitioner completed at the gastroenterologist's office a standard questionnaire for each patient. Each case was independently reviewed by four experts in a blind manner and made a final diagnosis of Crohn's disease (CD), ulcerative colitis (UC), or ulcerative proctitis and acute colitis (onset of symptoms < 6 weeks) or unclassified chronic colitis. RESULTS: Among 1,309 cases recorded, 88 were under 17 years of age (6.7%): 43 (49%) had CD (including three possible cases), 14 (16%) had UC (including three proctitis), 24 (27%) acute colitis and 7 (8%) unclassified chronic colitis. The crude mean annual incidence (per 100,000 children) based on definite and probable cases only was 2.5 for IBD, 1.6 for CD and 0.57 for UC, without variation between 1994 and 1997. The male/female ratio was 2.3 for CD and 1.3 for UC. The mean time between onset of disease and diagnosis was equal to 7.2 and 8.6 months for CD and UC respectively (median: 3 and 5 months). A familial history of IBD was present in 5 cases (8%). In CD, the small and large bowel were involved in 58% of patients, whereas an isolated involvement of small or large bowel occurred in 15% and 23% of cases. Among the 14 UC, there were three proctitis and four pancolitis. Among 43 CD, a granuloma was present in 48% of cases. CONCLUSIONS: In Brittany the incidence of CD and UC in childhood was similar to the published data from Northern France. Clinical presentation and symptoms were not different. However, the rate of acute colitis was higher and the accurate incidence of IBD could be underestimated, requiring a follow-up to classify these cases.