Exclusive Enteral Nutrition Remission Induction Treatment Influence on Transient Hypertransaminasemia in Children with Newly Onset Crohn's Disease.

Pediatric Crohn's disease (CD) is commonly associated with hepatobiliary complications, including transient liver enzymes elevation (LEE). Exclusive enteral nutrition (EEN) is recommended as primary treatment in mild-to-moderate pediatric CD. Data concerning EEN and liver enzymes (LE) abnormalities are limited. The aim of this study was to assess the LEE occurrence in newly diagnosed CD pediatric patients during EEN. Retrospective analysis of 73 patients, with no previous signs of liver disease, qualified to EEN. LE were assessed at diagnosis, during EEN, after completion of the nutritional treatment, and reintroduction of free diet. Thirty-one (42%) children presented with LEE and 28 (38%) with transient LEE. The LEE cohort presented with higher percentage of protein energy (24.0% ± 29.4 IQR [interquartile range] vs. 18.6% ± 23.6 IQR, P < .05) versus nonprotein energy (fat and carbohydrates) in total energy intake (75.9% ± 29.4 IQR vs. 81.4% ± 23.6 IQR, P < .05). Also, the protein/energy ratio was higher in the LEE group compared with the group with normal LE (0.026 vs. 0.024, P = .028). At the fourth week of EEN, aspartate aminotransferase elevation correlated with higher daily protein intake (P < .018). The LEE during EEN is typically a low-grade and transient condition that may be connected to applied treatment. We hypothesize that higher protein/energy ratio during EEN may be associated with mild, temporary LEE. Careful observation with repeated measurement of LE activity may be sufficient proceeding in patients without any other symptoms of CD-associated liver disease.

Evaluation of the infliximab therapy of severe form of pediatric Crohn's disease in Poland: Retrospective, multicenter studies.

BACKGROUND: Registration of infliximab in Poland has increased chances to induce clinical remission and mucosal healing in the severe form of pediatric Crohn's disease. OBJECTIVES: The aim of this retrospective study was to assess the results and safety of infliximab therapy in the severe form of pediatric Crohn's disease. MATERIAL AND METHODS: The study included 153 children with severe form of non-fistulizing Crohn's disease treated with infliximab. The clinical activity of Crohn's disease was assessed according to PCDAI scale, endoscopic scoring was graded according to SES-CD, body mass was measured with body mass index (BMI). Infliximab was administered at the dose 5 mg/kg body mass in the 0.2 and 6th week, and then, after clinical response, every 8 for the period of 12 months. RESULTS: One hundred thirty-six children (88.89%) achieved clinical response after induction therapy and 75.21% of children after the maintenance therapy. 39.68% of children achieved remission as graded with endoscopic scoring SES-CD. There was a statistically significant increase in body weight following the treatment. Side effects such as anaphylaxis, rash, and the activation of EBV infection appeared in 9 children at the time of infliximab injection. In other children the drug was well tolerated. CONCLUSIONS: Induction and maintenance therapy with infliximab resulted in clinical remission of Crohn's disease in 75.21% of children, and in the intestinal mucosa healing in 39.68% of children.

[Metabolic bone disease in children with chronic gastrointestinal tract condition]. / Choroba metaboliczna kosci w przebiegu przewleklych chorób przewodu pokarmowego u dzieci.

In this review issues concerning bone metabolism are presented. The diagnostic criteria of decreased mineral bone density is discussed with the significance of densitometry. The necessity of presence of low-trauma fracture to diagnosed the osteoporosis in children is signified. The paper reviews most common chronic gastrointestinal tract condition associated with the altered bone metabolism. The diagnostic and early treatment of decreased mineral bone density in children, who are before obtaining peak bone mass is crucial to prevent the risk of osteoporosis in adulthood.

Induction and Maintenance Infliximab Therapy for the Treatment of Crohn's Disease with Perianal Fistulas in Children: Retrospective, Multicenter Study.

BACKGROUND: Infliximab is a biological drug used for the treatment of Crohn's disease in children. OBJECTIVES: The aim of this retrospective study was the estimation of effectiveness and safety of infliximab in the treatment of Crohn's disease with perianal fistulas in children. MATERIAL AND METHODS: Analysis comprised 50 children with Crohn's disease with perianal fistulas aged 9 to 18 years (16 girls and 34 boys) who failed to respond to conventional therapy. The children were divided into two groups: the first group contained 23 children with simple fistulas and the second - 27 children with complex fistulas. All children were treated with infliximab, administered in the dose of 5 mg per kilogram of the body mass. In the induction phase infliximab was administered at weeks 0, 2 and 6 and after clinical response in maintenance phase the drug was administered every 8 weeks; together for 12 months. RESULTS: In 76% of children after induction therapy with infliximab and in 71.87% after maintenance therapy the complete closure of fistula occurred. During the first year after the treatment a recurrence of a fistula was observed in 30.43% of the children. In two children anaphylactic shock was observed during injection of infliximab. The remaining children tolerated the drug well. CONCLUSIONS: The treatment with infliximab was effective in the majority of fistulazing Crohn's disease and caused the closure of perianal fistula which improved quality of life.

Serum anti-glycan antibodies in paediatric-onset Crohn's disease: association with disease phenotype and diagnostic accuracy.

INTRODUCTION: Antibodies reacting with various microbial epitopes have been described in inflammatory bowel disease (IBD) and are associated with a specific diagnosis and clinical presentation. AIM: To evaluate the profile of new anti-glycan antibodies, their potential association with disease phenotype and diagnostic accuracy in paediatric Crohn's disease (CD). MATERIAL AND METHODS: Blood samples from 134 paediatric IBD patients (109 CD, 25 ulcerative colitis (UC)) and 67 controls were blindly analysed for anti-Saccharomyces cerevisiae (ASCA), anti-chitobioside carbohydrate (ACCA), anti-laminaribioside carbohydrate (ALCA), and anti-mannobioside carbohydrate (AMCA) antibodies using commercially available assays. The serological response to glycans was correlated with clinical disease characteristics. RESULTS: At least one of the tested anti-glycan antibodies was present in 75% of CD patients. Despite the high frequency of reactivity to glycan epitopes, a limited overlap of serological markers was observed. In total, 49% of ASCA-negative patients presented with one of the following: ACCA, ALCA, or AMCA. The occurrence of one antibody from the anti-glycan panel was independently associated with complicated disease phenotype and ileocolonic disease location. A higher level of immune response as assessed by the quartile sum scores for ACCA, ALCA, and AMCA was linked with older age at diagnosis (10-17 years) and ileocolonic disease location. The ASCA had the greatest accuracy for diagnosis and differentiation of CD. CONCLUSIONS: Qualitative and quantitative serologicalal response to glycan epitopes was associated with distinct clinical presentation in paediatric CD patients. This raises the possibility for the use of these markers to differentiate subgroups of CD patients with more sever clinical presentation. The ASCA was the most accurate serological marker for CD; however, testing for the new anti-glycan antibodies may constitute an adjunctive tool in a specific group of patients to aid in the differentiation of CD with absent ASCA from ulcerative colitis.

[Retrospective analysis of epidemiological and clinical aspects of acute pancreatitis in children]. / Retrospektywna analiza epidemiologiczna i kliniczna ostrego zapalenia trzustki u dzieci.

UNLABELLED: Acute pancreatitis (AP) is becoming more frequent cause of hospitalization in children. There are no guidelines concerning optimal medical treatment in this condition, up to know. The aim of the study was the epidemiological and clinical assessment of AP in pediatric population. The evaluation of influence of administered pharmacotherapy on symptoms remission and the time of laboratory tests normalization. MATERIAL AND METHODS: There were 54 patients with AP, in the age of 3, 5-18 years, admitted to our hospital between 1994-2011. The investigation was led on the basis of retrospective analysis of medical data. RESULTS: 41 (75%) patients were admitted with the first episode of AP. The oedematous pancreatitis was confirmed in 49 patients (91%) and necrotizing pancreatitis in 5 cases (9%). The cause of the condition was determined in 44 cases. The most common clinical symptoms were epigastric pain (94%) and vomiting (43%). CONCLUSIONS: There was no statistically significant difference in the time of obtaining normal range of serum and urine amylase activity and relief of symptoms according to administered pharmacotherapy and nutritional therapy

Kimura's Disease in a Caucasian Female: A Very Rare Cause of Lymphadenopathy.

Introduction. Kimura's disease is a rare chronic inflammatory disorder characterized by the head and neck lymphadenopathy often accompanied by eosinophilia and elevated serum IgE. It is benign condition with unknown etiology usually affecting young men of Asian race. Affected Caucasians are very rare. Case Presentation. We report a clinically and histopathologically typical case of this disease in a 40-year-old Caucasian female. In differential diagnosis particular attention has been paid to angiolymphoid hyperplasia with eosinophilia and neoplasms. Conclusion. The diagnosis of Kimura's disease can be very difficult and misleading; it is important not to ignore histopathological features. The presented patient has been under follow-up with no more symptoms of the disease for the last 1.5 years.

[Biological treatment of inflammatory bowel diseases in children in the years 2004-2013 in Poland]. / Leczenie biologiczne nieswoistych zapalen jelit u dzieci w latach 2004-2013 w Polsce.

UNLABELLED: In the last years an increase in Crohn's disease morbidity in children is observed together with constant morbidity of ulcerative colitis. The course of these diseases is severe, younger children are affected and the diseases are resistant to conventional treatment. Biological drugs are a chance for a longer remission and healing of the intestinal mucosa. OBJECTIVE OF THE WORK: Assessment of the use of biological drugs in treatment of inflammatory bowel disease in Poland was the objective of the work. MATERIAL AND METHODS: Gastroenterological centers treating inflammatory bowel disease during the years 2004-2013 were invited to a questionnaire retrospective study. RESULTS: The questionnaires of biological treatment of Crohn's disease and ulcerative colitis in children were received from 12 centers. In the years 2004-2013 the number of children aged 4 months to 18 years with Crohn's disease treated with biological drugs was 424. In the years 2004-2008--69 children were treated with infliximab and in the years 2009-2013--299 children, which was a four-fold increase. 56 children were treated with adalimumab in the years 2008-2013. In the years 2005-2013--72 children with ulcerative colitis were treated with infliximab and 11 with adalimumab. The age of the children ranged from 2 years to 18 years. The higher number of children treated was in the years 2009-2013: 59 with infliximab and 10 with adalimumab. CONCLUSIONS: In the last decade a significant increase on the number of children with Crohn's disease and ulcerative colitis treated with biological drugs was observed. It is connected not only to greater morbidity but above all to the introduction of a treatment program by the National Health Insurance Fund for children with Crohn's disease. There is an expectation that the introduction of biological treatment in inflammatory bowel disease will prolong clinical and endoscopic remission and diminish the number of surgeries.