Outcome following aminosalicylate therapy in children newly diagnosed as having ulcerative colitis.

OBJECTIVES: Despite a paucity of published supporting data, 5-aminosalicylate (5-ASA) use in pediatric ulcerative colitis (UC) is common. The present study describes the use and outcome of a large multicenter inception cohort of children with UC treated with 5-ASA. METHODS: Data were obtained from the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry, a prospective North American observational study of children newly diagnosed as having inflammatory bowel disease ages 16 years or younger. Patient data are recorded at diagnosis, 30 days, and then quarterly. Patients are managed by physician dictate, not protocol. Disease activity is classified by physician global assessment. The primary outcome examined was corticosteroid (CS) free, inactive UC at 1 year following initiation of 5-ASA within 30 days of diagnosis (with or without concomitant CS use) without the need for rescue therapy (immunomodulators, biologics, or colectomy). RESULTS: Study subjects included 213 patients newly diagnosed as having UC who received oral 5-ASA compounds (115 of whom also received CS) during the first 30 days after diagnosis, and no other oral therapies for the treatment of UC. Of these 213 patients, 86 (40%) were CS free and physician global assessment inactive at 1 year without rescue. Outcome was not associated with disease severity at diagnosis, demographic or laboratory factors examined, or initial dose of 5-ASA used. CONCLUSIONS: Forty percent of children taking 5-ASA as primary maintenance therapy at diagnosis are in CS-free remission after 1 year of treatment. Further pediatric studies will be needed to address whether increased adherence and/or higher dosing schedules will improve outcomes.

Hemorrhagic tonsillitis in an infant: A case report.

This case report describes a case of severe hemorrhagic tonsillitis in a nine month-old child who suffered significant amount of blood loss and was emergently taken to operating room for control of hemorrhage. The child was brought to emergency room by mom after noticing blood around child's mouth and nose and a subsequent episode of hematemesis having awoken from sleep. Initial impression was bleeding secondary to epistaxis however a thorough bedside otolaryngology exam including flexible rhinolaryngoscopy ruled this out. Rapid pooling of blood in oropharynx, continued hemorrhage with significant blood loss and recent history of hematemesis prompted emergent intervention in operating room for endoscopy for control of hemorrhage including esophagogastroduodenoscopy (EGD). Bleeding was identified from a blood vessel at left lower tonsil pole. Although there is a description in literature of such cases, these are uncommon in the pediatric population and none has been described in a patient this young requiring emergent operative intervention. This case report discusses the diagnostic and decision making dilemma in an infant in setting of ongoing active hemorrhage and the role of multidisciplinary team management.

Difficult-to-treat-pediatric Crohn's disease: focus on adalimumab.

Adalimumab is a fully humanized anti-tumor necrosis factor alpha monoclonal antibody that was recently granted regulatory approval in the USA for the treatment of moderate to severe Crohn's disease (CD) in children. Like infliximab, the first biologic agent used to treat pediatric CD, regulatory approval was secured many years following approval for adults. The long delay between adult and pediatric approval has led to many years of off-label use of adalimumab, although it is anticipated that the use of adalimumab may further increase with official regulatory approval. To date, pediatric literature on the use of adalimumab for treatment of CD is limited, and pediatric practitioners have mostly extrapolated from research and experience provided by the adult literature. The aim of this paper is to review the literature regarding adalimumab for the treatment of pediatric CD, and includes a review of landmark adult studies as well as the pivotal pediatric study that facilitated regulatory approval. We also discuss the role of anti-tumor necrosis factor alpha agents including adalimumab in the current treatment paradigm for pediatric CD.

Transition of management in adolescents with IBD.

Transfer of care is when a patient and his or her medical records move from one provider to another at a distinct point in time. By contrast, transition of care is a gradual process of change in knowledge, attitudes and behaviour through which the adolescent can learn to assume personal responsibility for his or her health care. IBD is a prevalent disorder, often diagnosed during childhood. Because mortality of this condition is fortunately low, children diagnosed with IBD will, at some point, transition from a paediatric to adult health-care model. Paediatric and adult health-care paradigms, including IBD-specific care, are different in a number of key areas and it is becoming increasingly apparent that young adults with chronic illness often face challenging transitions, resulting in compromised physical and emotional health outcomes. In the past decade, refining the processes related to transition of care for adolescents with chronic medical conditions has gained traction as an important public health initiative. The aim of this paper is to review concepts pertinent to transition of management for adolescents and young adults with IBD, and to review the current literature and evidence supporting transitional care in paediatric IBD.