RESUMO
OBJECTIVES: The primary aim of this study was to determine the proportion of pediatric Crohn disease (CD) subjects in sustained drug-free remission 52 weeks after stopping pharmacological therapy. We also aimed to explore the effects of the Crohn Disease Exclusion Diet (CDED) and microbiome composition on remission. METHODS: We performed a prospective study following 18 CD patients ages 13-21 years in deep clinical remission withdrawing from immunomodulator (n = 7) or anti-TNFα (n = 11) monotherapy at two tertiary care centers. Stool for calprotectin and microbiome analyses was collected over 52 weeks. Participants followed either the CDED or free diet after drug withdrawal. The primary endpoint was sustained relapse-free drug-free remission (calprotectin <250 µg/g) at 52 weeks. RESULTS: Seventeen participants were followed through 52 weeks with 11 (64.7%) in sustained remission. There was no improvement in remission among participants following the CDED (5/9; 55.6%), P = 0.63. By 104 weeks, only 8 (47.1 %) participants remained off immunosuppressive therapies. Analysis of shotgun metagenomic sequence data revealed that taxonomic and gene function abundance in the gut microbiome was relatively stable for participants in remission and relapse. However, a predictive model incorporating gut microbial gene pathway abundance for amino sugar/nucleotide sugar metabolism and galactose metabolism from baseline samples predicted relapse at 52 weeks with 80% accuracy. CONCLUSIONS: After withdrawal of immunomodulator or anti-TNFα monotherapy among a small cohort of pediatric CD subjects in deep remission, nearly 65% sustained remission at 52 weeks. Baseline microbiome alterations predicted relapse. Large prospective studies are needed to better understand outcomes after treatment de-escalation.
Assuntos
Doença de Crohn , Adolescente , Humanos , Adulto Jovem , Doença de Crohn/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Complexo Antígeno L1 Leucocitário , Estudos Prospectivos , Recidiva , Indução de RemissãoRESUMO
OBJECTIVES: To evaluate the integrity of the hypothalamic-pituitary-adrenal axis in active Crohn's disease (CD) among children and adolescents. STUDY DESIGN: We retrieved data on patients with CD who participated in a prospective study where budesonide treatment was evaluated. Basal and adrenocorticotropic hormone and corticotropin-stimulated cortisol levels in 52 children and adolescents with CD were compared with levels obtained in 52 age-matched control subjects. Correlations of cortisol levels with pediatric CD activity index and C-reactive protein (CRP) as an inflammatory marker were also assessed. RESULTS: Both basal and stimulated cortisol levels in CD were significantly higher than in control subjects: 364 +/- 173 versus 290 +/- 122 nmol/L (P = .029) and 865 +/- 236 versus 738 +/- 148 nmol/L (P < or = .001), respectively. Cortisol levels were correlated with CRP but not with pediatric CD activity index. Unlike in the control group, stimulated cortisol levels in patients with CD were not correlated with basal levels but rather with CRP (positive correlation) and age at diagnosis (negative correlation). CONCLUSIONS: Contrary to previous reports suggesting that dysregulation of the hypothalamic-pituitary-adrenal axis is implicated in the susceptibility to and severity of CD and other chronic inflammatory diseases, we demonstrated an adequate response of this axis in pediatric CD, in proportion to the inflammation severity.
Assuntos
Doença de Crohn/sangue , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo , Adolescente , Testes de Função do Córtex Suprarrenal , Estudos de Casos e Controles , Criança , Suscetibilidade a Doenças , Feminino , Humanos , Inflamação/sangue , Masculino , Índice de Gravidade de Doença , Adulto JovemRESUMO
We describe an association between congenital patent ductus venosus and hyper immunoglobulin E syndrome in a pair of siblings. The possibility that this is a separate entity or a genetically linked association is discussed.
Assuntos
Anormalidades Múltiplas/diagnóstico , Síndrome de Job/diagnóstico , Sistema Porta/anormalidades , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Síndrome de Job/complicações , Masculino , Veia Porta/anormalidades , Doenças Raras , Irmãos , Veia Cava Inferior/anormalidadesRESUMO
We prospectively evaluated a (13)C urea breath test (UBT) that involves passive continuous sampling for diagnosis of Helicobacter pylori in 72 children. Results were obtained within 10 minutes in 96% of patients. The test is rapid, user-friendly, and has 100% concordance with conventional diagnostic methods.
Assuntos
Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Ureia , Testes Respiratórios , Criança , Feminino , Gastroscopia , Humanos , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVES: Oral budesonide has been found to be efficacious for mild to moderate Crohn's disease in adults, with equal improvement rates for budesonide and prednisone. We report the results of a retrospective study of budesonide treatment in mild to moderate Crohn's disease in children. STUDY DESIGN: Charts of patients treated with budesonide (n = 62) with a pediatric Crohn's Disease Activity Index of 12.5 to 40 were compared with a cohort of 58 age-matched patients treated with prednisone. RESULTS: Among children treated with budesonide, 48% had remission compared with 77% of the children treated with prednisone (P =.001). Among patients who had failed previous medical therapy with mesalamine, 59% had remission with budesonide (9 mg/day). Remission with prednisone occurred in 73% of children who failed to achieve remission with budesonide. Patients responding to budesonide had significantly milder disease compared with nonresponders who had remission while taking prednisone. CONCLUSIONS: Budesonide is useful in mild to moderate Crohn's disease in children. It is more effective than mesalamine and antibiotics but less effective than prednisone. Budesonide should be considered for first-line therapy in mild to moderate Crohn's disease.