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Diet therapy for inflammatory bowel diseases: The established and the new

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World Journal of gastroenterology 2016年第7期22卷 2179-2194页

作者： Franziska Durchschein Wolfgang Petritsch Heinz F Hammer Department of Internal Medicine Division of Gastroenterology and Hepatology Medical University of Graz

Although patients with inflammatory bowel diseases(IBD) have a strong interest in dietary modifications as part of their therapeutic management, dietary advice plays only a minor part in published guidelines. The scientific literature shows that dietary factors might influence the risk of developing IBD, that dysbiosis induced by nutrition contributes to the pathogenesis of IBD, and that diet may serve as a symptomatic treatment for irritable bowel syndrome-like symptoms in IBD. The role of nutrition in IBD is underscored by the effect of various dietary therapies. In paediatric patients with Crohn's disease(CD) enteral nutrition(EN) reaches remission rates similar to steroids. In adult patients, however, EN is inferior to corticosteroids. EN is not effective in ulcerative colitis(UC). Total parenteral nutrition in IBD is not superior to steroids or EN. The use of specific probiotics in patients with IBD can be recommended only in special clinical situations. There is no evidence for efficacy of probiotics in CD. By contrast, studies in UC have shown a beneficial effect in selected patients. For patients with pouchitis, antibiotic treatment followed by probiotics, like VSL#3 or Lactobacillus GG, is effective. When probiotics are used, the risk of bacterial translocation and subsequent bacteremia has to be considered. More understanding of the normal intestinal microflora, and better characterization of probiotic strains at the phenotypic and genomic levels is needed as well as clarification of the mechanisms of action in different clinical settings. A FODMAP reduced diet may improve symptoms in IBD.

关键词： enteral nutrition parenteral nutrition probiotics fermentable oligo-, di-, and monosaccharidesand polyols Crohn's disease ulcerative colitis

Crohn’s and colitis in children and adolescents

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World Journal of gastroenterology 2012年第41期18卷 5862-5869页

作者： Andrew S Day Oren Ledder Steven T Leach Daniel A Lemberg Department of gastroenterology Sydney Children's HospitalRandwickSydneyNSW 2031Australia School of Women's and Children's Health University of New South WalesSydneyNSW 2031Australia Department of paediatrics University of Otago ChristchurchChristchurch 8140New Zealand

Crohn＇s disease and ulcerative colitis can be grouped as the inflammatory bowel diseases （IBD）. These conditions have become increasingly common in recent years, including in children and young people. Although much is known about aspects of the pathogenesis of these diseases, the precise aetiology is not yet understood, and there remains no cure. Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life, including in infancy. Pain, diarrhoea and weight loss are typical symptoms of paediatric Crohn＇s disease whereas bloody diarrhoea is more typical of colitis in children. However, atypical symptoms may occur in both conditions： these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythma nodosum. Growth and nutrition are commonly compromised at diagnosis in both Crohn＇s disease and colitis. Consideration of possible IBD and completion of appropriate investigations are essential to ensure prompt diagnosis, the- reby avoiding the consequences of diagnostic delay. Patterns of disease including location and progression of IBD in childhood differ substantially from adult- onset disease. Various treatment options are available for children and adolescents with IBD. Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn＇s disease. Medical and surgical therapies need to considered within the context of a growing and developing child. The overall management of these chronic conditions in children should include multi-disciplinary expertise, with focus upon maintaining control of gut inflammation, optimising nutrition, growth and quality of life, whilst preventing disease or treatment-related complications.

关键词： Children Adolescents Crohn's disease Ulcerative colitis Inflammatory bowel diseases

Gastric transposition as a valid surgical option for esophageal replacement in pediatric patients:experience from three Italian medical centers

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gastroenterology Report 2017年第1期5卷 47-51,I0002页

作者： Rossella Angotti Francesco Molinaro Carmine Noviello Giovanni Cobellis Ascanio Martino Carmine Del Rossi Adrian Bianchi Mario Messina Division of Pediatric Surgery Department of MedicineSurgical and Neurological SciencesUniversity of SienaSienaItaly Pediatric Surgery Unit Academic Salesi Children HospitalMarche Polytechnic UniversityAnconaItaly Department of Pediatric Surgery University of ParmaParmaItaly Neonatal and paediatric Reconstructive Surgery Royal Manchester Children’s HospitalManchesterUK

Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic ingestion).The purpose of our work was to describe the experience of gastric transposition in three Italian ***:This is a retrospective *** data were extrapolated from a prospective *** included all patients who had undergone gastric transposition in the last 15 ***:In the 15-year period,eight infants and children(3 males and 5 females)underwent gastric transposition for esophageal *** patients had long-gap esophageal atresia,and two had caustic esophageal *** were no deaths in the *** patients had an early postoperative complication:two had a self-limited salivary fistula at three weeks,and one(a patient with jejunostomy)had a jejunal perforation treated *** late complication,anastomotic stricture,was recorded that required two endoscopic *** median follow-up was 60 months(range:18–144 months).At final clinical follow-up,six patients had no eating problems,and two patients had some difficulties with eating(jejunostomy in situ),but they underwent logopedic therapy with improved *** patients had an increase in body weight and height ***:Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results,both in terms of surgical technique(simplicity,reproducibility,complication rate)and clinical follow-up(good oral feeding of young patients,normal social life and regular growth curves).

关键词： gastric transposition children esophageal atresia caustic ingestion

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英国医学杂志中文版 2020年第11期23卷 639-641页

作者： Matthew Kurien David S Sanders James J Ashton R Mark Beattie 赵巍(译) Academic Unit of gastroenterology Departments of Infection and Immunity and Cardiovascular ScienceUniversity of Sheffield Medical SchoolSheffieldUK Department of gastroenterology Royal Hallamshire HospitalSheffield Department of paediatric gastroenterology Southampton Children's HospitalUK Department of Human Genetics and Genomic Medicine University of Southampton 中华医学会杂志社总编室

Matthew Kurien和David S Sanders说,"作者付费"出版模式是让所有人都能获得生物医学研究成果的唯一公平途径,但James J Ashton和R Mark Beattie担心,这会导致证据基础因商业驱动造成偏倚。

关键词：医学研究成果出版模式开放获取期刊证据基础

Flatography: Detection of gastrointestinal diseases by faecal gas analysis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 111-113页

作者： Evelien F de Groot Tim G de Meij Daniel J Berkhout Marc P van der Schee Nanne K de Boer Department of Gastro-enterology and Hepatology VU University Medical Centre Department of paediatric gastroenterology VU University Medical Centre

Patients presenting with gastro-intestinal symptoms might suffer from a range of possible underlying diseases. An unmet need exists for novel cost-effective,reproducible, easy-to-perform and non-invasive tests. Hippocrates used body odours to diagnose diseases circa 460 before Christ. The art of diagnostic smelling is making a promising high-tech come-back with portable "electronic diagnostic noses". Analysis of faecal volatile organic compounds is a novel field in metabolomics with considerable potential to improve the diagnosis, phenotyping and monitoring of gastro-intestinal disease. Challenges will be to mature over the coming years by development of a standardized methodology for stool sample collection, storage, handling and analysis. Furthermore, key volatiles need to be identified to improve test accuracy and sensitivity by development of sensors tailored toward the accurate identification of disease specific volatiles. If these challenges are adequately faced, analysis of faecal volatiles has realistic potential to considerably improve screening, diagnosis and disease monitoring for gastro-intestinal diseases.

关键词： Flatography Electronic nose Smell Volatile organic

paediatric cholestatic liver disease:Diagnosis,assessment of disease progression and mechanisms of fibrogenesis

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World Journal of Gastrointestinal Pathophysiology 2010年第2期1卷 69-84页

作者： Tamara N Pereira Meagan J Walsh Peter J Lewindon Grant A Ramm The Hepatic Fibrosis Group The Queensland Institute of Medical Research Department of gastroenterology Royal Children's Hospital

Cholestatic liver disease causes significant morbidity and mortality in *** diagnosis and management of these diseases can be complicated by an inability to detect early stages of fibrosis and a lack of adequate interventional *** is no single gold standard test that accurately reflects the presence of liver disease,or that can be used to monitor fibrosis progression,particularly in conditions such as cystic *** has lead to controversy over how suspected liver disease in children is detected and *** review discusses the challenges in using commonly available methods to diagnose hepatic fibrosis and monitor disease progression in children with cholestatic liver *** addition,the review examines the mechanisms hypothesised to be involved in the development of hepatic fibrogenesis in paediatric cholestatic liver injury which may ultimately aid in identifying new modalities to assist in both disease detection and therapeutic intervention.

关键词： Cystic fibrosis Biliary atresia Liver biopsy Ultrasound Hepatic fibrosis Cirrhosis Hepatic stellatecell Bile acid Chemotaxis Monocyte chemotaxis protein-1

欧洲儿科胃肠病学、肝病学和营养协会儿童及青少年炎症性肠病诊断的改良波尔图标准(2014年版)

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中华儿科杂志 2016年第10期54卷 728-732页

作者： Arie Levine Sibylle Koletzko Dan Turner Johanna C.Escher Salvatore Cucchiara Lissy de Ridder Kaija-Leena Kolho Gabor Veres Richard K.Russell Anders Paerregaard Stephan Buderus Mary-Louise C.Greer Jorge A.Dias Gigi Veereman-Wauters Paolo Lionetti Malgorzata Sladek Javier Martin de Carpi Annamaria Staiano Frank M.Ruemmele David C.Wilson 罗优优陈洁 Pediatric gastroenterology and Nutrition Unit Wolfson Medical CenterSackler School of MedicineTel-Aviv University the Dr von Hauner Children's Hospital Ludwig Maximilians University the Pediatric gastroenterology Unit Shaare Zedek Medical CenterThe Hebrew University of Jerusalem the Pediatric gastroenterology Department of PediatricsErasmus MC-Sophia Children's Hospital 5. the Pediatric Gastroenterology and Liver UnitSapienza University of Rome 6. the Children's HospitalUniversity of Helsinki 7. the Semmelweis University 8. the Department of Paediatric Gastroenterology and NutritionYorkhill Children's Hospital 9. the Department of PaediatricsHvidovre University Hospital 10. the St.Marien-HospitalDepartment of Pediatrics 11. the Department of Diagnostic ImagingThe Hospital for Sick Childrenthe Department of Medical ImagingUniversity of Toronto 12. the Hospital S.Joao 13. the-Pediatric Gastroenterology and Nutrition 14. the Departement NeurofarbaUniversity of FlorenceMeyer Children Hospital 15. the Department of PediatricsGastroenterology and NutritionJagiellonian University Medical College 16. the Department of Pediatric GastroenterologyHepatology and NutritionHospital Sant Joan de De'u 17. the Department of Translational Medical SciencesSection of PediatricsUniversit

炎症性肠病(IBD)包括克罗恩病(CD)、溃疡性结肠炎(UC)和未分型IBD(IBDU)。IBD的确切诊断需综合病史、体检、实验室检查、内镜以及影像学的检查,并严格排除肠道感染、过敏性疾病或原发性免疫缺陷病(PID)。近年对儿童期起病的IBD(PIBD)的... 详细信息

炎症性肠病(IBD)包括克罗恩病(CD)、溃疡性结肠炎(UC)和未分型IBD(IBDU)。IBD的确切诊断需综合病史、体检、实验室检查、内镜以及影像学的检查,并严格排除肠道感染、过敏性疾病或原发性免疫缺陷病(PID)。近年对儿童期起病的IBD(PIBD)的研究高度提示3种PIBD的亚型均存在不典型的表型。本标准对2005年波尔图标准进行改良,利用循证方法,整合最新证据,包括诊断方法、以巴黎分型为基础的PIBD亚型的定义以及诊断误区,为新一代的PIBD提供优质的个体化管理以及可靠的诊断、评估和预后。

关键词：体检实验室检查内镜

Impact of IL28B and OAS gene family polymorphisms on interferon treatment response in Caucasian children chronically infected with hepatitis B virus

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World Journal of gastroenterology 2016年第41期22卷 9186-9195页

作者： Krzysztof Domagalski Malgorzata Pawlowska Agnieszka Zalesna Malgorzata Pilarczyk Pawel Rajewski Waldemar Halota Andrzej Tretyn Centre for Modern Interdisciplinary Technologies Nicolaus Copernicus University 87-100 Toruń Poland Department of paediatric Infectious Diseases and Hepatology Faculty of Medicine Collegium Medicum Bydgoszcz Nicolaus Copernicus University Torun 85-030 Bydgoszecz Poland Provincial Infectious Diseases Hospital in Bydgoszcz 85-030 Bydgoszecz Poland Department of Plant Physiology and Biotechnology Nicolaus Copernicus University 87-100 Toruń Poland

AIM To investigate the impact of IL28 B and OAS gene polymorphisms on interferon treatment responses in children with chronic hepatitis *** We enrolled 52 children(between the ages of 4 and 18) with hepatitis B e antigen-negative chronic hepatitis B(CHB), who were treated with pegylated interferon alfa for 48 wk. Single nucleotide polymorphisms in the OAS1(rs1131476), OAS2(rs1293747),OAS3(rs2072136), OASL(rs10849829) and IL28B(rs12979860, rs12980275 and rs8099917) genes were studied to examine their associations with responses to IFN treatment in paediatric patients. We adopted two criteria for the therapeutic response, achieving an hepatitis B virus(HBV) DNA level < 2000 IU/m L and normalization of ALT activity(< 40 IU/L). To perform the analyses, we compared the patients in terms of achieving a partial response(PR) and a complete response(CR) upon measurement at the 24-wk posttreatment follow-up. RESULTS The PR and CR rates were 80.8% and 42.3%, respectively. Factors such as age, gender and liver histology had no impact on the type of response(partial or complete). A statistically significant relationship between higher baseline HBV DNA and ALT activity levels and lower rates of PR and CR was shown(P < 0.05). The allele association analysis revealed that only the IL-28 B rs12979860(C vs T) and IL28 B rs12980275(A vs G) markers significantly affected the achievement of PR(P = 0.021, OR = 3.3, 95%CI: 1.2-9.2 and P = 0.014, OR = 3.7, 95%CI: 1.3-10.1, respectively). However, in the genotype analysis, only IL-28 B rs12980275 was significantly associated with PR(AA vs AG-GG, P = 0.014, OR = 10.9, 95%CI: 1.3-93.9). The association analysis for CR showed that the TT genotype of IL28 B rs12979860 was present only in the no-CR group(P = 0.033) and the AA genotype of OASL rs10849829 was significantly more frequent in the noCR group(P = 0.044, OR = 0.26, 95%CI: 0.07-0.88). The haplotype analysis revealed significant associations between PR and CR and OAS haplotype(P = 0

关键词： Chronic hepatitis B IL28B OAS Singlenucleotide polymorphisms IFN therapy Children

Transition care in inflammatory bowel disease: A needs assessment survey of Quebec gastroenterologists and allied nurses

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第3期8卷 186-192页

作者： Matthew Strohl Xun Zhang Dominique Lévesque Talat Bessissow Department of Internal Medicine McGill University Health Center Research Institute McGill University Health Centre Department of Pediatric gastroenterology McGill University Health Center Department of gastroenterology Montreal General Hospital C7-200 McGill University Health Center

To determine the tools needed and problems encountered during the transition of inflammatory bowel disease (IBD) patients from pediatric to adult gastroenterologists (GIs) in Québec, Canada. METHODSWe conducted a needs assessment survey of Quebec health care professionals (HCPs). The survey was handed out to 136 Québec HCPs at a local conference in 2013. Additionally, it was emailed to any other HCPs in Quebec involved in caring for IBD patients. The completed surveys were compiled to derive descriptive data. Further specific subgroup analysis was then conducted. RESULTSAmong the conference attendees and individuals emailed 77 (28.2%) completed the questionnaire. Respondents included adult GIs (61.3%), pediatric GIs (20.8%) and IBD nurses (18.3%). The majority of respondents believed that a standardized structure is important for a successful transition. Adult and pediatric GIs equally felt that patients were inadequately prepared for the transition (P = 0.6). There were significant differences between adult and pediatric GIs when it came to resource availability (55.6% vs 90.9%, P = 0.002) and perceived need of a formal transition clinic (21.7% vs 68.8%, P = 0.0006). Both transition program and medical summaries were identified as the most valuable tools to improve transition. CONCLUSIONAs described in previous studies, our survey reinforces the importance of a transition program, education for young adult IBD patients and the need to improve communication between adult and pediatric GIs.

关键词： Inflammatory bowel disease Transition paediatric Canada Tools Health care professionals