C. M. F. Kneepkens

The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited

Aliment Pharmacol Ther 2011; 33: 243–250

Discontinuation of tube feeding in young children by hunger provocation.

Objectives: Pathological food refusal (PFR) is not rare in young children with chronic conditions requiring prolonged tube feeding. We investigated whether these children could be weaned from tube feeding with a multidisciplinary hunger provocation program. Patients and Methods: The study included children younger than 2 years with PFR who had been dependent on tube feeding for at least 3 months. They followed a multidisciplinary in-hospital program. During step 1, only 50% of the normal allowance was given by tube. During step 2, oral feeding was offered and completed up to 50% with tube feeding afterwards. During step 3, supplementary tube feeding was given at night. During step 4, only insensible loss (400 mL/m2), was replaced. When the child had started eating, parents took over feeding (step 5). Primary endpoints were eating without tube feeding while gaining weight at 3 and 6 months after discharge. Results: Ten children (age 9–21 months; 7 girls) were exclusively tube fed for 7 to 19 months. Hospital stay lasted 9 to 33 days (mean 17.3 days). All children but 1 remained in clinically stable condition and started to eat within 1 week. Weight loss was 3.7% to 15.6% (mean 9.2%); in 1 child, the program was discontinued because of excessive weight loss. At follow-up after 3 and 6 months, 9 of 10 and 8 of 10 children, respectively, were eating adequately and gaining weight without tube feeding. Two children with recurrent infections resumed partial (25%–50%) tube feeding during follow-up. Conclusions: The multidisciplinary hunger provocation program seems to be a promising method to promote discontinuation of tube feeding in young children.

Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease.

Inflammatory bowel disease (IBD) affects a substantial number of female patients in their reproductive years. Therefore, many physicians face the dilemma whether thiopurines, prescribed to maintain remission, can be taken safely during pregnancy. Data on long‐term development outcome of children exposed to maternal thiopurine therapy are very limited.

Composition and diversity of the duodenal mucosa-associated microbiome in children with untreated coeliac disease

Abstract Background. Intestinal microbiome may play a role in the pathogenesis of coeliac disease (CD). Studies comparing intestinal microbiome in children with and without CD are contradictory. Aim. To compare the composition and diversity of the duodenal mucosa-associated microbiome in children with untreated CD and control children without CD and to identify specific gut bacteria associated with CD at diagnosis. Methods. Total microbiome profile in small bowel biopsies of 42 children (21 with untreated CD and 21 age-matched controls) were analyzed by means of IS-pro, a 16S-23S interspacer (IS) region-based profiling method. Results. Both groups showed a similar mucosa-associated microbiome pattern and diversity, with high concentrations of the genera Streptococcus, Lactobacillus, and Clostridium. Conclusion. Mucosa-associated duodenal microbiome composition and diversity did not differ between children with untreated CD and control children. Duodenal mucosa-associated bacteria do not seem to play an important role in the pathogenesis of CD.

Voeding bij kinderen met maag-darmaandoeningen

In dit hoofdstuk wordt ingegaan op prevalentie, pathofysiologie, klinische verschijnselen en behandeling van een aantal aandoeningen van slokdarm, maag en darmen bij kinderen. Gekozen is voor min of meer frequent voorkomende aandoeningen die elders in deze uitgave niet of onvoldoende aan bod komen, ofwel omdat ze specifiek bij kinderen voorkomen, ofwel omdat de pediatrische aspecten speciale aandacht vragen. Aandoeningen die al voldoende aan bod komen in andere hoofdstukken, zoals coeliakie, worden niet opnieuw besproken. Bij de behandeling wordt kort ingegaan op de medische aspecten ervan, gevolgd door een uitgebreidere bespreking van de dieetbehandeling.

Su1268 Microbiota Profiling in Children With Functional Constipation

BACKGROUND: The prevalence of functional gastrointestinal disorders (FGIDs) in infants and toddlers by Rome III criteria is unknown. The purpose of the current study was to determine the U.S. prevalence of gastrointestinal symptoms suggestive of an infant/toddler FGID as reported by mothers in a representative community sample. METHODS: A national community sample provided by the market research company Cint USA, Inc. consisted of 1,447 mothers of children age 0-18 from all 50 US states who completed an internet survey including Rome III symptom questions, demographics, health history and the pediatric quality of life questionnaire. Of these, 320 provided information about children 0-3 years old and 264 (82.5%) were judged valid (consistent survey answers and no diagnosed disease explaining the GI symptoms). Stratified sampling was used to ensure equal gender proportions, child age distribution and adequate representation of Hispanic and African American children. To avoid biasing the sample, invitations to participate described the study as a general health survey rather than a survey of gastrointestinal symptoms. RESULTS: The children in the sample were 47.7% female, 26.7% Hispanic, 56.8% Caucasian, 12% African American, and 6% Asian; 99.2% lived full time with their mothers. Children were approximately equally divided by age (32%

Voeding bij kinderen met leveraandoeningen: Augustus 2018

100,000 (9%). Twenty seven percent of infants/toddlers qualified for at least one FGID by Rome III criteria. All seven infant/toddler FGIDs occurred, with infant regurgitation as the most common disorder (see Table). No race and gender differences were found. Compared to those who did not meet Rome criteria, toddlers with FGID had lower quality of life (M=80.1 vs M=90.3, p<.001). There was a trend for children to qualify for a FGID if their mother also qualified for an FGID (p = .08). A child was also more likely to have hard stools if the parent reported hard stools (p= 0.02) but no such association was found for loose stools. CONCLUSION: This first national survey in the U.S. on infant and toddler FGIDS shows that these disorders are common, can be identified in the general population and reduce quality of life. No gender and race differences were found. More research is needed into these conditions as it may improve the lives of a significant number of young children [Research supported by the Rome foundation]. Percentages of infants/toddlers meeting Rome III criteria by mothers report