H. Szajewska

Randomized Feeding Intervention in Infants at High Risk for Celiac Disease

BACKGROUND A window of opportunity has been suggested for reducing the risk of celiac disease by introducing gluten to infants at 4 to 6 months of age. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled dietary-intervention study involving 944 children who were positive for HLA-DQ2 or HLA-DQ8 and had at least one first-degree relative with celiac disease. From 16 to 24 weeks of age, 475 participants received 100 mg of immunologically active gluten daily, and 469 received placebo. Anti-transglutaminase type 2 and antigliadin antibodies were periodically measured. The primary outcome was the frequency of biopsy-confirmed celiac disease at 3 years of age. RESULTS Celiac disease was confirmed by means of biopsies in 77 children. To avoid underestimation of the frequency of celiac disease, 3 additional children who received a diagnosis of celiac disease according to the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria (without having undergone biopsies) were included in the analyses (80 children; median age, 2.8 years; 59% were girls). The cumulative incidence of celiac disease among patients 3 years of age was 5.2% (95% confidence interval [CI], 3.6 to 6.8), with similar rates in the gluten group and the placebo group (5.9% [95% CI, 3.7 to 8.1] and 4.5% [95% CI, 2.5 to 6.5], respectively; hazard ratio in the gluten group, 1.23; 95% CI, 0.79 to 1.91). Rates of elevated levels of anti-transglutaminase type 2 and antigliadin antibodies were also similar in the two study groups (7.0% [95% CI, 4.7 to 9.4] in the gluten group and 5.7% [95% CI, 3.5 to 7.9] in the placebo group; hazard ratio, 1.14; 95% CI, 0.76 to 1.73). Breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, did not significantly influence the development of celiac disease or the effect of the intervention. CONCLUSIONS As compared with placebo, the introduction of small quantities of gluten at 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years of age in this group of high-risk children. (Funded by the European Commission and others; PreventCD Current Controlled Trials number, ISRCTN74582487.).

A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL OF LACTOBACILLUS GG FOR ABDOMINAL PAIN DISORDERS IN CHILDREN

Functional abdominal pain disorders (FAPD) are common in school‐aged children; however, there is no reliable treatment.

Meta-analysis: enteral nutrition in active Crohn’s disease in children

Controversy exists surrounding the optimal treatment for inducing remission in active Crohn’s disease.

Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood.

Background  A lack of reliable treatments for abdominal pain‐related functional gastrointestinal disorders prompts interest in new therapies.

Meta-analysis: the effects of Lactobacillus rhamnosus GG supplementation for the prevention of healthcare-associated diarrhoea in children.

Aliment Pharmacol Ther 2011; 34: 1079–1087

Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children – updated analysis of randomised controlled trials

The efficacy of each probiotic should be evaluated separately. Previously, we have shown that Lactobacillus GG (LGG) is effective in treating acute gastroenteritis (AGE) in children.

Systematic review: early infant feeding and the prevention of coeliac disease

PREVENTCD, Prevent Coeliac Disease, is an international project investigating the hypothesis of possible induction of tolerance to gluten in genetically predisposed children through introducing small quantities of gluten during the period of breastfeeding.

Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults.

The effects of probiotics are strain specific. The clinical effects of each strain need to be evaluated separately.

Saccharomyces boulardii for treating acute gastroenteritis in children: updated meta-analysis of randomized controlled trials

SIRS, Previously, we have shown in a meta-analysis that Saccharomyces boulardii, a nonpathogenic probiotic yeast, is effective in treating acute gastroenteritis (AGE) in children. A number of studies have been published since this meta-analysis, some with negative results, prompting interest in re-evaluating the role of S. boulardii in the management of AGE. This letter summarizes the updated results from trials of S. boulardii performed in children with AGE. The methods used in this meta-analysis are discussed in full detail in the original version of this review. In brief, the MEDLINE, EMBASE and the Cochrane Library databases, as well as major paediatric conference proceedings were searched from August 2006 (end date of last search) to August 2009. The pharmaceutical company, Biocodex (France) that manufactures S. boulardii was contacted to help identify published and unpublished data. The updated meta-analysis included nine randomized controlled trials (RCTs) involving 1117 participants compared with five RCTs (619 participants) included in the original analysis. Overall, five studies were placebocontrolled. In the remaining trials, there was no additional intervention in the control group. The ages of the participants varied from 2 months to 12 years. The daily dose of the study product ranged from 250–750 mg. The duration of the intervention ranged from 5–7 days. The methodological quality of the trials varied. Tables with the updated characteristics of included and excluded trials are available upon request. A meta-analysis of seven RCTs 7, 9, 10 (944 participants) showed a reduction in the duration of the diarrhoea (weighted mean difference )1.08 day, 95% CI )1.64 to )0.53, random effects model) in those treated with S. boulardii compared with placebo (Figure 1). In conclusion, this update of our meta-analysis of data from RCTs confirms that in otherwise healthy infants and children, the use of S. boulardii is associated with clinical benefits in the treatment of AGE, specifically a reduction in the duration of diarrhoea by approximately 1 day. As before, these findings should be interpreted with caution because of the methodological limitations and heterogeneity of some of the studies. The available evidence supports recent recommendations from two European societies that selected probiotics with proven clinical efficacy, such as S. boulardii or Lactobacillus GG that are administered in appropriate dosages, according to the strain and the patient population, may be used as an adjunct to rehydration therapy for the management of AGE in children. 9 Moore A, Bjarnason I, Cryer B, et al. Evidence for Endoscopic Ulcers as Meaningful Surrogate Endpoint for Clinically Significant Upper Gastrointestinal Harm. Clin Gastroenterol Hepatol. 2009. Apr 9. [Epub ahead of print] 10 Yeomans N, Lanas A, Labenz J, et al. Efficacy of esomeprazole (20 mg once daily) for reducing the risk of gastroduodenal ulcers associated with continuous use of low-dose aspirin. Am J Gastroenterol 2008; 103: 2465–73. 11 Chan FK, Hung LC, Suen BY, et al. Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial. Gastroenterology 2004; 127: 1038–43.

Review article: future research on coeliac disease – a position report from the European multistakeholder platform on coeliac disease (CDEUSSA)

Background  CDEUSSA is a Specific Support Action project from the Sixth Framework Programme Priority of the European Union (EU). Its aim is to bring together basic and applied research in the area of coeliac disease (CD). This paper reviews the main issues that are a result of the CDEUSSA initiative.