Melissa A. Shepanski

Safety and Steroid-Sparing Experience Using Infliximab for Crohn's Disease at a Pediatric Inflammatory Bowel Disease Center

OBJECTIVES:The published experience using infliximab (Remicade, Centocor, Malvern, PA) for the treatment of pediatric Crohns disease is limited but suggests utility in the treatment of refractory disease. Experience using infliximab at a large pediatric center is reviewed.METHODS:A retrospective review of all infliximab infusions administered to patients with Crohns disease (CD) was undertaken. Data were obtained from database and pharmacy records. Chart review and interviews with physicians, patients, and families were used to obtain missing data.RESULTS:A total of 432 infusions were administered to 82 patients (34 female and 48 male) with CD. The number of infusions each patient received ranged from one to 18, with a mean of 5.3 (SD 4.6) and median of 3. Of 33 patients, 19 (57.6%) became independent and remained free of corticosteroids. There was a statistically significant difference in the steroid dose between 0 and 4 wk and 0 and 8 wk. In all, 23 infusion reactions occurred (5.3%). Three patients developed herpes zoster, and one developed Listeria monocytogenes meningitis. No patients were documented to have delayed hypersensitivity reactions or malignancies.CONCLUSIONS:Infliximab is safe and effective for treating pediatric patients with CD. A steroid-sparing effect was demonstrated. The most common adverse reaction to infliximab was infusion reaction. These reactions did not preclude further use of the agent. Serious infections were seen in a small number of patients.

Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain

This study examined whether subjects with chronic low back pain demonstrate exercise-induced analgesia to experimentally induced pressure pain. We employed a repeated measures design to study eight subjects with chronic low back pain (mean +/- standard deviation age = 40 +/- 10, duration of pain = 7 +/- 4 years). Pain ratings were measured immediately before and 2 minutes and 32 minutes after 25 minutes of cycle ergometry (5 minutes at 50% peak oxygen uptake, then 20 minutes at 70% peak oxygen uptake). We based the pain ratings on subject input on a visual analog scale at 10-second intervals during the 2-minute pressure pain stimulus to the nondominant index finger. Compared with preexercise values, pain ratings were significantly (p < 0.05) decreased after exercise at both 2 and 32 minutes postexercise. We conclude that pressure pain perception can be reduced for more than 30 minutes following aerobic exercise from leg cycling among people with chronic low back pain.

Health‐related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and colitis foundation of America

Purpose: To describe the reported health‐related quality of life (HRQOL) in children and adolescents with inflammatory bowel disease (IBD) after attending an IBD summer camp. Methods: A prospective analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD, which was sponsored by the Crohns and Colitis Foundation of America. The IMPACT‐II questionnaire (Canada and United States) and the State‐Trait Anxiety Inventory for Children were administered to the campers at the beginning and at the end of a 1‐week camp to assess HRQOL and anxiety. The IMPACT‐II questionnaire consists of 35 questions measuring 6 quality‐of‐life domains (i.e., bowel domain, systemic symptoms, emotional functioning, social functioning, body image, and treatment/interventions). The State‐Trait Anxiety Inventory for Children consists of 2 different 20‐item sets of questions. One set assesses state anxiety, and the other, trait anxiety. A repeated‐measures multivariate analysis of variance was performed to determine the differences between scores attained before and after camp on the IMPACT‐II questionnaire and in each of its domains. Paired sample t tests were performed on state and trait anxiety before and after camp. Results: A total of 125 individuals consented to participate, but 61 patients (50 girls and 11 boys; age range, 9 to 16 y) completed the IMPACT‐II questionnaire in full. Of those 61 patients, 47 had Crohns disease and 14 had ulcerative colitis. There was statistically significant improvement between the mean (±SD) precamp total score (172.95 ± 36.61) and the mean postcamp total score (178.71 ± 40.97; P = 0.035), bowel symptoms scores (P = 0.036), social functioning scores (P = 0.022), and treatment interventions scores (P = 0.012). No difference was found between anxiety scores before and after camp on either the state or trait anxiety inventories (n = 55; P > 0.05). Conclusions: Overall, HRQOL improved in children after attending IBD summer camp. This exploratory study suggests that contributing factors for these improvements may be an increase in social functioning, a better acceptance of IBD symptoms, and less distress regarding treatment interventions, suggesting that a camp that is specifically designed for children with IBD may normalize the chronic illness experience. However, future research using a multimodal measurement approach is warranted to support these conclusions.

Is an abbreviated Pediatric Crohn's Disease Activity Index better than the original?

Objective: The Pediatric Crohns Disease Activity Index (PCDAI) is a validated measure of disease activity comprised of historical, laboratory and physical examination parameters. It has been suggested that an abbreviated PCDAI may be of similar utility without requiring laboratory evaluations or calculated height velocity. The aim of this study was to compare an abbreviated PCDAI and the original PCDAI and also compare the abbreviated PCDAI and a quality-of-life measurement. Methods: The authors prospectively analyzed quality of life and disease activity, using the IMPACT-35 Questionnaire, the PCDAI and an abbreviated PCDAI consisting of three historical items (abdominal pain, stools and patient functioning) and three physical examination items (weight, abdomen and perirectal disease). Results: Forty subjects aged 5–24 years (22 males) were included in analysis. Correlations were performed between the original PCDAI, an abbreviated PCDAI and the IMPACT-35. There was a significant, strong correlation between the PCDAI and the abbreviated PCDAI (n = 40, r = 0.849, p <0.001), a significant, moderate correlation between PCDAI and IMPACT-35 (n = 29, r = −0.547, p = 0.002) and a significant, moderate correlation between the abbreviated PCDAI and IMPACT-35 (n = 29, r = −0.579, p <0.001). Conclusions: An abbreviated PCDAI predicted disease activity as well as the full PCDAI. The IMPACT-35 correlated well with disease activity based on both PCDAI and an abbreviated PCDAI. An abbreviated PCDAI may offer advantages over the original PCDAI and should be prospectively validated in future studies.

Laparoscopic-assisted bowel resection offers advantages over open surgery for treatment of segmental Crohn's disease in children.

BACKGROUND/PURPOSE Minimally invasive approaches have been shown to decrease hospital length of stay (LOS), decrease postoperative pain, and speed return to normal activity for a number of intraabdominal procedures. In this study, laparoscopic (LAP)-assisted bowel resection is compared with an open technique for patients undergoing an initial bowel resection. METHODS A retrospective review was conducted of 28 patients (12 LAP, 16 open) undergoing initial bowel resection for segmental Crohns disease. RESULTS Patients in the LAP group had decrease LOS (5.5 days v 11.5 days) decreased days of parenteral narcotics (3 days v 5 days) and more rapid return to regular diet (3 days v 5 days). CONCLUSIONS The data suggest that the laparoscopic approach may offer advantages to pediatric patients undergoing an initial bowel resection for segmental Crohns disease.