Prevost Jantchou

Animal Protein Intake and Risk of Inflammatory Bowel Disease: The E3N Prospective Study

OBJECTIVES:Diet composition has long been suspected to contribute to inflammatory bowel disease (IBD), but has not been thoroughly assessed, and has been assessed only in retrospective studies that are prone to recall bias. The aim of the present study was to evaluate the role of dietary macronutrients in the etiology of IBD in a large prospective cohort.METHODS:The Etude Épidémiologique des femmes de la Mutuelle Générale de l’Education Nationale cohort consists of women living in France, aged 40–65 years, and free of major diseases at inclusion. A self-administered questionnaire was used to record dietary habits at baseline. Questionnaires on disease occurrence and lifestyle factors were completed every 24 months. IBDs were assessed in each questionnaire until June 2005, and subsequently validated using clinical and pathological criteria. We estimated the association between nutrients or foods and IBD using Cox proportional hazards models adjusted for energy intake.RESULTS:Among 67,581 participants (705,445 person-years, mean follow-up since completion of the baseline dietary questionnaire 10.4 years), we validated 77 incident IBD cases. High total protein intake, specifically animal protein, was associated with a significantly increased risk of IBD, (hazards ratio for the third vs. first tertile and 95% confidence interval being 3.31 and 1.41–7.77 (P trend=0.007), and 3.03 and 1.45–6.34 (P trend=0.005) for total and animal protein, respectively). Among sources of animal protein, high consumption of meat or fish but not of eggs or dairy products was associated with IBD risk.CONCLUSIONS:High protein intake is associated with an increased risk of incident IBD in French middle-aged women.

LOW EXPOSURE TO SUNLIGHT IS A RISK FACTOR FOR CROHN?S DISEASE

Aliment Pharmacol Ther 2011; 33: 940–945

Serological markers predict inflammatory bowel disease years before the diagnosis

Objective Anti-neutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae mannan antibodies (ASCAs) have been detected in the serum of patients with ulcerative colitis (UC) and Crohns disease (CD) and their unaffected family members. The aim of this study was to establish the value of serological markers as predictors of UC and CD. Design Individuals who developed CD or UC were identified from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. At recruitment, none of the participants had a diagnosis of CD or UC. For each incident case, two controls were randomly selected matched for centre, date of birth, sex, date of recruitment and time of follow-up. Serum of cases and controls obtained at recruitment were analysed for ASCA IgG, ASCA IgA, perinuclear anti-neutrophil cytoplasmic antibody (pANCA), antibodies against Escherichia coli outer membrane porin C (OmpC) and flagellin CBir1. Conditional logistic regression was used to determine risk of CD and UC. Receiver operating characteristic curves were constructed to test accuracy. Results A total of 77 individuals were diagnosed with CD and 167 with UC after a mean follow-up of 4.5 (SD 3.2) and 4.4 (SD 3.1) years following blood collection, respectively. Combinations of pANCA, ASCA, anti-CBir1 and anti-OmpC were most accurate in predicting incident CD and UC (area under curve 0.679 and 0.657, respectively). The predictive value of the combination of markers increased when time to diagnosis of CD or UC decreased. Conclusion A panel of serological markers is able to predict development of CD and UC in individuals from a low-risk population.

Environmental risk factors in Crohn's disease and ulcerative colitis: an update

Rapid increase in Crohns disease (CD) and ulcerative colitis (UC) incidence in developed countries, occurrence of CD in spouses and lack of complete concordance in monozygotic twins are strong arguments for the role of environmental factors in inflammatory bowel disease (IBD). Only two environmental factors have an established role in IBD. Smoking is a risk factor for CD and a protective factor for UC; appendectomy is a protective factor for UC. Many other environmental factors for IBD have been investigated. These are infectious agents, diet, drugs, stress and socio-economic factors. They are detailed in this paper. Among them, adherent invasive E. coli, infectious gastroenteritis, oral contraceptives and antibiotics could play a role in CD. To date, three theories integrate environmental factors to pathogenesis of IBD: hygiene, infection and cold chain. Much work remains to be done to identify risk factors for IBD. As exemplified by smoking, research of environmental risk factors of IBD is useful since it may lead to an improved disease course among patients and perhaps, to appropriate prevention among predisposed subjects. Further studies in this field are eagerly awaited.

Dietary patterns and risk of inflammatory bowel disease in Europe: Results from the EPIC study

Background:Specific nutrients or foods have been inconsistently associated with ulcerative colitis (UC) or Crohns disease (CD) risks. Thus, we investigated associations between diet as a whole, as dietary patterns, and UC and CD risks. Methods:Within the prospective EPIC (European Prospective Investigation into Cancer) study, we set up a nested matched case–control study among 366,351 participants with inflammatory bowel disease data, including 256 incident cases of UC and 117 of CD, and 4 matched controls per case. Dietary intake was recorded at baseline from validated food frequency questionnaires. Incidence rate ratios of developing UC and CD were calculated for quintiles of the Mediterranean diet score and a posteriori dietary patterns produced by factor analysis. Results:No dietary pattern was associated with either UC or CD risks. However, when excluding cases occurring within the first 2 years after dietary assessment, there was a positive association between a “high sugar and soft drinks” pattern and UC risk (incidence rate ratios for the fifth versus first quintile, 1.68 [1.00–2.82]; Ptrend = 0.02). When considering the foods most associated with the pattern, high consumers of sugar and soft drinks were at higher UC risk only if they had low vegetables intakes. Conclusions:A diet imbalance with high consumption of sugar and soft drinks and low consumption of vegetables was associated with UC risk. Further studies are needed to investigate whether microbiota alterations or other mechanisms mediate this association.

Les facteurs d’environnement dans la maladie de Crohn et la rectocolite hémorragique (tabac et appendicectomie exclus)

Resume L’augmentation rapide de l’incidence de la maladie de Crohn et de la recto-colite hemorragique dans les pays developpes, l’absence de concordance totale chez les jumeaux monozygotes, les formes conjugales de maladie de Crohn sont autant d’elements en faveur de l’intervention de facteurs d’environnement dans la genese de maladies inflammatoires chroniques de l’intestin (MICI). La recherche de facteurs d’environnement dans les MICI est fondee sur des etudes epidemiologiques (geographiques ou cas-temoin), cliniques et experimentales. Deux facteurs d’environnement ont un role etabli : le tabac (protecteur dans la RCH, facteur de risque dans la MC) et l’appendicectomie (protecteur dans la RCH). De nombreux autres facteurs d’environnement font l’objet de recherches. Il s’agit d’agents infectieux, alimentaires, medicamenteux, du stress et de facteurs socio-economiques. Ils sont detailles dans la presente mise au point. Parmi ces nouveaux facteurs, les mycobacteries atypiques, la contraception orale et l’antibiotherapie pourraient jouer un role dans la maladie de Crohn. A ce jour, trois hypotheses permettent d’integrer les facteurs d’environnement aux donnees connues de la physiopathologie des MICI (perte de la symbiose entre la flore commensale et l’immunite muqueuse intestinale) : celle de l’hygiene, celle de l’infection et celle de la chaine du froid. Beaucoup reste a faire pour identifier les facteurs d’environnement qui interviennent dans les MICI. Cette recherche est utile car elle peut mener a une prevention de la maladie chez les sujets predisposes et a une amelioration de son cours evolutif chez les malades.

Quality assessment of economic evaluation studies in pediatric surgery: A systematic review

PURPOSE To assess economic evaluation studies (EES) in pediatric surgery and to identify potential factors associated with high-quality studies. METHODS A systematic review of the literature using PubMed and Cochrane databases was conducted to identify EES in pediatric surgery published between 1 June 1993 and 30 June 2013. Assessment criteria are derived from the Drummond checklist. A high quality study was defined as a Drummond score ≥7. Logistic regression analysis was used to determine factors associated with high quality studies. RESULTS 119 studies were included. 43.7% (n=52) of studies were full EES. Cost-effectiveness analysis was the most frequent (61.5%) type of full EES. Only 31.6% of studies had a Drummond score ≥7 and 73% of these were full EES. The factors associated with high quality were identification of costs (OR: 14.08; 95% CI: 3.38-100; p<0.001), estimation of utility value (OR: 8.13; 95% CI: 2.02-43.47; p=0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p=0.02). CONCLUSION This review shows that the number and the quality of EES are low despite the increasing number of studies published in recent years. In the current context of budget constraints, our results should encourage pediatric surgeons to focus more on EES.

Prevalence and Risk Factors for Symptoms of Methotrexate Intolerance in Pediatric Inflammatory Bowel Disease.

Background: Methotrexate (MTX) intolerance is defined as gastrointestinal and behavioral symptoms occurring before or after MTX administration that may lead to treatment discontinuation. The aim of this study was to determine prevalence of MTX intolerance in pediatric inflammatory bowel disease (IBD) using the Methotrexate Intolerance Severity Score developed in rheumatology and to identify risk factors for MTX intolerance. Methods: Patients with pediatric IBD followed in the IBD clinic of Sainte Justine Hospital who had received MTX for IBD between 2004 and 2016 and were still actively on MTX were invited to fill out the Methotrexate Intolerance Severity Score questionnaire. A cutoff score of ≥6 points was used to define MTX intolerance, with at least one point for anticipatory, associative or behavioral items. Results: Among 102 pediatric patients with IBD, 32 (31%) patients reported symptoms of MTX intolerance. Using a multivariable logistic regression model, factors that were associated with having symptoms of MTX intolerance were female sex (odds ratio 4.31 [95% confidence interval, 1.37–13.60], P = 0.01), receiving a dose of MTX higher than 20 mg/wk at the time of the questionnaire (odds ratio 4.06 [95% confidence interval, 1.30–12.70], P = 0.02), and having active disease according to Physicians Global Assessment (odds ratio 3.44 [95% confidence interval, 1.15–10.26], P = 0.03). Prophylactic prescription of antiemetics and folic acid did not prevent symptoms of MTX intolerance. Conclusions: Symptoms of MTX intolerance are frequent in pediatric IBD. The Methotrexate Intolerance Severity Score questionnaire could help better recognition of these symptoms. Identification of risk factors could have important implications for the success of treatment.

Unusual Endoscopic Features in a Child With Drug Reaction With Eosinophilia and Systemic Symptoms.

e several days after discontinuing amoxicillin for otitis media. His medical history was -reactive protein was increased to 259 mg/L (normal range 0–6 mg/L) and circulating eosinophils to 1000/mL (normal range 0–400/mL). On day 3, circulating eosinophils increased to 6900/mL and C-reactive protein to 410 mg/L. Abdominal ultrasound and CT-scan showed mild hepatosplenomegaly, mesenteric adenopathy, and small bowel dilatation. Upper and lower gastrointestinal endoscopies (Fig. 1) showed unusual white eggshell-like lesions of the esophagus, stomach, and duodenum. These lesions were subsequently identified as eosinophilic abscesses on histology. Intravenous corticosteroids were started at 2 mg kg 1 day 1 for Drug Reaction with Eosinophilia and Systemic Symptoms syndrome. After 3 days, clinical and laboratory improvement led us to switch to oral corticosteroids. Intravenous corticosteroids had to be resumed when clinical symptoms recurred and circulating eosinophilis increased to 5200/mL. We repeated the upper endoscopy, which showed a significant improvement with complete disappearance of the esophageal lesions. The patient tolerated slow prednisone tapering during 3 months and remained asymptomatic 6 months after prednisone discontinuation (Fig. 2).

Sa1133 Prevalence of Methotrexate Intolerance in Pediatric Inflammatory Bowel Disease

• Participation: 64 patients and 44 parents completed the MISS questionnaire. Two patients refused. • MTX intolerance: 32 patients (50%) and 27 (42%) were intolerant to MTX based on the responses of the child and parents, respectively. • Mean (±SD) MISS score: 6.2 ± 5.8 for children and 6.8 ± 6.9 according to parents. • Good correlation between parents’ and children’s answers: r=0.77. • Prevalence and timing of gastrointestinal and behavioral symptoms are indicated in Fig. 1 and 2. The other symptoms noted were headaches (n=4), fatigue (n=2), alopecia (n=1) and negative conditioning to ondansetron (n=1). Division of Gastroenterology, Sainte-Justine Hospital, Montreal, Quebec Sainte-Justine Research Center, Montreal, Quebec.