Short- and long-term complications in pediatric inflammatory bowel disease patients, especially Crohn’s disease

Brückner, Annecarin (2020): Short- and long-term complications in pediatric inflammatory bowel disease patients, especially Crohn’s disease. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background and Aims: Perianal disease (PD), comprising fistula and abscess, is a severe complication in Crohn’s disease (CD). We examined prevalence, incidence and risk factors for PD development in a pediatric CD cohort. Methods: CD patients from the prospective, multi-center registry CEDATA-GPGE for pediatric inflammatory bowel disease (IBD) in Germany and Austria were included if diagnosed ≤18 years, registered within three months of diagnosis and having at least two follow-up visits within the first year of registration. We examined potential risk factors for PD with Kaplan-Meier analysis and a final cox model considering sex, family history of IBD, extraintestinal manifestations, disease localization, induction therapy (corticosteroids or nutritional therapy). Results: Of 2406 CD patients, 742 fulfilled inclusion criteria (59% male, mean age at diagnosis 12.4 ± 3.4 years). PD was present at diagnosis in 41 patients (5.5%; 80.9% male) while 32 (4.3%, 81.3% male) developed PD during follow up (mean 2.0 ±1.6 years). The cumulative incidence of PD 12 and 36 months after diagnosis was 3.5% and 7.5%, respectively. Potential risk factors for PD development during follow up were male sex (HR=3.2, [95%; CI 1.2-7.8]) and induction therapy with corticosteroids (HR=2.5 [1.1-5.5]). A guideline conform diagnostic work up for PD was performed in 60%. In half of the patient’s PD resolved after one year. Conclusion: About 10% of CD patients in our cohort suffer from PD within the first three years of their disease. Male sex and initial corticosteroid-therapy were associated with increased risk to develop this complication after diagnosis. Background and aims: Exclusive enteral nutrition induces remission, improves bone health and growth in paediatric Crohn’s disease (CD) patients, but is highly demanding for patients. We investigated efficacy of partial enteral nutrition (PEN) on bone health, growth and course in CD patients and assessed microbial and metabolic changes induced by PEN. Methods: We performed a two centre, non-randomized controlled intervention study in quiescent CD patients aged <18 years. Patients in intervention group received a liquid formula providing ~25% of daily energy for one year. At baseline, after 3, 6, 9 and 12 months, we collected data on bone, muscle (peripheral quantitative computertomography), anthropometry, disease activity (weighted paediatric CD activity index), metabolomic profile (liquid chromatography mass spectrometry), and faecal microbiome (16S rRNA gene sequencing). Results: Of 41 CD patients, 22 received the intervention (PEN) (mean age 15.0 ± 1.9 years, 55% male), 19 served as controls (non-PEN) (12.8 ± 3.1 years, 58% male). At baseline, mean bone quality was comparable to reference population with no improvement during the intervention. Relapse rate was low (8/41, PEN 4/22 and non- PEN 4/19, ns). PEN was not associated with microbiota community changes (beta diversity) but significantly reduced species diversity. Metabolome changes with upregulation of phosphatidylcholines in PEN patients are likely related to lipid and fatty acid composition of the formula. PEN significantly improved growth in a subgroup with Tanner stage 1-3. Conclusion: In our cohort of paediatric CD patients, PEN did not affect bone health but improved growth in patients with a potential to grow.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 29. Oktober 2020
• 1. Bericht­erstatter:in: Koletzko, Sibylle