A prospective cohort study of the influence of nonsteroidal anti-inflammatory drugs on disease activity in outpatients with inflammatory bowel disease (IBD)

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  • significantly < 0 m the 4 age groups at diagnosis (G1 -0.66, G2 -1.05, G3 -1.18, G4 -117) and oornlaliaed after one year in the 2 younger groups and at 2 years in the older goups. Height gains (delta z-scores) were present at one year ( group A: 0.81 vs group B: 030 ) and at 3 years (group A: 141 vs. group B: 0.51 ) Height gain was > 0 at 2 and 3 years even in children who wmv above average at the time of diagnosis (group B) In the population studied, 83% of patients with CD had a normal height for age (z > -2.0) at diagnosis. CONCLUSION: Even children who were of average height at diagnosis had catch- up growth and maintained it after three ),ears of a GFD, indicating prior suboptimal growth .Weight recovery was parallel to that of height. The overweight observed in group 2 during the third year roight be explained by the family attitude towards these children, aiming at a laster nutritional recovery"


    The Efflca W of Ondansetron in Attenuating Symptoms of Cyclic Vomiting Bhanu K. Sunku, B. U. la Terming Maa, John R. Hayes

    Background: Cyclic vomiting syndrome (CVS) is characterized by a clinical pattern of recurrent episodes of severe vomiting between which the child is normal. Because the pathophysinlo D, is unknovm, empiric therapy has been directed towards either preventing eDsodes , or aborting them in patients with infrequent episodes or attacks refractor}" to prophylaxis. In this study, we prospectively examined the efficacy of oral and IV ondansetmn used during acute episodes of CVS. Methods: A total of 25 patients meeting the consensus criteria for CVS were studied prospectively using a questionnaire: 17 patients were prescribed oral ondansetron and 14 patients received IV ondansetron dosed at 0.3 mg/kg, both adminis- tered at the onset of the episode Six patients were evaluated for both the IV and PO forms in separate episodes. Parents filled out a questinnnaim to e'

  • (p=0.0072 vs no-NSAIDs). For UC the corresponding scores were 5.64, 5.46, and 6.20 respectively (p=NS). The probabdity of moderately acnve disease did not demonstrate significant dilfi:mnce with NSA1D use, though CD patients on high-dose NSA1Ds had a 1,27dbld increase likelihood of moderately active disease as compared with patients on no- NSAIDs. Subgroup analysis showed die increase in disease activity among CD patients taking high-dose NSAIDs was limited to patients with colonic niw~lvement. For CD patients with limited ileal involvement the MHB scorn was 4.01 with no-NSAIDs and 3.85 on high-dose NSAIDs. CD patients with ileocolonic or isolated colonic disease had an MHB score of 4.11 with no- NSAIDs but increased to 5 47 with high-dose NSAIDs (p = 0.008). Among the UC patients, there was a trend towards a higher disease activity score among patients with pancofitiS(as opposed to distal disease). The LS increa~d from 5.79 to 7.43 comparing the pancofitis no-NSAIDs vs. high-dose NSAIDs (p = 0.21). Condusions: Use of low-dose NS?dDs was not a ~ i a t e d with an increase in disease activity for these outpatients witfi either CD or UC, Use of high-dose NSA1Ds was associated with a higher level of disease activity among CD patients with colonic involvement.


    Initial Response to Treatment (Rx) and Need for Intensified (Step-Up) Therapy in Children with Newly Diagnosed Inflammatory Bowel Disease (IBD): A Preliminary Investigation by the Pediatric IBD Collaborative Research Group James Markowitz, Jeffrey Hyams, Anne Griffiths, Athos Bousvaros, J. Fernando Del Rosario, Jonathan Ewans, Richard Grand, Aubrey Kate, Subra Kugathasan, David black, Adam Mezott, Maria Oliva-Hemker, Anthony Otley, Marian Pfeftkrkorn, Joel Rosh, Robert Rothbaum, Vasnndhara Tofia, Don W Cben

    The response of children with IBD to current Rx in dinical practice settings has received little systelratic attention. We therefore enrolled newly diagnosed children with IBD from 16 US & Canadian pediatric GI centers, identified between Jan-Nov 2002, in a prospective, observational registry" designed to assess the charactenstics of the North American pediatric IBD population, and their outcomes to current treatments. Methods: All children were managed according to the dictates of their treating physicians, not by standard ILx protocols. Baseline & 30 day disease characteristics and Rx were recorded prospectively. Responses to ILx aiter 30 days were assessed in regard to need tbr step-up Rx after initial Rx was established. Subjects were considered to have required step-up if the Physician Global Assessment (PGA) had worsened between baseline and 30 days, if steroids or infliximah were prescribed bdbre 30 days if these agents were not started as initial P,x, or if the initial dosage of steroid was increased prior to 30 days after the start of ILx. Results: 113 newly diagnosed children with IBD (79 Crohn d ~ a s e (CD), 25 ulcerative colitis (UC), 9 indetermi- rate colitis (ICY), mean age 11.3 yrs (range 1.4-15.9 yrs), were evaluated. Initial disease activity was characterized by PGA as mild (16 CD, 8 UC, 4 ICY or moderate-severe (63 CD, 17 UC, 5 ICY. 28 children were initially treated with steroids alone, 38 with steroids + additional agents, and 47 with no initial sysmmic steroid. Aiter 30 days of 1Lx, only 3/25 (12%) UC and 1~ (11%) IC subjects required stepmp, irrespective of niitial ~x. However, 2/16 (125%) subjects with mild CD and 13/63 (20.6%) of those with moderate-severe CD required step-up. Among those with moderate-severe CD, 30% of children not innially receiving steruids required step-up, compared to only 16.3% of those receiving steroids initially" (p = 036). Among the 3 children with moderate-severn CD who initially were treated with budesonide, 2 required step-up by" 30 day, s. Conclusions: Children with newly diagnosed [BD respond well to initial Rx and only rarely require step-up within the first 30 days of Rx. Those with moderate-severe CD at diagnosis are the most likely to require steDup, nspecially if their initial Rx does not include prednisone. Among all children with CD initially" receiving pradniso~m (+- other agents), 87% can be expected to improve within the' first 30 days of Rx


    Infliximab Is Not a Bridge to Immunomodulators In Crohns Disease Jeltrey A. Tuvlin, Kevin G. Schaeter, Nitin P ~me, Russell D Cohen, Stephen B. Hanauer

    Background: infliximab (IFX) induces and maintains remission m Crohn's disease (CD). The likelihood of long-term improvement without re-infusion after 1 to 3-induction inthaions, with or without immunomodulators, has not been determined. Methods: CD pts treated at the University ot Chicago IBD center with on-demand IFX induction regimens ( 1-3 infusions within 6 months) during the 3 years alter commercial release were prospectively analyzed tot initial efficacy duration oI response, and relapse within 12 months of the last infusion. lmmunomodulator therapy at baseline or subsequently added was determined and clinical improvement was compared to baseline according to a 3-point scale C0 =