Search

To systematically review the evidence base for the medical (pharmaceutical and nutritional) treatment of paediatric inflammatory bowel disease. Key clinical questions were formulated regarding different treatment modalities used in the treatment of paediatric (not adult-onset) IBD, in particular the induction and maintenance of remission in Crohn disease and ulcerative colitis. Electronic searches were performed from January 1966 to December 2006, using the electronic search strategy of the Cochrane IBD group. Details of papers were entered on a dedicated database, reviewed in abstract form, and disseminated in full for appraisal. Clinical guidelines were appraised using the AGREE instrument and all other relevant papers were appraised using Scottish Intercollegiate Guidelines Network methodology, with evidence levels given to all papers. A total of 6285 papers were identified, of which 1255 involved children; these were entered on the database. After critical appraisal, only 103 publications met our criteria as evidence on medical treatment of paediatric IBD. We identified 3 clinical guidelines, 1 systematic review, and 16 randomised controlled trials; all were of variable quality, with none getting the highest methodological scores. This is the first comprehensive review of the evidence base for the treatment of paediatric IBD, highlighting the paucity of trials of high methodological quality. As a result, the development of clinical guidelines for managing children and young people with IBD must be consensus based, informed by the best-available evidence from the paediatric literature and high-quality data from the adult IBD literature, together with the clinical expertise and multidisciplinary experience of paediatric IBD experts.

To systematically review the evidence base for the medical (pharmaceutical and nutritional) treatment of paediatric inflammatory bowel disease.

Although azathioprine usually is reserved for inflammatory bowel disease that proves difficult to control, routine early use has recently been advocated for children with Crohn disease. However, this practice carries with it an increased risk of adverse reactions. The objective of this study was to look for characteristics at first presentation that may identify those likely to benefit from early azathioprine. Study setting was a tertiary pediatric gastroenterology department. Retrospective cohort study of 156 children (93 Crohn disease, 47 ulcerative colitis, 16 indeterminate colitis), comparing characteristics at presentation in those who did and did not eventually require azathioprine. Azathioprine was reserved for patients with frequent relapses and steroid dependence/resistance. Twenty variables were examined, including patient and disease characteristics and initial treatment response. These were analysed using Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazard regression. Median follow-up was 3.9 years (range 0.5–10.6 years). Azathioprine was used in 36% with Crohn disease and 40% with ulcerative colitis. Median time to commencing azathioprine was 14 months (range 3–77.5 months). Multifactorial analysis revealed an association with endoscopic colitis severity in Crohn disease (P< 0.02). However, only 50% with severe Crohn colitis actually needed azathioprine. There was an association with need for intravenous corticosteroids for induction of remission in Crohn disease (P< 0.006) and ulcerative colitis (P< 0.05). Of these patients, 75% required azathioprine. These findings support the early use of azathioprine in children who require intravenous corticosteroids to induce initial remission. No other characteristics examined were of clinical utility in predicting need for azathioprine.

Although azathioprine usually is reserved for inflammatory bowel disease that proves difficult to control, routine early use has recently been advocated for children with Crohn disease. However, this practice carries with it an increased risk of adverse reactions. The objective of this study was to look for characteristics at first presentation that may identify those likely to benefit from early azathioprine.

The performance of the ONLINE Assay for Amphetamines on the Hitachi 737 was compared to the Syva Emit d.a.u. Assay and GC/MS. Randomly screened (n= 2964) patient urine samples were assayed using ONLINE and Emit d.a.u. assays concurrently, using d-amphetamine, 1000 ng/mL and d-methamphetamine, 1000 ng/mL as the screening cutoff for ONLINE and Emit d.a.u. assays, respectively. All presumptive positives were confirmed by GC/MS. The specificity was 99% (2937/2964) for ONLINE and 97% (2873/2964) for Emit. Agreement with GC/MS was 80% (110/137) for ONLINE and 55% (110/201) for Emit.