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Background Mucosal healing (MH) has become a perspective treatment target in patients with Crohn's disease (CD). Data about the impact of MH on long-term outcome in pediatric patients are still scarce. Methods 76 pediatric patients with CD were evaluated retrospectively (2000-2015) in a tertiary care center. Based on MH achievement, they were divided into two groups (MH, n= 17; and No MH, n=59). The primary endpoint was to assess the association of MH and the need for CD-related hospitalizations or surgery in pediatric patients with CD. Results The number of hospitalized patients was 24% in the MH group and 42% in the No MH group, P = 0.26. The total number of CD-related hospitalizations was not significant between the MH group and the No MH group (5 vs. 41, P = 0.15). The time to the first hospitalization was 24 months in MH and 21 months in No MH, P>0.99. 24% patients in the MH group and 39% patients in the No MH group underwent CD-related operation, P = 0.39. Time to the first operation was 43 months for MH and 19 months for the No MH group, P = 0.13. The follow-up period was 91 months in the MH group and 80 months in the No MH group, P = 0.74. The use of infliximab was positively associated with MH, P = 0.002. Conclusions MH was not associated with fewer CD-related hospitalizations or operations in pediatric patients with CD during seven years of follow-up.

Aim Over the past few years, mucosal healing (MH) has emerged as a promising goal in the treatment of pediatric patients with Crohn's disease (CD). The study aim was to assess if the combination therapy of infliximab (IFX) + azathioprine (AZA) was more effective than AZA therapy alone in achieving mucosal healing in pediatric patients with CD. Methods Newly-diagnosed pediatric patients with CD at the Department of Pediatrics, University Hospital in Hradec Kralove were retrospectively recruited (2000-2014). The patients were divided into two groups according to the therapy: A) IFX + AZA ± corticosteroids (CS) ± 5-aminosalicylic acid (5-ASA) (N=16); and B) AZA ± CS ± 5-ASA (n = 40). The patients were also divided into two groups "MH" and "No MH" according to MH status. MH was defined as complete endoscopic disappearance of all mucosal ulcerations (including aphthous ulcerations) and the absence of any signs of mucosal inflammation (erythema, edema) in the terminal ileum and the large bowel. Results From 56 patients, MH was observed in 56% (9/16) patients treated with combined therapy in comparison with 15 % (6/40) patients in the AZA group, p = 0.006. The mean dose of AZA in both groups was 2.0 ± 0.4 mg/kg/day. We observed 8 adverse events (AE) in 7 patients (44%) from the IFX+AZA group. AE were less commonly presented in the AZA group (4/40 (10%), p = 0.002). Conclusions Combined therapy (IFX+AZA) was more effective in achieving MH in pediatric CD compared to treatment with azathioprine alone.

Background: Treatment quality and outcomes of paediatric home parenteral nutrition (HPN) program during its development in the Czech Republic. Methods: A retrospective study of patients receiving HPN from May 1995 till June 2011. Results: Sixty-six patients were treated in 8 centres. In 48 patients, long-term PN began in the first year of life and in 35 of them in the first month. Sixty children had gastrointestinal and 6 had non-gastrointestinal disease. In a majority of the patients, the Broviac catheter was used. Thirty-two (48.5%) patients were weaned from PN after 1-117 months, 21 (32.8%) continued on HPN after 7-183 months, and 13 (19.7%) patients died, all on PN. The mortality in patients with primary gastrointestinal disease was significantly lower than in patients with non-gastrointestinal disease. Thirty-one paediatric patients were receiving HPN for 14,480 catheter days in 2009-2010. Fourteen patients had 23 Catheter Related Blood Stream Infections (CRBSI) episodes. The incidence of CRBSI in 2009-2010 was 1.58/1,000 catheter days. Conclusion: Submitted data showed that even in the absence of expert centres, patient care may achieve results comparable to countries with well-developed HPN program. A majority of Czech HPN patients are at present treated in specialized centres, following the most desirable pattern of care.