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The impact of endoscopic and histological mucosal healing on outcomes in adult settings is impressive. Despite many clinical parallels, pediatric ulcerative colitis (UC) is set apart from adult disease in several respects. Many frequently used indices are not fully validated, especially in pediatric settings, and consensus on precise definitions in clinical settings are lacking. Endoscopic mucosal healing is an acceptable long-term treatment goal in pediatrics, but not histologic normalization. Early prediction of disease course in UC may allow treatment stratification of patients according to risks of relapse, acute severe colitis, and colectomy. Putative endoscopic and histologic predictors of poor clinical outcomes in adults have not held true in pediatric settings, including baseline endoscopic extent, endoscopic severity, and specific histologic characteristics which are less prevalent in pediatrics at diagnosis. In this mini-review we appraise predictive endoscopic and histologic factors in pediatric UC with reference to relapse, severe colitis, and colectomy risks. We recommend that clinicians routinely use endoscopic and histologic sores to improve the quality of clinical and research practice. The review summarizes differences between adult and pediatric prediction data, advises special consideration of those with primary sclerosing cholangitis, and suggests areas for future study in this field.

The oral cavity is continuous with the gastrointestinal tract and in children, oral health may be closely linked with the overall health of the GI tract. In the case of pediatric Crohn's disease (CD), oral manifestations are an important clinical indicator of intestinal disease. Recent studies of the microbiome in IBD suggest that translocation of oral microbes to the gut may be a common feature of the microbial dysbiosis which is a signature of both CD and ulcerative colitis (UC). Murine studies suggest that translocation of oral bacteria and yeasts to the lower GI tract may trigger inflammation in susceptible hosts, providing a mechanistic link to the development of IBD. Conversely, some studies have shown that dysbiosis of the oral microbiome may occur, possibly as a result of inflammatory responses and could represent a useful source of biomarkers of GI health. This review summarizes our current knowledge of the oral microbiome in IBD and presents current hypotheses on the potential role of this community in the pathogenesis of these diseases.

Crohn disease and anorexia nervosa share common symptoms of weight loss and reduced oral intake. The prevalence of both disorders has increased over time. Symptoms of Crohn disease and anorexia nervosa can mimic each other leading to a delayed diagnosis and requiring complex, multidisciplinary management. Here we present a case of a 15 year old girl with Crohn disease who subsequently developed anorexia nervosa, and review the published literature on the occurrence of both diagnoses.

AimAll Irish children with ulcerative colitis (UC) attend the National Centre for Paediatric Gastroenterology at Our Lady’s Children’s Hospital, Crumlin. The aim of this study was to determine the outcomes of children with acute severe ulcerative colitis (ASC) and the impact of infliximab on these outcomes following its introduction for this indication in 2011.MethodsA retrospective chart review of all patients admitted with ASC between January 1, 2009 and December 31, 2015 was undertaken. Patients were identified from the departmental database cross-referenced with the hospital inpatient enquiry system. Inpatients with a paediatric ulcerative colitis activity index (PUCAI) of ≥65 were included. Data collected included baseline demographic and laboratory data, concomitant treatments, PUCAI scores on days 3 and 5, second-line treatments, surgery, and discharge outcomes. Infliximab dose, frequency, and available therapeutic drug monitoring results were recorded, along with clinical response outcomes (remission, primary, and secondary loss of response). The cohort was sub-analysed to determine if there was any era effect pre- and post-introduction of infliximab (2009–2010 and 2011–2015, respectively).ResultsFifty-five patients (M:F = 1.4:1) were treated for acute severe colitis over the study period (8 in the pre-infliximab and 47 in the post-infliximab era) and 46/55 (86%) had steroid-refractory disease. Of these, 7/8 (88%) required colectomy in the pre-infliximab era, compared with 15/47 (36%) in the post-infliximab era. The remission rate with second-line infliximab was 61% at maximal follow-up. There were no identifiable factors that predicted likely success or failure of infliximab, including gender, CRP, day-3 and day-5 PUCAI scores. Of the 33 patients treated with infliximab, dose increase was required in 23/33 (70%); 21/33 (64%) received an accelerated dose schedule, and 9/33 (27%) eventually needed colectomy. Primary and secondary loss of response to infliximab was seen in one and nine patients, respectively.ConclusionThis is the first population-based study of the outcomes of severe UC in Irish children, and suggests a higher burden of steroid-refractory disease compared with previous international studies. While infliximab treatment has led to reduction in colectomy rates, a significant proportion of patients lose therapeutic effect.

T cell subsets are considered central orchestrators of inflammation and homeostasis in the intestine and are established targets for the treatment of inflammatory bowel disease. While approaches aimed at the neutralization of T cell effector cytokines have provided significant benefits for pediatric and adult patients, more recent strategies aimed at inhibiting the infiltration of pathogenic T cell subsets have also emerged. In this review, we describe current knowledge surrounding the function of T cell subsets in pediatric inflammatory bowel disease and outline approaches aimed at targeting T cell trafficking to the intestine which may represent a new treatment option for pediatric inflammatory bowel disease.

Pain, irritability and feeding intolerance are common symptoms affecting quality of life in children with severe neurological impairment (SNI). We performed a retrospective study to explore the use of gabapentinoid medications for symptom control in children with SNI. Patients attending the palliative care or gastroenterology department being treated with gabapentin for irritability, vomiting or pain of unknown origin were included. Information was gathered retrospectively from medical documentation. Irritability was reduced in 30 of the 42 patients included. Gabapentin was discontinued in 15 children, 12 of whom then received pregabalin. Three children had a good response to pregabalin, six a minimal improvement and three no improvement. These results support the use of gabapentinoids in this patient cohort.