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© 2017 AGA Institute Background & Aims The guidelines of the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase (TGA-IgA) 10-fold or more the upper limit of normal (ULN), confirmed by detection of endomysium antibodies (EMA) and positivity for HLA-DQ2/DQ8. We performed a large, international prospective study to validate this approach. Methods We collected data from consecutive pediatric patients (18 years or younger) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014, seen at 33 pediatric gastroenterology units in 21 countries. Local centers recorded symptoms; measurements of total IgA, TGA, and EMA; and histopathology findings from duodenal biopsies. Children were considered to have malabsorption if they had chronic diarrhea, weight loss (or insufficient gain), growth failure, or anemia. We directly compared central findings from 16 antibody tests (8 for TGA-IgA, 1 for TGA-IgG, 6 for IgG against deamidated gliadin peptides, and 1 for EMA, from 5 different manufacturers), 2 HLA-DQ2/DQ8 tests from 2 manufacturers, and histopathology findings from the reference pathologist. Final diagnoses were based on local and central results. If all local and central results were concordant for celiac disease, cases were classified as proven celiac disease. Patients with only a low level of TGA-IgA (threefold or less the ULN) but no other results indicating celiac disease were classified as no celiac disease. Central histo-morphometry analyses were performed on all other biopsies and cases were carefully reviewed in a blinded manner. Inconclusive cases were regarded as not ha

L. WAUTERS (1), F. SMETS (2), E. DE GREEF (3), I. HOFFMAN (4), P. BONTEMS (5), S. VAN BIERVLIET (6), E. VAN DE VIJVER (7), I. PAQUOT (8), P. ALLIET (9), W. ARTS (10), B. HAUSER (11), H. PEETERS (12), M. DE VOS (13), P. BOSSUYT (14), J. RAHIER (15), O. DEWIT (16), O. DEWIT (16), T. MOREELS (16), F. FONTAINE (17), E. LOUIS (17), D. FRANCHIMONT (18), V. MULS (18), J. COCHE (19), F. BAERT (20), S. VERMEIRE (1), G. VEEREMAN (11) / [1] University Hospitals Leuven, Leuven, Belgium, Gastroenterology and Hepatology, [2] Clin universitaires St-Luc, UCL, Brussels, Belgium, Paediatric Gastroenterology, [3] UZ Brussel, Jette, Belgium, Paediatric Gastroenterology, [4] University Hospitals Leuven, Leuven, Belgium, Paediatric Gastroenterology, [5] HUDERF, City of Brussels, Belgium, Paediatric Gastroenterology, [6] UZ Gent, Gent, Belgium, Paediatric Gastroenterology, [7] UZ Antwerpen, Antwerp, Belgium, , Belgium, Pediatric Gastroenterology, [8] CHC Clinique de l'Esperance, Liège, Belgium, Paediatric Gastroenterology, [9] Jessa Hospital, Hasselt, Belgium, Paediatric Gastroenterology, [10] ZOL, Genk, Belgium, Paediatric Gastroenterology, [11] UZ Brussel, Jette, Belgium, Pediatric Gastroenterology, [12] AZ St Lucas, Ghent, Belgium, Gastroenterology, [13] UZ Gent, Gent, Belgium, Gastroenterology, [14] Imelda Hospital, Bonheiden, Belgium, Gastroenterology, [15] UCL, Mont-Godinne, Belgium, Gastroenterology, [16] Clin universitaires St-Luc, UCL, Brussels, Belgium, Gastroenterology, [17] CHU Liege, Liège, Belgium, Gastroenterology, [18] ULB Hôpital Erasme, Brussels, Belgium, Gastroenterology, [19] Clinique St. Pierre, Ottignies, Belgium, Gastroenterology, [20] Heilig Hart Ziekenhuis, Roeselare, Belgium, Gastroenterology Introduction The prolonged use of biologic agents with or without immunomodulators (IM) remains controversial in the management of paediatric Crohn’s disease (CD). Aim The prolonged use of biologic agents with or without immunomodulators (IM) remains controversial in the man

L. WAUTERS (1), F. SMETS (2), E. DE GREEF (3), P. BONTEMS (4), I. HOFFMAN (5), P. ALLIET (6), W. ARTS (7), S. VAN BIERVLIET (8), I. PAQUOT (9), E. VAN DE VIJVER (10), B. HAUSER (3), H. PEETERS (11), M. DE VOS (12), P. BOSSUYT (13), J. RAHIER (14), T. MOREELS (15), O. DEWIT (15), D. FRANCHIMONT (16), V. MULS (16), F. FONTAINE (17), E. LOUIS (17), J. COCHE (18), F. BAERT (19), S. VERMEIRE (20), G. VEEREMAN (3) / [1] University Hospitals Leuven, Leuven, Belgium, Gastroenterology and Hepatology, [2] Clin universitaires St-Luc, UCL, Brussels, Belgium, Pediatric Gastroenterology, [3] UZ Brussel, Jette, Belgium, Pediatric Gastroenterology, [4] HUDERF, City of Brussels, Belgium, Pediatric Gastroenterology, [5] University Hospitals Leuven, Leuven, Belgium, Pediatric Gastroenterology, [6] Jessa Hospital, Hasselt, Belgium, Pediatric Gastroenterology, [7] ZOL, Genk, Belgium, Pediatric Gastroenterology, [8] UZ Gent, Gent, Belgium, Pediatric Gastroenterology, [9] CHC, Liège, Belgium, Pediatric Gastroenterology, [10] UZ Antwerpen, Antwerp, Belgium, , Belgium, Pediatric Gastroenterology, [11] AZ St Lucas, Ghent, Belgium, Gastroenterology, [12] UZ Gent, Gent, Belgium, Gastroenterology, [13] Imelda Hospital, Bonheiden, Belgium, Gastroenterology, [14] UCL, Mont-Godinne, Belgium, Gastroenterology, [15] Clin universitaires St-Luc, UCL, Brussels, Belgium, Gastroenterology, [16] ULB Hôpital Erasme, Brussels, Belgium, Gastroenterology, [17] CHU Liege, Liège, Belgium, Gastroenterology, [18] Clinique St. Pierre, Ottignies, Belgium, Gastroenterology, [19] Heilig Hart Ziekenhuis, Roeselare, Belgium, Gastroenterology, [20] University Hospitals Leuven, Leuven, Belgium, Gastroenterology Introduction Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between treating physician and centre of care. Aim Treatment and outcomes in paediatric Crohn’s disease (CD) have not been compared between treating physician and centre of care. Methods Data from the BELCRO, an observati

AIM: A Belgian registry for pediatric Crohn's disease, BELCRO, was created. This first report aims at describing disease presentation and phenotype and determining associations between variables at diagnosis and registration in the database. METHODS: Through a collaborative network, children with previously established Crohn's disease and newly diagnosed children and adolescents (under 18 y of age) were recruited over a 2 year period. Data were collected by 23 centers and entered in a database. Statistical association tests analyzed relationships between variables of interest at diagnosis. RESULTS: Two hundred fifty-five patients were included. Median age at diagnosis was 12.5 y (range: 1.6-18 y); median duration of symptoms prior to diagnosis was 3 m (range: 1-12 m). Neonatal history and previous medical history did not influence disease onset nor disease behavior. Fifty three % of these patients presented with a BMI z-score < -1. CRP was an independent predictor of disease severity. Steroids were widely used as initial treatment in moderate to severe and extensive disease. Over time, immunomodulators and biological were prescribed more frequently, reflecting a lower prescription rate for steroids and 5-ASA. A positive family history was the sole significant determinant for earlier use of immunosuppression. CONCLUSION: In Belgium, the median age of children presenting with Crohn's disease is 12.5 y. Faltering growth, extensive disease and upper GI involvement are frequent. CRP is an independent predictive factor of disease activity. A positive family history appears to be the main determinant for initial treatment choice.

INTRODUCTION: Magnetic Resonance enterography (MRE) is an imaging modality avoiding ionizing radiation and the discomfort associated with enteroclysis. The results of MRE at diagnosis in the patients of the Belgian pediatric Crohn registry (Belcro) are compared to endoscopical and histological results. METHODS: Results of MRE, endoscopy and histology were obtained from the medical charts and assigned to one of the following segments: jejunum, ileum, ascending colon, transverse colon, descending colon or rectosigmoid. MRE images were reviewed in a blinded way by 4 radiologists with specific interest in pediatric MRE. RESULTS: From the Belcro registry, twenty-two patients underwent a MRE during their work-up for Crohn disease. The results of endoscopy, histology and MRE were concordant (either all negative or positive) in the ileum in 16/18 patients and in the rectosigmoid, descending colon, transverse colon and ascending colon in resp 9, 8, 8 and 8/22 patients. In the non-concordant cases (MRE colon negative but endoscopy and/or histology positive), MRE could not reflect the subtle endoscopic or histologic lesions such as erosions that were described.In 4 cases where ileocaecal valve intubation was impossible ileal MRE findings were abnormal. MRE detected ileal stenosis, jejunal lesions and fistula in resp 4/22, 3/22 en 2/22 patients. The 100% and 75% interobserver agreement was resp 50-82% and 773-100% according to the different intestinal segments. CONCLUSIONS: MRE is a promising imaging modality avoiding radiation in Crohn disease. It should probably become the technique of first choice for the evaluation of extensive small bowel disease in children with Crohn disease.

The STRONGkids is a nutritional screening tool for hospitalized children, which was found to predict a negative weight for height (WFH) standard deviation score (SDS) and a prolonged hospital length of stay (LOS) in a Dutch population of hospitalized children. This study aimed to test the ease of use and reproducibility of the STRONGkids, and to confirm its concurrent and prospective validity in a Belgian population of hospitalized children., Journal Article, Research Support, Non-U.S. Gov't, Validation Studies, SCOPUS: ar.j, info:eu-repo/semantics/published

To evaluate the nutritional status of hospitalized children in Belgian hospitals and to analyse the impact of undernutrition on the degree of weight loss and duration of hospitalization., Journal Article, SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

Biologicals have become an important component in the treatment of Crohn's disease in children. Their increased and long term use raises safety concerns. We describe safety and cost of infliximab in Belgian pediatric Crohn's disease patients. All patients on infliximab as part of the present or past treatment for Crohn's Disease until January 1st 2011 were selected from an existing database. Information on disease phenotype, medication and adverse events were extracted. Adverse events occurred in 25.9% of patients exposed to infliximab of which 29.6% were severe. In total 31.7% of patients stopped infliximab therapy. The main reasons for discontinuation were adverse events in 45.4% and loss of response in 30.3%. No malignancies or lethal complications occurred over this 241 patient year observation period. Immunomodulators were concomitant medication in 75% of patients and were discontinued subsequently in 38.4% of them. The cost of infliximab infusions per treated patient per year in the Belgian health care setting is approximately 9 474 euro, including only medication and hospital related costs. Even though infliximab is relatively safe in pediatric CD on the short term, close follow-up and an increased awareness of the possible adverse reactions is highly recommended. Adverse reactions appeared in 25.9% of all patients and were the main reason for discontinuation. Treatment cost has to be balanced against efficacy and modifications in disease course. In the Belgian health care system, the medication is available to all patients with moderate to severe CD.

The spectrum of hospital paediatric care is changing. The decrease in the amount and the duration of the classical hospitalizations leads to an increased workload for the medical and the paramedical team. The enhanced abilities for ambulant treatment result in a higher complexity and increased needs of the admitted patients. The rise in short-stay hospitalization implies special needs and financing. The tasks of the hospital paediatrician have changed dramatically over the years. The maximal working time is currently under discussion due to a changing mentality and the European directive. The organization of the future hospital care for children has to be focused mainly on the needs of the hospitalized sick child, based on the European charter of children admitted in hospitals. Each child being admitted in either classical or short-stay hospitalization or presenting at the outpatient clinic or the emergency room is entitled to a high-quality care with special attention for his physical, psychological and social well-being. The required enlargement and the better financing of the medical and paramedical teams can only be justified towards society and will only result in a better quality of care if the paediatric units assume a critical workload and if all hospital care for children is centralized in one site for each hospital. The accessibility of hospital care has to be guaranteed by a well-balanced geographical spreading of the units as well as by an appropriate and clearly structured first-line healthcare offer for children.

As in other European countries, Belgian hospitals encounter difficulties in recruiting paediatricians. The task of a paediatrician in the hospital is more diversified than in other specialties. The Belgian Academy of Paediatrics performed a survey in 2007 in order to assess the demographic characteristics and the workload of the hospital paediatricians in Belgium. There is an ongoing feminization among hospital paediatricians. No gender difference could be observed in the time spent in the various types of paediatric medical activity in the hospital. Male paediatricians spend however more than two half-days in clinical activities outside the hospital. Ambulatory care remains important as well in regional as in university paediatric departments. Non-curative tasks form about one third of the working time. The number of days on-call per paediatrician is higher in regional vs university hospitals. The mean size of paediatric regional hospital teams in Flanders is smaller than in French-speaking Belgium (4 vs 8), resulting in a higher on-call activity per paediatrician. In 2007, about 100 vacancies were reported by the heads of the paediatrics department, in three out of four hospitals.