178 research outputs found
Enteroscopy in paediatric Crohn's disease
No full textSmall bowel evaluation is crucial in children with suspected inflammatory bowel disease to differentiate Crohn's disease from other enteropathies, in making therapeutic decisions and planning the follow-up. Endoscopic investigation of small bowel has historically been difficult due to the length and tortuosity of the organ itself. New technology, introduced over the past decade, allows minimally invasive and detailed endoscopic evaluation of the entire small bowel mucosa. While understudied in the paediatric population, literature is emerging supporting the use of these techniques in children. In this review we will provide an overview on the currently available technology, on its feasibility in paediatric age and on the available literature concerning the use of enteroscopy in paediatric Crohn's disease. (C) 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved
Use of biosimilars in paediatric inflammatory bowel disease: A position statement of the ESPGHAN paediatric IBD porto group
No full textBecause the patents for biopharmaceutical monoclonal antibodies have or soon will expire, biosimilars are coming to the market. This will most likely lead to decreased drug costs and so easier access to these expensive agents. Extrapolation, however, of the limited available clinical data from adults with rheumatologic diseases to children with inflammatory bowel disease (IBD) should be done with caution and needs some considerations. Postmarketing surveillance programs for efficacy, safety, and immunogenicity should become mandatory in children with IBD using biosimilars, as for all biological drugs
Endoscopic Balloon Dilatation in Pediatric Crohn Disease: An IBD Porto Group Study
No full textObjective/Background: Endoscopic balloon dilatation (EBD) has been shown to be effective and safe in adults with stricturing Crohn disease (CD) yet pediatric data is sparse. We aimed to assess efficacy and safety of EBD in stricturing pediatric CD. Methods: International collaboration included 11 centers from Europe, Canada, and Israel. Recorded data included patient demographics, stricture features, clinical outcomes, procedural adverse events, and need for surgery. Primary outcome was surgery-free over 12 months and secondary outcomes were clinical response and adverse events. Results: Eighty-eight dilatations were performed over 64 dilatation series in 53 patients. Mean age at CD diagnosis was 11.1 (±4.0) years, stricture length 4 cm [interquartile range (IQR) 2.8-5], and bowel wall thickness 7 mm (IQR 5.3-8). Twelve of 64 (19%) patients underwent surgery in the year following the dilatation series, at a median of 89 days (IQR 24-120; range 0-264) following EBD. Seven of 64 (11%) had subsequent unplanned EBD over the year, of whom two eventually underwent surgical resection. Two of 88 (2%) perforations were recorded, 1 of whom was managed surgically, and 5 patients had minor adverse events managed conservatively. There was a significant improvement in all clinical measures following EBD with weighted pediatric CD activity index-defined remission increasing from 13% at baseline to 44%, 46%, and 61%, and absence of obstructive symptoms in 55%, 53%, and 64% of patients at week 2, 8, and 24 respectively. Conclusions: In this largest study of EBD in pediatric stricturing CD to date, we demonstrated that EBD is effective in relieving symptoms and avoiding surgery. Adverse events rates were low and consistent with adult data.</p
Etude des variants génétiques des déficits immuns primaires et des formes ethniques dans l’architecture génétique des maladies inflammatoires du tube digestif
No full textLa majeure partie de l'héritabilité des maladies inflammatoires des intestins (MICI) comprenant essentiellement la maladie de Crohn (MC) et la rectocolite ulcéro-hémorragique (RCUH) reste manquante. A côté des formes classiques de MICI polygéniques, un nombre croissant de maladies rares monogéniques avec un syndrome d’immunodéficience primaire innée ou acquise (ou Primary Immune Deficiency (PID) disorders) et un tableau clinique de maladie inflammatoire gastro-intestinale semblable aux MICI ont été identifiées au cours de ces dernières années. Les gènes mutés au sein de ces PID pourraient contenir des variants rares associés aux MICI dont l'identification aurait échappé aux études d'association du génome (GWAS) et qui pourraient être détectés avec le séquençage à haut débit. Nous avons sélectionné 23 gènes candidats associés à dix maladies monogéniques avec manifestations gastro-intestinales inflammatoires ressemblant aux MICI et avons évalué la contribution éventuelle de ces gènes à la prédisposition héréditaire à développer une MC via d'une part une étude d'association sur base des données de génotypage de 17000 patients atteints de MC issus des GWAS de l'IIBDGC et d'autre part, via une étude de séquençage à haut débit au sein d'une cohorte de 2390 patients atteints de MC. Nous avons identifié 4 nouveaux variants du gène XIAP qui sont associés chez les patients porteurs de la mutation, à un défaut d'activation de la voie de NOD2 après stimulation par le muramyl dipeptide (MDP). En complément à l'étude des formes monogéniques de MICI, les formes non européennes peuvent également constituer une source de données à exploiter pour pallier à l'héritabilité manquante. En effet, la plupart des GWAS ont été effectuées au sein de populations d'origine européenne. Or en combinant plusieurs groupes ethniques, il est possible d'identifier de nouveaux loci de susceptibilité tel qu'on a pu l'observer dans la première étude trans-éthnique réalisée au sein de patients atteints de MICI. Très peu d'études génétiques ont été réalisées au sein de la population d'origine marocaine qui est la population non européenne la plus prépondérante en Belgique. Nous avons entrepris une étude d'association sur des puces de génotypage de type Immunochip au sein d'une population de 306 patients d'origine marocaine atteints de MICI, se focalisant sur les 163 variants communs de susceptibilité connus dans les MICI lorsque l'étude a été débutée. L'étude a identifié une association significative aux MICI pour dix loci notamment au sein des gènes tels que IL23R, JAK2, CARD9 ou CCR6. Ces associations sont nouvelles et n'ont pas été étudiées ou confirmées dans les précédentes études faites au sein de patients d'origine marocaine atteints de MICI.Doctorat en Sciences médicales (Médecine)info:eu-repo/semantics/nonPublishe
Accidentele ingestie van een etsend middel op de kinderleeftijd: is endoscopie altijd nodig?
No full textAccidentele ingestie van een etsend middel op de kinderleeftijd: is endoscopie altijd nodig?
No full textInsensitizing controls for the heat equation with respect to boundary variations
No full textThis article is dedicated to insensitization issues of a quadratic functional
involving the solution of the linear heat equation with respect to domains
variations. This work can be seen as a continuation of [P. Lissy, Y. Privat,
and Y. Simpor\'e. Insensitizing control for linear and semi-linear heat
equations with partially unknown domain. ESAIM Control Optim. Calc. Var.,
25:Art. 50, 21, 2019], insofar as we generalize several of the results it
contains and investigate new related properties. In our framework, we consider
boundary variations of the spatial domain on which the solution of the PDE is
defined at each time, and investigate three main issues: (i) approximate
insensitization, (ii) approximate insensitization combined with an exact
insensitization for a finite-dimensional subspace, and (iii) exact
insensitization. We provide positive answers to questions (i) and (ii) and
partial results to question (iii)
Insensitizing controls for the heat equation with respect to boundary variations
No full textInternational audienceThis article is dedicated to insensitization issues of a quadratic functional involving the solution of the linear heat equation with respect to domains variations. This work can be seen as a continuation of [P. Lissy, Y. Privat, and Y. Simpor\'e. Insensitizing control for linear and semi-linear heat equations with partially unknown domain. ESAIM Control Optim. Calc. Var., 25:Art. 50, 21, 2019], insofar as we generalize several of the results it contains and investigate new related properties. In our framework, we consider boundary variations of the spatial domain on which the solution of the PDE is defined at each time, and investigate three main issues: (i) approximate insensitization, (ii) approximate insensitization combined with an exact insensitization for a finite-dimensional subspace, and (iii) exact insensitization. We provide positive answers to questions (i) and (ii) and partial results to question (iii)
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