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- Fagerberg, Ulrika Lorentzon
(författare)
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Fecal calprotectin in children with special reference to inflammatory bowel disease
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to study the clinical usefulness of fecal calprotectin as a noninvasive marker of colonic inflammation in children with suspected or confirmed chronic inflammatory bowel disease (IBD). Calprotectin, a calcium-binding protein predominantly expressed in neutrophils, is stable in feces for several days, and can be measured by an enzyme-linked immunosorbent assay. Gastrointestinal symptoms as abdominal pain, diarrhea, bloody stools, and weight loss are common in children presenting with IBD. However, the symptoms can be vague, or even similar to the symptoms of other more common gastrointestinal disorders and functional complaints. Early recognition of IBD is important to prevent adverse effects such as delayed onset of puberty, impaired growth, and unnecessary suffering. The routine investigations include blood tests, fecal cultures, endoscopy, and radiological examinations. Endoscopy with histological examinations of biopsy specimens is the gold standard for diagnosis. It is also used for objective estimation of disease activity and to monitor the efficacy of treatment. However, endoscopy is unsuitable for frequent use as it is an invasive and costly procedure requiring careful bowel preparation and, in children, general anesthesia. Study I establishes reference values for fecal calprotectin by analyzing fecal samples from 117 healthy children and adolescents. The conclusion was that the upper reference value for fecal calprotectin concentration is <50 mug/g in boys and girls aged 4 through 17 years. Study II evaluates the feasibility of fecal calprotectin to detect colorectal inflammation in children. Fecal samples were collected from 36 children with gastrointestinal symptoms suggestive of IBD before undergoing colonoscopy. Elevated fecal calprotectin concentrations strongly predicted the presence of IBD or other colorectal inflammation, and the test had a sensitivity of 95% and specificity of 93%. Thus, fecal calprotectin can be used as a diagnostic tool to facilitate selection of children who should undergo diagnostic colonoscopy. Study III aimed to evaluate fecal calprotectin as a quantitative marker of inflammatory activity in pediatric IBD. Thirty-nine children with IBD delivered fecal samples and underwent colonoscopies. The results demonstrated that fecal calprotectin is a valid surrogate marker for quantitative estimation of colonic inflammation in pediatric IBD. Normalized fecal calprotectin concentration seems to indicate complete, histological mucosal healing. Study IV compared plasma calprotectin, high sensitivity C-reactive protein and serum amyloid A with fecal calprotectin and routine blood tests as markers of histological inflammation in 32 children with IBD. Fecal calprotectin measurement was found to be a more reliable test for estimation of histological inflammatory activity in the colon. In conclusion, the present thesis demonstrates that fecal calprotectin is a simple and noninvasive method that can be used as a sensitive diagnostic tool to detect colorectal inflammation and IBD in children with gastrointestinal symptoms. Further, the fecal calprotectin method was shown to be useful as a quantitative, surrogate marker of colonic inflammatory activity. The simplicity of obtaining and analyzing fecal calprotectin will facilitate the care of children with gastrointestinal symptoms as well as the monitoring of inflammatory activity in pediatric IBD.
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- Lorentzon Fagerberg, Ulrika, et al.
(författare)
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Fecal calprotectin : a quantitative marker of colonic inflammation in children with inflammatory bowel disease
- 2007
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - 0277-2116 .- 1536-4801. ; 45:4, s. 414-420
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The protein calprotectin (S100 A8/A9) is present in neutrophils, monocytes, and macrophages. Colorectal inflammation can be detected by increased excretion of fecal calprotectin (FC). The aim of this study was to evaluate FC as a quantitative marker of inflammatory activity in children with inflammatory bowel disease (IBD). Patients and Methods: Thirty-nine children with IBD delivered a fecal spot sample and underwent colonoscopy. The samples were examined with an enzyme-linked immunosorbent assay for FC (Calprest, Eurospital, Trieste, Italy). The concentrations were correlated to macroscopic and microscopic assessments of extent and severity of inflammation in 8 colonic segments for each patient. Results: FC correlated significantly to the macroscopic extent (Spearman p=0.61) and the severity (Spearman p=0.52) of colonic inflammation and to a macroscopic, combined extent and severity score (Spearman p = 0.65). Significant correlations also were found to the microscopic extent (Spearman p=0.71) and severity (Spearman p = 0.72) of colonic inflammation and to a microscopic, combined extent and severity score (Spearman p=0.75). The median FC was 392 μg/g (95% confidence interval [CI], 278-440) in children with clinical IBD symptoms (n=23) and 32.9 μg/g (95% CI, 9.4-237) in asymptomatic IBD patients (n= 16). Of the asymptomatic children, 56% had a complete microscopic mucosal healing, and their median FC was 9.9 μg/g (95% CI, 5.9-41.9). Conclusions: FC can be used as a surrogate marker for estimation of colonic inflammation in pediatric IBD. Normalized FC concentration seems to indicate complete mucosal healing. FC is simple to obtain and analyze; this should facilitate objective assessment and monitoring of IBD activity.
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- Philipsson, Anna, 1978-, et al.
(författare)
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”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS
- 2019
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Konferensbidrag (refereegranskat)abstract
- Bakgrund och syfteFunktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.MetodEn randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.Resultat/(Planerade studier)Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. KonklusionStudien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.
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- Ruemmele, F M, et al.
(författare)
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Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease.
- 2014
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Ingår i: Journal of Crohn's & Colitis. - : Oxford University Press (OUP). - 1873-9946 .- 1876-4479. ; 8:10, s. 1179-207
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Tidskriftsartikel (refereegranskat)abstract
- Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition. The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutrition (EEN) is the induction therapy of first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission. The majority of patients with pediatric-onset CD require immunomodulator based maintenance therapy. The experts discuss several factors potentially predictive for poor disease outcome (such as severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, persistent severe disease despite adequate induction therapy), which may incite to an anti-TNF-based top down approach. These guidelines are intended to give practical (whenever possible evidence-based) answers to (pediatric) gastroenterologists who take care of children and adolescents with CD; they are not meant to be a rule or legal standard, since many different clinical scenario exist requiring treatment strategies not covered by or different from these guidelines.
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