Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis

AIM: To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score). METHODS: We reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed. RESULTS: We identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was moderate-substantial agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68). CONCLUSION: Endoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies

Terapéutica biológica en la enfermedad de Crohn y en la colitis ulcerosa

Inclou referències bibliogràfique

Serological markers for prediction of response to anti-tumor necrosis factor treatment in Crohn's disease

peer reviewedOBJECTIVES: The use of monoclonal anti-tumor necrosis factor (TNF) antibodies (infliximab, Remicade) is a new therapeutic approach for severe refractory luminal or fistulizing, Crohn's disease (CD). However, up to 30% of patients do not respond to this treatment. So far, no parameters predictive of response to anti-TNT have been identified. Our aim was to determine whether serological markers ASCA (anti-Saccharomyces cerevisiae antibodies) or pANCA (perinuclear antineutrophil cytoplasmic antibodies) could identify Crohn's patients likely to benefit from anti-TNF therapy. METHODS: Serum samples of 279 CID patients were analyzed for ASCA and pANCA before anti-TNF therapy. A blinded physician determined clinical response at week 4 (refractory luminal CD) or week 10 (fistulizing CD) after the first infusion of infliximab (5 mg/kg). RESULTS: Overall, there was no relationship between ASCA or pANCA and response to therapy. However, lower response rates were observed for patients with refractory intestinal disease carrying the pANCA+/ASCA- combination, although this lacked significance (p = 0.067). CONCLUSIONS: In this cohort of infliximab-treated patients, neither ASCA nor pANCA could predict response to treatment. However, the combination pANCA+/ASCA- might warrant further investigation for its value in predicting nonresponse in patients with refractory luminal disease

Vedolizumab for pediatric IBD

Pediatric ulcerative colitis is likely to be more severe than adult ulcerative colitis. Failure to thrive should be considered during therapy. A 10-year-old boy was diagnosed with ulcerative colitis based on his clinical presentation and colonoscopy and biopsy results. The administration of 5-aminosalicylic acid and prednisolone resulted in remission ; however, the symptoms reappeared after the discontinuation of prednisolone. Then, infliximab was administered ; however, the patient was resistant to it and appeared to be dependent on prednisolone. Vedolizumab, a monoclonal antibody against α4β7 integrin, was administered, which resulted in rapid remission. A steady decrease in prednisolone followed, and remission was maintained even after prednisolone discontinuation. Vedolizumab may be effective in pediatric patients with moderate-to-severe refractory ulcerative colitis. Vedolizumab prevents lymphocytes from binding to MAdCAM-1, which is selectively expressed in the gastrointestinal submucosa, leading to the mitigation of the systemic side effects of immunosuppression, such as infections. In Japan, vedolizumab use is not yet approved for use in children, but its effectiveness and safety in children is expected to be investigated in the future

Prendre la parole : Éléments pour une audiographie de Michel Foucault

Michel Foucault n’a cessé de s’interroger sur le pouvoir de la parole à travers ses travaux : dans l’histoire des discours qu’il propose, il souligne combien, dans nos sociétés occidentales, l’exercice de la parole est politique. Or, tout au long de ses interventions dans l’actualité au moment du Groupe Information Prison jusqu’à la Pologne, l’intellectuel Foucault a cherché non plus à répondre à la question « Qu’est-ce que parler ? », mais à subvertir l’ordre du discours. L’analyse de deux types de prise de parole chez Foucault — la conférence de presse et l’entretien — met en évidence des pratiques de résistance et indique une série de pistes pour comprendre le sens des engagements foucaldiens. L’auteur montre ainsi comment, très concrètement, Foucault « a cherché à n’avoir plus de visage ».Throughout his work Michel Foucault constantly questioned the power of speech : in the history of discourses that he proposes, he notes how political the exercise of speech is in our western societies. Yet in all his interventions in events at the time of the Groupe Information Prison up to Poland, Foucault the intellectual did not try to answer the question « What does speaking mean ? » but rather to subvert the order of the discourse. Analysis of two types of speaking in Foucault’s work — the press conference and the discussion — highlights practices of resistance and indicates a series of approaches to the understanding of Foucault’s commitments. The author thus shows how Foucault, very concretely, « tried to efface himself. »Michel Foucault no dejó de preguntarse sobre el poder de la palabra a través de sus trabajos. En la historia de los discursos que propone, destaca cuánto en nuestras sociedades occidentales, el ejercicio de la palabra es político. Ahora bien, a lo largo de sus intervenciones durante el Grupo de Información Prisión hasta la Polonia, la intención del intelectual Foucault no fue la de responder a la pregunta ¿“Qué es hablar ?”, si no subvertir el orden del discurso. El análisis de dos tipos de intervenciones en Foucault — la rueda de prensa y la entrevista — ponen en evidencia prácticas de resistencia e indican una serie de pistas para comprender el sentido de los compromisos foucaultianos. El autor muestra así cómo muy concretamente Foucault “ha pretendido no tener más de una cara”

La construction identitaire des jeunes océaniens francophones.

International audienceDepuis le transfert des compétences du 1er degré, la Nouvelle-Calédonie a la possibilité de répondre au défi que lui lancent les jeunes générations océaniennes qui coupées de leur langue et de leur tradition, veulent réussir sans renier leurs ancêtres. Quelle place l'école devrait-elle accorder aux langues et cultures océaniennes, afin que les enfants s'approprient l'espace scolaire et ne le subissent plus comme un espace obligé et aliénant

Going deeper: molecular inflammatory scores in IBD

The management of IBD is evolving. Not long ago, symptomatic relief, or 'clinical remission' was the major treatment goal-if not the only goal-for most patients. However, the disconnect between inflammation and symptoms has been long recognised, and there is now abundant evidence that patients with silent inflammation, unsurprisingly, develop more disease-related complications than those with inactive disease.1 For this reason, current IBD management usually involves a 'treat-to-target' approach-a concept borrowed from rheumatology2-where objective measures of inflammation are used to ensure that treatment leads to resolution of inflammation as well as of symptoms.

A Case of Crohn's Disease with Improvement after Azathioprine-Induced Pancytopenia

The immunosuppressant azathioprine (AZA) is widely used in the treatment of inflammatory bowel disease (IBD) for both inducing and maintaining remission. However, the adverse effects of AZA can often necessitate a dose reduction or discontinuation. Bone marrow suppression is one of the most serious complications with AZA treatment. On the other hand, some reports have suggested that neutropenia during AZA therapy reduced the relapse rates of IBD patients, and there have been some cases where eradication of the sensitized leukocytes by leukapheresis or bone marrow transplantation improved the IBD, which may explain the relevant role of neutropenia in controlling disease activity. This report describes the case of a 22-year-old male patient who had Crohn's colitis and complicated perianal fistulas that required immunosuppression; he achieved endoscopically determined remission and showed accelerated mucosal healing as well as clinical remission following the AZA-induced pancytopenia

Should we be CHARMed?

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56151/1/20191_ftp.pd