Faecal volatile organic compounds differ according to inflammatory bowel disease sub-type, severity, and response to treatment in paediatric patients.

Background Faecal volatile organic compounds (VOCs) differ with disease sub-type and activity in adults with established inflammatory bowel disease (IBD) taking therapy. Objective To describe patterns of faecal VOCs in children newly presented with IBD according to disease sub-type, severity, and response to treatment. Methods Children presenting with suspected IBD were recruited from three UK hospitals. Children in whom IBD was diagnosed were matched with a non-IBD child for age, sex, and recruitment site. Faecal VOCs were characterised by gas chromatography–mass spectrometry at presentation and 3 months later in children with IBD. Results In 132 case/control pairs, median (inter-quartile range) age in IBD was 13.3 years (10.2–14.7) and 38.6% were female. Compared with controls, the mean abundance of 27/62 (43.6%) faecal VOCs was statistically significantly decreased in Crohn's disease (CD), ulcerative colitis (UC) or both especially amongst ketones/diketones, fatty acids, and alcohols (p < 0.05). Short-chain, medium chain, and branched chain fatty acids were markedly reduced in severe colitis (p < 0.05). Despite clinical improvement in many children with IBD, the number and abundance of almost all VOCs did not increase following treatment, suggesting persistent dysbiosis. Oct-1-en-3-ol was increased in CD (p = 0.001) and UC (p = 0.012) compared with controls and decreased following treatment in UC (p = 0.01). In CD, propan-1-ol was significantly greater than controls (p < 0.001) and extensive colitis (p = 0.001) and fell with treatment (p = 0.05). Phenol was significantly greater in CD (p < 0.001) and fell with treatment in both CD (p = 0.02) and UC (p = 0.01). Conclusion Characterisation of faecal VOCs in an inception cohort of children with IBD reveals patterns associated with diagnosis, disease activity, and extent. Further work should investigate the relationship between VOCs and the microbiome in IBD and their role in diagnosis and disease monitoring

Characterisation of fasted state gastric and intestinal fluids collected from children

Fundamental knowledge about the composition of intestinal fluids in paediatric populations is currently unavailable. This study aimed to characterise gastric and intestinal fluid from paediatric populations. Gastric and intestinal fluid samples were obtained during routine clinical endoscopy from paediatric patients at a large teaching hospital. These fluids were characterised to measure the pH; buffer capacity; osmolality; bile acid concentration and composition. A total of 55 children were recruited to the study aged from 11 months to 15 years of age where 53 gastric fluid samples and 40 intestinal fluid samples were obtained. pH values recorded ranged from pH 0.57 to 11.05 (median: 2.50) in gastric fluids and from 0.89 to 8.97 (median: 3.27) in intestinal fluids. The buffer capacity did not change significantly between gastric and intestinal fluids with median values of 12 mM/L/ΔpH for both fluids. Gastric fluid osmolality values ranged from 1 to 615 mOsm/kg, while intestinal fluid values ranged from 35 to 631 mOsm/kg. Gastric fluid bile acid concentrations ranged from 0.002 to 2.3 mM with a median value of 0.017 mM whilst intestinal fluid bile acid concentrations ranged from 0.0008 to 3.3 mM with a median value of 0.178 mM. Glycocholate; taurocholic acid; glycochenodeoxycholate and taurochenodeoxycholate were the most commonly identified bile acids within paediatric intestinal fluids. All compositional components were associated with large inter-individual variability. Further work is required to develop simulated paediatric media and to explore the impact of these media on drug solubility and dissolution

Inflammatory bowel disease patient‐reported quality assessment should drive service improvement: A national survey of UK IBD units and patients

© 2022 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/apt.17042Background & Aims Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. This nationwide study assessed patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care. Methods Using the 2019 IBD Standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a Patient Survey and Service Self-Assessment. Results In all, 134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults then increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the National IBD Standards for recommended workforce numbers. Key metrics associated with patient-reported high-quality care were as follows: identification as a tertiary centre, patient information availability, shared decision-making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self-management and reporting high-quality care. Conclusions This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision-making and provision of information, and demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.This work was supported by Crohn's & Colitis UK.Published onlin

Improved Medical Treatment and Surgical Surveillance of Children and Adolescents with Ulcerative Colitis in the United Kingdom

This is a pre-copyedited, author-produced version of an article accepted for publication in Inflammatory Bowel Diseases following peer review. The version of record, Auth, M. K.-K., et al. (2018). "Improved Medical Treatment and Surgical Surveillance of Children and Adolescents with Ulcerative Colitis in the United Kingdom." Inflammatory Bowel Diseases: izy042-izy042. is available online at:https://doi.org/10.1093/ibd/izy042Background: Pediatric ulcerative colitis (UC) presents at an earlier age and increasing prevalence. Our aim was to examine morbidity, steroid sparing strategies, and surgical outcome in children with active UC. Methods: A national prospective audit was conducted for the inpatient period of all children with UC for medical or surgical treatment in the United Kingdom (UK) over 1 year. Thirty-two participating centers recruited 224 children in 298 admissions, comparisons over 6 years were made with previous audits. Results: Over 6 years, recording of Paediatric Ulcerative Colitis Activity Index (PUCAI) score (median 65)(23% to 55%, P < 0.001), guidelines for acute severe colitis (43% to 77%, P < 0.04), and ileal pouch surgery registration (4% to 56%, P < 0.001) have increased. Corticosteroids were given in 183/298 episodes (61%) with 61/183 (33%) not responding and requiring second line therapy or surgery. Of those treated with anti-TNFalpha (16/61, 26%), 3/16 (18.8%) failed to respond and required colectomy. Prescription of rescue therapy (26% to 49%, P = 0.04) and proportion of anti-TNFalpha (20% to 53%, P = 0.03) had increased, colectomy rate (23.7% to 15%) was not significantly reduced (P = 0.5). Subtotal colectomy was the most common surgery performed (n = 40), and surgical complications from all procedures occurred in 33%. In 215/224 (96%) iron deficiency anemia was detected and in 51% treated, orally (50.2%) or intravenously (49.8%). Conclusions: A third of children were not responsive to steroids, and a quarter of these were treated with anti-TNFalpha. Colectomy was required in 41/298 (13.7%) of all admissions. Our national audit program indicates effectiveness of actions taken to reduce steroid dependency, surgery, and iron deficiency. 10.1093/ibd/izy042_video1izy042.video15769503407001.Dr Richard K Russell is supported by an NHS Scotland Research Senior fellowship. Linda J Williams has been supported by the Royal College of Physicians

Wasaṭiyyah (moderation) as the principle and objective of the Shariah as a solution for preventing violence and extremism = Wasatiyyah (kesederhanaan) sebagai satu prinsip dan objektif Shariah adalah satu solusi mencegah keganasan dan ekstrim

The Shariah, the foundation of the scheme of life, seems to be the most misunderstood concept of our time. The Shariah is confined to the domain of law in a rigid way and used out of context in an exclusivist manner. This has generated numerous implications to thought and life. It is generally assumed that the violent extremism that we witness in many parts of the world is the result of this misrepresentation of the Shariah. The situation demands a textual and contextual reading of the Shariah’s principles scientifically, especially, the principle of the wasatiyyah as an objective of the Shariah [Maqasid Shariah]. A correct view of the Shariah and the principle of wasatiyyah will help to remove the misunderstandings. It will also help to prevent the violent extremist and terrorist tendencies. This paper, therefore, aims at examining the principle of wasatiyyah based on the textual study of the Principle Sources – the Quran and Sunnah - and determines its scope to counter violence, extremism and terrorism. The socio-ethical dimensions and the principle of wasatiyyah as principles and objectives of the Shariah in relation to extremist trends will be explored and analyzed in this paper. This paper will present the principle of wasaṭiyyah as a solution for preventing the current extremist tendencies among some Muslims. The descriptive and analytical approaches will be employed in this study. Based on the textual study in a changing context, this paper concludes that the principle of wasaṭiyyah, owing its significance in the Sharī‘ah, needs to be highlighted and acknowledged as a major principle and objective of the Sharī‘ah which would be helpful to solve the societal problems besides its significance in private life. ********************************************************* Shariah yang merupakan asas kehidupan manusia adalah konsep yang seringkali disalah ertikan masa kini, Shariah yang dianggap terhad kepada undang-undang dan digunakan di luar konteks deengan cara ekslusif telah memberi pelbagai implikasi terhadap pemikiran dan kehidupan manusia. Secara amnya, keganasan golongan ekstrimis di beberapa Negara di dunia ini adalah berpunca daripada pemahaman Shariah yang salah. Situasi ini perlu kepada pembacaan prinsip-prinsip Shariah secara saintifik terhadap teks dan konteks terutamanya prinsip wasatiyyah sebagai satu bentuk objektif Shariah. Pandangan sebenar terhadap Shariah dan prinsip wasatiyyah dapat menghapuskan tanggapan yang salah dan mampu mencegah keganasan golongan ekstrimis dan terroris. Oleh itu makalah ini mengkaji prinsip wasatiyyah berdasarkan teks al-Quran dan Sunnah untuk mengenalpasti skopnya demi mencegah keganasan, ekstrimis dan terroris. Dimensi sosio-etika dan prinsip wasatiyyah sebagai objektif Shariah akan dianalisis dalam makalah ini. Makalah ini akan membincangkan prinsip wasaṭiyyah sebagai penyelesaian untuk mencegah kecenderungan ekstremis semasa di kalangan umat Islam. Pendekatan deskriptif dan analisis digunakan dalam kajian ini. Berdasarkan kajian tekstual makalah ini menyimpulkan bahawa prinsip wasaṭiyyah, perlu diakui sebagai objektif dan prinsip utama Sharī'ah yang akan membantu menyelesaikan masalah sosial selain kepentingannya dalam kehidupan setiap individu

Management of ulcerative colitis

Ulcerative colitis (UC) in children is increasing. The range of treatments available has also increased too but around 1 in 4 children still require surgery to control their disease. An up-to-date understanding of treatments is essential for all clinicians involved in the care of UC patients to ensure appropriate and timely treatment while minimising the risk of complications and side effects