Immunophenotype in orofacial granulomatosis with and without Crohn's disease

Objectives: The aim of this investigation was to characterise and compare the inflammatory infiltrates in patients with orofacial granulomatosis solely (OFG-S) and OFG with coexisting Crohn's disease (OFG+CD). Study Design: Biopsy specimens with granulomas were obtained from patients with OFG-S (n=11) and OFG+CD (n=11) and immunostained with antibodies against CD1a, CD3, CD4, CD8, CD11c, CD20, CD68 and mast cell tryptase, followed by quantitative analysis. Results: Analyses of the connective tissue revealed a significantly higher number of CD3- expressing T cells and CD11c-expressing dendritic cells in the connective tissue of patients with OFG-S compared to patients with OFG+CD. Mast cells displayed a high level of activation, although no significant difference was detected when comparing the two groups. Conclusions: The results show a different composition of the inflammatory infiltrate in patients with OFG-S compared to patients with OFG+CD. The present observations support that partly divergent immune mechanisms are involved in these two different subcategories of OFG

Young adult male patients with childhood-onset IBD have increased risks of compromised cortical and trabecular bone microstructures

Background Young adults with childhood-onset inflammatory bowel disease (IBD) have increased risks of low areal bone mineral density and low skeletal muscle mass. Volumetric BMD (vBMD), bone geometry and microstructures, in addition to possible associations with skeletal muscle index (SMI) and physical exercise have been scarcely studied in this patient group. Patients and methods In total, 49 young adult male patients with childhood-onset IBD and 245 age- and height-matched young adult male controls were scanned with high-resolution peripheral quantitative computed tomography. Bone geometry, vBMD, and bone microstructures were calculated as median values and compared between the patients and controls. Multivariable linear regression analyses were performed to determine the independent associations among IBD diagnosis, SMI (kg/m2), and physical exercise. Results The group of young adult patients had, in comparison with the controls, significantly smaller median cortical area (126.1 mm2 vs151.1 mm2, P < .001), lower median total vBMD (296.7 mg/cm3 vs 336.7 mg/cm3, P < .001), and lower median cortical vBMD (854.4 mg/cm3 vs 878.5 mg/cm3, P < .001). Furthermore, the patients compared with the controls had lower median trabecular volume fraction (16.8% vs 18.2%, P < .001) and thinner median trabeculae (0.084 mm vs 0.089 mm, P < .001). The differences between the patients with IBD and controls persisted in multivariable analyses that included adjustments for SMI and physical exercise. Conclusions Young adult men with childhood-onset IBD are at increased risk of having reduced bone quality in both the cortical and trabecular bone structures compared with normative matched controls

Antibody-dependent cell-mediated cytotoxicity triggered by dietary antigens in cow's milk protein intolerance and coeliac disease

Small amounts of dietary proteins pass undegraded into the circulation, an event initiating antibody production. Antibodies to dietary antigens might be beneficial by immune elimination of antigen as well as potentially disease-provoking by eliciting harmful immune effector functions, such as immune complex-mediated complement activation or antibody-dependent cell-mediated cytotoxicity (ADCC). The biological activities of antibodies are related to their characteristics, such as isotope, epitope specificity and avidity.The aim of the study was to evaluate characteristics of serum antibodies to dietary anti-gens in children with food allergy/intolerance, focussing on ADCC-mediating capacity, isotype/subclass pattern and avidity.Sera were analysed with regard to ADCC-mediating capacity, i.e. lysis of target cells (erythrocytes coated with dietary antigen) in the presence of cytotoxic effector cells (NK cells or monocytes). Serum antibody levels of IgG, IgG subclasses and IgA against b-lactoglobulin or gliadin were determined with ELISA. Affinity chromatography was used for selective depletion of IgG subclasses. Antibody avidity was estimated using a thiocyanate elution enzyme immunoassay.Sera from children with cow´s milk protein intolerance (CMPI) and gastrointestinal symptomatology showed a substantial ADCC reactivity in a b-lactoglobulin-specific system with NK cells as effectors. Coeliac children exhibited moderate ADCC reactivity of their sera, despite high levels of antibodies against b-lactoglobulin. Absorption experiments indicated that primarily IgG1 antibodies were responsible for this b-lactoglobulin-specific ADCC reactivity. Accordingly, ADCC reactivity of indi-vidual sera correlated with IgG1 anti-b-lactoglobulin antibody levels. Sera from CMPI children with gastrointestinal symptoms, most of which had a high ADCC reactivity, also had a distinctive subclass pattern of their anti-b-lactoglobulin antibodies with high relative proportions of IgG1.Sera from coeliac children had poor capacity to mediate NK cell-induced ADCC against gliadin-coated target cells. However, using monocytes as ADCC effector cells, sera from children with active coeliac disease showed a substantial ADCC-mediating capacity. Depletion of IgG1 markedly diminished the ADCC, indicating that IgG1 anti-bodies against gliadin predominantly mediate this gliadin-specific monocyte ADCC. Further, IgG1 as well as IgG3 correlated positively to ADCC reactivity.The avidity of antibodies against dietary antigens seemed to increase progressively during early childhood in healthy as well as diseased children. Active coeliac disease was connected with an accelerated avidity maturation.It is conceivable that several immune effector mechanisms may coexist and synergize in the disease process of food allergy/intolerance. The results of the present study suggest that IgG antibodies against gliadin or b-lactoglobulin, predominantly of the IgG1 iso-type, may be involved in the disease process of coeliac disease or CMPI with gastroin-testinal symptoms, via their capacity to mediate an ADCC reactio

Inflammatory bowel disease and self-esteem in adolescence.

AIM: To compare the self-esteem of adolescents suffering from inflammatory bowel disease (IBD) with that of healthy adolescents, and to identify factors affecting self-esteem in the presence of IBD. METHODS: A self-assessment questionnaire, \u27I think I am\u27 (ITIA), was completed by 71 (41 boys) out of 77 adolescents (10-16 years) with IBD. Of the participating adolescents, 23 had Crohn\u27s disease, 44 had ulcerative colitis and 4 had indeterminate colitis. The self-esteem of adolescents with IBD was compared with that of 1037 school children. RESULTS: In this population-based study, children with IBD estimated their self-esteem in the same range as healthy adolescents. Using a multiple regression analysis, the self-esteem of adolescents with IBD was related to disease course severity and cohabitation status of parents. Children with severe disease and children of single parents were found to be most at risk of low self-esteem. CONCLUSION: This study shows that, as a group, adolescents with IBD have self-esteem in the same range as their healthy peers, but that there are some adolescents with IBD who are at risk of low self-esteem. Special attention should be given to adolescents with a severe disease course and to those with separated parents

Parents' views of their child's health and family function in paediatric inflammatory bowel disease.

Abstract Aim: The aim of this study was to explore parents' views and agreement of their child's current and future health, as well as the family's functioning in daily life with inflammatory bowel disease (IBD). Methods: In this study, 119 parents (65 mothers and 54 fathers) of 66 adolescents (11-16 years) with IBD completed a questionnaire regarding their views of their child's IBD and health-related behaviour. Results: The majority of the parents held a positive view of their child's current health status. However, the parents voiced a range of worries about their children's future health and life situation such as fear about the side effects of medication, concerns for future schooling, social life and employment options. Within the families, the parental pairs had more similar views about their child's current health status than about their future health. Factors that affected the parents' views consisted of cohabitation status, i.e. parents not living together, and severe disease course, both correlated with a more negative view of the child's current health and family functioning. Conclusion: The majority of the parents in this study had a largely positive view of their child's current health status, but they expressed concerns about their child's future health. Knowledge about parents' thoughts may be of importance for healthcare teams supporting families with IBD

Self-reported health, self-management, and the impact of living with inflammatory bowel disease during adolescence.

Perceptions of living with inflammatory bowel disease (IBD) during adolescence were explored in a cross-sectional study with a multimethod design. The adolescents as a group described general well-being and ability to handle the disease, which was related to their self-reported self-esteem. However, a subgroup of adolescents with a severe disease course reported a more negative view of the impact of IBD in their daily lives. Encouraging adolescents to communicate in different ways may help professionals to identify vulnerable subgroups with impaired health and to provide more appropriate support and treatment for those most in need

Altered body composition profiles in young adults with childhood-onset inflammatory bowel disease

Background: Patients with inflammatory bowel disease (IBD) often develop alterations in body composition in terms of their proportions of lean mass and fat mass, as well as reduced bone mineral density (BMD). However, there are limited data on the skeletal muscle index (SMI) and percentage fat (fat %) for young adults with childhood-onset IBD. Our aim was to investigate the body compositions of these patients, with the focus on SMI and fat %. Methods: Body composition was estimated by dual x-ray absorptiometry for 94 young adults with childhood-onset IBD aged 18–27 years, 65 of whom had ulcerative colitis. The Z-scores for SMI, fat %, and BMD were calculated using the normative data from 1,289 individuals with corresponding age. Based on the SMI and fat % Z-scores, each patient was classified as having a body composition profile that was: (i) normal; (ii) obese (fat % Z-score >1); (iii) myopenic (SMI Z-score < −1); or (iv) myopenic-obese. Results: A higher proportion of young adults with childhood-onset IBD had a body composition profile classified as myopenic (24%) or myopenic-obese (9%), as compared to the controls (myopenic [16%, p =.016]; myopenic-obese [2%, p =.002]). Patients with the myopenic or myopenic-obese profile had significantly lower total body BMD Z-scores (−1.3 ± 0.7 and −1.4 ± 0.9, respectively) than patients with the normal profile (−0.2 ± 1.1; p <.001 and p =.004, respectively). Diagnosis of IBD in childhood represented an additional risk for low BMD, regardless of SMI Z-score. Conclusion: Young adults with childhood-onset IBD have a high risk for having altered body composition traits.Summary Young adults with childhood-onset IBD carry a high risk for altered body composition traits. The myopenic and myopenic-obese body composition profiles were more frequently observed in patients with IBD than controls, and these profiles were strongly associated with low BMD

Physical exercise is associated with beneficial bone mineral density and body composition in young adults with childhood-onset inflammatory bowel disease

Background Patients with inflammatory bowel disease (IBD) have an increased risk of compromised bone mineral density (BMD) and body composition. There are limited data on the physical exercise (PE) habits of patients with childhood-onset IBD and on the associations between PE and BMD and body composition. Patients and methods In total, 72 young adults with childhood-onset IBD and 1341 normative young adult controls answered questionnaires regarding PE [hours/week (h/w)] in the last 12 months. BMD and body composition were measured with dual x-ray absorptiometry (DXA) and presented as age- and gender-adjusted Z-scores for BMD, skeletal muscle index (SMI, the weight of lean mass in arms and legs/m2), and percentage body fat (Fat %). Results A total of 41 (57%) patients with IBD engaged in PE during the previous 12 months, as compared to 913 (68%) of the controls (p = .053). Sedentary patients had significantly lower median BMD, SMI, and Fat % Z-scores than the controls with corresponding PE habits (all p 4 h/week) patients had total body BMD, SMI, and Fat % in the same range as the controls with corresponding PE levels (p = .151, p = .992, and p = .189, respectively), albeit with lower BMDs in the spine (p = .007) and femoral neck (p = .015). Using multiple regression analyses, a diagnosis of childhood-onset IBD was independently associated with inferior BMD and body composition, regardless of the amount of PE. Conclusion Physical exercise is associated with beneficial bone mineral density and body composition in patients with IBD despite the negative effects of the disease

Bone mass development from childhood into young adulthood in patients with childhood-onset inflammatory bowel disease

Background: Children who have inflammatory bowel disease (IBD) have increased risk of low bone mineral density (BMD). There is a scarcity of information on BMD development through puberty and into young adulthood in patients with childhood-onset IBD. Methods: We conducted a prospective longitudinal study of BMD in patients with childhood-onset IBD. In total, 74 children with IBD were followed into young adulthood, with a mean follow-up of 8.4 years. The BMD was assessed longitudinally using dual-energy X-ray absorptiometry of the lumbar spine, total hip and whole body, and related to anthropometric measures. Results: Young adult male patients with IBD had lower mean BMD Z-scores for the lumbar spine at −0.8 (±1.1 SD) and total hip at −0.5 (±0.9 SD), as compared to standard references. In young female patients, the BMD Z-scores were within the normal range at all 3 measured sites as compared to the standard references. There were no significant differences in the BMD Z-scores between patients with Crohn's disease and patients with ulcerative colitis. The female and male patients showed significantly improved mean lumbar spine BMD Z-scores during follow-up into young adulthood, indicating that bone accumulation in the lumbar spine continues beyond the expected age for achieving peak bone mass. Conclusions: Male patients with childhood-onset IBD seem to have an increased risk of compromised BMD in young adulthood. Both female and male patients with IBD seem to increase their BMD beyond the age for expected peak bone mass (see Video abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B648)