Treatment of pediatric refractory Crohn’s disease with thalidomide

AIM: To assess the efficacy and tolerability of thalidomide in pediatric Crohn's disease (CD). METHODS: Six patients with refractory CD received thalidomide at an initial dose of 2 mg/kg per day for one month, then increased to 3 mg/kg per day or decreased to 1 mg/kg per day, and again further reduced to 0.5 mg/kg per day, according to the individual patient's response to the drug. RESULTS: Remission was achieved within three months. Dramatic clinical improvement was demonstrated after thalidomide treatment. Endoscopic and pathological improvements were also observed after thalidomide treatment, which was well tolerated by all patients. CONCLUSION: Thalidomide is a useful drug for pediatric refractory CD.

Coordination and nursing care of pediatric patients undergoing double balloon enteroscopy

AIM:To review safety,efficacy,and proper nursing care of double-balloon enteroscopy (DBE) in pediatric patients with small intestinal disease.METHODS:Our study included 37 patients with abdominal pain,diarrhea,passage of blood in the stools,and other symptoms,who underwent DBE from December 2006 to July 2010.DBE was retrograde in 36 procedures,antegrade in six,and from both ends in five.The diagnostic significance and salient points in nursing care are discussed in this article.RESULTS:At least one lesion was discovered in 28 out of 37 patients,which yielded a positive diagnosis in 75.7% of cases.Good bowel preparation and skilled nursing care not only shortened the procedure time,but could also alleviate patient discomfort and enhance the quality of examination.No serious procedure-related complications were observed in any cases.CONCLUSION:DBE is a new modality of endoscopic procedure that improves the standard of diagnosis and treatment of small bowel diseases in children.Good nursing care is essential to the successful execution of the procedure.

Efficacy of thalidomide therapy in pediatric Crohn's disease with evidence of tuberculosis

AIM To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn's disease(CD) with tuberculosis infection.METHODS A retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year,and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.RESULTS Ten patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate,C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.CONCLUSION Thalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.

Selective endoscopic ligation for treatment of upper gastrointestinal protuberant lesions

This study explored the clinical value of endoscopic ligation for the treatment of upper gastrointestinal(GI)protuberant lesions in children.According to the appearance and size of lesions,we used different ligation techniques for the treatment of the lesions.Endoscopic ultrasonography was used for preliminary characterization of the lesions.One case diagnosed with PeutzJeghers syndrome was successfully treated by a detachable snare.Two cases with semi-pedunculated or broad-base lesions originating from the submucosal layer of the upper GI were treated with endoscopic variceal ligation;endoscopic examination showed that one case had complete healing 11 wk after ligation,while an ulcer scar was observed at the ligation site after 6 wk in the other case.All lesions were successfully ligated at the first attempt.No significant complications occurred either during or after the procedure.Selective endoscopic ligation of upper GI lesions is an effective and safe treatment for upper GI protuberant lesions in children.

Consensus for criteria of running a pediatric inflammatory bowel disease center using a modified Delphi approach

Background Good quality of care for inflammatory bowel disease(IBD)depends on high-standard management and facility in the IBD center.Yet,there are no clear measures or criteria for evaluating pediatric IBD(PIBD)center in China.The aim of this study was to develop a comprehensive set of quality indicators(QIs)for evaluating PIBD center in China.Methods A modified Delphi consensus-based approach was used to identify a set of QIs of structure,process,and outcomes for defining the criteria.The process included an exhaustive search using complementary approaches to identify potential QIs,and two web-based voting rounds to select the QIs defining the criteria for PIBD center.Results A total of 101 QIs(35 structures,48 processes and 18 outcomes)were included in this consensus.Structure QIs focused on the composition of multidisciplinary team,facilities and services that PIBD center should provide.Process QIs highlight core requirements in diagnosing,evaluating,treating PIBD,and disease follow-up.Outcome QIs mainly included criteria evaluating effectiveness of various interventions in PIBD centers.Conclusion The present Delphi consensus developed a set of main QIs that may be useful for managing a PIBD center.