An overview of the role of exclusive enteral nutrition for complicated Crohn’s disease

Mustafa Adamji,Andrew S Day 대한장연구학회 2019 Intestinal Research Vol.17 No.2

The role and efficacy of exclusive enteral nutrition (EEN) in the treatment of luminal Crohn’s disease (CD) has been well established over the last 2 decades. Consequently, in many centers nutritional therapy is now considered first line therapy in the induction of remission of active CD. However, the use of nutritional therapy in complicated CD has yet to be fully determined. This article aimed to review case reports and clinical trials published in the last decade that have considered and evaluated nutritional therapy in the setting of complicated CD in children and adults. Published literature focusing upon the use of nutritional therapy as part of medical therapy in the management of complicated CD were identified and reviewed. Although there continue to be various interventions utilized for complicated CD, the currently available literature demonstrates that nutritional therapies, especially EEN, have important roles in the management of these complex scenarios. Further assessments, involving large numbers of patients managed with consistent approaches, are required to further substantiate these roles. (Intest Res 2019;17:171-176)

Fecal Calprotectin and Phenotype Severity in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis

Saeedeh Talebi,Andrew S. Day,Majid Khadem Rezaiyan,Golnaz Ranjbar,Mitra Zarei,Mahammad Safarian,Hamid Reza Kianifar 대한소아소화기영양학회 2022 Pediatric gastroenterology, hepatology & nutrition Vol.25 No.1

Inflammation plays an important role in the outcome of patients with cystic fibrosis (CF). It may develop due to cystic fibrosis transmembrane conductance regulator protein dysfunction, pancreatic insufficiency, or prolonged pulmonary infection. Fecal calprotectin (FC) has been used as a noninvasive method to detect inflammation. Therefore, the aim of the current meta-analysis was to investigate the relationship between FC and phenotype severity in patients with CF. In this study, searches were conducted in PubMed, Science Direct, Scopus, and Embase databases up to August 2021 using terms such as “cystic fibrosis,” “intestine,” “calprotectin,” and “inflammation.” Only articles published in English and human studies were selected. The primary outcome was the level of FC in patients with CF. The secondary outcome was the relationship between FC and clinical severity. Statistical analysis was performed using Comprehensive Meta-Analysis software. Of the initial 303 references, only six articles met the inclusion criteria. The mean (95% confidence interval [CI]) level of FC was 256.5 mg/dL (114.1-398.9). FC levels were significantly associated with pancreatic insufficiency (mean, 243.02; 95% CI, 74.3 to 411.6; p=0.005; I2=0), pulmonary function (r=–0.39; 95% CI, –0.58 to –0.15; p=0.002; I2=60%), body mass index (r=–0.514; 95% CI, 0.26 to 0.69; p<0.001; I2=0%), and Pseudomonas colonization (mean, 174.77; 95% CI, 12.5 to 337.02; p=0.035; I2=71%). While FC is a reliable noninvasive marker for detecting gastrointestinal inflammation, it is also correlated with the severity of the disease in patients with CF.

Urinary chitinase 3-like 1 and intestinal fatty-acid binding proteins are not elevated in children with inflammatory bowel disease

Shaun Siong Chung Ho,Jacqueline Ilene Keenan,Andrew Stewart Day 대한장연구학회 2022 Intestinal Research Vol.20 No.4

Parent Perspectives of Diagnostic and Monitoring Tests Undertaken by Their Child with Inflammatory Bowel Disease

Ho, Shaun Siong Chung,Keenan, Jacqueline Ilene,Day, Andrew Stewart The Korean Society of Pediatric Gastroenterology 2021 Pediatric gastroenterology, hepatology & nutrition Vol.24 No.1

Purpose: To assess parent perspectives of the current and potential future tests for their child with inflammatory bowel disease (IBD). Methods: New Zealand parents of a child with IBD were invited to complete an anonymous online survey. Experiences relating to their child's blood or faecal tests, medical imaging (abdominal ultrasound [US], abdominal computerised tomography [CT] and magnetic resonance enterography) and colonoscopy were collected. Perceived attitudes to potential future testing of urine, saliva, and breath, were sought. Results: Twenty-eight parents, 93% female completed the survey, and 86% were aged between 35 and 54 years. Baseline information was provided by parents for 27 of 28 children, 70.3% had Crohn's disease with a mean disease duration of 2.67 years. Blood tests were the most requested and completed tests, while CT was the least ordered and most refused test. Colonoscopy was rated as the least comfortable and generated the most worry. Explanation of test significantly improved parent's levels of understanding when their child had blood, faecal, imaging (US) or colonoscopy tests. Providing an explanation, test invasiveness and the impact of the blood results may have on their child's treatment significantly improved parents' comfort levels. However, explanation of colonoscopy generated a significant parental concerns. Saliva, urine and blood tests were chosen as the most preferred disease monitoring tests. Conclusion: Parents preferred any tests less invasive than colonoscopy for monitoring their child's IBD. Although providing explanation of their child's tests enhanced parents' understanding, it can also affect parents' levels of concern and comfort.

IPMN-LEARN: A linear support vector machine learning model for predicting low-grade intraductal papillary mucinous neoplasms

Yasmin Genevieve Hernandez-Bar,Dania Daye,Carlos F. Fernandez-del Castil,Regina F. Parker,Brenna W. Casey,Andrew L. Warshaw,Cristina R. Ferrone,Keith D. Lillemoe,Motaz Qadan 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.2

Naturopathic approaches to irritable bowel syndrome: protocol for a prospective observational study in academic teaching clinics

Joshua Z. Goldenberg,Amie Steel,Andrew Day,Christina Yap,Ryan Bradley,Kieran Cooley 한국한의학연구원 2018 Integrative Medicine Research Vol.7 No.3

Background: Irritable bowel syndrome (IBS) is a common functional bowel disorder with a worldwide prevalence estimated between 10% and 20%. It has a significant impact on quality of life and societal expense. While there are pharmaceutical options available, few can be reliably recommended. Many IBS sufferers turn to complementary and alternative medicine including naturopathy. Naturopathic approaches to IBS are poorly studied to date. Methods: We aim to describe naturopathic approaches to IBS as well as establish pilot data on before and after changes in validated IBS instruments. The study will employ a multi-centered, international, prospective, observational, naturalistic design. The uncontrolled before-and-after study will examine the outcomes associated with individualized, whole system naturopathic care as determined by each provider. We will recruit adult patients diagnosed with IBS and presenting to a participating naturopathic academic teaching clinic. Participants’ IBS symptoms will be measured using validated instruments (IBS-SSS and IBS-AR). Quality of life will be measured by using the PROMIS-29 profile. Adverse events will be tracked, as followed for treatment descriptions. Our primary outcomes will be before-and-after differences using week twelve as the primary endpoint. A p values will be set at 0.05, and descriptive and summary data will be presented. Discussion: This study is designed to plug significant evidence gaps and to gather preliminary evidence to guide the design of a follow-up randomized active controlled trial. Australia and New Zealand Clinical Trial Registration Number: ACTRN12617001413314

Fecal Calprotectin and Cow’s Milk- Related-Symptoms Score in Children with Cow’s Milk Protein Allergy

Sahar Zain-Alabedeen,Noha Kamel,Mona Amin,Angharad Vernon-Roberts,Andrew S Day,Abdelmoneim Khashana 대한소아소화기영양학회 2023 Pediatric gastroenterology, hepatology & nutrition Vol.26 No.1

Purpose: The cow’s milk-related-symptom-score (CoMiSS) tool was developed as an awareness tool for the assessment of cow’s milk-related symptoms in infants or children. Fecal calprotectin (FC) is a noninvasive biomarker of gut inflammation that can be measured in serum and stool. This study aimed to investigate the relationship between FC levels and CoMiSS scores in infants with cow’s milk protein allergy. Methods: Infants (aged 6-12 months) who were allergic to cow’s milk protein were enrolled prospectively. Following completion of the CoMiSS scoring, the infants were divided into group 1 (positive CoMiSS scores ≥12) and group 2 (negative CoMiSS scores <12). FC was measured using immunoassay. Results: Of the 120 infants enrolled in this study, 60 (50.0%) had positive CoMiSS scores (group 1), while 60 (50.0%) had negative scores (group 2). The mean FC level was higher in the infants in group 1 than those in group 2 (2,934.57 μg/g vs. 955.13 μg/g; p<0.001). In addition, there was a positive correlation between FC and CoMiSS scores (R=0.168, p<0.0001). A FC level of 1,700 μg/g provided a sensitivity of 98.3%, specificity of 93.3%, and accuracy of 95.8% for the diagnosis of cow’s milk protein allergy (CMPA). Conclusion: FC measurement may have a role in the assessing infants with CMPA.

Neurosphere and adherent culture conditions are equivalent for malignant glioma stem cell lines

Maryam Rahman,Karina Reyner,Loic Deleyrolle,Sebastien Millette,Hassan Azari,Bryan W. Day,Brett W. Stringer,Andrew W. Boyd,Terrance G. Johns,Vincent Blot,Rohit Duggal,Brent A. Reynolds 대한해부학회 2015 Anatomy & Cell Biology Vol.48 No.1

Certain limitations of the neurosphere assay (NSA) have resulted in a search for alternative culture techniques forbrain tumor-initiating cells (TICs). Recently, reports have described growing glioblastoma (GBM) TICs as a monolayer usinglaminin. We performed a side-by-side analysis of the NSA and laminin (adherent) culture conditions to compare the growthand expansion of GBM TICs. GBM cells were grown using the NSA and adherent culture conditions. Comparisons weremade using growth in culture, apoptosis assays, protein expression, limiting dilution clonal frequency assay, genetic affymetrixanalysis, and tumorigenicity in vivo. In vitro expansion curves for the NSA and adherent culture conditions were virtuallyidentical (P=0.24) and the clonogenic frequencies (5.2% for NSA vs. 5.0% for laminin, P=0.9) were similar as well. Likewise,markers of differentiation (glial fibrillary acidic protein and beta tubulin III) and proliferation (Ki67 and MCM2) revealedno statistical difference between the sphere and attachment methods. Several different methods were used to determine thenumbers of dead or dying cells (trypan blue, DiIC, caspase-3, and annexin V) with none of the assays noting a meaningfulvariance between the two methods. In addition, genetic expression analysis with microarrays revealed no significant differencesbetween the two groups. Finally, glioma cells derived from both methods of expansion formed large invasive tumors exhibitingGBM features when implanted in immune-compromised animals. A detailed functional, protein and genetic characterization ofhuman GBM cells cultured in serum-free defined conditions demonstrated no statistically meaningful differences when grownusing sphere (NSA) or adherent conditions. Hence, both methods are functionally equivalent and remain suitable options forexpanding primary high-grade gliomas in tissue culture.

Agreement Level of Inflammatory Bowel Disease Symptom Reports between Children and Their Parents

Angharad Vernon-Roberts,Emma Rouse,Nerissa L Bowcock,Daniel A Lemberg,Andrew S Day 대한소아소화기영양학회 2023 Pediatric gastroenterology, hepatology & nutrition Vol.26 No.2

Purpose: Children with inflammatory bowel disease (IBD) frequently undergo clinical assessments, involving triadic communication between clinician, parent, and child. During such encounters parents are traditionally the main communicator of information on their child’s IBD, including subjective symptom reports. The level of agreement between children and their parents for IBD symptoms is poorly understood, and this study aimed to examine this factor. Methods: This was a cross-sectional study among children with IBD, and one parent. A validated paediatric IBD symptom report tool (IBDnow) enabled children and their parent to rate seven pain, well-being, and stool metrics, with dyads completing the tool concurrently. Results were assessed using: Individual agreement: proportion of identical symptom reports by each dyad (ideal score >0.7); Category agreement: percentage of identical reports for IBDnow metrics for the cohort; Inter-rater reliability: Gwet’s AC1 coefficient with higher scores indicating better reliability (maximum=1). Results: Seventy-four parent/child dyads participated; child’s mean age 12.2 years (standard deviation [SD] 2.9, range 6-16), mean time since diagnosis 2.8 years (SD 3), 54% female, 73% had Crohn’s Disease. Mean individual agreement level was 0.6, with 27% of dyads agreeing on ≥6/7 IBDnow metrics. Category agreement was reported by 61% of dyads, 20% of parents overestimated, and 19% underestimated, their child’s symptoms. Inter-rater reliability ranged from fair to good. Conclusion: These results should improve clinician awareness of how IBD symptom reports from parents may introduce bias. Children should be considered the most important source of symptom reports, and tools such as IBDnow utilised to enhance communication.

Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn's Disease: The Patient Perspective

Stephanie Christine Brown,Catherine L Wall,Richard B Gearry,Andrew S Day The Korean Society of Pediatric Gastroenterology 2023 Pediatric gastroenterology, hepatology & nutrition Vol.26 No.3

Crohn's disease (CD) is a chronic, incurable and relapsing disease involving any part of the gastrointestinal tract and exclusive enteral nutrition (EEN) is first-line therapy. Few studies have examined the patient experience of EEN. The aim of this study was to assess the child's experiences of EEN, to identify problematic themes and understand the child's mindset. Children with CD who previously completed EEN were recruited to complete a survey. All data were analyzed using Microsoft Excel and reported as N (%). Forty-four children (mean age 11.3 years) consented to participate. Sixty-eight percent of children reported limited formula flavors as the most challenging aspect and 68% of children identified 'support' to be important. This study highlights the psychological impact of chronic disease and its therapies on children. Providing adequate support is essential to insure EEN is successful. Further studies are required to determine psychological support strategies for children taking EEN.