随着时间的推移,全国范围的真实世界独家肠道营养实践:作为儿童克罗恩病诱导的持续使用以及新兴的与生物药物的组合策略
David I F Wands1,2,3, Laura Gianolio1, David C Wilson1,3
1Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom.
Inflammatory bowel diseases
|August 24, 2023
概括
独家肠道营养 (EEN) 仍然是儿童克罗恩病的关键治疗方法. EEN的使用一直稳定,但与生物药物的联合治疗正在增加,除了COVID-19大流行期间.
科学领域:
- 儿科胃肠病学 儿科胃肠病学
- 炎症性肠病研究研究
- 临床营养学 临床营养学
背景情况:
- 独家肠道营养 (EEN) 是对儿科克罗恩病 (CD) 的标准一线诱导疗法.
- 越来越多地使用生物疗法为EEN实践带来了不断变化的景观.
- 了解EEN趋势对于优化儿科CD管理至关重要.
研究的目的:
- 分析儿童克罗恩病专用肠道营养 (EEN) 实践的国家趋势.
- 评估增加生物使用对EEN管理的影响.
- 检查COVID-19大流行期间EEN的利用情况.
主要方法:
- 在苏格兰 (2015-2022) 全国范围内对新诊断的儿科CD患者进行分析.
- 用于时间分析,将接受EEN的患者分类为每6个月的时代.
- 对人口统计,EEN管理和结果进行回顾性数据收集,包括在COVID-19期间.
主要成果:
- 7.5年来,整体EEN使用率或结果 (缓解,响应,完成) 没有显著变化.
- 观察到越来越多地将EEN与生物药物结合使用为一线诱导策略.
- 在COVID-19大流行期间,EEN使用量暂时下降,但没有影响结果.
结论:
- 对于儿科克罗恩病来说,EEN仍然是一个一致的治疗方法,使用率稳定.
- 与生物药物联合治疗是第一线诱导的新兴趋势.
- 流行病相关的干扰暂时影响了EEN的使用,但没有影响其有效性.
相关概念视频
Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
199
Enteral nutrition encompasses various methods of delivering nutrition directly to the gastrointestinal (GI) tract, bypassing traditional oral intake. It is particularly beneficial for patients who cannot eat by mouth but have a functioning digestive system. Key methods include nasointestinal feeding, gastrostomy, and jejunostomy, each suited to different clinical scenarios based on the patient's needs and condition.
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
199
Inflammatory Bowel Disease IV: Pharmacological Management
152
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
152
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
173
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
173
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
150
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
150
Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
355
Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
355
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
195
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
195


