text:
section length and abnormal Schilling test result. CONCLUSIONS: Patients with Crohn's disease and terminal ileal resections <20 cm are not at risk of developing vitamin B12 deficiency. For patients with resections of 20-60 cm, options include doing a Schilling test and treating those with abnormal results, empirically treating patients on the presumption that they are at high risk of developing deficiency, or monitoring for biochemical evidence of deficiency. Further studies are needed to determine whether oral supplementation is effective in these patients.},
   keywords = {Adult
Anastomosis, Surgical
Crohn Disease/*metabolism/*surgery
Female
Humans
Ileum/*metabolism/*surgery
Intestinal Absorption
Malabsorption Syndromes/epidemiology/etiology
Male
Risk Factors
Vitamin B 12/*pharmacokinetics
Vitamin B 12 Deficiency/epidemiology/*etiology},
   ISSN = {0899-9007 (Print)
0899-9007},
   Accession Number = {17095407},
   DOI = {10.1016/j.nut.2006.08.017},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Duerr, R. H. and Taylor, K. D. and Brant, S. R. and Rioux, J. D. and Silverberg, M. S. and Daly, M. J. and Steinhart, A. H. and Abraham, C. and Regueiro, M. and Griffiths, A. and Dassopoulos, T. and Bitton, A. and Yang, H. and Targan, S. and Datta, L. W. and Kistner, E. O. and Schumm, L. P. and Lee, A. T. and Gregersen, P. K. and Barmada, M. M. and Rotter, J. I. and Nicolae, D. L. and Cho, J. H.},
   title = {A genome-wide association study identifies IL23R as an inflammatory bowel disease gene},
   journal = {Science},
   volume = {314},
   number = {5804},
   pages = {1461-3},
   note = {1095-9203
Duerr, Richard H
Taylor, Kent D
Brant, Steven R
Rioux, John D
Silverberg, Mark S
Daly, Mark J
Steinhart, A Hillary
Abraham, Clara
Regueiro, Miguel
Griffiths, Anne
Dassopoulos, Themistocles
Bitton, Alain
Yang, Huiying
Targan, Stephan
Datta, Lisa Wu
Kistner, Emily O
Schumm, L Philip
Lee, Annette T
Gregersen, Peter K
Barmada, M Michael
Rotter, Jerome I
Nicolae, Dan L
Cho, Judy H
DK62413/DK/NIDDK NIH HHS/United States
U01 DK062413/DK/NIDDK NIH HHS/United States
DK62431/DK/NIDDK NIH HHS/United States
U01 DK062432/DK/NIDDK NIH HHS/United States
U01 DK062429/DK/NIDDK NIH HHS/United States
P30 DK063491-039004/DK/NIDDK NIH HHS/United States
DK62429/DK/NIDDK NIH HHS/United States
DK62420/DK/NIDDK NIH HHS/United States
P30 DK063491/DK/NIDDK NIH HHS/United States
U01 DK062422/DK/NIDDK NIH HHS/United States
DK62422/DK/NIDDK NIH HHS/United States
P30 DK063491-029004/DK/NIDDK NIH HHS/United States
P30 DK063491-019004/DK/NIDDK NIH HHS/United States
U01 DK062423/DK/NIDDK NIH HHS/United States
P30 DK063491-049004/DK/NIDDK NIH HHS/United States
DK62432/DK/NIDDK NIH HHS/United States
DK62423/DK/NIDDK NIH HHS/United States
U01 DK062420/DK/NIDDK NIH HHS/United States
U01 DK062431/DK/NIDDK NIH HHS/United States
Journal Article
Research Support, N.I.H., Extramural
United States
Science. 2006 Dec 1;314(5804):1461-3. Epub 2006 Oct 26.},
   abstract = {The inflammatory bowel diseases Crohn's disease and ulcerative colitis are common, chronic disorders that cause abdominal pain, diarrhea, and gastrointestinal bleeding. To identify genetic factors that might contribute to these disorders, we performed a genome-wide association study. We found a highly significant association between Crohn's disease and the IL23R gene on chromosome 1p31, which encodes a subunit of the receptor for the proinflammatory cytokine interleukin-23. An uncommon coding variant (rs11209026, c.1142G>A, p.Arg381Gln) confers strong protection against Crohn's disease, and additional noncoding IL23R variants are independently associated. Replication studies confirmed IL23R associations in independent cohorts of patients with Crohn's disease or ulcerative colitis. These results and previous studies on the proinflammatory role of IL-23 prioritize this signaling pathway as a therapeutic target in inflammatory bowel disease.},
   keywords = {Alleles
Case-Control Studies
Chromosomes, Human, Pair 1/genetics
Cohort Studies
Colitis, Ulcerative/genetics
Crohn Disease/*genetics
Genetic Markers
Genetic Predisposition to Disease
Genetic Testing
Genome, Human
Haplotypes
Humans
Interleukin-23/metabolism
Jews/genetics
Linkage Disequilibrium
*Polymorphism, Single Nucleotide
Receptors, Interleukin/*genetics/physiology
Signal Transduction},
   ISSN = {0036-8075},
   Accession Number = {17068223},
   DOI = {10.1126/science.1135245},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Ebach, D. R. and Newberry, R. and Stenson, W. F.},
   title = {Differential role of tumor necrosis factor receptors in TNBS colitis},
   journal = {Inflamm Bowel Dis},
   volume = {11},
   number = {6},
   pages = {533-40},
   note = {Ebach, Dawn R
Newberry, Rodney
Stenson, William F
DK33165/DK/NIDDK NIH HHS/United States
DK55753/DK/NIDDK NIH HHS/United States
P30DK052574/DK/NIDDK NIH HHS/United States
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
United States
Inflamm Bowel Dis. 2005 Jun;11(6):533-40.},
   abstract = {BACKGROUND: Tumor necrosis factor alpha (TNFalpha) plays a central role in the pathology of T helper 1-mediated colitis such as Crohn's disease; however, the role of its 2 receptors in mediating pathology has not been fully explored. METHODS: Trinitrobenzene sulfonic acid colitis was used to induce colitis in mice lacking each of the TNF receptors (TNFRs) and in wild-type mice. TNFR1-/- mice lost more weight, became hypothermic, and had increased mortality compared with wild-type C57Bl/6 mice. TNFR2-/- mice, however, lost less weight, had normal temperatures, and had improved survival. RESULTS: Despite the improved clinical outcomes in TNFR2-/- mice, TNFalpha levels were increased in these mice. CONCLUSIONS: TNFalpha signaling through TNFR1 is protective in the trinitrobenzene sulfonic acid mouse model of inflammatory bowel disease.},
   keywords = {Animals
Colitis/*physiopathology/veterinary
Disease Models, Animal
Hypothermia/etiology
Mice
Mice, Inbred C57BL
Mortality
Receptors, Tumor Necrosis Factor/*physiology
Trinitrobenzenesulfonic Acid/administration & dosage/toxicity
Tumor Necrosis Factor-alpha/*analysis
Weight Loss},
   ISSN = {1078-0998 (Print)
1078-0998},
   Accession Number = {15905700},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Eidelwein, A. P. and Cuffari, C. and Abadom, V. and Oliva-Hemker, M.},
   title = {Infliximab efficacy in pediatric ulcerative colitis},
   journal = {Inflamm Bowel Dis},
   volume = {11},
   number = {3},
   pages = {213-8},
   note = {Eidelwein, Alexandra P
Cuffari, Carmen
Abadom, Vivian
Oliva-Hemker, Maria
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
United States
Inflamm Bowel Dis. 2005 Mar;11(3):213-8.},
   abstract = {BACKGROUND: The effects of infliximab, a tumor necrosis factor-alpha (TNF-alpha) antibody, have been well established in adult patients with inflammatory and fistulizing Crohn's disease. This study evaluates short- and long-term efficacy of infliximab in children with ulcerative colitis. METHODS: All pediatric patients with ulcerative colitis who received infliximab between July 2001 and November 2003 at the Johns Hopkins Children's Center were identified. Short- and long-term outcomes and adverse reactions were evaluated. RESULTS: Twelve pediatric patients with ulcerative colitis received infliximab for treatment of fulminant colitis (3 patients), acute exacerbation of colitis (3), steroid-dependent colitis (5), and steroid-refractory colitis (1). Nine patients had a complete short-term response, and 3 had partial improvement. The mean per patient dose of corticosteroid after the first infliximab infusion decreased from 45 mg/day at the first infusion to 22.2 mg/day at 4 weeks (P = 0.02) and 7.8 mg/day at 8 weeks (P = 0.008). Eight patients were classified as long-term responders with a median follow-up time of 10.4 months. Of the 4 long-term nonresponders, 3 underwent colectomy, and the fourth has ongoing chronic symptoms. Three of 4 long-term nonresponders were steroid-refractory compared with 1 of 8 long-term responders. Patients receiving 6-mercaptopurine had a better response to infliximab. CONCLUSION: Infliximab should be considered in the treatment of children with symptoms of acute moderate to severe ulcerative colitis.},
   keywords = {Adolescent
Adrenal Cortex Hormones/therapeutic use
Adult
Antibodies, Monoclonal/administration & dosage/*therapeutic use
Child
Child, Preschool
Colectomy
Colitis, Ulcerative/*drug therapy/pathology
Female
Gastrointestinal Agents/administration & dosage/*therapeutic use
Humans
Infliximab
Male
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Tumor Necrosis Factor-alpha},
   ISSN = {1078-0998 (Print)
1078-0998},
   Accession Number = {15735427},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Eivindson, M. and Gronbaek, H. and Nielsen, J. N. and Frystyk, J. and Flyvbjerg, A. and Jorgensen, L. and Vind, I. and Munkholm, P. and Jensen, S. and Brandslund, I. and Hey, H.},
   title = {Insulin-like growth factors (IGFs) and IGF binding proteins in active Crohn's disease treated with omega-3 or omega-6 fatty acids and corticosteroids},
   journal = {Scand J Gastroenterol},
   volume = {40},
   number = {10},
   pages = {1214-21},
   note = {Eivindson, Martin
Gronbaek, Henning
Nielsen, Jens Nederby
Frystyk, Jan
Flyvbjerg, Allan
Jorgensen, Lone
Vind, Ida
Munkholm, Pia
Jensen, Soren
Brandslund, Ivan
Hey, Henrik
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
England
Scand J Gastroenterol. 2005 Oct;40(10):1214-21.},
   abstract = {OBJECTIVE: Catabolism and growth impairment are well-known complications of inflammatory bowel disease (IBD). This may be caused by the disease activity itself and/or the medical treatment, and both may lead to changes in the growth hormone (GH)/insulin-like growth factor I (IGF-I) axis. The aim of the present study was to examine the effects of enteral nutrition, Impact Powder, as adjuvant therapy to corticosteroid treatment on changes in the GH/IGF-I axis in patients with Crohn's disease (CD). MATERIAL AND METHODS: The patients were randomized to 3-IP (omega-3-fatty acid (FA), 3 g/day) or 6-IP (omega-6-FA, 9 g/day). Changes in total IGF-I (tIGF-I) and total IGF-II (tIGF-II), free IGF-I (fIGF-I), IGF binding proteins (IGFBP-1 and IGFBP-3), IGFBP-3 protease activity and insulin levels were examined in 31 patients with active CD (CDAI: 186-603) during treatment with prednisolone (40 mg for 1 week) and tapering the dose by 5 mg/week. Clinical and biochemical markers of inflammation were studied at day 0, and after 5 and 9 weeks. RESULTS: There were no differences at baseline between the two groups. During the treatment period, tIGF-I, fIGF-I and IGFBP-3 increased significantly in both groups compared to baseline (p<0.05) without differences between the groups. Insulin and IGFBP-1 showed no significant changes throughout the treatment period. CONCLUSIONS: There was no difference between 3-IP and 6-IP as adjuvant enteral nutrition on the GH/IGF-I axis. The changes observed in the GH/IGF-I axis are in line with previously published studies and may be explained by corticosteroid treatment; however, we cannot exclude an additional effect of omega3-/omega6 FA as adjuvant enteral nutrition.},
   keywords = {Adolescent
Adrenal Cortex Hormones/*therapeutic use
Adult
Aged
Biomarkers/blood
Body Mass Index
C-Reactive Protein/metabolism
Crohn Disease/blood/*drug therapy
Endopeptidases/blood/drug effects
Fatty Acids, Omega-3/*therapeutic use
Fatty Acids, Omega-6/*therapeutic use
Female
Humans
Immunoassay
Insulin/blood
Insulin-Like Growth Factor Binding Proteins/blood/classification/*drug effects
Male
Middle Aged
Prednisolone/therapeutic use
Somatomedins/classification/*drug effects/metabolism
Treatment Outcome},
   ISSN = {0036-5521 (Print)
0036-5521},
   Accession Number = {16265778},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {El-Matary, W. and Jaffray, B. and Scott, J. and Hodges, S.},
   title = {Portal pyaemia as a presenting feature of paediatric crohn disease},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {43},
   number = {2},
   pages = {260-2},
   note = {El-Matary, W
Jaffray, B
Scott, J
Hodges, S
Case Reports
Journal Article
United States
J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):260-2.},
   keywords = {Adolescent
Anti-Bacterial Agents/therapeutic use
Crohn Disease/*complications/diagnostic imaging/surgery
Diagnosis, Differential
Female
Humans
Phlebitis/diagnostic imaging/drug therapy/*etiology
*Portal Vein
Tomography, X-Ray Computed
Treatment Outcome},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {16877996},
   DOI = {10.1097/01.mpg.0000221900.38286.17},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Eradi, B. and Sandhu, B. K. and Spray, C. and Cusick, E.},
   title = {Highly destructive perianal crohn disease},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {41},
   number = {5},
   pages = {667-9},
   note = {Eradi, Balgopal
Sandhu, B K
Spray, Christine
Cusick, Eleri
Case Reports
Journal Article
United States
J Pediatr Gastroenterol Nutr. 2005 Nov;41(5):667-9.},
   keywords = {Anti-Infective Agents/therapeutic use
Anti-Inflammatory Agents/therapeutic use
Anus Diseases/etiology/*pathology/surgery
Child
Child, Preschool
Colectomy
Crohn Disease/*complications/pathology/surgery
Humans
Male
Rectal Diseases/etiology/*pathology/surgery
Treatment Outcome},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {16254528},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Esaki, M. and Matsumoto, T. and Hizawa, K. and Nakamura, S. and Jo, Y. and Mibu, R. and Iida, M.},
   title = {Preventive effect of nutritional therapy against postoperative recurrence of Crohn disease, with reference to findings determined by intra-operative enteroscopy},
   journal = {Scand J Gastroenterol},
   volume = {40},
   number = {12},
   pages = {1431-7},
   note = {Esaki, Motohiro
Matsumoto, Takayuki
Hizawa, Kazuoki
Nakamura, Shotaro
Jo, Yukihiko
Mibu, Ryuichi
Iida, Mitsuo
Journal Article
England
Scand J Gastroenterol. 2005 Dec;40(12):1431-7.},
   abstract = {OBJECTIVE: The aim of this study was to elucidate the predictive value of intra-operative enteroscopy (IOE) and the effect of enteral nutrition (EN) with regard to the postoperative recurrence of Crohn disease (CD). MATERIAL AND METHODS: Forty patients requiring surgery for severe intestinal complications of CD were examined by IOE, and the severity of the remnant small intestine was determined. Patients were subclassified into either an EN group (>1,200 kcal/day) or a non-EN group (<1,200 kcal/day) according to the amount of daily EN intake after surgery. Contributions of IOE findings and EN to postoperative recurrence were analysed retrospectively. RESULTS: IOE identified intestinal lesions in 39 patients and active intestinal lesions in 24 patients. The cumulative rate of postoperative recurrence was significantly higher in patients with cobblestone appearance confirmed by IOE (p=0.006). However, other active intestinal lesions were not related to postoperative recurrence. EN reduced the cumulative rate of postoperative recurrence (p=0.017), especially in patients with penetrating type (p=0.005), in patients who did not have colitis (p=0.051) and in patients who did not have active intestinal lesions confirmed by IOE (p=0.02). CONCLUSIONS: EN is a prophylactic that prevents the postoperative recurrence of small intestinal CD. Patients with the penetrating type of CD, and those who do not have active lesions in the small intestine according to IOE, are candidates for EN after surgery.},
   keywords = {Adolescent
Adult
Aged
Crohn Disease/*pathology/*prevention & control/surgery
*Endoscopy, Gastrointestinal
*Enteral Nutrition
Female
Follow-Up Studies
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Secondary Prevention
Treatment Outcome},
   ISSN = {0036-5521 (Print)
0036-5521},
   Accession Number = {16316891},
   DOI = {10.1080/00365520510023729},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Esaki, M. and Matsumoto, T. and Nakamura, S. and Yada, S. and Fujisawa, K. and Jo, Y. and Iida, M.},
   title = {Factors affecting recurrence in patients with Crohn's disease under nutritional therapy},
   journal = {Dis Colon Rectum},
   volume = {49},
   number = {10 Suppl},
   pages = {S68-74},
   note = {Esaki, Motohiro
Matsumoto, Takayuki
Nakamura, Shotaro
Yada, Shinichiro
Fujisawa, Kiyoshi
Jo, Yukihiko
Iida, Mitsuo
Comparative Study
Journal Article
United States
Dis Colon Rectum. 2006 Oct;49(10 Suppl):S68-74.},
   abstract = {PURPOSE: This retrospective study was designed to determine risk factors for recurrence of Crohn's disease under enteral nutrition. METHODS: The clinical course of 145 patients with Crohn's disease, who were primarily induced into remission by total parenteral nutrition, was reviewed. The patients were classified into two groups: enteral nutrition group (n = 98; >/=1,200 kcal/day of enteral nutrition), or nonenteral nutrition group (n = 47;<1,200 kcal/day of enteral nutrition) according to the amount of their daily elemental or polymeric diet. Contributions of enteral nutrition and other clinical variables to the recurrence were analyzed retrospectively. A Crohn's disease activity index of >150 plus an increase in Crohn's disease activity index of >70 from the baseline value was defined as recurrence. RESULTS: Forty-two patients in the enteral nutrition group and 29 patients in the nonenteral nutrition group recurred during periods ranging from 3 to 159 months. The cumulative rate of recurrence was significantly higher in the nonenteral nutrition group than in the enteral nutrition group (P = 0.047). Among the Crohn's disease patients in the enteral nutrition group, penetrating type (relative risk, 3.89; 95 percent confidence interval, 1.58-9.62), colonic involvement (relative risk, 3.10; 95 percent confidence interval, 1.39-6.9), and previous history of surgery (relative risk, 2.48; 95 percent confidence interval, 1.16-5.33) were factors that significantly affected recurrence. In contrast, penetrating type was the only possible factor associated with recurrence in the nonenteral nutrition group (relative risk, 2.75; 95 percent confidence interval, 0.96-7.81). CONCLUSIONS: Among patients with Crohn's disease under maintenance enteral nutrition, the risk of recurrence differs according to the disease type and the site of involvement. The maintenance treatment by enteral nutrition alone seems insufficient for patients with penetrating type or with colonic involvement.},
   keywords = {Adolescent
Adult
Aged
Chi-Square Distribution
Crohn Disease/*diet therapy/*pathology
Enteral Nutrition
Female
Humans
Male
Middle Aged
Nutrition Therapy/*methods
Recurrence
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Treatment Outcome},
   ISSN = {0012-3706 (Print)
0012-3706},
   Accession Number = {17106818},
   DOI = {10.1007/s10350-006-0692-1},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Escher, J. C.},
   title = {Nutritional therapy in paediatric Crohn's disease: More food for thought?},
   journal = {Dig Liver Dis},
   volume = {38},
   number = {6},
   pages = {387-8},
   note = {Escher, J C
Comment
Journal Article
Netherlands
Dig Liver Dis. 2006 Jun;38(6):387-8. Epub 2006 Mar 29.},
   keywords = {Child
Crohn Disease/*therapy
*Enteral Nutrition
Humans
Nutritional Status
Remission Induction},
   ISSN = {1590-8658 (Print)
1590-8658},
   Accession Number = {16574514},
   DOI = {10.1016/j.dld.2006.02.006},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Fearnhead, N. S. and Chowdhury, R. and Box, B. and George, B. D. and Jewell, D. P. and Mortensen, N. J.},
   title = {Long-term follow-up of strictureplasty for Crohn's disease},
   journal = {Br J Surg},
   volume = {93},
   number = {4},
   pages = {475-82},
   note = {Fearnhead, N S
Chowdhury, R
Box, B
George, B D
Jewell, D P
Mortensen, N J McC
Journal Article
England
Br J Surg. 2006 Apr;93(4):475-82.},
   abstract = {BACKGROUND: Strictureplasty is an effective means of alleviating obstructive Crohn's disease while conserving bowel length. The aim of this study was to establish long-term outcomes of strictureplasty. METHODS: Between 1978 and 2003, 479 strictureplasties were performed in 100 patients during 159 operations. Information on Crohn's disease, medical therapy, laboratory indices, surgical details, complication rates and outcomes was recorded. The primary endpoint was abdominal reoperation. RESULTS: Mean follow-up was 85.1 (range 0.2-240.9) months. The overall morbidity rate was 22.6 per cent, with septic complications in 11.3 per cent, obstruction in 4.4 per cent and gastrointestinal haemorrhage in 3.8 per cent. The 30-day mortality rate was 0.6 per cent and the procedure-related series mortality rate 3.0 per cent. Perioperative parenteral nutrition was the only marker for morbidity (P < 0.001). Reoperation rates were 52 per cent at a mean of 40.2 (range 0.2-205.8) months after a first, 56 per cent at 26.1 (range 3.5-63.5) months after a second, 86 per cent at 27.4 (range 1.4-74.5) months after a third, and 62.5 per cent at 25.9 (range 7.3-70.5) months following a fourth strictureplasty procedure. The major risk factor for reoperation was young age (P < 0.001). CONCLUSION: Long-term follow-up has confirmed the safety of strictureplasty in Crohn's disease. Morbidity is appreciable, although the surgical mortality rate is low. Reoperation rates are comparable following first and repeat strictureplasty procedures.},
   keywords = {Adolescent
Adult
Aged
Crohn Disease/complications/*surgery
Female
Follow-Up Studies
Humans
Ileal Diseases/etiology/*surgery
Intestinal Obstruction/etiology/*surgery
Male
Middle Aged
Postoperative Complications/*etiology
Reoperation/statistics & numerical data
Retrospective Studies
Risk Factors
Suture Techniques},
   ISSN = {0007-1323 (Print)
0007-1323},
   Accession Number = {16502479},
   DOI = {10.1002/bjs.5179},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Fell, J. M.},
   title = {Control of systemic and local inflammation with transforming growth factor beta containing formulas},
   journal = {JPEN J Parenter Enteral Nutr},
   volume = {29},
   number = {4 Suppl},
   pages = {S126-8; discussion S129-33, S184-8},
   note = {Fell, John M E
Journal Article
Research Support, Non-U.S. Gov't
Review
United States
JPEN J Parenter Enteral Nutr. 2005 Jul-Aug;29(4 Suppl):S126-8; discussion S129-33, S184-8.},
   abstract = {Enteral nutrition therapy with liquid diet has been shown to be effective in achieving clinical remission in intestinal Crohn's disease. The mechanism of action of this therapy, however, is still poorly understood. As part of our assessment of the action of 3 related polymeric enteral therapies, we have used a variety of techniques to document the histological and cytokine responses, in the mucosa and, systemically, to these treatments. The feeds studied (AL110, Modulen IBD and ACD004 [Nestle, Vevey, Switzerland]) all have casein as the protein source, are lactose free and are rich in transforming growth factor beta (TGF-beta). They have all been shown to induce clinical remission associated with mucosal healing. In the case of Modulen IBD, as well as mucosal macroscopic and histological healing there was a fall in mucosal proinflammatory cytokines: interleukin-1 mRNA in colonic and ileal, interleukin-8 mRNA in the colon and interferon gamma mRNA in the ileum, but a rise in the regulatory cytokine TGF-beta mRNA in the ileum. These results indicate that these formulas are influencing the disease process itself, and thus suggest that the clinical remission achieved is a result of a reduction in inflammation, rather than a consequence of some other nutrition effect.},
   keywords = {Crohn Disease/therapy
Cytokines/biosynthesis/drug effects
*Enteral Nutrition
Humans
Inflammation/therapy
Inflammatory Bowel Diseases/*therapy
Intestinal Mucosa/immunology/pathology
Remission Induction
Transforming Growth Factor beta/*therapeutic use},
   ISSN = {0148-6071 (Print)
0148-6071},
   Accession Number = {15980274},
   DOI = {10.1177/01486071050290s4s126},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Ferrante, M. and Penninckx, F. and De Hertogh, G. and Geboes, K. and D'Hoore, A. and Noman, M. and Vermeire, S. and Rutgeerts, P. and Van Assche, G.},
   title = {Protein-losing enteropathy in Crohn's disease},
   journal = {Acta Gastroenterol Belg},
   volume = {69},
   number = {4},
   pages = {384-9},
   note = {Ferrante, Marc
Penninckx, Freddy
De Hertogh, Gert
Geboes, Karel
D'Hoore, Andre
Noman, Maja
Vermeire, Severine
Rutgeerts, Paul
Van Assche, Gert
Case Reports
Journal Article
Belgium
Acta Gastroenterol Belg. 2006 Oct-Dec;69(4):384-9.},
   abstract = {Protein-losing enteropathy (PLE) is a rare but severe complication of Crohn's disease (CD) and hypoalbuminemia can be one of the presenting symptoms of this illness. The diagnosis of PLE can only be made after exclusion of malnutrition and liver or kidney failure. Significant intestinal leakage can be caused by mucosal injury, increased lymphatic pressure or dilated lymphatics and has been reported in a large number of diseases. The protein-losing can be diagnosed by assessing the excretion of different radiolabeled macromolecules in the faeces or by the clearance of alpha-1-antitrypsine in stools. The primary approach should be the optimization of the nutritional status. Medical treatment of the underlying disease is primordial. In other cases surgical resection of the most affected areas is inevitable. We report a case of a 21-year-old male with a 4 year history of CD, who developed significant hypoproteinemia with pitting oedema, initially in the absence of any other sign of severe disease activity. A "Cr-chloride albumin excretion confirmed our hypothesis of protein-losing enteropathy. Because of sub-obstruction signs some months later, a laparotomy was performed which revealed a severely affected loop with dilatation of the proximal jejunum. Interestingly, multiple large lymph nodes and dilated lymphatics were seen. A partial jejunal resection was performed for stricturing Crohn's disease. Histology showed severe mesenteric granulomatosis, dilated lymph vessels and granulomatous vasculitis. After the resection our patient improved without further albumin infusions and the oedema resolved.},
   keywords = {Adult
Crohn Disease/*complications/pathology/surgery
Humans
Jejunum/pathology/surgery
Laparoscopy
Male
Protein-Losing Enteropathies/diagnosis/*etiology
Treatment Outcome},
   ISSN = {1784-3227 (Print)
1784-3227},
   Accession Number = {17343081},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Ferrarese, F. and Cecere, V. and Fabiano, G.},
   title = {[Extensive small bowel resections]},
   journal = {Chir Ital},
   volume = {57},
   number = {5},
   pages = {631-4},
   note = {Ferrarese, Filippo
Cecere, Vincenzo
Fabiano, Gennaro
English Abstract
Journal Article
Italy
Chir Ital. 2005 Sep-Oct;57(5):631-4.},
   abstract = {Bowel resections of at least 70% of the total length give rise to nutritional and metabolic disorders. The consequences are also related to the site of the resection itself, to the causative disease and thus to the patient's morphological and functional adaptation capacity. Over the past 20 years we have operated on 32 patients for vascular disorders, Crohn's disease, intestinal volvulus, actinic enteritis, and ileo-caecal carcinoma. In all patients total parenteral nutrition was started and followed by enteral nutrition and oral feeding after variable periods of time. The postoperative course, in terms of adaptation and stabilisation, was regular on most cases: only in the patients operated on for Crohn's disease was symptom and nutritional remission belated or incomplete. The perioperative mortality was 34% (11 patients). The extent of the resection was often conditioned by the topography of irreversible anatomico-pathological lesions and only in one case did a colic resection prove necessary. In more extensive resections, involving a longer adaptation time, enteral nutrition was supplemented with total parenteral nutrition for lengthier periods.},
   keywords = {Cecal Neoplasms/surgery
Crohn Disease/surgery
Enteral Nutrition
Enteritis/surgery
Humans
Ileal Neoplasms/surgery
Intestinal Volvulus/surgery
Intestine, Small/*surgery
Parenteral Nutrition, Total
Postoperative Care
Postoperative Period
Preoperative Care
*Short Bowel Syndrome/therapy
Time Factors
Water-Electrolyte Balance},
   ISSN = {0009-4773 (Print)
0009-4773},
   Accession Number = {16241095},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Filippi, J. and Al-Jaouni, R. and Wiroth, J. B. and Hebuterne, X. and Schneider, S. M.},
   title = {Nutritional deficiencies in patients with Crohn's disease in remission},
   journal = {Inflamm Bowel Dis},
   volume = {12},
   number = {3},
   pages = {185-91},
   note = {Filippi, Jerome
Al-Jaouni, Rima
Wiroth, Jean-Baptiste
Hebuterne, Xavier
Schneider, Stephane M
Comparative Study
Journal Article
United States
Inflamm Bowel Dis. 2006 Mar;12(3):185-91.},
   abstract = {BACKGROUND: Patients with Crohn's disease (CD) are at risk of developing nutritional deficiencies, especially because of restrictive diets. The aim of our study was to assess food intake and the status for vitamins and trace elements in nonselected CD patients in clinical remission. METHODS: A total of 54 consecutive CD patients (28 females, 26 males, 39 +/- 2 years of age [mean +/- SD]) in clinical remission for >3 months underwent body composition, resting energy expenditure, nutrient intake, and plasma concentration assessment, and were compared with 25 healthy controls (16 females, 9 males, 38 +/- 3 years old). RESULTS: According to the nutritional risk index, 37 patients (70%) were not malnourished, 12 were at moderate risk, and 4 were at severe risk for malnutrition. Fat mass was lower in patients in remission compared with controls (P = 0.04). The mean daily energy intake was comparable between patients (2218 +/- 92 kcal/day) and controls (2066 +/- 101 kcal/day), covering their needs. No significant difference was observed for macronutrient intake in comparison with controls; compared to controls, female CD patients had lower intakes of beta-carotene (P < 0.005), vitamins B1 (P < 0.05), B6 (P < 0.01), and C (P < 0.005), and magnesium (P < 0.01). They had significantly higher intakes of zinc (P < 0.01). Male CD patients had lower intakes of beta-carotene and vitamin C (P < 0.05). More than 50% of patients had low plasma concentrations of vitamin C (84%), copper (84%), niacin (77%), and zinc (65%). CONCLUSIONS: In CD patients in remission, macronutrient needs are usually covered by food intake. However, micronutrient deficiencies are frequent and call for specific screening and treatment.},
   keywords = {Adult
Body Composition
Case-Control Studies
Cohort Studies
Crohn Disease/*complications/diagnosis
*Diet
*Energy Intake
Female
Follow-Up Studies
Humans
Male
Malnutrition/*etiology/physiopathology
Nutritional Requirements
*Nutritional Status
Probability
Reference Values
Severity of Illness Index
Statistics, Nonparametric},
   ISSN = {1078-0998 (Print)
1078-0998},
   Accession Number = {16534419},
   DOI = {10.1097/01.MIB.0000206541.15963.c3},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Forchielli, M. L. and Walker, W. A.},
   title = {The role of gut-associated lymphoid tissues and mucosal defence},
   journal = {Br J Nutr},
   volume = {93 Suppl 1},
   pages = {S41-8},
   note = {Forchielli, Maria Luisa
Walker, W Allan
Journal Article
Review
England
Br J Nutr. 2005 Apr;93 Suppl 1:S41-8.},
   abstract = {The newborn infant leaves a germ-free intrauterine environment to enter a contaminated extrauterine world and must have adequate intestinal defences to prevent the expression of clinical gastrointestinal disease states. Although the intestinal mucosal immune system is fully developed after a full-term birth, the actual protective function of the gut requires the microbial stimulation of initial bacterial colonization. Breast milk contains prebiotic oligosaccharides, like inulin-type fructans, which are not digested in the small intestine but enter the colon as intact large carbohydrates that are then fermented by the resident bacteria to produce SCFA. The nature of this fermentation and the consequent pH of the intestinal contents dictate proliferation of specific resident bacteria. For example, breast milk-fed infants with prebiotics present in breast milk produce an increased proliferation of bifidobacteria and lactobacilli (probiotics), whereas formula-fed infants produce more enterococci and enterobacteria. Probiotics, stimulated by prebiotic fermentation, are important to the development and sustainment of intestinal defences. For example, probiotics can stimulate the synthesis and secretion of polymeric IgA, the antibody that coats and protects mucosal surfaces against harmful bacterial invasion. In addition, appropriate colonization with probiotics helps to produce a balanced T helper cell response (Th1=Th2=Th3/Tr1) and prevent an imbalance (Th1>Th2 or Th2>Th1) contributing in part to clinical disease (Th2 imbalance contributes to atopic disease and Th1 imbalance contributes to Crohn's disease and Helicobacter pylori-induced gastritis). Furthermore, a series of pattern recognition receptors, toll-like receptors on gut lymphoid and epithelial cells that interact with bacterial molecular patterns (e.g. endotoxin (lipopolysaccharide), flagellin, etc.), help modulate intestinal innate immunity and an appropriate adaptive immune response. Animal and clinical studies have shown that inulin-type fructans will stimulate an increase in probiotics (commensal bacteria) and these bacteria have been shown to modulate the development and persistence of appropriate mucosal immune responses. However, additional studies are needed to show that prebiotics can directly or indirectly stimulate intestinal host defences. If this can be demonstrated, then prebiotics can be used as a dietary supplement to stimulate a balanced and an appropriately effective mucosal immune system in newborns and infants.},
   keywords = {Animals
Antigens, Bacterial/immunology
Dietary Fiber/administration & dosage
Gastrointestinal Diseases/*immunology/microbiology
Humans
Infant
Infant, Newborn
Intestinal Mucosa/*immunology/microbiology
Inulin/administration & dosage
Lymphoid Tissue/*physiology
Oligosaccharides/administration & dosage
Peyer's Patches/physiology
Probiotics/administration & dosage
T-Lymphocytes/immunology},
   ISSN = {0007-1145 (Print)
0007-1145},
   Accession Number = {15877894},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Freeman, H. J.},
   title = {Long-term clinical behavior of jejunoileal involvement in Crohn's disease},
   journal = {Can J Gastroenterol},
   volume = {19},
   number = {9},
   pages = {575-8},
   note = {Freeman, Hugh J
Comparative Study
Journal Article
Canada
Can J Gastroenterol. 2005 Sep;19(9):575-8.},
   abstract = {Diffuse and extensive jejunoileal Crohn's disease is an uncommon entity. In 39 patients, including 21 males and 18 females, followed for a mean duration of over 16 years between 1979 and 2004, the extent of disease was defined and disease behaviour characterized. Over 80% of patients had concomitant colonic and/or gastroduodenal involvement with Crohn's disease, suggesting that this entity may represent a specific clinical phenotype of extensive disease localization. Classification of Crohn's disease behaviour using the Vienna classification schema revealed that virtually all patients in this study suffered from intestinal stricture formation or penetrating disease complications. Moreover, pharmacological therapies with corticosteroids and immunosuppressant drugs were rarely successful, with virtually all patients requiring at least one, and usually multiple, intestinal resections. Finally, most patients required long-term nutritional support, often with home parenteral nutrition. New treatments are required, possibly defined on the basis of their effectiveness in reducing the severity and extent of intestinal disease, rather than more conventional statistically driven reductions in disease activity indexes.},
   keywords = {Adult
Crohn Disease/*classification/pathology
Disease Progression
Enteritis/*classification/pathology
Female
Follow-Up Studies
Humans
Ileum/*pathology
Jejunum/*pathology
Male
Retrospective Studies
Severity of Illness Index
Time Factors},
   ISSN = {0835-7900 (Print)
0835-7900},
   Accession Number = {16151550},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Galvez, J. and Rodriguez-Cabezas, M. E. and Zarzuelo, A.},
   title = {Effects of dietary fiber on inflammatory bowel disease},
   journal = {Mol Nutr Food Res},
   volume = {49},
   number = {6},
   pages = {601-8},
   note = {Galvez, Julio
Rodriguez-Cabezas, M Elena
Zarzuelo, Antonio
Journal Article
Research Support, Non-U.S. Gov't
Review
Germany
Mol Nutr Food Res. 2005 Jun;49(6):601-8.},
   abstract = {The chronic idiopathic inflammatory bowel diseases (IBDs), namely Crohn's disease and ulcerative colitis, appear to be derived from an inappropriate reaction towards a luminal agent, most probably driven by the intestinal microflora, which upregulates the synthesis and release of different pro-inflammatory mediators, thus contributing to tissue damage that characterizes these intestinal conditions. Several studies have reported that IBD is associated with impairment in short-chain fatty acid (SCFA) production, mainly acetate, propionate, and butyrate. They are produced in the large bowel by anaerobic bacterial fermentation of undigested dietary carbohydrates and fiber polysaccharides, with butyrate being considered as the major fuel source for colonocytes. These SCFAs have been proposed to play a key role in the maintenance of colonic homeostasis. Therefore, it is reasonable to consider therapeutic approaches that increase colonic SCFA production, as it can be achieved by administration of dietary fiber to IBD patients. Unfortunately, there is quite limited documentation of efficacy of dietary fiber in properly designed trials. This review discusses the rationale, available evidence for the use of dietary fiber and its mechanisms of action in the treatment and prevention of IBDs.},
   keywords = {Animals
Colon/metabolism
Dietary Fiber/administration & dosage/*therapeutic use
Disease Models, Animal
Fatty Acids, Volatile/biosynthesis/physiology
Humans
Inflammatory Bowel Diseases/prevention & control/*therapy},
   ISSN = {1613-4125 (Print)
1613-4125},
   Accession Number = {15841496},
   DOI = {10.1002/mnfr.200500013},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Gassull, M. A.},
   title = {Review article: the intestinal lumen as a therapeutic target in inflammatory bowel disease},
   journal = {Aliment Pharmacol Ther},
   volume = {24 Suppl 3},
   pages = {90-5},
   note = {Gassull, M A
Journal Article
Review
England
Aliment Pharmacol Ther. 2006 Oct;24 Suppl 3:90-5.},
   abstract = {Undigested carbohydrates reaching the colon can act as competitors for epithelial bacterial receptors, making it difficult for noncommensal bacteria to adhere to them. On the contrary, fermentation of these carbohydrates by anaerobic flora produces - among other substrates - butyrate that is involved in numerous important metabolic processes. These include the provision of energy to the colonocytes, the enhancement of sodium and water absorption and the synthesis of mucus and cell membranes. In addition, butyrate inhibits the nuclear translocation of the transcription factor NFkappaB, which exerts a potent anti-inflammatory activity. Clinical experience with probiotics in inflammatory bowel disease (IBD) is controversial. Whereas some probiotic preparations appear to be useful in ulcerative colitis (UC) and pouchitis, most attempts to use probiotics for treating or preventing recurrence in Crohn's disease have failed. It should be pointed out that - unlike in the small bowel - the colon and ileal pouches are well-established microbiological ecosystems with increasing amounts of a wide variety of bacterial strains. These bacterial strains have a high degree of metabolic interaction with luminal nutrients and a greater probability of developing dysbiosis. With this in mind, the rationale for using pre- and probiotics appears to be stronger for colonic IBD (UC or Crohn's colitis) and pouchitis than for IBD mostly involving the small bowel.},
   keywords = {*Enterobacteriaceae
Humans
Inflammatory Bowel Diseases/*diet therapy
Intestinal Mucosa/*microbiology
Intestines/*microbiology
Probiotics/*therapeutic use},
   ISSN = {0269-2813 (Print)
0269-2813},
   Accession Number = {16961752},
   DOI = {10.1111/j.1365-2036.2006.03067.x},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Gavin, J. and Anderson, C. E. and Bremner, A. R. and Beattie, R. M.},
   title = {Energy intakes of children with Crohn's disease treated with enteral nutrition as primary therapy},
   journal = {J Hum Nutr Diet},
   volume = {18},
   number = {5},
   pages = {337-42},
   note = {Gavin, J
Anderson, C E
Bremner, A R
Beattie, R M
Journal Article
England
J Hum Nutr Diet. 2005 Oct;18(5):337-42.},
   abstract = {BACKGROUND: Enteral nutrition (EN) is widely used and is effective in the treatment of children with Crohn's disease given as an exclusive feed for 6-8 weeks. Current dietetic practice during EN is to recommend an energy intake based on estimated average requirement (EAR) for energy for age. AIMS: To examine factors affecting energy intake and weight gain during EN in relation to disease site and nutritional status. METHODS: A retrospective cohort study examining energy intake and weight gain during the exclusive EN feeding period in 40 patients newly diagnosed with Crohn's in relation to EAR, nutritional status, disease site. RESULTS: All patients improved clinically and gained weight during EN with improvement in the CRP as a marker of the systemic inflammatory response. Energy intake was higher than EAR in 82% (33/40 patients), with the median 117.5% of EAR. Weight gain correlated with body mass index standard deviation score (P = 0.001) at start of treatment, but not energy intake or CRP. CONCLUSION: Estimated average requirement underestimates energy intakes in most children with newly diagnosed Crohn's disease. During EN, an energy intake in the range of 100-149% (median 117.5%) EAR for energy for age may be required. Energy balance studies in children with active disease are required.},
   keywords = {Adolescent
Biomarkers/analysis
Body Mass Index
C-Reactive Protein/analysis
Child
Cohort Studies
Crohn Disease/*therapy
*Energy Intake/drug effects
*Enteral Nutrition
Female
Humans
Male
*Nutritional Requirements
Nutritional Status
Retrospective Studies
Weight Gain/drug effects},
   ISSN = {0952-3871 (Print)
0952-3871},
   Accession Number = {16150129},
   DOI = {10.1111/j.1365-277X.2005.00631.x},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Gibson, P. R. and Iser, J.},
   title = {Inflammatory bowel disease},
   journal = {Aust Fam Physician},
   volume = {34},
   number = {4},
   pages = {233-7},
   note = {Gibson, Peter R
Iser, John
Journal Article
Review
Australia
Aust Fam Physician. 2005 Apr;34(4):233-7.},
   abstract = {BACKGROUND: Inflammatory bowel disease (IBD) is increasing in frequency in Australia. General practitioners play an important role in early diagnosis and in a multidisciplinary approach to managing such patients. Keeping abreast of evolving concepts, particularly in treatment, is challenging. OBJECTIVE: This article aims to address key issues in diagnosis and management to better equip general practitioners for their role in multidisciplinary management of patients with IBD. DISCUSSION: Making the diagnosis can be difficult, but is facilitated by appropriate clinical suspicion and sensible judgment as to who undergoes diagnostic tests such as colonoscopy. Treatment of ulcerative colitis has changed little in recent years, except for our improved ability to deliver mesalazine to the large bowel via the recent availability of several oral and rectal preparations. Prevention of relapse using these is an important strategy in the majority of patients. Treatment of Crohn disease is changing due to more realistic concepts of the natural history of the disease and the development of new, powerful anti-inflammatory therapies. Attention to issues other than intestinal inflammation such as nutrition, education and counselling, remain important in achieving optimal management.},
   keywords = {Adrenal Cortex Hormones/therapeutic use
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Colitis, Ulcerative/diagnosis/therapy
Colonoscopy
Colorectal Neoplasms/etiology
Crohn Disease/diagnosis/therapy
Diarrhea/etiology
Digestive System Surgical Procedures
Family Practice/*methods/standards
Humans
Immunosuppression/methods
Inflammatory Bowel Diseases/complications/*diagnosis/*therapy
Mesalamine/therapeutic use
Practice Guidelines as Topic
Risk Factors},
   ISSN = {0300-8495 (Print)
0300-8495},
   Accession Number = {15861742},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Gilman, J. and Shanahan, F. and Cashman, K. D.},
   title = {Altered levels of biochemical indices of bone turnover and bone-related vitamins in patients with Crohn's disease and ulcerative colitis},
   journal = {Aliment Pharmacol Ther},
   volume = {23},
   number = {7},
   pages = {1007-16},
   note = {Gilman, J
Shanahan, F
Cashman, K D
Journal Article
Research Support, Non-U.S. Gov't
England
Aliment Pharmacol Ther. 2006 Apr 1;23(7):1007-16.},
   abstract = {BACKGROUND: The pathogenesis of inflammatory bowel disease-associated osteopenia may be related to pathological rates of bone turnover; however, the literature shows mixed results. AIM: To compare bone biomarkers in inflammatory bowel disease patients (Crohn's disease: n = 68, and ulcerative colitis: n = 32, separately) with age- and sex-matched healthy controls. SUBJECTS: Patients and controls were recruited from Cork University Hospital and Cork City area, respectively. RESULTS: Relative to that in their respective controls, Crohn's disease (n = 47) and ulcerative colitis (n = 26) patients (i.e. excluding supplement users) had significantly (P < 0.05-0.001) higher serum undercarboxylated osteocalcin (by 27% and 63%, respectively) and bone-specific alkaline phosphatase (by 15% and 21%, respectively) and urinary Type I collagen cross-linked N-telopeptides concentrations (by 87% and 112%, respectively). Relative to that in their respective controls, Crohn's disease and ulcerative colitis patients had significantly (P < 0.01) lower serum total osteocalcin (by 20% and 42%, respectively) and 25-hydroxyvitamin D (by 37% and 42%, respectively), while serum parathyroid hormone levels were similar. In the combined patient group (n = 100), undercarboxylated osteocalcin was positively associated with bone markers. CONCLUSIONS: Both Crohn's disease and ulcerative colitis patients have altered bone turnover relative to that in healthy controls.},
   keywords = {Adult
Alkaline Phosphatase/blood
Biomarkers/*analysis/blood/urine
Bone Density
Bone Diseases, Metabolic/blood/*metabolism/urine
Bone Resorption/blood/etiology/urine
Colitis, Ulcerative/blood/complications/urine
Collagen Type I/urine
Crohn Disease/blood/complications/urine
Female
Humans
Inflammatory Bowel Diseases/blood/*metabolism/urine
Male
Osteocalcin/blood
Osteogenesis/physiology
Parathyroid Hormone/blood
Peptides/urine
Vitamin D/analogs & derivatives/blood},
   ISSN = {0269-2813 (Print)
0269-2813},
   Accession Number = {16573803},
   DOI = {10.1111/j.1365-2036.2006.02835.x},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Gilman, J. and Shanahan, F. and Cashman, K. D.},
   title = {Determinants of vitamin D status in adult Crohn's disease patients, with particular emphasis on supplemental vitamin D use},
   journal = {Eur J Clin Nutr},
   volume = {60},
   number = {7},
   pages = {889-96},
   note = {Gilman, J
Shanahan, F
Cashman, K D
Journal Article
Research Support, Non-U.S. Gov't
England
Eur J Clin Nutr. 2006 Jul;60(7):889-96. Epub 2006 Feb 22.},
   abstract = {OBJECTIVE: To investigate determinants (pathophysiologic and physiologic, behavioural and lifestyle) of vitamin D status in Irish Crohn's disease (CD) patients. DESIGN: A cross-sectional observational study. SETTING: Cork City, Ireland (52 degrees N). SUBJECTS: Crohn's Disease patients (n=58; mean age 38.1 years) were recruited from Cork University Hospital. RESULTS: Fifty and nineteen percent of Irish CD patients were vitamin D deficient (defined by serum 25 hydroxyvitamin (OH) D levels <50 nmol/l) during winter and summer, respectively. Multiple regression analysis showed that summer-time serum 25 (OH) D levels were positively associated with use of vitamin D supplements (P=0.033) and negatively associated with smoking (P=0.006) and being male (P=0.063). During winter-time, use of vitamin D supplements (P=0.041) and sun habits (P=0.066) were positively associated, whereas small intestinal involvement (P=0.005) and body mass index (BMI) (P=0.083) were negatively associated with serum 25 (OH) D levels. There was no significant association between other non-pathophysiologic (age, dietary calcium or vitamin D) or pathophysiologic factors (steroid use, resection), and serum 25 (OH) D levels, at either season. Approximately 41 and 60% of the total variation in summer- and winter-time serum 25 (OH) D, respectively, was explained by this model. CONCLUSION: A high proportion of Irish CD patents had some level of vitamin D deficiency (<50 nmol/l) during late-wintertime. Use of regular low-dose supplemental vitamin D, particularly by patients with small intestinal involvement, cessation of smoking and adequate, but responsible, exposure to summer sunlight as well as maintaining BMI in the normal range could help maintain adequate vitamin D levels during wintertime.},
   keywords = {Adult
Crohn Disease/*blood/complications
Cross-Sectional Studies
Dietary Supplements
Female
Humans
Ireland/epidemiology
Male
Nutritional Requirements
Nutritional Status
Seasons
Sex Factors
Smoking/*adverse effects
Sunlight
Vitamin D/*administration & dosage/*analogs & derivatives/blood/metabolism
Vitamin D Deficiency/blood/*epidemiology},
   ISSN = {0954-3007 (Print)
0954-3007},
   Accession Number = {16493452},
   DOI = {10.1038/sj.ejcn.1602395},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Griffiths, A. M.},
   title = {Enteral nutrition in the management of Crohn's disease},
   journal = {JPEN J Parenter Enteral Nutr},
   volume = {29},
   number = {4 Suppl},
   pages = {S108-12; discussion S112-7, S184-8},
   note = {Griffiths, Anne M
Journal Article
Review
United States
JPEN J Parenter Enteral Nutr. 2005 Jul-Aug;29(4 Suppl):S108-12; discussion S112-7, S184-8.},
   abstract = {Exclusive feeding of defined formula diets has been used successfully as an alternative to corticosteroid treatment of active Crohn's disease, but the mechanism of efficacy remains conjectural. Recognition that polymorphisms in the NOD2/CARD15 gene confer susceptibility to Crohn's disease has increased appreciation of the interactions between the innate immune system and enteric bacteria, which lead to chronic intestinal inflammation. The 2 major goals of this workshop are: first, in light of current understanding of pathogenesis, to examine possible mechanisms of action of enteral nutrition as primary therapy; and second, to make evidence-based recommendations concerning its use in the new era of biologic therapies, when mucosal healing has become a realistic goal. Factors influencing efficacy, including duration, location of intestinal inflammation, and formula composition require consideration.},
   keywords = {Crohn Disease/genetics/immunology/*therapy
*Enteral Nutrition
Evidence-Based Medicine
Food, Formulated/*standards
Genetic Predisposition to Disease
Humans
Intestines/microbiology/pathology
Remission Induction
Treatment Outcome},
   ISSN = {0148-6071 (Print)
0148-6071},
   Accession Number = {15980272},
   DOI = {10.1177/01486071050290s4s108},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Griffiths, A. M.},
   title = {Enteral feeding in inflammatory bowel disease},
   journal = {Curr Opin Clin Nutr Metab Care},
   volume = {9},
   number = {3},
   pages = {314-8},
   note = {Griffiths, Anne M
Journal Article
Review
England
Curr Opin Clin Nutr Metab Care. 2006 May;9(3):314-8.},
   abstract = {PURPOSE OF REVIEW: Treatment algorithms for inflammatory bowel disease are changing rapidly. Increased and earlier use of immunomodulatory drugs and availability of biologic agents have reduced dependence on corticosteroids and made mucosal healing a realistic goal. It is timely to debate the role of enteral nutrition in this evolving therapeutic armamentarium for Crohn's disease, and to examine the mechanisms of its anti-inflammatory effects in light of current understanding of disease pathogenesis. RECENT FINDINGS: Clinical studies have suggested that response to enteral nutrition is associated with decreased mucosal inflammation in Crohn's disease, that isolated Crohn's colitis is less responsive and that exclusive enteral nutrition is required. Basic research has demonstrated that lipids in the intestinal lumen can alter signalling of the mucosal immune system by intestinal epithelial cells. Exclusive enteral nutrition is associated with alteration of enteric microflora. SUMMARY: Enteral nutrition is an efficacious treatment of active inflammation involving the ileum; recent-onset disease may be particularly responsive. The significance of effects on enteric flora deserves further exploration in view of the importance of microbes to disease pathogenesis.},
   keywords = {Crohn Disease/microbiology/therapy
*Enteral Nutrition
Humans
Inflammatory Bowel Diseases/*microbiology/*therapy
Patient Selection
Prognosis
Remission Induction
Treatment Outcome},
   ISSN = {1363-1950 (Print)
1363-1950},
   Accession Number = {16607134},
   DOI = {10.1097/01.mco.0000222117.76536.49},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Grimble, R. F.},
   title = {Immunonutrition},
   journal = {Curr Opin Gastroenterol},
   volume = {21},
   number = {2},
   pages = {216-22},
   note = {Grimble, Robert F
Journal Article
Review
United States
Curr Opin Gastroenterol. 2005 Mar;21(2):216-22.},
   abstract = {PURPOSE OF REVIEW: To outline recent findings on the efficacy of immunonutrients in patients undergoing inflammatory stress due to surgery, infection and cancer. RECENT FINDINGS: Enteral nutrition is more efficacious and poses lower risks than parenteral nutrition. It reduces infection rates and shortens ICU and hospital length of stay of critically ill patients. Beneficial effects of immunonutrition are most apparent in malnourished patients. Perioperative enteral nutrition is more effective than postoperative nutrition. In Crohn disease similar remission rates are achieved with enteral nutrition as with steroids. Glutamine, omega-3 fatty acids and antioxidants exert beneficial influences in diverse patient populations. L-arginine is an important immunonutrient having both beneficial and adverse effects. The former effect occurs in necrotizing enterocolitis; the latter influence is seen in septic patients. The gut plays a major role in whole body amino acid metabolism, particularly arginine homeostasis. Arginase and nitric oxide synthetase compete for arginine within immune cells and play a pivotal role in clinical outcome during infection. In cancer a range of antioxidants are able to ameliorate immunosuppression. Intravenous lipids may be deleterious due to the pro-inflammatory effects of omega-6 fatty acids. Omega-3 fatty acids are anti-inflammatory and combined with medium chain triglyceride (MCT) and olive oil may provide a more efficacious form of intravenous lipid. SUMMARY: Immunonutrition is effective in improving outcome in a wide range of patients when applied enterally, particularly in malnourished individuals. Parenteral immunonutrition carries a higher risk but can be efficacious in selected patient groups for whom enteral nutrition is problematic.},
   keywords = {Animals
Arginine/metabolism/pharmacology
Fatty Acids/pharmacology
Genetic Variation
Glutamine/metabolism/pharmacology
Glutathione/metabolism
Humans
*Immunotherapy
Infection/immunology
Nutritional Support/*methods
Transcription, Genetic
Wounds and Injuries/immunology},
   ISSN = {0267-1379 (Print)
0267-1379},
   Accession Number = {15711216},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Guandalini, S.},
   title = {Probiotics for children: use in diarrhea},
   journal = {J Clin Gastroenterol},
   volume = {40},
   number = {3},
   pages = {244-8},
   note = {Guandalini, Stefano
Journal Article
Review
United States
J Clin Gastroenterol. 2006 Mar;40(3):244-8.},
   abstract = {The use of probiotics in diarrheal diseases of children is increasing. Probiotics, mostly lactic acid bacteria such as Lactobacilli and Bifidobacteria, but also the yeast Saccharomyces boulardii, have been tried in many double-blinded, randomized, placebo-controlled studies, and several well-conducted meta-analyses are now available. There is some evidence of efficacy in the prevention of community-acquired and nosocomial diarrhea. More solid evidence of efficacy is found in the treatment of sporadic, infectious diarrhea, where several probiotics, and especially Lactobacillus GG, have been found capable of reducing by approximately 1 day the duration of diarrhea, shorten the initial phase of watery stools, and reducing hospital stay in developed countries. The effect is best documented in viral diarrheas. Although there are valid conceptual premises for probiotics to be helpful in inflammatory bowel diseases, only 1 trial has been published in children, showing Lactobacillus GG not to be superior to placebo in maintaining remission of Crohn disease. All considered, more research is needed for a better understanding of the role of probiotics in gastrointestinal diseases of children, addressing issues such as pharmacokinetics, mechanism of action, and role of specific probiotics, alone or in combination, in different disorders.},
   keywords = {Acute Disease
Child
Crohn Disease/prevention & control
Cross Infection/prevention & control
Diarrhea/microbiology/*prevention & control
Humans
Lactobacillus
Probiotics/*pharmacology},
   ISSN = {0192-0790 (Print)
0192-0790},
   Accession Number = {16633130},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Guarner, F.},
   title = {Inulin and oligofructose: impact on intestinal diseases and disorders},
   journal = {Br J Nutr},
   volume = {93 Suppl 1},
   pages = {S61-5},
   note = {Guarner, Francisco
Journal Article
Review
England
Br J Nutr. 2005 Apr;93 Suppl 1:S61-5.},
   abstract = {A large and diverse variety of bacteria have evolved and adapted to live in the human intestinal habitat in a symbiotic arrangement that influences both physiology and pathology in the host. Symbiosis between host and flora can be optimised by prebiotics. Inulin-type fructans have been shown to improve the metabolic functions of the commensal flora. Clinical and experimental data suggest that they also improve the gut mucosal barrier. Furthermore, modulation of the trophic functions of the flora by these prebiotics could help in the prevention of inflammatory bowel diseases. The anti-inflammatory effects of inulin or oligofructose have been assessed in the rat model of distal colitis induced by dextran sodium sulphate, which histologically resembles human ulcerative colitis, and in the trinitrobenzene sulphonic acid model that resembles human Crohn's disease. Both inulin and oligofructose stimulate colonic production of SCFA and favour the growth of indigenous lactobacilli and/or bifidobacteria. These effects are associated with reduced mucosal inflammation and decreased mucosal lesion scores. Inulin has also been tested in a placebo-controlled clinical trial in patients with relapsing pouchitis. Treatment reduced endoscopic and histological parameters of inflammation of the pouch mucosa. Inulin and oligofructose may offer an opportunity to prevent chronic inflammatory intestinal disorders, and this potential should be tested in further clinical studies.},
   keywords = {Animals
Bacterial Infections/*diet therapy/immunology/microbiology
Bifidobacterium
Dietary Fiber/*administration & dosage
Humans
Inflammatory Bowel Diseases/*diet therapy/immunology/microbiology
Intestinal Mucosa/immunology/microbiology
Inulin/*administration & dosage
Lactobacillus
Models, Animal
Oligosaccharides/*administration & dosage
Probiotics/administration & dosage},
   ISSN = {0007-1145 (Print)
0007-1145},
   Accession Number = {15877897},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Guilhon de Araujo Sant'Anna, A. M. and Dubois, J. and Miron, M. C. and Seidman, E. G.},
   title = {Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial},
   journal = {Clin Gastroenterol Hepatol},
   volume = {3},
   number = {3},
   pages = {264-70},
   note = {Guilhon de Araujo Sant'Anna, Ana Maria
Dubois, Josee
Miron, Marie-Claude
Seidman, Ernest G
Clinical Trial
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
United States
Clin Gastroenterol Hepatol. 2005 Mar;3(3):264-70.},
   abstract = {BACKGROUND AND AIMS: Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents. METHODS: Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group. RESULTS: Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy. CONCLUSIONS: Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.},
   keywords = {Adolescent
Capsules
Child
Crohn Disease/*diagnosis
Endoscopy, Gastrointestinal/*methods
Female
Gastrointestinal Hemorrhage/diagnosis
Humans
Ileal Diseases/*diagnosis
Intestinal Polyps/diagnosis
Jejunal Diseases/*diagnosis
Male
Prospective Studies
Treatment Outcome},
   ISSN = {1542-3565 (Print)
1542-3565},
   Accession Number = {15765446},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Gupta, N. and Khera, S. and Vempati, R. P. and Sharma, R. and Bijlani, R. L.},
   title = {Effect of yoga based lifestyle intervention on state and trait anxiety},
   journal = {Indian J Physiol Pharmacol},
   volume = {50},
   number = {1},
   pages = {41-7},
   note = {Gupta, Nidhi
Khera, Shveta
Vempati, R P
Sharma, Ratna
Bijlani, R L
Journal Article
India
Indian J Physiol Pharmacol. 2006 Jan-Mar;50(1):41-7.},
   abstract = {Considerable evidence exists for the place of mind body medicine in the treatment of anxiety disorders. Excessive anxiety is maladaptive. It is often considered to be the major component of unhealthy lifestyle that contributes significantly to the pathogenesis of not only psychiatric but also many other systemic disorders. Among the approaches to reduce the level of anxiety has been the search for healthy lifestyles. The aim of the study was to study the short-term impact of a comprehensive but brief lifestyle intervention, based on yoga, on anxiety levels in normal and diseased subjects. The study was the result of operational research carried out in the Integral Health Clinic (IHC) at the Department of Physiology of All India Institute of Medical Sciences. The subjects had history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders (depression, anxiety, 'stress'), gastrointestinal problems (non ulcer dyspepsia, duodenal ulcers, irritable bowel disease, Crohn's disease, chronic constipation) and thyroid disorders (hyperthyroidism and hypothyroidism). The intervention consisted of asanas, pranayama, relaxation techniques, group support, individualized advice, and lectures and films on philosophy of yoga, the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. The outcome measures were anxiety scores, taken on the first and last day of the course. Anxiety scores, both state and trait anxiety were significantly reduced. Among the diseased subjects significant improvement was seen in the anxiety levels of patients of hypertension, coronary artery disease, obesity, cervical spondylitis and those with psychiatric disorders. The observations suggest that a short educational programme for lifestyle modification and stress management leads to remarkable reduction in the anxiety scores within a period of 10 days.},
   keywords = {Adult
Aged
Anxiety Disorders/*therapy
Female
Humans
India
*Life Style
Male
*Meditation
Middle Aged
*Patient Education as Topic
Stress, Psychological/therapy
Time Factors
*Yoga},
   ISSN = {0019-5499 (Print)
0019-5499},
   Accession Number = {16850902},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Harpavat, M. and Greenspan, S. L. and O'Brien, C. and Chang, C. C. and Bowen, A. and Keljo, D. J.},
   title = {Altered bone mass in children at diagnosis of Crohn disease: a pilot study},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {40},
   number = {3},
   pages = {295-300},
   note = {Harpavat, Manisha
Greenspan, Susan L
O'Brien, Carey
Chang, Chung-Chou
Bowen, A'Delbert
Keljo, David J
1 K24 DK062895-02/DK/NIDDK NIH HHS/United States
M01RR00084/RR/NCRR NIH HHS/United States
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
United States
J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):295-300.},
   abstract = {OBJECTIVES: Recent studies have indicated that bone mineral density is reduced in children with inflammatory bowel disease. The exact cause of this reduction is unclear, but it is often attributed to corticosteroid use. This study examined the prevalence of reduced bone mass in otherwise healthy children newly diagnosed with Crohn disease without previous corticosteroid exposure. METHODS: Eighteen steroid-naive children newly diagnosed with Crohn disease underwent dual energy x-ray absorptiometry. Disease activity, growth and pubertal development, nutritional assessment and bone mass measurements were recorded. z scores were adjusted for bone age. RESULTS: Five of the 18 patients (28%) had a total bone mineral density z score less than -1 (one had a z score less than -2). Ten (56%) subjects had lumbar spine bone mineral density z scores less than -1 (two had z score less than -2). The subjects had significantly reduced mean lumbar spine bone mineral density z scores (P = 0.002). Delayed pubertal development correlated with whole body bone mineral density z scores (r = 0.64; P = 0.004). Most subjects were not meeting United States recommended dietary allowances for daily intake of calcium, vitamin D and total calories. The majority of subjects were not participating in weight-bearing physical activity. CONCLUSION: Decreased bone mass is common in steroid naive children newly diagnosed with Crohn disease. Crohn disease appears to contribute to impaired bone mass independent of corticosteroid therapy.},
   keywords = {Absorptiometry, Photon
Adolescent
Adrenal Cortex Hormones/adverse effects/therapeutic use
*Bone Density/physiology
Calcium, Dietary/administration & dosage
Child
Child, Preschool
Crohn Disease/diagnosis/drug therapy/*physiopathology
Energy Intake
Exercise/physiology
Female
Humans
Lumbar Vertebrae/diagnostic imaging
Male
Pilot Projects
Puberty, Delayed/diagnostic imaging
Vitamin D/administration & dosage},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {15750387},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Harpaz, N. and Schiano, T. and Ruf, A. E. and Shukla, D. and Tao, Y. and Fishbein, T. M. and Sauter, B. V. and Gondolesi, G. E.},
   title = {Early and frequent histological recurrence of Crohn's disease in small intestinal allografts},
   journal = {Transplantation},
   volume = {80},
   number = {12},
   pages = {1667-70},
   note = {Harpaz, Noam
Schiano, Thomas
Ruf, Andres E
Shukla, Deepti
Tao, Ye
Fishbein, Thomas M
Sauter, Berhard V
Gondolesi, Gabriel E
Journal Article
United States
Transplantation. 2005 Dec 27;80(12):1667-70.},
   abstract = {BACKGROUND: Recurrence of Crohn's disease in small intestinal allografts, although rarely described, can cause serious morbidity and jeopardize graft survival among transplant recipients with Crohn's disease. However, systematic studies to determine the frequency, predictors, and clinical implications of recurrent Crohn's disease have not been reported METHODS: We analyzed our transplant program's experience with small intestinal allografts in patients with Crohn's disease based on retrospective review of clinical and pathological records and corresponding pathology slides. RESULTS: Of 67 patients undergoing 70 transplantations between 1998 and 2004, six adults (three males, three females; mean age 48.1 years) had Crohn's disease complicated by short gut syndrome and total parenteral nutrition failure. Four survivors surveyed endoscopically for a mean 29 (range, 20-40) months and underwent a mean 37 endoscopic examinations with biopsies (range, 31-44) while on maintenance immunosuppression. Despite absence of any endoscopic or clinical manifestations of Crohn's disease throughout this period, two patients had granulomatous enteritis characteristic of Crohn's disease in multiple biopsies, one patient in 8/44 examinations (18%) ranging from 34 days to 20 months postoperatively and the other in 6/32 examinations (19%) ranging from 20 days to 22 months postoperatively. No comparable changes occurred in 57 other patients without Crohn's disease followed endoscopically under the same protocol CONCLUSIONS: Histological recurrence of Crohn's disease may occur in small intestinal allografts despite the absence of endoscopic and clinical disease manifestations. Such recurrences are probably not rare, may occur as early as 3 weeks after transplantation, and do not necessarily portend early clinical recurrence or mandate aggressive therapy to prevent allograft loss.},
   keywords = {Adult
Age of Onset
Child
Crohn Disease/epidemiology/*pathology/*surgery
Female
Follow-Up Studies
Granuloma/epidemiology/pathology
Humans
Intestine, Small/pathology/*surgery
Male
Middle Aged
Postoperative Complications/epidemiology
Recurrence
Retrospective Studies
Time Factors
Tissue Donors
Transplantation, Homologous/pathology},
   ISSN = {0041-1337 (Print)
0041-1337},
   Accession Number = {16378058},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Harsha, W. T. and Kalandarova, E. and McNutt, P. and Irwin, R. and Noel, J.},
   title = {Nutritional supplementation with transforming growth factor-beta, glutamine, and short chain fatty acids minimizes methotrexate-induced injury},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {42},
   number = {1},
   pages = {53-8},
   note = {Harsha, Wendy T F
Kalandarova, Ellina
McNutt, Patrick
Irwin, Robert
Noel, James
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
United States
J Pediatr Gastroenterol Nutr. 2006 Jan;42(1):53-8.},
   abstract = {OBJECTIVE: Gastrointestinal (GI) damage caused by methotrexate (MTX) results in mucosal injury, bacterial invasion, and activation of an immune system that is reduced in function. Diets enriched with glutamine, short chain fatty acids (SCFAs), and transforming growth factor (TGF)-beta have demonstrated decreased infection, weight loss, and GI damage in Crohn disease. We, therefore, sought to study the cytoprotective effects of a diet enriched in glutamine, TGF-beta, and SFCAs (Modulen) in Fischer 344 rats exposed to MTX. METHODS: Rats were divided into five groups: two receiving normal saline and three receiving MTX and fed either normal chow, Modulen supplemented chow starting with the first MTX dose, or Modulen supplemented chow beginning 3 days before MTX injection. Rats were weighed daily. On day 5, albumin and bicarbonate levels were drawn, and rats were killed for examination of their intestinal mucosa by a pathologist unaware of groupings. RESULTS: Rats pretreated with Modulen supplemented chow maintained weight (2.6 vs, 12.3 g weight loss), albumin levels (3.13 vs, 2.43 mg/dL), and bicarbonate levels (23.8 vs. 18.1 mg/dL) as compared with rats fed normal chow throughout MTX treatment (P < 0.05). Pretreatment with Modulen also protected against crypt cell loss, villus atrophy, crypt abscesses, crypt/villus ratio, and overall histologic damage (P < 0.05). CONCLUSION: When administered before and during MTX treatment, Modulen supplementation provided statistically significant protection against weight loss, hypoalbuminemia, acidosis, and GI damage in a rat model. Future animal research of Modulen's protective effects with other chemotherapeutic agents is needed before human trials.},
   keywords = {Animals
Antimetabolites, Antineoplastic/*toxicity
Body Weight/drug effects
Diet
Dietary Supplements
Fatty Acids, Volatile/*administration & dosage/therapeutic use
Glutamine/*administration & dosage/therapeutic use
*Intestinal Mucosa/drug effects/injuries/pathology
Intestine, Small/drug effects/injuries/pathology
Methotrexate/*toxicity
Mucositis/chemically induced/*prevention & control
Random Allocation
Rats
Rats, Inbred F344
Transforming Growth Factor beta/*administration & dosage/therapeutic use},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {16385254},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Hart, J. W. and Bremner, A. R. and Wootton, S. A. and Beattie, R. M.},
   title = {Measured versus predicted energy expenditure in children with inactive Crohn's disease},
   journal = {Clin Nutr},
   volume = {24},
   number = {6},
   pages = {1047-55},
   note = {Hart, J W
Bremner, A R
Wootton, S A
Beattie, R M
Journal Article
England
Clin Nutr. 2005 Dec;24(6):1047-55. Epub 2005 Sep 29.},
   abstract = {INTRODUCTION: The aim of the study was to assess if the estimated average requirements for energy for normal children (EAR) and the Schofield equation could reliably predict energy requirements in children with inactive Crohn's disease (CD). METHODS: Twenty-three children with inactive CD were studied, median age 14.3 years (range 7.8-16.9). Resting energy expenditure (REE) was measured by indirect calorimetry and compared with that predicted using the Schofield equation (BMR). Total energy expenditure (TEE) was measured using REE and a 3-day activity diary and compared with EAR. RESULTS: REE ranged from 79% to 136% of BMR. Mean REE was not significantly greater than mean BMR (P=0.25 2-tailed t-test). TEE ranged from 72% to 163% of estimated average requirements for energy for children of that weight (EARw). EARw tended to underestimate TEE in large children and overestimate TEE in small children (Bland-Altman plot R=0.5, P=0.002). EARw was a poor predictor of TEE (R=0.35, P=0.1). EAR underestimated energy requirements by >500 kcal/day in 40% of the children. CONCLUSIONS: The Schofield equation and EAR are unreliable methods of predicting total energy requirements in children with inactive CD with a significant potential to underestimate energy needs. When energy requirements were greater than EAR it was due to physical activity and body habitus rather than raised REE.},
   keywords = {Adolescent
Anthropometry
Basal Metabolism/*physiology
Body Weight/physiology
Calorimetry, Indirect/methods
Child
Crohn Disease/*metabolism
Energy Metabolism/*physiology
Female
Humans
Male
Mathematics
*Nutritional Requirements
Predictive Value of Tests},
   ISSN = {0261-5614 (Print)
0261-5614},
   Accession Number = {16198449},
   DOI = {10.1016/j.clnu.2005.08.007},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Heuschkel, R.},
   title = {Synergy between immunosuppressive therapy and enteral nutrition in the management of childhood Crohn's disease},
   journal = {JPEN J Parenter Enteral Nutr},
   volume = {29},
   number = {4 Suppl},
   pages = {S160-3; discussion S163-5, S184-8},
   note = {Heuschkel, Robert
Journal Article
Review
United States
JPEN J Parenter Enteral Nutr. 2005 Jul-Aug;29(4 Suppl):S160-3; discussion S163-5, S184-8.},
   abstract = {Induction of a remission in children with Crohn's disease is increasingly successful. However this success is dependent on what measure we use to define "remission." Achieving a clinical remission is possible in >70% of children with Crohn's disease at diagnosis, while a mucosal or even immunological remission may occur in <50%. The importance of what ;degree of remission' should be achieved during maintenance therapy is discussed. Does early aggressive management with immunomodulators or biological agents indeed alter the natural history of the disease, and is it possible to give a prognosis based on either a snap-shot of endoscopic appearance, or a mucosal cytokine profile? The potential benefits of using a 6-8 week course of exclusive enteral nutrition as an induction therapy in combination with azathioprine/6-mercaptopurine are discussed. Whole protein formulae are safe and effective at achieving a clinical remission, however they are not a long-term maintenance strategy. Given the relative safety of these immunosuppressants and their efficacy in children treated at diagnosis, it is now more important than ever to predict which individuals will benefit from use of immunomodulators very early in the disease process. There is brief mention of enteral nutrition as maintenance therapy. Given the very limited data available, it is still not possible to recommend long-term nutrition supplementation as a maintenance therapy in all children. However, some children may respond to repeated shorter cycles of exclusive enteral nutrition in the absence of other therapeutic options.},
   keywords = {Child
Crohn Disease/*therapy
Drug Synergism
Drug Therapy, Combination
*Enteral Nutrition
Humans
Immunosuppressive Agents/*therapeutic use
Remission Induction
Treatment Outcome},
   ISSN = {0148-6071 (Print)
0148-6071},
   Accession Number = {15980278},
   DOI = {10.1177/01486071050290s4s160},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Homan, M. and Baldassano, R. N. and Mamula, P.},
   title = {Managing complicated Crohn's disease in children and adolescents},
   journal = {Nat Clin Pract Gastroenterol Hepatol},
   volume = {2},
   number = {12},
   pages = {572-9},
   note = {Homan, Matjaz
Baldassano, Robert N
Mamula, Petar
Journal Article
Review
England
Nat Clin Pract Gastroenterol Hepatol. 2005 Dec;2(12):572-9.},
   abstract = {The natural history of Crohn's disease is characterized by recurrent exacerbations. A small, but significant, number of pediatric patients with Crohn's disease are resistant to standard medical therapies. The goal of therapy in pediatric patients is not only to achieve and maintain clinical remission, but also to promote growth, development and improve quality of life. All of this needs to be achieved within a relatively short window of opportunity, before growth and development deficiencies become permanent. The standard therapy for pediatric patients with Crohn's disease consists of 5-aminosalicylic-acid compounds, antibiotics and enteral nutrition. Enteral nutrition has an excellent adverse-effect profile and, in addition to its therapeutic effect, positively impacts growth and nutritional status. Immunomodulating medications, such as azathioprine, 6-mercaptopurine and methotrexate, are frequently used to maintain remission, and to treat corticosteroid-dependent and perianal disease. Recently, biologic treatment with the anti-tumor-necrosis-factor-alpha antibody infliximab has dramatically changed the therapeutic approach. The long-term safety of this therapy still needs to be established. Limited data are available on other biologic therapies, which, at this point in time, are considered experimental and are only available through clinical trials.},
   keywords = {Adolescent
Antibodies, Monoclonal/*therapeutic use
Child
Crohn Disease/*drug therapy
Decision Making
Gastrointestinal Agents/*therapeutic use
Humans
Immunosuppressive Agents/*therapeutic use
Infliximab
Quality of Life
Remission Induction
Treatment Outcome
Tumor Necrosis Factor-alpha/*antagonists & inhibitors},
   ISSN = {1743-4378 (Print)
1743-4378},
   Accession Number = {16327836},
   DOI = {10.1038/ncpgasthep0338},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Hyams, J. and Markowitz, J. and Otley, A. and Rosh, J. and Mack, D. and Bousvaros, A. and Kugathasan, S. and Pfefferkorn, M. and Tolia, V. and Evans, J. and Treem, W. and Wyllie, R. and Rothbaum, R. and del Rosario, J. and Katz, A. and Mezoff, A. and Oliva-Hemker, M. and Lerer, T. and Griffiths, A.},
   title = {Evaluation of the pediatric crohn disease activity index: a prospective multicenter experience},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {41},
   number = {4},
   pages = {416-21},
   note = {Hyams, Jeffrey
Markowitz, James
Otley, Anthony
Rosh, Joel
Mack, David
Bousvaros, Athos
Kugathasan, Subra
Pfefferkorn, M
Tolia, Vasundhara
Evans, Jonathan
Treem, William
Wyllie, Robert
Rothbaum, Robert
del Rosario, J
Katz, Aubrey
Mezoff, Adam
Oliva-Hemker, M
Lerer, Trudy
Griffiths, Anne
Pediatric Inflammatory Bowel Disease Collaborative Research Group
Comparative Study
Journal Article
Multicenter Study
United States
J Pediatr Gastroenterol Nutr. 2005 Oct;41(4):416-21.},
   abstract = {BACKGROUND AND OBJECTIVES: Longitudinal assessment of disease activity is necessary for studies of therapeutic intervention in children with Crohn disease. The Pediatric Crohn Disease Activity Index (PCDAI) was developed a decade ago for such a purpose, but it function has only been examined in a small number of studies with a limited number of patients. The primary objectives of the present study were to develop cut scores reflecting disease activity as determined by physician global assessment (PGA) and to evaluate the responsiveness of the PCDAI to changes in patient condition after therapeutic interventions. METHODS: Data were derived from a prospective database of newly diagnosed children with inflammatory bowel disease established in 2002 at 18 pediatric gastroenterology centers in the United States and Canada. At diagnosis, at 30 days and 3 months after diagnosis, and quarterly thereafter, children (<16 years of age) with Crohn disease had disease assessment performed by PGA and PCDAI. Disease management was provided according to the dictates of the attending gastroenterologist and not by predetermined protocol. RESULTS: 181 patients had concomitant PGA and PCDAI performed at diagnosis, and 95 of these had similar assessment at short-term follow up. Mean +/- SD PCDAI scores for mild, moderate, and severe disease by PGA at diagnosis were 19.5 +/- 10.4, 32.2 +/- 12.7, and 47.8 +/- 14.9, respectively (P < 0.001 for all comparisons). Mean +/- SD PCDAI for inactive disease after treatment was 5.2 +/- 5.4. Receiver operating characteristic (ROC) curve analysis suggested that: 1) activity of moderate/severe disease was best reflected by a PCDAI of > or = 30 points, 2) clinical response (moderate/severe disease improving to mild/inactive) was best reflected by a decrease in PCDAI of > or = 12.5 points, and 3) a PCDAI < 10 best reflected inactive disease. CONCLUSIONS: PCDAI scores accurately reflect disease activity as assessed by physician global assessment. A PCDAI score of > or = 30 has acceptable sensitivity and specificity to indicate disease of moderate/severe activity. A PCDAI decrease of 12.5 points or greater following therapeutic intervention accurately reflects a clinically significant response. The PCDAI is an appropriate tool for intervention trials in Crohn disease in children.},
   keywords = {Child
Crohn Disease/diagnosis/pathology/*physiopathology
Female
Humans
Male
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
*Severity of Illness Index},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {16205508},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Hyams, J. S.},
   title = {Inflammatory bowel disease},
   journal = {Pediatr Rev},
   volume = {26},
   number = {9},
   pages = {314-20},
   note = {1526-3347
Hyams, Jeffrey S
Journal Article
Review
United States
Pediatr Rev. 2005 Sep;26(9):314-20.},
   keywords = {Adenocarcinoma/etiology
Arthralgia/etiology
Child
Colitis, Ulcerative/*diagnosis/genetics/immunology/*therapy
Colonic Neoplasms/etiology
Colonic Pouches
Crohn Disease/*diagnosis/genetics/immunology/*therapy
Endoscopy, Gastrointestinal
Humans
Prognosis
Risk Factors},
   ISSN = {0191-9601},
   Accession Number = {16140873},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Hyams, J. S.},
   title = {Use of 6-mercaptopurine/azathioprine as the immunomodulator of choice for moderately active Crohn's disease: pro},
   journal = {Inflamm Bowel Dis},
   volume = {11},
   number = {2},
   pages = {197-9},
   note = {Hyams, Jeffrey S
Editorial
United States
Inflamm Bowel Dis. 2005 Feb;11(2):197-9.},
   keywords = {6-Mercaptopurine/administration & dosage/*therapeutic use
Adolescent
Adrenal Cortex Hormones/therapeutic use
Adult
Azathioprine/administration & dosage/*therapeutic use
Child
Child Welfare
Clinical Trials as Topic
Crohn Disease/*drug therapy/*immunology
Decision Making
Drug Therapy, Combination
Humans
Immunosuppressive Agents/administration & dosage/*therapeutic use
Quality of Life
Severity of Illness Index},
   ISSN = {1078-0998 (Print)
1078-0998},
   Accession Number = {15677914},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Hyams, J. S. and Markowitz, J. F.},
   title = {Can we alter the natural history of Crohn disease in children?},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {40},
   number = {3},
   pages = {262-72},
   note = {Hyams, Jeffrey S
Markowitz, James F
Journal Article
Research Support, Non-U.S. Gov't
Review
United States
J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):262-72.},
   abstract = {The natural history of Crohn disease is characterized by recurrent bouts of active disease, the consequences of which can severely impair sufferers' physical and social functioning. Not only does the illness cause day-to-day morbidity for children but the consequence of the chronic inflammatory process also commonly results in the need for major intestinal surgery. The present challenge facing physicians treating children with Crohn disease is to alleviate symptoms and prolong periods of remission via the use of specifically targeted therapies while minimizing toxicity and promoting normal growth and development. Although systemic corticosteroids are effective in inducing clinical remission, they are of little or no benefit in maintaining remission and can contribute to linear growth retardation. Immunomodulating drugs such as azathioprine, 6-mercaptopurine and methotrexate have proved effective for inducing and maintaining remission of active Crohn disease. These agents are now commonly prescribed in children at diagnosis, after a severe attack or after surgery or in those who become corticosteroid-dependent or corticosteroid-resistant. Their use is not without potential adverse effects and not all patients respond well to these agents. With the introduction of biologic agents, notably the tumor necrosis factor-alpha monoclonal antibody infliximab, progress has been made in targeting specific pathogenetic mechanisms of Crohn disease and potentially altering the underlying disease process. Published experience in children is currently limited, but infliximab has been shown to improve symptoms and achieve corticosteroid independence in this age group. Unresolved issues with infliximab and other emerging biologic agents, including long-term safety, necessitate a degree of caution in selecting appropriate patients for treatment and with careful monitoring of their effects. The collection of contemporary natural history data is crucial to facilitate the better integration of current and emerging therapies in an attempt to alter the natural history of Crohn disease in children.},
   keywords = {6-Mercaptopurine/adverse effects/therapeutic use
Adrenal Cortex Hormones/adverse effects/*therapeutic use
Antibodies, Monoclonal/adverse effects/therapeutic use
Azathioprine/adverse effects/therapeutic use
Child
Crohn Disease/complications/*drug therapy/surgery
Disease-Free Survival
Gastrointestinal Agents/adverse effects/*therapeutic use
Humans
Immunosuppressive Agents/adverse effects/*therapeutic use
Infliximab
Methotrexate/adverse effects/therapeutic use},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {15735477},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Hyman, N. H. and Cataldo, P. and Osler, T.},
   title = {Urgent subtotal colectomy for severe inflammatory bowel disease},
   journal = {Dis Colon Rectum},
   volume = {48},
   number = {1},
   pages = {70-3},
   note = {Hyman, Neil H
Cataldo, Peter
Osler, Turner
Journal Article
United States
Dis Colon Rectum. 2005 Jan;48(1):70-3.},
   abstract = {PURPOSE: The purpose of this study was to assess the safety of subtotal colectomy and outcomes after this procedure in the modern era of immunosuppressive agents and primary pelvic pouch surgery. METHODS: All patients undergoing subtotal colectomy with ileostomy for ulcerative colitis or Crohn's colitis from July 1, 1990 to June 30, 2003 were identified from a prospective database. Only patients who were operated on while hospitalized for disease exacerbation were included in the analysis. Age at colectomy, preoperative days in the hospital, postoperative length of stay, and complications were recorded. The medical records were then reviewed for duration of disease, preoperative diagnosis, use of steroids and immunomodulators, parenteral nutrition, endoscopy findings, albumin level, postoperative diagnosis, and ultimate disposition. RESULTS: One hundred one patients underwent subtotal colectomy for inflammatory bowel disease during the study period. Seventy-four patients met all the inclusion criteria. The mean age was 35.9 (range, 18-86) years. Median duration of disease was 36 (0-240) months, but 28 patients had colitis for less than 1 year, whereas 10 patients had disease of greater than 10 years duration at the time of colectomy. Median preoperative hospital stay was 7 (range, 0-43) days and median postoperative length of stay was 6.5 (range, 4-37) days. Sixty-six patients underwent surgery for refractory exacerbation, 5 for free perforation, 2 for abscess, and 1 patient for hemorrhage. Twenty-seven patients (36.5 percent) had a change in diagnosis after surgery. Complications occurred in 17 patients (23 percent), including 8 cases of central venous catheter-associated thrombosis; 7 of these occurred in patients who had been hospitalized for more than a week before surgery. In the ulcerative colitis patients, 31 of 52 ultimately underwent ileal pouch-anal anastomosis, but 20 (39 percent) chose either completion proctectomy or no further surgery. CONCLUSIONS: Subtotal colectomy with ileostomy remains a safe and effective treatment for patients requiring urgent surgery for severe inflammatory bowel disease. Because of the substantial incidence of change in diagnosis and satisfaction in many patients with an ileostomy, subtotal colectomy with ileostomy may be preferable to primary ileal pouch-anal anastomosis, even when a pouch is considered safe.},
   keywords = {Adolescent
Adult
Aged
Aged, 80 and over
*Colectomy/adverse effects/methods
Female
Humans
*Ileostomy
Inflammatory Bowel Diseases/*surgery
Length of Stay
Male
Middle Aged
Patient Satisfaction
*Postoperative Complications
Severity of Illness Index},
   ISSN = {0012-3706 (Print)
0012-3706},
   Accession Number = {15690660},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Idestrom, M. and Rubio, C. and Granath, F. and Finkel, Y. and Hugot, J. P.},
   title = {CARD15 mutations are rare in Swedish pediatric Crohn disease},
   journal = {J Pediatr Gastroenterol Nutr},
   volume = {40},
   number = {4},
   pages = {456-60},
   note = {Idestrom, Maja
Rubio, Carlos
Granath, Fredrik
Finkel, Yigael
Hugot, J-P
Journal Article
Research Support, Non-U.S. Gov't
United States
J Pediatr Gastroenterol Nutr. 2005 Apr;40(4):456-60.},
   abstract = {BACKGROUND: An association between mutations in a gene involved in bacterial recognition by monocytes, CARD15/NOD2 and Crohn disease (CD) has been reported in studies of adults and children. The aim of this study was to investigate the presence of CARD15 mutations in Swedish children with CD and analyze genotype-phenotype correlations. PATIENTS AND METHODS: Fifty-eight children (62% boys) with CD diagnosed between 2.8 and 16.9 years (median 10.9 years), were reviewed. Histopathology, retrospective data collection and mutational analyses for the three main mutations R702W, G908R and 1007fs were independently performed. First-degree relatives were also genotyped. RESULTS: A CARD15 mutation was found in 8.6% (95% confidence interval, 2.9% to 19.0%), all of whom were heterozygotes, giving an overall allele frequency of 4.3% (95% confidence interval, 1.4-9.8). In 12%, all patients without mutations, a first-degree relative had CD. In four of five children, mutations were transferred from their healthy mothers. Granulomas at onset were found in 80% of patients with mutations and in 43% of those without (P = 0.17). No statistical association was found between mutation and phenotype regarding age at onset, anatomic location at onset or follow-up, severity of inflammation at onset, development of stenosis, perianal disease or extra intestinal manifestations. CONCLUSIONS: The frequency of CARD15 mutation in this Swedish pediatric CD population is lower than reported in a mixed adult and pediatric population. The genotype-phenotype correlations were non-significant although a trend was found between the presence of mutations and granuloma formation. Healthy heterozygote mothers conveyed the mutation to their children with CD.},
   keywords = {Adolescent
Adult
Age of Onset
Child
Crohn Disease/*genetics
DNA Mutational Analysis
Female
Gene Frequency
Genetic Predisposition to Disease/genetics
Genotype
Heterozygote
Humans
Intracellular Signaling Peptides and Proteins/*genetics
Male
Mutation/*genetics
Nod2 Signaling Adaptor Protein
Phenotype
Retrospective Studies
Severity of Illness Index
Sweden},
   ISSN = {0277-2116 (Print)
0277-2116},
   Accession Number = {15795594},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Jacobstein, D. A. and Baldassano, R. N.},
   title = {Use of 6-mercaptopurine/azathioprine as the immunomodulator of choice for moderately active Crohn's disease: balance},
   journal = {Inflamm Bowel Dis},
   volume = {11},
   number = {2},
   pages = {203-5},
   note = {Jacobstein, Douglas A
Baldassano, Robert N
Comment
Journal Article
United States
Inflamm Bowel Dis. 2005 Feb;11(2):203-5.},
   keywords = {6-Mercaptopurine/*therapeutic use
Azathioprine/administration & dosage/adverse effects/*therapeutic use
Child
Crohn Disease/*drug therapy/pathology
Drug Therapy, Combination
Humans
Immunosuppressive Agents/administration & dosage/adverse effects/*therapeutic use
Patient Care Planning
Patient Selection
Phenotype
*Practice Guidelines as Topic
Prognosis
Quality of Life
Randomized Controlled Trials as Topic
Severity of Illness Index},
   ISSN = {1078-0998 (Print)
1078-0998},
   Accession Number = {15677916},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Jacobstein, D. A. and Mamula, P. and Markowitz, J. E. and Leonard, M. and Baldassano, R. N.},
   title = {Predictors of immunomodulator use as early therapy in pediatric Crohn's disease},
   journal = {J Clin Gastroenterol},
   volume = {40},
   number = {2},
   pages = {145-8},
   note = {Jacobstein, Douglas A
Mamula, Petar
Markowitz, Jonathan E
Leonard, Mary
Baldassano, Robert N
Journal Article
United States
J Clin Gastroenterol. 2006 Feb;40(2):145-8.},
   abstract = {GOALS: The goals of this study were to identify markers in a patient's presentation and disease progression that predict the need for the use of immunomodulators in a pediatric population. BACKGROUND: Although immunomodulator safety and efficacy have been documented in Crohn's disease, models for predicting outcome and the need for immunomodulators (azathioprine, 6-mercaptopurine, or methotrexate) early in the disease course have not been investigated in children or adults. METHODS: Data on newly diagnosed Crohn's disease patients were prospectively collected within 3 weeks of diagnosis, 6 months after diagnosis, and 1 year after diagnosis. Information collected at each visit included medication use and disease activity assessment. RESULTS: A total of 57 patients who were followed for > or = 6 months were evaluated. Overall, 34 of 57 (59.6%) were started on immunomodulators within 1 year of diagnosis. Mean serum albumin (3.35 g/dL vs. 3.7 g/dL, P = 0.013) and hematocrit (33.3% vs. 35.9%, P = 0.023) at diagnosis were lower, and erythrocyte sedimentation rate (32 vs. 12, P = 0.011) at diagnosis was higher in patients who required immunomodulators. The total Pediatric Crohn's Disease Activity Index score as well as the physical examination score and patient recall score within the PCDAI at diagnosis were not different among those who received immunomodulators and those that did not. CONCLUSIONS: Immunomodulators are frequently used within 1 year of diagnosis in pediatric Crohn's disease. Lower serum albumin levels and hematocrit, and elevated erythrocyte sedimentation rate at diagnosis may predict the need for immunomodulators earlier in the disease course.},
   keywords = {6-Mercaptopurine/*therapeutic use
Adolescent
Azathioprine/*therapeutic use
Biomarkers/*blood
Chi-Square Distribution
Child
Child, Preschool
Crohn Disease/*blood/*drug therapy
Disease Progression
Female
Humans
Immunosuppressive Agents/*therapeutic use
Male
Methotrexate/*therapeutic use
Predictive Value of Tests
Prospective Studies
Statistics, Nonparametric},
   ISSN = {0192-0790 (Print)
0192-0790},
   Accession Number = {16394876},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {James, S. P.},
   title = {Prototypic disorders of gastrointestinal mucosal immune function: Celiac disease and Crohn's disease},
   journal = {J Allergy Clin Immunol},
   volume = {115},
   number = {1},
   pages = {25-30},
   note = {James, Stephen P
Comparative Study
Journal Article
Review
United States
J Allergy Clin Immunol. 2005 Jan;115(1):25-30.},
   abstract = {Celiac disease is a disorder of the small intestine characterized by chronic inflammation of the mucosa and protean clinical manifestations caused by loss of tolerance to dietary antigens. Two strongly associated cofactors have been identified: the presence of HLA-DQ2 or HLA-DQ8 in the host and specific antigenic peptides in the diet that are present in wheat, rye, and barley. Most patients have complete remission after dietary elimination of these foods. Crohn's disease is characterized by chronic, relapsing, recurrent, focal, transmural inflammation of the gastrointestinal tract that can lead to multiple serious problems requiring chronic medical and surgical therapy. Crohn's disease is associated with multiple genetic mutations, at least one of which has been clearly implicated in innate immunity. Multiple lines of evidence suggest that the disease involves abnormal immune responses to gut microbial flora.},
   keywords = {Allergens/immunology
Animals
*Celiac Disease/diagnosis/immunology/therapy
*Crohn Disease/genetics/immunology/therapy
Dietary Proteins/immunology
Gastrointestinal Tract/immunology/pathology
HLA-DQ Antigens/immunology
Humans
Immune Tolerance
Immunity, Mucosal
Mutation},
   ISSN = {0091-6749 (Print)
0091-6749},
   Accession Number = {15637543},
   DOI = {10.1016/j.jaci.2004.11.011},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Jantchou, P. and Turck, D. and Balde, M. and Gower-Rousseau, C.},
   title = {Breastfeeding and risk of inflammatory bowel disease: results of a pediatric, population-based, case-control study},
   journal = {Am J Clin Nutr},
   volume = {82},
   number = {2},
   pages = {485-6},
   note = {Jantchou, Prevost
Turck, Dominique
Balde, Mamadou
Gower-Rousseau, Corinne
Comment
Letter
United States
Am J Clin Nutr. 2005 Aug;82(2):485-6.},
   keywords = {Breast Feeding/*adverse effects
Case-Control Studies
Crohn Disease/etiology
Female
Humans
Infant
Infant, Newborn
Inflammatory Bowel Diseases/*etiology
Risk},
   ISSN = {0002-9165 (Print)
0002-9165},
   Accession Number = {16087998},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Johnson, T. and Macdonald, S. and Hill, S. M. and Thomas, A. and Murphy, M. S.},
   title = {Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial},
   journal = {Gut},
   volume = {55},
   number = {3},
   pages = {356-61},
   note = {Johnson, T
Macdonald, S
Hill, S M
Thomas, A
Murphy, M S
Journal Article
Multicenter Study
Randomized Controlled Trial
England
Gut. 2006 Mar;55(3):356-61. Epub 2005 Sep 14.},
   abstract = {BACKGROUND AND AIMS: Total enteral nutrition (TEN) with a liquid formula can suppress gut inflammation and induce remission in active Crohn's disease. The mechanism is obscure. Studies have suggested that long term nutritional supplementation with a liquid formula (partial enteral nutrition (PEN)) may also suppress inflammation and prevent relapse. The aim of this study was to compare PEN with conventional TEN in active Crohn's disease. PATIENTS AND METHODS: Fifty children with a paediatric Crohn's disease activity index (PCDAI)>20 were randomly assigned to receive 50% (PEN) or 100% (TEN) of their energy requirement as elemental formula for six weeks. The PEN group was encouraged to eat an unrestricted diet while those receiving TEN were not allowed to eat. The primary outcome was achievement of remission (PCDAI<10). Secondary analyses of changes in erythrocyte sedimentation rate (ESR), C reactive protein, albumin, and platelets were performed to look for evidence of anti-inflammatory effects. RESULTS: Remission rate with PEN was lower than with TEN (15% v 42%; p=0.035). Although PCDAI fell in both groups (p=0.001 for both), the reduction was greater with TEN (p=0.005). Moreover, the fall in PCDAI with PEN was due to symptomatic and nutritional benefits. With both treatments there were significant improvements in relation to abdominal pain, "sense of wellbeing", and nutritional status. However, only TEN led to a reduction in diarrhoea (p=0.02), an increase in haemoglobin and albumin, and a fall in platelets and ESR. CONCLUSIONS: TEN suppresses inflammation in active Crohn's disease but PEN does not. This suggests that long term nutritional supplementation, although beneficial to some patients, is unlikely to suppress inflammation and so prevent disease relapse.},
   keywords = {Adolescent
Adolescent Nutritional Physiological Phenomena
Blood Sedimentation
C-Reactive Protein/metabolism
Child
Child Nutritional Physiological Phenomena
Crohn Disease/blood/*therapy
Energy Intake
Enteral Nutrition/*methods
Female
Food, Formulated/analysis
Humans
Male
Remission Induction
Severity of Illness Index
Treatment Outcome},
   ISSN = {0017-5749 (Print)
0017-5749},
   Accession Number = {16162683},
   DOI = {10.1136/gut.2004.062554},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Keefer, L. and Stepanski, E. J. and Ranjbaran, Z. and Benson, L. M. and Keshavarzian, A.},
   title = {An initial report of sleep disturbance in inactive inflammatory bowel disease},
   journal = {J Clin Sleep Med},
   volume = {2},
   number = {4},
   pages = {409-16},
   note = {Keefer, Laurie
Stepanski, Edward J
Ranjbaran, Ziba
Benson, Laura M
Keshavarzian, Ali
Journal Article
Research Support, Non-U.S. Gov't
United States
J Clin Sleep Med. 2006 Oct 15;2(4):409-16.},
   abstract = {BACKGROUND: There is an increased prevalence of gastrointestinal symptoms, peptic ulcer disease, and colon cancer in night-shiftworkers, whose sleep is commonly disrupted. Sleep complaints are an extrapyramidal symptom of irritable bowel syndrome (IBS). Sleep disruption may contribute to increased medical morbidity by weakening the ability of the immune system to protect against endotoxins-this pathway could be of potential importance to the pathogenesis and/or clinical course of inflammatory bowel disease (IBD), a chronic immunoinflammatory gastrointestinal disorder associated with marked reductions in quality of life. This is the first study to comprehensively examine sleep concerns in patients with IBD. METHODS: Sixteen patients with biopsy-proven inactive IBD (8 with Crohn disease and 8 with ulcerative colitis), 9 patients with IBS, and 7 healthy controls completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Inflammatory Bowel Disease Questionnaire, SF-12, and a single overnight polysomnogram. Polysomnography and arousals were scored according to standard criteria. Multivariate analyses were used to compare subjective and objective sleep parameters between groups and to identify associations between sleep complaints and quality of life. RESULTS: Patients with IBD did not seem to significantly differ from patients with IBS, who have established sleep complaints. On polysomnography, total sleep time differentiated the 3 groups well, with the IBS and IBD groups appearing numerically similar. Whereas IBS and IBD groups were similar with respect to observed sleep parameters, IBS patients did report the most concerns, consistent with earlier research suggesting that hyperarousal and perceptual differences may contribute to symptom reporting. CONCLUSION: Sleep parameters greatly influenced quality of life in both groups and highlight the need to address sleep concerns as part of IBD management.},
   keywords = {Adult
Colitis, Ulcerative/epidemiology
Crohn Disease/epidemiology
Female
Humans
Inflammatory Bowel Diseases/*epidemiology
Male
Middle Aged
Prevalence
Quality of Life/psychology
Sleep Stages/physiology
Sleep Wake Disorders/diagnosis/*epidemiology
Surveys and Questionnaires},
   ISSN = {1550-9389 (Print)
1550-9389},
   Accession Number = {17557469},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Klement, E. and Reif, S.},
   title = {Breastfeeding and risk of inflammatory bowel disease},
   journal = {Am J Clin Nutr},
   volume = {82},
   number = {2},
   pages = {486},
   note = {Klement, Eyal
Reif, Shimon
Comment
Letter
United States
Am J Clin Nutr. 2005 Aug;82(2):486.},
   keywords = {Breast Feeding/*adverse effects
Crohn Disease/etiology
Female
Humans
Inflammatory Bowel Diseases/*etiology
Risk Factors},
   ISSN = {0002-9165 (Print)
0002-9165},
   Accession Number = {16088000},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Knight, C. and El-Matary, W. and Spray, C. and Sandhu, B. K.},
   title = {Long-term outcome of nutritional therapy in paediatric Crohn's disease},
   journal = {Clin Nutr},
   volume = {24},
   number = {5},
   pages = {775-9},
   note = {Knight, C
El-Matary, Wael
Spray, Christine
Sandhu, Bhupinder K
Journal Article
England
Clin Nutr. 2005 Oct;24(5):775-9.},
   abstract = {BACKGROUND AND AIMS: Long-term effects of using enteral feed therapy to induce remission in paediatric Crohn's disease are poorly documented. The aim of this study is to examine the short and long-term impact of enteral nutrition as primary therapy for children with newly diagnosed Crohn's disease. METHODS: Since 1994, a data base was set up in Bristol for all children with inflammatory bowel diseases. The data of newly diagnosed patients with Crohn's disease in whom enteral nutrition was used as the primary therapy (44 children) was analysed, with particular reference to time to remission, to first and subsequent relapse, and to first steroid usage. RESULTS: Forty out of 44 patients (90%) responded to enteral nutrition, with a median time to remission of 6 weeks. 25 of these 40 (62%) relapsed, with a median duration of remission of 54.5 weeks (range 4-312). 15 (38%) have not relapsed. 21 of the 44 (47%) have not received steroids. In those who eventually required steroids, their use was postponed for a median 68 weeks (range 6-190). Site of disease activity had no impact on response to enteral nutrition, but there was a trend towards earlier relapse in those with isolated colonic involvement. CONCLUSIONS: This data suggests that there are long-term benefits to the use of enteral nutrition to induce remission in children with Crohn's disease Steroids may be avoided in nearly half the cases and, in others, their use postponed by 68 weeks.},
   keywords = {Adolescent
Child
Crohn Disease/drug therapy/*therapy
Enteral Nutrition/*methods
Female
*Growth
Humans
Longitudinal Studies
Male
Recurrence
Remission Induction
Steroids/*therapeutic use
Time Factors
Treatment Outcome},
   ISSN = {0261-5614 (Print)
0261-5614},
   Accession Number = {15904998},
   DOI = {10.1016/j.clnu.2005.03.005},
   year = {2005},
   type = {Ref–rence Type}
}

@article{
   author = {Konno, M. and Kobayashi, A. and Tomomasa, T. and Kaneko, H. and Toyoda, S. and Nakazato, Y. and Nezu, R. and Maisawa, S. and Miki, K.},
   title = {Guidelines for the treatment of Crohn's disease in children},
   journal = {Pediatr Int},
   volume = {48},
   number = {3},
   pages = {349-52},
   note = {Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition
Konno, Mutsuko
Kobayashi, Akio
Tomomasa, Takeshi
Kaneko, Hiroaki
Toyoda, Shigeru
Nakazato, Yutaka
Nezu, Riichiro
Maisawa, Shun-Ichi
Miki, Kazunori
Journal Article
Practice Guideline
Australia
Pediatr Int. 2006 Jun;48(3):349-52.},
   abstract = {This paper shows guidelines for the treatment of Crohn's disease in children by the Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (Chair: Akio Kobayashi). The points in which these guidelines differ from those for adult patients are as follows. (i) Total enteral nutrition in the form of an elemental formula is indicated as primary therapy for children with Crohn's disease at onset as well as the active stage. Oral mesalazine is used together. (ii) Total parenteral nutrition (TPN) with oral mesalazine is required for children with serious illness. The use of a corticosteroid should be withheld for at least 1 week after TPN has been started. (iii) When TPN is not considered to be effective, additional corticosteroid is used. Full doses of corticosteroid should be used for at least 2 weeks after clinical improvement has been achieved, and then the dose of the corticosteroid should be tapered carefully. (iv) When surgery is indicated in pediatric patients with stricture or fistula formation and complicated by persistent growth failure despite medical therapy, the optimum time for surgery is thought to be before epiphyseal plates have been closed.},
   keywords = {Child
Crohn Disease/*therapy
Humans
Japan},
   ISSN = {1328-8067 (Print)
1328-8067},
   Accession Number = {16732811},
   DOI = {10.1111/j.1442-200X.2006.02220.x},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Lal, S. and Teubner, A. and Shaffer, J. L.},
   title = {Review article: intestinal failure},
   journal = {Aliment Pharmacol Ther},
   volume = {24},
   number = {1},
   pages = {19-31},
   note = {Lal, S
Teubner, A
Shaffer, J L
Journal Article
Review
England
Aliment Pharmacol Ther. 2006 Jul 1;24(1):19-31.},
   abstract = {Intestinal failure is a specific disease entity resulting from intestinal resection or disease-associated malabsorption and characterized by the inability to maintain protein-energy, fluid, electrolyte or micronutrient balance. We performed a MEDLINE search (1966-2006) to identify relevant articles, using keywords intestinal failure, parenteral or enteral nutrition, intestinal fistula and short bowel syndrome. Causes of intestinal failure are varied, with self-limiting or 'Type 1' intestinal failure occurring relatively commonly following abdominal surgery, necessitating short-term fluid or nutritional support. The rarer, 'Type 2' intestinal failure, is associated with septic, metabolic and complex nutritional complications, usually following surgical resection in patients with Crohn's or mesenteric vascular disease. A multidisciplinary approach to the management of patients with Type 2 intestinal failure is crucial: resolution of sepsis is required before adequate nutritional repletion can be achieved, and it is important to optimize nutritional status, not only through enteral or parenteral supplementation, but also by addressing complications of short bowel syndrome, before considering definitive surgical reconstruction. A structured approach to the management of Type 2 intestinal failure should reduce the likelihood of these complex patients developing 'Type 3' intestinal failure, which is characterized by the need for long-term parenteral nutrition.},
   keywords = {Humans
Intestinal Absorption/physiology
*Intestinal Diseases/etiology/physiopathology/therapy
Nutritional Support/methods
Patient Care Planning
Sepsis/etiology/therapy},
   ISSN = {0269-2813 (Print)
0269-2813},
   Accession Number = {16803600},
   DOI = {10.1111/j.1365-2036.2006.02941.x},
   year = {2006},
   type = {Ref–rence Type}
}

@article{
   author = {Lemann, M. and Allez, M.},
   title = {[Treatment strategies for inflammatory bowel disease]},
   journal = {Rev Prat},
   volume = {55},
   number = {9},
   pages = {984-92},
   note = {Lemann, Marc
Allez, Matthieu
English Abstract
Journal Article
Review
France
Rev Prat. 2005 May 15;55(9):984-92.},
   abstract = {In patients with active inflammatory bowel disease (IBD), the objective is to achieve clinical remission. For ulcerative colitis (UC), oral or rectal aminosalycilates are widely used, and in more severe flares, corticoids and occasionally ciclosporine. In active Crohn's disease, corticosteroids represent the main treatment

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branch_name: refs/heads/master

extension: bib