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Inflammatory Bowel Disease (IBD) - Crohn’s disease, ulcerative colitis, and unclassified inflammatory bowel disease are increasingly being diagnosed in children and adolescents. This is particularly important because the clinical picture, prevalence, and severity of the disease vary greatly if the disease originated in the pediatric population. Moreover, it is stated more pronounced that the age at which the disease occurred is younger. It is the increase in the incidence of these diseases, but also their specificity in diagnosis and treatment that has led to the development of specific algorithms for the diagnosis and treatment of IBD in children. There is a large body of research trying to answer the question of why the disease occurs more and more often, what are the etiopathogenetic mechanisms of its occurrence and what is it that makes the clinical picture and therapeutic response different in childhood. The purpose of this talk is, therefore, to present and discuss the specifics of IBD in children, especially in relation to epidemiology, phenotypic characteristics and diagnostic and therapeutic approaches.

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Objectives:To prospectively investigate the incidence,clinical presentation and diagnostic approach of diagnosed childhood celiac disease (CD) in the Netherlands and compare the findings with national survey data from 1975-1990 and 1993-2000.Methods:National, prospective investigation of diagnosed CD in children aged 0-14 years using the same approach as in the survey of 1993-2000. From January 2010 to December 2013,all practicing pediatricians were invited by the Dutch Paediatric Surveillance Unit to report new celiac diagnoses.Data about the diagnoses were collected via questionnaires.Results were compared with these from the previous surveys.Results:1107 children with newly diagnosed CD were reported (mean age:5.8 years; range:10 months-14.9 years;60.5% female).The overall incidence rate of childhood CD was 1.59/1000 live births, which is 8.8-fold higher than in 1975-1990 (0.18 / 1000 live births) and 2.0-fold higher than in 1993-2000 (0.81 / 1000 live births).During the study period, the prevalence of diagnosed CD was 0.14% (total population 0-14 years of age, 2.898.642), far below the 0.7% of CD identified by screening in the general Dutch paediatric population recently.The clinical presentation has shifted towards less severe and extra-intestinal symptoms.Seventy-five percent of the diagnoses were made according to the accepted ESPGHAN criteria with a significant decrease of 46.3% in small bowel biopsies whereas the use of EMA and HLA typing significantly increased with 25.8% and 62.1%, respectively.Conclusion:The incidence of diagnosed CD among children in the Netherlands is still rising significantly with a continuous changing clinical presentation and diagnostic approach.Despite the increasing incidence of diagnoses, significant underdiagnosis of the disease remains.

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Objective: In children, CMV-associated protein-losing enteropathy (PLE) can lead to alarming symptoms as generalised oedema. Mostly unknown, it is diagnosed after invasive tests. This study describes the largest cohort of immunocompetent and immunosuppressed children with CMV-associated PLE.

Methods: Children diagnosed with a CMV-associated PLE between 2007 and 2019 in two French hospitals were retrospectively described. Clinical and biological signs, methods of CMV identification, endoscopy and histological findings as the disease management and course were analysed.

Results: CMV-associated PLE was proved in 21 immunocompetent and 22 immunosuppressed patients. The median patients’ age at diagnosis was 29.7 months [1-133.7] in immunocompetent patients versus 100.9 months [3.4-156.4] in immunosuppressed ones (p<0.001), and hence was consistent with primo-infection and reactivation, respectively. The digestive symptoms were prevailing on immunocompetent children with mainly vomiting (85.7% versus 50%, CI [1.2; 39.2] p=0.02). Immunocompetent patients showed more often oedema (61.9% versus 4.5%, CI [3.6; 1502.4], p<0.001) 10 days after the digestive symptoms. Oedema was linked to hypoalbuminemia, observed in both groups (85.7% versus 95.5%, CI [0.005; 4], p=0.34) but, more severe in immunocompetent patients (21.2g/L [17.6-25.7] versus 29.6g/L [24.9-33.9], p=0.01). Evidence of CMV infection based on non-invasive methods was found on 88.9% of immunocompetent and 95.5% of immunosuppressed patients (CI [0.006; 8.1], p= 0.58) while endoscopy was performed on 95.2% and 100% of them, respectively (p=0.48), without any therapeutic change.

Conclusion: Digestive symptoms days before generalised oedema should lead to suspect CMV-associated PLE, confirmed by non-invasive tests. EGD indications should be limited to the distinction with graft-versus-host disease.

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Aim: Proton pump inhibitors (PPI) are associated with serious adverse effects. In order to prevent their excessive use, especially their off-label use in the pediatric population, clinical guidelines were established in France and internationally. Our objectives were to describe the ambulatory pediatric PPI use in France, its trends, and the impact of French (2014) and international (2018) clinical practice guidelines.

Methods: We described the yearly and monthly aggregated PPI prescription rates based on national dispensation data in French children (IQVIA’s Xponent database, 2009-2019). In an interrupted time-series analysis, we assessed the impact of clinical guidelines on the PPI prescription rate using segmented linear regression. Analyses were performed for the aggregated pediatric population, then by age subgroups (infants <2 years old, children 2-11, adolescents 12-17).

Results: During the study period, 8,060,297 pediatric PPI prescriptions were delivered, for a mean PPI prescription rate of 52.5/1,000 inhabitants/year. Between 2009 and 2019, the PPI prescription rate increased by 41% in the pediatric population (+110%in infants). The PPI prescription rate showed seasonal patterns with peaks in winter and dips in summer. After the release of French guidelines, significant decreases in trends of prescription rates were observed in all age groups. After the release of international guidelines, a significant decrease in trend was observed in adolescents only.

Conclusion: The pediatric PPI prescriptions rate in France was one of the highest in the world and displayed a major increase over the last decade, mainly among infants. Clinical guidelines had a modest impact, further corrective actions are needed.