BACKGROUND: Inflammatory bowel disease (IBD) is a group of conditions characterized by chronic inflammation of the gastrointestinal (GI) tract. A new diagnosis of IBD in children and adolescents can have significant psychosocial effects on both the patient and the family. Child and parental coping strategies play a crucial role in the adjustment to IBD, especially within the first year of the diagnosis. AIMS: The primary aim of the study was to assess the stability of coping measures over time in children and parents following a new pediatric IBD diagnosis. The study also aimed to assess the impact of parental coping on parental healthcare resource utilization for children with newly diagnosed IBD, as well as the impact of parental coping on anxiety, depression, and quality of life in children with newly diagnosed IBD. METHODS: This was a prospective, longitudinal cohort study at Boston Children’s Hospital (BCH) that focused on children and adolescents with newly diagnosed IBD, as well as their parents. Patients and their parents were approached at the time they enrolled in the study and then again about 12 months later as part of a one-year follow-up. At both time points, they were asked to fill out various questionnaires about psychological functioning and answer other questions about medical care. RESULTS: The study identified and encountered 465 IBD patients, of which 126 were eligible for recruitment. There were 70 patients and families who signed a consent form for enrollment, 55 who fully or partially completed the questionnaires at baseline, and only 5 who also completed the questionnaires at follow-up. Due to the limited number of participants who completed the questionnaires at follow-up, no definitive conclusions could be drawn about the stability of coping measures over time. Parental anxiety, parental depression, frequent parental stress, and difficult parental stress were all found to be positively correlated with healthcare utilization and negatively correlated with the child’s quality of life. Parental anxiety, frequent parental stress, and difficult parental stress were all found to be positively correlated with the child’s anxiety. Parental depression, frequent parental stress, and difficult parental stress were all found to be positively correlated with the child’s depression. CONCLUSION: Preliminary findings suggest that poor parental coping leads to decreased child quality of life and increased healthcare utilization, child anxiety, and child depression. A larger sample size is needed to accurately evaluate the stability of coping measures over time. The next steps for this study involve further examination of the impact of parental coping and enrollment of more patients and families.

Inflammatory bowel disease (IBD) is a growing disorder with unknown etiology. However, increasing evidence strongly highlights the role of gut microbiota with possible involvement of microbial plasmidome in the inflammatory process. Although the composition of the gut microbiota has been extensively studied, important functional groups such as butyrate producers remain poorly characterized, particularly in pediatric IBD. Furthermore, evaluation of the gut plasmidome in healthy and IBD children is missing. In this study, we used molecular techniques involving quantitative PCR (qPCR) and next-generation sequencing of functional and 16S rRNA genes to analyze the level and composition of butyrate-producing microbes in mucosal washes collected from the right colon of healthy children and Crohn's disease (CD) patients during diagnostic colonoscopy. Also, we isolated and characterized the gut plasmidome from the right colon mucosal washes collected from pediatric non-IBD control, ulcerative colitis (UC), and CD subjects. Although no difference was observed in the total amount of butyrate producers that utilize the butyrate kinase (BUK) pathway for butyrate synthesis, butyrate producers that use the butyryl CoA:acetate CoA-transferase (BCoAT) pathway were decreased in CD patients with inflamed colon as compared to controls. This functional gene approach shows that pediatric CD is characterized by generalized decreased abundance of Eubacterium rectale and increased abundance of Faecalibacterium prausnitzii in patients with inflamed colon. Also, phylogenetic analysis highlighted 15 Operational Taxonomic Units (OTUs) as potential novel butyrate producers, five of which were decreased in CD patients. Using 16S rRNA sequencing approach validated the functional gene results and showed decreased abundance of Coprococcus in CD patients with inflamed colon. Furthermore, non-IBD plasmidome has higher level of genes involved in butyrate synthesis and regulation of different cellular processes and stress response. On the other hand, IBD plasmidome is enriched with antibiotic resistance genes and phage elements, and pediatric CD plasmidome in particular has higher abundance of the adenosine-5'-phosphosulfate reductase gene. Altogether, our study represents the first comprehensive description of gut butyrate producers and plasmidome of pediatric subjects that emphasize a characteristic dysbiosis of butyrate producers in pediatric CD and a potential link between the gut plasmidome and IBD pathogenesis.

Iron deficiency anemia (IDA) is a common extra-intestinal manifestation of inflammatory bowel disease (IBD). It is particularly common in the pediatric population, with 40-60% of pediatric patients with IBD meeting criteria for anemia (Aljomah et al, 2018). A number of studies have examined the use of both IV and oral iron treatments to treat anemia in IBD, but few have examined the safety and efficacy of these treatments in children and how they impact a patient’s health-related quality of life. We conducted a prospective cohort study of 79 pediatric patients admitted to Boston Children’s Hospital for management of their IBD. 48 of these patients received IV iron, 13 received oral iron, and 12 were not treated with either. Treatment with IV iron resulted in a statistically significant increase in hemoglobin of 1.75g/dL+/-1.4g/dL (mean +/- SD) from admission to the time of their first post-discharge visit (p=0.0001). Prescription of oral iron at the time of discharge did not result in a significant increase in hemoglobin over the same interval (p=0.481). Though there was a positive trend, IV iron treatment did not result in a significant change in health-related quality of life (HRQOL) measurements as measured by the IMPACT-III questionnaire (p=0.06). Our study suggests that IDA is common in patients admitted for management of their IBD, IV iron is more efficacious in raising hemoglobin, and that larger studies will be needed to more fully demonstrate the impact of effective iron repletion on overall quality of life in these patients.

This study assesses generic and disease-specific Health-Related Quality of Life (HRQOL) in children and adolescents with Inflammatory Bowel Disease (IBD). More specifically, the purpose of the study is to address the relationship between disease- specific indicators, both on a symptom-by-symptom basis and as a whole, to overall HRQOL. Self- and proxy-report versions of the Pediatric Quality of Life Inventory™ (PedsQL™) Generic Core Scales and the newly developed Pediatric Quality of Life Inventory™ Gastrointestinal Symptoms Module were administered to 187 parent-child dyads at ten study sites across the United States. Disease-specific indicators included: stomach pain, stomach upset, trouble swallowing, heartburn and reflux, gas and bloating, constipation, and diarrhea. It was hypothesized that caregiver- and child-reported disease-specific HRQOL would be positively correlated with generic HRQOL, and that physical disease-specific indicators would contribute the greatest variance in total generic HRQOL scores, for both self and proxy report. Results confirmed the hypothesis that disease-specific HRQOL would be positively correlated with generic HRQOL for children and caregivers. Multivariate regression results revealed that the Stomach Pain and Hurt, Worry, Medicines, and Communication scales contributed the most variance to overall HRQOL scores for children. The same analysis performed for parent ratings yielded one statistically significant scale: Worry. In essence, intervention efforts aimed at reducing the influence of worry and anxiety may prove more effective in improving HRQOL outcomes than interventions targeting reduction of physical symptoms.

INTRODUCTION: Inflammatory bowel disease (IBD) is a complex, chronic, autoimmune disease of the gastrointestinal tract. Reactive oxygen species (ROS), a product of active leukocytes, have been implicated in the pathogenesis of IBD. The ability to reliably measure ROS in blood, urine, and stool samples could represent a new approach to assessing disease activity and response to therapy in pediatric patients with IBD. OBJECTIVES: To assess the relationship between redox measurements and clinical disease activity in pediatric patients with IBD. METHODS: Biological specimens, including stool, urine, blood plasma, and intestinal aspirates, were collected from patients at Boston Children’s Hospital. Each sample’s oxidation-reduction potential was measured by two oxidation-reduction potential probes (an Arrowdox probe and a Mettler Toledo probe). Probes were directly immersed into the sample, returning a millivolt measurement of oxidation-reduction potential. Linear regression was performed to explore the relationship between patient-reported outcome measures (PROMs) and redox measurements of biological specimens. Patients were also stratified by disease severity, and ANOVA testing was performed to test for differences in oxidation-reduction potential observed in patients with remittent, mild, moderate, and severe disease activity. RESULTS: Redox values in stool, urine, plasma, and intestinal aspirate did not significantly correlate with PROMs or differ significantly among groups categorized by disease severity. CONCLUSIONS: Measurements of oxidation-reduction potential from stool, urine, plasma, and intestinal aspirate do not appear to be useful for assessing disease severity in pediatric patients with inflammatory bowel disease.