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  • 1
    ISSN: 0009-8981
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Crohn's disease is a chronic debilitating disorder affecting a child's physical and emotional well-being. Recent emphasis on ‘quality of life’ (QOL) has led to re-evaluation of available medical treatments.Aim : To assess prospectively change in QOL, clinical disease activity and intestinal mucosal inflammation in active paediatric Crohn's disease after treatment with exclusive enteral nutrition. In addition, we evaluated whether change in QOL could predict changes in paediatric Crohn's disease activity index (PCDAI) and mucosal inflammation (endoscopic and histologic).Methods : The IMPACT II questionnaire was used prospectively and longitudinally in 26 consecutively recruited children [16 males (67%), median 14 years, s.d. = 1.7 years] with active Crohn's disease (PCDAI 〉 20). They were treated with a new polymeric enteral feed (ACD004, Nestle) for a period of 8 weeks. All had PCDAI, QOL and endoscopic assessment at the time of diagnosis and after 8 weeks of treatment.Results : Twenty-three of 26 children achieved a clinical remission at 8 weeks, with improvement in the QOL scores (P 〈 0.05). The change in QOL score after treatment was predictive of achieving a clinical remission, but not of histological improvement.Conclusions : Although children may find dietary restrictions difficult, this study confirms a clear improvement in QOL after treatment with exclusive enteral nutrition. However, improvement in QOL scores is not reflected by improvement in mucosal inflammation. Whilst improving QOL remains a core principal in patient management, the long-term consequences of ongoing mucosal inflammation must be better understood before relying only on short-term QOL measures to dictate treatment choices.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Treize enfants âgés de 2 à 16 ans ont subi une résection subtotale de l'intestin grêle dont 10 pour volvulus de sa partie moyenne. Tous ont survécu leur croissance s'étant effectuée normalement. Le total en années de la nutrition parentérale qu'ils ont reçu s'élève à 36 ans. Dans 7 cas, où la longueur du segment intestinal restant variait entre 30 et 120 cm, il fut possible d'arrêter l'alimentation parentérale 30 mois en moyenne après la résection. En revanche si la résection est quasi totale, la longueur du segment de grêle conservé étant inférieure à 20 cm, le maintien permanent de l'alimentation parentérale est inévitable à moins que la transplantation intestinale ne devienne possible. Grâce à l'alimentation parentérale organisée à domicile, la qualité de vie de ces sujets est presque normale.
    Abstract: Resumen Trece niños de edades entre los 2 y los 16 años han sido sometidos a resección subtotal del intestino delgado, como consecuencia de vólvolus del intestino medio en 10 casos. Todos los niños se encuentran vivos y su crecimiento es normal; ellos representan 36 años-pacientes acumulados de nutrición parenteral y 11 años de nutrición enteral a tasa constante. En siete casos en quienes el intestino residual media entre 30 y 120 cm, fué posible terminar todo tipo de soporte nutricional artificial a los 30 meses, en promedio, después de realizada la resección intestinal. Por el contrario, si la resección fué casi total con menos de 20 cm de intestino residual, la dependencia vitalicia de nutrición parenteral es inevitable, a menos que el transplante intestinal llegue a ser factible. Mediante la nutrición parenteral cíclica realizada a domicilio, la calidad de la vida de estos pacientes llega a ser casi normal.
    Notes: Abstract Thirteen children, aged 2 to 16 years, had a subtotal resection of small bowel, following a mid-gut volvulus in 10 cases. All children are alive, and their growth is normal; 36 cumulative patient-years of parenteral nutrition and 11 years of constant-rate enteral nutrition were performed. In 7 cases, in which residual small bowel varied between 30 to 120 cm, termination of all artificial nutritional support was possible 30 months in mean after intestinal resection. In contrast, if resection was near total with less than 20 cm remaining, life-long dependence on parenteral nutrition is unavoidable unless intestinal transplantation becomes feasible. With cyclic parenteral nutrition at home, the patients' quality of life is near normal.
    Type of Medium: Electronic Resource
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