Presenters: PROF TONY CATTO-SMITH, DR JOSEF WAGNER, DR JEREMY ROSENBAUM, A/PROF DON CAMERON
PDF Slides: Tony Catto-Smith – Crohns and colitis in children
PDF Slides: Josef Wagner – Aetiology of Crohns
PDF Slides: Jeremy Rosenbaum – Imaging in crohns
PDF Slides: Don Cameron – Crohns treatment
Crohns disease and Ulcerative Colitis have increased dramatically over the last 20-30 years. Australia now has one of the highest incidence rates in the world for both of these conditions. This presentation will provide information on the extent of this change, ground-breaking research being undertaken at RCH into aetiology, the latest in diagnostic techniques, the complexities that need to be considered in treating patients, and the importance of a team approach.
Prof Tony Catto-Smith (Introduction) is Director of Gastroenterology at RCH and has had a long term interest in inflammatory bowel disease since training in Canada on an Ileitis and Colitis Foundation Fellowship. He has actively combined a clinical career with that of research.
Dr Josef Wagner (Studies on the Microbial Etiology) did his PhD at the MCRI and finished in 2006. Then he changed his research direction from stem cell to Crohn’s disease. Since then he is working at the Enteric Virus Group headed by Carl Kirkwood. Their research focuses on the identification of microbial triggers in paediatric Crohn’s disease and to correlate the presence of specific microbes with defined Crohn’s disease associated mutations. Recently he has moved towards using next generation sequencing to analysis the viral gut flora in mucosal biopsies from Crohn’s disease patients.
Dr Jeremy Rosenbaum (Imaging Techniques) has been a Fellow in the Department of Gastroenterology at the RCH since 2009 and has developed a keen interest in IBD. He will be pursuing this interest further in the coming years after recently being awarded a Fellowship in Paediatric IBD at The Hospital for Sick Children in Toronto from 2012.
A/Prof Don Cameron (Biologicals and Immunosuppresants) has been looking after children with inflammatory bowel disease for over 35 years and has witnessed the extraordinary increase in incidence of Crohn’s disease over the past three decades. He joined the Gastroenterology Department in the mid-1970s then had three years overseas training at Great Ormond Street, Kings and St Marks Hospitals in London before returning to Melbourne. He is also Head of Gastroenterology at Monash Children’s.
Presented on Wednesday 27th July 2011
5 comments for “Crohns and Colitis in Children – a growing problem: A cause? A capsule? A cure?”
Michael Ee
Qs to Jeremy.
What are the current indications for the use of pillcam at the RCH?
Inability to swallow the pillcam can be overcome but what is the cut-off lower limit for age for its safe use?
Was the intussusception visualised in the pillcam a transient phenomenon?
Jeremy Rosenbaum
Hi,
Thank you for your questions.
The current PBS reimbursable indications for the Pillcam SB are unexplained GI bleeding or anemia with normal gastroscopy and colonoscopy in the prior 12months, in children over 10. Polyposis syndrome (ie. PJS) screening is also an indication. Work is being done to increase the indications and will hopefully be expanded to include query small bowel Crohns Disease in the near term future.
The TGA in the USA approves it’s use in children older than 2 so hopefully we will also be able to increase our use in younger children in the future. These children will usually need endoscopic placement into the small bowel.
With regards to the intussusception- yes, it was transient and asymptomatic. (A known obstructive lesion would almost always be a contraindication to Pillcam). This boy had recurrent abdominal pain and anemia which was not explained by his endoscopy or Pillcam. The finding suggests that transient intussusception may be a normal physiological phenomenon.
Regards,
Jeremy
Christina Port
Qs to Dr Don Cameron
Prior to Infliximab treatment, is tuberculin test done or BCG is given?
What does MAP stand for ? Is it mycobacterium species?
Regarding nutrition, what is the normal advice for children with Crohn’s disease?
Prof Tony Catto-Smith
Dear Dr Port, Dr Cameron is currently on leave and I will answer in his absence.
1) There have been some changes in approach to screening practice. Most people would advocate the use of the Quantiferon test for TB screening.
2) MAP stands for mycobacterium avium paratuberculosis. There is a considerable literature about this organism and its putative role in Crohns. 3) In most situations, we would normally advice a “normal health diet” for children with Crohns. However, if the child is malnourished, they may need nutritional supplementation either in terms of increased energy or specific nutrients. There is a degree of interest in the use of “liquid” feeds as a primary treatment for Crohns, especially in children.
Eva Grady
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