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| |  DG DISPATCH - WCPGHN: Rapid Remission Of Pediatric Crohn's Disease Without Steroids By Maria Bishop Special to DG News
BOSTON, MA -- August 10, 2000 -- U.S. researchers used a three-step antibiotics approach without steroids to gain rapid remission for children with Crohn's disease in a study presented at the first World Congress of Pediatric Gastroenterology, Hepatology and Nutrition in Boston, MA. Seven children with Crohn’s disease diagnosed at the Columbia/Cornell Medical Center in New York City were included in the study. The children were between the ages of 7.5 and 17 years old (four males). Medical records from 1995-99 were reviewed retrospectively and only newly diagnosed patients were eligible. Lead investigator, Dana Ursea, MD, noted that the extent of the patients' Crohn's disease was assessed through radiology, endoscopy and pathology before the trial began. Dr. Ursea, of the pediatrics department, New York-Presbyterian Hospital and Columbia/Cornell Medical Center, in New York, described the study as including three stages -- priming, consolidation and remission. The priming phase was aimed at controlling inflammation, providing bowel rest and treating patients for bacterial overgrowth (e.g., Clostridium difficile). The priming phase was applied only to four patients who had moderate-severe disease (as shown on the Pediatric Crohn's Disease Activity Index [PCDAI]), and consisted of elemental diet or parenteral nutrition, metronidazole and aminosalicylic acid. All patients received clarithromycin courses during the consolidation phase. During the consolidation phase, the researchers maintained inflammation control and treated patients for colonization with Mycobacterium avium complex (MAC); five patients had grown MAC from colonic aspirates. The remission phase consisted of clinical, biochemical and histological resolution and discontinuation of medications. Results showed that all seven patients achieved clinical remission (PCDAI score of <10) within two to seven weeks of treatment. The longest remission was 24 months. One patient who had an entero-enteral fistula achieved healing. At present, five patients remain in remission and off all medications. Two patients are lost to follow-up. Dr. Ursea concluded that "Treatment of Crohn's disease in children is efficacious and safe using this approach. We recommend routine screening for MAC colonization and treating with appropriate antibiotics as an alternative management of Crohn's disease in children." Controlled, prospective trials aimed at further defining the role of antibiotics and MAC in progression of pediatric Crohn's disease are in progress at the Columbia/Cornell Medical Center.
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