Inflammatory Bowel Disease
Everything in the library about inflammatory bowel disease — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
2 items
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 3 articles from May 2023, the CAPS issue, with editor Dr. Sonia Butterworth and authors Drs. Jacob Langer, Reto Baert
podcast11:17 · Aug 2023
Quick Literature Updates Episode 15
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We’re back with fifteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most inte
video4:12 · Jan 2024
Case-Based Learning
1 item
Colorectal Quiz Episode 26: Perianal Crohn's Disease
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In this week's episode, Dr. Levitt and Dr. Frischer discuss perianal Crohn's disease with Dr. Lisa McMahon, director of the IBD center at Phoenix Children's Hospital and pediatric surgery fellow, Dr. Cristine Velazco.
We'll go over how to a
podcast23:58 · Jan 2022
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Colorectal Quiz Episode 26: Perianal Crohn's Disease
In pediatric patients, unlike adult patients, the first presenting factor for Crohn's disease can often be perianal disease.
clinicalJason Frischer9:29 ↗
Male gender over the age of 10, and presence of a fistula are risk factors with much higher incidence of Crohn's disease being diagnosed in patients presenting with perianal lesions to the emergency room.
epidemiologicalJason Frischer9:00 ↗
The mucosa heals first compared to skin in perianal disease, so leaving a mucosal opening without a seton risks recurrent abscess when biologics heal the mucosa.
clinicalJason Frischer12:31 ↗
Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy.
clinicalJason Frischer13:12 ↗
The highest risk factors for lymphoma with biologic therapy are male gender, teenage age, and combination therapy with methotrexate.
clinicalJason Frischer6:52 ↗
Real risks of biologic agents include infectious complications such as tuberculosis and risk of lymphoma.
clinicalChristine Velasco6:29 ↗
When the colonoscope cannot intubate the terminal ileum, capsule endoscopy or fecal calprotectin can be used to aid diagnosis.
clinicalChristine Velasco3:47 ↗
If terminal ileum cannot be intubated, gastroenterologists may treat presumptively and re-scope after a few months of treatment when inflammation has decreased.
clinicalJason Frischer4:36 ↗
Setons should remain in place for at least 6 months to allow the inflammatory tract to become non-inflammatory.
clinicalLisa McMahon17:54 ↗
Before removing a seton, the bottom must look better, drainage must be better, the patient must be symptom-free, and they must have reached steady state of biologic (loading dose plus at least 3 more doses, typically 2-3 months from start).
clinicalJason Frischer19:23 ↗
Inflammatory markers including fecal calprotectin, ESR, and CRP should be checked before removing a seton to ensure systemic disease is under control.
clinicalJason Frischer19:55 ↗
The initial Remicade paper from 1998 or 1999 in the New England Journal of Medicine was on perianal disease and demonstrated improved healing time and improved length of time between recurrence when combination of seton and infliximab is used versus either separately.
clinicalJason Frischer20:49 ↗
Remicade (infliximab) has the most literature on healing perianal disease; Humira also has good evidence but less literature; Stelara and vedolizumab are sometimes used with less information available.
clinicalLisa McMahon20:27 ↗
Literature shows about a 10% response rate for perianal fistulas even without biologics if a seton is placed and removed, with much better outcomes with biologics.
epidemiologicalLisa McMahon19:12 ↗
Source control of infection must be achieved before starting immunosuppressive therapy including steroids and biologics.
clinicalJason Frischer17:17 ↗
If an abscess is not adequately drained, reimaging should be performed before giving biologics or steroids.
clinicalJason Frischer17:17 ↗
Hydrogen peroxide is preferred over methylene blue for identifying fistula tracts because it is neater; 3% hydrogen peroxide in a syringe with 16-20 gauge angiocath is used with a speculum in the anus.
clinicalJason Frischer14:15 ↗
When a fistula opening cannot be found despite hydrogen peroxide testing, a seton should not be placed at that time to avoid creating a hole where there isn't one.
clinicalJason Frischer14:54 ↗
For recurrent patients requiring repeat seton placement, repeat imaging should be obtained before seton removal.
clinicalLisa McMahon18:45 ↗
It is common to have perianal disease in Crohn's; this patient had a delay in diagnosis and had perianal disease for quite some time with multiple skin tags and fissures.
clinicalLisa McMahon7:24 ↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
The Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.
host_summaryCecilia Gigena1:33 ↗
50% of Hirschsprung-associated IBD patients had long segment disease.
host_summaryCecilia Gigena2:05 ↗
Enterocolitis was reported in 68% of Hirschsprung patients after pull-through.
host_summaryCecilia Gigena2:05 ↗
The most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.
host_summaryCecilia Gigena2:17 ↗
Three risk factors for Hirschsprung-associated IBD are trisomy 21, a history of enterocolitis following pull-through surgery, and long segment disease.
clinicalJacob Langer2:24 ↗
Biologic therapy is most likely to be effective for treating Hirschsprung-associated IBD.
clinicalSonia Butterworth2:33 ↗
Hirschsprung's associated IBD is very poorly defined, presents in a number of different ways, and the reason why it happens is unknown.
clinicalJacob Langer3:05 ↗
Hirschsprung's enterocolitis that persists past age 5, or that is unresponsive to typical treatment under age 5, should prompt consideration of Hirschsprung-associated IBD diagnosis.
clinicalSonia Butterworth3:18 ↗
The COVID-19 appendicitis study assessed patients from February 2018 to June 2019 (pre-pandemic control) and mid-February 2020 to June 2021 (COVID period).
host_summaryEm Tombash4:32 ↗
The study included 1100 patients total: 44% in pre-pandemic control group and 56% in COVID-19 group.
host_summaryEm Tombash4:55 ↗
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