Studies on inflammatory bowel disease and functional gastrointestinal disorders in children and adults

Functional and inflammatory gastrointestinal disorders are discussed in part I and II, respectively, and the co-occurence of the two in part III.
Part I: In analysis of costs for children with functional abdominal pain who participated in a randomized controlled trial (RCT), the annual costs per patient were approximately €2500. A systematic review of RCTs showed that approximately 41% of children with functional abdominal pain respond to placebo. Despite the widespread use of laxatives for childhood constipation, no firm recommendations can be made on which laxative to prefer. In a head-to-head-RCT, Transipeg® and Forlax® appeared equally effective and safe.
Part II: In a cross-sectional study, we've shown that infliximab serum concentration correlates with disease activity in children. Furthermore, in adult quiescent Crohn's disease, determination of intermediate infliximab concentrations can facilitate timely dose adjustment. In analysis of long-term outcomes of an RCT in Crohn's disease, early combined immunosuppression was associated with fewer relapses and a lower use of anti-TNF-agents and corticosteroids, compared to conventional management. In a cohort of pediatric inflammatory bowel disease (IBD) patients, we found a strong discrepancy between inflammatory biomarkers and symptoms. Nonetheless, biomarkers were predictive of the risk of inflammation in asymptomatic patients.
Part III: Ongoing (irritable bowel syndrome-type) gastrointestinal symptoms in quiescent IBD are much less common in children compared to adults. These symptoms appear to be unrelated to inflammation, both in children and in adults. Hypnotherapy is not superior to standard medical treatment in the management of IBD patients with irritable bowel syndrome-type symptoms.