Objective To study the efficacy of oral vancomycin (POV) treatment in pediatric inflammatory bowel disease (IBD). Methods We conducted retrospective and prospective chart reviews, identifying patients using the Division’s Inflammatory Bowel Disease (IBD) registry, ICD-9 and ICD-10 codes for IBD, and recall of patients receiving POV. Patients aged 2–21 years with active IBD at initiation of POV were included unless they had Clostridium difficile infection or primary sclerosing cholangitis (PSC). Pre- and posttreatment analysis included a Physician Global Assessment (PGA), pediatric ulcerative colitis (UC) activity index (PUCAI), and an abbreviated pediatric Crohn’s disease (CD) activity index (PCDAI). The Wilcoxon Signed Ranks test, determined if pre- and post-POV rankings of symptom severity differed. Mann–Whitney U tests assessed improvement in presenting symptoms. Results Nineteen patients met inclusion criteria (12 CD and 7 UC). POV improved the PGA score in 16 of 19 patients (P < 0.001). Mean PGA score pretreatment was 3 ± 0.471; posttreatment mean of 1.58 ± 0.769. Abdominal pain (P < 0.001), diarrhea (P < 0.002), anemia (P < 0.002), and blood in stool (P < 0.001) showed significant improvement. PUCAI and PCDAI scores, pretreatment means of 50 ± 17 and 33 ± 9, respectively, also improved with mean score reduction of 23 in CD and 38 in UC patients after POV initiation (P-value < 0.0001). This improvement was noted for both IBD subtypes. Conclusions POV may be an effective adjuvant treatment for pediatric IBD. Its effectiveness is likely due to a combination of its anti-tumor necrosis factor alpha-α activity and its influence on the gut microbiome. Further controlled studies of POV in IBD are warranted to determine the most efficacious use of POV in pediatric IBD. Aim This study attempts to expand on the current literature to determine efficacy of POV as an adjuvant therapy in treating active IBD in children.

Aim The standard serological test to screen for coeliac disease (CD) is tissue transglutaminase (tTG) but some experts recommend including deamidated gliadin peptide (DGP) antibodies for children younger than 3 years old. This study evaluated the utility of DGP‐immunoglobulin A (IgA) and DGP‐immunoglobulin G (IgG) serologies when screening children younger than 3 years old for CD. Methods A retrospective chart review was conducted including children 3 years old and under, who had DGP and/or tTG serologies along with duodenal biopsies during their initial diagnostic evaluation. Serology results were compared to the gold‐standard histopathology by χ2 to determine the significance of including DGP‐IgG/IgA serologies when screening for CD in this age group. Results We identified 478 patients, 52 who were younger than 3 years old, 43 of whom met inclusion criteria. The positive predictive value (PPV) of the DGP‐IgA test was 91.7% whereas, DGP‐IgG was 77.8%. When DGP serology was examined in conjunction with tTG‐IgA, the PPV with DGP‐IgA was 90.9% and with DGP‐IgG was 87.5%. Conclusions In isolation, DGP‐IgA provides a high PPV and specificity for CD in children younger than 3 years old, whereas DGP‐IgG had a much lower PPV in this age group. When used alone or in conjunction with tTG‐IgA, the DGP‐IgA test results in a high PPV of 91.7 and 90.9%, respectively. Based on our study, we recommend obtaining both the DGP‐IgA and the tTG‐IgA serology when screening infants and children younger than 3 years old for coeliac disease.