No abstract

Summary Background Patients with ulcerative colitis (UC) have an increased risk of Clostridioides difficile infection (CDI). There is a well‐documented relationship between bile acids and CDI. Aims To evaluate faecal bile acid profiles and gut microbial changes associated with CDI in children with UC. Methods This study was conducted at Children's Hospital Los Angeles. Faecal bile acids and gut microbial genes related to bile acid metabolism were measured in 29 healthy children, 23 children with mild to moderate UC without prior CDI (UC group), 16 children with mild to moderate UC with prior CDI (UC+CDI group) and 10 children without UC with prior CDI (CDI group). Results Secondary faecal bile acids, especially lithocholic acid (3.296 vs 10.793, P ≤ 0.001) and ursodeoxycholic acid (7.414 vs 10.617, P ≤ 0.0001), were significantly lower in children with UC+CDI when compared to UC alone. Secondary faecal bile acids can predict disease status between these groups with 84.6% accuracy. Additionally, gut microbial genes coding for bile salt hydrolase, 7α‐hydroxysteroid dehydrogenase and 7α/β‐dehydroxylation were all diminished in children with UC+CDI compared to children with UC alone. Conclusions Bile acids can distinguish between children with UC based on their prior CDI status. Bile acid profile changes can be explained by gut microbial genes encoding for bile salt hydrolase, 7α‐hydroxysteroid dehydrogenase and 7α/β‐dehydroxylation. Bile acid profiles may be helpful as biomarkers to identify UC children who have had CDI and may serve as future therapeutic targets.

Ulcerative colitis (UC), a subtype of inflammatory bowel disease (IBD), is characterized by chronic inflammation of the colon. It is an important pediatric disease, with as many as 20%-25% of all cases presenting during childhood. The incidence of UC is constantly rising with alarming increases in pediatrics (Ye et al., 2020). Gut microbial dysbiosis has been suggested to play a role in the development in IBD (Goncalves et al., 2018). IBD patients have been shown to have dysbiosis

Inflammatory bowel disease is an important pediatric disease, with as many as 25% of cases presenting during childhood. In this article, we review the types, etiology epidemiology, presentation, diagnosis, and management of pediatric inflammatory bowel disease. We also highlight the unique aspects of pediatric-onset inflammatory bowel disease versus adult-onset and future directions in this field, such as the use of genetic studies and ultrasound for the management of pediatric patients with inflammatory bowel disease.

a CRM was defined as RBS 5 0 and SFS #1 point (and a decrease of $1 point from the baseline SFS) and mucosal endoscopy subscore #1 without friability. b CRS was defined as reduction of 3-component Mayo score of $2 points and at least 35%, and reduction in RBS of #1 point or an absolute RBS of #1. c Denominators for OC were based on the number of pts who completed Week 46. d Denominators for NRI were based on the number of pts who completed Week 46 of the OLE and those who withdrew before Week 46 but would have reached Week 46 if they had stayed. This did not include the number of pts in the OLE who have not yet completed Week 46 or who discontinued and would not have reached Week 46 by this data cutoff. e Endoscopy subscore of #1 point. f Clinical remission while off corticosteroids for $12 weeks. CRM, clinical remission; CRS, clinical response; CRS only, clinical response but not remission; RBS, rectal bleeding subscore; SFS, stool frequency subscore.