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  1. Article ; Online: Inflammatory Bowel Disease in Children.

    Jois, Asha / Alex, George

    Indian journal of pediatrics

    2023  Volume 91, Issue 5, Page(s) 490–498

    Abstract: Inflammatory bowel disease is an important cause of chronic diarrhea in children, with a rising incidence, globally. The two main subtypes include Crohn's disease and ulcerative colitis. The clinical features are variable, and diagnosis requires initial ... ...

    Abstract Inflammatory bowel disease is an important cause of chronic diarrhea in children, with a rising incidence, globally. The two main subtypes include Crohn's disease and ulcerative colitis. The clinical features are variable, and diagnosis requires initial first-line investigations followed by the involvement of specialist input for targeted imaging and endoscopy with biopsy, to confirm the diagnosis. Despite detailed investigation, inflammatory bowel disease may be clinically indistinguishable from chronic infections such as intestinal tuberculosis, and anti-tuberculosis treatment may be considered prior to further management considerations. The medical management of inflammatory bowel disease depends on subtype classification and severity, and may involve a step-wise approach to immunosuppressive therapies. In children, the consequences of poorly controlled disease are wide ranging, from psychosocial impacts and school non-attendance, to growth impairment and pubertal delay with subsequent impacts on bone health. In addition, an increased need for hospitalization and surgical intervention, and ultimately risk of cancer long-term. A multi-disciplinary team with expertise in inflammatory bowel disease is recommended to mitigate these risks and help to achieve the goal of sustained remission with endoscopic healing. This review focuses on updates on best clinical practice on the diagnosis and management of inflammatory bowel disease in children.
    MeSH term(s) Child ; Humans ; Inflammatory Bowel Diseases/drug therapy ; Inflammatory Bowel Diseases/pathology ; Inflammatory Bowel Diseases/surgery ; Crohn Disease/diagnosis ; Colitis, Ulcerative ; Endoscopy ; Diarrhea
    Language English
    Publishing date 2023-06-20
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 218231-2
    ISSN 0973-7693 ; 0019-5456
    ISSN (online) 0973-7693
    ISSN 0019-5456
    DOI 10.1007/s12098-023-04671-0
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    Zs.A 826: Show issues Location:
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  2. Article: Use of Dual-Energy X-ray Absorptiometry in Children with Inflammatory Bowel Disease: A Large Single Centre Study.

    Jois, Asha / Perera, Sajini / Simm, Peter / Alex, George

    Pediatric gastroenterology, hepatology & nutrition

    2022  Volume 25, Issue 6, Page(s) 473–480

    Abstract: Purpose: Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a ... ...

    Abstract Purpose: Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a single site retrospective analysis of DXA use.
    Methods: Children aged 5-18 years with IBD diagnosed between 2013 to 2017 at the Royal Children's Hospital, Australia, were included. Patient demographics, measures of disease activity, DXA scores, and factors related to BMD were collected.
    Results: Over a median follow up of 5.1 (4-6.4) years, 72/239 (30.1%) children underwent DXA, and 28/239 (11.7%) children had a second DXA. Our DXA practice differed to consensus guidelines regarding initial screening based on height and/or body mass index (BMI) z-score (8/17 [47.1%]), and repeat surveillance (13/42 [31.0%]). Children had a median lumbar spine (LS) z-score -0.80 (-1.65-0.075). Children with LS z-score≤-2.0 (n=14) had lower weight (6.57 [1.78-23.7] vs. 51.1 [26.5-68.7],
    Conclusion: Children with IBD had low BMD. In addition to height centile and weight centile, FCP was associated with lower BMD, and should be considered in DXA screening guidelines. Greater clinician awareness of DXA consensus guidelines is required. Future prospective studies are required.
    Language English
    Publishing date 2022-11-02
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3032413-0
    ISSN 2234-8840 ; 2234-8646
    ISSN (online) 2234-8840
    ISSN 2234-8646
    DOI 10.5223/pghn.2022.25.6.473
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  3. Article ; Online: Medication Adherence Across the Life Span in Inflammatory Bowel Disease: Implications and Recommendations for Nurses and Other Health Providers.

    Knowles, Simon R / Alex, George

    Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates

    2020  Volume 43, Issue 1, Page(s) 76–88

    Abstract: This article reviews the differences and similarities in medication adherence between adolescent and adult cohorts with inflammatory bowel disease. The review covers the rates of medication adherence, as well as predictors, consequences, and related ... ...

    Abstract This article reviews the differences and similarities in medication adherence between adolescent and adult cohorts with inflammatory bowel disease. The review covers the rates of medication adherence, as well as predictors, consequences, and related interventions. Rates of adherence were more favorable among adolescents (65%-90%) than among adults (55%-70%). Major risk factors for poor adherence in adolescents include low medication knowledge, not establishing good medication habits initially, and peer victimization with low social support. For adults, nonadherence is more frequently unintentional (e.g., forgetting) and occurs more often in the context of a poor-quality patient-physician relationship, low medication knowledge, infrequent/missed appointments, busy lifestyle, and concurrent mental health concerns. Nonadherence to medication is associated with worsening of symptoms and risk of relapse in adults and adolescents. Nurses can play a significant role in influencing adherence to medication in patients with inflammatory bowel disease. In particular, nurses can help to impart knowledge on the importance of medication and identify factors that may help or hinder an individual in terms of adherence. Based on the current review, implications for practice and recommendations for nurses to promote medication adherence across both adolescent and adult cohorts are provided. Limitations of the currently available evidence and suggestions for future research are discussed.
    MeSH term(s) Adolescent ; Adult ; Age Factors ; Humans ; Inflammatory Bowel Diseases/drug therapy ; Inflammatory Bowel Diseases/psychology ; Medication Adherence ; Nurse's Role
    Language English
    Publishing date 2020-01-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1109536-2
    ISSN 1538-9766 ; 1042-895X
    ISSN (online) 1538-9766
    ISSN 1042-895X
    DOI 10.1097/SGA.0000000000000467
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  4. Article ; Online: Management of inflammatory bowel disease in children: It is time for an individualised approach.

    Grover, Zubin / Alex, George

    Journal of paediatrics and child health

    2019  Volume 56, Issue 11, Page(s) 1677–1684

    Abstract: Paediatric-onset inflammatory bowel disease (PO-IBD) is associated with greater morbidity compared to adult-onset IBD. However, as not all children with PO-IBD will have poor outcome and the best management decisions involve weighing risks versus benefit ...

    Abstract Paediatric-onset inflammatory bowel disease (PO-IBD) is associated with greater morbidity compared to adult-onset IBD. However, as not all children with PO-IBD will have poor outcome and the best management decisions involve weighing risks versus benefit and wishes of patient's and family, we review risk factors of IBD progression in children and summarise rapidly expanding treatment choices, potential drug-related adverse events and risk minimisation strategies, ending with new treatment paradigms focusing on long-term goal of intestinal healing. For the purpose of this article, we have outlined the conventional approach, including medications currently licenced and available for use in Australia for paediatric IBD through the Pharmaceutical Benefit Scheme and briefly discuss other promising therapies that are shown to be effective in adults but are undergoing paediatric clinical trials.
    MeSH term(s) Australia ; Child ; Colitis, Ulcerative ; Humans ; Inflammatory Bowel Diseases/drug therapy ; Risk Factors ; Wound Healing
    Language English
    Publishing date 2019-10-15
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 1024476-1
    ISSN 1440-1754 ; 1034-4810
    ISSN (online) 1440-1754
    ISSN 1034-4810
    DOI 10.1111/jpc.14652
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    Zs.A 227: Show issues Location:
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  5. Article ; Online: Immunisation status of children and adolescents with a new diagnosis of inflammatory bowel disease.

    Ford, Timothy / Danchin, Margie / McMinn, Alissa / Perrett, Kirsten / Alex, George / Crawford, Nigel W

    BMC infectious diseases

    2022  Volume 22, Issue 1, Page(s) 6

    Abstract: Background: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification ... ...

    Abstract Background: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines.
    Methods: Paediatric patients (0-18 years) seen at the tertiary Royal Children's Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available.
    Results: Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC.
    Conclusions: Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.
    MeSH term(s) Adolescent ; Adult ; Australia/epidemiology ; Child ; Humans ; Immunization ; Inflammatory Bowel Diseases/diagnosis ; Inflammatory Bowel Diseases/drug therapy ; Influenza Vaccines ; Vaccination
    Chemical Substances Influenza Vaccines
    Language English
    Publishing date 2022-01-04
    Publishing country England
    Document type Journal Article
    ISSN 1471-2334
    ISSN (online) 1471-2334
    DOI 10.1186/s12879-021-06976-x
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  6. Article ; Online: Impact of ulcerative colitis on liver-related outcomes of children with primary sclerosing cholangitis.

    Sathiaseelan, Mohana / Bolia, Rishi / Barallon, Raychel / Alex, George / Hardikar, Winita / Rajanayagam, Jeremy

    Journal of paediatrics and child health

    2022  Volume 58, Issue 7, Page(s) 1221–1227

    Abstract: Aim: Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic disorder associated with ulcerative colitis (UC). Although the inflammatory bowel disease phenotype has been characterised in patients with PSC, the impact of UC on the ... ...

    Abstract Aim: Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic disorder associated with ulcerative colitis (UC). Although the inflammatory bowel disease phenotype has been characterised in patients with PSC, the impact of UC on the course and progression of PSC-UC is less clear. We aimed to evaluate the effects of UC on liver-related outcomes in children with PSC.
    Methods: Retrospective analysis of children aged ≤18 years diagnosed with PSC with/without UC at a single tertiary paediatric liver unit between January 1998 and May 2016. Patients were followed up until transition to an adult service. Outcomes studied included biliary complications, clinically significant portal hypertension, need for liver transplantation and post-transplantation recurrence.
    Results: Fifty-one children (31 female) were diagnosed with PSC (median age - 11.3 years (interquartile range 7)), follow-up median duration 54 months (interquartile range 56). Thirty-seven (73%) patients had concurrent UC, of which 26 had their diagnosis confirmed prior to or within 6 months of PSC diagnosis (early-onset). PSC complications were more common in children with PSC-UC compared with PSC alone (24/37 (65%) vs. 2/14 (14%); P = 0.001). Furthermore, children with endoscopically mild or moderate UC at diagnosis showed a greater propensity for liver-related complications compared with children with severe UC (24/32 vs. 0/5; P = 0.003). Children with late-onset UC had higher rates of clinically significant portal hypertension (5/11 (45%) vs. 3/26 (12%); P = 0.007) and liver transplantation (5/11(45%) vs. 2/26 (8%); P = 0.02). Children with PSC-UC had significantly higher rates of pancolitis, rectal sparing and milder colitis than those with UC alone.
    Conclusion: The presence and a later-onset of UC are associated with more significant progression to end-stage liver disease. There is an inverse trend between UC severity and PSC severity in children with concurrent PSC-UC.
    MeSH term(s) Cholangitis, Sclerosing/complications ; Cholangitis, Sclerosing/diagnosis ; Cholangitis, Sclerosing/surgery ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/surgery ; Female ; Humans ; Hypertension, Portal/complications ; Retrospective Studies
    Language English
    Publishing date 2022-04-04
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 1024476-1
    ISSN 1440-1754 ; 1034-4810
    ISSN (online) 1440-1754
    ISSN 1034-4810
    DOI 10.1111/jpc.15954
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  7. Article ; Online: Modified subcuticular stitch.

    Alex, George

    Journal of cutaneous and aesthetic surgery

    2010  Volume 1, Issue 2, Page(s) 106

    Language English
    Publishing date 2010-02-04
    Publishing country India
    Document type Journal Article
    ZDB-ID 2461107-4
    ISSN 0974-5157 ; 0974-2077
    ISSN (online) 0974-5157
    ISSN 0974-2077
    DOI 10.4103/0974-2077.44173
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  8. Article ; Online: The challenge of outpatient clinical triage in paediatric gastroenterology: Who is referred and what is needed?

    McGrath, Kathleen H / Alex, George

    Australian journal of general practice

    2019  Volume 48, Issue 4, Page(s) 230–233

    MeSH term(s) Abdominal Pain/etiology ; Abdominal Pain/therapy ; Adolescent ; Ambulatory Care/methods ; Ambulatory Care/standards ; Celiac Disease/etiology ; Celiac Disease/therapy ; Child ; Child, Preschool ; Female ; Gastroenterology/methods ; Gastroenterology/standards ; Gastroesophageal Reflux/etiology ; Gastroesophageal Reflux/therapy ; Humans ; Male ; Pediatrics/methods ; Pediatrics/standards ; Prospective Studies ; Referral and Consultation/standards ; Referral and Consultation/trends ; Triage/methods ; Triage/standards
    Language English
    Publishing date 2019-06-29
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2924889-9
    ISSN 2208-7958 ; 2208-794X
    ISSN (online) 2208-7958
    ISSN 2208-794X
    DOI 10.31128/AJGP-09-18-4697
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    Zs.B 2235: Show issues Location:
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  9. Article ; Online: Impact of Changing Treatment Strategies on Outcomes in Pediatric Ulcerative Colitis.

    Bolia, Rishi / Rajanayagam, Jeremy / Hardikar, Winita / Alex, George

    Inflammatory bowel diseases

    2019  Volume 25, Issue 11, Page(s) 1838–1844

    Abstract: Background: In recent years, treatment strategies for ulcerative colitis have evolved with an early step-up approach, the availability of biologicals, and therapeutic drug monitoring.We carried out this study to evaluate the effect of these changes on ... ...

    Abstract Background: In recent years, treatment strategies for ulcerative colitis have evolved with an early step-up approach, the availability of biologicals, and therapeutic drug monitoring.We carried out this study to evaluate the effect of these changes on disease outcomes.
    Methods: In this retrospective review, 2 time periods were defined: Group 1 (2005-2010) and Group 2 (2011-2016). Baseline demographic, endoscopic parameters, and medication use were compared. Overall colectomy rate, number of disease flares per year, and number of hospital admissions per year were compared between the 2 groups.
    Results: Group 1 had 71 children, and in children in Group 2. The use of 5-ASA increased in Group 2 (Group 2, 99.2% vs. Group 1, 84.5%, P = 0.0007). In addition, infliximab and thiopurines were introduced earlier in the disease course.The 2-year cumulative probability of colectomy decreased from 14% to 3% (P = 0.02) between the 2 periods. No change in median number of flares per year [Group 1, 0.41 (IQR 0.6) vs. Group 2, 0.62 (IQR 0.91), P = 0.28] or median number of hospital admissions per year [Group 1, 0.30 (IQR 0.77) vs. Group 2, 0.21 (IQR 0.75), P = 0.52] was seen.Thereafter, we proceeded to identify the changes in treatment strategies that were responsible for the reduction in colectomy and we found that the use of infliximab OR 3.7 (95% CI 1.1-11.7), P = 0.02, was independently associated with it.
    Conclusions: A reduction in 2-year colectomy rates has been observed in patients with pediatric ulcerative colitis since biologics have become available for its treatment. The numbers of disease-flares rates and hospital admissions remain unchanged.
    MeSH term(s) Adolescent ; Australia ; Child ; Child, Preschool ; Colectomy/statistics & numerical data ; Colectomy/trends ; Colitis, Ulcerative/drug therapy ; Colitis, Ulcerative/surgery ; Female ; Gastrointestinal Agents/therapeutic use ; Humans ; Infliximab/therapeutic use ; Logistic Models ; Male ; Mesalamine/therapeutic use ; Practice Patterns, Physicians'/trends ; Retrospective Studies ; Treatment Outcome
    Chemical Substances Gastrointestinal Agents ; Mesalamine (4Q81I59GXC) ; Infliximab (B72HH48FLU)
    Language English
    Publishing date 2019-04-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 1340971-2
    ISSN 1536-4844 ; 1078-0998
    ISSN (online) 1536-4844
    ISSN 1078-0998
    DOI 10.1093/ibd/izz072
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    Zs.A 4530: Show issues Location:
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  10. Article ; Online: Nipple aspiration device.

    Alex, George

    Annals of the Royal College of Surgeons of England

    2009  Volume 91, Issue 1, Page(s) 82–83

    MeSH term(s) Breast Diseases/diagnosis ; Equipment Design ; Humans ; Nipples ; Suction/instrumentation
    Language English
    Publishing date 2009-01-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/rcsann.2009.91.1.82b
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