Nutritional Therapy for IBD and Venous Thromboembolism in Pediatric Inflammatory Bowel Disease

I was recently made aware of a useful website for IBD patients interested in nutritional therapy: Nutritional Therapy for IBD -Home Page

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EB Mitchell et al. Journal of Pediatric Gastroenterology and Nutrition. 72(5):742-747, May 2021.Venous Thromboembolism in Pediatric Inflammatory Bowel Disease: A Case-Control Study

Methods: A nested case-control study comparing hospitalized children with IBD diagnosed with VTE to those without VTE over a decade at a large referral center

Key findings:

  • Twenty-three cases were identified.
  • Central venous catheter (CVC) presence (odds ratio [OR] 77.9; 95% confidence interval [CI]: 6.9–880.6; P < 0.001) and steroid use (OR 12.7; 95% CI: 1.3–126.4; P = 0.012) were independent risk factors
  • Table 2 lists five severe cases which included interventions like balloon angioplasty, stent placement, surgical thrombectomy, and plasmapheresis/subtotal colectomy
  • The authors note that 1.3% of adolescents/children hospitalized with IBD had VTE

The authors note that ‘inherited prothrombotic disorders are not increased in IBD; “the pathogenesis of VTE in patients with IBD has been associated with increased activation of the coagulation cascade, impaired fibrinolysis, increased platelet count, and dysfunction of the endothelium.”

My take: The absolute risk of VTE is low in the pediatric population; presence of CVC and use of steroids are risk factors and require consideration of, at minimum, nonpharmacologic interventions.

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