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  Subjects -> NUTRITION AND DIETETICS (Total: 201 journals)
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Journal of Pediatric Gastroenterology and Nutrition (JPGN)
Journal Prestige (SJR): 1.376
Citation Impact (citeScore): 2
Number of Followers: 52  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0277-2116 - ISSN (Online) 1536-4801
Published by LWW Wolters Kluwer Homepage  [330 journals]
  • Growth After Menarche in Pediatric Inflammatory Bowel Disease

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      Authors: Salguero; Maria V.; Deplewski, Dianne; Gokhale, Ranjana; Wroblewski, Kristen; Sentongo, Timothy; Jan, Aseel; Kirschner, Barbara S.
      Abstract: imageObjectives: Growth impairment in pediatric patients with pediatric onset inflammatory bowel disease (IBD) is multifactorial. Reports on the effect of age at menarche on adult stature in this population are limited. This study investigated the impact of age at menarche, disease-associated factors, and mid-parental height on growth from menarche to final height (FHt) in pediatric patients with Crohn disease (CD) and ulcerative colitis (UC) and IBD unclassified (IBD-U).Methods: Subjects were enrolled from a prospectively maintained pediatric IBD database when IBD preceded menarche and dates of menarche and FHt measurements were recorded.Results: One hundred forty-six patients: CD 112 and UC 30/IBD-U 4. Mean age (years) at diagnosis (10.9 vs 10.1), menarche (14.4 vs 14.0), and FHt (19.6 vs 19.7). CD and UC/IBD-U patients showed significant association between Chronological age (CA) at menarche and FHt (cm, P < 0.001) but not FHt z score (FHt-Z) < −1.0 (P = 0.42). FHt-Z < −2.0 occurred in only 5 patients. Growth impairment (FHt-Z < −1.0) was associated with surgery before menarche (P = 0.03), jejunal disease (P = 0.003), low mid-parental height z score (MPH-Z) (P < 0.001), hospitalization for CD (P = 0.03) but not UC, recurrent corticosteroid, or anti-tumor necrosis factor alpha (anti-TNFα) therapy.Conclusions: Early age of menarche was associated with greater potential for linear growth to FHt but not FHt-Z (P < 0.05). Surgery before menarche, jejunal disease, hospitalization for CD, low MPH, and weight z score were associated with FHt-Z < −1.0.
      PubDate: Thu, 01 Dec 2022 00:00:00 GMT-
       
  • Prevalence of Gastrointestinal Symptoms and Impact on Quality of Life at
           1-Year Follow-Up of Initial Attack of Acute Pancreatitis

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      Authors: Nasr; Alexander; Hornung, Lindsey; Thompson, Tyler; Lin, Tom K.; Vitale, David S.; Nathan, Jaimie D.; Varni, James W.; Abu-El-Haija, Maisam
      Abstract: imageObjectives: This study aims to describe the prevalence of gastrointestinal (GI) symptoms following the first time occurrence of acute pancreatitis (AP) and to measure the impact of the episode on patient health-related quality of life (HRQOL) from the perspectives of patients and parents.Methods: Questionnaires regarding GI symptoms 1 year following the initial occurrence of AP were obtained from 74 pediatric patients. Thirty of these patients completed both the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the PedsQL Gastrointestinal Symptoms and Worry Scales. These data were compared to legacy-matched healthy controls.Results: Children with a standalone occurrence of AP experienced a similar rate of GI symptoms compared to those who progressed to acute recurrent pancreatitis (ARP) within 1 year. PedsQL 4.0 Generic Core Scales scores were significantly lower for children self-report and parent proxy-report for patients that experienced AP compared to healthy controls. AP patients also demonstrated significantly more symptoms than healthy controls in the Gastrointestinal Symptoms and Worry Scales across multiple domains.Conclusions: Gastrointestinal symptoms affect many children who experience a single AP event even without recurrent attacks. The burden of symptoms is not significantly different from those who develop ARP. This is a novel study that evaluates patient-reported outcomes in children following an AP attack and demonstrates there is a significant impact on HRQOL in children and family experiences post AP. More data are needed to study the progression of disease and the extended impact of AP following an initial AP attack in pediatric patients.
      PubDate: Thu, 01 Dec 2022 00:00:00 GMT-
       
  • Fecal Elastase in Preterm Infants to Predict Growth Outcomes

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      Authors: Holzapfel; Lindsay F.; Hair, Amy B.; Preidis, Geoffrey A.; Halder, Tripti; Yang, Heeju; Unger, Jana P.; Freedman, Steven; Martin, Camilia R.
      Abstract: imageObjectives: Preterm infants are born functionally pancreatic insufficient with decreased pancreatic production of lipase and proteases. Developmental pancreatic insufficiency (PI) may contribute to reduced nutrient absorption and growth failure. We sought to determine longitudinal fecal elastase (ELA1) levels in a cohort of preterm infants and whether levels are associated with growth outcomes.Methods: Prospective observational study of 30 infants 24–34 weeks gestational age and birth weight ≤1250 g fed the exclusive human milk diet, consisting of human milk with human milk-based fortifier. ELA1 was quantified by ELISA during the first 2 weeks of life [Early; 7.5 ± 1.8 days of life (DOL)] and after attainment of full, fortified feedings (Late; 63.6 ± 24.1 DOL).Results: Early ELA1 levels were 192.2 ± 96.4 µg/g, and Late ELA1 levels were 268.0 ± 80.3 µg/g, 39.4% higher (P = 0.01). Infants with early PI (ELA1 < 200 µg/g) were more likely male and of lower gestational age, weight, length, and head circumference at birth. These variables, but not PI status, independently predicted somatic growth.Conclusions: Fecal ELA1 in preterm infants fed exclusive human milk diet increases with postnatal age. Although pancreatic function in preterm infants may serve as a biological contributor to early postnatal growth failure, additional studies using fecal ELA1 as a predictive biomarker for growth failure are needed in larger cohorts.
      PubDate: Thu, 01 Dec 2022 00:00:00 GMT-
       
  • Strain-Specificity of Probiotics in Pediatrics: A Rapid Review of the
           Clinical Evidence

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      Authors: Jankiewicz; Mateusz; Łukasik, Jan; Kotowska, Maja; Kołodziej, Maciej; Szajewska, Hania
      Abstract: Objective: The dogma of probiotic strain-specificity is widely accepted. However, only the genus- and species-specific effects of probiotics are supported by evidence from clinical trials. The aim of this rapid review was to assess clinical evidence supporting the claim that the efficacy of probiotics in the pediatric population is strain-specific.Methods: The Cochrane Library, MEDLINE, and EMBASE databases were searched (up to August 2022) for randomized controlled trials (RCTs) conducted in children aged 0–18 years evaluating the effects of prophylactic or therapeutic administration of probiotics (well-characterized at the strain level) for conditions such as antibiotic-associated diarrhea, acute diarrhea, necrotizing enterocolitis, respiratory tract infections, Helicobacter pylori infection, and atopic dermatitis. To allow evaluation of strain-specificity, a trial could only be included in the review if at least one additional RCT assessed the effect of a different strain of the same species against the same comparator. RCTs without proper strain-level data were excluded. In the absence of identifying head-to-head strain versus strain RCTs, indirect comparisons were made between interventions.Results: Twenty-three RCTs were eligible for inclusion. Out of the 11 performed comparisons, with 1 exception (two Lacticaseibacillus paracasei strains in reducing atopic dermatitis symptoms), no significant differences between the clinical effects of different strains of the same probiotic species were found.Conclusions: Head-to-head comparison is an optimal study design to compare probiotic strains, but such comparisons are lacking. Based on indirect comparisons, this rapid review demonstrates insufficient clinical evidence to support or refute the claim that probiotic effects in children are strain-specific.
      PubDate: Thu, 01 Dec 2022 00:00:00 GMT-
       
  • When is Acute Pancreatitis Over'

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      Authors: Schwarzenberg; Sarah Jane
      Abstract: No abstract available
      PubDate: Wed, 30 Nov 2022 00:00:00 GMT-
       
  • Characterizing the Pain Experience of Children With Acute Gastroenteritis
           Based on Identified Pathogens

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      Authors: Ma; Keon; Ali, Samina; Xie, Jianling; Maki, Claudia; Lee, Bonita; Chui, Linda; Pang, Xiao-Li; Zhuo, Ran; Parsons, Brendon; Vanderkooi, Otto; Poonai, Naveen; MacDonald, Shannon E.; Tarr, Phillip; Freedman, Stephen B.; on behalf of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE Pediatric Emergency Research Canada (PERC
      Abstract: imageObjectives: Pain is common with acute gastroenteritis (AGE) yet little is known about the severity associated with specific enteropathogens. We sought to explore the correlation of pain severity with specific enteropathogens in children with AGE.Methods: Participants were prospectively recruited by the Alberta Provincial Pediatric EnTeric Infection TEam at 2 pediatric emergency departments (EDs) (December 2014–August 2018). Pain was measured (by child and/or caregiver) using the 11-point Verbal Numerical Rating Scale.Results: We recruited 2686 participants; 46.8% (n = 1256) females, with median age 20.1 months (interquartile range 10.3, 45.3). The mean highest pain scores were 5.5 [standard deviation (SD) 3.0] and 4.2 (SD 2.9) in the 24 hours preceding the ED visit, and in the ED, respectively. Prior to ED visit, the mean highest pain scores with bacterial detection were 6.6 (SD 2.5), compared to 5.5 (SD 2.9) for single virus and 5.5 (SD 3.1) for negative stool tests. In the ED, the mean highest pain scores with bacterial detection were 5.5 (SD 2.7), compared to 4.1 (SD 2.9) for single virus and 4.2 (SD 3.0) for negative stool tests. Using multivariable modeling, factors associated with greater pain severity prior to ED visit included older age, fever, illness duration, number of diarrheal or vomiting episodes in the preceding 24 hours, and respiratory symptoms, but not enteropathogen type.Conclusion: Children with AGE experience significant pain, particularly when the episode is associated with the presence of a bacterial enteric pathogen. However, older age and fever appear to influence children’s pain experiences more than etiologic pathogens.
      PubDate: Wed, 30 Nov 2022 00:00:00 GMT-
       
  • Disturbed Pediatric Gut Microbiome Maturation in the Developmental Origins
           of Subsequent Chronic Disease

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      Authors: Simon; David Aaron; Kellermayer, Richard
      Abstract: imageThe microbiome is known to play an important role in the development and maintenance of human health. During early childhood the gut microbiome undergoes a rapid evolution, making this developmental window most susceptible to microbial manipulation and, therefore, most vulnerable to environmental stimuli. Such stimuli may induce persistent alterations (or dysbiosis) in microbiome and/or host physiology, thereby resulting in susceptibility to subsequent disease development. This phenomenon is frequently described as “the microbial developmental origins of disease.” In this topic of the month, we call attention to the microbial developmental origins of disease by examining the potential for childhood antibiotic exposures and appendectomy (ie, inducers of dysbiosis) to influence the pathogenesis of certain multifactorial, common diseases (eg, celiac disease, inflammatory bowel disease, obesity), especially those with increasing incidence worldwide. We conclude that fully appreciating the critical components in the microbial developmental origins of common chronic disorders is a major task ahead of pediatric gastroenterologists in the 21st century. Such information will be key in working to prevent numerous common and emerging disorders.
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT-
       
  • Evaluation of Chronic Constipation in Children With Autism Spectrum
           Disorder

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      Authors: Coe; Alexander; Ciricillo, Jacob; Mansi, Sherief; El-Chammas, Khalil; Santucci, Neha; Bali, Neetu; Lu, Peter L.; Damrongmanee, Alisara; Fei, Lin; Liu, Chunyan; Kaul, Ajay; Williams, Kent C.
      Abstract: imageObjectives: Chronic constipation occurs frequently in children with autism spectrum disorder (ASD). The primary objective was to determine whether chronic constipation is associated with a higher rate of abnormal colonic motor activity in ASD children than in non-ASD children. A secondary goal was to determine if clinical variables could identify children with ASD at risk for possessing abnormal colonic motility.Methods: A retrospective, propensity-matched, case-control study compared colonic manometry (CM) of an ASD cohort and non-ASD controls with chronic constipation. Clinical variables were evaluated as potential predictors for abnormal colonic motility.Results: Fifty-six patients with ASD and 123 controls without the diagnosis of ASD who underwent CM were included. Propensity score resulted in 35 matched cohorts of ASD and controls. The rate of abnormal CM findings between ASD and matched controls (24% vs 20%, P = 0.78) did not differ significantly. A prediction model of abnormal CM that included ASD diagnosis, duration of constipation, and soiling achieved a sensitivity of 0.94 and specificity of 0.65. The risk for abnormal colonic motility increased 11% for every 1-year increase in duration of constipation. Odds for abnormal motility were 30 times higher in ASD children with soiling than controls with soiling (P < 0.0001).Conclusions: Chronic constipation does not appear to be associated with a higher rate of abnormal colonic motility in children with ASD. Clinical information of disease duration and presence of soiling due to constipation show promise in identifying patients with ASD at a greater risk for abnormal colonic motility.
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT-
       
  • Postvaccination Immunogenicity of BNT162b2 SARS-CoV-2 Vaccine and Its
           Predictors in Pediatric Inflammatory Bowel Disease

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      Authors: Bronsky; Jiri; Copova, Ivana; Durilova, Marianna; Kazeka, Denis; Kubat, Michal; Lerchova, Tereza; Vlckova, Eva; Mitrova, Katarina; Rataj, Michal; Klocperk, Adam; Sediva, Anna; Hradsky, Ondrej
      Abstract: imageObjectives: We prospectively compared the postvaccination immunity to messenger ribonucleic acid BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine of our pediatric patients over 12 years old with inflammatory bowel disease (IBD) to that of healthy controls and looked for predictors of its robustness.Methods: Anti-receptor binding domain, anti-spike S2, and anti-nucleocapsid immunoglobin-G (IgG) and immunoglobin-A levels were measured in 139 pediatric patients with IBD [65 fully vaccinated (2 doses), median age 16.3, interquartile range (IQR) 15.2–17.8 years, median time from vaccination (IQR) 61.0 (42.0–80.0) days] and 1744 controls (46, 37–57 years) using microblot array.Results: All IBD and control patients developed positive anti-receptor binding domain IgG antibodies at comparable titers. The proportion of observations with positive anti-spike S2 IgG was higher in patients with IBD than in controls [63% vs 21%, odds ratio 2.99 (1.51–5.90)], as was its titer [median (IQR) 485 (92–922) vs 79 [33–180] IU/mL]. Anti-receptor binding domain and anti-spike S2 IgG levels were associated with IBD status. We found an association between anti-spike S2 IgG levels and time since vaccination (β −4.85, 95% CI −7.14 to 2.71, P = 0.0001), history of SARS-CoV-2 polymerase chain reaction positivity (206.76, 95% CI 39.93–374.05, P = 0.0213), and anti-tumor necrosis factor treatment (−239.68, 95% CI −396.44–83.55, P = 0.0047). Forty-three percent of patients reported vaccination side effects (mostly mild). Forty-six percent of observations with positive anti-nucleocapsid IgG had a history of SARS-CoV-2 infection.Conclusions: Patients with IBD produced higher levels of postvaccination anti-spike S2 antibodies than controls. Previous SARS-CoV-2 infection is associated with higher production of postvaccination antibodies and anti-tumor necrosis factor treatment with lower production.
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT-
       
  • Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis:
           Predictive Factors and Long-Term Step-Down Efficacy

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      Authors: Gutiérrez-Junquera; Carolina; Fernández-Fernández, Sonia; Domínguez-Ortega, Gloria; Vila Miravet, Víctor; García-Puig, Roger; La Orden-Izquierdo, Enrique; Peña Quintana, Luis; Barrio Torres, Josefa; Medina Benítez, Enrique; Leis, Rosaura; García-Romero, Ruth; Fernández de Valderrama, Ana; Vecino López, Raquel; Donado Palencia, Paloma; on behalf of the SEGHNP EoE Working Group
      Abstract: imageObjectives: To assess the short- and long-term efficacy of proton pump inhibitor (PPI) therapy for pediatric eosinophilic esophagitis (EoE) in real-world practice with a step-down strategy, and to evaluate factors predictive of PPI responsiveness.Methods: We collected data regarding the efficacy of PPIs during this cross-sectional analysis of the prospective nationwide RENESE registry. Children with EoE treated with PPI monotherapy were included. Histological remission was defined as a peak eosinophilic count of
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT-
       
  • Fish Oil And/Or Probiotics Intervention in Overweight/Obese Pregnant Women
           and Overweight Risk in 24-Month-Old Children

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      Authors: Saros; Lotta; Vahlberg, Tero; Koivuniemi, Ella; Houttu, Noora; Niinikoski, Harri; Tertti, Kristiina; Laitinen, Kirsi
      Abstract: imageObjectives: To evaluate whether a fish oil and/or probiotics intervention in pregnant women with overweight or obesity would influence the tendency of their 24-month-old children to become overweight and alter their body fat percentage.Methods: Women (n = 439) were double-blindly randomized into 4 intervention groups: fish oil+placebo, probiotics+placebo, probiotics+fish oil, and placebo+placebo (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid, probiotics: Lacticaseibacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). The intervention lasted from early pregnancy until 6 months postpartum. Children’s (n = 330) growth data (height, weight, head circumference), a secondary outcome of the trial, were evaluated at birth, 3, 6, 12, and 24 months of age and compared to Finnish growth charts. Body fat percentage was measured with air displacement plethysmography (24 months). Logistic regression and general linear models were used to analyze the data.Results: Probiotics+placebo [weight-for-height% adj. Odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.14–0.95] and probiotics+fish oil [weight-for-age standard deviation score (SD-score) adj. OR = 0.22, 95% CI = 0.07–0.71] associated with lower overweight odds in 24-month-old children compared to placebo+placebo. Results remained essentially the same, when probiotics’ main effect (combined probiotics+placebo and probiotics+fish oil) was estimated; that is, lower overweight odds (weight-for-height% adj. OR = 0.48, 95% CI = 0.25–0.95 and weight-for-age SD-score adj. OR = 0.42, 95% CI = 0.20–0.88) compared to non-probiotics. No fish oil main effect (combined fish oil+placebo and probiotics+fish oil) was seen. The intervention did not influence body fat percentage.Conclusions: The administration of probiotics solely and in combination with fish oil during pregnancy to women with overweight or obesity lowered the overweight odds of their 24-month-old children.
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT-
       
  • Ansa Pancreatica

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      Authors: Banaszkiewicz; Aleksandra; Bukowski, Jan; Pertkiewicz, Jan; Dembiński, Łukasz; Kluczewska, Ewa; Kwiecień, Jarosław
      Abstract: imageNo abstract available
      PubDate: Wed, 23 Nov 2022 00:00:00 GMT-
       
  • Development of Inflammatory Bowel Disease in Children With Juvenile
           Idiopathic Arthritis Treated With Biologics

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      Authors: Broekaert; Ilse J.; Klein, Ariane; Windschall, Daniel; Rogalski, Betina; Weller-Heinemann, Frank; Oommen, Prasad; Küster, Michael; Foeldvari, Ivan; Minden, Kirsten; Hospach, Anton; Hufnagel, Markus; Berger, Thomas; Geikowski, Til; Quietzsch, Jürgen; Horneff, Gerd
      Abstract: imageObjective: The aim of our study was to describe the distinct features of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) patients and to identify risk factors for its development.Methods: Data from the German biologics in pediatric rheumatology registry (Biologika in der Kinderrheumatologie) collected between 2001 and 2021 were analyzed retrospectively.Results: In 5009 JIA patients, 28 developed confirmed IBD before the age of 18 years: 23 (82.1%) with Crohn disease (CD), 4 (14.3%) with ulcerative colitis (UC), and 1 (3.6%) with IBD-unclassified (IBD-U). The incident rate of IBD during 20 years of observation was 0.56% (0.46% for CD, 0.08% for UC, and 0.02% for IBD-U), of whom 20.3% were HLA-B27 positive, 25% had enthesitis-related arthritis, and 14.3% psoriatic arthritis. Within 90 days before IBD diagnosis, 82.1% (n = 23) received treatment with etanercept (ETA), 39.3% (n = 11) non-steroidal anti-inflammatory drugs, 17.9% (n = 5) systemic corticosteroids, 8 (28.6%) methotrexate (MTX), 14.3% (n = 4) sulfasalazine, 10.7% (n = 3) leflunomide, and 3.6% (n = 1) adalimumab and infliximab, respectively. The incidence of IBD was lower in patients treated with MTX, but higher in patients treated with ETA except if ETA was combined with MTX. Also in patients on leflunomide or sulfasalazine, the IBD incidence was higher.Conclusions: In our JIA cohort, an increased IBD incidence is observed compared to the general population, and the ratio of CD to UC is markedly higher hinting at a distinct phenotype of IBD. Pretreatment with MTX seems to be protective. Treatment with ETA does not prevent IBD development and JIA patients treated with leflunomide and sulfasalazine may be at an increased risk for IBD development.
      PubDate: Fri, 18 Nov 2022 00:00:00 GMT-
       
  • Sharp-Pointed Foreign Body Ingestion in Pediatric Age

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      Authors: Quitadamo; Paolo; Battagliere, Ilaria; Del Bene, Margherita; Caruso, Flora; Gragnaniello, Piergiorgio; Dolce, Pasquale; Caldore, Mariano; Bucci, Cristina
      Abstract: imageObjectives: To assess the clinical complications reported after the ingestion of sharp/pointed foreign bodies (FBs) in pediatric age, their incidence among all FB ingestions, and the features and clinical presentation of children.Study design: We have recruited all consecutive patients aged 0–14 years, admitted for sharp/pointed FB ingestion. Clinical data until hospital discharge were accurately recorded, including both children with esophagogastric FB retention who underwent endoscopic removal and children who were radiologically followed-up till spontaneous FB expulsion. Clinical outcomes were recorded for each patient, with special reference to possible prolonged retention and wall perforation during the intestinal passage.Results: We have enrolled 580 children (males/females: 292/288; age range: 11–180 months; mean age ± standard deviation: 50.5 ± 42 months). Sharp/pointed FBs mainly included fragments of metal 270 of 580 (46.55%) and glass 180 of 580 (31%). FBs were endoscopically removed in 79 of 580 (13.6%) children whereas the remaining FBs passed through the gastrointestinal tract over an overall mean time of 29 hours. No cases of intestinal perforation nor prolonged retention were observed. In 3 of 65 (4.6%) procedures the endoscopist faced an uncomfortable endoscopic removal due to the shape and size of the FB which hampered the retrograde passage through the esophageal sphincters.Conclusions: Our original and extensive data emphasize that accidental ingestion of sharp/pointed FB ingestion is a current issue in pediatric age, especially in toddlers. Metal and glass objects are the most involved FBs and their endoscopic retrieval may not be easy in about 5% of cases. Fortunately, in our pediatric sample no surgical intervention was needed.
      PubDate: Tue, 08 Nov 2022 00:00:00 GMT-
       
  • Hepatic Dry Copper Weight in Pediatric Autoimmune Liver Disease

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      Authors: Nayagam; Jeremy S.; Joshi, Deepak; Thompson, Richard J.; Dhawan, Anil; Hadzic, Nedim; Mestre-Alagarda, Claudia; Deheragoda, Maesha; Samyn, Marianne
      Abstract: imageObjectives: Elevated hepatic dry copper weight is recognized in adults with autoimmune liver disease (AILD) and chronic cholestasis. We aim to review hepatic dry copper weight in pediatric AILD.Methods: Retrospective review of pediatric AILD managed at our institution from 1999 to 2018, and 104 patients with hepatic dry copper weight assessment were included.Results: Median age at presentation was 13.4 years (interquartile range, IQR, 11.7–14.9), 60% female, 54% autoimmune hepatitis, 42% autoimmune sclerosing cholangitis, and 4% primary sclerosing cholangitis. Histological features of advanced liver fibrosis in 68%. Median hepatic dry copper weight was 51.1 µg/g dry weight (IQR, 28.0–103.8). Elevated hepatic dry copper weight (>50 µg/g dry weight) was present in 51%, and was not associated with AILD subtype (P = 0.83), age at presentation (P = 0.68), or advanced fibrosis (P = 0.53). Liver transplantation (LT) was performed in 10%, who had higher hepatic dry copper weight (148.5 µg/g dry weight [IQR, 39.5–257.3] vs 47.5 [IQR, 27.8–91.5], P = 0.04); however this was not associated with LT on multivariate analysis (hazard ratio 1.002, 95% CI 0.999–1.005, P = 0.23). In 8 (7.7%) patients ATP7B was sequenced and potentially disease causing variants were identified in 2 patients, both who required LT.Conclusions: Elevations in hepatic dry copper weight are common in pediatric AILD. Unlike in adults, it is not associated with AILD subtypes with cholestasis. Higher dry copper weight was detected in patients who required LT. While further work is needed to identify the significance of copper deposition in pediatric AILD, we recommend close monitoring of patients with elevated levels for progressive liver disease.
      PubDate: Fri, 04 Nov 2022 00:00:00 GMT-
       
  • Prevalence and Risk Factors of Functional Gastrointestinal Disorders: A
           Cross-Sectional Study in Italian Infants and Young Children

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      Authors: Scarpato; Elena; Salvatore, Silvia; Romano, Claudio; Bruzzese, Dario; Ferrara, Dante; Inferrera, Ramona; Zeevenhooven, Judith; Steutel, Nina F.; Benninga, Marc A.; Staiano, Annamaria
      Abstract: imageObjectives: Reports of prevalence of functional gastrointestinal disorders (FGIDs) in infants/toddlers are widely variable. Reasons for this variability are not yet fully understood. The objective of this study is to estimate the prevalence of FGIDs according to Rome IV criteria and to evaluate associated factors, in Italian infants and toddlers.Methods: Subjects aged 0–48 months were enrolled by general pediatricians from 3 Italian regions. Parents or legal guardians were administered questionnaires including information about the child, the family, and GI symptoms according to Rome IV criteria.Results: Five hundred eight infants aged 0–12 months [mean age 4.4 ± 3.4 months; females (F) 40.9%], and 268 children aged 13–48 months (mean age 30.8 ± 10.7 months; F 44.4%) were included. In infants, prevalence of FGIDs was 21.1%, and the most prevalent FGID was infant colic (9.3%). In toddlers, prevalence of FGIDs was 19.6%, with functional constipation being the most frequent disorder (16.1%). In infants, multivariable analysis found that being older, being the only child, and living in a rural environment were associated with a lower rate of FGIDs. Prevalence was, in contrast, higher in infants fed with formula.Conclusions: One out of 5 Italian infants and young children is affected by at least 1 FGID. The most frequent FGID in infants is infant colic, while in toddlers this is functional constipation. In infants, prevalence of FGIDs is lower if the subject has no siblings, and in children living in a rural environment, while formula feeding represents a risk factor for FGIDs occurrence.
      PubDate: Tue, 01 Nov 2022 00:00:00 GMT-
       
  • Intestinal Ultrasound for the Pediatric Gastroenterologist: A Guide for
           Inflammatory Bowel Disease Monitoring in Children: Expert Consensus on
           Behalf of the International Bowel Ultrasound Group (IBUS) Pediatric
           Committee

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      Authors: Kellar; Amelia; Dolinger, Michael; Novak, Kerri L.; Chavannes, Mallory; Dubinsky, Marla; Huynh, Hien
      Abstract: imageCrohn disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) often diagnosed in childhood. A strict monitoring strategy can potentially alter the disease course and facilitate early effective treatment before irreversible bowel damage occurs. Serial colonoscopy in children, the gold standard for monitoring, is impractical. Accurate, real-time, noninvasive markers of disease activity are needed. Intestinal ultrasound is an accurate, noninvasive, real-time, point-of-care, cross-sectional imaging tool used to monitor inflammation in pediatric IBD patients in Europe, Canada, and Australia. It is now emerging in a few expert centers in the United States as a safe, non-radiating, inexpensive, bedside tool used by the treating gastroenterologist for real-time decision-making. Unlike the standard biomarkers of pediatric IBD activity, C-reactive protein, and fecal calprotectin, intestinal ultrasound (IUS) facilitates disease localization, characterizes severity, extent, and accurately detects complications. Perhaps most importantly, IUS may enhance shared understanding and ease the burden of treatment decision-making for both the gastroenterologist and the patient. There is a lack of standardization for bedside IUS among pediatric gastroenterologists. The purpose is to outline a standardized approach to pediatric bedside IUS, including basic equipment requirements and technique, patient selection, preparation and positioning, technical considerations and limitations, documentation of mesenteric and luminal features of IBD, characterization of penetrating disease and strictures, and provide a proposed pediatric IUS monitoring algorithm to guide care.
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT-
       
  • Adalimumab Therapy in Pediatric Crohn Disease: A 2-Year Follow-Up
           Comparing “Top-Down” and “Step-Up” Strategies

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      Authors: Payen; Elise; Neuraz, Antoine; Zenzeri, Letizia; Talbotec, Cécile; Abi Nader, Elie; Chatenoud, Lucienne; Chhun, Stephanie; Goulet, Olivier; Ruemmele, Frank M.; Pigneur, Bénédicte
      Abstract: imageObjectives: European Crohn’s Colitis Organization (ECCO) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines recommend the early use of anti-tumor necrosis factor (TNF) biologicals in pediatric Crohn disease (CD) patients with positive predictors for poor outcome. The objective of the present study was to compare early “Top-Down” use of adalimumab (ADA) immunomodulator/biologics-naive patients to conventional “Step-Up” management.Methods: One hundred and twenty consecutive patients with a confirmed diagnosis of CD and treated with ADA between 2008 and 2019 were included and allocated to the ADA-Top Down (n = 59) or ADA-Step Up group (n = 61). The primary endpoint was prolonged steroid-/enteral nutrition-free clinical remission at 24 months, defined by a weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) < 12.5. Clinical and biological data were collected at 12 and 24 months.Results: At start of ADA, disease activity was comparable between the ADA-Top Down group and the ADA-Step Up group (wPCDAI = 31 ± 16 vs 31.3 ± 15.2, respectively, P = 0.84). At 24 months, the remission rate was significantly higher in the ADA-Top Down group (73% vs 51%, P < 0.01). After propensity score, the Top-Down strategy is still more effective than the Step-Up strategy in maintaining remission at 24 months [hazard ratio (HR) = 0.36, 95% CI (0.15–0.87), P = 0.02]. Patients in the ADA-Top Down group were mainly on monotherapy compared to patients in the ADA-Step Up group (53/55 vs 28/55 respectively, P < 0.001). Serum levels of ADA were higher in the ADA-Top Down group than in the ADA-Step Up group (12.8 ± 4.3 vs 10.4 ± 3.9 µg/mL, respectively, P < 0.01). There were no serious adverse events.Conclusions: Early use of ADA appears to be more effective in maintaining relapse-free remission at 2 years, while using it as monotherapy. These findings further favor the recommendation of early anti-TNF use in high-risk CD patients.
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT-
       
  • Enteral Nutrition in Preterm Infants (2022): A Position Paper From the
           ESPGHAN Committee on Nutrition and Invited Experts

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      Authors: Embleton; Nicholas David; Jennifer Moltu, Sissel; Lapillonne, Alexandre; van den Akker, Chris H.P.; Carnielli, Virgilio; Fusch, Christoph; Gerasimidis, Konstantinos; van Goudoever, Johannes B.; Haiden, Nadja; Iacobelli, Silvia; Johnson, Mark J.; Meyer, Sascha; Mihatsch, Walter; de Pipaon, Miguel Saenz; Rigo, Jacques; Zachariassen, Gitte; Bronsky, Jiri; Indrio, Flavia; Köglmeier, Jutta; de Koning, Barbara; Norsa, Lorenzo; Verduci, Elvira; Domellöf, Magnus
      Abstract: imageObjectives: To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight 90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached.Results: In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier.Conclusions: We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT-
       
  • Perioperative Management of Pediatric Crohn’s Disease

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      Authors: Pasternak; Brad; Patel, Ashish; Tran, Paul; McMahon, Lisa
      Abstract: imageNo abstract available
      PubDate: Thu, 27 Oct 2022 00:00:00 GMT-
       
  • Acute Liver Failure in Dengue: A Common but Overlooked Entity in Pediatric
           Patients in Tropical Countries

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      Authors: Dogra; Surabhi; Kumar, Karunesh; Malhotra, Smita; Jerath, Nameet; Sibal, Anupam
      Abstract: imageObjective: The objective of the study is to estimate the incidence of acute liver failure (ALF) in dengue infection, understand the demographic and biochemical profiles, and identify prognostic factors associated with mortality.Methodology: This is a retrospective observational study. We evaluated the data of all pediatric dengue patients admitted over the last 5 years in our hospital to identify patients who fulfilled the criteria for pediatric ALF. Demographic profile, and biochemical and radiological parameters were assessed. Their outcomes and mortality data were analyzed to identify prognostic factors.Results: Thirty children with dengue infection were identified to have developed a during the ALF study period which was 29.1% (30 of 103) of all our ALF admissions. A total of 189 children with dengue infection needed admission during the same period and 15.8% (30 of 189) of them developed ALF. The mean duration of onset of ALF was 5.4 days after fever onset. Twenty-two patients (73%) survived, and 8 patients expired. High creatinine, low albumin level, and multisystemic involvement were identified as poor prognostic markers in those patients who did not survive.Conclusion: ALF is common in admitted severe dengue patients. A significant proportion of acute liver patients in endemic countries can be attributed to dengue infection. Low serum albumin, high creatinine, and multi-organ dysfunction during acute illness can be used as prognostic markers in these children. Multicentric prospective studies are needed to validate these results.
      PubDate: Thu, 27 Oct 2022 00:00:00 GMT-
       
  • The Power of Observation in Advancing Celiac Disease

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      Authors: Bosch; Barbara; Holt, Peter R.
      Abstract: imageThe link between bread and wheat products and celiac disease was first recognized by Willem Dicke in the 1930s through clinical observations of his child patients. The role of gluten as the toxic factor was then proven by Drs. Dicke, Weijers and Van de Kamer in brilliant and prolonged studies in a small number of children.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT-
       
  • Pseudomelanosis Duodeni in a Child With Chronic Diarrhea

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      Authors: Oduru; Olawale; Jo Gumm, Alexis; Sigurdsson, Luther; Cook, Shelley; O’Connell, Daniel M.
      Abstract: imageNo abstract available
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT-
       
  • Equivalence of Paper and Electronic-Based Patient Reported Outcome
           Measures for Children: A Systematic Review

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      Authors: Kortbeek; Simone; Pawaria, Arti; Ng, Vicky Lee
      Abstract: imagePatient-reported outcome measures (PROMs) exist for a variety of chronic gastrointestinal disorders in children. The availability of electronic (e-)formats of PROMs enhance the accessibility of these tools. The International Society for Pharmacoeconomic and Outcomes Research (ISPOR) defines measurement equivalence (ME) as “comparability of the psychometric properties of data” obtained from the administration of original and adapted versions of PROMs. Consideration of proxy PROM versions is unique to pediatrics and must be included in ME evaluations. We conducted a systematic review (SR) of the literature evaluating ME of e-versions adapted from pediatric paper-based PROMs. A literature search was conducted through Medline, Embase, APA PsychInfo, and the Cochrane Library. Titles, abstracts, and manuscripts were reviewed by 2 independent reviewers. The search yielded 19 studies meeting pre-defined criteria. Just over half (52.6%) of 19 PROMs were disease-specific ones. ME between paper- and e-PROM versions was reported as present in all 19 studies evaluating 5653 participants under the age of 18 years. However, only 6 (31.6%) studies evaluated ME in proxy reported e-versions. Despite the use of PROMs for children with a variety of chronic gastrointestinal disorders, only 1 study evaluated a PROM in this population (IMPACT III for inflammatory bowel disease). Findings from this SR highlight strategic opportunities for the pediatric gastroenterologist to broaden the clinical and research armamentarium to include e-PROMs.
      PubDate: Fri, 14 Oct 2022 00:00:00 GMT-
       
  • Probiotics for the Management of Pediatric Gastrointestinal Disorders:
           Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and
           Modifications

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      Authors: Szajewska; Hania; Berni Canani, Roberto; Domellöf, Magnus; Guarino, Alfredo; Hojsak, Iva; Indrio, Flavia; Lo Vecchio, Andrea; Mihatsch, Walter A.; Mosca, Alexis; Orel, Rok; Salvatore, Silvia; Shamir, Raanan; van den Akker, Chris H. P.; van Goudoever, Johannes B.; Vandenplas, Yvan; Weizman, Zvi; on behalf of the ESPGHAN Special Interest Group on Gut Microbiota Modifications
      Abstract: Background: Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders.Methods: All systematic reviews and/or meta-analyses, as well as subsequently published randomized controlled trials (RCTs) (until December 2021), that compared the use of probiotics in all delivery vehicles and formulations, at any dose, with no probiotic (ie, placebo or no treatment), were eligible for inclusion. The recommendations were formulated only if at least 2 RCTs on a similar well-defined probiotic strain were available. The modified Delphi process was used to establish consensus on the recommendations.Results: Recommendations for the use of specific probiotic strains were made for the management of acute gastroenteritis, prevention of antibiotic-associated diarrhea, nosocomial diarrhea and necrotizing enterocolitis, management of Helicobacter pylori infection, and management of functional abdominal pain disorders and infant colic.Conclusions: Despite evidence to support the use of specific probiotics in some clinical situations, further studies confirming the effect(s) and defining the type, dose, and timing of probiotics are still often required. The use of probiotics with no documented health benefits should be discouraged.
      PubDate: Tue, 11 Oct 2022 00:00:00 GMT-
       
 
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