Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4-18 years.","authors":"Jip Groen, Morris Gordon, Ashish Chogle, Marc Benninga, Rachel Borlack, Osvaldo Borrelli, Anil Darbari, Jernej Dolinsek, Julie Khlevner, Carlo Di Lorenzo, Hannibal Person, Rinarani Sanghavi, Julie Snyder, Nikhil Thapar, Arine Vlieger, Vasiliki Sinopoulou, Merit Tabbers, Miguel Saps","doi":"10.1002/jpn3.70070","DOIUrl":"https://doi.org/10.1002/jpn3.70070","url":null,"abstract":"<p><strong>Objectives: </strong>Abdominal pain related disorders of gut-brain interaction (AP-DGBIs) such as irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP) are common conditions in children, significantly impacting quality of life. This treatment guideline for IBS and FAP in children of 4-18 years is a collaborative effort of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN and NASPGHAN). We aim to comprehensively review the current evidence on treatment options and offer evidence-based recommendations with utility across all treatment settings worldwide, as well as to provide methodological directions for future research.</p><p><strong>Methods: </strong>The guideline development followed the \"Grading of Recommendations Assessment, Development and Evaluation\" (GRADE) approach, which is in accordance with the GRADE handbook and supported by the World Health Organization. The Guideline Development Group (GDG) comprised clinical experts, representing ESPGHAN, NASPGHAN, and Cochrane. Individual members have put forward a final consensus list of treatment options, which were then translated into \"patient, intervention, comparison, outcome\" (PICO) format options. Prospective agreement on decision thresholds for efficacy and safety outcomes was reached through a Delphi process among the GDG to support GRADEing of the literature. Consensus voting was used to finalize recommendations, and a treatment algorithm was developed.</p><p><strong>Results: </strong>Systematic literature searches for this output identified 86 original randomized controlled trials assessing treatment of IBS and FAP. Consensus was reached for 25 GRADEd recommendations. Ten best practice statements were formulated, and guidance for future research methodology was proposed.</p><p><strong>Conclusion: </strong>This guideline represents the first collaborative output of ESPGHAN and NASPGHAN on treatment options for AP-DGBIs. Systematic review of the evidence has exposed major evidence gaps for the treatment of these disorders and incentivizes large pediatric trials, particularly on treatment options for which, to date, no evidence exists.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired physical fitness in pediatric inflammatory bowel disease.","authors":"Saija Kantanen, Kati Räsänen, Kaija-Leena Kolho, Heini Huhtala, Kalle Sipilä, Ilkka Pörsti, Laura Vekara, Eija Piippo-Savolainen, Timo Lakka, Pekka Arikoski, Pauliina Hiltunen","doi":"10.1002/jpn3.70091","DOIUrl":"https://doi.org/10.1002/jpn3.70091","url":null,"abstract":"<p><strong>Objective: </strong>There are only a few studies on physical fitness in pediatric inflammatory bowel disease (PIBD). We compared physical fitness in PIBD patients versus healthy controls and analyzed the role of contributing disease- and patient-related factors.</p><p><strong>Methods: </strong>This cross-sectional study included 73 patients with PIBD aged 13.0 (2.8) (mean [standard deviation]) years from two Finnish university hospitals, 31 with Crohn's disease and 42 with ulcerative or unclassified colitis, and 74 age- and sex-matched controls. Cardiorespiratory and neuromuscular fitness were assessed, physical activity (PA) was measured, and disease characteristics concerning physical fitness were analyzed.</p><p><strong>Results: </strong>Cardiorespiratory fitness, that is, maximal workload (W_max/kg) and peak oxygen uptake (VO₂peak/kg) were lower in patients with PIBD than in controls: W_max/kg 3.01 (0.72) versus 3.29 (0.57) W/kg, p = 0.007; VO₂peak/kg 38.3 (8.5) versus 46.9 (7.4) mL/kg/min, p < 0.001, respectively. Neuromuscular fitness, as evaluated using sit-up, standing long jump, grip strength, and shuttle run tests, was lower in patients compared with controls. Disease activity, severity, and duration, or PA, were not related to W_max/kg and VO₂peak/kg in univariate analysis. However, in multivariate analysis, the use of biological medications was associated positively, and higher age- and sex-adjusted body mass index for children and adolescents was associated negatively with W_max/kg and VO₂peak/kg.</p><p><strong>Discussion: </strong>Patients with PIBD had lower physical fitness than age- and sex-matched controls. The causes of lower physical fitness in PIBD are likely complex, warranting the need for longitudinal studies examining the associations of factors like body composition, visceral fat, and control of disease severity with physical fitness.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous transhepatic cholangiography and drainage for biliary strictures after pediatric liver transplantation.","authors":"Jonathan Seisenbacher, Anna M Kavallar, Christoph Mayerhofer, Denise Aldrian, Lukas Hackl, Thomas Müller, Georg F Vogel","doi":"10.1002/jpn3.70093","DOIUrl":"https://doi.org/10.1002/jpn3.70093","url":null,"abstract":"<p><strong>Objectives: </strong>Biliary strictures (BS) remain frequent after pediatric liver transplantation (pLT) and best management practices are still lacking. This study systematically assesses efficacy of stricture treatment by percutaneous transhepatic cholangiography and drainage (PTCD).</p><p><strong>Methods: </strong>Online databases were searched for studies on PTCD treatment of BS after pLT from the year 2000 to 2024. Efficacy and safety profile of PTCD were analyzed. Influence of various risk factors on outcome parameters was compared by meta-regression.</p><p><strong>Results: </strong>Twenty-seven observational studies with 802 patients undergoing PTCD for BS met the inclusion criteria. Incidence of BS was 13.1% (95% confidence interval [CI]: 10.3-16.1) in 6543 patients reported who underwent pLT between 1989 and 2020. Overall efficacy of PTCD to achieve stricture resolution was 78.3% (95% CI: 66.5-80.4). Drainage duration longer or shorter than 109.1 days did not impact on achievement of resolution with efficacies of 76.5% (95% CI: 65.4-86.2) in short versus 75.1% (95% CI: 61.9-86.5, p = 0.87) in long drainage. Overall recurrence rate after stricture resolution was 16.0% (95% CI: 7.5-26.3). Drainage duration longer or shorter than 109.1 days did not affect recurrence rate which was 17.4% (95% CI: 3.3-37.3) in short versus 20.9% (95% CI: 14.0-28.5, p = 0.68) in long drainage duration. Overall rate of procedure-related complications was 9.9% (95% CI: 2.6-20.0, p = 0.99) and was not influenced by drainage duration.</p><p><strong>Conclusions: </strong>PTCD is efficient to treat BS after pLT. Drainage time does not impact efficacy, recurrence rate, and complication rate. Randomized trials are necessary to determine the best treatment protocol concerning drainage duration and intervals between interventions.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal involvement in graft versus host disease in children: An overview by the ESPGHAN Gastroenterology Committee.","authors":"Marina Vincent, Amit Assa, Osvaldo Borrelli, Matjaž Homan, Javier Martin-de-Carpi, Zrinjka Misak, Maria Giovanna Puoti, Isabelle Scheers, Sara Sila, Caterina Strisciuglio, Christos Tzivinikos, Jernej Dolinsek, Emmanuel Mas","doi":"10.1002/jpn3.70087","DOIUrl":"https://doi.org/10.1002/jpn3.70087","url":null,"abstract":"<p><p>Graft versus host disease (GVHD) is a complication that frequently occurs after haematopoietic stem cell transplantation and concerns many children in paediatric haematology-oncology and bone marrow transplantation departments. It can affect various organs, with the skin, gastrointestinal tract and liver being the most commonly involved. To confirm intestinal GVHD and to rule out differential diagnoses endoscopy is frequently needed. Currently, there are no specific consensus recommendations concerning the best method for endoscopic exploration and medical management of this disease in children, with limited studies available, including a low number of patients. Sigmoidoscopy could be initially proposed under sedation. If sigmoidoscopy is normal or if a general anaesthesia is required, colonoscopy and upper endoscopy should be planned, avoiding duodenal biopsy because of the risk of duodenal haematoma. Regarding therapeutic options, corticosteroids are the first-line treatment for GVHD. Ruxolitinib, a Janus kinase inhibitor, is indicated for children aged 12 years and older with acute or chronic GVHD who have an inadequate response to corticosteroids or other systemic therapies. Nutritional support has a key role in the management of intestinal GVHD and should be considered to guarantee the best possible evolution of intestinal GVHD.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of microbiota-based interventions on depression and anxiety in children and adolescents-A systematic review.","authors":"Jiayu Hu, Yan Zhang, Chuwen Liu, Antigone Gkaravella, Jinyue Yu","doi":"10.1002/jpn3.70092","DOIUrl":"https://doi.org/10.1002/jpn3.70092","url":null,"abstract":"<p><p>This study aims to systematically review evidence on gut microbiota-based interventions for reducing depression- and anxiety-like symptoms in children and adolescents with autism spectrum disorder, irritable bowel syndrome, Prader-Willi syndrome, below-average literacy skills or anorexia nervosa, where some individuals may exhibit indicators of depression or anxiety. This review includes evaluated evidence from randomized controlled trials (RCTs) involving children and adolescents aged 3-19 years, identified from PsycINFO, Medline (Ovid version), Web of Science, and the reference lists of existing reviews. Risk of bias were assessed using Risk of Bias Tool (RoB 2) in RevMan (version 5.4, Cochrane Collaboration). The results were qualitatively summarized by describing the main findings across the studies. Of the 1561 studies screened, 10 RCTs with 408 participants were included. Three gut microbiota-based interventions evaluated were probiotics, prebiotics, and dietary supplementation. Probiotics and dietary supplementation were identified as effective on reducing depression and anxiety in three studies; no significant effects were reported in the remaining seven studies. No evidence supported the effectiveness of prebiotics in reducing depression and anxiety in children and adolescents. Four studies presented low risk of bias, while others showed some bias in the randomization process, allocation concealment, selective reporting, and blinding of the outcome assessment. This review highlights the potential of probiotics and dietary supplements in treating depression and anxiety in children and adolescents. However, the current evidence is constrained by inadequate mental health measurements, participant heterogeneity, and small sample sizes in reviewed studies. Further well-designed studies are needed to confirm their effectiveness.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Clostridioides difficile in asymptomatic children with inflammatory bowel disease: Are they really asymptomatic?","authors":"Wael El-Matary","doi":"10.1002/jpn3.70089","DOIUrl":"https://doi.org/10.1002/jpn3.70089","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential fatty acid deficiency, olive oil-based intravenous lipid emulsion, and genetic polymorphisms: A pediatric randomized controlled trial.","authors":"Cynthia Blanco, Weili Chang, Abhay J Bhatt, Erick Gerday, Ajay J Talati, Narendra Dereddy, Rachana Singh, Erika Ryan, Thibault Senterre","doi":"10.1002/jpn3.70072","DOIUrl":"https://doi.org/10.1002/jpn3.70072","url":null,"abstract":"<p><strong>Objectives: </strong>There is a concern that decreasing soybean oil (SO) content in intravenous lipid emulsions (ILEs) may increase the risk for essential fatty acid deficiency (EFAD). This study evaluates the risk of EFAD in pediatric patients who were expected to require parenteral nutrition for at least 7 days with an 80% olive oil/20% SO ILE (OO/SO group) versus a 100% SO ILE (SO group).</p><p><strong>Methods: </strong>This randomized, double-blind, controlled, multicenter study evaluated 101 pediatric patients including 94 preterm infants. The primary outcome was the incidence of EFAD, including the analysis of the plasma fatty acid (FA) profiles and genetic polymorphism in the FA desaturase genes in patients with extreme arachidonic acid values.</p><p><strong>Results: </strong>Treatment duration was 10.3 ± 7.8 and 11.3 ± 9.4 days in the OO/SO and SO groups respectively. No EFAD was observed. Linoleic acid values increased in both groups but to a lesser extent in the OO/SO group. Arachidonic acid values remained stable within the two groups. The changes in mead acid value were opposite in the two groups, demonstrating an increase in the OO/SO group and a decrease in the SO group, leading to similar changes in the triene:tetraene ratio (T:T). Genetic polymorphisms were frequently observed in patients presenting extreme arachidonic acid values in both groups.</p><p><strong>Conclusions: </strong>The use of an 80% OO/20% SO ILE is well tolerated, safe, and does not increase the risk of EFAD in pediatric patients. The assessment of EFAD should not only consider the T:T but also the complete FA profile and genetic polymorphisms.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic from Clostridioides difficile or symptomatic from inflammatory bowel disease: Highlighting diagnostic challenges.","authors":"Maribeth R Nicholson","doi":"10.1002/jpn3.70090","DOIUrl":"https://doi.org/10.1002/jpn3.70090","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic-Z-score predicts severe portal hypertensive changes on colonoscopy in infants and children with biliary atresia.","authors":"Vipul Gautam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal, Shalini Thapar Laroia, Vikram Bhatia, Seema Alam","doi":"10.1002/jpn3.70079","DOIUrl":"https://doi.org/10.1002/jpn3.70079","url":null,"abstract":"<p><strong>Objectives: </strong>Biliary atresia (BA) is one of the common causes of progressive portal hypertension (PHT) in children. Rectal varices and colopathy are seen in 38%-92% and 40%-54% of adults with PHT, and 94% and 75% of children with extrahepatic portal venous obstruction. The present work aimed to study the prevalence of rectal varices and colopathy in children with BA.</p><p><strong>Methods: </strong>From March 2020 to February 2022, all consecutive children with BA with clinically evident PHT were enrolled. Colonoscopy was performed after overnight bowel preparation under monitored anesthesia care. The association of colonoscopic findings with esophagogastroduodenoscopy findings, clinical and laboratory parameters was analyzed. Presence of rectal varices, friability or ulcerations was defined as severe PHT changes on coloscopy.</p><p><strong>Results: </strong>Twenty-nine BA children (21 males) were enrolled with a median age of 24 (9, 48) months. Majority (21, 72.4%) were post-Kasai portoenterostomy (KPE)-20 were successful. Median PELD score was 1(-6, 16). Clinically significant varices were present in 12 (41.4%); 5 (17.2%) had variceal bleeding at a median age of 24 months. Hemorrhoids, rectal varices and colopathy were present in 37.9%, 48.3%, and 75.9%. Colitis-like and vascular changes were present in 75.9% and 37.9%. Severe PHT changes were seen in 65.5%. On binary logistic regression analysis, severe changes on colonoscopy were independently associated with splenic-Z score [Exp(B) = 3.03, 95% CI 1.07-8.58, p = 0.037] and using the model improved prediction from 65.5% to 82.8%.</p><p><strong>Conclusion: </strong>Children with BA have rectal varices and colopathy in 48% and 76%. Severe PHT changes, present in two-thirds, are independently associated with higher splenic-Z score.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical course and management of pediatric chronic pancreatitis in the 21st century.","authors":"Sherif Y Ibrahim, Maisam Abu-El-Haija","doi":"10.1002/jpn3.70077","DOIUrl":"https://doi.org/10.1002/jpn3.70077","url":null,"abstract":"<p><p>Chronic pancreatitis (CP) is a debilitating condition characterized by progressive inflammation and fibrosis of the pancreas. While this condition primarily affects adults, an increasing number of pediatric cases have been reported in recent years. Accurate prediction of the clinical course of CP in pediatric patients is crucial for effective management and improved patient outcomes. This manuscript reviews the current progress in predicting the clinical course of CP in pediatric patients, focusing on relevant studies published in medical journals. It involves the review of many recent articles and historical articles through the PubMed database. Additionally, it highlights the predictive factors, imaging modalities, and treatment plans that hold promise for better prognosis and personalized treatment approaches. CP in the pediatric population is an ever-evolving field with substantially less literature than in adults. Treating pediatric patients with this disease process requires a deep understanding of its mechanism and treatment options. Advancements in medicine have provided alternatives for patients with chronic, debilitating disease, but further studies are still needed in hopes of prophylactic management.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}