Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Identification of human leukocyte antigen class I risk alleles and enriched T cell receptor groups in activated T cell pediatric acute liver failure.","authors":"Catherine A Chapin, Tamir Diamond, Joshua B Wechsler, Samantha L Gadd, Michelle Lau, Wenzhao Meng, Eline T Luning Prak, Jamie L Duke, Daria V Babushok, Kathleen M Loomes, Anat R Tambur, Estella M Alonso, Edward M Behrens","doi":"10.1002/jpn3.70573","DOIUrl":"10.1002/jpn3.70573","url":null,"abstract":"<p><strong>Objective: </strong>Activated T cell pediatric acute liver failure (TC-PALF) is characterized by CD8+T cells in liver and peripheral blood. TC-PALF patients are at increased risk of developing aplastic anemia (AA), an immune-mediated disorder in which CD8+ T cells target hematopoietic stem and progenitor cells. Clonal expansion of T cell receptors (TCRs) and specific human leukocyte antigen (HLA) class I risk alleles have been reported in AA. We hypothesized TC-PALF shares similar HLA associations and exhibits increased TCR clonality.</p><p><strong>Methods: </strong>Thirty-one TC-PALF and 15 other PALF diagnosis (other-PALF) patients enrolled in the Pediatric Acute Liver Failure Study Group (PALFSG) were included. Liver tissue DNA underwent TCR β-chain (TCRβ) complementarity-determining region 3 sequencing and HLA genotyping. HLA allele frequencies were compared with ethnicity-matched controls. TCR clonality was assessed and Grouping of Lymphocyte Interactions by Paratope Hotspots 2 (GLIPH2) was used to identify antigen-convergent, disease-associated TCR groups.</p><p><strong>Results: </strong>HLA class I alleles HLA-A*23:01, HLA-B*35:03, HLA-B*52:01, and HLA-B*39:05 were significantly overrepresented among TC-PALF patients compared to ethnicity-matched controls. Hepatic TCRβ clonality was increased in the TC-PALF group. GLIPH2 identified 158 statistically significant TCR convergence groups enriched in TC-PALF with significant HLA associations, representing putative antigen-specific TCR clusters.</p><p><strong>Conclusions: </strong>Enrichment of specific HLA class I alleles, increased hepatic TCR clonality, and HLA-associated TCR convergence groups support an HLA-restricted, antigen-driven CD8+ T cell response as a central mechanism of TC-PALF. These findings provide a mechanistic framework for antigen discovery and future development of immunogenetic biomarkers to improve disease classification, risk stratification, and targeted immunomodulatory therapy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900865","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":"Race and neighborhood factors influence clinical outcomes in children hospitalized with acute pancreatitis.","authors":"Amy Fan, Elizabeth Baker, Chinenye R Dike","doi":"10.1002/jpn3.70569","DOIUrl":"10.1002/jpn3.70569","url":null,"abstract":"<p><strong>Objectives: </strong>Disparities impacting acute pancreatitis (AP) outcomes have been reported. Although racial/ethnic disparities are known in AP, geospatial disparities have been unexplored in pediatric AP. We aimed to investigate area level social determinant of health (SDOH) factors on pediatric AP outcomes.</p><p><strong>Methods: </strong>This is a retrospective study of children hospitalized with AP over 5 years. Data including home addresses and zip codes were geocoded to determine area level factors for SDOH. Descriptive statistics were used to summarize overall sample and stratified by length of stay (LOS), AP severity, and complications. Significance tests were performed using high-dimensional fixed effects regression with multiway cluster-robust standard errors.</p><p><strong>Results: </strong>A total of 242 encounters for 182 participants living in 160 different census tracts were included. Non-Hispanic Black (NHB) children were more likely to live in urban and more minority neighborhoods. Children living in more urban and minority neighborhoods had increased mean LOS, and AP severity. Increased mean LOS persisted in NHB children after adjusting for co-variates (p = 0.009). Abstract charges were higher in children with AP who live in poorer neighborhoods even after adjusting for co-variates (p = 0.048).</p><p><strong>Conclusions: </strong>Children hospitalized with AP living in minority and urban neighborhoods experience an increased LOS and complications. NHB children are more likely to live in urban and minority neighborhoods and have an increased mean LOS. Abstract charges are higher for children with AP who live in poorer neighborhoods.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906203","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":"Longitudinal changes in polyunsaturated fatty acids and their metabolites in preterm human milk during early lactation.","authors":"Andrea Martinez Pederzini, Hiroki Suganuma, Naho Ikeda, Natsuki Ohkawa, Naoko Kaga, Hikari Taka, Yoshiki Miura, Irena Santosa, Hiromichi Shoji","doi":"10.1002/jpn3.70567","DOIUrl":"10.1002/jpn3.70567","url":null,"abstract":"<p><strong>Objectives: </strong>Long-chain polyunsaturated fatty acids (LC-PUFAs) are integral components of cell membranes and serve as precursors of bioactive lipid mediators known as oxylipins. Although oxylipins have been identified in human milk (HM), their temporal dynamics and relationships with precursor LC-PUFAs during early lactation, particularly in preterm milk, remain under-examined. This study characterized longitudinal changes in LC-PUFAs and oxylipins in HM from Japanese mothers of moderately preterm infants during the first 3 weeks of lactation.</p><p><strong>Methods: </strong>HM samples were collected weekly for 3 consecutive weeks from breastfeeding women who delivered infants born moderately preterm (30-34 weeks of gestation). Analyses were performed on 50 HM samples from 21 participants. Selected precursor fatty acids and their derived oxylipins were quantified using liquid chromatography-tandem mass spectrometry.</p><p><strong>Results: </strong>Despite significant declines in milk arachidonic acid (AA) and docosahexaenoic acid (DHA) concentrations over the first 3 weeks of lactation, many corresponding oxylipins remained stable or increased. All measured linoleic acid (LA)-derived oxylipins increased significantly (p < 0.01) despite constant LA concentrations. Several n-3-derived oxylipins, including α-linolenic acid (ALA)-derived 13-hydroxy-9,11,15-octadecatrienoic acid (13-HOTrE), eicosapentaenoic acid (EPA)-derived 15-hydroxyeicosapentaenoic acid (15-HEPE) and DHA-derived protectin DX also increased by Week 3. Although some selected oxylipins were positively associated with their precursor fatty acids, the temporal oxylipin trajectories were not consistently aligned with changes in precursor concentrations.</p><p><strong>Conclusion: </strong>These findings highlight the dynamic, pathway-specific regulation of bioactive lipid mediators in preterm HM and provide a biochemical basis for future studies investigating the potential relationship between these mediators and prematurity-related morbidity.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906080","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":"Reflux symptom burden and duration of physical therapy in infants with congenital muscular torticollis: Prospective cohort analysis.","authors":"Laura K Bess, Jessica Costa, Jamie L Fierstein, Ernest Amankwah, Michael J Wilsey","doi":"10.1002/jpn3.70560","DOIUrl":"10.1002/jpn3.70560","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence of provider-diagnosed gastroesophageal reflux disease (GERD) and clinically significant reflux symptoms in infants evaluated for congenital muscular torticollis (CMT) and their association with physical therapy duration.</p><p><strong>Methods: </strong>In this prospective cohort, 323 infants <12 months of age were enrolled and evaluated by physical therapists for CMT management. GERD status was established by medical record documentation and/or an infant gastroesophageal reflux questionnaire revised (I-GERQ-R) score >16. Demographic, clinical, and musculoskeletal characteristics were compared between infants with CMT alone and those with CMT plus reflux. Outcomes included time to achieve midline head posture, time to treatment discharge, and changes in I-GERQ-R scores over time.</p><p><strong>Results: </strong>GERD was identified in 93 infants (28.8%). Baseline demographic and musculoskeletal characteristics were similar between groups. The I-GERQ-R identified an additional subset of infants (5.6%) with clinically significant reflux symptom burden beyond those with a prior provider diagnosis. Head posture and muscle function improved gradually in both groups. Median time to discharge did not differ significantly; however, infants with CMT and reflux had a longer median duration of physical therapy (144 vs. 119 days, p = 0.08). I-GERQ-R scores decreased significantly over time in infants with (15-5; p < 0.0001) and without (8-4; p < 0.0001) reflux.</p><p><strong>Conclusions: </strong>Reflux symptoms were common among infants with CMT and were associated with a modestly longer duration of physical therapy. Although this association should not be interpreted as causal, awareness of reflux symptoms during CMT evaluation may inform counseling regarding the anticipated course of therapy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900862","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":"Therapeutic response to ferric hydroxide versus ferrous glycine sulfate in pediatric autoimmune gastritis-related iron deficiency anemia.","authors":"Joana Carvalho Queirós, Inês Aires Martins, Ana Lachado, Francisco Ribeiro-Mourão, Helena Moreira-Silva, Isabel Couto Guerra, Marta Tavares, Emília Costa, Rosa Lima","doi":"10.1002/jpn3.70574","DOIUrl":"10.1002/jpn3.70574","url":null,"abstract":"<p><strong>Objectives: </strong>Autoimmune gastritis (AIG) is characterized by immune-mediated destruction of gastric parietal cells and impaired iron absorption. Refractory iron deficiency anemia (IDA) is often the main clinical presentation in pediatric patients. Because oral ferrous glycine sulfate (FGS) is absorbed independently of gastric pH, it may represent an effective alternative to ferric hydroxide (FH) in this setting.</p><p><strong>Aim: </strong>To compare the therapeutic response to FH and FGS in children and adolescents with AIG-associated IDA.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including pediatric patients diagnosed with AIG-associated IDA and followed at a tertiary Pediatric Gastroenterology Unit between 2007 and 2023. Treatment non-response was defined as a hemoglobin (Hb) increase <1 g/dL after 4 weeks of therapy and/or failure to normalize ferritin after 3 months.</p><p><strong>Results: </strong>Thirty-two patients were included (71% female; median age 12 years). IDA was the presenting feature in 94% of cases. Median baseline Hb was 9.8 g/dL and ferritin was 5 ng/mL. Thirty patients had previously received FH, of whom only four achieved an adequate response. The remaining 26 patients showed minimal improvement in Hb and ferritin and were subsequently switched to FGS. After switching, a significant increase in Hb and ferritin was observed (both p < 0.001), with normalization of Hb and ferritin achieved in 86% and 81% of patients, respectively. Two patients treated initially with FGS also demonstrated favorable hematologic responses.</p><p><strong>Conclusions: </strong>In this retrospective cohort, FGS was associated with substantial hematologic improvement in pediatric patients with AIG-associated IDA, particularly in those who had failed previous FH therapy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906156","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":"Exclusive enteral nutrition versus the Crohn's disease exclusion diet for remission induction in pediatric Crohn's disease: 52-week study.","authors":"Danielle Pevzner, Adi Anafy, Hadar Moran-Lev, Tut Galai, Achiya Amir, Shlomi Cohen, Tomer Ziv-Baran, Anat Yersushalmy-Feler","doi":"10.1002/jpn3.70562","DOIUrl":"10.1002/jpn3.70562","url":null,"abstract":"<p><strong>Objective: </strong>Nutritional therapy is a cornerstone for the induction of remission in pediatric Crohn's disease (CD); however, the optimal dietary strategy remains uncertain. This study aimed to compare the short- and long-term therapeutic outcomes of exclusive enteral nutrition (EEN) and the Crohn's disease exclusion diet (CDED) in a large cohort of children with CD.</p><p><strong>Methods: </strong>This historical cohort study included children diagnosed with CD between 2014 and 2023 who were treated exclusively with either EEN or the CDED for the induction of disease remission. Demographic, clinical, and laboratory data were collected over a 52-week follow-up period.</p><p><strong>Results: </strong>A total of 159 patients were included: 75 treated with EEN and 84 with the CDED. Baseline demographic and disease characteristics were comparable between groups. At 6 weeks, clinical remission was achieved in 58 (77%) children in the EEN group and 63 (75%) children in the CDED group (p = 0.730). Treatment adherence rates were similarly high (EEN 89% vs. CDED 88%, p = 0.810). Week 6 normalization of C-reactive protein (EEN 43% vs. CDED 46%, p = 0.709) and fecal calprotectin <150 mcg/g (EEN 35% vs. CDED 34%, p = 0.982) were also comparable between the groups. A Mucosal Inflammation Noninvasive index score <8 was documented in 52% versus 69% of the groups, respectively (p = 0.219). There were no group differences in rates of disease exacerbation, corticosteroid or biologic therapy use, hospitalizations, or need for surgery during 52 weeks of follow-up.</p><p><strong>Conclusions: </strong>EEN and the CDED demonstrated no significant differences in efficacy across all assessed clinical and biochemical outcomes throughout the 52-week follow-up period.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887866","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":"Characteristics and management of gastrointestinal bleeding in children on ventricular assist device support.","authors":"Megan Foley, Kathleen R Ryan, Monique T Barakat","doi":"10.1002/jpn3.70528","DOIUrl":"https://doi.org/10.1002/jpn3.70528","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887873","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":"Somatic and gastrointestinal symptoms longitudinally predict early adolescent disordered eating.","authors":"Antonia L Hamilton, Alexa G Deyo, Katherine M Kidwell","doi":"10.1002/jpn3.70474","DOIUrl":"10.1002/jpn3.70474","url":null,"abstract":"<p><strong>Objectives: </strong>Somatic complaints have been identified as potential risk factors for the development of disordered eating. Emerging evidence suggests that gastrointestinal (GI) symptoms, specifically, may precede and contribute to disordered eating onset. However, existing research in early adolescents is limited and largely cross-sectional. This study examined whether (1) general somatic complaints and (2) GI-specific somatic complaints predicted (a) disordered eating symptoms and (b) clinically significant disordered eating 1 year later.</p><p><strong>Methods: </strong>Participants included 6228 early adolescents from the Adolescent Brain and Cognitive Development^SM Study (ABCD Study®) assessed at 2- and 3-year follow-up.</p><p><strong>Results: </strong>Results showed that both general somatic complaints and GI-specific somatic complaints significantly predicted later disordered eating symptoms, including at clinically significant levels.</p><p><strong>Conclusions: </strong>These findings underscore the importance of early identification of somatic complaints, particularly GI-specific symptoms, as potential markers for later disordered eating. Early screening and intervention targeting these complaints may help mitigate the onset of disordered eating in early adolescents.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"390-396"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic esophagitis: An aerodigestive perspective.","authors":"Tsega A Temtem, Kelly Liu, Kenneth L Kennedy, Benjamin D Gold","doi":"10.1002/jpn3.70496","DOIUrl":"10.1002/jpn3.70496","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory condition of the esophagus that is characterized by esophageal dysfunction and distinct histopathologic findings of elevated eosinophils in the esophageal mucosa. EoE can present in the aerodigestive patient with a variety of symptoms ranging from feeding difficulty to extraesophageal symptoms such as chronic cough. Routine evaluation for EoE should be performed in high-risk patients such as esophageal atresia/tracheoesophageal fistula and should be considered for those undergoing evaluation for laryngotracheal reconstruction surgery. When selecting treatments for EoE in aerodigestive patients, the clinician should consider limitations such as ability to take oral treatments and other nutritional considerations in the management of these fragile patients. Long-term monitoring of aerodigestive patients with EoE should include assessment of growth, feeding, nutrition, and follow-up for resolution of the primary presenting symptoms often requires continued involvement of the multidisciplinary team which includes a dietitian and feeding therapist.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"467-473"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of infant milks: Contamination with cereulide. A commentary by ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology, and Nutrition).","authors":"Nadja Haiden, Mary Fewtrell, Elin Hård Af Segerstad, Iva Hojsak, Lorenzo Norsa, Berthold Koletzko","doi":"10.1002/jpn3.70488","DOIUrl":"10.1002/jpn3.70488","url":null,"abstract":"<p><p>Since late 2025, precautionary recalls of specific infant and follow-on formula batches in Europe have occurred due to contamination with cereulide, a heat- and acid-stable emetic toxin produced by certain Bacillus cereus strains. Contamination was traced to arachidonic acid (ARA)-containing algal oil from a single supplier; no viable bacteria were detected in the affected products. The European Food Safety Authority established a conservative acute reference dose for infants, and available monitoring data indicate that detected concentrations were generally low and unlikely to pose significant health risks, although some batches may have exceeded precautionary thresholds. This commentary reviews the toxicological background, current risk assessment, analytical challenges, and clinical implications. While cereulide should not be present beyond unavoidable trace levels in infant formula, risk management must remain proportionate and avoid promoting nutritionally inadequate substitutes. Ensuring validated analytical surveillance, stringent raw material control, transparent communication, and continued provision of appropriately regulated formulas containing recommended long-chain polyunsaturated fatty acids, including docosahexaenoic acid (DHA) and ARA, is essential to safeguard infant health and maintain public confidence.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"371-373"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}