Journal of Pediatric Gastroenterology and Nutrition最新文献

{"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}

{"title":"Inter-tissue relationships of gene expression in liver, muscle and adipose tissue of children with end-stage chronic liver disease.","authors":"Eirini Kyrana, Cheng Zhang, Han Jin, Siamak Salehi, Jonathan C K Wells, Maesha Deheragoda, Ragai R Mitry, Anil Dhawan","doi":"10.1002/jpn3.70498","DOIUrl":"10.1002/jpn3.70498","url":null,"abstract":"<p><strong>Objectives: </strong>End-stage chronic liver disease in children is associated with sarcopenia and aberrant adipose tissue mass. We investigated correlations between liver pathology-associated gene pathways (fibrosis, inflammation and steatosis) and metabolic genes in muscle and adipose tissue.</p><p><strong>Methods: </strong>Liver, rectus abdominis muscle and subcutaneous adipose tissue were collected during liver transplant for microarray gene expression analysis. Patients underwent pre-transplant indirect calorimetry, anthropometry and laboratory assessments. Weighted gene co-expression network analysis identified highly correlated gene modules within each tissue and explored inter-tissue correlations.</p><p><strong>Results: </strong>Nine patients were studied, three male:six female, age 7 months to 17 years. Liver gene clusters associated with fibrosis and ribosome function/protein secretion negatively correlated with muscle mitochondrial function genes and positively correlated with adipose tissue mitochondrial function genes. Notable correlations included a negative correlation between muscle growth hormone receptor (GHR) and liver ARID5B, MFGE8 and YWHAZ, and a positive correlation between adipose AKT1, ADG5, and SRM and liver RRAGA, YES1, EIF3M and COX3A. Liver inflammation-associated genes (vimentin, TIMP2, CXCL6 and endothelin-1) negatively correlated with adipose genes improving insulin sensitivity (THRSP) and fibrosis-related genes (KRT36, DMTN). Liver steatosis genes (ADRA2B) negatively correlated with adipose genes involved in adipogenesis (FGF10) and thyroid hormone metabolism (NHLH1).</p><p><strong>Conclusions: </strong>Genes related to liver fibrosis and protein secretion negatively correlated with muscle and adipose tissue metabolism/proliferation genes. Liver inflammation and steatosis gene clusters were associated with muscle and adipose metabolism genes. This pilot study highlights important inter-tissue gene correlations warranting further investigation in paediatric end-stage chronic liver disease.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"500-508"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391037","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":"Rotational thromboelastometry versus conventional tests in decompensated cirrhotic children undergoing invasive procedures.","authors":"Snigdha Verma, Bikrant Bihari Lal, Rajeev Khanna, Vikrant Sood, Amar Mukund, Meenu Bajpai, Seema Alam","doi":"10.1002/jpn3.70471","DOIUrl":"10.1002/jpn3.70471","url":null,"abstract":"<p><strong>Objectives: </strong>This randomized controlled trial (RCT) aimed to evaluate the efficacy and safety of a rotational thromboelastometry (ROTEM)-guided transfusion strategy in children with decompensated cirrhosis presenting with severe coagulopathy and/or thrombocytopenia undergoing invasive procedures.</p><p><strong>Methods: </strong>This was an open-label, RCT which included (i) children 6 months to 18 years of age with decompensated liver cirrhosis, (ii) international normalized ratio (INR) between 2.5 and 3.5 (for procedures other than liver biopsy) and 2-2.5 (for liver biopsy), and/or (iii) platelet count between 20 and 50 × 10⁹/L listed for invasive procedures. An interactive web response system was used to randomize the patient. Blood component transfusions in both arms were administered according to a predefined criterion.</p><p><strong>Results: </strong>A total of 363 invasive procedures in decompensated chronic liver disease patients were screened for inclusion into the study. Of these, 76 were randomized (38 in each group with comparable baseline parameters). The proportion of patients receiving any blood component transfusion was significantly lower in the ROTEM arm (76.3% vs. 100%, p = 0.001). However, the volume of total and individual blood components transfused was comparable between groups. There was no difference in procedure-related bleed and transfusion-related complications between the two arms. In our study, the total costs incurred were higher in the ROTEM group (p < 0.001).</p><p><strong>Conclusion: </strong>In this cohort of children with decompensated cirrhosis and severe coagulopathy, ROTEM-guided transfusion reduced overall transfusion exposure but did not decrease blood product volume and was not cost-effective under the applied thresholds.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05734001 (Clinicaltrials.gov); CTRI/2023/02/049779 (Clinical trials registry of India).</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"474-482"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150244","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":"Impact of a slow feeding advancement protocol on necrotizing enterocolitis incidence in preterm infants: A before-and-after study.","authors":"Samuele Caruggi, Andrea Calandrino, Marcella Battaglini, Francesca Baudi, Barbara Lionetti, Federica Mongelli, Francesco Vinci, Paolo Massirio, Alessandro Parodi, Luca Antonio Ramenghi","doi":"10.1002/jpn3.70559","DOIUrl":"10.1002/jpn3.70559","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in very low birth weight infants, while the safest rate of enteral feed advancement remains debated. We performed a retrospective single-center before-after cohort study in a tertiary neonatal intensive care unit, comparing two feeding strategies in 572 infants (286 per group): faster advancement (20-30 mL/kg/day) from 2015-2018 and slower advancement (10-25 mL/kg every 48 h, weight-dependent) from 2020-2023. The primary outcome was NEC, defined as Bell stage ≥IIb or diagnosis at surgery. NEC was less frequent in the slower-advancement era (2.1% vs 7.9%; adjusted p = 0.02). Mortality, late-onset sepsis, central venous catheter duration, and extrauterine growth restriction were similar. Faster advancement led to earlier full enteral feeding, while discharge weight centiles were comparable. A cautious feeding strategy was associated with lower NEC incidence without evidence of worse infectious or growth outcomes.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874458","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":"Rumination syndrome and eosinophilic esophagitis in children: Defining the relationship.","authors":"Dennis Yang, Peter L Lu, Janice S Khoo, Raul E Sanchez, Rajitha D Venkatesh, John M Russo, Neetu Bali, Karla Vaz, Desale Yacob, Carlo Di Lorenzo, Ashley M Kroon Van Diest","doi":"10.1002/jpn3.70454","DOIUrl":"10.1002/jpn3.70454","url":null,"abstract":"<p><strong>Objectives: </strong>While rumination syndrome (RS) and eosinophilic esophagitis (EoE) can share overlapping symptoms, their association remains unclear. Our objective was to explore the relationship between RS and EoE and understand the clinical course of children with both conditions.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children with RS and EoE evaluated at our institution from 2016 to 2023. Patient characteristics, symptoms, treatments, and outcomes were compared.</p><p><strong>Results: </strong>Among 230 children with RS, 22 (10%) had both RS and EoE (77% male, median age 18 years). Sixteen (70%) were first diagnosed with EoE, two (9%) with RS, and four (18%) concurrently. Most (91%) presented with regurgitation; 64% reported dysphagia at some point. EoE treatment led to mucosal remission in 73% and improved dysphagia in 41%, but 86% continued to experience regurgitation. RS treatment, including behavioral therapy and baclofen, improved or resolved regurgitation in 64%. Peak eosinophil counts were similar in children with and without dysphagia (43 vs. 51 eos/HPF, p = 0.589). Those without dysphagia responded better to RS treatment (67% vs. 22%), though the difference was not statistically significant. Among those diagnosed with EoE first, RS diagnosis occurred after a median of 15.4 months.</p><p><strong>Conclusions: </strong>EoE was more prevalent among children with RS than in the general population. Regurgitation seemed more responsive to RS treatment than EoE treatment. In patients with EoE and persistent regurgitation, RS should be considered, especially when symptoms persist despite EoE remission.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"374-380"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963858","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":"Feasibility and efficacy of fecal microbiota transplantation in adolescents with refractory irritable bowel syndrome: A randomized clinical pilot trial.","authors":"Clara M A de Bruijn, Anna O J Oorthuys, Judith Zeevenhooven, Mark Davids, Johannes H M Levels, Arine M Vlieger, Hilde Herrema, Max Nieuwdorp, Marc A Benninga","doi":"10.1002/jpn3.70459","DOIUrl":"10.1002/jpn3.70459","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the feasibility and efficacy of fecal microbiota transplantation (FMT) in adolescents (16-21 years) with refractory irritable bowel syndrome (IBS).</p><p><strong>Methods: </strong>Randomized controlled pilot trial. Thirty-two patients were included and randomized to receive two allogeneic or autologous FMTs. At baseline and after 6 weeks, two allogeneic or autologous FMTs were administered via a nasoduodenal tube. Feasibility outcomes included dropout rate. Clinical efficacy was evaluated by the proportion of responders (≥50 points reduction in total score of the IBS severity-scoring-system) at 12, 24, and 48 weeks follow-up. Secondary outcomes included health-related quality of life (QoL), depression and anxiety scores, and school/work absenteeism.</p><p><strong>Results: </strong>One patient (3%) withdrew after randomization, due to lack of effect after the first FMT. Response rates 12 weeks after allogeneic and autologous FMTs were 40% and 38% (p = 0.886). At 24 weeks, significantly more patients responded after allogeneic FMTs (60% vs. 25% autologous, p = 0.048), without significant differences at 48 weeks (60% vs. 50%, p = 0.576). Total QoL score was significantly better after allogeneic than autologous FMTs at 12, 24, and 48 weeks (p = 0.028, p = 0.007, p = 0.011). In the allogeneic FMTs group, school/work absenteeism was 7% at 24 weeks (vs. 41% autologous, p = 0.037).</p><p><strong>Conclusions: </strong>Allogeneic FMTs were feasible and resulted in high response rates and better QoL compared to autologous FMTs. These results provide preliminary evidence for the use of allogeneic FMTs in adolescents with refractory IBS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT03074227 (https://clinicaltrials.gov/study/NCT03074227?id=NCT03074227&rank=1).</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"381-389"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138425","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}