Journal of Pediatric Gastroenterology and Nutrition最新文献

{"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}

{"title":"Safety and effectiveness of milk and egg ladders in children with IgE-mediated food allergy-A case series.","authors":"Daria Wiszniewska, Agata Stróżyk, Andrea Horvath","doi":"10.1002/jpn3.70088","DOIUrl":"https://doi.org/10.1002/jpn3.70088","url":null,"abstract":"<p><strong>Objectives: </strong>Introducing baked cow's milk and egg proteins to children with severe immunoglobulin E (IgE)-mediated food allergies is controversial. This case series aimed to evaluate the safety and efficiency of the 5-step milk ladder (5-ML) and the 4-step egg ladder (4-EL) in a group of \"high risk\" children with IgE-mediated cow's milk (CMA) and hen's egg (HEA) allergies in the real-life settings.</p><p><strong>Methods: </strong>Twenty-nine children with IgE-mediated CMA and/or HEA, with a history of severe allergic symptoms and/or asthma and/or elevated specific IgE levels (defined as \"high risk\"), were included. Tolerance acquisition to baked products was assessed via open-label supervised oral food challenges (OFCs), subsequent steps of the food ladders were performed in the majority through home-based reintroduction.</p><p><strong>Results: </strong>Five out of 15 children (33%) developed tolerance to raw cow's milk proteins, while 11 children (73%) tolerated baked cow's milk (muffins). Three out of 23 children (13%) developed tolerance to any form of egg. Seventeen children (74%) tolerated baked egg in the form of muffins, 11 children (48%) tolerated pancakes, and 8 (35%) tolerated hard-boiled egg or well-cooked scrambled eggs. Tolerance loss occurred in two cases due to inconsistent introduction. In one case, parental concerns led to temporary withdrawal, but tolerance was reconfirmed. During OFCs, no anaphylaxis occurred; antihistamines were used in 10 children for minor reactions.</p><p><strong>Conclusion: </strong>This case series provides evidence that assessing tolerance following the 5-ML and 4-EL in a \"high-risk\" group of children with IgE-mediated food allergies is safe. However, regular monitoring of these children is essential.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119993","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":"Retrospective study on safety and complications of direct percutaneous endoscopic gastrostomy in children below 10 kg.","authors":"Ilse J Broekaert, Christoph Hünseler","doi":"10.1002/jpn3.70085","DOIUrl":"https://doi.org/10.1002/jpn3.70085","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119992","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":"Clinical risk factors for body composition deficits in children with inflammatory bowel disease.","authors":"Erin Alexander, Ronen Stein, Sharmistha Rudra, Lindsey Albenberg, Babette Zemel","doi":"10.1002/jpn3.70075","DOIUrl":"https://doi.org/10.1002/jpn3.70075","url":null,"abstract":"<p><strong>Objectives: </strong>Children with inflammatory bowel disease (IBD) often have low body mass index (BMI). BMI does not distinguish between fat and lean mass. Body composition deficits may be associated with worse clinical outcomes. We examined the prevalence of risk factors associated with body composition deficits in youth with pediatric-onset IBD, and factors associated with low lean mass in the presence of a normal BMI Z-score (BMI-Z).</p><p><strong>Methods: </strong>Newly diagnosed IBD patients ages 5-20 years with whole body dual energy x-ray absorptiometry scans acquired between 2014 and 2019 were included. Appendicular lean soft tissue mass index (AppLSTMI) and fat mass index (FMI) were expressed as age and sex-specific Z-scores. Clinical and demographic data were collected retrospectively. Logistic regression was used to assess associations with body composition outcomes.</p><p><strong>Results: </strong>Five hundred sixteen patients were included, 26% had AppLSTMI Z-score (AppLSTMI-Z) < -2, 4% had BMI-Z < -2, and none had FMI Z-score (FMI-Z) < -2. Increased risk of low AppLSTMI-Z associated with Crohn's diagnosis, Asian ethnicity, disease activity, elevated platelets, and glucocorticoid use. Females had lower FMI-Z. Low AppLSTMI-Z within the context of BMI-Z (n = 112) was associated with Crohn's disease, Asian (odds ratio [OR] = 3.77, p = 0.001) and Black identity (OR = 0.32, p = 0.02), and elevated platelets (OR = 1.76, p = 0.02) compared to those with normal BMI-Z and normal AppLSTMI-Z.</p><p><strong>Conclusions: </strong>BMI is a poor indicator of body composition in children with IBD as it masks lean mass deficits which are highly prevalent. Future studies regarding the long-term consequences and reversibility of this deficit are warranted.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094068","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":"Severe hepatitis in pediatric patients: The Severe Hepatitis In Pediatric Patients (SHIPP) registry.","authors":"Mohit Kehar, Katherine Black, Christopher Chu, Rohit Kohli, Saeed Mohammad","doi":"10.1002/jpn3.70083","DOIUrl":"https://doi.org/10.1002/jpn3.70083","url":null,"abstract":"<p><strong>Objectives: </strong>Clusters of severe acute hepatitis in children were reported worldwide beginning in October 2021. Although most children recovered, some progressed to liver failure leading to death or liver transplantation. Herein, we characterize the clinical characteristics, and outcomes of this group of children through an international collaborative effort.</p><p><strong>Methods: </strong>Participation was solicited via a global listserv to pediatric gastroenterologists worldwide. Patients <18 years, alanine aminotransferase >500 U/L, without chronic liver disease or acetaminophen ingestion were eligible. Data were submitted by individual sites into a Research Electronic Data Capture registry created in July 2022.</p><p><strong>Results: </strong>Two hundred and seven cases were collected, with a peak incidence of 28 in April 2022. The median age was 40 months, 52.7% were male, 63.3% were white, and 44% were Hispanic. At presentation, 80% reported gastrointestinal symptoms followed by fever (27.7%). The median duration of hospitalization was 5.5 days with 51 patients requiring intensive care. Adenovirus serum/whole blood DNA was detected in 28/133 (21%) and seven patients were treated with cidofovir. Liver biopsies, performed in 76 patients revealed portal and lobular inflammation with none identifying a viral etiology. Eleven patients underwent liver transplantation, four were adenovirus positive, all of whom survived. There were four reported deaths.</p><p><strong>Conclusions: </strong>In this large data set of pediatric patients with severe acute hepatitis, the majority did not have a singular definitive etiology but did recover spontaneously. Continued community surveillance and close cooperation are critical toward understanding the etiology of such clusters in pediatrics.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094079","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":"Technical review by the ESPGHAN Special Interest Group on Gut Microbiota and Modifications on the health outcomes of infant formula supplemented with prebiotics.","authors":"Walter Mihatsch, Ener Cagri Dinleyici, Roberto Berni Canani, Iva Hojsak, Alexis Mosca, Rok Orel, Silvia Salvatore, Francesco Savino, Hania Szajewska, Chris H P van den Akker, Zvi Weizman, Yvan Vandenplas","doi":"10.1002/jpn3.70064","DOIUrl":"https://doi.org/10.1002/jpn3.70064","url":null,"abstract":"<p><p>Prebiotics are defined as substrates that are selectively utilized by host microorganisms, conferring health benefits. This technical review focusing on prebiotic-supplemented infant formulas is one of the five manuscripts developed by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Special Interest Group on Gut Microbiota and Modifications (SIG-GMM). The SIG-GMM conducted a technical review to evaluate the clinical outcomes of prebiotic-supplemented infant formulas in healthy infants (0-12 months) that were published before 2024. The review focused on the following clinical outcomes: anthropometric measurements, stool frequency and consistency, gastrointestinal symptoms, allergy prevention, infection prevention, and safety/tolerability. Following the review, all 20 SIG members anonymously voted on each statement, scoring them from 0 to 9. A score ≥6 indicated agreement with a statement. A statement was rejected if ≥75% of the members voted <6. Fifty-one publications were included, focusing on prebiotics such as short-chain galacto-oligosaccharides, long-chain fructo-oligosaccharides, acidic oligosaccharides, and polydextrose/galacto-oligosaccharides. This technical review demonstrates that prebiotic-supplemented formulas are well tolerated, with no significant differences in anthropometric parameters compared to those fed non-supplemented formula. Prebiotic supplementation decreased stool consistency and increased stool frequency depending on the dosage and type. This technical review provides information on prebiotic-supplemented infant formulas in healthy infants. Overall, no significant clinical health benefits were observed in terms of infections and antibiotic use, colic, and allergy.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094086","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":"Sirolimus utilization in pediatric liver transplantation: A large high-volume quaternary center experience.","authors":"Wenly Ruan, Dana N Cerminara, Nhu Thao Nguyen Galvan, Douglas S Fishman, Sanjiv Harpavat, Paula M Hertel, Krupa R Mysore, Mary Elizabeth Tessier, Kelby Fuller, Marielle Faraone, Ronald T Cotton, Christine A O'Mahony, Abbas Rana, John A Goss, Daniel H Leung","doi":"10.1002/jpn3.70073","DOIUrl":"https://doi.org/10.1002/jpn3.70073","url":null,"abstract":"<p><strong>Objectives: </strong>Optimization of liver transplant (LT) immunosuppression is essential for long-term graft function in children. Mammalian target of rapamycin (mTOR) inhibitors, such as sirolimus, have not been extensively studied in pediatric LT. We aimed to explore the usage of and indications for sirolimus at a quaternary pediatric LT center in a retrospective cohort analysis.</p><p><strong>Methods: </strong>Pediatric LT patients who received sirolimus from 2010 to 2018 were included. Their electronic medical records were evaluated for demographic information, clinical data, and laboratory data before and after initiation of sirolimus.</p><p><strong>Results: </strong>Sirolimus was initiated on 41 pediatric LT recipients at a median of 0.67 years post-transplant (interquartile range [IQR]: 0.13-1.83) at Texas Children's Hospital. The leading indications for initiating sirolimus were chronic rejection (CR) (n = 12, 29.3%), T-cell-mediated rejection (TCMR) on tacrolimus (n = 8, 19.5%), posterior reversible encephalopathy syndrome (PRES) (n = 8, 19.5%), and unresectable hepatic tumors/malignancies (n = 7, 17.1%). Among patients started on sirolimus for CR, 58% (n = 7/12) demonstrated histological or biochemical improvement. Among those started for TCMR augmentation, 62.5% experienced biochemical improvement. No patients who started on sirolimus for unresectable hepatic tumors/malignancies had malignancy recurrence 1-year post-LT. Median cholesterol and triglyceride levels 1-year post-initiation were higher than values 1-year pre-initiation (p < 0.0001); however, sirolimus-induced anemia, nephrotoxicity, and HAT were not observed.</p><p><strong>Conclusions: </strong>This study is among the first to review the clinical experience of sirolimus usage in pediatric LT. Our experience suggests sirolimus can be used safely and effectively. Further research is warranted to evaluate long-term benefits, adverse effects, and optimal dosing of sirolimus in pediatric liver transplantation.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094083","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":"Reduced miR-212-3p is a novel indicator of estimating disease activity in pediatric Crohn's disease.","authors":"WenXin Chen, Li Gu, Xue Qiao, Zhuo Zhang, Hui Yang","doi":"10.1002/jpn3.70062","DOIUrl":"https://doi.org/10.1002/jpn3.70062","url":null,"abstract":"<p><strong>Objectives: </strong>Mammalian non-coding RNA disease database showed that miR-212-3p had a strong correlation with Crohn's disease (CD). We aimed to investigate the differential expression of miR-212-3p in the serum and intestinal mucosa of children with CD and non-CD and analyzed its role in evaluating CD disease activity.</p><p><strong>Methods: </strong>We studied 118 children with suspected CD and divided them into CD (n = 25), non-CD (n = 93), and control (n = 33) groups. Serum and intestinal mucosal samples were detected for miR-212-3p expression. Disease activity was assessed using the pediatric CD activity index (PCDAI), simplified CD endoscopic index of severity (SES-CD), Chiu's score, and occluding expression. The area under the curve value was calculated using receiver operating characteristic (ROC) curves to compare the evaluation efficacy of serum and intestinal mucosal miR-212-3p, fecal calprotectin (FC), C-reactive protein (CRP), and other laboratory indicators for disease activity.</p><p><strong>Results: </strong>Intestinal mucosal miR-212-3p negatively correlated with PCDAI, SES-CD, and Chiu's scores but positively correlated with occludin expression (p < 0.05). Serum miR-212-3p also negatively correlated with PCDAI and SES-CD (p < 0.05). ROC curve analysis indicated that both serum and intestinal miR-212-3p outperformed FC, CRP, and other indicators in assessing CD activity.</p><p><strong>Conclusions: </strong>Intestinal mucosal and serum miR-212-3p is a promising biomarker for assessing disease activity in pediatric CD.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094071","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}