Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Gastroesophageal reflux in children with cerebral palsy: Does symptom presence reflect disease severity?","authors":"Cristina Lorenzo, Cecilia Zubiri, Anabella Zosi, Sandro Miculan, Daniela Neder, Ana Rocca, Judith Cohen Sabban, Roman Bigliardi, Maria Florencia Biasoli, Manuela Manterola, Maria de Los Angeles Savia, Luis Orlando Perez, Carlos Ruiz Hernández, Renata Weinschelbaum, Ana Cristina Fontenele Soares, Soraia Tahan, Veronica Plante, Christian Boggio Marzet, Soledad Arcucci, Erick Toro-Monjaraz, Maria Alejandra Mortarini, Samantha Arrizabalo, Miguel Saps","doi":"10.1002/jpn3.70606","DOIUrl":"https://doi.org/10.1002/jpn3.70606","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether the presence of gastroesophageal reflux symptoms in children with cerebral palsy (CP) reflects pathological reflux severity as assessed by 24-h multichannel intraluminal impedance-pH monitoring (MII-pH).</p><p><strong>Methods: </strong>We conducted a multicenter retrospective review of MII-pH tracings in children with CP (Gross Motor Function Classification System IV-V), aged 1-15 years, evaluated before gastrostomy placement across 11 centers in Argentina, Brazil, Mexico, and Spain. Patients were classified as symptomatic or asymptomatic based on caregiver reports. Reflux index (RI), number and type of reflux episodes, acid clearance time, and mean nocturnal baseline impedance (MNBI) were compared.</p><p><strong>Results: </strong>A total of 201 MII-pH tracings were included. A pathological RI (≥7%) was identified in 18.4% of patients: 23.1% of symptomatic and 12.9% of asymptomatic children (p = 0.03). No significant differences were found in total reflux episodes, acid clearance time, or MNBI. Among symptomatic children, 27% demonstrated a positive symptom-reflux correlation. Respiratory symptoms (p = 0.009), regurgitation (p < 0.001), and rumination (p = 0.005) were associated with reflux events, while most symptoms showed no association.</p><p><strong>Conclusions: </strong>Children with CP can have abnormal RI in the absence of symptoms. Symptoms do not reliably indicate abnormal acid exposure. These findings highlight the limitations of symptom-based diagnosis and reinforce the value of objective assessment with MII-pH monitoring.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164707","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":"Extensive polycystic pancreas in a child: A rare congenital lesion.","authors":"Bianca De Grande, Annalisa Madeo, Marta Pongiglione, Andrea Chiaro","doi":"10.1002/jpn3.70612","DOIUrl":"https://doi.org/10.1002/jpn3.70612","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169983","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":"Early lactation breast milk protein and lactose as independent predictors of infant regurgitation: A prospective cohort study.","authors":"Pei Li, Dan Wu, Yilun Jiang, Shuangmei Lu, Jing Peng, Chun Yang, Peng-Gao Li","doi":"10.1002/jpn3.70600","DOIUrl":"https://doi.org/10.1002/jpn3.70600","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether breast milk (BM) macronutrient composition in the first 2 weeks postpartum is associated with subsequent infant regurgitation (IR) risk, independent of maternal dietary intake.</p><p><strong>Methods: </strong>In this prospective cohort study (Beijing, China), 78 mother-infant dyads were followed for 5 months. BM samples were collected at 1-2 weeks, 1, 2, and 5 months postpartum. IR was diagnosed using Rome IV criteria. Macronutrient composition (protein, fat, lactose) was analyzed using standardized methods. Maternal diet was assessed via a validated food frequency questionnaire. Multivariable logistic regression adjusted for maternal (body mass index, gestational age) and infant (birth weight, gender) characteristics.</p><p><strong>Results: </strong>IR incidence peaked at 1 month (61.5%) and declined thereafter. Compared with controls, infants who developed IR at 1-2 months were exposed to lower protein and higher lactose concentrations in BM collected at 1-2 weeks (p < 0.05 for both). Maternal dietary intake was not associated with BM macronutrient composition. In adjusted models, lower early BM protein (odds ratio [OR] 0.090; 95% confidence interval [CI] 0.012-0.670) and higher lactose (OR 2.571; 95% CI 1.039-6.363) were associated with increased IR risk at 1 month.</p><p><strong>Conclusions: </strong>Early BM composition may be associated with subsequent IR risk, independent of maternal diet. Protein and lactose levels in early lactation may serve as potential markers for identifying infants at risk. These findings suggest early lactation as a sensitive period linking maternal physiology to infant gastrointestinal outcomes.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168150","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 characteristics and treatment outcomes in pediatric microscopic colitis: A retrospective 13-year experience.","authors":"Stephanie Camhi, Kamryn Jebb, Kendall Kleinman, Victoria Kenyon, Victoria M Martin, Maureen M Leonard","doi":"10.1002/jpn3.70601","DOIUrl":"https://doi.org/10.1002/jpn3.70601","url":null,"abstract":"<p><strong>Objectives: </strong>Microscopic colitis (MC) is a histological inflammatory disease of the colon, commonly diagnosed in adults and known to be associated with autoimmune conditions. Clinical presentation and treatment outcomes in pediatrics are not well described. The aim of the current study was to describe pediatric MC cases encountered at a single center over a 13-year period.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients aged 18 years and younger (inclusive) evaluated in our health system between 2013 and 2025 for MC.</p><p><strong>Results: </strong>Thirty-five patients (80% female) with an average age of 14.2 years at MC diagnosis were included. Presenting symptoms were chronic diarrhea, abdominal pain, and weight loss. Histologically, most patients had lymphocytic colitis (74%), and seven patients (20%) had concurrent celiac disease (CeD). At diagnosis, no patients had elevated systemic inflammatory markers and fecal calprotectin (tested in 26% of patients) was elevated in 66%. The most prescribed treatments included Budesonide (77%) and aminosalicylates (34%). Two patients required biologic therapy including Vedolizumab, Ustekinumab, and Adalimumab. A clinical subgroup emerged who showed complete symptomatic response to Budesonide without additional therapy (n = 8), and four patients in this group had CeD.</p><p><strong>Conclusions: </strong>This study adds to the limited pediatric MC literature, including two cases requiring biologic therapy. Fecal calprotectin is presently underutilized but, when tested, was not reliably elevated in the active disease state. Like adults, Budesonide was the most prescribed therapy for pediatric MC and may represent an important first line treatment option due to select patients exhibiting complete symptomatic response.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170123","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":"Evaluating social validity in practice: Parents' experiences of an eating intervention for children with avoidant restrictive food intake disorder.","authors":"Emilia Carlsson, Jonas Hermansson, Petra Linnsand","doi":"10.1002/jpn3.70603","DOIUrl":"https://doi.org/10.1002/jpn3.70603","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore parents' experiences following an eating intervention for children with avoidant/restrictive food intake disorder (ARFID), focusing on the perceived significance of goals, the acceptability of intervention procedures, and the relevance of outcomes within a social validity framework.</p><p><strong>Methods: </strong>Forty children, meeting criteria for ARFID and referred to a regional multiprofessional eating team were included, along with 67 caregivers. A retrospective mixed-methods design was employed. Quantitative data consisted of parent-reported goal-attainment ratings collected from pre- and post-intervention. Qualitative data were derived from retrospective reviews of medical charts and analyzed using content analysis. The analysis examined the intervention process, documented outcomes, and their alignment with core domains of the social validity framework.</p><p><strong>Results: </strong>Intervention goals were perceived as meaningful and relevant to everyday eating and feeding challenges, and documented experiences reflected varying levels of acceptability and perceived benefit. Analyses showed that parents' visual analogue scale scores were significantly lower following the intervention. Paired-samples t-tests revealed changes in parents' reports of weight concern, mealtime functioning, and concerns about the child's eating from pre- to post-intervention.</p><p><strong>Conclusions: </strong>The findings underscore the importance of having a holistic and individualized approach to eating interventions. Tailoring interventions to individual family circumstances and priorities may enhance relevance, acceptability, and overall impact.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167937","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":"Long-term trends in pediatric intussusception in Hokkaido, Japan, 2007-2024 across the rotavirus vaccination era.","authors":"Yuya Fukuda, Yoshinori Araki, Toshitaka Kizawa, Kenji Kondo, Wataru Ikemoto, Kouhei Nishino, Toshiya Sato, Masayoshi Kikuchi, Kazushige Nagai, Minako Kihara, Takuro Ito, Hiroyuki Kabutoya, Hirofumi Asakura, Yuta Sasaoka, Noriaki Adachi, Takeshi Nishida, Takeshi Tsugawa","doi":"10.1002/jpn3.70599","DOIUrl":"https://doi.org/10.1002/jpn3.70599","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric intussusception is the most common cause of acute intestinal obstruction in young children. We investigated long-term epidemiological trends in pediatric intussusception before and after rotavirus vaccine introduction and during the COVID-19 pandemic in Hokkaido, Japan.</p><p><strong>Methods: </strong>A retrospective multicenter surveillance study was conducted at 17 hospitals in Hokkaido between 2007 and 2024. Clinical characteristics, management, outcomes, and viral antigen test results were collected. Only cases fulfilling Brighton Level 1 diagnostic certainty were included. Annual incidence rates were calculated using regional population statistics.</p><p><strong>Results: </strong>A total of 513 children met the inclusion criteria, with 93.0% aged 0-4 years. Non-surgical reduction was successful in 94.0% of cases, and no deaths or long-term sequelae were observed. Among infants aged <1 year, incidence decreased from 99.4 per 100,000 person-years during the pre-vaccination period (2007-2011) to 69.9 during the voluntary vaccination period (2012-2019), and was 79.7 during the universal vaccination/COVID-19 period (2020-2024). Corresponding incidence rates among children aged 0-4 years were 55.4, 36.7, and 38.1 per 100,000 person-years, respectively.</p><p><strong>Conclusion: </strong>Among children aged 0-4 years, intussusception incidence was lower during the period following rotavirus vaccine introduction than during the pre-vaccine period and remained broadly stable during the universal vaccination and COVID-19 period. The observed changes cannot be attributed to rotavirus vaccination alone because of concurrent changes in infectious disease circulation and other population-level factors. Continued surveillance is warranted to further clarify the epidemiology of pediatric intussusception.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167490","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":"Heterogeneous effects of donor-related risk factors in 954 pediatric liver transplantations.","authors":"Christoph Leiskau, Norman Junge, Tobias Laue, Imeke Goldschmidt, Frauke E Mutschler, Moritz Schmelzle, Nicolas Richter, Philipp Felgendreff, Cornelius J van Beekum, Florian W R Vondran, Clara A Weigle, Eva-D Pfister, Ulrich Baumann","doi":"10.1002/jpn3.70593","DOIUrl":"https://doi.org/10.1002/jpn3.70593","url":null,"abstract":"<p><strong>Objectives: </strong>Accepting a suitable donor for a child awaiting pediatric liver transplantation (pLT) is increasingly challenging. Donor-specific risk factors influence post-transplant outcomes, but evidence in pediatric patients remains inconsistent. We aimed to identify their influence on mortality and graft loss and investigate their dependence on recipient- and transplant-associated variables.</p><p><strong>Methods: </strong>We analyzed 954 consecutive pLT cases (1983-2024). Patient and graft survival was analyzed and correlated to donor- and graft-specific variables by univariate and multivariate regression analyses, with a subgroup analysis for time era and indication for pLT.</p><p><strong>Results: </strong>Multivariate analysis showed that patient/graft survival was significantly impaired by elevated donor creatinine (hazard ratio [HR]: 1.951/1.728, p = 0.011/0.007) and cerebrovascular cause of death (HR: 1.691/3.797, p = 0.020/<0.001). ABO-incompatible pLT negatively correlated with patient survival (HR, 2.628; p = 0.002). Prolonged cold ischemic time (HR: 2.912, p = 0.005) and donor age >50 years (HR: 1.623, p = 0.042) impaired graft survival. Living donor liver transplantation (LDLT) showed improved patient survival (HR: 0.267, p < 0.001). The impact varied clearly by era and indication, as creatinine and AB0-incompatible pLT showed a significant impact only up to 2006, while higher donor age impaired graft survival in the current era. Cold ischemic time affected graft survival only in recipients with chronic cirrhotic liver disease.</p><p><strong>Conclusions: </strong>Our results strengthen the position of LDLT in pLT in current times of organ shortages. Newly identified donor-specific risk factors as renal impairment alongside confirmed factors, like advanced donor age, prolonged CIT and cerebrovascular disease, help to identify marginal donors. Their impact is clearly dependent on recipient and transplant conditions, which underlines the importance of individually tailored donor profiles.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169836","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":"An interpretable machine learning model for outpatient referral risk assessment in pediatric biliary atresia after Kasai portoenterostomy.","authors":"Yanran Zhang, Xingyuan Ke, Jiaying Liu, Qianhui Yang, Rongjuan Sun, Shengqiao Zhao, Zhixin Zhang, Liang Ge, Wei Gao, Jianghua Zhan","doi":"10.1002/jpn3.70505","DOIUrl":"10.1002/jpn3.70505","url":null,"abstract":"<p><strong>Objectives: </strong>To develop an interpretable model using routine outpatient data to assist risk stratification and referral assessment in children with biliary atresia (BA) after Kasai portoenterostomy (KPE).</p><p><strong>Methods: </strong>This multicenter retrospective study included 512 children with type III BA who underwent KPE across eight pediatric centers. Clinical, laboratory, and ultrasonographic variables collected during outpatient follow-up were analyzed. Feature selection was performed using least absolute shrinkage and selection operator, and eight machine learning algorithms were evaluated. Model performance was assessed using discrimination, calibration, and decision curve analysis. The optimal model was further interpreted using Shapley Additive Explanations analysis and implemented as an online calculator.</p><p><strong>Results: </strong>Ten variables were selected for model development. Among the evaluated algorithms, the K-nearest neighbors model showed the best overall performance in the test set (area under the receiver operating characteristic curve 0.954) with good calibration and clinical utility. Key contributors included albumin, cholestasis index, the variceal prediction rule, and total bile acids.</p><p><strong>Conclusions: </strong>This model provides an accessible tool for outpatient assessment after KPE and may assist clinicians in identifying high-risk patients and improving risk stratification during follow-up.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"591-599"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430267","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":"Response to invited commentary: Should Europe have a European infant feeding policy?","authors":"Julie Lanigan","doi":"10.1002/jpn3.70503","DOIUrl":"10.1002/jpn3.70503","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"580-582"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471464","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 containing transforming growth factor-β improves intestinal barrier function in a colitis mouse model.","authors":"Kawthar Boumessid, Vickie Lacroix, Ekaterina Ovtchinnikova, Sophie Thenet, Marie Carriere, Frédérick Barreau, Emmanuel Mas","doi":"10.1002/jpn3.70517","DOIUrl":"10.1002/jpn3.70517","url":null,"abstract":"<p><strong>Objectives: </strong>Exclusive enteral nutrition (EEN) is the first-line treatment for pediatric Crohn's disease, but its mechanisms of action remain poorly understood. Our aim was to identify the mechanisms that could explain the anti-inflammatory effects of EEN, studying the nutritional composition and transforming growth factor-β (TGF-β) effects, in a mouse model of colitis.</p><p><strong>Methods: </strong>Mice were treated with dextran sulfate sodium (DSS) to induce colitis. After DSS treatment, we compared two enteral nutrition formulas, and we evaluated the effect of TGF-β itself on clinical and microscopic inflammation, and intestinal permeability, by TGF-β-supplementation, -inhibition, or -deletion. Colonic crypts from DSS and EEN mice were cultured and their cellular properties were analyzed.</p><p><strong>Results: </strong>Both EEN formulas improved weight recovery and disease activity index. In contrast, EEN mice treated with TGF-β formula presented faster weight recovery and decreased inflammatory parameters, with a normalized intestinal permeability, suggesting gut restitution and functionality. These functional improvements were not found in the absence of TGF-β in the formulas. Finally, organoids from colonic crypts treated with Modulen IBD® containing TGF-β showed enhanced survival and re-epithelialization capacity.</p><p><strong>Conclusions: </strong>Both EEN formulas have anti-inflammatory properties based on their nutritional composition. However, TGF-β plays a significant role in intestinal functional restitution.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"692-702"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536275","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}