Journal of Pediatric Gastroenterology and Nutrition最新文献

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Esophagitis, treatment outcomes, and long-term follow-up in children with esophageal atresia. 食管闭锁儿童的食管炎、治疗效果和长期随访。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-16 DOI: 10.1002/jpn3.12386
Anam Bashir, Amornluck Krasaelap, Dave R Lal, David M Gourlay, Amy Y Pan, Namratha Jan, Siri McCord, Diana G Lerner
{"title":"Esophagitis, treatment outcomes, and long-term follow-up in children with esophageal atresia.","authors":"Anam Bashir, Amornluck Krasaelap, Dave R Lal, David M Gourlay, Amy Y Pan, Namratha Jan, Siri McCord, Diana G Lerner","doi":"10.1002/jpn3.12386","DOIUrl":"https://doi.org/10.1002/jpn3.12386","url":null,"abstract":"<p><strong>Objectives: </strong>Survival rates in children born with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) have improved; however, morbidity associated with the disease remains high. This study aimed to assess the prevalence of gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), fungal esophagitis, esophageal strictures, and long-term outcomes in children with EA/TEF.</p><p><strong>Methods: </strong>We conducted a retrospective chart review on patients with EA/TEF who were seen at Children's Wisconsin from January 2003 to January 2023. Patients born with EA/TEF were included if they underwent at least one endoscopy after 1 year of age. GERD was diagnosed based on abnormal findings on endoscopy, pH-metry, and/or history of fundoplication. EoE and fungal esophagitis were diagnosed based on abnormal endoscopy. Esophageal stricture diagnosis was based on findings on endoscopy and/or esophagram, and clinical symptoms necessitating esophageal dilation.</p><p><strong>Results: </strong>Eighty-five patients (64.7% males, mean age 7.5 years) were included, the majority had type C EA/TEF (90.6%). GERD was diagnosed in 61.1% (n = 52), 49.4% (n = 42) by macro and/or microscopic endoscopic findings, 22.3% (n = 19) by abnormal pH-metry, and 21.1% (n = 18) by the need for fundoplication for refractory reflux and/or esophageal stricture. Risk of GERD increased with lower gestational age (p = 0.0030), lower birth weight (p = 0.023), and long-gap EA (p = 0.034). In children diagnosed with GERD, only 13.4% of patients (n = 7/52) were able to be weaned off proton pump inhibitor (PPI) without disease recurrence. However, overall, at the completion of the study, 44.7% (n = 38) of patients were successfully weaned off PPI without evidence of GERD. EoE was diagnosed in 20% of the patients (n = 17). All patients diagnosed with EoE required escalation of therapy from PPI alone to swallowed corticosteroids in 52.9% (n = 9), dupilumab in 23.5% (n = 4), elemental formula in 17.6% (n = 3), and elemental formula and swallowed steroids in 5.8% (n = 1). Fungal esophagitis was diagnosed in 15.3% of patients (n = 13). An esophageal stricture requiring dilation was diagnosed in 77.6% (n = 66) of patients at a mean age of 28.5 months, with over 60% diagnosed by 24 months of age.</p><p><strong>Conclusions: </strong>Children born with EA/TEF continue to be at high risk of developing GERD, EoE, fungal esophagitis, and esophageal stenosis. Diagnostic and therapeutic endoscopy remains a high-yield test to identify and treat these comorbidities.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468246","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}
引用次数: 0
Efficacy of vedolizumab and ustekinumab in pediatric-onset inflammatory bowel disease: A real-world multicenter study. 维多珠单抗和乌司替尼对儿科炎症性肠病的疗效:一项真实世界多中心研究。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-16 DOI: 10.1002/jpn3.12384
Soleynne Rébus, Stéphanie Coopman, Djamal Djeddi, Audrey Vanrenterghem, Claire Dupont, Edouard Lacotte, Delphine Ley
{"title":"Efficacy of vedolizumab and ustekinumab in pediatric-onset inflammatory bowel disease: A real-world multicenter study.","authors":"Soleynne Rébus, Stéphanie Coopman, Djamal Djeddi, Audrey Vanrenterghem, Claire Dupont, Edouard Lacotte, Delphine Ley","doi":"10.1002/jpn3.12384","DOIUrl":"https://doi.org/10.1002/jpn3.12384","url":null,"abstract":"<p><strong>Objectives: </strong>Vedolizumab and ustekinumab are effective in inducing and maintaining corticosteroid-free clinical remission (CFR) in adult patients with inflammatory bowel disease (IBD). This study describes the efficacy and safety of vedolizumab and ustekinumab in pediatric IBD.</p><p><strong>Methods: </strong>All patients ≤18 years of age with Crohn's disease (CD) or ulcerative colitis (UC) treated with vedolizumab or ustekinumab in three centers in Northern France were followed retrospectively. The primary outcome was CFR at Week 14 (W14).</p><p><strong>Results: </strong>Twenty-five patients (9 CD, 16 UC) and 33 patients (28 CD, 5 UC) were started on vedolizumab and ustekinumab respectively between 2016 and 2021. All were previously treated with antitumor necrosis factor (TNF). The median time from diagnosis to treatment initiation was 21.0 (12.0-44.0) and 42.0 (22.0-73.5) months for vedolizumab and ustekinumab respectively. Among vedolizumab-treated patients, 36% were in CFR at W14, including 22% in CD and 44% in UC. At W52, 56% were in CFR, including 33% in CD and 69% in UC. Among ustekinumab-treated patients, 49% were in CFR at W14, including 54% in CD and 20% in UC. At W52, 55% were in CFR, including 57% in CD and 40% in UC. There was a significant increase in median growth velocity between W0 and W52 of +2 SD in vedolizumab-treated patients (p = 0.0002). Four adverse events were reported during vedolizumab treatment, none for ustekinumab-treated patients.</p><p><strong>Conclusions: </strong>Vedolizumab and ustekinumab appear to be effective in inducing and maintaining CFR in pediatric-onset IBD. Randomized controlled trials are needed to confirm these results.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468244","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}
引用次数: 0
Is HLA-DQ typing useful in screening for celiac disease among Arabs with type 1 diabetes? A case-control study. HLA-DQ 分型是否有助于筛查阿拉伯 1 型糖尿病患者中的乳糜泻?一项病例对照研究。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-15 DOI: 10.1002/jpn3.12385
Abdulrahman Al-Hussaini, Abdulhameed Alsaheel, Mussa AlMalki, Riccardo Troncone, Hanan Alharthi, Nezar Eltayeb-Elsheikh, Ghadeer Alshammari, Shawana Zaheer Allah, Ghadeer Aldossari, Norah AlRajhi, Fatimah Abdulkareem, Ahmed Alzahrani, Ola AlNemer, Lulwa AlMazrou, Muhammed Salman Bashir
{"title":"Is HLA-DQ typing useful in screening for celiac disease among Arabs with type 1 diabetes? A case-control study.","authors":"Abdulrahman Al-Hussaini, Abdulhameed Alsaheel, Mussa AlMalki, Riccardo Troncone, Hanan Alharthi, Nezar Eltayeb-Elsheikh, Ghadeer Alshammari, Shawana Zaheer Allah, Ghadeer Aldossari, Norah AlRajhi, Fatimah Abdulkareem, Ahmed Alzahrani, Ola AlNemer, Lulwa AlMazrou, Muhammed Salman Bashir","doi":"10.1002/jpn3.12385","DOIUrl":"https://doi.org/10.1002/jpn3.12385","url":null,"abstract":"<p><strong>Objectives: </strong>The data on the usefulness of DQ-typing in screening for celiac disease (CD) among type 1 diabetic (T1D) patients came from the West. We conducted this study among T1D patients to: (1) determine the frequency of DQ-genotypes, (2) assess the risk associated with human leukocyte antigen (HLA)-DQ genotypes, and (3) identify the cost-effective screening strategy.</p><p><strong>Methods: </strong>HLA-DQ genotyping was performed on 67 T1D patients with CD (cases) (mean age 15 years) and 224 T1D patients without CD (controls) (mean age 18.29 years) (2021-2023). The entry criterion for the control group was duration of T1D ≥5 years and negative annual celiac serology assay.</p><p><strong>Results: </strong>On comparison of the cases versus controls, T1D patients carrying homozygous DQ2.5 genotype (30% vs. 13.8%) or DR3-DQ2.5 haplotype (81.3% vs. 65.7%) showed significantly \"higher risk\" (odds ratio [OR] = 2.64, p = 0.002; OR = 2.3, p = 0.008, respectively) to develop CD. Only 4% do not harbor any of the CD-at risk genotypes (DQ2.5, DQ8, or DQ2.2) and none developed CD. Heterozygous DQ8 was associated with a significantly lower risk of developing CD with OR of 0.123 (1.5% in cases vs. 10.3% in controls, p = 0.022).</p><p><strong>Conclusion: </strong>Only 4% of Saudi patients with T1D carry DQ-genotypes at no risk to develop CD, which supports the European guidelines that recommend celiac serology test as the most cost-effective screening method. We identified the risk gradient associated with DQ-genotypes to develop CD in our population which could help in counseling patients for the risk to develop CD and planning follow-up serology tests.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468247","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}
引用次数: 0
Effectiveness and safety of polyethylene-glycol-4000 versus sodium picosulphate plus magnesium oxide and citric acid for bowel cleansing before colonoscopy in children: A systematic review with meta-analysis. 聚乙二醇-4000 与皮磷酸钠加氧化镁和柠檬酸在儿童结肠镜检查前进行肠道清洁的有效性和安全性对比:系统回顾与荟萃分析。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-13 DOI: 10.1002/jpn3.12388
Silvia Furio, Alessio Lucarini, Maurizio Mennini, Caterina Strisciuglio, Enrico Felici, Alessandro Ferretti, Pasquale Parisi, Francesco D'Angelo, Giovanni Marasco, Giovanni Barbara, Luca Ricciardi, Marisa Piccirillo, Giovanni Di Nardo
{"title":"Effectiveness and safety of polyethylene-glycol-4000 versus sodium picosulphate plus magnesium oxide and citric acid for bowel cleansing before colonoscopy in children: A systematic review with meta-analysis.","authors":"Silvia Furio, Alessio Lucarini, Maurizio Mennini, Caterina Strisciuglio, Enrico Felici, Alessandro Ferretti, Pasquale Parisi, Francesco D'Angelo, Giovanni Marasco, Giovanni Barbara, Luca Ricciardi, Marisa Piccirillo, Giovanni Di Nardo","doi":"10.1002/jpn3.12388","DOIUrl":"https://doi.org/10.1002/jpn3.12388","url":null,"abstract":"<p><p>Colonoscopy is performed for diagnostic and therapeutic purposes. The quality of colonoscopy depends on adequate bowel cleansing. However, there is no standardized protocol for bowel preparation in children. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effectiveness, safety, and tolerability profile of polyethylene glycol (PEG) compared with those of sodium picosulfate (SPMC) in children. The primary sources of the reviewed studies were Scopus, PubMed, and Cochrane Library. The databases were systematically searched for RCTs comparing PEG 4000 to SPMC as a bowel cleansing solution. Six studies were included. The analysis showed that both PEG and SPMC are effective for bowel cleansing, while a split-dose regimen may be preferable to a day-before one. There were no differences between the two groups regarding adverse events such as abdominal pain, nausea, vomiting, bloating, and anal discomfort. Additionally, preparation with SPMC was preferred in terms of acceptability and compliance. Still, the need to place a nasogastric tube was significantly lower in the SPMC group compared to the PEG group and in the split dose regimen compared to the day before. In conclusion, PEG and SPMC are equally effective in obtaining an adequate bowel cleansing with a comparable adverse event rate; moreover, split-dose administration may be preferable to day-before one in terms of effective bowel cleansing. However, SPMC preparation is more acceptable seems to result in higher compliance, and to reduce the use of a nasogastric tube, that we encounter daily in clinical practice, is perceived as a stressful experience for children and their families.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468243","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}
引用次数: 0
Endomysial antibodies or anti-tissue transglutaminase type 2 IgA antibodies as a confirmatory test in children with celiac disease. 内含物抗体或抗组织转谷氨酰胺酶 2 型 IgA 抗体作为乳糜泻患儿的确诊试验。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-13 DOI: 10.1002/jpn3.12383
Amir Ben-Tov, Tomer Achler, Rochelle Fayngor, Raanan Shamir, Lia Supino, Yael Weintraub, Anat Yerushalmy-Feler, Shlomi Cohen
{"title":"Endomysial antibodies or anti-tissue transglutaminase type 2 IgA antibodies as a confirmatory test in children with celiac disease.","authors":"Amir Ben-Tov, Tomer Achler, Rochelle Fayngor, Raanan Shamir, Lia Supino, Yael Weintraub, Anat Yerushalmy-Feler, Shlomi Cohen","doi":"10.1002/jpn3.12383","DOIUrl":"https://doi.org/10.1002/jpn3.12383","url":null,"abstract":"<p><p>The no-biopsy approach to diagnose celiac disease (CD), introduced in the 2012 European Society for Gastroenterology and Hepatology and Nutrition guidelines, requires an anti-endomysial antibody (EMA) confirmatory serology test following a high-positive immunoglobulin A anti-tissue transglutaminase-2 (anti-TG2) antibody ≥10 times the upper limit of normal (ULN). The aim of this retrospective study is to compare EMA positivity and high-positive anti-TG2 in patients who had their confirmatory test within two month of their first high-positive anti-TG2 test. Among 933 patients who had high-positive anti-TG2 serology more than 10 times the ULN in their first sample, all had both high-positive anti-TG2 and positive EMA, most of them with very high EMA titers (99.6%) in their confirmatory test. In conclusion, we suggest that a repeated anti-TG2 test can replace the EMA test as the confirmatory serology test for the confirmation of the diagnosis of CD in the no-biopsy approach.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468245","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}
引用次数: 0
Lateral flow test versus enzyme-linked immunosorbent assay to measure infliximab trough concentrations: A head-to-head comparison. 测量英夫利西单抗谷浓度的侧流试验与酶联免疫吸附试验:正面比较
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-10 DOI: 10.1002/jpn3.12372
Marleen Bouhuys, Margreet M S Wessels, Willemien de Vries, Annechien J A Lambeck, Daan J Touw, Patrick F van Rheenen
{"title":"Lateral flow test versus enzyme-linked immunosorbent assay to measure infliximab trough concentrations: A head-to-head comparison.","authors":"Marleen Bouhuys, Margreet M S Wessels, Willemien de Vries, Annechien J A Lambeck, Daan J Touw, Patrick F van Rheenen","doi":"10.1002/jpn3.12372","DOIUrl":"https://doi.org/10.1002/jpn3.12372","url":null,"abstract":"<p><strong>Objectives: </strong>Infliximab is an antitumour necrosis factor agent used to treat inflammatory bowel disease (IBD). Measurement of infliximab trough concentrations (C-troughs) are used to optimize drug exposure and improve outcomes. Currently, enzyme-linked immunosorbent assays (ELISAs) are used predominantly for this purpose. Novel lateral flow immunoassays provide a rapid result.</p><p><strong>Methods: </strong>We collected 100 paired serum samples of adolescents and young adults with IBD, who were treated with infliximab maintenance infusions. C-troughs were measured with the Quantum Blue® lateral flow test (QB) with ELISA. Results were categorized as low-range (mean C-trough ≤5 µg/mL) or high-range (>5 µg/mL). A Bland-Altman plot was created with limits of clinical acceptability set at ≤2 µg/mL for low-range and ≤40% for high-range C-troughs. A concordance matrix was created to evaluate the C-trough-based clinical scenario (whether or not to escalate infliximab) using a cutoff value of 5 µg/mL.</p><p><strong>Results: </strong>Agreement between QB and ELISA was good (intraclass correlation coefficient: 0.85). In the low-range, 90% (95% confidence interval [CI]: 79-96) of measurements were within the limits of clinical acceptability. In the high-range this was 67% (95% CI: 53-79). QB provided higher results than ELISA. The concordance matrix showed 81% agreement (95% CI: 72-88, κ: 0.62).</p><p><strong>Conclusions: </strong>Lateral flow- and ELISA-based infliximab C-trough measurements were in agreement. The swift establishment of infliximab C-troughs matters for patients experiencing increased disease activity. In the event of a low C-trough, prompt dose escalation can be initiated.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400542","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}
引用次数: 0
Impact of inflammatory bowel diseases on the intimate lives of youths: Creating a brief screening questionnaire. 炎症性肠病对青少年亲密生活的影响:制作简短的筛查问卷。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-07 DOI: 10.1002/jpn3.12379
Alexandre Mancheron, Agnès Dumas, Christine Martinez, Aurélie Bourmaud
{"title":"Impact of inflammatory bowel diseases on the intimate lives of youths: Creating a brief screening questionnaire.","authors":"Alexandre Mancheron, Agnès Dumas, Christine Martinez, Aurélie Bourmaud","doi":"10.1002/jpn3.12379","DOIUrl":"https://doi.org/10.1002/jpn3.12379","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives were to describe the challenges faced by youths with inflammatory bowel disease (IBD) in their intimate lives before the onset of sexual activity and develop a screening tool to detect early difficulties.</p><p><strong>Methods: </strong>We conducted a cross-sectional qualitative study via semi-structured interviews with 15-19-year-olds diagnosed with IBD. To be eligible for inclusion, these adolescents had to respond having not yet started their sexual life. This led to a collaborative development of a detection tool with a multidisciplinary team to evaluate adolescents' intimate life stage and to early screen difficulties.</p><p><strong>Results: </strong>Fifteen subjects were recruited. Among them eight were males, 10 were followed for Crohn's disease while five were followed for ulcerative colitis. The median age was 16 years. Nine out of fifteen teenagers felt unprepared and reluctant for intimate relationship. Teenagers who have started their romantic journey, expressed satisfaction with their intimate lives, but the possibility of experiencing diarrhea or abdominal pain during intimate moments may be a concern.</p><p><strong>Conclusion: </strong>The study highlights a general reluctance among adolescents with IBD to engage in intimate relationships, and IBD symptoms may be a concern for intimate life. It resulted in the creation of a brief detection tool allowing clinicians to early screen and address intimate life issues, fostering better support for this vulnerable group's challenges.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381136","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}
引用次数: 0
Tissue transglutaminase immunoglobulin A exceeds endomysial antibody in specificity of celiac diagnosis at ≥10 times the upper limit of normal. 组织转谷氨酰胺酶免疫球蛋白 A 对乳糜泻诊断的特异性超过内膜抗体,是正常值上限的≥10 倍。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-03 DOI: 10.1002/jpn3.12382
Maria Cristina Pacheco, Susan L Fink, Dale Lee, Jane Dickerson
{"title":"Tissue transglutaminase immunoglobulin A exceeds endomysial antibody in specificity of celiac diagnosis at ≥10 times the upper limit of normal.","authors":"Maria Cristina Pacheco, Susan L Fink, Dale Lee, Jane Dickerson","doi":"10.1002/jpn3.12382","DOIUrl":"https://doi.org/10.1002/jpn3.12382","url":null,"abstract":"<p><strong>Objective: </strong>Serologic diagnosis using tissue transglutaminase immunoglobulin A (TTG-IgA) and endomysial antibody (EMA) is being integrated into the care of pediatric patients with positive screening for celiac disease. The purpose of this study was to assess the utility of EMA in pediatric patients being considered for serologic diagnosis.</p><p><strong>Methods: </strong>Patients with TTG-IgA testing performed between May 1, 2022 and April 30, 2023 and with subsequent duodenal biopsy within 6 months were included. TTG-IgA serum samples were frozen and sent for EMA testing and titer. EMA was evaluated for positivity and TTG-IgA (normal <15 u/mL) for elevation <10 times (10x) the upper limit of normal (ULN) and ≥10x ULN (≥150 u/mL). Sensitivity and specificity of EMA and TTG-IgA were calculated using biopsy histology as the gold standard.</p><p><strong>Results: </strong>Four hundred and eighty-six patients were included. The sensitivity and specificity of TTG-IgA ≥15 u/mL was 87.5% and 95.4% while EMA was 77.5% and 97.3%. For patients with TTG-IgA ≥10x ULN the specificity was 99.3%. The positive predictive value of TTG-IgA at ≥10x ULN was 91.4% and for EMA was 83.6%. All three patients with false positive TTG-IgA ≥10x ULN also had false positive EMA, and two of these patients had type 1 diabetes mellitus.</p><p><strong>Conclusions: </strong>TTG-IgA has greater sensitivity at the screening threshold of ≥15 u/mL and greater specificity and positive predictive value at ≥10x ULN than EMA. TTG-IgA at ≥10x ULN is superior to EMA for the serologic diagnosis of celiac disease.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365594","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}
引用次数: 0
Clinical presentation and factors associated with gluten exposure in children with celiac disease. 乳糜泻患儿的临床表现以及与麸质暴露相关的因素。
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1002/jpn3.12321
Andrew Krueger, Lisa Fahey, Qin Sun, Stephanie Regis, Nasim Khavari, Hilary Jericho, Vahe Badalyan, Imad Absah, Ritu Verma, Maureen M Leonard, Vanessa Weisbrod, Temara Hajjat, Dale Lee, Mary Shull, Jocelyn A Silvester, Daniel Mallon
{"title":"Clinical presentation and factors associated with gluten exposure in children with celiac disease.","authors":"Andrew Krueger, Lisa Fahey, Qin Sun, Stephanie Regis, Nasim Khavari, Hilary Jericho, Vahe Badalyan, Imad Absah, Ritu Verma, Maureen M Leonard, Vanessa Weisbrod, Temara Hajjat, Dale Lee, Mary Shull, Jocelyn A Silvester, Daniel Mallon","doi":"10.1002/jpn3.12321","DOIUrl":"10.1002/jpn3.12321","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of celiac disease (CeD) is increasing, yet it is still underdiagnosed, in part because of its heterogeneous presentation. Diagnostic criteria are evolving and management with strict adherence to a gluten-free diet is challenging for many. We aimed to characterize the clinical presentation of CeD among a large multicenter cohort of pediatric patients and to identify factors associated with gluten-free diet adherence.</p><p><strong>Methods: </strong>Patients with CeD aged 0-18 years were recruited from 11 United States health centers. Parents completed surveys about gluten-free diet adherence and patient electronic health records were reviewed. Logistic regression analyses were performed to identify risk factors associated with gluten exposure.</p><p><strong>Results: </strong>Charts were reviewed for 460 children with a median age of 6.4 years. Abdominal pain was reported in 57% of the cohort, but diverse symptoms were identified. Parent surveys were completed for 455 participants. Sixty-five (14%) participants were at high risk for gluten exposure based on parental reports of weekly or daily gluten exposure or eating gluten by choice in the past year. Participants under the age of 5 years had a lower risk of gluten exposure, while participants without repeat serology testing 18 months after initial diagnosis were at higher risk of gluten exposure.</p><p><strong>Conclusions: </strong>In a large, multicenter cohort of pediatric CeD patients, clinical presentation is highly variable, necessitating a high index of suspicion to make a diagnosis. Parent surveys indicate that 14% of patients are at high risk of gluten exposure, with patient age and lack of close follow-up associated with gluten-free diet adherence.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"895-904"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988193","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}
引用次数: 0
Lymphocytic esophagitis causing esophageal stenosis in children: Part of a disease spectrum or a new disease? 淋巴细胞性食管炎导致儿童食管狭窄:疾病谱的一部分还是一种新疾病?
IF 2.4 3区 医学
Journal of Pediatric Gastroenterology and Nutrition Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI: 10.1002/jpn3.12353
Joana Filipe Ribeiro, Margarida Vicente-Ferreira, Joana Lage, Isabel Pinto Pais, Céu Espinheira, Joanne Lopes, Fátima Carneiro, Eunice Trindade
{"title":"Lymphocytic esophagitis causing esophageal stenosis in children: Part of a disease spectrum or a new disease?","authors":"Joana Filipe Ribeiro, Margarida Vicente-Ferreira, Joana Lage, Isabel Pinto Pais, Céu Espinheira, Joanne Lopes, Fátima Carneiro, Eunice Trindade","doi":"10.1002/jpn3.12353","DOIUrl":"10.1002/jpn3.12353","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"924-925"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004407","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}
引用次数: 0
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