Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Health-related quality of life determinants in Spanish children with eosinophilic esophagitis.","authors":"Ruth García-Martínez de Bartolomé, Josefa Barrio-Torres, Tomás Sebastián-Viana, Víctor Vila-Miravet, Enrique La Orden-Izquierdo, Sonia Fernández-Fernández, Myriam Herrero-Álvarez, Marta Soria-López, Gonzalo Botija-Arcos, Alejandro Rodríguez-Martínez, Gonzalo Galicia-Poblet, Alejandro García-Díaz, Marta Herreros-Sáenz, Javier Blasco-Alonso, Gloria Rodrigo-García, Natalia Alonso-Pérez, Ana Fernández de Valderrama-Rodríguez, Noel Oppenau-López, Begoña Pérez-Moneo, Sara Feo-Ortega, Raquel Vecino-López, Paloma Donado-Palencia, José Ramón Alberto-Alonso, Margarita Revenga-Parra, Helena Lorenzo-Garrido, Miguel Ángel Carro-Rodríguez, Luis Grande-Herrero, Saioa Vicente-Santamaría, Elena Balmaseda-Serrano, María Carmen Miranda-Cid, Jessica Martín-González, Ruth García-Romero, Diana García-Tirado, Jana Rizo-Pascual, Pedro Alonso-López, Miriam Blanco-Rodríguez, Alicia Rendo-Vázquez, Antonio Millán-Jiménez, Ana Castro-Millán, Eduard Bastida-Ratera, M Luz Cilleruelo-Pascual","doi":"10.1002/jpn3.12426","DOIUrl":"10.1002/jpn3.12426","url":null,"abstract":"<p><strong>Objectives: </strong>To study the health-related quality of life (HRQoL) and its possible determinant factors in Spanish children with eosinophilic esophagitis (EoE) and their parents.</p><p><strong>Methods: </strong>Multicenter observational cross-sectional study. The Spanish version of the Pediatric Quality of Life Eosinophilic Esophagitis Module was filled out by EoE patients aged 8-18 and their parents. Demographic, psychosocial, and clinical variables were studied. Multiple linear regression was performed to identify related factors of HRQoL.</p><p><strong>Results: </strong>A total of 279 children and their parents participated (72.7% males). 39.1% received swallowed corticosteroids, 35.5% proton pump inhibitors and 16.8% diet. 1.1% received other treatments and 7.5% received no treatment. Poor compliance to treatment was observed in 11.5% and 6.5% of patients were referred to mental health. The Total Scale Scores were 72.71 ± 17.50 and 75.62 ± 16.73 for children and parents, respectively. \"Communication\" was the dimension with the highest scores (82.14 ± 21.65 and 81.59 ± 24.13) while \"Food and Eating\" (48.92 ± 32.94 and 62.85 ± 28.78), and \"Food Feelings\" (53.55 ± 29.96 and 53.95 ± 27.78) had the lower scores. Patients and parents under dietary treatment showed lower scores than those under pharmacological treatment, 65.77 ± 16.96 versus 74.28 ± 16.96, p = 0.001 and 68.33 ± 17.32 versus 77.24 ± 15.97, p = 0.001, respectively. Factors associated with worse HRQoL scores were symptom frequency, diet, food allergies, and the need for mental health assistance.</p><p><strong>Conclusions: </strong>The HRQoL of children and their parents was \"good.\" However, diet, frequency of symptoms, food allergies, and the need for mental health care were the factors that had a negative impact on HRQoL of children with EoE.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"308-317"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813627","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":"Current practice in the management of paediatric autoimmune liver disease in Europe.","authors":"Mara Cananzi, Marianne Hørby Jørgensen, Gustav Buescher, Ruth De Bruyne, Marianne Samyn","doi":"10.1002/jpn3.12424","DOIUrl":"10.1002/jpn3.12424","url":null,"abstract":"<p><strong>Objective: </strong>Paediatric autoimmune liver disease (pAILD) is a rare condition with serious health implications. Notwithstanding treatment advancements, areas of uncertainty and knowledge gaps still exist. We here investigated the real-life approach to pAILD management in Europe.</p><p><strong>Methods: </strong>A survey was distributed to members of the European Rare Liver Disease Reference Network (ERN RARE-LIVER) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Hepatology Interest Group. Information was gathered regarding clinical activity, medications used, and access to paediatric drug formulations at each site.</p><p><strong>Results: </strong>Thirty-six centres from 22 European countries responded to the survey. The majority are exclusively paediatric units (86%). Among participants, 80% follow <50 children with pAILD, of which 25%-50% are <10 years old in 44% of centres. All centres use predniso(lo)ne as first-line therapy, alone (15/36) or with azathioprine (21/36). Azathioprine and mycophenolate are the preferred second-line options in centres using first-line steroid monotherapy (11/15) or combined steroid-azathioprine (19/21), respectively. Tacrolimus is used as third-line agent in 15/36 centres. Proactive measurement of drug metabolites and target levels vary widely among centres. Paediatric predniso(lo)ne formulations are commercially available in 7/22 European countries, azathioprine in 3, mycophenolate in 14, tacrolimus in 15 and ursodeoxycholic acid in 14. When paediatric formulations are unavailable, children are treated with magisterial preparations or 'solid' formulations (crushed or intact).</p><p><strong>Conclusions: </strong>Treatment of pAILD in Europe varies widely in terms of medications used and treatment monitoring. Availability of paediatric drug formulations across Europe is limited. Collaborative initiatives are needed to define evidence-based strategies for management of pAILD and to promote an equal, age-appropriate treatment for affected children.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"260-270"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770030","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":"Primary sclerosing cholangitis in children with inflammatory bowel disease: An ESPGHAN position paper from the Hepatology Committee and the IBD Porto group.","authors":"Patrick F van Rheenen, Kaija-Leena Kolho, Richard K Russell, Marina Aloi, Annamaria Deganello, Séamus Hussey, Norman Junge, Jan De Laffolie, Mark R Deneau, Emer Fitzpatrick, Anne M Griffiths, Iva Hojsak, Emanuele Nicastro, Andreia Nita, Mikko Pakarinen, Amanda Ricciuto, Lissy de Ridder, Aurelio Sonzogni, Andrea Tenca, Marianne Samyn, Giuseppe Indolfi","doi":"10.1002/jpn3.12378","DOIUrl":"10.1002/jpn3.12378","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to provide an evidence-supported approach to diagnose, monitor, and treat children with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC).</p><p><strong>Methods: </strong>The core group formulated seven PICO-structured clinical questions. A systematic literature search from inception to December 2022 was conducted by a medical librarian using MEDLINE and EMBASE. Core messages from the literature were phrased as position statements and then circulated to a sounding board composed of international experts in pediatric gastroenterology and hepatology, histopathology, adult gastroenterology and hepatology, radiology, and surgery. Statements reaching at least 80% agreement were considered as final. The other statements were refined and then subjected to a second online vote or rejection.</p><p><strong>Results: </strong>Regular screening for gamma-glutamyltransferase (GGT) is essential for detecting possible biliary disease in children with IBD. MR cholangiopancreatography is the radiological modality of choice for establishing the diagnosis of PSC. Liver biopsy is relevant in the evaluation of small duct PSC or autoimmune hepatitis. Children who do not have known IBD at the time of PSC diagnosis should undergo initial screening with fecal calprotectin for asymptomatic colitis, and then at least once yearly thereafter. Children with a cholestatic liver enzyme profile can be considered for treatment with ursodeoxycholic acid and can continue if there is a meaningful reduction or normalization in GGT. Oral vancomycin may have a beneficial effect on GGT and intestinal inflammation, but judicious use is recommended due to the lack of long-term studies. Children with PSC-IBD combined with convincing features of autoimmune hepatitis may benefit from corticosteroids and antimetabolites.</p><p><strong>Conclusions: </strong>We present state-of-the-art guidance on the diagnostic criteria, follow-up strategies, and therapeutic strategies and point out research gaps in children and adolescents with PSC-IBD.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"374-393"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915248","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":"A decade of real-world clinical experience with 8-week azithromycin-metronidazole combined therapy in paediatric Crohn's disease.","authors":"Maria Teresa Fioretti, Laura Gianolio, Katherine Armstrong, Rosalind M Rabone, Paul Henderson, David C Wilson, Richard K Russell","doi":"10.1002/jpn3.12430","DOIUrl":"10.1002/jpn3.12430","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of our study was to assess the effectiveness and side-effect profile of a combination of azithromycin and metronidazole (CD AZCRO) as alternative induction therapy for 8 weeks in mild to moderately active paediatric Crohn's disease (CD).</p><p><strong>Methods: </strong>We performed a retrospective cohort study (November 2012 to July 2023) of a regional paediatric inflammatory bowel disease service. Disease activity, faecal calprotectin (FC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haematological parameters and albumin were collected at baseline, 8 and 16 weeks. At Week 8, patients were divided based on (paediatric Crohn's disease activity index) score and inflammatory markers (blood and stool) into: Group 1 clinical remission and Group 2 non-remission.</p><p><strong>Results: </strong>A total of 48 patients were initially identified of whom 44 were included in the intention-to-treat analysis. After 8 weeks, the overall remission rate was 64%. Of the 38 patients who completed the CD AZCRO course, 28 patients (74%) entered remission (Group 1) and 10 (26%) did not (Group 2). At baseline a shorter disease duration, low weight z score and higher inflammatory burden (ESR, platelets and FC levels) were observed in Group 2. After 8 weeks, Group 1 showed improved CRP levels and higher albumin and haemoglobin levels than Group 2. Median FC declined significantly from 650 mcg/g at baseline to 190 mcg/g at Week 8 in Group 1 (p < 0.001). At 16 weeks, 23/28 patients (82%) continued in clinical remission. Nausea and vomiting were reported in 4/44 patients.</p><p><strong>Conclusions: </strong>Our real-world data demonstrate that CD AZCRO represents an alternative induction therapy for mild to moderate paediatric CD.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"300-307"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794850","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":"Unveiling distinctive patterns in pediatric PSC-IBD: Time for a tailored histopathologic index?","authors":"Oscar F Lopez-Nunez, Sarangarajan Ranganathan","doi":"10.1002/jpn3.12435","DOIUrl":"10.1002/jpn3.12435","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"257-259"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818459","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":"Evaluation and management of pediatric refractory constipation: Recommendations from the NASPGHAN neurogastroenterology and motility committee.","authors":"Alexandra L Kilgore, Mary K Rogers Boruta, Lusine Ambartsumyan, Roberto Gomez Suarez, Dhiren Patel, Richard J Wood, Anil Darbari, Leonel Rodriguez","doi":"10.1002/jpn3.12390","DOIUrl":"10.1002/jpn3.12390","url":null,"abstract":"<p><p>Refractory constipation (RC) in pediatric patients should be recognized as a distinct condition with long-term impacts on patient and family quality of life. RC requires a more targeted diagnostic evaluation and complex management strategy that may involve management by pediatric neurogastroenterology and motility specialists and multidisciplinary teams including surgeons. Currently, there is a lack of a clear definition, evaluation, and management strategies for RC. This is the first North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper to address pediatric RC regarding its definition, evaluation, and management.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"353-373"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915245","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 management of acute caustic ingestion in pediatrics.","authors":"Elliott S Gordon, Elaine Barfield, Benjamin D Gold","doi":"10.1002/jpn3.12440","DOIUrl":"https://doi.org/10.1002/jpn3.12440","url":null,"abstract":"<p><p>This review is intended to provide an overview of currently available literature related to caustic ingestion in pediatric patients, including initial management considerations in symptomatic versus asymptomatic children, timing and necessity of endoscopic evaluations, and the use of various therapeutic interventions. Further, this review provides management considerations for children presenting for evaluation following caustic ingestion based on the best available evidence. Additional research is needed to develop conclusive pediatric guidelines that meet GRADE criteria for management of caustic ingestion in children.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066325","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":"Ustekinumab is safe and effective in pediatric patients with Crohn's disease.","authors":"Elana B Mitchel, Michael T Dolinger, Brad Constant, Zi Wang, Daniela Guisado, Michael Gao, Steven Fusillo, Robert N Baldassano, Judith Kelsen, Marla Dubinsky, Jing Huang, Lindsey Albenberg","doi":"10.1002/jpn3.12452","DOIUrl":"https://doi.org/10.1002/jpn3.12452","url":null,"abstract":"<p><strong>Objectives: </strong>Real-world data on ustekinumab for the treatment of pediatric Crohn's disease (CD) are limited. This study sought to evaluate the effectiveness, long-term durability, and safety of ustekinumab in the treatment of children with CD.</p><p><strong>Methods: </strong>A retrospective longitudinal cohort study of children with CD treated with ustekinumab from two large centers between 2015 and 2020 was performed. The primary outcome was frequency of steroid-free clinical remission at 1 year. Secondary outcomes included time to steroid-free clinical remission, frequency of clinical and biochemical remission, drug escalation and discontinuation, serum level data, and adverse events. Standard descriptive and comparative statistics were performed. Logistic regression was used to identify factors associated with steroid-free remission at 1 year. Kaplan-Meier curves were used to visualize time-to-event relationships for outcomes.</p><p><strong>Results: </strong>A total of 101 patients were included. Median follow-up time on ustekinumab was 16.6 months (interquartile range [IQR]: 8.71-31.2) with drug failure in 28% at 1 year. Fifty-nine patients were in steroid-free clinical remission at 1 year. Higher baseline disease activity (odds ratio [OR]: 0.91 (95% confidence interval [CI]: 0.84-0.97), p = 0.01) and stricturing/penetrating disease phenotype (OR: 0.14 (95% CI: 0.03-0.65), p = 0.02) were associated with decreased likelihood of steroid-free clinical remission at 1-year. Ustekinumab drug escalation occurred in 70% of patients, and after escalation, 50 (70%) achieved clinical remission, and 49 (69%) achieved steroid-free remission at the last follow-up. Adverse events were rare and did not require therapy discontinuation.</p><p><strong>Conclusions: </strong>Ustekinumab is effective and safe in the treatment of children with CD. Escalation of therapy occurs frequently but results in sustained durability.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066328","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":"Association between dairy product intake and prevalence of dental caries in 3-year-old Japanese children.","authors":"Hisanori Utsunomiya, Keiko Tanaka, Hitomi Okubo, Chisato Nagata, Yoshihiro Miyake","doi":"10.1002/jpn3.12475","DOIUrl":"https://doi.org/10.1002/jpn3.12475","url":null,"abstract":"<p><strong>Objectives: </strong>Epidemiologic evidence on the association between intake of milk and dairy products and dental caries is limited, particularly in Asia. This cross-sectional study examined the association between the consumption of milk and dairy products and dental caries among Japanese children aged 3 years.</p><p><strong>Methods: </strong>The study subjects were 6221 children. Parents or guardians completed a questionnaire, including a self-administered food frequency questionnaire for children. Dentists assessed dental caries, and these data were recorded in each child's maternal and child health handbook. Parents or guardians transcribed these data from the handbook to our questionnaire. Children were classified as having dental caries if they had one or more decayed or filled primary teeth. Associations with dental caries were assessed using logistic regression analysis with adjustments in demographics, dietary and lifestyle factors, and parental socioeconomic status.</p><p><strong>Results: </strong>The prevalence of dental caries was 14.6%. Intakes of milk, cheese, and yogurt were associated with 21%, 26%, and 35% decreases, respectively, in the odds of the prevalence of dental caries (p = 0.02, 0.001, and 0.002, respectively), whereas the intake of other dairy products, such as probiotic milk, ice cream, or custard pudding, was associated with a 2.3-fold increase in the odds of the prevalence of dental caries (p < 0.0001). There was no association between intake of total dairy products and dental caries.</p><p><strong>Conclusions: </strong>Consumption of milk, cheese, or yogurt had a beneficial effect on childhood dental caries, even in Japan where people consume relatively less milk and dairy products.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066323","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":"Low TTG-IgA associated with isolated bulb pathology in pediatric celiac disease: Implications in a no-biopsy approach era.","authors":"Qing Yin Wang, Prévost Jantchou, Martha Dirks, Sébastien B Lavoie, Luc L Oligny, Dorothée Dal Soglio, Natacha Patey","doi":"10.1002/jpn3.12474","DOIUrl":"https://doi.org/10.1002/jpn3.12474","url":null,"abstract":"<p><strong>Objectives: </strong>Duodenal involvement in celiac disease (CD) can be patchy, with a subset of patients demonstrating histopathological involvement limited to the bulb. This study evaluates whether bulb-restricted CD represents a distinct subgroup associated with lower titers of immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) compared to distal duodenal CD in pediatric patients. Additionally, we assess the impact of a no-biopsy approach for pediatric CD with TTG-IgA ≥10 times the upper limit of normal (TTG-IgA ≥10× ULN) on the relative frequency of bulb-restricted CD among biopsied patients.</p><p><strong>Methods: </strong>Incident pediatric CD cases were identified retrospectively between 2017 and 2022. A no-biopsy approach for TTG-IgA ≥10× ULN was locally implemented in 2020. Serum TTG-IgA was categorized as negative, equivocal, positive TTG-IgA <10× ULN, and positive TTG-IgA≥ 10× ULN. Biopsies were classified by Marsh score and site of involvement.</p><p><strong>Results: </strong>Of the 405 cases included (mean age = 9.6 years, female-to-male ratio = 2.1:1), bulb-restricted CD was present in 7.4%. TTG-IgA was negative or equivocal in 60.0% of bulb-restricted CD, compared to 5.3% of distal duodenal CD (odds ratio [OR] = 26.6; 95% confidence interval [CI] = [11.1-63.3], p < 0.001). Notably, no bulb-restricted CD cases attained TTG-IgA ≥10× ULN, compared to 48.5% of distal duodenal CD. Following local implementation of the no-biopsy approach for TTG-IgA ≥10× ULN, the relative percentage of bulb-restricted CD significantly increased from 4.6% to 12.4% (OR = 2.9, 95% CI = [1.4-6.4], p = 0.004).</p><p><strong>Conclusion: </strong>Pediatric CD with isolated bulb pathology presents with lower serum TTG-IgA titers than cases with distal duodenal involvement. Implementation of the no-biopsy approach increased the relative proportion of bulb-limited CD, as these cases were not associated with TTG-IgA ≥10× ULN.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066327","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}