Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Current practices and unmet needs in the management of Clostridioides difficile infection in pediatric inflammatory bowel disease: A national survey.","authors":"Anastasiia Romanchuk, Matteo Bramuzzo, Flavio Labriola, Marina Aloi, Claudia Banzato, Luca Bosa, Antonio Colucci, Mara Corpino, Rita Сozzali, Giulia D'Arcangelo, Vanessa Nadia Dargenio, Elvira Difrancisca, Giovanni Di Nardo, Michele Di Toma, Simona Gatti, Laura Gianolio, Francesco Graziano, Maria Teresa Illiceto, Silvia Iuliano, Martina Mainetti, Antonio Marseglia, Massimo Martinelli, Matteo Motta, Francesca Musto, Anna Opramolla, Luca Scarallo, Paola Sgaramella, Giovanna Zuin, Lorenzo D'Antiga, Naire Sansotta","doi":"10.1002/jpn3.70575","DOIUrl":"10.1002/jpn3.70575","url":null,"abstract":"<p><strong>Objectives: </strong>Children with inflammatory bowel disease (IBD) are at increased risk for Clostridioides difficile infection (CDI), which is associated with worse clinical outcomes. We aimed to assess current diagnostic and therapeutic practices for CDI among Italian pediatric IBD centers.</p><p><strong>Methods: </strong>A nationwide survey was conducted in 2025 using a structured 28-item questionnaire distributed to all pediatric IBD centers in Italy. Items addressed diagnostic strategies, treatment approaches, recurrence management, and immunosuppressive therapy handling in children with IBD and CDI.</p><p><strong>Results: </strong>Twenty-seven centers responded (response rate, 90%). Diagnostic approaches varied: toxin enzyme immunoassays (EIA) were indicated by 21/27 centers (78%), glutamate dehydrogenase (GDH) testing by 19/27 (70%), and nucleic acid amplification tests (NAAT) by 13/27 (48%). Routine CDI testing at IBD diagnosis was indicated by 12/27 centers (44%), whereas 23/27 (85%) reported testing during IBD flares. For a first non-severe episode, vancomycin and metronidazole were equally identified as preferred first-line options (18/27; 66% each). Oral vancomycin was the preferred treatment for recurrent CDI (26/27; 96%). Third or subsequent recurrences prompted consideration of fidaxomicin (19/27; 70%), fecal microbiota transplantation (6/27; 22%), and bezlotoxumab (2/27; 7%). In fulminant CDI, 7/27 centers (26%) indicated adding fidaxomicin to standard therapy. In acute severe colitis with concomitant CDI at diagnosis, 18/27 centers (67%) described a cautious approach to biologic initiation.</p><p><strong>Conclusions: </strong>This nationwide survey highlights substantial unmet needs in CDI management in pediatric IBD, including variability in diagnostic strategies, lack of consensus on first-line therapy, and uncertainty regarding immunosuppressive management, supporting the need for evidence-based pediatric-specific guidelines.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990374","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 Vibration-controlled transient elastography in pediatric metabolic dysfunction-associated steatotic liver disease: Considerations for risk stratification and clinical use.","authors":"Lauren B Nichols, Sebastian G J Oakes, Cynthia Behling, Jean P Molleston, Marialena Mouzaki, Claude B Sirlin, Stavra A Xanthakos, Jeffrey B Schwimmer","doi":"10.1002/jpn3.70584","DOIUrl":"https://doi.org/10.1002/jpn3.70584","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977125","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":"Vibration-controlled transient elastography in pediatric metabolic dysfunction-associated steatotic liver disease: Considerations for risk stratification and clinical use.","authors":"Mohit Kehar, Charina Ramirez, Jennifer A Panganiban","doi":"10.1002/jpn3.70585","DOIUrl":"https://doi.org/10.1002/jpn3.70585","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977052","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":"Gastric electrical stimulation for children with refractory nausea and vomiting: A sham-controlled trial.","authors":"Kathryn Hawa, Eduardo Castillo-Leon, Raul E Sanchez, Amina P Usman, Karen Diefenbach, Ashley M Kroon Van Diest, Neetu Bali Puri, Karla Vaz, Desale Yacob, Carlo Di Lorenzo, Peter L Lu","doi":"10.1002/jpn3.70583","DOIUrl":"10.1002/jpn3.70583","url":null,"abstract":"<p><strong>Objectives: </strong>Gastric electrical stimulation (GES) improves symptoms in children with refractory nausea and vomiting, but pediatric evidence is limited to observational studies. We conducted the first controlled trial of GES in children.</p><p><strong>Methods: </strong>We performed a single-blind, sham-controlled trial of temporary GES in children using a nasogastric lead. After endoscopic lead placement on study day 1, the stimulator was OFF for 4 days and then ON for 4 days. Participants were blinded to stimulation status. Symptom Monitor Worksheet (SMW) scores and nutrient drink test volumes were collected at baseline (day 1), end of the OFF phase (study day 5), and end of the ON phase (study day 9).</p><p><strong>Results: </strong>Thirty children (83% female, median age 16 years) were included. All carried a clinical diagnosis of gastroparesis, although only 53% had delayed gastric emptying on scintigraphy; 40% also had functional dyspepsia. Average SMW scores improved from baseline during the OFF phase (β = -0.59, p < 0.001) and improved further when the stimulator was ON (β = -0.42, p = 0.005). Both symptom frequency and severity improved over time. Exploratory analyses showed reductions in postprandial fullness, nausea, and vomiting scores during active stimulation. Maximum tolerated volume during the nutrient drink test increased significantly only when the stimulator was ON (β = 38.9 mL, p = 0.01). After the trial, 25 of 30 participants (83%) proceeded with permanent GES implantation.</p><p><strong>Conclusions: </strong>In this sham-controlled trial, children with refractory nausea and vomiting demonstrated significant symptom improvement. When the stimulator was ON, nausea showed a numerically greater reduction, vomiting continued to improve and nutrient intake increased significantly.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT07474415 (https://clinicaltrials.gov/study/NCT07474415).</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969478","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":"Impact of early enteral nutrition on children with acute pancreatitis: A systematic review and meta analysis.","authors":"Lufang Rao, Weiwei Zhou, Beili Zhong, Yingying Jiang, Yan Ying","doi":"10.1002/jpn3.70581","DOIUrl":"10.1002/jpn3.70581","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the impact of early enteral nutrition (EEN) on children with acute pancreatitis (AP).</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) and quasi-experimental studies investigating the effects of EEN on children with AP were retrieved from databases including China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, Embase, and Web of Science from inception to October 1, 2025. Data analysis was performed using RevMan 5.2 software.</p><p><strong>Results: </strong>Nine trials involving 485 children with AP were included. The analysis revealed that the observation group (EEN) demonstrated significant improvements compared to the control group in the following outcomes: serum albumin (standardized mean difference [SMD] = 1.28, 95% confidence interval [CI] = 0.68-1.88, p < 0.0001), acute physiology and chronic health evaluation II (APACHE-II) score (SMD = -2.58, 95% CI = -4.46 to -0.70, p = 0.007), tumor necrosis factor-α (TNF-α) level (SMD = -2.23, 95% CI = -3.36 to -1.10, p = 0.0001), and incidence of adverse events (odds ratio [OR] = 0.30, 95% CI = 0.17-0.52, p < 0.0001).</p><p><strong>Conclusion: </strong>EEN significantly increases serum albumin levels, reduces APACHE-II scores and TNF-α levels, and decreases the incidence of adverse events in children with AP.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969507","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":"Vitamin D supplementation for pediatric steatotic liver disease: A systematic review and meta-analysis.","authors":"Ehsaneh Taheri, Shirin Esmaeili, Armita Mahdavi-Gorabi, Nima Baziar, Kiavash Semnani, Mostafa Qorbani","doi":"10.1002/jpn3.70539","DOIUrl":"https://doi.org/10.1002/jpn3.70539","url":null,"abstract":"<p><strong>Objectives: </strong>This review aimed to systematically evaluate the evidence from interventional studies for the effects of vitamin D supplementation on hepatic and metabolic parameters in children with metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>MEDLINE, Scopus, Web of Science, and clinical trial registers were systematically searched using MeSH terms until April 30, 2025. Study selection, data extraction, and assessment of risk of bias (ROB 2 and ROBINS-I) were performed independently by two reviewers. Random-effects meta-analysis was used to pool mean differences (MDs) for hepatic and metabolic outcomes. Sensitivity analyses were used to examine the robustness of obtained results.</p><p><strong>Results: </strong>Data from 10 studies were included. Despite the lack of improvement in hepatic fibrosis (MD = -0.03; 95% CI -0.20, 0.13), Non-alcoholic fatty liver disease (NAFLD) activity scores improved (MD = -2.41; 95% confidence interval [CI] -3.59, -1.23). Estimates for reduction in alanine aminotransferase (ALT) for participants with MASLD (MD = -12.16; 95% CI -21.09, -3.2) suggested improvements that may overlap with clinical benefit. Improvements in glucose regulation, lipid profile, and body mass index z-scores were also noted for children with MASLD.</p><p><strong>Conclusions: </strong>Interventional evidence suggests possible hepatic benefits for vitamin D supplementation in deficient MASLD children and adolescents, with or without additional metabolic benefits. Significant inconsistencies regarding the magnitude of effect, and the low quality of evidence precludes recommendations for change in clinical practice beyond a more targeted evaluation of vitamin D status in at-risk populations, and supplementation where otherwise indicated. Future trials examining vitamin D for pediatric MASLD and exploring subgroups further benefiting from the intervention may be warranted.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969419","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":"Absence of progressive liver disease after treatment in children with chronic hepatitis C: A nationwide registry study.","authors":"Hitoshi Tajiri, Mitsuyoshi Suzuki, Yuri Etani, Yoshinori Ito, Koichi Ito, Tomoya Fukuoka, Tatsuki Mizuochi","doi":"10.1002/jpn3.70582","DOIUrl":"https://doi.org/10.1002/jpn3.70582","url":null,"abstract":"<p><strong>Objectives: </strong>In adults with chronic hepatitis C (CHC) and advanced fibrosis, hepatocellular carcinoma (HCC) surveillance is recommended after achieving a sustained virologic response (SVR). However, post-SVR surveillance strategies for children remain unclear. The aim of this study was to assess the durability of SVR and determine an appropriate follow-up duration by evaluating longitudinal changes in liver enzymes, fibrosis markers, and liver-related complications in children with CHC.</p><p><strong>Methods: </strong>Using a nationwide annual Japanese registry, we analyzed children with CHC treated with interferon (IFN)-based therapies or direct-acting antivirals (DAAs). Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, platelet counts, AST-to-platelet ratio index (APRI), and liver-related complications were evaluated.</p><p><strong>Results: </strong>Among the 168 IFN-treated patients assessed 1 year after treatment, 140 (83%) achieved SVR. Although the number of evaluable patients decreased after 5 years of follow-up, all patients who were followed for 5-15 years maintained SVR, and none developed liver cirrhosis or HCC. Compared with pretreatment values, the IFN-SVR group showed significant reductions in serum aminotransferase levels at 1-5 years after treatment. APRI decreased significantly during the first 3 years after SVR and remained stable thereafter. These improvements were consistently observed among IFN-treated patients with mild-to-moderate fibrosis. All 43 evaluable DAA-treated patients achieved SVR and maintained SVR for up to 5 years.</p><p><strong>Conclusions: </strong>Children with CHC who achieve SVR demonstrate long-term viral eradication and favorable liver outcomes. The stabilization of APRI within 3 years after SVR suggests that follow-up for at least 3 years after SVR may be warranted in most children.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969438","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":"Exocrine pancreatic function and highly effective modulators: A dual center retrospective study.","authors":"Raffaele Cerchione, Antonella Tosco, Chiara Cimbalo, Francesca Capasso, Laura Salvadori, Gabriele Simonetti, Cristina Fevola, Daniela Dolce, Alice Castaldo, Vito Terlizzi, Angela Sepe","doi":"10.1002/jpn3.70555","DOIUrl":"10.1002/jpn3.70555","url":null,"abstract":"<p><strong>Objectives: </strong>Highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulators (HEMTs) have significantly improved outcomes in people with cystic fibrosis (CF). Their impact on established pancreatic disease remains uncertain. We aimed to evaluate the effects of HEMTs on exocrine pancreatic function in children with CF.</p><p><strong>Methods: </strong>This retrospective dual-center observational study included children with CF treated with HEMTs for at least 12 months at the CF centers of Naples and Florence, Italy. Patients received elexacaftor/tezacaftor/ivacaftor (ETI) or ivacaftor (IVA). Fecal elastase-1 (FE-1), body mass index (BMI) z-score, sweat chloride, ppFEV1, pancreatic enzyme replacement therapy (PERT) use and history of recurrent acute pancreatitis (RAP) were evaluated at baseline and during follow-up. Patients with EPI were categorized as responders if FE-1 increased by ≥100 μg/g.</p><p><strong>Results: </strong>A total of 136 children (median age 11 years) were included. At baseline, 116/136 (85.3%) had EPI. Median FE-1 increased from 7.5 μg/g (interquartile range [IQR] 7.5-11) at baseline to 11.9 μg/g (IQR 7.5-21) after 12 months (p < 0.01). An increase in FE-1 was observed in 55/116 patients (47.4%), while a clinically relevant increase (≥ 100 μg/g) occurred in 5 patients at 12 months and in 3 additional patients at 24 months. One patient reached repeated FE-1 values in the pancreatic-sufficient range and discontinued PERT under clinical and nutritional monitoring. Significant improvements were observed in BMI z-score, ppFEV1, and sweat chloride (p < 0.01). Among pancreatic-sufficient patients, none with prior RAP experienced recurrence during follow-up.</p><p><strong>Conclusions: </strong>Clinically meaningful FE-1 improvement in established EPI appears limited, although a subset of younger patients may show meaningful improvement. HEMTs may also reduce pancreatitis recurrence in pancreatic-sufficient individuals.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920092","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":"Efficacy and safety of intrapyloric botulinum toxin injection in pediatrics: Current evidence and future directions.","authors":"Lorenzo Chidiac, Binghong Xu, Sharon Wolfson, Alain J Benitez, Haley Pearlstein, Prasanna Kapavarapu, David Piccoli, Hayat Mousa","doi":"10.1002/jpn3.70571","DOIUrl":"https://doi.org/10.1002/jpn3.70571","url":null,"abstract":"<p><p>Pediatric gastroparesis is a debilitating disease requiring more diverse and effective treatment options. Intrapyloric botulinum toxin (IPBT) injection has emerged as a therapeutic option, although evidence supporting its use in children remains limited. The aim of this review is to summarize the current literature on IPBT injection for pediatric gastroparesis, focusing on symptomatic outcomes and potential predictors of response. Overall, most studies report some degree of symptomatic improvement following the injection; however, these findings are derived from small, retrospective cohorts without control groups. Objective predictors of response evaluated include gastric emptying scintigraphy, which did not show correlation with treatment response. Similarly, antroduodenal manometry general impressions and endoscopic functional luminal probe parameters did not reliably predict symptomatic response to the injection. Several studies describe repeated injections, although protocols for repeat are unclear, and the response is varied. Body surface gastric mapping represents a novel modality that may provide gastric physiological data allowing its use as a biomarker guiding IPBT injection, although pediatric data is still limited. Other emerging modalities, including gastric emptying breath test and gastric magnetic resonance imaging, may further enhance assessment of gastroparesis and treatment response. The current pediatric evidence on IPBT injection for gastroparesis is limited by suboptimal study designs and lack of objective assessments of treatment response. Future prospective, controlled studies are needed to strengthen conclusions on IPBT injection efficacy for pediatric gastroparesis and to clarify its role in clinical practice.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912657","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":"Hair loss in pediatric inflammatory bowel disease: Clinical recognition and implications for care.","authors":"Angela Anaeme, Liza Siegel, Meryl Perlman","doi":"10.1002/jpn3.70568","DOIUrl":"https://doi.org/10.1002/jpn3.70568","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912639","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}