JPGN reportsPub Date : 2024-05-22DOI: 10.1002/jpr3.12084
Lacey Miller, Hyung‐Gyo Cho, Charlotte Banayan, Vivian Vega Lemus, Shagun Sharma, Thomas Wallach
{"title":"Achalasia in Klinefelter syndrome: A suspected pediatric case as well as prevalence analysis suggesting increased risk in this population","authors":"Lacey Miller, Hyung‐Gyo Cho, Charlotte Banayan, Vivian Vega Lemus, Shagun Sharma, Thomas Wallach","doi":"10.1002/jpr3.12084","DOIUrl":"https://doi.org/10.1002/jpr3.12084","url":null,"abstract":"A 4‐year‐old male with Klinefelter syndrome (KS), speech delay, and intermittent history of coughing and choking during meals was referred for evaluation. Prior evaluation with computed tomography showed a dilated esophagus at the gastroesophageal junction. The patient was unable to tolerate a barium swallow. Upper endoscopy was performed, and an intraoperative esophagogram, demonstrated a “birds beak” appearance suggestive of achalasia. There is no documented relationship between achalasia and KS. However, we utilized TriNetX (a large‐scale data clearinghouse) to demonstrate a higher prevalence of achalasia in patients with KS as compared to the general population.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"48 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141111370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-05-20DOI: 10.1002/jpr3.12081
R. Lalitha, Matthew Hicks, Mosarrat Qureshi, Kumar Kumaran
{"title":"Umbilical arterial catheter duration as risk factor for Bell's Stage III necrotizing enterocolitis in preterm neonates","authors":"R. Lalitha, Matthew Hicks, Mosarrat Qureshi, Kumar Kumaran","doi":"10.1002/jpr3.12081","DOIUrl":"https://doi.org/10.1002/jpr3.12081","url":null,"abstract":"To explore risk factors for Stage‐III necrotizing enterocolitis (NEC‐III) in preterm neonates.This was a retrospective case‐control study of neonates born <33 weeks gestational age (GA) who were admitted to a tertiary neonatal intensive care unit, between 2015 and 2018. NEC‐III cases were compared with Stage‐II NEC (NEC‐II) and non‐NEC controls. Two to four non‐NEC controls were matched by GA ± 1 week and date of birth ± 3 months, to one NEC‐III case. Univariate and multivariate analyses were used to examine risk factors for NEC‐III.Of 1360 neonates born <33 weeks, 71 (5.2%) had NEC‐II and above, with 46% being NEC‐III. Mean age of onset of NEC‐III was 13.7 days versus 23.9 days for NEC‐II (p = 0.01). Neonates with NEC‐III were of lower GA (NEC‐III 25.4 weeks, NEC‐II 27.3 weeks, and non‐NEC 26 weeks; p = 0.0008) and had higher Score for Neonatal Acute Physiology Perinatal Extension‐II scores (NEC‐III 47.5, NEC‐II 28.4 and non‐NEC 37, p = 0.003). Multivariate analysis showed duration of umbilical arterial catheter (UAC) >5 days was significantly associated with the development of NEC‐III with adjusted odds ratio (AOR) 3.8; 95% confidence interval (CI) (1.05–13.66) for NEC‐III versus non‐NEC and AOR 5.57; 95% CI (1.65–18.73), p = 0.006 for NEC‐III versus NEC‐II. Rupture of membranes (ROM) >1 week was associated with NEC‐III (AOR 6.93; 95% CI [1.56–30.69] vs. non‐NEC and AOR 11.74; 95% CI [1.14–120.34] vs. NEC‐II).The increased association of NEC‐III with duration of UAC and ROM could be further examined in prospective studies, and an upper limit for UAC duration could be considered in NEC prevention bundles.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"74 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141121272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-04-29eCollection Date: 2024-08-01DOI: 10.1002/jpr3.12076
Brandon J Calley, Alexandra Polovneff, Kathryn Henry, Paula North, David C Moe, Cara L Mack
{"title":"Autoimmune hepatitis presenting as severe anemia.","authors":"Brandon J Calley, Alexandra Polovneff, Kathryn Henry, Paula North, David C Moe, Cara L Mack","doi":"10.1002/jpr3.12076","DOIUrl":"10.1002/jpr3.12076","url":null,"abstract":"<p><p>Autoimmune hepatitis (AIH) is relatively rare in children. Herein, our case demonstrates a unique presentation of AIH in a previously healthy 18-year-old female presenting with a mild cough, fatigue, and severe anemia (hemoglobin 2.9 g/dL). Initial evaluation revealed jaundice and scleral icterus, prompting transfer of care and further testing, which demonstrated severe microcytic anemia, pancytopenia, elevated liver enzymes, direct hyperbilirubinemia, and marked splenomegaly. Concern for autoimmune hemolytic anemia resulted in a delayed diagnosis. The combination of triple antibody positivity (anti-nuclear antibodies, anti-actin, and anti-liver-kidney microsomal-1) and liver histology findings confirmed the diagnosis of AIH. Intravenous methylprednisolone was initiated to induce remission. Due to pancytopenia and persistently elevated international normalized ratio, tacrolimus was chosen as the maintenance immunosuppression instead of azathioprine. This case highlights several significant considerations for clinicians, including the importance of a timely clinicopathologic diagnosis, the severe anemia presentation secondary to hypersplenism, and the rare finding of triple autoantibody-positive AIH.</p>","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"5 3","pages":"402-406"},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11322014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-04-04eCollection Date: 2024-08-01DOI: 10.1002/jpr3.12068
Ulrika Liliemark, Afrodite Psaros Einberg, Jan F Svensson, Björn Fischler
{"title":"Considerable differences in management of cytomegalovirus infection in patients with biliary atresia.","authors":"Ulrika Liliemark, Afrodite Psaros Einberg, Jan F Svensson, Björn Fischler","doi":"10.1002/jpr3.12068","DOIUrl":"10.1002/jpr3.12068","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with biliary atresia (BA) and ongoing cytomegalovirus (CMV) infection may have poorer outcomes after Kasai portoenterostomy than uninfected patients. Still, there is no consensus on the usefulness of viral testing and antiviral treatment (AVT). This study aims to explore the need for future research on AVT for CMV infection by assessing how CMV infection in BA patients is managed in different centers.</p><p><strong>Methods: </strong>An online questionnaire with 10 questions was offered to participants at an international congress on BA, organized in collaboration with the European Reference Network for rare liver diseases in 2022. Answers to questions were either dichotomic or multiple choices of different numeric intervals. Ongoing CMV infection was defined by detecting cytomegalovirus-immunoglobulin M (CMV-IgM) in serum or cytomegalovirus-deoxyribonucleic acid (CMV-DNA) by polymerase chain reaction in blood or urine.</p><p><strong>Results: </strong>There were 43 respondents from 36 centers in 26 countries. The total number of BA patients per year was between 208 and 380 from centers with 0-5 to >20 BA patients yearly (median 6-10). CMV infection was tested in 27 centers (75%), of which 18 (67%) use AVT. The rate of CMV infection varied between 0%-5% and 40%-50% (median 5%-10%). Willingness to treat the infection did not differ between centers with low and high rates of CMV infection.</p><p><strong>Conclusions: </strong>Most centers test for CMV infection, and a considerable proportion use AVT despite the lack of evidence of its benefits. A future randomized study on treating CMV infection in BA patients is necessary and feasible.</p>","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"5 3","pages":"303-308"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11322013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-03-26DOI: 10.1002/jpr3.12059
Dalal Ben Sabbahia, Meriem Atrassi, Halima Msaaf, Imane Chahid, A. Khoaja, Nissrine Bennani, Mehdi Karkouri, Abdelhak Abkari
{"title":"Visceral leishmaniasis as a rare cause of granulomatous hepatitis","authors":"Dalal Ben Sabbahia, Meriem Atrassi, Halima Msaaf, Imane Chahid, A. Khoaja, Nissrine Bennani, Mehdi Karkouri, Abdelhak Abkari","doi":"10.1002/jpr3.12059","DOIUrl":"https://doi.org/10.1002/jpr3.12059","url":null,"abstract":"Visceral leishmaniasis (VL) is a potentially fatal infection caused by species of Leishmania. It is characterized by fever, weight loss, anemia, and enlargement of the spleen and liver. Hepatitis due to VL is one of the causes of granulomatous hepatitis rarely described in the literature. It poses a problem of differential diagnosis with other causes, notably infectious and autoimmune. Hence the need for a global clinical, biological, and histological evaluation to orientate this entity, especially in endemic countries like ours. In the present case study, a 2‐year 8‐month‐old boy was diagnosed with VL and treated with meglumine antimoniate; the evolution was marked after 2 months by the persistence of a large liver; laboratory results showed elevated liver functions and anemia. A liver biopsy was performed, and the histological findings confirmed the diagnosis of granulomatous hepatitis.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"80 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-02-28DOI: 10.1002/jpr3.12050
C. Mandato, Angelo Colucci, Pietro Vajro
{"title":"Letter to the editor in response to distinguishing autoimmune hepatitis from steatohepatitis in adolescents with obesity and positive screening alanine aminotransferase, appearing in JPGN rep 2023 feb 28;4(2):E292","authors":"C. Mandato, Angelo Colucci, Pietro Vajro","doi":"10.1002/jpr3.12050","DOIUrl":"https://doi.org/10.1002/jpr3.12050","url":null,"abstract":"","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"20 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140419911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-02-26DOI: 10.1002/jpr3.12054
Athreya Steiger, Nathan T. VanderVeen, Esther H. Kang, Amy K. Weimer
{"title":"Resolution of metabolic dysfunction‐associated steatohepatitis with estradiol in a transgender female: A case report","authors":"Athreya Steiger, Nathan T. VanderVeen, Esther H. Kang, Amy K. Weimer","doi":"10.1002/jpr3.12054","DOIUrl":"https://doi.org/10.1002/jpr3.12054","url":null,"abstract":"A 16‐year‐old trans female patient presented to our Gender Health Program for gender‐affirming care. Her intake evaluation revealed signs of hepatocellular injury and fibrosis concerning for metabolic dysfunction‐associated steatohepatitis (MASH) and she was referred to a Pediatric Hepatologist. Subsequent delays in initiating hormone therapy caused a decline in her mental health, and she began experiencing suicidal ideations. Gender‐affirming hormone therapy has been shown to significantly reduce depressive symptoms and suicidal ideations in transgender and gender diverse youth, and studies in animal models suggest improvement in hepatic steatosis in response to estrogen. A multidisciplinary meeting with Gender Health, Psychiatry, and Hepatology appropriately weighed the benefits of life‐saving hormone therapy and the possibility of an improvement in her comorbid liver condition with the risk of further liver damage from estrogen therapy. The teams and the patient agreed to start estradiol with subsequent resolution of laboratory and radiographic evidence of MASH.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"33 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-02-26DOI: 10.1002/jpr3.12026
Amber Hildreth, J. Schwimmer
{"title":"Letter to the editor in response to: A case of pediatric alcohol‐associated hepatitis evaluated for liver transplant listing","authors":"Amber Hildreth, J. Schwimmer","doi":"10.1002/jpr3.12026","DOIUrl":"https://doi.org/10.1002/jpr3.12026","url":null,"abstract":"","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"4 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140430635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-02-26DOI: 10.1002/jpr3.12058
Ryan Morrow, Marisa G. Stahl, Ed Liu, Mary Shull, Monique M. Germone, Sadie Nagle, Isabel Griffith, Pooja Mehta
{"title":"Food insecurity screening practices in a pediatric gastroenterology population","authors":"Ryan Morrow, Marisa G. Stahl, Ed Liu, Mary Shull, Monique M. Germone, Sadie Nagle, Isabel Griffith, Pooja Mehta","doi":"10.1002/jpr3.12058","DOIUrl":"https://doi.org/10.1002/jpr3.12058","url":null,"abstract":"Food insecurity is a rising concern for US households and leads to adverse child health outcomes. Pediatric gastroenterology providers are uniquely equipped to help guide families experiencing this challenge given their specialized training in nutritional support and dietary therapy for disease management. Hence, this study aimed to evaluate food insecurity screening practices from the perspectives of patient caregivers and healthcare providers in a tertiary pediatric gastroenterology practice. A survey was administered to 1279 caregivers and 121 providers. Of the 248 completed caregiver responses, 10%−15% reported being asked about food insecurity. Among the 36 healthcare provider responses, 53% expressed comfort in conducting food insecurity screening but only 14% routinely screened. The most cited barrier to screening was the lack of readily available patient resources. Further research is imperative to address these screening barriers and assess the impact of food insecurity screening and interventions on pediatric gastrointestinal health outcomes.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"1 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140430335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPGN reportsPub Date : 2024-02-22DOI: 10.1002/jpr3.12055
Natalie Rodriguez, Soma Kumar, Jun Mo, Phillipp Hartmann
{"title":"Collagenous gastritis with elevated fecal calprotectin in a pediatric patient","authors":"Natalie Rodriguez, Soma Kumar, Jun Mo, Phillipp Hartmann","doi":"10.1002/jpr3.12055","DOIUrl":"https://doi.org/10.1002/jpr3.12055","url":null,"abstract":"Collagenous gastritis is a rare and chronic inflammatory condition of undetermined etiology characterized histologically by thickened subepithelial collagen bands and increased intraepithelial lymphocytes. Here, we present a collagenous gastritis case in a 16‐year‐old female with chronic abdominal pain, persistently elevated fecal calprotectin (507 and 796 mcg/g), and resolved iron deficiency anemia. The patient's history, laboratory tests, endoscopy, and magnetic resonance imaging ruled out common causes of elevated fecal calprotectin, including Helicobacter pylori and gastrointestinal infections, medications, celiac disease, and inflammatory bowel disease, as well as less common causes such as collagenous colitis. Esophagogastroduodenoscopy revealed significant antral nodularity. Gastric biopsies showed thickened subepithelial collagen band and surface epithelium damage with increased intraepithelial lymphocytes. The ileocolonoscopy was normal. This is among the first reported cases of collagenous gastritis with elevated fecal calprotectin levels that could solely be attributed to this condition.","PeriodicalId":501015,"journal":{"name":"JPGN reports","volume":"15 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140442172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}