Non-peptic, nonhypertrophic pyloric stenosis has rarely been reported in pediatric literature. Endoscopic pyloric balloon dilation has been shown to be a safe procedure in treating gastric outlet obstruction in older ...Non-peptic, nonhypertrophic pyloric stenosis has rarely been reported in pediatric literature. Endoscopic pyloric balloon dilation has been shown to be a safe procedure in treating gastric outlet obstruction in older children and adults. Partial gastric outlet obstruction (GOO) was diagnosed in an infant by history and confirmed by anupper gastrointestinal series (UGI). Abdominal ultrasonography and computed tomography scan excluded idiopathic hypertrophic pyloric stenosis, abdominal tumors, gastrointestinal and hepato-biliary-pancreatic anomalies. Endoscopic findings showed a pinhole-sized pylorus and did not indicate peptic ulcer disease, Helicobacter pylori infection, antral web, or eviden-ce of allergic and inflammatory bowel diseases. Three sessions of a step-wise endoscopic pyloric balloon dilation were conducted under general anesthesia and a fluoroscopy at two week intervals using catheter balloons (Boston Scientific Microvasive?, MA, USA) of increasing diameters. Repeat UGI after the first session revealed normal gastrointestinal transit and no intestinalobstruction. The patient tolerated solid food without any gastrointestinal symptoms since the first session. The endoscope was able to be passed through the pylorus after the last session. Although the etiology of GOO in this infant is unclear (proposed mechanisms are herein discussed), endoscopic pyloric balloon dilation was a safe procedure for treating this young infant with non-peptic, non-hypertrophic pyloric stenosis and should be considered as an initial approach before pyloroplasty in such presentations.展开更多
Based on systematic review and meta-analysis,the risk for developing cancers in patients with cystic fibrosis(CF)is known to be significantly greater than in the general population,including site-specific cancers of t...Based on systematic review and meta-analysis,the risk for developing cancers in patients with cystic fibrosis(CF)is known to be significantly greater than in the general population,including site-specific cancers of the esophagus,small bowel,colon,liver,biliary tract,and pancreas.An even higher risk has been found in patients who have severe CF transmembrane conductance regulator(CFTR)genotypes or who have undergone organ transplantation and are immunosuppressed.The risk continues to rise as life expectancies steadily climb due to advancements in medical care and treatment for CF.The colorectal cancer risk is at such a high level that CF has now been declared a hereditary colon cancer syndrome by the Cystic Fibrosis Foundation.The CFTR gene has been stronglyassociated with the development of gastrointestinal(GI)cancers and mortality in the CF population.Even CF carriers have shown an increased rate of GI cancers compared to the general population.Several limitations exist with the reported guidelines for screening of GI and hepatopancreatobiliary cancers in the CF population,which are largely universal and are still emerging.There is a need for more precise screening based on specific risk factors,including CFTR mutation,medical co-morbidities(such as gastroesophageal reflux disease,distal intestinal obstruction syndrome,and diabetes mellitus),familial risks for each cancer,gender,age,and other factors.In this review,we propose changes to the guidelines for GI screening of patients with CF.With the development of CFTR modulators,additional studies are necessary to elucidate if there is an effect on cancer risk.展开更多
Rationale:Hepatitis C in the pediatric population is a large health burden globally.With its diverse genotypes as well as genotypic subtypes,there is a discrepancy in the genotypes used in research compared to their p...Rationale:Hepatitis C in the pediatric population is a large health burden globally.With its diverse genotypes as well as genotypic subtypes,there is a discrepancy in the genotypes used in research compared to their prevalence.HCV genotype 6 which is endemic to South China and Southeast Asia comprises approximately one-third of all HCV infections worldwide,but make up a minority of cases studied in HCV research.Patient concerns:We report a case of HCV-6 seen in an 11-yearold Burmese immigrant to the U.S.and describe the new direct acting antiviral treatment guidelines for pediatrics with HCV genotype 6.Interventions:The patient completed a 12-week course of ledipasvir/sofosbuvir(90 mg/400 mg),per FDA weight-based recommendations for treatment-naive HCV genotypes 4-6,without any complications.Outcomes:The patient was treated successfully with an undetectable HCV viral load one month after treatment completion.Lessons:HCV-6,although previously uncommon in the U.S.,is becoming more prevalent.Updated guidelines include the use of direct acting antivirals,which have been proven effective for HCV-6.Lessons on barriers to care in the immigrant population as well as the value of HCV genotyping are also discussed.展开更多
AIM To explore and to analyze the patterns in decisionmaking by pediatric gastroenterologists in managing a child with a suspected diagnosis of functional gallbladder disorder(FGBD).METHODS The questionnaire survey in...AIM To explore and to analyze the patterns in decisionmaking by pediatric gastroenterologists in managing a child with a suspected diagnosis of functional gallbladder disorder(FGBD).METHODS The questionnaire survey included a case history with right upper quadrant pain and was sent to pediatric gastroenterologists worldwide via an internet list server called the PEDGI Bulletin Board.RESULTS Differences in decision-making among respondents in managing this case were observed at each level of investigations and management.Cholecystokinin-scintigraphy scan(CCK-CS) was the most common investigation followed by an endoscopy.A proton pump inhibitor was most commonly prescribed treating the condition.The majority of respondents considered a referral for a surgical evaluation when CCK-CS showed a decreased gallbladder ejection fraction(GBEF) value with biliary-type pain during CCK injection.CONCLUSION CCK infusion rate in CCK-CS-CS and GBEF cut-off limits were inconsistent throughout practices.The criteria for a referral to a surgeon were not uniform from one practitioner to another.A multidisciplinary team approach with pediatric gastroenterologists and surgeons is required guide the decision-making managing a child with suspected FGBD.展开更多
BACKGROUND Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.CASE SUMMARY Here we report a case of a 12-year-old male who was admitted to the pediatric inte...BACKGROUND Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.CASE SUMMARY Here we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress.He was treated conservatively but the symptoms persisted requiring a surgical approach.While there have been several cases of Chilaiditi syndrome reported in adults,there is a scarcity of cases reported in the pediatric population.Our review of the literature found only 30 pediatric cases,including our reported case,with Chilaiditi syndrome,19(63%)of which were male.The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years.In our review,we found that the most common predisposing factors in children are aerophagia(12/30 cases)and constipation(13/30 cases).Ninety percent of the cases presented with complete intestinal interposition,in 100%of which,the colon was involved.Three of the 30 cases were associated with volvulus.CONCLUSION In the pediatric population,conservative(21/30 cases)and surgical(8/30 cases)treatment approaches have produced satisfactory outcomes for all the patients,regardless of approach.展开更多
In October 2022,the European Association for the Study of the Liver(EASL)published in Journal of Hepatology the Clinical Practice Guidelines(CPG)in regard to the diagnosis and management of cystic liver diseases(1).Am...In October 2022,the European Association for the Study of the Liver(EASL)published in Journal of Hepatology the Clinical Practice Guidelines(CPG)in regard to the diagnosis and management of cystic liver diseases(1).American College of Gastroenterology published similar guidelines in 2014 regarding focal liver lesions,but this is the first comprehensive guideline focusing on cystic liver lesions with robust background support and knowledge(2).展开更多
文摘Non-peptic, nonhypertrophic pyloric stenosis has rarely been reported in pediatric literature. Endoscopic pyloric balloon dilation has been shown to be a safe procedure in treating gastric outlet obstruction in older children and adults. Partial gastric outlet obstruction (GOO) was diagnosed in an infant by history and confirmed by anupper gastrointestinal series (UGI). Abdominal ultrasonography and computed tomography scan excluded idiopathic hypertrophic pyloric stenosis, abdominal tumors, gastrointestinal and hepato-biliary-pancreatic anomalies. Endoscopic findings showed a pinhole-sized pylorus and did not indicate peptic ulcer disease, Helicobacter pylori infection, antral web, or eviden-ce of allergic and inflammatory bowel diseases. Three sessions of a step-wise endoscopic pyloric balloon dilation were conducted under general anesthesia and a fluoroscopy at two week intervals using catheter balloons (Boston Scientific Microvasive?, MA, USA) of increasing diameters. Repeat UGI after the first session revealed normal gastrointestinal transit and no intestinalobstruction. The patient tolerated solid food without any gastrointestinal symptoms since the first session. The endoscope was able to be passed through the pylorus after the last session. Although the etiology of GOO in this infant is unclear (proposed mechanisms are herein discussed), endoscopic pyloric balloon dilation was a safe procedure for treating this young infant with non-peptic, non-hypertrophic pyloric stenosis and should be considered as an initial approach before pyloroplasty in such presentations.
文摘Based on systematic review and meta-analysis,the risk for developing cancers in patients with cystic fibrosis(CF)is known to be significantly greater than in the general population,including site-specific cancers of the esophagus,small bowel,colon,liver,biliary tract,and pancreas.An even higher risk has been found in patients who have severe CF transmembrane conductance regulator(CFTR)genotypes or who have undergone organ transplantation and are immunosuppressed.The risk continues to rise as life expectancies steadily climb due to advancements in medical care and treatment for CF.The colorectal cancer risk is at such a high level that CF has now been declared a hereditary colon cancer syndrome by the Cystic Fibrosis Foundation.The CFTR gene has been stronglyassociated with the development of gastrointestinal(GI)cancers and mortality in the CF population.Even CF carriers have shown an increased rate of GI cancers compared to the general population.Several limitations exist with the reported guidelines for screening of GI and hepatopancreatobiliary cancers in the CF population,which are largely universal and are still emerging.There is a need for more precise screening based on specific risk factors,including CFTR mutation,medical co-morbidities(such as gastroesophageal reflux disease,distal intestinal obstruction syndrome,and diabetes mellitus),familial risks for each cancer,gender,age,and other factors.In this review,we propose changes to the guidelines for GI screening of patients with CF.With the development of CFTR modulators,additional studies are necessary to elucidate if there is an effect on cancer risk.
文摘Rationale:Hepatitis C in the pediatric population is a large health burden globally.With its diverse genotypes as well as genotypic subtypes,there is a discrepancy in the genotypes used in research compared to their prevalence.HCV genotype 6 which is endemic to South China and Southeast Asia comprises approximately one-third of all HCV infections worldwide,but make up a minority of cases studied in HCV research.Patient concerns:We report a case of HCV-6 seen in an 11-yearold Burmese immigrant to the U.S.and describe the new direct acting antiviral treatment guidelines for pediatrics with HCV genotype 6.Interventions:The patient completed a 12-week course of ledipasvir/sofosbuvir(90 mg/400 mg),per FDA weight-based recommendations for treatment-naive HCV genotypes 4-6,without any complications.Outcomes:The patient was treated successfully with an undetectable HCV viral load one month after treatment completion.Lessons:HCV-6,although previously uncommon in the U.S.,is becoming more prevalent.Updated guidelines include the use of direct acting antivirals,which have been proven effective for HCV-6.Lessons on barriers to care in the immigrant population as well as the value of HCV genotyping are also discussed.
文摘AIM To explore and to analyze the patterns in decisionmaking by pediatric gastroenterologists in managing a child with a suspected diagnosis of functional gallbladder disorder(FGBD).METHODS The questionnaire survey included a case history with right upper quadrant pain and was sent to pediatric gastroenterologists worldwide via an internet list server called the PEDGI Bulletin Board.RESULTS Differences in decision-making among respondents in managing this case were observed at each level of investigations and management.Cholecystokinin-scintigraphy scan(CCK-CS) was the most common investigation followed by an endoscopy.A proton pump inhibitor was most commonly prescribed treating the condition.The majority of respondents considered a referral for a surgical evaluation when CCK-CS showed a decreased gallbladder ejection fraction(GBEF) value with biliary-type pain during CCK injection.CONCLUSION CCK infusion rate in CCK-CS-CS and GBEF cut-off limits were inconsistent throughout practices.The criteria for a referral to a surgeon were not uniform from one practitioner to another.A multidisciplinary team approach with pediatric gastroenterologists and surgeons is required guide the decision-making managing a child with suspected FGBD.
文摘BACKGROUND Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.CASE SUMMARY Here we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress.He was treated conservatively but the symptoms persisted requiring a surgical approach.While there have been several cases of Chilaiditi syndrome reported in adults,there is a scarcity of cases reported in the pediatric population.Our review of the literature found only 30 pediatric cases,including our reported case,with Chilaiditi syndrome,19(63%)of which were male.The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years.In our review,we found that the most common predisposing factors in children are aerophagia(12/30 cases)and constipation(13/30 cases).Ninety percent of the cases presented with complete intestinal interposition,in 100%of which,the colon was involved.Three of the 30 cases were associated with volvulus.CONCLUSION In the pediatric population,conservative(21/30 cases)and surgical(8/30 cases)treatment approaches have produced satisfactory outcomes for all the patients,regardless of approach.
文摘In October 2022,the European Association for the Study of the Liver(EASL)published in Journal of Hepatology the Clinical Practice Guidelines(CPG)in regard to the diagnosis and management of cystic liver diseases(1).American College of Gastroenterology published similar guidelines in 2014 regarding focal liver lesions,but this is the first comprehensive guideline focusing on cystic liver lesions with robust background support and knowledge(2).
