Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic ...Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.展开更多
Hepatitis A virus(HAV)infection remains a significant public health concern in many developing countries.The annual incidence of HAV infection is 1.5 million,though this figure may be underestimated owing to the infec...Hepatitis A virus(HAV)infection remains a significant public health concern in many developing countries.The annual incidence of HAV infection is 1.5 million,though this figure may be underestimated owing to the infection’s asymptomatic nature and the presence of milder disease variants.The clinical spectrum of HAV infection now ranges from asymptomatic infection to fulminant hepatitis.Despite the availability of safe and highly effective vaccines,HAV infections remain a major contributor to acute viral hepatitis worldwide.展开更多
This article examines the growing prevalence of pediatric obesity and its con-nection to metabolic dysfunction-associated steatotic liver disease(MASLD)in children and adolescents,focusing on the role of glucagon-like...This article examines the growing prevalence of pediatric obesity and its con-nection to metabolic dysfunction-associated steatotic liver disease(MASLD)in children and adolescents,focusing on the role of glucagon-like peptide-1 receptor agonists in treatment.Pediatric obesity and MASLD present significant long-term health risks,making early intervention crucial.The article reviews the patho-physiology of both pediatric obesity and MASLD,explores current therapeutic strategies,and discusses the emerging role of glucagon-like peptide-1 receptor agonists,such as liraglutide,semaglutide,exenatide,and dulaglutide,in managing obesity,as well as explores current limited pediatric literature on the use of these medications in MASLD.展开更多
AIM To develop a locally adapted, patient-focused transitionprogram, we evaluated the perceptions of adult and adolescent patients and parents regarding transitionprograms and transfer.METHODS We evaluated these perce...AIM To develop a locally adapted, patient-focused transitionprogram, we evaluated the perceptions of adult and adolescent patients and parents regarding transitionprograms and transfer.METHODS We evaluated these perceptions by analyzing the responses of pre-transfer adolescents(n = 57), their parents(n = 57) and post-transfer adults(n = 138) from a cohort of pediatric-liver-transplant-patients using a self-designed questionnaire. Furthermore, we compared a responder group with a non-responder group as well as the provided answers with baseline characteristics and clinical outcomes to exclude selection bias, characterize high-risk patients for nonadherence and test for gender differences. Included in our study were all pre-transfer liver transplant and combined liver-kidney transplant recipients aged 11-19 currently under our care and their parents, as well as all post-transfer liver transplant and combined liverkidney transplant recipients aged ≥ 17 years who had received a liver transplant and were treated at our center during childhood.RESULTS Fifty-seven(24 female) pre-transfer patients who received a transplant in the previous 8-186 mo(mean 93.9 mo, median 92 mo, SD 53.8 mo) and 138(57 female) post-transfer patients who received a transplant in the preceding 2-29 years(mean 15.6 years, median 17, SD 6.90) met the inclusion criteria. A total of 67% of pre-transfer patients(71% of female; 64% of male; P = 0.78) and their parents replied. Additionally, 54% of post-transfer patients(26% of female; 48% of male; P = 0.01) replied. No differences in clinical outcomes were observed between the responder and non-responder groups, and responses did not differ significantly based on clinical complication rates, although they did differ based on gender and the location of medical follow-up after transfer. Adolescents were generally ambivalent toward transition programs. However, adults strongly supported transition programs. CONCLUSION Transition programs need to be developed in close collaboration with adolescents. The best clinical practices regarding transition should respect local circumstances, gender and the location of post-transfer medical follow-up.展开更多
BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their...BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.展开更多
BACKGROUND Esophageal atresia(EA)is the most common congenital anomaly of the gastrointestinal tract.Gastroesophageal reflux disease(GERD)is a frequent and lifelong problem in these patients.GERD can be asymptomatic a...BACKGROUND Esophageal atresia(EA)is the most common congenital anomaly of the gastrointestinal tract.Gastroesophageal reflux disease(GERD)is a frequent and lifelong problem in these patients.GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia(Barrett’s esophagus)is increased in adults with EA compared with the general population.Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing.AIM To assess symptoms and pH-impedance data in children after EA,in order to identify their specific features of GERD.METHODS This study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair(51.35%boys,48.65%girls;age range:1-14 years,median:4.99 years).GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established:EA without GERD,n=17;EA with GERD,n=20.A control group was established with 66 children with proven GERD(68.18%boys,31.82%girls;median age:7.21 years),composed of a nonerosive reflux disease(referred to as NERD)group(n=41)and a reflux esophagitis group(n=25).Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients.RESULTS The most frequently observed symptom in EA patients with GERD and without GERD was cough(70%and 76.5%respectively).The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group(P=0.03).In the control reflux esophagitis group,prevalence of gastrointestinal symptoms was significantly higher than in the NERD group(P=0.017).For both EA groups,there was strong correlation with index of proximal events(IPE)and total proximal events(EA with GERD:0.96,P<0.001;EA without GERD:0.97,P<0.001)but level of IPE was significantly lower than in GERD patients without any surgical treatment(P<0.001).Data on distal mean nocturnal baseline impedance were significantly different between the EA with GERD group(P<0.001)and the two control groups but not between EA without GERD and the two control groups.CONCLUSION Mean nocturnal baseline impedance may have diagnostic value for GERD in EA children after open surgical repair.IPE might be an additional parameter of pHimpedance monitoring.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
Chronic infections by hepatitis B virus(HBV)and hepatitis C virus(HCV)major causes of advanced liver disease and mortality worldwide.Although regarded as benign infections in children,their persistence through adultho...Chronic infections by hepatitis B virus(HBV)and hepatitis C virus(HCV)major causes of advanced liver disease and mortality worldwide.Although regarded as benign infections in children,their persistence through adulthood is undoubtedly of concern.Recent advances in HCV treatment have restored the visibility of these conditions and raised expectations for HBV treatment,which is currently far from being curative.Herein we describe direct-acting antivirals available for pediatric HCV(sofosbuvir/ledipasvir,sofosbuvir/velpatasvir,glecaprevir/pibrentasvir)and their real-world use.A critical review of the HBV pediatric classification is provided.Anti-HBV investigational compounds are reviewed in light of the pathophysiology in the pediatric population,including capsid assembly modulators,antigen secretion inhibitors,silencing RNAs,and immune modifiers.Recommendations for screening and management of immunosuppressed children or those with other risk factors or comorbidities are also summarized.展开更多
BACKGROUND Eosinophilic esophagitis(EoE)is an eosinophilic-predominant inflammation of the esophagus diagnosed by upper endoscopy and biopsies.A non-invasive and cost-effective alternative for management of EoE is bei...BACKGROUND Eosinophilic esophagitis(EoE)is an eosinophilic-predominant inflammation of the esophagus diagnosed by upper endoscopy and biopsies.A non-invasive and cost-effective alternative for management of EoE is being researched.Previous studies assessing utility of fractional exhaled nitric oxide(FeNO)in EoE were low powered.None investigated the contribution of eosinophilic inflammation of the stomach and duodenum to FeNO.AIM To assess the utility of FeNO as a non-invasive biomarker of esophageal eosinophilic inflammation for monitoring disease activity.METHODS Patients aged 6-21 years undergoing scheduled upper endoscopy with biopsy for suspected EoE were recruited in our observational study.Patients on steroids and with persistent asthma requiring daily controller medication were excluded.FeNO measurements were obtained in duplicate using a chemiluminescence nitric oxide analyzer(NIOX MINO,Aerocrine,Inc.;Stockholm,Sweden)prior to endoscopy.Based on the esophageal peak eosinophil count(PEC)/high power field on biopsy,patients were classified as EoE(PEC≥15)or control(PEC≤14).Mean FeNO levels were correlated with presence or absence of EoE,eosinophil counts on esophageal biopsy,and abnormal downstream eosinophilia in the stomach(PEC≥10)and duodenum(PEC≥20).Wilcoxon rank-sum test,Spearman correlation,and logistic regression were used for analysis.P value<0.05 was considered significant.RESULTS We recruited a total of 134 patients,of which 45 were diagnosed with EoE by histopathology.The median interquartile range FeNO level was 17 parts per billion(11-37,range:7-81)in the EoE group and 12 parts per billion(8-19,range:5-71)in the control group.After adjusting for atopic diseases,EoE patients had significantly higher FeNO levels as compared to patients without EoE(Z=3.33,P<0.001).A weak yet statistically significant positive association was found between the number of esophageal eosinophils and FeNO levels(r=0.30,P<0.005).On subgroup analysis within the EoE cohort,higher FeNO levels were noted in patients with abnormal gastric(n=23,18 vs 15)and duodenal eosinophilia(n=28,21 vs 14);however,the difference was not statistically significant.CONCLUSION After ruling out atopy as possible confounder,we found significantly higher FeNO levels in the EoE cohort than in the control group.展开更多
BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity...BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.展开更多
BACKGROUND Functional gastrointestinal disorders(FGIDs),defined as‘Disorders of Gut-Brain Interaction’,are now considered a global health problem.There is a dearth of concepts and scales to assess the severity of th...BACKGROUND Functional gastrointestinal disorders(FGIDs),defined as‘Disorders of Gut-Brain Interaction’,are now considered a global health problem.There is a dearth of concepts and scales to assess the severity of the different symptoms encountered while dealing with the variety of FGIDs as described in the ROME IV classi-fication.We introduced a novel scoring system with the incorporation of 16 different symptoms called Bacharyya’s Questionnaire Scale and started using it while dealing with children suffering from FGIDs.AIM To verify the usefulness and applicability of this recently developed scale,this study was undertaken with the objectives to establish the validity of this scoring system in assessing the severity of symptoms associated with a specific FGID in children and to determine the scoring system's applicability in assessing the treatment response.METHODS The study included children aged 5 to 18 years diagnosed with any FGID based on ROME IV criteria.They completed the newly developed scale and a Visual Analog Scale at initial diagnosis and after a 2-month treatment period.A control group without FGID participated for comparative baseline purposes.Treatment response was defined as a less than or equal to 50%reduction in the total score,which is statistically significant.RESULTS Results from a comprehensive cohort of 190 cases and 90 controls indicated a female preponderance(57.9%)and prevalent disorders such as functional constipation(28%)and functional abdominal pain,not otherwise specified(21%).The grade of FGID(mild,moderate,severe)experienced by the patients was also derived.Post-treatment,96 children demonstrated symptom improvement.The Spearman rank correlation coefficient for pre(r=0.72,95%CI:0.65-0.77,P value<0.0001)and post(r=0.49,95%CI:0.3-0.64,P value<0.0001)treatment data showed positive results with significant P values.CONCLUSION The novel scoring system shows high comprehensibility and gives an objective view of the symptomatology of FGIDs.The use of this novel score in clinical settings will be helpful to typify the FGIDs and may significantly improve decision-making processes to initiate appropriate treatment.展开更多
Chronic pancreatitis(CP)is no longer considered a disease of adults alone;it is increasingly being recognized in children as well.It is a chronic inflammatory condition of the pancreas that can lead to exocrine and en...Chronic pancreatitis(CP)is no longer considered a disease of adults alone;it is increasingly being recognized in children as well.It is a chronic inflammatory condition of the pancreas that can lead to exocrine and endocrine insufficiency over time.The clinical aspects and medical management of pediatric CP are often discussed;however,its impact on the quality of life(QOL)remains largely unaddressed in routine clinical care.The review focus on physical,emotional,educational,and social challenges experienced by children with CP and their families.Pain-related disability,frequent hospitalizations,and the risk of developing exocrine and endocrine insufficiency significantly affect daily functioning and mental well-being.Therefore,improving QOL in children with CP requires a multidisciplinary care strategy,including effective pain management,nutritional optimization,and psychological support.展开更多
Antituberculosis drug-induced hepatotoxicity(ATDIH)is a significant concern while managing pediatric tuberculosis.There is limited data on pediatric ATDIH,and much of the management practices are extrapolated from adu...Antituberculosis drug-induced hepatotoxicity(ATDIH)is a significant concern while managing pediatric tuberculosis.There is limited data on pediatric ATDIH,and much of the management practices are extrapolated from adult experiences.This article provides a comprehensive overview of the incidence,risk factors,clinical presentation,and management strategies for ATDIH in children.Pyrazi-namide,isoniazid,and rifampicin are the most hepatotoxic first-line antituber-culosis therapy(ATT).Though pyrazinamide has the highest potential for ATDIH,isoniazid is most frequently implicated.Hepatotoxicity typically mani-fests within the first 2–8 weeks of treatment,particularly during the intensive phase.Risk factors include younger age,female gender,malnutrition,hypoalbu-minemia,and baseline liver dysfunction.Extra-pulmonary TB,particularly tuberculous meningitis,and concomitant hepatotoxic medications such as anti-retro viral therapy or antiepileptic drugs further increase susceptibility.Genetic predisposition,including N-acetyltransferase 2 and cytochrome P4502E1 polymorphisms and specific HLA alleles also contribute to the increased risk.Clinically,ATDIH ranges from asymptomatic transaminase elevation to severe acute liver failure(ALF),necessitating prompt recognition and intervention.Diagnosis relies on the temporal association of liver injury with ATT initiation,supported by liver function tests,improvement upon ATT cessation,and recu-rrence upon reintroduction.Management involves discontinuing hepatotoxic drugs,initiating non-hepatotoxic regimens,and sequential reintroduction of ATT under close monitoring.For children with ALF,care in a tertiary center with liver transplantation expertise is essential.While pediatric ATDIH generally has favor-able outcomes with timely intervention,delays can result in significant morbidity and mortality.Improved understanding of risk factors,vigilant monitoring protocols,and standardized pediatric management strategies are critical for optimizing outcomes in pediatric ATDIH.展开更多
BACKGROUND Cow's milk allergy(CMA)is a common condition in infants,requiring alternative protein sources in their diets.Soya milk has become a popular substitute,especially in developing countries where it is a mo...BACKGROUND Cow's milk allergy(CMA)is a common condition in infants,requiring alternative protein sources in their diets.Soya milk has become a popular substitute,especially in developing countries where it is a more affordable option compared to expensive hypoallergenic feeds for infants with insufficient breast milk supply.However,recent observations have shown an increase in soya cross-allergic reactions among infants with CMA.AIM To determine how often infants diagnosed with CMA also had soya cross-allergy and to examine the symptoms and outcomes of these infants at 2 years of age.METHODS Data from two pediatric centers were analyzed,looking at clinical records of children under 2 years old diagnosed with CMA from August 2015 to July 2023,divided into two four-year periods.RESULTS The records of 432 infants with CMA were analyzed.In the first four-year period from August 2015 to July 2019,142 infants were studied,with 27(19%)found to have soya-protein allergy as well.In the second four-year period,a total of 290 infants were studied,and soya allergy was found in 136 babies(47%).This represents a significant increase(P<0.0001)in cases of soya protein cross-allergy among infants with CMA.The most common symptoms observed were gastroesophageal reflux disorder(39%),followed by failure to thrive,bloody diarrhea,watery diarrhea,and constipation.At 2 years of age,these infants showed significant growth failure compared to infants with CMA only.CONCLUSION In conclusion,this study emphasizes the importance of being cautious when using soy protein in infants with cow's milk protein allergy,especially in areas where cost is a major concern.展开更多
BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM...BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM To determine if prematurity and neonatal factors influence the development of DGBI in adults.METHODS A case-control study was carried out at a tertiary referral center from July 2019 to July 2021.Cases(adults born with extremely premature<29 weeks of gestation)were recruited from the Health of Adults Born Preterm Investigation cohort.Control subjects were recruited from the general population.All participants completed the Rome IV diagnostic questionnaire online.Cases completed anxiety and depression questionnaires(Patient-Reported Outcomes Measurement Infor-mation System-29 items,Generalized Anxiety Disorder-7 items,Patient Health Questionnaire-9 items).Neonatal data and sociodemographic status were collected.RESULTS A total of 79 cases and 124 controls were enrolled in the study.The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders(P=0.01)and a trend suggesting a higher prevalence of func-tional gastroduodenal disorders(P=0.06).Among women born prematurely,the prevalence of functional gastroduodenal disorders,functional bowel disorders,and functional constipation was significantly higher compared to the female control group(P=0.02 for all).The identified risk factors are categorized as directly linked to prematurity(e.g.,chorioamnionitis),indirectly related to prematurity(e.g.,anxiety,depression,and social skills as consequences of prematurity),or independent of prematurity(e.g.,female sex).CONCLUSION This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely.We confirm that prematurity is a risk factor for developing a DGBI.展开更多
BACKGROUND The diagnosis of inflammatory bowel disease(IBD)involves clinical,endoscopic,and radiologic evaluation.Endoscopic procedures,particularly in pediatrics,require general anesthesia and carry potential risks.A...BACKGROUND The diagnosis of inflammatory bowel disease(IBD)involves clinical,endoscopic,and radiologic evaluation.Endoscopic procedures,particularly in pediatrics,require general anesthesia and carry potential risks.AIM To investigate whether serum biomarkers can differentiate between pediatric patients with and without IBD.Secondary objectives included identifying biomarkers that distinguish Crohn’s disease(CD)from ulcerative colitis(UC)and assessing their predictive value for progression to biologic therapy.METHODS Pediatric patients undergoing diagnostic colonoscopy at British Columbia Children’s Hospital between December 2017 and June 2022 were enrolled.Blood samples were collected at colonoscopy,and demographic clinical data,laboratory,and histopathologic evaluation were obtained.An exploratory screen of 50 biomarkers was undertaken in a subset of patients(54 IBD,41 controls)using LegendplexTM flow cytometry kits to identify candidates.A refined panel of 12 serum biomarkers was subsequently selected and a supervised learning model was developed to classify patients.RESULTS The study included 246 pediatric patients,who had a median age of 13.03 years and were 37.4%female(103 CD,52 UC,91 controls).In univariate analyses,C-X-C motif chemokine ligand 9(CXCL9)was the only biomarker significantly elevated in IBD vs controls(P<0.001).A multivariable model achieved an area under the receiver operating characteristic of 0.861 for distinguishing IBD from controls.Interleukin 8(IL-8)emerged as a key biomarker alongside CXCL9 and IL-22 in the model.The random forest model identified CXCL9 with the greatest diagnostic accuracy(area under the curve[AUC]=0.81),followed by IL8 and IL22(AUC=0.737 and 0.68,respectively).CXCL9 and IL-18 showed higher levels in CD(P=0.016),whereas CXCL1 levels predicted progression to biologic therapy within 1 year(P=0.039).However,the model did not effectively predict disease subclassification or progression to biologic therapy.CONCLUSION Serum biomarkers,particularly CXCL9,IL-8,and IL-22,can aid in the diagnosis of pediatric IBD.CXCL9 and IL18 were found to be significant predictors of CD,and CXCL1 differed between patients requiring biologic therapy vs those who did not.展开更多
AIM： To investigate the role of oxidative injury in pancreatitis-induced hepatic damage and the effect of antioxidant agents such as melatonin, ascorbic acid and N-acetyl cysteine on caerulein-induced pancreatitis an...AIM： To investigate the role of oxidative injury in pancreatitis-induced hepatic damage and the effect of antioxidant agents such as melatonin, ascorbic acid and N-acetyl cysteine on caerulein-induced pancreatitis and associated liver injury in rats. METHODS： Thirty-eight female Wistar rats were used. Acute pancreatitis （AP） was induced by two i.p. injections of caerulein at 2-h intervals （at a total dose of 100 μg/kg b.wt）. The other two groups received additional melatonin （20 mg/kg b.wt） or an antioxidant mixture containing L（＋）-ascorbic acid （14.3 mg/kb.wt.） and N-acetyl cysteine （181 mg/kg b.wt.） i.p. shortly before each injection of caerulein. The rats were sacrificed by decapitation 12 h after the last injection of caerulein. Pancreatic and hepatic oxidative stress markers were evaluated by changes in the amount of lipid peroxides measured as malondialdehyde （MDA） and changes in tissue antioxidant enzyme levels, catalase （CAT） and glutathione peroxidase （GPx）. Histopathological examination was performed using scoring systems. RESULTS： The degree of hepatic cell degeneration, intracellular vacuolization, vascular congestion, sinusoidal dilatation and inflammatory infiltration showed a significant difference between caerulein and caerulein＋melatonin （P= 0.001）, and careulein and caerulein ＋ L（＋）- ascorbic acid ＋N-acetyl cysteine groups （P= 0.002）. The degree of aciner cell degeneration, pancreatic edema, intracellular vacuolization and inflammatory infiltration showed a significant difference between caerulein and caerulein ＋ melatonin （P=0.004）, and careulein and caerulein ＋ L（＋）-ascorbic acid ＋N-acetyl cysteine groups （P=0.002）. Caerulein-induced pancreatic and liver damage was accompanied with a significant increase in tissue MDA levels （P= 0.01, P= 0.003, respectively） whereas a significant decrease in CAT （P= 0.002, P=0.003, respectively） and GPx activities （P= 0.002, P= 0.03, respectively）. Melatonin and L（＋）-ascorbic acid ＋N-acetyl cysteine administration significantly decreased MDA levels in pancreas （P= 0.03, P= 0.002, respectively） and liver （P= 0.007, P= 0.01, respectively）. Administration of these agents increased pancreatic and hepatic CAT and GPx activities. Melatonin significantly increased pancreatic and hepatic CAT （P= 0.002, P= 0.001, respectively） and GPx activities （P=0.002, P=0.001）. Additionally, L（＋）-ascorbic acid＋N-acetyl cysteine significantly increased pancreatic GPx （P= 0.002） and hepatic CAT and GPx activities （P= 0.001, P= 0.007, respectively） CONCLUSION： Oxidative injury plays an important role not only in the pathogenesis of AP but also in pancreatitis-induced hepatic damage. Antioxidant agents such as melatonin and ascorbic acid＋N-acetyl cysteine, are capable of limiting pancreatic and hepatic damage produced during AP via restoring tissue antioxidant enzyme activities.展开更多
AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients. METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey be...AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients. METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative en-ema. The patients were followed up for 2 h after the procedure in terms of possible complications. RESULTS: DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); PeutzJeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation. CONCLUSION: With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.展开更多
AIM: To evaluate different methods in differentiating idiopathic neonatal hepatitis from biliary atresia. METHODS: Sixty-five infants with cholestatic jaundice and final diagnosis of idiopathic neonatal hepatitis and ...AIM: To evaluate different methods in differentiating idiopathic neonatal hepatitis from biliary atresia. METHODS: Sixty-five infants with cholestatic jaundice and final diagnosis of idiopathic neonatal hepatitis and biliary atresia were studied prospectively from September 2003 to March 2006. A thorough history and physical examination were undertaken and the liver enzymes were examined. All cases underwent abdominal ultrasonography, hepatobiliary scintigraphy, and percutaneous liver biopsy. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. RESULTS: There were 34 girls and 31 boys, among them 46 subjects had idiopathic neonatal hepatitis (age, 61 ± 17 d) and 19 had biliary atresia (age, 64 ± 18 d). The mean age at onset of jaundice was significantly lower in cases of biliary atresia when compared to idiopathic neonatal hepatitis cases (9 ± 13 d vs 20 ± 21 d; P = 0.032). The diagnostic accuracy of different methods was as follows: liver biopsy, 96.9%; clinical evaluation, 70.8%; ultrasonography, 69.2%; hepatobiliary scintigraphy, 58.5%; and liver enzymes, 50.8%.CONCLUSION: Our results indicate that clinical evaluation by an experienced pediatric hepatologist and a biopsy of the liver are considered as the most reliable methods to differentiate idiopathic neonatal hepatitis and biliary atresia.展开更多
AIM: To describe the ages at diagnosis and operation of biliary atresia(BA) and its incidence over a 15-year period in Taiwan.METHODS: This was a population-based cohort study. BA cases were identified from the Taiwan...AIM: To describe the ages at diagnosis and operation of biliary atresia(BA) and its incidence over a 15-year period in Taiwan.METHODS: This was a population-based cohort study. BA cases were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases,Ninth Revision(ICD-9) code of BA 751.61 plus Kasai operation(ICD-9 procedure code 51.37) or liver transplantation(LT,ICD-9 procedure code 50.5). The patients' characteristics including sex,age at diagnosis,age at receiving Kasai operation and age at receiving LT were compared among three birth cohorts:(1) 1997 to 2001;(2) 2002 to 2006; and(3) 2007 to 2011.RESULTS: There were a total of 540 BA cases(275 females) with an incidence of 1.62 per 10000 live births. No seasonality of BA was noted. The mean ages at diagnosis of three cohorts were 57.9,55.6 and 52.6 d.A linear regression model demonstrated a decreasing trend of the mean age at diagnosis(1.27 d per year). The proportion of BA cases that received the Kasai operation within 60 d of age increased from 76% to 81%. A total of 189(35%) BA patients underwent LT. The mean age at LT was reduced from 3-year-old to 1-year-old. The rates of LT were 25.6% and 32.3% in patients who received the Kasai operation within 60 d or after 60 d of age,respectively. All patients who did not undergo a Kasai operation eventually required LT.CONCLUSION: The ages at diagnosis and operation in BA cases have decreased over time. Kasai operation performed at younger age reduces the need for LT. The incidence of BA in Taiwan fluctuates,but without certain trend.展开更多
文摘Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.
文摘Hepatitis A virus(HAV)infection remains a significant public health concern in many developing countries.The annual incidence of HAV infection is 1.5 million,though this figure may be underestimated owing to the infection’s asymptomatic nature and the presence of milder disease variants.The clinical spectrum of HAV infection now ranges from asymptomatic infection to fulminant hepatitis.Despite the availability of safe and highly effective vaccines,HAV infections remain a major contributor to acute viral hepatitis worldwide.
文摘This article examines the growing prevalence of pediatric obesity and its con-nection to metabolic dysfunction-associated steatotic liver disease(MASLD)in children and adolescents,focusing on the role of glucagon-like peptide-1 receptor agonists in treatment.Pediatric obesity and MASLD present significant long-term health risks,making early intervention crucial.The article reviews the patho-physiology of both pediatric obesity and MASLD,explores current therapeutic strategies,and discusses the emerging role of glucagon-like peptide-1 receptor agonists,such as liraglutide,semaglutide,exenatide,and dulaglutide,in managing obesity,as well as explores current limited pediatric literature on the use of these medications in MASLD.
文摘AIM To develop a locally adapted, patient-focused transitionprogram, we evaluated the perceptions of adult and adolescent patients and parents regarding transitionprograms and transfer.METHODS We evaluated these perceptions by analyzing the responses of pre-transfer adolescents(n = 57), their parents(n = 57) and post-transfer adults(n = 138) from a cohort of pediatric-liver-transplant-patients using a self-designed questionnaire. Furthermore, we compared a responder group with a non-responder group as well as the provided answers with baseline characteristics and clinical outcomes to exclude selection bias, characterize high-risk patients for nonadherence and test for gender differences. Included in our study were all pre-transfer liver transplant and combined liver-kidney transplant recipients aged 11-19 currently under our care and their parents, as well as all post-transfer liver transplant and combined liverkidney transplant recipients aged ≥ 17 years who had received a liver transplant and were treated at our center during childhood.RESULTS Fifty-seven(24 female) pre-transfer patients who received a transplant in the previous 8-186 mo(mean 93.9 mo, median 92 mo, SD 53.8 mo) and 138(57 female) post-transfer patients who received a transplant in the preceding 2-29 years(mean 15.6 years, median 17, SD 6.90) met the inclusion criteria. A total of 67% of pre-transfer patients(71% of female; 64% of male; P = 0.78) and their parents replied. Additionally, 54% of post-transfer patients(26% of female; 48% of male; P = 0.01) replied. No differences in clinical outcomes were observed between the responder and non-responder groups, and responses did not differ significantly based on clinical complication rates, although they did differ based on gender and the location of medical follow-up after transfer. Adolescents were generally ambivalent toward transition programs. However, adults strongly supported transition programs. CONCLUSION Transition programs need to be developed in close collaboration with adolescents. The best clinical practices regarding transition should respect local circumstances, gender and the location of post-transfer medical follow-up.
文摘BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.
文摘BACKGROUND Esophageal atresia(EA)is the most common congenital anomaly of the gastrointestinal tract.Gastroesophageal reflux disease(GERD)is a frequent and lifelong problem in these patients.GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia(Barrett’s esophagus)is increased in adults with EA compared with the general population.Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing.AIM To assess symptoms and pH-impedance data in children after EA,in order to identify their specific features of GERD.METHODS This study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair(51.35%boys,48.65%girls;age range:1-14 years,median:4.99 years).GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established:EA without GERD,n=17;EA with GERD,n=20.A control group was established with 66 children with proven GERD(68.18%boys,31.82%girls;median age:7.21 years),composed of a nonerosive reflux disease(referred to as NERD)group(n=41)and a reflux esophagitis group(n=25).Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients.RESULTS The most frequently observed symptom in EA patients with GERD and without GERD was cough(70%and 76.5%respectively).The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group(P=0.03).In the control reflux esophagitis group,prevalence of gastrointestinal symptoms was significantly higher than in the NERD group(P=0.017).For both EA groups,there was strong correlation with index of proximal events(IPE)and total proximal events(EA with GERD:0.96,P<0.001;EA without GERD:0.97,P<0.001)but level of IPE was significantly lower than in GERD patients without any surgical treatment(P<0.001).Data on distal mean nocturnal baseline impedance were significantly different between the EA with GERD group(P<0.001)and the two control groups but not between EA without GERD and the two control groups.CONCLUSION Mean nocturnal baseline impedance may have diagnostic value for GERD in EA children after open surgical repair.IPE might be an additional parameter of pHimpedance monitoring.
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Chronic infections by hepatitis B virus(HBV)and hepatitis C virus(HCV)major causes of advanced liver disease and mortality worldwide.Although regarded as benign infections in children,their persistence through adulthood is undoubtedly of concern.Recent advances in HCV treatment have restored the visibility of these conditions and raised expectations for HBV treatment,which is currently far from being curative.Herein we describe direct-acting antivirals available for pediatric HCV(sofosbuvir/ledipasvir,sofosbuvir/velpatasvir,glecaprevir/pibrentasvir)and their real-world use.A critical review of the HBV pediatric classification is provided.Anti-HBV investigational compounds are reviewed in light of the pathophysiology in the pediatric population,including capsid assembly modulators,antigen secretion inhibitors,silencing RNAs,and immune modifiers.Recommendations for screening and management of immunosuppressed children or those with other risk factors or comorbidities are also summarized.
文摘BACKGROUND Eosinophilic esophagitis(EoE)is an eosinophilic-predominant inflammation of the esophagus diagnosed by upper endoscopy and biopsies.A non-invasive and cost-effective alternative for management of EoE is being researched.Previous studies assessing utility of fractional exhaled nitric oxide(FeNO)in EoE were low powered.None investigated the contribution of eosinophilic inflammation of the stomach and duodenum to FeNO.AIM To assess the utility of FeNO as a non-invasive biomarker of esophageal eosinophilic inflammation for monitoring disease activity.METHODS Patients aged 6-21 years undergoing scheduled upper endoscopy with biopsy for suspected EoE were recruited in our observational study.Patients on steroids and with persistent asthma requiring daily controller medication were excluded.FeNO measurements were obtained in duplicate using a chemiluminescence nitric oxide analyzer(NIOX MINO,Aerocrine,Inc.;Stockholm,Sweden)prior to endoscopy.Based on the esophageal peak eosinophil count(PEC)/high power field on biopsy,patients were classified as EoE(PEC≥15)or control(PEC≤14).Mean FeNO levels were correlated with presence or absence of EoE,eosinophil counts on esophageal biopsy,and abnormal downstream eosinophilia in the stomach(PEC≥10)and duodenum(PEC≥20).Wilcoxon rank-sum test,Spearman correlation,and logistic regression were used for analysis.P value<0.05 was considered significant.RESULTS We recruited a total of 134 patients,of which 45 were diagnosed with EoE by histopathology.The median interquartile range FeNO level was 17 parts per billion(11-37,range:7-81)in the EoE group and 12 parts per billion(8-19,range:5-71)in the control group.After adjusting for atopic diseases,EoE patients had significantly higher FeNO levels as compared to patients without EoE(Z=3.33,P<0.001).A weak yet statistically significant positive association was found between the number of esophageal eosinophils and FeNO levels(r=0.30,P<0.005).On subgroup analysis within the EoE cohort,higher FeNO levels were noted in patients with abnormal gastric(n=23,18 vs 15)and duodenal eosinophilia(n=28,21 vs 14);however,the difference was not statistically significant.CONCLUSION After ruling out atopy as possible confounder,we found significantly higher FeNO levels in the EoE cohort than in the control group.
文摘BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.
文摘BACKGROUND Functional gastrointestinal disorders(FGIDs),defined as‘Disorders of Gut-Brain Interaction’,are now considered a global health problem.There is a dearth of concepts and scales to assess the severity of the different symptoms encountered while dealing with the variety of FGIDs as described in the ROME IV classi-fication.We introduced a novel scoring system with the incorporation of 16 different symptoms called Bacharyya’s Questionnaire Scale and started using it while dealing with children suffering from FGIDs.AIM To verify the usefulness and applicability of this recently developed scale,this study was undertaken with the objectives to establish the validity of this scoring system in assessing the severity of symptoms associated with a specific FGID in children and to determine the scoring system's applicability in assessing the treatment response.METHODS The study included children aged 5 to 18 years diagnosed with any FGID based on ROME IV criteria.They completed the newly developed scale and a Visual Analog Scale at initial diagnosis and after a 2-month treatment period.A control group without FGID participated for comparative baseline purposes.Treatment response was defined as a less than or equal to 50%reduction in the total score,which is statistically significant.RESULTS Results from a comprehensive cohort of 190 cases and 90 controls indicated a female preponderance(57.9%)and prevalent disorders such as functional constipation(28%)and functional abdominal pain,not otherwise specified(21%).The grade of FGID(mild,moderate,severe)experienced by the patients was also derived.Post-treatment,96 children demonstrated symptom improvement.The Spearman rank correlation coefficient for pre(r=0.72,95%CI:0.65-0.77,P value<0.0001)and post(r=0.49,95%CI:0.3-0.64,P value<0.0001)treatment data showed positive results with significant P values.CONCLUSION The novel scoring system shows high comprehensibility and gives an objective view of the symptomatology of FGIDs.The use of this novel score in clinical settings will be helpful to typify the FGIDs and may significantly improve decision-making processes to initiate appropriate treatment.
文摘Chronic pancreatitis(CP)is no longer considered a disease of adults alone;it is increasingly being recognized in children as well.It is a chronic inflammatory condition of the pancreas that can lead to exocrine and endocrine insufficiency over time.The clinical aspects and medical management of pediatric CP are often discussed;however,its impact on the quality of life(QOL)remains largely unaddressed in routine clinical care.The review focus on physical,emotional,educational,and social challenges experienced by children with CP and their families.Pain-related disability,frequent hospitalizations,and the risk of developing exocrine and endocrine insufficiency significantly affect daily functioning and mental well-being.Therefore,improving QOL in children with CP requires a multidisciplinary care strategy,including effective pain management,nutritional optimization,and psychological support.
文摘Antituberculosis drug-induced hepatotoxicity(ATDIH)is a significant concern while managing pediatric tuberculosis.There is limited data on pediatric ATDIH,and much of the management practices are extrapolated from adult experiences.This article provides a comprehensive overview of the incidence,risk factors,clinical presentation,and management strategies for ATDIH in children.Pyrazi-namide,isoniazid,and rifampicin are the most hepatotoxic first-line antituber-culosis therapy(ATT).Though pyrazinamide has the highest potential for ATDIH,isoniazid is most frequently implicated.Hepatotoxicity typically mani-fests within the first 2–8 weeks of treatment,particularly during the intensive phase.Risk factors include younger age,female gender,malnutrition,hypoalbu-minemia,and baseline liver dysfunction.Extra-pulmonary TB,particularly tuberculous meningitis,and concomitant hepatotoxic medications such as anti-retro viral therapy or antiepileptic drugs further increase susceptibility.Genetic predisposition,including N-acetyltransferase 2 and cytochrome P4502E1 polymorphisms and specific HLA alleles also contribute to the increased risk.Clinically,ATDIH ranges from asymptomatic transaminase elevation to severe acute liver failure(ALF),necessitating prompt recognition and intervention.Diagnosis relies on the temporal association of liver injury with ATT initiation,supported by liver function tests,improvement upon ATT cessation,and recu-rrence upon reintroduction.Management involves discontinuing hepatotoxic drugs,initiating non-hepatotoxic regimens,and sequential reintroduction of ATT under close monitoring.For children with ALF,care in a tertiary center with liver transplantation expertise is essential.While pediatric ATDIH generally has favor-able outcomes with timely intervention,delays can result in significant morbidity and mortality.Improved understanding of risk factors,vigilant monitoring protocols,and standardized pediatric management strategies are critical for optimizing outcomes in pediatric ATDIH.
文摘BACKGROUND Cow's milk allergy(CMA)is a common condition in infants,requiring alternative protein sources in their diets.Soya milk has become a popular substitute,especially in developing countries where it is a more affordable option compared to expensive hypoallergenic feeds for infants with insufficient breast milk supply.However,recent observations have shown an increase in soya cross-allergic reactions among infants with CMA.AIM To determine how often infants diagnosed with CMA also had soya cross-allergy and to examine the symptoms and outcomes of these infants at 2 years of age.METHODS Data from two pediatric centers were analyzed,looking at clinical records of children under 2 years old diagnosed with CMA from August 2015 to July 2023,divided into two four-year periods.RESULTS The records of 432 infants with CMA were analyzed.In the first four-year period from August 2015 to July 2019,142 infants were studied,with 27(19%)found to have soya-protein allergy as well.In the second four-year period,a total of 290 infants were studied,and soya allergy was found in 136 babies(47%).This represents a significant increase(P<0.0001)in cases of soya protein cross-allergy among infants with CMA.The most common symptoms observed were gastroesophageal reflux disorder(39%),followed by failure to thrive,bloody diarrhea,watery diarrhea,and constipation.At 2 years of age,these infants showed significant growth failure compared to infants with CMA only.CONCLUSION In conclusion,this study emphasizes the importance of being cautious when using soy protein in infants with cow's milk protein allergy,especially in areas where cost is a major concern.
基金Supported by Sainte-Justine University Hospital Research Center excellence grant in 2020-2021.
文摘BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM To determine if prematurity and neonatal factors influence the development of DGBI in adults.METHODS A case-control study was carried out at a tertiary referral center from July 2019 to July 2021.Cases(adults born with extremely premature<29 weeks of gestation)were recruited from the Health of Adults Born Preterm Investigation cohort.Control subjects were recruited from the general population.All participants completed the Rome IV diagnostic questionnaire online.Cases completed anxiety and depression questionnaires(Patient-Reported Outcomes Measurement Infor-mation System-29 items,Generalized Anxiety Disorder-7 items,Patient Health Questionnaire-9 items).Neonatal data and sociodemographic status were collected.RESULTS A total of 79 cases and 124 controls were enrolled in the study.The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders(P=0.01)and a trend suggesting a higher prevalence of func-tional gastroduodenal disorders(P=0.06).Among women born prematurely,the prevalence of functional gastroduodenal disorders,functional bowel disorders,and functional constipation was significantly higher compared to the female control group(P=0.02 for all).The identified risk factors are categorized as directly linked to prematurity(e.g.,chorioamnionitis),indirectly related to prematurity(e.g.,anxiety,depression,and social skills as consequences of prematurity),or independent of prematurity(e.g.,female sex).CONCLUSION This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely.We confirm that prematurity is a risk factor for developing a DGBI.
基金Supported by the Lutsky Family Foundation and AdMare Bioinnovations(previously known as the Genome BC CDRD Development Fund).
文摘BACKGROUND The diagnosis of inflammatory bowel disease(IBD)involves clinical,endoscopic,and radiologic evaluation.Endoscopic procedures,particularly in pediatrics,require general anesthesia and carry potential risks.AIM To investigate whether serum biomarkers can differentiate between pediatric patients with and without IBD.Secondary objectives included identifying biomarkers that distinguish Crohn’s disease(CD)from ulcerative colitis(UC)and assessing their predictive value for progression to biologic therapy.METHODS Pediatric patients undergoing diagnostic colonoscopy at British Columbia Children’s Hospital between December 2017 and June 2022 were enrolled.Blood samples were collected at colonoscopy,and demographic clinical data,laboratory,and histopathologic evaluation were obtained.An exploratory screen of 50 biomarkers was undertaken in a subset of patients(54 IBD,41 controls)using LegendplexTM flow cytometry kits to identify candidates.A refined panel of 12 serum biomarkers was subsequently selected and a supervised learning model was developed to classify patients.RESULTS The study included 246 pediatric patients,who had a median age of 13.03 years and were 37.4%female(103 CD,52 UC,91 controls).In univariate analyses,C-X-C motif chemokine ligand 9(CXCL9)was the only biomarker significantly elevated in IBD vs controls(P<0.001).A multivariable model achieved an area under the receiver operating characteristic of 0.861 for distinguishing IBD from controls.Interleukin 8(IL-8)emerged as a key biomarker alongside CXCL9 and IL-22 in the model.The random forest model identified CXCL9 with the greatest diagnostic accuracy(area under the curve[AUC]=0.81),followed by IL8 and IL22(AUC=0.737 and 0.68,respectively).CXCL9 and IL-18 showed higher levels in CD(P=0.016),whereas CXCL1 levels predicted progression to biologic therapy within 1 year(P=0.039).However,the model did not effectively predict disease subclassification or progression to biologic therapy.CONCLUSION Serum biomarkers,particularly CXCL9,IL-8,and IL-22,can aid in the diagnosis of pediatric IBD.CXCL9 and IL18 were found to be significant predictors of CD,and CXCL1 differed between patients requiring biologic therapy vs those who did not.
文摘AIM： To investigate the role of oxidative injury in pancreatitis-induced hepatic damage and the effect of antioxidant agents such as melatonin, ascorbic acid and N-acetyl cysteine on caerulein-induced pancreatitis and associated liver injury in rats. METHODS： Thirty-eight female Wistar rats were used. Acute pancreatitis （AP） was induced by two i.p. injections of caerulein at 2-h intervals （at a total dose of 100 μg/kg b.wt）. The other two groups received additional melatonin （20 mg/kg b.wt） or an antioxidant mixture containing L（＋）-ascorbic acid （14.3 mg/kb.wt.） and N-acetyl cysteine （181 mg/kg b.wt.） i.p. shortly before each injection of caerulein. The rats were sacrificed by decapitation 12 h after the last injection of caerulein. Pancreatic and hepatic oxidative stress markers were evaluated by changes in the amount of lipid peroxides measured as malondialdehyde （MDA） and changes in tissue antioxidant enzyme levels, catalase （CAT） and glutathione peroxidase （GPx）. Histopathological examination was performed using scoring systems. RESULTS： The degree of hepatic cell degeneration, intracellular vacuolization, vascular congestion, sinusoidal dilatation and inflammatory infiltration showed a significant difference between caerulein and caerulein＋melatonin （P= 0.001）, and careulein and caerulein ＋ L（＋）- ascorbic acid ＋N-acetyl cysteine groups （P= 0.002）. The degree of aciner cell degeneration, pancreatic edema, intracellular vacuolization and inflammatory infiltration showed a significant difference between caerulein and caerulein ＋ melatonin （P=0.004）, and careulein and caerulein ＋ L（＋）-ascorbic acid ＋N-acetyl cysteine groups （P=0.002）. Caerulein-induced pancreatic and liver damage was accompanied with a significant increase in tissue MDA levels （P= 0.01, P= 0.003, respectively） whereas a significant decrease in CAT （P= 0.002, P=0.003, respectively） and GPx activities （P= 0.002, P= 0.03, respectively）. Melatonin and L（＋）-ascorbic acid ＋N-acetyl cysteine administration significantly decreased MDA levels in pancreas （P= 0.03, P= 0.002, respectively） and liver （P= 0.007, P= 0.01, respectively）. Administration of these agents increased pancreatic and hepatic CAT and GPx activities. Melatonin significantly increased pancreatic and hepatic CAT （P= 0.002, P= 0.001, respectively） and GPx activities （P=0.002, P=0.001）. Additionally, L（＋）-ascorbic acid＋N-acetyl cysteine significantly increased pancreatic GPx （P= 0.002） and hepatic CAT and GPx activities （P= 0.001, P= 0.007, respectively） CONCLUSION： Oxidative injury plays an important role not only in the pathogenesis of AP but also in pancreatitis-induced hepatic damage. Antioxidant agents such as melatonin and ascorbic acid＋N-acetyl cysteine, are capable of limiting pancreatic and hepatic damage produced during AP via restoring tissue antioxidant enzyme activities.
文摘AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients. METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative en-ema. The patients were followed up for 2 h after the procedure in terms of possible complications. RESULTS: DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); PeutzJeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation. CONCLUSION: With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.
文摘AIM: To evaluate different methods in differentiating idiopathic neonatal hepatitis from biliary atresia. METHODS: Sixty-five infants with cholestatic jaundice and final diagnosis of idiopathic neonatal hepatitis and biliary atresia were studied prospectively from September 2003 to March 2006. A thorough history and physical examination were undertaken and the liver enzymes were examined. All cases underwent abdominal ultrasonography, hepatobiliary scintigraphy, and percutaneous liver biopsy. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. RESULTS: There were 34 girls and 31 boys, among them 46 subjects had idiopathic neonatal hepatitis (age, 61 ± 17 d) and 19 had biliary atresia (age, 64 ± 18 d). The mean age at onset of jaundice was significantly lower in cases of biliary atresia when compared to idiopathic neonatal hepatitis cases (9 ± 13 d vs 20 ± 21 d; P = 0.032). The diagnostic accuracy of different methods was as follows: liver biopsy, 96.9%; clinical evaluation, 70.8%; ultrasonography, 69.2%; hepatobiliary scintigraphy, 58.5%; and liver enzymes, 50.8%.CONCLUSION: Our results indicate that clinical evaluation by an experienced pediatric hepatologist and a biopsy of the liver are considered as the most reliable methods to differentiate idiopathic neonatal hepatitis and biliary atresia.
基金Supported by The Ditmanson Medical Foundation Chia-Yi Christian Hospital Research ProgramNo.R102-11
文摘AIM: To describe the ages at diagnosis and operation of biliary atresia(BA) and its incidence over a 15-year period in Taiwan.METHODS: This was a population-based cohort study. BA cases were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases,Ninth Revision(ICD-9) code of BA 751.61 plus Kasai operation(ICD-9 procedure code 51.37) or liver transplantation(LT,ICD-9 procedure code 50.5). The patients' characteristics including sex,age at diagnosis,age at receiving Kasai operation and age at receiving LT were compared among three birth cohorts:(1) 1997 to 2001;(2) 2002 to 2006; and(3) 2007 to 2011.RESULTS: There were a total of 540 BA cases(275 females) with an incidence of 1.62 per 10000 live births. No seasonality of BA was noted. The mean ages at diagnosis of three cohorts were 57.9,55.6 and 52.6 d.A linear regression model demonstrated a decreasing trend of the mean age at diagnosis(1.27 d per year). The proportion of BA cases that received the Kasai operation within 60 d of age increased from 76% to 81%. A total of 189(35%) BA patients underwent LT. The mean age at LT was reduced from 3-year-old to 1-year-old. The rates of LT were 25.6% and 32.3% in patients who received the Kasai operation within 60 d or after 60 d of age,respectively. All patients who did not undergo a Kasai operation eventually required LT.CONCLUSION: The ages at diagnosis and operation in BA cases have decreased over time. Kasai operation performed at younger age reduces the need for LT. The incidence of BA in Taiwan fluctuates,but without certain trend.
