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The Unsung Heroes: Health-Related Quality of Life of Caregivers and Patients in Pediatric Intestinal Failure
Belza, Christina?,†; Wales, Paul W.?,‡
doi : 10.1097/MPG.0000000000003193
September 2021 - Volume 73 - Issue 3 - p 291
Iron Balance in Premature Infants: Old is New
Baker, Robert D.
doi : 10.1097/MPG.0000000000003221
September 2021 - Volume 73 - Issue 3 - p 292
Immunomodulation in Children: The Role of the Diet
Verduci, Elvira?,†; Köglmeier, Jutta‡
doi : 10.1097/MPG.0000000000003152
September 2021 - Volume 73 - Issue 3 - p 293-298
Immune maturation and response to inflammation depend on good nutritional status. Protein and amino acid deficiencies can compromise innate and adaptive immune functions, particularly following injury or during illness. Dietary omega-3 long-chain fatty acids, prebiotics and micronutrients are beneficial to the immune system. A complex interplay exists between diet, microbiome, and epigenetic factors. The effect of single nutrients on immune function may hence be difficult to study. Well-designed intervention studies, investigating the effects of whole dietary pattern on the immune system, are needed.
Gastrointestinal Perspective of Coronavirus Disease 2019 in Children—An Updated Review
Assa, Amit?,†; Benninga, Marc A.‡; Borrelli, Osvaldo§; Broekaert, Ilse||; de Carpi, Javier Martin¶; Saccomani, Marco Deganello#; Dolinsek, Jernej??; Mas, Emmanuel††; Miele, Erasmo‡‡; Thomson, Mike§§; Tzivinikos, Christos||||; The Gastrointestinal Committee of ESPGHAN
doi : 10.1097/MPG.0000000000003204
September 2021 - Volume 73 - Issue 3 - p 299-305
Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.
Regional Gastrointestinal Motility in Healthy Children
Brinck, Christian Emil?,†; Mark, Esben Bolvig‡; Ejerskov, Cecilie?; Johansen, Klaus Birkelund?; Sutter, Nanna†; Schlageter, Vincent§; Drewes, Asbjørn Mohr‡; Krogh, Klaus†
doi : 10.1097/MPG.0000000000003198
September 2021 - Volume 73 - Issue 3 - p 306-313
The aim of the study was to evaluate the safety and use of the 3D-Transit system (Motilis SA, Lausanne, Switzerland) and to describe regional gastrointestinal transit times, segmental colonic transit times, and colonic movement patterns in healthy children.
Comparison of Symptom Control in Pediatric Gastroparesis Using Endoscopic Pyloric Botulinum Toxin Injection and Dilatation
Mercier, Clémence?; Ley, Delphine?; Aumar, Madeleine?; Lemale, Julie†; Fabre, Alexandre‡; Colinet, Stéphanie§; Duhamel, Alain||; Gottrand, Frédéric?
doi : 10.1097/MPG.0000000000003195
September 2021 - Volume 73 - Issue 3 - p 314-318
The objective of this study was to assess the tolerance and efficacy of endoscopic intrapyloric botulinum toxin injection compared with pyloric dilatation in children with gastroparesis.
Colonic Transit Time and Fecal Impaction in Children and Adolescents With Cystic Fibrosis-associated Constipation
de Sillos, Marcela Duarte?; Chiba, Sonia Mayumi†; Soares, Ana Cristina Fontenele?; Gomes, Clóvis Eduardo Tadeu†; de Morais, Mauro Batista?
doi : 10.1097/MPG.0000000000003202
September 2021 - Volume 73 - Issue 3 - p 319-324
Constipation is prevalent in pediatric cystic fibrosis (CF) patients and colonic motility has not been studied in this population. In this study, we aimed to evaluate the total and segmental colonic transit time in children and adolescents with CF based on the presence of constipation and radiological fecal impaction.
Inadequate Bowel Preparation in Pediatric Colonoscopy—Prospective Study of Potential Causes
Kumar, Sanjay?; Bennett, William E.†; Bozic, Molly A.†; Croffie, Joseph M.†; Ferrell, Emily†; Hon, Emily C.†; Khan, Hamza H.‡; McFerron, Brian A.†; Molleston, Jean P.†; Pfefferkorn, Marian D.†; Steiner, Steven J.†; Rao, Girish S.†; Vanderpool, Charles P.†; Waseem, Shamaila†; Watts, Abhishek§; Gupta, Sandeep K.†,||
doi : 10.1097/MPG.0000000000003178
September 2021 - Volume 73 - Issue 3 - p 325-328
Inadequate bowel preparation (IBP) for colonoscopy leads to missed diagnosis, longer anesthesia time, higher chance of complications and increased costs. Adult studies have demonstrated that patient characteristics such as male gender and obesity are associated with IBP. Little is known about factors affecting bowel preparation in children. Our aim was to determine factors associated with IBP in children.
Impact of Infant Milk-Type and Childhood Eating Behaviors on Functional Constipation in Preschool Children
de Oliveira, Marcela Barros Barbosa?; Jardim-Botelho, Anne?; de Morais, Mauro Batista†; da Cruz Melo, Ingrid Ribeiro?; Maciel, Júlia Franco‡; Gurgel, Ricardo Queiroz?
doi : 10.1097/MPG.0000000000003163
September 2021 - Volume 73 - Issue 3 - p e50-e56
To investigate the association between functional constipation, infant feeding in early infancy and eating behavior in preschool children.
A European Survey on Digestive Perianastomotic Ulcerations, a Rare Crohn-like Disorder Occurring in Children and Young Adults
Madre, Chrystele?; Maši?, Mario†; Prlenda-Touilleux, Daniela‡; Brueckner, Annecarin§; Koletzko, Sibylle§,||; Fabre, Alexandre¶,#; Viala, Jérome??,††; Lima, Rosa‡‡; Enaud, Raphael§§; Lemale, Julie||||; Kolho, Kaija-Leena¶¶; Bergoin, Charlotte##; Martinez-Vinson, Christine??; Dugelay, Emmanuelle??; Alvisi, Patrizia???; Aloi, Marina†††; Miele, Erasmo‡‡‡; Duclaux-Loras, Remi§§§; Nachury, Maria||||||; Languepin, Jane¶¶¶; Willot, Stephanie###; Dupont-Lucas, Claire????,††††; Mosca, Alexis??; Tzivinikos, Christos‡‡‡‡; Shamasneh, Ibrahim§§§§; Kola?ek, Sanja†; Hugot, Jean-Pierre??,††; on behalf of the pediatric GETAID group and the ESPGHAN IBD Porto group
doi : 10.1097/MPG.0000000000003200
September 2021 - Volume 73 - Issue 3 - p 333-337
Digestive perianastomotic ulcerations (DPAU) resembling Crohn disease lesions are long-term complications of intestinal resections, occurring in children and young adults. They are known to be uncommon, severe and difficult to treat.
Generic and Disease-specific Health-related Quality of Life in Pediatric Intestinal Failure
McCaig, Jessica K.?; Henry, Owen S.†; Stamm, Danielle A.?; Dorval, Gaby‡; Hurley, Alexis?; Han, Sam M.?,†; Hong, Charles R.?,†; Staffa, Steven J.†; Modi, Biren P.?,†
doi : 10.1097/MPG.0000000000003102
September 2021 - Volume 73 - Issue 3 - p 338-344
The aim of the study was to assess overall and disease-specific health-related quality of life (hrQOL) in patients with pediatric intestinal failure (PIF) and caregivers and elucidate differences from healthy and chronic gastrointestinal (GI) illness cohorts.
Reduced Systemic Corticosteroid Use among Pediatric Patients With Inflammatory Bowel Disease in a Large Learning Health System
Kandavel, Prashanthi?; Eder, Sally J.†; Adler, Jeremy?,†; and the ImproveCareNow Network Pediatric IBD Learning Health System‡
doi : 10.1097/MPG.0000000000003182
September 2021 - Volume 73 - Issue 3 - p 345-351
Corticosteroids have long been used to treat inflammatory bowel disease. However, cumulative corticosteroid exposure is associated with adverse effects, particularly in growing children. Professional guidelines recommend steroid-sparing strategies. It remains unknown whether corticosteroid use has decreased in children with inflammatory bowel disease.
Tofacitinib Therapy in Children and Young Adults With Pediatric-onset Medically Refractory Inflammatory Bowel Disease
Moore, Hillary?,†; Dubes, Lucie?; Fusillo, Steven?,†; Baldassano, Robert?,†; Stein, Ronen?,†
doi : 10.1097/MPG.0000000000003190
September 2021 - Volume 73 - Issue 3 - p e57-e62
Tofacitinib, a selective Janus kinase inhibitor, effectively induces and maintains remission in adults with inflammatory bowel disease (IBD), but data are limited in children. This study aimed to evaluate the efficacy and safety of tofacitinib for medically refractory pediatric-onset IBD.
Oncostatin-M Does Not Predict Treatment Response in Inflammatory Bowel Disease in a Pediatric Cohort
Ezirike Ladipo, Jennifer?,§,||; He, Zhaoping‡; Chikwava, Kudakwashe†; Robbins, Katherine‡; Beri, Jonathan?; Molle-Rios, Zarela?
doi : 10.1097/MPG.0000000000003201
September 2021 - Volume 73 - Issue 3 - p 352-357
This study aimed to determine whether mRNA expression of oncostatin-M (OSM) and its receptor (OSMR) in initial, pre-treatment intestinal biopsies is predictive of response to tumor necrosis factor antagonists (anti-TNF) in a pediatric inflammatory bowel disease (IBD) cohort. Secondary outcomes correlated OSM and OSMR expression with demographic variables; IBD type, extent, phenotype, and severity; laboratory values; and endoscopic findings.
Associations Between Subclass Profile of IgG Response to Gluten and the Gastrointestinal and Motor Symptoms in Children With Cerebral Palsy
Stenberg, Reidun?,†,‡; Uhde, Melanie?,†; Ajamian, Mary?,§; Green, Peter H.?,†; Myleus, Anna||; Alaedini, Armin?,†,§,¶
doi : 10.1097/MPG.0000000000003181
September 2021 - Volume 73 - Issue 3 - p 367-375
Gastrointestinal problems are often seen in children with cerebral palsy, although the etiology and underlying mechanisms are not fully understood. Recent data point to significantly elevated levels of IgG antibody to dietary gluten in cerebral palsy independent of celiac disease, a gluten-mediated autoimmune enteropathy. We aimed to further characterize this antibody response by examining its subclass distribution and target reactivity in the context of relevant patient symptom profile.
Diagnosing Coeliac Disease During Mass-Screening of General Paediatric Population: Is Biopsy Avoidable?
Al-Hussaini, Abdulrahman?,†,‡; Al-Jurayyan, Abdullah§; Alharbi, Sahar§; Bashir, Muhammed Salman||; Troncone, Riccardo¶
doi : 10.1097/MPG.0000000000003164
September 2021 - Volume 73 - Issue 3 - p e63-e67
Studies evaluating the correlation between tissue transglutaminase immunoglobulin antibody (TGA-IgA) levels and the degree of enteropathy in screening-detected coeliac disease (CD) patients from the general childhood population are scarce. The objectives of our study were to evaluate the correlation between the TGA-IgA titre and the degree of enteropathy and to evaluate whether the no-biopsy approach to diagnose CD in symptomatic patients proposed by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition could be extended to asymptomatic CD patients diagnosed during mass screening studies.
Adherence, Mental Health and Illness Perceptions in Autoimmune Liver Disease: Looking Beyond Liver Function Tests
Hames, Anna?; Matcham, Faith†; Makin, Isobel?; Day, Jemma?; Joshi, Deepak‡; Samyn, Marianne?
doi : 10.1097/MPG.0000000000003119
September 2021 - Volume 73 - Issue 3 - p 376-384
Autoimmune liver disease is commonly diagnosed during adolescence; a period associated with a higher prevalence of non-adherence, mental health concerns and worse health outcomes. The aim of the study was to explore adherence patterns, mental health and illness perceptions in young people with autoimmune liver disease.
Survival Benefits Following Liver Transplantation: A Matched-pair Analysis in Pediatric Patients With Cystic Fibrosis
Flemming, Gunter?,†; Baumann, Ulrich?; Richter, Nicolas‡; Vondran, Florian‡; Tümmler, Burkhard§; Dittrich, Anna-Maria§; Müller, Carsten§; Vogel, Mandy†; Pfister, Eva-Doreen?
doi : 10.1097/MPG.0000000000003194
September 2021 - Volume 73 - Issue 3 - p 385-390
Cystic fibrosis-related liver disease (CFLD) with consecutive cirrhosis is the third most common cause of death in CF patients. The aim of this study was to identify the potential long-term benefits of liver transplantation (LTx) in a match-control comparison.
A Particular SORL1 Micro-haplotype May Prevent Severe Liver Disease in a French Cohort of Alpha 1-Antitrypsin-deficient Children
Joly, Philippe‡,§; Ruiz, Mathias?; Garin, Roman‡; Karatas, Esra†; Lachaux, Alain?; Restier, Lioara?; Belmalih, Abdelouahed?; Renoux, Céline‡,§; Lombard, Christine||; Dechomet, Magali||; Bouchecareilh, Marion†
doi : 10.1097/MPG.0000000000003125
September 2021 - Volume 73 - Issue 3 - p e68-e72
The presence of modifier genes is now well recognized in severe liver disease outcome associated with alpha-1-antitrypsin deficiency (A1ATD) but their identification remains to be fully elucidated. To address this goal, we performed a candidate gene study with the SORL1 gene, already identified as risk gene in early-onset Alzheimer Disease families. A particular SORL1 micro-haplotype constituted with 3 SNPs (wild-type form TTG) was genotyped on 86 ZZ A1ATD children issued from 66 families. Interestingly, the mutated forms of this micro-haplotype (CAT most of the time) were associated with lower occurrence of severe liver disease and in cellulo studies showed that SORL1 influences Z-A1ATD cellular toxicity and biogenesis. These data suggest that the mutated CAT form of SORL1 micro-haplotype may partly prevent from severe liver disease in A1ATD children. Overall, these findings support a replication study on an independent cohort and additional in cellulo studies to confirm these promising results.
Acute Liver Injury Among Pediatric Liver Transplantation Recipients With Coronavirus Disease 2019: An International Collaborative Study
Sin, Priscila?; Díaz, Luis Antonio†; Martínez, Mercedes‡; Vizcaya, Cecilia§; D’Agostino, Daniel||; Gana, Juan Cristóbal?
doi : 10.1097/MPG.0000000000003213
September 2021 - Volume 73 - Issue 3 - p 391-394
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic. The occurrence of acute liver injury (ALI) has been reported in liver transplant (LT) recipients; however, the findings on children remain controversial. This is the first extensive, worldwide report on the impact of COVID-19 on pediatric LT recipients. Our online survey reported 110 pediatric LT recipients with severe acute respiratory syndrome coronavirus 2 infection. Of these, 37 were symptomatic and 20 out of them (54%) had complicated COVID-19, which included ALI and acute liver graft rejection. No mortality was reported. Pediatric LT recipients who had undergone transplantation less than 6 months before contracting COVID-19 had a greater number of hospital admissions and a higher ALI frequency (P = 0.013 and P = 0.033, respectively) than those who had undergone transplantation more than 6 months prior. Our study found that COVID-19 cases among pediatric LT recipients demonstrated a high complication rate. We propose that these patients must be followed up strictly.
Gastrointestinal Factors Associated With Hospitalization in Infants With Cystic Fibrosis: Results From the Baby Observational and Nutrition Study
Sathe, Meghana?; Huang, Rong†; Heltshe, Sonya‡,¶¶; Eng, Alexander§; Borenstein, Elhanan||,##,???; Miller, Samuel I.¶; Hoffman, Lucas#; Gelfond, Daniel??; Leung, Daniel H.††; Borowitz, Drucy‡‡; Ramsey, Bonnie§§; Freeman, A. Jay||||
doi : 10.1097/MPG.0000000000003173
September 2021 - Volume 73 - Issue 3 - p 395-402
To identify factors that increase the risk of gastrointestinal-related (GI-related) hospitalization of infants with cystic fibrosis (CF) during the first year of life.
Factors Affecting Selenium Status in Infants on Parenteral Nutrition Therapy
Rao, Anita?; Jericho, Hilary?; Patton, Tiffany?; Sriram, Sudhir†; Hebert, Taylor†; Weinstein, Dana?; Pompeii-Wolfe, Cecelia?; Wroblewski, Kristen‡; Sentongo, Timothy?
doi : 10.1097/MPG.0000000000003174
September 2021 - Volume 73 - Issue 3 - p e73-e78
Selenium is an essential micronutrient that must be supplemented in infants and young children on exclusive parenteral nutrition (PN). We examined selenium status and clinical factors associated with a deficiency in infants on PN.
Iron Balance and Iron Nutritional Status in Preterm Infants During the First Four Months of Life
Cooke, Richard J.?; Griffin, Ian†
doi : 10.1097/MPG.0000000000003183
September 2021 - Volume 73 - Issue 3 - p 403-407
To determine whether iron absorption occurs in a dose-dependent fashion and/or is a function of iron nutritional status (INS) in preterm infants during the first 4 months of life.
Anastomotic Ulcers: A Tertiary Centre Experience of Endoscopic Management Techniques
Barraclough, Harriet?; Girach, Ayesha†; Rao, Prithviraj‡; Urs, Arun‡; Marven, Sean‡; Murthi, Govind‡; Thomson, Mike‡; Narula, Priya‡
doi : 10.1097/MPG.0000000000003159
September 2021 - Volume 73 - Issue 3 - p 329-332
Improvements in neonatal care and surgical advances, has led to an increased prevalence of children with small and large bowel anastomoses. Ulceration at the site of anastomosis is a rare, but well-recognised phenomenon, with no clearly understood pathogenesis. Paediatric case series have been reported but there remains no clear effective treatment strategy and there is limited experience with endoscopic techniques in their management. We report our tertiary centre experience of managing nine anastomotic ulcer patients, including endoscopic treatment with argon plasma coagulation and clips.
Epstein-Barr Virus Status and Subsequent Thiopurine Exposure Within a Paediatric Inflammatory Bowel Disease Population
Harris, Rachel E.?; Hegde, Vikas†; Curtis, Lee‡; Garrick, Vikki‡; Gervais, Lisa‡; Armstrong, Lawrence§; Delahunty, Caroline||; Eccleston, Andrew¶; Al-Hourani, Ghassan#; Flynn, Diana M.‡; Merrick, Victoria??; Barclay, Andrew R.‡; Tayler, Rachel‡; Hansen, Richard‡; Russell, Richard K.??
doi : 10.1097/MPG.0000000000003197
September 2021 - Volume 73 - Issue 3 - p 358-362
The use of thiopurine therapy in Epstein-Barr virus (EBV)-naïve inflammatory bowel disease (IBD) patients remains controversial due to a risk of EBV-associated complications. We evaluated EBV status and outcomes within our paediatric IBD population over an 8-year period; finding that 217 of 409 (53%) screened patients were seropositive for EBV at IBD diagnosis; that thiopurines were used in 189 of 217 (87%) seropositive and 159 of 192 (83%) seronegative patients (P = 0.22); and that 7 of 192 (4%) previously seronegative patients subsequently tested positive for EBV with 6 of 7 (86%) patients having concurrently recorded thiopurine use. All six patients continued thiopurine with/without a period of cessation; no EBV-associated lymphoproliferative disorders/serious complications were recorded within our cohort. A significant proportion of our patients would not receive thiopurine therapy should their use be avoided in EBV-negative patients (47%) or seronegative males (30%). The small but significant risks of thiopurine treatment must be balanced against the potential benefits of successful IBD management; further research into this is required.
High Seroconversion Rate Against Severe Acute Respiratory Syndrome Coronavirus 2 in Symptomatic Pediatric Inflammatory Bowel Disease Patients
Ruan, Wenly?,†; Nguyen, Huyen?,†; Wyatt, Allyson?,†; Ihekweazu, Faith?,†; Vartabedian, Bryan S.?,†; Karam, Lina?,†; Walsh, Seema?,†; Kellermayer, Richard?,†,‡
doi : 10.1097/MPG.0000000000003211
September 2021 - Volume 73 - Issue 3 - p 363-366
Understanding coronavirus disease 2019 (COVID-19) in pediatric inflammatory bowel disease (PIBD) is important. We describe a single-center cohort of COVID-19 PIBD patients where seroconversion against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was examined.
Human Milk Oligosaccharides Modulate Fecal Microbiota and Are Safe for Use in Children With Overweight: A Randomized Controlled Trial
Fonvig, Cilius Esmann?,†,‡; Amundsen, Ingvild Dybdrodt§; Vigsnæs, Louise Kristine§; Sørensen, Nikolaj||; Frithioff-Bøjsøe, Christine?,†; Christiansen, Michael¶,#; Hedley, Paula Louise¶; Holm, Louise Aas?,†; McConnell, Bruce§; Holm, Jens-Christian?,†,??
doi : 10.1097/MPG.0000000000003205
September 2021 - Volume 73 - Issue 3 - p 408-414
Human milk oligosaccharides (HMOs) impact the intestinal microbiota by increasing beneficial bacteria in infants and adults, and are safe and well tolerated in these age groups. Effects on intestinal microbiota, safety, and digestive tolerance in children have not been, however, assessed. The aims of this trial were to evaluate if HMOs are able to specifically modulate the intestinal microbiota in children, and to assess safety and digestive tolerance.
Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper
Homan, Matjaž?; Hauser, Bruno†; Romano, Claudio‡; Tzivinikos, Christos§; Torroni, Filippo||; Gottrand, Frédéric¶; Hojsak, Iva#; Dall’Oglio, Luigi||; Thomson, Mike??; Bontems, Patrick††; Narula, Priya??; Furlano, Raoul‡‡; Oliva, Salvatore§§; Amil-Dias, Jorge||||
doi : 10.1097/MPG.0000000000003207
September 2021 - Volume 73 - Issue 3 - p 415-426
The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014.
Presyncope Leading to the Diagnosis of Gastrointestinal Stromal Tumor in a Pediatric Patient
Fernandez, Jenelle; Thomas, Jessina; Levy, Marc; Patel, Nishant; Levy, Alejandro; Smadi, Yamen
doi : 10.1097/MPG.0000000000003144
September 2021 - Volume 73 - Issue 3 - p e79
Diagnosis of Annular Pancreas With Congenital Duodenal Stenosis by Endoscopic Ultrasound in a Paediatric Patient
Yabe, Kiyoaki; Kouchi, Katsunori; Takenouchi, Ayako; Matsuoka, Aki; Kudou, Wataru
doi : 10.1097/MPG.0000000000003192
September 2021 - Volume 73 - Issue 3 - p e79
