Journal of Pediatric Gastroenterology and Nutrition

ABSTRACT: Liver involvement is found in nearly 40% of children with sickle cell disease. The most frequent complication is cholelithiasis. The most severe complication is acute hepatic crisis, with symptoms ranging from increasing jaundice to multiple organ failure and death. The emergency and mostly efficient treatment is exchange transfusion. Chronic cholangiopathy is increasingly recognized, with autoimmune features in most cases, worsened by chronic ischemia. Transfusion-related iron overload is not yet a concern in children, and hepatotoxicity of iron chelators is rare. We propose recommendations to prevent, explore, and treat these complications. We emphasize the close collaboration required between hepatologists and specialists of sickle cell disease.

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Living Related Liver Transplantation for Metabolic Liver Diseases in Children

Sood, Vikrant*; Squires, James E.+; Mazariegos, George V.++; Vockley, Jerry[S]; McKiernan, Patrick J.+

doi : 10.1097/MPG.0000000000002952

Issue: Volume 72(1), January 2021, p 11-17

ABSTRACT: Metabolic liver diseases (MLDs) are a heterogeneous group of inherited conditions for which liver transplantation can provide definitive treatment. The limited availability of deceased donor organs means some who could benefit from transplant do not have this option. Living related liver transplant (LrLT) using relatives as donors has emerged as one solution to this problem. This technique is established worldwide, especially in Asian countries, with shorter waiting times and patient and graft survival rates equivalent to deceased donor liver transplantation. However, living donors are underutilized for MLDs in many western countries, possibly due to the fear of limited efficacy using heterozygous donors. We have reviewed the published literature and shown that the use of heterozygous donors for liver transplantation is safe for the majority of MLDs with excellent metabolic correction. The use of LrLT should be encouraged to complement deceased donor liver transplantation (DDLT) for treatment of MLDs.

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Evaluation of the Effectiveness of In-line Immobilized Lipase Cartridge in Enterally Fed Patients With Cystic Fibrosis

Sathe, Meghana N.*; Patel, Dhiren+; Stone, Archie++; First, Eric++

doi : 10.1097/MPG.0000000000002984

Issue: Volume 72(1), January 2021, p 18-23

Background: Pancreatic insufficiency occurs in most patients with cystic fibrosis (CF) contributing to malnutrition. In the United States, 3600 patients with CF require enteral feeding (EF). Oral pancreatic enzymes are commonly used with EF, despite not being designed or approved for this use. An immobilized lipase cartridge (ILC) for extracorporeal digestion of enteral feedings was developed. The sponsor provided it to patients via a structured program, which we evaluated to assess the effectiveness of the ILC on nutritional status.

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Factors Associated With Nonadherence in an Emergency Department-based Multicenter Randomized Clinical Trial of a Probiotic in Children With Acute Gastroenteritis

Schnadower, David*; Roskind, Cindy G.+; VanBuren, John M.++; Powell, Elizabeth C.[S]; Norris, Jesse G.++; Tarr, Phillip I.||; Sapien, Robert E.[P]; O'Connell, Karen J.#; Chun, Thomas H.**; Rogers, Alexander J.++; Bhatt, Seema R.*; Mahajan, Prashant++; Gorelick, Marc H.++++; Vance, Cheryl[S][S]; Dean, J. Michael++; Freedman, Stephen B.||||; Pediatric Emergency Care Applied Research Network (PECARN)

doi : 10.1097/MPG.0000000000002904

Issue: Volume 72(1), January 2021, p 24-28

ABSTRACT: Nonadherence in clinical trials affects safety and efficacy determinations. Predictors of nonadherence in pediatric acute illness trials are unknown. We sought to examine predictors of nonadherence in a multicenter randomized trial of 971 children with acute gastroenteritis receiving a 5-day oral course of Lactobacillus rhamnosus GG or placebo. Adherence, defined as consuming all doses of the product, was reported by the parents and recorded during daily follow-up contacts. Of 943 patients with follow-up data, 766 (81.2%) were adherent. On multivariate analysis, older age (OR 1.19; 95% CI: 1.00-1.43), increased vomiting duration (OR 1.23; 95% CI: 1.05-1.45), higher dehydration score (OR 1.23, 95% CI: 1.07-1.42), and hospitalization following ED discharge (OR 4.16, 95% CI: 1.21--14.30) were factors associated with nonadherence; however, those with highest severity scores were more likely to adhere (OR 0.87, 95% CI: 0.80-0.95). These data may inform strategies and specific targets to maximize adherence in future pediatric trials.

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Fructose Malabsorption in Chilean Children Undergoing Fructose Breath Test at a Tertiary Hospital

Alliende, Francisco; Lucero, Yalda; Jaime, Francisca; Rios, Gloria; Arancibia, Maria E.; Rodriguez, Lorena

doi : 10.1097/MPG.0000000000002903

Issue: Volume 72(1), January 2021, p e1-e3

ABSTRACT: Fructose is a highly abundant carbohydrate in western diet and may induce bowel symptoms in children as in adults. The main objective of this study is to describe the frequency of fructose malabsorption (FM) in symptomatic patients 18 years or younger undergoing fructose breath test in a single tertiary center between 2013 and 2018, and to evaluate whether certain symptoms are related to positivity of the test. Out of 273 tests 183 (67%) were compatible with FM. The most frequent pretest symptom in the overall study population was bloating (83%), followed by abdominal pain (73%). Patients with positive test were younger than those with a negative test (median 5 vs 8 years, P < 0.001). In multivariate analysis, which included age, sex, and symptoms (diarrhea, abdominal pain, bloating, nausea), only age <6 years (odds ratio 2.93, 95% confidence interval 1.64-5.23) and absence of nausea (odds ratio = 3.32, 95% confidence interval 1.56-7.05) were associated with FM.

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Sucrase-isomaltase Gene Variants in Patients With Abnormal Sucrase Activity and Functional Gastrointestinal Disorders

Deb, Chirajyoti*; Campion, Stephani*; Derrick, Veronica*; Ruiz, Vanessa*; Abomoelak, Bassam*; Avdella, Angelina*; Zou, Baiming++; Horvath, Karoly*,+; Mehta, Devendra I.*,+

doi : 10.1097/MPG.0000000000002852

Issue: Volume 72(1), January 2021, p 29-35

Objectives: The aim of the study was to determine prevalence and characterize sucrase-isomaltase (SI) gene variants of congenital sucrase-isomaltase deficiency in non-Hispanic white pediatric and young adult patients with functional gastrointestinal disorders (FGIDs), and abnormal sucrase activity on histologically normal duodenal biopsy.

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Variants in the Enteric Smooth Muscle Actin [gamma]-2 Cause Pediatric Intestinal Pseudo-obstruction in Chinese Patients

Wei, Zhiliang*,+,++; Lu, Lina*; Zheng, Youjie+,++; Yan, Weihui*,[S]; Tao, Yijng*; Xiao, Yongtao++; Cai, Wei+,++,[S]; Wang, Ying*,[S]

doi : 10.1097/MPG.0000000000002897

Issue: Volume 72(1), January 2021, p 36-42

Objectives: Pediatric intestinal pseudo-obstruction (PIPO) is a severe gastrointestinal disorder occurring in children, leading to failure to thrive, malnutrition, and long-term parenteral nutrition dependence. Enteric smooth muscle actin [gamma]-2 (ACTG2) variants have been reported to be related to the pathogenesis of PIPO. This study aimed to determine the presence of ACTG2 variants in Chinese PIPO patients.

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Open Primary Button Versus Laparoscopic Percutaneous Endoscopic Gastrostomy: Results From a Case-control Study

Davidson, Joseph R.* , +; Lee, Do Rae.++; Suresh, Dhivya++; Wright, Hannah*; Upadhyaya, Manasvi* , ++; Yardley, Iain E.* , ++

doi : 10.1097/MPG.0000000000002877

Issue: Volume 72(1), January 2021, p e4-e9

Objectives: Open primary balloon gastrostomy (PBG) presents a potential alternative to percutaneous endoscopic gastrostomy (PEG) in children as it obviates the need for change under general anaesthetic; however, the complication profile of PBG compared to PEG is not well defined. Previous series comparing the two have been hampered by the groups not being equivalent. Our paediatric surgical centre has offered PBG as an alternative PEG since 2014. We used a matched case-control study to compare outcomes for PBG and PEG.

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Cisapride Use in Pediatric Patients With Intestinal Failure and Its Impact on Progression of Enteral Nutrition

Martinez, Andrea*,+,++; Belza, Christina*,++; Betts, Zachary*; de Silva, Nicole*; Avitzur, Yaron*,+,++; Wales, Paul W.*,++,[S]

doi : 10.1097/MPG.0000000000002868

Issue: Volume 72(1), January 2021, p 43-48

Objective: Gastrointestinal dysmotility is common in patients with pediatric intestinal failure (PIF), leading to delays in advancement of enteral nutrition (EN). Few studies have been published regarding the safety and efficacy of cisapride for improvement of enteral tolerance and ability to wean parenteral nutrition. Our objective was to describe a single center experience on the use of cisapride in patients with PIF.

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Anti-TNF-[alpha] Therapy Exerts Intestinal Anti-inflammatory and Anti-apoptotic Effects After Massive Bowel Resection in a Rat

Sukhotnik, Igor*,++; Ben-Shahar, Yoav+,++; Pollak, Yulia++; Cohen, Shlomi*,[S]; Guz-Mark, Anat*,||; Shamir, Raanan*,||

doi : 10.1097/MPG.0000000000002876

Issue: Volume 72(1), January 2021, p 49-55

Objectives: The aim of this study was to examine the effect of massive small bowel resection on proinflammatory cytokine intestinal expression and the effect of anti-TNF-[alpha] antibodies (ATA) on intestinal inflammation, epithelial cell turnover, and intestinal adaptation after bowel resection in rats.

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Infliximab Level Between Venous and Capillary Blood Using Novel Device Strongly Correlate in Paediatric Inflammatory Bowel Disease Patients

Zijlstra, Marieke*; Jongsma, Maria M.E.+; de Vries, Annick++; Schaap, Tiny++; Bloem, Karien++; de Ridder, Lissy+

doi : 10.1097/MPG.0000000000002906

Issue: Volume 72(1), January 2021, p 56-60

Objectives: Blood to measure infliximab (IFX) levels is typically obtained with venipuncture. Dried blood sampling (DBS), using capillary blood obtained from a finger prick, would be an alternative to measure IFX blood levels while being more patient friendly. The aim of this study is to compare IFX blood level measured by venipuncture versus DBS in patients with paediatric inflammatory bowel disease (PIBD) to assure accuracy.

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Positivity of Stool Pathogen Sampling in Pediatric Inflammatory Bowel Disease Flares and Its Association With Disease Course

Melnik, Pesah*; Soffair, Niv*; Matar, Manar*; Shamir, Raanan*,+; Assa, Amit*,+

doi : 10.1097/MPG.0000000000002895

Issue: Volume 72(1), January 2021, p 61-66

Objectives: Acute exacerbations of inflammatory bowel disease (IBD) may involve enteric pathogen. We aimed to assess the frequency and outcomes of Clostridium difficille toxin (CDT) and non-CDT enteric infections in symptomatic pediatric patients with IBD.

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Development and Validation of a Self-management Skills Assessment Tool for Children With Inflammatory Bowel Disease: The Inflammatory Bowel Disease-Skills Tasks and Abilities Record (IBD-STAR)

Vernon-Roberts, Angharad*; Frampton, Chris+; Gearry, Richard B.+; Day, Andrew S.*

doi : 10.1097/MPG.0000000000002905

Issue: Volume 72(1), January 2021, p 67-73

Objectives: For children with inflammatory bowel disease (IBD), the development of self-management skills has the potential to improve disease outcomes. No assessment tools are aimed at measuring self-management skills in this population. A tool was developed called the IBD-Skills Tasks and Abilities Record (IBD-STAR) which measures children's allocation of responsibility for specific skills. IBD-STAR contains 18 items, scored whether completed independently (score 2), with help (score 1) or not at all (score 0).

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Clinical Remission and Psychological Management are Major Issues for the Quality of Life in Pediatric Crohn Disease

Gourdonneau, Anne*; Bruneau, Lea+,++; Ruemmele, Frank M.[S]; Norsa, Lorenzo[S]; Takeda, Armelle[S]; Le Gall, Catherine||; Clouzeau, Haude*; Rebouissoux, Laurent*; Dabadie, Alain[P]; Bridoux-Henno, Laure[P]; Rebeuh, Julie#; Thomassin, Nadege**; Viala, Jerome++; Willot, Stephanie++++; Breton, Anne[S][S]; Coopman, Stephanie||||; Spyckerelle, Claire[P][P]; Languepin, Jeanne##; Bertrand, Valerie***; Mouterde, Olivier+++; Degas, Vanessa++++++; Bonneton, Marjorie[S][S][S]; Lemale, Julie||||||; Destombe, Sylvie[P][P][P]; Billiemaz, Kareen[P][P][P]; Caron, Nicolas###; Borderon, Corinne###; Dupont, Claire****; Triolo, Valerie++++; Jobert, Agathe++++++++; Lamireau, Thierry*; Enaud, Raphael*

doi : 10.1097/MPG.0000000000002865

Issue: Volume 72(1), January 2021, p 74-79

Objectives: Crohn disease (CD) can affect patient's quality of life (QOL) with physical, social, and psychological impacts. This study aimed to investigate the QOL of children with CD and its relationship with patient and disease characteristics.

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Higher Waitlist Mortality in Pediatric Acute-on-chronic Liver Failure in the UNOS Database

Godfrey, Elizabeth*; Desai, Moreshwar*,+; Lam, Fong*,+; Goss, John*,+; Rana, Abbas*,+; Miloh, Tamir++

doi : 10.1097/MPG.0000000000002891

Issue: Volume 72(1), January 2021, p 80-87

Objectives: Acute-on-chronic liver failure (ACLF), whereas increasingly well-defined in adults, has been poorly characterized in pediatric patients other than having a poor prognosis. This study aimed to identify ACLF and evaluate prognosis in the American pediatric population.

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Use of Dietary Supplements in Pediatric Liver Disease and Transplantation

Korotkaya, Yelena*; Conner, Kim+; Lau, Jen++; Mullin, Gerard[S]; Harpavat, Sanjiv||; Miloh, Tamir[P]; Mogul, Douglas*

doi : 10.1097/MPG.0000000000002922

Issue: Volume 72(1), January 2021, p e10-e14

Background: Dietary supplements are frequently used by healthy individuals and those with chronic medical conditions but may cause damage to the liver. The aim of this study was to examine the prevalence and attitudes of dietary supplement use, and the frequency of disclosure to healthcare providers among parents/caregivers for children with chronic liver disease.

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Segmental Atrophy of Explanted Livers in Biliary Atresia: Pathological Data From 63 Cases of Failed Portoenterostomy

Santo, Kenji*,[S]; Nakano, Noriyuki*; Kasahara, Mureo+; Sakamoto, Seisuke+; Fukuda, Akinari+; Kanamori, Yutaka++; Fujino, Akihiro++; Horiike, Masaki[S]; Shibata, Toshihiko[S]; Muraji, Toshihiro||; Yoshioka, Takako*

doi : 10.1097/MPG.0000000000002929

Issue: Volume 72(1), January 2021, p 88-94

Objectives: Atrophy of the left lateral segment (LLS) is often encountered in liver transplantation (LT) for biliary atresia (BA). To clarify the meaning of the heterogeneous atrophy, we compared the pathological characteristics of the LLS with the right posterior segment (RPS) of BA livers obtained during LT.

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Efficacy of Sofosbuvir/Ledipasvir in Adolescents With Chronic Hepatitis C Genotypes 1, 3, and 4: A Real-world Study

Serranti, Daniele*; Nebbia, Gabriella+; Cananzi, Mara++; Nicastro, Emanuele[S]; Di Dato, Fabiola||; Nuti, Federica[P]; Garazzino, Silvia#; Silvestro, Erika#; Giacomet, Vania**; Forlanini, Federica**; Pinon, Michele++; Calvo, Pier Luigi++; Riva, Silvia++++; Dodi, Icilio[S][S]; Cangelosi, Antonina Marta[S][S]; Antonucci, Roberto||||; Ricci, Silvia[P][P]; Bartolini, Elisa*; Mastrangelo, Greta*; Trapani, Sandra*; Lenge, Matteo##; Gaio, Paola++; Vajro, Pietro***; Iorio, Raffaele||; D'Antiga, Lorenzo[S]; Indolfi, Giuseppe+++

doi : 10.1097/MPG.0000000000002900

Issue: Volume 72(1), January 2021, p 95-100

Objectives: Sofosbuvir/Ledipasvir (SOF/LDV) has been approved by the European Medicine Agency (EMA) for the treatment of children and adolescents (at least 3 years of age) with chronic hepatitis C (CHC) genotype 1, 3, and 4 infection. The aim of this study was to evaluate the efficacy and safety of SOF/LDV in adolescents (12 to <18 years old) with CHC in the real-world setting.

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Presentation and Outcomes of Autoimmune Hepatitis Type 1 and Type 2 in Children: A Single-center Study

Roepe, Isaiah G.*; Vierling, John M.*; Goss, John A.*; Miloh, Tamir*,+,++

doi : 10.1097/MPG.0000000000002892

Issue: Volume 72(1), January 2021, p 101-107

Objective: Autoimmune hepatitis (AIH) is designated as type 1 or 2 (AIH-1/2) on the basis of serum autoantibody (Ab) profiles. In children, AIH may present as acute or chronic liver failure or cirrhotic AIH (ALF/CLF/CAIH) with or without overlap sclerosing cholangitis (SC). The aim of this study was to compare demographics, presentation, and outcomes between groups in children.

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Multiparametric MRI as a Noninvasive Monitoring Tool for Children With Autoimmune Hepatitis

Janowski, Kamil*; Shumbayawonda, Elizabeth+; Dennis, Andrea+; Kelly, Matt+; Bachtiar, Velicia+; DeBrota, David+; Langford, Caitlin+; Thomaides-Brears, Helena+; Pronicki, Maciej++; Grajkowska, Wieslawa++; Wozniak, Malgorzata*; Pawliszak, Piotr[S]; Chelstowska, Sylwia[S]; Jurkiewicz, Elzbieta[S]; Banerjee, Rajarshi+; Socha, Piotr*

doi : 10.1097/MPG.0000000000002930

Issue: Volume 72(1), January 2021, p 108-114

Objectives: Autoimmune hepatitis (AIH) is a progressive liver disease managed with corticosteroids and immunosuppression and monitored using a combination of liver biochemistry and histology. However, liver biopsy is invasive with risk of pain and bleeding. The aim of the present study was to investigate the utility of noninvasive imaging with multiparametric magnetic resonance imaging (MRI) (mpMRI) to provide clinically useful information on the presence and extent of hepatic inflammation, potentially guiding immunosuppression.

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Optimized Trientine-dihydrochloride Therapy in Pediatric Patients With Wilson Disease: Is Weight-based Dosing Justified?

Mayr, Toni*; Ferenci, Peter+; Weiler, Markus++; Fichtner, Alexander[S]; Mehrabi, Arianeb||; Hoffmann, Georg Friedrich[S]; Mohr, Isabelle*; Pfeiffenberger, Jan*; Weiss, Karl Heinz*; Teufel-Schafer, Ulrike[S],[P]

doi : 10.1097/MPG.0000000000002902

Issue: Volume 72(1), January 2021, p 115-122

Objectives: The aim of the study was to investigate the efficacy and safety of trientine-dihydrochloride (TD) in pediatric patients with Wilson disease (WD) and the effect of different weight-based dosages on their clinical and biochemical outcome.

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Fat-soluble Vitamin Deficiency is Common in Children With Chronic Pancreatitis Undergoing Total Pancreatectomy With Islet Autotransplantation

McEachron, Kendall R.*; Downs, Elissa M.+; Schwarzenberg, Sarah J.+; Chinnakotla, Srinath*; Bellin, Melena D.*,+

doi : 10.1097/MPG.0000000000002950

Issue: Volume 72(1), January 2021, p 123-126

ABSTRACT: The prevalence of fat-soluble vitamin (FSV) deficiency in children undergoing total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis (CP) is unknown. We quantified FSV deficiency in 100 children (age <=18) undergoing TPIAT. FSV levels (vitamins A, E, D) and clinical history were abstracted from medical records. Vitamin A was low in 4% before and 7% at 1 year after TPIAT, vitamin E in 17% and 18%, and vitamin D in 22% and 24%, respectively, regardless of pancreatic enzyme or vitamin supplement dosing. Longer duration of CP was associated with pre-TPIAT vitamin D insufficiency (P = 0.0002). This remained significant in a multivariate regression model (adjusted P = 0.01). On multivariate analysis, there were no significant predictors of low FSV levels post-TPIAT. FSV deficiencies are common among children undergoing TPIAT and patients who have had longer disease duration may be at increased risk. All children should be monitored for FSV deficiency after TPIAT.

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Lifestyle Modification Improves Insulin Resistance and Carotid Intima-Media Thickness in a Metabolically Healthy Obese Prepubescent Population

Gallardo-Escribano, Cristina*; Vargas-Candela, Antonio+; Vilches-Perez, Alberto++; Munoz-Melero, Maite+; Ruiz-Moreno, M. Isabel+; Benitez-Porres, Javier[S]; Romance-Garcia, Angel Ramon||; Rodriguez-Ortega, Rocio[P]; Rosa-Lopez, Andres[P]; Rosales-Jaime, Antonio#; Diaz-Ruiz, Juan**; Tinahones, Francisco J.++,**; Gomez-Huelgas, Ricardo+,++; Bernal-Lopez, M. Rosa+,++

doi : 10.1097/MPG.0000000000002901

Issue: Volume 72(1), January 2021, p 127-134

Objectives: The aim of this study was to analyze effects of a 12-month lifestyle modification that involved a Mediterranean diet (MedDiet) and physical activity (PA) program in a population of metabolically healthy obese children (MHOCh).

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Switch to Efavirenz Attenuates Lipoatrophy in Girls With Perinatal HIV

Su, Junwei*; Shiau, Stephanie+; Arpadi, Stephen M.++,[S],||; Strehlau, Renate[P]; Burke, Megan[P]; Patel, Faeezah[P]; Kuhn, Louise[S],||; Coovadia, Ashraf[P]; Yin, Michael T.#; CHANGES Bone Study Team

doi : 10.1097/MPG.0000000000002907

Issue: Volume 72(1), January 2021, p e15-e20

Objectives: Children with HIV (CHIV) have lifetime exposure to antiretrovirals (ART); therefore, optimizing their regimens to have the least impact on fat redistribution is a priority.

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Factors Associated With Success and Failure of Weaning Children From Prolonged Enteral Nutrition: A Retrospective Cohort Study

Dipasquale, Valeria*; Lecoeur, Katia*; Aumar, Madeleine*,+; Guimber, Dominique*; Coopman, Stephanie*; Nicolas, Audrey*; Turck, Dominique*,+; Gottrand, Frederic*,+; Ley, Delphine*,+

doi : 10.1097/MPG.0000000000002909

Issue: Volume 72(1), January 2021, p 135-140

Objectives: The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure.

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Emergency Presentations for Gastrostomy Complications Are Similar in Adults and Children

Chua, Nina*,+; Singh, Harveen*; Lay, Joshua*; Murray, Megan++; McDonald, Jennifer++; Craig, Simon S.*,[S],||; Giles, Edward M.*,[P]

doi : 10.1097/MPG.0000000000002920

Issue: Volume 72(1), January 2021, p 141-143

ABSTRACT: Gastrostomy tube (GT) complications are often managed in the Emergency Department (ED). We aimed to characterize and compare the pattern of ED presentations of GT complications in adults and children. A retrospective chart review of patients with GT complications presenting to 3 Australian EDs in 2 years was undertaken. ED visits for GT complications occurred in 70 GT patients (36 adults, 34 children) with 122 presentations. When comparing adults to children, infections occurred in 21% versus 36%, respectively; P = 0.08, mechanical issues in 48% versus 52%; P = 0.86, vomiting in 23% versus 8%; P = 0.02, and other issues in 7% versus 5%; P = 0.7. Presentation to ED within 28 days of initial GT insertion occurred in 3 (8%) adults and 3 (9%) children, predominantly with tube dislodgement. GT complications seen in ED are predominantly infectious and mechanical in nature, with an increased frequency of vomiting in adults when compared with children.

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Endoscopic Pancreatic Function Testing (ePFT) in Children: A Position Paper From the NASPGHAN Pancreas Committee

Patel, Nishant*; Sellers, Zachary M.+; Grover, Amit++; Liu, Quin Y.[S]; Maqbool, Asim||; Morinville, Veronique D.[P]; Abu-El-Haija, Maisam#,**; Husain, Sohail Z.+

doi : 10.1097/MPG.0000000000002931

Issue: Volume 72(1), January 2021, p 144-150

ABSTRACT: Endoscopic pancreatic function testing (ePFT) is one of the few ways to directly diagnose exocrine pancreatic insufficiency, and considerable confusion regarding indications, utility, and interpretation of the test remains. This position paper of the Pancreas Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition reviews the history and indications for ePFT in children. We compare various methods in current practice and determine their strengths and limitations, and based on data from children and adults we provide guidance on a protocol on how to perform ePFT in children. Lastly, we pose areas in need of further research relating to ePFT in children.

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North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the Society for Pediatric Radiology Joint Position Paper on Noninvasive Imaging of Pediatric Pancreatitis: Literature Summary and Recommendations

Trout, Andrew T.*,+,++; Anupindi, Sudha A.[S]; Freeman, A. Jay||; Macias-Flores, Jorge Alberto[P]; Martinez, J. Andres#; Parashette, Kalyan R.**; Shah, Uzma++; Squires, Judy H.++++; Morinville, Veronique D.[S][S]; Husain, Sohail Z.||||; Abu-El-Haija, Maisam++

doi : 10.1097/MPG.0000000000002964

Issue: Volume 72(1), January 2021, p 151-167

ABSTRACT: The reported incidence of pediatric pancreatitis is increasing. Noninvasive imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), play important roles in the diagnosis, staging, follow-up, and management of pancreatitis in children. In this position paper, generated by members of the Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the Abdominal Imaging Committee of The Society for Pediatric Radiology (SPR), we review the roles of noninvasive imaging in pediatric acute, acute recurrent, and chronic pancreatitis. We discuss available evidence related to noninvasive imaging, highlighting evidence specific to pediatric populations, and we make joint recommendations for use of noninvasive imaging. Further, we highlight the need for research to define the performance and role of noninvasive imaging in pediatric pancreatitis.

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Development of Entrustable Professional Activities and Standards in Training in Pediatric Neurogastroenterology and Motility: North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and American Neurogastroenterology and Motility Society Position Paper

Khlevner, Julie*; Rosen, Rachel+; Ambartsumyan, Lusine++; Lusman, Sarah Shrager*; Rosen, John M.[S]; Yacob, Desale||; Mousa, Hayat[P]; Nurko, Samuel+; Di Lorenzo, Carlo||; Boruta, Mary#; Ratcliffe, Elyanne M.**; Feinstein, Laurence++; Snyder, Julie+; Wood, Richard J.++++; Graham, Kahleb[S][S]; Saps, Miguel||||; Gyawali, C. Prakash[P][P]; Rodriguez, Leonel##; Belkind-Gerson, Jaime***

doi : 10.1097/MPG.0000000000002965

Issue: Volume 72(1), January 2021, p 168-180

ABSTRACT: Neurogastroenterology and motility (NGM) disorders are common in childhood and are often very debilitating. Although pediatric gastroenterology fellows are expected to obtain training in the diagnosis and management of patients with these disorders, there is an ongoing concern for unmet needs and lack of exposure and standardized curriculum. In the context of tailoring training components, outcome and expressed needs of pediatric gastroenterology fellows and programs, members of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and American Neurogastroenterology and Motility Society (ANMS) developed guidelines for NGM training in North America in line with specific expectations and goals of training as delineated through already established entrustable professional activities (EPAs). Members of the joint task force applied their expertise to identify the components of knowledge, skills, and management, which are expected of NGM consultants. The clinical knowledge, skills and management elements of the NGM curriculum are divided into domains based on anatomic regions including esophagus, stomach, small bowel, colon and anorectum. In addition, dedicated sections on pediatric functional gastrointestinal (GI) disorders, research and collaborative approach, role of behavioral health and surgical approaches to NGM disorders and transition from pediatric to adult neurogastroenterology are included in this document. Members of the NASPGHAN-ANMS task force anticipate that this document will serve as a resource to break existing barriers to pursuing a career in NGM and provide a framework towards uniform training expectations at 3 hierarchical tiers corresponding to EPA levels.

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Anal Canal Duplication in a 12-Year-old Girl

Ozbey, Huseyin*,+

doi : 10.1097/MPG.0000000000002850

Issue: Volume 72(1), January 2021, p e21

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Preduodenal Portal Vein Associated With Intestinal Malrotation as a Possible Cause of Intermittent Acholia

Alonso-Arroyo, Veronica*; Garcia-Fraile, Laura+; Torres, Irune+; Gonzalez, Susana++; Molina, Maria E.*; Gomez, Oscar*; Sanchez-Abuin, Alberto[S]

doi : 10.1097/MPG.0000000000002889

Issue: Volume 72(1), January 2021, p e21

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MYO5B Pathogenic Variants Found to Cause Intestinal Symptoms Without Microvillus Inclusion Disease in a Child Who Previously Underwent Liver Transplantation for PFIC-like Cholestasis

Jarasvaraparn, Chaowapong*; He, Mai+; Granadillo, Jorge L.++; Kulkarni, Sakil*; Stoll, Janis*; Liss, Kim*

doi : 10.1097/MPG.0000000000002792

Issue: Volume 72(1), January 2021, p e22-e24

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Pediatric Endoscopy During the COVID-19 Pandemic: Addressing the Implications of Universal Preprocedural Testing for PPE Utilization

Hsu, Evelyn K.*; Ambartsumyan, Lusine*; Wahbeh, Ghassan T.*; Zerr, Danielle M.+; Lin, Tom K.++

doi : 10.1097/MPG.0000000000002962

Issue: Volume 72(1), January 2021, p e25-e26

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Pediatric Endoscopy During the COVID-19 Pandemic: Implications of Universal Preprocedural Testing for PPE Utilization

Walsh, Catharine M.*; Fishman, Douglas S.+; Lerner, Diana G.++

doi : 10.1097/MPG.0000000000002963

Issue: Volume 72(1), January 2021, p e26-e28

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Break the Rule of Three: Critical Thoughts From a Tertiary Care Experience With Bougie Dilators

Tambucci, Renato; Malamisura, Monica; Napoli, Marco; Rea, Francesca; Faraci, Simona; Romeo, Erminia Francesca; Angelino, Giulia; Caldaro, Tamara; Guerra, Luciano; Contini, Anna Chiara Iolanda; Federici di Abriola, Giovanni; Dall'Oglio, Luigi; De Angelis, Paola; Torroni, Filippo

doi : 10.1097/MPG.0000000000002969

Issue: Volume 72(1), January 2021, p e28

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Commentary on "Break the Rule of Three: Critical Thoughts from a Tertiary care Experience with Bougie Dilators"

Yasuda, Jessica L.*; Ngo, Peter D.*; Staffa, Steven J.+; Zendejas, Benjamin++; Hamilton, Thomas E.++; Jennings, Russell W.++; Manfredi, Michael A.*

doi : 10.1097/MPG.0000000000002970

Issue: Volume 72(1), January 2021, p e29

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Recognizing Pediatric Acute-on-chronic Liver Failure: the Need of the Hour

Bolia, Rishi*; Srivastava, Anshu+

doi : 10.1097/MPG.0000000000002934

Issue: Volume 72(1), January 2021, p e29-e30

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Response to: Recognizing Pediatric Acute-on-chronic Liver Failure: the Need of the Hour

Banc-Husu, Anna M.; Alonso, Estella M.

doi : 10.1097/MPG.0000000000002935

Issue: Volume 72(1), January 2021, p e30

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