Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Celiac disease (CeD) is a common autoimmune condition requiring lifelong adherence to a gluten-free diet (GFD). Patients and caregivers increasingly seek information online, and large language models (LLMs) have emerged as potential educational tools. However, their reliability in CeD remains uncertain. This study aimed to evaluate the performance of three popular LLMs in answering frequently asked questions (FAQs) about CeD and GFD management.

Methods: We conducted a cross-sectional comparative evaluation in which 12 FAQs were submitted to three LLMs: ChatGPT-4 (OpenAI), Gemini Flash 2.5 (Google), and Claude Sonnet 3.7 (Anthropic). Six pediatric gastroenterologists with expertise in CeD research and education, independently assessed and rated responses for accuracy, completeness, clarity, and overall quality using a 5-point Likert scale.

Results: The mean overall score across models was 4.3 ± 0.35 out of 5. Clarity received the highest ratings (4.56 ± 0.21), followed by accuracy (4.26 ± 0.52), completeness (4.17 ± 0.21), and overall quality (4.20 ± 0.36). Responses to management-related questions scored significantly higher than those to diagnostic questions (4.4 vs. 4.2, p = 0.013). Inter-rater reliability was good (intraclass correlation coefficient = 0.74). Overall, Gemini achieved the highest ratings (p < 0.01).

Conclusions: LLMs provide clear and generally accurate responses to CeD FAQs, particularly on management-related topics. While they represent a promising tool for patient education, variability in accuracy highlights the need for clinician oversight when interpreting artificial intelligence-generated medical information.

Objective: Identifying predictors of unfavorable disease course in pediatric ulcerative colitis (UC) will impact therapeutic strategy. We aimed to define predictors of nonremission 2 years after diagnosis in pediatric patients with UC.

Methods: This retrospective analysis of prospectively collected data from ImproveCareNow included pediatric UC patients (<18 years) diagnosed between 2007 and 2023 with at least a 2-year follow-up. Remission was defined as a pediatric UC activity index (PUCAI) < 10 points. Statistical analysis was performed using the International Business Machines Corporation Statistical Package for the Social Sciences (SPSS) version 29. Demographic information at diagnosis/enrollment (T0), first visit (T1) and follow-up (T2, closest to 24 months) were calculated between relevant groups. Binary logistic regression was used to identify outcome predictors. Multiple imputation was used for missing data. This study was approved by the Ethics Committee (Protocol 23135-ICN_UC).

Results: We included 1290 pediatric UC patients. Two years after diagnosis, 390 patients (30%) were not in remission at T2. Differences in disease severity and treatment were observed at T1 and T2. PUCAI (mild odds ratio [OR] = 1.946, moderate OR = 1.735, or severe disease OR = 3.183, p < 0.01), the use of immunomodulators (IM) (OR = 0.631, p = 0.053) and body mass Index (BMI) z-score (OR = 1.149, p = 0.022) at T1 (mean 30 days) predicted non-remission at T2 with poor discriminating ability (area under the curve 0.599-0.621).

Conclusion: Predictors for unfavorable disease course were increasing disease severity according to PUCAI (vs. inactive disease), increasing BMI z-score (per z-score increase) and nonuse of IM at T1. These predictors may impact therapeutic strategy shortly after diagnosis.

Objective: This study investigated the relationship between the consumption of ultra-processed foods (UPF), dietary profile, and inflammation on the intestinal microbiome in children.

Methods: A cross-sectional study was conducted using data from a community-based controlled trial involving 82 children aged 7-11 years enrolled in public schools in João Pessoa, Paraíba, Brazil. The gut microbiome was assessed by 16S rRNA gene sequencing. Dietary intake was assessed by a 24-h food recall and UPF intake was estimated using the NOVA system. Anthropometry, socio-economic variables, and cytokines (IL-2, IL-4, IL-6, IL-10, IL-17a, IFN-γ, and TNF-α) were also assessed.

Results: Children in the third tertile (higher consumption of UPF) had a higher intake of calories from UPF (p < 0.01), trans-fatty acids (p = 0.01), thiamine (p = 0.02), while the intake of protein (p = 0.01), and copper (p = 0.04) was lower. Children in the third tertile had lower abundance of Ruminococcaceae (p = 0.04) and Barnesiellaceae (p = 0.02) and higher abundance of the Monoglobaceae and Erysipelotrichaceae (p = 0.04). Several bacterial genera showed significant correlations with inflammatory cytokines. Dorea and Subdoligranulum were associated with IL-17A and IL-10; Agathobacter with IL-6, IL-10, and IFN-γ; Faecalibacterium with IL-10, IFN-γ, and TNF-α; Fusicatenibacter and Bifidobacterium with IL-10; and Roseburia with TNF-α (all q < 0.05).

Conclusions: A high UPF intake was associated with a poorer-quality diet and changes in the composition of the gut microbiome, suggesting potential interactions between diet, microbial communities, and immune responses.

Objectives: High-resolution anorectal manometry (HR-ARM) is a diagnostic test assessing anorectal neuromuscular function in children with constipation and/or fecal incontinence. Interrater reliability of HR-ARM in children has not been previously studied. The aim of this study was to assess the interrater reliability of pediatric HR-ARM studies.

Methods: Ten pediatric gastroenterologists specialized in neurogastroenterology and motility analyzed ten deidentified pediatric HR-ARM studies using dedicated analysis software (Solar GI HRM v9.1, MMS, Enschede, the Netherlands). Anal canal resting pressure, squeeze pressure and duration, presence of the rectoanal inhibitory reflex (RAIR), bear down maneuver (normal/abnormal), and final interpretation of the study (normal/abnormal) were evaluated. Fleiss' Kappa (κ) and intraclass correlation coefficient (ICC) were used for categorical and continuous data, respectively.

Results: Interrater reliability was excellent for resting pressure (ICC 0.97, 95% confidence interval [CI 0.93-0.99), squeeze pressure (ICC 0.97, 95% CI 0.94-0.99), and squeeze duration (ICC 0.93, 95% CI 0.85-0.98). A fair interrater agreement for the RAIR (κ = 0.35) was seen, and a moderate interrater agreement was seen for interpretation of the bear down maneuver and the final interpretation of the study either being normal or abnormal (κ = 0.50 and κ = 0.43, respectively).

Conclusions: This study demonstrated excellent interrater reliability in assessing HR-ARM anal canal resting pressure, squeeze pressure, and squeeze duration and suboptimal reliability in interpreting the detection of a RAIR and bear down maneuver. These findings highlight the need for standardization of HR-ARM protocols and interpretation criteria in children.

Objective: To report a single-center experience with a multidisciplinary minimally invasive surgical approach for pediatric ulcerative colitis (UC) and identify risk factors for early postoperative complications (EPC).

Methods: A retrospective analysis was conducted on UC patients followed at the Gastroenterology Unit of Meyer Children's Hospital, who underwent surgery between 2010 and 2023.

Results: Seventy-four surgical procedures in 31 patients were analyzed. All patients underwent subtotal colectomy; 24 proceeded to ileal-pouch-anal anastomosis (IPAA), and 19 had completed ileostomy closure at the time of analysis. Twenty-five (80.7%) colectomies were laparoscopic, and 6 (19.3%) were open. Among IPAA procedures, 20.8% (n = 5) were open, 50% (n = 12) were laparoscopic, and 29.2% (n = 7) were robotic. Eight patients (25.8%) experienced EPC after colectomy. Univariate analysis identified diagnosis before 6 years of age (very early onset inflammatory bowel disease) as a significant risk factor for EPC (p = 0.026; OR: 10.5; 95% CI: 1.4-38). Open and laparoscopic approaches showed comparable EPC rates (colectomy: 16.7% vs. 28%, p = 0.998; IPAA: 20% vs. 8.3%, p = 0.515). Laparoscopic surgery was associated with a significantly lower time to enteral feeding, bowel function recovery, and hospital discharge for both colectomies (p = 0.005, 0.002, and 0.025, respectively) and IPAA procedures (p = 0.008, 0.001, and 0.044, respectively). Robotic approach further shortened return of bowel function compared to both laparoscopic and to open approach (p = 0.032 and p = 0.002, respectively).

Conclusions: Minimally invasive surgery for pediatric UC is safe and associated with improved postoperative recovery. Younger age and poor nutritional status may increase the risk of early complications. The robotic approach also shows promise in further improving recovery times.

Objectives: This study evaluated enothelial function in children with Helicobacter pylori (H. pylori) using flow-mediated dilatation (FMD) and assessed the effect of eradication therapy.

Methods: Sixty symptomatic children were enrolled consecutively and divided into two groups after endoscopy: 30 children with confirmed H. pylori infection, and 30 children with negative H. pylori. Thirty age- and sex-matched healthy children served as controls. Complete blood count, high-sensitivity C-reactive protein (hs-CRP), and complete lipid profiles were obtained. Endothelial function was assessed by brachial artery FMD. H. pylori positive patients received triple therapy for 2 weeks and were reassessed after 3 months.

Results: H. pylori-positive children had significantly higher hs-CRP (6.7 ± 2.3), cholesterol (190.2 ± 31.2), triglycerides (133.2 ± 60.5), and low-density lipoprotein (129.6 ± 24.7) than H. pylori-negative (2.9 ± 1.6, 167.6 ± 41.0, 86.3 ± 23.6, and 95.5 ± 28.8) and controls (0.7 ± 0.2, 151.8 ± 31.3, 90.5 ± 32.5, and 84.5 ± 23.3) (p < 0.001). Conversely, hemoglobin (9.7 ± 1.2), high-density lipoprotein (HDL) (35.9 ± 9.1), and FMD (6.07 ± 1.60) were significantly lower compared to the H. pylori-negative (11.5 ± 0.8, 45.4 ± 13.3, and 9.500 ± 1.20) and controls (11.7 ± 0.9, 55.0 ± 10.1, and 9.80 ± 1.20) (p < 0.001). After eradication, responders showed significant increases in hemoglobin, HDL, and FMD with significant decreases in hs-CRP and other lipid profiles (p < 0.001). FMD correlated negatively with symptoms' duration, hs-CRP, cholesterol, and Sydney score, but positively with HDL.

Conclusion: Children with H. pylori infection exhibited endothelial dysfunction and dyslipidemia, both of which improved significantly after successful eradication.

Objectives: Transabdominal ultrasound (TAUS) is frequently utilized in pediatric acute pancreatitis, but less is known about its use in acute recurrent (ARP) or chronic pancreatitis (CP). Our aim was to describe TAUS utilization and findings from the largest multicenter cohort of pediatric ARP and CP, the International Study Group of Pediatric Pancreatitis: In Search for a CuRE-2 (INSPPIRE-2).

Methods: Demographic and imaging data from physician questionnaires were obtained for patients with available TAUS data. Utilization and findings were compared between ARP and CP groups. Kappa statistics were used to compare agreement of TAUS to computed tomography (CT), magnetic resonance imaging/cholangiopancreatography (MRI/MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) for CP findings.

Results: There were 895 patients (460 ARP, 435 CP) included with 2531 TAUS examinations. Mean number of TAUS per year was similar between CP and ARP patients (0.90 vs. 0.90, p = 0.97). The pancreas was well visualized in 65% of examinations (60% ARP vs. 68% CP, p ≤ 0.001). TAUS and CT demonstrated the most consistent agreement among other modalities with kappa values ranging from 0 to 0.66 with substantial agreement for pancreatic duct irregularities (ĸ = 0.62) and moderate agreement for calcifications (ĸ = 0.57). Agreement between other modalities and TAUS was generally lower and diminished closer to CP diagnosis date.

Conclusion: This is the largest report of TAUS findings in children with ARP or CP. TAUS has several benefits in the initial or emergent evaluation of ARP including availability and tolerance. The ability of TAUS to screen for progression of disease requires further study.