Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Functional dyspepsia (FD) is a disorder of the gut-brain interaction characterized by epigastric pain, nausea, and/or early satiety. Existing literature suggests a physical link between psychiatric diagnoses and disorders of the gut-brain interaction at intestinal mast cells (MC) via corticotropin-releasing hormone (CRH) and its intestinally located receptors (CRHR1/CRHR2). Our study aimed to further clarify the physiologic connection between pediatric psychiatric illness and FD.

Methods: Study subjects were identified and classified into three groups. The FD group met Rome IV criteria and had insignificant gross endoscopic and histologic findings on gastric and duodenal biopsies. The control group reported no gastrointestinal symptoms or documented psychiatric illness. A third group consisted of Helicobacter pylori (HP)-positive dyspepsia patients independent of psychiatric history. Duodenal biopsy blocks were stained with antibodies targeting MCs, CRH, and CRHR1/CRHR2.

Results: We included 49 patients: 21 FD, nine controls, and 19 HP patients. We found a statistical difference between duodenal MC density in FD versus controls and HP versus controls (p < 0.05). We found no significant CRHR2 staining in the control group, yet the FD and HP groups yielded strong stains. We found a significant increase in MC density and CRHR2 staining in patients with a psychiatric history versus without (p < 0.05).

Conclusion: Our data show increased MC density and stronger CRHR2 staining in patients with FD and in patients with a psychiatric history. Our data support a pathophysiologic theory of FD development via a "gut-brain axis" intersecting at the level of MCs with influence via peripheral CRH.

Objectives: In a subgroup of children with refractory constipation, colonic function investigations, such as colonic transit scintigraphy (CS) and colonic manometry (CM), are used to define the underlying pathophysiologic mechanisms. There are limited studies comparing colonic transit and contractile function. We aimed to correlate CS and CM and assess whether specific manometric patterns might predict the luminal transit findings.

Methods: Children with refractory constipation undergoing both CS and CM between 2012 and 2022 at two Tertiary Pediatric Gastroenterology Services were retrospectively reviewed. For CS, the geometric center (GC) was used to quantify the transit across the different colonic segments and studies were categorized into normal transit, recto-sigmoid hold-up, and slow transit. Contractile patterns from CM were classified into equivalent regional subtypes as normal, distal colonic dysmotility and pan-colonic dysmotility, respectively.

Results: Twenty-two patients (59% male, median age: 10.94 years) were included. No significant agreement in the subtype of constipation was found between CS and CM (K = 0.224, p = 0.070). However, a strong correlation was observed between the numeric score of the GC at 6 h and the amplitude of bisacodyl-induced high amplitude propagating contractions (HAPCs) in the rectosigmoid (r = 0.761, p = 0.007). Moreover, a higher percentage of radiotracers in the ascending colon at 24 h was related to a higher number of bisacodyl-induced HAPCs.

Conclusions: Scintigraphic GC at 6 h showed a substantial correlation with parameters from CM in the rectosigmoid colon, implicating the potential role of this colonic region as a gatekeeper for colonic luminal transit.

Objectives: To examine the effects of lipid-based nutrient supplements (LNS) containing milk protein (MP) and/or whey permeate (WP) on markers of intestinal inflammation and enterocyte mass among stunted children. Furthermore, to explore whether gut status modifies effects of LNS on growth and micronutrient status.

Methods: In a 2 × 2 factorial trial 12-59 months-old Ugandan children with stunting were randomized to four LNS formulations (100 g/day for 12 weeks) containing MP or soy protein and WP or maltodextrin, or to no supplementation. Linear mixed-effects models were used to explore faecal myeloperoxidase (f-MPO) and plasma citrulline (p-cit) as outcomes and modifiers of the intervention effects (ISRCTN13093195).

Results: Of 750 children, mean ± SD age was 32.0 ± 11.7 months and height-for-age Z-score was -3.02 ± 0.74. Neither MP nor WP had effects on p-cit or f-MPO. f-MPO decreased over time among controls (ratio of change 0.54, 95% confidence interval [CI]: 0.35, 0.84), but not among those given LNS (0.99, 95% CI: 0.79, 1.23) (p = 0.016). In contrast, LNS had no effect on p-cit (p = 0.27). The effect of LNS on cobalamin (B12) status was reduced in children with p-cit <20 µmol/L; whereby there was 20% (95% CI: 2, 35) lower increase in plasma cobalamin and 59% (95% CI: 13, 125) smaller decrease in plasma methylmalonic acid. p-cit or f-MPO did not modify the effects of LNS on growth or other micronutrient markers.

Conclusion: LNS had no effect on enterocyte mass and possibly increased intestinal inflammation. The effect of LNS on cobalamin status was reduced in those with low enterocyte mass.

Introduction: Acute gastroenteritis (AGE) is a frequent cause of infant morbidity and mortality. There are many adjuvants therapeutic strategies for treatment, including probiotics, however, their efficacy is still debated.

Objectives: To assess the efficacy of the strain Lactobacillus reuteri DSM 17938 adjunct to oral rehydration therapy (ORT) in the treatment of children with AGE.

Methods: Randomized, controlled, double-blind, clinical trial conducted in a pediatric emergency department (PED) from October 2021 to January 2023. Children between 1 and 60 months of age with AGE, absence of or mild to moderate dehydration, were included. Clinical and management characteristics were recorded.

Results: Sixty-two patients in L. reuteri (group 1) and seventy patients in the placebo group (group 2) were included. Group 1 had less duration of diarrhea (2.77 ± 0.6 vs. 3.10 ± 1.1 days; p = 0.036). The mean frequencies of watery diarrhea in group 1 versus 2 on Days 2, 3, 4, and 5 were less in group 1. Watery diarrhea persisted in 58.6% in group 2 and in 19.4% of group 1 at 5 days of treatment.

Conclusions: This study shows that L. reuteri DSM 17938 is effective in decreasing frequency and consistency of stools; and is safe at high doses in patients from 1 month to 5 years of age, in emergency management. It is a low-risk and easy-to-administer intervention, which could reduce complications associated with losses due to AGE.

Objectives: To determine total, night- and daytime sleep duration and waking frequency among infants exclusively fed goat milk-based infant formula (GMF) or cow's milk-based infant formula (CMF) enroled in a randomised controlled trial and compare these to a human milk (HM) fed reference group.

Methods: Post hoc analysis from a double-blind randomised controlled trial in 304 healthy term infants was performed. Formula-fed infants were randomly assigned to receive exclusively GMF or CMF for a period of 112 days and compared to a reference group fed HM. Sleep was assessed using a 3-day 24-h diary before the five visits throughout the trial. The association between feeding type and sleep was studied longitudinally and cross-sectionally at the five visits. All models were adjusted for infant sex and study site of enrolment. For associations between formula-fed infants and the non-randomised HM group, additional adjustments were made.

Results: Total sleep duration slowly and similarly decreased over the course of study duration for all groups, with a decrease of about an hour between the first and last measurement. Longitudinally, daytime sleep duration was significantly longer for GMF (mean 8.6 h, standard error [SE] 0.17) and HM (8.8, 0.18) fed infants as compared to CMF (8.1, 0.17; p < 0.05). Cross-sectional analyses show that infants fed GMF or HM had higher total sleep duration than infants fed CMF at all visits, with significant differences between the groups at Visits 3 and 4.

Conclusions: In infants fed GMF a significantly longer daytime sleep duration and a non-significant trend towards a longer total sleep duration were found when compared to infants fed CMF. These findings suggest that nutrition plays a role in sleep duration.

Colonization by Clostridioides difficile is common in children with inflammatory bowel disease (IBD) and complicates both the management of IBD and the diagnosis of C. difficile infection (CDI). There is a paucity of data on rates, risk factors, and outcomes associated with asymptomatic C. difficile colonization in children with IBD. We enrolled and prospectively followed 87 children with IBD without acute gastrointestinal symptoms. Twelve patients (13.8%) tested positive for C. difficile and were considered to have asymptomatic colonization. Elevated white blood cell count was associated with C. difficile colonization based on univariate regression. Three of the 12 (25%) C. difficile colonized patients were diagnosed with CDI in the 90 days following screening for C. difficile, versus 0 of the 75 who tested negative for C. difficile (p = 0.002). This data set the stage for further longitudinal tracking of children with IBD for C. difficile colonization and associated outcomes.

Anaemia is a frequent consequence of many gastrointestinal (GI) diseases in children and it can even be the initial presenting symptom of underlying chronic GI disease. The definition of anaemia is age and gender-dependent and it can be classified based on pathophysiology, red cell morphology, and clinical presentation. Although nutritional deficiencies, including GI malabsorption of nutrients and GI bleeding, play a major role, other pathophysiologic mechanisms seen in chronic GI diseases, whether inflammatory (e.g., inflammatory bowel disease) or not (e.g., coeliac disease and dysmotility), are causing anaemia. Drugs, such as proton pump inhibitors, mesalamine, methotrexate and sulfasalazine, are also a potential cause of anaemia. Not uncommonly, due to a combination of factors, such as iron deficiency and a chronic inflammatory state, the underlying pathophysiology may be difficult to decipher and a broad diagnostic work-up is required. The goal of treatment is correction of anaemia by supplementation of iron and vitamins. The first therapeutic step is to treat the underlying cause of anaemia including bleeding control, restoration of intestinal integrity and reduction of inflammatory burden. The route of iron and vitamin supplementation is guided by the severity of anaemia.