Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Esophageal anastomotic stricture is a common complication following esophageal atresia (EA) repair. While multiple endoscopic therapies exist, predicting individual stricture response remains challenging. Existing classification systems focus primarily on luminal diameter and do not account for complex physical characteristics of the stricture. We developed and evaluated a novel endoscopic scoring tool, stricture classification of pediatric esophageal strictures (SCOPES), to determine if physical features are predictive of treatment response. In addition to its predictive utility, SCOPES aims to standardize the description of and improve communication of stricture morphology across providers and institutions.

Methods: A retrospective cohort study was conducted on EA patients treated at a tertiary referral center between 2019 and 2024. Patients with ≥2 endoscopies and documented SCOPES scores were included. The SCOPES tool categorizes strictures based on diameter, length, scar band intrusion, symmetry, and presence of diverticula. Multivariable mixed-effects regression models were used to analyze associations between SCOPES characteristics and the primary outcome of number of therapeutic endoscopies within 6 months.

Results: Seventy patients (238 endoscopies) met inclusion criteria. In multivariable analysis, symmetric strictures and those with highly intrusive scar bands were significantly associated with a greater number of therapeutic endoscopies within 6 months. Two complications were observed, both managed without long-term sequelae.

Conclusions: The SCOPES classification tool identifies physical stricture features that significantly influence response to endoscopic therapy. Circumferential symmetry and scar tissue protuberance were associated with higher treatment burden, suggesting these characteristics may guide therapeutic decision-making. SCOPES may aid in individualizing endoscopic management of pediatric esophageal strictures and warrants prospective validation.

Objective: Achalasia is a rare esophageal motility disorder in children. Peroral endoscopic myotomy (POEM) has emerged as a promising treatment yet standardized post-treatment evaluation remains lacking. While high-resolution manometry (HRM) is the diagnostic gold standard, its role post-treatment is limited. Pressure-flow analysis (PFA), derived from high-resolution impedance manometry (HRIM), offers a novel approach to assessing bolus transport and esophageal emptying. We aimed to evaluate PFA metrics in pediatric achalasia patients before and after POEM and assess its utility in monitoring post-treatment outcomes.

Methods: This retrospective study included 13 pediatric patients (8 males; mean age 13.3 ± 3.38 years) with achalasia treated with POEM at a tertiary referral center between 2016 and 2024. Inclusion required both pre- and post-POEM HRIM. HRM metrics were analyzed using Chicago Classification version 4.0 (CCv4.0), while PFA parameters, including impedance ratio (IR) and distension pressure during emptying (DPE), were calculated using the Swallow Gateway™ platform.

Results: All patients experienced symptomatic improvement, with the median Eckardt Symptom Score (ESS) significantly decreasing from 6 (range 2-10) to 0 (range 0-2; p = 0.0002). Following POEM, there was a significant reduction in median integrated relaxation pressure (IRP4s: 35.6-15.8 mmHg; p = 0.0002), although 7 out of 13 patients (53.8%) achieved IRP4s values below the upper limit of normal. Additionally, significant decreases were observed in median IR (0.65-0.52, p = 0.0002) and median DPE (28.9-17.3 mmHg, p = 0.0171). Subgroup analysis showed that improvements in IR and DPE occurred regardless of IRP4s normalization.

Conclusion: PFA enhances post-POEM evaluation in pediatric achalasia, offering an objective assessment of esophageal emptying beyond conventional pressure metrics. This study supports the potential role of PFA in post-treatment follow-up, warranting further validation in larger cohorts.

Objectives: This study aimed to investigate the potential of long non-coding RNAs (lncRNA)-MIR3142HG as a novel biomarker for assessing disease activity in pediatric Crohn's disease (CD).

Methods: A total of 119 children suspected of having CD who visited the outpatient department of the affiliated Children's Hospital of Nanjing Medical University from September 2022 to March 2025 and were classified into CD and non-CD groups based on clinical diagnosis. Serum and intestinal mucosal samples were collected, and lncRNA-MIR3142HG expression was quantified using real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR). Clinical activity and endoscopic activity were similarly assessed using the pediatric Crohn's disease activity index (PCDAI) and simplified endoscopic score for CD (SES-CD). Correlations between lncRNA-MIR3142HG levels and clinical indices, including Chiu's histopathological score and Occludin protein expression, were analyzed, with receiver operating characteristic curve area under the curve values calculated for evaluation efficacy.

Results: LncRNA-MIR3142HG expression was significantly elevated in the CD group compared to non-CD and control groups (p < 0.05). Intestinal mucosal lncRNA-MIR3142HG was positively correlated with PCDAI, SES-CD, and Chiu's scores (p < 0.05) and negatively with Occludin expression (p < 0.05). Serum lncRNA-MIR3142HG also showed positive correlations with PCDAI and Chiu's scores (p < 0.05) and a negative correlation with Occludin (p < 0.05).

Conclusions: This study indicated that both serum and intestinal mucosal lncRNA-MIR3142HG, alone or combined with fecal calprotectin, may be useful for evaluating clinical and endoscopic activity in pediatric CD, with combined assessments yielding superior efficacy.

Objectives: Autoimmune gastritis (AIG) is a chronic immune-mediated condition characterized by the destruction of the gastric oxyntic mucosa. Though commonly diagnosed in adults, its occurrence in pediatric patients with autoimmune comorbidities is increasingly reported. This study aims to determine the prevalence of AIG in children with Type 1 diabetes, autoimmune thyroiditis, primary immune regulatory disorders, or refractory anemia (RA), and to assess the diagnostic performance of anti-parietal cell antibodies (APCAs) and anti-intrinsic factor antibodies (AIFAs) in this group of patients.

Methods: We conducted a prospective study in 203 children aged 4-17 years. All underwent laboratory screening for APCAs and AIFAs. Those who tested positive for at least one of the two antibodies were referred for upper endoscopy with gastric biopsies for histological confirmation. A control group of 26 patients with dyspeptic symptoms and negative histology was also evaluated.

Results: Nineteen patients tested positive for APCAs and/or AIFAs (9.4%). Among them, nine (47.4%) had histologically confirmed AIG. Additionally, two patients with RA and negative serology were diagnosed with AIG based on histology. Thus, a total of 11 patients (5.4%) were diagnosed with AIG. The sensitivity and specificity of antibody testing for AIG were 81.8% and 77.9%, respectively.

Conclusions: AIG may be underdiagnosed in children with autoimmune conditions. Our findings support the integration of serological screening with histological assessment to enhance early recognition. The combined use of APCAs and AIFAs demonstrates good diagnostic accuracy, offering a valuable tool for timely diagnosis and improved management in this at-risk pediatric population.

Objectives: Dysbiosis due to early-life antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This follow-up study of a birth cohort primarily investigates the association between antibiotic treatment in the first week of life and the presence of FGIDs at 9-12 years. Secondarily, it examines whether a history of infantile colic or current food allergy is associated with FGIDs.

Methods: A prospective observational birth cohort of 436 term-born infants was followed up at the age of 9-12 years; 151 received intravenous antibiotics in the first week of life due to suspected early onset sepsis (AB+) and 285 did not (AB-). Participants filled out questionnaires on the presence of FGIDs (Rome IV questionnaire) and food allergies, and FGID diagnoses were reported by general practitioners. Statistical analyses included chi-squared tests and multivariable logistic regression.

Results: 306 of 388 eligible participants (79.5%) participated in the follow-up study: 109 (35.6%) AB+ and 197 (64.4%) AB-. FGID prevalence at 9-12 years was similar in AB+ and AB- (any FGID: odds ratio [OR] 1.083, 95% confidence interval [CI] 0.608-1.932). Infantile colic was not significantly associated with FAPDs after adjusting for confounders (adjusted OR 2.007, 95% CI 0.978-4.003, p = 0.051). Children with a food allergy were more likely to have a functional abdominal pain disorder (FAPD) (adjusted OR 4.028, 95% CI 1.532-10.286).

Conclusions: No statistically significant association was observed between first-week antibiotics or infantile colic and FGIDs at 9-12 years of age, but FAPDs were significantly more prevalent in children with food allergies.

Objectives: Disorders of gut-brain interaction (DGBI) affect about 40% of children and are often comorbid with hypermobility spectrum disorders (HSDs) and orthostatic intolerance (OI). However, how these comorbidities impact outcomes in pediatric DGBI is not well understood. This study aimed to compare outcomes in DGBI patients with HSD, OI, both, or neither.

Methods: We reviewed records of patients aged 9-21 years from a multidisciplinary DGBI clinic. Patients met Rome IV criteria for DGBI and had documented HSD and/or OI diagnoses from specialists in gastroenterology, rheumatology, genetics, cardiology, adolescent medicine, and others. HSD terms included Ehlers-Danlos syndrome, hypermobile Ehlers-Danlos syndrome, and generalized hypermobility; OI terms included postural orthostatic tachycardia syndrome, dysautonomia, and orthostatic hypotension. Clinical data included the following validated questionnaires: abdominal pain index, nausea severity scale, functional disability inventory, patient health questionnaire-9 (Depression), children somatization inventory, pediatric insomnia severity index, pain catastrophizing scale for children, and screen for child anxiety related disorders (Anxiety). We compared DGBI patients with both HSD and OI, those with either disorder, and those without.

Results: Of 175 patients, 46% had HSD and 43% had OI. Patients with both HSD and OI had significantly worse nausea, depression, disability, and somatization scores than others (p < 0.01). HSD and OI groups individually also showed worse outcomes than non-HSD/non-OI groups. Moderate correlations were found between depression and anxiety in OI and nausea and disability in HSD.

Conclusions: Comorbid HSD and OI worsen DGBI symptoms. Accurate diagnosis and treatment are critical to improving outcomes due to shared autonomic dysfunction.

Objective: To evaluate neurodevelopment at 24 months in infants surgically treated for esophageal atresia (EA), using the ages and stages questionnaire (ASQ), and identify perinatal and early-life factors associated with developmental delay.

Methods: Infants with EA were prospectively enrolled in a structured multidisciplinary follow-up program. Total ASQ scores ≤185 were considered indicative of significant neurodevelopmental delay, while scores >220 reflected reassuring neurodevelopment. Five skill domains (communication, gross motor skills, fine motor skills, problem solving, and social skills) were also assessed. Clinical, surgical, and growth data were analyzed to identify associated risk factors.

Results: Of the 74 infants included, 13 patients (18%) had an ASQ score ≤185. Lower ASQ scores were significantly associated with prematurity, prolonged hospitalization, multiple surgeries, poor weight gain at 1 and 2 years, and feeding disorders. After adjusting for gestational age and genetic anomalies, prolonged hospitalization remained associated with lower ASQ scores, and higher weight-for-age at 1 and 2 years with better ASQ scores. Communication and social skills were the most severely affected, with approximately 80% of infants in the ASQ ≤ 185 group scoring below -2 standard deviations.

Conclusion: Although most children with EA demonstrated normal development at 2 years, a minority experienced significant delays, especially in communication and social skills. Early screening and targeted multidisciplinary follow-up are essential to support optimal outcomes in this high-risk population.

Objectives: The complex care needs of pediatric patients with short bowel syndrome-associated intestinal failure (SBS-IF) can negatively impact the health-related quality of life (HRQoL) of patients and their caregivers. We assessed the impact of teduglutide on HRQoL of pediatric patients with SBS-IF.

Methods: Two long-term extension (LTE) studies (NCT02949362, NCT02954458) assessed HRQoL over 96 weeks using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the PedsQL Family Impact Module. Patients included in this analysis received teduglutide in one of three randomized Phase 3 parent studies and the respective LTE study. We assessed changes in HRQoL over time, as well as the impact of attaining enteral autonomy on HRQoL and predictors of change in HRQoL.

Results: In pediatric patients with SBS-IF receiving teduglutide (n = 69), the total mean (standard deviation) patient-reported PedsQL score was 75.0 (16.2). Higher mean number of stools per day at LTE study baseline (p = 0.03) predicted increased patient-reported HRQoL. Longer teduglutide exposure (p = 0.047), increasing length of remnant small intestine (p = 0.034), and older age (p = 0.026) predicted higher caregiver-proxy-reported HRQoL. Mean PedsQL scores remained stable over 96 weeks regardless of patients achieving enteral autonomy.

Conclusions: HRQoL of pediatric patients with SBS-IF treated with teduglutide was generally stable over 96 weeks. Predictors of improved HRQoL included higher baseline stool number, longer teduglutide treatment duration, greater length of small intestine, and older age. To better understand these observations, future studies should assess HRQoL before initiation of treatment.