Journal of Pediatric Gastroenterology and Nutrition最新文献

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.

Objective: This study examines the association between metabolic-dysfunction-associated steatotic liver disease (MASLD) and cardiovascular risk, focusing on the predictive value of anthropometric, metabolic, and hepatic markers.

Methods: A predictive cross-sectional study was conducted in children aged 5-18 years with overweight, obesity, or metabolic alterations suggestive of hepatic steatosis, with and without MASLD, at a Mexican pediatric endocrine clinic. MASLD was diagnosed via ultrasound, while cardiovascular risk was assessed using carotid intima-media thickness (CIMT) and metabolic markers. Multiple regression models were developed to evaluate the contribution of vascular (CIMT), anthropometric, metabolic, and hepatic variables to cardiovascular risk.

Results: Children with MASLD had significantly higher body mass index (BMI) percentiles (97.56 ± 2.93 vs. 68.91 ± 33.89, p < 0.01), systolic blood pressure (SBP): 113.93 ± 9.38 mmHg versus 101.41 ± 11.45 mmHg, p < 0.01), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR): 7.55 ± 2.23 versus 3.62 ± 1.76, p < 0.01) compared to controls. CIMT was greater in MASLD patients (0.738 mm vs. 0.56 mm, p < 0.01), suggesting early vascular remodeling. Model 4, which incorporated CIMT, metabolic markers, and liver enzymes, demonstrated the highest predictive value (R² = 0.935, p < 0.001), reinforcing the multifactorial nature of MASLD-related cardiovascular risk.

Conclusions: MASLD is strongly associated with subclinical atherosclerosis and cardiometabolic dysregulation in children. The progressive increase in predictive accuracy across models underscores the importance of a multifactorial approach to cardiovascular risk assessment. Early subclinical cardiovascular findings are detectable in children with MASLD, supporting the rationale for early risk stratification and further research in this population.

Objectives: Dolichocolon (DC), classified under International Classification of Diseases, Tenth Revision (ICD-10) code Q43.8 ("Other specified congenital malformations of intestine"), refers to an elongated or redundant large intestine. Recent studies in adults indicate a role for dolichocolon in constipation and disorders of gut-brain interaction. Contrast enema (CE) imaging is commonly used to identify DC, typically defined as a sigmoid colon extending above, or a transverse colon descending below, the iliac crest line. Despite its potential relevance, the prevalence and clinical significance of DC in pediatric gastroenterology remain poorly understood.

Methods: This retrospective study assessed the prevalence of DC in pediatric patients presenting with constipation and related gastrointestinal symptoms. A total of 155 contrast enemas from pediatric gastroenterology patients meeting predefined inclusion criteria were reviewed. Three blinded pediatric gastroenterologists independently evaluated each CE for features of colonic redundancy consistent with dolichocolon, based on a priori imaging criteria.

Results: Consensus-based identification (i.e., independent agreement among all three reviewers) of DC was observed in 74.1% of children under 2 years old and 88.6% of those aged 2-4 years presenting with constipation. The prevalence significantly decreased with age, with 68.8% in children aged 5-10 years and 47.6% in adolescents aged 11-17 years.

Conclusions: These findings suggest that dolichocolon is common in pediatric patients with constipation and relatable symptoms, particularly in early childhood. Further research is warranted to clarify its clinical implications and potential role in pediatric gastrointestinal disorders.

Objectives: Hepatitis-associated aplastic anemia (HAAA) is described as acute severe hepatitis of unknown origin followed by bone marrow failure (BMF). We aimed to provide a comprehensive picture of pediatric HAAA.

Methods: Two-center retrospective analysis was performed using data from children diagnosed with acquired BMF, including severe aplastic anemia (SAA) and myelodysplastic syndrome type refractory cytopenia of childhood (RCC). The assessment of the subcohort of HAAA included clinical features indicative of diagnosis and disease progression, with additional data from previously published case series.

Results: Cohort comprised 62 children with acquired BMF and 22 children with HAAA. Median age of HAAA patients was 13.5 years. Potentially triggering viral infections were detected in 45%. The median interval from hepatitis onset to cytopenia was 3 weeks. All cases presented with severe hepatitis (median alanine transaminase 2127 U/L) and all but one with hyperbilirubinemia (median bilirubin 15.3 mg/dL). Coagulopathy was variable (median international normalized ratio 1.5). Four patients (18%) developed acute liver failure, two (9%) required liver transplantation. Hepatic parameters normalized within a median of 8.5 weeks. There was no statistically significant difference in the course of hepatitis between patients with SAA and RCC. Early lymphopenia was a key finding in patients with HAAA, progressing from a median of 905/µL at hepatitis onset to 530/µL within 4 weeks.

Conclusions: HAAA occurs in both SAA and RCC. Most cases present with severe acute cholestatic hepatitis and variable coagulopathy. Hepatic recovery is common. Lymphopenia at disease onset is frequent and may serve as a diagnostic marker.

Objectives: People with cystic fibrosis (CF) are at risk of iron deficiency (ID), and although well established in adults, data in children are limited. We assessed iron status in a cohort of children with CF and evaluated the effectiveness of ID management.

Methods: We retrospectively analysed iron status and treatment data from medical records of 190 children with CF (aged 1-16 years) assessed routinely in 2021 and 2022 at the Royal Brompton Hospital (RBH), London. Ferritin, mean corpuscular volume (MCV), and haemoglobin were used to determine the prevalence of ID, ID erythropoiesis (IDE) and ID anaemia (IDA) using RBH definitions.

Results: The proportion of children with abnormal iron status indices decreased between the assessments (2021 - 63% vs. 2022 - 54%, p = 0.03). Prevalence of ID without anaemia (51% vs. 44%, p = 0.12), IDE (8% vs. 6%, p = 0.63), and IDA (4% vs. 3%, p = 1.00) did not differ between assessments. Sixty children received dietary advice for ID without anaemia, and iron supplements were prescribed for six and seven children with IDE and IDA, respectively. Change in iron status indices between assessments did not differ between treated and untreated children, although ferritin increased in the seven children treated for IDA (p = 0.04). There was a positive association between highly effective modulator therapy and change in MCV.

Conclusions: ID remains an issue in children with CF, warranting annual monitoring of iron status. Management with dietary advice and/or iron supplementation showed limited effectiveness using our criteria for abnormal iron status.