Journal of Pediatric Gastroenterology and Nutrition最新文献

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.

Objectives: Intestinal ultrasound (IU) has emerged as an alternative to detect bowel wall inflammation. The aim of this study was to compare IU findings to clinical disease, fecal calprotectin (FC), and endoscopic findings in newly diagnosed pediatric inflammatory bowel disease (IBD) patients.

Methods: This study was a 1-year, single-center, prospective study. Any pediatric patient undergoing colonoscopy could be recruited. Following ileo-colonoscopy, subjects were divided into two groups: patients diagnosed with IBD and patients without IBD. Participants had an IU within 1 month. Endoscopists and radiologists were blinded to each other. The IU findings were compared with clinical disease activity, FC, and endoscopic findings.

Results: A total of 50 subjects were enrolled in the study; 29 (58%) were females, median age was 13.5 years, and 25 (50%) were diagnosed with IBD. IU sensitivity was 76%, specificity 84%, positive predictive value (PPV) 83%, and negative predictive value (NPV) 78%. For detection of moderate to severe disease, sensitivity, specificity, PPV, and NPV were 91.3%, 86.21%, 84%, and 92.6%, respectively. A significant correlation was noted between IU and FC, Mayo score, and Simple Endoscopic Score (0.513, 0.565, and 0.731, respectively). Pediatric Ulcerative Colitis Activity Index and Pediatric Crohn's Disease Activity Index scores had Pearson correlations of 0.070 and -0.159, respectively.

Conclusions: IU can be considered a screening tool for pediatric IBD. It has reasonable sensitivity, specificity, PPV, and NPV, particularly for moderate-to-severe disease. The severity noted on IU correlated with FC and endoscopic disease activity but did not correlate with clinical disease activity.

As rates of obesity rise worldwide, incidence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease, is increasing, worsening the burden of healthcare systems. The council of the Federation of International Societies for Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) identified the topic of MASLD epidemiology, treatment, and prevention as a global priority issue to be addressed by an expert team, with the goal to describe feasible and evidence-based actions that may contribute to reducing MASLD risk. The FISPGHAN member societies nominated experts in the field. The FISPGHAN council selected and appointed members of the expert team and a chair. The subtopics included in this manuscript were chosen through a consensus of the experts involved. We review the epidemiology, natural history, and screening and management. We further expand to relevant public health measures aimed at MASLD prevention, including identifying interventions that could reduce risk factors (environmental and iatrogenic), optimize maternal and newborn health, and support healthier lifestyles for older children and adolescents on a local, national, and international scale. While recognizing that various aspects of population health and public policy can shape MASLD risk, we also review what we can do on an individual level to support our patients to reduce the significant burden of this ever rising disease in pediatrics.

Objective: The utilization of biologic drugs in children with inflammatory bowel disease (IBD) surged following the publications of positive results in randomized controlled trials and real-world studies. We aimed to explore the extent of publication bias associated with these findings.

Methods: Two reviewers assessed all abstracts evaluating the efficacy or safety of biologics presented at the annual European Society for Pediatric Gastroenterology Hepatology and Nutrition and North American Society for Pediatric Gastroenterology conferences from 2015 to 2019. Abstracts were classified as "positive" or "negative." Time to publication was analyzed using Kaplan-Meier curve and groups were compared using the log-rank test. A Cox proportional model was utilized to determine the likelihood of publication.

Results: Out of 209 included abstracts, only 130 (62%) were published as full manuscripts. The median time to publication was 2.8 years (interquartile range = 0-8.2). In the univariate Cox model, the likelihood of publication was four times higher for abstracts reporting positive results (hazard ratio = 4.4 [95% confidence interval, CI = 2.3-8.5]). The probabilities for publication at 1, 3, and 5 years after the conference were 32%, 59%, and 66% for abstracts with significantly positive results in favor of biologic treatment compared to 10%, 22%, and 25% for those with negative results (p < 0.001). In multivariable model, positive results (odds ratio = 6.4 [95% CI = 2.5-16.4]) were significant associated with publication rate.

Conclusion: Only 62% of abstracts presented in medical conferences regarding biologics in pediatric IBD are eventually published as full manuscripts, and those reporting positive results were more likely to be published and at an earlier time. Clinicians, guideline groups, and medical authorities dealing with drug approval, need to be aware of potential publication bias of published studies when employing evidence-based management strategies.