Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Pediatric intestinal pseudo-obstruction (PIPO) is a severe bowel motility disorder characterized by impaired propulsion of gastrointestinal contents without mechanical obstruction. PIPO encompasses congenital and acquired disorders, including neuropathies, myopathies, and mesenchymopathies. PIPO presents with abdominal distension, bilious vomiting, and severe constipation. Diagnosis is based on objective measures of neuromuscular dysfunction, dilated bowel on imaging, parenteral and/or enteral nutrition dependence, and genetic or metabolic testing. Antroduodenal manometry permits objective assessment of proximal bowel neuromuscular function. Genetic testing is increasingly valuable although causes of PIPO often remain incompletely defined. Understanding genotype-phenotype correlations is essential for clarifying disease mechanisms and guiding therapies. This study aimed to characterize the clinical and genetic profiles of children with PIPO, utilizing manometric data for subtype classification.

Methods: A retrospective chart review was conducted at a tertiary care pediatric medical center, with inclusion criteria of PIPO diagnosis, completed manometry testing, and genetic evaluation.

Results: Nineteen children met inclusion criteria. Antroduodenal manometry classified 59% as neuropathic, 35% as myopathic, and one with mixed neuropathic and myopathic dysfunction. Genetic testing revealed pathogenic ACTG2 mutations in all myopathic cases, while neuropathic PIPO exhibited more genetic variability. Histopathology was inconsistent and often nonspecific. Therapeutic approaches focused on nutritional support and promotility agents, with surgical intervention more common in myopathic cases.

Conclusions: This study highlights the association of ACTG2 mutations with a myopathic phenotype, and genetic diversity in neuropathic PIPO, emphasizing the need for further research to improve phenotyping to enhance diagnosis and treatment.

Objectives: Patient travel accounts for around 10% of healthcare-related greenhouse gas emissions. Telemedicine (TM) may contribute to reducing emissions. This study aimed to compare CO₂ emissions, costs, and satisfaction associated with TM versus face-to-face (FTF) visits for follow-up of pediatric patients with celiac disease (CeD).

Methods: CeD patients (2-16 years), attending follow-up visits, were invited to choose between FTF or TM visits via Google Meet. Data on carbon footprint, cost, usability, and satisfaction (telehealth usability questionnaire [TUQ]), and dietary adherence (celiac dietary adherence test [CDAT]) were collected using Google Forms.

Results: Between March 2023 and November 2024, 300 patients were invited and 131 included (58 TM, 73 FTF). Baseline characteristics were similar (gender, age, and respondent). CDAT scores were comparable (p = 0.9). Compared to FTF, TM visits were shorter (30 vs. 75 min), with lower CO₂ emissions (0.08 vs. 24.00 kg), fewer lost workdays (18.9% vs. 81.1%), and reduced costs (€0.55 vs. €15.7; all p < 0.001); satisfaction was high except for "reliability" (median score: 16).

Conclusions: TM is a sustainable alternative for CeD follow-up, reducing CO₂ emissions, costs, and time. High satisfaction supports broader TM implementation in line with environmental goals.

Objective: To assess whether sports drinks as polyethylene glycol (PEG) solvent improve compliance, bowel preparation, and acceptability in children with autism spectrum disorder (ASD).

Methods: In this randomized trial, 60 ASD children (30 per group) received PEG in sports drinks (experimental) or water (control). Outcomes included compliance, Boston Bowel Preparation Scale (BBPS) scores, need for enemas, safety (glucose and electrolytes), adverse events, and caregiver-reported tolerance.

Results: The sports drink group had higher compliance (83.3% vs. 60.0%, relative risk [RR]:1.39, 95% confidence interval [CI]: 1.00-1.94, p = 0.045), reaching borderline statistical significance, as well as better BBPS (7.5 ± 0.8 vs. 6.0 ± 1.0, p < 0.05), and more adequate preparation (96.7% vs. 66.7%, RR: 1.45, 95% CI: 1.12-1.88, p = 0.003). They required fewer enemas (6.7% vs. 26.7%, RR: 0.25, 95% CI: 0.06-1.08, p = 0.038) and had fewer adverse events (10.0% vs. 33.3%, RR: 0.30, 95% CI: 0.09-0.98, p = 0.028). No concerning side effects were observed, and blood glucose and electrolyte levels remained within normal ranges. Caregiver tolerance scores were higher (median 8 vs. 6, p < 0.001).

Conclusion: Sports drinks as PEG solvent significantly enhance compliance, bowel preparation, and acceptability in ASD children without safety concerns, offering a practical child-friendly strategy.

Objectives: Probiotic effects are strain-specific; each strain needs to be assessed individually. In this review, we evaluated the effectiveness of Limosilactobacillus reuteri DSM 17938 in preventing antibiotic-associated diarrhoea (AAD) in children receiving systemic antibiotics.

Methods: We searched the Cochrane Library, MEDLINE, EMBASE and trial registries (January 2016-July 2025) for randomized controlled trials (RCTs) comparing L. reuteri DSM 17938 with placebo, no treatment, or other probiotics in children. Risk of bias was assessed with Risk of Bias 2 (ROB-2), and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results: Three RCTs (1070 randomized, 998 analysed) were included. No significant effect was observed with ≤14-day administration (two RCTs, n = 901; risk ratio [RR] 0.85, 95% confidence interval [CI]: 0.26-2.77; low certainty evidence), with interpretation limited by heterogeneity (I² = 91%) and analytical differences. A regimen of up to 21 days reduced AAD risk (two RCTs, n = 751; RR: 0.50, 95% CI: 0.33-0.75; moderate certainty evidence). A post hoc analysis of trials with follow-up up to 56 days showed no significant effect (three RCTs, n = 998; RR: 0.85, 95% CI: 0.29-2.46; I² = 83%). A subgroup analysis limited to children receiving amoxicillin-clavulanate showed benefit (two RCTs, n = 690; RR: 0.49, 95% CI: 0.32-0.76; I² = 0%).

Conclusions: L. reuteri DSM 17938 may reduce the risk of AAD in children when administered for up to 21 days or in those receiving amoxicillin-clavulanate. No benefit was found with shorter administration or extended follow-up. Further high-quality trials are needed before routine use can be recommended.

Objectives: Baby-Led Weaning (BLW) has been anecdotally linked to healthier eating habits and lower picky eating tendencies, yet empirical evidence remains limited. This study investigates the association between BLW and picky eating in children aged 2-5 years, comparing it with traditional spoon-feeding methods.

Methods: A cross-sectional study was conducted in Metro Manila, Philippines (June to August 2024), using convenience and snowball sampling. Parents (n = 284) reported their child's complementary feeding method, classified it as: (1) Strict BLW (BLW > 90%), (2) Predominantly BLW (BLW 51%-90%), (3) Predominantly traditional spoon-feeding (BLW 10%-50%), or (4) Strict Traditional Spoon-Feeding (BLW < 10%). Picky eating was assessed using the Food Fussiness (FF) subscale of the Children's Eating Behavior Questionnaire (CEBQ), with FF $\ge$  3 indicating picky eating. Logistic regression examined associations between feeding method and picky eating, with sensitivity analyses using FF  $\ge$ 2.8 and FF  $\ge$ 3.2, and linear regression modeling FF as continuous outcome. Associations with other CEBQ subscales were also explored.

Results: Strictly BLW was associated with a 95.4% lower likelihood of picky eating compared to strict traditionally spoon-feeding (p < 0.01). Findings remained robust across alternative cut-offs when FF was modeled as a continuous outcome. Satiety responsiveness, slowness in eating, and emotional undereating were positively associated with fussiness, while higher enjoyment of food and food responsiveness were inversely related.

Conclusion: BLW is consistently associated with substantially lower odds of picky eating in early childhood. These findings support BLW as a potentially effective approach to fostering positive feeding behavior and food acceptance in early childhood.