Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: Ultra-short bowel syndrome (USBS) constitutes the most severe form of short bowel syndrome (SBS). Contemporary outcome data are scarce. The aim was to describe the experience of managing children with USBS and assess outcomes.

Methods: This retrospective study analyzed children with intestinal failure (IF) managed at a single center between 2018 and 2022. Patients with USBS were matched to SBS controls by age and sex. Demographics and medical history were retrieved. Primary outcomes focused on long-term complications, including cholestasis, central line-associated bloodstream infections (CLABSI), mortality, oral aversion, and vitamin deficiencies.

Results: The cohort included 28 children (median age: 44.4 months), 14 with USBS. Compared to SBS, children with USBS had significantly shorter small bowel lengths (percentage of remaining bowel length 6 (4, 8) vs. 25 (18, 29), p < 0.001) and reduced large bowel percentages (58% vs. 100%, p < 0.01). At data collection, 93% of USBS patients required PN, compared to 30% with SBS. Despite longer PN dependency, rates of cholestasis and CLABSI were similar. Oral aversion was more prevalent in USBS (71% vs. 21%, p < 0.001). High rates of vitamin B12 and iron deficiencies were observed in both groups. No mortality was recorded, and one USBS patient achieved enteral autonomy.

Conclusions: When compared with SBS, children with USBS exhibited greater PN dependency but similar rates of major IF-related complications. These findings highlight that even among children with USBS and intestinal failure, long-term outcomes can be favorable under specialized care.

Objectives: Perianal abscesses (PA) and fistulas-in-ano (FIA) are frequently diagnosed in children and may be presenting symptoms of Crohn's disease (CD). The association between age at presentation of PA/FIA and the risk of subsequent CD development is largely unknown. Aim of this study was to investigate the association between PA/FIA and risk for CD development, stratified by age.

Methods: In this retrospective multicenter study children between 2 and 18 years presenting with PA/FIA, were included. Patient characteristics, biochemical data, and data on CD development were collected. The risk of developing IBD was stratified by age in three subgroups (<6, 6-12, and 12-18 years).

Results: One hundred and fifty-two children with PA/FIA were included (78% male; median age 11.1 years; interquartile range [IQR]: 8.0), of whom 32 (21.1%) were diagnosed with CD. Children aged 12-18 years (n = 23; 32.4%) were more often diagnosed with CD compared to the subgroup 6-12 years (n = 8; 15.1%) odds ratio (OR) 2.09; p = 0.03) and the subgroup 2-6 years (n = 1; 3.6%; OR 14.24; p = 0.01). Recurrent PA/FIA (OR 3.20; p = 0.005) and typical inflammatory bowel disease (IBD)-associated symptoms (OR 4.85; p < 0.001) were significantly associated with CD development. Median value of elevated fecal calprotectin (FCP) was significantly higher in the CD group (1212 µg/g) than in the non-CD group (22.5 µg/g; p < 0.001).

Conclusions: The overall risk of developing CD in children presenting with PA/FIA was 21%, this risk was age dependent. Our findings emphasize the need for high awareness by physicians in children presenting with PA/FIA for the development of CD, also in the years following first presentation, particularly when aged ≥6 years.

Objective: To evaluate the response to transcutaneous sacral neurostimulation (tSNS) treatment in children with refractory functional constipation (RFC), myelomeningocele (MMC), and anorectal malformations (ARM) with fecal incontinence (FI). To compare manometric data before and after treatment.

Methods: A prospective, analytical, quasi-experimental cohort study was conducted in the three populations over a period of 2 years. Twelve 30-min electrostimulation sessions were performed once weekly, using two posterior cutaneous electrodes placed between S2 and S4, with anorectal manometry performed before and after treatment.

Results: Forty-two patients with FI were included: 20 with MMC, 14 with ARM, and 8 with RFC. Mean age: 10 years; 71.4% were male. After treatment, complete continence was achieved in 57%, partial continence in 26%, and without improvement in 17% of patients. In manometry, a significant increase in median resting pressure and squeezing pressure was observed as well as an improvement of sensory function, with first sensation occurring at a median pretreatment volume of 100 cc and a median posttreatment volume of 20 cc (p < 0.001). Urge sensation required less volume in 66.7% of patients, and maximum tolerance decreased in 61.9%. Laxatives were discontinued after treatment in 31.4%, and urinary incontinence resolved in 32%.

Conclusion: tSNS was shown to be effective in improving symptoms of constipation and FI, especially in patients with organic pathology. Urinary incontinence also improved. Favorable changes were observed at the second manometry in patients with total or partial continence, especially for sensory function.

Objectives: Monitoring for Helicobacter pylori (H. pylori)-eradication is important, since symptom improvement does not indicate treatment success. Using EuroPedHp Registry data, we investigated characteristics of children missing monitoring visits after prescribed therapy, compliance effect on eradication, and factors associated with loss to follow-up and low compliance.

Methods: Between 2017 and 2020, 30 paediatric hospitals from 17 European countries reported 1605 children with biopsy-proven H. pylori-infection. Children with prescribed therapy were analysed. Risk factors for loss to follow-up or low compliance (taking ≤90% of prescribed medications) were identified applying multivariable logistic regression.

Results: Of 1263 infected children with prescribed therapy, 390 (31%) were lost to follow-up. Risk factors for loss to follow-up included nausea/dyspepsia (p = 0.004) or gastrointestinal bleeding (p = 0.03) as indication for endoscopy, living in Israel or Türkiye (p = 0.0002), and having no antibiotic susceptibility result (p = 0.004). Risk decreased with living in Southern Europe (p = 0.002), migration background (p = 0.052), and probiotic use during therapy (p = 0.02). Low compliance, reported in 69/831 (8%) children with follow-up data, was associated with vomiting (p = 0.003), peptic ulcers or erosions (p = 0.03), living in EasternEurope (p = 0.009), Israel or Türkiye (p = 0.0008), and any adverse event during therapy (p = 0.0009). First-line tailored triple therapy (TTT) for 14 days (N = 480) was successful in 92% with excellent versus 61% with low compliance (p < 0.0001). After ≥1 failed therapies (N = 60), TTT was successful in 71% with high versus 13% with low compliance (p = 0.003).

Conclusion: The registry data identified several factors associated with non-adherence to medication and monitoring visits. Improving information to patient/caregiver may increase adherence, care and treatment success.

Objective: Although adverse childhood experiences (ACEs) have been linked to gastrointestinal (GI) conditions in children, it remains unclear which specific adversities confer greatest risk and how psychosocial or contextual factors modify these associations. This study identified ACEs most strongly associated with GI symptoms in US youth and evaluated emotional, behavioral, and environmental pathways that may affect these relationships.

Methods: We analyzed nationally representative data from 73,055 US children and adolescents in the 2021-2023 National Survey of Children's Health. Least Absolute Shrinkage and Selection Operator regression identified ACEs most predictive of GI symptoms (primary outcome), with co-occurring GI symptoms and chronic pain examined secondarily. Mediation and moderation analyses assessed psychosocial mechanisms and potential protective factors.

Results: GI symptoms were reported in 6% of children. Five ACEs were retained for the primary outcome; strongest associations were for household mental illness (adjusted odds ratio [aOR] 1.56; 95% confidence interval [CI] 1.44-1.70) and economic insecurity (aOR 1.38; 95% CI 1.26-1.50), followed by neighborhood violence (aOR 1.34; 95% CI 1.19-1.52) and racial discrimination (aOR 1.31; 95% CI 1.16-1.47). Emotional/behavioral difficulties mediated 20%-35% of effects; food insecurity mediated 26% for economic insecurity. School and neighborhood safety and community support attenuated several ACE-GI associations.

Conclusions: Household mental illness and economic insecurity were the strongest ACEs associated with GI symptoms in US youth. Emotional distress and perceived environmental safety mitigated these associations. Integrating psychosocial and contextual factors into evaluation of recurrent GI symptoms may improve care and identify targets for early intervention.

Objectives: Pediatric patients with in-remission inflammatory bowel disease (IBD) often report persistent gastrointestinal symptoms, suggesting a potential overlap with disorders of gut-brain-interaction (DGBIs). While DGBIs affect up to 40% of the general population, their prevalence in quiescent IBD children remains limited. We aimed to evaluate the prevalence and distribution of DGBIs, based on Rome-IV criteria, in children with quiescent IBD compared to healthy controls, identifying demographic, clinical and therapeutic factors associated with DGBIs.

Methods: In this multicenter, prospective, controlled study, in-remission IBD pediatric patients and healthy controls were enrolled completing the Rome IV-Questionnaire. IBD-remission was defined by pediatric ulcerative colitis activity index (PUCAI)/pediatric Crohn's disease activity index scores < 10, normal inflammatory markers and recent endoscopic mucosal healing.

Results: Forty-one pediatric patients with IBD in remission and 179 healthy controls were enrolled. DGBIs were found in 41.46% of IBD-patients versus 27.93% of controls (p = 0.089). Functional Dyspepsia was significantly more prevalent in IBD patients (p < 0.001), while irritable bowel syndrome was more frequent among controls, though not significantly (p = 0.466). No differences in DGBI prevalence emerged between Crohn's disease and ulcerative colitis (p = 0.54). At the multivariate analysis, psychological comorbidities (odds ratio [OR] 40.767, p < 0.001) and low weight (0.953, p ≤ 0.001) were significantly associated with DGBIs. Notably, 5-aminosalicylic-acid (ASA) administration was associated with reduced DGBIs likelihood (OR 0.139, p = 0.005).

Conclusions: In our cohort, the overall DGBIs prevalence was numerically but not significantly higher in quiescent-IBD patients compared to controls, while upper gastrointestinal DGBIs were significantly more frequent in IBD patients. Psychological and nutritional factors emerged as strong predictors of DGBIs, while 5-ASA may be associated with lower likelihood of DGBIs.

Objective: To relate post-surgical feeding regimens to growth and surgical outcomes in children with biliary atresia (BA) after hepato-portoenterostomy (Kasai).

Methods: Retrospectively, all children with BA from Denmark and the Netherlands who underwent Kasai from 2014 to 2022 were included. The effect of breastmilk intake on anthropometry after Kasai was evaluated using jointed modeling of longitudinal and survival data, removing children from the analysis at transplantation. Mixed linear models were used to assess surgical outcomes in relation to breastmilk intake and anthropometry in relation to medium-chain triglycerides (MCT) intake, adjusted for calorie intake.

Results: We included 116 children. After Kasai, breastmilk with MCT supplementation was received in 22% for at least 1 month, 9% for 1 week, and 68% did not receive breastmilk. Those receiving breastmilk after Kasai had stable length-for-age z-score (LAZ) over 12 months whereas LAZ decreased in infants without breastmilk feeding (-0.48; 95% confidence interval [CI] 0.24, 0.72). Infants receiving breastmilk for at least 1 month had lower total bilirubin at 3 months (79 vs. 116 µmol/L, p = 0.028) and a lower incidence of cholangitis compared with infants not receiving breastmilk after Kasai. Of those only receiving formula after Kasai, 4% received <40% MCT, 72% received 40-59% MCT and 24% received ≥60% MCT. LAZ was lower in children with MCT intake <40% than in children with MCT intake ≥40%.

Conclusion: Feeding regimens in children with BA after Kasai are related to growth and surgical outcomes. Further studies with infants randomized to receive breast milk and to different MCT levels are needed.

Objectives: Moderate and late preterm infants (MLPTI, gestational age 32 0/7-36 6/7 weeks) have altered body composition compared to term-born infants, but data beyond infancy are lacking. This study aimed to assess body composition at 2 years corrected age for prematurity (CA) in MLPTI, compare it to the literature on term-born infants, and identify the association with early-life growth.

Methods: MLPTI born between 32 0/7 and 35 6/7 weeks' gestation were included. Body composition at 2 years CA was determined using deuterium-labeled water. Multivariable regression analyses were performed to analyze associations between early-life growth and body composition.

Results: A total of 80 MLPTI were included. Mean percentage body fat mass was 25.3% (standard deviation [SD] 4.30), mean total fat-free percentage 74.7% (SD 3.70), mean fat mass index (FMI) was 3.9 kg/m² (SD 0.8), and mean fat-free mass index was 11.4 kg/m² (SD 0.8). Moreover, 1 SD increase in delta z score for weight from term-age until 3 months of age was associated with a 2.2% higher fat mass at 2 years CA (p = 0.025). This association was not observed for FMI.

Conclusion: MLPTI have higher fat mass percentages at 2 years CA compared to the literature on term-born infants, while FMI was within range, and fat-free mass index (FFMI) was relatively low. This suggests an altered body composition with reduced fat-free mass instead of excess fat accumulation. This highlights the need for more research on body composition, feeding practices, and cautious weight gain in MLPTI.

Objectives: Vonoprazan, a potassium-competitive acid blocker, provides more rapid, potent, and durable elevations in gastric pH than proton pump inhibitors in adults and may be a treatment option for adolescents and children with gastroesophageal reflux disease (GERD). The pharmacokinetics and safety of vonoprazan in pediatric subjects (6-17 years) with symptomatic GERD were evaluated in two clinical studies.

Methods: Forty-two subjects were randomized to vonoprazan 10 or 20 mg once daily for 14 days. Plasma vonoprazan concentrations were analyzed employing a two-compartment population pharmacokinetic model developed using adult data. Individual estimates of maximum concentration at steady state (C_max,SS) and area under the drug concentration-time curve during the dosing interval τ at steady state (AUC_τ,SS) were calculated. Individual apparent oral clearance (CL/F) and central volume of distribution (V_c/F) were calculated from the model-based estimates. The effect on GERD symptoms and their severity was qualitatively assessed.

Results: Model-based analyses showed that exposures (AUC_τ,ss) of vonoprazan in pediatric subjects (6-17 years) were nearly identical to adult exposures. Model-based exposure estimates from pediatric subjects were also nearly identical to noncompartmental exposure estimates from adults in other studies for both vonoprazan doses. Subjects reported improvement in GERD symptoms, regardless of vonoprazan dosage. There were six treatment-emergent adverse events, one of which was related to the study drug; none were serious, nor resulted in treatment discontinuation.

Conclusions: Exposures of vonoprazan in adolescents and children were nearly identical to exposures observed in adults, confirming the appropriateness of vonoprazan 10 and 20 mg doses in a pediatric population.