Journal of Pediatric Gastroenterology and Nutrition最新文献

Objectives: To assess the use of ultrasound (US) to visualize and determine the correct position of a multichannel intraluminal impedance-pH probe (MII-pH).

Methods: This is a monocenter study recruiting newborns who underwent MII-pH for suspicious of gastroesopahegal reflux (GER). Catheter position was based on US and was confirmed by X-ray. Moreover, the depth of the probe was compared with those calculated with several mathematical formula used for pH impedance. The US was performed using (US) system Alpinion-eCube-i7® in B-mode with linear and convex probe. US was used to evaluate the correct positioning of the MII-pH catheter before the beginning and during the MII-pH execution to evaluate any changes of the position. The results were also compared with retrospective cases collected in our center in previous years.

Results: Thirty-six newborns were included. US allowed to visualize the esophageal probe in all the newborn tested. US-based positioning was correct in 100% of patients considering an error acceptance of 1 cm, and 66.7% with an error acceptance of 0.5 cm, compared to X-ray. The median duration of the US was 3.2 min (range 2.5-5.78 min), with prolonged time in crying babies. Previous cohort consisted of 35 newborns who underwent MII-pH: one patient had the probe in the respiratory tract and six patients needed new positioning of the MII-pH probe and second X-ray control because of bad positioning or accidental removal of the probe.

Conclusions: US seems to be a valid alternative for the assessment of the MII-pH probe position and the identification of the pH sensor and the lower esophageal sphincter in real time. However, US expertise is needed to provide accurate results.

Objectives: Children with celiac disease (CD) must follow a lifelong gluten-free diet (GFD). This can create psychosocial challenges for the family, making caregiver support essential. This study evaluated the feasibility and acceptability of a self-help psychological intervention designed to empower parents in supporting their own well-being, and their child's quality of life.

Methods: Parents of children with CD (8-11 years) took part in an online self-help intervention, including psychoeducation, and family-based activities, to support well-being and quality of life (QoL) in the context of CD. Parents were randomly assigned to the intervention or a waitlist control group. Feasibility outcomes included recruitment, retention, and acceptability. Outcomes included parent-reported wellbeing and GFD knowledge, their child's QoL, and GFD management at baseline, 1-month, and 2-month postintervention. Children also completed measures on their GFD management and CD-related QoL at these time points.

Results: A total of 98 parents were randomized. Families reported the intervention was acceptable, although additional social support was recommended to help embed psychological skills into daily life. A moderate effect was observed for parent-reported aspects of their child's QoL (social domain, g = 0.72, 95% confidence interval [CI]: 0.24-1.19; psychosocial summary g = 0.61, 95% CI: 0.13-1.08). Other outcomes showed trends in the expected direction.

Conclusions: This is the first study to evaluate a self-help psychological intervention for parents aimed at enhancing children's quality of life in the context of CD. While the intervention was well-received, further refinement and adjustments are needed for larger trials.

Objectives: To investigate the prognostic significance of aspartate aminotransferase to platelet ratio index (APRI) in relation to histopathological features across the clinical course of biliary atresia (BA).

Methods: In this observational cohort study, we enrolled 135 BA patients with available APRI values at Kasai portoenterostomy (KPE, n = 116) or at post-KPE follow-up (n = 70; serum samples, n = 139; liver biopsies, n = 139). APRI was matched to manual scorings of liver histology, ductular reaction (DR) analysed using neural network model and fibrosis quantified from Sirius Red-stained sections.

Results: APRI was elevated at both KPE and post-KPE follow-up (0.92 vs. 1.2, p = 0.5), and associated with biochemical markers of cholestasis, and decreased liver function. At KPE, APRI was higher in patients failing to resolve cholestasis postoperatively (0.80 vs. 0.96, p = 0.02) and both at KPE (0.77 vs. 0.94, p = 0.06) and post-KPE (0.7 vs. 2.1, p < 0.001) in those with subsequent need for liver transplant (LT). Across the disease course, APRI moderately predicted LT need (at KPE, HR = 1.4, p = 0.01; post-KPE, HR = 1.2, p < 0.001). APRI correlated with DR (at KPE, R = 0.37, p < 0.001; post-KPE, R = 0.35, p < 0.001), composed of biliary epithelium (R = 0.34, p < 0.001; R = 0.25, p < 0.01) and parenchymal intermediate hepatocytes (R = 0.33, p < 0.001; R = 0.43, p < 0.001) during the entire clinical course. APRI showed no correlation with quantified liver fibrosis at KPE (R = 0.16, p = 0.13), but correlated with quantified fibrosis (R = 0.22, p = 0.02) and Metavir staging (R = 0.46, p < 0.001) after KPE. No association was observed with portal inflammatory cell infiltration or histological cholestasis.

Conclusions: APRI reflects biliary and portal injury rather than generalised liver fibrosis and associates with poor prognosis in BA.

Objectives: This study aimed to investigate the eating behaviors of preschool children who had been exposed to a restricted diet due to an oral food challenge-confirmed diagnosis of cow's milk protein allergy (CMPA) during early infancy.

Methods: This prospective cohort study compared the eating behaviors of Brazilian children previously diagnosed with CMPA to those of a nonallergic control group. Baseline data on infant feeding, clinical history, and sociodemographic characteristics were collected and later analyzed in association with the Children's eating behavior questionnaire (CEBQ) at 4 years of age. Linear regression models were used to assess associations between CMPA and CEBQ scores, with both crude and adjusted analyses performed.

Results: A total of 74 children, with a mean age of 3.2 months at recruitment, were enrolled (30 with CMPA and 44 controls). Cesarean section delivery, rural geographic location, early introduction of substitute infant formula, and a family history of atopy were associated with higher food fussiness scores. After adjusting for early predictors of eating behaviors, the CMPA group scored significantly higher on the "desire to drink" scale (B adjusted: 2.61; p = 0.031) and on the "food fussiness" scale (B adjusted: 4.07; p = 0.017).

Conclusions: Adherence to a CME diet during infancy, following an OFC-confirmed CMPA diagnosis, was found to have a long-term impact on eating behavior, as evidenced by higher scores on food fussiness and desire to drink scales, which are linked to feeding difficulties.

Objectives: STRIDE (selecting therapeutic targets in inflammatory bowel disease) established evidence-based targets for treat-to-target strategies in IBD. STRIDE-II designates clinical remission, C-reactive protein (CRP) normalization, and fecal calprotectin (FC) reduction as short- to intermediate-term targets, and mucosal healing as a long-term target. This study evaluated STRIDE-II application and disease control in a real-world pediatric cohort.

Methods: We retrospectively analyzed newly diagnosed pediatric IBD patients (ages 3-18 years) treated according to guidelines between June 2017 and January 2023. Time-to-reach STRIDE-II targets and time-to-first flare were assessed over 52 weeks using disease activity indices, inflammatory biomarkers (CRP, FC), and endoscopy.

Results: Seventy-four patients were included (37 Crohn's disease [CD], 37 ulcerative colitis [UC]). All CD patients received primary maintenance therapy with immunomodulators or biologics, versus 51% UC patients. Clinical remission and CRP normalization occurred within 5-10 weeks; FC normalization within 12-19 weeks. By 6 months, combined targets (clinical remission plus CRP and FC normalization) were achieved by 54% of CD patients and 43% of UC patients. Clinical relapse after remission occurred more frequently in UC than in CD (67% vs. 43%, p = 0.0334). Follow-up endoscopy at a median of 41 weeks (CD) and 52 weeks (UC) showed endoscopic healing in 7/18 (39%) CD and 13/22 (59%) UC patients.

Conclusions: Most pediatric IBD patients achieved clinical remission and CRP normalization within STRIDE-II timeframes, whereas FC normalization occurred later, and relapses-particularly in UC-remained common. The notable proportion of patients with suboptimal disease control underscores the need for continuous monitoring in pediatric IBD.

Objective: Feeding difficulties (FDs) are common among children with esophageal atresia (EA) and tracheoesophageal fistula (TEF), but knowledge about their prevalence and risk factors is limited. This multicenter study aimed to assess the prevalence, subtypes, and associated factors of FD in children with EA/TEF.

Methods: Parents of children who underwent surgery for EA/TEF in four tertiary centers in Israel (2005-2022) completed a structured questionnaire. Pediatric feeding disorder (PFD) was diagnosed by means of the Montreal Children's Hospital Feeding Scale and classified by consensus criteria into four subtypes: feeding skills, nutritional, medical, and psychosocial dysfunctions.

Results: Seventy-five children were included (median age: 40 months; 48 males), of whom 57 (76%) were reported to have FD, primarily due to impaired feeding skills (42%). Lower gestational age, low birth weight, and delayed oral feeding were significantly associated with PFD (37 vs. 39 weeks, p = 0.001, 2130 g versus 3084 g, p = 0.001 and 14 versus 10 days, p = 0.05, respectively). Only half of the children received timely and appropriate multidisciplinary follow-up care.

Conclusion: FDs are highly prevalent in children with EA/TEF, mostly due to impaired feeding skills. Several clinical and perinatal factors are associated with the development of these problems, calling for early and multidisciplinary intervention to improve outcomes.

Objectives: High protein intake during infancy has been linked to accelerated weight gain and increased obesity risk. This study aimed to examine the effects of a low-protein formula during the first 6 months of life on blood metabolic and hormonal markers during early childhood.

Methods: Formula-fed infants (<45 days) were randomized to receive either a low-protein formula with modified amino acid composition (mLP; n = 90; 1.7 g protein/100 kcal) or a control formula (CTRL; n = 88; 2.1 g protein/100 kcal) until 6 months of age. Breastfed infants served as a reference group (n = 67). Blood samples were collected in cooperating subjects at 1, 2, and 6 years. We measured insulin-like growth factor-1 (IGF-1), IGF-binding proteins (BPs), leptin, glucose, and insulin, and calculated Homeostatic-Model-Assessment-of-Insulin-Resistance (HOMA-IR). Data were analyzed using linear mixed models and linear regression, adjusting for confounders. In addition, results were correlated to priorly published body composition measurement.

Results: Venous blood was collected from 87 (36%), 77 (31%), and 63 (26%) participants at ages 1, 2, and 6 years, respectively. No differences were found in metabolic markers between the formula groups or compared to the breastfed group at any time point. Furthermore, at 6 years of age, a positive correlation was found between some biomarkers (IGF-1, leptin, and HOMA-IR) and body composition measurements, but not all biomarkers showed such an association.

Conclusions: In this relatively small study, providing a modified, low-protein infant formula during the first months of life did not affect hormonal and metabolic markers during early childhood.

Objectives: Eosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation and epithelial remodeling. However, current biomarkers focus predominantly on eosinophilia, overlooking basal cell hyperplasia (BCH), a histologic feature that may persist despite treatment. We aimed to differentiate EoE from non-EoE based on inflammatory biomarker profiles, identify biomarkers associated with BCH, and explore their relation toPPI response and food impaction using high-throughput proteomics.

Methods: We conducted a prospective case-control study of patients aged 6-65 undergoing upper endoscopy for suspected EoE. Histology classified patients as EoE (>15 eos/hpf), non-EoE, and assessed for the presence of BCH. Serum was analyzed using the Olink® Explore 384 Inflammation Panel. We compared biomarker expression between EoE versus non-EoE, and BCH versus non-BCH, with adjustment for age, sex, and atopic disease. Exploratory analyses investigated biomarkers related to PPI response and food impaction.

Results: Among 86 patients, 26 (30.2%) had EoE and 32 (37.2%) had BCH. CCL26, a marker of eosinophilic inflammation, was the most significantly upregulated biomarker in EoE, was also elevated in BCH, and remained nominally significant even after adjusting for maximum eosinophil count. ITGA11 and TNFRSF11A were nominally associated with BCH independent of eosinophil count. COL9A1 was nominally associated with PPI response and downregulated in non-EoE patients. Oncostatin M (OSM) and TGF-α were nominally associated with food impaction.

Conclusions: High-throughput proteomic profiling revealed distinct biomarker signatures in EoE. CCL26 was the most significantly upregulated marker, associated with both eosinophilic inflammation and epithelial remodeling. COL9A1 may be associated with GERD-related inflammation and PPI responsiveness. These findings support a dual-pathway model of EoE and suggest potential for biomarker-guided diagnosis and treatment.

Little information exists about social risk among pediatric gastroenterology, hepatology, and nutrition (PGHN) patients. The goal of this study was to examine racial and ethnic differences in social risk among Medicaid-insured PGHN patients. Electronic health records from 1341 patients between May 2022 and February 2024 with responses to the Accountable Health Communities screening tool were included. The main outcome was presence of any social risk. To test the hypothesis that racial and ethnic differences in social risk exist, logistic regression adjusting for child age, sex, and preferred language was used. Overall, 29% of patients reported a social risk. Compared to non-Hispanic white patients, patients with Hispanic/Latino, Black, other, and missing race and ethnicity had higher odds of reporting social risks. To promote health equity, better understanding of effective, holistic strategies to integrate social care into PGHN care is warranted.

Objectives: To characterise early postnatal microbial development across maternal gut, breast milk, and infant gut compartments, and explore potential modulation by maternal stress in a cohort of Chinese mothers practising traditional postpartum confinement.

Methods: This secondary analysis draws on a randomised controlled trial of a maternal relaxation intervention in late preterm and early-term dyads. Vaginally delivered mothers (34 + 0 to 37 + 6 weeks) and their exclusively breastfed infants were followed from 1 to 8 weeks postpartum. Maternal stool, breast milk, and infant stool samples were collected at both time points and analysed via 16S rRNA gene amplicon sequencing. Changes in gut microbiome diversity and composition (alpha andbeta diversity metrics) and the relative abundance of dominant genera were assessed overall and by intervention group.

Results: Microbiome diversity (alpha diversity metrics) remained stable across all sample types. However, we observed a compositional temporal shift in breast milk microbiota (p = 0.039), driven primarily by changes in the control group. Infant gut microbiota showed increased Bifidobacterium and decreased Staphylococcus and Enterobacteriaceae with time. A significant reduction in Staphylococcus was observed in breast milk of the intervention group only. Maternal gut microbiota remained stable.

Conclusions: Microbial composition in breast milk and infant gut shifted over the first 8 weeks postpartum, while maternal gut remained stable. Findings suggest maternal stress-reduction interventions may influence breast milk microbiota. Further research is warranted to confirm these effects and investigate mechanisms.