Pub Date : 2020-05-01DOI: 10.1097/MPG.0000000000002439
Amanda A Wenzel, Cynthis K Rigsby, Lee M. Bass
A 17-year-old girl presented to our Emergency Department after reporting ingestion of multiple razor blades. She endorsed sharp abdominal pain and had epigastric abdominal tenderness without rebound or guarding. Abdominal X-ray revealed many rectangular, high-density objects projecting over the left abdomen without evidence of obstruction or perforation (Fig. 1). The patient underwent urgent esophagogastroduodenoscopy. Multiple safety blades were noted in the stomach with abrasions throughout the distal esophagus and stomach (Fig. 2). Given their unusual shape, attempts to remove the razors using an overtube were unsuccessful. We were able to remove all razors using raptor forceps grasped on 1 end and an endoscopic protector hood, without further injury to the mucosa postprocedure. The patient was discharged the following day with psychiatry follow-up.
{"title":"The Cutting Edge: a 17-Year-Old Female with Razor Blade Ingestion.","authors":"Amanda A Wenzel, Cynthis K Rigsby, Lee M. Bass","doi":"10.1097/MPG.0000000000002439","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002439","url":null,"abstract":"A 17-year-old girl presented to our Emergency Department after reporting ingestion of multiple razor blades. She endorsed sharp abdominal pain and had epigastric abdominal tenderness without rebound or guarding. Abdominal X-ray revealed many rectangular, high-density objects projecting over the left abdomen without evidence of obstruction or perforation (Fig. 1). The patient underwent urgent esophagogastroduodenoscopy. Multiple safety blades were noted in the stomach with abrasions throughout the distal esophagus and stomach (Fig. 2). Given their unusual shape, attempts to remove the razors using an overtube were unsuccessful. We were able to remove all razors using raptor forceps grasped on 1 end and an endoscopic protector hood, without further injury to the mucosa postprocedure. The patient was discharged the following day with psychiatry follow-up.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79966133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/MPG.0000000000002460
H. Barraclough, K. Siau, S. Ward, P. Dunckley, N. Hawkes, M. Thomson, P. Narula
BACKGROUND The learning curve in paediatric oesophago-gastro-duodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated. METHODS This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation (LC-Cusum) analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach. RESULTS 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22-571, IQR 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By LC-Cusum analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (p < 0.001), higher trainee seniority (p < 0.001), patient age (p = 0.002), outpatient status (p < 0.001) and attendance at a national Basic Skills OGD course (p = 0.011). CONCLUSIONS This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.
{"title":"Learning Curve Analyses for Achieving Satisfactory Procedural Completion Rates in Paediatric Oesophagogastroduodenoscopy.","authors":"H. Barraclough, K. Siau, S. Ward, P. Dunckley, N. Hawkes, M. Thomson, P. Narula","doi":"10.1097/MPG.0000000000002460","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002460","url":null,"abstract":"BACKGROUND\u0000The learning curve in paediatric oesophago-gastro-duodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated.\u0000\u0000\u0000METHODS\u0000This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation (LC-Cusum) analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach.\u0000\u0000\u0000RESULTS\u00008929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22-571, IQR 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By LC-Cusum analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (p < 0.001), higher trainee seniority (p < 0.001), patient age (p = 0.002), outpatient status (p < 0.001) and attendance at a national Basic Skills OGD course (p = 0.011).\u0000\u0000\u0000CONCLUSIONS\u0000This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"1012 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77171083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/MPG.0000000000002527
Sarah Orkin, C. Brokamp, Toshifumi Yodoshi, A. Trout, Chunyan Liu, Syeda Meryum, Stuart Taylor, C. Wolfe, R. Sheridan, A. Seth, M. A. N. Bhuiyan, Sanita L. Ley, Ana Catalina Arce-Clachar, Kristin Bramlage, R. Kahn, S. Xanthakos, A. Beck, M. Mouzaki
BACKGROUND AND OBJECTIVES Nonalcoholic Fatty Liver Disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area-level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity. METHODS Retrospective study of patients < 21 years with NAFLD, followed from 2009-2018. The patients' addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0 to 1, higher values indicating higher deprivation, calculated from six SES-related variables available publicly in US Census databases). RESULTS Two cohorts were evaluated; one with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy-confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were male (66%), non-Hispanic (77-78%), severely obese (79-80%) and publicly-insured (55-56%, respectively). The median CDI for both groups was 0.36 (range 0.15-0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI-measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high and low deprivation groups. CONCLUSIONS Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.
{"title":"Community Socioeconomic Deprivation and Non-Alcoholic Fatty Liver Disease Severity.","authors":"Sarah Orkin, C. Brokamp, Toshifumi Yodoshi, A. Trout, Chunyan Liu, Syeda Meryum, Stuart Taylor, C. Wolfe, R. Sheridan, A. Seth, M. A. N. Bhuiyan, Sanita L. Ley, Ana Catalina Arce-Clachar, Kristin Bramlage, R. Kahn, S. Xanthakos, A. Beck, M. Mouzaki","doi":"10.1097/MPG.0000000000002527","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002527","url":null,"abstract":"BACKGROUND AND OBJECTIVES\u0000Nonalcoholic Fatty Liver Disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area-level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity.\u0000\u0000\u0000METHODS\u0000Retrospective study of patients < 21 years with NAFLD, followed from 2009-2018. The patients' addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0 to 1, higher values indicating higher deprivation, calculated from six SES-related variables available publicly in US Census databases).\u0000\u0000\u0000RESULTS\u0000Two cohorts were evaluated; one with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy-confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were male (66%), non-Hispanic (77-78%), severely obese (79-80%) and publicly-insured (55-56%, respectively). The median CDI for both groups was 0.36 (range 0.15-0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI-measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high and low deprivation groups.\u0000\u0000\u0000CONCLUSIONS\u0000Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91536495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/MPG.0000000000002536
O. Courbette, C. Aupiais, J. Viala, J. Hugot, X. Roblin, S. Candon, B. Louveau, L. Chatenoud, C. Martinez-Vinson
OBJECTIVE Infliximab (IFX) is a frequent therapeutic option for Crohn disease (CD) patients. Early detection of responders to IFX is critical for the management of CD in order to avoid long-term exposure to the drug without benefit. This retrospective study aimed at analysing which early parameters recorded during the induction period are able to predict response to IFX during the maintenance period in pediatric CD. PATIENTS AND METHODS Medical records of all CD patients ages from 2 to 18 years who received IFX at a tertiary IBD center were retrospectively analyzed. Children were classified in 3 groups according to their response at week 14 (W14) (1) remission, (2) clinical response or (3), no response. The factors recorded at W0, W2, and W6, which were associated with remission at W14 were analyzed using a logistic regression. RESULTS Among the 111 patients included, 74.8% patients were responders to IFX at W14, including 38.7% in clinical remission and 36% with partial clinical response. Clinical remission at W14 was associated with normal growth (P < 0.01), and normal albuminemia (P = 0.01) at baseline, It was also associated with trough levels to IFX >8.3 μg/ml at week 6 (P < 0.01). CONCLUSION Trough levels to IFX >8.3 μg/ml at week 6 are predictive of remission at W14 for luminal disease.
{"title":"Trough Levels of Infliximab at W6 Are Predictive of Remission at W14 in Pediatric Crohn Disease.","authors":"O. Courbette, C. Aupiais, J. Viala, J. Hugot, X. Roblin, S. Candon, B. Louveau, L. Chatenoud, C. Martinez-Vinson","doi":"10.1097/MPG.0000000000002536","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002536","url":null,"abstract":"OBJECTIVE\u0000Infliximab (IFX) is a frequent therapeutic option for Crohn disease (CD) patients. Early detection of responders to IFX is critical for the management of CD in order to avoid long-term exposure to the drug without benefit. This retrospective study aimed at analysing which early parameters recorded during the induction period are able to predict response to IFX during the maintenance period in pediatric CD.\u0000\u0000\u0000PATIENTS AND METHODS\u0000Medical records of all CD patients ages from 2 to 18 years who received IFX at a tertiary IBD center were retrospectively analyzed. Children were classified in 3 groups according to their response at week 14 (W14) (1) remission, (2) clinical response or (3), no response. The factors recorded at W0, W2, and W6, which were associated with remission at W14 were analyzed using a logistic regression.\u0000\u0000\u0000RESULTS\u0000Among the 111 patients included, 74.8% patients were responders to IFX at W14, including 38.7% in clinical remission and 36% with partial clinical response. Clinical remission at W14 was associated with normal growth (P < 0.01), and normal albuminemia (P = 0.01) at baseline, It was also associated with trough levels to IFX >8.3 μg/ml at week 6 (P < 0.01).\u0000\u0000\u0000CONCLUSION\u0000Trough levels to IFX >8.3 μg/ml at week 6 are predictive of remission at W14 for luminal disease.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80939447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/MPG.0000000000002489
J. Squires, V. Ng, Kieran Hawthorne, Lisa Henn, Lisa G. Sorensen, E. Fredericks, E. Alonso, K. Murray, K. Loomes, S. Karpen, L. Cavallo, J. Molleston, J. Bezerra, P. Rosenthal, Robert H. Squires, Kasper S. Wang, K. Schwarz, R. Arnon, J. Magee, R. Sokol
OBJECTIVES To assess neurodevelopmental outcomes among children with biliary atresia (BA) surviving with their native liver at age 3-12 years and evaluate variables that associate with neurodevelopment. METHODS Participants (age 3-12 years) in a prospective, longitudinal, multicenter study underwent neurodevelopmental testing with Weschler Preschool and Primary Scale of Intelligence, 3 edition (WPPSI-III, age 3-5 yrs.) and Weschler Intelligence Scale for Children, 4 edition (WISC-IV, age 6-12 yrs.). Continuous scores were analyzed using Kolmogorov-Smironov tests compared to a normal distribution (mean = 100 ± 15). Effect of covariates on Full-Scale Intelligence Quotient (FSIQ) was analyzed using linear regression. RESULTS Ninety-three participants completed 164 WPPSI-III (mean age 3.9) and 51 WISC-IV (mean age 6.9) tests. WPPSI-III FSIQ (104 ± 14, P < 0.02), Verbal IQ (106 ± 14, P < 0.001), and General Language Composite (107 ± 16, P < 0.001) distributions were shifted higher compared to test norms. WISC-IV FSIQ (105 ± 12, P < 0.01), Perceptual Reasoning Index (107 ± 12, P < 0.01), and Processing Speed Index (105 ± 10, P < 0.02) also shifted upwards. In univariate and multivariable analysis, parent education (P < 0.01) was a significant predictor of FSIQ on WPPSI-III and positively associated with WISC-IV FSIQ. Male sex and higher total bilirubin and gamma glutamyl transferase (GGT) predicted lower WPPSI-III FSIQ. Portal hypertension was predictive of lower WISC-IV FSIQ. CONCLUSION This cohort of children with BA and native liver did not demonstrate higher prevalence of neurodevelopmental delays. Markers of advanced liver disease (higher total bilirubin and GGT for age ≤5 yrs; portal hypertension for age ≥6) correlate with lower FSIQ and may identify a vulnerable subset of patients who would benefit from intervention.
{"title":"Neurodevelopmental Outcomes in Pre-School and School Aged Children with Biliary Atresia and their Native Liver.","authors":"J. Squires, V. Ng, Kieran Hawthorne, Lisa Henn, Lisa G. Sorensen, E. Fredericks, E. Alonso, K. Murray, K. Loomes, S. Karpen, L. Cavallo, J. Molleston, J. Bezerra, P. Rosenthal, Robert H. Squires, Kasper S. Wang, K. Schwarz, R. Arnon, J. Magee, R. Sokol","doi":"10.1097/MPG.0000000000002489","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002489","url":null,"abstract":"OBJECTIVES\u0000To assess neurodevelopmental outcomes among children with biliary atresia (BA) surviving with their native liver at age 3-12 years and evaluate variables that associate with neurodevelopment.\u0000\u0000\u0000METHODS\u0000Participants (age 3-12 years) in a prospective, longitudinal, multicenter study underwent neurodevelopmental testing with Weschler Preschool and Primary Scale of Intelligence, 3 edition (WPPSI-III, age 3-5 yrs.) and Weschler Intelligence Scale for Children, 4 edition (WISC-IV, age 6-12 yrs.). Continuous scores were analyzed using Kolmogorov-Smironov tests compared to a normal distribution (mean = 100 ± 15). Effect of covariates on Full-Scale Intelligence Quotient (FSIQ) was analyzed using linear regression.\u0000\u0000\u0000RESULTS\u0000Ninety-three participants completed 164 WPPSI-III (mean age 3.9) and 51 WISC-IV (mean age 6.9) tests. WPPSI-III FSIQ (104 ± 14, P < 0.02), Verbal IQ (106 ± 14, P < 0.001), and General Language Composite (107 ± 16, P < 0.001) distributions were shifted higher compared to test norms. WISC-IV FSIQ (105 ± 12, P < 0.01), Perceptual Reasoning Index (107 ± 12, P < 0.01), and Processing Speed Index (105 ± 10, P < 0.02) also shifted upwards. In univariate and multivariable analysis, parent education (P < 0.01) was a significant predictor of FSIQ on WPPSI-III and positively associated with WISC-IV FSIQ. Male sex and higher total bilirubin and gamma glutamyl transferase (GGT) predicted lower WPPSI-III FSIQ. Portal hypertension was predictive of lower WISC-IV FSIQ.\u0000\u0000\u0000CONCLUSION\u0000This cohort of children with BA and native liver did not demonstrate higher prevalence of neurodevelopmental delays. Markers of advanced liver disease (higher total bilirubin and GGT for age ≤5 yrs; portal hypertension for age ≥6) correlate with lower FSIQ and may identify a vulnerable subset of patients who would benefit from intervention.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81017251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/MPG.0000000000002541
Kieran Jian Peng Chen, E. Fujitake
{"title":"Development of a Patient-reported Experience and Outcome Measures in Pediatric Bowel Management.","authors":"Kieran Jian Peng Chen, E. Fujitake","doi":"10.1097/MPG.0000000000002541","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002541","url":null,"abstract":"","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86322287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/MPG.0000000000002497
S. Husby, S. Koletzko, I. Korponay-Szabó, K. Kurppa, M. Mearin, C. Ribes-Koninckx, R. Shamir, R. Troncone, R. Auricchio, G. Castillejo, R. Christensen, J. Dolinsek, P. Gillett, A. Hrõbjartsson, T. Koltai, M. Maki, S. Nielsen, A. Popp, Bucharest, K. Størdal, K. Werkstetter, Margreet Wessels
OBJECTIVES The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented. METHODS Literature databases and other sources of information were searched for studies that could inform on ten formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations. RESULTS Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable an IgG based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10xULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10xULN at least 4 biopsies from the distal duodenum and at least one from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely. CONCLUSIONS CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.
{"title":"European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2019.","authors":"S. Husby, S. Koletzko, I. Korponay-Szabó, K. Kurppa, M. Mearin, C. Ribes-Koninckx, R. Shamir, R. Troncone, R. Auricchio, G. Castillejo, R. Christensen, J. Dolinsek, P. Gillett, A. Hrõbjartsson, T. Koltai, M. Maki, S. Nielsen, A. Popp, Bucharest, K. Størdal, K. Werkstetter, Margreet Wessels","doi":"10.1097/MPG.0000000000002497","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002497","url":null,"abstract":"OBJECTIVES\u0000The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.\u0000\u0000\u0000METHODS\u0000Literature databases and other sources of information were searched for studies that could inform on ten formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.\u0000\u0000\u0000RESULTS\u0000Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable an IgG based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10xULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10xULN at least 4 biopsies from the distal duodenum and at least one from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.\u0000\u0000\u0000CONCLUSIONS\u0000CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73301023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/MPG.0000000000002513
Kathleen J. Holland, J. Slaven, C. Ren, D. Sanders, W. Bennett
BACKGROUND Late preterm infants (born 34 to 36 weeks gestation) without cystic fibrosis (CF) are at risk for growth failure during the first two years of life. Infants with CF are at risk of being born premature and thus at risk for growth failure. The aim for this study was to assess weight-for-length (WFL) at two years of age for late preterm infants compared to term infants with CF. METHODS Data were collected from the U.S. CF Foundation Patient Registry. We compared growth parameters between late preterm and term infants with CF born from 2010 to 2013. Our primary outcome was WFL <10 and <50 percentile at two years of age. A multivariate logistical regression analysis evaluated late preterm gestation and WFL<10 or <50 percentile. RESULTS A total of 2955 infants were born from 2010 to 2013 with CF. Eight percent late preterm. Forty five percent late preterm versus 43% term were below the 50 percentile for WFL at age two (p = 0.75). Twelve percent late preterm versus 6% term for WFL <10 percentile at age two (p = 0.010). The multivariate regression model identified two-fold increased odds of being < 10 percentile for WFL at age two (p = 0.025) for preterm over term. Late preterm infants used higher calorie dense feeds and more feeding tubes (p = 0.035 and p = 0.006). CONCLUSIONS Late preterm infants with CF are at higher risk of being below the 10 percentile for WFL at two years of age compared to their term peers. This indicates a population that is at risk for growth failure.
{"title":"A Retrospective Cohort Study of Growth in the First Two Years of Life in Preterm Infants with Cystic Fibrosis.","authors":"Kathleen J. Holland, J. Slaven, C. Ren, D. Sanders, W. Bennett","doi":"10.1097/MPG.0000000000002513","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002513","url":null,"abstract":"BACKGROUND\u0000Late preterm infants (born 34 to 36 weeks gestation) without cystic fibrosis (CF) are at risk for growth failure during the first two years of life. Infants with CF are at risk of being born premature and thus at risk for growth failure. The aim for this study was to assess weight-for-length (WFL) at two years of age for late preterm infants compared to term infants with CF.\u0000\u0000\u0000METHODS\u0000Data were collected from the U.S. CF Foundation Patient Registry. We compared growth parameters between late preterm and term infants with CF born from 2010 to 2013. Our primary outcome was WFL <10 and <50 percentile at two years of age. A multivariate logistical regression analysis evaluated late preterm gestation and WFL<10 or <50 percentile.\u0000\u0000\u0000RESULTS\u0000A total of 2955 infants were born from 2010 to 2013 with CF. Eight percent late preterm. Forty five percent late preterm versus 43% term were below the 50 percentile for WFL at age two (p = 0.75). Twelve percent late preterm versus 6% term for WFL <10 percentile at age two (p = 0.010). The multivariate regression model identified two-fold increased odds of being < 10 percentile for WFL at age two (p = 0.025) for preterm over term. Late preterm infants used higher calorie dense feeds and more feeding tubes (p = 0.035 and p = 0.006).\u0000\u0000\u0000CONCLUSIONS\u0000Late preterm infants with CF are at higher risk of being below the 10 percentile for WFL at two years of age compared to their term peers. This indicates a population that is at risk for growth failure.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74362631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/MPG.0000000000002542
P. Minneci, K. Deans
{"title":"Development of a Patient-reported Experience and Outcome Measures in Pediatric Bowel Management","authors":"P. Minneci, K. Deans","doi":"10.1097/MPG.0000000000002542","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002542","url":null,"abstract":"","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81168509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.1097/mpg.0000000000002520
The Journal of Pediatric Gastroenterology and Nutrition provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.
{"title":"Journal of Pediatric Gastroenterology and Nutrition 2019 Reviewer Acknowledgement","authors":"","doi":"10.1097/mpg.0000000000002520","DOIUrl":"https://doi.org/10.1097/mpg.0000000000002520","url":null,"abstract":"The Journal of Pediatric Gastroenterology and Nutrition provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76028136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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