Pub Date : 2019-11-14DOI: 10.1097/MPG.0000000000002563
S. Shankar, R. Bolia, H. Foo, C. D'Arcy, N. Hardikar, Martin Wensing, W. Hardikar
OBJECTIVES Gamma-glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of 'normal GGT' BA has not been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to 1) describe outcomes of a single-centre Australian cohort of infants with biliary atresia and 2) assess the impact of GGT level at presentation on outcomes in BA. METHODS Infants diagnosed with BA between 1991 - 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT) and death. Patients were categorised into normal (<200IU/L) or high GGT groups based on a mean of three consecutive GGT values done prior to Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice and outcomes were compared between the two groups. RESULTS 113 infants underwent KPE at median 61 (30-149) days. At a median follow-up of 14.2 (0.9-26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pre-transplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to clearance of jaundice were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18months, p = 0.02), underwent LT at a younger age (14 vs 20months, p = 0.04) and had poorer transplant-free survival (p = 0.04) than high GGT group. CONCLUSION 12.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in biliary atresia was associated with a poorer outcome.
{"title":"Normal Gamma Glutamyl Transferase Levels at Presentation Predict Poor Outcome in Biliary Atresia.","authors":"S. Shankar, R. Bolia, H. Foo, C. D'Arcy, N. Hardikar, Martin Wensing, W. Hardikar","doi":"10.1097/MPG.0000000000002563","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002563","url":null,"abstract":"OBJECTIVES\u0000Gamma-glutamyl transferase levels (GGT) are typically elevated in biliary atresia (BA), but normal GGT levels have been observed. This cohort of 'normal GGT' BA has not been described nor has the prognostic value of GGT level on outcomes in BA. We aimed to 1) describe outcomes of a single-centre Australian cohort of infants with biliary atresia and 2) assess the impact of GGT level at presentation on outcomes in BA.\u0000\u0000\u0000METHODS\u0000Infants diagnosed with BA between 1991 - 2017 were retrospectively analysed. Outcomes were defined as survival with native liver, liver transplantation (LT) and death. Patients were categorised into normal (<200IU/L) or high GGT groups based on a mean of three consecutive GGT values done prior to Kasai portoenterostomy (KPE). Baseline parameters, age at surgery, clearance of jaundice and outcomes were compared between the two groups.\u0000\u0000\u0000RESULTS\u0000113 infants underwent KPE at median 61 (30-149) days. At a median follow-up of 14.2 (0.9-26.3) years, 35% (39/113) patients were surviving with native liver, 55% (62/113) underwent LT and 11% (12/113) died pre-transplant. 12.3% (14/113) patients had normal GGT. Age at KPE and time to clearance of jaundice were similar between normal and high GGT groups. Normal GGT group had shorter time from KPE to LT (11 vs 18months, p = 0.02), underwent LT at a younger age (14 vs 20months, p = 0.04) and had poorer transplant-free survival (p = 0.04) than high GGT group.\u0000\u0000\u0000CONCLUSION\u000012.3% of infants with BA had normal GGT levels at diagnosis. Low GGT levels at presentation in biliary atresia was associated with a poorer outcome.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75052734","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 : 2019-11-14DOI: 10.1097/MPG.0000000000002559
I. Trivić, Z. Mišak, Višnjica Kerman, H. Prlić, S. Kolaček, I. Hojsak
Reliable venous access is prerequisite for patients receiving long-term parenteral nutrition (PN). However, central venous catheters (CVCs) are an important risk factor for the development of potentially lethal complications, including catheter related bloodstream infection (CRBSI). We have retrospectively assessed the incidence of CRBSIs in children on long-term PN who were treated at the Children's Hospital Zagreb from January 2011 until January 2019 and the cost effectiveness of the use of taurolidine line locks in children at home PN (HPN). During this period 48 children received long-term PN and 24 children were discharged to HPN. The rate of CRBSI 1.15/1000 catheter days in total; 2.35/1000 days in the hospital and 0.48/1000 days at home. If taurolidine line lock was used every day of PN for children on HPN total costs would exceed existing CRBSI treatment costs more than 5 times.
{"title":"Central Catheter Related Bloodstream Infection Rates In Children on Home Parenteral Nutrition.","authors":"I. Trivić, Z. Mišak, Višnjica Kerman, H. Prlić, S. Kolaček, I. Hojsak","doi":"10.1097/MPG.0000000000002559","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002559","url":null,"abstract":"Reliable venous access is prerequisite for patients receiving long-term parenteral nutrition (PN). However, central venous catheters (CVCs) are an important risk factor for the development of potentially lethal complications, including catheter related bloodstream infection (CRBSI). We have retrospectively assessed the incidence of CRBSIs in children on long-term PN who were treated at the Children's Hospital Zagreb from January 2011 until January 2019 and the cost effectiveness of the use of taurolidine line locks in children at home PN (HPN). During this period 48 children received long-term PN and 24 children were discharged to HPN. The rate of CRBSI 1.15/1000 catheter days in total; 2.35/1000 days in the hospital and 0.48/1000 days at home. If taurolidine line lock was used every day of PN for children on HPN total costs would exceed existing CRBSI treatment costs more than 5 times.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81792962","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 : 2019-11-06DOI: 10.1097/MPG.0000000000002550
W. Koo
T o the Editor: The position paper by ESPGHAN on palm oil (PO) and beta-palmitate in infant formula (1) shows undisputed biochemical and physiological basis for the negative nutrient absorption effect of palmitic acid from plant-based PO versus that from human or animal fat; and negative clinical effects in animal and tissue models. Use of PO in infant formula results in impaired fat and calcium absorption (2,3), lower growth measurements (4), and bone mass (5). There is uncertainty whether the negative effect on growth and bone accretion persists (1) because 1 cross-sectional follow-up study lacks control for multiple confounders of growth and bone mineralization and a longitudinal follow-up study had only 28% of the original cohort. In an era of evidence-based medicine, it seems prudent to recommend caution with the addition of PO in infant formula, given the multiple potential negative biochemical, physiological, and clinical effects of PO and lack of demonstrated benefits from PO. During infancy, there is a gain of 25 to 30 cm in length and tripling of the bone mass, an amount comparable to the peak bone accretion during adolescence on an annualized basis (6). Since the achievement of optimal peak bone mass throughout childhood and young adulthood is a cornerstone in the prevention of osteoporosis (7), and no guaranteed reversal of the negative effects of PO, it seems prudent to avoid adding PO to infant formula.
{"title":"Palm Oil and Beta-Palmitate in Infant Formula.","authors":"W. Koo","doi":"10.1097/MPG.0000000000002550","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002550","url":null,"abstract":"T o the Editor: The position paper by ESPGHAN on palm oil (PO) and beta-palmitate in infant formula (1) shows undisputed biochemical and physiological basis for the negative nutrient absorption effect of palmitic acid from plant-based PO versus that from human or animal fat; and negative clinical effects in animal and tissue models. Use of PO in infant formula results in impaired fat and calcium absorption (2,3), lower growth measurements (4), and bone mass (5). There is uncertainty whether the negative effect on growth and bone accretion persists (1) because 1 cross-sectional follow-up study lacks control for multiple confounders of growth and bone mineralization and a longitudinal follow-up study had only 28% of the original cohort. In an era of evidence-based medicine, it seems prudent to recommend caution with the addition of PO in infant formula, given the multiple potential negative biochemical, physiological, and clinical effects of PO and lack of demonstrated benefits from PO. During infancy, there is a gain of 25 to 30 cm in length and tripling of the bone mass, an amount comparable to the peak bone accretion during adolescence on an annualized basis (6). Since the achievement of optimal peak bone mass throughout childhood and young adulthood is a cornerstone in the prevention of osteoporosis (7), and no guaranteed reversal of the negative effects of PO, it seems prudent to avoid adding PO to infant formula.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87583193","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 : 2019-11-01DOI: 10.1097/MPG.0000000000002459
A. Correani, Ilaria Giretti, L. Antognoli, C. Monachesi, P. Cogo, R. D’Ascenzo, C. Biagetti, V. Carnielli
OBJECTIVES In case of hypertriglyceridemia (HiTG) during parenteral nutrition (PN), the 2018 ESPGHAN guidelines recommend an intravenous (IV) lipid titration, but its consequences in small preterm infants are largely unknown. We compared macronutrient and energy intakes, growth, diseases associated with prematurity and neurodevelopment in small preterm infants on PN who developed (cases) or did not develop HiTG (controls, CNTR). METHODS We retrospectively reviewed data of preterm infants with a birth weight (BW) <1250 g consecutively admitted to our NICU (2004-2016) who received routine PN. HiTG infants were defined by at least one triglyceride (TG) measurement >250 mg/dL during the first 10 days of life (DOL). Patients with and without HiTG were match-paired for BW and gestational age (GA). RESULTS 658 infants were analysed and 196 (30%) had HiTG. 136 HiTG patients were matched with 136 CNTR. In the first 10 DOL, IV lipid, non-protein energy (NPE) and total energy intakes, but not IV amino acids (AA) and carbohydrates (CHO), were significantly lower in HiTG infants. We found no differences between groups in diseases associated with prematurity. Anthropometry at 36 weeks (W), anthropometry at 2-year (Y) corrected age (CA), and neurodevelopment at 2Y CA were not different. CONCLUSIONS Growth, diseases associated with prematurity and neurodevelopment at 2Y CA in HiTG infants were similar to CNTR. This occurred despite a statistically significant albeit small reduction in IV lipid and NPE intakes due to a strict TG monitoring and IV lipid titration at TG levels >250 mg/dL.
{"title":"Hypertriglyceridemia and Intravenous Lipid Titration during Routine Parenteral Nutrition in Small Preterm Infants.","authors":"A. Correani, Ilaria Giretti, L. Antognoli, C. Monachesi, P. Cogo, R. D’Ascenzo, C. Biagetti, V. Carnielli","doi":"10.1097/MPG.0000000000002459","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002459","url":null,"abstract":"OBJECTIVES\u0000In case of hypertriglyceridemia (HiTG) during parenteral nutrition (PN), the 2018 ESPGHAN guidelines recommend an intravenous (IV) lipid titration, but its consequences in small preterm infants are largely unknown. We compared macronutrient and energy intakes, growth, diseases associated with prematurity and neurodevelopment in small preterm infants on PN who developed (cases) or did not develop HiTG (controls, CNTR).\u0000\u0000\u0000METHODS\u0000We retrospectively reviewed data of preterm infants with a birth weight (BW) <1250 g consecutively admitted to our NICU (2004-2016) who received routine PN. HiTG infants were defined by at least one triglyceride (TG) measurement >250 mg/dL during the first 10 days of life (DOL). Patients with and without HiTG were match-paired for BW and gestational age (GA).\u0000\u0000\u0000RESULTS\u0000658 infants were analysed and 196 (30%) had HiTG. 136 HiTG patients were matched with 136 CNTR. In the first 10 DOL, IV lipid, non-protein energy (NPE) and total energy intakes, but not IV amino acids (AA) and carbohydrates (CHO), were significantly lower in HiTG infants. We found no differences between groups in diseases associated with prematurity. Anthropometry at 36 weeks (W), anthropometry at 2-year (Y) corrected age (CA), and neurodevelopment at 2Y CA were not different.\u0000\u0000\u0000CONCLUSIONS\u0000Growth, diseases associated with prematurity and neurodevelopment at 2Y CA in HiTG infants were similar to CNTR. This occurred despite a statistically significant albeit small reduction in IV lipid and NPE intakes due to a strict TG monitoring and IV lipid titration at TG levels >250 mg/dL.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86572983","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 : 2019-11-01DOI: 10.1097/MPG.0000000000002462
Sara K. Naramore, W. Bennett, Guanglong Jiang, S. Kugathasan, L. Denson, J. Hyams, S. Steiner
OBJECTIVES Children with Crohn's disease may present with malnutrition and linear growth impairment which can be secondary to insufficient caloric intake, chronic inflammation, malabsorption, and suppression of growth-promoting hormones. We evaluated clinical, serologic, and genetic data to determine risk factors for impaired anthropometrics in Crohn's disease at diagnosis. METHODS Our study evaluated 772 children newly diagnosed with Crohn's disease, inflammatory phenotype, enrolled in the RISK Stratification Project to determine the factors associated with anthropometric impairment. Data were collected on demographics, growth parameters, disease location, serologic and immunologic markers, and disease severity. We performed a genome-wide association study of genetic polymorphisms associated with inflammatory bowel disease. Regression analysis determined associations between anthropometrics and clinical, serologic, and genetic variables. RESULTS There were 59 (7%) children with height z-score <-2, 126 (14%) with a weight z-score <-2, and 156 (17%) with a BMI z-score <-2. Linear growth impairment was associated with hypoalbuminemia (p = 0.0052), elevated granulocyte-macrophage colony stimulating factor auto-antibodies (GM-CSF Ab) (p = 0.0110), and elevated CBir antibodies against flagellin (p = 0.0117). Poor weight gain was associated with female gender (p = 0.0401), hypoalbuminemia (p = 0.0162), and thrombocytosis (p = 0.0081). Malnutrition was associated with hypoalbuminemia (p = 0.0061) and thrombocytosis (p = 0.0011). Children with moderate or severe disease had lower weight (p = 0.02 and p = 1.16×10, respectively) and BMI z-scores (p = 2.7 × 10 and p = 1.01 × 10, respectively) than children with quiescent and mild disease. There was no association between age of diagnosis, Tanner stage, or disease location and having impaired anthropometrics. There was no genome-wide association between the genetic polymorphisms and the serologic variables and anthropometric measurements. CONCLUSIONS This is the largest study evaluating growth in treatment-naïve children with Crohn's disease, inflammatory phenotype. It is the first study to use genome-wide sequencing to assess for genetic determinants of growth impairment. GM-CSF auto-antibodies and CBir antibodies are more likely to be elevated in children with growth impairment. Future investigations should evaluate the relationship between genetic polymorphisms, pathologic immune responses, and the biological pathways regulating growth.
{"title":"Serologic, but not Genetic, Markers are Associated with Impaired Anthropometrics at Diagnosis of Pediatric Crohn's Disease.","authors":"Sara K. Naramore, W. Bennett, Guanglong Jiang, S. Kugathasan, L. Denson, J. Hyams, S. Steiner","doi":"10.1097/MPG.0000000000002462","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002462","url":null,"abstract":"OBJECTIVES\u0000Children with Crohn's disease may present with malnutrition and linear growth impairment which can be secondary to insufficient caloric intake, chronic inflammation, malabsorption, and suppression of growth-promoting hormones. We evaluated clinical, serologic, and genetic data to determine risk factors for impaired anthropometrics in Crohn's disease at diagnosis.\u0000\u0000\u0000METHODS\u0000Our study evaluated 772 children newly diagnosed with Crohn's disease, inflammatory phenotype, enrolled in the RISK Stratification Project to determine the factors associated with anthropometric impairment. Data were collected on demographics, growth parameters, disease location, serologic and immunologic markers, and disease severity. We performed a genome-wide association study of genetic polymorphisms associated with inflammatory bowel disease. Regression analysis determined associations between anthropometrics and clinical, serologic, and genetic variables.\u0000\u0000\u0000RESULTS\u0000There were 59 (7%) children with height z-score <-2, 126 (14%) with a weight z-score <-2, and 156 (17%) with a BMI z-score <-2. Linear growth impairment was associated with hypoalbuminemia (p = 0.0052), elevated granulocyte-macrophage colony stimulating factor auto-antibodies (GM-CSF Ab) (p = 0.0110), and elevated CBir antibodies against flagellin (p = 0.0117). Poor weight gain was associated with female gender (p = 0.0401), hypoalbuminemia (p = 0.0162), and thrombocytosis (p = 0.0081). Malnutrition was associated with hypoalbuminemia (p = 0.0061) and thrombocytosis (p = 0.0011). Children with moderate or severe disease had lower weight (p = 0.02 and p = 1.16×10, respectively) and BMI z-scores (p = 2.7 × 10 and p = 1.01 × 10, respectively) than children with quiescent and mild disease. There was no association between age of diagnosis, Tanner stage, or disease location and having impaired anthropometrics. There was no genome-wide association between the genetic polymorphisms and the serologic variables and anthropometric measurements.\u0000\u0000\u0000CONCLUSIONS\u0000This is the largest study evaluating growth in treatment-naïve children with Crohn's disease, inflammatory phenotype. It is the first study to use genome-wide sequencing to assess for genetic determinants of growth impairment. GM-CSF auto-antibodies and CBir antibodies are more likely to be elevated in children with growth impairment. Future investigations should evaluate the relationship between genetic polymorphisms, pathologic immune responses, and the biological pathways regulating growth.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78960696","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 : 2019-11-01DOI: 10.1097/MPG.0000000000002473
Andrew S Phelps
n this issue’s article, ‘‘Texture analysis of magnetic resonance enterography contrast enhancement can detect fibrosis in Crohn I disease strictures,’’ Tabari and co-workers demonstrated that a computer had greater diagnostic accuracy than a human radiologist (1). Using histology as the gold standard for fibrosis, the computer distinguished no fibrosis and mild fibrosis from moderate-to-severe fibrosis with an impressive area under the curve (AUC) of 0.995. To appreciate the significance of this article and that AUC, it will be helpful to review how far imaging has advanced in the 87 years since Dr Burrill Crohn’s seminal paper. In patients diagnosed with Crohn disease, almost half will develop a fibrotic stricture within 10 years of first receiving their diagnosis, often requiring surgical resection (2). The gold standard for diagnosing fibrosis is the deposition of collagen, detected histologically from full-thickness bowel resection. Due to the submucosal and subserosal location of the collagen deposition, fibrosis may be difficult to appreciate by endoscopic visualization or partial-thickness endoscopic biopsy. By imaging, a fibrotic stricture classically demonstrates 3 anatomic features: luminal narrowing, wall thickening, and prestenotic dilation (3). However, these 3 anatomic features alone are late features and are nonspecific, as active inflammation without fibrosis can have a similar appearance. In Crohn’s original 1932 article, he acknowledged the promise and limitations of anatomic imaging: ‘‘The barium meal, however, when carefully interpreted, gives definite positive findings. ... though only in the late or stenotic stages is the delay striking. The midler degrees of stasis and puddling in the ileal loops may easily be overlooked by any but a careful roentgenologist’’(4). It would be another 50 years before cross-sectional imaging (including computed tomography, magnetic resonance imaging ‘‘MRI,’’ and ultrasound) demonstrated diagnostic superiority compared with the traditional fluoroscopic ‘‘barium meal,’’ or what we would now call a ‘‘small bowel follow through’’(5). However, improvements in anatomic detail would only take diagnostic accuracy so far. What
{"title":"Intestinal Wall Texture Analysis: Finding Fibrosis in Pediatric Patients with Crohn Disease.","authors":"Andrew S Phelps","doi":"10.1097/MPG.0000000000002473","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002473","url":null,"abstract":"n this issue’s article, ‘‘Texture analysis of magnetic resonance enterography contrast enhancement can detect fibrosis in Crohn I disease strictures,’’ Tabari and co-workers demonstrated that a computer had greater diagnostic accuracy than a human radiologist (1). Using histology as the gold standard for fibrosis, the computer distinguished no fibrosis and mild fibrosis from moderate-to-severe fibrosis with an impressive area under the curve (AUC) of 0.995. To appreciate the significance of this article and that AUC, it will be helpful to review how far imaging has advanced in the 87 years since Dr Burrill Crohn’s seminal paper. In patients diagnosed with Crohn disease, almost half will develop a fibrotic stricture within 10 years of first receiving their diagnosis, often requiring surgical resection (2). The gold standard for diagnosing fibrosis is the deposition of collagen, detected histologically from full-thickness bowel resection. Due to the submucosal and subserosal location of the collagen deposition, fibrosis may be difficult to appreciate by endoscopic visualization or partial-thickness endoscopic biopsy. By imaging, a fibrotic stricture classically demonstrates 3 anatomic features: luminal narrowing, wall thickening, and prestenotic dilation (3). However, these 3 anatomic features alone are late features and are nonspecific, as active inflammation without fibrosis can have a similar appearance. In Crohn’s original 1932 article, he acknowledged the promise and limitations of anatomic imaging: ‘‘The barium meal, however, when carefully interpreted, gives definite positive findings. ... though only in the late or stenotic stages is the delay striking. The midler degrees of stasis and puddling in the ileal loops may easily be overlooked by any but a careful roentgenologist’’(4). It would be another 50 years before cross-sectional imaging (including computed tomography, magnetic resonance imaging ‘‘MRI,’’ and ultrasound) demonstrated diagnostic superiority compared with the traditional fluoroscopic ‘‘barium meal,’’ or what we would now call a ‘‘small bowel follow through’’(5). However, improvements in anatomic detail would only take diagnostic accuracy so far. What","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"9 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72585111","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 : 2019-11-01DOI: 10.1097/MPG.0000000000002467
K. Schwarz, M. Lombardero, A. D. Di Bisceglie, K. Murray, P. Rosenthal, S. Ling, Y. Cloonan, N. Rodriguez-Baez, S. Schwarzenberg, J. Hoofnagle, J. Teckman
OBJECTIVE Define chronic HBV phenotypes in a large, cohort of US and Canadian children utilizing recently published population-based upper limit of normal alanine aminotransferase levels (ULN ALT), compared to local laboratory ULN; identify relationships with host and viral factors. BACKGROUND Chronic hepatitis B virus (HBV) infection has been characterized by phases or phenotypes, possibly associated with prognosis and indications for therapy. METHODS Baseline enrollment data of children in the Hepatitis B Research Network were examined. Phenotype definitions were; inactive carrier: HBeAg negative with low HBV DNA and normal ALT levels; immune tolerant: HBeAg positive with high HBV DNA but normal ALT levels; or chronic hepatitis B: HBeAg-positive or -negative with high HBV DNA and abnormal ALT levels. RESULTS 371 participants were analyzed of whom 274 were HBeAg-positive (74%). Younger participants were more likely be HBeAg-positive with higher HBV DNA levels. If local laboratory ULN ALT levels were used, 35% were assigned the immune tolerant phenotype, but if updated ULN were applied, only 12% could be so defined, and the remaining 82% would be considered to have chronic hepatitis B. Among HBeAg-negative participants, only 21 (22%) were defined as inactive carriers and 14 (14%) as HBeAg-negative chronic hepatitis B; the majority (61%) had abnormal ALT and low levels of HBV DNA, thus having an indeterminant phenotype. Increasing age was associated with smaller proportions of HBeAg-positive infection. CONCLUSIONS Among children with chronic HBV infection living in North America, the immune tolerant phenotype is uncommon and HBeAg positivity decreases with age.
{"title":"Phenotypes of Chronic Hepatitis B in Children from a Large North American Cohort.","authors":"K. Schwarz, M. Lombardero, A. D. Di Bisceglie, K. Murray, P. Rosenthal, S. Ling, Y. Cloonan, N. Rodriguez-Baez, S. Schwarzenberg, J. Hoofnagle, J. Teckman","doi":"10.1097/MPG.0000000000002467","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002467","url":null,"abstract":"OBJECTIVE\u0000Define chronic HBV phenotypes in a large, cohort of US and Canadian children utilizing recently published population-based upper limit of normal alanine aminotransferase levels (ULN ALT), compared to local laboratory ULN; identify relationships with host and viral factors.\u0000\u0000\u0000BACKGROUND\u0000Chronic hepatitis B virus (HBV) infection has been characterized by phases or phenotypes, possibly associated with prognosis and indications for therapy.\u0000\u0000\u0000METHODS\u0000Baseline enrollment data of children in the Hepatitis B Research Network were examined. Phenotype definitions were; inactive carrier: HBeAg negative with low HBV DNA and normal ALT levels; immune tolerant: HBeAg positive with high HBV DNA but normal ALT levels; or chronic hepatitis B: HBeAg-positive or -negative with high HBV DNA and abnormal ALT levels.\u0000\u0000\u0000RESULTS\u0000371 participants were analyzed of whom 274 were HBeAg-positive (74%). Younger participants were more likely be HBeAg-positive with higher HBV DNA levels. If local laboratory ULN ALT levels were used, 35% were assigned the immune tolerant phenotype, but if updated ULN were applied, only 12% could be so defined, and the remaining 82% would be considered to have chronic hepatitis B. Among HBeAg-negative participants, only 21 (22%) were defined as inactive carriers and 14 (14%) as HBeAg-negative chronic hepatitis B; the majority (61%) had abnormal ALT and low levels of HBV DNA, thus having an indeterminant phenotype. Increasing age was associated with smaller proportions of HBeAg-positive infection.\u0000\u0000\u0000CONCLUSIONS\u0000Among children with chronic HBV infection living in North America, the immune tolerant phenotype is uncommon and HBeAg positivity decreases with age.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81463923","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 : 2019-11-01DOI: 10.1097/MPG.0000000000002481
Yanping Yu, Yunfeng Fu
{"title":"Diagnosis and Management of Pancreaticopleural Fistula in Children.","authors":"Yanping Yu, Yunfeng Fu","doi":"10.1097/MPG.0000000000002481","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002481","url":null,"abstract":"","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74349341","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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