Pediatric Gastroenterology, Hepatology & Nutrition最新文献_第10页

To Button or Not to Button? Primary Gastrostomy Tubes Offer No Significant Advantage Over Buttons 按还是不按?初级胃造口管与纽扣相比没有明显优势

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.211

Hector Osei, A. S. Munoz-Abraham, Alice Martino, Kaveer Chatoorgoon, J. Greenspon, Colleen Fitzpatrick, Gustavo A. Villalona

Purpose Outcomes between primary gastrostomy tubes and buttons (G-tube and G-button) have not been established in pediatric patients. We hypothesized that primary G-tube have decreased complications when compared to G-button. Methods A retrospective review of surgically placed gastrostomy devices from 2010 to 2017 was performed. Data collected included demographics, outcomes and 90-day complications. We divided the patients into primary G-tube and primary G-button. Results Of 265 patients, 142 (53.6%) were male. Median age and weight at the time of surgery were 7 months (interquartile range [IQR], 2–44 months) and 6.70 kg (IQR, 3.98–14.15 kg), respectively. Among the groups, G-tube had 80 patients (30.2%) while G-button 185 patients (69.8%). There were 153 patients with at least one overall complication within 90 days postoperative. There was no significant difference in overall complications between groups (G-tube 63.8% vs. G-button 55.7%, p=0.192). More importantly, there were no significant differences in major complications among the groups, G-tube vs. G-button (5% vs. 4%; p=0.455). Conclusion Primary G-tube offers no significant advantage in overall, minor or major complications when compared to primary G-button.

目的:在儿科患者中，初级胃造口管和按钮(g管和g按钮)之间的结果尚未确定。我们假设与G-button相比，primary G-tube有更少的并发症。方法回顾性分析2010年至2017年手术放置胃造口装置的情况。收集的数据包括人口统计学、结局和90天并发症。我们将患者分为初级g管和初级g扣。结果265例患者中，男性142例，占53.6%。手术时的中位年龄和体重分别为7个月(四分位间距[IQR]， 2-44个月)和6.70 kg (IQR, 3.98-14.15 kg)。其中g管组80例(30.2%)，g扣组185例(69.8%)。153例患者在术后90天内至少出现一次并发症。两组总并发症发生率无显著差异(g管63.8% vs g扣55.7%，p=0.192)。更重要的是，g管组与g扣组在主要并发症方面无显著差异(5% vs. 4%;p = 0.455)。结论初级g管与初级g扣相比，在总体、轻微或严重并发症方面均无明显优势。

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引用次数: 1

Outcomes of Endoscopic Drainage in Children with Pancreatic Fluid Collections: A Systematic Review and Meta-Analysis. 胰液积聚儿童的内镜引流效果：系统回顾与元分析》。

IF 1.3 Q3 PEDIATRICS

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 Epub Date: 2022-05-09 DOI: 10.5223/pghn.2022.25.3.251

Zaheer Nabi, Rupjyoti Talukdar, Sundeep Lakhtakia, D Nageshwar Reddy

Purpose: Endoscopic drainage is an established treatment modality for adult patients with pancreatic fluid collections (PFCs). Available data regarding the efficacy and safety of endoscopic drainage in pediatric patients are limited. In this systematic review and meta-analysis, we aimed to analyze the outcomes of endoscopic drainage in children with PFCs.

Methods: A literature search was performed in Embase, PubMed, and Google Scholar for studies on the outcomes of endoscopic drainage with or without endoscopic ultrasonography (EUS) guidance in pediatric patients with PFCs from inception to May 2021. The study's primary objective was clinical success, defined as resolution of PFCs. The secondary outcomes included technical success, adverse events, and recurrence rates.

Results: Fourteen studies (187 children, 70.3% male) were included in this review. The subtypes of fluid collection included pseudocysts (60.3%) and walled-off necrosis (39.7%). The pooled technical success rates in studies where drainage of PFCs were performed with and without EUS guidance were 95.3% (95% confidence interval [CI], 89.6-98%; I ²=0) and 93.9% (95% CI, 82.6-98%; I ²=0), respectively. The pooled clinical success after one and two endoscopic interventions were 88.7% (95% CI, 82.7-92.9%; I ²=0) and 92.3% (95% CI, 87.4-95.4%; I ²=0), respectively. The pooled rate of major adverse events was 6.3% (95% CI, 3.3-11.4%; I ²=0). The pooled rate of recurrent PFCs after endoscopic drainage was 10.4% (95% CI, 6.1-17.1%; I ²=0).

Conclusion: Endoscopic drainage is safe and effective in children with PFCs. However, future studies are required to compare endoscopic and EUS-guided drainage of PFCs in children.

目的：内窥镜引流术是治疗胰腺积液（PFC）成人患者的一种成熟治疗方式。有关内镜引流术在儿童患者中的有效性和安全性的现有数据非常有限。在这篇系统综述和荟萃分析中，我们旨在分析内镜引流术在儿童胰腺积液患者中的疗效：方法：我们在 Embase、PubMed 和 Google Scholar 上检索了从开始到 2021 年 5 月期间有关在内镜超声波（EUS）引导下或不在内镜超声波（EUS）引导下对 PFCs 儿童患者进行内镜引流的结果的文献。研究的首要目标是临床成功，即 PFCs 的消退。次要结果包括技术成功率、不良事件和复发率：本次研究共纳入 14 项研究（187 名儿童，70.3% 为男性）。积液的亚型包括假性囊肿（60.3%）和贴壁坏死（39.7%）。在 EUS 引导和无 EUS 引导的情况下进行 PFCs 引流的研究中，汇总的技术成功率分别为 95.3%（95% 置信区间 [CI]，89.6-98%；I 2=0）和 93.9%（95% 置信区间，82.6-98%；I 2=0）。经过一次和两次内镜干预后，汇总的临床成功率分别为88.7%（95% CI，82.7-92.9%；I 2=0）和92.3%（95% CI，87.4-95.4%；I 2=0）。主要不良事件的汇总发生率为 6.3% (95% CI, 3.3-11.4%; I 2=0)。内镜引流术后PFCs复发的汇总率为10.4% (95% CI, 6.1-17.1%; I 2=0)：结论：内镜下引流术对PFCs患儿安全有效。结论：内镜引流对儿童 PFCs 患者安全有效，但还需在今后的研究中对内镜和 EUS 引导下的儿童 PFCs 引流进行比较。

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引用次数: 0

Incidence and Associated Factors of Infantile Colic in Thai Infants. 泰国婴儿肠绞痛的发生率及相关因素。

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.276

Kamonnan Suklert, Nopaorn Phavichitr

Purpose: Infantile colic, a common functional gastrointestinal condition, causes distress and frustration in families. Its prevalence and incidence vary from community to community. The purpose of our study was to demonstrate the incidence of and factors associated with infantile colic in Thai infants.

Methods: We conducted a prospective analytic study to explore the incidence and factors associated with infantile colic in 386 Thai infants aged between one month and six months. Caregivers were interviewed using a questionnaire about infants' symptoms of colic based on the definition from the Rome IV criteria. Family background and potential precipitating factors of colic were also evaluated.

Results: The incidence of colic in infants younger than 6 months was 6.5%. All infants' colic started within 12 weeks of life and lasted approximately 6 weeks. Sex, gestational age, birth weight, delivery route, birth order, family factors, and parental factors were not correlated with the occurrence of colic. Infants who were exclusively breastfed for the first 2 months of life had a lower incidence of infantile colic than those who were mixed- or formula-fed (odds ratio=3.0; 95% confidence intervals=1.3 to 7.2).

Conclusion: The incidence of infantile colic in Thai infants in our study was 6.5%, which is similar to that in other reports. Being exclusively breastfed for the first two months was the only risk factor in our cohort.

目的:婴儿绞痛是一种常见的功能性胃肠道疾病，给家庭带来痛苦和挫折。其患病率和发病率因社区而异。我们研究的目的是证明泰国婴儿肠绞痛的发生率和相关因素。方法:我们进行了一项前瞻性分析研究，探讨386名年龄在1个月至6个月之间的泰国婴儿肠绞痛的发病率和相关因素。根据Rome IV标准的定义，使用关于婴儿绞痛症状的问卷对护理人员进行访谈。并对家庭背景和可能诱发绞痛的因素进行了评价。结果:6个月以下婴儿肠绞痛发生率为6.5%。所有婴儿的绞痛都在12周内开始，持续约6周。性别、胎龄、出生体重、分娩方式、出生顺序、家庭因素、父母因素与绞痛的发生无相关性。出生后2个月纯母乳喂养的婴儿比混合或配方奶喂养的婴儿发生绞痛的几率更低(优势比=3.0;95%置信区间=1.3 ~ 7.2)。结论:本研究中泰国婴儿肠绞痛发生率为6.5%，与其他报道相似。在我们的队列中，头两个月纯母乳喂养是唯一的风险因素。

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引用次数: 2

International Cross-Sectional Survey among Healthcare Professionals on the Management of Cow’s Milk Protein Allergy and Lactose Intolerance in Infants and Children 医疗保健专业人员对婴儿和儿童牛奶蛋白过敏和乳糖不耐受管理的国际横断面调查

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.263

J. Madrazo, F. Alrefaee, A. Chakrabarty, Julie C. De Leon, L. Geng, S. Gong, R. Heine, A. Järvi, J. Ngamphaiboon, C. Ong, J. Rogacion

Purpose The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow’s milk protein allergy (CMPA) and lactose intolerance (LI) in infants. Methods A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. Results Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. Conclusion The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.

目的本研究旨在收集婴儿牛奶蛋白过敏(CMPA)和乳糖不耐受(LI)诊断和管理的理论知识和临床实践数据。方法在几个不同卫生保健机构的国家进行了一项全球调查。调查包括3个主要领域的多项选择题:(1)对CMPA和LI的理解和临床实践;(2)案例场景;(3)疾病特异性知识和潜在教育需求。结果对1663名参与者进行了调查。约62%的受访者是全科医生或普通儿科医生，其余是儿科过敏症专家/胃肠病学家(18%)或其他卫生从业人员(20%)。该调查确定了关于CMPA类型(ige介导与非ige介导)的知识差距以及与LI的临床重叠。该调查表明，在使用低过敏性配方奶粉的临床实践中存在差异，以及对非母乳喂养的CMPA婴儿广泛水解配方奶粉中乳糖的益生元益处存在误解。对这两种情况的反应突出了对相关临床实践指南的不同程度的认识。虽然受访者普遍对管理患有CMPA和LI的婴儿有信心，但约80%的人表示有兴趣在这一领域进行进一步培训。结论目前的调查发现了一些知识差距和地区差异在婴幼儿CMPA或LI的管理。在普通和儿科医疗保健提供者中开展地方教育活动可以提高对这两种疾病的诊断和治疗的临床实践指南的认识，并有助于改善临床结果。

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引用次数: 2

Correlation between Transient Elastography (Fibroscan®) and Ultrasonographic and Computed Tomographic Grading in Pediatric Nonalcoholic Steatohepatitis 儿童非酒精性脂肪性肝炎瞬时弹性成像(Fibroscan®)与超声和计算机层析成像分级的相关性

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.240

J. E. Lee, Kyung Ok Ko, J. Lim, E. Cheon, Young Hwa Song, J. Yoon

Purpose This study aimed to examine the advantages and usefulness of transient elastography (Fibroscan®) in diagnosing non-alcoholic steatohepatitis in children and adolescents compared to those of abdominal computed tomography and liver ultrasonography. Methods Forty-six children and adolescent participants aged between 6 and 16 years who underwent transient elastography (Fibroscan®) as well as liver ultrasonography or abdominal computed tomography were included. Thirty-nine participants underwent liver ultrasonography and 11 underwent computed tomography. The physical measurements, blood test results, presence of metabolic syndrome, and the degree of liver steatosis and liver fibrosis were analyzed, and their correlations with transient elastography (Fibroscan®), abdominal computed tomography, and liver ultrasonography, as well as the correlations between examinations, were analyzed. Results Thirty-six participants (78.3%) were boys, and the mean age was 12.29±2.57 years, with a mean body mass index of 27.88±4.28. In the 46 participants, the mean values for aspartate aminotransferase, alanine aminotransferase, and total bilirubin were 89.87±118.69 IU/L, 138.54±141.79 IU/L, and 0.77±0.61 mg/dL, respectively. Although transient elastography (Fibroscan®) and abdominal computed tomography grading had a statistically significant positive correlation with aspartate aminotransferase and alanine aminotransferase values, the correlations between the results of grading performed by transient elastography (Fibroscan®), abdominal computed tomography, and liver ultrasonography were not statistically. Conclusion We confirmed that each examination was correlated with the results of some blood tests, suggesting the usefulness and possibility of diagnosis and treatment of steatohepatitis mediated by transient elastography (Fibroscan®) in the department of pediatrics.

目的本研究旨在探讨瞬时弹性成像(Fibroscan®)在诊断儿童和青少年非酒精性脂肪性肝炎方面的优势和有效性，并与腹部计算机断层扫描和肝脏超声检查进行比较。方法选取46名年龄在6 ~ 16岁的儿童和青少年，分别进行了瞬时弹性成像(Fibroscan®)、肝脏超声或腹部计算机断层扫描。39名参与者接受了肝脏超声检查，11名接受了计算机断层扫描。分析体格测量、血液检查结果、有无代谢综合征、肝脂肪变性和肝纤维化程度，并分析其与瞬时弹性成像(Fibroscan®)、腹部计算机断层扫描和肝脏超声检查的相关性，以及各检查之间的相关性。结果男性36例(78.3%)，平均年龄12.29±2.57岁，平均体重指数27.88±4.28。在46名参与者中，天冬氨酸转氨酶、丙氨酸转氨酶和总胆红素的平均值分别为89.87±118.69 IU/L、138.54±141.79 IU/L和0.77±0.61 mg/dL。虽然瞬时弹性成像(Fibroscan®)和腹部计算机断层扫描分级与天冬氨酸转氨酶和丙氨酸转氨酶值有统计学意义的正相关，但瞬时弹性成像(Fibroscan®)、腹部计算机断层扫描和肝脏超声检查分级结果之间的相关性没有统计学意义。结论:我们证实每项检查都与一些血液检查结果相关，提示儿科瞬时弹性成像(Fibroscan®)诊断和治疗脂肪性肝炎的有效性和可能性。

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引用次数: 4

Pediatric Inflammatory Bowel Disease: A Multicenter Study of Changing Trends in Argentina Over the Past 30 Years 儿童炎症性肠病:阿根廷过去30年变化趋势的多中心研究

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.218

M. S. Arcucci, M. Contreras, J. Gallo, Mariela Andrea Antoniska, V. Busoni, Cecilia Tennina, D. D'Agostino, Maria Hisae Kakisu, Christian Weyersberg, M. Orsi

Purpose To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn’s disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.

目的分析阿根廷儿童炎症性肠病(IBD)过去30年的特点，并确定前20年与过去10年之间是否存在差异。方法:我们对阿根廷三个三级卫生中心1987年至2017年诊断为IBD的0至18岁儿童进行了一项回顾性多中心分析研究。评估包括临床特征、内窥镜检查、组织学和影像学资料以及治疗策略。患者分为两组:第一组，1987年至2007年诊断;第二组，2008年至2017年诊断。结果纳入的756例患者中，409例(54%)患有溃疡性结肠炎(UC)， 250例(33%)患有克罗恩病(CD)， 97例(13%)患有IBD-unclassified (IBD-U)。家族史阳性率为3.8%，以2岁以下儿童居多(6.7%)。不同时期的临床表现和肠外表现无显著差异，以肝脏表现最常见。在过去的十年中，我们发现CD呈上升趋势，UC/IBD-U呈下降趋势，即使在调整了社会经济地位之后，随着生物治疗的出现，手术治疗减少了50%。这是拉丁美洲国家第一个多中心队列研究，描述了过去30年的临床、内窥镜和治疗数据。虽然乳糜泻是发病率总体上升的原因，但UC在该地区仍然普遍存在。

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引用次数: 1

Composition of Human Breast Milk Microbiota and Its Role in Children’s Health 人母乳微生物群的组成及其对儿童健康的作用

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.194

Veronica Notarbartolo, M. Giuffré, C. Montante, G. Corsello, M. Carta

Human milk contains a number of nutritional and bioactive molecules including microorganisms that constitute the so-called “Human Milk Microbiota (HMM)”. Recent studies have shown that not only bacterial but also viral, fungal, and archaeal components are present in the HMM. Previous research has established, a “core” microbiome, consisting of Firmicutes (i.e., Streptococcus, Staphylococcus), Proteobacteria (i.e., Serratia, Pseudomonas, Ralstonia, Sphingomonas, Bradyrhizobium), and Actinobacteria (i.e., Propionibacterium, Corynebacterium). This review aims to summarize the main characteristics of HMM and the role it plays in shaping a child’s health. We reviewed the most recent literature on the topic (2019-2021), using the PubMed database. The main sources of HMM origin were identified as the retrograde flow and the entero-mammary pathway. Several factors can influence its composition, such as maternal body mass index and diet, use of antibiotics, time and type of delivery, and mode of breastfeeding. The COVID-19 pandemic, by altering the mother-infant dyad and modifying many of our previous habits, has emerged as a new risk factor for the modification of HMM. HMM is an important contributor to gastrointestinal colonization in children and therefore, it is fundamental to avoid any form of perturbation in the HMM that can alter the microbial equilibrium, especially in the first 100 days of life. Microbial dysbiosis can be a trigger point for the development of necrotizing enterocolitis, especially in preterm infants, and for onset of chronic diseases, such as asthma and obesity, later in life.

人乳含有许多营养和生物活性分子，包括构成所谓“人乳微生物群”的微生物。最近的研究表明，HMM中不仅存在细菌，还存在病毒、真菌和古细菌成分。先前的研究已经建立了一个“核心”微生物组，包括厚壁菌门(即链球菌、葡萄球菌)、变形菌门(即沙雷氏菌、假单胞菌、拉尔斯顿菌、鞘单胞菌、慢根瘤菌)和放线菌门(即丙酸杆菌、棒状杆菌)。本综述旨在总结HMM的主要特点及其在塑造儿童健康方面的作用。我们使用PubMed数据库回顾了有关该主题的最新文献(2019-2021)。HMM起源的主要来源被确定为逆行血流和肠-乳腺通路。有几个因素可以影响其组成，如产妇体重指数和饮食、抗生素的使用、分娩时间和类型以及母乳喂养方式。COVID-19大流行通过改变母婴关系和改变我们以前的许多习惯，已成为改变HMM的新风险因素。HMM是儿童胃肠道定植的重要贡献者，因此，避免任何形式的HMM扰动可能改变微生物平衡是至关重要的，特别是在生命的前100天。微生物生态失调可能是坏死性小肠结肠炎发展的一个触发点，特别是在早产儿中，以及在以后的生活中发生慢性疾病，如哮喘和肥胖。

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引用次数: 17

Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation 沙特专家对儿童功能性便秘诊断和治疗的共识

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.163

Dhafer B. Alshehri, H. H. Sindi, Ibrahim Mohamod AlMusalami, Ibrahim Hosamuddin Rozi, Mohamed Shagrani, N. Kamal, N. Alahmadi, S. Alfuraikh, Y. Vandenplas

Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.

虽然功能性胃肠疾病(fgid)在儿科患者中非常常见，但沙特阿拉伯缺乏公开的流行病学数据、特征和管理模式。沙特阿拉伯是面积第二大的阿拉伯国家，人口第六大阿拉伯国家，10%的人口年龄<5岁。功能性便秘(FC)是一种FGID，近年来在沙特婴儿和儿童中的患病率不断上升，这促使我们更新我们的临床实践。9名儿科顾问参加了两次咨询委员会会议，讨论和解决当前的挑战，提供解决方案，并就儿科便秘的管理达成沙特全国共识。儿科顾问一致认为，儿科医生应该注意在病史记录或身体检查中发现的任何警示迹象(危险信号)。他们还一致认为Rome IV标准是儿科FC诊断的金标准。小儿FC患者有不同的治疗选择。对于6个月以下的便秘婴儿，建议采用饮食治疗。当非药物干预不能改善FC症状时，需要使用泻药进行药物治疗。首先，治疗的目的是去除粪便团块。这是通过给予高剂量的口服聚乙二醇(PEG)或乳果糖几天来实现的。随后，应开始使用聚乙二醇维持治疗，以防止粪便重新积聚。除了聚乙二醇外，还可以使用其他几种选择，如富含镁的配方或刺激性泻药。然而，直肠灌肠和栓剂通常用于需要缓解急性疼痛的病例。相比之下，含有益生元或益生菌的婴儿配方奶粉尚未被证明对婴儿便秘有效，而部分水解配方奶粉的使用尚无定论。这些临床实践建议旨在被沙特阿拉伯的儿科医生和初级保健医生采用。

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引用次数: 4

Cerebrovascular Events in Pediatric Inflammatory Bowel Disease: A Review of Published Cases 儿童炎症性肠病的脑血管事件:已发表病例综述

IF 1.9 Q2 Medicine

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 DOI: 10.5223/pghn.2022.25.3.180

P. Rohani, Nazanin Taraghikhah, M. Nasehi, Hosein Alimadadi, Hamid Assadzadeh Aghdaei

Pediatric inflammatory bowel disease (PIBD) is a multisystem disorder characterized by intestinal and extraintestinal manifestations and complications. Cerebrovascular events (CVE) are rare extraintestinal complications in patients with PIBD. Statistics show that 3.3% patients with PIBD and 1.3–6.4% adult patients with inflammatory bowel disease (IBD) experience CVE during the course of the disease. Therefore, this study aimed to review the records of children with IBD who developed CVE during the course of the disease. We retrospectively reviewed 62 cases of PIBD complicated by CVE. The mean patient age at the time of thrombotic events was 12.48±4.13 years. The incidence of ulcerative colitis was significantly higher than that of Crohn’s disease (43 [70.5%] vs. 13 [21.3%] patients). Most patients (87.93%) were in the active phase of IBD at the time of CVE. The mean time interval between the onset of IBD and CVE was 20.84 weeks. Overall, 11 (26.83%) patients showed neurological symptoms of CVE at disease onset. The most frequent symptom on admission was persistent and severe headaches (67.85%). The most common site of cerebral venous thrombosis was the transverse sinuses (n=23, 53.48%). The right middle cerebral artery (n=3, 33.34%) was the predominant site of cerebral arterial infarction. Overall, 41 (69.49%) patients who were mostly administered unfractionated heparin or low-molecular-weight heparin (56.09%) recovered completely. Patients with IBD are at a risk of thromboembolism. CVE may be the most common type of thromboembolism. Based on these findings, the most common risk factor for CVE is IBD flares. In patients with CVE, anticoagulant therapy with heparin, followed by warfarin, is necessary.

小儿炎症性肠病(PIBD)是一种以肠道和肠外表现和并发症为特征的多系统疾病。脑血管事件(CVE)是PIBD患者罕见的肠外并发症。统计数据显示，3.3%的PIBD患者和1.3-6.4%的成年炎症性肠病(IBD)患者在病程中经历CVE。因此，本研究旨在回顾IBD患儿在病程中发生CVE的记录。我们回顾性分析了62例PIBD合并CVE的病例。患者发生血栓事件时的平均年龄为12.48±4.13岁。溃疡性结肠炎的发生率明显高于克罗恩病(43例[70.5%]对13例[21.3%])。大多数患者(87.93%)在CVE时处于IBD活动期。IBD与CVE发病的平均时间间隔为20.84周。总体而言，11例(26.83%)患者在发病时出现CVE的神经系统症状。入院时最常见的症状是持续性和重度头痛(67.85%)。脑静脉血栓形成的最常见部位为横窦(n=23, 53.48%)。右侧大脑中动脉是脑动脉梗死的主要部位(n=3, 33.34%)。总体而言，41例(69.49%)患者(56.09%)接受未分离肝素或低分子肝素治疗后完全康复。IBD患者有血栓栓塞的风险。CVE可能是最常见的血栓栓塞类型。基于这些发现，CVE最常见的危险因素是IBD耀斑。在CVE患者，抗凝治疗肝素，随后华法林，是必要的。

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引用次数: 1

Sodium Picosulphate with Magnesium Citrate versus Polyethylene Glycol for Bowel Preparation in Children: A Systematic Review. 用于儿童肠道准备的皮果硫酸钠和柠檬酸镁与聚乙二醇：系统回顾

IF 1.3 Q3 PEDIATRICS

Pediatric Gastroenterology, Hepatology & Nutrition

Pub Date : 2022-05-01 Epub Date: 2022-05-09 DOI: 10.5223/pghn.2022.25.3.228

Piotr Dziechciarz, Marek Ruszczyński, Andrea Horvath

Purpose: To compare the effectiveness, tolerability, acceptability, and safety of sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) in children (≤18 years) preparing for colonoscopy.

Methods: Three electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were searched till July 2020. Only randomized controlled trials (RCTs) were included. At least two authors independently selected studies and performed risk of bias assessment and data extraction.

Results: Four RCTs (n=390), with overall good quality were included. A meta-analysis of two trials (n=224) found no statistically significant difference between the groups with respect to the proportion of patients who had excellent and good scores (≥6 points) according to the Boston Bowel Preparation Scale (relative risk: 0.99; 95% confidence interval [CI]: 0.90 to 1.08). Excellent and good scores were observed in both groups in approximately 90% of children. A meta-analysis of two other trials (n=150) showed no significant difference between the groups with respect to the mean total score for the Ottawa Bowel Preparation Scale (mean difference: 0.20; 95% CI: -0.74 to 1.14). Both regimens provided a comparable safety profile; however, PS/Mg was significantly superior to high volume PEG in terms of tolerability (abdominal pain, nausea, vomiting, bloating/flatulence/fullness) and acceptability (ease of formulation consumption, taste acceptance, need for nasogastric tube, compliance with full dose).

Conclusion: PS/Mg provides a quality and safety profile similar to PEG for bowel cleansing; however, it has better acceptance and tolerance in children preparing for colonoscopy.

目的：比较皮磷酸钠与枸橼酸镁（PS/Mg）和聚乙二醇（PEG）对准备接受结肠镜检查的儿童（18 岁以下）的有效性、耐受性、可接受性和安全性：检索了三个电子数据库（MEDLINE、EMBASE、Cochrane 对照试验中央登记册），检索期至 2020 年 7 月。仅纳入随机对照试验（RCT）。至少有两名作者独立选择研究，并进行偏倚风险评估和数据提取：结果：共纳入四项随机对照试验（n=390），总体质量良好。对两项试验（n=224）进行的荟萃分析发现，根据波士顿肠道准备量表（Boston Bowel Preparation Scale），获得优秀和良好评分（≥6 分）的患者比例在组间无统计学差异（相对风险：0.99；95% 置信区间 [CI]：0.90 至 1.08）。两组中均有约 90% 的患儿获得优和良的评分。对另外两项试验（n=150）进行的荟萃分析表明，在渥太华肠道准备量表的平均总分方面，两组之间没有显著差异（平均差异：0.20；95% 置信区间：-0.74 至 1.14）。两种治疗方案的安全性相当；但在耐受性（腹痛、恶心、呕吐、腹胀/胀气/饱胀）和可接受性（配方服用的难易程度、对口味的接受程度、鼻胃管的需求、对全剂量的依从性）方面，PS/Mg明显优于大容量PEG：结论：PS/Mg 在肠道清洁方面的质量和安全性与 PEG 相似，但在准备接受结肠镜检查的儿童中具有更好的接受性和耐受性。

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引用次数: 0