Pediatric Gastroenterology, Hepatology & Nutrition最新文献

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. pylori infection in children with dyspepsia.

Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022. H. pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea.

Results: Among 185 patients, the prevalence of H. pylori infection was 16.2%. Obesity and a family history of H. pylori infection were more frequently observed in patients with H. pylori infection than in those without. Anemia was also more common in patients with H. pylori infection than in those without. H. pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. pylori infection than among those without.

Conclusion: We observed a low prevalence of H. pylori infection in children with dyspepsia; however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. pylori infection in children, especially, who had obesity or family history of H. pylori infection.

Prebiotics are substrates selectively utilized by microorganisms to confer health benefits to their hosts. Various prebiotics have been supplemented in standard milk formulas for infants who cannot be exclusively breastfed, aiming to provide benefits similar to those of breast milk. One of the most commonly used prebiotics is a mixture of 90% short-chain galacto-oligosaccharides and 10% long-chain fructo-oligosaccharides (scGOS/lcFOS [9:1]). Systematic review and meta-analysis were conducted to determine the effectiveness of scGOS:lcFOS (9:1) supplementation in standard milk formula for improving gastrointestinal health and immunity among healthy infants and toddlers, using parameters such as stool pH and intestinal colonization with beneficial bacteria. This systematic review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized clinical trials comparing scGOS/lcFOS (9:1)-supplemented formula versus placebo- or non-supplemented formula milk were eligible for inclusion. Related studies on gastrointestinal health and immunity among healthy infants up to five years old were searched from the earliest available date until February 29, 2024. Eighteen publications (number of participants=1,675) were selected for the systematic review, of which 11 were subsequently subjected to a meta-analysis. Results showed that the standard formula supplemented with scGOS/lcFOS (9:1) was well tolerated and conferred various gastrointestinal health and immunity to healthy infants and toddlers. These findings support the supplementation of standard milk formula with scGOS/lcFOS (9:1) for healthy infants and toddlers.

Purpose: Significant debate exists on the association between Helicobacter pylori infection and childhood asthma. We aimed to explore this association in a cohort of children in Palestine while estimating the prevalence of H. pylori in this population.

Methods: We conducted a prospective case-control study among children aged 6-15 years in Palestine, including 44 asthma cases diagnosed by pediatric pulmonologists and 99 age-matched healthy controls recruited through cluster sampling from schools. H. pylori status was determined using a stool antigen test. Asthma severity was assessed using the International Study of Asthma and Allergies in Childhood questionnaire. Data on recent antibiotic use, which could affect H. pylori status, were collected for both groups. Multiple logistic regression analyzed the association between H. pylori and asthma, adjusting for age and sex. The chi-square test assessed the impact of antibiotic use on H. pylori status.

Results: The prevalence of H. pylori infection in the study population was 45%. Children with asthma had a lower prevalence of H. pylori infection compared to healthy controls (32% vs. 51%, adjusted odds ratios, 0.46; 95% confidence interval, 0.22-0.99; p=0.04). Antibiotic use in the past month or year did not significantly impact H. pylori status. Among children with asthma, H. pylori infection rates did not vary by asthma severity (p=0.05).

Conclusion: H. pylori infection is associated with a reduced risk of asthma in children, suggesting a potential protective role. Further prospective cohort studies are warranted to clarify the mechanisms underlying this association.

Purpose: Research proved the beneficial effect of Zinc on human health and Gastrointestinal tract inflammatory diseases. We propose that zinc would be of value in children with Hirschsprung's disease (HD) undergoing elective pull-through surgery. This study was carried out to determine the influence of preoperative zinc intake on postoperative outcomes, especially the hospital length of stay in patients diagnosed with HD as a primary outcome. Other outcomes include identification of the nutritional and inflammatory status including the nutritional and inflammatory markers in children with HD with possible impacts on hospital outcomes.

Methods: This is a randomized interventional control study that was applied to 50 children diagnosed with HD who underwent elective pull-through surgery. We randomly allocated 25 diagnosed with HD who underwent elective pull-through surgery. We randomly allocated 25 patients to zinc treatment.

Results: The results demonstrated that the interventional group had a lower incidence of complications (20%) when compared to the control group (64%), with a significant p-value of 0.002. In addition, less incidence of Hirschsprung's associated enterocolitis (HAEC) (12% vs. 40%) and skin excoriation (8% vs. 32%) were documented in the interventional group compared to the controls respectively.

Conclusion: Pre-operative zinc supplementation may have a beneficial impact on HD children undergoing elective pull-through surgery as regards outcomes such as HAEC and skin excoriation.

Despite being an essential specialty, pediatrics in South Korea faces the threat of collapse. While the declining birth rate is an important contributor to the decrease in the pediatric population, a more critical issue lies in the dysfunctional healthcare system. Primary care pediatricians are troubled by the lack of patients, whereas tertiary care specialists are concerned about the shortage of doctors. Although the absolute number of pediatric specialists is not small, there is a scarcity of doctors willing to specialize in pediatrics. Recently, pediatric abdominal ultrasonography has been conducted in tertiary hospitals. However, there is an argument that this responsibility should be shifted to primary care pediatricians. As someone who has been performing pediatric abdominal ultrasound examinations for years, I am committed to educating pediatric specialists in this field. My aim is to contribute, albeit modestly, to improving the South Korean healthcare system.

[This corrects the article on p. 274 in vol. 27, PMID: 39319279.].

Purpose: This study investigated the prevalence of bowel dysfunction and associated factors after pull-through surgery.

Methods: The medical records of children under 18 years old diagnosed with Hirschsprung disease (HD) based on histopathology between 2004 and 2022 were reviewed. Bowel dysfunction after pull-through surgery was categorized into Hirschsprung-associated enterocolitis (HAEC), constipation, and fecal incontinence.

Results: Among 97 children diagnosed with HD, the median age at presentation was 3 (2-15) days (84.54% male). The clinical manifestations included abdominal distension (58.76%), constipation (17.52%), bilious vomiting (17.52%), nonbilious vomiting (14.43%), and enterocolitis (12.37%). HDs were classified by the location of aganglionosis: short segments (74.23%), long segments (8.25%), total colonic (12.37%), and small intestinal (5.15%). Excluding surgical complications, the prevalence of bowel dysfunction was 64.95% during an average follow-up of 8.33 years. HAEC was the most common issue (46.39%), followed by nonretentive incontinence (22.68%), constipation (20.62%), and retentive incontinence (15.46%). Preoperative HAEC was significantly associated with post-surgery HAEC (adjusted odds ratio [aOR] 18.31; 95% confidence interval [CI], 1.30-257.73; p=0.031). The Duhamel operation was associated with constipation and retentive incontinence (aOR 62.15; 95% CI, 1.64-2,349.13; p=0.026). Age under 6 months at pull-through surgery was associated with nonretentive fecal incontinence after 4 years (aOR 8.83; 95% CI, 1.11-70.39; p=0.040).

Conclusion: The prevalence of bowel dysfunction in children with HD remains high despite successful surgical correction. Preoperative HAEC, Duhamel operation, and pull-through surgery before the age of 6 months were found to be independent factors associated with bowel dysfunction after pull-through surgery.

Purpose: The practice of withholding oral nutrition for children hospitalized for critical asthma receiving continuous albuterol is not evidence based. We sought to characterize oral nutrition practices in this population and estimate the frequency of aspiration-related respiratory failure.

Methods: We performed a single-center retrospective, matched cohort study of children 3-17 years of age admitted to a pediatric intensive care unit from Oct 2020 to May 2023 for critical asthma receiving continuous albuterol. Cases provided oral nutrition were matched 1:2 to controls withheld nutrition by age and National Heart Lung and Blood Institute asthma severity classification. The primary outcome was aspiration-related respiratory failure defined as any respiratory support escalation following observed aspiration. Descriptive data included demographics, anthropometrics, pediatric asthma severity scores, adjunct asthma interventions, continuous albuterol duration, mortality, and length of stay.

Results: Of 36 cases and 72 matched controls, the mean age was 9.1±3.9 years and 66.7% had moderate-severe persistent asthma. Cases and controls had comparable anthropometrics and admission pediatric asthma severity scores. No aspiration-related respiratory failure events were observed even among those receiving nutrition concurrent to noninvasive ventilation. Compared to controls, cases experienced a longer continuous albuterol duration (median: 1.1 [interquartile range: 0.7-1.8] versus 0.7 [interquartile range: 0.3-1.3] days, p<0.001). No differences in length of stay, adjunct interventions, endotracheal intubation rates, and mortality were observed between cases and controls.

Conclusion: For children hospitalized for critical asthma, oral nutrition during continuous nebulized albuterol appeared well tolerated. While prospective validation is required, the practice of withholding oral nutrition for continuous albuterol administration may be unwarranted.

Purpose: Helicobacter pylori infections differ between children and adults. The Pediatric society practice guidelines recommend against a test-and-treat approach, characterized by the use of non-invasive tests for diagnosis (e.g. urea breath test [UBT] or stool antigen test). However, significant variations exist in clinical practice. This study examined the use of non-invasive testing for the screening and diagnosis of H. pylori infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes.

Methods: A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for H. pylori infection using either a stool antigen test or UBT between January 2018 and June 2020.

Results: Among the 1,397 children tested, 117 (8.4%) had a positive stool H. pylori antigen result, and 5 out of 85 tested (5.9%) had a positive UBT. Abdominal pain was the predominant symptom (n=98; 80.3%). Only 7 treatment-naïve children had biopsy-proven disease. Tissue biopsies for H. pylori culture were sent to 2 children, with 1 negative result. A total of 111 children (91.0%) received treatment, wherein proton pump inhibitor, amoxicillin, and clarithromycin for 14 days was the most common therapeutic regimen. Symptom resolution was observed in 62 children (50.8%).

Conclusion: A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of H. pylori infections in children at our center and significant false-positive rates.

Purpose: The study aimed to investigate the recruiting of T lymphocytes including IL-7Rα^low CX3CR1⁺ effector memory (EM) CD8⁺ T cells and α4β7 integrin tagged T cells to inflamed intestinal mucosa.

Methods: Whole blood and mucosal tissues of intestine were collected from 40 children with or without inflammatory bowel disease (IBD). T cell surface staining and immunohistochemistry were done with several antibodies in peripheral blood mononuclear cells (PBMCs) and intestinal mucosa, respectively. Serum levels of cytokines were measured by ELISA.

Results: The frequency of IL-7Rα^lowCX3CR1⁺ EM CD8⁺ T cells in the PBMC was significantly higher in the ulcerative colitis group than in the control group (57.9±17.80% vs. 33.9±15.70%, p=0.021). The frequency of integrin α4β7⁺ CD4⁺ T cells in the PBMC was significantly lower in the ulcerative colitis group than in the control group (53.2±27.6% vs. 63.9±13.2%, p=0.022). Serum concentration of TNF-α was higher in the Crohn's disease group than in the control group (26.13±5.01 pg/mL vs. 19.65±6.07 pg/mL, p=0.008). Of the three groups, the ulcerative colitis group had the highest frequency of integrin α4β7⁺ T cells based on immunohistochemistry analyses for intestinal tissues, followed by the Crohn's disease group and the control group (4.63±1.29 cells vs. 2.0±0.57 cells vs. 0.84±0.52 cells, p<0.001).

Conclusion: Trafficking immune cells with effector memory CD8⁺ T cells clarified by IL-7Rα^lowCX3CR1⁺ and integrin α4β7⁺ CD4⁺ T cells might be highly associated with the pathogenesis of ulcerative colitis.