Pub Date : 2024-11-01Epub Date: 2024-11-05DOI: 10.5223/pghn.2024.27.6.336
Charanya Rajan, Fang Kuan Chiou, Christopher Wen Wei Ho
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.
{"title":"Prevalence, Management, and Outcomes of Non-Invasive <i>Helicobacter pylori</i> Testing in Children at a Tertiary Paediatric Hospital in Singapore.","authors":"Charanya Rajan, Fang Kuan Chiou, Christopher Wen Wei Ho","doi":"10.5223/pghn.2024.27.6.336","DOIUrl":"10.5223/pghn.2024.27.6.336","url":null,"abstract":"<p><strong>Purpose: </strong><i>Helicobacter pylori</i> 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 <i>H. pylori</i> infection in children at a tertiary pediatric hospital in Singapore, reviewing both management decisions and patient outcomes.</p><p><strong>Methods: </strong>A retrospective review was conducted on children between the ages of 0 and 18 years who were tested for <i>H. pylori</i> infection using either a stool antigen test or UBT between January 2018 and June 2020.</p><p><strong>Results: </strong>Among the 1,397 children tested, 117 (8.4%) had a positive stool <i>H. pylori</i> 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 <i>H. pylori</i> 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%).</p><p><strong>Conclusion: </strong>A test-and-treat strategy was more widely utilized than endoscopy-based testing, showing a low compliance to existing guidelines for the management of <i>H. pylori</i> infections in children at our center and significant false-positive rates.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 6","pages":"336-344"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-11-05DOI: 10.5223/pghn.2024.27.6.345
Da Hee Yang, Hyo Jin Kim, Duong Thi Thuy Dinh, Jiwon Yang, Chang-Lim Hyun, Youngheun Jee, Naeun Lee, Min Sun Shin, Insoo Kang, Ki Soo Kang
Purpose: The study aimed to investigate the recruiting of T lymphocytes including IL-7Rαlow 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-7RαlowCX3CR1+ 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-7RαlowCX3CR1+ and integrin α4β7+ CD4+ T cells might be highly associated with the pathogenesis of ulcerative colitis.
目的:该研究旨在调查T淋巴细胞(包括IL-7Rα-low CX3CR1+效应记忆(EM)CD8+T细胞和α4β7整合素标记T细胞)对炎症肠粘膜的招募情况:方法:收集 40 名患有或未患有炎症性肠病(IBD)的儿童的全血和肠道粘膜组织。用几种抗体分别对外周血单核细胞(PBMCs)和肠粘膜进行了 T 细胞表面染色和免疫组化。用酶联免疫吸附法测定了血清中细胞因子的水平:结果:溃疡性结肠炎组 PBMC 中 IL-7RαlowCX3CR1+ EM CD8+ T 细胞的频率明显高于对照组(57.9±17.80% vs. 33.9±15.70%,P=0.021)。溃疡性结肠炎组 PBMC 中整合素 α4β7+ CD4+ T 细胞的频率明显低于对照组(53.2±27.6% vs. 63.9±13.2%,P=0.022)。克罗恩病组的血清 TNF-α 浓度高于对照组(26.13±5.01 pg/mL vs. 19.65±6.07 pg/mL,P=0.008)。根据肠道组织的免疫组化分析,三组中溃疡性结肠炎组的整合素α4β7+ T细胞频率最高,其次是克罗恩病组和对照组(4.63±1.29 cells vs. 2.0±0.57 cells vs. 0.84±0.52 cells,P=0.008):通过IL-7Rα-lowCX3CR1+和整合素α4β7+ CD4+ T细胞明确的具有效应记忆CD8+ T细胞的交通免疫细胞可能与溃疡性结肠炎的发病机制高度相关。
{"title":"Expression of IL-7Rα<sup>low</sup>CX3CR1<sup>+</sup> CD8<sup>+</sup> T Cells and α4β7 Integrin Tagged T Cells Related to Mucosal Immunity in Children with Inflammatory Bowel Disease.","authors":"Da Hee Yang, Hyo Jin Kim, Duong Thi Thuy Dinh, Jiwon Yang, Chang-Lim Hyun, Youngheun Jee, Naeun Lee, Min Sun Shin, Insoo Kang, Ki Soo Kang","doi":"10.5223/pghn.2024.27.6.345","DOIUrl":"10.5223/pghn.2024.27.6.345","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to investigate the recruiting of T lymphocytes including IL-7Rα<sup>low</sup> CX3CR1<sup>+</sup> effector memory (EM) CD8<sup>+</sup> T cells and α4β7 integrin tagged T cells to inflamed intestinal mucosa.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The frequency of IL-7Rα<sup>low</sup>CX3CR1<sup>+</sup> EM CD8<sup>+</sup> 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%, <i>p</i>=0.021). The frequency of integrin α4β7<sup>+</sup> CD4<sup>+</sup> 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%, <i>p</i>=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, <i>p</i>=0.008). Of the three groups, the ulcerative colitis group had the highest frequency of integrin α4β7<sup>+</sup> 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, <i>p</i><0.001).</p><p><strong>Conclusion: </strong>Trafficking immune cells with effector memory CD8<sup>+</sup> T cells clarified by IL-7Rα<sup>low</sup>CX3CR1<sup>+</sup> and integrin α4β7<sup>+</sup> CD4<sup>+</sup> T cells might be highly associated with the pathogenesis of ulcerative colitis.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 6","pages":"345-354"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-11-05DOI: 10.5223/pghn.2024.27.6.355
Sunghyun An, Homin Huh, Jae Sung Ko, Jin Soo Moon, Ky Young Cho
Purpose: This study aimed to establish and characterize patient-derived intestinal organoids (PDOs) from children with Crohn's disease (CD).
Methods: To generate PDOs, endoscopic biopsy specimens were obtained from non-inflamed duodenal bulbs of normal controls and CD patients. To verify the presence of PDOs, histological staining and quantitative reverse transcription polymerase chain reaction (RT-qPCR) analyses were performed.
Results: PDOs were successfully established in normal controls (n=2) and CD patients (n=2). Hematoxylin and eosin staining of formalin-fixed, paraffin-embedded PDO sections revealed crypt and villus structures, whereas immunofluorescence staining with EpCAM and DAPI confirmed the epithelial-specific architecture of the PDOs. RT-qPCR results revealed a significant increase in Lgr5, Si, and Chga gene expression and a decrease in Olfm4 and Muc2 expression in CD patients compared to normal controls, suggesting altered stem cell activity and mucosal barrier function (p<0.05).
Conclusion: We successfully established and characterized PDOs in children with CD, providing a valuable tool for understanding the pathophysiology of the disease and evaluating potential therapeutic approaches. The differential gene expression of PDOs in CD patients might be caused by the complex interplay between epithelial adaptation and inflammation in the intestinal epithelium.
目的:本研究旨在建立克罗恩病(CD)儿童患者来源的肠器官组织(PDOs)并确定其特征:为生成 PDOs,从正常对照组和 CD 患者的无炎症十二指肠球部获取内窥镜活检标本。为了验证 PDO 的存在,进行了组织学染色和定量反转录聚合酶链反应(RT-qPCR)分析:结果:正常对照组(2 例)和 CD 患者(2 例)均成功建立了 PDO。福尔马林固定、石蜡包埋的 PDO 切片经苏木精和伊红染色后显示出隐窝和绒毛结构,而 EpCAM 和 DAPI 的免疫荧光染色证实了 PDO 的上皮特异性结构。RT-qPCR结果显示,与正常对照组相比,CD患者的Lgr5、Si和Chga基因表达量显著增加,而Olfm4和Muc2表达量减少,这表明干细胞活性和粘膜屏障功能发生了改变(P结论:我们成功地在 CD 儿童中建立了 PDOs 并对其进行了表征,为了解该疾病的病理生理学和评估潜在的治疗方法提供了宝贵的工具。CD 患者 PDOs 基因表达的差异可能是肠上皮适应性和炎症之间复杂的相互作用造成的。
{"title":"Establishment and Characterization of Patient-Derived Intestinal Organoids from Pediatric Crohn's Disease Patients.","authors":"Sunghyun An, Homin Huh, Jae Sung Ko, Jin Soo Moon, Ky Young Cho","doi":"10.5223/pghn.2024.27.6.355","DOIUrl":"10.5223/pghn.2024.27.6.355","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to establish and characterize patient-derived intestinal organoids (PDOs) from children with Crohn's disease (CD).</p><p><strong>Methods: </strong>To generate PDOs, endoscopic biopsy specimens were obtained from non-inflamed duodenal bulbs of normal controls and CD patients. To verify the presence of PDOs, histological staining and quantitative reverse transcription polymerase chain reaction (RT-qPCR) analyses were performed.</p><p><strong>Results: </strong>PDOs were successfully established in normal controls (n=2) and CD patients (n=2). Hematoxylin and eosin staining of formalin-fixed, paraffin-embedded PDO sections revealed crypt and villus structures, whereas immunofluorescence staining with EpCAM and DAPI confirmed the epithelial-specific architecture of the PDOs. RT-qPCR results revealed a significant increase in <i>Lgr5</i>, <i>Si</i>, and <i>Chga</i> gene expression and a decrease in <i>Olfm4</i> and <i>Muc2</i> expression in CD patients compared to normal controls, suggesting altered stem cell activity and mucosal barrier function (<i>p</i><0.05).</p><p><strong>Conclusion: </strong>We successfully established and characterized PDOs in children with CD, providing a valuable tool for understanding the pathophysiology of the disease and evaluating potential therapeutic approaches. The differential gene expression of PDOs in CD patients might be caused by the complex interplay between epithelial adaptation and inflammation in the intestinal epithelium.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 6","pages":"355-363"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-09DOI: 10.5223/pghn.2024.27.5.267
Susanne Jenneke Van Veen, Elvira Ingrid Levy, Koen Huysentruyt, Yvan Vandenplas
Helicobacter pylori infection is often acquired in early childhood. While most infected children remain asymptomatic, H. pylori can cause chronic gastritis, gastric ulceration, and, in the long term, gastric cancer. This article aimed to review different diagnostic and treatment options and discuss the challenges associated with applying the current guidelines in the real world. Relevant articles published from 2015 to August 2023 in the English language in PubMed and Medline electronic databases were extracted using subject headings and keywords of interest to the topic. References of interest in the selected articles were also considered. Invasive and noninvasive diagnostic tests have advantages but also disadvantages and limitations according to the clinical setting and age of the child. Guidelines recommend not performing diagnostic testing in children with long-lasting or recurrent abdominal complaints or cases of a family history of severe disease caused by H. pylori. However, parents regularly consult with the explicit demand to test for H. pylori because of them or a close family member experiencing severe gastric disease caused by H. pylori. In some situations, it may be challenging for the healthcare professional to stick to evidence-based guidelines and not consider "patient-centered care," with the risk of putting a trustful relationship in danger. Physicians may find it challenging not to perform diagnostic tests for H. pylori and prescribe eradication treatment in specific clinical settings when maintaining a trusting patient-physician relationship by applying this "patient-centered care" method when evidence-based guidelines recommend differently.
{"title":"Clinical Dilemmas for the Diagnosis and Treatment of <i>Helicobacter pylori</i> Infection in Children: From Guideline to Practice.","authors":"Susanne Jenneke Van Veen, Elvira Ingrid Levy, Koen Huysentruyt, Yvan Vandenplas","doi":"10.5223/pghn.2024.27.5.267","DOIUrl":"https://doi.org/10.5223/pghn.2024.27.5.267","url":null,"abstract":"<p><p><i>Helicobacter pylori</i> infection is often acquired in early childhood. While most infected children remain asymptomatic, <i>H. pylori</i> can cause chronic gastritis, gastric ulceration, and, in the long term, gastric cancer. This article aimed to review different diagnostic and treatment options and discuss the challenges associated with applying the current guidelines in the real world. Relevant articles published from 2015 to August 2023 in the English language in PubMed and Medline electronic databases were extracted using subject headings and keywords of interest to the topic. References of interest in the selected articles were also considered. Invasive and noninvasive diagnostic tests have advantages but also disadvantages and limitations according to the clinical setting and age of the child. Guidelines recommend not performing diagnostic testing in children with long-lasting or recurrent abdominal complaints or cases of a family history of severe disease caused by <i>H. pylori</i>. However, parents regularly consult with the explicit demand to test for <i>H. pylori</i> because of them or a close family member experiencing severe gastric disease caused by <i>H. pylori</i>. In some situations, it may be challenging for the healthcare professional to stick to evidence-based guidelines and not consider \"patient-centered care,\" with the risk of putting a trustful relationship in danger. Physicians may find it challenging not to perform diagnostic tests for <i>H. pylori</i> and prescribe eradication treatment in specific clinical settings when maintaining a trusting patient-physician relationship by applying this \"patient-centered care\" method when evidence-based guidelines recommend differently.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 5","pages":"267-273"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-09DOI: 10.5223/pghn.2024.27.5.298
Salahuddin Mahmud, Tanzila Farhana, Ataul Mustufa Anik, Fayaza Ahmed, Mashud Parvez, Madhabi Baidya, Rafia Rashid, Farhana Tasneem, Ahmed Rashidul Hasan, Mohammad Jahangir Alam, Shafi Ahmed Muaz
Purpose: Cytomegalovirus (CMV) infection affects the hepatic, neurologic, hematopoietic, respiratory, gastrointestinal, and other organs, resulting in a high mortality rate and long-term sequelae. It may cause acute or chronic hepatitis, or even lead to hepatic cirrhosis. Valganciclovir (VGCV) is an effective, safe, and well-tolerated treatment for congenital CMV infection, without any serious adverse effects. This study was conducted to evaluate the clinical, biochemical, and virological profiles of infants with CMV with intrahepatic cholestasis and to determine the outcomes with or without treatment with VGCV.
Methods: Twenty infants aged <6 months diagnosed with congenital CMV infection with evidence of intrahepatic cholestasis were included in this study. Randomization was used to divide the study participants into 2 groups. The control group (n=10) was treated with only supportive management, and the intervention group (n=10) was treated with oral VGCV at 16 mg/kg/dose 12 hours a day for 6 weeks plus supportive treatments. Physical examinations and biochemical, serological, and virological tests were performed at the time of diagnosis and at the end of 6 weeks and 6 months.
Results: The control and intervention groups were compared in terms of clinical and laboratory parameters such as jaundice, dark urine, pale stool, hepatomegaly, total bilirubin, aminotransferases, gamma-glutamyl transferase, alkaline phosphatase, and CMV polymerase chain reaction load, which showed a significant reduction after treatment in the intervention group (p<0.05) with oral VGCV, with very few side effects, whereas the control group showed no significant changes.
Conclusion: Oral VGCV can be used to effectively treat CMV infection with intrahepatic cholestasis without notable side effects.
{"title":"Efficacy and Safety of Valganciclovir in Congenital Cytomegalovirus Infection with Isolated Intrahepatic Cholestasis: A Randomized Controlled Trial.","authors":"Salahuddin Mahmud, Tanzila Farhana, Ataul Mustufa Anik, Fayaza Ahmed, Mashud Parvez, Madhabi Baidya, Rafia Rashid, Farhana Tasneem, Ahmed Rashidul Hasan, Mohammad Jahangir Alam, Shafi Ahmed Muaz","doi":"10.5223/pghn.2024.27.5.298","DOIUrl":"https://doi.org/10.5223/pghn.2024.27.5.298","url":null,"abstract":"<p><strong>Purpose: </strong>Cytomegalovirus (CMV) infection affects the hepatic, neurologic, hematopoietic, respiratory, gastrointestinal, and other organs, resulting in a high mortality rate and long-term sequelae. It may cause acute or chronic hepatitis, or even lead to hepatic cirrhosis. Valganciclovir (VGCV) is an effective, safe, and well-tolerated treatment for congenital CMV infection, without any serious adverse effects. This study was conducted to evaluate the clinical, biochemical, and virological profiles of infants with CMV with intrahepatic cholestasis and to determine the outcomes with or without treatment with VGCV.</p><p><strong>Methods: </strong>Twenty infants aged <6 months diagnosed with congenital CMV infection with evidence of intrahepatic cholestasis were included in this study. Randomization was used to divide the study participants into 2 groups. The control group (n=10) was treated with only supportive management, and the intervention group (n=10) was treated with oral VGCV at 16 mg/kg/dose 12 hours a day for 6 weeks plus supportive treatments. Physical examinations and biochemical, serological, and virological tests were performed at the time of diagnosis and at the end of 6 weeks and 6 months.</p><p><strong>Results: </strong>The control and intervention groups were compared in terms of clinical and laboratory parameters such as jaundice, dark urine, pale stool, hepatomegaly, total bilirubin, aminotransferases, gamma-glutamyl transferase, alkaline phosphatase, and CMV polymerase chain reaction load, which showed a significant reduction after treatment in the intervention group (<i>p</i><0.05) with oral VGCV, with very few side effects, whereas the control group showed no significant changes.</p><p><strong>Conclusion: </strong>Oral VGCV can be used to effectively treat CMV infection with intrahepatic cholestasis without notable side effects.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 5","pages":"298-312"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To evaluate prolonged esomeprazole use in Japanese pediatric patients for reflux esophagitis (RE) maintenance therapy and prevention of gastric (GU) and/or duodenal ulcers (DU) while using non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (LDA).
Methods: This multicenter, open-label, parallel-group, phase III study (NCT03553563) included patients who were administered esomeprazole according to body weight (10 mg/day [Groups 1 and 3] and up to 20 mg/day [Groups 2 and 4] for patients weighing 10-20 kg and ≥20 kg, respectively). Efficacy outcomes for Groups 1 and 2 (maintenance therapy for healed RE) and Groups 3 and 4 (prevention of long-term NSAID/LDA use-associated GU/DU) were the presence/absence of RE relapse and GU/DU recurrence, respectively.
Results: Esomeprazole as maintenance therapy was associated with a low RE recurrence rate, independent of body weight or dosage. Recurrence rates of RE were 0.0% and 5.3% for Groups 1 and 2, respectively. In patients previously diagnosed with GU and/or DU due to long-term NSAID/LDA use, the recurrence rates of GU/DU during weeks 0-32 were 11.1% and 0.0% in Groups 3 and 4, respectively.
Conclusion: Long-term use of 10- or 20-mg, once-daily esomeprazole demonstrated a favorable benefit-risk balance in preventing RE and suppressing recurrence of GU and/or DU secondary to NSAID or LDA therapy in Japanese pediatric patients. No new safety concerns were identified. Esomeprazole may be a viable option for managing RE and preventing GU and DU in Japanese pediatric patients.
{"title":"Efficacy and Safety of Long-Term Administration of Esomeprazole in Japanese Pediatric Patients Aged 1-14 Years with Chronic Gastric Acid-Related Disease.","authors":"Masaaki Mori, Yoshiko Nakayama, Shigeo Nishimata, Tadafumi Yokoyama, Ryo Matsuoka, Reiko Hatori, Masaki Shimizu, Katsuhiro Arai, Yuri Etani, Tsuyoshi Sogo, Tomoko Ishizu, Masahiro Nii, Ryosuke Nakashima, Toshiaki Shimizu","doi":"10.5223/pghn.2024.27.5.274","DOIUrl":"10.5223/pghn.2024.27.5.274","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate prolonged esomeprazole use in Japanese pediatric patients for reflux esophagitis (RE) maintenance therapy and prevention of gastric (GU) and/or duodenal ulcers (DU) while using non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (LDA).</p><p><strong>Methods: </strong>This multicenter, open-label, parallel-group, phase III study (NCT03553563) included patients who were administered esomeprazole according to body weight (10 mg/day [Groups 1 and 3] and up to 20 mg/day [Groups 2 and 4] for patients weighing 10-20 kg and ≥20 kg, respectively). Efficacy outcomes for Groups 1 and 2 (maintenance therapy for healed RE) and Groups 3 and 4 (prevention of long-term NSAID/LDA use-associated GU/DU) were the presence/absence of RE relapse and GU/DU recurrence, respectively.</p><p><strong>Results: </strong>Esomeprazole as maintenance therapy was associated with a low RE recurrence rate, independent of body weight or dosage. Recurrence rates of RE were 0.0% and 5.3% for Groups 1 and 2, respectively. In patients previously diagnosed with GU and/or DU due to long-term NSAID/LDA use, the recurrence rates of GU/DU during weeks 0-32 were 11.1% and 0.0% in Groups 3 and 4, respectively.</p><p><strong>Conclusion: </strong>Long-term use of 10- or 20-mg, once-daily esomeprazole demonstrated a favorable benefit-risk balance in preventing RE and suppressing recurrence of GU and/or DU secondary to NSAID or LDA therapy in Japanese pediatric patients. No new safety concerns were identified. Esomeprazole may be a viable option for managing RE and preventing GU and DU in Japanese pediatric patients.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 5","pages":"274-285"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Liver cirrhosis is a major cause of hospital admission and mortality among children. Understanding the factors that influence disease severity is essential for preventing and reducing mortality. This study explored the association between hemoglobin levels and liver disease severity in children with cirrhosis.
Methods: This cross-sectional study included 326 children with cirrhosis admitted to Namazi Teaching Hospital between 2015 and 2020. Clinical data, Child-Turcotte-Pugh (CTP) scores, and pediatric end-stage liver disease/model for end-stage liver disease (PELD/MELD) scores were collected to assess disease severity. Anemia was defined based on age, sex, and hemoglobin levels.
Results: Among the children with cirrhosis, 275 (84.4%) were anemic, with a mean age of 5.4±4.8 years. The overall mean hemoglobin level was 9.2±2.1 g/dL. A significant inverse correlation was observed between hemoglobin levels and CTP and PELD/MELD scores in children with anemia (p<0.001). Moreover, lower hemoglobin levels were associated with more higher CTP classes (p<0.001).
Conclusion: According to the data analysis, a significant correlation was observed between hemoglobin level and the severity of liver disease, and hemoglobin level decreased with increasing severity of liver disease. According to CTP class, the mean hemoglobin level decreased progressively as the disease progressed. A comparison of the mean CTP scores between children with and those without anemia revealed that those with anemia had more severe disease than those without anemia.
{"title":"Evaluating the Association between Anemia and the Severity of Liver Disease in Children with Cirrhosis: A Cross-Sectional Study from 2015 to 2020.","authors":"Seyed Mohsen Dehghani, Iraj Shahramian, Hamideh Salehi, Leila Kasraian, Maryam Ataollahi, Masoud Tahani","doi":"10.5223/pghn.2024.27.5.286","DOIUrl":"https://doi.org/10.5223/pghn.2024.27.5.286","url":null,"abstract":"<p><strong>Purpose: </strong>Liver cirrhosis is a major cause of hospital admission and mortality among children. Understanding the factors that influence disease severity is essential for preventing and reducing mortality. This study explored the association between hemoglobin levels and liver disease severity in children with cirrhosis.</p><p><strong>Methods: </strong>This cross-sectional study included 326 children with cirrhosis admitted to Namazi Teaching Hospital between 2015 and 2020. Clinical data, Child-Turcotte-Pugh (CTP) scores, and pediatric end-stage liver disease/model for end-stage liver disease (PELD/MELD) scores were collected to assess disease severity. Anemia was defined based on age, sex, and hemoglobin levels.</p><p><strong>Results: </strong>Among the children with cirrhosis, 275 (84.4%) were anemic, with a mean age of 5.4±4.8 years. The overall mean hemoglobin level was 9.2±2.1 g/dL. A significant inverse correlation was observed between hemoglobin levels and CTP and PELD/MELD scores in children with anemia (<i>p</i><0.001). Moreover, lower hemoglobin levels were associated with more higher CTP classes (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>According to the data analysis, a significant correlation was observed between hemoglobin level and the severity of liver disease, and hemoglobin level decreased with increasing severity of liver disease. According to CTP class, the mean hemoglobin level decreased progressively as the disease progressed. A comparison of the mean CTP scores between children with and those without anemia revealed that those with anemia had more severe disease than those without anemia.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 5","pages":"286-297"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-09DOI: 10.5223/pghn.2024.27.5.322
You Jin Choi, Da Hye Lee, Jeonglyn Song, Ki-Uk Kim, Hyeyoung Min, Sung-Hoon Chung, Tae Hyeong Kim, Chae-Young Kim, Insoo Kang, Na Mi Lee, Dae Yong Yi
Purpose: Human breast milk (HBM) contains immune components that produced and delivered from the mother along with nutrients necessary for the baby. MicroRNA (miRNA) is a small noncoding RNA molecule, that is used as an ideal biomarker for diagnosis and prognosis of various diseases and are more abundant in HBM. We analyzed and compared the immune components and miRNAs of HBM.
Methods: HBM were collected from 20 healthy breastfeeding mothers. We measured the amount of lactoferrin, lysozyme, and immunoglobulin A (IgA) and extracted the miRNAs from each breast milk samples. Next, the top 5 and bottom 5 expressed miRNAs were compared and analyzed based on the amounts of the 3 immune components.
Results: The mean levels and ranges of lactoferrin, lysozyme, and IgA were 6.33 (2.24-14.77)×106 ng/mL, 9.90 (1.42-17.59)×107 pg/mL, and 6.64 (0.48-20.01)×105 ng/mL, respectively. The miRNAs concentration per 1 mL of skim milk was 40.54 (14.95-110.01) ng/μL. Comparing the bottom 5 and top 5 groups of each immune component, 19 miRNAs were significantly upregulated (6, 9, and 4 targeting lactoferrin, lysozyme, and IgA, respectively) and 21 were significantly downregulated (4, 9, and 8 targeting lactoferrin, lysozyme, and IgA, respectively). There were no miRNAs that were expressed significantly higher or lower in common to all 3 components. However, 2 and 3 miRNAs were commonly overexpressed and underexpressed, in the top 5 groups of lysozyme and IgA concentrations.
Conclusion: We identified the immune components and miRNAs in breast milk and found that each individual has different ingredients.
{"title":"Relationship of MicroRNA according to Immune Components of Breast Milk in Korean Lactating Mothers.","authors":"You Jin Choi, Da Hye Lee, Jeonglyn Song, Ki-Uk Kim, Hyeyoung Min, Sung-Hoon Chung, Tae Hyeong Kim, Chae-Young Kim, Insoo Kang, Na Mi Lee, Dae Yong Yi","doi":"10.5223/pghn.2024.27.5.322","DOIUrl":"https://doi.org/10.5223/pghn.2024.27.5.322","url":null,"abstract":"<p><strong>Purpose: </strong>Human breast milk (HBM) contains immune components that produced and delivered from the mother along with nutrients necessary for the baby. MicroRNA (miRNA) is a small noncoding RNA molecule, that is used as an ideal biomarker for diagnosis and prognosis of various diseases and are more abundant in HBM. We analyzed and compared the immune components and miRNAs of HBM.</p><p><strong>Methods: </strong>HBM were collected from 20 healthy breastfeeding mothers. We measured the amount of lactoferrin, lysozyme, and immunoglobulin A (IgA) and extracted the miRNAs from each breast milk samples. Next, the top 5 and bottom 5 expressed miRNAs were compared and analyzed based on the amounts of the 3 immune components.</p><p><strong>Results: </strong>The mean levels and ranges of lactoferrin, lysozyme, and IgA were 6.33 (2.24-14.77)×10<sup>6</sup> ng/mL, 9.90 (1.42-17.59)×10<sup>7</sup> pg/mL, and 6.64 (0.48-20.01)×10<sup>5</sup> ng/mL, respectively. The miRNAs concentration per 1 mL of skim milk was 40.54 (14.95-110.01) ng/μL. Comparing the bottom 5 and top 5 groups of each immune component, 19 miRNAs were significantly upregulated (6, 9, and 4 targeting lactoferrin, lysozyme, and IgA, respectively) and 21 were significantly downregulated (4, 9, and 8 targeting lactoferrin, lysozyme, and IgA, respectively). There were no miRNAs that were expressed significantly higher or lower in common to all 3 components. However, 2 and 3 miRNAs were commonly overexpressed and underexpressed, in the top 5 groups of lysozyme and IgA concentrations.</p><p><strong>Conclusion: </strong>We identified the immune components and miRNAs in breast milk and found that each individual has different ingredients.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 5","pages":"322-331"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-09DOI: 10.5223/pghn.2024.27.5.313
Hye Min Ha, Yu Jin Jung, Yoo Rha Hong, So Yoon Choi
Purpose: For neonates admitted to the neonatal intensive care unit (NICU), appropriate nutritional assessment and intervention are important for adequate growth. In this study, we aimed to determine whether there were changes in the nutritional supply and growth status of premature infants hospitalized in the NICU after the introduction of the Nutrition support team (NST).
Methods: This study retrospectively analyzed premature infants admitted to the NICU for over 14 days. The average daily calorie, protein, and fat supply at 1 and 2 weeks after birth were compared before and after NST, and growth was evaluated by changes in length, weight, and head circumference z-scores at birth and 28 days after birth.
Results: A total of 79 neonates were included in the present study, with 32 in the pre-NST group and 47 in the post-NST group. The average daily energy supply during the first (p=0.001) and second (p=0.029) weeks postnatal was significantly higher in the post-NST group than in the pre-NST group. Lipid supply for the first week was significantly higher in the post-NST group than in the pre-NST group (p=0.010). The change in the z-score for length was significantly higher in the post-NST group than in the pre-NST group (p=0.049).
Conclusion: Nutrient supply and length z-score change increased significantly at 28 days after birth in the post-NST group. These results suggest that calorie calculators and NST activity can promote adequate growth and development in neonates.
{"title":"Nutrition Supply and Growth Post Nutrition Support Team Activity in Neonatal Intensive Care Unit.","authors":"Hye Min Ha, Yu Jin Jung, Yoo Rha Hong, So Yoon Choi","doi":"10.5223/pghn.2024.27.5.313","DOIUrl":"https://doi.org/10.5223/pghn.2024.27.5.313","url":null,"abstract":"<p><strong>Purpose: </strong>For neonates admitted to the neonatal intensive care unit (NICU), appropriate nutritional assessment and intervention are important for adequate growth. In this study, we aimed to determine whether there were changes in the nutritional supply and growth status of premature infants hospitalized in the NICU after the introduction of the Nutrition support team (NST).</p><p><strong>Methods: </strong>This study retrospectively analyzed premature infants admitted to the NICU for over 14 days. The average daily calorie, protein, and fat supply at 1 and 2 weeks after birth were compared before and after NST, and growth was evaluated by changes in length, weight, and head circumference z-scores at birth and 28 days after birth.</p><p><strong>Results: </strong>A total of 79 neonates were included in the present study, with 32 in the pre-NST group and 47 in the post-NST group. The average daily energy supply during the first (<i>p</i>=0.001) and second (<i>p</i>=0.029) weeks postnatal was significantly higher in the post-NST group than in the pre-NST group. Lipid supply for the first week was significantly higher in the post-NST group than in the pre-NST group (<i>p</i>=0.010). The change in the z-score for length was significantly higher in the post-NST group than in the pre-NST group (<i>p</i>=0.049).</p><p><strong>Conclusion: </strong>Nutrient supply and length z-score change increased significantly at 28 days after birth in the post-NST group. These results suggest that calorie calculators and NST activity can promote adequate growth and development in neonates.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 5","pages":"313-321"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-08DOI: 10.5223/pghn.2024.27.4.206
Sung Hee Lee, Minsoo Shin, Seo Hee Kim, Seong Pyo Kim, Hyung-Jin Yoon, Yangsoon Park, Jaemoon Koh, Seak Hee Oh, Jae Sung Ko, Jin Soo Moon, Kyung Mo Kim
Purpose: Few studies have reported the prevalence of inflammatory bowel disease unclassified (IBDU) among Korean pediatric IBD (PIBD) population. To address this gap, we used two tertiary centers and nationwide population-based healthcare administrative data to estimate the prevalence of Korean pediatric IBDU at the time of diagnosis.
Methods: We identified 136 patients aged 2-17 years with newly diagnosed IBD (94 Crohn's disease [CD] and 42 ulcerative colitis [UC]) from two tertiary centers in Korea between 2005 and 2017. We reclassified these 136 patients using the revised Porto criteria. To estimate the population-based prevalence, we analyzed Korean administrative healthcare data between 2005 and 2016, which revealed 3,650 IBD patients, including 2,538 CD and 1,112 UC. By extrapolating the reclassified results to a population-based dataset, we estimated the prevalence of PIBD subtypes.
Results: Among the 94 CD, the original diagnosis remained unchanged in 93 (98.9%), while the diagnosis of one (1.1%) patient was changed to IBDU. Among the 42 UC, the original diagnosis remained unchanged in 13 (31.0%), while the diagnoses in 11 (26.2%), 17 (40.5%), and one (2.4%) patient changed to atypical UC, IBDU, and CD, respectively. The estimated prevalences of CD, UC, atypical UC, and IBDU in the Korean population were 69.5%, 9.4%, 8.0%, and 13.1%, respectively.
Conclusion: This study is the first in Korea to estimate the prevalence of pediatric IBDU. This prevalence (13.1%) aligns with findings from Western studies. Large-scale prospective multicenter studies on PIBDU are required to examine the clinical features and outcomes of this condition.
{"title":"Prevalence of Inflammatory Bowel Disease Unclassified, as Estimated Using the Revised Porto Criteria, among Korean Pediatric Patients with Inflammatory Bowel Disease.","authors":"Sung Hee Lee, Minsoo Shin, Seo Hee Kim, Seong Pyo Kim, Hyung-Jin Yoon, Yangsoon Park, Jaemoon Koh, Seak Hee Oh, Jae Sung Ko, Jin Soo Moon, Kyung Mo Kim","doi":"10.5223/pghn.2024.27.4.206","DOIUrl":"10.5223/pghn.2024.27.4.206","url":null,"abstract":"<p><strong>Purpose: </strong>Few studies have reported the prevalence of inflammatory bowel disease unclassified (IBDU) among Korean pediatric IBD (PIBD) population. To address this gap, we used two tertiary centers and nationwide population-based healthcare administrative data to estimate the prevalence of Korean pediatric IBDU at the time of diagnosis.</p><p><strong>Methods: </strong>We identified 136 patients aged 2-17 years with newly diagnosed IBD (94 Crohn's disease [CD] and 42 ulcerative colitis [UC]) from two tertiary centers in Korea between 2005 and 2017. We reclassified these 136 patients using the revised Porto criteria. To estimate the population-based prevalence, we analyzed Korean administrative healthcare data between 2005 and 2016, which revealed 3,650 IBD patients, including 2,538 CD and 1,112 UC. By extrapolating the reclassified results to a population-based dataset, we estimated the prevalence of PIBD subtypes.</p><p><strong>Results: </strong>Among the 94 CD, the original diagnosis remained unchanged in 93 (98.9%), while the diagnosis of one (1.1%) patient was changed to IBDU. Among the 42 UC, the original diagnosis remained unchanged in 13 (31.0%), while the diagnoses in 11 (26.2%), 17 (40.5%), and one (2.4%) patient changed to atypical UC, IBDU, and CD, respectively. The estimated prevalences of CD, UC, atypical UC, and IBDU in the Korean population were 69.5%, 9.4%, 8.0%, and 13.1%, respectively.</p><p><strong>Conclusion: </strong>This study is the first in Korea to estimate the prevalence of pediatric IBDU. This prevalence (13.1%) aligns with findings from Western studies. Large-scale prospective multicenter studies on PIBDU are required to examine the clinical features and outcomes of this condition.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"27 4","pages":"206-214"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}