Pediatric Gastroenterology, Hepatology & Nutrition最新文献

Despite advances in the understanding of disease pathogenesis and treatment, diarrhea remains the primary cause of death among children around the world. Nutrition plays a significant role in treating diarrheal diseases. Malnourished children who have infectious diarrhea are at great risk of developing prolonged and more severe symptoms. The objective of this study was to review the effects of oral nutritional supplements on children with diarrhea. A systematic search for information was conducted using specific keywords in several databases. The results showed that oral food supplements are effective in reducing the symptoms of diarrhea, and the success rate with some formulations reached 100%. The rate of success and failure of formulas of oral nutritional supplements is dependent on the ingredients and foods used: Supplements high in zinc and fiber, as well as the foods yogurt and lactose-free milk, had the greatest impact on the success rate. Oral nutritional supplements are an effective way to reduce the duration and symptoms of diarrhea and can be used to treat diarrhea.

Purpose: Excessive fat accumulation can adversely affect vital organs, primarily because of energy imbalance. Hepatosteatosis is characterized by visceral fat accumulation, whereas obesity is associated with central fat deposition. This study aimed to determine the differences in bone morphogenetic protein 4 (BMP-4) levels according to the presence of obesity and hepatosteatosis.

Methods: A total of 84 volunteers evaluated at the Erciyes University Faculty of Medicine Child Health and Diseases Polyclinic were included. Pediatric radiological assessments were conducted for hepatosteatosis, and BMP-4 gene expression analysis was performed at the Erciyes University Genome and Stem Cell Center, using patient records and RNA extracted from peripheral blood samples. Subsequently, groups were formed based on obesity and hepatosteatosis status, and BMP-4 expression levels were compared between groups.

Results: The mean BMP-4 expression coefficient in the entire cohort was 1.3. Based on the BMI percentile groups, BMP-4 expression was highest in normal-weight individuals and lowest in overweight individuals, showing a statistically significant difference (p=0.024). In children with obesity, a weak positive correlation was noted between BMP-4 and glucose levels (r=0.315) and between BMP-4 and gamma-glutamyl transpeptidase levels (r=0.328).

Conclusion: BMP-4 may play a role in the modulation of obesity and hepatosteatosis. These findings suggest that BMP-4 expression decreases during initial weight gain, but increases in obese individuals. This suggests that BMP-4 increases with the onset of obesity. An increase in BMP-4 levels at the onset of obesity initiates the activation of resistance mechanisms.

Purpose: Polyethylene glycol (PEG) is recommended as the first-line laxative for fecal disimpaction in pediatric functional constipation. PEG 3350+electrolyte (E) and PEG 4000 are the most commonly available formulations. PEG 3350+E and PEG 4000 have hypothesized benefits of lower risk of electrolyte imbalance and better palatability, respectively. However, a head-to-head comparison of these two formulations for fecal disimpaction remains lacking. This study aimed to compare the efficacy, tolerability, and acceptability of PEG 3350+E vs. PEG 4000 for fecal disimpaction in pediatric functional constipation.

Methods: This double-blind, randomized controlled intention-to-treat trial included pediatric patients with functional constipation (as per ROME IV) and fecal impaction. Patients with organic constipation, h/o prior to gastrointestinal surgery, and those who were already receiving PEG/lactulose were excluded. Computer-generated block randomization was performed. Colorless liquid formulations of study medication were provided by investigator (JBK) as per treatment allocation in identical opaque bottles @1.5 gm/kg/dayx6 days or until fecal impaction resolution (passage of clear liquid stool), whichever is earlier.

Results: One hundred patients were randomized in a 1:1 ratio (50 patients in each arm). Efficacy of PEG 3350+E vs. PEG 4000 was similar (84% vs. 86%; p=0.9). Similarly, no significant differences were noted in the adverse event rates between two groups. Abdominal discomfort and vomiting were the most common adverse effects. PEG 4000 showed better palatability than PEG 3350+E (p=0.044). However, there was no significant difference in the compliance rate.

Conclusion: PEG 3350+E and PEG 4000 showed similar efficacies for fecal disimpaction, with minor side effects. PEG 4000 had better palatability; however, both were well tolerated by children.

Purpose: The aim of this study was to elucidate the genetic variants associated with progressive familial intrahepatic cholestasis (PFIC), a rare class of disorders driven by pathogenic monogenic variants in bile acid transporters. Furthermore, the long-term clinical outcomes of PFIC patients were evaluated.

Methods: A retrospective cohort study was conducted at Seoul National University Hospital and included pediatric patients diagnosed with PFIC and confirmed by genetic testing between January 2000 and October 2024. Genetic testing, encompassing either single-gene testing or a neonatal cholestasis 34-gene panel, was performed for all patients.

Results: Six patients were identified, including five with PFIC2, classified as bile salt export pump deficiency, and one with PFIC3, classified as multidrug resistance protein 3 deficiency. The median age of symptom onset was 3 months. The genetic analyses revealed no widely known variants associated with PFIC. However, a novel frameshift variant (c.589dup, p.(Glu197GlyfsTer8)) was detected in the ABCB11 gene. Additionally, a missense variant (c.3812T>A, p.(Ile1271Asn)) was commonly identified in the same gene. All patients ultimately underwent liver transplantation; two patients who developed hepatocellular carcinoma (HCC) were diagnosed at a median age of 1.6 years. Notably, all patients survived without recurrence after transplantation, with a median follow-up duration of 12.0 years.

Conclusion: This study is the first documented case of PFIC3 in a Korean child. Genotype is not associated with the risk of developing HCC. Given the early diagnosis of HCC observed in some patients, routine surveillance for HCC is strongly recommended in all patients with PFIC2.

Purpose: Foreign body (FB) ingestion is a common health problem that affects children. It requires endoscopic removal in up to 20% of cases. In this study, we reviewed all our pediatric cases of FB ingestion requiring endoscopy and compared their management to the published guidelines.

Methods: Retrospective study of children (aged 0-16 years) who were admitted to the emergency pediatric service department and underwent endoscopy for FB ingestion from January 2007 to December 2022. All statistical analyses were performed using STATA software version 17.0 (StataCorp LP).

Results: Of a total of 962 children diagnosed with FB ingestion, 62 of them (median age 4 years; interquartile range 2-8 years) underwent endoscopies and were included in this study. Of these, 39 (62.9%) were symptomatic and 23 (37.1%) were asymptomatic. The most common symptoms were vomiting (24.2%), pain (24.2%), sialorrhea (22.6%). In most patients, FBs were located in the esophagus (56.2%), with coins being the most common type (42.0%). The occurrence of at least one symptom was found to be associated with the FBs located in the upper-middle esophagus (compared to all other anatomical regions) (p<0.001). NASPGHAN and ESPGHAN guidelines were met in 68.8% of patients, while SIGENP guidelines were met in 72.9%.

Conclusion: FB ingestion is common in children. Coins are the most frequently encountered objects, typically located in the esophagus or stomach. An association was observed between the presence of at least one symptom and FBs located in the upper-middle esophagus. Performing endoscopies within 2 hours of FB ingestion is challenging in some cases.

Optimal nutrition during infancy and early childhood is crucial for promoting lifelong health and well-being. Complementary feeding is a crucial phase in the nutritional journey of growing babies, as their nutritional requirements begin to surpass those provided by breast milk at approximately 4-6 months of age. While a nutritional gap, notably iron deficiency, is prevalent in the Middle East and North Africa (MENA) region, optimal complementary feeding practices and fortified food items such as iron-fortified infant cereals can help bridge this gap and achieve nutritional targets. Healthcare professionals play a pivotal role in providing expert guidance and support to parents during this crucial stage of development. However, the MENA region, with its diverse populations and varied weaning practices in different cultures, lacks unified guidelines specific to the region. This consensus is intended to serve as a foundation for pediatricians and primary care physicians in the MENA region to advise parents and caregivers about optimal complementary feeding practices.

Purpose: Sigmoid volvulus rarely causes bowel obstruction in children. Early diagnosis and treatment are critical for preventing complications such as bowel ischemia and peritonitis. This study aimed to develop a structured diagnostic and treatment algorithm for sigmoid volvulus in pediatric patients.

Methods: Two clinical cases of pediatric sigmoid volvulus were reviewed, focusing on the clinical presentation, diagnosis, and surgical treatment. These findings were compared with those in the literature to establish evidence-based recommendations.

Results: Sigmoid volvulus should be considered in children who present with abdominal pain and signs of intestinal obstruction. The initial diagnosis can be made using abdominal radiography with computed tomography scans, if necessary. Colonoscopy with endoscopic detorsion of the volvulus is recommended in the absence of peritonitis. Owing to the high risk of recurrence, early resection of the sigmoid colon is recommended. Rectal biopsy is a key component of the diagnostic algorithm as it helps to confirm or exclude Hirschsprung's disease. Acute surgical intervention is indicated in children with clinical signs of peritonitis and/or pneumoperitoneum. Resection of the affected sigmoid bowel with or without primary anastomosis is recommended. Indocyanine green fluorescence imaging is a promising method for objectively evaluating bowel viability when viability is uncertain.

Conclusion: The proposed diagnostic and therapeutic algorithm offers a clear approach for managing sigmoid volvuli in pediatric patients.

Purpose: Nutritional intervention is critical in managing pediatric non-alcoholic fatty liver disease (NAFLD). This study assessed eating habits and dietary quality of Korean children and adolescents with NAFLD using the Nutrition Quotient (NQ).

Methods: In this prospective multicenter study across seven pediatric centers in Korea, children diagnosed with NAFLD completed the NQ questionnaire. Participants were grouped as mild, moderate, or severe based on hepatic steatosis grade on ultrasonography. Total and subfactor NQ scores were compared among groups.

Results: Of 163 participants, 26.4% had mild, 52.8% moderate, and 20.8% severe steatosis. Total NQ scores decreased with steatosis severity (mild 59.3±16.9, moderate 54.2±12.9, severe 52.9±14.2; p=0.033). Likewise, moderation scores declined (mild 59.1±16.9, moderate 53.0±12.8, severe 52.4±14.0; p=0.024), as did practice scores (mild 67.6±37.8, moderate 57.1±19.0, severe 54.7±21.4; p=0.038). The severe group also reported more frequent fast food intake near schools or academies (p=0.02).

Conclusion: Children with NAFLD had lower NQ scores than healthy peers reported in previous studies, reflecting poorer dietary quality. Lower moderation and practice scores, along with frequent fast food consumption, were associated with greater hepatic steatosis. These findings underscore the urgent need to improve eating habits through family-based nutritional education and sustained dietary management to mitigate NAFLD progression.

Purpose: Functional dyspepsia (FD) is a chronic disorder characterized by upper abdominal symptoms in the absence of an identifiable organic cause. Although the efficacy of acotiamide has been demonstrated in adults with FD, its effectiveness in pediatric patients remains unclear. This study aimed to evaluate the efficacy of acotiamide in pediatric patients with FD.

Methods: We conducted a retrospective analysis of 33 patients with FD, aged <16 years, who received acotiamide at a single children's hospital between August 2013 and March 2022.

Results: Symptomatic improvement was observed in 57.6% (19/33) of patients one month after acotiamide administration. The improvement rates were 63.6%, 20.0%, and 66.7% among patients with epigastric pain syndrome (EPS), postprandial distress syndrome (PDS), and overlap PDS-EPS, respectively. No statistically significant differences in symptomatic improvement rates were noted among the subtypes (p=0.213). Two patients discontinued acotiamide because of abdominal pain, but no serious adverse events were reported.

Conclusion: Acotiamide demonstrated efficacy in pediatric FD, which is consistent with previously reported outcomes in adults. Acotiamide may be a beneficial treatment option for pediatric FD across all subtypes.

Purpose: The long-term efficacy and safety of infliximab (IFX) in Japanese children with inflammatory bowel disease (IBD) remain unclear. This study aimed to examine the long-term outcomes of IFX treatment in Japanese children with IBD.

Methods: We retrospectively recruited patients aged <16 years who were diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) at Kurume University Hospital in Japan between 2011 and 2022 and examined the effectiveness and safety of IFX. We characterized the responses to IFX as primary response, primary nonresponse (PNR), secondary loss of response (sLOR), or still receiving IFX.

Results: Among the 77 enrolled patients with UC (median age, 10 years) and 48 with CD (median age, 12 years), 55 (27 with UC and 28 with CD) received IFX treatment. IFX treatment was significantly more common in patients with CD (58.3%) than in those with UC (35.1%; p=0.016). The PNR was significantly greater in patients with UC (18.5%) than in those with CD (0.0%; p=0.023), as was the sLOR (UC, 51.9%; CD, 21.4%; p=0.026). The likelihood of continuing IFX treatment during follow-up (median, 38 months) was significantly higher in patients with CD (71.4%) than in those with UC (29.6%; p=0.003). Adverse events resulting in the discontinuation of IFX occurred in 3.6% of the patients; one patient with CD developed leukemia, and the other had a serious infusion reaction.

Conclusion: The long-term durability of IFX in Japanese pediatric patients with IBD was inadequate in UC compared with CD. Serious adverse events in 3.6% of patients required discontinuation.