Pediatric Gastroenterology, Hepatology & Nutrition最新文献

The transition of young patients with inflammatory bowel disease (IBD) from pediatric to adult-centered healthcare presents a significant challenge, particularly in regions like Oman, where transfer occurs as early as 14 years old. Although both pediatric and adult patients require multidisciplinary management, key differences in disease characteristics, vaccination needs, growth considerations, and treatment approaches necessitate a carefully structured transition process. Effective communication between pediatric and adult gastroenterologists is crucial for ensuring optimal management for these young patients. This mini-review explores the complexities involved in transitioning young patients with IBD to adult healthcare services.

The increasing incidence of dyslipidemia among children and adolescents has emerged as a significant public health concern due to its associated risk of long-term cardiovascular complications. The prevalence of dyslipidemia has increased in parallel with rising obesity rates, highlighting the importance of early intervention. In this narrative review, we explore the epidemiology, screening, diagnosis, and treatment of dyslipidemia in pediatric populations, focusing on recent advancements and updates in clinical management. Key diagnostic criteria and risk assessment strategies are discussed, emphasizing the role of lipid profile screening in high-risk groups. Lifestyle and dietary interventions are key for managing dyslipidemia, while pharmacological treatments including statins, cholesterol absorption inhibitors, and emerging therapies are reviewed in cases requiring further intervention. Updated guidelines and evidence-based recommendations from Korean and other international institutions are consolidated to provide a comprehensive overview. These findings underscore the necessity of a multidisciplinary approach combining early detection, tailored treatment, and lifestyle modifications to mitigate the long-term health risks associated with dyslipidemia in younger individuals.

Purpose: Disorders of the gut-brain interaction (DGBIs), formerly known as functional gastrointestinal disorders, are a set of recurrent or chronic digestive symptoms that are not explained by structural or biochemical alterations. The pathophysiology of these disorders is not completely known, but it is believed that different environmental, genetic, social, or psychological factors may generate them. Therefore, the sphere of mental health must be taken into consideration. Our objective was to determine the prevalence of disorders of the gut-brain interaction, anxiety, depressive symptomatology, and perfectionist traits in children and adolescents aged 10-14 years and to analyze the relationship between psychological features and abdominal pain.

Methods: This cross-sectional descriptive-analytical observational study included 447 students (51.9% female) aged between 10-14 (median age=12.26) years from four schools in the province of Castellón.

Results: Notably, 37.1% of the students had some type of DGBI. Children with depressive symptoms had 4.69 times higher odds of presenting with some type of DGBI, and children with anxiety had 2.86 times higher odds of presenting with some type of DGBI. Students who exhibited only socially prescribed perfectionism had 2.07 times higher odds of presenting with some type of DGBI.

Conclusion: Children aged 10-14 years who had depressive symptomatology, perfectionist personality traits (specifically socially prescribed perfectionism), and anxiety (only in children over 12 years) were more likely to have DGBIs.

Purpose: The KidZ Health Castle Formula (KHC-F) was developed to improve the positioning of multichannel intraluminal impedance-pH probes (MII-pH). We hypothesized that the updated formula KHC-Fv2 would performs better than the original formula. This study aimed to evaluate the reliability of KHC-Fv2.

Methods: A prospective cohort study was conducted to assess MII-pH probe positioning in patients aged 1 month to 18 years. Margins of error within 1 cm above or below the target position, as determined using KHC-Fv2 and compared with fluoroscopy, were accepted.

Results: Eighty-four children were included in the study. The mean difference between the KHC-Fv2 and target positions was +0.25 cm cranially. The KHC-Fv2 insertion length fell within the accepted difference of ±1 cm of the target position in 67.9% of the children. This percentage increased in infants under 1 year of age (79.5%) or shorter than 100 cm (74.0%) in height.

Conclusion: KHC-Fv2 demonstrated strong agreement with correct positioning and significantly reduced the need for a second radiologic control after probe repositioning, particularly in infants or children shorter than 100 cm.

[This corrects the article on p. 286 in vol. 27, PMID: 39319282.].

Purpose: This study aimed to estimate the prevalence and predictors of portopulmonary hypertension (POPH) in children with portal hypertension.

Methods: We recruited children of both sexes aged 3-15 years with portal hypertension that was clinically suspected and confirmed by the presence of varices on esophagogastroduodenoscopy (EGD). The participants underwent clinical examination, 6-min walk distance (6-MWD), and echocardiography.

Results: We enrolled 94 children with portal hypertension: 26.6% with pre-hepatic causes and 73.4% secondary to chronic liver disease. Among our participants, 13.8% had one or more cardiac manifestations, such as exercise intolerance, dyspnea on exertion, cyanosis, or orthopnea, whereas 86.2% were asymptomatic. EGD examination revealed grade I varices in 54.3% of cases, grade II-III in 43.6%, and grade IV in 2.1%. Pulmonary hypertension (>35 mmHg) was detected in 30.9% of cases using echocardiography; two of them were >45 mmHg. Patients with POPH had significantly more frequent dyspnea on exertion, lower O₂ saturation, and more severe variceal grades than those with normal pulmonary artery pressure. Five (6.9%) cases had <300 m 6-MWD, with no significant difference between patients with normal and those with elevated pulmonary artery pressure. The duration of portal hypertension and 6-MWD were correlated significantly with the echocardiographic measures. High-grade varices (p=0.04) and low O₂ saturation (p=0.03) were identified as risk factors for POPH.

Conclusion: POPH was detected in 30.9% of our study group. High-grade varices and low O₂ saturation are predictors of POPH. Echocardiography screening is crucial for the early detection of cases.

The use of abdominal ultrasound is becoming a necessity, rather than an option, for pediatricians. Incorporating abdominal ultrasound training into resident training programs for pediatricians provides a direct pathway for physicians to effectively utilize point-of-care ultrasound (POCUS) in their clinical practice after board certification. This study proposed a detailed system to support this initiative by establishing 22 standard views of pediatric abdominal ultrasound and emphasizing a structured training regimen with repeated practice to achieve proficiency. This approach offers a streamlined method for trainees to become experts rapidly. After board certification, this foundational training serves as the basis for advanced learning, allowing clinicians to tailor POCUS techniques according to their specific areas of practice.

Purpose: Pediatric gastrointestinal (GI) endoscopy significantly contributes to the diagnosis and management of GI diseases in children. Global data on pediatric GI endoscopy in the Asia-Pacific region are limited. We aimed to report the findings of a regional survey on pediatric endoscopy in the Asia-Pacific region.

Methods: A questionnaire-based survey involving GI endoscopy centers in 13 Asia-Pacific countries (June to November 2021). The questionnaires included annual procedure volumes (from basic diagnostics to advanced therapeutic endoscopy), endoscopists, sedation procedures, and national training programs.

Results: A total of 162 GI endoscopy centers completed the survey. All centers performed basic endoscopies (esophagogastroduodenoscopy and ileocolonoscopy); however, 45.1% and 59.1% of the centers performed less than 50 esophagogastroduodenoscopies and ileocolonoscopies per year, respectively. Small bowel evaluation (capsule endoscopy or balloon-assisted enteroscopy) was performed in 59.3% of the centers. Foreign body removal, polypectomy, and percutaneous endoscopic gastrostomy were performed in 89.5%, 85.8%, and 52.5% of centers, respectively. Endoscopic hemostatic interventions, which are life-saving procedures, included glue injection (30.9%), hemostasis of nonvariceal bleeding (65.4%), and endoscopic variceal ligation (70.4%). Pediatric GI endoscopy is performed not only by pediatric gastroenterologists but also by adult gastroenterologists in 21-50% of centers for many kinds of procedures. Sedation was provided by anesthesiologists in 65.4% of the centers. Most centers offer both adult and pediatric endoscopy training.

Conclusion: The study highlights regional disparities in pediatric GI endoscopy services. It emphasizes the need for expanded pediatric GI training and improved access to therapeutic endoscopy, particularly for life-saving procedures.

Purpose: This study aimed to evaluate the efficacy of oil massage as an adjunct therapy for neonatal jaundice during phototherapy.

Methods: A total of 160 neonates with unconjugated hyperbilirubinemia were enrolled and randomly allocated into two study groups using a computer-generated random number table. Group 1 (Intervention Group) consisted of 84 patients who received both phototherapy and massage therapy, while Group 2 (Control Group) consisted of 76 patients who received only phototherapy. The intervention group underwent massage therapy three times daily for 20 minutes over two consecutive days. Transcutaneous bilirubin levels were measured every eight hours. Additionally, the total duration of phototherapy and the 24-hour stool and urine output frequency were recorded in both groups.

Results: There were no significant differences in the demographic characteristics between the two groups. However, stool frequency and urine output were significantly higher in the intervention group. The average duration of phototherapy was 19.4±4.17 hours in the intervention group compared to 28.4±6.58 hours in the control group (p<0.001). The rate of Transcutaneous bilirubin reduction was significantly higher in the intervention group during the first 24 hours. A rebound increase in bilirubin levels was observed at 40 and 48 hours in both groups after phototherapy was discontinued.

Conclusion: Phototherapy combined with massage significantly reduced total bilirubin levels in newborns with neonatal hyperbilirubinemia, making it a valuable adjunct treatment for the rapid reduction of bilirubin in neonates.

Purpose: Cholestatic complications remain a primary cause of post-liver transplantation (LTX) morbidity in pediatric patients. Standard biliary access by endoscopic retrograde cholangioscopy may not be feasible due to modified biliary drainage. Percutaneous transhepatic biliary drainage (PTCD) may be performed alternatively. However, systematic data concerning safety and efficacy of PTCD in these patients are scarce.

Methods: In this retrospective study, procedural and safety characteristics of PTCD in pediatric patients following LTX were analyzed. We compared laboratory indicators of inflammation, cholestasis, and graft function before and at 6 and 12 months after the first PTCD insertion. Efficacy was analyzed by percentage of patients without cholangitis, need for surgical biliary re-intervention and re-transplantation during a follow-up period of 60 months.

Results: Over a decade, PTCD was attempted in a total of 15 patients, with technical success (93.3%) in 14 patients. Periprocedural complications, including bleeding (7.1%) and cholangitis (21.4%) were observed in patients. During follow-up, both MELD-score (baseline: 13 [8-15] vs. 12 months: 8 [7-8], p<0.001) and parameters of cholestasis (GGT: baseline: 286 [47-458] U/L vs. 12 months: 105 [26-147] U/L, p=0.024) decreased. Prior to PTCD, cholangitis (64.3%) and cholangiosepsis (21.4%) were common complications. In contrast, following PTCD, cholangitis occurred in only one patient (7.1%). Five patients (35.7%) needed surgical biliary re-intervention and two (14.3%) required re-transplantation.

Conclusion: PTCD in pediatric patients following LTX had an acceptable safety profile, demonstrating a biochemical improvement of both cholestasis and graft function and may prevent cholestatic complications, thus reducing the need for surgical re-intervention and re-transplantation.