Pub Date : 2023-03-01Epub Date: 2023-03-07DOI: 10.5223/pghn.2023.26.2.88
Angharad Vernon-Roberts, Emma Rouse, Nerissa L Bowcock, Daniel A Lemberg, Andrew S Day
Purpose: Children with inflammatory bowel disease (IBD) frequently undergo clinical assessments, involving triadic communication between clinician, parent, and child. During such encounters parents are traditionally the main communicator of information on their child's IBD, including subjective symptom reports. The level of agreement between children and their parents for IBD symptoms is poorly understood, and this study aimed to examine this factor.
Methods: This was a cross-sectional study among children with IBD, and one parent. A validated paediatric IBD symptom report tool (IBDnow) enabled children and their parent to rate seven pain, well-being, and stool metrics, with dyads completing the tool concurrently. Results were assessed using: Individual agreement: proportion of identical symptom reports by each dyad (ideal score >0.7); Category agreement: percentage of identical reports for IBDnow metrics for the cohort; Inter-rater reliability: Gwet's AC1 coefficient with higher scores indicating better reliability (maximum=1).
Results: Seventy-four parent/child dyads participated; child's mean age 12.2 years (standard deviation [SD] 2.9, range 6-16), mean time since diagnosis 2.8 years (SD 3), 54% female, 73% had Crohn's Disease. Mean individual agreement level was 0.6, with 27% of dyads agreeing on ≥6/7 IBDnow metrics. Category agreement was reported by 61% of dyads, 20% of parents overestimated, and 19% underestimated, their child's symptoms. Inter-rater reliability ranged from fair to good.
Conclusion: These results should improve clinician awareness of how IBD symptom reports from parents may introduce bias. Children should be considered the most important source of symptom reports, and tools such as IBDnow utilised to enhance communication.
{"title":"Agreement Level of Inflammatory Bowel Disease Symptom Reports between Children and Their Parents.","authors":"Angharad Vernon-Roberts, Emma Rouse, Nerissa L Bowcock, Daniel A Lemberg, Andrew S Day","doi":"10.5223/pghn.2023.26.2.88","DOIUrl":"10.5223/pghn.2023.26.2.88","url":null,"abstract":"<p><strong>Purpose: </strong>Children with inflammatory bowel disease (IBD) frequently undergo clinical assessments, involving triadic communication between clinician, parent, and child. During such encounters parents are traditionally the main communicator of information on their child's IBD, including subjective symptom reports. The level of agreement between children and their parents for IBD symptoms is poorly understood, and this study aimed to examine this factor.</p><p><strong>Methods: </strong>This was a cross-sectional study among children with IBD, and one parent. A validated paediatric IBD symptom report tool (IBDnow) enabled children and their parent to rate seven pain, well-being, and stool metrics, with dyads completing the tool concurrently. Results were assessed using: Individual agreement: proportion of identical symptom reports by each dyad (ideal score >0.7); Category agreement: percentage of identical reports for IBDnow metrics for the cohort; Inter-rater reliability: Gwet's AC1 coefficient with higher scores indicating better reliability (maximum=1).</p><p><strong>Results: </strong>Seventy-four parent/child dyads participated; child's mean age 12.2 years (standard deviation [SD] 2.9, range 6-16), mean time since diagnosis 2.8 years (SD 3), 54% female, 73% had Crohn's Disease. Mean individual agreement level was 0.6, with 27% of dyads agreeing on ≥6/7 IBDnow metrics. Category agreement was reported by 61% of dyads, 20% of parents overestimated, and 19% underestimated, their child's symptoms. Inter-rater reliability ranged from fair to good.</p><p><strong>Conclusion: </strong>These results should improve clinician awareness of how IBD symptom reports from parents may introduce bias. Children should be considered the most important source of symptom reports, and tools such as IBDnow utilised to enhance communication.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 2","pages":"88-98"},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/3c/pghn-26-88.PMC10025573.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164439","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 : 2023-03-01DOI: 10.5223/pghn.2023.26.2.79
Yoo Min Lee, Yoon Lee, So Yoon Choi, Hyun Jin Kim, Suk Jin Hong, Yunkoo Kang, Eun Hye Lee, Kyung Jae Lee, Youjin Choi, Dae Yong Yi, Seung Kim, Ben Kang
Purpose: Gastrointestinal (GI) endoscopy is an important tool for diagnosing and treating GI diseases in children. This study aimed to analyze the current GI endoscopy practice patterns among South Korean pediatric endoscopists.
Methods: Twelve members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition developed a questionnaire. The questionnaire was emailed to pediatric gastroenterologists attending general and tertiary hospitals in South Korea.
Results: The response rate was 86.7% (52/60), and 49 of the respondents (94.2%) were currently performing endoscopy. All respondents were performing esophagogastroduodenoscopy, and 43 (87.8%) were performing colonoscopy. Relatively rare procedures for children, such as double-balloon enteroscopy (DBE) (4.1%), endoscopic retrograde cholangiopancreatography (ERCP) (2.0%), and endoscopic ultrasound (EUS) (2.0%), were only performed by pediatric gastroenterologists at very few centers, but were performed by adult endoscopists in most of the centers; of all the respondents, 83.7% (41/49) performed emergency endoscopy. In most centers, the majority of the endoscopies were performed under sedation, with midazolam (100.0%) and ketamine (67.3%) as the most frequently used sedatives.
Conclusion: While most pediatric GI endoscopists perform common GI endoscopic procedures, rare procedures, such as DBE, ERCP, and EUS, are only performed by pediatric gastroenterologists at very few centers, and by adult GI endoscopists at most of the centers. For such rare procedures, close communication and cooperation with adult GI endoscopists are required.
{"title":"A Nationwide Survey on Gastrointestinal Endoscopy Practice Patterns among Pediatric Endoscopists in South Korea.","authors":"Yoo Min Lee, Yoon Lee, So Yoon Choi, Hyun Jin Kim, Suk Jin Hong, Yunkoo Kang, Eun Hye Lee, Kyung Jae Lee, Youjin Choi, Dae Yong Yi, Seung Kim, Ben Kang","doi":"10.5223/pghn.2023.26.2.79","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.2.79","url":null,"abstract":"<p><strong>Purpose: </strong>Gastrointestinal (GI) endoscopy is an important tool for diagnosing and treating GI diseases in children. This study aimed to analyze the current GI endoscopy practice patterns among South Korean pediatric endoscopists.</p><p><strong>Methods: </strong>Twelve members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition developed a questionnaire. The questionnaire was emailed to pediatric gastroenterologists attending general and tertiary hospitals in South Korea.</p><p><strong>Results: </strong>The response rate was 86.7% (52/60), and 49 of the respondents (94.2%) were currently performing endoscopy. All respondents were performing esophagogastroduodenoscopy, and 43 (87.8%) were performing colonoscopy. Relatively rare procedures for children, such as double-balloon enteroscopy (DBE) (4.1%), endoscopic retrograde cholangiopancreatography (ERCP) (2.0%), and endoscopic ultrasound (EUS) (2.0%), were only performed by pediatric gastroenterologists at very few centers, but were performed by adult endoscopists in most of the centers; of all the respondents, 83.7% (41/49) performed emergency endoscopy. In most centers, the majority of the endoscopies were performed under sedation, with midazolam (100.0%) and ketamine (67.3%) as the most frequently used sedatives.</p><p><strong>Conclusion: </strong>While most pediatric GI endoscopists perform common GI endoscopic procedures, rare procedures, such as DBE, ERCP, and EUS, are only performed by pediatric gastroenterologists at very few centers, and by adult GI endoscopists at most of the centers. For such rare procedures, close communication and cooperation with adult GI endoscopists are required.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 2","pages":"79-87"},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/ec/pghn-26-79.PMC10025574.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164437","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}
Hepatic hemangiomas (HH) - classified into congenital hepatic hemangiomas (CHH) or infantile hepatic hemangiomas (IHH) - are benign vascular tumors that are mainly asymptomatic, but may cause clinical problems that require treatment. While focal, multifocal, and diffuse IHH are responsive to propranolol treatment, CHH is mainly focal and thought to be resistant to treatment with propranolol. The clinical and imaging distinctions between CHH and IHH in cases of focal lesions can be challenging, while histopathological distinction is mostly lacking in the clinical setting. We report 4 neonatal symptomatic cases of focal HH treated with propranolol, with partial or complete resolution of the tumor, and the positive hemodynamic effect of propranolol in one case. We believe that although clear differentiation cannot be achieved between CHH and IHH without histopathological examination in cases of focal HH in neonates, propranolol treatment should be attempted in symptomatic cases since its benefits outweigh the possible small risk of side effects of propranolol.
{"title":"Treatment of Symptomatic Focal Hepatic Hemangioma with Propranolol in Neonates: Is It Efficient?","authors":"Jana Lozar Krivec, Nina Lah, Mojca Glušič, Orjana Velikonja, Darja Paro-Panjan","doi":"10.5223/pghn.2023.26.1.70","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.1.70","url":null,"abstract":"<p><p>Hepatic hemangiomas (HH) - classified into congenital hepatic hemangiomas (CHH) or infantile hepatic hemangiomas (IHH) - are benign vascular tumors that are mainly asymptomatic, but may cause clinical problems that require treatment. While focal, multifocal, and diffuse IHH are responsive to propranolol treatment, CHH is mainly focal and thought to be resistant to treatment with propranolol. The clinical and imaging distinctions between CHH and IHH in cases of focal lesions can be challenging, while histopathological distinction is mostly lacking in the clinical setting. We report 4 neonatal symptomatic cases of focal HH treated with propranolol, with partial or complete resolution of the tumor, and the positive hemodynamic effect of propranolol in one case. We believe that although clear differentiation cannot be achieved between CHH and IHH without histopathological examination in cases of focal HH in neonates, propranolol treatment should be attempted in symptomatic cases since its benefits outweigh the possible small risk of side effects of propranolol.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 1","pages":"70-77"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/af/f9/pghn-26-70.PMC9911173.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9314487","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 : 2023-01-01DOI: 10.5223/pghn.2023.26.1.43
Sahar Zain-Alabedeen, Noha Kamel, Mona Amin, Angharad Vernon-Roberts, Andrew S Day, Abdelmoneim Khashana
Purpose: The cow's milk-related-symptom-score (CoMiSS) tool was developed as an awareness tool for the assessment of cow's milk-related symptoms in infants or children. Fecal calprotectin (FC) is a noninvasive biomarker of gut inflammation that can be measured in serum and stool. This study aimed to investigate the relationship between FC levels and CoMiSS scores in infants with cow's milk protein allergy.
Methods: Infants (aged 6-12 months) who were allergic to cow's milk protein were enrolled prospectively. Following completion of the CoMiSS scoring, the infants were divided into group 1 (positive CoMiSS scores ≥12) and group 2 (negative CoMiSS scores <12). FC was measured using immunoassay.
Results: Of the 120 infants enrolled in this study, 60 (50.0%) had positive CoMiSS scores (group 1), while 60 (50.0%) had negative scores (group 2). The mean FC level was higher in the infants in group 1 than those in group 2 (2,934.57 µg/g vs. 955.13 µg/g; p<0.001). In addition, there was a positive correlation between FC and CoMiSS scores (R=0.168, p<0.0001). A FC level of 1,700 µg/g provided a sensitivity of 98.3%, specificity of 93.3%, and accuracy of 95.8% for the diagnosis of cow's milk protein allergy (CMPA).
Conclusion: FC measurement may have a role in the assessing infants with CMPA.
目的:开发牛奶相关症状评分(CoMiSS)工具,作为评估婴儿或儿童牛奶相关症状的意识工具。粪钙保护蛋白(FC)是一种无创的肠道炎症生物标志物,可以在血清和粪便中测量。本研究旨在探讨牛奶蛋白过敏婴儿FC水平与CoMiSS评分之间的关系。方法:前瞻性招募对牛奶蛋白过敏的婴儿(6-12个月)。CoMiSS评分完成后,将婴儿分为1组(CoMiSS阳性评分≥12)和2组(CoMiSS阴性评分)结果:本研究纳入的120例婴儿中,60例(50.0%)为CoMiSS阳性评分(1组),60例(50.0%)为CoMiSS阴性评分(2组)。1组婴儿的平均FC水平高于2组(2934.57µg/g vs 955.13µg/g;结论:FC测量对CMPA患儿有一定的评价价值。
{"title":"Fecal Calprotectin and Cow's Milk-Related-Symptoms Score in Children with Cow's Milk Protein Allergy.","authors":"Sahar Zain-Alabedeen, Noha Kamel, Mona Amin, Angharad Vernon-Roberts, Andrew S Day, Abdelmoneim Khashana","doi":"10.5223/pghn.2023.26.1.43","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.1.43","url":null,"abstract":"<p><strong>Purpose: </strong>The cow's milk-related-symptom-score (CoMiSS) tool was developed as an awareness tool for the assessment of cow's milk-related symptoms in infants or children. Fecal calprotectin (FC) is a noninvasive biomarker of gut inflammation that can be measured in serum and stool. This study aimed to investigate the relationship between FC levels and CoMiSS scores in infants with cow's milk protein allergy.</p><p><strong>Methods: </strong>Infants (aged 6-12 months) who were allergic to cow's milk protein were enrolled prospectively. Following completion of the CoMiSS scoring, the infants were divided into group 1 (positive CoMiSS scores ≥12) and group 2 (negative CoMiSS scores <12). FC was measured using immunoassay.</p><p><strong>Results: </strong>Of the 120 infants enrolled in this study, 60 (50.0%) had positive CoMiSS scores (group 1), while 60 (50.0%) had negative scores (group 2). The mean FC level was higher in the infants in group 1 than those in group 2 (2,934.57 µg/g vs. 955.13 µg/g; <i>p</i><0.001). In addition, there was a positive correlation between FC and CoMiSS scores (R=0.168, <i>p</i><0.0001). A FC level of 1,700 µg/g provided a sensitivity of 98.3%, specificity of 93.3%, and accuracy of 95.8% for the diagnosis of cow's milk protein allergy (CMPA).</p><p><strong>Conclusion: </strong>FC measurement may have a role in the assessing infants with CMPA.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 1","pages":"43-49"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/21/pghn-26-43.PMC9911171.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9314492","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 : 2023-01-01DOI: 10.5223/pghn.2023.26.1.1
Kaan Demiroren
Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.
{"title":"Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines.","authors":"Kaan Demiroren","doi":"10.5223/pghn.2023.26.1.1","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.1.1","url":null,"abstract":"<p><p>Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 1","pages":"1-14"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bb/6f/pghn-26-1.PMC9911172.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328829","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 : 2023-01-01DOI: 10.5223/pghn.2023.26.6.320
Omnia El-Kassas, Ayman Amer, Hesham Abdel-Hady, Tamer Abou-Elsaad
Purpose This study aimed to develop a new bedside scoring system scale that assesses preterm infants’ oral feeding skills (OFS) in the neonatal intensive care unit (NICU). Methods A literature review and critical appraisal of available oral feeding assessment tools/scores were performed. Subsequently, we developed the “Mansoura Early Feeding Skills Assessment” (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. Results Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. Conclusion The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU.
{"title":"Developing the Mansoura Early Feeding Skills Assessment Scale for Preterm Infants","authors":"Omnia El-Kassas, Ayman Amer, Hesham Abdel-Hady, Tamer Abou-Elsaad","doi":"10.5223/pghn.2023.26.6.320","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.6.320","url":null,"abstract":"Purpose This study aimed to develop a new bedside scoring system scale that assesses preterm infants’ oral feeding skills (OFS) in the neonatal intensive care unit (NICU). Methods A literature review and critical appraisal of available oral feeding assessment tools/scores were performed. Subsequently, we developed the “Mansoura Early Feeding Skills Assessment” (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. Results Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. Conclusion The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU.","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135563616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The purpose of this study was to determine the pattern of human leukocyte antigen (HLA)-DQ genotype in children diagnosed with celiac disease (CD) (biopsy proven), and to compare this with a control group; and secondarily, to correlate HLA genotypes with clinical profiles of CD.
Methods: This cross-sectional comparative observational study included 26 controls and 52 patients diagnosed with CD who presented at Sir Padampat Mother and Child Health Institute, Jaipur, from May, 2017 to October, 2018. HLA DQ genotype was assessed for each patients and correlated with clinical profiles.
Results: HLA DQ2/DQ8 genotypes were significantly more common in CD (present in 100.0% cases) than in controls (23.1%) in Northern India (Rajasthan). When HLA DQ2.5 and DQ8 were present together, individuals had significantly more atypical presentations and severe findings on duodenal biopsy. Similarly, patients with the HLA DQ 2.5 genotype were also predisposed to more severe endoscopic findings, while HLA DQ2.2 predisposed them to less severe biopsy findings. HLA DQ8 was significantly associated with later age at diagnosis (>5 years) and shorter stature. The highest HLA DQ relative risk (RR) for CD development was associated with HLA DQ2.5 and DQ2.2 in combination, followed by HLA DQ2.5 and DQ8 in combination, while HLA DQx.5 and HLA DQ2.2 together had the lowest risk.
Conclusion: HLA DQ2/DQ8 genotypes are strongly associated with pediatric CD patients in northern India. These genotypes and their combinations may be associated with different clinical presentations of CD, and may help predict severity of CD.
{"title":"Human Leukocyte Antigen-DQ Genotyping in Pediatric Celiac Disease.","authors":"Stuti Pareek, Raj Kumar Gupta, Abhinav Sharma, Sandhya Gulati","doi":"10.5223/pghn.2023.26.1.50","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.1.50","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the pattern of human leukocyte antigen (HLA)-DQ genotype in children diagnosed with celiac disease (CD) (biopsy proven), and to compare this with a control group; and secondarily, to correlate HLA genotypes with clinical profiles of CD.</p><p><strong>Methods: </strong>This cross-sectional comparative observational study included 26 controls and 52 patients diagnosed with CD who presented at Sir Padampat Mother and Child Health Institute, Jaipur, from May, 2017 to October, 2018. HLA DQ genotype was assessed for each patients and correlated with clinical profiles.</p><p><strong>Results: </strong>HLA DQ2/DQ8 genotypes were significantly more common in CD (present in 100.0% cases) than in controls (23.1%) in Northern India (Rajasthan). When HLA DQ2.5 and DQ8 were present together, individuals had significantly more atypical presentations and severe findings on duodenal biopsy. Similarly, patients with the HLA DQ 2.5 genotype were also predisposed to more severe endoscopic findings, while HLA DQ2.2 predisposed them to less severe biopsy findings. HLA DQ8 was significantly associated with later age at diagnosis (>5 years) and shorter stature. The highest HLA DQ relative risk (RR) for CD development was associated with HLA DQ2.5 and DQ2.2 in combination, followed by HLA DQ2.5 and DQ8 in combination, while HLA DQx.5 and HLA DQ2.2 together had the lowest risk.</p><p><strong>Conclusion: </strong>HLA DQ2/DQ8 genotypes are strongly associated with pediatric CD patients in northern India. These genotypes and their combinations may be associated with different clinical presentations of CD, and may help predict severity of CD.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 1","pages":"50-57"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/41/pghn-26-50.PMC9911170.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9314489","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 : 2023-01-01DOI: 10.5223/pghn.2023.26.1.34
Yu Bin Kim, Ju Young Kim, Sujin Choi, Yoo Min Lee, So Yoon Choi, Soon Chul Kim, Hyo-Jeong Jang, Yoon Lee, In Sook Jeong, Dae Yong Yi, Yunkoo Kang, Kyung Jae Lee, Byung-Ho Choe, Ben Kang
Purpose: We aimed to investigate factors that correlate with fecal calprotectin (FC) levels in children and adolescents with colorectal polyps.
Methods: Pediatric patients aged <19 years who underwent colonoscopic polypectomy for a juvenile polyps (JPs) and FC tests were simultaneously conducted in a multicenter, retrospective study. Baseline demographics, colonoscopic and histological findings, and laboratory tests, including FC levels, were investigated. Correlations between the factors were investigated, and linear regression analysis revealed factors that correlated with FC levels. FC levels measured after polypectomies were investigated and the FC levels pre- and post-polypectomies were compared.
Results: A total of 33 patients were included in the study. According to Pearson correlation analysis, the polyp size was the only factor that showed a statistically significant correlation with FC levels (r=0.75, p<0.001). Furthermore, according to the multivariate linear regression analysis, polyp size was the only factor that showed a statistically significant correlation with FC levels (adjusted R2 =0.5718, β=73.62, p<0.001). The median FC level was 400 mg/kg (interquartile range [IQR], 141.6-1,000 mg/kg), and the median polyp size was 14 mm (IQR, 9-20 mm). Nineteen patients underwent post-polypectomy FC tests. FC levels showed a significant decrease after polypectomy from a median of 445.2 mg/kg (IQR, 225-1,000) to 26.5 mg/kg (11.5-51) (p<0.001).
Conclusion: FC levels significantly correlated with polyp size in children and adolescents with JPs.
{"title":"Fecal Calprotectin Levels Significantly Correlate with Polyp Size in Children and Adolescents with Juvenile Colorectal Polyps.","authors":"Yu Bin Kim, Ju Young Kim, Sujin Choi, Yoo Min Lee, So Yoon Choi, Soon Chul Kim, Hyo-Jeong Jang, Yoon Lee, In Sook Jeong, Dae Yong Yi, Yunkoo Kang, Kyung Jae Lee, Byung-Ho Choe, Ben Kang","doi":"10.5223/pghn.2023.26.1.34","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.1.34","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate factors that correlate with fecal calprotectin (FC) levels in children and adolescents with colorectal polyps.</p><p><strong>Methods: </strong>Pediatric patients aged <19 years who underwent colonoscopic polypectomy for a juvenile polyps (JPs) and FC tests were simultaneously conducted in a multicenter, retrospective study. Baseline demographics, colonoscopic and histological findings, and laboratory tests, including FC levels, were investigated. Correlations between the factors were investigated, and linear regression analysis revealed factors that correlated with FC levels. FC levels measured after polypectomies were investigated and the FC levels pre- and post-polypectomies were compared.</p><p><strong>Results: </strong>A total of 33 patients were included in the study. According to Pearson correlation analysis, the polyp size was the only factor that showed a statistically significant correlation with FC levels (<i>r=</i>0.75, <i>p</i><0.001). Furthermore, according to the multivariate linear regression analysis, polyp size was the only factor that showed a statistically significant correlation with FC levels (adjusted <i>R<sup>2</sup></i> =0.5718, β<i>=</i>73.62, <i>p</i><0.001). The median FC level was 400 mg/kg (interquartile range [IQR], 141.6-1,000 mg/kg), and the median polyp size was 14 mm (IQR, 9-20 mm). Nineteen patients underwent post-polypectomy FC tests. FC levels showed a significant decrease after polypectomy from a median of 445.2 mg/kg (IQR, 225-1,000) to 26.5 mg/kg (11.5-51) (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>FC levels significantly correlated with polyp size in children and adolescents with JPs.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 1","pages":"34-42"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/aa/pghn-26-34.PMC9911176.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9314491","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 : 2023-01-01DOI: 10.5223/pghn.2023.26.1.15
Yoon Lee, Sujin Choi, Ben Kang
Purpose: Total colonoscopy is recommended if colorectal polyps are clinically suspected. This study aimed to investigate the performance status of pediatric colonoscopic polypectomy in Korea.
Methods: We surveyed pediatric endoscopic specialists who perform colonoscopic polypectomy in Korea using a questionnaire of 13 questions on pediatric colonoscopic polypectomy performance status.
Results: The survey was conducted at 45 institutions, and 32 specialists (71.1%) responded. Among the respondents, 31.2% (10/32) said colonoscopy was performed in all age groups, while 12.5% (4/32) said sigmoidoscopy was performed in all age groups. Meanwhile, 56.2% (18/32) said that sigmoidoscopy was performed in young children, while colonoscopy was performed in older children. Among them, 38.9% (7/18) believe that 4-6 years were young, and 44.5% (8/18) believe that 7-9 years were young. Regarding surveillance examinations, 21.9% (7/32) said they would perform a surveillance colonoscopy or sigmoidoscopy in the future if less than five juvenile polyps were found in the colon. Meanwhile, if less than five adenomatous polyps were found in the colon, 93.8% (30/32) said they would perform surveillance colonoscopy or sigmoidoscopy in the future.
Conclusion: More than half of the pediatric endoscopic specialists in Korea choose between a colonoscopy and sigmoidoscopy depending on the patient's age, contrary to the generally accepted recommendation of total colonoscopy if colorectal polyps are suspected in children and adolescents. In this survey, most pediatric endoscopists used the age range of 4-9 years as the reference age.
{"title":"Practice Patterns of Colorectal Polypectomy in Pediatric Endoscopic Specialists in South Korea: A Nationwide Survey Study.","authors":"Yoon Lee, Sujin Choi, Ben Kang","doi":"10.5223/pghn.2023.26.1.15","DOIUrl":"https://doi.org/10.5223/pghn.2023.26.1.15","url":null,"abstract":"<p><strong>Purpose: </strong>Total colonoscopy is recommended if colorectal polyps are clinically suspected. This study aimed to investigate the performance status of pediatric colonoscopic polypectomy in Korea.</p><p><strong>Methods: </strong>We surveyed pediatric endoscopic specialists who perform colonoscopic polypectomy in Korea using a questionnaire of 13 questions on pediatric colonoscopic polypectomy performance status.</p><p><strong>Results: </strong>The survey was conducted at 45 institutions, and 32 specialists (71.1%) responded. Among the respondents, 31.2% (10/32) said colonoscopy was performed in all age groups, while 12.5% (4/32) said sigmoidoscopy was performed in all age groups. Meanwhile, 56.2% (18/32) said that sigmoidoscopy was performed in young children, while colonoscopy was performed in older children. Among them, 38.9% (7/18) believe that 4-6 years were young, and 44.5% (8/18) believe that 7-9 years were young. Regarding surveillance examinations, 21.9% (7/32) said they would perform a surveillance colonoscopy or sigmoidoscopy in the future if less than five juvenile polyps were found in the colon. Meanwhile, if less than five adenomatous polyps were found in the colon, 93.8% (30/32) said they would perform surveillance colonoscopy or sigmoidoscopy in the future.</p><p><strong>Conclusion: </strong>More than half of the pediatric endoscopic specialists in Korea choose between a colonoscopy and sigmoidoscopy depending on the patient's age, contrary to the generally accepted recommendation of total colonoscopy if colorectal polyps are suspected in children and adolescents. In this survey, most pediatric endoscopists used the age range of 4-9 years as the reference age.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":"26 1","pages":"15-22"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/59/pghn-26-15.PMC9911175.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328831","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}