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Utility of Subjective Global Nutritional Assessment Tool for the Assessment of Malnutrition in Pediatric Patients with Chronic Liver Disease 主观整体营养评估工具在儿科慢性肝病患者营养不良评估中的应用
Q2 Medicine Pub Date : 2023-01-01 DOI: 10.5223/pghn.2023.26.6.346
Anwesha Ray, Srikanta Basu, Praveen Kumar
Purpose Approximately 30% of children with chronic liver disease (CLD) are malnourished. However, proper assessment of their nutritional status is difficult. The subjective global nutritional assessment (SGNA) is a comprehensive approach that uses nutrition-focused history and examination, followed by grading of malnourishment. We aimed to study the prevalence of malnutrition in children with CLD using the SGNA tool. Methods This cross-sectional observational study included patients aged <18 years with CLD. Nutritional assessments were recorded using SGNA tool. Conventional anthropometric measurements were performed and corroborated with nutritional status using SGNA tool. Results A total of 85 children with CLD and mean age of 62 months were enrolled in this study. The prevalence of malnourished children according to SGNA was 34%; 22% were moderately malnourished and 12% were severely malnourished. We found statistically significant differences in anthropometric parameters among the three groups. A moderate degree of agreement was found between SGNA and weight-for-age (W/A) (p=0.020), mid-upper arm circumference (MUAC) (p<0.001), and triceps skin-fold thickness (TSF)-for-age (p=0.029). Furthermore, a fair degree of agreement was found between height-for-age (H/A) (p=0.001) and weight-for-height (W/H) (p<0.001). The sensitivity of W/A for detecting malnutrition was 93%, H/A was 90%, MUAC was 86%, and TSF was 88%. The sensitivity was much lower for W/H and body mass index for age (55% for both). Conclusion In our study, more than one-third of children with CLD were malnourished. Nutritional assessment using SGNA is a reliable method for evaluating nutritional status and is significantly correlated with common anthropometric measurements.
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引用次数: 0
Use of Dual-Energy X-ray Absorptiometry in Children with Inflammatory Bowel Disease: A Large Single Centre Study. 双能x线吸收仪在儿童炎症性肠病中的应用:一项大型单中心研究
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.473
Asha Jois, Sajini Perera, Peter Simm, George Alex

Purpose: Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a single site retrospective analysis of DXA use.

Methods: Children aged 5-18 years with IBD diagnosed between 2013 to 2017 at the Royal Children's Hospital, Australia, were included. Patient demographics, measures of disease activity, DXA scores, and factors related to BMD were collected.

Results: Over a median follow up of 5.1 (4-6.4) years, 72/239 (30.1%) children underwent DXA, and 28/239 (11.7%) children had a second DXA. Our DXA practice differed to consensus guidelines regarding initial screening based on height and/or body mass index (BMI) z-score (8/17 [47.1%]), and repeat surveillance (13/42 [31.0%]). Children had a median lumbar spine (LS) z-score -0.80 (-1.65-0.075). Children with LS z-score≤-2.0 (n=14) had lower weight (6.57 [1.78-23.7] vs. 51.1 [26.5-68.7], p=0.0002) and height centiles (3.62 [1.17-17.1] vs. 42 [16.9-67.1], p=0.0001), and higher faecal calprotectin (FCP) (3041 [1182-4192] vs. 585 [139-2419], p=0.009) compared to children with LS z-score>-2.0. No fractures were reported. Of 28 children who underwent a second DXA 1.6 (1.1-2.2) years following initial DXA, no significant change in z-scores occurred.

Conclusion: Children with IBD had low BMD. In addition to height centile and weight centile, FCP was associated with lower BMD, and should be considered in DXA screening guidelines. Greater clinician awareness of DXA consensus guidelines is required. Future prospective studies are required.

目的:低骨密度(BMD)是儿童炎症性肠病(IBD)的并发症。评估双能x线吸收仪(DXA)作为IBD儿童低骨密度筛查工具的数据有限。我们对DXA的使用进行了单站点回顾性分析。方法:纳入2013年至2017年在澳大利亚皇家儿童医院诊断为IBD的5-18岁儿童。收集患者人口统计资料、疾病活动度测量、DXA评分和与BMD相关的因素。结果:中位随访5.1(4-6.4)年,72/239(30.1%)名儿童接受了DXA治疗,28/239(11.7%)名儿童进行了第二次DXA治疗。我们的DXA实践不同于基于身高和/或体重指数(BMI) z-score(8/17[47.1%])的初始筛查和重复监测(13/42[31.0%])的共识指南。儿童腰椎中位(LS) z-score为-0.80(-1.65-0.075)。LS z-score≤-2.0的儿童(n=14)体重(6.57[1.78-23.7]比51.1 [26.5-68.7],p=0.0002)、身高(3.62[1.17-17.1]比42 [16.9-67.1],p=0.0001)、粪钙保护蛋白(FCP)(3041[1182-4192]比585 [139-2419],p=0.009)均低于LS z-score>-2.0的儿童。无骨折报告。在首次DXA后1.6(1.1-2.2)年进行第二次DXA的28名儿童中,z分数没有发生显着变化。结论:IBD患儿骨密度低。除了身高百分位数和体重百分位数外,FCP还与较低的骨密度有关,应在DXA筛查指南中予以考虑。需要提高临床医生对DXA共识指南的认识。需要进一步的前瞻性研究。
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引用次数: 1
Postoperative Complications of Esophageal Atresia and Role of Endoscopic Balloon Dilatation in Anastomotic Strictures. 食管闭锁术后并发症及内镜球囊扩张在吻合口狭窄中的作用。
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.453
Jin Young Cho, Mea-Young Chang, Mi Hyeon Gang, Yong Wook Lee, Jun Beom Park, Jae Young Kim, Hyun Jin Kim

Purpose: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture.

Methods: We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients' baseline characteristics, associated anomalies, and postoperative complications were reviewed.

Results: Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2-15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2-7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD.

Conclusion: Approximately half of the patients experienced complications after EA repair. In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.

目的:食管闭锁(EA)伴或不伴气管食管瘘(TEF)是一种先天性异常,即使在修复后也会引起频繁的消化和营养问题。最常见的并发症是吻合口狭窄,需要再次手术或球囊扩张。本研究旨在探讨内镜下球囊扩张术(EBD)在吻合口狭窄病例中的作用及术后并发症。方法:回顾性分析2000年1月至2021年2月期间诊断为EA伴或不伴TEF的患者。回顾了患者的基线特征、相关异常和术后并发症。结果:26例患者中,男性14例(53.8%),并发畸形12例(46.2%),中位随访6.1年(范围1.2 ~ 15.7年)。在单因素分析中,早产、低出生体重和长间隙EA与12例(46.2%)患者的术后并发症相关。吻合口狭窄10例(38.5%)中9例(90.0%)需行EBD。第一例EBD手术的中位时间为修复后3.3个月(1.2-7.6个月),患者平均体重为4.6 kg。平均直径3.3 ~ 9.1 mm,无重大并发症。在单变量分析中,长间隙EA单独与EBD显著相关。结论:大约一半的患者在EA修复后出现并发症。特别是,长间隙EA患者发生吻合口狭窄等并发症的风险显著增加。EBD可以安全使用,即使对婴儿也是如此。
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引用次数: 0
Effectiveness of High-Volume Therapeutic Plasma Exchange for Acute and Acute-on-Chronic Liver Failure in Korean Pediatric Patients. 大容量血浆置换治疗韩国儿童急性和急性伴慢性肝衰竭的疗效
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.481
Hyeji Lim, Yunkoo Kang, Sowon Park, Hong Koh

Purpose: Liver transplantation (LT) is the only curative treatment for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). In high-volume therapeutic plasma exchange (HV-TPE), extracorporeal liver support filters accumulate toxins and improve the coagulation factor by replacing them. In this study, we aimed to evaluate the effectiveness of HV-TPE in pediatric patients with ALF and ACLF.

Methods: We reviewed the records of children waiting for LT at Severance Hospital who underwent HV-TPE between 2017 and 2021. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), total and direct bilirubin (TB and DB), gamma-glutamyl transferase (GGT), ammonia, and coagulation parameter-international normalized ratio (INR) were all measured before and after HV-TPE to analyze the liver function. The statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Co., Armonk, NY, USA).

Results: Nine patients underwent HV-TPE with standard medical therapy while waiting for LT. One had neonatal hemochromatosis, four had biliary atresia, and the other four had ALF of unknown etiology. Significant decreases in AST, ALT, TB, DB, GGT, and INR were noted after performing HV-TPE (930.38-331.75 IU/L, 282.62-63.00 IU/L, 11.75-5.59 mg/dL, 8.10-3.66 mg/dL, 205.62-51.75 IU/L, and 3.57-1.50, respectively, p<0.05). All patients underwent LT, and two expired due to acute complications.

Conclusion: HV-TPE could remove accumulated toxins and improve coagulation. Therefore, we conclude that HV-TPE can be regarded as a representative bridging therapy before LT.

目的:肝移植(LT)是治疗急性肝衰竭(ALF)和急性伴慢性肝衰竭(ACLF)的唯一方法。在大容量治疗血浆交换(HV-TPE)中,体外肝支持过滤器积聚毒素并通过替代它们来改善凝血因子。在本研究中,我们旨在评估HV-TPE在小儿ALF和ACLF患者中的有效性。方法:我们回顾了2017年至2021年在Severance医院接受HV-TPE的等待LT的儿童记录。在HV-TPE前后分别测定天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素和直接胆红素(TB和DB)、γ -谷氨酰转移酶(GGT)、氨、凝血参数-国际标准化比值(INR),分析肝功能。采用IBM SPSS Statistics for Windows, version 26.0 (IBM Co., Armonk, NY, USA)进行统计分析。结果:9例患者在等待lt期间接受了标准药物治疗的HV-TPE,其中1例为新生儿血色素沉着症,4例为胆道闭锁,4例为病因不明的ALF。经HV-TPE治疗后,AST、ALT、TB、DB、GGT、INR分别显著降低(930.38 ~ 331.75 IU/L、282.62 ~ 63.00 IU/L、11.75 ~ 5.59 mg/dL、8.10 ~ 3.66 mg/dL、205.62 ~ 51.75 IU/L、3.57 ~ 1.50)。结论:HV-TPE能清除积聚的毒素,改善凝血功能。因此,我们认为HV-TPE可以作为LT前的代表性桥接治疗。
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引用次数: 1
Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study. 巴西慢性腹痛儿童健康相关生活质量受损:一项横断面研究
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.500
Carine Dias Ferreira de Jesus, Mary de Assis Carvalho, Nilton Carlos Machado

Purpose: We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs).

Methods: This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS).

Results: Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD.

Conclusion: This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.

目的:比较功能性腹痛障碍(FAPDs)和器质性腹痛障碍(ORGDs)儿童和青少年的健康相关生活质量(HRQOL)。方法:这是一项单中心、横断面、观察性研究。在首次就诊时分别对130例fapd和56例orgd患儿的家长/照顾者进行PedsQL 4.0通用核心量表家长代理报告。采用视觉模拟量表(VAS)和面部情感量表(FAS)评估患者自我报告的疼痛强度。结果:最常见的fapd为肠易激综合征,最常见的orgd为反流性食管炎(41.1%)和幽门螺杆菌相关胃炎(21.4%)。诊断为ORGDs和FAPDs的患者HRQOL差异无统计学意义(p>0.05)。ORGDs患者和FAPDs HRQOL规模较低分数比巴西和美国儿童健康的引用,高比例的孩子HRQOL受损的风险(ppppConclusion:这项研究表明不同受损HRQOL ORGDs患者和FAPDs之间。因此,考虑到儿童慢性腹痛的高患病率,一个良好的治疗计划是必要的多学科认知行为疼痛管理方案。
{"title":"Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study.","authors":"Carine Dias Ferreira de Jesus,&nbsp;Mary de Assis Carvalho,&nbsp;Nilton Carlos Machado","doi":"10.5223/pghn.2022.25.6.500","DOIUrl":"https://doi.org/10.5223/pghn.2022.25.6.500","url":null,"abstract":"<p><strong>Purpose: </strong>We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs).</p><p><strong>Methods: </strong>This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS).</p><p><strong>Results: </strong>Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with <i>Helicobacter pylori</i> (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (<i>p</i>>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (<i>p</i><0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (<i>p</i><0.02), although poor school performance (<i>p</i><0.0007) and bullying (<i>p</i><0.01) were higher in patients with ORGD.</p><p><strong>Conclusion: </strong>This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/a1/pghn-25-500.PMC9679301.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40492248","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}
引用次数: 0
Pediatric Liver Transplantation: Caregivers' Quality of Life. 儿童肝移植:照顾者的生活质量。
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.489
Ana Paula Bastos Tavares, Lucas Belém Pessôa de Melo Guerra Seixas, Caren Lopes Wanderlei Jayme, Gilda Porta, Renata Belém Pessôa de Melo Seixas, Elisa de Carvalho

Purpose: The survival rate of pediatric patients undergoing liver transplantation has increased considerably. Despite this, the period after transplantation is still complex and poses several challenges to the recipient's family, which is responsible for care management. Recently, more attention has been paid to the impact of this complex procedure on the quality of life of caregivers. Hence, this study is aimed at assessing the quality of life of caregivers of patients who have undergone liver transplantation and the aspects that influence it.

Methods: This was an observational and cross-sectional study. From November 2020 to January 2021, short-form-36 questionnaires and additional questions were given to the main caregivers of children and adolescents who underwent pediatric liver transplantation.

Results: Thirty-eight questionnaires were completed and the results revealed a lower quality of life in comparison to Brazilian standards, primarily in the mental domains (41.8±14.1 vs. 51.1±2.8; p<0.001). It did not show a significant association with socioeconomic or transplant-related factors, but it did show a negative impact on parents' perception of the child's health. Parents who reported worse health status for their children had a lower mental quality of life (44.1±13.8 vs. 33.3±12.6; p<0.05).

Conclusion: The caregivers of transplanted children have a lower quality of life than those of the local population. Psychological assistance should be routinely provided to parents for long-term follow-up to mitigate potential negative effects on the transplanted child's care.

目的:小儿肝移植患者的生存率显著提高。尽管如此,移植后的一段时间仍然很复杂,对负责护理管理的受者家庭构成了一些挑战。最近,人们越来越关注这一复杂程序对护理人员生活质量的影响。因此,本研究旨在评估肝移植患者护理人员的生活质量及其影响因素。方法:这是一项观察性横断面研究。从2020年11月至2021年1月,对接受儿童肝移植的儿童和青少年的主要照顾者进行问卷调查,问卷共36份。结果:完成了38份问卷调查,结果显示与巴西标准相比,生活质量较低,主要在精神领域(41.8±14.1比51.1±2.8;结论:移植患儿护理人员的生活质量低于当地人群。应定期向父母提供长期随访的心理援助,以减轻对移植儿童护理的潜在负面影响。
{"title":"Pediatric Liver Transplantation: Caregivers' Quality of Life.","authors":"Ana Paula Bastos Tavares,&nbsp;Lucas Belém Pessôa de Melo Guerra Seixas,&nbsp;Caren Lopes Wanderlei Jayme,&nbsp;Gilda Porta,&nbsp;Renata Belém Pessôa de Melo Seixas,&nbsp;Elisa de Carvalho","doi":"10.5223/pghn.2022.25.6.489","DOIUrl":"https://doi.org/10.5223/pghn.2022.25.6.489","url":null,"abstract":"<p><strong>Purpose: </strong>The survival rate of pediatric patients undergoing liver transplantation has increased considerably. Despite this, the period after transplantation is still complex and poses several challenges to the recipient's family, which is responsible for care management. Recently, more attention has been paid to the impact of this complex procedure on the quality of life of caregivers. Hence, this study is aimed at assessing the quality of life of caregivers of patients who have undergone liver transplantation and the aspects that influence it.</p><p><strong>Methods: </strong>This was an observational and cross-sectional study. From November 2020 to January 2021, short-form-36 questionnaires and additional questions were given to the main caregivers of children and adolescents who underwent pediatric liver transplantation.</p><p><strong>Results: </strong>Thirty-eight questionnaires were completed and the results revealed a lower quality of life in comparison to Brazilian standards, primarily in the mental domains (41.8±14.1 vs. 51.1±2.8; <i>p</i><0.001). It did not show a significant association with socioeconomic or transplant-related factors, but it did show a negative impact on parents' perception of the child's health. Parents who reported worse health status for their children had a lower mental quality of life (44.1±13.8 vs. 33.3±12.6; <i>p</i><0.05).</p><p><strong>Conclusion: </strong>The caregivers of transplanted children have a lower quality of life than those of the local population. Psychological assistance should be routinely provided to parents for long-term follow-up to mitigate potential negative effects on the transplanted child's care.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/c2/pghn-25-489.PMC9679308.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40492249","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}
引用次数: 0
Long-Term Efficacy and Safety of Golimumab for Ulcerative Colitis in a Pediatric Inflammatory Bowel Disease Center in Japan. Golimumab在日本儿童炎症性肠病中心治疗溃疡性结肠炎的长期疗效和安全性
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.461
Kazuhide Tokita, Hirotaka Shimizu, Ichiro Takeuchi, Toshiaki Shimizu, Katsuhiro Arai

Purpose: Golimumab (GLM) is an anti-tumor necrosis factor (TNF)-α antibody preparation known to be less immunogenic than infliximab (IFX) or adalimumab. Few reports on GLM in pediatric patients with ulcerative colitis (UC) are available. This study aimed to review the long-term durability and safety of GLM in a pediatric center.

Methods: The medical records of 17 pediatric patients (eight boys and nine girls) who received GLM at the National Center for Child Health and Development were retrospectively reviewed.

Results: The median age at GLM initiation was 13.9 (interquartile range 12.0-16.3) years. Fourteen patients had pancolitis, and 11 had severe disease (pediatric ulcerative colitis activity index ≥65). Ten patients were biologic-naïve, and 50% achieved corticosteroid-free remission at week 54. Two patients discontinued prior anti-TNF-α agents because of adverse events during remission. Both showed responses to GLM without unfavorable events through week 54. However, the efficacy of GLM in patients who showed primary nonresponse or loss of response to IFX was limited. Four of the five patients showed non-response at week 54. Patients with severe disease had significantly lower corticosteroid-free remission rate at week 54 than those without severe disease. No severe adverse events were observed during the study period.

Conclusion: GLM appears to be safe and useful for pediatric patients with UC. Patients with mild to moderate disease who responded to but had some adverse events with prior biologics may be good candidates for GLM. Its safety and low immunogenicity profile serve as favorable options for selected children with UC.

目的:Golimumab (GLM)是一种抗肿瘤坏死因子(TNF)-α抗体制剂,已知其免疫原性低于英夫利昔单抗(IFX)或阿达木单抗。关于小儿溃疡性结肠炎(UC)患者GLM的报道很少。本研究旨在回顾GLM在儿科中心的长期耐久性和安全性。方法:回顾性分析在国家儿童健康与发展中心接受GLM治疗的17例儿童患者(8男9女)的医疗记录。结果:GLM开始时的中位年龄为13.9岁(四分位数范围为12.0-16.3)。14例患者出现全结肠炎,11例为重症(小儿溃疡性结肠炎活动指数≥65)。10例患者biologic-naïve,其中50%在第54周达到无皮质类固醇缓解。两名患者因缓解期间的不良事件停用了先前的抗tnf -α药物。在第54周,两例患者均对GLM有反应,无不良反应。然而,GLM在原发性对IFX无反应或无反应的患者中的疗效有限。5名患者中有4名在第54周无反应。严重疾病患者在第54周的无糖皮质激素缓解率明显低于无严重疾病患者。在研究期间未观察到严重不良事件。结论:GLM对于儿童UC患者是安全有效的。对既往生物制剂有反应但有一些不良事件的轻中度疾病患者可能是GLM的良好候选者。它的安全性和低免疫原性是选择的UC患儿的有利选择。
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引用次数: 1
Homozygous Missense Epithelial Cell Adhesion Molecule Variant in a Patient with Congenital Tufting Enteropathy and Literature Review. 先天性簇状肠病患者的纯合子错义上皮细胞粘附分子变异及文献综述。
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.441
Merve Güvenoğlu, Pelin Özlem Şimşek-Kiper, Can Koşukcu, Ekim Z Taskiran, İnci Nur Saltık-Temizel, Safak Gucer, Eda Utine, Koray Boduroğlu

Congenital diarrheal disorders (CDDs) with genetic etiology are uncommon hereditary intestinal diseases characterized by chronic, life-threatening, intractable watery diarrhea that starts in infancy. CDDs can be mechanistically divided into osmotic and secretory diarrhea. Congenital tufting enteropathy (CTE), also known as intestinal epithelial dysplasia, is a type of secretory CDD. CTE is a rare autosomal recessive enteropathy that presents with intractable neonatal-onset diarrhea, intestinal failure, severe malnutrition, and parenteral nutrition dependence. Villous atrophy of the intestinal epithelium, crypt hyperplasia, and irregularity of surface enterocytes are the specific pathological findings of CTE. The small intestine and occasionally the colonic mucosa include focal epithelial tufts. In 2008, Sivagnanam et al. discovered that mutations in the epithelial cell adhesion molecule (EpCAM, MIM# 185535) were the genetic cause of CTE (MIM# 613217). More than a hundred mutations have been reported to date. Furthermore, mutations in the serine peptidase inhibitor Kunitz type 2 (SPINT2, MIM# 605124) have been linked to syndromic CTE. In this study, we report the case of a 17-month-old male infant with congenital diarrhea. Despite extensive etiological workup, no etiology could be established before admission to our center. The patient died 15 hours after being admitted to our center in a metabolically decompensated state, probably due to a delay in admission and diagnosis. Molecular autopsy with exome sequencing revealed a previously reported homozygous missense variant, c.757G>A, in EpCAM, which was confirmed by histopathological examination.

先天性腹泻疾病(cdd)是一种罕见的遗传性肠道疾病,其特征是始于婴儿期的慢性、危及生命的难治性水样腹泻。从机理上可分为渗透性腹泻和分泌性腹泻。先天性簇状肠病(CTE),也称为肠上皮发育不良,是一种分泌性肠病。CTE是一种罕见的常染色体隐性肠病,表现为新生儿难治性腹泻、肠衰竭、严重营养不良和肠外营养依赖。小肠上皮绒毛萎缩、隐窝增生、表面肠细胞不规则是CTE的特异性病理表现。小肠和偶尔的结肠粘膜包括局灶性上皮簇。2008年,Sivagnanam等人发现上皮细胞粘附分子(EpCAM, MIM# 185535)的突变是CTE (MIM# 613217)的遗传原因。迄今为止,已经报道了一百多种突变。此外,丝氨酸肽酶抑制剂Kunitz 2型(SPINT2, MIM# 605124)的突变与综合征性CTE有关。在这项研究中,我们报告的情况下,17个月大的男婴先天性腹泻。尽管进行了广泛的病因学检查,但入院前仍无法确定病因。患者在入院15小时后以代谢失代偿状态死亡,可能是由于入院和诊断的延误。外显子组测序的分子解剖显示,在EpCAM中存在先前报道的纯合错义变体c.757G> a,这一结果经组织病理学检查证实。
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引用次数: 1
Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients. 低发酵低聚糖、双糖、单糖和多元醇饮食对小儿功能性腹痛症状的影响
IF 1.9 Q2 Medicine Pub Date : 2022-11-01 Epub Date: 2022-11-02 DOI: 10.5223/pghn.2022.25.6.510
Yasmine Gamal Abdou El Gendy, Mohammad Ashraf Abdel Wahed, Mostafa Hussein Hassan Ragab, Yosra Mohamed Mohsen Awad

Purpose: Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children.

Methods: This clinical trial included 50 patients aged 3-18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores.

Results: After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight.

Conclusion: A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

目的:近年来,人们对膳食中可发酵低聚糖、双糖、单糖和多元醇(FODMAPs)治疗功能性腹痛(FAP)的研究引起了极大的兴趣。一些荟萃分析,包括对成年人的分析,已经发表,加强了它的作用。然而,儿科研究很少。我们的目的是评估低fodmap饮食对儿童FAP严重程度的影响。方法:本临床试验包括50例3-18岁的肠易激综合征和FAP患者,其他未注明。在营养师的指导下,患者接受低FODMAP饮食。主要结果是饮食干预2个月后与基线相比的应答者百分比。其他结果包括使用KIDSCREEN-10问卷的粪便一致性和生活质量(QoL)评分的变化,以及年龄体重z分数。结果:饮食干预后,74%的患者疼痛强度降低30%以上,使用Wong-Baker Faces疼痛评定量表进行检查。患者的生活质量显著改善,体重也有所增加。结论:低FODMAP饮食可改善功能性腹痛患儿的疼痛强度和生活质量,对体重无不良影响。
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引用次数: 1
Cardiac Complications Associated with Eating Disorders in Children: A Multicenter Retrospective Study. 儿童饮食失调相关的心脏并发症:一项多中心回顾性研究
IF 1.9 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-09-05 DOI: 10.5223/pghn.2022.25.5.432
So Yoon Choi, Kyung Jae Lee, Soon Chul Kim, Eun Hye Lee, Yoo Min Lee, Yu-Bin Kim, Dae Yong Yi, Ju Young Kim, Ben Kang, Hyo-Jeong Jang, Suk Jin Hong, You Jin Choi, Hyun Jin Kim

Purpose: Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors.

Methods: We retrospectively analyzed patients aged 10-18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020.

Results: In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m2. Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m2 vs. 16.06± 4.55 kg/m2, p<0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, p<0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings.

Conclusion: Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.

目的:饮食失调常导致躯体并发症,包括心脏异常。心脏异常可累及心脏的任何部位,包括心脏传导系统,并可导致心源性猝死。本研究旨在评估儿童饮食失调患者心脏并发症的发生率及其相关因素。方法:我们回顾性分析了2015年1月至2020年5月期间被诊断为DSM-V(精神障碍诊断与统计手册- v)饮食失调并接受心电图和/或超声心动图检查的10-18岁患者。结果:共纳入127例患者,其中女性113例(89.0%)。中位体重指数(BMI)为15.05±3.69 kg/m2。总体而言,74例(58.3%)患者有心电图异常,窦性心动过缓是最常见的异常(91.9%)。心电图异常患者的BMI(14.35±2.78 kg/m2 vs. 16.06±4.55 kg/m2, ppp)明显低于心电图异常患者(14.35±2.78 kg/m2 vs. 16.06±4.55 kg/m2)。医生应关注这种躯体并发症,并需要仔细监测。
{"title":"Cardiac Complications Associated with Eating Disorders in Children: A Multicenter Retrospective Study.","authors":"So Yoon Choi,&nbsp;Kyung Jae Lee,&nbsp;Soon Chul Kim,&nbsp;Eun Hye Lee,&nbsp;Yoo Min Lee,&nbsp;Yu-Bin Kim,&nbsp;Dae Yong Yi,&nbsp;Ju Young Kim,&nbsp;Ben Kang,&nbsp;Hyo-Jeong Jang,&nbsp;Suk Jin Hong,&nbsp;You Jin Choi,&nbsp;Hyun Jin Kim","doi":"10.5223/pghn.2022.25.5.432","DOIUrl":"https://doi.org/10.5223/pghn.2022.25.5.432","url":null,"abstract":"<p><strong>Purpose: </strong>Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors.</p><p><strong>Methods: </strong>We retrospectively analyzed patients aged 10-18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020.</p><p><strong>Results: </strong>In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m<sup>2</sup>. Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m<sup>2</sup> vs. 16.06± 4.55 kg/m<sup>2</sup>, <i>p</i><0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, <i>p</i><0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings.</p><p><strong>Conclusion: </strong>Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.</p>","PeriodicalId":19989,"journal":{"name":"Pediatric Gastroenterology, Hepatology & Nutrition","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/3f/pghn-25-432.PMC9482826.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33477651","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}
引用次数: 0
期刊
Pediatric Gastroenterology, Hepatology & Nutrition
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