JPGN reports最新文献

Objectives: Helicobacter pylori (H. pylori) is a widespread Gram-negative bacterium, affecting over half of the global population. This study investigated the prevalence of H. pylori among children in Ilam, western Iran, and assessed potential associations between infection, fecal occult blood tests (FOBT), hemoglobin concentration (HbC), and seasonality.

Methods: Overall, we recruited 92 children less than 12 years of age who were investigated with an H. pylori stool antigen (HpSA) test from January 2021 to December 2022. The HpSA test was carried out based on a sandwich enzyme immunoassay using enzyme-linked immunosorbent assay (ELISA) method. FOBT was performed on fresh samples using one-step rapid diagnostic kit. HbC was determined with an automated blood analyzer.

Results: From 92 participants, 20 (21.7%) cases showed a positive result for H. pylori antigen. This result included 9 (45%) female and 11 (55%) males. There were no significant differences between H. pylori prevalence and gender (p-value = 0.46), FOBT results (p-value = 0.99), HbC (p-value = 0.60), and seasonality (p-value = 0.31).

Conclusions: The findings of this study demonstrated that the results of FOBT and HbC may not provide valuable data for predicting H. pylori infection in children.

Objectives: Pediatric feeding disorders can result from psychosocial dysfunction, poor feeding skills, or medical or nutritional disorders. The primary aim of this study was to evaluate patient satisfaction at the multidisciplinary feeding clinic (MFC) and improve patient satisfaction by reducing patient wait times, improving communication, maximizing clinic space, and expanding inclusivity of our patients and their families in the decision-making process.

Methods: A survey was created with 14 questions and distributed to all patients who came to the MFC at the University of Iowa. The baseline surveys were administered from September 2021 to November 2021. The following interventions were implemented: reducing time to room a patient, maximizing clinic space, increasing clinical efficiency, and providing more education. Follow-up surveys were collected from December 2022 to March 2023.

Results: A total of 84 subjects: 41 for the pre-intervention group and 43 for the post-intervention group. There were statistically significant differences noted in these categories: the team thoroughly explaining the treatment plan, answering all questions, and getting parents involved in the decision-making process. Families appreciated the team making the patient feel included throughout the visit. Providing spacious rooms and short wait times were also rated highly.

Conclusion: Overall satisfaction for the MFC at the University of Iowa was rated as highly satisfactory. Areas of further improvement included shortening patient wait times and providing more education for families. This study highlights the continued importance of surveying patients to identify areas of improvement in multidisciplinary clinics.

Reactions to intravenous ustekinumab for inflammatory bowel disease (IBD) occur, the frequency of which is uncertain. It is unclear how often subcutaneous treatment is continued after reactions to the intravenous dose, or how well it is tolerated. We therefore conducted a retrospective cohort study of pediatric patients who initiated ustekinumab for Crohn's disease from 6 pediatric IBD centers in the United States. Ten of 207 (5%) patients had an infusion reaction to their induction ustekinumab dose. Of these, 6 (60%) restarted their infusion, five completed the infusion. Subsequently, eight patients were treated with subcutaneous ustekinumab, none of whom develop reactions. Reaction to intravenous induction ustekinumab occurs in 5% of patients. Subcutaneous ustekinumab is generally well tolerated after intravenous reaction.

Gastric emptying scintigraphy (GES) using technetium-99m-sulfur colloid (^99mTc-SC) is an important tool for evaluating feeding intolerance. Stable ^99mTc-SC binding to the solid component of the meal is imperative for accurate result interpretation. The objective of this study is to quantify the binding characteristics of ^99mTc-SC to blenderized tube feeds. ^99mTc-SC stably bound to chicken and egg blenderized diets over 4 h, the typical duration of gastric emptying exams. While more ^99mTc-SC was found in the liquid phase for both blenderized feeds compared to the standard egg meal, this was within clinically acceptable range (chicken-blend T₀ 15%, T_1h 17%, and T_4h 18.5%; egg-blend T₀ 12%, T_1h 11%, and T_4h 10%; egg-standard T₀ 2.5%, T_1h 3.5%, and T_4h 7%, p < 0.05 for all pairwise comparisons at each time point except chicken-blend vs. egg-blend at T₀). Results suggest that ^99mTc-SC binding characteristics in blenderized feeds are acceptable for use in GES.

Objectives: Cow's milk protein allergy (CMPA) is very frequent in infants. Presentation is variable, and symptoms fluctuate in intensity. Diagnosis can be challenging as it is mostly clinical. In severe cases, patients can present with anasarca secondary to protein-losing enteropathy (PLE). The exact mechanism underlying PLE is incompletely understood. Here we report four cases of severe PLE caused by CMPA warranting endoscopic workup in whom histological expression was characterized by variable features along the gastrointestinal (GI) tract.

Methods: We report four cases of severe CMPA with PLE requiring extensive workup including endoscopy to exclude immune deficiency or congenital enteropathy. The different histological expressions along the GI tract are presented.

Results: Histology ranged from the expected eosinophilia, observed in all cases, to severe mucosal atrophy with subtotal loss of colonic glands. Correlation between endoscopy and histology was poor.

Conclusion: CMPA can affect any segment of the GI tract and the intensity of the histological findings varies among patients and localizations. Food protein allergy should be considered in infants and children with hypoalbuminemia.

Sickle cell anemia (SCA) is a genetic disorder that presents with a variety of systemic complications, including gastrointestinal (GI) manifestations. These GI symptoms can overlap with those of digestive autoimmune diseases (DAD) such as inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH), complicating the diagnosis and management. This study presents three cases of SCA patients diagnosed with DAD, highlighting the diagnostic challenges and therapeutic outcomes. Our goal is to stress how abdominal symptoms in SCA can mask the presence of DAD, leading to potential misdiagnoses. We review the implications of these findings in clinical practice and compare them to the literature to emphasize the importance of recognizing and differentiating these conditions to avoid delays in treatment.

Objectives: Pediatric inflammatory bowel disease (IBD) presents significant psychological challenges, including anxiety and depression. This study investigates the prevalence of depression and anxiety symptoms in pediatric IBD patients in remission and examines the correlation between patient and parental assessments of these symptoms.

Methods: Patients with a diagnosis of Crohn's disease (CD), ulcerative colitis, or IBD-unclassified (IBD-U) aged 1-21 years in clinical remission as measured by the pediatric CD activity index or pediatric ulcerative colitis activity index were enrolled. Demographic data and patient psychological well-being were assessed using the IMPACT-III and the patient-reported outcomes measurement information system (PROMIS) emotional distress depression short-form 8a and anxiety short-form 8a.

Results: Forty-eight pediatric IBD patients and their parents completed psychological assessments. Prevalence of anxiety and depression were 29.1% and 14.5%, respectively. A moderate inverse correlation between PROMIS depression and anxiety scores, and quality of life was observed. Strong correlations were observed between child- and parent-reported PROMIS scores for both anxiety (r = 0.68) and depression (r = 0.75).

Conclusions: These findings underscore the persistent burden of anxiety and depression in pediatric IBD patients and the valuable role of parental assessments in identifying psychological distress. Routine screening is essential for improving outcomes in this population.

A lactobezoar is a conglomerate of undigested and partially digested milk components and is the most common form of bezoar in infants. Described treatments include hospitalization for intravenous fluids and cessation of feeds, endoscopy with administration of N-acetyl cysteine, and surgical or endoscopic removal. We report a case of a 5-month-old infant with a history of prematurity of 28 weeks, with poor feeding and emesis, found to have a gastric lactobezoar on imaging without signs of obstruction that was managed without surgical intervention. This case presentation describes the successful treatment of a patient with 100% whey formula for the treatment of lactobezoar, avoiding invasive treatment and hospitalization.

Pyloric stenosis is a condition of infancy characterized by hypertrophy of the pylorus, which can progress to significant narrowing and near-obstruction of the gastric outlet. We describe a case of a patient with pyloric stenosis who was incidentally found to have portal venous gas on ultrasound. While the presence of portal venous gas can be an ominous finding, this case demonstrates that in the setting of pyloric stenosis, portal venous gas may be benign in nature. Additionally, we compile information from previous studies to further promote general recognition of this association and propose potential future standardization of care for these patients with an apparent benign finding.

Objectives: Pediatric intestinal pseudo-obstruction (PIPO) is a rare, heterogeneous, and severe gut motility disorder. In 2014, Chetaille et al. described chronic atrial and intestinal dysrhythmia (CAID) syndrome associated with a recessive SGO1 mutation (p.Lys23Glu) linking it to both intestinal pseudo-obstruction and cardiac dysrhythmia. This study aimed to describe the clinical and nutritional features and outcomes of pediatric patients with the homozygous SGO1 (p.Lys23Glu) mutation.

Methods: We retrospectively enrolled children under 18 years with PIPO and homozygous (p.Lys23Glu) SGO1 mutation.

Results: Eight patients were included (five girls), two were first-degree relatives. All exhibited a typical PIPO clinical presentation, but with a later onset than usually seen in primary PIPO (median age: 6.3 years). Contrast studies revealed massively distended small bowel and colon in all patients. Antroduodenal and/or colonic manometry, performed in six patients, revealed a neuropathic pattern. A full-thickness intestinal biopsy showed variable fibrosis of the smooth muscle internal layer associated with an abnormal presence of Cajal cells within the muscular layers. All patients required parenteral nutrition (PN) at a median age of 11.8 years. Five patients needed an ileostomy. At 18 years, one patient was off PN. Three patients developed sinus dysfunction: one at the time of PIPO diagnosis and two later. All required pacemakers. One patient died in her twenties secondary to cardiac complications.

Conclusions: Recessive SGO1 mutation is a form of late onset PIPO associated with sinus dysfunction. Long-term outcome is unclear. Cardiac, intestinal, and neurologic follow-up is recommended as cerebral small vessel disease has been described in adults.