JPGN reports最新文献

Objectives: In young adults with inflammatory bowel disease (IBD), the time following transfer to adult care is high-risk for adverse outcomes. We used quality improvement (QI) methods to standardize care, decrease variation, and improve preparation of young adults during the transition/transfer process.

Methods: We created the IBD Transition Care Index (TCI), a list of 10 variables whose completion was felt to represent a more comprehensive transition/transfer process. Variables were organized into three domains: Disease Control/Physical Health, Psychosocial Well-being, and Transition/Transfer Preparation. We educated patients, caregivers, and providers on the value of completing the TCI to deliver complete, multidisciplinary preparation. We recorded variable completion in a database, reviewed results regularly with providers, and compared rates of variable completion between IBD-focused and general gastroenterology (GI) physicians.

Results: Three hundred twenty-two patients transferred to adult care during the project period (211 pre-intervention and 121 post-intervention). In the overall cohort, the mean percentage of TCI variables completed increased from a baseline of 62%-71% in the post-intervention period, with a significant increase in the rate of multidisciplinary IBD annual visit (IBD AV) attendance (51% vs. 62%, p = 0.03). Patients cared for by general GI physicians had significantly increased rates of both overall TCI variable completion (54% vs. 72%, p = 0.02) and IBD AV attendance (34% vs. 57%, p = 0.02) in the pre- versus post-intervention period.

Conclusions: Care Indexes such as the TCI can be used to reduce variability and standardize complex clinical processes like transition/transfer for young adults with IBD, with the goal of improving patient outcomes.

Objectives: To evaluate carbon dioxide (CO₂) footprint of celiac disease (CeD) diagnostic guidelines and follow-up practices for children/adolescents.

Methods: Two-hundred and thirty-six patients diagnosed and followed up for CeD in Umbria region during 2020-2023 were included in this retrospective study. Patients were divided in two groups: Group 1 included patients diagnosed by duodenal biopsies (total: 43), while Group 2 included no-biopsy patients (total: 193). Transport emissions of CO₂ per kilometer traveled by a diesel car was estimated as 171 g/km. CO₂ cost was estimated as 22 kg for each anesthesia and as 5.4 kg for each upper GI endoscopy.

Results: The median CO₂ cost/patient/year in Group 1 was 397.9 kg, while the median CO₂ cost/patient/year in Group 2 was 57.2 kg (p < 0.001). As regards the follow-up of these children, we estimated a median CO₂ amount of 39.3 kg produced per year by car emission and there was no difference between the two groups (Group 1 40.5 kg vs. Group 2 38.1 kg; p:ns).

Conclusions: The no-biopsy approach for the CeD diagnosis strongly decreases the CO₂ emissions. Whether implementing telemedicine, handing over to primary care or reducing outpatient consultations for follow-up will be feasible and environmentally more sustainable should be evaluated.

Objectives: Treatment adherence in pediatric patients with eosinophilic esophagitis (EoE) is suboptimal. This study aimed to identify barriers to adherence, comparing experiences between patients on elimination diets and those prescribed medication.

Methods: This observational study utilized a questionnaire incorporating elements from a previously validated medication adherence tool, in addition to studies assessing dietary and medication adherence in pediatric gastrointestinal disorders.

Results: A total of 125 patients were enrolled. Among them, 94 patients were prescribed medication, and 58 patients were prescribed dietary elimination, with 27 subjects receiving both medication and dietary elimination. High rates of nonadherence were observed in both groups. In the pharmacological group, the most common barrier was forgetting to take medication, particularly among those prescribed swallowed topical corticosteroids. In the dietary therapy group, limited food options and challenges when away from home were key barriers. Furthermore, older children, those unsupervised by parents, and those living in single or separate households exhibited lower adherence to dietary therapy.

Conclusion: Shared decision-making between healthcare providers, patients, and their families is critical for optimizing treatment adherence in pediatric EoE. Our findings offer new insights into the barriers to dietary and pharmacologic treatment in pediatric EoE, and understanding and addressing these barriers may enhance long-term treatment adherence and improve quality of life for this population.

Gastric heterotropia (GHT) may present from the oropharynx to the anus and is commonly associated with Meckel's diverticula. Here, we describe a rare case of anorectal GHT localized to the distal anal canal. A 14-month-old male patient presented for evaluation of rectal bleeding, severe constipation, and abdominal distention with poor response to laxative medications. Physical examination revealed anal stenosis, and the patient underwent rectal examination under anesthesia with anal dilation and a full-thickness rectal biopsy, which revealed GHT. Cutback anoplasty relieved the stenosis, and due to the risk of dysplasia, surgical resection and pull-through were discussed. The care team and family elected medical management with chronic acid suppression given the distal location of the GHT. All pediatric case reports of anorectal GHTs to date are reviewed. This is one of few associated with anal stenosis, and the second to be managed exclusively nonsurgically.

Objectives: Sedation-free transnasal endoscopy (TNE) is a safe, feasible, and well tolerated procedure performed in children to evaluate the upper gastrointestinal tract. The procedural technique of TNE in children is adopted from procedural standards in adults, typically using the upright seated position. The left lateral decubitus (LLD) position may be preferred for optimal safety and visualization during TNE. This pilot study explored the feasibility and tolerance of TNE in pediatric patients using the LLD position.

Methods: This was a retrospective review of 13 children who underwent sedation-free TNE in the LLD position from October 2024 to February 2025 in an outpatient gastroenterology procedure suite. Procedure time, patient tolerance (TNEase score), adverse events, and patient demographics were collected and analyzed.

Results: A total of 13 TNE procedures were successfully completed in the LLD position. The mean (standard deviation (SD)) age of the cohort was 12 years (2.7); 38% were female. The mean (SD) procedural time for esophagoscopy was 5.1 min (1.6). All patients had TNEase score of 2 or lower. Ten (77%) of patients had a TNEase score of 1. Two patients with history of anxiety and orthostasis experienced syncope in the upright seated position but subsequently completed the TNE in the LLD position without adverse events.

Conclusions: LLD position for sedation-free TNE is feasible and well tolerated in children. Findings should prompt further, prospective investigations of the benefits of LLD versus upright seated position, particularly in children with orthostatic intolerance.

Selective androgenic receptor modulators (SARMs) have similar properties to anabolic steroids but bind to androgen receptors in a tissue-specific manner. Studies have investigated the benefits of SARMs in promoting bone and muscle growth while limiting the adverse effects of androgenic stimulation of other organs. However, an increase in the reported cases of hepatotoxicity in adults secondary to SARMs found in bodybuilding supplements has raised concerns about their safety. We report the first known adolescent case of SARMs-associated liver injury with a primarily hepatocellular pattern of injury. Previous reports in adults had shown a primarily cholestatic pattern of injury. Our case highlights, the variations in the phenotypic and histologic patterns of injury based on the amount and type of SARMs. The purpose of this case report is to shed light on the potential spectrum of liver injury related to SARMs use and continue to raise awareness of the associated health risks.

In this report, we present a case of an atypical presentation with a solitary recalcitrant adenomatous colonic polyp, managed by endoscopic mucosal resection (EMR). The patient is a 17-year-old previously healthy male, who was evaluated by the gastroenterology clinic in the setting of abdominal pain, hematochezia and iron deficiency anemia. Patient was found to have a solitary rectosigmoid adenomatous polyp with low-grade dysplasia, and a normal upper endoscopy. The rectosigmoid polyp was difficult to completely resect via snare polypectomy and showed persistent regrowth, requiring EMR for complete resection. Of note, family history is extensive for malignancy, with patient's hereditary colorectal cancer genetic testing showing a heterozygous variant of unknown significance in one copy of his RNF43 gene. Follow-up endoscopic evaluation was unremarkable, with no polyp recurrence and negative pathology at the resected polyp site.

Lynch syndrome (LS) is an autosomal dominant condition caused by a loss of function in the deoxyribonucleic acid mismatch repair system. This case report presents a 17-year-old male with abdominal pain, weight loss, and anemia who was diagnosed with LS-associated adenocarcinoma of the colon in the setting of a mutS homolog 6 genetic mutation, which was confirmed by genetic testing. This highlights an urgent need to reevaluate current pediatric screening guidelines for hereditary cancer syndromes to prevent delayed diagnosis and improve outcomes. Family history-taking, genetic screening, and aggressive surveillance practices should also be integrated into standard pediatric care protocols.

Esophageal atresia (EA), with or without tracheoesophageal fistula, is the most common congenital anomaly of the esophagus. Surgical correction is the primary treatment, however, up to 80% of patients experience anastomotic stenosis, with esophageal balloon dilation (EBD) being the first-line treatment. Unfortunately, some patients develop refractory anastomotic stenosis (RAS), defined by the presence of strictures after three EBD sessions. The endoscopic management of RAS remains controversial. Although EA itself is rare, the incidence of postoperative stricture is significant, contributing to high morbidity characterized by symptoms such as dysphagia, short stature, choking, drooling, among others. The first-line treatment for RAS is EBD, as current literature lacks clinical trials on alternative techniques. This case report highlights the successful management of refractory anastomotic stenosis in a Colombian infant using advanced endoscopic techniques.

We report a case of an adolescent girl post cardiac transplant with hypergammaglobulinemia and presumed celiac disease (CD), who had a persistently elevated anti-tissue transglutaminase immunoglobulin A despite a gluten free diet. Refractory CD and Crohn's disease were excluded. Concomitant dairy elimination led to normalization of celiac titers but no histological improvement. Ultimately, she was diagnosed with polytypic plasmacytosis from suspected immune dysregulation.