bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphonodular Hyperplasia on the Mucosa of the Lower Gastrointestinal Tract in Children: An Indication of Enhanced Immune Response?
Authors: Kokkonen Jorma , Karttunen Tuomo J.
Published: January 2024

Background

To discover the prevalence and significance of lymphonodular hyperplasia (LNH) of the lower gastrointestinal tract, the authors did a retrospective analysis of a consecutive series of children using colonoscopy to evaluate persistent and severe gastrointestinal symptoms. The authors also sought to discover in more detail how often subjects with LNH of the terminal ileum (TI) or colon show an association with food allergy (FA).

Methods

The analysis included a consecutive series of 140 children evaluated at the Oulu University Hospital using colonoscopy, which extended to the TI in 74 of these children. A total of 102 patients underwent gastroduodenoscopy. The disease category was assessed using endoscopic, histopathologic, and clinical information. To diagnose FA, a masked or an open food challenge was administered to all patients who aroused any suspicion of food‐related exacerbation of symptoms.

Results

Of 140 patients, LNH of the colon was diagnosed in 46 subjects, 9 of 38 patients had colitis, 1 of 8 patients had Crohn disease, and 36 of the remaining 94 subjects did not have colitis. Twelve patients of the 22 with LNH of the colon (55%) showed concomitant LNH on the bulb of the duodenum. Lymphonodular hyperplasia of the TI was diagnosed in 53 of the 74 subjects in whom TI could be visualized. It was seen in most patients without colitis (80%), in one half the subjects with colitis (48%), and in one quarter of those with Crohn disease (25%). Among the whole study group 37 (26%) could be defined as having FA. It was more prevalent in patients with (52%) than in those without (13%) LNH of the colon (P < 0.001). The presence of LNH in the TI also showed some association with FA (P < 0.05), but less than did LNH of the colon.

Conclusion

We consider LNH on the mucosa of the colon or TI common but not an innocent bystander. Significantly related to a diagnosis of gastrointestinal FA in this study, it is an expression of mucosal immune response. If detected on the colon, FA should be considered, whereas if present in TI, it may be related to FA but also to a variety of other immunologically active disease states.
Immune Status of Infants Fed Soy‐Based Formulas With or Without Added Nucleotides for 1 Year: Part 2: Immune Cell Populations
Authors: Cordle Christopher T. , Winship Timothy R. , Schaller Joseph P. , Thomas Debra J. , Buck Rachael H. , Ostrom Karin M. , Jacobs Joan R. , Blatter Mark M. , Cho Sechin , Gooch Willis M. , Pickering Larry K.
Published: January 2024

Background

Infants fed a soy protein isolate–based formula have immunization responses similar to breast‐fed infants. However, cellular aspects of the immunologic development of soy‐fed infants have not been studied extensively. Nucleotides added to milk‐based formula benefit infant immune status, but reports of the immunologic effects of adding nucleotides to soy‐based formula are not available. This study examines immune cell populations of infants fed soy protein isolate formulas with and without added nucleotides for 1 year.

Methods

Newborn, term infants studied in a masked 12‐month feeding trial were assigned randomly to soy formula groups with and without added nucleotides (n = 94, n = 92). A nonrandomized human milk/formula‐fed cohort (n = 81), was concurrently enrolled. Blood samples were collected at 6, 7, and 12 months. Thirty‐two immune cell populations were characterized using three‐color flow cytometry. Cellular markers were chosen to assess general pediatric immune status, emphasizing maturation and activation of B, T, and NK lymphocytes.

Results

All cell populations, number and percentages, were within age‐related normal ranges. The only significant difference found between soy formula and human milk/formula‐fed infants was the percentage of CD57+ NK T cells at 12 months (human milk/formula > soy formula, P = 0.034). There were significant differences at some time points between human milk/formula‐fed and nucleotide‐supplemented soy formula–fed infants in populations of lymphocytes, eosinophils, total T, helper T, naive helper, memory/effector helper, CD57−T, and CD11b+CD8+NK cells. None of the cell populations differed between infants fed soy formula versus soy plus nucleotides.

Conclusions

Infants fed this commercial soy formula demonstrated immune cell status similar to human milk/formula‐fed infants, consistent with normal immune system development. The addition of nucleotides to soy formula did not significantly change specific individual immune cell populations but tended to increase numbers and percentages of T cells and decreased numbers and percentages of NK cells.
Ganciclovir Treatment in Infants With Cytomegalovirus Infection and Cholestasis
Authors: Fischler Björn , Casswall Thomas H. , Malmborg Petter , Nemeth Antal
Published: January 2024

Background

The authors have previously described an association between cytomegalovirus (CMV) infection and intrahepatic and extrahepatic forms of neonatal cholestasis. Pediatric use of the antiviral drug ganciclovir to treat patients with CMV infection has increased. In this study, infants with CMV infection and cholestasis were treated with ganciclovir.

Methods

Six infants with cholestasis (age, 3–16 weeks) and with signs of ongoing CMV infection were treated with intravenous ganciclovir for 3 to 7 weeks and observed for 4 to 31 months after treatment. Two patients had biliary atresia, one had suspected septo‐optic dysplasia and three had no obvious cause for intrahepatic cholestasis other than ongoing CMV infection.

Results

Four patients, including one with biliary atresia, responded to the treatment, whereas two patients, including the one with septo‐optic dysplasia did not. The latter patient had episodes of symptomatic hypoglycemia during the treatment, which was subsequently stopped. Liver function at the end of follow‐up was good in four patients, intermediate in one, and poor in one.

Conclusion

Ganciclovir treatment may be beneficial in infants with CMV‐associated intrahepatic cholestasis, but controlled studies are needed. Because of the possible side effect of hypoglycemia, infants with cholestasis who have increased risk for such episodes should not be treated.
Early Constipation and Toilet Training in Children With Encopresis
Authors: Fishman Laurie , Rappaport Leonard , Cousineau Dominique , Nurko Samuel
Published: January 2024

Objective

To evaluate the frequency of predisposing factors for encopresis before and during toilet training, comparing children with primary and secondary encopresis.

Methods

In this retrospective study, questionnaires from the initial evaluation at an encopresis clinic at a tertiary care pediatric hospital were reviewed for the presence or absence of factors in the first 2 years of life, for toilet training practices, and for disruptive events during the training process. Children younger than 48 months or those with organic defecation disorders were excluded.

Results

In 411 children with encopresis, the reported frequency of predisposing factors included constipation in 35%, and previous treatment for constipation in 24%. Toilet training was initiated before age 2 years in 26% and after age 3 years in 14%. Interruption of toilet training and punishment were seen more in primary encopresis than in secondary encopresis (50% versus 23%;P < 0.05) and (52% versus 26%;P < 0.05) respectively. Constipation (30% versus 18%;P < 0.05) and abdominal pain (23% versus 9%;P <0.0:5) during toilet training were more common in primary encopresis as was fear of the toilet (47% versus 10%;P < 0.05).

Conclusions

In children with encopresis, early difficult defecation, previous treatment for constipation, and early initiation of toilet training were less common than expected. Children with primary encopresis did not have an increased incidence of early constipation or invasive treatments compared with those with secondary encopresis. However, children with primary encopresis did have more difficult and disruptive toilet training experiences.
Ranitidine and Omeprazole as Adjuvant Therapy to Pancrelipase to Improve Fat Absorption in Patients With Cystic Fibrosis
Authors: Francisco Mary Pat , Wagner Mary H. , Sherman James M. , Theriaque Douglas , Bowser Ellen , Novak Donald A.
Published: January 2024

Background

Inadequate treatment of pancreatic insufficiency in patients with cystic fibrosis (CF) causes malabsorption of nutrients with significant sequelae. The objective of this study was to measure the effect of acid suppressant therapy on fat absorption in patients with CF who received a pH‐sensitive, enteric‐coated microtablet enzyme product.

Methods

A double‐blind, placebo‐controlled crossover study of 12 children and 10 adults with pancreatic insufficient CF was performed. All subjects were receiving pancrelipase therapy (Pancrease MT10 and MT16; Ortho‐McNeil, Springhouse, PA, U.S.A.) and for the study also received either placebo or ranitidine (Zantac; Glaxo‐Wellcome, Research Triangle Park, NC U.S.A.) 5 mg/kg or 10 mg/kg daily. The adult subjects also received omeprazole therapy (Prilosec; AstraZeneca/Merck, Wilmington, DE, U.S.A.), 20 mg daily, as adjuvant therapy to pancreatic enzymes. Serial 3‐day fat‐balance studies were performed in the Clinical Research Center. The data were analyzed using individual paired t tests that compared each treatment with placebo and two repeated‐measures, general linear model F tests.

Results

The linear model for all subjects showed no overall adjuvant drug effect on fat absorption, P = 0.32. A second linear model F test analysis of adult subjects, comparing all four drug treatments (placebo, ranitidine 5 and 10 mg/kg daily and omeprazole), also showed no difference in fat absorption, P = 0.15. Paired t test subgroup analysis of the adults showed an improvement of 4.97% (P = 0.003) in mean fat absorption comparing low‐dose ranitidine to placebo. All other t test analyses showed no significant change in fat absorption between placebo and acid suppressant treatment. There was marked intersubject and intrasubject variability in fat absorption.

Conclusions

No overall significant improvement in fat absorption could be demonstrated with adjuvant therapy. Fat absorption measured by 3‐day fat‐balance studies varied greatly even when comparing the same subject for placebo and baseline treatments, despite identical dietary fat and enzyme intakes. The large variability limited our ability to test for a difference in fat absorption and has significant implication for the use of this test, considered the gold standard, for determining enzyme dosage adequacy.
Plasma Endothelin‐1 Concentrations in Children With Cirrhosis and Their Relationship to Renal Function and the Severity of Portal Hypertension
Authors: Bakr A. M. , Abdalla A. F. , El‐Marsafawy H. , Abu‐Hashem I. , El‐Regal M. Ezz , Amer T. , Abdel‐Khalik M. K. , Mostafa H. , A‐Kader H. H.
Published: January 2024

Background

Plasma endothelin‐1 (ET‐1) is a potent vasoconstrictor peptide involved in the pathogenesis of several disorders. Endothelin‐1 concentrations are increased in adult patients with cirrhosis. However, little is known about ET‐1 concentrations in children with cirrhosis.

Methods

Radioimmune assay was used to measure plasma ET‐1 concentrations in 19 children with cirrhosis (8 patients with ascites, and 11 without ascites), and 11 age‐ and sex‐matched healthy children. The plasma ET‐1 concentrations were correlated with the mean blood pressure, creatinine clearance, and severity of portal hypertension, as measured by portal flow volume and portal flow velocity.

Results

Patients with cirrhosis and ascites had increased plasma ET‐1 concentrations compared with patients who did not have ascites (6.8 pg/mL ± 0.62 pg/mL vs. 4.6 pg/mL ± 0.35 pg/mL; mean ± SEM;P < 0.01) and controls (3.6 pg/mL ± 0.27 pg/mL; mean ± SEM;P < 0.0005). Plasma ET‐1 concentrations were higher in patients with cirrhosis who did not have ascites compared with controls (P < 0.005). No significant differences were observed between concentrations of the patients with cholestasis and those without cholestasis (5.4 pg/mL ± 0.52 pg/mL vs. 5.2 ± 0.32 pg/mL; mean ± SEM;P = 0.1). Plasma ET‐1 concentrations correlated positively with the mean blood pressure (r = 0.58;P < 0.05) and negatively with renal function, as measured by creatinine clearance (r = −0.7;P <0.005). However, no correlation was detected between ET‐1 concentrations and portal flow volume (r = −0.02;P = 0.4) or portal flow velocity (r = −0.16;P = 0.4).

Conclusions

Plasma ET‐1 concentrations are increased in children with cirrhosis, with or without ascites, compared with controls. Patients with cirrhosis and ascites have increased ET‐1 concentrations compared with those without ascites. The degree of increase does not relate to the severity of portal hypertension. This increase tends to maintain systemic blood pressure but is associated with a decrease in renal function.
Mechanisms of Vitamin B12 Absorption in Breast‐Fed Infants
Authors: Adkins Yuriko , Lönnerdal Bo
Published: January 2024

Objectives

The mechanisms of vitamin B12 absorption in infants are unknown. We investigated whether haptocorrin (HC), a vitamin B12‐binding protein in human milk, facilitates vitamin B12 absorption during the neonatal period or if it occurs by a process similar to that in adults involving another vitamin B12‐binding protein, intrinsic factor (IF).

Methods

To determine whether HC or IF can deliver vitamin B12 to the enterocyte, binding studies using Caco‐2 intestinal cells in culture and purified human milk HC‐[57Co]vitamin B12 or [125I]IF‐vitamin B12 were performed. Determination of IF secretion by infant stomach was investigated by a competitive ELISA on fecal extracts from breast‐fed infants. Determination of receptors specific for IF‐vitamin B12 or HC‐vitamin B12 in infant intestine was achieved by ligand blot analysis using isolated brush border membrane vesicles (BBMV) from fetal and adult intestine and Caco‐2 cells. PCR was performed to identify the IF receptor gene transcript in Caco‐2 cells and fetal intestine.

Results

Limited binding of both HC and IF to Caco‐2 cells was observed; however, HC displayed affinity to low molecular weight proteins in BBMV from fetal intestine and Caco‐2 cells while IF showed affinity for a 240 kDa protein in BBMV from fetal intestine and Caco‐2 cells. IF receptor gene transcript was identified in fetal intestine and Caco‐2 cells. An increase in IF excretion from breast‐fed infants throughout early life was observed.

Conclusions

An IF‐dependent vitamin B12 absorption mechanism appears to be in place in breast‐fed infants. However, IF levels may be too low in early life to participate in vitamin B12 absorption; therefore, haptocorrin may mediate vitamin B12 absorption until the absorption function can be taken over by a more mature IF system.
Quantitation of Colonic Luminal Synthesis of Butyric Acid in Piglets
Authors: Kien C. Lawrence , Chang J. C. , Cooper James R.
Published: January 2024

Objectives

Butyric acid, synthesized via bacterial fermentation in colonic lumen, may play an important role in the nutrition of the colonic mucosa. Since disaccharides, especially lactose, are the principal dietary carbohydrates during infancy, it is important to determine if their fermentation is associated with butyric acid synthesis. The objective of this paper is to describe a newly developed stable isotope method for quantifying butyric acid synthesis in the colonic lumen and to demonstrate its application during cecal infusions of lactose and lactulose in piglets.

Methods

Nine piglets aged 21 to 30 days were studied during acute anesthesia. The 13C enrichment of butyric acid was monitored in the portal vein before and during a 120 minutes cecal infusion of [1–13C]‐butyric acid and either unlabeled lactose (N = 4) or lactulose (N = 5).

Results

The luminal synthesis of BA (μmol x kg−1 x min−1) (Mean ± S.D.) was respectively 1.5 ± 0.9 and 1.2 ± 0.6 during lactulose and lactose infusion.

Conclusions

This study provides new quantitative data on in vivo butyric acid production in the mammalian colon.
Children and Genetically Engineered Food: Potentials and Problems
Authors: Perr Hilary A.
Published: January 2024

Changes in food production and dietary practices are occurring faster than our understanding of their potential impact on children's health. Traditionally, pediatric gastroenterologists have studied food with respect to its nutritive value and digestibility, its influence on metabolism, its growth‐promoting characteristics, and its relationship to risk and severity of disease. Biotechnology is now expanding the science of food to include disease prevention and treatment, as well as the feeding of children on a global scale. Bioengineered (“genetically modified”, or “transgenic”) plants were initially developed to enhance the food supply by increasing crop yields. Such previously developed transgenic plants are now prevalent worldwide and appear in many processed food products. The implementation of the technology of genetic modulation of food plants has led to considerable fear, controversy, and confusion as the understanding of the technology is poor in the general population. This review presents an overview of genetically modified food crops and their potential unique benefits and risks to children's health. Political, economical, and ecological issues related to transgenic crops are not discussed.
Variable Effects of Short Chain Fatty Acids and Lactic Acid in Inducing Intestinal Mucosal Injury in Newborn Rats
Authors: Lin Jing , Nafday Suhas M. , Chauvin Sara N. , Magid Margret S. , Pabbatireddy Sudha , Holzman Ian R. , Babyatsky Mark W.
Published: January 2024

Background

Short chain fatty acids and lactic acid are colonic bacterial fermentation products.

Methods

To evaluate the effects of these organic acids on the intestinal mucosa, a total of 72 newborn Sprague‐Dawley rats (10 days old) were studied. A 3.5F catheter was inserted per rectum 4.0 cm deep into the proximal colon for organic acid administration at a volume of 0.1 ml/10 g body weight. The pH of organic acid solutions and normal saline was adjusted to 4.0. Group 1 (n = 10) received normal saline as a control. Group 2 (n = 11) received 150 mM acetic acid. Group 3 (n = 11) received 300 mM acetic acid. Group 4 (n = 10) received 150 mM butyric acid. Group 5 (n = 11) received 300 mM butyric acid. Group 6 (n = 7) received 150 mM lactic acid, and group 7 (n = 12) received 300 mM lactic acid. Animals were killed 24 hours after colonic installation of test solutions.

Results

Both 300 mM acetic acid and 300 mM butyric acid were associated with impaired weight gain, increased colon wet weight, and increased histologic injury scores in the colon and distal ileum (P < 0.05, analysis of variance). Both 150 mM acetic acid and butyric acid at 150 mmol/L induced minimal injury in the colon and distal ileum. Neither 150 mM nor 300 mM lactic acid induced any identifiable gross or microscopic intestinal mucosal injury.

Conclusion

Luminal short chain fatty acids can induce dose‐dependent intestinal mucosal injury in newborn rats, resembling the pathology seen in neonatal necrotizing enterocolitis. Overproduction/accumulation of short chain fatty acids, but not lactic acid, in the proximal colon and/or distal ileum may play a role in the pathogenesis of necrotizing enterocolitis in premature infants.
Cytomegalovirus‐Associated Manifestations Involving the Digestive Tract in Children With Human Immunodeficiency Virus Infection
Authors: Ukarapol Nuthapong , Chartapisak Wattana , Lertprasertsuk Nirush , Wongsawasdi Lumduan , Kattipattanapong Vinaisak , Singhavejsakul Jesda , Sirisanthana Virat
Published: January 2024

Objective

To study the clinical manifestations of gastrointestinal cytomegalovirus disease in children with human immunodeficiency virus infection.

Methods

Review of clinical records of eight human immunodeficiency virus–infected children and histopathologically confirmed gastrointestinal cytomegalovirus disease from 1995 to 2001.

Results

Six of the eight children were younger than 1 year. The most common clinical presentations were fever and chronic diarrhea. Lower gastrointestinal hemorrhage and bowel perforation were noted in four and three patients, respectively. The colon was the most commonly affected site, followed by the small bowel and esophagus. The diagnosis was established by histopathology, obtained during endoscopy and surgery. Mucosal edema, erythema, and ulcer comprised the most common endoscopic findings. Two patients with fever, chronic diarrhea, and lower gastrointestinal bleeding developed remission after being treated with a 14‐day course of ganciclovir.

Conclusion

Gastrointestinal cytomegalovirus disease can result in serious life‐threatening complications, such as bowel perforation and massive gastrointestinal bleeding. Patients with chronic diarrhea and fever of unidentified cause might benefit from gastrointestinal endoscopy for early diagnosis and treatment. Although ganciclovir does not eradicate the infection and relapses are frequent, this treatment can prevent complications and reduce morbidity.
A Critical Assessment of Items on the Pediatric Crohn's Disease Activity Index
Authors: Loonen H. J. , Griffiths A. M. , Merkus M. P. , Derkx H. H. F.
Published: January 2024

Objectives

Questions have been raised about the discriminative value of the three laboratory items (hematocrit, erythrocyte sedimentation rate, and albumin) and three physical items (height, perirectal disease, and extraintestinal manifestations) included in the Pediatric Crohn's Disease Activity Index (PCDAI). The aim of this study was to analyze the value of these six “criticized” items to the discriminative properties of the PCDAI.

Methods

Data from 71 children with Crohn's disease visiting an outpatient clinic were analyzed. Physician global assessment of disease activity was used as the gold standard. A “basic index” was calculated by subtracting the score of the six criticized items from the score of the PCDAI calculated in the standard fashion. Multivariate logistic regression procedures identified which items significantly contributed to the “basic index”. Receiver operating characteristic curves were produced comparing the standard PCDAI score to the “basic index” and a new “clinical index” which included only the criticized items truly contributing to the discriminatory ability of the “basic index”.

Results

Logistic regression models identified only perirectal disease as contributing to the discriminative abilities of the basic index. The clinical index therefore consists of the three history items (abdominal pain, number of liquid stools, and general well‐being), three physical examination items (weight loss, abdominal examination, and perirectal disease) and no laboratory tests. The clinical index had an area under the curve not significantly inferior to that of the original PCDAI (0.93 [95% confidence interval, 0.89–0.99] vs. 0.96 [95% confidence interval, 0.92–0.99]).

Conclusions

A clinical index consisting of three history items and three physical examination items has an accuracy equal to the standard PCDAI in distinguishing children with disease in remission from those with a relapse.
Limitations of Probiotic Therapy in Acute, Severe Dehydrating Diarrhea
Authors: Costa‐Ribeiro Hugo , Ribeiro Tereza Cristina M. , Mattos Angela P. , Valois Sandra S. , Neri Daniela A. , Almeida Patricia , Cerqueira Celina M. , Ramos Eduardo , Young Rosemary J. , Vanderhoof Jon A.
Published: January 2024

Background

Recent studies have shown that probiotics, most commonly Lactobacillus GG, may be useful in treating acute gastroenteritis. However, beneficial effects appear to be limited to a modest decrease in the duration of diarrhea. No studies have evaluated this therapy in moderate to severe dehydrating diarrhea in a metabolic facility.

Methods

Male children less than 2 years of age were admitted to a metabolic unit of the Department of Pediatrics at the Federal University of Bahia, Brazil, with moderate dehydration and were randomized in a double‐blind, placebo‐controlled fashion. Oral rehydration solution (ORS) was administered per protocol and either placebo or Lactobacillus GG was given in combination with the ORS. Output of urine, stool, and vomitus was recorded along with stool weight, nude body weight, and standard laboratory assessments for hydration.

Results

There was no significant reduction in diarrhea duration and stool output in the Lactobacillus GG group. However, Kaplan‐Meier survival analysis demonstrated that, even in moderate to severe diarrhea, resolution of the illness occurred so rapidly, that statistically significant benefits of probiotic therapy could not be demonstrated.

Conclusion

Our data implies that colonization must occur before benefits of probiotics can be realized. Probiotics are, therefore, likely to be of limited benefit in treating diarrheal illnesses of short duration such as viral enteritis. The beneficial effects of probiotics may be limited to prophylactic usage in high‐risk populations.
Expression, Characterization, and Biologic Activity of Recombinant Human Lactoferrin in Rice
Authors: Suzuki Yasushi A. , Kelleher Shannon L. , Yalda Dorice , Wu Liying , Huang Jianmin , Huang Ning , Lönnerdal Bo
Published: January 2024

Background

Lactoferrin has been suggested to have many biologic activities, such as facilitating iron absorption and having antimicrobial and antiinflammatory effects. In humans, several of these activities are likely to only be facilitated by human lactoferrin because they depend on the binding of human lactoferrin to specific receptors. Rice may be a useful vehicle to introduce recombinant human lactoferrin to infant foods because it has low allergenicity and is likely to be safer than using microorganisms or transgenic animals.

Methods

Recombinant human lactoferrin was expressed in the rice cell culture system, and its biologic activity was assessed by iron‐binding and ‐releasing properties, antimicrobial activity, and binding and uptake to Caco‐2 cells. The authors also compared the stability of recombinant and native human lactoferrins against heat, low pH, and in vitro digestion.

Results

Biologic activity of rice‐expressed recombinant human lactoferrin was similar to that of native human lactoferrin. Heat‐treated proteins retained their functional activities except with severe treatment at 100°C for 8 seconds, which disturbed the iron‐binding capacity of recombinant human lactoferrin. Both types of proteins retained their functional activities between pH 2 and 7.4. After in vitro digestion, 50% of both proteins were detectable by enzyme linked immunosorbent assay. The remaining native and recombinant lactoferrins retained antimicrobial and Caco‐2 binding and uptake activities.

Conclusions

The results indicate recombinant human lactoferrin has stability similar to native human lactoferrin when exposed to thermal treatment, pH treatment, and in vitro digestion, suggesting it may be active when added to infant formula.
Management of Childhood Pancreatic Disorders: A Multidisciplinary Approach
Authors: Yachha Surender K. , Chetri Kamal , Saraswat Vivek A. , Baijal Sanjay S. , Sikora Sadiq S. , Lal Richa , Srivastava Anshu
Published: January 2024

Introduction

Data on therapeutic endoscopy and radiologic interventions for the management of childhood pancreatic disorders are relatively limited. This study focuses on the multidisciplinary approach to the management of pancreatitis in children.

Patients and Methods

Children with pancreatic disorders were studied from January 1992 to May 2001. Acute pancreatitis (AP) was diagnosed by clinical evaluation, serum amylase more than three times normal, and morphologic abnormalities of the pancreas on imaging. Children with recurrent abdominal pain, pancreatic calcification or ductal stones on imaging, and pancreatic ductal changes on endoscopic retrograde cholangiopancreatography (ERCP) were diagnosed with chronic pancreatitis (CP). Patients were treated by gastroenterologists, surgeons, and interventional radiologists. Pancreatic exocrine insufficiency was diagnosed in appropriate settings.

Results

Fifteen children—6 with AP (posttrauma, 3; gallstone disease, 1; and viral, 1), 7 with CP, and 2 with pancreatic exocrine insufficiency—were diagnosed. Local complications observed in children with AP included pseudocyst in three, and infected acute fluid collection, right‐sided pleural effusion, and ascites in one patient each. Complications of AP were managed with percutaneous catheter drainage (n = 3; pseudocyst, 2; infected fluid collection, 1), additional pancreatic duct stenting (n = 2), surgical drainage (n = 1), and octreotide for pleural effusion (n = 1). Signs of CP included abdominal pain (n = 7), obstructive jaundice resulting from lower common bile duct stricture (n = 2), and bleeding from gastroduodenal artery pseudoaneurysm (n = 1). Pancreatic duct stenting relieved pain in one patient, and steel coil embolization arrested bleeding from the pseudoaneurysm. Common bile duct strictures were managed by surgical bypass (n = 2), one of which required preoperative endoscopic bile duct stenting for management of cholangitis. Two other patients with CP required no intervention.

Conclusion

A multidisciplinary approach of radiologic and endoscopic interventions and surgery are complimentary to each other in achieving successful outcomes of complicated childhood pancreatitis.
Knowledge, Attitudes, and Practice Styles of North American Pediatric Gastroenterologists:Helicobacter pylori Infection
Authors: Chang Howard Y. , Sharma Virender K. , Howden Colin W. , Gold Benjamin D.
Published: January 2024

Objective

Most Helicobacter pylori infections are acquired during childhood. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) recently published practice guidelines for managing pediatric H. pylori infection. Before this publication, the authors conducted a survey to assess pediatric gastroenterologists' knowledge and practices regarding H. pylori.

Methods

One hundred nine of 514 NASPGHAN members completed an Internet‐based questionnaire on H. pylori infection.

Results

Eighty‐two percent of respondents performed outpatient testing for H. pylori. Of these, only 31% restricted testing to children aged >5 years. Most recommended testing for H. pylori in guideline‐recommended conditions; some would not treat infected patients. Ninety‐seven percent would test for H. pylori in a child with new duodenal ulcer (DU), 79% in a child with a history of DU, and 91% in a child with new gastric ulcer. However, only 86%, 60%, and 91%, respectively, would treat H. pylori infection in those conditions. A proton pump inhibitor (PPI)‐based triple regimen was the first‐choice therapy for 78% of respondents. Correct estimates of rates of resistance to amoxicillin, clarithromycin, metronidazole, and tetracycline were 10%, 17%, 43%, and 12%, respectively. Eighty‐six percent believed there was insufficient research on H. pylori in children.

Conclusions

North American pediatric gastroenterologists seem well informed about H. pylori infection in children despite the lack of published guidelines at the time of survey. Knowledge about antibiotic resistance rates was deficient. Most offered some outpatient testing for H. pylori and would test children with ulcer disease. However, some would not treat patients based on a positive result.
Nondigestible Carbohydrates in the Diets of Infants and Young Children: A Commentary by the ESPGHAN Committee on Nutrition
Authors: Aggett Peter J. , Agostoni Carlo , Axelsson Irene , Edwards Christine A. , Goulet Olivier , Hernell Olle , Koletzko Berthold , Lafeber Harry N. , Micheli Jean‐Léopold , Michaelsen Kim F. , Rigo Jacques , Szajewska Hania , Weaver Lawrence T.
Published: January 2024

The consumption of nondigestible carbohydrates is perceived as beneficial by health professionals and the general public, but the translation of this information into dietary practice, public health recommendations, and regulatory policy has proved difficult.

Nondigestible carbohydrates are a heterogeneous entity, and their definition is problematic. Without a means to characterize the dietary components associated with particular health benefits, specific attributions of these cannot be made. Food labeling for “fiber” constituents can be given only in a general context, and the development of health policy, dietary advice, and education, and informed public understanding of nondigestible carbohydrates are limited.

There have, however, been several important developments in our thinking about nondigestible carbohydrates during the past few years. The concept of fiber has expanded to include a range of nondigestible carbohydrates. Their fermentation, fate, and effects in the colon have become a defining characteristic; human milk, hitherto regarded as devoid of nondigestible carbohydrates, is now recognized as a source for infants, and the inclusion of nondigestible carbohydrates in the diet has been promoted for their “prebiotic” effects.

Therefore, a review of the importance of nondigestible carbohydrates in the diets of infants and young children is timely. The aims of this commentary are to clarify the current definitions of nondigestible carbohydrates, to review published evidence for their biochemical, physiologic, nutritional, and clinical effects, and to discuss issues involved in defining dietary guidelines for infants and young children.
Low Fecal Elastase: Potentially Related to Transient Small Bowel Damage Resulting from Enteric Pathogens
Authors: Salvatore Silvia , Finazzi Sergio , Barassi Alessandra , Verzelletti Mascia , Tosi Anna , Melzi d'Eril Gian Vico , Nespoli Luigi
Published: January 2024

Fecal elastase is considered to be a highly sensitive and specific non‐invasive exocrine pancreatic function test. However, enteropathy may theoretically cause decreased exocrine pancreatic enzyme secretion through alteration of enteric hormone release.

Objective

The aim of this study was to evaluate the possible influence of transient small bowel damage on pancreatic elastase secretion.

Methods

We studied 166 children (aged 4 months to 14 years, mean 2 years); 114 of these children had acute enteritis and 52 children were control subjects (with gastro‐intestinal symptoms or extra‐intestinal diseases). Feces were collected from each patient 3 days after the onset of diarrhea and then tested for fecal elastase, bacterial pathogens, Rotavirus, and Adenovirus. Liquid fecal samples were not considered eligible for elastase measurement. Pancreatic elastase was measured using an ELISA method (Sche.Bo.Tech, Germany). We classified the results, expressed in μg/g stool, as: severe pancreatic insufficiency (<100 μg/g), moderate pancreatic insufficiency (100 to 200 μg/g), and normal (>200 μg/g).

Results

In the acute enteritis group we found severe levels in 14 (12%) children, moderate levels in 18 children (16%), and normal levels in 82 children (72%). In contrast, 52 of 52 (100%) control subjects demonstrated normal results. Statistical analysis (Wilcoxon rank test) demonstrated a significant difference between the enteritis and control groups (P < 0.01). Serial measurement of fecal elastase performed in 10 patients with enteritis showed a progressive increase of levels in 6 patients and an early decline with subsequent increases in the other 4 patients.

Conclusions

Transient exocrine pancreatic insufficiency may be present in transient small bowel disease, caused by both bacterial and viral infections, possibly related to reduced enteric CCK secretion.
Consensus and Controversy in the Management of Pediatric Crohn Disease: An International Survey
Authors: Levine Arie , Milo Tamir , Buller Hans , Markowitz James
Published: January 2024

Objectives

Treatment options for patients with Crohn disease (CD) have expanded, but the use of some of these options in pediatric patients remains controversial. The authors evaluate current trends in treatment and areas of consensus or controversy.

Methods

An international survey of certified pediatric gastroenterologists was conducted using an e‐mail questionnaire in an attempt to evaluate management of active Crohn disease, attitudes toward four types of therapy, and prevalence of testing for osteopenia and 6‐thioguanine levels.

Results

One hundred sixty‐seven physicians from the United States, Canada, Western Europe, and Israel were included. The majority of North American physicians (71%) prefer to use conventional steroids and azathioprine (AZA) before nutritional therapy or budesonide for patients with mild to moderately active disease, versus 21% of Western Europeans (P < 0.001). Western Europeans prefer nutritional therapy followed by budesonide or steroids for those with mild or moderate disease. Only 4% of North American gastroenterologists use nutritional therapy frequently versus 62% of their Western European colleagues (P < 0.001). Infliximab was thought to be effective for steroid‐unresponsive disease by almost all physicians surveyed, although its efficacy as a maintenance therapy was rated higher by North American physicians than by their Western European and Israeli colleagues (P < 0.01). Bone mineral density is routinely evaluated by about 45% of physicians in Western Europe and North America.

Conclusions

Attitudes toward current therapies vary significantly by region, with North Americans strongly favoring corticosteroids followed by immunomodulatory therapy, and Western Europeans favoring nutritional therapy or budesonide and the avoidance of conventional corticosteroids.
Parenteral Fat Emulsions Based on Olive and Soybean Oils: A Randomized Clinical Trial in Preterm Infants
Authors: Göbel Yvonne , Koletzko Berthold , Böhles Hans‐Josef , Engelsberger Ilse , Forget Dominique , Le Brun Alexia , Peters Jochen , Zimmermann Andrea
Published: January 2024

Objective

To evaluate in premature infants a new parenteral lipid emulsion based on olive and soybean oils (ratio 4:1), with less polyunsaturated fatty acids (PUFA) and more α‐tocopherol than standard soybean oil emulsion.

Study design

Premature infants (gestational age, 28–<37 weeks) were randomized to receive one of the two emulsions within the first 72 hours of life. The triglyceride dose was increased to 2 g/kg/day within 3 days. Plasma phospholipid fatty acids, α‐tocopherol/lipid ratio, and urinary malondialdehyde (MDA) excretion were determined at baseline and after 7 days.

Results

Of 45 recruited infants, 33 completed the study per protocol (15 soybean oil, 18 olive oil emulsion). At study end, groups did not differ in plasma phospholipid arachidonic acid, total n‐6 and n‐3 metabolites, but the olive oil group showed higher values of the PUFA intermediates C18:3n‐6 (0.19% ± 0.01% vs. 0.13% ± 0.02%, P < 0.05) and C20:3n‐6 (2.92% ± 0.12% vs. 2.21% ± 0.17%, P = 0.005). The plasma α‐tocopherol/total lipd ratio was higher in the olive oil group (2.45 ± 0.27 μmol/mmol vs. 1.90 ± 0.08 μmol/mmol, P = 0.001), whereas urinary MDA excretion did not differ.

Conclusion

The lower PUFA supply with the olive/soybean oil emulsion appears to enhance linoleic acid conversion. The reduced PUFA content, combined with a higher antioxidant intake in the olive oil group, results in an improved vitamin E status. The olive oil‐based emulsion is a valuable alternative for parenteral feeding of preterm infants who are often exposed to oxidative stress, while their antioxidative defense is weak.
Gastric Dysrhythmia in Infants with Gastrointestinal Diseases Measured by Epigastric Impedance
Authors: Lange Aksel , Funch‐Jensen Peter , Schiøtz Peter Oluf
Published: January 2024

Background

Gastrointestinal symptoms have been reported in association with myoelectrical dysrhythmia, where different types of gastric electrical activity have been described. These types of gastric myoelectrical activity and dysrhythmia can be measured by electrogastrography using cutaneous electrodes. Epigastric impedance is a non‐invasive method used to study gastric emptying time and gastric phasic activity.

At present no study of gastric dysrhythmia, measured with epigastric impedance, has been presented, and the purpose of the present study was to investigate gastric rhythms by means of impedance gastrography in control infants, compared to infants with different gastrointestinal diseases, before and after treatment of their disease.

Method

21 patients (age 0–2 months) and 40 healthy infants (age 0–2 months) were investigated. The patients suffered from partial or total intestinal obstruction, necrotizing enterocolitis or pyloric stenosis.

All infants were fasting and studied during periods of at least one hour. The patients were examined in the acute state and after treatment when possible.

Results

A pathologic result was found in 90% of the patients. A persistent phasic activity pattern was found in 19 of the 21 patients, high frequency phasic activity in 11 of the 21 patients. Short‐term phasic activity was only found in 13 out of 40 of the normal infants (32.5%).

Conclusion

Using epigastric impedance we found that infants with partial or total intestinal obstruction had gastric phasic activity, which was not found in the control infants. The origin of the gastric phasic activity patterns is unknown, but they may be related to electrical control activity.
Long‐term Survival Following Kasai Portoenterostomy: Is Chronic Liver Disease Inevitable?
Authors: Hadžić Nedim , Davenport Mark , Tizzard Sarah , Singer Jeanette , Howard Edward R. , Mieli‐Vergani Giorgina
Published: January 2024

Objectives

Extrahepatic biliary atresia (EHBA) is the most common indication for liver transplantation in childhood. Most children who do not undergo transplant are reported to have chronic liver disease and its complications. The aim of this single‐center study was to identify children with normal laboratory indices and no clinical evidence of chronic liver disease 10 or more years after Kasai portoenterostomy (KP).

Methods

A retrospective analysis of the medical notes of all children surgically treated at the authors' center between 1979 and 1991 was undertaken. Criteria for inclusion were absence of surgical complications, unremarkable clinical examination, and normal bilirubin, aspartate aminotransferase, albumin, international normalized prothrombin ratio, and platelet count.

Results

Of 244 children surgically treated during the observation period, the authors identified 28 (11%) adolescents (14 male) who fulfilled the entry criteria. Their median age was 13.4 years (range, 10.2–22.2 years). Twenty‐six with type 3 EHBA had conventional KP, whereas 2 underwent modified operations. The corrective surgery was performed at a median age of 58 days (range, 20–99 days). Median time of complete clearance of jaundice from the date of KP was 75 days (range, 21–339 days). Twelve (43%) patients had history of cholangitis at a median age of 3.4 years. The liver histologic findings were suggestive of mild to moderate fibrosis in 54.2% and cirrhosis in 40.7% of the patients who underwent biopsy. No child had gastrointestinal bleeding during follow‐up. Thirteen (46%) patients had an elective esophagogastroduodenoscopy, which was normal in all. Twenty‐six (93%) patients were in mainstream education, whereas the remaining two (7%) attended special school because of reasons unrelated to liver disease.

Conclusions

A sizable proportion of children with EHBA avoid significant chronic liver disease and its complications 10 years or more after conventional surgical correction and have an excellent quality of life. Their good outcome is not hampered by isolated episodes of ascending cholangitis. Whether or not the residual histologic damage will become symptomatic during their lifetime remains to be established.
Fecal Calprotectin Levels in Healthy Children Studied With an Improved Assay
Authors: Fagerberg Ulrika Lorentzon , Lööf Lars , Merzoug Rumjana Djilali , Hansson Lars‐Olof , Finkel Yigael
Published: January 2024

Background

Calprotectin is a protein abundant in neutrophils. Fecal calprotectin can be used as a marker of gastrointestinal inflammation, and an improved assay has recently been developed. The aim of this study was to establish reference values for fecal calprotectin in healthy children aged between 4 and 17 years.

Methods

Fecal samples were obtained from 117 healthy children classified into four age groups: 4 to 6 years, 7 to 10 years, 11 to 14 years, and 15 to 17 years. A health questionnaire was used to ensure that these children fulfilled the inclusion criterion and did not have intercurrent disease, nasal or menstrual bleeding, or nonsteroidal anti‐inflammatory drug medication before the sampling period. Calprotectin was analyzed using a quantitative enzyme‐linked immunosorbent assay (Calprest, Eurospital SpA, Trieste, Italy). Children with fecal calprotectin values >50 μg/g were asked to deliver an additional sample.

Results

The overall median fecal calprotectin concentration was 13.6 μg/g (95% confidence interval, 9.9–19.5 μg/g) in the 117 children. In the different age groups, 4 to 6 years, 7 to 10 years, 11 to 14 years, and 15 to 17 years, the median calprotectin concentrations were 28.2, 13.5, 9.9, and 14.6 μg/g, respectively. Of these children, 104 (89%) had a concentration <50 μg/g. The remaining 13 children with a calprotectin concentration >50 μg/g delivered one additional fecal sample. All showed a lower concentration in the second sample except for one teenager who later proved to have proctitis.

Conclusions

The suggested cutoff level for adults (<50 μg/g) can be used for children aged from 4 to 17 years regardless of sex. A fecal calprotectin concentration >50 μg/g warrants follow‐up.
The Relationship Between the Concentration of Dextran Sodium Sulfate and the Degree of Induced Experimental Colitis in Weanling Rats
Authors: Shimizu Toshiaki , Suzuki Mitsuyoshi , Fujimura Junya , Hisada Ken , Yoshikazu Ohtsuka , Obinata Kaoru , Yamashiro Yuichiro
Published: January 2024

Background

Although a dextran sodium sulfate (DSS)‐induced colitis is commonly used as an ulcerative colitis (UC) model in adult rodents, there are no studies using this model in young animals. We examined differences in the severity of DSS‐induced colitis as a function of the concentration of DSS administered and sought to establish a DSS‐induced colitis model in young rats.

Methods

We administrated different concentrations of DSS solution (2%, 3%, and 4%) to 4‐week‐old weanling rats and compared their clinical findings, colonic histologic findings, mucosal leukotriene B4 (LTB4) production, and mucosal blood flow with control weanling rats and 8‐week‐old adult rats given 4% DSS for induced colitis.

Results

Clinical symptoms, such as diarrhea and rectal bleeding, histologic findings, and disturbance of mucosal microcirculation in weanling rats given 4% DSS were significantly more severe than those in adult rats given the same treatment. Three of 10 rats given 2% DSS had no bloody stool and 2 of 10 rats given 4% DSS died during the experimental periods. Clinical symptoms, hemoglobin levels, histologic damage scores, mucosal LTB4 production, and mucosal blood flow became more severely deranged as the concentration of DSS increased from 2% to 4%.

Conclusion

These findings suggest that we can adjust disease severity in UC model for young children by giving different concentrations of DSS to weanling rats.