bluuebunny/crossref_metadata_2025 huggingface dataset:
Gut Hormones in Preterm Infants With Necrotizing Enterocolitis During Starvation and Reintroduction of Enteral Nutrition
Authors: Sharman‐Koendjbiharie Meenakoemarie , Hopman Wim P. M. , Piena‐Spoel Marjolein , Albers Marcel J. I. J. , Jansen Jan B. M. J. , Tibboel Dick
Published: January 2024

Objectives

Gastrointestinal hormones control gut functions in response to enteral nutrition. Diseases involving the gastrointestinal tract, such as necrotizing enterocolitis, may affect gut hormone secretion and therefore influence gut functions. Because bowel rest is an important part of the treatment, infants with this disease are especially at risk for an altered gut hormone secretion and thus for compromised gut functions.

Methods

In the current study, the gastrointestinal hormone profiles of eight preterm infants with an ileostomy after necrotizing enterocolitis (Bell stages 2 and 3) were evaluated during starvation and reintroduction of enteral nutrition. Basal and postprandial plasma concentrations of gastrin, cholecystokinin, and peptide YY were measured with sensitive and specific radioimmunoassays. The results were compared with those of 11 controls.

Results

In the patients and the controls, plasma concentrations of all hormones were higher postprandially. The increases in cholecystokinin and peptide YY were significant in the patients. Compared with the controls, all concentrations were higher in the patients, and changes were significant for basal and postprandial cholecystokinin and postprandial peptide YY.

Conclusions

Enteral nutrition stimulates the secretion of gastrointestinal hormones, also in premature infants with a diseased distal small bowel and colon, as in necrotizing enterocolitis. The postprandial increase of peptide YY in patients with an ileostomy indicates that enteral substrate in the colon is not necessary for stimulation of peptide YY secretion.
Pediatric Crohn Disease Activity Index: Responsive to Short‐term Change
Authors: Kundhal P. S. , Critch J. N. , Zachos M. , Otley A. R. , Stephens D. , Griffiths A. M.
Published: January 2024

Background/Aims

Despite documented feasibility, reliability, and validity, the Pediatric Crohn's Disease Activity Index (PCDAI) has yet to be demonstrated to be sensitive to change in the time frame of acute treatment trials. We evaluated short‐term responsiveness and determined the minimal change in PCDAI score associated with a clinically meaningful improvement in disease activity.

Methods

Standardized effect size (SES) and standardized response mean (SRM) were calculated as measures of responsiveness among pediatric patients being treated for acute exacerbations of Crohn disease 1) in a regular clinical practice setting and 2) as part of a multicenter, randomized controlled trial (RCT). Receiver operating characteristic (ROC) curves were constructed to determine the minimal PCDAI score change associated with significant clinical improvement used as the gold standard in 1) physician global assessment of change and in 2) change in adult Crohn disease activity index (CDAI).

Results

Among responders, the SES and SRM of the PCDAI were 1.78 and 1.41 (95% CI: 0.89–1.92) and 2.10 and 1.95 (95% CI: 1.70–2.20) in the clinical practice setting and RCT setting, respectively. The optimal minimal PCDAI change score associated with clinically significant change in physician global assessment was determined to be ‐12.5 (sensitivity 83.3%, specificity 92.3%). In the RCT setting a change in PCDAI of –10 corresponded to a change in CDAI of ≱ 70 points.

Conclusions

The PCDAI is responsive to improvement in disease activity in Crohn disease patients over a short interval. As such, the PCDAI is an appropriate instrument to use in pediatric acute treatment trials.
Experimentally Induced Gluten Enteropathy and Protective Effect of Epidermal Growth Factor in Artificially Fed Neonatal Rats
Authors: Štěpánková Renata , Kofroňová Olga , Tučková Ludmila , Kozáková Hana , Cebra John J. , Tlaskalová‐ Hogenová Helena
Published: January 2024

Background

A protective effect of breast‐feeding against the development of celiac disease has been described, but the nature and effects of the actual milk components have not been established. Epidermal growth factor (EGF), a milk cytokine affecting the proliferation and differentiation of mucosal epithelial cells, was studied as to its potential protective effect on the damage of intestinal mucosa by gliadin in a model system.

Methods

Enteropathy was induced by gliadin in inbred AVN strain rat pups delivered by cesarean section, breast‐fed, or hand‐fed a milk formula. All experimental groups were treated with interferon‐γ (1,000 U per animal, administered intraperitoneally) after birth. Gliadin (0.5 and 3 mg) was intragastrically administered to the pups on days 0 and 3, and a 30‐mg challenge dose was given on day 20 (24 hours before the termination of the experiment). One group of artificially fed pups received EGF (100 ng/ml) continuously in the diet.

Results

Gliadin‐ and interferon‐γ–treated formula‐fed rat pups showed villus atrophy, increase of inflammatory cells, including CD4+ T lymphocytes in the lamina propria, and damage to epithelial tight junctions and the enterocyte brush border. Morphometrically, the villus height was significantly less than in other groups. Recombinant EGF was markedly increased in the epithelial cells of injured jejunum. The intestinal mucosa of gliadin‐ and interferon‐γ–treated pups kept on a EGF‐supplemented artificial diet resembled that of breast‐fed pups.

Conclusion

Pathologic changes in jejunal mucosa (villus atrophy and inflammation) resembling gliadin‐induced atrophy appeared on administration of interferon‐γ and gliadin to rat pups fed an artificial milk diet immediately after birth. Addition of EGF to the diet protected the rats against pathologic mucosal changes.
Hair Relaxers: A Benign Caustic Ingestion?
Authors: Aronow Stefanie P. , Aronow Herbert D. , Blanchard Thomas , Czinn Steven , Chelimsky Gisela
Published: January 2024

Background

Despite federally legislated safety regulations, caustic ingestions remain a significant problem in the pediatric population. The current standard of care for caustic ingestion includes upper gastrointestinal endoscopy in most cases. Hair relaxers are a common caustic ingestion at our institution, yet few data have been published describing the clinical or endoscopic outcome. We explored the relative frequency of hair relaxer ingestion, the incidence of associated upper gastrointestinal injury, and the adverse clinical sequelae resulting from these ingestions.

Methods

Consecutive caustic ingestions admitted to our institution between January 1990 and January 2001 were identified. The data were collected through retrospective physician chart review, were analyzed, and were pooled with the existing literature to evaluate for the presence of esophageal injury.

Results

96 charts were reviewed, 29 (30%) of which were hair relaxer ingestions that underwent esophagogastroduodenoscopy; these ingestions served as our study cohort. The median age of the cohort was 14.0 months and patients were evenly divided in gender. The most common symptoms at presentation were drooling and emesis. At endoscopy, lip and oropharyngeal mucosa were most commonly affected. While six patients (20.7%) had Grade I esophageal mucosal injury and five patients (17.2%) had Grade I gastric mucosal injury, none had greater than Grade I mucosal damage. No adverse clinical events were identified. When our data were combined with all previously published cohort data, the findings were similar and no adverse clinical outcomes were reported.

Conclusions

Hair relaxer is the most common childhood caustic ingestion presenting to our large metropolitan tertiary care center. Symptoms are common at presentation. However, despite the high pH of these products, no clinically significant esophageal or gastric mucosal injuries and no long‐term sequelae were identified.
Oribasius (Fourth Century) and Early Byzantine Perinatal Nutrition
Authors: Lascaratos J. , Poulakou‐Rebelakou E.
Published: January 2024

Background

The purpose of the study is the investigation of perinatal nutrition in the early Byzantine period.

Methods

The original Greek language works of the celebrated physician of the fourth century, Oribasius, were studied.

Results

The first Byzantine author who studied perinatal nutrition, Oribasius, provided his own concepts about the topic, focusing on the suitable choice of wet nurse and evaluation of the quality of the milk. His research proves that physicians from early Byzantine times were greatly interested in perinatal nutrition. He was aware of the knowledge of eminent ancient Greek and Roman physicians, whose extracts he quoted and opinions he generally followed.

Conclusions

The study concludes that concepts of perinatal nutrition in the early Byzantine period followed those of the Hippocratic, Hellenistic, and Roman periods. The early Byzantine physicians then influenced later Byzantine and Arab physicians, and afterward, their research was introduced to European medicine.
Milk Sphingomyelin Accelerates Enzymatic and Morphological Maturation of the Intestine in Artificially Reared Rats
Authors: Motouri Mutsumi , Matsuyama Hiroaki , Yamamura Jun‐ichi , Tanaka Miyako , Aoe Seiichiro , Iwanaga Toshihiko , Kawakami Hiroshi
Published: January 2024

Objectives

Sphingomyelin (SPM) is the dominant phospholipid, comprising 38% of total human milk phospholipids. Although little is known about the nutritional importance of SPM during the neonatal period, SPM may affect the growth and development of tissues in the newborn infant through mechanisms regulating cell proliferation and differentiation. We evaluated the effect of sphingomyelin (SPM) in artificially reared rats as a suitable model of gut maturation in the suckling infant.

Methods

Seven‐day‐old Sprague‐Dawley rat pups were cannulated intragastrically and reared artificially on milk containing 0.5% SPM or 0.5% phosphatidylcholine (PC) for 1 week.

Results

Intestinal lactase activity in the SPM group was significantly lower than that in the control or PC group. Upon histologic examination, intestinal villi were found to be occupied with vacuolated cells in the control and the PC group, whereas the vacuolated cells were restricted to the tip of villi in the SPM group. The Auerbach nerve plexus area of the ileum in the SPM group was significantly greater, possibly due to accelerated development, than that in the control group or PC group.

Conclusions

The present results suggest that SPM, the dominant phospholipid in milk, plays an important role in neonatal gut maturation during the suckling period.
The Utility of Ultrasound Site Selection for Pediatric Percutaneous Liver Biopsy
Authors: Kader Howard A. , Bellah Richard , Maller Eric S. , Mamula Petar , Piccoli David A. , Markowitz Jonathan E.
Published: January 2024

Background

The site for percutaneous liver biopsy is determined by physical examination and anatomic landmarks. The authors compared physical examination with ultrasound examination to determine liver location, size, and an optimal biopsy site.

Methods

A pediatric gastroenterology fellow or attending gastroenterologist initially selected a biopsy site by physical examination. An ultrasonographer performed a limited ultrasound examination to evaluate this site.

Results

Sixty biopsy sites from 58 patients were evaluated. Forty‐six patients had no previous liver surgery. Two patients had had a Kasai procedure. Ten patients had had orthotopic liver transplantation. The mean age of the patients was 11.1 ± 7.6 years. Ultrasonography detected the following potential complications of percutaneous biopsy at the site determined by physical examination: insufficient liver (7 of 15, 47.0%), diaphragm injury (4 of 15, 27.0%), bowel perforation (2 of 15, 13.0%), kidney laceration (1 of 15, 7.0%), and large blood vessel laceration (1 of 15, 7.0%). These ultrasound findings directed a change in biopsy site for 15 (25.0%) physical examination sites. Major biopsy complications were rare (1.7%).

Conclusion

Ultrasound examination resulted in a location change to a more optimal site in 25.0% of the sites determined by physical examination. Ultrasound determination of the biopsy site should be considered before pediatric percutaneous liver biopsy.
Esophageal Crohn Disease in Children: A Clinical Spectrum
Authors: Ramaswamy Kannan , Jacobson Kevan , Jevon Gareth , Israel David
Published: January 2024

Background

The incidence of esophageal Crohn disease (ECD) in adults ranges from 0.2% to 11.2% and in children is up to 43%. The aim of the study was to determine the clinical and endoscopic spectrum of ECD and its prevalence in our patient population.

Methods

Chart review of children with Crohn disease (CD). Esophageal Crohn disease was defined by accepted endoscopic and/or histologic findings.

Results

210 children with CD were identified; 27 of those children had ECD. Nine children presented with specific upper GI symptoms; dysphagia, heartburn, nausea, vomiting, and odynophagia. Esophagoscopy in children with upper gastrointestinal symptoms revealed deep ulcers (n = 2), aphthous ulcers (n = l), erosions (n = l), edematous nodules, (n = l) and normal mucosa (n = 4). In asymptomatic children aphthous ulcers (n = 5), erosions (n = 3), deep ulcers (n = 3), and normal looking mucosa (n = 7) were seen. Twenty children also had gastric lesions, 3 children had duodenal lesions, and 3 children had both duodenal and gastric involvement. All 27 children had evidence of ileo‐colonic or colonic disease. Acid suppressive medications were given only to children with upper GI symptoms and endoscopic esophageal lesions. The mean duration of follow‐up from diagnosis of CD was 3.02 years (range 2 months—11.7 years). At last follow‐up review, 7 children were receiving acid suppression and no children were receiving steroids. There were no complications related to ECD.

Conclusion

The prevalence of endoscopic ECD is 7.6% but as many as 17.6% of our patient population had histologic evidence of ECD. The clinical and endoscopic spectrum of ECD are highly variable and poorly correlate with each other.
Longitudinal Follow‐Up of Exocrine Pancreatic Function in Pancreatic Sufficient Cystic Fibrosis Patients Using the Fecal Elastase‐1 Test
Authors: Walkowiak Jaroslaw , Nousia‐Arvanitakis Sanda , Agguridaki Christina , Fotoulaki Maria , Strzykala Krystyna , Balassopoulou Angeliki , Witt Michal , Herzig Karl‐Heinz
Published: January 2024

Background

A progressive decline in pancreatic function is possible in cystic fibrosis (CF) patients with exocrine pancreatic sufficiency. The secretin–cholecystokinin test is invasive and not acceptable as a repeatable procedure for children. Steatorrhea, conversely, has low sensitivity. Therefore, the aim of the present study was to evaluate the usefulness of the noninvasive fecal elastase‐1 (E1) test for the longitudinal assessment of exocrine pancreatic function (EPF) in pancreatic‐sufficient (PS) CF patients.

Methods

One hundred eighty‐four CF patients were included in the study. In all subjects, E1 concentrations and fecal fat excretion were measured. PS patients were followed for 5 years.

Results

At the beginning of the study, 35 (19.0%) CF patients were PS, and 32 (17.4%) had normal E1 concentrations. Longitudinal measurements of E1 concentrations in PS patients with CF demonstrated stable enzyme output in 27 and gradual decrease in 8. The decrease was rapid in five infant patients and gradual in three older patients. The decrease of E1 concentrations preceded the appearance of steatorrhea in all eight subjects.

Conclusions

The decline of EPF in patients with CF appears more frequently during the first months and years of life. However, late PS to pancreatic‐insufficient (PI) conversion is also possible. The appearance of maldigestion is preceded by the decrease of fecal E1 concentration. Thus, the fecal E1 test is a helpful screening tool for the longitudinal assessment of declining EPF in PS patients with CF to demonstrate pancreatic deterioration. In suspected patients, fecal fat excretion should be assessed.
Intrahepatic Biliary Cysts in Biliary Atresia in the Era of Liver Transplantation
Authors: Takahashi Atsushi , Tsuchida Yoshiaki , Suzuki Norio , Kuroiwa Minoru , Murai Hideaki , Toki Fumiaki , Nomoto Kenichi , Kuwano Hiroyuki
Published: January 2024

Objectives

The development of intrahepatic biliary cysts (IBC) after Kasai operation in patients with biliary atresia (BA) is recognized as an important problem; however, management strategy for IBC has not been clarified, particularly in the light of the increased use of liver transplantation.

Methods

Forty consecutive BA patients underwent hepatic portoenterostomy during 18 years from 1983 to 2000. We compared the clinical course and prognosis of the patients who developed IBC with those who did not.

Results

Seven of the 40 patients developed IBC. Three patients had type A (non‐communicating cyst) and three patients had type C (multiple cystic dilation) IBC, and the remaining patients had type B (communicating cyst). Of the 7 patients, one patient underwent successful internal intestinal drainage, and one patient died of complications at the time of internal intestinal drainage. Three patients underwent liver transplantation due to either hepato‐pulmonary syndrome (one case) or liver failure (two cases). One patient with IBC with liver failure was judged to require transplant, but was found to have pulmonary hypertension and was thus not a candidate. The remaining patient has survived without jaundice for 21 months postoperatively. Two of 21 patients with good initial bile drainage and without IBC underwent liver transplantation. The percentage of patients undergoing transplant was significantly higher in the group with IBC than in the group without IBC (P < 0.05).

Conclusions

IBC was associated with worsening liver function. Previously, IBC was treated using internal/external drainage, or the patients were observed without treatment, with limited success. We now consider it reasonable to carry out liver transplantation in patients with long‐standing IBC.
Cytokines and Adhesion Molecules in Duodenal Mucosa of Children with Delayed‐Type Food Allergy
Authors: Veres Gabor , Westerholm‐Ormio Mia , Kokkonen Jorma , Arato Andras , Savilahti Erkki
Published: January 2024

Objectives:

The aim was to investigate the expression of cytokines, adhesion molecules, and activation and proliferation markers in duodenal biopsies from children with delayed‐type food allergy (FA).

Methods:

Seven children with untreated FA (uFA), seven children with treated FA (tFA) to cow milk and/or cereals, and five normal controls furnished duodenal biopsy specimens. Additionally, five pediatric patients with celiac disease were included, serving exclusively as positive controls for in situ hybridization. Interferon‐γ (IFN‐γ), interleukin‐4 (IL‐4), adhesion molecules, and activation markers were detected by immunohistochemistry, and expression of IFN‐γ and IL‐4 messenger RNA was revealed by in situ hybridization.

Results:

uFA patients had a higher density of IFN‐γ positive cells in the lamina propria than did tFA patients and controls (P = 0.053 and P = 0.018). Moreover, the uFA patients exhibited a higher proportion of crypt cells in mitosis than did tFA patients (P = 0.026), and stronger staining of HLA‐DR in the crypts and increased density of γδ‐T cell receptor‐positive intraepithelial lymphocytes than did controls (P = 0.048 and P = 0.010). The densities of α4β7 positive cells in the lamina propria tended to be higher in controls than in uFA or tFA patients (P = 0.106, P = 0.073). Expression of IL‐4 mRNA was significantly higher in celiac patients than in the other study groups (uFA P = 0.006, tFA P = 0.010; controls P = 0.029), and celiac patients showed higher expression of IFN‐γ mRNA than did tFA patients or controls (P = 0.017 and P = 0.016).

Conclusions:

As expected, Th1 dominance was present in the lamina propria of children with delayed‐type FA. It may cause activation of epithelial cells and increase their turnover.
Gastric Electric Activity Assessed by Electrogastrography and Gastric Emptying Scintigraphy in Adolescents With Eating Disorders
Authors: Diamanti A. , Bracci F. , Gambarara M. , Ciofetta G. C. , Sabbi T. , Ponticelli A. , Montecchi F. , Marinucci S. , Bianco G. , Castro M.
Published: January 2024

Background:

Patients with eating disorders can refer to a variety of gastrointestinal symptoms, sometimes to justify reduced food intake and vomiting. The authors investigated whether adolescent patients with eating disorders and dyspeptic symptoms have altered gastric electric activity and abnormal gastric emptying as assessed respectively by electrogastrography and scintigraphy.

Methods:

Twenty‐eight patients (18 with anorexia and 10 with bulimia) and 16 healthy volunteers underwent electrogastrography; 20 of the 28 patients (14 with anorexia and 6 with bulimia) underwent gastric emptying scintigraphy. Electrogastrography with bipolar recording lasted 1 hour, 30 minutes before and after a standard meal. Before gastric emptying scintigraphy, patients fasted overnight; during testing, they ingested a solid meal labeled with technetium‐99m sulfur colloid. The ratio of fasting to postprandial electrogastrographic variables was evaluated using the Wilcoxon matched‐pair test. The Mann‐Whitney test was used to compare absolute values for electrogastrographic data in each group. The Student paired t test was used to compare scintigraphic results expressed as percentage of gastric emptying at 60 minutes and as the gastric emptying time (T½).

Results:

Patients with bulimia significantly differed from those with anorexia and control subjects regarding the amount of normal gastric electric activity and bradygastria, and from patients with anorexia only regarding tachygastria. These electrogastrographic variables did not differ significantly between patients with anorexia and control subjects. Gastric emptying time (T½) was significantly longer in patients with bulimia than in those with anorexia.

Conclusions:

Adolescent patients with bulimia who complain of dyspeptic symptoms have documentable abnormalities of gastric electric activity and emptying, whereas their counterparts with anorexia, probably owing to their shorter disease duration, do not.
Propofol Versus Midazolam plus Meperidine for Sedation During Ambulatory Esophagogastroduodenoscopy
Authors: Khoshoo Vikram , Thoppil Dipu , Landry Lisa , Brown Shannan , Ross Gerald
Published: January 2024

Objective

To evaluate the efficacy and safety of propofol and meperidine plus midazolam for sedation during esophagogastroduodenoscopy (EGD) in children.

Methods

Data were collected prospectively and retrospectively from neurologically intact children (0.2–17.7 years of age) who underwent ambulatory diagnostic EGD during a 4‐year period. Data were included from 155 consecutive patients receiving propofol with or without premedication with midazolam (PM group). One hundred five consecutive patients who received sedation with a midazolam plus meperidine combination served as a comparison (MM group). Outcome variables were: time required for induction of sedation, length of procedure, time for recovery, need for additional supportive measures, and need for physical restraint.

Results

The onset of sedation was faster and the length of procedure and recovery were significantly shorter in the PM group as compared with the MM group (P < 0.01). Patients in the MM group required restraint more often than in the PM group. A higher dose of meperidine and midazolam was used in the prospective study. This led to deeper sedation but increased need for additional support.

Conclusions

Propofol is safe and effective for facilitating EGD in children.
Dermatologic Manifestations of Crohn Disease in Children: Response to Infliximab
Authors: Kugathasan Subra , Miranda Adrian , Nocton James , Drolet Beth A. , Raasch Carolyn , Binion David G.
Published: January 2024

Dermatologic extraintestinal manifestations of Crohn disease may be refractory to treatment with corticosteroids and immunomodulators. The authors describe four children with Crohn disease with dermatologic manifestations: pyoderma gangrenosum, orofacial involvement, erythema nodosum, and idiopathic lymphedema. These dermatologic conditions were unresponsive to conventional therapy but had rapid and sustained response to the anti–TNF‐α antibody infliximab. No adverse reactions occurred. Infliximab should be considered for treating the extraintestinal dermatologic manifestations of Crohn disease in children.
Stimulation with Fatty Meal (Lipomul) to Assess Gallbladder Emptying in Children with Chronic Acalculous Cholecystitis
Authors: Hadigan Colleen , Fishman Steven J. , Connolly Leonard P. , Treves S. Ted , Nurko Samuel
Published: January 2024

Objective

Chronic acalculous cholecystitis previously has been diagnosed by hepatobiliary scan stimulated with intravenous octapeptide of cholecystokinin. This compound may soon be unavailable in the United States. The goal of this study was to describe the characteristics of children with chronic acalculous cholecystitis diagnosed by hepatobiliary scintigraphy with oral Lipomul challenge, and to evaluate their clinical response to cholecystectomy.

Methods

Retrospective chart review of patients with no gall stones detected by abdominal ultrasound or computed tomography with gallbladder ejection fraction (GBEF) <35% after Lipomul challenge who subsequently underwent cholecystectomy. Fifteen patients with a mean age of 14.9 ± 0.9 years were included. The mean duration of symptoms before evaluation was 8.2 ± 2.5 months.

Results

The mean GBEF after Lipomul challenge was 16.7% ± 2.7%. All patients had abdominal pain. Ninety percent had right upper quadrant pain and 86% had typical biliary colic. Pain was precipitated by fatty meals in 73.3%. Histopathologic analysis of the gallbladder demonstrated chronic cholecystitis in 80% of cases. The mean postoperative follow‐up was 20 ± 5 months. Six months after the surgery, nine patients (60%) were asymptomatic, five (33%) had marked improvement of symptoms, and one (6%) was unchanged. At the time of latest follow‐up, symptoms had reappeared in two patients who had been asymptomatic at the 6‐month visit (13%). Seven patients (46%) remained asymptomatic, five (33%) had marked improvement but continued to have some persistent symptoms, and one (6%) was unchanged.

Conclusions

Chronic acalculous cholecystitis may be responsible for right upper quadrant pain in children without gallstones. A GBEF <35% at 30 minutes after Lipomul challenge may be useful in identifying patients who could benefit from cholecystectomy. Lipomul may be a good alternative to cholecystokinin for gallbladder stimulation during scintigraphy.
rRNA Probes Used to Quantify the Effects of Glycomacropeptide and α‐Lactalbumin Supplementation on the Predominant Groups of Intestinal Bacteria of Infant Rhesus Monkeys Challenged with Enteropathogenic Escherichia coli
Authors: Brück Wolfram M. , Kelleher Shannon L. , Gibson Glenn R. , Nielsen Karin E. , Chatterton Dereck E. W. , Lönnerdal Bo
Published: January 2024

Objectives

Certain milk factors may help to promote the growth of a host‐friendly colonic microflora (e.g. bifidobacteria, lactobacilli) and explain why breast‐fed infants experience fewer and milder intestinal infections than those who are formula‐fed. The effects of supplementation of formula with two such milk factors was investigated in this study.

Materials and Methods

Infant rhesus macaques were breast‐fed, fed control formula, or formula supplemented with glycomacropeptide (GMP) or α‐lactalbumin (α‐LA) from birth to 5 months of age. Blood was drawn monthly and rectal swabs were collected weekly. At 4.5 months of age, 108 colony‐forming units of enteropathogenic E.coli O127, strain 2349/68 (EPEC) was given orally and the response to infection assessed. The bacteriology of rectal swabs pre‐ and post‐infection was determined by culture independent fluorescence in situ hybridization.

Results

Post‐challenge, breast‐fed infants and infants fed α‐LA‐supplemented formula had no diarrhea, whilst those infants fed GMP‐supplemented formula had intermittent diarrhea. In infants fed control formula the diarrhea was acute.

Conclusions

Supplementation of infant formula with appropriate milk proteins may be useful for improving the infant's ability to resist acute infection caused by E.coli.
Erythromycin Fails to Improve Feeding Outcome in Feeding‐Intolerant Preterm Infants
Authors: ElHennawy Adel A. , Sparks John W. , Armentrout Debra , Huseby Valerie , Berseth Carol Lynn
Published: January 2024

Objective

Approximately half of extremely low birth weight infants have feeding intolerance, which delays their achievement of full enteral feedings. Erythromycin, a motilin receptor agonist, triggers migrating motor complexes and accelerates gastric emptying in adults with feeding intolerance. Few studies have assessed the efficacy of this drug in preterm infants with established feeding intolerance. This study was designed to assess the efficacy of erythromycin in feeding‐intolerant infants, as measured by gastric emptying, maturation of gastrointestinal motor patterns, and time to achieve full enteral feedings.

Methods

Subjects were 27 preterm infants who were admitted to the neonatal intensive care unit and who did not achieve full enteral feeding volumes (150 mL/kg/day) within 8 days of the initiation of feedings. In a controlled, randomized, double‐blinded clinical trial, infants received intragastric erythromycin or placebo for 8 days without crossover. At study entry, the authors recorded motor activity in the antrum and the duodenum during fasting, in response to intragastric erythromycin (1.5 mg/kg) or placebo, and in response to feeding. Gastric emptying at 20 minutes and transit time from duodenum to anus were determined. Each infant then received erythromycin or placebo for 8 days, and feeding characteristics were prospectively tracked.

Results

Gastric emptying and characteristics of antroduodenal motor contractions were similar in the two groups, as were the transit times from duodenum to anus. Feeding outcomes were comparable in the two groups.

Conclusion

Intragastric erythromycin does not improve feeding tolerance in preterm infants with established feeding intolerance because it fails to improve gastrointestinal function in the short or long term.
Pancreatitis in Children
Authors: Werlin Steven L. , Kugathasan Subra , Frautschy Brenda Cowan
Published: January 2024

Objectives

To determine the incidence, etiology and outcome of pancreatitis at a regional children's hospital.

Methods

Chart review of all patients with pancreatitis seen during a 6 year period at the Children's Hospital of Wisconsin. The diagnosis of pancreatitis required either a serum amylase or lipase >3 times normal or radiographic evidence of pancreatitis.

Results

Two hundred fourteen episodes of pancreatitis in 180 patients were documented. The most common etiologies were systemic disease (14%), trauma (14%), drug induced (12%), biliary tract disease (12%), infectious (8%), and idiopathic (8%), which made up 68% of the total cases. Eleven patients died, all from underlying systemic illnesses. The serum amylase and lipase were elevated in 82% and 83% of patients respectively.

Conclusions

Pancreatitis is more common in children than previously thought. Upon careful assessment fewer cases were found to be idiopathic than in previous series. The outcome of pancreatitis depends on co‐morbid conditions.
CagA Antibodies as a Marker of Virulence in Chilean Patients With Helicobacter pylori Infection
Authors: Harris Paul R. , Godoy Alex , Arenillas Silvana , Riera Francisca , García Daniela , Einisman Helly , Peña Alfredo , Rollán Antonio , Duarte Ignacio , Guiraldes Ernesto , Perez‐Perez Guillermo
Published: January 2024

Background

The bacterial and host factors that influence the clinical outcomes of the Helicobacter pylori infection have not been fully identified. Cytotoxin‐associated gene product (CagA), one of the virulence factors, has been associated with a more aggressive form of infection. The authors studied the relationship between CagA status and clinical outcome in Chilean children and adults with H. pylori infection.

Methods

One hundred eighty consecutive patients undergoing upper gastrointestinal endoscopic analysis were enrolled after informed consent was obtained. Rapid urease test and histologic analysis were used to detect H. pylori infection. IgA and IgG antibodies to H. pylori whole cell antigen preparation and IgG antibodies to CagA were measured by enzyme‐linked immunosorbent assay (ELISA).

Results

H. pylori infection was detected in 42% of the patients by biopsy or urease test and in 38% and 20% of patients by IgG and IgA antibodies, respectively. The prevalence of H. pylori either by the invasive or the serologic tests was directly related to patient age. Among patients with H. pylori, there was no significant association between age and prevalence of CagA. Nearly 70% of the patients with H. pylori and peptic ulcer disease had CagA‐positive strains. In contrast, only 49% of the patients with chronic gastritis alone had CagA‐positive strains (P < 0.05).

Conclusions

In Chile, patients infected with H. pylori have a proportion of CagA‐positive strains similar to that reported in developed countries. CagA prevalence was not significantly different in adults and children infected with H. pylori, suggesting that variations in clinical outcome may be related to host immune or environmental factors.
Changing the Paradigm: New Directions in Federal Oversight of Human Research
Authors: Koski Greg
Published: January 2024

The system of institutional review boards (IRBs) was established about 30 years ago for the protection of human subjects and as a mechanism for assuring an independent peer review of research activities. To keep pace with an evolving environment, a new model for human research oversight is needed that focuses less on achieving regulatory compliance and more on applying our conscience to the responsible conduct of research. The recent implementation of a unified federal registration system for IRBs and a new assurance system point the way to a more effective structure for the oversight of clinical trials.
Overview of Pediatric Gastroesophageal Reflux Disease and Proton Pump Inhibitor Therapy
Authors: Colletti Richard B. , Di Lorenzo Carlo
Published: January 2024

Symptoms of gastroesophageal reflux disease (GERD) are prevalent in children of all ages. Despite limited clinical data, proton pump inhibitors (PPIs) are frequently prescribed in pediatric patients. Studies are needed to determine the natural history of GERD, to assess its impact on the quality of life of affected children, and to identify risk groups in infancy and childhood. There is a critical need to evaluate PPI efficacy and safety in infants and children.
Eosinophilic Esophagitis in Children and Adults
Authors: Liacouras Chris A.
Published: January 2024

Children with eosinophilic esophagitis, an isolated, severe esophageal eosinophilia, present with symptoms similar to gastroesophageal reflux but do not experience response to aggressive antireflux therapy. Increasingly, eosinophilic esophagitis is considered to be a separate entity from reflux disease. Current theory suggests that the former may be caused by cell‐mediated food hypersensitivity or may be a subset of eosinophilic gastroenteritis. Reports support the efficacy of dietary restriction or corticosteroid therapy. Additional research is needed to determine etiology, allow earlier clinical recognition, and improve treatment.
Neonatal Enteropathies: Defining the Causes of Protracted Diarrhea of Infancy
Authors: Sherman Philip M. , Mitchell David J. , Cutz Ernest
Published: January 2024

The underlying causes of chronic diarrhea beginning early in life are increasingly well defined. Infectious and post‐infectious enteropathies and food sensitive/allergic enteropathy account for the majority of cases. Recent attention has focused on characterizing defined entities, which cause protracted diarrhea in infants and young children. Disorders of intestinal ion transport usually present at birth following a pregnancy complicated by polyhydramnios. Intestinal mucosal biopsies show normal architect with intact villus‐crypt axis. Neonatal enteropathies, by contrast, are characterized by blunting of the villi. These include microvillus inclusion disease, tufting enteropathy, autoimmune enteropathy and IPEX syndrome ‐ and it is these conditions that are the subject of the current review.
Serum Lipids in Preterm Infants Fed a Formula Supplemented With Nucleotides
Authors: Siahanidou Tania , Mandyla Helen , Papassotiriou Ioannis , Anagnostakis Dimitris
Published: January 2024

Background

The effect of dietary nucleotides on lipid metabolism has been the subject of clinical studies with conflicting results. We measured serum triglycerides, total cholesterol (total‐C), and lipoprotein cholesterol levels (HDL‐C, LDL‐C, and VLDL‐C) in preterm neonates fed formula with and without nucleotide supplements.

Methods

This prospective, randomized, controlled study included 150 healthy preterm neonates (gestational age, 33.0 ± 1.9 weeks) matched for gestational age, birth weight, and gender. Subjects were assigned at birth to receive either a standard milk formula supplemented with nucleotides (group F‐NT) or the same formula without nucleotides (group F). Serum was obtained before discharge (29.1 ± 10.0 days of life) and triglycerides, total‐C, and HDL‐C were determined enzymatically. LDL‐C and VLDL‐C were estimated by the Friedewald formula. For statistical analysis t test, Mann Whitney‐U test, two‐way ANOVA, and χ2 test were used, as appropriate. The influence of several factors on serum lipid levels was evaluated by linear regression analysis.

Results

Serum triglycerides, total‐C, and VLDL‐C levels did not differ between groups. HDL‐C levels (median; 25th–75th percentiles) were significantly higher (P < 0.001) in group F‐NT (48.0 mg/dL; 40.5–57.0 mg/dL) than in group F (34.5 mg/dL; 27.2–44.0 mg/dL). On the contrary, LDL‐C levels (median; 25th‐75th percentiles) were significantly lower (P < 0.001) in group F‐NT (39.0 mg/dL; 26.0–54.0 mg/dL) than in group F (65.0 mg/dL; 41.0–73.0 mg/dL). In the multiple regression analysis, nucleotide supplementation was identified as one of the controlled independent factors influencing serum HDL‐C and LDL‐C levels.

Conclusions

Preterm neonates fed from birth with formula supplemented with nucleotides have significantly higher HDL‐C and lower LDL‐C serum levels than do neonates fed unsupplemented formula. The clinical relevance of these results remains to be elucidated.
Weaning to Hypoallergenic Formula Improves Gut Barrier Function in Breast‐Fed Infants With Atopic Eczema
Authors: Arvola Taina , Moilanen Eeva , Vuento Risto , Isolauri Erika
Published: January 2024

Objectives

Infants may be sensitized to dietary antigens even during exclusive breast‐feeding. Because food antigen traces in breast milk may have harmful effects on gut barrier function in infants with atopy, the authors sought to evaluate whether or not it is beneficial to shift such infants from breast milk to a hypoallergenic formula.

Methods

Fifty‐six infants (mean age, 5.0 months) manifesting atopic eczema during exclusive breast‐feeding were studied at weaning to a tolerated hypoallergenic formula. The urinary recovery ratios of orally administered lactulose and mannitol, fecal α‐1 antitrypsin and urinary methylhistamine, and eosinophil protein X concentrations were assessed during breast‐feeding and after weaning.

Results

The median (interquartile range, IQR) concentration of fecal α‐1 antitrypsin was 2.3 mg/g (range, 1.2–3.3 mg/g) during breast‐feeding and 0 (0.0–1.9 mg/g) after weaning to a tolerated hypoallergenic formula, z = −4.23, P < 0.0001. The urinary recovery ratio of lactulose and mannitol decreased from 0.029 (range, 0.021–0.042) to 0.023 (range, 0.016–0.031), respectively, z = −3.45, P = 0.0006. Concomitantly, the atopic eczema improved, and the concentration of urinary eosinophil protein X decreased significantly.

Conclusions

In breast‐fed infants with atopy, gut barrier function is improved after cessation of breast‐feeding and starting of hypoallergenic formula feeding.
Safety and Efficacy of a Premixed, Rice‐Based Oral Rehydration Solution
Authors: Maulen‐Radovan Irene , Gutierrez‐Castrellón Pedro , Hashem Mohamed , Neylan Michael , Baggs Geraldine , Zaldo Ricardo , Ndife Louis I. , Pollack Paul F. , Santosham Mathuram
Published: January 2024

The authors compared the safety and efficacy of a ready‐to‐use, premixed, rice‐based oral rehydration solution (R‐ORS) with a glucose‐based oral rehydration solution (G‐ORS), each containing 75 mmol/L sodium, in Mexican children with acute diarrhea for less than 5 days.

Methods

One hundred eighty‐nine boys 3 to 24 months old admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either G‐ORS or R‐ORS. Intake and output were measured every 3 hours.

Results

In the group treated with R‐ORS, significantly fewer patients required supplemental intravenous fluids during the rehydration phase compared to the G‐ORS group (1%v 8.7%; P < 0.01). Mean stool output, percent weight gain, ORS intake, urine output, and number of patients who vomited during rehydration were similar in the two groups. The mean total stool output after the first 24 hours of maintenance phase was significantly lower in the R‐ORS group than in the G‐ORS group.

Conclusions

The authors found rice‐based ORS to be safe, and its use reduced the rate of intravenous fluid therapy in comparison with the use of a glucose‐based ORS.
Symptoms and Signs Have Changed in Swedish Children With Coeliac Disease
Authors: Ludvigsson Jonas F. , Ansved Pär , Fälth‐Magnusson Karin , Hammersjö Jan‐Åke , Johansson Calle , Edvardsson Stig , Ljungkrantz Magnus , Stenhammar Lars , Ludvigsson Johnny
Published: January 2024

Objective

To examine symptoms and signs in children with coeliac disease and determine whether the clinical picture at disease onset has changed as incidence of the disease has decreased in the last 10 years. This project was part of the ABIS study (All Babies in Southeast Sweden, born from October 1997 to October 1999).

Methods

Eight paediatric departments in Southeast Sweden recorded all children with coeliac disease and registered symptoms according to a standard form. Data were obtained from 79 children with biopsy‐confirmed coeliac disease, 43 contemporary controls, and 65 historic controls.

Results

When compared with children with normal intestinal biopsies, children with coeliac disease more often had abdominal distension (odds ratio [OR] = 22.17; 95% confidence interval [CI] OR = 5.00–98.25), thin extremities (OR = 5.89; 95% CI OR = 2.09–16.55), irritability (OR = 6.50; 95% CI OR = 1.83–23.03), and tiredness (OR = 15.43; 95% CI OR = 2.00–119.16). When compared with coeliac children diagnosed at ≤2 years of age in Gothenburg between 1985 and 1989, when the incidence of coeliac disease was three times higher, ABIS patients aged ≤2 years at diagnosis had less often experienced diarrhoea (OR = 0.23; 95% CI OR = 0.12–0.65), suboptimal weight gain (OR = 0.02; 95% CI OR = 0.01–0.10), or suboptimal linear growth (OR = 0.14; 95% CI OR = 0.05–0.39).

Conclusion

This study indicates that, in parallel to changes in incidence, clinical features of coeliac disease in young children have changed during the last 10 years.
The Incidence of Pediatric Inflammatory Bowel Disease in the Netherlands: 1999–2001
Authors: van der Zaag‐Loonen H. J. , Casparie M. , Taminiau J. A. J. M. , Escher J. C. , Pereira R. Rodrigues , Derkx H. H. F.
Published: January 2024

Background

The incidence of inflammatory bowel disease (IBD) seems to be rising. Incidence studies could provide more insight into geographical differences and thereby lead to the identification of etiological factors. The aim of this study was to prospectively assess the incidence of pediatric IBD in the Netherlands from 1999 to 2001, using both an active physician case‐reporting registry and a nationwide pathology database.

Methods

All pediatricians in the Netherlands were sent monthly identification cards to be returned if they had diagnosed a new case of IBD in a pediatric patient. Follow‐up questionnaires were sent to physicians reporting new cases of IBD. The pathology database contains reports from all cytologic and histologic diagnoses made in the Netherlands. Two independent raters searched the database for new IBD cases. Cases identified from the pathology database were labeled as “probable IBD” and “possible IBD.” Cases were cross‐checked across databases on the basis of gender, date of birth, date of biopsy, and place of residence. Age‐specific incidence rates were calculated for the Dutch population for the year 2000.

Results

Five hundred forty‐six probable cases of IBD were identified; 217 cases were labeled as possible. The incidence rate was 5.2 new cases per 100,000 children (<18 years) per year. An increase in incidence with age was observed. Only 24% of the cases were ascertained through the clinical registry.

Conclusion

The incidence of IBD cases in the Netherlands is comparable with that reported in other European countries. Epidemiological studies using case reporting by physicians may be underestimates of true incidence rates.
Effect of Reflux and Esophagitis on Esophageal Volume and Acid Clearance in Piglets
Authors: Vicente Yvone , da Rocha Cecilia , Perez‐Mies Belén , Madero Rosario , Tovar Juan A.
Published: January 2024

Background/aims

The study investigates esophageal motor function and esophageal clearance immediately after surgical induction of reflux in piglets and 8 weeks later after peptic esophagitis has developed.

Methods

Twenty‐four sedated, nonintubated piglets were divided into three groups: sham (laparotomy only), reflux (distal esophageal myotomy), and reflux + esophagitis (8 weeks after myotomy). All animals underwent stationary manometry of the esophagus with a four‐lumen perfused assembly after injection of 1‐, 2‐, and 3‐mL boluses of saline and acid into the proximal esophagus. Simultaneous pH monitoring allowed assessment of acid clearance. Wave features and clearance times after saline and acid were compared among groups.

Results

There were minor changes in peristaltic activity of the esophagus after saline boluses in animals with reflux. Acid clearance time was prolonged, especially the time to re‐establish resting esophageal pH, in animals with esophagitis. These changes, which were volume‐dependent, were related to the loss of peristaltic organization of the esophageal waves. The esophageal wave frequency, amplitude, and duration were only slightly changed by the induction of reflux and by esophagitis.

Conclusions

The esophagus affected by acid reflux, with or without esophagitis, was capable of near‐normal motor responses after boluses of saline. Reflux impaired the peristaltic response to acid, and the effect was more pronounced when reflux and esophagitis were both present. The acid clearance time was also strikingly prolonged in the presence of reflux and esophagitis. The results suggest that long episodes of reflux seen on pH tracings from individuals with esophagitis might be secondary both to acid‐related motor dysfunction and large volumes of refluxate.