bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Surgical Management of Patients with Chronic Ulcerative Colitis
Authors: Martin Lester W.
Published: January 2024

This report consists of a review of an experience with total colectomy with mucosal proctectomy and neorectal reservoir for pediatric patients with ulcerative colitis. The entire experience includes 221 patients, with 73 patients <21 years of age. Fifty‐six consecutive surviving pediatric patients, all > 1 year after operation, have been studied with 100% follow‐up evaluation for up to 17 years after operation. Fifty (89%) are leading normal lives with an acceptable stool frequency and complete continence. A number of postoperative complications have been encountered that are of particular concern to the pediatric gastroenterologist. The most distressing finding has been the subsequent diagnosis of Crohn's disease in most of the patients whose postoperative course was unsatisfactory. This underscores the need for a more accurate means of differentiating ulcerative colitis from Crohn's colitis before advising surgery.
Interleukin‐2 Production in Pediatric Inflammatory Bowel Disease
Authors: Gurbindo C. , Sabbah S. , Menezes J. , Justinich C. , Marchand R. , Seidman E. G.
Published: January 2024

Crohn's disease (CD) and ulcerative colitis (UC) represent clinically distinct chronic imflammatory bowel diseases (IBD) of unknown etiology. Although the mucosal immune system is implicated in their pathogenesis, immunological differences between the two disorders are not well defined. The aim of this study was to compare in vitro mucosal T‐lymphocyte function in CD and UC. Peripheral blood mononuclear cell interleukin‐2 (IL‐2) production was similar in pediatric IBD and control patients under unstimulated conditions, but was significantly increased in response to phytohemagglutinin (PHA) stimulation for the UC group. Lamina propria mononuclear cells (LPMNC) isolated from colonic resections in IBD patients had significantly lower spontaneous proliferation and IL‐2 production in vitro than did LPMNC of control patients. In contrast, significantly greater IL‐2 production was detected when the LPMNC of CD patients were cultured with PHA, in comparison with those of UC or control patients. When indomethacin, a prostaglandin synthetase inhibitor, was added to the cultures, significantly increased IL‐2 secretion was observed for CD LPMNC, but not for UC cultures, under both stimulated and unstimulated conditions. These findings demonstrate abnormal LPMNC IL‐2 production in IBD. Furthermore, our data suggest that inhibition of the prostaglandin synthetase pathway upregulates IL‐2 production by LPMNC in CD. These results support the hypothesis that immunoregulatory mechanisms controlling IL‐2 production differ between CD and UC.
The Diagnostic Value of the Gliadin Antibody Test in Celiac Disease in Children
Authors: Bodé S. , Weile B. , Krasilnikoff P. A. , Gudmand‐Høer E.
Published: January 2024

Serum gliadin antibodies (IgA/IgG) were determined in 191 consecutive children (median age, 2.75 years; range, 0.33–15.5 years) admitted for a small‐intestinal biopsy on suspicion of celiac disease. The test was a diffusion‐in‐gel enzyme‐linked immunosorbent assay (DIG‐ELISA). Of these 191, 14 (7.3%) appeared to have untreated celiac disease. Depending on the choice of cut‐off value of the test (combined determination of IgA and IgG), the sensitivity was 86–100%, the specificity was 97–99%, and the positive/negative predictive values were 70–92% and 99–100%, respectively. No variation according to age was found. Gliadin antibodies were determined in 47 children who had well‐treated celiac disease. Fourteen of these children were also investigated when challenged with gluten. Gliadin antibodies (IgA or IgG) decreased significantly in 13 of 13 cases when the patients shifted from a gluten‐containing diet to a gluten‐free one. During the gluten challenge, the IgG and IgA increased in 14 of 14 and 11 of 14 cases, respectively (two patients suffered from IgA deficiency). In eight patients who later appeared to be free of celiac disease, the gliadin antibodies were determined on gluten‐free diet and during gluten challenge; no significant differences in gliadin antibodies were found. We conclude that this test is useful in selecting patients with symptoms suggesting celiac disease for a small‐intestinal biopsy. The test seems to be of some value in monitoring the effects of a gluten‐free diet and during gluten challenge.
Do Umbilical Vein Catheterization and Sepsis Lead to Portal Vein Thrombosis? A Prospective, Clinical, and Sonographic Evaluation
Authors: Yadav S. , Dutta A. K. , Sarin S. K.
Published: January 2024

Extrahepatic portal vein obstruction (EHPVO) affects 20–30% of all patients with portal hypertension in India. The etiopathogenesis of this disease is unknown. In retrospective studies, umbilical vein cannulation and sepsis have been alleged to cause portal thrombosis. This prospective study was undertaken to detect clinically and by serial sonography whether thrombosis and consequent obstruction of the splenoportal venous system develops after umbilical vein catheterization and sepsis. Forty‐seven children who had undergone exchange transfusion for hyperbilirubinemia, belonging to two different age groups, were studied. Twenty‐two new‐borns (Group A) were studied within 4 weeks of birth and later at 3‐month intervals until the age of 12 months and subsequently at 24 months. Another group of 25 children (Group B), 1− to 5‐year‐olds who had earlier undergone exchange transfusion and 15 healthy newborns (Group C) were also screened. In Group A, seven (29%) neonates had septicemia, and in five, the splenic vein could not be initially visualized. The splenic vein was not seen in five of the 15 newborns in Group A who had no umbilical sepsis. Twenty‐one of the 22 neonates in Group A were folio wed‐up, and the splenic vein was well visualized and found patent on subsequent ultrasound in all of them. In Group B, four (16%) children had umbilical sepsis. None of these or the other Group B children showed any thrombosis or obstruction of the splenoportal system. The portal vein and its branches and the splenic vein were visualized in all healthy (Group C) neonates. In conclusion, our results demonstrate that umbilical vein catheterization and sepsis do not lead to development of portal vein thrombosis, at least, in the hospital.
Asymptomatic Uveitis in Children with Chronic Inflammatory Bowel Diseases
Authors: Hofley P. , Roarty J. , McGinnity G. , Griffiths A. M. , Marcon M. , Kraft S. , Sherman P.
Published: January 2024

Uveitis may be an asymptomatic ocular process when it occurs in association with chronic inflammatory bowel disease (IBD). However, the frequency of uveitis in pediatric IBD is not known, as few patients have eye examinations on a routine basis. Experience with a child with Crohn's disease, who had asymptomatic uveitis identified by routine screening initiated because of associated arthritis, prompted us to undertake this evaluation. The purpose of this cross‐sectional prospective study was to ascertain the point‐prevalence of uveitis in pediatric IBD patients, including 97 with Crohn's disease and 50 with ulcerative colitis. Each child underwent an ophthalmologic assessment, including slit‐lamp examination. In Crohn's disease, inflammatory cells and/or flare were observed in the anterior chamber of six (6.2%) patients. These changes were mild in all six patients and required no treatment. In the group with ulcerative colitis, there were no cases of asymptomatic uveitis. There was a higher frequency of asymptomatic transient uveitis in patients with Crohn's colitis (four of 22, 18.2%) than in those of other anatomic subgroups (two of 75, 2.7%; p < 0.05). Frequency of uveitis was also higher in IBD patients having other extraintestinal manifestations (15.0%) than in those without (3.1%; p < 0.10). There was no relationship observed between the activity of bowel disease and presence of ocular inflammation.
Effects of Different Formula Feeds on the Developmental Pattern of Urinary Bile Acid Excretion in Infants
Authors: Wahlén Eva , Strandvik Birgitta
Published: January 2024

The excretion of bile acids in urine was followed prospectively during the first year of life in 17 infants fed different diets from the age of 3 to 10 days. Eight infants were breast‐fed, four were fed formulas that were based on adapted cow's milk, and five were fed a formula that was based on soy protein isolate. The formulas had higher protein concentrations than human milk; had different types of proteins, and had not been supplemented with taurine. Urinary bile acids were determined by gas‐liquid chromatographic/mass spectrometric analyses of 24‐h urinary samples collected at 1–12 days (only formula‐fed infants) and at 1, 3, 6, 9, and 12 months of age. The results showed a higher urinary bile acid excretion at 3 months of age in both formula groups than in the breastfed infants. A deficiency of dietary taurine during formula‐feeding did not seem to limit the formation of taurine conjugates during the first month of life. The developmental pattern of urinary bile acid excretion during the first year differed according to the type of feeding. Isomers of cholic and chenodeoxycholic acid appeared in the urine of all breast‐fed infants at 6 to 12 months of age. These metabolites, assumed to be the first metabolites derived from the developing gut flora of the infants, appeared at an earlier age and in higher amounts in both formula groups compared to breast‐fed infants. Bile acids lacking a 7‐hydroxy group, known to be formed by the intestinal flora, appeared in infants in all feeding groups later than the isomers. The results of the study imply that the early introduction of formula may modify bile acid metabolism in infants.
Establishment of a Mucin‐Degrading Intestinal Microflora During the First Two Years of Human Life
Authors: Midtvedt Ann‐Christine , Carlstedt‐Duke Bodil , Midtvedt Tore
Published: January 2024

The establishment of a mucin‐degrading intestinal microflora was followed in 30 healthy Swedish children by agar gel electrophoresis of fecal samples taken at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months of age. At 3 months, 18 children showed a limited degree of mucin degradation, while 12 children showed no degradation. In children exclusively breast‐fed for at least 4 months, mucin degradation was initiated significantly later than in children who received formula, with or without breast milk, by 1 month of age. Complete degradation of mucin was seen in 21 children after 1 year of age and in all children at 2 years. A positive correlation between increasing age and increased degradation of mucin was found between birth and 1 month and between 6 and 9 months, after standardization for the period of exposure to foods other than breast milk.
Effect of Enteral Tube Feeding on Growth of Children with Symptomatic Human Immunodeficiency Virus Infection
Authors: Henderson Robin A. , Saavedra Jose M. , Perman Jay A. , Hutton Nancy , Livingston Robert A. , Yolken Robert H.
Published: January 2024

Malnutrition and growth failure are frequent clinical consequences of human immunodeficiency virus (HIV) infection in children. Tube feeding is a means by which to increase the enteral intake of nutrients. We examined the effect of tube feeding in 18 children, median age 6 months (range, 3–159). Tube feedings were initiated due to growth failure in all, which was also associated with dysfunctional swallowing or aspiration in seven children and gastroesophageal reflux in two. Tube feedings were infused via nasogastric tube (n = 4) or gastrostomy tube (n = 14) and were continued for a median of 8.5 months (range, 2–24). Stoma complications developed in three children with gastrostomy tubes; these were the only tube‐related side effect. Tube feedings were discontinued due to noncompliance (n = 3), gastrostomy leakage (n = 2), intolerance (n = 2), and death (n = 3). Anthropometric changes were evaluated comparing mean standard deviation scores (Z) before and after tube feeding. Tube feeding resulted in significantly increased weight for age (Z, −2.13 + 0.7 vs. −1.46 + 1.4; p = 0.04), weight for height (Z, −1.07 + 1.0 vs. −0.13 + 1.0; p = 0.004), and arm fat area (Z, −1.75 + 1.3 vs. −0.62 + 1.2; p = 0.01). However, tube feeding did not result in significant changes in height for age (Z, −1.93 + 0.8 vs. −1.74 + 1.6) or arm muscle area (Z, −1.24 + 0.9 vs. −0.57 + 1.2). Tube feedings effectively increased the weight of HIV‐infected children in this study, but they were not sufficient to correct linear growth deficits.
Symptomatic Gastroesophageal Reflux
Authors: Westra Sjirk J. , Derkx Herbert H. F. , Taminiau Jan A. J. M.
Published: January 2024

Ultrasound is a new test proven to be sensitive in the demonstration of gastroesophageal reflux (GER). Following reflux seen with ultrasound various symptoms can be observed in physiological circumstances, and thereby a causal relationship between reflux and these symptoms can be observed in physiological circumstances, and thereby a causal relationship between reflux and these symptoms can be proven. We performed a study in 220 children suspected of GER to determine the incidence of sonographically demonstrated “symptomatic reflux” in different clinical groups: children with (1) vomiting only, (2) respiratory symptoms, (3) attack‐like symptoms, and (4) pain and irritability. Overall, GER was demonstrated in 78% of all 209 children in whom technically satisfactory studies could be performed. This reflux was associated with symptoms in 32% of the cases. Symptomatic reflux was most frequent in group 3, which included children investigated for near‐miss sudden infant death syndrome. The symptoms that were noted most frequently were vomiting, motor unrest, coughing, and wheezing. Apnea, bradycardia and attacks of unusual posturing could incidentally be related to reflux. Ultrasound is a cheap, simple, noninvasive, and physiological test to show clinically significant reflux.
Effect of a Medium Dose of Ursodeoxycholic Acid with or without Taurine Supplementation on the Nutritional Status of Patients with Cystic Fibrosis
Authors: Merli M. , Bertasi S. , Servi R. , Diamanti S. , Martino F. , De Santis A. , Goffredo F. , Quattrucci S. , Antonelli M. , Angelico M.
Published: January 2024

Ursodeoxycholic acid administration has been reported to improve cholestasis and inflammatory activity in primary biliary cirrhosis and, in an uncontrolled study, also in young adults with cystic fibrosis (CF) and chronic cholestasis. As an improvement in nutritional status was also observed in these young adult patients, we investigated whether the administration of a medium dose of ursodeoxycholic acid ameliorates the nutritional status of malnourished young adult CF patients with chronic liver disease. The study included 51 patients (27 male patients and 24 female patients; age range, 8–32 years; median, 14) with body mass percentiles < 90%. Patients were randomly assigned to receive either ursodeoxycholic acid (10–12 mg/kg/day) alone or with taurine (18–22 mg/kg/day). Patients were followed in a crossover fashion within each group; 6 months of treatment was randomly alternated with 6 months of placebo. Nine patients dropped out before concluding the study. Liver function tests, nutritional status, and coefficients of fat absorption were determined at entry and after each 6 months of placebo or treatment. Nutritional status and fat absorption were not significantly modified by either treatment. Liver function tests improved after ursodeoxycholic acid administration only in patients with concomitant chronic liver disease. Our findings indicate that 6 months of therapy with a medium dose of ursodeoxycholic acid, either alone or with taurine, does not improve the nutritional status of young malnourished CF patients. Higher doses given for longer periods might be worth investigating.
Platelet‐Activating Factor Acetylhydrolase in Term and Preterm Human Milk
Authors: Moya Fernando R. , Eguchi Hideshi , Zhao Biren , Furukawa Masayuki , Sfeir SJuan , Osorio Marcial , Ogawa Yunosuke , Johnston John M.
Published: January 2024

Human milk may protect against necrotizing enterocolitis (NEC). Since platelet‐activating factor (PAF) may participate in the pathophysiology of NEC, we measured PAF acetylhydrolase (PAF‐AH), which metabolizes PAF, in term and preterm human milk. The activity of PAF‐AH in term milk collected 2‐A days after delivery (n = 17) was 2.7 |Mp 1.2 nmol x min−1 x ml−1. A higher activity was found in milk collected at similar times from mothers who delivered between 33 and 36 weeks of gestation (n = 6, 5.6 |Mp 2.1 nmol x min−1 x ml−1, p < 0.01). However, milk from mothers who delivered between 26 and 32 weeks of gestation had a PAF‐AH activity similar to that of term milk (n = 6, 3.0 |Mp 0.7 nmol X min−1 x ml−1). With advancing lactational age, PAF‐AH activity in term milk decreased, whereas the activity of this enzyme in preterm milk remained unchanged. In milk samples collected beyond 14 days after delivery from women who gave birth between 33 and 36 weeks or 26 and 32 weeks of gestation, PAF‐AH activity was fivefold higher than that found in milk for women delivering at term (3.7 |Mp 1.3 and 3.6 |Mp 3.6 nmol x min−1 X ml−1 serum 0.7 |Mp 0.4 nmol x min−1 x ml−1, respectively, p < 0.05). We speculate that the presence of PAF‐AH in human milk may protect against NEC in preterm newborns.
Committee Report
Authors: Heine Wilhelm , Hernell Olle , Koletzko Berthold , Lafeber Harry , Ormission Anne , Rey Jean , Tormo Ramon
Published: January 2024

Summary Coronary heart disease is a major cause of morbidity and mortality in Europe, particularly northern, central, and eastern Europe. Several strategies have been recommended for children and adolescents to promote a healthy lifestyle and thereby reduce the risk of coronary heart disease in later life. The European Society of Pediatric Gastroenterology and Nutrition (ESPGAN) Committee on Nutrition reviewed some of these strategies, and our conclusions and recommendations are reported herein.
The Epidemiology of Rotavirus Infections
Authors: Haffejee Ismail E.
Published: January 2024

Rotavirus, which is the most common cause of infantile diarrhea worldwide, mainly affects infants between the ages of 6 and 24 months. Most infections in human newborns are mild or asymptomatic, due to the inherently attenuated nature of the “nursery” rotavirus strains. Adults are also sometimes affected, especially those in families with an infected child; the disease also occurs in closed adult communities, HIV‐infected persons, travelers, or as a result of water‐borne epidemics. Nosocomially acquired hospital infections add to morbidity and to the cost of hospitalization. A winter predominance of rotavirus diarrhea has been noted in temperate climates but not in tropical areas. Group A rotavirus infections are generally more common, but human infections with groups B and C have also been documented. The prevalence of scrum antibodies is high during the neonatal period, but it declines sharply between the ages of 3 and 6 months, then rises steeply, peaking at 2 years and remaining high into adulthood. Vaccines against rotavirus are currently under evaluation
The Treatment of Intractable Rejection with Tacrolimus (FK506) in Pediatric Liver Transplant Recipients
Authors: McDiarmid S. V. , Wallace P. , Vargas J. , Ament M. E. , Busuttil R. W.
Published: January 2024

We report our experience in 17 pediatric orthotopic liver transplant (OLT) patients converted from cyclosporine (CsA) to FK506 for intractable acute and chronic rejection. FK506 was initiated orally at a dose of 0.3 mg/kg/day in most patients; the dose was then adjusted to achieve serum levels of 0.5–1.5 ng/ml. Azathio‐prine was discontinued and low‐dose prednisone maintained. The median time between liver transplantation and FK506 conversion was 41 months. Patients have been treated for an average of 14.8 ± 9.6 months. Six patients were converted for acute rejection and 11 for chronic rejection, i.e., vanishing bile duct syndrome (VBDS). After FK506 conversion, the actual patient and graft survival was 88% and 82%, respectively, in the group as a whole. Two patients died, one of chronic active hepatitis C and the other of lymphoma. Three patients, all with VBDS, did not respond to FK506 and therefore required retransplantation. The serum bilirubin is currently normal in 14 patients and the serum transaminases < 100 IU/ml in 12. The mean bilirubin pre‐FK506 of patients successfully converted to FK506 was 4.2 mg/dl compared to 11.8 mg/dl in patients who failed conversion. Major complications included nephrotoxicity, neurotoxicity, and lymphoma. The mean glomerular filtration rate (GFR) of 97 ± 29 mls/min/1.73m2 prior to FK506 conversion dropped to 51 ± 20 mls/min/1.73m2 (p = 0.0001) after a mean of 13.6 months of FK506 therapy. Three patients have developed B‐cell lymphomas; two of them responded to decreased immunosuppression and one died. We conclude that intractable liver graft rejection in children is most successfully reversed if FK506 is instituted before cholestasis becomes pronounced. The high cumulative doses of immunosuppression needed to control intractable rejection places these patients at special risk for developing lymphomas.