bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Sex in the Treatment and Clinical Outcomes of Pediatric Patients With Inflammatory Bowel Disease
Authors: Lee Grace J. , Kappelman Michael D. , Boyle Brendan , Colletti Richard B. , King Eileen , Pratt Jesse M. , Crandall Wallace V. 
Published: November 2012

ABSTRACTObjective:To examine sex differences in medical therapy and clinical outcomes in pediatric patients with inflammatory bowel disease (IBD).Methods:We performed a cross‐sectional analysis of children with Crohn disease (CD) and ulcerative colitis (UC) using data from the ImproveCareNow Network collected between May 2007 and May 2010. Clinical remission, disease severity, body mass index (BMI) z scores, normal height velocity, and medication use were analyzed by sex and age.Results:One thousand four hundred nine patients were included (993 had CD and 416 had UC). No significant sex differences were found in disease severity, BMI, height velocity, or use of medications. Further analysis of combination therapy with infliximab + 6‐mercaptopurine/azathioprine and infliximab + methotrexate also did not reveal any differences. No sex differences were found after mediation use was stratified by age (those younger than 13 years and those 13 years old or older).Conclusions:In this sample of CD and UC pediatric patients, no significant sex differences were found in disease severity, BMI, height velocity, or medication use. Our data do not support the use of sex as a major factor in patient risk stratification for children with IBD. In addition, despite concerns for sex‐specific complications of some medications, our analysis did not suggest any sex differences in medication use.
Ultrashort Bowel Syndrome in Children
Authors: Sanchez Sabrina E. , Javid Patrick J. , Healey Patrick J. , Reyes Jorge , Horslen Simon P. 
Published: November 2012

ABSTRACTObjective:Recent data have demonstrated improved survival in children with intestinal failure. We hypothesized that this trend would also be observed in children with ultrashort bowel syndrome.Methods:A prospective database from Seattle Children's Intestinal Failure Program was used to evaluate outcomes and morbidities of consecutive patients with 10 cm or less of small bowel enrolled in the program since 2005. Data are listed as median (range).Results:Five patients were identified with a bowel length of 6 (1–10) cm and follow‐up of 54 (43–61) months. All children have survived and are currently between 3.5 and 5.5 years of age. One patient underwent isolated intestinal transplantation and one patient is currently listed for intestinal transplantation. The transplanted child is fully enterally fed. The other patients remain at least partially dependent on parenteral nutrition. None of these patients have current evidence of parenteral nutrition‐associated liver disease. Patients have required extensive care after referral to our program, including 18 (15–32) visits to the emergency room, 152 (114–273) days of inpatient care, and 6 (5–9) central line–associated blood stream infections.Conclusions:Long‐term survival in children with ultrashort bowel length is possible after referral to an intestinal failure program, although extensive medical management is required. These children may be reasonable candidates for long‐standing intestinal rehabilitation as a bridge to intestinal transplantation.
Prospective Evaluation of 1‐Day Polyethylene Glycol‐3350 Bowel Preparation Regimen in Children
Authors: Abbas Mazen I. , Nylund Cade M. , Bruch Carol J. , Nazareno Luzviminda G. , Rogers Philip L. 
Published: November 2012

ABSTRACTObjectives:The aim of the present study was to evaluate efficacy, safety, and tolerability of a pediatric colonoscopy bowel preparation regimen composed of polyethylene glycol‐3350 (PEG‐3350) and a sports drink completed in a few hours.Methods:A prospective, open‐label trial of a colonoscopy bowel preparation in children ages 8 to 18 years that included 238 g of PEG‐3350 mixed with 1.9 L of Gatorade completed in a few hours. Efficacy was determined using the Boston Bowel Preparation Scale. Basic metabolic profiles and questionnaires were obtained that assessed for safety, adverse effects, tolerability, and patient acceptability.Results:Forty‐six patients completed the study. Patients were predominately boys (56.5%) with a mean age of 14.50 years (SD ±2.9 years). Forty‐three (93.5%) were able to complete the regimen. All of the colonoscopies were completed to the cecum and 84% had terminal ileum visualization. Seventy‐seven percent were found to be effective preparations. Nausea/vomiting were the most common reported adverse effect (60%) followed by abdominal pain/cramping (44%) and fatigue/weakness (40%). Overall, the regimen was acceptable with 1 exception being the large volume to drink. There were no clinically significant changes in basic metabolic profiles, although there was a statistically significant decrease in the mean potassium (0.16 mEq/L; P = 0.016), blood urea nitrogen (2.68 mg/dL; P < 0.0001), and carbon dioxide (1.89 mmol/L; P < 0.0001).Conclusions:This study demonstrated that PEG‐3350 + Gatorade administered in a few hours is an effective, safe, and moderately tolerable bowel preparation regimen for colonoscopy in children.
Endoscopic Ultrasound–guided Drainage of Pancreatic Fluid Collections in Children
Authors: Ramesh Jayapal , Bang Ji Y. , Trevino Jessica , Varadarajulu Shyam 
Published: November 2012

ABSTRACTBackground and Objective:Although endoscopic ultrasound (EUS)–guided drainage of pancreatic fluid collections (PFCs) has evolved as the standard of care in adults, its role as a single‐step drainage modality in children is unclear. The aim of the present study was to evaluate the efficacy and safety of single‐step EUS‐guided drainage of PFCs in children.Methods:This is a retrospective study of all of the children who underwent single‐step EUS‐guided drainage of PFCs during a 4‐year period at 1 institution. An endoscopic retrograde cholangiopancreatography was attempted before EUS‐guided drainage to evaluate the pancreatic duct and bridge any ductal disruption.Results:A total of 7 children (4 boys; mean age 8.4 years [standard deviation 2.1]) underwent EUS‐guided drainage of PFCs. The etiology was blunt abdominal trauma in 5, hereditary pancreatitis in 1, and idiopathic pancreatitis in 1. Both technical and treatment success rates were 100% with median procedural duration of 12 minutes (interquartile range 12–20 minutes). Two patients underwent repeat EUS‐guided drainage due to lack of adequate resolution of PFC on follow‐up computed tomography. There were no immediate or delayed complications. At a median follow‐up of 1033 days (interquartile range 193–1167 days), all of the children were doing well with no PFC recurrence.Conclusions:Single‐step EUS‐guided drainage of PFC in children is technically feasible, safe, clinically effective, and when available, should be the first‐line treatment modality.
Antireflux Surgery in Children With Neurological Impairment
Authors: O'Loughlin Edward V. , Somerville Helen , Shun Albert , Gangemi Rachel , La Hei Erik , Desphande Aniruddh , O'Loughlin Timothy F. 
Published: November 2012

ABSTRACTObjectives:The aim of the present study was to report caregiver perceptions to antireflux surgery and gastrostomy in children with severe neurological impairment and to report the complications of the surgery.Methods:Children were identified from a clinic database and clinical information and surgical complications were extracted from the database and hospital medical records. A cross‐sectional questionnaire addressing severity of symptoms was administered to parents/caregivers and scored with a 5‐point Likert scale (1 is much better to 5, much worse).Results:A total of 122 children, median age 74 months (interquartile range 29–124), 63% spastic quadriplegic cerebral palsy, had antireflux surgery. Laparoscopic surgery was performed in 77 of 122 (63%) and 117 of 122 (96%) had gastrostomy insertion. Questionnaire was completed by 89 of 122 (73%) children; median duration of time from fundoplication to questionnaire was 77 months (43–89). The majority of caregivers indicated that surgery improved or greatly improved weight gain, chest infections, vomiting, and feeding tolerance. Only 2 caregivers reported that they regretted consenting to surgery. Serious surgical complications occurred in 10%.Conclusions:Serious complications were uncommon in this series of antireflux surgery in neurologically impaired children. Although gagging and retching were common following surgery, a high percentage of caregivers reported improved nutrition, reflux‐related symptoms, and high levels of satisfaction.
Endoscopic and Pharmacological Secondary Prophylaxis in Children and Adolescents With Esophageal Varices
Authors: dos Santos Juliana Magalhães Reis , Ferreira Alexandre Rodrigues , Fagundes Eleonora Druve Tavares , Ferreira Amanda Pifano Soares , Ferreira Letícia Sauma , Magalhães Maria Carolina Ribeiro , Bittencourt Paulo Fernando Souto , Carvalho Simone Diniz , Filho Paulo Pimenta Figueiredo , Penna Francisco José 
Published: November 2012

ABSTRACTObjective:The aim of this study was to describe the results of endoscopic secondary prophylaxis, alone or in combination with propranolol, used to prevent upper gastrointestinal bleeding (UGIB) in children and adolescents with esophageal varices.Methods:This observational study followed 43 patients younger than 18 years who received secondary prophylaxis between August 2001 and December 2009. Sclerotherapy and/or band ligation were performed, and propranolol was used when no contraindications were present. The rebleeding rate, number of endoscopic sessions required for variceal eradication, rate of varix recurrence, the occurrence of varices at the gastric fundus, and the occurrence of portal hypertensive gastropathy were evaluated.Results:Endoscopic prophylaxis in combination with propranolol was performed in 25 patients (58.1%) and endoscopic prophylaxis alone was performed in 18 patients (41.9%). Esophageal varices were eradicated in all of the patients after a median of 3 sessions. Varices recurred in 22 patients (51.2%). Rebleeding occurred in 13 patients (30.2%). Fundal varices and portal hypertensive gastropathy developed in 31% and 61.9% of patients, respectively. No deaths related to the endoscopic procedure or UGIB occurred. No statistically significant differences in any of the studied variables were observed when comparing endoscopic prophylaxis with propranolol and endoscopic prophylaxis alone.Conclusions:No significant differences were observed between sclerotherapy and band ligation. Secondary prophylaxis was effective in eradicating esophageal varices. The use of propranolol did not affect the results of the endoscopic prophylaxis. Furthermore, randomized studies will be necessary to assess the best form of prevention during childhood.
Duodenal Intraepithelial Lymphocytosis With Normal Villous Architecture in Pediatric Patients
Authors: Shmidt Eugenia , Smyrk Thomas C. , Faubion William A. , Oxentenko Amy S. 
Published: November 2012

ABSTRACTObjectives:Small bowel intraepithelial lymphocytosis (IELs) with normal villous architecture is a relatively common finding, often of uncertain significance. The aims of our study were to determine the prevalence of this finding, its clinical associations, its specificity for celiac disease (CD), and whether histologic clues exist that increase the specificity for CD in this setting, all in the pediatric population.Methods:The Mayo Clinic electronic pathology database was searched between January 1, 2000 and December 31, 2009 for patients younger than 18 years who had the terms “normal villi” and “increased intraepithelial lymphocytes” in their small bowel biopsy reports. All of the slides were reviewed to confirm the histologic findings. Demographic, serologic, pathologic, and clinical informations were obtained.Results:Among 1290 duodenal biopsies obtained from children during the years 2000 and 2009, 56 (4.3%) were noted to have “normal villous architecture with increased intraepithelial lymphocytes.” In the 54 patients not known to have CD before biopsy, 48 (89%) had serologic testing for CD. Of these 48 patients, 9 were labeled with CD, although only 5 of 9 met the definite criteria for the diagnosis, based on a combination of serologic markers, human leukocyte antigen haplotyping, and response to gluten‐free diet. No clinical features pointed to a diagnosis of CD. There was no correlation between CD and number of IELs, but patients with newly diagnosed CD were more likely to have a tip‐heavy lymphocyte distribution. Other diagnoses made during the study period and in follow‐up were inflammatory bowel disease (5), Helicobacter pylori infection (3), medication‐related injury (10), and systemic autoimmune disorders (2).Conclusions:Increased IELs with normal villous architecture in small bowel biopsies are clinically important in children, and are associated with a new definite diagnosis of CD in 9% of pediatric patients. Even at this low sensitivity, clinical work‐up for CD is mandated in all of the patients with this finding.
Time‐ and Segment‐related Changes of Postresected Intestine
Authors: Buccigrossi Vittoria , Armellino Carla , Tozzi Arturo , Nicastro Emanuele , Esposito Ciro , Alicchio Francesca , Cozzolino Santolo , Guarino Alfredo 
Published: November 2012

ABSTRACTObjectives:The aim of the present study was to investigate the segment‐ and time‐related changes in rat short bowel syndrome and construct a 4‐dimensional (4D) geometrical model of intestinal adaptation.Methods:Sprague‐Dawley rats were divided into 3 groups: 2‐day, 7‐day, and 15‐day postresection groups in which 75% of the jejunoileum was removed. Histological and morphometrical parameters in the remaining proximal to distal intestinal segments, from the jejunum to the distal colon, were comparatively evaluated in the groups. The data were used to construct a 4D geometric model in which villi were considered as cylinders, and their surface area was expressed as cylinder lateral area.Results:Major adaptive changes were observed in the ileum consisting of an increase in both the diameter of base and the height of villi. A parallel reduction in their number/mm2 was observed. The resulting ileal architecture was characterized by a limited number of large villi. An opposite pattern was observed in the jejunum whose postresection structure consisted of an increased number of villi. No changes were observed in the colon. Postresection restructuring was early and faster in the ileum than in the jejunum resulting in an increase in absorptive area of 81.5% and 22.5% in the ileum and jejunum, respectively.Conclusions:Postresection adaptation is intestinal segment–specific because all of the major changes occur in the ileum rather than in the jejunum. Sparing ileal segments during resection may improve the outcome of patients undergoing extensive intestinal resection. Our 4D model can be used to test interventions aimed at optimizing postresection intestinal adaptation.
Detection of Low‐concentration Host mRNA Transcripts in Malawian Children at Risk for Environmental Enteropathy
Authors: Agapova Sophia , Stephenson Kevin , Manary Micah , Weisz Ariana , Tarr Phillip I. , Mkakosya Rahjab , Maleta Ken , Shulman Robert J. , Manary Mark , Shaikh Nurmohammad 
Published: November 2012

ABSTRACTBackground and Objective:Transcriptomic analysis of fecal samples is an emerging method for the diagnosis of gastrointestinal pathology because it is noninvasive and requires minute volumes of analyte; however, detection of mRNA in low copy numbers in human stool is challenging. Our objective was to develop a method for detecting human mRNA suggestive of environmental enteropathy (EE) in feces.Methods:Stool samples from 70 Malawian children, 34 without EE and 36 with EE, as defined by dual sugar absorption, were used to develop the methodology for mRNA detection. Multiple RNA isolation techniques and polymerase chain reaction formats were tested to detect 38 potential mRNA biomarkers suggestive of EE, and the results compared.Results:RNA isolation using magnetic bead extraction best recovered host mRNA in stool, and digital droplet polymerase chain reaction was the most sensitive format to detect low copy numbers of mRNA. In all of the 70 samples, >20 copies of glyceraldehyde‐3‐phosphate dehydrogenase/200 mg of stool were detected. Copy numbers of potential biomarkers were normalized to glyceraldehyde‐3‐phosphate dehydrogenase, to account for interspecimen differences in concentration of human mRNA. Of the 38 transcripts chosen for initial evaluation, 24 had copy numbers >10 in all of the samples tested. Of the 6 potential markers measured in all of the 70 samples, REG4 best differentiated children with and without EE.Conclusions:A reproducible and reliable method to quantify human mRNA in stool present in low copy numbers has been developed, and may prove useful in investigations of EE and possibly other inflammatory gut conditions.
Should Intussusception in Children Prompt Screening for Celiac Disease?
Authors: Reilly Norelle R. , Aguilar Kathleen M. , Green Peter H. 
Published: November 2012

ABSTRACTObjectives:An association between adult celiac disease (CD) and intussusceptions (ISs) has been described. Although more common among children, intussusception has not been linked with childhood CD aside from isolated case reports. Our aim was to investigate the frequency of IS among children with CD.Methods:A patient database containing children with biopsy‐proven CD was reviewed, in addition to radiology records contained in a hospital‐maintained clinical data repository.Results:Of 254 children with biopsy‐proven CD and complete records available for review, abdominal imaging was performed in 21%, mainly because of abdominal pain. Among children with CD, 1.2% experienced an IS <9 months before their diagnosis with CD. Among children seen at our institution in the same time period, 0.07% experienced an IS. The majority of those children with CD who were found to have IS had no evidence of nutritional deficit at the time of IS. IS was not identified in any children with CD who had been treated with a gluten‐free diet.Conclusions:IS was far more common among children in our cohort with untreated CD than in the general pediatric population simultaneously seen at our center. The diagnosis of CD should be considered in children with IS, even in the absence of signs of nutritional compromise.
Balloon Expulsion Test as a Screen for Outlet Obstruction in Children With Chronic Constipation
Authors: Belkind‐Gerson Jaime , Goldstein Allan M. , Kuo Braden 
Published: November 2012

ABSTRACTObjective:Chronic constipation (CC) is a common problem in pediatrics and is often the result of obstructed defecation. The aim of the present study was to study the feasibility and efficacy of the balloon expulsion test (BET) in the diagnosis and management of children with CC.Methods:Retrospective study comparing BET and high‐resolution anorectal manometry (ARM). The BET was done together with ARM in 29 children, ages 8 to 19 years, with CC. For BET, a 60‐mL balloon was used. Passage of balloon in 1 minute or less was considered normal.Results:Fifteen of the 29 children had a normal BET. Of these, 14 also had an ARM, all of which were normal (except for 2 cases with a hypertonic baseline anal sphincter). Thus 12 of 14 with BET and ARM were normal on both (correlation between the tests 86%). Of the 14 children that failed BET, 10 had distal abnormalities by ARM, contrast studies, EMG, or assessment by a pelvic physical therapist. All of the patients with a nonrelaxing sphincter or outlet obstruction were treated with laxatives, anal sphicter Botox, and/or pelvic physical therapy and biofeedback. In follow‐up of at least 3 months, all of the patients with a failed BET were improved.Conclusions:We found a high correlation between a normal ARM and BET. If the BET is abnormal and the ARM does not identify a cause for the distal obstruction, additional studies may be needed, including contrast enema, defecography, or electromyography. BET appears to be a safe, reliable, and useful test in the evaluation and management of CC in children.
Childhood Obesity for Pediatric Gastroenterologists
Authors: Huang Jeannie S. , Barlow Sarah E. , Quiros‐Tejeira Ruben E. , Scheimann Ann , Skelton Joseph , Suskind David , Tsai Patrika , Uko Victor , Warolin Joshua P. , Xanthakos Stavra A. ,   NASPGHAN Obesity Task Force
Published: November 2012

ABSTRACTObesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity‐related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity‐related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology.
Consanguinity and Inflammatory Bowel Diseases
Authors: Mouzan Mohammad El , Al‐Mofarreh Mohammad , Assiri Asaad , Hamid Yassin , Saeed Anjum 
Published: November 2012

ABSTRACTObjective:The aim of the present study was to investigate the relation between consanguinity and inflammatory bowel diseases (IBD).Methods:Review of the medical records of children with a final diagnosis of IBD to determine age, sex, and type of IBD, supplemented by information on consanguinity and family history (FH) of IBD in relatives. There were 138 children, ages 1.4 to 19.3 years, and 50% were girls.Results:The prevalence of consanguinity was 50%, 53%, 39% and 60% in IBD, Crohn disease (CD), ulcerative colitis (UC), and controls, respectively. There was a significantly higher prevalence of consanguinity in controls than in patients with IBD and UC (P = 0.02 and 0.026, respectively), whereas the difference between CD patients and controls was not significant (P = 0.20). The prevalence of first cousin consanguinity was 71%, 73.2%, 61.5% and 70.5% in patients with IBD, CD, UC, and controls, respectively, indicating no significant difference between these conditions and controls (P = 0.95, P = 0.78, P = 0.33, respectively). There was no significant difference in the prevalence of consanguinity in the parents of children with or without a FH of either CD (P = 0.89) or UC (P = 0.32).Conclusions:There is no significant relation between parental consanguinity and IBD in this population, especially when there is no FH of disease, suggesting reduced genetic susceptibility; however, further studies including larger sample size and details of FH of consanguinity and IBD in multiple generations are needed for further definitions of the role of consanguinity.