bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

ABSTRACTDermatologic 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

ABSTRACTObjectiveChronic 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.MethodsRetrospective 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.ResultsThe 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.ConclusionsChronic 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

ABSTRACTObjectivesCertain 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 MethodsInfant 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.ResultsPost‐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.ConclusionsSupplementation 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

ABSTRACTObjectiveApproximately 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.MethodsSubjects 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.ResultsGastric 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.ConclusionIntragastric 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

ABSTRACTObjectivesTo determine the incidence, etiology and outcome of pancreatitis at a regional children's hospital.MethodsChart 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.ResultsTwo 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.ConclusionsPancreatitis 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

ABSTRACTBackgroundThe 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.MethodsOne 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).ResultsH. 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).ConclusionsIn 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

ABSTRACTThe 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

ABSTRACTSymptoms 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

ABSTRACTChildren 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

ABSTRACTThe 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

ABSTRACTBackgroundThe 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.MethodsThis 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.ResultsSerum 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.ConclusionsPreterm 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

ABSTRACTObjectivesInfants 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.MethodsFifty‐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.ResultsThe 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.ConclusionsIn 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

ABSTRACTThe 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.MethodsOne 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.ResultsIn 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.ConclusionsThe 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

ABSTRACTObjectiveTo 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).MethodsEight 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.ResultsWhen 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).ConclusionThis 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

ABSTRACTBackgroundThe 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.MethodsAll 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.ResultsFive 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.ConclusionThe 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

ABSTRACTBackground/aimsThe 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.MethodsTwenty‐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.ResultsThere 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.ConclusionsThe 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.