bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repeatability of the Sugar‐Absorption Test, Using Lactulose and Mannitol, for Measuring Intestinal Permeability for Sugars
Authors: van Elburg R. M. , Uil J. J. , Kokke F. T. M. , Mulder A. M. , van de Broek W. G. M. , Mulder C. J. J. , Heymans H. S. A. 
Published: January 2024

SummaryDifferential sugar‐absorption tests for measuring intestinal permeability for sugars have been studied in a variety of gastrointestinal diseases. Their use in general practice has been hampered by a lack of data on reference values and repeatability of the test and the laboratory assay. In this study, we determined the reference values of the sugar‐absorption test, using lactulose and mannitol as probe molecules, for children and adults. The repeatability of the test is good; linear relationship: slope, 0.825 [95% confidence interval (CI), 0.571, 1.152); intercept, 0.005 (95% CI, −0.004, 0.010). The repeatability of the laboratory assay for the sugar‐absorption test is excellent; linear relationship: slope, 1.014 (95% CI, 0.870, 1.094); intercept, 0.002 (95% CI, −0.005,0.010). The validation of the sugar‐absorption test makes the test useful as a simple, noninvasive, reliable intestinal permeability test for sugars, which can be of use for clinical practice. Taking possible interfering factors into account, the sugar‐absorption test can be used as a diagnostic test for enteropathy of different etiologies and evaluation of therapeutic interventions in both children and adults. Studies with the sugar‐absorption test may clarify the role of intestinal permeability in the pathophysiology of a variety of gastrointestinal diseases.
Utility of Duplex Doppler Ultrasound in Evaluating Portal Hypertension in Children
Authors: Kozaiwa Kousuke , Tajiri Hitoshi , Yoshimura Norikazu , Ozaki Yoshikazu , Miki Kazunori , Shimizu Kazuo , Harada Tokuzo , Okada Shintaro 
Published: January 2024

Summary:We measured the maximal velocity of the blood flow in the main portal trunk by duplex Doppler ultrasound in children suffering from a variety of liver diseases. The maximal velocity of the main portal vein in children with chronic active hepatitis and liver cirrhosis was decreased significantly as compared to those in control children (p < 0.01). The maximal velocity of the main portal trunk and K indocyanine green (ICG) had no significant correlation (r = 0.25, n = 27). The patient with the lowest portal velocity had esophageal and gastric varices with red color sign. We conclude that the measurement of the maximal velocity of the main portal trunk with duplex Doppler ultrasound is useful in evaluating portal hypertension in children.
Vitamin A and E Supplementation in Breast‐Fed Newborns
Authors: Delvin Edgard E. , Salle Bernard L. , Reygrobellet Bernadette , Mellier Georges , Claris Olivier 
Published: January 2024

ABSTRACTBackgroundVitamins A and E are two potent antioxidant nutrients that play a significant role in immune function. In contrast to the numerous studies of vitamin A and E status in children, adolescents, and adults, information on term infants, particularly breast‐fed infants, is scarce. The goals of the present investigation were to examine the vitamins A and E nutritional status of term breast‐fed infants at birth and to assess retinol and tocopherol plasma levels during a 3‐month supplementation trial.MethodsThe study was a prospective, blinded comparison of a supplementation protocol with a placebo in a group of consecutively recruited term newborns. The supplemented group received 3000 IU vitamin A and 5 IU vitamin E orally. The placebo group received a solution of similar viscosity and organoleptic characteristics. Vitamin A and E were separated by reverse‐phase high‐performance liquid chromatography on a C18 Spectrasyl column and quantified by ultraviolet spectrophotometry.ResultsVitamin A and E levels steadily increased with age in both groups of infants. However, levels at 3 months were higher in the supplemented than in the control group.ConclusionThe data show that supplementation with 3000 IU vitamin A and 5 IU vitamin E for 3 months increases circulating vitamin levels in newborn term babies compared with those in nonsupplemented infants.
Guidelines for Evaluation and Treatment of Gastroesophageal Reflux in Infants and Children
Authors: Rudolph Colin D. , Mazur Lynnette J. , Liptak Gregory S. , Baker Robert D. , Boyle John T. , Colletti Richard B. , Gerson William T. , Werlin Steven L. 
Published: January 2024

AbstractGastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esophagitis and respiratory disorders. The GER Guideline Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated a clinical practice guideline for the management of pediatric GER. The GER Guideline Committee, consisting of a primary care pediatrician, two clinical epidemiologists (who also practice primary care pediatrics) and five pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method.The Committee examined the value of diagnostic tests and treatment modalities commonly used for the management of GERD, and how those interventions can be applied to clinical situations in the infant and older child. The guideline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow‐up management and indications for consultation by a specialist. The guideline also provides recommendations for management by the pediatric gastroenterologist.This document represents the official recommendations of the North American Society for Pediatric Gastroenterology and Nutrition on the evaluation and treatment of gastroesophageal reflux in infants and children. The American Academy of Pediatrics has also endorsed these recommendations. The recommendations are summarized in a synopsis within the article. This review and recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.
Accidental Caustic Ingestion in Children: Is Endoscopy Always Mandatory?
Authors: Lamireau Thierry , Rebouissoux Laurent , Denis Delphine , Lancelin Frantz , Vergnes Pierre , Fayon Michael 
Published: January 2024

ABSTRACTBackgroundPatients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested‐substance types as markers of severe esophagogastric lesions and to define indications for endoscopy.MethodsIngested‐product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion.ResultsForty‐eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1).ConclusionsIn conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.
Colonic Diversion for Intractable Constipation in Children: Colonic Manometry Helps Guide Clinical Decisions
Authors: Villarreal Jorge , Sood Manu , Zangen Tsili , Flores Alejandro , Michel Reynaldo , Reddy Narasimha , Di Lorenzo Carlo , Hyman Paul E. 
Published: January 2024

ABSTRACTBackgroundColonic manometry helps discriminate functional and behavioral causes for childhood constipation from colonic neuromuscular disease.MethodsOf 375 colonic manometries performed for clinical indications, 12 could not be interpreted because of chronic colonic dilation. Based on colonic manometries that showed either no contractions or an absence of the gastrocolonic response or an absence of high‐amplitude propagating contractions, the authors recommended diverting colostomies or ileostomies in 12 chronically constipated children (mean age, 4 years; range, 2–14 years, 5 boys). Before study, medical treatment was ineffective in all children. These children had persistently dilated colons with pathologic diagnoses of intestinal neuronal dysplasia (n = 4), hypoganglionosis (n = 2), hollow visceral myopathy (n = 1), and normal (n = 5).ResultsSix to 30 months after diversion, the authors restudied all the children. Eleven of 12 diverted colons were no longer dilated. In two patients, abnormal motility involving the entire colon was unchanged from the initial study, small bowel motility was abnormal, and we recommended no further surgery. In two cases, the colon remained abnormal but small bowel motility was normal, and we recommended subtotal colectomy and ileoproctostomy. In four cases, the left colon remained abnormal, but the right colon was normal, and we recommended reanastomosis after left hemicolectomy. In four cases, motility in the diverted colons was normal, including a gastrocolonic response and high‐amplitude propagating contractions, and the authors recommended reanastomosis. Defecation problems resolved in 10 of 12 when followed up 5 to 30 months after treatment.ConclusionThese data suggest that in some cases of intractable childhood constipation associated with colonic distention, temporary diversion improved colonic motility. Colonic manometry may be used to predict which patients will benefit from resection or reanastomosis.
Total Dose Intravenous Infusion of Iron Dextran for Iron‐Deficiency Anemia in Children With Inflammatory Bowel Disease
Authors: Mamula Petar , Piccoli David A. , Peck Susan N. , Markowitz Jonathan E. , Baldassano Robert N. 
Published: January 2024

ABSTRACTBackgroundIron‐deficiency anemia is a frequent complication in children with inflammatory bowel disease (IBD). Parenteral iron therapy is rarely prescribed because of concern about potential side effects. The aim of this study was to retrospectively evaluate the safety and efficacy of total dose intravenous (TDI) iron therapy.MethodsCharts of all the pediatric patients with IBD who received TDI iron therapy between February of 1994 and February of 2000 were reviewed.ResultsSeventy patients (20 with ulcerative colitis and 50 with Crohn disease) received a total of 119 TDI iron dextran infusions. Thirty‐four patients qualified for the efficacy analysis. The average increase in hemoglobin concentration was 2.9 g/dL, (P < 0.0001). Eleven immediate hypersensitivity reactions developed in 10 patients (9% of the total number of infusions). None of the reactions was life threatening and none required hospitalization.ConclusionsTotal dose intravenous infusion of iron dextran, when appropriately used, is a safe and potentially efficacious treatment for children with inflammatory bowel disease and iron deficiency anemia who are unresponsive to or noncompliant with oral iron therapy.
Gastrointestinal Malformations, Associated Congenital Abnormalities, and Intrauterine Growth
Authors: Tárnok András , Méhes Károly 
Published: January 2024

ABSTRACTBackgroundIn contrast with other malformations, congenital anomalies of the gastrointestinal tract have been scarcely investigated.MethodsThe prevalence of gastrointestinal malformations with special reference to associated disorders and intrauterine growth was retrospectively analyzed in the newborn infants admitted to the Neonatal Intensive Care Unit of the Department of Pediatrics, University of Pécs, Hungary, in the 14‐year period between 1987 and 2000.ResultsOf 4,241 neonates with gastrointestinal malformations, 241 (5.68%) had a total of 304 malformations (excluding Hirschsprung disease). In 133 patients, the gastrointestinal anomalies were observed as one of multiple malformations; a specific syndrome or association was diagnosed in 36 cases. Skeletal disorders were the most frequently associated anomalies. Intrauterine growth retardation was found in a large number of patients with both isolated and multiple gastrointestinal malformations (38.9% and 30.8%, respectively).ConclusionsGastrointestinal malformations often are complicated by skeletal anomalies and intrauterine growth retardation. The association among these disorders requires further investigation. However, from a practical point of view, this association should be considered in treating affected patients.
13C‐Urea Breath Test With Infrared Spectroscopy for Diagnosing Helicobacter pylori Infection in Children and Adolescents
Authors: Kawakami Elisabete , Machado Rodrigo Strehl , Reber Marialice , Patrício Francy Reis S. 
Published: January 2024

ABSTRACTBackground and ObjectiveStudies support the accuracy of 13C‐urea breath test for diagnosing and confirming cure of Helicobacter pylori infection in children. Three methods are used to assess 13CO2 increment in expired air: mass spectrometry, infrared spectroscopy, and laser‐assisted ratio analysis. In this study, the 13C‐urea breath test performed with infrared spectroscopy in children and adolescents was evaluated.MethodsSeventy‐five patients (6 months to 18 years old) were included. The gold standard for diagnosis was a positive culture or positive histology and a positive rapid urease test. Tests were performed with 50 mg of 13C‐urea diluted in 100 mL orange juice in subjects weighing up to 30 kg, or with 75 mg of 13C‐urea diluted in 200 mL commercial orange juice for subjects weighing more than 30 kg. Breath samples were collected just before and at 30 minutes after tracer ingestion. The 13C‐urea breath test was considered positive when delta over baseline (DOB) was greater than 4.0%.ResultsTests were positive for H. pylori in 31 of 75 patients. Sensitivity was 96.8%, specificity was 93.2%, positive predictive value was 90.9%, negative predictive value was 97.6%, and accuracy was 94.7%.Conclusions13C‐urea breath test performed with infrared spectroscopy is a reliable, accurate, and noninvasive diagnostic tool for detecting H. pylori infection.
Use of Quantitative Ultrasound to Assess Osteopenia in Children With Crohn Disease
Authors: Levine Arie , Mishna Leora , Ballin Ami , Givoni Shlomo , Dinari Gabriel , Hartman Corina , Shamir Raanan 
Published: January 2024

ABSTRACTBackground and AimsChildren with Crohn disease are at increased risk for osteopenia and osteoporosis. Early development of osteopenia can increase the lifetime risk for fractures and may be amenable to early intervention. The gold standard for measuring bone mineral density (BMD) and fracture risk is dual x‐ray absorptiometry (DXA), but this involves some radiation and specialized programs for measuring BMD in children. Bone density Z scores were evaluated with quantitative ultrasound (QUS) using a novel portable device and were compared with DXA in children with Crohn disease.MethodsThirty‐five children with documented Crohn disease (mean age 14.3 ± 2.3 years) had speed of sound measured at the left radius and left tibia. Normative values for QUS Z scores were calculated from a cohort of 1,110 healthy children. A subgroup of 26 children with Crohn disease underwent both QUS and DXA. Z scores were calculated and compared for both groups.ResultsThe mean Z score using lumbar spine DXA was −1.04 ± 1.51 SD, compared with −0.15 ± 1.49 SD, using the lowest Z score for QUS (P < 0.05). Using height adjusted DXA, 50% of children with Crohn disease had osteopenia, whereas QUS detected only 19.2% of these children (P < 0.05). Significantly fewer cases of osteopenia were detected using QUS at Z scores up to −2 SD.ConclusionsQuantitative ultrasound performed on the radius and tibia may not be sensitive enough to pick up osteopenia in children with Crohn disease.
Celiac Disease in India: Are They True Cases of Celiac Disease?
Authors: Poddar Ujjal , Thapa Babu Ram , Nain Chander Kanwal , Prasad Arun , Singh Kartar 
Published: January 2024

ABSTRACTBackgroundIn a developing country, many conditions other then celiac disease (CD) can give rise to villous atrophy. We therefore assessed the role of immunoglobulin A (IgA)–antigliadin antibody (AGA) in addition to the ESPGHAN criteria in the diagnosis of CD in 104 Indian children.MethodsConsecutive children with suspected CD were evaluated over 3 years with an intention to diagnose CD. Complete hemogram, d‐xylose absorption test, endoscopic duodenal biopsy, and IgA–AGA titers were performed in all. CD was diagnosed on the basis of modified ESPGHAN criteria irrespective of IgA–AGA positivity (>5 U/mL), and those diagnosed were put on gluten‐free diet and were monitored regularly. Children with suspected CD who had a normal duodenal biopsy result were taken as controls.ResultsThe mean age of 50 children with CD was 6.3 ± 2.6 years, with a male to female ratio of 3:2. The mean duration of symptoms was 3.4 ± 2.2 years. Predominant symptoms were pallor in 96%, failure to thrive in 92%, and diarrhea in 80%. On follow‐up (19.6 ± 8 months), symptoms subsided within 16 ± 9.8 days, and patients showed significant weight gain (mean weight at diagnoses and at last follow‐up visit were 66% and 86% of expected, respectively;P< 0.001) and height gain (mean height at diagnoses and at last follow‐up visit were 88% and 94% of expected, respectively;P= nonsignificant). The control group comprised 47 children with a mean age of 6.9 ± 3 years. On comparing CD with controls, diarrhea, anemia, low weight, and stunting were significantly (P< 0.001) more frequent in patients with CD. Sensitivity and specificity of AGA at a cutoff value of 5 U/mL were 94% and 91.5% and at 10 U/mL 88% and 100%, respectively. Follow‐up AGA test was performed in 42 of 47 positive cases. All showed significant decrease in AGA titer, and 29 (70%) had a negative test result.ConclusionsIndian children with CD are true cases of CD. They present late, diarrhea is absent in 20% of cases, and AGA test results show 88% of children without false‐positive results at a cutoff value of 10 U/mL. However, AGA test with 94% sensitivity at a cutoff value of 5 U/mL can be used as screening test to select suspected cases for further workup.
Linear Programming: A Mathematical Tool for Analyzing and Optimizing Children's Diets During the Complementary Feeding Period
Authors: Briend André , Darmon Nicole , Ferguson Elaine , Erhardt Juergen G. 
Published: January 2024

ABSTRACTDuring the complementary feeding period, children require a nutrient‐dense diet to meet their high nutritional requirements. International interest exists in the promotion of affordable, nutritionally adequate complementary feeding diets based on locally available foods. In this context, two questions are often asked: 1) is it possible to design a diet suitable for the complementary feeding period using locally available food? and 2) if this is possible, what is the lowest‐cost, nutritionally adequate diet available? These questions are usually answered using a “trial and error” approach. However, a more efficient and rigorous technique, based on linear programming, is also available. It has become more readily accessible with the advent of powerful personal computers. The purpose of this review, therefore, is to inform pediatricians and public health professionals about this tool. In this review, the basic principles of linear programming are briefly examined and some practical applications for formulating sound food‐based nutritional recommendations in different contexts are explained. This review should facilitate the adoption of this technique by international health professionals.
Body Composition and Components of Energy Expenditure in Children With End‐ Stage Liver Disease
Authors: Greer Ristan , Lehnert Megan , Lewindon Peter , Cleghorn Geoffrey J. , Shepherd Ross W. 
Published: January 2024

ABSTRACTBackgroundBetter understanding of body composition and energy metabolism in pediatric liver disease may provide a scientific basis for improved medical therapy aimed at achieving optimal nutrition, slowing progression to end‐stage liver disease (ESLD), and improving the outcome of liver transplantation.MethodsTwenty‐one children less than 2 years of age with ESLD awaiting liver transplantation and 15 healthy, aged‐matched controls had body compartment analysis using a four compartment model (body cell mass, fat mass, extracellular water, and extracellular solids). Subjects also had measurements of resting energy expenditure (REE) and respiratory quotient (RQ) by indirect calorimetry. Nine patients and 15 control subjects also had measurements of total energy expenditure (TEE) using doubly labelled water.ResultsMean weights and heights were similar in the two groups. Compared with control subjects, children with ESLD had higher relative mean body cell mass (33 ± 2% vs 29 ± 1% of body weight, P < 0.05), but had similar fat mass, extracellular water, and extracellular solid compartments (18% vs 20%, 41% vs 38%, and 7% vs 13% of body weight respectively). Compared with control subjects, children with ESLD had 27% higher mean REE/body weight (0.285 ± 0.013 vs 0.218. ± 0.013 mJ/kg/24h, P < 0.001), 16% higher REE/unit cell mass (P < 0.05); and lower mean RQ (P < 0.05). Mean TEE of patients was 4.70 ± 0.49 mJ/24h vs 3.19 ± 0.76 in controls, (P < 0.01).ConclusionsIn children, ESLD is a hypermetabolic state adversely affecting the relationship between metabolic and nonmetabolic body compartments. There is increased metabolic activity within the body cell mass with excess lipid oxidation during fasting and at rest. These findings have implications for the design of appropriate nutritional therapy.