bluuebunny/crossref_metadata_2025_split 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

ABSTRACTObjectivesGastrointestinal 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.MethodsIn 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.ResultsIn 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.ConclusionsEnteral 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

ABSTRACTBackground/AimsDespite 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.MethodsStandardized 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).ResultsAmong 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.ConclusionsThe 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

ABSTRACTBackgroundA 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.MethodsEnteropathy 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.ResultsGliadin‐ 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.ConclusionPathologic 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

ABSTRACTBackgroundDespite 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.MethodsConsecutive 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.Results96 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.ConclusionsHair 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

ABSTRACTBackgroundThe purpose of the study is the investigation of perinatal nutrition in the early Byzantine period.MethodsThe original Greek language works of the celebrated physician of the fourth century, Oribasius, were studied.ResultsThe 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.ConclusionsThe 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

ABSTRACTObjectivesSphingomyelin (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.MethodsSeven‐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.ResultsIntestinal 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.ConclusionsThe 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

ABSTRACTBackgroundThe 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.MethodsA 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.ResultsSixty 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%).ConclusionUltrasound 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

ABSTRACTBackgroundThe 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.MethodsChart review of children with Crohn disease (CD). Esophageal Crohn disease was defined by accepted endoscopic and/or histologic findings.Results210 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.ConclusionThe 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

ABSTRACTBackgroundA 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.MethodsOne 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.ResultsAt 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.ConclusionsThe 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

ABSTRACTObjectivesThe 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.MethodsForty 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.ResultsSeven 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).ConclusionsIBC 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

ABSTRACTObjectives: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

ABSTRACTBackground: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

ABSTRACTObjectiveTo evaluate the efficacy and safety of propofol and meperidine plus midazolam for sedation during esophagogastroduodenoscopy (EGD) in children.MethodsData 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.ResultsThe 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.ConclusionsPropofol is safe and effective for facilitating EGD in children.