Gastrointestinal Disease In Children Research Articles

Efficacy of lactose-free formula in acute diarrheal management for children under 5 years: a systematic review and meta-analysis

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time. Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis. Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores. Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group. Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.

Molecular epidemiology and antimicrobial resistance in Clostridioides difficile strains isolated from children and adolescents in a tertiary referral pediatric hospital in Fortaleza, Brazil

BackgroundC. difficile has been increasingly reported as a cause of gastrointestinal disease in children, ranging from mild self-limiting diarrhea to severe conditions such as pseudomembranous colitis and toxic megacolon. Only two pediatric research groups reported the presence of C. difficile infection in Brazilian children, but no previous research has examined C. difficile infection among children in northeastern Brazil. This prospective cross-sectional study investigated the molecular epidemiology and antimicrobial resistance of C. difficile strains isolated from children and adolescents with diarrhea referred to a tertiary pediatric hospital in Brazil while exploring the associated risk factors. ResultsToxin positivity or C. difficile isolation was found in 30.4 % (17/56) samples. C. difficile was isolated from 35 % (6/17) samples. Four toxigenic strains were identified (tpi+, tcdA+, tcdB+, cdtB-, without tcdC deletions) belonging to PCR ribotypes and PFGE-pulsotypes: 046 (new pulsotype 1174), 106 (NAP11), 002 (new pulsotype 1274), 012 (new pulsotype NML-1235). Two of the six isolates belonging to ribotypes 143 and 133 were non-toxigenic. All toxigenic strains were sensitive to metronidazole and vancomycin. Regarding the clinical manifestation, diarrhea lasted an average of 11 days, ranging from 3 to 50 days and was often associated with mucus and/or blood. All six patients from whom the C. difficile was isolated had a chronic disease diagnosis, with these comorbidities as the main risk factors. ConclusionOur study enhances our understanding of the present epidemiological landscape of C. difficile-associated diarrhea (CDI) among children in northeastern Brazil, reveling a substantial CDI frequency of 30.4 %, with toxigenic strains detected in 76.4 % of cases, highlighting a higher prevalence compared to earlier Brazilian studies. In the globalized world, an understanding of disease-generating strains, the associated risk factors, clinical manifestation, and antimicrobial sensitivity has fundamental epidemiological importance and draws attention to preventive measures, allowing for more decisive action.

Serum Eosinophilic Cationic Protein as a Useful Noninvasive Marker of Eosinophilic Gastrointestinal Disease in Children.

Recently, the prevalence of eosinophilic gastrointestinal disease (EGID) has shown an increasing trend worldwide. As the diagnosis of EGID requires invasive endoscopy with biopsy, noninvasive markers for detecting EGID in suspected patients, particularly children, are urgently needed. Therefore, this study aimed to evaluate the diagnostic accuracy of serum eosinophil cationic protein (ECP) beyond peripheral eosinophil counts in pediatric patients with EGID. Overall, 156 children diagnosed with EGID were enrolled and 150 children with functional abdominal pain disorder (FAPD) were recruited as controls. All participants underwent endoscopic biopsy in each segment of the gastrointestinal (GI) tract and serum ECP measurement, as well as peripheral eosinophil percent and absolute eosinophil count. Comparing EGID (n=156) with FAPD (n=150) patients, serum ECP levels were significantly higher in pediatric patients with EGID than in those with FAPD (25.8±28.6 µg/L vs. 19.5±21.0 µg/L, p=0.007), while there was no significant difference in peripheral eosinophil percent and absolute eosinophil counts between the two groups. Serum ECP levels were correlated with peripheral eosinophil percent (r=0.593, p<0.001) and the absolute eosinophil count (r=0.660, p<0.001). The optimal cutoff value of serum ECP for pediatric EGID was 10.5 µg/mL, with a sensitivity of 69.9% and a specificity of 43.4% with an area under the receiver operating characteristic curve of 0.562. The combination of serum ECP levels and peripheral eosinophil counts, when employed with appropriated thresholds, could serve as a valuable noninvasive biomarker to distinguish between EGID and FAPD in pediatric patients manifesting GI symptoms.

552 Using the TriNetX database to describe the prevalence of VTE and gastrointestinal disease in children with cystic fibrosis

552 Using the TriNetX database to describe the prevalence of VTE and gastrointestinal disease in children with cystic fibrosis

Exploring GI Diseases Across the Lifespan.

Exploring GI Diseases Across the Lifespan.

Gastrointestinal disease in children with autism spectrum disorders: Etiology or consequence?

Chronic gastrointestinal (GI) symptoms and disorders are common in children with autism spectrum disorder and have been shown to be significantly correlated with the degree of behavioral and cognitive impairment. In this unique population, GI symptoms often arise very early in development, during infancy or toddlerhood, and may be misdiagnosed - or not diagnosed at all – due in part to the challenges associated with recognition of symptoms in a minimally or non-communicative child. Evidence demonstrating that the gut-brain-axis can communicate gut dysbiosis and systemic immune dysregulation in a bidirectional manner raises the question as to whether an untreated gastrointestinal disorder can directly impact neurodevelopment or, conversely, whether having a neurodevelopmental disorder predisposes a child to chronic GI issues. From the data presented in this mini review, we conclude that the preponderance of available evidence would suggest the former scenario is more strongly supported.

Pediatric Functional Constipation and Whey Protein: A Randomized Clinical Trial

Background: Functional constipation is a chronic gastrointestinal disease in children. Pharmacological treatment of constipation is mostly based on the prescription of laxatives. In addition to this treatment, complementary therapies were also proposed to treat constipation. In this study, the effect of whey protein in the treatment of constipation was investigated.&#x0D; Method and Materials: A total of 56 children with functional constipation within the age range of 1 to 16 years were included in the study. Patients were randomly divided into the intervention (n=28) and control (n=28) groups. The intervention group received 15 g whey protein and the control group received 15 g placebo. Both groups received 0.4 - 0.8 gr/kg PEG powder. The amount of PEG was adjusted every four days based on having soft stools. Demographic information were collected and recorded. Furthermore, fecal consistency, stool frequency, symptoms of stool retention, fecal incontinence, and abdominal pain were recorded prior to the intervention and at the second and fourth weeks of the intervention.&#x0D; Results: All patients had soft daily stools at the end of the intervention. At the end of the fourth week, the mean required amounts of PEG powder were respectively 0.62 and 0.28 g/kg in the control and intervention groups, which showed a significant difference (p value ≤0.001).&#x0D; Conclusion: Based on these findings, whey protein is safe and can improve constipation. However, more studies with larger sample size and longer follow-up period are needed to confirm the results of this study.

Role of vitamin D in pediatric irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disease in children and has the clinical manifestations of recurrent abdominal pain with the changes in defecation frequency or stool form. Many studies have shown that children with IBS have a significantly lower vitamin D level than the healthy population, and vitamin D supplementation can significantly improve the clinical symptoms and quality of life of the children, suggesting that vitamin D supplementation may play a role in the treatment of IBS. This article reviews the association between vitamin D and IBS in children and elaborates on the possible mechanism of action of vitamin D.

Application of the Effect of Latitude on the Starting of Hand, Foot, and Mouth Disease Epidemic on Early Warning in Dalian, Liaoning Province, China

ABSTRACT Hand, foot, and mouth disease (HFMD) is a common infectious gastrointestinal disease in children under the age of 5. Many studies have documented that meteorological variables, especially temperature, are associated with HFMD. Since the general climate patterns occur as latitude increases, so latitude may indirectly influence the peak time of HFMD. The objective of this study was to explore the effect of latitude on the starting of an HFMD epidemic in Dalian, which can help in the development of an early warning model of HFMD in difference latitude districts. Spearman’s rank correlation coefficient was used to analyze the tendency of HFMD incidence rate over the year. A circular distribution method was used to calculate the gold standard of beginning of the HFMD epidemic. A negative binomial regression model was used to establish the early warning of the starting of the HFMD epidemic. The annualized crude incidence rate of HFMD disease in Dalian, Liaoning Province, China as a whole was 169.14 per 100,000 from 2009 to 2013.The incidence rate of HFMD varied considerably by district during the study period, but there was no significant declining or rising trend in disease incidence over the years by district of Dalian. The circular statistical analysis results showed that there was latitudinal gradient in the starting of the HFMD epidemic except for region B; the starting time of HFMD epidemic of Region A was earlier than other regions range 9 days to 18 days. The starting time of the HFMD epidemic differs from region to region with different latitudes in Dalian, Liaoning Province, China. This result can provide a scientific basis for early warning of HFMD.

Gut Microbiota in Children With Cystic Fibrosis: A Taxonomic and Functional Dysbiosis

Intestinal dysbiosis has been observed in children with cystic fibrosis (CF), yet the functional consequences are poorly understood. We investigated the functional capacity of intestinal microbiota and inflammation in children with CF. Stool samples were collected from 27 children with CF and 27 age and gender matched healthy controls (HC) (aged 0.8–18 years). Microbial communities were investigated by iTag sequencing of 16S rRNA genes and functional profiles predicted using Tax4Fun. Inflammation was measured by faecal calprotectin and M2-pyruvate kinase. Paediatric CF gastrointestinal microbiota demonstrated lower richness and diversity compared to HC. CF samples exhibited a marked taxonomic and inferred functional dysbiosis when compared to HC. In children with CF, we predicted an enrichment of genes involved in short-chain fatty acid (SCFA), antioxidant and nutrient metabolism (relevant for growth and nutrition) in CF. The notion of pro-inflammatory GI microbiota in children with CF is supported by positive correlations between intestinal inflammatory markers and both genera and functional pathways. We also observed an association between intestinal genera and both growth z-scores and FEV1%. These taxonomic and functional changes provide insights into gastrointestinal disease in children with CF and future gastrointestinal therapeutics for CF should explore the aforementioned pathways and microbial changes.

The Prevalence of Cryptosporidium among Children Hospitalized because of Gastrointestinal Symptoms and the Efficiency of Diagnostic Methods for Cryptosporidium.

Cryptosporidium is a parasite that causes watery diarrhea among both children and adults. However, because many physicians do not routinely ask for Cryptosporidium diagnostic test, cryptosporidiosis prevalence is likely underestimated. The current study investigated the prevalence of cryptosporidiosis among children admitted to the hospital with gastrointestinal symptoms. Stool sample was collected from each child and subjected to routine microbiological culture. Cryptosporidium presence was tested by three different methods: real-time PCR (RT-PCR), quick antigen, and microscopic examination with acid-fast staining. Each positive specimen was further tested with BioFire FilmArray Multiplex PCR (bioMérieux SA, Marcy-l'Etoile, France) to determine that Cryptosporidium is the only pathogen in the sample. Demographic and epidemiological data were collected from the patients' medical records. Of 291 patient stool samples, nine were positive for Cryptosporidium hominis or Cryptosporidium parvum. The average age of the nine Cryptosporidium-positive cases was 2.3 years, lower than the average age of the study population (4.2 years). Of the positive cases, 66.7% were Arabs and 33.3% were Jews. The main complaint of children with Cryptosporidium was diarrhea. Regarding the laboratory methods for Cryptosporidium identification, of the positive samples, 100% (9/9) were identified by RT-PCR, 88% (8/9) were positive by antigen test, and only 67% (6/9) were positive by microscopic examination with acid-fast staining. Because of the low incidence of Cryptosporidium among patients in our facility, the prevalence of cryptosporidiosis still cannot be established. Nevertheless, among the other pathogens found in stool samples, Cryptosporidium is the second leading cause of hospitalization due to gastrointestinal disease in children in our area.

Clinical analysis of enteral nutrition in 47 children

To explore the efficacy and safety of the application of enteral nutrition (EN) in gastrointestinal disease in children, and to explore the possibility of the implementation of family EN. Retrospective analysis of disease spectrum, EN approach, preparation, speed and time as well as adverse reactions and outcomes in 47 pediatric patients with gastrointestinal disease underwent EN therapy during July 2014 to March 2015. The nutrition indicators before and after EN therapy were compared by paired t-test. A total of 47 patients were selected, 27 male (57%) and 20 female (43%), aged 0.8 (0.3, 4.0) years, 9 with mechanical or chemical damage to the esophagus, 7 with inflammatory bowel disease (including ulcerative colitis and Crohn's disease), 6 with chronic diarrhea, 5 with acute pancreatitis, 3 with acute diarrhea and severe malnutrition, 3 with short bowel syndrome, 3 with improper feeding, 3 with feeding difficulties, 3 with protein losing enteropathy, 2 with post-enterostomy, 2 with enterocolitis, 1 with gastroesophageal reflux, were diagnosed. Of 47 cases, 22 were given oral nutrition, 28 were fed with nasogastric tube and 4 with nasojejunal tube feeding, 2 with percutaneous endoscopic gastrojejunostomy tube feeding for each. In these tube-feeding cases, 20 cases were treated with continuous infusion and 21 cases with intermittent infusion. Eleven cases were fed with amino acid formula; 21 cases took the choice of peptide formulations; 16 cases chose whole protein formula, including six cases who chose 3.3-4.2 kJ/ml higher energy density formula, 10 cases selected common energy density formula including breast milk. Twenty-one cases suffered from different degrees of adverse reactions, including vomiting in 7 cases, abdominal pain and bloating in 3, diarrhea in 12, secondary respiratory infections in 5. Five patients were discharged after giving up of treatment by parents due to poor efficacy on primary disease; 3 cases were transferred to other departments for further treatment; 15 cases were discharged with a feeding tube for family nutrition and specialist out-patient treatment. The rest 24 cases were all improved and discharged. There were significant differences in nutrition indicators before and after EN, weight-for-age Z score (WAZ)(-2.3±1.9 vs. -1.9±1.8, t=4.156, P=0.000), weight-for-height Z score (WHZ)(-1.9±1.7 vs. -1.2±1.5, t=3.714, P=0.001), albumin ((35±9)g/L vs.(39±6) g/L, t=3.017, P=0.005) and prealbumin ((0.11±0.05)g/L vs.(0.18±0.07)g/L, t=5.144, P=0.000). EN is suitable for a variety of children's digestive diseases, which can improve the nutritional status of the patients and was safe for clinical application. As the implementation of EN is simple and has good compliance, family EN is proven to be feasible.

ROLE OF ABDOMINAL ULTRASOUND IN EVALUATION OF CHILDREN WITH SUSPECTED UPPER GASTROINTESTINAL DISEASE.

To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and describe the gastrointestinal disease patterns that can be evaluated by ultrasound. Descriptive prospective study. Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of one year five months. Seventy seven percent were two years and below. Of the 56. children, six were normal on sonography; 18 (32.1%) had intussusception, 16 (28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejunal/ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male: female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with bloodstained stool. More than two thirds of the children with gastro-oesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusception,jejunal/ ileal atresia and enteric duplication cysts. Trans-abdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionising radiation. Findings in this study confirm that ultrasound is an accurate, reliable and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.

De novo food sensitization and eosinophilic gastrointestinal disease in children post‐liver transplantation

Children have increased prevalence of food allergy (FA) and eosinophilic gastrointestinal disease (EGID) following liver transplantation. The aim of this study was to identify related risk factors. Chart review of pediatric liver transplant (LT) recipients with de novo FA and/or EGID post-LT and non-allergic controls. We identified 30 (8.5%) children with FA and/or EGID among 352 pediatric LT recipients. Median age at transplant was 0.9 inter-quartile range (IQR 0.6-2.0) years. FA developed at a median 1.0 (IQR 0.5-8.2) yr post-LT and manifested with gastrointestinal symptoms (53%) or urticaria/angioedema (40%). Commonly avoided foods included milk (60%), egg (57%), and peanut (47%). Of the 15 children with FA who underwent endoscopy, 11 had eosinophilic infiltrates in multiple segments of the esophagus alone or in combination with other bowel segments. FA and EGID were linked to transplantation at a younger age (median, 0.9 vs. 5.5 yr), higher frequency of blood eosinophilia, and prior history of rhinitis and atopic dermatitis. Tacrolimus use and tacrolimus serum levels were similar between allergic subjects and controls. Findings suggest that exposure to tacrolimus alone post-LT is insufficient to initiate de novo allergic disease in LT recipients; rather, younger age and underlying predisposition to atopic disease may play larger roles.

Relationship between Celiac Disease Markers and Gastrointestinal Disease in Children with Autism

Aim This study was designed to determine if there is a relationship between celiac disease (CD) and the presence of gastrointestinal disease (GI) disease in children with autism. Subjects and Methods One hundred twenty-two children were tested for IgG and IgA anti-transglutaminase autoantibodies (55 autistic children with GI disease, 28 non autistic children with no GI disease, 30 autistic children with no GI disease, and 9 non autistic children with GI Disease). We also compared the presence/level of these autoantibodies to presence of anti-neutrophil cytoplasmic antibodies (ANCA) and level of Alpha-1 Antitrypsin (AAT). Results We did not find a significant difference in the level of anti-transglutaminase IgG or IgA in autistic children with GI disease compared to controls. However, we found a significant relationship between the presence of ANCA and low-level IgG anti-transglutaminase IgG in children with autism and GI disease. Discussion Although there appears to be no relationship between these celiac disease markers and the presence of GI disease in autistic children, these results suggest a possible association between sub diagnostic levels of anti-transglutaminase IgG and the presence of ANCA, and therefore, supports the hypothesis that there is a generalized autoimmune dysfunction in autistic children with GI disease.

Helicobacter pylori as cause of gastrointestinal disease in children with hemato‐oncologic diseases

After documentation of a case of life threatening Helicobacter pylori (H. pylori) gastric ulcer in an adolescent girl on treatment for acute lymphoblastic leukaemia, we started to systematically look for gastro-intestinal symptoms due to H. pylori infection in our cancer patients at G. Gaslini Children's Hospital. During a period of 46 months, we observed 13 further cases of severe dyspepsia syndrome or gastro intestinal bleeding associated with presence of H. pylori faecal antigen. All patients recovered with appropriate therapy. H. pylori may represent a cause of severe gastrointestinal complications in children with cancer or following bone marrow transplant.

The evaluation and treatment of gastrointestinal disease in children with cystinosis receiving cysteamine

Objectives Cysteamine prevents organ damage in children with cystinosis, but may cause gastrointestinal (GI) symptoms. In this study we evaluated the nature of GI disease, and the value of omeprazole in controlling GI symptoms in these children. Study design Upper GI disease was evaluated with endoscopy, gastrin levels, and acid secretion studies after oral administration of cysteamine, before and after 16 weeks of therapy with omeprazole. A symptom score was devised. Results Eleven children (mean age, 5.7 years) were studied. After cysteamine ingestion, before and after omeprazole therapy, the mean maximum acid output was significantly higher than the mean basal acid output. The maximum acid output was measured within 60 minutes of cysteamine ingestion and was reduced by omeprazole therapy ( P<.01). The mean peak gastrin level was 30 minutes postcysteamine and was higher than baseline ( P<.01). The initial mean symptom score (maximum score, 14) was 6.9 and fell to 0.7 ( P<.0001) after 16 weeks of omeprazole therapy. At endoscopy, two children had diffuse gastric nodularity, and nearly all had cystine crystal deposits. Conclusions GI symptoms in children with cystinosis receiving cysteamine are often acid-mediated and improve with omeprazole. Cystine crystals were detected in the GI tract and may signify inadequate treatment with cysteamine.

Clinical aspects and pathophysiology of inflammatory bowel disease.

The chronic inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, are recognized as important causes of gastrointestinal disease in children and adults. In this review we delineate the clinical manifestations and diagnostic features of IBD. In addition, we summarize important recent advances in our understanding of the immune mediators of intestinal inflammation. This information has led to new therapeutic approaches in IBD. Further, we discuss the considerable data that point to the significance of genetic factors in the development of IBD and the genetic loci which have been implicated through genome-wide searches. The commensal bacterial flora also appears to be a critical element, particularly in regards to Crohn's disease, although the precise role of the bacteria in the disease manifestations remains unclear. Current investigations promise to yield fresh insights in these areas.

Pediatric Endoscopy

The emergence of pediatric gastroenterology as a subspecialty and improved design and widespread distribution of small diameter endoscopes have combined to foster dramatic expansion in the practice of pediatric endoscopy over the past three decades. Endoscopic evaluation and treatment of gastrointestinal disease in children has led to new diagnoses and provided exciting opportunities for nonsurgical treatment. This article will focus on important pediatric applications, highlight differences with adult practice, and anticipate future research and development of pediatric endoscopy.

Update on medications used to treat gastrointestinal disease in children.

Progress in the pharmacotherapy of pediatric gastrointestinal diseases continued during 1998 despite ongoing obstacles encountered by clinicians and researchers. The major change involved warnings that cisapride, a widely used prokinetic agent, could cause potentially fatal arrythmias in susceptible people. The risk for children is unclear and a consensus of prescribing guidelines is needed. Excellent pediatric-oriented reviews have been published that summarize our knowledge of proton pump inhibitors, probiotics, 5-hydroxtryptamine-3 (5-HT3) antagonists, and the treatment of gastrointestinal infections and chronic abdominal pain. Triple medication therapy for the eradication of Helicobacter pylori is now the standard of care, but the optimal combination and duration of therapy needs to be determined. Also described are interesting developments requiring further confirmation: the treatments of infectious diarrhea with zinc; achalasia and Hirschsprung's disease with botulinum toxin; weight loss with megestrol acetate; and sialorrhea with glycopyrollate.