Gastrointestinal Disorders In Children Research Articles

High prevalence of gastrointestinal disorders in a large cohort of patients with joint hypermobility.

The gastrointestinal (GI) manifestations in children with hypermobile Ehlers-Danlos syndrome/joint hypermobility syndrome (hEDS/JHS) are not well described. We investigated the prevalence of GI disorders in children and young adults with hEDS/JHS through a single-center retrospective review. Demographic data, clinical history, symptoms, and diagnostic studies were reviewed. Of 435 patients with hEDS/JHS, 66% were females (age 5-28 years). We noted a high prevalence of constipation (61%), dysphagia (32%), dyspepsia and/or gastroparesis (25%), eosinophilic esophagitis (EoE) (21%), and celiac disease (4%) in our cohort. Upper endoscopy and gastric emptying scans had the highest yield to detect abnormalities. Motility studies were abnormal in 31% of the 80 patients who underwent them. Dysphagia symptoms are significantly associated with EoE. Thirty-three percent of dysphagia patients had EoE, versus 16%of non-dysphagia patients (p < 0.001). Screening hEDS/JHS patients for GI issues should be routine, with further investigations and referrals guided by identified symptoms.

Probiotic formulations and gastro-intestinal diseases in the paediatric population: a narrative review.

Probiotics are live microbial supplements that improve the microbial balance in the host animal when administered in adequate amounts. They play an important role in relieving symptoms of many diseases associated with gastrointestinal tract, for example, in necrotizing enterocolitis (NEC), antibiotic-associated diarrhea, relapsing Clostridium difficile colitis, Helicobacter pylori infections, and inflammatory bowel disease (IBD). In this narrative review, the authors aim to evaluate the role of different probiotic formulations in treating gastrointestinal diseases in pediatric population aged 18 years or younger and highlight the main considerations for selecting probiotic formulations for use in this population. The authors searched PubMed and Clinicaltrials.gov from inception to 24th July 2022, without any restrictions. Using an iterative process, the authors subsequently added papers through hand-searching citations contained within retrieved articles and relevant systematic reviews and meta-analyses. The effectiveness of single-organism and composite probiotics in treating gastrointestinal disorders in pediatric patients aged 18 or under were analyzed and compared in this study. A total of 39 studies were reviewed and categorized based on positive and negative outcomes, and compared with a placebo, resulting in 25 studies for single-organism and 14 studies for composite probiotics. Gastrointestinal disorders studied included NEC, acute gastroenteritis (AGE), Acute Diarrhea, Ulcerative Colitis (UC), and others. The results show that probiotics are effective in treating various gastrointestinal disorders in children under 18, with single-organism probiotics demonstrating significant positive outcomes in most studies, and composite probiotics showing positive outcomes in all studies analyzed, with a low incidence of negative outcomes for both types. This study concludes that single-organism and composite probiotics are effective complementary therapies for treating gastrointestinal disorders in the pediatric population. Hence, healthcare professionals should consider using probiotics in standard treatment regimens, and educating guardians can enhance the benefits of probiotic therapy. Further research is recommended to identify the optimal strains and dosages for specific conditions and demographics. The integration of probiotics in clinical practice and ongoing research can contribute to reducing the incidence and severity of gastrointestinal disorders in pediatric patients.

Activation of ASIC3/ERK pathway by paeoniflorin improves intestinal fluid metabolism and visceral sensitivity in slow transit constipated rats.

Slow transit constipation (STC) is one of the most common gastrointestinal disorders in children and adults worldwide. Paeoniflorin (PF), a monoterpene glycoside compound extracted from the dried root of Paeonia lactiflora, has been found to alleviate STC, but the mechanisms of its effect remain unclear. The present study aimed to investigate the effects and mechanisms of PF on intestinal fluid metabolism and visceral sensitization in rats with compound diphenoxylate-induced STC. Based on the evaluation of the laxative effect, the abdominal withdrawal reflex test, enzyme-linked immunosorbent assay, quantitative real-time polymerase chain reaction, western blot, and immunohistochemistry were used to detect the visceral sensitivity, fluid metabolism-related proteins, and acid-sensitive ion channel 3/extracellular signal-regulated kinase (ASIC3/ERK) pathway-related molecules. PF treatment not only attenuated compound diphenoxylate-induced constipation symptoms and colonic pathological damage in rats but also ameliorated colonic fluid metabolic disorders and visceral sensitization abnormalities, as manifested by increased colonic goblet cell counts and mucin2 protein expression, decreased aquaporin3 protein expression, improved abdominal withdrawal reflex scores, reduced visceral pain threshold, upregulated serum 5-hydroxytryptamine, and downregulated vasoactive intestinal peptide levels. Furthermore, PF activated the colonic ASIC3/ERK pathway in STC rats, and ASIC3 inhibition partially counteracted PF's modulatory effects on intestinal fluid and visceral sensation. In conclusion, PF alleviated impaired intestinal fluid metabolism and abnormal visceral sensitization in STC rats and thus relieved their symptoms through activation of the ASIC3/ERK pathway.

Psycho-emotional state during pregnancy and one year after childbirth in mothers of children with functional gastrointestinal disorders

Aim. To determine the relationship between the incidence of functional gastrointestinal disorders in children up to 1 year of age and the psycho-emotional state of their mothers during pregnancy and after childbirth.&#x0D; Materials and methods. A survey of 1203 mothers of children under 4 years of age was conducted using a questionnaire of functional gastrointestinal disorders according to the Rome IV criteria (2016). The questionnaire contained domains on general issues (the age of the mother at the time of the child's birth, the data of obstetric and gynecological anamnesis, the type of child's nutrition at the time of the survey), psycho-emotional state (retrospectively, the psychological component of the gestational dominant – PСGD – during pregnancy, Beck's anxiety and Beck's depression questionnaires) and questions on functional disorders in infants and young children.&#x0D; Results. Questionnaires of 487 mothers of children of the 1st year of life were analyzed. Only in 34.4% of cases, mothers' responses lacked anxious and depressive PCGD. In mothers with anxious PСGD, the risk of regurgitation in their children was statistically significantly 2-fold higher compared to mothers with depressive PСGD. In mothers with optimal PСGD, the rate of colic in their children was statistically significantly 2-fold lower compared to mothers with anxious and depressive PСGD. After childbirth, anxiety was noted in 17% mothers and signs of depression in 59% mothers. Significant and severe depression was diagnosed in 10% mothers; the children of these mothers had persistent regurgitation.. In the absence of depression in mothers, the probability of no regurgitation and colic in their children was statistically significantly 2-fold higher compared to the children of mothers with depression.&#x0D; Conclusion. The incidence of functional gastrointestinal disorders in a child up to 1 year of age is associated with maternal anxiety during pregnancy and maternal depression after childbirth.

Functional gastrointestinal disorders in children: a single centre experience

Functional gastrointestinal disorders in children: a single centre experience

Yoga Therapy in Functional Dyspepsia. A Narrative Review.

Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.

Evaluation of the physical activity in children with functional gastrointestinal disorders

Abstract. Functional gastrointestinal disorders have been known for centuries. However, this concept appeared quite recently, and is currently a common pediatric problem. Interest in functional pathology is fully justified and understandable: despite the fact that functional diseases of the gastrointestinal tract do not pose a direct threat to the patient’s life, they significantly reduce the quality of his life. The problem of functional disorders is also complicated by the fact that they affect all strata of society, regardless of age, socio-economic status, gender or race. The active process of studying the clinical and anamnestic features of various nosological forms, predictors of functional disorders, combined functional disorders and prevention approaches is also due to significant economic damage due to direct and indirect costs of their treatment. The prevalence of functional gastrointestinal disorders in the world reaches 40.3 %, and among children's gastro pathology they occupy one of the leading places. More than half of children of various age groups have at least one of the symptoms, which is a cause of concern for both the child and the parents, as well as entails a violation of the microclimate in the family. The peak prevalence of various symptoms of disorders of the gastrointestinal tract occurs at school age and adolescents, who almost fill the appointment of a pediatrician and a pediatric gastroenterologist. If we trace the evolution of ideas about functional disorders of the digestive organs, it can be noted that it changed many times and influenced the understanding of the pathogenesis and, especially, the etiology of this nasology. According to the Rome Consensus IV (2016), functional gastrointestinal disorders are defined as disorders of the interaction of the «gut-brain» axis, taking into account this concept, a lot of time has been devoted to studying the role of various factors: genetic predisposition, infection theory, nature of feeding at an early age, hormonal imbalance, psychological state, food preferences, lifestyle and physical activity. An important aspect of studying predictors of functional bowel disorders is the level of physical activity of children and adolescents. In the process of studying literary data, it was noted that the role of insufficient physical activity in the development of functional gastrointestinal disorders remains not fully determined. Most of the materials are related to the adult population and critically few among children. That complicates the study of forecasting and prevention of a more severe course of functional dyspepsia and irritable bowel syndrome, and, as a consequence, to optimize therapy. The aim of the study was to assess the level of physical activity in children with FGID. Materials and methods. 72 children aged 8–14 with FGIR were observed. I group of study included 26 patients with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the II group – 46 patients with FD. The control group included 22 healthy children. The diagnosis of FD and IBS were established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The PAQ-C questionnaire, developed by K. Kowalski, P. Kroker, and R. Donen, was used to assess PA in children. Research results. The total PA index in children with combined FD and SPC was 1,87 ± 0,07 and was lower compared to the group of children with FD (2,21 ± 0,05; p &lt; 0,05) and the control group (2,75 ± 0,05; p &lt; 0,01). The total PA index in children with FD is lower than in the control group (p &lt; 0,01). Conclusion. Insufficient physical activity can be considered a risk factor for the development of functional gastrointestinal disorders in children.

The influence of serotonin on the formation of clinical symptoms of functional gastrointestinal disorders in children

The influence of serotonin on the formation of clinical symptoms of functional gastrointestinal disorders in children

Prebiotics in New-Born and Children's Health.

At present, prebiotics, like probiotics, are receiving more attention as a promising tool for health maintenance. Many studies have recognized the role of prebiotics in preventing and treating various illnesses including metabolic disorders, gastrointestinal disorders, and allergies. Naturally, prebiotics are introduced to the human body in the first few hours of life as the mother breastfeeds the newborn. Prebiotic human milk oligosaccharides (HMOs) are the third largest constituent of human breastmilk. Studies have proven that HMOs modulate an infant's microbial composition and assist in the development of the immune system. Due to some health conditions of the mother or beyond the recommended age for breastfeeding, infants are fed with formula. Few types of prebiotics have been incorporated into formula to yield similar beneficial impacts similar to breastfeeding. Synthetic HMOs have successfully mimicked the bifidogenic effects of breastmilk. However, studies on the effectiveness and safety of consumption of these synthetic HMOs are highly needed before massive commercial production. With the introduction of solid foods after breastfeeding or formula feeding, children are exposed to a range of prebiotics that contribute to further shaping and maturing their gut microbiomes and gastrointestinal function. Therefore, this review evaluates the functional role of prebiotic interventions in improving microbial compositions, allergies, and functional gastrointestinal disorders in children.

Association between MIS-C and Functional Gastrointestinal Disorders in Children: A Cross-Sectional Study

Abstract Objective Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of coronavirus disease 2019 which causes a hyperinflammatory syndrome that can affect all organ systems. Functional gastrointestinal disorders (FGIDs) are a heterogeneous disease spectrum with unclear etiology. Today, it is known that low-grade inflammation can cause FGIDs. Our aim in this study was to investigate whether there is a higher frequency of FGID in children diagnosed with MIS-C. Methods In this study, 48 pediatric patients diagnosed with MIS-C were evaluated for functional gastrointestinal diseases according to the Rome IV criteria at least 6 months after diagnosis. The control group consisted of 61 pediatric patients without any chronic disease. Results In our study, the overall prevalence of FGIDs was 54.1% (n = 26) in the patient group and 22.9% (n = 14) in the control group. The difference between the groups was statistically significant (p &lt; 0.001). The frequencies of undiagnosed abdominal pain, irritable bowel syndrome, constipation, and dyspepsia were 41.6% (n = 20), 12.5% (n = 6), 8.3% (n = 4), and 6.2% (n = 3) in the patient group, respectively. In the control group, the corresponding rates were 9.8% (n = 6), 3.2% (n = 2), 4.9% (n = 3), and 4.9% (n = 3), respectively. A significant difference was observed between the patient and control groups in terms of functional abdominal pain (p &lt; 0.001). Conclusion The overall frequency of FGIDs and the prevalence of functional abdominal pain were higher in MIS-C patients than in control subjects. The data from this study support the hypothesis that FGIDs are more common in patients diagnosed with MIS-C than in healthy controls.

Role of gastrointestinal health in managing children with autism spectrum disorder.

Children with autism spectrum disorders (ASD) or autism are more prone to gastrointestinal (GI) disorders than the general population. These disorders can significantly affect their health, learning, and development due to various factors such as genetics, environment, and behavior. The causes of GI disorders in children with ASD can include gut dysbiosis, immune dysfunction, food sensitivities, digestive enzyme deficiencies, and sensory processing differences. Many studies suggest that numerous children with ASD experience GI problems, and effective management is crucial. Diagnosing autism is typically done through genetic, neurological, functional, and behavioral assessments and observations, while GI tests are not consistently reliable. Some GI tests may increase the risk of developing ASD or exacerbating symptoms. Addressing GI issues in individuals with ASD can improve their overall well-being, leading to better behavior, cognitive function, and educational abilities. Proper management can improve digestion, nutrient absorption, and appetite by relieving physical discomfort and pain. Alleviating GI symptoms can improve sleep patterns, increase energy levels, and contribute to a general sense of well-being, ultimately leading to a better quality of life for the individual and improved family dynamics. The primary goal of GI interventions is to improve nutritional status, reduce symptom severity, promote a balanced mood, and increase patient independence.

Features of drug therapy for functional gastrointestinal disorders in children of preschool and primary school age

The article explores modern concepts about functional gastrointestinal disorders in children, considers features of the classification according to the Rome criteria and Russian clinical guidelines, and presents the evolution of views in the context of understanding the general pathophysiological mechanism as impaired “gut-brain” interactions, which leads to dysmotility in different parts of the gastrointestinal tract, visceral hypersensitivity, changes in the local immune system functions, dysbiosis of the gut microbiota and a failure of the central nervous system to process signals. Dysregulation of the central nervous system and the enteric nervous system causes functional gastrointestinal disorders with pain syndrome: irritable bowel syndrome, functional dyspepsia and centrally mediated abdominal pain syndrome. In addition, the article discusses the Russian version of the guidelines due to differences in the diagnostic instrumental and laboratory facilities, as well as national peculiarities of marketing authorization, indications and contraindications for drug use in children. Subject to understanding of the mechanisms of functional gastrointestinal disorders in children, the authors presented information on the role of trimebutine, a universal motility regulator of different parts of the gastrointestinal tract, in the development of functional gastrointestinal disorders, as well as modern approaches to their prevention and correction using a drug of proven efficacy. Numerous national and foreign studies proved the efficacy of trimebutine in hyperkinetic and hypokinetic movement disorders, decreased gastric evacuation function, and impaired gallbladder contractile function in patients with both hypomotor and hypermotor types of functional disorders. The accumulated experience determines the prospects for its use in pediatric practice.

Irritable bowel syndrome in children with chronic gastrointestinal symptoms in primary care.

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in children. However, in primary care, it is still unknown whether there are differences in the prognosis of children with IBS compared to other diagnostic subgroups. Therefore, our aim was to describe the course of symptoms and health-related quality of life (HRQoL) for children with chronic gastrointestinal symptoms who either do or do not fulfil the Rome criteria for IBS in primary care. Second, we compared the diagnosis of the general practitioner (GP) with the Rome criteria. We conducted a prospective cohort study with 1-year follow-up, including children aged 4-18 years with chronic diarrhoea and/or chronic abdominal pain in primary care. During follow-up, the Rome III questionnaire, Child Health Questionnaire, and symptom questionnaires were completed. A total of 60/104 children (57.7%) fulfilled the Rome criteria for IBS at baseline. Compared to children without IBS, children with IBS were more commonly referred to secondary care, used more laxatives, and more often developed chronic diarrhoea and low physical HRQoL during 1 year. The diagnosis "IBS" from the GP matched the Rome criteria for only 10% of children, as most were diagnosed with "Constipation." There seems to be a difference in the treatment and prognosis of symptoms and HRQoL between children with and without IBS in primary care. This suggests that it is relevant to differentiate between these groups. The evaluation and use of feasible criteria to define IBS in different healthcare settings remains subject for further studies.

Effect of the nutrition violation on the of development of functional gastrointestinal disorders in school-age children

Nutrition is one of the important risk factors for the occurrence of functional gastrointestinal disorders in children (FGID).&#x0D; Objective — to study the nutrition violations in children with FGID.&#x0D; Materials and methods. Observation involved 110 children with FGID aged 6 to 18 years. The patients were divided into two groups: I study group included 44 children with an overlap of functions dyspepsia (FD) and irritable bowel syndrome (IBS). The II study group consisted of 66 pediatric patients with FD. The control group consisted of 30 healthy children. The diagnosis of functional dyspepsia and IBS was established based on the clinical symptoms according to the Rome IV criteria (2016). To detect violations in the nutritional regimen and food preferences of schoolchildren, a questionnaire survey was performed with the use of the Youth Adolescent Food Frequency Questionnaire, adapted to the model of children’s nutrition in Ukraine.&#x0D; Results. The frequency of violations in the nutritional regimen, such as refusal of breakfast or a full lunch at school, reducing the daily frequency of meals, was higher in children with FGID than in healthy children. The violations of nutrition in children with overlapping FD and IBS was observed more often than in children with FD. The frequency of consumption of vegetables, cereals and grains was lower in children with FGID, and the consumption of meat, sausages and confectionery, fast food, chips, nuts and seeds, energetics and sweet carbonated beverages was higher than in healthy children. In children with overlapping FD and IBS, the frequency of consumption of vegetables, cereals and grains is lower, and the consumption of confectionery, fast food, energetics, and sweet carbonated drinks was higher than in children with FD.&#x0D; Conclusions. Violations of the regimen and quality of nutrition is a risk factor for the formation of FGIR in children and should be considered in the treatment.&#x0D;

Functional abdominal pain disorders in children in southern Anhui Province, China are related to academic stress rather than academic performance

BackgroundFunctional abdominal pain disorders (FAPDs) are one of the most common gastrointestinal disorders in children. The aim of this study was to investigate the prevalence of FAPDs in children in southern Anhui Province, China and their association with academic stress.MethodsIn this cross-sectional survey, we randomly selected children aged 6–17 years from 11 public schools in southern Anhui Province. FAPDs were diagnosed according to the Rome IV criteria, and a custom-designed questionnaire was used to investigate the association between academic stress and FAPDs in children.ResultsA total of 2,344 children aged 6–17 years were enrolled. The mean age was 12.4 ± 3.0 years. Of these children, 335 (14.3%) were diagnosed with FAPDs according to the Rome IV criteria. Among the children with FAPDs, 156 (46.6%) were boys, and 179 (53.4%) were girls. The prevalence was higher in girls than in boys. The most common disorder was irritable bowel syndrome (IBS) (n = 182 (7.8%)). Other types of FAPDs included functional abdominal pain–not otherwise specified (FAPNOS) (n = 70 (3.0%)), functional dyspepsia (FD) (n = 55 (2.3%)), and abdominal migraine (AM) (n = 28 (1.2%)). Academic stress, not meeting parental expectations, poor relationships with parents, and sleep disturbances were independent risk factors for FAPDs in children; academic performance was not associated with the development of FAPDs.ConclusionThere was a high prevalence of FAPDs among children in southern Anhui Province, China, and IBS was the most common subtype of functional abdominal pain. Academic stress, rather than academic performance, was associated with FAPDs in children.

Synthesis of some Curcumin derivatives of Non-Steroidal Anti-Inflammatory (NSAIDs) Prodrugs for Treatment of Inflammatory Bowel Diseases

Inflammatory Bowel Disease (IBD) is the most prevalent chronic gastrointestinal disorder in children and adolescents. IBD is a collection of recurrent and remitting inflammatory gastrointestinal illnesses that mostly includes ulcerative colitis (UC) and Crohn's disease (CD). Amino salicylates, corticosteroids, and biological agents are drugs that are now utilized to treat inflammatory bowel disorders. The research envisaged and plan of work to be carried out can be summarized as adetailed review of curcumin derivatives, synthesis of compound and their derivatives, physio-chemical properties, structure elucidation, and biological evaluation of synthesized compounds for anti-inflammatory potential. Prodrugs are synthesized by conjugation of NSAID derivatives with some curcumin derivatives by the reflux in different solvents in the presence of thionyl chloride as an acid catalyst.The synthetic compounds YK-01 and YK-02 were obtained in a series. The FTIR, NMRspectroscopy, and other physiochemical properties have characterized the structure of the synthesized prodrugs. The anti-inflammatory activity of the synthesized compounds was tested in a carrageenan-induced rat paw oedema model, and it was discovered that the prodrugs treated compound (YK-02) showed decreased inflammation and paw oedema volume, as well as a better activity than synthesized prodrugs (YK-01).

Recent research on the application of defoamers in children undergoing digestive endoscopy

Endoscopy is a common tool for the diagnosis and treatment of gastrointestinal disorders in children. The presence of bubbles in the gastrointestinal tract is one of the important factors affecting the clarity of endoscopic visual field, and the application of defoamers can significantly reduce bubbles in the gastrointestinal tract, improve the quality of gastrointestinal preparation, and further increase disease detection rate. Various studies have been conducted on gastrointestinal preparation before endoscopy in children, but there still lacks a uniform protocol for the application of defoamers. This article summarizes the use of defoamers in children before digestive endoscopy and related research advances and points out that existing studies on defoamers have a small sample size and that there are still controversies over the selection and timing of administration, so as to provide a reference for in-depth research on defoamers in the future.

Functional constipation in children: What physicians should know.

Functional constipation (FC) is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4% (95% confidence interval: 11.2-17.6) when diagnosed based on the Rome IV criteria. Its pathophysiological mechanisms are thought be multifactorial and complicated, resulting in difficult management. Currently, the most effective medication, when used in parallel with toilet training, is osmotic laxatives. Children's adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure. Recently, novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines; nonetheless, well-designed research to support the use of these therapies is needed. This review aims to focus on multiple aspects of FC in children, including global prevalence, pathogenesis, diagnostic criteria, tools, as well as conventional and novel treatment options, such as non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators. We also report that in very difficult cases, surgical intervention may be required.

Pathogen-Specific Benefits of Probiotic and Synbiotic Use in Childhood Acute Gastroenteritis: An Updated Review of the Literature.

Probiotics represent viable microorganisms which are found within the normal gut microbiota, that exert strain-specific benefits in the management of several gastrointestinal disorders in children, including acute gastroenteritis. This review aims to evaluate the pathogen-specific role of probiotic supplementation in childhood diarrhea. A search of scientific databases was conducted to identify studies which investigated efficacy of probiotics and synbiotics in influencing outcome of acute gastroenteritis of known etiology. We identified 32 studies, most of which analyzed impact of probiotic supplementation in rotavirus gastroenteritis, while a very limited number of these conducted a separate analysis on bacterial diarrhea. Lactobacillus rhamnosus (L. rhamnosus), L. reuteri and S. boulardii still remain the most researched strains, with a proven role in decreasing diarrhea and hospitalization duration, especially in the setting of rotavirus infection. Combined products containing at least one of the aforementioned strains also performed similarly and might also influence rotavirus fecal shedding. Rotavirus immunization status has also been proposed as a significant influencing factor of probiotic use impact. The paucity of research focusing on bacterial etiologies, as well as of clinical trials conducted within ambulatory care units leaves room for further research on the matter, which needs to include larger cohort studies.

Coronavirus disease 2019 and gastrointestinal disorders in children.

During the past 3 years, the coronavirus disease 2019 (COVID-19) pandemic has had a great impact on people all over the world. However, it has become evident that disease manifestations and severity differ across age groups. Most children have a milder disease course than adults but possibly more pronounced gastrointestinal (GI) symptoms. Given the child's developing immune system, the impact of COVID-19 on disease development may differ compared to adults. This study reviews the potential bi-directional relationship between COVID-19 and GI diseases in children, focusing on common pediatric conditions such as functional GI disorders (FGID), celiac disease (CeD), and inflammatory bowel disease (IBD). Children with GI diseases, in general, and CeD and IBD, in particular, do not seem to have an increased risk of severe COVID-19, including risks of hospitalization, critical care need, and death. While infections are considered candidate environmental factors in both CeD and IBD pathogenesis, and specific infectious agents are known triggers for FGID, there is still not sufficient evidence to implicate COVID-19 in the development of either of these diseases. However, given the scarcity of data and the possible latency period between environmental triggers and disease development, future investigations in this field are warranted.