Pediatric Gastroenterology Clinic Research Articles

Predictors of Unplanned Health Care Utilization Among Children with Inflammatory Bowel Disease in a Rural Region of the Southeastern US.

Pediatric Inflammatory Bowel Disease (IBD) imposes significant healthcare costs and strains emergency services. This study aimed to identify factors associated with unplanned healthcare usage among children with IBD in a rural, medically underserved region in the southeastern United States. In this retrospective cohort study, we analyzed children (<18years) with moderate or severe IBD followed at an academic pediatric gastroenterology clinic between 2016 and 2021. Each planned visit was treated as a separate observation, and patients were followed after each planned visit until the occurrence of the earliest unplanned healthcare event, until the next planned visit, or until censoring. In our analysis of 471 planned visits from 70 children with IBD, we observed 84 (18%) unplanned visits within 12months, with 39 of these visits related to IBD. Unplanned visits occurred at a median interval of 39 days, predominantly to the emergency department (ED). Multivariate Cox proportional hazards analysis revealed a higher hazard of unplanned visits among female patients, individuals with elevated C-reactive protein levels and anemia, those covered by Medicaid insurance, and those residing closer to the clinic. This study elucidates the challenges faced by children with IBD in rural settings. By identifying factors associated with unplanned healthcare utilization, we can better pinpoint patients who may benefit from targeted interventions to reduce such visits.

Potty Stools, a Pilot Study to Step Up the Management of Functional Constipation in Children.

Functional constipation (FC) comprises 30% of pediatric gastroenterology clinic visits. FC results from withholding behaviors that can be worsened by poor toileting posture. The use of a defecation posture modification device (DPMD)-a potty stool-has demonstrated benefit in adults. The aim of this study was to assess the risks and benefits of incorporating a DPMD as an adjunct to the FC treatment plan for children. Toilet-trained children aged ≥4 years meeting the Rome IV criteria for FC were enrolled and offered a DPMD at no cost and were followed for 4 months. There were no injuries or treatment-related adverse events reported by the 43 subjects who completed the study. Notably, 98% (n = 42) of respondents would recommend the DPMD to assist other children with FC. DPMD users showed a 33% reduction in fecal incontinence compared with 60% non-users. The DPMD represents a safe adjunct to incorporate into the FC management plan of children.

Efficacy of Ultrasound for the Detection of Possible Fatty Liver Disease in Children.

Pediatric MASLD (previously referred to as NAFLD) incidence has continued to rise along with the obesity pandemic. Pediatric MASLD increases the risk of liver fibrosis and cirrhosis in adulthood. Early detection and intervention can prevent and reduce complications. Liver biopsy remains the gold standard for diagnosis, although imaging modalities are increasingly being used. We performed a retrospective study of 202 children seen in a pediatric gastroenterology clinic with a complaint of abdominal pain, elevated liver enzymes or MASLD, or a combination of the three to evaluate screening methods for MASLD. A total of 134 of the 202 patients included in the study underwent laboratory testing and abdominal ultrasound. Ultrasound images were reviewed with attention to liver size and echotexture by a fellowship-trained pediatric radiologist for liver size and echotexture. Overall, 76.2% of the initial radiology reports correctly identified hepatomegaly based on age and 75.4% of the initial radiology reports correctly described hepatic echogenicity that was consistent with increased hepatic fat deposition. Use of screening ultrasound in concert with other clinical evaluations can be helpful to identify children at risk of MASLD. Utilizing ranges for liver span according to age can help to diagnose hepatomegaly, and understanding how to identify hepatic echogenicity is important for identifying possible hepatic steatosis.

Association between Autoimmune Hepatitis and Celiac Disease among Egyptian Children and Adolescents

Abstract Background Celiac disease (CD) is an immune-mediated intolerance to gluten .CD has been recognized as a multisystem disorder which may affect other extra intestinal organs, such as the skin, thyroid, heart, nervous system, pancreas and liver. Individuals with CD are at increased risk of liver disease namely cryptogenic liver disorder and autoimmune liver disorder. However, until now, it remains unknown whether these two forms of liver disease are really different entities or only different severities of the same disorder. Objective To evaluate the association of CD with autoimmune hepatitis in pediatrics. Subjects and Methods This was a cross-sectional study that was conducted at the Pediatric Hepatology Clinic and Pediatric Gastroenterology Clinic, Children’s Hospital, Ain Shams University. The study included 2 groups of patients each comprised 20 children and adolescents as follow: Group I: Patients with established diagnosis of autoimmune hepatitis (AIH). All patients were receiving corticosteroids and azathioprine Group II: Patients with established diagnosis of CD. In group I patients with AIH, CD was screened for using anti-tissue transglutaminase (tTG) IgA in addition to measuring serum IgA to determine the need to measure anti-tTG IgG. Immunological markers (ANA, anti-smooth muscle antibody (ASMA) and liver and kidney microsomal (LKM) antibodies in addition to protein electrophoresis were done for group II patients with CD to screen for AIH. Results All patients in group I with AIH had normal serum IgA levels and were found negative for anti-tTG IgA. Also, group II patients with CD were negative for ANA, ASMA and LKM antibodies with normal protein electrophoresis. Conclusion The current study showed that CD does not seem to have significant association with AIH, however, the small sample size is a study limitation. Further wider scale studies are needed to evaluate the risk of AIH in CD.

An Evaluation of Demographic, Clinical, Endoscopic and Pathological Findings in Children Who Underwent Colonoscopic Polypectomy: A Pediatric Gastroenterology Clinic Experience

An Evaluation of Demographic, Clinical, Endoscopic and Pathological Findings in Children Who Underwent Colonoscopic Polypectomy: A Pediatric Gastroenterology Clinic Experience

Gastric antral web presenting with esophageal stricture and severe malnutrition

Gastric antral web is a rare cause of gastric outlet obstruction in children. Common complaints include intermittent non-bilious vomiting, bloating, pain, loss of appetite, and weight loss. Herein, we report a case of gastric antral web presenting with esophageal stricture and malnutrition, which was followed for many years with a misdiagnosis. An 8-year-old African boy was referred to our pediatric gastroenterology clinic due to recurrent vomiting and severe malnutrition. According to his medical history, the patient began experiencing non-bilious vomiting at 40 days of age and a diagnosis of gastroesophageal reflux was made. He was hospitalized multiple times and received nasogastric tube feedings in the following 4 years. He was re-evaluated for growth retardation and malnutrition at 4 years of age. He had been diagnosed with gluten enteropathy and was fed a gluten-free diet. Recently, he developed difficulty swallowing solid food and was only able to consume liquid meals. Esophagography revealed segmental stenosis in the distal portion of the esophagus. After stricture excision with thoracotomy, upper gastrointestinal series with a radiopaque substance indicated normal esophageal passage; however, prolonged gastric emptying time was also noted. Upon examination during laparotomy, a congenital web was detected in the antral region and was excised. Esophageal and gastric pathologies were consistent with stricture caused by reflux esophagitis and gastric antral web. Today, gastric antral web is mostly diagnosed and treated in infancy. Near total obstruction is relatively easy to diagnose; however, many patients with partial obstruction are followed-up for years with an incorrect diagnosis. Therefore, it should be considered in such cases, persistent vomiting and gastroesophageal reflux may be associated with esophageal stricture.

Patient perspective on exercise practices, preferences, and barriers in pediatric nonalcoholic fatty liver disease: A multicenter survey.

Nonalcoholic fatty liver disease (NAFLD) is prevalent among children, and lifestyle modification is the primary treatment approach. However, the optimal exercise duration, frequency, and intensity for managing NAFLD remain undefined. This study aimed to gain insights from the patient perspective by examining exercise behaviors, preferences, and barriers in children with NAFLD. A multicenter survey was conducted among children 8-18 years with NAFLD in pediatric gastroenterology clinics. Participants completed a questionnaire on exercise practices, preferences, and barriers, while parents completed a questionnaire on their willingness and ability to support their child's exercise. Data were analyzed using χ 2 test with Yates' correction and two-sample t test. The study included 408 children with NAFLD, with a mean age of 13.8 years. Approximately 52.5% of participants had physical education classes at school, while 59.5% engaged in extracurricular exercise, averaging 3.7 days per week. However, 11.5% reported no physical activity. A significant majority (81.1%) expressed interest in increasing their exercise levels, primarily driven by health-related factors. Time-related constraints were the most cited barriers to exercise (53.7%). Approximately 80% of parents demonstrated willingness and ability to support their child's exercise regimen. This study provides insights into exercise behaviors, preferences, and barriers among children with NAFLD. Half of the children lacked exercise opportunities at school but expressed interest in increasing their physical activity. Time limitation was the major obstacle cited. Parents are motivated to support increased physical activity. Exercise intervention programs for NAFLD should consider the perspective of the children and their families.

Paediatric steatotic liver disease has unique characteristics:A multisociety statement endorsing the new nomenclature.

Nonalcoholic fatty liver disease (NAFLD) has been a commonly used term and diagnosis in paediatric hepatology, gastroenterology, and endocrinology clinics for over 30 years. A multisociety Delphi process has determined a new name "Steatotic Liver Disease"(SLD) as the overarching term for disorders associated with hepatic lipid accumulation. Our Societies give our support to steatotic liver disease as the best overarching term for use in our communities. Metabolic dysfunction-associated steatotic liver disease (MASLD) overcomes many of the shortcomings of the name NAFLD. Here, we highlight several points of the new nomenclature that are of particular importance for our community and their consequences for implementation including: diagnostic criteria, considering alternate diagnoses, practical implementation, research, advocacy, and education for paediatricians. As with all nomenclature changes, it will take a concerted effort from our paediatric societies to help integrate the optimal use of this into practice.

Sleep Patterns, Pain, and Emotional Functioning in Youth with Inflammatory Bowel Disease.

Youth with inflammatory bowel disease (IBD) may be at increased risk for sleep difficulties due to the painful and inflammatory nature of their disease. Moreover, children and adolescents with IBD experience impairment across a variety of psychosocial domains. However, researchers have yet to investigate the complex interplay between sleep, disease-related symptoms, and psychosocial factors in this population. The purpose of this study was to examine sleep patterns, pain, and mood in pediatric IBD. A sample of 25 children and adolescents with IBD (Mage = 14.24, Range = 10-18 years; 56% male) were recruited from a pediatric gastroenterology clinic. Youth wore an actigraphy watch and completed daily measures of affect and pain over the course of 14 days. Statistical analyses involved repeated measures general estimating equations. No significant association for sleep with negative affect was demonstrated. Despite majority of this sample being in disease remission, results revealed that increased sleep onset latency was associated with presence of next day pain and pain was associated with better next night sleep efficiency. Findings of the current study suggest youth with IBD experience poor sleep quality, which is significantly related to the pain they experience. Consequently, healthcare providers should screen for and address sleep quality to optimize outcomes in their pediatric patients. Objectively assessing sleep patterns (e.g., actigraphy) may prove useful for pediatric IBD samples; however, additional research is needed to determine actigraphy's feasibility and efficacy in assessing sleep patterns in real world settings (e.g., pediatric medical clinics).

A73 EVALUATING MENTAL HEALTH CONDITIONS IN YOUTH WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE STUDY

Abstract Background Adolescents with chronic disease are at increased risk of psychosocial and socio-emotional challenges. During and after the COVID-19 pandemic, an increased prevalence of mental health conditions was observed in youth with chronic conditions. It is essential to understand the prevalence of mental health conditions in youth with Inflammatory Bowel Disease (IBD) to better support, advocate, and treat mental health conditions within a pediatric healthcare setting. Aims We aimed to determine the number and proportion of patients with IBD at McMaster Children’s Hospital (MCH) whose medical charts have documentation of 1) a mental health condition (generalized anxiety disorder (GAD), social anxiety disorder (SAD), eating disorder, major depressive disorder (MDD), suicidal ideation, attention deficit disorder and other) and/or 2) medication(s) used to treat mental health conditions. Methods Patients 12-17 years old with IBD who were treated in the pediatric Gastroenterology Clinic at MCH and had at least one appointment since June 4, 2022 were eligible. Medical records were reviewed to identify documented mental health conditions and patients’ current medications. The prevalence was then determined. Results Of 114 patients (77 male) (mean (SD) age 15.1 (1.6) years old), 33 (29%, n=20 males) had ≥ 1 recorded mental health condition: GAD (n=27, 82%), SAD (n=1, 3%), eating disorders (n=4, 12%), MDD (n=9, 27%), suicide ideations (n=5, 15%), attention deficit disorder (n=9, 24%), and other mental health conditions (n=1, 3%). Among the 33 patients with documented mental health conditions, 19 (58%) patients were taking medications related to mental health (Table I). Conclusions Our results estimate a 29% prevalence of mental health conditions in youth with IBD at MCH. A lack of mental health resources and screening protocols within this setting could result in an underrepresentation of adolescents with IBD and mental health comorbidities. Future studies will focus on incorporating screening methods for mental health conditions within pediatric healthcare settings to determine current barriers and accessibility to mental health supports. Table I. Medications in patients (n=33) with documented mental health condition Note Medications were prevalent in patients with ampersand:003E1 mental health diagnosis, thus frequency is lower than # of documented mental health diagnoses. *Other mental health conditions: borderline personality disorder and bipolar disorder with depression. Funding Agencies None

Home-based fecal calprotectin utilization in a general pediatric gastroenterology clinic.

Remote investigation and monitoring have gained importance in ambulatory practice. A home-based fecal calprotectin (FC) test has been developed where the sample is processed and analyzed at home through a smartphone application. We aimed to assess the use of standard ELISA (sFC) versus home-based (hFC) FCtesting in a general pediatric gastroenterology clinic. Ambulatory pediatric patients with hFCor sFC performed between August 2019 and November 2020 were included. Data regarding demographics, clinical characteristics, medication use, investigations, and final diagnosis, categorized as inflammatory bowel disease (IBD), functional gastrointestinal (GI) disorders, organic non-IBD (ONI) GI disorders, non-GI disorders, and undetermined after 6 months of investigation, were recorded. A total of 453 FC tests from 453 unique patients were included. Of those, 249 (55%) were hFC. FC levels (median) were higher in children with IBD compared to non-IBD diagnosis (sFC 795 vs. 57 μg/g, hFC 595 vs. 47 μg/g, p < 0.001), and in ONI compared to functional GI disorders (sFC 85 vs. 54 μg/g, p = 0.003, hFC 57 vs. 40 μg/g, p < 0.001). No significant difference was observed between different ONI GI disorders or subtypes of functional disorders. Age did not significantly influence levels. Overall, hFC and sFC provide similar results in the general pediatric GI ambulatory setting. FC is a sensitive but not disease-specific marker to identify patients with IBD. Values appear to be higher in ONI GI disorders over functional disorders, although cut-off values have yet to be determined.

N27 Group meetings for adolescents with IBD: results of a survey on patients’ interests

Abstract Background The increase in both the incidence and prevalence of IBD, especially in people under 21 years of age1,2,3 outlines new issues to be considered in caring for these patients, like the psychosocial effects on both adolescents and their families, school absences, and developmental delay2. The need for better support to improve their HRQoL4, the embarrassment related to the disease, the anxiety about a sudden appearance of gut symptoms, frequent hospital admissions, and diet restrictions, can lead to social isolation5,6. Group meetings designed to make adolescents and young adults with IBD meet each other and with healthcare professionals (HCP) who are experts in IBD can create a safe environment in which to discuss fears, everyday problems and possible solutions, and any doubt about their condition. This could also provide support, suggestions, and opportunities to peer-compare, further promoting social relationships. This study investigated their willingness to participate in this experience and what they consider important to discuss. Methods A focus group involving HCP from a paediatric gastroenterology clinic and interviews with a sample of patients provided the basis on which a clear and easy-to-understand survey was developed concerning interest in the project, willingness to participate, topics to be discussed, and needs of peer relationship. The survey was then performed collecting anonymous data to avoid any kind of potential bias. Results Twenty-two patients aged 14 to 19 years completed the survey, showing their poor occasions of discussion about the disease and its related issues with other patients (54.5% of them do not know people with IBD) even if they can talk with their family, HCP and peers outside the hospital or outpatient clinic settings (tab 1). The willingness to participate in a group meeting is higher in the oldest subjects, and they show the highest interest in a peer relationship with patients of the same age and expert HCP. The topics considered more significant are 'nutrition' and 'mood' (described by almost two-thirds of patients) followed by ‘symptoms’ and ‘social life’ (fig 1). The best meeting schedule from the patient's point of view is every 6-8 weeks, with both in-person and virtual participation. Conclusion This study provides useful information on the feasibility and willingness of young patients with IBD to participate in such interventions. After the experimental application of group meetings, it will be mandatory to let patients provide feedback on this activity and to assess their effects on patients’ psychosocial well-being. References (DOI) 1 10.1016/j.crohns.2013.01.010 2 10.1053/j.gastro.2021.12.282 3 10.1016/j.gtc.2023.05.001 4 10.1093/ibd/izy041 5 10.1007/s10880-021-09778-0 6 10.1111/hsc.13755

Frequency of hepatitis C virus infection in patients with pediatric inflammatory bowel disease: a cross-sectional study

BackgroundPatients with pediatric inflammatory bowel disease (PIBD) are believed to be at higher risk of hepatitis C virus (HCV) infection not only due to using of immunosuppressive drugs but also because of repeated blood transfusion and endoscopic and other invasive procedures used for diagnoses and effective controlling of the disease, so this study aimed to assess the frequency of HCV infection, in patients with PIBD at the New Children’s Hospital, Cairo University, and identify the potential risk factors.MethodsThis cross-sectional analytic study included 165 IBD patients between 1 and 16 years old of both sexes who were attending the Pediatric Gastroenterology Clinic in the New Children’s University Hospital, Cairo University. All patients were screened for anti-HCV antibodies using ELISA. Factors related to IBD (severity, modalities of the treatment, and invasive procedures), to infection (blood transfusion history and family history of hepatitis), and liver enzymes were registered. The risk factors were evaluated by multivariate logistic regression analysis.ResultsPresent and/or past HCV infection was found in five (3%) of the IBD patients. The multivariate logistic regression to detect independent predictors of HCV +ve antibodies patients had statistically significant value with number of hospital admission related to IBD with p-value = 0.002, odd ratio (OR) = 1.467, and confidence interval (CI) = 95% (1.145–1.879) and with number of hospital admission unrelated to IBD with p-value = 0.024, OR = 0.750, and CI 95% (0.585–0.963).ConclusionThe frequency of HCV infection in PIBD patients was 3%. Thus, the frequency of HCV infection in PIBD patients is similar to that in the normal population of the developing countries, and it is strongly related to hospital admission due to IBD or non-IBD causes.

Investigation of Gastric Intestinal Metaplasia in Children According to the Current Sidney System: Single Centre Experience

Aim: The purpose of this investigation was to examine the occurrence of intestinal metaplasia in pediatric patients who underwent upper gastrointestinal endoscopy and its clinical implications. Methods: A retrospective evaluation was conducted on the endoscopy and pathology reports of 1280 patients who underwent upper gastrointestinal system endoscopy for various indications at the Pediatric Gastroenterology Clinic of XX University Faculty of Medicine Hospital from January 2019 to December 2022. The study included 66 cases that were diagnosed with intestinal metaplasia based on the histopathological examination of biopsy samples.&#x0D; Results: Among the patients, 37 (56.1%) were female and 29 (43.9%) were male. The mean age for females was 12.92±4.297 years (ranging from 1 to 17 years), while for males it was 12.07±4.765 years (ranging from 2 to 17 years). The average number of endoscopies performed was 1.66 times (ranging from 1 to 5 times). The top three indications for endoscopy included abdominal pain, growth retardation, and suspicion of celiac disease. Detection of H. Pilori positivity was observed in 67.1% of cases.&#x0D; Conclusion: While Gastric Intestinal Metaplasia is uncommon in childhood, it should not be disregarded due to its associated risk. It is important to remember that endoscopic biopsies may not provide sufficient diagnostic information in cases involving patchy involvement or diseases affecting the submucosa or deeper layers.

Increasing Mental Health Screening inPediatric Subspecialty Clinics: An Improvement Project at Brooke Army Medical Center.

Mental health screening allows for the early identification of patients at risk of mental health disorders such as anxiety and depression. The Defense Health Administration Procedures Manual 6025.01 established that patients older than 12 years of age should receive annual mental health screening assessing suicidality risk with a standardized screening tool. To improve rates of mental health screening in this at-risk population, an A3 Lean approach to quality improvement was undertaken in the Pediatric Subspecialty Clinics at Brooke Army Medical Center. Baseline data of Patient Health Questionnaire-9 or General Anxiety Disorder-7 screening from pediatric pulmonology and cardiology clinics were 6.3%. Plan-Do-Study-Act quality improvement methods evaluated possible interventions to improve screening. A standard operating procedure (SOP) outlining scoring and interpretation recommendations was distributed in pediatric pulmonology and cardiology clinics. Using the Armed Forces Health Longitudinal Technology Application, a post-implementation chart review was conducted for 8 weeks. With the initiation of Military Health System Genesis, the SOP was adjusted and a root cause analysis was performed. The pediatric gastroenterology clinic cares for patients presenting with functional abdominal pain; therefore, the clinic was added to the second iteration to determine if anxiety or depression may play a role. Providers were educated on documentation and coding. A second post-implementation chart review was conducted for 8 weeks. Over two iterations, mental health screening of new adolescent patients in pediatric subspecialty clinics increased by 794% from baseline. Our providers screened 50% of the adolescent patients. With increased surveillance of an at-risk population, more adolescents will receive the standard of care. With refinement of the SOP and expansion to other subspecialties, this project has the potential to expand within Brooke Army Medical Center and other clinics in the Defense Health Administration.

33 Gluten-free Diet Knowledge and Adherence in Adolescents with Celiac Disease: A Cross-sectional Study

Abstract Background Adolescents with celiac disease (CD) are at risk for non-adherence to the gluten-free diet (GFD). Knowledge of the GFD may impact adherence. Objectives To examine the relationship between knowledge and adherence to the GFD in a local population of adolescents with CD. Secondary objectives were to identify information sources used to learn about the GFD and to compare adolescent and parent knowledge of the GFD. Design/Methods Adolescents (12-17 years) with CD and their parents from local paediatric gastroenterology clinics completed an online survey containing a knowledge assessment (Gluten-Free Diet Quiz [GFD-Q]), validated adherence scale, GFD information sources, and demographic/clinical information. GFD-Q scores were categorized as “sufficient knowledge” based on correctly identifying: 3/3 gluten-containing foods, at least 4/7 gluten-free foods, and at least 4/7 foods that may contain gluten. Otherwise, scores were termed as indicating “insufficient knowledge”. Results Of 40 adolescents, 15/40 (37%) had sufficient knowledge and 25/40 (63%) had insufficient knowledge. Within the insufficient knowledge group, 14/25 (56%) did not correctly identify enough allowed, gluten-free foods. Parents scored higher on the GFD-Q (67% with sufficient knowledge). Adolescents reported overall adherence to the GFD (88%), with adherence similar between sufficient and insufficient knowledge groups (80% vs. 92%). Most helpful information sources include physicians, another person with CD, parent(s), and Google (online search engine). Apps were infrequently used (20% of adolescents). Conclusion Adolescents report good adherence, but struggle with knowledge of the GFD, particularly in identifying gluten-free foods. Further research is required to explore GFD educational tools, including mobile apps and dietician-led teaching sessions.

Okul Öncesi Çocuklarda Çölyak Hastalığı: Retrospektif Bir Analiz

Background: The aim of this study is to evaluate the medical parameters of celiac disease cases in the preschool age group in terms of public health and to make recommendations to health professionals, policy makers and the society. Materials and Methods: This study was conducted between February 2017 and December 2018 in Şanlıurfa Education and Research Hospital, Pediatric Gastroenterology Clinic. Clinical and laboratory findings of preschool children diagnosed with celiac disease were retrospectively analyzed. Anamnesis, physical examination findings, laboratory findings, endoscopic biopsies and pathology results of pati-ents were evaluated. Results: The most common presenting complaint was growth retardation (96.3%), followed by chronic diarrhea (32.5%) and constipation (27.5%). Height-for-age and weight-for-age values were found to be lower in patients with chronic diarrhea and duodenitis compared to those without (p&amp;lt;0.05). Patients with strong positive tissue transglutaminase-IgA (tTG IgA) levels had significantly higher Marsh scores (p&amp;lt;0.05). Conclusions: For preschool-age children, initiating the diet via early diagnosis and ensuring adherence to diet are the main objectives. Children adhering to the diet have a higher success in elementary school and a shorter adaptation period.

Gluten-Free Diet Knowledge and Adherence in Adolescents with Celiac Disease: A Cross-Sectional Study.

This study examined the relationship between knowledge of, and adherence to, the gluten-free diet (GFD) in a local population of adolescents with celiac disease (CD). The secondary objectives were to identify information sources used to learn about the GFD and to compare adolescents' and parents' knowledge of the GFD. Adolescents (12-17 years) with CD and their parents from pediatric gastroenterology clinics in Calgary, Alberta, completed an online survey containing a knowledge assessment (Gluten-Free Diet Quiz [GFD-Q]), an adherence scale, questions about GFD information sources, and demographic/clinical information. GFD-Q scores were deemed "sufficient knowledge" with correct identification of 3/3 gluten-containing foods, ≥4/7 gluten-free foods, and ≥ 4/7 foods that may contain gluten; otherwise, scores were termed "insufficient knowledge". Of the 40 adolescent-parent pairs, 15 of 40 adolescents (37%) had sufficient knowledge, and 25 of 40 adolescents (63%) had insufficient knowledge. Within the insufficient knowledge group, 14 of 25 (56%) did not correctly identify enough allowed gluten-free foods. Parents scored higher on the GFD-Q (67% had sufficient knowledge). Adolescents reported overall adherence to the GFD (88%), with adherence being similar between the sufficient and insufficient knowledge groups (80% versus 92%). The most helpful information sources included physicians, another person with CD, parent(s), and Google; apps were infrequently used. Adolescents report good adherence; however, they struggle with GFD knowledge, particularly in identifying gluten-free foods. Further research is required to explore GFD educational tools, including mobile apps and dietician-led teaching sessions.

The Results of Pneumatic Balloon Dilatation Treatment in Children with Achalasia: A Single-Center Experience.

Achalasia is a primary motility disorder characterized by a relaxation disorder of the lower esophageal sphincter. In pneumatic balloon dilatation, which is one of the treatment methods, the muscle fibers are torn with an endoscopically inflated balloon in the lower esophageal sphincter. This study aimed to evaluate the results of long-term pneumatic balloon dilatation treatment in our clinic for children diagnosed with achalasia. Pediatric patients who underwent pneumatic balloon dilatation with a diagnosis of achalasia in our pediatric gastroenterology clinic between 2016 and 2021 were included in the study. Demographic data of the patients, clinical findings at diagnosis, and follow-up results were evaluated retrospectively. Ten patients who underwent 18 pneumatic balloon dilatation operations were included in the study. The mean follow-up period of the patients was 23.7 ± 14.1 months. It was observed that the procedure was performed once in 3 (30%) patients, twice in 2 (20%) patients, and 3 times in 3 (30%) patients. It is noteworthy that the diameter of the balloon used in the first procedure in patients who needed repeated operations was less than 30 mm. No complications were observed except for chest pain, which was detected in 1 patient. When the patients who needed recurrent dilatation were evaluated, it was noted that the diameter of the balloon in which the first procedure was performed in these patients was smaller. This study is an important contribution to the literature due to the scarcity of the pediatric achalasia data, in which long-term results related to pneumatic balloon dilatation are reported in Turkey.

Serum Zinc in Patients with Protein-Energy Malnutrition Retrospective Assessment of Levels

Aim: This study aimed to investigate the frequency of serum zinc deficiency in children with PEM and to show the relationship between the degree of PEM and serum zinc level.&#x0D; Methods: Retrospective study conducted at Pediatric Gastroenterology, Hepatology, and Nutrition clinic, in a Selçuk University Hospital, 506 patients who aged between 1 and 18 years and diagnosed with PEM according to the Waterlow (YGB, BGA) classification were included in the study. &#x0D; Results: The prevalence of serum zinc deficiency in PEM patients was found to be 61.1%. The mean serum zinc levels of the patients in aged 1-5 founded significantly lower than the mean serum zinc levels of the patients in aged 5-12 and aged 12-18. There was no difference between PEM grades which calculated according to BGA and YGB criteria and serum zinc level averages. Although the relationship between the PEM grade calculated according to the BGA scale and the serum zinc level averages was not statistically significant degree, contrary to the increase in PEM grade, the mean decrease in serum zinc levels was noteworthy. &#x0D; Conclusion: It is important to measure serum zinc levels routinely in patients with PEM and to initiate zinc supplementation if deficiency is detected.