Pediatric Gastrointestinal Disease Research Articles

Summary of the 15th National Pediatric Gastrointestinal Diseases Conference

Summary of the 15th National Pediatric Gastrointestinal Diseases Conference

Fecal calprotectin in pediatric gastrointestinal diseases: Pros and cons.

Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases. However, its role, pros, and cons in various conditions must be comprehensively elucidated. To explore the role of fecal calprotectin in pediatric gastrointestinal diseases, including its advantages and limitations. A comprehensive search was conducted on PubMed, PubMed Central, Google Scholar, and other scientific research engines until February 24, 2024. The review included 88 research articles, 56 review articles, six meta-analyses, two systematic reviews, two consensus papers, and two letters to the editors. Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders, inflammatory bowel disease, coeliac disease, coronavirus disease 2019-induced gastrointestinal disorders, gastroenteritis, and cystic fibrosis-associated intestinal pathology. However, its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation. Despite these limitations, fecal calprotectin offers significant advantages in diagnosing, monitoring, and managing pediatric gastrointestinal diseases. Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology, offering insights into disease activity, treatment response, and prognosis. Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges. Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Robotic Approach to Paediatric Gastrointestinal Diseases: A Systematic Review.

The use of minimally invasive surgery (MIS) for paediatric surgery has been on the rise since the early 2000s and is complicated by factors unique to paediatric surgery. The rise of robotic surgery has presented an opportunity in MIS for children, and recent developments in the reductions in port sizes and single-port surgery offer promising prospects. This study aimed to present a systematic overview and analysis of the existing literature around the use of robotic platforms in the treatment of paediatric gastrointestinal diseases. In accordance with the PRISMA Statement, a systematic review on paediatric robotic gastrointestinal surgery was conducted on Pubmed, Cochrane, and Scopus. A critical appraisal of the study was performed using the Newcastle Ottawa Scale. Fifteen studies were included, of which seven were on Hirschsprung's disease and eight on other indications. Included studies were heterogeneous in their populations, age, and sex, but all reported low incidences of intraoperative complications and conversions in their robotic cohorts. Only one study reported on a comparator cohort, with a longer operative time in the robotic cohort (180 vs. 152 and 156 min, p < 0.001), but no significant differences in blood loss, length of stay, intraoperative complications, postoperative complications, or conversion. Robotic surgery may play a role in the treatment of paediatric gastrointestinal diseases. There is limited data available on modern robotic platforms and almost no comparative data between any robotic platforms and conventional minimally invasive approaches. Further technological developments and research are needed to enhance our understanding of the potential that robotics may hold for the field of paediatric surgery.

Reply to Verma et al. Comment on "Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093".

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Summary of the 14th National Pediatric Gastrointestinal Diseases Conference in 2023

Summary of the 14th National Pediatric Gastrointestinal Diseases Conference in 2023

Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases.

The benefits of zinc in treating certain gastrointestinal (GI) diseases have been recognized for over two decades. This review aims to explore zinc deficiency (ZD) and the potential therapeutic value and safety of zinc supplementation in pediatric GI diseases. A systematic review of published articles on ZD and zinc as adjuvant treatments for GI diseases was conducted using various databases. Children with inflammatory bowel disease (IBD), celiac disease, and those receiving long-term proton pump inhibitor treatments are particularly susceptible to ZD. ZD in children with celiac disease and IBD is attributed to insufficient intake, reduced absorption, and increased intestinal loss as a result of the inflammatory process. Zinc plays a crucial role in maintaining the integrity of the gastric mucosa and exerts a gastroprotective action against gastric lesions. Although considerable evidence supports the use of zinc as adjuvant therapy for certain GI diseases in adults, its use is unspecified in children except for infectious diarrhea. Current evidence suggests that zinc supplementation with well-documented dosages helps reduce the duration of diarrhea in children with acute or persistent diarrhea, while there are no specific guidelines for zinc supplementation in children with IBD and celiac disease. Zinc supplementation appears to be beneficial in peptic ulcer disease or gastroesophageal reflux disease. The available evidence highlights the need for intervention programs to enhance zinc status and reduce the morbidity of certain GI diseases in children.

Helicobacter pylori Found Incidentally During Upper Endoscopy Performed for Diagnosis of Common Pediatric Gastrointestinal Diseases.

Helicobacter pylori ( H. pylori ) gastritis may be an incidental finding during upper endoscopy performed to diagnose celiac disease (CeD), inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE). We aimed to describe the incidence of H. pylori in children undergoing endoscopy for CeD, IBD and EoE and determine the indications for treatment. A retrospective, single-center study based on the review of endoscopy reports of pediatric patients, diagnosed with CeD, IBD and EoE, between January 2017 and December 2021. Data collected included; age, gender, hematologic parameters, endoscopic, histologic and H. pylori culture results, and information on eradication treatment. H. pylori gastritis was diagnosed in 120 of 558 (21.5%) children [72 (60%) female, mean age 10.6 years] during gastroscopy performed for the diagnosis of other GI diseases. H. pylori was present in 87 of 404 (21.5%) CeD, 27 of 113 (23.9%) IBD and 6 of 41 (14.6%) EOE patients ( P = 0.46). The main indication for treatment was the presence of ulcers, in 4 of 120 (3.3%), and erosions in 17 of 120 (14.2%). Eradication treatment was recommended in 22 of 120 (18.3%) patients, 8 of 87 (9.2%) CeD, 10 of 27 (37%) IBD and 4 of 6 (66.7%) EoE patients, P < 0.001. Four independent positive treatment predictors were identified; age above 10 years {odds ratio (OR) = 10.57 [95% confidence interval (CI) 1.88-59.36], P = 0.007} the presence of nodular gastritis (OR = 5.03 [95% CI 1.09-23.15], P = 0.38), erosions [OR = 49.21 (95% CI 8.19-295.83), P < 0.000] and ulcers [OR = 22.69 (95% CI 1.25-410.22), P = 0.035]. CeD was a strong negative predictor for treatment [OR = 0.23 (95% CI 0.002-0.241), P = 0.002]. H. pylori gastritis is a common incidental finding during endoscopy. The indications for treatment are not well defined and should be further investigated.

Spectrum of Upper GI Endoscopy in Children: A Tertiary Centre Experience from Bangladesh

Background: Upper gastrointestinal endoscopy is an essential, safe and sensitive investigation for diagnosing pediatric gastrointestinal diseases. In resource-limited countries like Bangladesh, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. There is limited study on paediatric upper GI endoscopy in our country.&#x0D; Objectives: The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children.&#x0D; Methods: This is a retrospective study; the records of all the patients whose age is less than 18 years and who underwent endoscopy in the last 6 years were studied.&#x0D; Results: Among the total of 384 children (age &lt;18 years), the most common indications were recurrent abdominal pain in 133 (34.7%) patients followed by hematemesis±melena in 99 (25.8%), esophageal varices (follow up with eradication) in 67 (17.5%), recurrent vomiting in 31 (8.1%), foreign body, CLD screening, suspected celiac disease, isolated splenomegaly, corrosive injury, and weight loss. The most common abnormal findings were gastritis in 103 (26.9%) children followed by esophageal varices in 73 (19.2%), duodenitis in 26 (6.8%), foreign body, esophagitis, hiatus hernia, esophageal stricture, esophageal ulcer, gastric ulcer, duodenal ulcer etc. Minor adverse events occurred in 7.0% of children.&#x0D; Conclusion: The commonest indication for Pediatric UGI endoscopy was recurrent abdominal pain and the commonest endoscopic feature was gastritis. No significant post procedure complication was noted in the study.&#x0D; DS (Child) H J 2021; 37(2): 123-128

Pandemic-Related Social Disruption and Well-Being in Pediatric Gastrointestinal Diseases.

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has impacted everyone, but there are few data regarding how the pandemic has influenced the lives of children with gastrointestinal (GI) conditions. This cross-sectional study assessed pandemic-related social disruption (PRSD) in children with inflammatory bowel disease (IBD), celiac disease (CD), and irritable bowel syndrome (IBS), and the potential buffering effect of the parent–child relationship.MethodsA survey completed between September and December 2020 asked 146 children (ages 8–17) diagnosed with IBD (n = 44), CD (n = 81), or IBS (n = 51) and 185 parents how the pandemic has contributed to social disruption (i.e., financial stability, COVID-19 exposure, school changes, GI needs, and isolation) and their social–emotional well-being. Structural equation modeling was used to examine the role of social disruption on well-being, and the moderating effect of the parent–child relationship.ResultsIncreased social disruption predicted worse parent, β = 0.24, p = .02, and child well-being, β = 0.38, p < .01. The parent–child relationship moderated the relationship between parent and child well-being, β = 0.21, p = .03. Strong parent–child relationships predicted a positive association between parent and child well-being, β = 0.23, p = .003, whereas medium, β = 0.09, p = .14, and poor, β = −0.06, p = .52, relationships did not.ConclusionsPRSD negatively impacted the well-being of children with GI conditions, and the parent–child relationship moderated this relationship. These findings are relevant to pediatric psychologists treating the physical and mental health needs of children with GI conditions and their parents.

Fecal Microbiota Transfer (FMT) in Children and Adolescents - Review and statement by the GPGE microbiome working group

The human microbiome and especially the gastrointestinal microbiota are associated with health and disease. Disturbance in the composition or function of fecal microbiota (dysbiosis) plays a role in the development of pediatric gastrointestinal diseases. Fecal microbiota transfer (FMT) is a special intervention, where microbiota are transferred from a healthy donor.In this review we describe the current state of knowledge for FMT in pediatric patients. There is satisfactory evidence concerning FMT in patients with recurrent C. difficile infection. For inflammatory bowel disease, few studies show a potential benefit.Adverse events occurred frequently in clinical studies, but were mostly mild and transient. There are hardly any data on long-term side effects of FMT, which are particularly significant for pediatrics. In practice, there is uncertainty as to which application route, dosage or frequency should be used. Legally, donor stool is considered a drug in German-speaking countries, for which no marketing authorization exists.In conclusion, knowledge about physiology, efficacy and side effects of FMT is insufficient and legal concerns complicate its implementation. More studies on this topic are needed urgently.

Venous Thromboembolic Complications in Pediatric Gastrointestinal Diseases: Inflammatory Bowel Disease and Intestinal Failure.

In children with gastrointestinal disorders such as inflammatory bowel disease (IBD) and intestinal failure (IF), the risk of venous thromboembolism (VTE) is increased. VTE may lead to pulmonary embolism, sepsis and central line infection, stroke and post-thrombotic syndrome. The purpose of this review is to summarize current knowledge and recent advances around VTE management in pediatric gastroenterology with a focus on IBD and IF. The VTE incidence in children with IBD is reported to be around 4–30 per 10,000 patient-years, with higher incidences for hospitalized children. While in general, IF is less common than IBD, the VTE incidence in children with IF is around 750 per 10,000 patient-years. The most common risk factors for development of VTE involve deviations leading to Virchow's triad (endothelial damage, stasis, and hypercoagulability) and include active inflammation, particularly with colonic involvement, presence of a central venous catheter, underlying thrombophilia, reduced mobility, surgery, and hospitalization. Classes of anticoagulants used for treatment of VTE are low molecular weight heparins and vitamin K antagonists. However, the use of direct oral anticoagulants for treatment or prevention of VTE has not been studied in this pediatric population yet. Pediatric gastroenterologists apply different VTE prevention and treatment strategies due to lack of literature and lack of consensus. We discuss the role of primary and secondary prophylactic use of anticoagulants, and provide tools and recommendations for screening, prevention and management for the specific pediatric populations.

Safety and efficacy of probiotics in the prevention of necrotizing enterocolitis in premature and/or low-birthweight infants: a systematic review and meta-analysis.

BackgroundNeonatal necrotizing enterocolitis (NEC) is a serious pediatric gastrointestinal disease and a cause of death in neonates, especially in premature infants. The addition of probiotics to the diet can reduce the incidence and severity of neonatal NEC. This meta-analysis explored the preventive effect of probiotics on NEC.MethodsEndnote X9 software was used to search for relevant studies in the Ovid, Embase, PubMed, and Web of Science databases. The search terms were “probiotics” and “necrotizing enterocolitis”. After retrieval, screening, and quality evaluation of the studies, Stata 16.0 software was used to analyze the data.ResultsA total of 10 studies, which collectively included 3,227 patients, were selected for analysis. Of them, 5 used a multiple-strain probiotics, and 5 used single-strain probiotic. Meta-analysis showed that treatment with probiotics could reduce the incidence of severe NEC [risk ratio (RR) =0.66; 95% confidence interval (CI): (0.50, 0.87); Z=−2.978; P=0.003], reduce mortality in underweight premature children [RR =0.81; 95% CI: (0.70, 0.94); Z=−2.864; P=0.004], and reduce the incidence of feeding intolerance [RR =0.78; 95% CI: (0.67, 0.90); Z=−3.280; P=0.001].DiscussionThe addition of probiotics to the diet of low-birthweight and premature infants can reduce the incidence of severe NEC and reduce related mortality rates.

Hyponatremia at the onset of necrotizing enterocolitis is associated with intestinal surgery and higher mortality

It has previously been shown that hyponatremia reflects the severity of inflammation in pediatric gastrointestinal diseases. Interpretation of electrolyte disorders is a common, but not well studied challenge in neonatology, especially in the context of early detection of necrotizing enterocolitis and bowel necrosis. The aim of this study was to assess if hyponatremia, or a decrease in plasma sodium level, at the onset of necrotizing enterocolitis (NEC) is associated with intestinal ischemia/necrosis requiring bowel resection and/or NEC-related deaths. This was a retrospective cohort study including patients with verified NEC (Bell’s stage ≥ 2) during the period 2009–2014. Data on plasma sodium 1–3 days before and at the onset of NEC were collected. The exposure was hyponatremia, defined as plasma sodium < 135 mmol/L and a decrease in plasma sodium. Primary outcome was severe NEC, defined as need for intestinal resection due to intestinal ischemia/necrosis and/or NEC-related death within 2 weeks of the onset of NEC. Generalized linear models were applied to analyze the primary outcome and presented as odds ratio. A total of 88 patients with verified NEC were included. Fifty-four (60%) of them had severe NEC. Hyponatremia and a decrease in plasma sodium at onset of NEC were associated with increased odds of severe NEC (OR crude 3.91, 95% CI (1.52–10.04) and 1.19, 95% CI (1.07–1.33), respectively). Also, a sub-analysis, excluding infants with pneumoperitoneum during the NEC episode, showed an increased odds ratio for severe NEC in infants with hyponatremia (OR 23.0, 95% CI (2.78–190.08)).Conclusions: The findings of hyponatremia and/or a sudden decrease in plasma sodium at the onset of NEC are associated with intestinal surgery or death within 2 weeks.What is Known:• Clinical deterioration, despite optimal medical treatment, is a relative indication for surgery in infants with necrotizing enterocolitis.• Hyponatremia is a common condition in preterm infants from the second week of life.What is New:• Hyponatremia and a decrease in plasma sodium level at the onset of necrotizing enterocolitis are positively associated with need of surgery or death within 2 weeks.• In infants with necrotizing enterocolitis, without pneumoperitoneum, where clinical deterioration despite optimal medical treatment is the only indication for surgery, hyponatremia, or a decrease in plasma sodium level can predict the severity of the disease.

Epidemiology of Gastrointestinal Disease among Children and Adolescents in Kazakhstan: 2012–2019

BACKGROUND: Gastrointestinal diseases are important trigger of public health concern in pediatric population. Non treated pathologies led to chronic inflammatory processes in adulthood. AIM: With respect to the lack of international studies on epidemiology of gastrointestinal disease in pediatric population, this study was aimed at analysis of national and local incidence rates of gastrointestinal disorders among children and adolescents in Kazakhstan over the period from 2012 to 2019. METHODS: This was a retrospective cross-sectional study located on South part of Kazakhstan and based on the data obtained from the Republican Center for Health Development – the major data source on the country’s health statistics. From this, we extracted information on children (0–14 years) and adolescents (15–17 years) with gastrointestinal disease (K00-K95 International Classification of Diseases, Revision 10 codes). We calculated incidence rates for the whole country and Turkestan province. RESULTS: The national incidence of pediatric disease was characterized by relative stability, and was 7760.4 per 100,000 population in 2017. The incidence of peptic ulcers and gallbladder disease in adolescents substantially exceeded that in children. At provincial level the incidence of gastritis/duodenitis and peptic ulcers was gradually declining, while that of gallbladder disease was subjected to growth over the past years. Adolescents had higher rates of gastrointestinal disease both at national and provincial levels. CONCLUSION: The analysis of national and local incidence rates of gastrointestinal disorders among children and adolescents in Kazakhstan showed that more studies are needed to obtain in-depth understanding of risk factors associated with gastrointestinal disease in child and adolescent population of Kazakhstan, including the prevalence of Helicobacter pylori infection. Besides, a national registry on pediatric gastrointestinal disease should be envisaged to overcome the lack of essential data.

Summary of the Forum on Standardized Diagnosis, Treatment and Management of Pediatric Diseases: the 12th National Pediatric Gastrointestinal Diseases Conference

儿科疾病的规范化诊治与管理高峰论坛——第十二届全国儿童消化系统疾病学术会议于2021年7月8至10日以现场参会和线上直播的形式在西安召开，有力推动了全国儿科消化系统疾病规范化诊治水平的提高。.

Nutritional Aspects of Pediatric Gastrointestinal Diseases.

In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively “harmless” nature. Apart from a diet’s therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical “side effects”, however, it should be emphasized that any dietary modification might have negative consequences on children’s growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.

Evolution of pediatric gastrointestinal ulcer disease: Is acute surgical intervention relevant?

BackgroundThere is a lack of contemporary data about pediatric gastrointestinal ulcer disease. We hypothesized that ulcers found in immunosuppressed children were more likely to require surgical intervention. MethodsAll children <21 years (n = 129) diagnosed with ulcers at a quaternary hospital from 1990 to 2019 were retrospectively reviewed. Clinical findings and pertinent information were collected. ResultsOf 129 cases, 19 (14.7%) were immunosuppressed. Eight were post-transplant; four were diagnosed with post-transplant lymphoproliferative disease (PTLD). Eight were associated with cancer. Three were both. Three of 19 immunosuppressed and 28/110 immunocompetent patients were taking acid suppression therapy. Nine immunosuppressed patients required surgical intervention, including all PTLD cases, compared to 14 immunocompetent (47.3% vs 16.4%, p < 0.01). Five patients had duodenal perforation, two had multiple small bowel perforations, and two had uncontrolled bleeding. Of 9/19 immunosuppressed patients, surgical complications included bleeding (n = 7), sepsis (n = 2), ostomy reoperation/readmissions (n = 2), and death within 30 days (n = 2). Two/eighteen immunocompetent patients had bleeding complications. ConclusionSurgical treatment for ulcers remains relevant for pediatric patients. Immunosuppressed patients have more complications, longer hospital stays, and are more likely to need surgical intervention. Efforts should be made for ulcer prophylaxis with a low threshold to investigate epigastric pain in these complex patients. Level of evidencePrognosis Study Level III Evidence

Summary of the 11th National Pediatric Gastrointestinal Diseases Conference in 2020

Summary of the 11th National Pediatric Gastrointestinal Diseases Conference in 2020

Learn pediatric gastrointestinal diseases from patients ~ treatment with awareness of red flags

Learn pediatric gastrointestinal diseases from patients ~ treatment with awareness of red flags

Clinical features of capsule endoscopy in 825 children: A single-center, retrospective cohort study.

Video capsule endoscopy (VCE) can detect mucosal lesions in the intestine, especially in the small bowel.Our study aims to evaluate the applications of VCE for pediatric gastrointestinal diseases.In this retrospective study, we included all patients who underwent VCE between December 2012 and December 2018. Clinical information and VCE data were analyzed.Among 828 patients, the completion rate was 99.6% (n = 825), with an average age of 10.2 ± 3.3 years old. A total of 459 VCE procedures showed abnormalities, and the overall diagnostic yield was 55.6%. The most common indications for VCE were abdominal pain among 505 (61.2%) patients and hematochezia (10.1%) among 83. Among the positive results of VCE, small bowel ulcers accounted for the highest percentage (57.7%), of which 164 cases were diagnosed as inflammatory bowel disease. For obscure gastrointestinal bleeding, 12 cases were diagnosed as Meckel's diverticulum. In terms of the small bowel transit time of VCE, compared with the negative group [288 (216.5, 390.3) min] and the enteritis group [277 (192.5, 374.8) min], a longer transit time was needed in the small bowel ulcer group [332.5 (240, 451.5) min, P < .01]. There were no correlations of positive VCE findings with anemia, the white blood cell count, the C-reactive protein level or the small bowel transit time according to Spearman rank analysis.VCE is relatively well tolerated and safe in children and has great value for the diagnosis and treatment of abdominal pain, especially inflammatory bowel disease and obscure gastrointestinal bleeding.