To evaluate the performance of 2D shear-wave elastography from General Electric (2D-SWE.GE) for the noninvasiveassessment of liver fibrosis and to identify liver stiffness (LS) cut-off values for ...predicting different stages of fibrosisusing Transient Elastography (TE) as the reference method.
We included 331 consecutive subjectswith or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastographic techniques:TE and 2D-SWE.GE. Reliable LS measurements were defined for TE as the median value of 10 measurements with a successrate of ≥60% and an interquartile range (IQR)<30% and for 2D-SWE.GE as the median value of 10 measurements acquiredin a homogenous area and an IQR<30%. To discriminate between TE fibrosis stages we used the following cut-offs: F2- 7;F3- 9.5 and F4- 12kPa.
Reliable LS measurements were obtained in 95.8% subjects by 2D-SWE.GE, and 94.2%by TE (p=0.44). Based on TE cut-off values we divided our cohort into four groups: F<2: 30.1%; F=2: 10.2%; F=3: 12.2%;F=4: 47.5%. A strong correlation was found between the LS values obtained by the 2 methods: r=0.83, p<0.0001.LS valuesobtained by 2D-SWE.GE were significantly lower than those obtained by TE: 10.14±4.24 kPa vs. 16.72±13.4 kPa (p<0.0001).The best cut-off value for F≥2, F≥3 and for F=4 were 6.7, 8.2 and 9.3 kPa.
The best 2D-SWE.GE cut-off valuesfor predicting F≥2, F≥3 and F=4 were 6.7, 8.2 and 9.3kPa.
Primary lactose intolerance (PLI) is characterized by the inability to digest lactose. Homozygotes for the lactase gene polymorphisms (CC or GG) are considered to be genetically predisposed to PLI. ...Still, symptoms may only be present later in life. The evidence supporting a link between PLI, dairy intake, and quality of life (QoL) is limited in children.
This study investigates the link between LCT polymorphisms and suggestive symptoms and the influence of the genetic predisposition to PLI on dairy intake and QoL in Romanian children.
We recruited consecutive children evaluated in our ambulatory clinic. We asked all participants to complete a visual-analog symptoms scale, a dairy intake, and a QoL questionnaire. We used strip genotyping to identify genetic predisposition to PLI.
51.7% of children had a CC genotype, and 34.5% also had a GG genotype. Most children reported no or mild symptoms. Dairy intake and QoL were similar across study groups.
Our study shows that genetic predisposition does not necessarily assume the presence of specific symptoms. Genetic predisposition to PLI did not lead to dairy avoidance, nor did it negatively influence our children's QoL.
ABSTRACT
Familial adenomatous polyposis (FAP) is a well‐described inherited syndrome, characterized by the development of hundreds to thousands of adenomas in the colorectum, with implications in ...children and adolescents. Almost all adult patients will develop colorectal cancer if they are not identified and treated early enough. Identifying and screening for FAP commences in adolescence. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the adenomatous polyposis (APC) gene. This European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper provides a guide for diagnosis, assessment, and management of FAP in children and adolescents.
This is the first position paper regarding FAP published by ESPGHAN. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, these of the recommendations are supported on expert opinion. This position paper will instruct on the appropriate management and timing of procedures in children and adolescents with FAP.
Studies performed using transient elastography (TE), point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have shown that these techniques are all feasible and ...accurate in children for the evaluation of liver fibrosis due to several etiologies. However, for some specific pediatric pathologies, such as biliary atresia, the evidence is still limited. As shown in adults, inflammation is a confounding factor when assessing fibrosis severity and care should be taken when interpreting the results. Due to the scarce comparative data between serological tests and elastography techniques in children, a definite conclusion regarding which is the best cannot be drawn. Neither non-invasive elastographic techniques nor laboratory scores allow determination of the presence and the degree of inflammation, necrosis, iron or copper deposits.
Crohn’s disease (CD) is an inflammatory bowel disease (IBD) of multifactorial etiology that affects all segments of the gastrointestinal tract and is associated with multiple extra-intestinal ...manifestations. Spondyloarthropathies are the most common extra-digestive manifestation of IBD’s. Spondyloarthropathies primarily involve the axial skeleton, but mai also be associated with peripheral symptoms such as synovitis, dactylitis or enthesitis.ObjectivesCase presentation of a teenager, aged 14, diagnosed with CD A1 L3L4B1p-score PCDAI 45, (November 2018) that presented with joint manifestations as a form of onset.Case presentationThe patient exhibits joint pain at the level of large joints of self-limiting character, as well as pain at the level of the costochondral joints associated with fever spikes. In recent history, over a period of two months, the patient presented up to 10 stools/day, without pathological features, with consecutive weight loss. An infectious etiology was suspected and empiric antibiotic treatment was instituted, with the evolution being unfavorable.She is admitted to the clinic for further investigation and treatment. Biologically she presented: marked inflammatory syndrome, reactive thrombocytosis, hypochromic microcytic anemia, positive calprotectin. The suspicion of an IBD, is raised, multiple biopsies from the upper digestive tract being performed. The macro and microscopic appearance suggested Crohn’s disease in the stage of active lesions. Induction therapy with exclusive enteral nutrition (EEN) is established, as well as azathioprine, to maintain remission. Evolution is favorable with the remission of joint symptoms in the first 2 weeks of EEN.ConclusionIn some cases, patients with Crohn’s disease, due to chronic inflammatory syndrome, may develop symptoms similar to those encountered in spondyloarthropathies.
ABSTRACT Button batteries (BB) remain a health hazard to children as ingestion might lead to life‐threatening complications, especially if the battery is impacted in the esophagus. Worldwide ...initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably <2 hours). Honey and sucralfate can be considered in ingestions ⩽12 hours while waiting for endoscopic removal but should not delay it. In case of delayed diagnosis (first confirmation of the BB on X‐ray >12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (⩽12 hours after ingestion) and position of the BB beyond the esophagus, one can monitor with repeat X‐ray (if not already evacuated in stool) in 7 to 14 days, which is different from previous guidelines where repeat X‐ray and removal is recommended after 2–4 days and is also based on age. Finally, prevention strategies are discussed in this paper.
ABSTRACTFamilial adenomatous polyposis (FAP) is a well-described inherited syndrome, characterised by the development of hundreds to thousands of adenomas in the colorectum, with implications in ...children and adolescents. Almost all adult patients will develop colorectal cancer (CRC) if they are not identified and treated early enough. Identifying and screening for FAP commences in adolescence. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the adenomatous polyposis (APC) gene. This European Society for Paediatric Gastroenterology, Hepatology and Nutrition (EPGHAN) position paper provides a guide for diagnosis, assessment and management of familial adenomatous polyposis in children and adolescents.This is the first position paper regarding FAP published by ESPGHAN. Literature from PubMed, Medline and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, these of the recommendations are supported on expert opinion. This position paper will instruct on the appropriate management and timing of procedures in children and adolescents with FAP.
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper ...provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta‐analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over‐diagnosis. CMA is also over‐diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over‐diagnosis of CMA occurs much more frequently than under‐diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2–4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
What Is Known
Cow's milk allergy (CMA) is mostly a disease of infancy and early childhood.
Although both over‐ and under‐diagnosis do occur, over‐diagnosis is more frequent; both are associated with potentially long‐term negative health consequences.
A previous guideline on CMA developed by European Society of Paediatric Gastroenterology, Hepatology and Nutrition was published in 2012.
What Is New
Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated.
The impact of CMA on nutrition, growth, cost, and quality of life is discussed.
The roles of hydrolysed rice formula, soy, and vegetable infant feeds in the diagnostic and therapeutic approaches to CMA are discussed.
The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children.
A literature search ...was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors.
A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9.
Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.
Childhood obesity has followed, during the last two decades, an ascending trend. Insulin resistance (IR) is central to the pathophysiology of obesity. So far, several methods of assessing IR have ...been proposed. We aimed to evaluate critically some of the simplest methods used to assess IR in the pediatric population. We studied retrospectively the records of children evaluated for obesity in the “Louis Ţurcanu” Emergency Hospital for Children Timisoara, over a period of 10 years. The study population consisted of 342 children. Anthropometric and metabolic variables were analyzed, and the following indices of IR were assessed: impaired glucose tolerance (IGT), Homeostatic Model of Assessment-IR (HOMA-IR), Homeostatic Model of Assessment- b (HOMAβ), Quantitative Insulin Sensitivity Check Index (QUICKI) as well as the TG/HDLc ratio. Data was expressed as frequencies, means ± standard deviations or median ± interquartile interval for or a 95% confidence interval. The t-test for independent groups or the Mann-Whitney test to assess differences of IR indices across weight, gender and pubertal categories. HOMA-IR diagnosed the most children with IR, at the opposite pole we found QUICKI. IGT was a rare finding. It is necessary to reconsider how we assess the carbohydrate metabolism in children. Of the methods we evaluated, HOMA-IR is the optimal method for assessing IR children.
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