The pathogenesis of inflammatory bowel diseases is not very well understood; it is currently thought to be caused by the interaction between genetic factors, environmental factors, intestinal microbes, and immune factors. Biological agents such as anti-tumor necrosis factor (anti-TNF) are widely being used as therapeutic agents. Infliximab, a chimeric monoclonal IgG1 antibody against tumor necrosis factor, has been demonstrated to have an effect in the induction and maintenance of remission in Crohn's disease in children. The effects of biological agents, typified by anti-TNFs, in inflammatory bowel disease in children; the recent concern on the administration of biological agents in combination with immunomodulators; and 'Top-down' therapy are some of the topics covered in this review.
Antibodies, Monoclonal ; Biological Agents ; Biological Therapy ; Child ; Crohn Disease ; Humans ; Immunoglobulin G ; Immunologic Factors ; Inflammatory Bowel Diseases ; Necrosis ; Tumor Necrosis Factor-alpha ; Infliximab

The gut mucosal barrier plays an important role in maintaining a delicate immune homeostasis. The pathogenesis of inflammatory bowel disease (IBD) is considered to involve a defective mucosal immunity along with a genetic predisposition. Recent views have suggested an excessive response to components of the gut microbiota in IBD. A condition of "dysbiosis", with alterations of the gut microbial composition, has been observed in patients with IBD. In this article, the author review recent studies of gut microbiota in IBD, particularly the importance of the gut microbiota in the pathogenesis of pediatric IBD.
Child ; Genetic Predisposition to Disease ; Homeostasis ; Humans ; Immunity, Mucosal ; Inflammatory Bowel Diseases ; Metagenome

There are few studies of underweight in adolescents in Korea and other developed countries. According to the recent surveillance in Korea, prevalence of underweight in adolescents is lower than those in developing countries, and higher than those in developed countries in Northern Europe. This article reviews the problems, diagnosis, and nutritional support of underweight in adolescents.
Adolescent ; Developed Countries ; Developing Countries ; Europe ; Humans ; Korea ; Nutritional Support ; Prevalence ; Thinness

Historically, gastrointestinal stroma tumors (GIST) have been considered as smooth muscle tumors, but the controversy over this histogenesis is provoked due to various results with utilizing immunohistochemical methods. In andeffort to further clarify the histogenesis of GIST, we performed the immunohistochemical study, as well as histopathologic reexamination, of 24 cases, all diagnosed as smooth muscle tumors of gastrointestinal tract, from Seoul Paik Hospital and Ewha University Hospital between 1980 and 1989, and the main results were as follows; 1) In the histopathologic features by light microscopic study, 11 benign and 13 malignant lesions (including one high grade malignancy and 12 low-grade malignant lesions) were disclosed. 2) In the immunohistochemical study, all tumors showed Vimentin positivity (100%), but no tumor showed S-100 protein positivity (0%), and 7 cases (29.1%) showed Desmin positivity. Positive reaction for Desmin made it possible to suggest that the histogenesis of GIST be in smooth muscle, and neurogenic origin would be excluded by all negativity for S-100 protein. In summary, we would like to conclude that GIST would be smooth muscle tumors on account of their morphological characteristics and their intramural location, but most of them appear poorly differentiated by immunohistochemical method.

We successfully closed the isolated patent ductusarteriosus(PDA) in 2 female patients using the Rashkind Double-Disc Occlusion system. nonsurgical closure of PDA usin plug was introduced by Porstmann in 1968 through transfemoral artery catheter and using umbrella by Rashkind in 1977 througth venous site. There has been continued improvement and simplification of the equipment as well as in the implantation technique. Nowaday, a multicenter study was conducted to test the safety and effectiveness of this interventioal method in States. Successful closure rate was high but some problems were reported such as embolization, abnormal deployment and residual shunt. Residual shunt was visualized by aortography in our both cases immediately after intervention but continuous murmur could not be heard in both cases. Oxygen step-up disappeared immediately after occluder implantation in both cases. Complete occlusion was expected with thrombus in near future.
Aortography ; Arteries ; Catheters ; Ductus Arteriosus, Patent* ; Female ; Humans ; Oxygen ; Thrombosis

There are many causes of chronic and/or recurrent vomiting. The differential diagnosis is sometimes difficult because the clinical manifestations are often similar with each other. In this review, common causes of chronic and/or recurrent vomiting, and a general approach to children with vomiting are described. The involuntary passage of ingested material from the stomach into the esophagus, gastroesophageal reflux (GER), is a common event in infants. GER-disease can arise when the refluxed material causes esophagitis, resulting in pain, impaired esophageal function, poor growth or some respiratory symptoms. Esophageal impedance-pH meter will be the golden standard test in these cases. Parental reassurance and dietary management are expected to be the important components of managing mild GER-disease. Eosinophilic esophagitis is a clinicopathological disease characterized by (1) Feeding intolerance and GER-disease symptoms in children; (2) >15 eosinophils/HPF; (3) Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD. Appropriate treatments include dietary approaches based upon eliminating exposure to food allergens, or topical corticosteroids. Cyclic vomiting syndrome (CVS), a paroxysmal, especially severe, recurrent vomiting disorder, may be second to GER-disease as a cause of recurrent vomiting in children. It is highly incapacitating brain-gut disorder. The different diagnosis of CVS cuts a broad swath across neurologic, gastrointestinal, renal, metabolic, and endocrinologic disorders. Treatment is divided between acute intervention, when a patient is actively and severe vomiting, and prophylactic treatment in their interictal phase, the goal of which is reducing frequency and intensity of subsequent episodes.
Adrenal Cortex Hormones ; Allergens ; Child ; Diagnosis, Differential ; Eosinophilic Esophagitis ; Esophagitis ; Esophagus ; Gastroesophageal Reflux ; Humans ; Infant ; Parents ; Stomach ; Vomiting

Acute diarrhea is one of the most common symptoms in children. Common causes and differential diagnosis are reviewed in this article. In children with suspicious diarrhea, one should consider whether the stool is normal variant or true diarrhea and in the case of true diarrhea, whether it is infectious or noninfectious diarrhea, particularly bacterial or viral infection; last, in the case of bacterial infection, whether antibiotics is needed or not. Rotaviruses and noroviruses are the most common causes in children with acute diarrhea. The seasonal distribution of rotavirus infection is changing. Epidemics of norovirus are increasing. The main symptom of norovirus infection in children is vomiting, unlike rotavirus infection. Bacterial infection is not a common cause. When a child shows bloody and mucoid diarrhea, the use of antibiotics should be considered if the patient is a young infant, is immunocompromised, or has toxic symptoms such as high fever, severe dehydration, or malnutrition. Clinical approaches focused on etiology can support the proper management and prediction of prognosis. Genetic epidemiology research is needed to monitor the efficacy of rotavirus vaccination and to develop a norovirus vaccine.
Anti-Bacterial Agents ; Bacterial Infections ; Child ; Dehydration ; Diagnosis, Differential ; Diarrhea ; Fever ; Humans ; Infant ; Malnutrition ; Molecular Epidemiology ; Norovirus ; Organothiophosphorus Compounds ; Prognosis ; Rotavirus ; Rotavirus Infections ; Seasons ; Vaccination ; Vomiting

We investigated recent epidemiologic trends regarding campylobacteriosis vs. nontyphoidal salmonellosis (NTS), a previously known leading cause of bacterial enterocolitis in Korean children. Among 363 hospitalized children with acute inflammatory diarrhea, Campylobacter (18.7%) was the most frequently detected pathogen using multiplex polymerase chain reaction tests followed by Salmonella (15.4%). Children with campylobacteriosis were older than children with NTS (112.6 months [interquartile range (IQR) 66.0–160.1] vs. 53 months [IQR 31.0–124.0], P < 0.001) and had higher prevalences of abdominal cramping and stool hemoglobin. Campylobacteriosis may be suspected as a primary cause of acute inflammatory diarrhea in hospitalized school-aged Korean children and adolescents.
Adolescent ; Age Distribution* ; Campylobacter ; Child* ; Child, Hospitalized ; Colic ; Diarrhea* ; Enterocolitis ; Humans ; Multiplex Polymerase Chain Reaction ; Prevalence ; Salmonella ; Salmonella Infections*

Recent studies on pediatric inflammatory bowel disease (IBD) have revealed that early-onset IBD has distinct phenotypic differences compared with adult-onset IBD. In particular, very early-onset IBD (VEO-IBD) differs in many aspects, including the disease type, location of the lesions, disease behavior, and genetically attributable risks. Several genetic defects that disturb intestinal epithelial barrier function or affect immune function have been noted in these patients from the young age groups. In incidence of pediatric IBD in Korea has been increasing since the early 2000s. Neonatal or infantile-onset IBD develops in less than 1% of pediatric patients. Children with “neonatal IBD” or “infantile-onset IBD” have higher rates of affected first-degree relatives, severe disease course, and a high rate of resistance to immunosuppressive treatment. The suspicion of a monogenic cause of VEO-IBD was first confirmed by the discovery of mutations in the genes encoding the interleukin 10 (IL-10) receptors that cause impaired IL-10 signaling. Patients with such mutations typically presented with perianal fistulae, shows a poor response to medical management, and require early surgical interventions in the first year of life. To date, 60 monogenic defects have been identified in children with IBD-like phenotypes. The majority of monogenic defects presents before 6 years of age, and many present before 1 year of age. Next generation sequencing could become an important diagnostic tool in children with suspected genetic defects especially in children with VEO-IBD with severe disease phenotypes. VEO-IBD is a phenotypically and genetically distinct disease entity from adult-onset or older pediatric IBD.
Child ; Fistula ; Humans ; Incidence ; Infant ; Inflammatory Bowel Diseases* ; Interleukin-10 ; Korea ; Phenotype

Following nonpharmaceutical intervention (NPI) to mitigate coronavirus disease 2019 has led to drastic reduction in incidence of communicable disease. Intussusception is commonly preceded by infectious pathogens. Indirect effect from NPI implementation on incidence of intussusception has not been understood fully. We conducted a cohort study to estimate the impact of NPI on incidence of intussusception in Korean children. The net risk ratio of intussusception incidence for 2020 compared to 2010–2019 was 0.53 (95% confidence interval [CI], 0.43–0.64) for boys and 0.56 (95% CI, 0.44–0.71) for girls (P for difference = 0.017). Our study showed an association between NPI implementation and reduction of intussusception incidence, with more profound reduction in boys compared to girls.