Pediatric esophagogastroduodenoscopy (EGD) has become an established diagnostic and therapeutic modality in pediatric gastroenterology. Effective sedation strategies have been adopted to improve patient tolerance during pediatric EGD. For children, safety is a fundamental consideration during this procedure as they are at a higher risk of severe adverse events from procedural sedation compared to adults. Therefore, a detailed risk evaluation is required prior to the procedure, and practitioners should be aware of the benefits and risks associated with sedation regimens during pediatric EGD. In addition, pediatric advanced life support by endoscopists or immediate intervention by anesthesiologists should be available in the event that severe adverse events occur during pediatric EGD.
Adult ; Child ; Endoscopy, Digestive System* ; Gastroenterology ; Humans ; Risk Assessment

PURPOSE: Exclusive enteral nutrition (EEN) therapy effectively induces clinical remission in Crohn's disease (CD). It remains unclear, however, whether partial enteral nutrition (PEN) can maintain remission. This study was performed to determine the abilities of oral EEN and oral PEN to induce and maintain clinical remission in pediatric patients with CD, respectively. MATERIALS AND METHODS: Pediatric patients with CD who received oral EEN at a single center in 2000-2014 were identified retrospectively. Remission rates of the EEN and PEN during the 2 years study period were determined. Risk factors for EEN and PEN failure were identified. RESULTS: Of the 66 patients who started EEN, 61 (92%) completed the course. Clinical remission was achieved in 88% (58/66) of the patients. All 58 patients with remission continued with PEN: 43 (74%) were treatment adherent. The cumulative remission rates at 1 and 2 years were 67% and 52%, respectively. Differing from EEN, limited therapeutic efficacy of PEN was shown in severe CD patients. Female gender associated significantly with non-adherence. CONCLUSION: Oral EEN and PEN effectively induced and maintained remission in a pediatric population. Non-adherence was a limiting factor in the success of therapy.
Adolescent ; Child ; Crohn Disease/*therapy ; Enteral Nutrition/*methods ; Female ; Humans ; Male ; Remission Induction ; Retrospective Studies

BACKGROUND/AIMS: Malnutrition and growth retardation are important issues in treating pediatric Crohn's disease (CD). Thus, we aimed to investigate the prevalence of various nutritional and growth parameters at the time of diagnosis in Korean children with CD. METHODS: Seventy-one children (<18 years) were enrolled. We analyzed the Z-scores of height-for-age (HAZ), weight-for-height (WHZ), body mass index for age (BMIZ), bone mineral density for age (BMDZ), and the biochemical markers measured at the time of diagnosis. RESULTS: At diagnosis, HAZ <-2 was observed in three patients (4%), WHZ <-2 in 20 patients (28%), BMIZ <-2 in 19 patients (27%), and BMDZ <-2 in 11 patients (18%). The HAZ was significantly lower in females and patients with extraintestinal manifestations, and the WHZ and BMIZ were significantly lower in patients with stricturing and penetrating disease. Subnormal serum levels were highly prevalent for hemoglobin, albumin, iron, ferritin, calcium, magnesium, folate, vitamin B12, and zinc. There was a significant correlation between nutritional status, growth retardation, and disease activity. CONCLUSIONS: Abnormal nutritional status was highly prevalent in Korean children with CD at the time of diagnosis and was associated with the extent, behavior, and activity of the disease.
Adolescent ; Age Factors ; Body Mass Index ; Body Size ; Body Weight ; Bone Density ; Child ; Crohn Disease/blood/*complications/diagnosis/physiopathology ; Female ; Growth Disorders/complications ; Humans ; Male ; Malnutrition/complications ; Nutritional Status ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies

PURPOSE: Studies on the efficacy of infliximab (IFX) in a large population of pediatric patients with Crohn's disease (CD) are limited, and prognostic factors are not well-known. The aim of this study was to evaluate outcomes of IFX in pediatric patients with CD and to identify factors associated with poor prognosis. METHODS: We retrospectively analyzed medical data of 594 pediatric patients with CD between 1987 and 2013 in a tertiary center. Of these, 156 children treated with IFX were enrolled and were followed up for at least a year with intact data. Outcomes of induction and maintenance, classified as failure or clinical response, were evaluated on the tenth and 54th week of IFX therapy. RESULTS: We treated 156 pediatric patients with CD with IFX, and the median duration of IFX therapy was 47 months. For IFX induction therapy, 134 (85.9%) patients experienced clinical response on the 10th week. Among the 134 patients who showed response to induction, 111 (82.8%) patients maintained the clinical response on the 54th week. In multivariate analysis, low hematocrit (p=0.046) at the time of IFX initiation was associated with the failure of IFX induction. For IFX maintenance therapy, longer duration from the initial diagnosis to IFX therapy (p=0.017) was associated with maintenance failure on the 54th week. CONCLUSION: We have shown the acceptable outcomes of IFX in a large cohort of pediatric CD patients in Korea. Hematocrit and early introduction of IFX may be prognostic factors for the outcomes of IFX.
Child ; Cohort Studies ; Crohn Disease* ; Diagnosis ; Hematocrit ; Humans ; Infliximab* ; Korea ; Multivariate Analysis ; Prognosis ; Retrospective Studies

PURPOSE: Studies on the efficacy of infliximab (IFX) in a large population of pediatric patients with Crohn's disease (CD) are limited, and prognostic factors are not well-known. The aim of this study was to evaluate outcomes of IFX in pediatric patients with CD and to identify factors associated with poor prognosis. METHODS: We retrospectively analyzed medical data of 594 pediatric patients with CD between 1987 and 2013 in a tertiary center. Of these, 156 children treated with IFX were enrolled and were followed up for at least a year with intact data. Outcomes of induction and maintenance, classified as failure or clinical response, were evaluated on the tenth and 54th week of IFX therapy. RESULTS: We treated 156 pediatric patients with CD with IFX, and the median duration of IFX therapy was 47 months. For IFX induction therapy, 134 (85.9%) patients experienced clinical response on the 10th week. Among the 134 patients who showed response to induction, 111 (82.8%) patients maintained the clinical response on the 54th week. In multivariate analysis, low hematocrit (p=0.046) at the time of IFX initiation was associated with the failure of IFX induction. For IFX maintenance therapy, longer duration from the initial diagnosis to IFX therapy (p=0.017) was associated with maintenance failure on the 54th week. CONCLUSION: We have shown the acceptable outcomes of IFX in a large cohort of pediatric CD patients in Korea. Hematocrit and early introduction of IFX may be prognostic factors for the outcomes of IFX.
Child ; Cohort Studies ; Crohn Disease* ; Diagnosis ; Hematocrit ; Humans ; Infliximab* ; Korea ; Multivariate Analysis ; Prognosis ; Retrospective Studies

Right sided aortic arch is commonly accompanied by congenital heart disease, but abnormally originated left subvlavian artery can be acompression of trachea or esophagus by ducturs arteriosus or ligamentum arteriosus. But right sided aortic arch compressing superior vena cava has not been reported in Korea.We exerienced a case of right sided aortic arch with left subclavian artery compressing the superior vena cava, resulting in superior vena cava syndrome. So we report this case with brief review of literature.
Aorta, Thoracic* ; Arteries ; Esophagus ; Heart Defects, Congenital ; Subclavian Artery ; Superior Vena Cava Syndrome* ; Trachea ; Vena Cava, Superior*

PURPOSE: The aim of this study was to compare the efficacy and safety of band ligation and injection sclerotherapy in the endoscopic treatment of children with variceal bleeding. METHODS: The study population included 55 children, all of whom were treated at the time of endoscopic diagnosis of esophageal varices at Asan Medical Center, Seoul, Korea, between January 1994 and January 2011. The primary outcomes included initial success rates and duration of hemostasis after endoscopic management (band ligation vs. injectionsclerotherapy). RESULTS: The mean age was 6.7+/-5.2 years and the mean follow-up time was 5.4+/-3.7 years. The most common cause of esophageal varices was biliary atresia. Of 55 children with acute variceal bleeding, 39 had band ligation and 16 had injection sclerotherapy. No differences between groups were observed in terms of the size, location, and presence of red color sign. The success rates of band ligation and sclerotherapy in the control of acute bleeding episodes were 89.7% and 87.5%. The mean duration of hemostasis after endoscopic intervention was 13.2+/-25.1 months. After one year, 19 of 39 patients (48.7%) treated with band ligation and 7 of 16 patients (43.8%) with injection sclerotherapy had experienced rebleeding episodes. Complications after the procedures were observed in 10.3% and 18.8% of children treated with band ligation and injection sclerotherapy. CONCLUSION: The results of our current study suggest that band ligation and injection sclerotherapy are equally efficient treatments for the control of acute variceal bleeding and prevention of rebleeding.
Biliary Atresia ; Child* ; Chungcheongnam-do ; Diagnosis ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Hemostasis ; Humans ; Hypertension, Portal* ; Korea ; Ligation ; Sclerotherapy ; Seoul

Pediatric intestinal failure causes growth failure and mortality in children due to the inability to maintain normal nutritional balance. Short bowel syndrome is the most common cause in pediatric cases, and the residual bowel length is important for predicting long-term dependence on parenteral nutrition. Based on the possibility that the process of intestinal adaptation in children can continue throughout the first five years, enteral autonomy should be prioritized in the management of intestinal failure. Despite the lack of well-established guidelines, careful advance of enteral feeding and a multidisciplinary team approach are critical for optimizing survival outcomes.
Child ; Enteral Nutrition ; Humans ; Mortality ; Parenteral Nutrition ; Short Bowel Syndrome

Inflammatory bowel disease (IBD) is a chronic relapsing disorder of unknown etiology, which is believed to be multifactorial. Recently, the incidence of pediatric IBD has steeply increased in Korea since 2000. Poorly controlled disease activity can result in complications such as intestinal fistulae, abscess, and stricture, as well as growth retardation and delayed puberty in children. Because of a lack of confirmative tests, various diagnostic modalities must be used to diagnose IBD. Onset age, location, behavior, and activity are important in selecting treatments. Monogenic IBD must be excluded among infantile and refractory very-early-onset IBD. Early aggressive therapy using biologics has recently been proposed for peripubertal children to prevent growth failure and malnutrition.
Abscess ; Age of Onset ; Biological Products ; Child ; Colitis, Ulcerative ; Constriction, Pathologic ; Crohn Disease ; Humans ; Incidence ; Inflammatory Bowel Diseases* ; Intestinal Fistula ; Korea ; Malnutrition ; Puberty, Delayed

Crohn's disease (CD) is a chronic, relapsing disorder of unknown etiology and which affects patients for their entire life. Pediatric CD is significant in that approximately 25% of inflammatory bowel disease (IBD) patients are diagnosed as children and adolescents. The incidence continues to rise rapidly, but has not yet plateaued in Korea. The other important issues of pediatric CD are growth impairment and pubertal delay, both of which may result in permanent problems and which should be considered as one of the important aspects of treatment in contrast to that seen in adult patients. This review article presents pediatric clinicians with the basic principles of the medical treatment of Crohn's disease as it presents in childhood and adolescence. The goal of treatment in pediatric Crohn's disease is to achieve physical and psychological remission which includes freedom from abdominal pain, hematochezia, anemia, luminal inflammation, maintaining the normal value of albumin and inflammatory markers, stopping the use of corticosteroids, achieving normal growth and puberty, and also maintaining optimal mental health. We extensively reviewed the current studies in addition to conventional treatments which include 5-ASA, nutritional therapy, antibiotics, immunosuppressants, and anti-TNF-alpha blockades. We also attempted to consider the specific treatment of luminal and fistulizing disease, management in postoperative situations, and the optimal management strategy in order to maintain normal physical growth.
Abdominal Pain ; Adolescent ; Adrenal Cortex Hormones ; Adult ; Anemia ; Anti-Bacterial Agents ; Child ; Crohn Disease ; Freedom ; Gastrointestinal Hemorrhage ; Humans ; Immunosuppressive Agents ; Incidence ; Inflammation ; Inflammatory Bowel Diseases ; Korea ; Mental Health ; Phenobarbital ; Puberty ; Reference Values