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Efficacy and Tolerance of a New Anti-Regurgitation Formula.

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(2):104-109. doi:10.5223/pghn.2016.19.2.104

PURPOSE: Regurgitation is a common physiological phenomenon in infants. The aim of the present study was to evaluate the efficacy of a new anti-regurgitation (AR) formula (Novalac), thickened with an innovative complex including fibres, on the daily number of regurgitations and to assess its impact on stool consistency and frequency. METHODS: Infants younger than five months, presenting at least 5 regurgitations per day were recruited in this trial. The efficacy of the new formula on regurgitation (daily number and Vandenplas score), stool frequency and consistency were assessed at day 14 and 90. Growth data were recorded at each study visit. RESULTS: Ninety babies (mean age 9.6±5.8 weeks) were included in the full analysis data set. The mean number of regurgitation episodes at inclusion was 7.3±3.4. In all infants, regurgitations improved after 2 weeks. The daily number of regurgitations decreased significantly (-6.3±3.3, p<0.001) including in those previously fed a thickened formula (-6.2±3.0, p<0.001). There was no significant change in stool consistency at day 14. After 3 months, 97.5% of infants had formed or soft stools. Growth was appropriate with a slight increase of weight-for-age z-score (from -0.5±1.0 to -0.1±0.9) and no change of weight-for length z-score (-0.1±1.1 to -0.1±-1.1). CONCLUSION: The new AR formula thickened with an innovative complex is very effective in reducing the daily number of regurgitations without having a negative impact on stools consistency.
Dataset ; Gastroesophageal Reflux ; Humans ; Infant ; Infant Formula ; Physiological Phenomena

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Updates on the Diagnosis of Helicobacter pylori Infection in Children: What Are the Differences between Adults and Children?.

Hye Ran YANG

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(2):96-103. doi:10.5223/pghn.2016.19.2.96

Helicobacter pylori infection is acquired mainly during childhood and causes various diseases such as gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphoma, and iron deficiency anemia. Although H. pylori infection in children differs from adults in many ways, this is often overlooked in clinical practice. Unlike adults, nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. Histopathological findings of gastric tissues are also different in children due to predominance of lymphocytes and plasma cells and the formation of gastric MALT. Although endoscopy is recommended for the initial diagnosis of H. pylori infection, several non-invasive diagnostic tests such as the urea breath test (UBT) and the H. pylori stool antigen test (HpSA) are available and well validated even in children. According to recent data, both the ¹³C-UBT and HpSA using enzyme-linked immunosorbent assay are reliable non-invasive tests to determine H. pylori status after eradication therapy, although children younger than 6 years are known to have high false positives. When invasive or noninvasive tests are applied to children to detect H. pylori infection, it should be noted that there are differences between children and adults in diagnosing H. pylori infection.
Adult* ; Anemia, Iron-Deficiency ; Breath Tests ; Child* ; Diagnosis* ; Diagnostic Tests, Routine ; Endoscopy ; Enzyme-Linked Immunosorbent Assay ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Lymphocytes ; Lymphoid Tissue ; Lymphoma ; Peptic Ulcer ; Plasma Cells ; Urea

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Hepatitis C Viral Infection in Children: Updated Review.

Mohamed A EL-GUINDI

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(2):83-95. doi:10.5223/pghn.2016.19.2.83

Hepatitis C virus (HCV) infection is a major medical challenge affecting around 200 million people worldwide. The main site of HCV replication is the hepatocytes of the liver. HCV is a positive enveloped RNA virus from the flaviviridae family. Six major HCV genotypes are implicated in the human infection. In developed countries the children are infected mainly through vertical transmission during deliveries, while in developing countries it is still due to horizontal transmission from adults. Minimal nonspecific and brief symptoms are initially found in approximately 15% of children. Acute and chronic HCV infection is diagnosed through the recognition of HCV RNA. The main objective for treatment of chronic HCV is to convert detected HCV viremia to below the detection limit. Children with chronic HCV infection are usually asymptomatic and rarely develop severe liver damage. Therefore, the benefits from current therapies, pegylated-Interferon plus ribavirin, must be weighed against their adverse effects. This combined treatment offers a 50-90% chance of clearing HCV infection according to several studies and on different HCV genotype. Recent direct acting antiviral (DAA) drugs which are well established for adults have not yet been approved for children and young adults below 18 years. The most important field for the prevention of HCV infection in children would be the prevention of perinatal and parenteral transmission. There are areas of focus for new lines of research in pediatric HCV-related disease that can be addressed in the near future.
Adult ; Child* ; Developed Countries ; Developing Countries ; Epidemiology ; Flaviviridae ; Genotype ; Hepacivirus ; Hepatitis C* ; Hepatitis* ; Hepatocytes ; Humans ; Limit of Detection ; Liver ; Ribavirin ; RNA ; RNA Viruses ; Viremia ; Young Adult

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Poor Prognostic Factors in Patients with Parenteral Nutrition-Dependent Pediatric Intestinal Failure.

Shin Jie CHOI ; Kyung Jae LEE ; Jong Sub CHOI ; Hye Ran YANG ; Jin Soo MOON ; Ju Young CHANG ; Jae Sung KO

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(1):44-53. doi:10.5223/pghn.2016.19.1.44

PURPOSE: Parenteral nutrition (PN) not only provides nutritional support but also plays a crucial role in the treatment of children with intestinal failure. The aim of this study was to evaluate the clinical significance and clinical outcomes of long-term PN. METHODS: Retrospective cohort study was conducted using the medical records of patients treated at Seoul National University Children's Hospital. This study included 19 patients who received PN for over six months. Most patients received home PN. RESULTS: The indications for PN included short bowel syndrome, chronic intestinal pseudo-obstruction, and intractable diarrhea of infancy. The median age of PN initiation was 1.3 years, and the median treatment duration was 2.9 years. Two patients were weaned from PN; 14 continued to receive PN with enteral feedings; and 3 patients died. The overall survival rates at 2 and 5 years were 93.3% and 84.0%, respectively. The incidence of catheter-related bloodstream infections was 2.7/1,000 catheter-days and was associated with younger age at PN initiation and lower initial height Z-score. Six patients developed catheter-related central vein thrombosis, with an incidence of 0.25/1,000 catheter-days. Eleven patients experienced PN-associated liver disease (PNALD), and one patient underwent multi-visceral transplant. The patients with PNALD exhibited lower final heights and body weight Z-scores. All patients experienced micronutrient deficiencies transiently while receiving PN. CONCLUSION: PN is an important and safe treatment for pediatric intestinal failure. PNALD was linked to final anthropometric poor outcomes. Micronutrient deficiencies were common. Anthropometric measurements and micronutrient levels must be monitored for successful PN completion.
Body Weight ; Catheter-Related Infections ; Child ; Cholestasis ; Cohort Studies ; Diarrhea ; Humans ; Incidence ; Intestinal Pseudo-Obstruction ; Liver Diseases ; Medical Records ; Micronutrients ; Nutritional Support ; Parenteral Nutrition ; Retrospective Studies ; Seoul ; Short Bowel Syndrome ; Survival Rate ; Thrombosis ; Veins

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Colon Transit Time Test in Korean Children with Chronic Functional Constipation.

Ha Yeong YOO ; Mock Ryeon KIM ; Hye Won PARK ; Jae Sung SON ; Sun Hwan BAE

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(1):38-43. doi:10.5223/pghn.2016.19.1.38

PURPOSE: Each ethnic group has a unique life style, including diets. Life style affects bowel movement. The aim of this study is to describe the results of colon transit time (CTT) tests in Korean children who had chronic functional constipation based on highly refined data. METHODS: One hundred ninety (86 males) out of 415 children who performed a CTT test under the diagnosis of chronic constipation according to Rome III criteria at Konkuk University Medical Center from January 2006 through March 2015 were enrolled in this study. Two hundreds twenty-five children were excluded on the basis of CTT test result, defecation diary, and clinical setting. Shapiro-Wilk and Mann-Whitney U, and chi-square tests were used for statistical analysis. RESULTS: The median value and interquartile range (IQR) of CTT was 54 (37.5) hours in Encopresis group, and those in non-encopresis group was 40.2 (27.9) hours (p<0.001). The frequency of subtype between non-encopresis group and encopresis was statistically significant (p=0.002). The non-encopresis group (n=154, 81.1%) was divided into normal transit subgroup (n=84, 54.5%; median value and IQR of CTT=26.4 [9.6] hours), outlet obstruction subgroup (n=18, 11.7%; 62.4 [15.6] hours), and slow transit subgroup (n=52, 33.8%; 54.6 [21.0] hours]. The encopresis group (n=36, 18.9%) was divided into normal transit subgroup (n=8, 22.2%; median value and IQR of CTT=32.4 [9.9] hours), outlet obstruction subgroup (n=8, 22.2%; 67.8 [34.8] hours), and slow transit subgroup (n=20, 55.6%; 59.4 [62.7]hours). CONCLUSION: This study provided the basic pattern and value of the CTT test in Korean children with chronic constipation.
Academic Medical Centers ; Child* ; Colon* ; Constipation* ; Defecation ; Diagnosis ; Diet ; Encopresis ; Ethnic Groups ; Humans ; Korea ; Life Style

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Stepwise Endoscopy Based on Sigmoidoscopy in Evaluating Pediatric Graft-versus-Host Disease.

Kyung Jae LEE ; Shin Jie CHOI ; Hye Ran YANG ; Ju Yuong CHANG ; Hyoung Jin KANG ; Hee Young SHIN ; Gyeong Hoon KANG ; Jae Sung KO ; Jin Soo MOON

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(1):29-37. doi:10.5223/pghn.2016.19.1.29

PURPOSE: The aim of our study was to establish a safe and convenient diagnostic method for acute gastrointestinal (GI) graft-versus-host disease (GVHD) in children by determining the sensitivity and negative predictive values of upper and lower endoscopic biopsies for children suspected of GI GVHD. METHODS: Patients suspected of GI GVHD who received endoscopic evaluation within 100 days after stem cell transplantation and endoscopies between January 2012 and March 2014 in Seoul National University Children's Hospital were included in our study. RESULTS: Fifteen patients with a total of 20 endoscopic procedures were included in our study. Sensitivity at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 80.0%, respectively. Negative predictive values at the esophagus, stomach, and duodenum were 22.2%, 30.0%, and 60.0%, respectively. Overall sensitivity and negative predictive values of upper endoscopic biopsy for GVHD were 77.8% and 50.0%, respectively. Overall sensitivity and negative predictive values of lower endoscopic biopsy for GVHD were 88.9% and 66.7%, respectively. CONCLUSION: We recommend flexible sigmoidoscopy as a safe and accurate diagnostic tool for GVHD, similar to other studies reported previously. However, if there is no evidence of GVHD on sigmoidoscopy with high index of suspicion of GI bleeding, full colonoscopy and upper endoscopy should be considered.
Biopsy ; Child ; Colonoscopy ; Duodenum ; Endoscopy* ; Esophagus ; Graft vs Host Disease* ; Hemorrhage ; Humans ; Seoul ; Sigmoidoscopy* ; Stem Cell Transplantation ; Stomach

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Foreign Body Ingestion in Children: Should Button Batteries in the Stomach Be Urgently Removed?.

Jun Hee LEE ; Jee Hoo LEE ; Jung Ok SHIM ; Jung Hwa LEE ; Baik Lin EUN ; Kee Hwan YOO

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(1):20-28. doi:10.5223/pghn.2016.19.1.20

PURPOSE: Foreign body (FB) ingestion is common in children, and button battery (BB) ingestion has been increasing in recent years. This study was to identify factors related to outcomes of FB ingestion, particularly BBs in the stomach. We evaluated whether the current recommendations are appropriate and aimed to suggest indications for endoscopic removal of BB in the stomach in young children. METHODS: We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children. We observed types, size, location of BB and outcomes, and analyzed their associations with complications. RESULTS: Coins and BB were the two most common FBs. Their shapes and sizes were not associated with the spontaneous passage time. Size, spontaneous passage time, and age were also not associated with any specific complications. For BB ingestion, all 5 cases with lithium batteries (≥1.5 cm, 3 V) presented moderate to major complications in the esophagus and stomach without any symptoms, even when the batteries were in the stomach and beyond the duodenum, while no complications were noted in 7 cases with alkaline batteries (<1.5 cm, 1.5 V) (p=0.001). All endoscopies were conducted within 24 hours after ingestion. CONCLUSION: The type and voltage of the battery should be considered when determining whether endoscopy is required to remove a BB in the stomach. For lithium battery ingestion in young children, urgent endoscopic removal might be important in order to prevent complications, even if the child is asymptomatic and the battery is smaller than 2 cm.
Child* ; Duodenum ; Eating* ; Endoscopy ; Esophagus ; Foreign Bodies* ; Humans ; Lithium ; Numismatics ; Stomach*

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Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children.

Rodrigo Strehl MACHADO ; Frederick W WOODLEY ; Beth SKAGGS ; Carlo Di LORENZO ; Ihuoma ENELI ; Mark SPLAINGARD ; Hayat MOUSA

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(1):12-19. doi:10.5223/pghn.2016.19.1.12

PURPOSE: This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children. METHODS: Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals. RESULTS: Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux. CONCLUSION: The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.
Arousal ; Child* ; Cystic Fibrosis ; Electric Impedance ; Esophageal pH Monitoring ; Fundoplication ; Gastroesophageal Reflux* ; Humans ; Infant ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring*

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Cholestasis beyond the Neonatal and Infancy Periods.

Racha KHALAF ; Claudia PHEN ; Sara KARJOO ; Michael WILSEY

Pediatric Gastroenterology, Hepatology & Nutrition.2016;19(1):1-11. doi:10.5223/pghn.2016.19.1.1

Cholestasis results from impairment in the excretion of bile, which may be due to mechanical obstruction of bile flow or impairment of excretion of bile components into the bile canaliculus. When present, cholestasis warrants prompt diagnosis and treatment. The differential diagnosis of cholestasis beyond the neonatal period is broad and includes congenital and acquired etiologies. It is imperative that the clinician differentiates between intrahepatic and extrahepatic origin of cholestasis. Treatment may be supportive or curative and depends on the etiology. Recent literature shows that optimal nutritional and medical support also plays an integral role in the management of pediatric patients with chronic cholestasis. This review will provide a broad overview of the pathophysiology, diagnostic approach, and management of cholestasis beyond the neonatal and infancy periods.
Alagille Syndrome ; Bile ; Bile Canaliculi ; Cholelithiasis ; Cholestasis* ; Diagnosis ; Diagnosis, Differential ; Hepatitis ; Hepatolenticular Degeneration ; Humans ; Jaundice ; Pruritus

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Correction: Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy.

Yvan VANDENPLAS ; Ahmed ABUABAT ; Suleiman AL-HAMMADI ; Gamal Samy ALY ; Mohamad S MIQDADY ; Sanaa Youssef SHAABAN ; Paul Henri TORBEY

Pediatric Gastroenterology, Hepatology & Nutrition.2014;17(3):201-201. doi:10.5223/pghn.2014.17.3.201

Table 2 contains a typographical error.
Consensus* ; Diagnosis* ; Hypersensitivity* ; Middle East* ; Milk Proteins*

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