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Publications in this journal

• Optimal Assessment of Paediatric IBD With MRI and Barium Follow-through.

  Authors: Edward Giles, Ozan Hanci, Alison McLean, Niall Power, Angela Cole, Nicholas M Croft, Kirsteen McDonald, Sam Chippington, Sandhia Naik

  Journal of pediatric gastroenterology and nutrition. 54(6):758-62.

  : The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of: The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of radiation, unpalatable contrast, and volume intolerance are involved with BaFT. Practice in investigating Crohn disease (CD) is changing with the increasing use of magnetic resonance imaging (MRI). The aim of the present study was to compare BaFT and a new abdominal MRI protocol in a paediatric IBD population. : All consecutive patients with a new diagnosis of IBD or requiring reassessment from September 2008 to December 2010 were investigated with both abdominal MRI and BaFT in accordance with a specific local paediatric IBD protocol. The studies were reported by nonblinded radiologists with an interest in gastrointestinal imaging. The reports were compared in conjunction with case note review. : Eighty-seven patients underwent both BaFT and MRI abdomen. Thirty-one percent of patients had additional pathology on MRI, not seen on the BaFT. Sixty-seven percent of patients (n = 59) had an MRI finding equivalent to BaFT. Using histology as a criterion standard for detecting terminal ileal disease, BaFT had a sensitivity and specificity of 76% and 67%, and MRI had a sensitivity and specificity of 83% and 95%, respectively. : This is the largest series of small bowel MRI in a paediatric population. MRI reports were at least equivalent to BaFT. MRI had higher sensitivity and, particularly, specificity in detecting terminal ileal pathology. These findings suggest that MRI should become the criterion standard investigation in children with IBD in centres with appropriate expertise, with zero radiation exposure being highly advantageous.

• Magnet ingestion in children and teenagers: an emerging health concern for pediatricians and pediatric subspecialists.

  Authors: Suma Chandra, Girish Hiremath, Stephen Kim, Benjamin Enav

  Journal of pediatric gastroenterology and nutrition. 54(6):828.

• Additional Value of Upper GI Tract Endoscopy in the Diagnostic Assessment of Childhood IBD.

  Authors: Thalia Z Hummel, Fiebo J W Ten Kate, Johannes B Reitsma, Marc A Benninga, Angelika Kindermann

  Journal of pediatric gastroenterology and nutrition. 54(6):753-7.

  : For the choice of treatment in children with inflammatory bowel disease (IBD), it is important to make a distinction between Crohn disease (CD) and ulcerative colitis (UC). To look for: For the choice of treatment in children with inflammatory bowel disease (IBD), it is important to make a distinction between Crohn disease (CD) and ulcerative colitis (UC). To look for pathognomonic features of CD, upper gastrointestinal tract (UGT) endoscopy has become part of the routine evaluation of children with suspected IBD; however, pathological changes can also be found in the UGT in patients with UC. The aims of the present study were to establish the role of UGT involvement in the diagnostic assessment of suspected IBD in children and to detect histopathological changes in the UGT mucosa, which can distinguish CD from non-CD (UC and non-IBD). : Biopsies (colon, ileum, duodenum, stomach, esophagus) from children suspected of having IBD who underwent endoscopy between 2003 and 2008 were reassessed by a blinded, expert pathologist. The histological findings of the UGT were compared with the diagnosis based on ileocolonic biopsies and the final diagnosis. : In 11% of the children with CD, the diagnosis was based solely on the finding of granulomatous inflammation in the UGT. Focal cryptitis of the duodenum and focally enhanced gastritis were found significantly more frequently in children with CD compared with children with UC and non-IBD, with a specificity and positive predictive value of 99% and 93% and 87.1% and 78.6%, respectively. : Histology on ileocolonic biopsies alone is insufficient for a correct diagnosis of CD or UC in children. UGT endoscopy should, therefore, be performed in the diagnostic assessment of all children suspected of having IBD.

• Risk of Infection and Prevention in Pediatric Patients With IBD: ESPGHAN IBD Porto Group Commentary.

  Authors: Gigi Veereman-Wauters, Lissy de Ridder, Gábor Veres, Sanja Kolacek, John Fell, Petter Malmborg, Sibylle Koletzko, Jorge Amil Dias, Zrinjka Misak, Jean-François Rahier, Johanna C Escher

  Journal of pediatric gastroenterology and nutrition. 54(6):830-837.

  ABSTRACT: Combined immunosuppression by immunomodulators and biological therapy has become standard in the medical management of moderate-to-severe inflammatory bowel disease (IBD) because of clearlyABSTRACT: Combined immunosuppression by immunomodulators and biological therapy has become standard in the medical management of moderate-to-severe inflammatory bowel disease (IBD) because of clearly demonstrated efficacy. Clinical studies, registries, and case reports warn of the increased risk of infections, particularly opportunistic infections; however, already in the steroid monotherapy era, patients are at risk because it is accepted that a patient should be considered immunosuppressed when receiving a daily dose of 20 mg of prednisone for 2 weeks. Prescriptions increasingly involve azathioprine, methotrexate, and various biological agents. The TREAT registry evaluated safety in >6000 adult patients, half of them treated with infliximab (IFX) for about 1.9 years. IFX-treated patients had an increased risk of infections and this was associated with disease severity and concomitant prednisone use. The REACH study, evaluating the efficacy of IFX in children with moderate-to-severe Crohn disease, refractory to immunomodulatory treatment, reports serious infections as the major adverse events and their frequency is higher with shorter treatment intervals. The combination of immunosuppressive medications is a risk factor for opportunistic infections. Exhaustive guidelines on prophylaxis, diagnosis, and management of opportunistic infections in adult patients with IBD have been published by a European Crohn's and Colitis Organization working group, including clear evidence-based statements. We have reviewed the literature on infections in pediatric IBD as well as the European Crohn's and Colitis Organization guidelines to present a commentary on infection prophylaxis for the pediatric age group.

• Effect of amoxicillin/clavulanate on gastrointestinal motility in children.

  Authors: Roberto Gomez, Sergio Fernandez, Ann Aspirot, Jaya Punati, Beth Skaggs, Hayat Mousa, Carlo Di Lorenzo

  Journal of pediatric gastroenterology and nutrition. 54(6):780-4.

  : The aim of the present study was to evaluate the effect of amoxicillin/clavulanate (A/C) on gastrointestinal motility. : Twenty consecutive pediatric patients referred for antroduodenal manometry: The aim of the present study was to evaluate the effect of amoxicillin/clavulanate (A/C) on gastrointestinal motility. : Twenty consecutive pediatric patients referred for antroduodenal manometry received 20 mg/kg of A/C into the small bowel lumen. In 10 patients (group A), A/C was given 1 hour after and in 10 (group B), 1 hour before ingestion of a meal. Characteristics of the migrating motor complex, including presence, frequency, amplitude, and propagation of duodenal phase III and phase I duration and phase II motility index (MI), were evaluated 30 minutes before and after A/C administration. : There were no statistically significant differences in age and sex between the 2 groups. Manometry studies were considered normal in 8 patients in each group. In group A, 2 patients developed duodenal phase III after receiving A/C, and no significant difference was found in the MI before and after the drug administration. In group B, 9 patients developed duodenal phase III (P < 0.05 vs group A). All phase III occurred within a few minutes from the medication administration. Most duodenal phase III contractions were preceded by an antral component during fasting but never after the medication was administered in either of the 2 groups (P < 0.001 vs fasting). In group B, the duration of duodenal phase I was shorter after drug administration (P < 0.05). There was no significant difference in duodenal phase II MI before and after A/C administration for the 2 study groups. : In children, administration of A/C directly into the small bowel before a meal induces phase III-type contractions in the duodenum, with characteristics similar to those present in the fasting state. These data suggest the possible use of A/C as a prokinetic agent. Further studies are needed to clarify its specific mechanism of action and the group of patients most likely to benefit from its use.

• Concomitant gastroparesis negatively affects children with functional gallbladder disease.

  Authors: Bruno P Chumpitazi, Stanton M Malowitz, Warren Moore, G S Gopalakrishna, Robert J Shulman

  Journal of pediatric gastroenterology and nutrition. 54(6):776-9.

  : The aim of the present study was to determine whether concomitant gastroparesis and biliary dyskinesia (BD) occur in children, and if so, to determine whether concomitant gastroparesis affects: The aim of the present study was to determine whether concomitant gastroparesis and biliary dyskinesia (BD) occur in children, and if so, to determine whether concomitant gastroparesis affects clinical outcome in children with BD. : We conducted a retrospective chart review of children with BD (ejection fraction <35% on cholescintigraphy, with no other metabolic or structural cause) who completed a solid-phase gastric emptying scintigraphy scan within 12 months of abnormal cholescintigraphy. Children were classified into 1 of 4 clinical outcome groups (excellent, good, fair, poor). : Thirty-five children with a mean follow-up time of 23.1 ± 17.3 (standard deviation) months were included. Twenty (57%) children were identified as having concomitant gastroparesis (GP) with BD. Children with concomitant GP were more likely to have a poor clinical outcome compared with those with BD alone (P < 0.005). In children undergoing cholecystectomy, those with concomitant GP were more likely to have a fair or poor clinical outcome compared with those with BD alone (P < 0.01). Factors predicting a more favorable clinical outcome were having BD alone and not having limitations in activity (eg, school absences) at the time of presentation. : Concomitant GP may occur in children with functional gallbladder disorders. Concomitant GP may negatively affect clinical outcome in children with BD.

• A Pilot Study of an Oral Absorbable Fat-Soluble Vitamin Formulation in Pediatric Patients with Cholestasis.

  Authors: Yu-Mei Shen, Jia-Feng Wu, Hong-Yuan Hsu, Yen-Hsuan Ni, Mei-Hwei Chang, Yu-Wen Liu, Hong-Shiee Lai, Wen-Ming Hsu, Hui-Ling Weng, Huey-Ling Chen

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVE:: Fat-soluble vitamin deficiencies are common complications in pediatric patients with chronic cholestasis. The aim of this study was to evaluate the status of fat-soluble vitaminOBJECTIVE:: Fat-soluble vitamin deficiencies are common complications in pediatric patients with chronic cholestasis. The aim of this study was to evaluate the status of fat-soluble vitamin deficiencies in patients under current practice and to test the effect of an oral, absorbable, fat-soluble vitamin formulation (OAFSV) in these patients. METHODS:: We recruited a total of 23 pediatric patients receiving conventional fat-soluble vitamin supplementation in a single medical center, with diagnosis of biliary atresia (10), progressive familial intrahepatic cholestasis (9), Alagille syndrome (2), and other conditions (2). Ten patients switched to OAFSV and continued for 3 months. Plasma levels of vitamins A, D, and E and a normalized ratio (INR) for prothrombin time (PT), a surrogate marker for vitamin K deficiency, were measured. RESULTS:: The proportion of patients with fat-soluble vitamin A, D, E, and K deficiencies under conventional supplementation was 73.9%, 81.8%, 91.3%, and 20.0%, respectively. In patients with total bilirubin levels above 3.0 mg/dl, the proportion of at least one FSV deficiency was 100%; and the deficiency rates of vitamin A, D, E, and K were 78.6%, 100.0%, 100.0% and 21.4%, respectively. Of the 10 patients receiving standard daily dose of OAFSV for 3 months, no adverse events or overdose effects were found. The rates of vitamin A, D, and E deficiency in the patients receiving OAFSV decreased from 80.0%, 100%, and 100%, respectively; to 70.0%, 60.0%, and 60.0% after 3 months of oral supplementation. CONCLUSIONS:: High rates of fat-soluble vitamin deficiency were found in pediatric patients with chronic cholestasis under current follow-up. OAFSV supplementation is safe and potentially effective in pediatric cholestatic patients.

• Significant reduction in central venous catheter related bloodstream infections in children on home parenteral nutrition after starting treatment with taurolidine line lock.

  Authors: Hui-Ping Chu, Joanne Brind, Rajeev Tomar, Susan Hill

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVE:: The aim of this study was to review the incidence and type of central venous catheter related bloodstream infection in children on treatment with home parenteral nutrition before andOBJECTIVE:: The aim of this study was to review the incidence and type of central venous catheter related bloodstream infection in children on treatment with home parenteral nutrition before and after the introduction of taurolidine. Taurolidine is a catheter lock solution which prevents biofilm formation and has broad spectrum bactericidal and anti-fungal action. Its use in paediatric patients on parenteral nutrition has only been reported in case studies. METHODS:: 19 children were reviewed, with the diagnoses of enteropathy (8 cases), short bowel syndrome (7 cases) and gastrointestinal dysmotility (4 cases). Incidence and type of sepsis were reviewed for 8-12 months pre- (when heparin was used) and 2-33 months post-introduction of the taurolidine catheter lock. RESULTS:: There were 8.6 episodes of catheter-related bloodstream infections per 1000 catheter days with heparin and 1.1 episodes per 1000 catheter days with taurolidine (p = 0.002). 14 of the 19 patients (74%) had no infections for up to 33 months after changing to taurolidine. No reports of multiresistant organisms or adverse effects with taurolidine were found. CONCLUSIONS:: Taurolidine line lock was associated with a decreased incidence of catheter-related bloodstream infections. This finding supports its use in patients with a history of septicaemia on treatment with cyclical parenteral nutrition.

• Also Children Unresponsive to Hepatitis B Virus Vaccination Need Celiac Disease Testing.

  Authors: Pietro Vajro, Giulia Paolella, Valerio Nobili

  Journal of pediatric gastroenterology and nutrition.

• Identification of Serum Protein Biomarkers in Biliary Atresia by Mass Spectrometry and ELISA.

  Authors: Zai Song, Rui Dong, Yuxia Fan, Shan Zheng

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVE:: There is an urgent need to identify noninvasive and convenient biomarkers for early diagnosis of biliary atresia (BA). The aim of this study was to identify potential protein biomarkersOBJECTIVE:: There is an urgent need to identify noninvasive and convenient biomarkers for early diagnosis of biliary atresia (BA). The aim of this study was to identify potential protein biomarkers for BA. PATIENTS AND METHODS:: Serum samples from 42 BA infants, 38 non-BA neonatal cholestasis infants (NC), and 36 healthy controls (HC) were randomly divided into a training set and a test set. Serum proteomic profiles were measured using SELDI-TOF-MS. Candidate biomarkers were purified using HPLC, identified using LC-MS/MS, and validated using ELISA. RESULTS:: A total of 2 protein peaks (m/z with 8697 and 9098 Da) with differential expression levels were found using SELDI-TOF-MS. These peaks were then analyzed by a support vector machine to construct a classification model in the training set. The sensitivity and specificity of the model were 94.1% and 91.8%, respectively, in the test set. One candidate biomarker (9098 Da) was identified as Apo C-II, and was found to be down-regulated in BA samples compared with HC samples, and up-regulated in BA samples compared to NC samples. The other candidate biomarker (8697 Da) was identified as Apo C-III, and was found to be up-regulated in BA compared with NC and HC. CONCLUSIONS:: Apo C-II and Apo C-III may be potential protein biomarkers of BA and may be usefull in distinguishing BA infants from healthy and NC infants. Further studies with additional populations or using prediagnostic serum are needed to confirm the importance of these findings as diagnostic markers of BA infants.

• Investigative Magnetic Resonance Cholangiopancreatography for Primary Sclerosing Cholangitis (PSC)-type lesions in children with Inflammatory Bowel Disease (IBD): Results from a cross-sectional study.

  Authors: Efthymia Alexopoulou, Polis E Xenophontos, Nikos Economopoulos, Themistoklis N Spyridopoulos, Olympia Papakonstantinou, Ioanna Panayotou, Konstantina Dimakou, Eleftheria Roma, Nikolaos L Kelekis

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVES:: To estimate the frequency of primary sclerosing cholangitis (PSC)-type lesions in children with inflammatory bowel disease (IBD), by means of magnetic resonance cholangiopancreatographyOBJECTIVES:: To estimate the frequency of primary sclerosing cholangitis (PSC)-type lesions in children with inflammatory bowel disease (IBD), by means of magnetic resonance cholangiopancreatography (MRCP); furthermore, to investigate the association between a series of easily applicable data on one hand and the presentation of such lesions at MRCP on the other hand. METHODS:: Collected demographic, laboratory and magnetic resonance enterography (MRE) data from the records of 73 children with IBD were cross-sectionally related to the MRCP-based diagnosis. RESULTS:: Around the time of MRCP, the distribution of IBD subtypes was 64.4%, 24.7% and 11% for Crohn's disease, indeterminate colitis and ulcerative colitis, respectively. Eleven patients (15.1%) were identified with PSC-type lesions. Demographic and MRE data were unrelated to the MRCP outcome. Biochemical abnormalities were of low prevalence (<50%) among PSC patients. The abnormality prevalences of AST, ALT and γ-GT were significantly higher in the PSC group, both at initial diagnosis of IBD and at the time of MRCP. Less consistent results were documented for bilirubin and ALP, especially at initial diagnosis of IBD. CONCLUSIONS:: The abnormality prevalences of AST, ALT and γ-GT were significantly higher in the PSC group. Nevertheless, PSC-type lesions frequently occur at pediatric IBD, even if the biochemical profile is hardly indicative of this probability.

• Screening For Subclinical Primary Sclerosing Cholangitis. Does It Contribute To The Management Of Children With IBD?

  Authors: Guido Engelmann

  Journal of pediatric gastroenterology and nutrition.

• Diagnostic approach and management of cow's milk protein allergy in infants and children: A practical guideline of the GI-committee of ESPGHAN.

  Authors: S Koletzko, B Niggemann, A Arato, J A Dias, R Heuschkel, S Husby, M L Mearin, A Papadopoulou, F M Ruemmele, A Staiano, M G Schäppi, Y Vandenplas

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVES:: This position paper provides recommendations for the diagnosis and management of suspected cow's milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnosticOBJECTIVES:: This position paper provides recommendations for the diagnosis and management of suspected cow's milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence based guidelines on CMPA. DIAGNOSIS:: If CMPA is suspected by history and examination, strict allergen avoidance is initiated. In certain circumstances (e.g. a clear history of immediate symptoms or a life threatening reaction with a positive test for cow's milk protein (CMP) specific IgE) the diagnosis can be made without a milk challenge. In all other circumstances, a controlled oral food challenge (open or blind) under medical supervision is required to confirm or exclude the diagnosis CMPA. TREATMENT:: In breast-fed infants, the mother should start a strict CMP-free diet. Non-breast fed infants with confirmed CMPA should receive an extensively hydrolyzed protein based formula with proven efficacy in appropriate clinical trials; amino acids based formulae are reserved for certain situations. Soy protein formula, if tolerated, is an option beyond 6 months of age. Nutritional counseling and regular monitoring of growth is mandatory in all age groups requiring CMP exclusion. RE-EVALUATION:: Patients should be re-evaluated every 6-12 months to assess whether they have developed tolerance to CMP. This is achieved in >75% by three years and >90% by six years of age. Inappropriate or overly long dietary eliminations should be avoided. Such restrictions may impair the quality of life of both child and family, induce improper growth, and also incur unnecessary healthcare costs.

• Anomalous Pancreaticobiliary Junction (APBJ).

  Authors: Ankur Arora, Amar Mukund, Shalini Thapar, Seema Alam

  Journal of pediatric gastroenterology and nutrition.

• Clinical Significance of Eosinophilia And Chronic Inflammatory Infiltrate In Children's Rectal Biopsies.

  Authors: Maurizio Pacilli, Simon Eaton, Alessandra Clarke, Anita Whitehead, Anita Nagy, Jeffrey L Brain

  Journal of pediatric gastroenterology and nutrition.

  BACKGROUND/PURPOSE:: The aim was to determine the clinical significance of an incidental finding of eosinophilia (EOS) and chronic inflammatory infiltrate (CINF) in rectal biopsies of childrenBACKGROUND/PURPOSE:: The aim was to determine the clinical significance of an incidental finding of eosinophilia (EOS) and chronic inflammatory infiltrate (CINF) in rectal biopsies of children investigated for suspected Hirschsprung's disease (HSCR). METHODS:: A retrospective study (2000-2010) of children incidentally found to have EOS and CINF was performed. HSCR cases were excluded. Presence of gastro-intestinal symptoms and nutritional status (weight-for-age Z-score) were investigated and compared with a matched cohort with normal biopsy. RESULTS:: Of 364 children undergoing rectal biopsy for suspected HSCR, 109 had confirmed HSCR whereas 255 children had normal ganglia. 44/255 (17%) had EOS and/or CINF incidentally reported and are the subject of this study. In 13/44 (29%), the biopsy was performed neonatally. At follow-up [4.6 months (1-22)], 21 (48%) had food and/or milk allergy, 30 (68%) had constipation and/or other gastro-intestinal symptoms. There was no change in weight-for-age Z-score (p = 0.85) at follow-up and 8 (20%) had failure to thrive. Only 10/44 (p = 0.0001 vs. patients with EOS and/or CINF) children with normal biopsy had persistent constipation at follow-up [9.7 months (0.5-84.7)] and 1 patient had atopy. Patients with normal biopsy exhibited an increase in weight-for-age Z-score at follow-up (p = 0.003) and only 3 patients (7%) had failure to thrive. CONCLUSIONS:: EOS and CINF are found in 17% of rectal biopsy in children who had rectal biopsies negative for HSCR. Half of these children will need further medical input for the presence of persisting G-I symptoms, food/milk allergy and failure to thrive and the possibility to develop inflammatory bowel disease later in life.

• Health Supervision in the Management of Children and Adolescents with Inflammatory Bowel Disease - recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN).

  Authors: P A Rufo, L A Denson, F A Sylvester, E Szigethy, P Sathya, Y Lu, G T Wahbeh, L M Sena, W A Faubion

  Journal of pediatric gastroenterology and nutrition.

  ABSTRACT: Ulcerative colitis (UC) and Crohn disease (CD), collectively referred to as Inflammatory Bowel Disease (IBD), are chronic inflammatory disorders that can affect the gastrointestinal tractABSTRACT: Ulcerative colitis (UC) and Crohn disease (CD), collectively referred to as Inflammatory Bowel Disease (IBD), are chronic inflammatory disorders that can affect the gastrointestinal tract of children and adults. Like other autoimmune processes, the cause(s) of these disorders remain unknown but likely involves some interplay between genetic vulnerability and environmental factors. Children in particular with UC or CD can present to their primary care providers with very similar symptoms, including abdominal pain, diarrhea, weight loss, and bloody stool. While UC and CD are more predominant in adults, epidemiologic studies have demonstrated that a significant percentage of these patients were diagnosed during childhood. The chronic nature of the inflammatory process observed in these children, as well as the waxing and waning nature of their clinical symptoms, can be especially disruptive to their physical, social, and academic development. As such, physicians caring for children must consider these diseases when evaluating patients with compatible symptoms. Recent research efforts have made available a variety of more specific and effective pharmacologic agents, as well as improved endoscopic and radiologic assessment tools, to assist clinicians in the diagnosis and interval assessment of their patients with IBD. However, as the level of complexity of these interventions has increased, so too has the need for practitioners to become familiar with a wider array of treatments as well as the risks and benefits of particular diagnostic testing. Nonetheless, in most cases, and especially when frequent visits to sub-specialty referral centers are not geographically feasible, primary care providers can be active participants in the management of their pediatric patients with IBD. The goal of this article is to educate and assist pediatricians and adult GI physicians caring for children with IBD, and in doing so, help to develop more collaborative care plans between primary care and subspecialty providers.

• Developmental Assessment of Infants with Biliary Atresia: Differences between Males and Females.

  Authors: Susan E Caudle, Jennifer M Katzenstein, Saul Karpen, McLin Valérie

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVE:: To investigate whether male and female infants with biliary atresia differ cognitively and to confirm previously documented developmental lags in infants with biliary atresia prior toOBJECTIVE:: To investigate whether male and female infants with biliary atresia differ cognitively and to confirm previously documented developmental lags in infants with biliary atresia prior to liver transplantation. METHODS:: With the Mullen Scales of Early Learning (MSEL), we examined 21 female and 12 male infants (ages 3 - 20 months) with biliary atresia, comparing scores across indices by gender and correlating MSEL scores with standard clinical and biochemical parameters. RESULTS:: Overall, both males and females were found to be quite vulnerable to developmental lags in the areas of expressive language and gross motor. In comparison to their male peers, females were found to be weaker in the area of visual reception skills (p = 0.05) with a trend found for expressive language (p = 0.08). Females were also found to have higher C-bilirubin levels and to be of shorter length. Growth parameters were found to be correlated with expressive language scores. International normalized ratio (INR) was found to be correlated with gross motor performance and with a trend also noted for fine motor skills. Age at Kasai predicted receptive language skills. CONCLUSIONS:: As has been previously shown, infants with biliary atresia appear to be vulnerable to developmental lags prior to transplantation. In particular, female infants appear to be vulnerable to cognitive and skill delays in comparison to their male peers. C-bilirubin levels may play a role in this increased vulnerability for females.

• Esophageal Mucosal Bridge in a 7 Year-old.

  Authors: Mazen I Abbas, Cortney C Wilson, David M Biko, Matthew D Goldman

  Journal of pediatric gastroenterology and nutrition.

• JPGN Editorial Announcement RE: Professor John Walker-Smith.

  Authors: David Branski, Melvin B Heyman

  Journal of pediatric gastroenterology and nutrition.

• Dietary outcomes of the healthy dads healthy kids Randomised controlled Trial.

  Authors: Tracy Burrows, Philip J Morgan, David R Lubans, Robin Callister, Tony Okely, James Bray, Clare Collins

  Journal of pediatric gastroenterology and nutrition.

  ABSTRACT: Fathers have not been exclusively targeted in family-based lifestyle programs. The aim was to determine whether dietary intakes of fathers and children can be improved, following anABSTRACT: Fathers have not been exclusively targeted in family-based lifestyle programs. The aim was to determine whether dietary intakes of fathers and children can be improved, following an intervention targeting fathers. Overweight and obese fathers (n = 50, 21-65 years), BMI (mean±SD) 33.3 ± 4.1 and their children (5-12 years) were recruited. Dietary intake was assessed at baseline and 6-month (n = 35) by food frequency questionnaire. Linear mixed models determined differences by time. Fathers significantly reduced portion size (P 0.03) but not energy intakes, while children reduced energy intakes(kJ) (P 0.02). There is an opportunity to target fathers as to improve child intakes.

• Oesophagitis Dissecans in a Child with Vomiting.

  Authors: Mohamed Mutalib, Alan Bates, Mark Furman, Muhammad Khan, Deborah Woodman, Ajmal Kader

  Journal of pediatric gastroenterology and nutrition.

• Comparison of Magnetic Resonance Enterography (MRE) to endoscopy, histopathology and laboratory evaluation in Pediatric Crohn's Disease.

  Authors: Cary G Sauer, Jeremy P Middleton, Adina Alazraki, Unni K Udayasankar, Bobby Kalb, Kimberly E Applegate, Diego R Martin, Subra Kugathasan

  Journal of pediatric gastroenterology and nutrition.

  BACKGROUND:: Children with Crohn's Disease (CD) often undergo cross-sectional imaging during clinical evaluation. Magnetic resonance enterography (MRE) is becoming the preferred radiologic assessmentBACKGROUND:: Children with Crohn's Disease (CD) often undergo cross-sectional imaging during clinical evaluation. Magnetic resonance enterography (MRE) is becoming the preferred radiologic assessment due to the lack of radiation exposure. However, there are little data in children with CD comparing MRE to objective disease measures. OBJECTIVE:: To compare MRE to endoscopy, histopathology, and laboratory evaluation in children with CD. METHODS:: We performed an IRB-approved query of our prospective CD MRE Database which includes data in children with CD undergoing MRE since 2008. RESULTS:: A total of 147 MRE studies were performed on 119 different children with symptomatic CD. Of those, 53 (39.6%) MRE studies were performed at diagnosis to evaluate small bowel disease burden. A total of 117 (79.6%) MRE studies displayed active and/or chronic disease while 30 (20.4%) MRE studies were normal. When compared to normal MRE studies, active inflammation on MRE was associated with a higher mean CRP (3.6 vs. 1.1, p < 0.001), higher ESR (36 vs. 22, p = 0.0.31), higher platelet value (439 vs. 352, p = 0.033), and lower albumin (3.4 vs. 3.7, p = 0.049). Comparison between MRE and endoscopy demonstrated excellent agreement when ulcers were present; and moderate agreement with histopathology. CONCLUSIONS:: Active inflammation on MRE is associated with higher CRP, ESR, platelets, and lower albumin in children with CD. MRE displays excellent agreement with endoscopic disease described by ulcers but poor agreement with mild mucosal disease described by erythema and friability. This study adds to a growing body of evidence that MRE provides excellent assessment of inflammation and measures disease activity in CD.

• North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Practice Guidelines: Diagnosis and Management of Hepatitis C Infection in Infants, Children and Adolescents.

  Authors: Cara L Mack, Regino P Gonzalez-Peralta, Nitika Gupta, Daniel Leung, Michael R Narkewicz, Eve A Roberts, Philip Rosenthal, Kathleen B Schwarz

  Journal of pediatric gastroenterology and nutrition.

  ABSTRACT: Hepatitis C (HCV) is an RNA virus that affects over 180 million individuals worldwide with a high propensity for chronic infection. Children with HCV infection differ from adults in severalABSTRACT: Hepatitis C (HCV) is an RNA virus that affects over 180 million individuals worldwide with a high propensity for chronic infection. Children with HCV infection differ from adults in several ways including some modes of transmission, rates of clearance, progression of fibrosis and the duration of potential chronic infection when acquired at birth. Since the discovery of HCV in 1989, there have been significant advances in the understanding of the virology and natural history of chronic HCV infection in children. In addition, there are now several treatment options for children with chronic hepatitis C infection and many new therapies on the horizon. As a consequence, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition brought together experts in pediatric hepatology to review the available data in children and provide clinicians with approaches to the diagnosis, management and prevention of HCV infection in children and adolescents. The guideline details the epidemiology and natural history of HCV infection in children, the diagnostic workup, monitoring and treatment of disease, and provide updates on future treatment options and areas of research.

• Crowning Pancreatic Stone In A Pediatric Patient.

  Authors: Kimberly A Mackey, Douglas S Fishman

  Journal of pediatric gastroenterology and nutrition.

• Influence of Shielding Total Parenteral Nutrition From Photooxidation On The Number of Early Blood Transfusions In Extremely Low Birthweight Premature Neonates.

  Authors: Amélie Stritzke, Valérie Turcot, Thérèse Rouleau, Jean-Claude Lavoie, Philippe Chessex

  Journal of pediatric gastroenterology and nutrition.

  OBJECTIVES:: The smallest premature neonates often receive blood transfusions early in life. Non-restrictive transfusion policies are linked to deleterious outcomes. Exposure of TPN to ambient lightOBJECTIVES:: The smallest premature neonates often receive blood transfusions early in life. Non-restrictive transfusion policies are linked to deleterious outcomes. Exposure of TPN to ambient light (LE) generates oxidation products associated with haemolysis in vitro. Shielding TPN from light (LP) limits oxidation. Hypothesis: protecting TPN from light decreases haemolysis and therefore the need for early blood transfusions. METHODS:: Comparison of haemolysis between animals fed enterally and those receiving TPN, and exploratory case control retrospective analysis of transfusion counts in premature infants receiving LE or LP TPN. Statistical analysis: ANOVA and longitudinal binomial regression model adjusting for potential covariables of transfusion counts. RESULTS:: In animals: TPN is associated with higher (p < 0.05) haemolysis compared to enteral feeds; photoprotection induces lower peroxide load with no effect on level of haemolysis. In premature infants: LE (n=76) or LP (n = 57) populations exhibited similar clinical characteristics. Initial hematocrit, gestational age and index of disease severity had a significant effect on the number of transfusions. When adjusting for these covariables photoprotection was no longer significant. CONCLUSION:: Even though peroxides are associated in vitro with haemolysis, shielding TPN fom light to reduce infused peroxides does not significantly decrease the need for early transfusions in premature infants.

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