Iva Hojsak

Children's Hospital Zagreb · Referral center for pediatric gastroenetrology and nutrition

Background and Aims Data on upadacitinib therapy in children with ulcerative colitis (UC) or unclassified inflammatory bowel disease (IBD-U) are scarce. We aimed to evaluate the effectiveness and safety of upadacitinib as an induction therapy in pediatric UC or IBD-U. Methods In this multicenter retrospective study, children treated with upadaciti...

Background/Objectives: Celiac disease (CD) is a common immune-mediated, chronic systemic disorder that is treated with a strict, lifelong gluten-free diet (GFD). In addition to gas-trointestinal manifestations, CD also presents with a variety of extraintestinal symptoms, including significant neurological and neuropsychiatric symptoms. Among these...

What is Known Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction. What is New In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes. BoNT has been suggested for treating cri...

The use of omega-3 fatty acids (omega-3 FA) in the treatment of atopic dermatitis (AD) is an area of ongoing research. Some studies suggest that dietary supplementation with omega-3 FA can help manage symptoms of AD by reducing lesion severity, skin inflammation, dryness and itching, while others show no significant beneficial effect. The aim of th...

Diet has been implicated in the pathogenesis of inflammatory bowel disease (IBD) and, more specifically, Crohn’s disease (CD), for a long time [...]

Background This study aimed to evaluate the effect of overweight and obesity at the start of anti-TNF therapy on treatment response and relapse rate in children with inflammatory bowel disease (IBD). Methods This multicenter, retrospective cohort study included 22 IBD centers in 14 countries. Children diagnosed with IBD in whom antitumor necrosis...

Background The aim of our study was to investigate the effect of an exercise program on health‐related quality of life (HRQoL) and sleep quality in children with inflammatory bowel disease (IBD) in remission. Methods A total of 42 pediatric IBD patients in remission were recruited to participate in a 6‐month‐long home‐based exercise program. Their...

The most frequent functional gastrointestinal disorders (FGID) in children include infantile colic, constipation, functional abdominal pain (FAP), and irritable bowel syndrome (IBS). Unfortunately, treatment options for FGID in children are limited, therefore many dietary interventions have been evaluated, including probiotics. This chapter summari...

The use of omega-3 fatty acids (omega-3 FA) in the treatment of atopic dermatitis (AD) is an area of ongoing research. Some studies suggest that dietary supplementation with omega-3 FA can help manage symptoms of AD by reducing lesion severity, skin inflammation, dryness and itching, while other show no significant beneficial effect. The aim of thi...

OBJECTIVES This study described disease characteristics and long-term outcomes in patients diagnosed with very early onset inflammatory bowel disease (VEOIBD) (diagnosed before 6 years of age) and infantile-IBD (before 2 years). METHODS Cases from 21 centers worldwide diagnosed with VEOIBD (2008–2018), with minimum 2 years of follow-up, were retro...

Background: Gut microbial features and the role of early life stress in pediatric functional abdominal pain-not otherwise specified (FAP-NOS) have never been investigated before. Here, we hypothesize that early life stress is more prevalent in FAP-NOS compared to healthy controls and that fecal microbial profiles and related metabolites differ betw...

Background: Although parenteral nutrition (PN) significantly improves mortality rates in pediatric short bowel syndrome (SBS), long-term PN has many possible complications and impacts quality of life. Bowel lengthening procedures (BLPs) increase the contact surface of food and the intestinal mucosa and enable the better absorption of nutrients and...

The recent advisory issued by the United States Food and Drug Administration, cautioning against the routine administration of probiotics in preterm neonates, has sparked a lively debate within the scientific community. This commentary presents a perspective from members of the Special Interest Group on Gut Microbiota and Modifications within the E...

Dysbiosis corresponds to the disruption of a formerly stable, functionally complete microbiota. In the gut, this imbalance can lead to adverse health outcomes in both the short and long terms, with a potential increase in the lifetime risks of various noncommunicable diseases and disorders such as atopy (like asthma), inflammatory bowel disease, ne...

Probiotics are live microorganisms that confer health benefits to the host when administered in adequate amounts. Although recommendations for probiotic use should be strain-specific, many systematic reviews, including recommendations from different societies, recommend probiotic use in general, providing no relevant information for healthcare prof...

Stratified and precision nutrition refers to disease management or prevention of disease onset, based on dietary interventions tailored to a person's characteristics, biology, gut microbiome, and environmental exposures. Such treatment models may lead to more effective management of inflammatory bowel disease (IBD) and reduce risk of disease develo...

Background: Recurrent wheezing and gastroesophageal reflux disease (GERD) are common in young children, with a suggested but challenging link between them. This study aimed to investigate the diagnostic value of pH-MII monitoring in preschool children with recurrent wheezing and evaluate GERD-related therapy effects. Methods: Children under 6 years...

Background and aims: From the patients’ perspective, diet has a relevant role in triggering symptoms of inflammatory bowel disease (IBD). There is a lack of prospective studies regarding the diet of children with IBD. The aim of this study was to assess the frequency and impact of self-imposed elimination diets on the nutritional status and clinica...

Background: Whether primary sclerosing cholangitis related to inflammatory bowel disease (PSC-IBD) diagnosed before 6 years (ie, VEO-IBD) has a distinct phenotype and disease course is uninvestigated. We aimed to analyze the characteristics and natural history of VEO-PSC-IBD, compared with early and adolescent-onset PSC-IBD. Methods: This is a m...

Background: Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the prevalence and duration of breastfeeding could significantly reduce healthcare costs and improve maternal and children health outcomes. However, widespread adoption of breas...

Background: This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA). Methods: Children with newly diagnosed Crohn's disease (CD) who had MRI enterography (MRE) and BIA and had at least 12 months of follow-up were included. Total psoas muscle are...

Purpose: The aim of our study was to investigate the effect of an exercise program on HRQoL and sleep quality in children with IBD in remission. Methods: A total of 42 paediatric IBD patients in remission (aged 15.3±2.08 years; 25 boys; disease type: Crohn's disease (CD) n=22, ulcerative colitis (UC) n=18, inflammatory bowel disease-unclassified (I...

Background and aims: Ulcerative proctitis (UP) is an uncommon presentation in paediatric patients with ulcerative colitis. We aimed to characterize the clinical features and natural history of UP in children, and identify predictors of poor outcomes. Methods: Retrospective study involving 37 sites affiliated with the IBD Porto Group of ESPGHAN....

Dietary fibers (DFs) are essential components of human nutrition and are principally defined as non-digestible carbohydrates (oligosaccharides and polysaccharides) usually classified by their physicochemical and physiological characteristics (water solubility, viscosity, fermentability, and bulking effect). Unfortunately, there is limited informati...

Objectives: Iatrogenic viscus perforation in paediatric gastrointestinal endoscopy (GIE) is a very rare, yet potentially life-threatening event. There are no evidence-based recommendations relating to immediate post-procedure follow-up to identify perforations and allow for timely management. This study aims to characterize the presentation of chi...

Objective: We aimed to compare the cellular composition of bronchoalveolar lavage (BAL) fluids in children with chronic unexplained cough (group 1) and severely neurologically impaired children with chronic or recurrent respiratory problems (group 2) with the BAL cytology of children without pulmonary or systemic diseases (group 3). Methods: Bro...

Aim: To assess parents' attitudes toward childhood COVID-19 immunization in Croatia. Methods: In this multicenter cross-sectional study, we collected data from four tertiary care facilities in Zagreb, Split, and Osijek between December 2021 and February 2022. During the visit to the Pediatric Emergency Departments, parents were asked to fill out...

This study aims to determine changes in the intestinal microbiota of children with Crohn’s disease (CD) before and during exclusive enteral nutrition (EEN) and after its discontinuation. A total of 14 newly diagnosed children with CD (median age 16.0 years; 43% female) were included in this study. Patients were initially treated with EEN and were f...

Adults with inflammatory bowel disease (IBD) have an increased risk for vascular events. This study aims to evaluate arterial parameters in paediatric IBD. Carotid intima-media thickness (CIMT) was measured by ultrasound, and Arteriograph was used to assess aortic pulse wave velocity (PWVao), brachial and aortic augmentation indexes (AixBrach, AixA...

Background Primary sclerosing cholangitis related to inflammatory bowel disease (PSC-IBD) diagnosed under the age of 6 years (i.e., VEO-IBD) may have unique characteristics and disease course. We aimed to analyze the characteristics and natural history of children with VEO PSC-IBD and compare them to children diagnosed with PSC-IBD at an older age....

Background Current guidelines recommend first-line anti-TNF therapy (start at diagnosis) only in children with high risk for a complicated disease course. However, previous results of the TISKids study showed that first-line infliximab (FL-IFX) treatment (5 infusions in total) combined with azathioprine (AZA) was more effective to achieve clinical...

Background Ulcerative proctitis (UP) is an uncommon presentation in paediatric patients with ulcerative colitis, accounting for <10% of cases. Here we aimed to characterize the clinical features and natural history of paediatric patients with UP, and to identify predictors of poor outcomes. Methods A retrospective cohort study involving 37 sites a...

Coeliac disease (CD) is an immune-mediated inflammatory disease triggered by dietary gluten and related proteins in genetically predisposed individuals. Point-of-care (POC) methods are non-invasive and easily performed tests, which could help to reduce the diagnostic delay of CD. The aim of our study was to determine the prevalence of CD using rapi...

BACKGROUND: The aim of our study was to investigate the impact of a structured exercise program on bone mineral density (BMD) and body composition parameters in children and adolescents with IBD in remission. METHODS: Patients were recruited to participate in a 6-month exercise program. Total body less head (TLBH) dual energy X-ray absorptiometry (...

A lifelong strict gluten-free diet is the only available treatment for patients with coeliac disease (CD). As with any restrictive diet, it may potentially lead to nutritional deficits. Seventy-six patients with CD (mean age 9.0 ± 4.3 years, 57% female) and 590 healthy controls (HC) (mean age 9.9 ± 0.1 years, 54% female) were recruited and requeste...

Background: Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The ESPGHAN Special Interest Group on Gut Microbiota and Modifications provides updated recommendations...

The characteristics of Helicobacter (H.) pylori infection in children differ from the infection in adults, so diagnostic and treatment approaches are different. In addition, numerous data point to a worrying increase of antibiotic resistance and unsatisfactory eradication rate of H. pylori in children. Due to all this, and since there are only guid...

Protein loss is often the result of kidney or intestinal disease (protein-losing enteropathy) and can cause a number of serious, potentially life-threatening complications such as hypotension, thrombocytosis, electrolyte imbalance, and cerebellar ischemia. Recent research suggests an association between extremely severe atopic dermatitis (AD) and a...

To induce remission in luminal paediatric Crohn’s disease (CD), the ESPGHAN/ECCO guideline recommends treatment with exclusive enteral nutrition (EEN) or oral corticosteroids. In newly diagnosed moderate-to-severe paediatric CD patients, we determined the proportion of patients in which EEN or corticosteroids induced remission and maintained remiss...

Background: Synbiotics are a mixture comprising of live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host. There is an increasing number of studies investigating their role in different diseases and disorders. Aim: The purpose of this manuscript is to provide recommendations for...

Digital clubbing is most commonly caused by pulmonary or cardiac disease, and only rarely it is a manifestation of a gastroenterological disorder. We report a pediatric patient in whom severe gastroesophageal reflux disease caused anemia and digital clubbing, partial clinical presentation of the Herbst triad.

Objectives and Study: Coeliac disease (CD) is an immune-mediated enteropathy occurring after ingesting dietary gluten in human leukocyte antigen (HLA) DQ2 and HLA-DQ8 predisposed individuals, presenting with various symptoms. Coeliac-specific serology tests and HLA genetic testing are essential tools for screening first-degree relatives, among othe...

Objectives and Study: During the COVID-19 pandemic, many patients with chronic diseases, including patients with coeliac disease (CD), faced difficulties accessing healthcare professionals due to the practices of social distancing, fear of being infected, or unavailability of physicians due to their increased workload. The use of telemedicine optio...

. Introduction and aim: Chronic constipation, primarily functional, is one of the most common gastrointestinal problems in children and one of the most common reasons for referral to gastroenterologist. With the aim to promote adequate diagnosis and treatment, the Croatian Society of Pediatric Gastroenterology, Hepatology and Nutrition (HDPGHP) has...

. Introduction and aim: Celiac disease is immune mediated, chronic systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals that is treated with strict, life-long gluten-free diet. It is one of the most common gastrointestinal and systemic diseases with the prevalence of 1%, but often, due to different clin...

. Introduction and aim: In every fourth person with inflammatory bowel disease (IBD), the diagnosis is made in childhood, before the age of eighteen. We are witnessing a significant increase in the incidence in the last decade and today IBD is one of the most common chronic gastrointestinal diseases of childhood. Recently, incidence in Croatia has...

Fibre is an essential nutrient in the human diet that is crucial for human health. It provides a range of functional benefits, including stool bulking, and physiological benefits through fermentation of diverse fibre types by the gut microbiome including cholesterol lowering, glycaemic control and weight control. The by-products of the fermentation...

BACKGROUND Adult studies suggest that patients with isolated colonic Crohn’s disease (L2 CD) exhibit unique characteristics differentiating them from patients with ileo-cecal (L1) CD and ulcerative colitis (UC). We aimed to characterize clinical features and outcomes of paediatric patients with L2. METHODS Retrospective data was collected through...

Background Very early-onset inflammatory bowel disease (VEOIBD) is diagnosed before the age of 6 years while infantile IBD occurs before the age of 2 years. We aimed to assess disease characteristics and long-term outcomes in these populations. Methods We conducted a retrospective longitudinal cohort study in 21 pediatric centers worldwide. Patien...

Helicobacter (H.) pylori poses a significant health burden worldwide, despite the evidence that the prevalence of the infection is decreasing in some areas. The majority of the H. pylori-infected population remains asymptomatic, but some individuals may develop chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue (MALT) lympho...

Adherence to the Mediterranean diet (MD) has been found beneficial for the prevention and treatment of various chronic non-communicable diseases; however, adherence to MD is declining, especially in the Mediterranean countries. Croatia is characteristic for having both traditionally continental and Mediterranean regions, with distinct dietary featu...

Aim: To assess the number of visits to pediatric emergency departments in Croatia and reasons for visiting before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: We reviewed the medical records of pediatric patients visiting emergency departments of four tertiary medical centers between February 25 and April 25, 2018 and 2019,...

Objectives: Adult studies suggest that patients with isolated colonic Crohn's disease (L2 CD) exhibit unique characteristics differentiating them from patients with ileo-caecal (L1) CD and ulcerative colitis (UC). We aimed to characterize clinical features and outcomes of paediatric patients with L2. Methods: Retrospective data was collected thr...

Inflammatory bowel disease (IBD) in children is associated with malnutrition and growth failure. Body composition alternations, such as bone mass deficits, decreased bone mineral density (BMD) and reductions in lean body mass (LBM) have been described. Physical activity (PA) plays an important role in normal growth and development. Moderate-to-vigo...

Coeliac disease (CD) is an immune-mediated inflammatory disease triggered by dietary gluten and related proteins in genetically predisposed individuals.Standard serology testing and small bowel biopsy are used to establish the diagnosis of CD. New and improved point-of-care (POC) methods are non-invasive and could help reduce the diagnostic delay o...

Introduction Acute biliary pancreatitis during early postpartum period in adolescent pregnancy is a rare, but challenging clinical entity in terms of diagnosis and management. We report a case of acute pancreatitis, occurring in early postpartum period in an adolescent patient who had an otherwise uneventful course of pregnancy. Case Report A 15-y...

The data on the relationship on gastroesophageal reflux (GER) and brief resolved unexplained events (BRUE) in infants are scarce. The aim of this study was to investigate the diagnostic usefulness of combined multichannel intraluminal impedance-pH (MII-pH) monitoring in children with suspected GER-related BRUE.Infants hospitalized due to BRUE and w...

Introduction Cyclic vomiting syndrome (CVS) is a chronic disorder characterized by recurrent episodic attacks of intense nausea and vomiting lasting hours to days and separated by a return to baseline health.The episodes are usually stereotypical in an individual patient, oftentimes preceded by prodromal symptoms. Similarly to other functional gast...

The prevalence of malnutrition in hospitalized children in the last ten years notable decreased. However, the issue of nutritional status deterioration during hospitalization remains. The aim of this study was to determine the impact of hospitalisation on nutritional and functional status of hospitalised paediatric patients, and to evaluate their e...

Wilson’s disease (WD) is an autosomal recessive genetic disorder that leads to the impairment of cellular copper metabolism.Clinical presentation is heterogeneous, with predominantly hepatic, neurological and psychiatric manifestations. Acute decompensated WD presenting as fulminant liver failure is a life-threatening condition for which liver tran...

Aims of this study were to determine the phenotype of pediatric inflammatory bowel disease (IBD) in patients in Croatia at the time of disease presentation, evaluate diagnostic and therapeutic approaches and investigate early disease-course in one-year follow-up.During a one-year time period (June 1st, 2016 to May 31st, 2017), children and adolesce...

Introduction Arterial stiffness increases with age. Various factors, including chronic inflammation, enhance this process. Adult patients with inflammatory bowel disease (IBD) have increased arterial stiffness despite the lower influence of other risk factors. It is not clear at which age these changes start.This study aims to determine if there ar...

Objective Infestation with pinworm (Enterobius vermicularis) is common in young children, and the most common typical symptoms are perianal itching, nocturnal restlessness, and irritability. Although the clinical presentation is usually mild or completely asymptomatic, the infestation rarely can present with non-specific colitis, weight loss, and t...

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated gastrointestinal food hypersensitivity of infancy, characterized by repetitive profuse vomiting, often in association with lethargy, pallor and diarrhea. It is most commonly caused by cow’s milk protein (CMP) and soy. Breastfeeding is suggested to have a pr...

Carotid intima-media thickness (cIMT) reflects early structural changes on arteries and independently predicts cardiovascular risk in asymptomatic individuals. Previous studies showed increased cIMT in adult inflammatory bowel disease (IBD) patients compared with healthy subjects.This study aims to identify early structural changes in carotid arter...

Introduction Pediatric intestinal pseudoobstruction (PIPO) is a rare and complex gastrointestinal motility disorder affecting mainly the small intestine and the colon resulting in intestinal failure.Due to severe and reccurent episodes of pseudo-obstruction, children are unable to meet their nutritional needs enterally and might even need parental...

Introduction and Aims Coeliac disease is an immune-mediated systemic disease caused by gluten consumption that occurs in children and adults with a hereditary predisposition. The clinical features of the disease are diverse, and the most common symptoms in children are chronic diarrhoea, failure to thrive, vomiting, abdominal pain and chronic const...

To evaluate the presence of autonomic nervous system abnormalities (ANS) in children with irritable bowel syndrome (IBS) and quiescence inflammatory bowel disease (IBD) comparing to controls.Consecutive children with quiescence IBD, IBS and aged and sex matched healthy controls (HC) were referred for the evaluation of dysautonomia (IBD: N=24, mean...

Protein loss is often the result of kidney or intestinal disease (protein losing enteropathy) and can cause a number of serious, potentially life-threatening complications such as hypotension, thrombocytosis, electrolyte imbalance and cerebellar ischemia. Recent research suggests an association between extremely severe atopic dermatitis (AD) and al...

Paediatric-onset ulcerative colitis (UC) is often more extensive than in adults, and as disease severity is associated with disease extent, children are more prone to refractory severe episodes, sometimes requiring colectomy.Previous population-based studies in patients with UC revealed variable colectomy rates. However, a decrease in colectomy rat...

Children with inflammatory bowel disease (IBD) have significantly lower health related quality of life (HRQoL) compared to healthy controls. HRQoL presents a broad, multidimensional concept compromising one’s physical health, psychological state, level of independence, social relationships, personal beliefs and relationship to the environment. Good...

Primary aims of this study were to determine the annual incidence and geographic distribution of pediatric inflammatory bowel disease (IBD), respectively existence of north to south gradient in Croatia as well as baseline characteristics at the time of diagnosis. Secondary aim was to compare data on frequency and distribution of pediatric IBD in tw...

Parenteral nutrition is used to treat children that cannot be fully fed by the enteral route. While the revised ESPGHAN/ESPEN/ESPR/CSPEN pediatric parenteral nutrition guidelines provide clear guidance on the use of parenteral nutrition in neonates, infants, and children based on current available evidence, they have helped to crystallize areas whe...

Parenteral nutrition is used to treat children that cannot be fully fed by the enteral route. While the revised ESPGHAN/ESPEN/ESPR/CSPEN pediatric parenteral nutrition guidelines provide clear guidance on the use of parenteral nutrition in neonates, infants, and children based on current available evidence, they have helped to crystallize areas whe...

Introduction: There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement. Method...

Introduction: Pediatric-specific quality standards for endoscopy are needed to define best practices, while measurement of associated indicators is critical to guide quality improvement. The international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group was assembled to develop and define quality standards and indicators for...

Introduction: High quality procedure reports are a cornerstone of high quality pediatric endoscopy as they ensure the clear communication of procedural events and outcomes, guide patient care and facilitate continuous quality improvement. The aim of this document is to outline standardized reporting elements that achieved international consensus a...

Introduction:High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all approp...

Introduction: High quality pediatric endoscopy requires reliable performance of procedures by competent individual providers who consistently uphold all standards determined to assure optimal patient outcomes. Establishing consensus expectations for ongoing monitoring and assessment of individual pediatric endoscopists is a method for confirming t...

Background: Data on the efficacy of the newly established dietetic treatment of Crohn's disease (CD), the CD exclusion diet (CDED), are scarce. The aim of this study was to provide real-world data on the efficacy of CDED in comparison with exclusive enteral nutrition (EEN) for remission induction. Methods: A retrospective analysis of children di...

Objectives: Decreased mineral bone density (BMD) and reduced lean body mass (LBM) are common amongst children with inflammatory bowel disease (IBD). The aim of our cross-sectional, observational study was to evaluate the relationship between BMD, body composition and physical activity (PA) in children with IBD in remission. Methods: Total body l...

Background: The ESPGHAN position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. Methods: A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including re...