Theme: Pediatric Gastroenterology
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Theme: Pediatric Gastroenterology Very early-onset inflammatory bowel NASPGHAN position paper (J Pediat Gastroent Nutr. 2020;70:389-403)
abdomen, a fundus examination, an ultrasound and barium meal follow through. The second line investigations involved endoscopy with esophageal biopsies and gastric emptying scan. A diagnosis of rumination syndrome was made in 30 children followed by cyclical and functional vomiting in 8 and 6 children, respectively. Intestinal tuberculosis was diagnosed in 4 children. Children with rumination syndrome had a relapsing and remitting course in 40% and a chronically symptomatic course in 60% of the cases. It was seen that a diagnosis of rumination syndrome was often missed or delayed. The authors concluded that the diagnosis can often be made clinically, and diaphragmatic breathing is an effective treatment.
disease–
In view of the increasing rate of pediatric inflammatory bowel disease (IBD) and increasing knowledge and experience with this condition, the NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition) has come out with a position paper on very early onset (VEO) IBD. It describes the epidemiology classification, genetic etiologies, phenotypes and treatment modalities for VEO-IBD. IBD diag-nosed in the first 2 years of life is called infantile-onset IBD while that diagnosed between 2 to 6 years is known as VEO-IBD. Monogenic defects can be detected in 15-20% of children with VEO-IBD. The genes involved are those of the intestinal epithelial barrier function and immunological disorders. Detailed phenotypic characterization including clinical evaluation, endoscopy and biopsies can help narrow down the plausible genetic defects, which can further be identified by targeted or whole exome sequencing. The current data on VEO-IBD is limited to case reports and small case series. The available treatment modalities include immunomodulators such as methotrexate and azathioprine, biologi-cals such as infliximab and abatacept. The child may also require surgical interventions or hematopoietic stem cell transplant. It is important to have a collaborative multidisciplinary team to manage these patients.
Ursodeoxycholic acid in infants with Increased morbidity and mortality (Medicine (Baltimore). 2020;99:e18730)
cholestasis
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Ursodeoxycholic acid is often used in the management of infants with cholestasis. This is an off label use. In this study from Egypt, a retrospective review was done of the data of 779 neonates and infants with cholestasis over a period of 10 years. The etiology was surgical in 19.5% cases, neonatal hepatitis in 67.2%, and paucity of intrahepatic bile ducts in 13.3%. Out of all the infants, 54.4% received UDCA (15-30 mg/kg/d), 45.6% did not. Both groups were matched with regards to the etiology and severity. Seventy three percent achieved a cure without UDCA as against only 45% of those on UDCA. Those on UDCA had significantly worse outcomes and more complications. The authors concluded that the use of UDCA was associated with s
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