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Strategies to Prevent Mother-to-child Transmission of Hepatitis B Virus

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Journal of Clinical and Translational Hepatology 2023年第4期11卷 967-974页

作者： Palittiya Sintusek Nasamon Wanlapakorn Yong Poovorawan Department of Pediatrics Division of GastroenterologyFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityThailand and Thai Pediatric GastroenterologyHepatology and Immunology(TPGHAI)Research UnitChulalongkorn UniversityBangkokThailand Center of Excellence in Clinical Virology Faculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand

Mother-to-child transmission(MTCT)of hepatitis B virus(HBV)is the primary cause of chronic HBV infection worldwide.MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden.Antiviral treatment of hepatitis B surface antigen(HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV.However,for worldwide application of those strategies,feasibility,availability,cost,safety,and effectiveness should be considered.Cesarean section and breastfeeding avoidance in hepatitis B e antigenpositive mothers with a high viral load and without antiviral therapy during pregnancy could be an option,but more supporting evidence is needed.HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention,except in areas with limited resources.Timely HBV vaccination series administered soon after birth might be the mainstay of prevention.This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.

关键词： Mother-to-child transmission Children Hepatitis B virus Vertical transmission Prevention Vaccine

Cytomegalovirus infection in liver-transplanted children

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World Journal of Hepatology 2022年第2期14卷 338-353页

作者： Norrapat Onpoaree Anapat Sanpavat Palittiya Sintusek Faculty of Medicine Chulalongkorn UniversityBangkok 10330Thailand Division of Pathology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Thai Paediatric Gastroenterology Hepatology and Immunology Research UnitChulalongkorn UniversityBangkok 10330Thailand Division of Gastroenterology Department of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

Cytomegalovirus (CMV) infection is a common complication of liver transplantationin children. The CMV serostatus of recipients and donors is theprimary risk factor, and prophylaxis or pre-emptive strategies are recommendedfor high-risk patients. Graft rejection, coinfection and Epstein-Bar virusreactivation, which can lead to post-transplant lymphoproliferative disease, areindirect effects of CMV infection. Assessment of CMV infection viral load shouldbe routinely performed upon clinical suspicion. However, tissue-invasive CMVdisease is not associated with CMV viraemia and requires confirmation by tissuepathology. Oral valganciclovir and intravenous ganciclovir are equivalenttreatments, and the duration of treatment depends on factors including CMV viralload, tissue pathology, and clinical response. Risk stratification by donor andrecipient status prior to transplantation and post-transplantation antiviralprophylaxis or pre-emptive therapy are recommended. Adult guidelines havebeen established but additional study of the effectiveness of the preventiveguidelines in children is needed. This review summarizes the burden, risk factors,clinical manifestations, laboratory evaluation, treatment, and prevention of CMVinfection in children after liver transplantation.

关键词： Cytomegalovirus Children Liver transplantation Pediatric Infection

Eliminating viral hepatitis in children after liver transplants:How to reach the goal by 2030

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World Journal of Gastroenterology 2022年第3期28卷 290-309页

作者： Palittiya Sintusek Kessarin Thanapirom Piyawat Komolmit Yong Poovorawan The Thai Pediatric Gastroenterology Hepatology and Immunology(TPGHAI)Research UnitChulalongkorn UniversityBangkok 10330Thailand Division of Gastroenterology Department of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Division of Gastroenterology Department of MedicineLiver Fibrosis and Cirrhosis Research UnitFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Center of Excellence in Liver Diseases King Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Clinical Virology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

Viral hepatitis infections are a great burden in children who have received liver transplant.Hepatotropic viruses can cause liver inflammation that can develop into liver graft fibrosis and cirrhosis over the long term.Immunological reactions due to viral hepatitis infections are associated with or can mimic graft rejection,rendering the condition difficult to manage.Prevention strategies using vaccinations are agreeable to patients,safe,cost-effective and practical.Hence,strategies to eliminate viral hepatitis A and B focus mainly on immunization programmes for children who have received a liver transplant.Although a vaccine has been developed to prevent hepatitis C and E viruses,its use is not licensed worldwide.Consequently,eliminating hepatitis C and E viruses mainly involves early detection in children with suspected cases and effective treatment with antiviral therapy.Good hygiene and sanitation are also important to prevent hepatitis A and E infections.Donor blood products and liver grafts should be screened for hepatitis B,C and E in children who are undergoing liver transplantation.Future research on early detection of viral hepatitis infections should include molecular techniques for detecting hepatitis B and E.Moreover,novel antiviral drugs for eradicating viral hepatitis that are highly effective and safe are needed for children who have undergone liver transplantation.

关键词： Viral hepatitis Children Adolescent Liver transplantation Infection Elimination

High prevalence of hepatitis B-antibody loss and a case report of de novo hepatitis B virus infection in a child after living-donor liver transplantation

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World Journal of Gastroenterology 2018年第6期24卷 752-762页

作者： Palittiya Sintusek Nawarat Posuwan Piyaporn Wanawongsawad Suttiruk Jitraruch Yong Poovorawan Voranush Chongsrisawat Division of Gastroenterology and Hepatology Department of Pediatrics Faculty of Medicine Chulalongkorn University Center of Excellence in Clinical Virology Chulalongkorn University Excellence Center of Organ Transplantation King Chulalongkorn Memorial Hospital

AIM To assess the seroprevalence of hepatitis B virus(HBV) immunity among previously vaccinated pediatric liver transplant recipients and present a case report of de novo hepatitis B infection after liver transplantation.METHODS This study focused on children with chronic liver diseases who received primary hepatitis B immunization and had a complete dataset of anti-HBs before and after liver transplantation between May 2001 and June 2017. Medical records were retrospectively reviewed for potential factors relating to HBV immunity loss. RESULTS In total, 50 children were recruited. The mean time from liver transplantation to anti-HBs testing was 2.53 ± 2.11 years. The mean anti-HBs levels before and after liver transplantation were 584.41 ± 415.45 and 58.56 ± 6.40 IU/L, respectively. The rate of nonimmunity(anti-HBs three years following liver transplantation. The potential factors relating to HBV immunity loss after liver transplantation were identified as anti-HBs(P = 0.002), serum albumin(P = 0.04), total bilirubin(P = 0.001) and direct bilirubin(P = 0.003) before liver transplantation. A five-year-old boy with biliary cirrhosis received 4 doses of HBV vaccine with an anti-HBs titer of > 1000 IU/L and underwent liver transplantation; his anti-HBc-negative father was the donor. After liver transplantation, the boy had stenosis of the hepatic artery up to the inferior vena cava anastomosis and underwent venoplasty three times. He also received subcutaneous injections of enoxaparin for 5 mo and 20 transfusions of blood components. Three years and ten months after the liver transplantation, transaminitis was detected with positive tests for HBs Ag, HBe Ag, and anti-HBc(2169.61, 1706 and 8.45, respectively; cutoff value: < 1.00) and an HBV viral load of 33212320 IU/mL.CONCLUSION The present study showed that loss of hepatitis B immunity after liver transplantation is unexpectedly common. In our case report, desp

关键词： Hepatitis B vaccine Liver transplantation De novo hepatitis B infection Anti-HBs antibody Immunity

Cohort analysis of pediatric intussusception score to diagnose intussusception

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World Journal of Clinical Cases 2023年第21期11卷 5014-5022页

作者： Punwadee Rukwong Nathawit Wangviwat Teerasak Phewplung Palittiya Sintusek Department of Pediatrics Phrapokklao HospitalChantaburi 22000MeuangThailand Division of Laboratory Medicine King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Radiology Chulalongkorn UniversityBangkok 10330Thailand Thai Pediatric Gastroenterology Hepatology and Immunology Research UnitDivision of GastroenterologyDepartment of PediatricsKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

BACKGROUND Intussusception is a primary cause of intestinal obstruction in young children.Delayed diagnosis is associated with increased morbidity.Ultrasonography(USG)is the gold standard for diagnosis,but it is operator dependent and often unavailable in limited resource areas.AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography(AR)and the promising parameters found in the pediatric intussusception score(PIS).METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited.Clinical manifestations,investigations,and treatment outcomes were recorded.AR images were interpreted by a pediatric radiologist.Diagnosis of intussusception was composed of compatible USG and response with reduction.The diagnostic value of the proposed PIS was evaluated.RESULTS Ninety-seven children were diagnosed with intussusception(2.06±2.67 years,62.9%male),of whom 74%were<2 years old and 37.1%were referrals.The common manifestations of intussusception were irritability or abdominal pain(86.7%)and vomiting(59.2%).Children aged 6 mo to 2 years,pallor,palpable abdominal mass,and positive AR were the parameters that could discriminate intussusception from other mimics(P<0.05).Referral case was the only significant parameter for failure to reduce intussusception(P<0.05).AR to diagnose intussusception had a sensitivity of 59.2%.The proposed PIS,a combination of clinical irritability or abdominal pain,children aged 6 mo to 2 years,and compatible AR,had a sensitivity of 85.7%.CONCLUSION AR alone provides poor screening for intussusception.The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity,leading to timely clinical management.

关键词： Intussusception Pediatric Specificity Sensitivity Abdominal radiography Diagnosis

Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video,multichannel intraluminal impedance-pH study

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World Journal of Clinical Pediatrics 2023年第3期12卷 151-161页

作者： Sutha Eiamkulbutr Termpong Dumrisilp Anapat Sanpavat Palittiya Sintusek Department of Pediatrics King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Pediatrics Bhumibol Adulyadej HospitalBangkok 10220Thailand Department of Pathology Chulalongkorn UniversityBangkok 10330Thailand Thai Pediatric Gastroenterology Hepatology and Immunology Research UnitKing Chulalongkorn Memorial HospitalFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

BACKGROUND Gastroesophageal reflux disease(GERD)might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms,without any best methods or criterion for diagnosing it in children.AIM To evaluate the prevalence of extraesophageal GERD using conventional and combined-video,multichannel intraluminal impedance-pH(MII-pH),and to propose novel diagnostic parameters.METHODS The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022.The children underwent conventional and/or combined-video MII-pH.The potential parameters were assessed and receiver operating characteristic was used for the significant parameters.RESULTS Of 51 patients(52.9%males),aged 2.24 years were recruited.The common problems were cough,recurrent pneumonia,and hypersecretion.Using MII-pH,35.3%of the children were diagnosed with GERD by reflux index(31.4%),total reflux events(3.9%),and symptom indices(9.8%)with higher symptom recorded in the GERD group(94 vs 171,P=0.033).In the video monitoring group(n=17),there were more symptoms recorded(120 vs 220,P=0.062)and more GERD(11.8%vs 29.4%,P=0.398)by symptom indices.Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907(P=0.001)and 0.726(P=0.014).CONCLUSION The prevalence of extraesophageal GERD in children was not high as expected.The diagnostic yield of symptom indices increased using video monitoring.Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

关键词： Extraesophageal reflux pH-impedance Children Gastroesophageal reflux Mean nocturnal baseline impedance

Diseases of bile duct in children

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World Journal of Gastroenterology 2024年第9期30卷 1043-1072页

作者： Sutha Eiamkulbutr Chomchanat Tubjareon Anapat Sanpavat Teerasak Phewplung Nimmita Srisan Palittiya Sintusek Department of Pediatrics King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Pediatrics Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Pathology Chulalongkorn UniversityBangkok 10330Thailand Department of Radiology Chulalongkorn UniversityBangkok 10330Thailand Department of Surgery Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand Center of Excellence in Thai Pediatric Gastroenterology Hepatology and ImmunologyDivision of GastroenterologyDepartment of PediatricsKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

Several diseases originate from bile duct pathology.Despite studies on these diseases,certain etiologies of some of them still cannot be concluded.The most common disease of the bile duct in newborns is biliary atresia,whose prognosis varies according to the age of surgical correction.Other diseases such as Alagille syndrome,inspissated bile duct syndrome,and choledochal cysts are also time-sensitive because they can cause severe liver damage due to obstruction.The majority of these diseases present with cholestatic jaundice in the newborn or infant period,which is quite difficult to differentiate regarding clinical acumen and initial investigations.Intraoperative cholangiography is potentially necessary to make an accurate diagnosis,and further treatment will be performed synchronously or planned as findings suggest.This article provides a concise review of bile duct diseases,with interesting cases.

关键词： Bile duct Cholestasis Biliary atresia Biliary hypoplasia Biliary imaging Inspissated bile syndrome Choledochal cyst

Gastroesophageal reflux disease in children: What’s new right now?

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World Journal of Gastrointestinal Endoscopy 2023年第3期15卷 84-102页

作者： Palittiya Sintusek Mohamed Mutalib Nikhil Thapar Thai Pediatric Gastroenterology Hepatology and Immunology Research Unit(TPGHAI)Division of GastroenterologyDepartment of PediatricsKing Chulalongkorn Memorial Hospital and Thai Red CrossFaculty of MedicineChulalongkorn UniversityBangkok 10330BangkokThailand Department of Paediatric Gastroenterology Pediatric and Gastroenterology ServicesEvelina London Children’s HospitalLondon SE17EHUnited Kingdom Department of Gastroenterology Hepatology and Liver TransplantQueensland Children’s HospitalBrisbaneQueensland 4101Australia School of Medicine University of QueenslandBrisbaneQueensland 4006Australia Woolworths Centre for Child Nutrition Research Queensland University of TechnologyBrisbaneQueensland 4101Australia

Gastroesophageal reflux(GER)in children is very common and refers to the involuntary passage of gastric contents into the esophagus.This is often physiological and managed conservatively.In contrast,GER disease(GERD)is a less common pathologic process causing troublesome symptoms,which may need medical management.Apart from abnormal transient relaxations of the lower esophageal sphincter,other factors that play a role in the pathogenesis of GERD include defects in esophageal mucosal defense,impaired esophageal and gastric motility and clearance,as well as anatomical defects of the lower esophageal reflux barrier such as hiatal hernia.The clinical manifestations of GERD in young children are varied and nonspecific prompting the necessity for careful diagnostic evaluation.Management should be targeted to the underlying aetiopathogenesis and to limit complications of GERD.The following review focuses on up-to-date information regarding of the pathogenesis,diagnostic evaluation and management of GERD in children.

关键词： Gastroesophageal reflux Gastroesophageal reflux disease Children Infant Impedance study Lower esophageal sphincter

Liver tumors in children with chronic liver diseases

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World Journal of Gastrointestinal Oncology 2021年第11期13卷 1680-1695页

作者： Palittiya Sintusek Teerasak Phewplung Anapat Sanpavat Yong Poovorawan Thai Pediatric Gastroenterology Hepatology and Immunology Research UnitDepartment of PediatricsDivision of GastroenterologyFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Department of Radiology Faculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Pathology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Clinical Virology Chulalongkorn UniversityBangkok 10330Thailand

Liver tumors are rare in children,but the incidence may increase in some circumstances and particularly in chronic liver diseases.Most liver tumors consequent to chronic liver diseases are malignant hepatocellular carcinoma.Other liver tumors include hepatoblastoma,focal nodular hyperplasia,adenoma,pseudotumor,and nodular regenerative hyperplasia.Screening of suspected cases is beneficial.Imaging and surrogate markers of alpha-fetoprotein are used initially as noninvasive tools for surveillance.However,liver biopsy for histopathology evaluation might be necessary for patients with inconclusive findings.Once the malignant liver tumor is detected in children with cirrhosis,liver transplantation is currently considered the preferred option and achieves favorable outcomes.Based on the current evidence,this review focuses on liver tumors with underlying chronic liver disease,their epidemiology,pathogenesis,early recognition,and effective management.

关键词： Liver tumor Chronic liver disease Children Hepatocellular carcinoma Liver cancer Liver neoplasm