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Fatigue in children and adolescents with inflammatory bowel disease

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World Journal of gastroenterology 2019年第5期25卷 632-643页

作者： Els Van de Vijver Ann Van Gils Laura Beckers Yannick Van Driessche Nicolette Dorien Moes Patrick Ferry van Rheenen Department of paediatric gastroenterology Hepatology and Nutrition Antwerp University Hospital Department of Anesthesiology Antwerp University Hospital Family Medicine Department of paediatric gastroenterology Hepatology and Nutrition University Medical Center Groningen

AIM To identify factors other than active disease and anemia that contribute to fatigue in pediatric inflammatory bowel disease(IBD).METHODS We performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term "fatigue" or the related keywords "physical impairment" and "inflammatory bowel disease" with the filter "child"(age 0-18 years). Cross-sectional and case-control studies were included. We restricted our search to studies published in English. We used the PRISMA checklist and flow diagram. Duplicate articles were manually deleted in End Note. To identify further relevant studies, we checked the reference lists of the selected articles.RESULTS We identified 149 papers, of which 19 were retrieved for full text review. Eleven studies were subsequently excluded because fatigue was not evaluated as an outcome measure. Eight papers focused on the desired topic and were discussed in the final analysis. A lack of uniformity of outcome measures made the pooling of data impossible. In all but one study, questionnaires were used to evaluate fatigue. In the remaining study, an accelerometer was used to measure daily activities, sleeping time and their relationships with fatigue in a more quantifiable manner. Adolescents with IBD are significantly more fatigued than healthy controls. In addition to active disease, increased anxiety or depression and disturbed family relationships were frequently reported predictors of fatigue. Quantitative measurement of physical activity in patients with Crohn's disease showed a reduction in the number of steps per day, and patients with ulcerative colitis had a shorter duration of physical activity during the day.CONCLUSION Fatigue in pediatric IBD is related to a combination of biological, functional and behavioral factors, which should all be taken into account when managing fatigue.

关键词： Adolescents Children Fatigue Inflammatory bowel disease Physical impairment Sleep

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

Treating children with inflammatory bowel disease: Current and new perspectives

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World Journal of gastroenterology 2017年第30期23卷 5469-5485页

作者： Graziella Guariso Marco Gasparetto University of Padova Department of paediatric gastroenterology Cambridge University Hospitals CUH-FT

Inflammatory bowel disease(IBD) is a chronic inflammatory condition of the gut characterised by alternating periods of remission and relapse. Whilst the mechanism underlying this disease is yet to be fully understood, old and newer generation treatments can only target selected pathways of this complex inflammatory process. This narrative review aims to provide an update on the most recent advances in treatment of paediatric IBD. A MEDLINE search was conducted using "paediatric inflammatory bowel disease", "paediatric Crohn's disease", "paediatric ulcerative colitis", "treatment", "therapy", "immunosuppressant", "biologic", "monitoring" and "biomarkers" as key words. Clinical trials, systematic reviews, and meta-analyses published between 2014 and 2016 were selected. Studies referring to earlier periods were also considered in case the data was relevant to our scope. Major advances have been achieved in monitoring the individual metabolism, toxicity and response to relevant medications in IBD including thiopurines and biologics. New biologics acting on novel mechanisms such as selective interference with lymphocyte trafficking are emerging treatment options. Current research is investing in the development of reliable prognostic biomarkers, aiming to move towards personalised treatments targeted to individual patients.

关键词：儿科学的煽动性的肠疾病 Crohns 疾病 Ulcerative 大肠炎治疗治疗抑制免疫力的药生物学监视 Biomarker

Double balloon enteroscopy in children:Diagnosis,treatment,and safety

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World Journal of gastroenterology 2010年第1期16卷 56-62页

作者： Mike Thomson Krishnappa Venkatesh Khalid Elmalik Willam van der Veer Maartan Jaacobs Centre for paediatric gastroenterology Sheffield Children's NHS Foundation Trust Department of gastroenterology VU University Medical Center

AIM:To assess the feasibility and utility of double balloon enteroscopy(DBE)in the management of small bowel diseases in children. METHODS:Fourteen patients(10 males)with a median age of 12.9 years(range 8.1-16.7)underwent DBE; 5 for Peutz-Jeghers syndrome(PJ syndrome),2 for chronic abdominal pain,4 for obscure gastrointestinal (GI)bleeding,2 with angiomatous malformations(1 blue rubber bleb nevus syndrome)having persistent GI bleeding,and 1 with Cowden's syndrome with multiple polyps and previous intussusception.Eleven procedures were performed under general anesthesia and 3 with deep sedation. RESULTS:The entire small bowel was examined in 6 patients,and a length between 200 cm and 320 cm distal to pylorus in the remaining 8.Seven patients had both antegrade(trans-oral)and retrograde(transanal and via ileostomy)examinations.One patient underwent DBE with planned laparoscopic assistance.The remaining 6 had trans-oral examination only.The median examination time was 118 min(range 95-195). No complications were encountered.Polyps were detected and successfully removed in all 5 patients with PJ syndrome,in a patient with tubulo-villous adenoma of the duodenum,in a patient with significant anemia and occult bleeding,and in a patient with Cowden's syndrome.A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy,and in 1 with a discrete angioma which was treated with argon plasma coagulation.The source of bleeding was identified in a further patient with varices.DBE was normal or revealed minor mucosal friability in the remaining 3 patients.Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. CONCLUSION:Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children,allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

关键词： Double balloon enteroscopy Gastrointestinal Peutz Jeghers syndrome Wireless video capsule endoscopy Children

Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

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World Journal of gastroenterology 2011年第2期17卷 191-196页

作者： Mike Thomson Prithviraj Rao David Rawat Tobias G Wenzl Centre for paediatric gastroenterology Royal Free and University College Medical School Centre for paediatric gastroenterology Sheffield Childrens NHS TrustWestern BankSheffieldS10 2TH United Kingdom Kinderklinik Universittsklinikum Aachen

AIM:To investigate the effects of percutaneous endoscopic gastrostomy(PEG) feeding on gastro-oesophageal reflux(GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance(pH/MII) . METHODS:Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. METHODS:Prior to PEG placement(pre-PEG) a total of 183 GOR episodes were detected,156(85.2%) were non-acidic.After PEG placement(post-PEG) a total of 355 episodes were detected,182(51.3%) were nonacidic.The total number of distal acid reflux events statistically significantly increased post-PEG placement(prePEG total 27,post-PEG total 173,P=0.028) and themean distal pH decreased by 1.1 units.The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25(0-2) ,post-PEG 2.95(0-40) ].Average proximal pH was lower post-PEG but the within subject difference was not statistically significant(P=0.058) . Median number of non-acid GOR,average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG,but not statistically significant. CONCLUSION:PEG placement increases GOR episodes in neurologically impaired children.

关键词：儿童回流内镜神经学胃 PEG 神经功能 pH值

Functional constipation in children:What physicians should know

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World Journal of gastroenterology 2023年第8期29卷 1261-1288页

作者： Duc Long Tran Palittiya Sintusek thailand and Department of Pediatrics Faculty of MedicineChulalongkorn UniversityBangkok 10330BangkokThailand Faculty of Medicine Can Tho University of Medicine and PharmacyCan Tho City 9000Viet Nam thai Pediatric gastroenterology Hepatology and Immunology Research UnitDivision of GastroenterologyDepartment of PediatricsKing Chulalongkorn Memorial Hospital and Thai Red CrossFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

Functional constipation(FC)is considered the most common functional gastrointestinal disorder in children with a pooled global prevalence of 14.4%(95%confidence interval:11.2-17.6)when diagnosed based on the Rome IV criteria.Its pathophysiological mechanisms are thought be multifactorial and complicated,resulting in difficult management.Currently,the most effective medication,when used in parallel with toilet training,is osmotic laxatives.Children’s adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure.Recently,novel therapies with a high safety profile have been developed,such as probiotics,synbiotics,serotonin 5-hydroxytryptamine 4 receptor agonists,chloride channel activators,and herbal and transitional medicines;nonetheless,well-designed research to support the use of these therapies is needed.This review aims to focus on multiple aspects of FC in children,including global prevalence,pathogenesis,diagnostic criteria,tools,as well as conventional and novel treatment options,such as non-pharmacological management,including adequate fiber and fluid intake,physiotherapy,or neuromodulators.We also report that in very difficult cases,surgical intervention may be required.

关键词： Constipation Children Laxative Treatment Toilet training Herbal

Variability of anti-human transglutaminase testing in celiac disease across Mediterranean countries

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World Journal of gastroenterology 2017年第24期23卷 4437-4443页

作者： Andrea Smarrazzo Giuseppe Magazzù Mongi Ben-Hariz Maria Legarda Tamara Virtut Velmishi Elefhteria Roma Aydan Kansu Dusanka Micetic-Turk Enzo Bravi Pio Stellato Carmela Arcidiaco Luigi Greco Department of Translational Medical Sciences School of MedicineSection of PediatricsUniversity of Naples“Federico II” European Laboratory for Food Induced Diseases Celiac Regional Centre Pediatric Gastroenterology and Cystic Fibrosis UnitUniversity of Messina Pediatric Unit Mongi SLIM’s Hospital of Tunis paediatric gastroenterology Unit Cruces University Hospital Service of Pediatric gastroenterology"Mother Teresa"Hospital First Department of Pediatrics University of Athens Department of Pediatric gastroenterology School of MedicineAnkara University University Medical Centre Paediatric Department Eurospital SpA

AIM To verify the precision and accuracy of transglutaminase antibodies(TGA)assays across Mediterranean countries.METHODS This study involved 8 referral centres for celiac disease(CD)in 7 Mediterranean countries.A central laboratory prepared 8 kits of 7 blinded and randomized serum samples,with a titrated amount of Human TGA Ig A.Each sample was analysed three times on three different days,with each centre running a total of 21tests.The results were included in a blindly coded report form,which was sent to the coordinator centre.The coordinator estimated the mean coefficient of Variation(Co Var=σ/μ),the mean accuracy(Accur=Vobserved-Vreal)and the mean percent variation(Var%=[(Vobserved-Vreal)/Vreal]×100).RESULTS The analysis showed that 79.17%of the mean variation fell between-25%and+25%of the expected value,with the accuracy and precision progressively increasing with higher titres of TGA.From values 1.25 times greater than the normal cut-off,the measurements were highly reliable.CONCLUSION TGA estimation is a crucial step for the diagnosis of CD;given its accuracy and precision,clinicians could be confident in establishing a diagnosis.

关键词：腹的疾病面筋 Transglutaminase 非侵略的测试精确性精确

Fatty liver in childhood

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World Journal of Hepatology 2014年第1期6卷 33-40页

作者： Yesim Ozturk Ozlem Bekem Soylu Department of Pediatrics Division of Pediatric Gastroenterology Dokuz Eylul University School of Medicine Hepatology and Nutrition Unit Department of Paediatric Gastroenterology Behcet Uz Children’s Disease and Pediatric Surgery Training and Research Hospital

Fatty liver is a growing health problem worldwide. It might evolve to nonalcoholic steatohepatitis, cirrhosis and cause hepatocellular carcinoma. This disease, which has increased because of eating habits, changes in food content and lifestyle, affects people from childhood. The most important risk factors are obesity and insulin resistance. Besides these factors, gender, ethnicity, genetic predisposition and some medical problems are also important. Cirrhosis in children is rare but is reported. Nonalcoholic fatty liver disease(NAFLD) has no specific symptoms or signs but should be considered in obese children. NAFLD does not have a proven treatment. Weight loss with family based treatments is the most acceptable management. Exercise and an applicable diet with low glycemic index and appropriate calorie intake are preferred. Drugs are promising but not sufficient in children for today.

关键词： Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Children Obesity Metabolic syndrome Insulin resistance Chronic liver disease

Feasibility of a finger prick-based self-testing kit in first- and second-degree relatives of children with coeliac disease

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World Journal of gastroenterology 2011年第14期17卷 1840-1843页

作者： Judith Pichler Matthias Zilbauer Franco Torrente Robert Heuschkel Alan Phillips Camilla Salvestrini Department of paediatrics and Adolescent Medicine Medical University of Vienna1090 ViennaAustria Department of paediatric gastroenterology Addenbrooke's HospitalCambridge CB2 0QQUnited Kingdom Centre for paediatric gastroenterology Royal Free HospitalLondon NW3 2QGUnited Kingdom

AIM:To assess feasibility of a finger prick-based kit as method for self-testing of first and second-degree relatives of coeliac disease (CD) patients. METHODS:A total number of 379 subjects were invited to participate in this study,consisting of 197 first- degree and 182 second-degree relatives of CD patients. The self-testing kit (BiocardTM) was sent out with included instructions for use. Completed tests were sent back to the study coordinator for assessment. RESULTS:One hundred and ninety-six invited relatives carried out the BiocardTM test at home. Amongst these,70% were children. In 97% of the cases the test was performed correctly. Three tests revealed a positive result,all of which were later confirmed by serology and histology as coeliac disease.CONCLUSION:Our study indicates that BiocardTM test is a reliable,easy to use and well-accepted tool for home testing of first- and second-degree relatives of CD patients.

关键词：检测试剂盒第一代腹腔学位疾病儿童手指测试评估