Eosinophil Counts in the Small Intestine and Colon of Children Without Apparent Gastrointestinal Disease-a Meta-analysis

ABSTRACTObjectives:The aim of the current study was to review the available data regarding eosinophil density in healthy tissue specimen originating from lower gastrointestinal segments to support suggested diagnostic cut-offs widely used in clinical practice.Methods:A systematic search was performed in three different databases. Calculations were made with Comprehensive MetaAnalysis software using random effects model. Cell number measurements were pooled using the random effects model and displayed on forest plots. Summary point estimations, 95% Confidence Intervals (CIs), and 95% Prediction Intervals (PIs) were calculated.Results:The cumulative mean cell numbers were 8.26 (95% CI: 3.49, 13.03) with PI of 0–25.32 for the duodenum, 11.51 (95% CI: 7.21, 15.82) with PI of 0–60.59 for the terminal ileum, and 11.10/HPF (95% CI: 9.11, 13.09) with PI of 0.96–21.23 in the large intestine and the rectum (HPF area = 0.2 mm2). Previous studies included control patients with irritable bowel syndrome (IBS) and functional GI disorders. As mucosal eosinophils have a role in their pathomechanism, those patients should have been excluded. A critical point of interpreting reported data is that HPF is relative to the technical parameters of the microscopes, therefore it is important to report findings in cell/mm2.Conclusions:The present meta-analysis does not support the higher (>20) or lower (20) or lower (

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NMDA-receptor Antagonism in Pediatric Pancreatitis: Use of Ketamine and Methadone in a Teenager With Refractory Pain

No abstract available

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Practice Differences in the Diagnosis and Management of Eosinophilic Esophagitis among Adult and Pediatric Gastroenterologists in Israel

ABSTRACTObjectives:Eosinophilic esophagitis (EoE) guidelines call for similar practices in adults and children with EoE. We compared the diagnostic and management practices of gastroenterologists treating adult and pediatric patients suspected of having, or diagnosed with, EoE.Methods:A 19 question multiple choice questionnaire was given to gastroenterologists treating either adults or children. Questions explored four areas of interest: Physician demographics, diagnosis and tissue sampling practices, management, and the need for societal publications on EoE.Results:Completed questionnaires were returned by 85/180 adult and 30/40 pediatric gastroenterologists. Compared to pediatric gastroenterologists, adult gastroenterologists took esophageal biopsies significantly less frequently in the following scenarios: endoscopy without esophageal symptoms or macroscopic endoscopic findings (10% vs. 57%; p 

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Should Giant Cell Hepatitis With Autoimmune Hemolytic Anemia Be Considered a Pediatric Autoimmune Liver Disease?

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Should Giant Cell Hepatitis With Autoimmune Hemolythic Anemia Be Considered A Pediatric Autoimmune Liver Disease?

No abstract available

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Survey on the Adherence to the 2009 NASPGHAN-ESPGHAN Gastroesophageal Reflux Guidelines by Brazilian Paediatricians

ABSTRACTObjective:To evaluate the management of gastroesophageal reflux in children among Brazilian pediatricians and adherence to the 2009 North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), and European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Guideline in Brazil.Methods:An observational cross-sectional study was conducted, applying a standard questionnaire with 12 questions about gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) management in infants, children, and adolescents to the pediatricians during the 37th Brazilian Pediatrics Congress in October, 2015. Adherence to the 2009 NASPGHAN-ESPGHAN Guideline was verified through analyses of interviewees' answers. Pediatricians' demographic and professional characteristics were screened.Results:390 Brazilian pediatricians answered the questionnaire. None showed complete adherence to Guideline recommendations. GERD diagnosis by history alone was reported by 67%, irrespective of the child's age. The mean score for diagnostic adherence to the guidelines was 0.94 ± 0.86 (range 0–4). Working in public health services (p = 0.026) was the only variable retained as a significant predictor of poor adherence for GER/GERD diagnosis after multivariate logistic regression analysis. No significant statistical differences were found between Brazilian regions on total score (p = 0.774). Proton pump inhibitors (PPIs) were prescribed by 28.4% of the pediatricians independent of child's age, and 59% use PPI to treat babies with unexplained crying and/or distressed behavior.Conclusions:2009 NASPGHAN-ESPGHAN Guideline recommendations had poor adherence by Brazilian pediatricians. Studies evaluating the reasons for the poor adherence to NASPGHAN/ESPGHAN guidelines are urgently needed. Objective: To evaluate the management of gastroesophageal reflux in children among Brazilian pediatricians and adherence to the 2009 North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), and European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Guideline in Brazil. Methods: An observational cross-sectional study was conducted, applying a standard questionnaire with 12 questions about gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) management in infants, children, and adolescents to the pediatricians during the 37th Brazilian Pediatrics Congress in October, 2015. Adherence to the 2009 NASPGHAN-ESPGHAN Guideline was verified through analyses of interviewees' answers. Pediatricians' demographic and professional characteristics were screened. Results: 390 Brazilian pediatricians answered the questionnaire. None showed complete adherence to Guideline recommendations. GERD diagnosis by history alone was reported by 67%, irrespective of the child's age. The mean score for diagnostic adherence to the guidelines was 0.94 ± 0.86 (range 0–4). Working in public health services (p = 0.026) was the only variable retained as a significant predictor of poor adherence for GER/GERD diagnosis after multivariate logistic regression analysis. No significant statistical differences were found between Brazilian regions on total score (p = 0.774). Proton pump inhibitors (PPIs) were prescribed by 28.4% of the pediatricians independent of child's age, and 59% use PPI to treat babies with unexplained crying and/or distressed behavior. Conclusions: 2009 NASPGHAN-ESPGHAN Guideline recommendations had poor adherence by Brazilian pediatricians. Studies evaluating the reasons for the poor adherence to NASPGHAN/ESPGHAN guidelines are urgently needed. Address correspondence and reprint requests to Sarah Cristina Fontes Vieira, Rua Claudio Batista, SN, Bairro Cidade Nova, ZIP code 49060-108, Aracaju-SE, Brazil (E-mail: sarahcfv@yahoo.com.br). Received 20 May, 2017 Accepted 22 December, 2017 Conflicts of interest and source of funding: None to declare. Institution: Federal University of Sergipe, Aracaju-Sergipe, Brazil. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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CHILD syndrome: A modified pathogenesis-targeted therapeutic approach

Congenital Hemidysplasia with Ichthyosiform nevus and Limb Defects (CHILD syndrome) is a rare X-linked dominant genodermatosis caused by mutations in the NAD(P) dependent steroid dehydrogenase-like protein gene. Its defect leads to accumulation of toxic metabolic intermediates upstream from the pathway block and to the deficiency of bulk cholesterol, probably leading to altered keratinocyte membrane function, resulting in the phenotype seen in CHILD syndrome. Symptomatic treatment using emollients and retinoids to reduce scaling has long been used until recently, whereby new therapeutic means based on the pathogenesis-targeted therapy have been developed. We subsequently chose to use the same pathogenesis-based therapy using a 2% cholesterol and 2% lovastatin cream with or without glycolic acid in two of our patients. Improvement in CHILD skin lesions was seen as early as 4 weeks after initiation. The addition of glycolic acid helped improve the penetrance of the cholesterol and lovastatin cream into the thick waxy scales. Our study confirms the efficacy of the pathogenesis-targeted therapy and introduces the possibility of modifying its formula by adding glycolic acid in order to improve the treatment.

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