INTRODUCTION:Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction that significantly affects patients' quality of life, particularly in educational and professional settings. This study aimed to assess the impact of IBS on schooling, higher education, and future professional life. METHODS:An online survey was conducted among members of a French patient association and visitors to its website. Adult participants provided demographic data, details on disease severity, and feedback on their educational and professional experiences. RESULTS:Among 365 participants with IBS, 42% reported having IBS during their schooling or higher education. The most commonly reported difficulties included restricted access to toilets during class (40%), problems with school-provided meals (39%), and lack of privacy in restrooms (50%). Additionally, 62% of the participants reported that IBS had a direct negative impact on their academic performance, leading to frequent late arrivals at class (59%), absenteeism (70%), and repeating a year (23%). Irritable bowel syndrome was rarely addressed in academic settings (27%), though 52% of adaptation requests were granted. Finally, IBS was associated with lower income levels and reduced career prospects compared with individuals without IBS during their education (p < 0.005). CONCLUSION:Irritable bowel syndrome has a significant impact on schooling and career development. Greater awareness and recognition of this condition in educational and professional environments are necessary to improve affected individuals' quality of life and professional integration.

Microbial colonization of the newborn (primocolonization) plays a crucial role in the development of digestive, metabolic, and immune systems. Disruptions may impair intestinal barrier function and raise the risk of chronic diseases like inflammatory bowel disease, allergies, and obesity. Recent evidence suggests probiotic supplementation in infants may help counter or prevent these effects. This study isolates and characterizes potential probiotic candidates from the gut microbiota of exclusively breastfed infants. Bifidobacterium and Lacticaseibacillus strains were selectively isolated and initially characterized in vitro. To evaluate their ability to reach the colon intact, we assessed their growth and bile tolerance. Strains safety was evaluated in vitro by determining antibiotic resistance profiles, DNase, and β-hemolytic activities. Additionally, their potential effects on the intestinal barrier and their ability to modulate the immune response were assessed in order to highlight potential probiotic functionality. The most promising strains underwent further characterizations. We performed whole genome sequencing (WGS) analysis to examine transferable antibiotic resistance, virulence factors, toxicity, and biogenic amine formation, thereby confirming the safety of the strains. Bile salt hydrolase (BSH) and glycoside hydrolase (GH) genes were also investigated. Furthermore, we explored the ability of certain strains to ferment human milk oligosaccharides (HMOs) and engage in cross-feeding interactions. The study showed that isolated strains exhibit probiotic traits such as acid and bile resistance, immunomodulatory potential, and strong safety with no detected virulence or resistance genes. Bifidobacterium longum A1 stood out for its metabolic strength, safety, ability to degrade human milk oligosaccharides, and support beneficial cross-feeding.

BACKGROUND:Fecal microbiota transplantation (FMT) is validated for recurrent Clostridioides difficile infections but is increasingly considered for compassionate indications: steroid-refractory graft-versus-host disease (GVHD), multidrug-resistant organism (MDRO) eradication, severe inflammatory or infectious colitis. Evidence remains limited outside clinical trials. METHODS:Retrospective multicenter analysis of requests submitted to the French National Commission for compassionate FMT between 2019 and 2022. Approved cases were evaluated for feasibility, safety, and clinical outcomes. RESULTS:Among 67 requests, 54 were approved and 40 FMT procedures were performed. The main indications were severe steroid-resistant GVHD (35%), MDRO carriage (28%), and inflammatory/infectious colitis (12%). Overall success was 37.5%. The response rate for GVHD was 53% and 31% for MDRO eradication. Adverse events were mostly mild. CONCLUSIONS:Compassionate FMT in France is feasible through a centralized process but shows variable efficacy depending on the indication. GVHD seems to be the most promising target, while MDRO eradication and colitis require further evaluation.

Fecal microbiota transplantation (FMT) requires rigorous donor screening, limiting donor eligibility and increasing costs. Recent evidence suggests that bacterial viability may not be essential for treating recurrent Clostridioides difficile infections. This study aimed to evaluate whether inactivated fecal preparations retain anti-C. difficile (CD) activity in vitro. Stool samples from three donors underwent eight different inactivation protocols, including mechanical, thermal, and chemical treatments. Bacterial viability and anti-CD activity were assessed by culture and inhibition assays. Mechanical filtration, pasteurisation, and sterilisation eliminated bacterial growth, while tyndallisation and ethanol treatments only partially reduced viability. Inhibition of CD growth was observed exclusively in samples containing live bacteria, with no significant difference compared to native stool. Inactivated samples, despite potentially retaining other microbiota-derived components, showed no anti-CD activity. These results suggest that live bacteria are essential for in vitro antagonism of C. difficile and thus in the therapeutic effects of FMT.

For many years, biotics (including probiotics, prebiotics, human identical milk oligosaccharides, synbiotics, and postbiotics) have been added to infant formula to influence the gut microbiota of formula-fed infants, aiming to bring it closer to that of breastfed infants. The Special Interest Group on Gut Microbiota and Modifications (SIG-GMM) of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) evaluated clinical outcomes from studies on biotic-supplemented infant formulas. A modified Delphi process was used to establish consensus on recommendations. This document is supported by separately published technical reviews, which synthesize the available evidence, analyze its limitations, and identify research gaps. ESPGHAN SIG-GMM concludes that infant formulas supplemented with one or more of the biotics evaluated so far fed to healthy infants do not raise safety concerns regarding growth, tolerance, and adverse effects. Based on available evidence, for some prebiotics (short-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides), a weak recommendation in favor can be formulated because they soften stools by reducing stool consistency, and, to a lesser extent, increase stool frequency in presumed healthy infants. However, due to variability in study designs, intervention types, and measured outcomes, no clear conclusions can be drawn about their overall clinical benefits. Due to differences in interventions (e.g., duration, amount, and composition), inclusion criteria, and primary and secondary outcomes, for most biotics evaluated so far, no recommendations can actually be made "in favor" or "against." This conclusion may reflect the limited data on specific biotics and outcomes because of the heterogeneity in the randomized controlled trials, rather than an actual lack of effect.

BACKGROUND: Anastomotic stenosis after pull-through surgery remains a challenge in the management of Hirschsprung disease. Based on the management of esophageal stenosis, we evaluated the efficacy of combined radial incision and steroid injection for the treatment of refractory colorectal anastomotic stenosis after pull-through. IMPACT OF INNOVATION: Combined radial incision and steroid injection is an alternative conservative treatment of refractory anastomotic stenosis after pull-through for Hirschsprung disease, avoiding a potential complicated redo pull-through surgery. TECHNOLOGY, MATERIALS, AND METHODS: We included patients with rectosigmoid Hirschsprung disease who developed a refractory anastomotic stenosis after a laparoscopic-assisted Swenson pull-through at Robert-Debré Children University Hospital in Paris, France. Refractory stenosis was defined as obstructive symptoms associated with an anastomotic stenosis on rectal examination without improvement after serial anal dilations. Under general anesthesia, an injection of 10-mg delayed-action steroid per quadrant was combined with a radial incision of the stenosis using monopolar cautery. PRELIMINARY RESULTS: Combined radial incision and steroid injection were performed in 4 children for either early or late refractory stenosis. This resulted in improved refractory anastomotic stenosis, avoiding a redo pull-through in 75% of patients. One child presented with transient improvement after a combined radial incision and steroid injection but developed recurrent stenosis despite additional combined radial incision and steroid injection and redo pull-through. The median follow-up was 29 months. CONCLUSIONS: We observed a clinical improvement in all the patients after combined radial incision and steroid injection. FUTURE DIRECTIONS: Steroid injection should be considered as a potential alternative therapy for anastomotic stenosis.

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 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and other authors who contributed to the ESPGHAN position paper on probiotics for preterm infants, as well as representatives from the European Foundation for the Care of Newborn Infants. We advocate for a more nuanced and supportive approach to the use of certain probiotics in this vulnerable population, balancing the demonstrated benefits and risks.

BACKGROUND:Detailed comparative assessment of procedure-related factors associated with faecal microbiota transplantation (FMT) efficacy in Clostridioides difficile infection (CDI) is limited. AIMS:We took advantage of the differences in procedures at the various French FMT centres to determine clinical and procedure-related factors associated with FMT success in CDI. METHODS:We performed a nationwide retrospective multicentre cohort study. All FMTs performed within The French Faecal Transplant Group for CDI from 2018 to 2022 were included. Clinical data were collected retrospectively from recipient medical files, characteristics of stool transplant preparations were prospectively collected by each Pharmacy involved. Univariate and multivariate analyses were performed using Fisher's test and multiple logistic regression. RESULTS:Six hundred fifty-eight FMTs were performed for 617 patients in 17 centres. The overall efficacy of FMT was 84.3% (520/617), with 0.5% of severe adverse events possibly related to FMT (3/658). Forty-seven patients were treated at the first recurrence of CDI with a similar success rate (85.1%). Severe chronic kidney disease (CKD; OR: 2.18, 95%CI [1.20-3.88]), non-severe refractory CDI (OR: 15.35, [1.94-318.2]), the use of ≥ 80% glycerol (OR: 2.52, [1.11-5.67]), insufficient bowel cleansing (OR: 5.47, [1.57-20.03]) and partial FMT retention (OR: 9.97, [2.62-48.49]) were associated with CDI recurrence within 8 weeks. CONCLUSIONS:Conditions of transplant manufacturing, bowel cleansing, and a route of delivery tailored to the patient's characteristics are key factors in optimising FMT efficacy. FMT at first recurrence showed high success in real-life practice, whereas it had lower efficacy in severe CDI and non-severe refractory CDI.

In children, CMV-associated protein-losing enteropathy (PLE) is characterised by a benign course and spontaneous healing but can lead to generalised oedema. Poorly defined, it is diagnosed after unnecessary invasive tests. Children with CMV-associated PLE between 2009 and 2019 in two French hospitals are retrospectively described. Clinical and biological signs, CMV identification, endoscopy and histological findings, disease management and course are analysed. CMV-associated PLE is proven in 21 immunocompetent and 22 immunosuppressed patients, with ages consistent with primo-infection and reactivation, respectively. The digestive symptoms prevail in immunocompetent children, mainly with vomiting (85.7% versus 50%, CI [1.2; 39.2], p = 0.02). Immunocompetent patients show more oedema (61.9% versus 4.5%, CI [3.6; 1502.4], p < 0.001), linked to more severe hypoalbuminemia (21.2 g/L [17.6–25.7] versus 29.6 g/L [24.9–33.9], p = 0.01). A severe course is observed in 23.8% of the immunocompetent patients and 54.5% of the immunosuppressed ones (p = 0.06). Evidence of CMV infection based on non-invasive methods is found on 88.9% of immunocompetent and 95.5% of immunosuppressed patients (p = 0.58), while endoscopy was performed on 95.2% and 100% of them, respectively (p = 0.48), without any therapeutic change. Thus, CMV-associated PLE should be suspected in children with generalised oedema. Not as benign as previously described, it can be confirmed using non-invasive tests.

Objectives: The objective of this study is to determine whether jejunal nutrition by gastrojejunal tube (GJT) could be a therapeutic option for refractory gastroesophageal reflux disease (GERD), avoiding further antireflux surgery. Methods: A monocentric retrospective study was conducted for all children <18 years who underwent GJT placement to treat GERD. We collected data at the first GJT placement, 5 months after last GJT withdrawal, and at the end of the follow-up (June 2021). Results: Among 46 GERD patients with 86 GJT, 32 (69.6%) and 30 (65.2%) avoided antireflux surgery 5 and 28 months, respectively, after the definitive GJT removal. Five months after GJT removal, discharge from hospital, transition to gastric nutrition, GERD complications, and treatment were significantly improved. Median age and weight at the first GJT placement were 7 months and 6.8 kg. Patients had digestive comorbidities or complicated GERD in 69.6% and 76.1% patients, respectively. The median duration of jejunal nutrition using GJT was 64.5 days. GJT had to be removed in 63 (75.9%) cases for technical problems. Conclusions: Jejunal nutrition by GJT could be an alternative to antireflux surgery avoiding sustainably antireflux surgery in most of complicated GERD patients. The high frequency of mechanical complications raises that these devices should be technically improved.

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 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders. Methods: All systematic reviews and/or meta-analyses, as well as subsequently published randomized controlled trials (RCTs) (until December 2021), that compared the use of probiotics in all delivery vehicles and formulations, at any dose, with no probiotic (ie, placebo or no treatment), were eligible for inclusion. The recommendations were formulated only if at least 2 RCTs on a similar well-defined probiotic strain were available. The modified Delphi process was used to establish consensus on the recommendations. Results: Recommendations for the use of specific probiotic strains were made for the management of acute gastroenteritis, prevention of antibiotic-associated diarrhea, nosocomial diarrhea and necrotizing enterocolitis, management of Helicobacter pylori infection, and management of functional abdominal pain disorders and infant colic. Conclusions: Despite evidence to support the use of specific probiotics in some clinical situations, further studies confirming the effect(s) and defining the type, dose, and timing of probiotics are still often required. The use of probiotics with no documented health benefits should be discouraged.

L’encoprésie est une expulsion répétée d’une selle normale, involontaire ou intentionnelle, dans des endroits inappropriés, par un enfant de 4 ans ou plus. C’est une pathologie fréquente qui concerne 0,8–4,1 % de la population pédiatrique occidentale et 13 à 21 % des consultations de gastropédiatrie. Sa prise en charge est généralement tardive avec une première consultation entre 7 et 8 ans, principalement chez des garçons (ratio 3–6/1). Il existe différents types d’encoprésie mais nous nous intéresserons ici à l’encoprésie fonctionnelle rétentionnelle qui est 4,5 fois plus fréquente (vs organique et fonctionnelle non rétentionnelle). Sa prise en charge peut être réalisée à l’aide de médicaments (laxatifs oraux ou lavement), d’un suivi psychologique (psychothérapie ou thérapie comportementale) ou de biofeedback (BFB). Le BFB est une méthode visant l’amélioration de la compréhension de la défécation et de ses mécanismes périnéaux tout en renforçant l’investissement de cette zone « tabou ». Il a pour objectif de rétablir une dynamique de défécation normale en améliorant la sensation rectale, en rééduquant les efforts de poussée (dissociation de la contraction sphinctérienne et des efforts de poussée) et en évitant la rétention. Il se réalise à l’aide d’une manométrie et d’une sonde rectales chez des patients en âge de compréhension (> 7 ans). Une étude rétrospective monocentrique a été réalisée à l’hôpital Necker de 2017 à 2020. Elle évaluait l’efficacité du BFB centré sur l’hyposensiblité rectale après la réalisation de 5 à 6 séances chez 44 patients encoprétiques fonctionnelles de 5 à 17 ans en échec de traitement médical (ratio ♂/♀ de 10/1). L’efficacité était jugée sur la clinique (guérison ou diminution de 50 % des fuites), les scores d’envie et les volumes de besoins. Avant l’étude, ces enfants étaient pris en charge principalement par laxatifs (à 77 %) et psychothérapie (18 %). Après BFB, on retrouve une efficacité clinique à court terme de 84 % et à moyen terme de 73 % (médiane de 14,7 mois). Les volumes de besoin et les scores d’envie étaient également diminués. Une autre étude rétrospective monocentrique a été menée à l’hôpital Robert Debré de 2017 à 2022. Celle-ci évaluait l’efficacité du BFB centré sur la rééducation de l’asynchronisme abdomino-sphinctérien chez 41 patients encoprétiques de 0 à 18 ans (ratio ♂/♀ de 3/1, au moins une séance de BFB). L’efficacité clinique, définie par la disparition de l’encoprésie, était de 53,6 % après BFB. Par ailleurs, elle semblait plus importante pour les enfants sans antécédents avec une constipation simple. Le BFB est donc une éducation thérapeutique qui donne des résultats très positifs dans la prise en charge de l’encoprésie rétentionnelle. Ses différentes méthodes, rééducation de l’hypo-sensibilité rectal ou de l’asynchronisme-sphinctérien, semble tout aussi efficace. Aussi, il existe certainement un intérêt à additionner les 2 techniques.

An optimally operating microbiome supports protective, metabolic, and immune functions, but disruptions produce metabolites and toxins which can be involved in many conditions. Probiotics have the potential to manage these. However, their use in vulnerable people is linked to possible safety concerns and maintaining their viability is difficult. Interest in postbiotics is therefore increasing. Postbiotics contain inactivated microbial cells or cell components, thus are more stable and exert similar health benefits to probiotics. To review the evidence for the clinical benefits of postbiotics in highly prevalent conditions and consider future potential areas of benefit. There is growing evidence revealing the diverse clinical benefits of postbiotics in many prevalent conditions. Postbiotics could offer a novel therapeutic approach and may be a safer alternative to probiotics. Establishing interaction mechanisms between postbiotics and commensal microorganisms will improve the understanding of potential clinical benefits and may lead to targeted postbiotic therapy.

Background: Chronic abdominal pain occurs frequently in pediatric patients with inflammatory bowel disease (IBD) in remission. Aims: To assess the prevalence and factors associated with Functional Abdominal Pain Disorders among IBD children in remission (IBD-FAPD). Methods: Patients with IBD for symbolscript 1 year, in clinical remission for symbolscript 3 months were recruited from a National IBD network. IBD-FAPDs were assessed using the Rome III questionnaire criteria. Patient-or parent-reported outcomes were assessed. Results: Among 102 included patients, 57 (56%) were boys, mean age (DS) was 15.0 symbolscript 2.0) years and 75 (74%) had Crohn's disease. Twenty-two patients (22%) had at least one Functional Gastrointestinal Disorder among which 17 had at least one IBD-FAPD. Past severity of disease or treatments received and level of remission were not significantly associated with IBD-FAPD. Patients with IBD-FAPD reported more fatigue (peds-FACIT-F: 35.9 symbolscript 9.8 vs. 43.0 symbolscript 6.9, p symbolscript 0.01) and a lower HR-QoL (IMPACT III: 76.5 symbolscript 9.6 vs. 81.6 symbolscript 9.2, p symbolscript 0.04) than patients without FAPD, and their parents had higher levels of State and Trait anxiety than the other parents. Conclusions: Prevalence of IBD-FAPD was 17%. IBD-FAPD was not associated with past severity of disease, but with fatigue and lower HR-QoL. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.

ABSTRACT Objectives: Digestive perianastomotic ulcerations (DPAU) resembling Crohn disease lesions are long-term complications of intestinal resections, occurring in children and young adults. They are known to be uncommon, severe and difficult to treat. Methods: In the absence of recommendations, we performed a large European survey among the members of the ESPGHAN working group on inflammatory bowel disease (IBD) in order to collect the experience of expert pediatric gastroenterologists on DPAU. Results: Fifty-one patients (29 boys and 22 girls) were identified from 19 centers in 8 countries. Most patients were followed after necrotizing enterocolitis (n = 20) or Hirschsprung disease (n = 11). The anastomosis was performed at a median age (interquartile range) of 6 [1–23] months, and first symptoms occurred 39 [22–106] months after surgery. Anemia was the most prevalent symptom followed by diarrhea, abdominal pain, bloating, and failure to thrive. Hypoalbuminemia, elevated CRP, and fecal calprotectin were common. Deep ulcerations were found in 59% of patients usually proximally to the anastomosis (68%). During a median follow-up of 40 [19–67] months, treatments reported to be the most effective included exclusive enteral nutrition (31/35, 88%), redo anastomosis (18/22, 82%), and alternate antibiotic treatment (37/64, 58%). Conclusions: Unfortunately, persistence of symptoms, failure to thrive, and abnormal laboratory tests at last follow-up in most of patients show the burden of DPAU lacking optimal therapy and incomplete understanding of the pathophysiology.

Gut microbiota and exercise have recently been shown to be interconnected. Both moderate and intense exercise are typically part of the training regimen of endurance athletes, but they exert different effects on health. Moderate exercise has positive effects on the health of average athletes, such as a reduction in inflammation and intestinal permeability and an improvement in body composition. It also induces positive changes in the gut microbiota composition and in the microbial metabolites produced in the gastrointestinal tract. Conversely, intense exercise can increase gastrointestinal epithelial wall permeability and diminish gut mucus thickness, potentially enabling pathogens to enter the bloodstream. This, in turn, may contribute to the increase in inflammation levels. However, elite athletes seem to have a higher gut microbial diversity, shifted toward bacterial species involved in amino acid biosynthesis and carbohydrate/fiber metabolism, consequently producing key metabolites such as short-chain fatty acids. Moreover, rodent studies have highlighted a bidirectional relationship, with exercise impacting the gut microbiota composition while the microbiota may influence performance. The present review focuses on gut microbiota and endurance sports and how this interconnection depends upon exercise intensity and training. After pointing out the limits of the studies so far available, we suggest that taking into account the microbiota composition and its metabolic contribution to human host health could help in monitoring and modulating athletes' health and performance. Such an integrated approach should help in the design of microbiome-based solutions for health or performance.

We present the case of a four-year-old girl, who was hospitalized in intensive care unit for a coma resulting from metabolic acidosis with increased anion gap. The patient was treated for short bowel syndrome, following necrotising enterocolitis, which occurred 51 days after birth. In our initial evaluation of the patient's metabolic acidosis, we were unable to identify the cause of the increased anion gap. Urinary organic acids chromatography identified a large peak of lactate (quantified at 15 mmol/mol of creatiniuria), as well as its metabolites. The discrepancy between normal blood lactate concentration assayed by enzymatic assay, and the large amount of lactate found by gas-chromatography/mass spectrometry (GC/MS) in urine highlights the limit of the stereospecificity of enzymatic assays. Indeed, most lactates assay use enzymatic assays that are specific for L-lactate, whereas organic acids chromatography, whose column is mostly achiral, can detect both stereoisomers, D- and L-lactate. Organic acids in urine analysis, in addition to the clinical context, suggested a diagnosis of D-lactic acidosis. Following a review of the physiopathology and treatment of short bowel syndrome, we will discuss the mechanism and diagnosis of the D-lactic acidosis in our patient. This case highlights the need to perform an organic acid profile in urine in the presence of any unexplained increased anion gap to determine its cause.