BACKGROUND:The incidence and prevalence of inflammatory bowel disease [IBD] have increased significantly in low- and middle-income countries [LMICs] in recent decades. Managing IBD in these settings presents substantial challenges. This consensus aims to describe the epidemiology of IBD in LMICs and to highlight the key challenges in its diagnosis and treatment. METHOD:The consensus-defining strategy followed the previous European Crohn's and Colitis Organisation [ECCO] consensus guidelines [available at www.ecco-ibd.eu]. The authors reviewed the available evidence and formulated statements accordingly. Provisional ECCO statements and supporting text were drafted based on a comprehensive literature review and further refined through two voting rounds, which included external reviewers and national representatives from ECCO's 36 member countries. The final ECCO statements, representing a consensus of at least 80% agreement among participants, were approved during an online meeting. Consensus statements should be interpreted in context with their accompanying commentary rather than in isolation and should not be used solely to guide patient management. The supporting text was finalized under the guidance of each working group leader [VP, HY, TK, AH] and subsequently integrated by the consensus leader [AE]. RESULTS:Data on IBD epidemiology in LMICs remain limited. Public and healthcare professional awareness and timely access to early diagnostic modalities, advanced medical and surgical therapies, and specialist multidisciplinary care are key gaps in IBD care in LMICs. The complexity and chronic nature of IBD, along with the necessity for a multidisciplinary approach, pose significant challenges to adopting a holistic management strategy in LMICs. CONCLUSION:There is a critical need for further studies to assess the specific needs of LMICs. Such research will help guide resource allocation and improve IBD management in these settings.

Purpose:Gastrointestinal integrity in young population warrants special attention. Infectious pathogens may induce changes in intestinal microbiota, facilitating gut permeability. This study aimed to investigate the gut integrity and inflammatory markers in children with parasitic and non-parasitic infection in Kupang and North Kodi, Indonesia. Methods:A cross-sectional study assessed the anthropometric measurement, socio-demographic factors and personal hygiene practices. Stool samples for helminthic and protozoan infections were analysed using standard microscopy, while blood samples for gut integrity (intestinal fatty acid-binding protein [I-FABP] and fatty acid-binding protein 6 [FABP6]) and inflammatory markers (soluble cluster of differentiation 14 [sCD14] and soluble cluster of differentiation 163 [sCD163]) were assessed using enzyme-linked immunosorbent assay kit. Results:As many as 80 stool samples taken from the children with age of 36-45 months to examine gut parasites in East Nusa Tenggara. Thirty-three from 80 children have intestinal parasites infection and 5 of them infected with 2 types of parasites. A total of 38 intestinal parasites were found with 47.37% protozoa and 52.63% helminths. The most predominant parasites found are Giardia lamblia (21.1%) for protozoans and Trichuris trichiura (26.3%) for helminths. Furthermore, significantly, the median levels of gut integrity biomarkers concentration were higher in non-parasitic group compared to parasitic group, as follows I-FABP 99.50 ng/mL (33.81-393.39); FABP6 56.13 ng/mL (2.43-234.69); sCD14 4.87 ng/mL (1.98-15.06) and sCD163 17.338 ng/mL (1.98-60.92) and significant in FABP6 and sCD14 (p=0.014; 0.001 respectively). Conclusion:In Kupang and North Kodi, intestinal parasitic infections remain a significant concern. The elevated markers of gut integrity and inflammation biomarkers in children with non-parasitic infection are quite concerning and need additional research to justify the causality.

Purpose:Published data on pediatric gastroenterology, hepatology, and nutrition (PGHN) training centers in the Asia-Pacific region are limited. This study aimed to evaluate the infrastructure, resources, and training opportunities in PGHN centers across the region to inform future development of training programs. Methods:We conducted an international multicenter, cross-sectional survey among Asia-Pacific nations between August 2023 and July 2024. Results:A total of 43 responses were received from 11 countries. Most centers (58.1%) operated with ≤3 specialists, and trainees in these centers were less likely to receive formal supervision or participate in research. Procedural exposure varied significantly: although endoscopy was widely available, 50% of centers reported fewer than 100 colonoscopies performed annually. Access to training in specialized procedures was limited (pH/impedance, 48.8%; high-resolution manometry, 34.9%; intestinal ultrasound, 41.9%), with radiologists performing most liver biopsies and intestinal ultrasounds in many centers. Conclusion:This first comprehensive survey of PGHN training in the Asia-Pacific region identified considerable variations, with key challenges in training infrastructure and procedural exposure. Most centers operate with limited specialist numbers, impacting supervision and research opportunities, and many struggle to meet international volume-based training requirements for essential procedures. Enhanced regional collaboration and alternative training approaches may help address these gaps.

Latar belakang. Perkembangan saluran cerna pada awal kehidupan berlangsung sangat dinamis, kolonisasi awal mikrobiota usus didominasi oleh genus Bifidobacterium sebagai penanda ekosistem yang sehat. Namun, keseimbangan ini rentan mengalami disbiosis yang dapat mengganggu kematangan fungsi mukosa dan pertahanan lokal usus. Tujuan. Tinjauan komprehensif ini bertujuan untuk mengulas peran serta mekanisme molekuler faktor bifidogenik dalam mempertahankan integritas barier saluran cerna. Pembahasan. Faktor bifidogenik, baik alami seperti Human Milk Oligosaccharides maupun prebiotik tambahan Galakto-Oligosakarida (GOS), Frukto-Oligo Sakarida (FOS), Inulin atau protein bioaktif laktoferin, bekerja sebagai substrat selektif untuk memicu proliferasi Bifidobacterium. Secara fungsional, stimulasi ini mempertahankan barier usus melalui empat jalur biologis utama: peningkatan sekresi mukus pelindung melalui produksi Short-Chain Fatty Acids (SCFA), penguatan protein kerapatan dinding usus (tight junctions seperti Occludin), pematangan sel enterosit, serta stimulasi antibodi Secretory IgA. Bukti ilmiah mengonfirmasi keberhasilan komponen ini dalam menurunkan derajat keasaman (pH) luminal, menghambat adhesi bakteri patogen, dan mendukung maturasi imun secara aman. Kesimpulan. Pemanfaatan faktor bifidogenik merupakan strategi nutrisi yang kuat dan fisiologis untuk mendukung perkembangan serta kekuatan barier pencernaan anak. Paradigma ini membuka peluang besar bagi implementasi nutrisi personalisasi berbasis teknologi omics di masa depan.

Background: Inflammatory Bowel Disease (IBD) and Juvenile Idiopathic Arthritis (JIA) are chronic diseases characterized by persistent inflammation. The incidence of IBD in patients with JIA is higher than in the general pediatric population. The clinical manifestations of these diseases sometimes overlap or may even be absent, making early detection more difficult. This review aims to explore the pathophysiological interplay between IBD and JIA, highlighting their potential mutual influence and clinical implications. Discussion: Both IBD and JIA share a similar mechanism involving the interplay between immunological processes and environmental influences. A key common factor in both diseases is the involvement of gut microbiota. Alterations in gut microbiota can lead to gut dysfunction and immunological abnormalities. The involvement of intestinal factors in JIA pathophysiology is gaining more attention, as emerging evidence indicates a connection with the gastrointestinal system. Additionally, the use of specific medications in JIA patients has been recognized as a potential risk factor for developing IBD. Conclusion: Multiple underlying mechanisms suggest a connection between the IBD and JIA. However, additional research is needed to gain a more comprehensive understanding of this connection.

Background Infantile colic, defined according to the Rome IV criteria as excessive crying in otherwise healthy infants without signs of illness or failure to thrive, could be linked to inadequate mother-infant bonding. The risk of infantile colic is increased in mothers with depression and insufficient family support. Infantile colic could lead to recurrent emergency department admissions, unnecessary treatments, and child abuse. Mothers in medical residency programs who often face long working hours, reduced bonding time with their infants, burnout, and depression, may be at an increased risk of having infants with colic. However, data on the prevalence and associated factors of infantile colic in infants of mothers in this specific population are lacking. Objective To determine the prevalence of infantile colic and its associated factors among infants of mothers participating in medical residency programs. Methods We conducted a cross-sectional study involving 67 infants of mothers in medical residency programs across seven centers in Java and Sumatra. We used the Indonesian-translated Parent Report Questionnaire for Children Aged 0-3 Years from the Rome Foundation to obtain information on infantile colic based on Rome IV criteria and the Indonesian version of the Mother-Infant Bonding Scale Questionnaire to assess the risk level of mother-infant bonding problems. An online questionnaire was distributed to subjects' mothers via WhatsApp (c) application. Results Of 67 subjects, 18 (26.8%) experienced infantile colic. High risk of mother-infant bonding problems, as indicated by elevated Mother-Infant Bonding Scale-Indonesian version (MIBS-I) scores, were significantly associated with infantile colic (OR 2.922; 95%CI 1.07 to 4.87; P=0.046). The type of nutrition, whether breast milk or a combination of formula and breast milk, did not significantly differ between infants with and without colic (OR 1.333; 95%CI 0.451 to 3.940; P=0.602). Conclusion Elevated MIBS-I scores, reflecting impaired mother-infant bonding, are associated with an increased risk of infantile colic in infants born to mothers in medical residency training programs. [Paediatr Indones. 2026;66:25-34; DOI: https://doi.org/10.14238/ pi66.1.2026.25-34 ].

A significant increase in the incidence of pediatric inflammatory bowel disease (PIBD) across the Asia Pacific region has been observed. Countries in the region have diverse economies, with both developed and resource limited economies being represented. Literature from the region also varies, from reports on detailed epidemiological data and nuanced therapeutic outcomes derived from PIBD registries to case series from several geographic areas that have previously not reported on the condition. Through this position paper, we aimed to provide a comprehensive review of the challenges faced with diagnosing PIBD in the Asia Pacific region and offer pragmatic recommendations based on region-specific literature.

Prebiotics are substrates selectively utilized by microorganisms to confer health benefits to their hosts. Various prebiotics have been supplemented in standard milk formulas for infants who cannot be exclusively breastfed, aiming to provide benefits similar to those of breast milk. One of the most commonly used prebiotics is a mixture of 90% short-chain galacto-oligosaccharides and 10% long-chain fructo-oligosaccharides (scGOS/lcFOS [9:1]). Systematic review and meta-analysis were conducted to determine the effectiveness of scGOS:lcFOS (9:1) supplementation in standard milk formula for improving gastrointestinal health and immunity among healthy infants and toddlers, using parameters such as stool pH and intestinal colonization with beneficial bacteria. This systematic review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized clinical trials comparing scGOS/lcFOS (9:1)-supplemented formula versus placebo- or non-supplemented formula milk were eligible for inclusion. Related studies on gastrointestinal health and immunity among healthy infants up to five years old were searched from the earliest available date until February 29, 2024. Eighteen publications (number of participants=1,675) were selected for the systematic review, of which 11 were subsequently subjected to a meta-analysis. Results showed that the standard formula supplemented with scGOS/lcFOS (9:1) was well tolerated and conferred various gastrointestinal health and immunity to healthy infants and toddlers. These findings support the supplementation of standard milk formula with scGOS/lcFOS (9:1) for healthy infants and toddlers.

Gastric mucosal injury is a common condition affecting the gastrointestinal tract that is frequently caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In this study, we determined the effect of various doses of ibuprofen on gastric mucosal damage in rat models. Male Wistar rats (n = 32) aged 12 weeks with body weights ranging from 200-250g were randomly assigned to two experimental doses of ibuprofen: 200mg/kg body weight (BW) and 300mg/kg BW for 1 day. Specific doses of ibuprofen in sterile water were orally administered to the rats on day 0, followed by treatment with distilled water. Rats were euthanized at 1-, 3-, 5-, and 7-days post treatment and gastric mucosa damage was assessed microscopically. Gastric mucosal damage was assessed based on five parameters: inflammation, epithelial defect, oxyntic atrophy, hemorrhage, and submucosal edema, using Roger’s modified (2012) histology activity index (HAI). Ibuprofen treatment at 200 and 300mg/kg BW significantly exacerbated gastrointestinal hemorrhage at 1-, 3-, 5- and 7-days post administration. Both doses can cause gastric mucosal injury on the first day post-treatment and persist longer at higher doses. Conclusively, administration of ibuprofen at 200mg/kg BW induced gastric mucosal damage, which was exacerbated at a higher dose of 300mg/kg BW.

Background. Idiopathic nephrotic syndrome (INs) is the common kidney disorder characterized by severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Although it predominantly affects children, adults can also be affected. The condition is believed to be immune-mediated and involves alterations in the permeability of the glomerular filtration barrier. The aim of the study is to assess serum and urinary iron profile parameters in patients with steroid-sensitive and steroid-resistant nephrotic syndrome. Method. This was an observational, cross-sectional study designed to evaluate the iron profile parameters in children with nephrotic syndrome (NS) and compare the results between the steroid-sensitive nephrotic (SSN) and steroid-resistant nephrotic (SRN) groups. The study was conducted in the Nephrology Department of Thi-Qar City, Iraq. SSN patients responded to steroid therapy within four weeks, while SRN patients did not. The study included two groups: 50 patients with SSN and 50 with SRN. SRN patients had lower hemoglobin, serum iron, and transferrin levels, along with higher urinary albumin-to-creatinine ratios and cholesterol levels. Moreover, SRN patients had a longer disease duration, suggesting a more severe disease course. Conclusion. This study focused on children with SSN and SRN, revealing significant differences in disease progression and iron metabolism. SRN patients showed prolonged disease durations, lower hemoglobin levels, and impaired iron metabolism compared to SSN, indicating a more severe clinical presentation. These findings highlight the need for personalized treatment approaches for SRN patients to address anemia and improve overall health outcomes.

This is a comprehensive review of pediatric foreign body (FB) ingestions, emphasizing the global burden, epidemiology, and management strategies. Predominantly occurring in children under 6, with a peak between 6 months and 3 years, these incidents pose significant health risks with substantial regional variations in ingested objects-ranging from household items to caustic substances. The pathophysiological effects of ingestions are outlined, highlighting specific dangers associated with button batteries, sharp objects, and caustic agents, which can lead to severe tissue damage and long-term complications. A survey of (70) pediatric gastroenterologists from FISPGHAN societies revealed varied regional practices in the frequency of different FB ingestions with food impaction highest in North America and Ocenaia and caustic ingestion more common is Asia. Button batterers were serious concerns across all regions. Management approaches, specifically intubation practice varied across regions. A review of management protocols for different types of ingestions are provided, emphasizing the urgency of endoscopic removal and follow-up care. Prevention strategies are critical, with a focus on public health interventions, legislation, and education to mitigate the risks associated with FB and caustic ingestions. This report underscores the need for enhanced preventive measures and uniform management guidelines to reduce the incidence and improve outcomes of pediatric ingestions worldwide.

Gastroparesis, characterized by delayed gastric emptying in the absence of mechanical obstruction, is a challenging condition to diagnose and treat in children due to limited pediatric-specific data. This case report presents a 15-month-old girl with recurrent and chronic vomiting since infancy, which worsened upon the introduction of solid foods. Initial diagnostic evaluations, including esophagogastroduodenoscopy (EGD) and upper gastrointestinal contrast study, ruled out structural abnormalities. A gastric emptying scintigraphy (GES) with 99mTc DTPA confirmed significant gastric retention, leading to a diagnosis of idiopathic gastroparesis. Endoscopic intra-pyloric botulinum toxin injection (IPBI) was performed and resulting in significant symptom improvement. Post-procedure assessments revealed improved gastric emptying, with reduced retention at 60 and 180 minutes and a markedly decreased half-time (t1/2) was shown following the procedure. These findings highlight that IPBI may be a promising therapeutic option for pediatric idiopathic gastroparesis unresponsive to standard treatments. Further research is warranted to refine treatment protocols and evaluate long-term outcomes.

Background: Obesity is a chronic condition and a global epidemic, associated with impaired intestinal permeability owing to dysbiosis. Gut microbiota reportedly plays a potential role in obesity treatment. Probiotics have emerged as the most widely used approach for treating dysbiosis. This study explored the effect of oral probiotic supplementation on intestinal permeability in individuals with obesity. Methods: A Systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, ScienceDirect, PLOS One, and Cochrane databases were searched to identify articles published between 2014 and September 2024. The Cochrane risk-of-bias tool for randomized trials was used to assess publication bias. Results: A total of 690 human RCTs (randomized controlled trials) were identified, of which nine were eligible for this review. Probiotics (Akkermansia, Bifidobacterium, Enterococcus, Lactobacillus, Streptococcus, and a combination of Saccharomyces yeast) used for over 8 weeks may decrease gut permeability outcomes, including plasma zonulin, fecal zonulin, plasma or serum LPS, urinary lactulose, and urinary mannitol; however, BMI (body mass index) levels exhibited inconsistent measurements across all groups. Conclusions: Probiotic supplementation for a minimum of 8 weeks may reduce gut permeability. However, further studies are required to develop standardized protocols for probiotic strains, dosages, durations, and delivery methods, to better understand their effects on intestinal permeability and related outcomes in individuals with obesity.

Purpose:The prevalence of disorders of gut-brain interaction (DGBI), previously known as functional gastrointestinal disorders, has increased among children and adolescents, impacting their quality of life. Lifestyle changes during the coronavirus disease (COVID-19) pandemic, such as decreased physical activity and altered dietary habits, may have contributed to this increase rise. This study aimed to assess the prevalence of DGBIs among Indonesian adolescents during the COVID-19 pandemic using the Rome IV diagnostic criteria. Methods:A cross-sectional survey was conducted from March 2022 to April 2023 involving 5,247 adolescents (aged 13-18 years) from nine provinces in Indonesia (Riau, Riau Islands, Central Java, East Java, Bali, South Kalimantan, East Kalimantan, East Nusa Tenggara, and Papua). Data were collected via online and offline versions of the Rome IV questionnaire and analyzed descriptively to determine DGBI prevalence rates by age, sex, and region. Results:The prevalence of DGBIs was greater in females than males and among adolescents living in urban areas. We found that 28.4% of adolescents were diagnosed with at least one DGBI, with functional constipation being the most prevalent (21.8%), followed by functional dyspepsia (4.5%). Additionally, 13.5% of respondents experienced two overlapping DGBIs, and 1.3% suffered from three overlapping DGBIs simultaneously. The prevalence rate of DGBI varied significantly across the participating provinces. Conclusion:DGBIs are highly prevalent among Indonesian adolescents after the COVID-19 pandemic. These findings can guide public health strategies to address adolescent gastrointestinal health in Indonesia and other regions.

Background/Aims:Parenteral nutrition is often administered after a small bowel resection, but it can increase the risk of complications such as sepsis and organ disorders. Citrulline has been identified as a potential biomarker that correlates with intestinal adaptation, affects the tolerance to enteral nutrition, and predicts the duration of parenteral nutrition. This study examined the correlation between parenteral nutrition and the plasma citrulline levels of pediatric patients who underwent surgery for small bowel disorders. Methods:This cross-sectional study compared the citrulline levels before and after administering parenteral nutrition to infants and children with small bowel disorders who required surgery at the Pediatric and Surgery Inpatient Ward of Dr. Soetomo General Hospital, Surabaya, Indonesia, between April and July 2023. Results:The mean citrulline level before parenteral nutrition administration was 1.44 nmol/mL (±0.48 nmol/mL) and increased to 1.89 nmol/mL (±1.73 nmol/mL) after (no significant difference; p=0.231). No significant changes in the citrulline levels in any of the samples, intestinal resection, or the presence of the ileocecal junction were observed before and after administering parenteral nutrition. Positive correlations were observed between the citrulline level and hospital length of stay (moderate strength; r=0.451; p=0.024) and between the citrulline level and parenteral nutrition duration (moderate strength; r=0.439; p=0.028). Conclusions:The citrulline levels before and after parenteral nutrition administration were similar.

OBJECTIVE:Pediatric inflammatory bowel diseases (PIBDs), despite being more prevalent in westernized nations, show an increasing incidence worldwide. Accurate evaluation, diagnosis, therapy, and monitoring are mandatory for the adequate management of patients, as is a sensible use of expensive resources, which may be limited in some parts of the world. This limitation often poses challenges to diagnose and treat patients. As the long-term prognosis very much depends on early diagnosis and remission of active disease, it is important to consider reasonable alternatives that may help clinicians to act accordingly within resource constraints, without downgrading previously published guidelines. METHODS:A group of experts from the "Paediatric IBD Porto Group" of European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) as well as pediatric and adult IBD experts, trained in IBD centers and having working experience in limited-resource settings (LR settings), joined efforts to suggest alternative options in settings where resources are limited, while prioritizing an acceptable cost-effectiveness ratio. Almost all recently published ESPGHAN guidelines and position papers on PIBD were evaluated, and the writing group framed proposals for adaptation in situations with limited access to more expensive resources or tools. RESULTS:Ninety consensus-based recommendations, derived from the available evidence, were formulated. Diagnostic protocol, biochemical evaluation, imaging and endoscopy, monitoring and options for nutritional, medical and surgical treatment were addressed. Cooperation between professionals and institutions was suggested to improve quality of care and optimize use of available expertise. Patient education, counseling, mental health and transition of care were also addressed. CONCLUSION:Diagnosis and management of PIBD are complex and costly in medical resources, but some alternative protocols could provide acceptable results and help with accurate diagnosis and management. These recommendations and practice points may offer useful guidance in settings where resources may be limited while still providing good medical practice.

Acute Lymphoblastic Leukemia (ALL) is the most common pediatric malignancy, with survival rates exceeding 90% due to advancements in chemotherapy, including high-dose methotrexate (HD-MTX). However, gastrointestinal (GI) mucositis remains a significant complication, impairing treatment continuity and quality of life. Citrulline, a biomarker synthesized in enterocytes, reflects intestinal integrity and offers a non-invasive alternative for monitoring mucosal damage. This study aimed to evaluate citrulline dynamics in children with ALL undergoing HD-MTX chemotherapy during the consolidation phase. This cross-sectional study included 34 pediatric ALL patients in consolidation phase. Serum citrulline levels were measured pre- and post-HD-MTX chemotherapy using high-performance liquid chromatography. Mucositis severity was assessed using the National Cancer Institute Common Terminology Criteria. Data analysis involved paired t-tests and subgroup comparisons by risk stratification (Standard Risk [SR], High Risk [HR]) and mucositis grades. Overall, no significant changes in serum citrulline levels were observed post-chemotherapy. SR patients exhibited a significant decline in citrulline levels, consistent with mucosal injury. Conversely, HR patients demonstrated an unexpected increase in citrulline, potentially due to compensatory enterocyte responses or altered metabolism. Grade 1 mucositis patients showed increased citrulline levels, indicating early recovery, while grade 2 mucositis patients showed no significant changes, reflecting sustained injury. Citrulline is a promising biomarker for monitoring chemotherapy-induced GI mucositis in pediatric ALL patients. Its non-invasive measurement and correlation with mucosal health highlight its potential for improving personalized care. Further validation in diverse populations is required to optimize its clinical application.

Purpose:Pediatric gastrointestinal (GI) endoscopy significantly contributes to the diagnosis and management of GI diseases in children. Global data on pediatric GI endoscopy in the Asia-Pacific region are limited. We aimed to report the findings of a regional survey on pediatric endoscopy in the Asia-Pacific region. Methods:A questionnaire-based survey involving GI endoscopy centers in 13 Asia-Pacific countries (June to November 2021). The questionnaires included annual procedure volumes (from basic diagnostics to advanced therapeutic endoscopy), endoscopists, sedation procedures, and national training programs. Results:A total of 162 GI endoscopy centers completed the survey. All centers performed basic endoscopies (esophagogastroduodenoscopy and ileocolonoscopy); however, 45.1% and 59.1% of the centers performed less than 50 esophagogastroduodenoscopies and ileocolonoscopies per year, respectively. Small bowel evaluation (capsule endoscopy or balloon-assisted enteroscopy) was performed in 59.3% of the centers. Foreign body removal, polypectomy, and percutaneous endoscopic gastrostomy were performed in 89.5%, 85.8%, and 52.5% of centers, respectively. Endoscopic hemostatic interventions, which are life-saving procedures, included glue injection (30.9%), hemostasis of nonvariceal bleeding (65.4%), and endoscopic variceal ligation (70.4%). Pediatric GI endoscopy is performed not only by pediatric gastroenterologists but also by adult gastroenterologists in 21-50% of centers for many kinds of procedures. Sedation was provided by anesthesiologists in 65.4% of the centers. Most centers offer both adult and pediatric endoscopy training. Conclusion:The study highlights regional disparities in pediatric GI endoscopy services. It emphasizes the need for expanded pediatric GI training and improved access to therapeutic endoscopy, particularly for life-saving procedures.

Introduction:Functional abdominal pain disorders (FAPDs) are pediatric gastrointestinal conditions marked by chronic or recurrent abdominal pain without anatomical and/or biochemical abnormalities. This position paper guides primary care providers in the early diagnosis and management of FAPDs to improve the well-being of affected children and their families. Methods:A 12-member expert advisory board reviewed current approaches to diagnosing and managing FAPDs in children. Based on literature and discussions, 23 statements were drafted and voted on to achieve an acceptable level of agreement. Results:First-line healthcare professionals are key in diagnosing FAPDs, using ROME diagnostic criteria and recognizing red flags for accurate assessment and referrals. Comprehensive evaluation, including medical, dietary, and psychosocial history, physical exams, and basic tests helped to identify the initial triggers. Probiotics such as Limosilactobacillus (L. reuteri) DSM 17938 and Lacticaseibacillus rhamnosus (L. rhamnosus) help in alleviating functional abdominal pain (FAP) in children along with primary measures, such as dietary modifications [a balanced diet advocating moderation in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-rich foods] and physical activity. Probiotics should be given for 6-8 weeks and can be resumed if symptoms recur. Cognitive-behavioral and hypnotic therapy also help, with remote options such as web-based, compact disk (CD)-based or application-based tools available. Discussion:This position paper provides expert insights to guide primary care providers in diagnosing and managing FAPDs, equipping them to make informed decisions for effective management of FAPDs.

Background: Diarrhea is the first cause of death for children under five years of age worldwide. In Indonesia, diarrhea cases due to rotavirus infection tend to be detected throughout the year. Purpose: The study was to determine the epidemiology of diarrhea cases due to rotavirus infection of pediatric patients in Dr. Soetomo Hospital, Surabaya based on the variables of person, place, and time. Methods: This type of research uses both descriptive and quantitative methods. The samples used were cases of rotavirus infection in toddlers in Dr. Soetomo Hospital, Surabaya in 2015–2019. Results: From 2015 to 2019, there were about 110 cases (31.98%) of acute diarrhea caused by rotavirus infection at Dr. Soetomo Hospital, Surabaya. The findings revealed that the majority of rotavirus infections (42.73%) occurred in children aged 6-11 months followed 12-23 months (35.45%) and were male (56.36%). The highest cumulative incidence was observed in August 2018 and February 2029, with a value of 1,0. Rotavirus infection was most common among children living in Gubeng sub-District, with 19 cases (17.27%). Conclusion: Epidemiological studies of rotavirus infection by person, place, and time reveal the distribution of disease cases and enable targeted interventions to respond to the disease.