Background and Aim:Crohn's Colitis Care, a structured, disease-specific electronic medical record, is proven to promote more complete data capture in adult Inflammatory Bowel Disease care. This study aimed to determine whether similar effectiveness was seen in pediatrics. Methods:Matched patient records from a hospital's standard electronic medical record (pre-Crohn's Colitis Care) and those in Crohn's Colitis Care were retrospectively reviewed (12 months each). The presence of disease-specific data items per platform were compared (21 core, 5 age-specific). Data are presented as percentage recorded (recorded items/total eligible for age). Descriptive and statistical analytics were used. Results:Paired records were reviewed for 114 children, of whom 78 (68%) had Crohn's disease and 69 (61%) were male. Median age at diagnosis was 13.5 years (IQR12.0-15.5), with mean disease duration 3.6 years (±2.4). Crohn's Colitis Care was more likely to capture 9 items: general wellbeing, stool urgency and frequency, disease duration, comorbidities, pubertal stage, sexual activity, alcohol and drug usage (each p < 0.05). The standard platform was more likely to capture 4 items: liquid stools, phenotype, disease indices, and vaccinations (each p < 0.05). Crohn's Colitis Care achieved more eligible data items recorded per patient (75.3% ±11.5 vs. 67.7% ± 8.9; p < 0.001). Item completion rate in both platforms inversely correlated with patient age (p < 0.05). Conclusions:Consistent with findings in adult care, Crohn's Colitis Care achieved more complete disease-data capture in pediatrics compared to a standard platform. Given that not all items were better recorded in the structured platform, work to understand and address barriers is needed to optimize complete data capture for care and research.

OBJECTIVES:Experience with subcutaneous infliximab (SC-IFX) use in pediatric inflammatory bowel disease (IBD) remains limited. We aimed to evaluate the clinical efficacy, tolerability, and cost-benefit of SC-IFX as a treatment for children with IBD in a real-world setting. METHODS:A prospective, single-center cohort study was conducted at the Children's Hospital at Westmead, Australia, from February to June 2024. Thirty-three children aged 8-18 years with established IBD commenced SC-IFX (120 mg fortnightly). Assessments included clinical disease activity indices (Pediatric Crohn's Disease Activity Index [PCDAI]/Pediatric Ulcerative Colitis Activity Index [PUCAI]), biochemical markers, and infliximab levels. Patient experience was assessed via questionnaires on quality-of-life (QOL) and treatment satisfaction. RESULTS:Thirty-one (31/33) children completed treatment over a 12-week follow-up period. Median infliximab levels increased from 7.8 ug/mL (interquartile range [IQR]: 5.7-11) at baseline to 19.6 ug/mL (IQR: 13.2-21.8) at Week 12 (p < 0.001). Serum infliximab level >20 ug/mL was seen in 48% of children at Week 12. Minimal change was observed in fecal calprotectin and clinical disease activity indices. High satisfaction rates with improved patient and caregiver QOL are described. Cost analyses indicated a potential for net institutional savings. Drug continuation was planned in 85% (28/33) following the 12-week study period. CONCLUSIONS:Our experience suggests SC-IFX may be an effective and well-tolerated alternative to intravenous infliximab (IV-IFX) in pediatric IBD. Median serum infliximab levels increased across over the study period. Use of SC-IFX may offer a positive impact on patient and caregiver QOL, along with resource and cost saving benefits for healthcare systems. Larger-scale studies are needed to validate these findings and optimize treatment protocols.

BACKGROUND:The frequency of EoE has been increasing in Northern Hemisphere cohorts, yet there is a scarcity of data in our region. Regional climatic factors, and lifestyle habits may influence the presentation of EoE, and appropriate management is crucial to prevent complications. WIth this is mind we undertook the first comprehensive multisite study of EoE in Australasian children. AIM:To determine the incidence, prevalence, clinical characteristics and management of eosinophilic esophagitis (EoE) in Australasian children. METHODS:Retrospective audit of endoscopic records, histology reports and case notes (ICD code) over a 10-year period (1 January 2008 to 31 December 2018). Cases were defined as having >15 eosinophils per high-power field (HPF) at endoscopy and oesophageal biopsy, while treatment response was defined as <5 eosinophils per HPF. Included were patients aged 0-18 years presenting to tertiary paediatric hospitals in seven capital cities (Adelaide, Auckland, Brisbane, Christchurch, Melbourne, Perth and Sydney), while those with conditions that could cause eosinophilia (organ transplantation, hyper-eosinophilic syndrome) or taking medications that may influence tissue eosinophilia (systemic corticosteroids immunosuppressants) were excluded. Australian Bureau of Statistics and Stats NZ were used to define comparative population data. Demographics (age at diagnosis, gender, country of birth, race) comorbidities (atopic conditions, e.g. asthma, seasonal rhinitis, eczema) and treatment (diet, steroids, proton pump inhibitors) were noted. RESULTS:The prevalence of EoE ranged from 15 to 54 per 100 000 children, where cases were more common in Adelaide than other localities. Incidence increased significantly in all sites across the 10 years, with peak incidence in Adelaide of 6.4 per 100 000 children in 2017. EoE was most frequent in males (male:female ratio = 3:1) and >90% were white Caucasian. Polynesian racial background in Auckland (10%) and middle eastern racial background in Sydney (10%) were the next most frequent. Treatment choice varied across sites, and greater than 30% of patients did not undergo endoscopy to assess initial treatment success. CONCLUSION:The prevalence of EoE in Australasian children is comparable to that observed elsewhere, and the incidence is increasing significantly. Regional differences in disease frequency, management practices and access to endoscopy warrant further study.

Aim: To explore the perceptions and practices of Australasian paediatric gastroenterologists in diagnosing coeliac disease (CD) before and during the COVID-19 pandemic. Methods: Paediatric gastroenterologists in Australasia were invited via email to complete an anonymous online questionnaire over a 2-week period in 2021. Results: The questionnaire was completed by 39 respondents: 33 from Australia and six from New Zealand (NZ) equating to a 66% response rate. Thirty-four (87%) of the 39 respondents reported they currently practised non-biopsy diagnosis of CD in eligible children, while the rest diagnosed CD using biopsy confirmation only. All NZ respondents practised non-biopsy CD diagnosis. A majority of responders (76%) who practised non-biopsy CD diagnosis followed the 2020 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines. Twenty-two (56%) respondents reported that they started using a non-biopsy CD diagnosis protocol before the pandemic and did not change their practice during the pandemic, 10 (26%) started diagnosing non-biopsy CD during the pandemic, 5 (13%) stated their practices of CD were not impacted by the pandemic and 2 (5%) did not respond on whether the pandemic changed their practice. Conclusion: The majority of Australasian gastroenterologist respondents reported they routinely utilised the 2020 ESPGHAN diagnostic criteria in eligible children; half of them started prior to the pandemic and another quarter started this approach due to the pandemic. A minority of practitioners routinely rely only on biopsy confirmation to diagnose CD.

OBJECTIVE:Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE. Our study aim was to determine the efficacy of MD for organic EFBI in the pediatric population especially in children with EoE.METHODS:A retrospective chart review was performed using the International Classification of Diseases codes and the emergency department database of patients presenting with EFBI from January 2010 to December 2014. Response to MD was defined as symptomatic relief of obstruction. Age, object ingested, medical agent used, EoE status, complications, and outcome were recorded.RESULTS:A total of 317 presentations of EFBI were identified during the study period, of which organic EFBI accounted for 101 impactions (31.9%). Medical disimpaction was attempted for 42 (41.6%) with organic EFBI, resulting in resolution of symptoms for 16 (38.1%). One child with EoE responded to MD compared with 15 without EoE (4.8% vs 71.4%, P < 0.0001).CONCLUSIONS:Medical disimpaction was ineffective in children with EoE but may be of help with symptom resolution in approximately 70% of children without EoE.

Purpose: Inspissated bile syndrome (IBS) is a rare cause of obstructive jaundice in neonates and infants with several treatment options reported. We present our experience with the use of minimally invasive ultrasound-guided percutaneous cholecystostomy drain catheter placement with ongoing saline lavage in neonates and infants.Methods: Retrospective chart review of patients treated with percutaneous cholecystostomy, from February 2010 till June 2015. We reviewed the technical and clinical success along with complications of the procedure.Results: There were 6 patients, mean age 17 weeks (range 4-40). Most had significant risk factors for IBS presenting with biliary obstruction. A total of 7 procedures performed on the 6 patients, with a technical success rate of 6/7. One patient required cannulation of the intrahepatic biliary system. Drains were flushed for a median of 26 days (10-70). Clinical success was achieved in all patients. 3 had displacement of the drain, one of which required re-insertion. Another developed a small sub-hepatic collection post procedure with pyrexia. On long term follow up one was found to have a forme fruste choledochal cyst.Conclusion: Centers with suitable interventional radiology services ultrasound-guided percutaneous cholecystostomy drain catheter placement with ongoing saline lavage is a safe and effective minimally invasive treatment for IBS in neonates and infants. (C) 2016 Elsevier Inc. All rights reserved.