The advent of ERCP began with diagnostic visualization of the pancreaticobiliary ducts in the 1970s.1 This innovation rapidly evolved to therapeutic utility that has progressively supplanted more invasive surgical interventions for a variety of biliary and pancreatic conditions, most notably choledocholithiasis and acquired strictures.2 The adoption of ERCP in pediatric medicine has mirrored that of other medical advances where utility and safety were first demonstrated in adult patients.

Type III sphincter of Oddi dysfunction (SOD) is classified as biliary pain without the presence of abnormal liver function or common bile duct dilatation. It is a difficult diagnosis to make due to lack of objective diagnostic criteria and due to the symptomatic overlap of biliary pain that is also found in gallbladder dyskinesia. While cholecystectomy is the treatment for patients with gallbladder dyskinesia, it can exacerbate biliary colic in patients with SOD type III, further complicating the ability to select the appropriate therapeutic modality for these patients.

Objectives: Measurement of gastrointestinal (GI) permeability is commonly used in research and often used clinically. Despite its utility, little is known about sugar excretion timeframes or the potential effects of age and sex on GI permeability testing. We seek to determine the timeframes of sugar excretion and the potential effects of age and sex on urinary recovery of the sugars.Subjects and Methods: Healthy adults (n = 17) and children (n = 15) fasted 4 hours after the evening meal and then ingested a solution of sucrose, lactulose, mannitol, and sucralose. Urine was collected at 30, 60, and 90 minutes after ingestion and then each time the subjects voided during the next 24 hours. Each urine void was collected separately.Results: Median age for the adults was 47.5 years (range 21-57 years) and for children 10 years (range 5-17 years). There were no differences between children and adults in mean percent dose of sugar recovered. The time of peak urinary recovery of the sugars was generally similar between children and adults. Sucrose urinary recovery declined with age (P = 0.008; r(2) = 0.19) unrelated to sex. Lactulose and sucralose urinary recovery declined with age in females (P = 0.05, r(2) = 0.24 and P = 0.011, r(2) = 0.41; respectively) but not in males.Conclusions: Overall, sugar urinary recovery is comparable in children and adults. Specific sugar urinary recovery may change as a function of age and/or sex. These results need to be taken into account when planning and interpreting gastrointestinal permeability studies.

breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence.Methods: Eighty (80) consecutive patients affected by SIBO and decontaminated by rifaximin (1200 mg per day for 1 week) were enrolled.Diagnosis of SIBO was based on GBT.GBT was reassessed at 3, 6, and 9 months after decontamination.GBT positivity recurrence, predisposing conditions and gastrointestinal symptoms were evaluated.Results: Ten (10/ 80, 12.6%), 22 (22/80, 27.5%) and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6 and 9 months after successful antibiotic decontamination, respectively.At multivariate analysis, older age (OR 1.09, 95% CI 1.02-1.16),history of appendectomy (OR 5.9, 95% CI 1. 45-24.19) and chronic use of proton pump inhibitors (OR 3.52, 95% CI 1.07-11.64)were significantly associated to GBT positivity recurrence.All gastrointestinal symptoms significantly increased at 3, 6 and 9 months in patients with evidence of GBT positivity recurrence.Conclusions: GBT positivity recurrence rate was high after antibiotic decontamination.Older age, history of appendectomy and chronic use of proton pump inhibitors were associated with GBT positivity recurrence.Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.Cyclic courses of non-absorbable antibiotics could be necessary in order to prevent SIBO recurrence.

Purpose of review Recurrent abdominal pain continues to be one of the most ubiquitous conditions faced by the healthcare team, and has a significant emotional and economic impact. We have moved from considering it a psychological condition to recognizing the physiological and environmental contributions, and considering the condition in the framework of a biopsychosocial model where biology, psychology and social environment interact. Here, we review current studies addressing etiologies, diagnostic techniques and treatment options for recurrent abdominal pain in children.Recent findings Studies continue to highlight the role of visceral hypersensitivity in recurrent abdominal pain. The psychological state of the child and the parent (most often the mother) in terms of their anxiety, somatization and coping skills can, however, modulate the expression of symptoms. Diagnosis still is made by history and physical examination. Newer treatment options include relaxation and distraction therapies as well as medications. The role of probiotics in children remains to be defined.Summary The approach to the child with recurrent abdominal pain must include the recognition of the physiological contributions, and this information must be relayed to the child and parents. Acknowledgement also must be paid to the role of psychological state in the parent as well as in the child in modulating the severity of symptoms.