Importance:Infliximab and adalimumab are the only biologics approved by the US Food and Drug Administration for use in children with inflammatory bowel disease (IBD). The comparative infection risks between infliximab and adalimumab have not been evaluated in clinical settings. Objective:To compare the risk of infections with infliximab vs adalimumab among pediatric patients with IBD using nationwide claims data. Design, Setting, and Participants:This cohort study used data from 2 nationwide health care claims databases from January 1, 2016, to February 28, 2025. The study included children and adolescents aged 6 to 17 years with a diagnosis of Crohn disease or ulcerative colitis who newly initiated infliximab or adalimumab and had 180 days or more of prior continuous enrollment. Exposures:Initiation of adalimumab vs infliximab. Main Outcomes and Measures:Serious infections were defined as infections requiring hospitalization, using a validated algorithm. Outpatient infections were defined as an outpatient infection diagnosis with a targeted antimicrobial dispensed within 1 day. Baseline covariates within each dataset were balanced with 1:1 propensity score matching and results were pooled using fixed effects meta-analysis. Incidence rates and hazard ratios (HRs) were estimated over a 180-day follow-up. Results:After applying exclusion criteria, 4239 children with IBD initiating infliximab (2467; mean [SD] age, 13.3 [2.9] years; 1462 boys [59.3%]; 1502 with Crohn disease [60.9%]) or adalimumab (1772; mean [SD] age, 14.0 [2.7] years; 1047 boys [59.1%]; 1068 with Crohn disease [60.3%]) were identified. After matching, each exposure group included 1533 patients. The incidence of serious infections was 29 per 1000 person-years for infliximab (reference) and 34 per 1000 person-years for adalimumab (pooled HR, 1.15; 95% CI, 0.63-2.11). Outpatient infections were more common, with rates of 358 per 1000 person-years for infliximab and 386 per 1000 person-years for adalimumab (pooled HR, 1.08; 95% CI, 0.90-1.29). Results of sensitivity analyses, including restriction to monotherapy, originator-only use, first-line users only, exclusion of gastrointestinal infections from the outcome, and extending follow-up to 365 days, were all consistent with the primary findings. No mycobacterial infections were observed in the overall cohort. Conclusions and Relevance:In this cohort study of children and adolescents with IBD, serious infections were rare. No evidence of differences in infection risk were observed between infliximab and adalimumab. These findings suggest that the 2 agents may have comparable infection risk profiles in pediatric IBD, although meaningful differences cannot be ruled out.

Disease course following hospitalization for severe ulcerative colitis (UC) is poorly understood. Here, we evaluate the outcomes of hospitalized patients with severe UC defined using endoscopic activity across the Mass General Brigham (MGB) health system over a 24-year period. We developed and internally validated a natural language processing (NLP) algorithm to derive endoscopic disease severity. We included all hospitalized patients with UC across MGB from 1997 to 2021 and used the NLP algorithm to identify those with severe disease activity, defined using the Mayo Endoscopic Score. We used Cox proportional hazards modeling to estimate the risk of 90-day colectomy and rehospitalization across three calendar periods (1997–2005, 2006–2015, and 2016–2021) for patients hospitalized with severe UC. The NLP algorithm had excellent performance for identifying endoscopic features, with high Cohen’s Kappa scores between the algorithm’s prediction and the reviewers’ consensus for derived Mayo endoscopic score (k = 0.92). We identified 279 independent hospitalizations for severe UC using our NLP algorithm and manual validation methods from 1997 to 2021. The 90-day cumulative incidence of colectomy were 17.9

INTRODUCTION:Opioid-induced esophageal dysfunction has been described with characteristic manometric patterns, but the population burden of dysphagia attributable to opioid use remains unclear. METHODS:The National Ambulatory Medical Care Survey from 2008 to 2018 was used to assess the relationship between opioid use and outpatient visits for dysphagia. RESULTS:After controlling for potential confounders, there were no significant difference in ambulatory visits for dysphagia between opioid users and nonusers (adjusted odds ratio = 0.98, confidence interval: 0.59-1.65). DISCUSSION:No correlation between opioid use and ambulatory visits for dysphagia was found in a nationwide sample. Opioid-related manometric changes may be clinically relevant only in a small proportion of patients.

Among All of Us participants, the prevalence of inflammatory bowel disease is similar to past estimates (around 1%) and is highest among White, non-Hispanic, college-educated participants. Medication treatment patterns differ significantly based on ethnicity, education, and income status.

In this retrospective case series, six eyes in six patients with dialysis-associated retinal detachments were successfully repaired with one pneumatic retinopexy procedure. Pneumatic retinopexy can be considered a viable treatment option in appropriately selected cases.

Microscopic colitis is a chronic inflammatory disease that most commonly affects post-menopausal women. Exogenous hormone use has recently been linked with increased risk of microscopic colitis. Yet, it is unclear whether levels of endogenous sex hormones are also associated with risk of microscopic colitis. To evaluate the association between prediagnostic plasma androgens and subsequent risk of microscopic colitis. We conducted a case–control study nested within prospective cohort studies of the Nurses' Health Study (NHS) and NHSII. Cases of microscopic colitis were each matched to two controls according to age, cohort, menopause status, fasting status, and season of plasma collection. Prediagnosis plasma levels of androgens including dehydroepiandrosterone sulfate, testosterone, and sex hormone-binding globulin were measured. We examined the association of each analyte with risk of microscopic colitis using conditional logistic regression models. Our study included 96 cases of microscopic colitis matched to 190 controls. Plasma levels of testosterone were not associated with risk of microscopic colitis (Ptrend = 0.70). Compared to participants in the lowest quartile of plasma testosterone levels, the aOR of microscopic colitis for women in the highest quartile was 0.88, 95

A 2-year-old patient with chronic abdominal pain presented with acutely worsening abdominal pain and acute anemia. The patient had no stigmata of bleeding including no hematemesis, melena or hematochezia, but had falling hemoglobin and hematocrit over the course of 24 hours. Abdominal ultrasound and computerized tomography showed a large cystic, fluid filled mass in the right midabdomen. The patient was taken to the operating room and a blood-filled mass arising from the ileum was identified and resected by the surgical team. Pathology was consistent with Meckel’s diverticulum with heterotopic gastric mucosa. This is an atypical presentation of Meckel’s diverticulum with bleeding contained within the diverticulum rather than bleeding in the intestinal lumen. Gastroenterologists must consider this unusual presentation when encountering progressive, acute anemia even in the absence of overt gastrointestinal blood loss.

Acta PaediatricaEarly View BRIEF REPORT Evaluating the adherence to national guidelines for treatment of gastroesophageal reflux in infants Michaela S. Tracy, Michaela S. Tracy orcid.org/0000-0001-9162-7869 Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USASearch for more papers by this authorDaniel R. Duncan, Daniel R. Duncan Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USASearch for more papers by this authorRachel L. Rosen, Corresponding Author Rachel L. Rosen rachel.rosen@childrens.harvard.edu orcid.org/0000-0003-3949-3060 Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA Correspondence Rachel L. Rosen, Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Email: rachel.rosen@childrens.harvard.eduSearch for more papers by this author Michaela S. Tracy, Michaela S. Tracy orcid.org/0000-0001-9162-7869 Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USASearch for more papers by this authorDaniel R. Duncan, Daniel R. Duncan Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USASearch for more papers by this authorRachel L. Rosen, Corresponding Author Rachel L. Rosen rachel.rosen@childrens.harvard.edu orcid.org/0000-0003-3949-3060 Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, USA Correspondence Rachel L. Rosen, Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Email: rachel.rosen@childrens.harvard.eduSearch for more papers by this author First published: 07 October 2021 https://doi.org/10.1111/apa.16142 Funding information: This work was supported by NIH R01 DK097112, NIH K23 DK127251, and NIH T32 DK007477-33. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Protein-losing enteropathy (PLE) in the setting of severe iron deficiency anemia (IDA) and excessive cow milk intake is an uncommonly recognized phenomenon. Here, we describe a series of 7 toddlers who presented for evaluation of edema in the setting of excessive cow milk intake between November 2016 and January 2019. Laboratory studies in each patient were consistent with IDA and hypoalbuminemia with evidence of PLE. Diagnostic evaluation and treatment of each patient differed, although all were instructed to restrict cow milk and provided with oral iron supplementation. The edema had resolved, and the IDA had improved in all 7 patients by the time of their follow-up outpatient appointments. Iron deficiency and PLE should be considered in patients who present with anasarca.

BACKGROUND AND OBJECTIVE: Efforts to advance patient safety have been hampered by the lack of high quality measures of adverse events (AEs). This study's objective was to develop and test the Global Assessment of Pediatric Patient Safety (GAPPS) trigger tool, which measures hospital-wide rates of AEs and preventable AEs. METHODS: Through a literature review and expert panel process, we developed a draft trigger tool. Tool performance was tested in 16 academic and community hospitals across the United States. At each site, a primary reviewer (nurse) reviewed ∼240 randomly selected medical records; 10% of records underwent an additional primary review. Suspected AEs were subsequently evaluated by 2 secondary reviewers (physicians). Ten percent of records were also reviewed by external expert reviewers. Each trigger's incidence and positivity rates were assessed to refine GAPPS. RESULTS: In total, 3814 medical records were reviewed. Primary reviewers agreed 92% of the time on presence or absence of a suspected AE (κ = 0.69). Secondary reviewers verifying AE presence or absence agreed 92% of the time (κ = 0.81). Using expert reviews as a standard for comparison, hospital-based primary reviewers had a sensitivity and specificity of 40% and 91%, respectively. As primary reviewers gained experience, their agreement with expert reviewers improved significantly. After removing low-yield triggers, 27 and 30 (of 54) triggers met inclusion criteria to form final manual and automated trigger lists, respectively. CONCLUSIONS: GAPPS reliably identifies AEs and can be used to guide and monitor quality improvement efforts. Ongoing refinement may facilitate future interhospital comparisons.

BACKGROUND AND OBJECTIVES: Hospital readmission rates are increasingly used to assess quality. Little is known, however, about potential preventability of readmissions among children. Our objective was to evaluate potential preventability of 30-day readmissions using medical record review and interviews. METHODS: A cross-sectional study in 305 children (<18 years old) readmitted within 30 days to a freestanding children’s hospital between December 2012 and February 2013. Interviews (N = 1459) were conducted with parents/guardians, patients (if ≥13 years old), inpatient clinicians, and primary care providers. Reviewers evaluated medical records, interview summaries, and transcripts, and then rated potential preventability. Multivariate regression analysis was used to identify factors associated with potentially preventable readmission. Adjusted event curves were generated to model days to readmission. RESULTS: Of readmissions, 29.5% were potentially preventable. Potentially preventable readmissions occurred sooner after discharge than non–potentially preventable readmissions (5 vs 9 median days; P < .001). The odds of a readmission being potentially preventable were greatest when the index admission and readmission were causally related (adjusted odds ratio [AOR]: 2.6; 95% confidence interval [CI]: 1.0–6.8) and when hospital (AOR: 16.3; 95% CI: 5.9–44.8) or patient (AOR: 7.1; 95% CI: 2.5–20.5) factors were identified. Interviews provided new information about the readmission in 31.2% of cases. CONCLUSIONS: Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. Hospital and patient factors are associated with potential preventability and may provide targets for quality improvement efforts. Interviews contribute important information and should be considered when evaluating readmissions.

Study describes emotion processing in EMS providers at Georgetown and predictors of burnout satisfaction and compassion.