IntroductionVideo capsule endoscopy (VCE) enables direct, radiation-free visualization of the small bowel mucosa and is endorsed by pediatric guidelines as a key tool in the evaluation of Crohn's disease (CD). Despite this, VCE remains underused in routine pediatric practice, and its real-world clinical impact is insufficiently characterized. We aimed to assess the diagnostic yield, safety, and management consequences of pediatric VCE in a tertiary center and to compare its findings with cross-sectional imaging and biomarkers.MethodsWe conducted a retrospective, single-center study of VCE procedures in children younger than 18 years performed between 2018 and 2024. Demographic, clinical, imaging, and laboratory data were reviewed to characterize indications, safety, and clinical yield.ResultsSeventy-six VCE examinations were performed in 60 children (mean age 14.8 years; 41% female). Endoscopic placement was required in 19 patients (25%). Dissolvable patency capsule testing to evaluate non-retention of the real VCE was performed in 22/80 (27.5%) planned VCEs, with four failures that abrogated further application of VCE. The main indication for VCE was suspected or established CD (57 VCEs in 45 children); other indications included polyposis syndromes, eosinophilic gastrointestinal disease, iron deficiency anemia, and gastrointestinal bleeding. In the CD subgroup, VCE supported a new diagnosis in 13 of 28 cases (46%) and prompted disease reclassification in 12 of 29 cases (41%). Small bowel inflammation was noted in 35 of 42 VCEs (83%) in new or known patients with CD [Lewis score (LS) > 135], with a median LS of 563. VCE findings led to the initiation or escalation of CD treatment in 22 of 42 patients (52%). One capsule retention occurred, revealing a previously unsuspected severe stricturing (B2) phenotype and leading to a planned, nonurgent intestinal resection. Among the 46 children who underwent both VCE and cross-sectional imaging, concordance between VCE and MRE/IUS was modest (κ = 0.07, 95% CI −0.19 to 0.34), underscoring the complementary value of VCE.ConclusionVCE is a safe and well-tolerated modality for evaluating pediatric small bowel disease, particularly CD, and frequently reveals clinically relevant inflammation missed by conventional imaging. These findings support its broader integration into pediatric practice.

OBJECTIVE:Ghrelin is an orexigenic hormone that regulates growth hormone release, appetite, energy balance, and fat utilization. We aimed to evaluate the number of ghrelin-positive cells in the gastric fundus among children referred for upper gastrointestinal endoscopy (UGE) with various indications. METHODS:Retrospective study of pediatric patients referred for UGE during 2015-2017. The number of ghrelin-positive cells in the gastric fundus was calculated using immunohistochemical staining with a specific antighrelin antibody) and compared between patients with and without Helicobacter pylori (H. pylori)-induced gastritis. RESULTS:A total of 53 children (H. pylori gastritis [n = 18] and without H. pylori gastritis (celiac disease [CeD] (n = 15), faltering growth [n = 6], and controls [n = 14])) were included. The mean number per mm2 of gastric ghrelin-positive cells was lower for the H. pylori gastritis group (49.8 ± 29.7), than for non-H. pylori group (CeD [91.2 ± 26.2], faltering growth [83 ± 43.0], and control [91.9 ± 40.2]), p = 0.001. Severe acute gastric antral inflammation (grade 2-3 in the Sydney system) presented in 7 (39%) of the H. pylori gastritis group and 1 (2.9%) in non-H. pylori group, p = 0.001. Severe chronic gastric antral inflammation (grade 2-3 in the Sydney system) presented in 7 (39%) of the H. pylori gastritis group compared to 3 (8.6%) in non-H. pylori group, p = 0.02. A negative correlation was observed between ghrelin-positive cell count and acute antral inflammation severity (r = -0.4, p = 0.004). CONCLUSIONS:Among pediatric patients with H. pylori gastritis, compared to patients without H. pylori, the mean number of ghrelin-stained positive cells in the gastric fundus was lower, and higher proportions had more severe acute and chronic inflammations.

BACKGROUND AND AIMS:The development of antibodies to infliximab (ATI) is a major challenge in pediatric inflammatory bowel disease (IBD). This real-world study aimed to identify predictors of ATI, evaluate strategies to overcome ATI, and compare the durability of continuing infliximab (IFX) versus switching to adalimumab (ADA) after ATI development. METHODS:We retrospectively analyzed 194 pediatric IBD patients treated with IFX from 2010 to 2024. ATI titers were measured uniformly before each infusion. Demographic data, disease characteristics, ATI titers, infusion reactions, management strategies, and treatment durability were collected and analyzed. RESULTS:ATI developed in 52 of 194 patients (26.8 %), more frequently in Crohn's disease (31.2 %) than ulcerative colitis (16.1 %, p < 0.01), and was associated with female gender (57.7 % vs. 39.4 %, p = 0.03) and younger age at diagnosis. High-titer ATI (≥8 mcg/ml-eq) correlated with infusion reactions (56.5 % vs. 3.5 %, p < 0.001). ATI was managed with dose/interval adjustment (61.9 %), immunomodulator addition (16.7 %), or both (21.4 %). IFX continuation was successful in 71.4 %, especially in low-titer ATI (92.0 % vs. 41.2 %, p < 0.001). IFX durability after ATI was significantly longer (median 94 months) than ADA after switching (47 months, p < 0.01). CONCLUSIONS:About 27 % of pediatric IBD patients developed ATI to IFX. Personalized management can restore IFX efficacy and provides superior long-term outcomes compared to switching to ADA.

Purpose: Rett syndrome is a rare neurodevelopmental disorder associated with methyl CpG binding protein 2 (MECP2) gene mutations. We aimed to characterize the long-term nutritional and gastrointestinal course of Rett syndrome in a large national patient population. Methods: We conducted a retrospective cohort study of patients followed during 1991–2021 at a national center for Rett syndrome. The data retrieved included clinical features, laboratory and genetic analyses. Continuous anthropometric measurements were calculated for the closest visit to the median ages: 2.5, 7.5, 12.5 and 17.5 years. Kaplan Meier curves were used to describe the appearance of clinical manifestations during the follow up period. Generalized estimating equation models were used to compare repeated measurements. Results: Included were 141 patients (139 females), the median age at the first visit was 3.2 years (interquartile range [IQR] 2.3–5.7), and the median length of follow-up was 94.5 months (IQR 28.6–153.3). Mean weight, height and BMI Z-scores were -1.09, -1.03 and -0.56, respectively, at median age 2.5 years; and deteriorated to -3.95, -3.01 and -1.19, respectively, at median age 17.5 years (P < 0.001). Gastrointestinal features included constipation (47.5

BACKGROUND:Several studies have proposed models to predict disease outcomes in paediatric ulcerative colitis (UC), notably PROTECT, Schechter and PIBD-ahead, but none has been validated by external cohorts AIM: To explore these models in a prospective multicentre inception cohort METHODS: Children newly diagnosed with UC in 17 centres were followed at disease onset and 3 and 12 months thereafter, as well as at last visit. Outcomes included steroid-free remission (SFR) and acute severe colitis (ASC).RESULTS:Of the 223 included children, 74 (34%), 97 (43%) and 52 (23%) presented with mild, moderate and severe disease, respectively. SFR rate was 35% at 3 months and 47% at 12 months (62% of those with mild disease at diagnosis vs. 41% in moderate-severe disease; p = 0.01). Thirty-six (16%) children developed ASC during the first month after diagnosis, and 53 (24%) during the first year. The AUC of the PROTECT model for predicting SFR at 3 and 12 months was 0.78 [95% CI 0.65-0.92] and 0.57 [95% CI 0.47-0.66], respectively. The sensitivity/specificity/PPV/NPV of Schechter's criteria to predict sustained SFR at 12 months was 50%/60%/35%/74%. ASC was predicted only by the PUCAI score at diagnosis and at 3 months.CONCLUSIONS:The PROTECT model had a good predictive utility for SFR at 3 months, but not at 12 months. The other predictive models did not achieve sufficient accuracy, which was far from that reported in the original studies. This highlights the necessity for external validation of any prediction model prior to its implementation into clinical practice.

Umbilical venous catheters are commonly inserted in critically ill newborns and can lead to severe complications when misplaced. We report a preterm female with a prenatal diagnosis of duodenal atresia who presented 2 days after the surgical repair with abdominal distension, hemodynamic instability, elevated liver enzymes with severe cholestatic jaundice, and a hepatic collection on abdominal sonography. An urgent explorative laparotomy demonstrated a large amount of white, milky-appearing fluid in the abdominal cavity. Together with the sonographic findings, this led to the diagnosis of hepatic total parenteral nutrition extravasation. Upon removal of the umbilical venous catheter line, the infant's clinical state rapidly improved; however, cholestasis continued for months, with a very slow resolution. During follow-up, the liver enzymes normalized, and a complete resolution of the liver collection was observed, without drainage.

Supplemental Digital Content is available in the text ABSTRACT Objectives: Adult studies suggest that patients with isolated colonic Crohn disease (L2 CD) exhibit unique characteristics differentiating them from patients with ileo-caecal (L1) CD and ulcerative colitis (UC). We aimed to characterize clinical features and outcomes of paediatric patients with L2. Methods: Retrospective data was collected through the Porto Inflammatory Bowel Disease group of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on Paediatric patients with L2, L1 or UC at different time-points. Outcome measures included time to first flare, hospital admissions, initiation of anti-tumor necrosis factor-alpha (TNFα) drug, stricture and surgery. Results: Three hundred patients were included: 102 L1, 94 L2 and 104 UC. Rates of hematochezia at presentation were 14.7%, 44.7% and 95.2%, while rates of fever were 12.7%, 26.6% and 2.9%, for patients with L1, L2 and UC, respectively (P < 0.001 for all comparisons). Skip lesions were identified in 65% of patients with L2, and granulomas in 36%, similar to L1 patients. Rates of anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear antineutrophil cytoplasmic (pANCA) positivity significantly differed between the three groups: 25.4% and 16.7% for patients with L2, compared with 55.2% and 2.3%, and 1.8% and 52.9% for patients with L1 and UC, respectively. Response rates to exclusive enteral nutrition were comparable between L1 and L2 (78.3–82.4%), as was the response to oral steroids (70.4–76.5%) in the three groups. While times to first flare and admission were similar between groups, patients with L1 were commenced on anti-TNFα earlier. Moreover, stricturing phenotype and need for colectomy were very rare in patients with L2. Conclusions: Significant differences are observed in the clinical presentation and outcomes of Paediatric patients with L2, compared to patients with L1 and UC.

BACKGROUND:The number of investigative esophagogastroduodenoscopies (EGD) in children has increased over several decades, despite their unclear diagnostic yields.OBJECTIVES:To evaluate the indications for performing EGD, their diagnostic yields, and consequences on pediatric patient management.METHODS:A retrospective chart review was performed of consecutive pediatric patients aged 0-18 years, who underwent EGD between January and August 2014.RESULTS:During the study period, 547 EGD were performed on 478 children. The most frequent indications were suspected celiac disease, chronic non-specific abdominal pain, persistent Helicobacter pylori infection, and gastrointestinal hemorrhage. The yield of the diagnostic EGD was 59.2%, and the most common new diagnoses were celiac disease (28%), Helicobacter pylori-positive gastritis (16.5%), and Crohn's disease (5.4%). Of the patients with documented follow-up, 74.1% reported improved symptoms. Procedures performed for chronic unexplained abdominal pain had significantly lower yields (26.2%) and only 39.3% improved at follow-up.CONCLUSIONS:Our findings suggest a general high diagnostic yield for EGD in pediatric patients, stemming mainly from patients in whom a specific condition was suspected a priori. However, the role of the procedure in the diagnosis and management of non-specific gastrointestinal complaints was minor suggesting that EGD may be superfluous for some of these patients.

BACKGROUND:Adequate dietary habits and physical activity during childhood and adolescence may promote growth and cognitive development and contribute to the prevention of chronic disease in later life. School is considered an important social environment that can promote healthy eating habits and life-style changes.OBJECTIVES:To evaluate the effects of a school-based intervention on nutritional knowledge, eating habits, and physical activity of adolescents.METHODS:We conducted a prospective questionnaire-based study. Anonymous questionnaires were administered at the beginning of the academic year (September 2014) in one high school. During the following year, vending machines containing milk products were installed within the school facility, and students were given two informative nutrition lectures regarding proper nutrition for age, calcium requirement and importance, and physical activity. One active sports day was initiated. At the beginning of the following academic year (September 2015), the students completed the same questionnaires.RESULTS:The study was comprised of 330 teenagers, mean age 15.1 ± 1.39 years, 53% males. Response rate was 83.6% ± 0.4% to multiple choice questions, 60.7% ± 0.5% to multiple section tables, and 80.3% ± 0.9% to open questions. Post-intervention, respondents reported an increase in eating breakfast (57% vs. 47.5%, P = 0.02) and a decrease in purchasing food at school (61.6% vs. 54.3%, P = 0.03). No changes were observed in consumption of milk products, knowledge regarding calcium and vegetable consumption, or sports activities.CONCLUSIONS:Short-term high school-based interventions may lead to improvements in eating habits but are not sufficient for changing nutritional knowledge and physical activity.