|
1
|
Barnett D, Thijs C, Mommers M, Endika M, Klostermann C, Schols H, Smidt H, Nauta A, Arts I, Penders J. Why do babies cry? Exploring the role of the gut microbiota in infantile colic, constipation, and cramps in the KOALA birth cohort study. Gut Microbes 2025; 17:2485326. [PMID: 40159147 PMCID: PMC11959906 DOI: 10.1080/19490976.2025.2485326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 02/17/2025] [Accepted: 03/18/2025] [Indexed: 04/02/2025] Open
Abstract
Gastrointestinal symptoms are common during infancy, including infantile colic. Colic can be loosely defined as prolonged and recurrent crying without obvious cause. The cause indeed remains unclear despite much research. Results on infant nutrition are inconclusive, but prior work has linked maternal mental health to infant crying. Recently, several small studies have described associations between gut microbiota and colic. We used a larger cohort to examine the role of the microbiota in infant gastrointestinal health, while also accounting for other biopsychosocial factors. Using fecal 16S rRNA gene amplicon sequencing data from 1,012 infants in the KOALA birth cohort, we examined associations between the 1-month gut microbiota and parent-reported functional gastrointestinal symptoms throughout infancy, including colic, constipation, and cramps. These analyses were adjusted for biopsychosocial factors that were associated with symptoms in a broader analysis involving 2,665 participants. In 257 infants, we also explored associations between breastmilk human milk oligosaccharides (HMOs) and gastrointestinal symptoms. Higher relative abundance of Staphylococcus at one month was associated with less constipation in the first three months of life. Conversely, Ruminococcus gnavus group abundance was associated with more colicky symptoms, particularly between four and seven months. Breastmilk concentrations of the HMOs lacto-N-hexaose (LNH) and lacto-N-neohexaose (LNnH) were associated with less constipation in the first three months. Our results support the conclusion that gut microbiota are relevant in infantile colic and constipation. However more work is needed to elucidate the underlying mechanisms, and explore their interplay with other relevant biopsychosocial factors such as maternal mental health.
Collapse
Affiliation(s)
- David Barnett
- Maastricht Centre for Systems Biology, Maastricht University, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Carel Thijs
- CAPHRI Care and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Monique Mommers
- CAPHRI Care and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Martha Endika
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, Netherlands
| | - Cynthia Klostermann
- Department of Food Chemistry, Wageningen University & Research, Wageningen, Netherlands
| | - Henk Schols
- Department of Food Chemistry, Wageningen University & Research, Wageningen, Netherlands
| | - Hauke Smidt
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, Netherlands
| | - Arjen Nauta
- FrieslandCampina Ingredients, FrieslandCampina, Amersfoort, Netherlands
| | - Ilja Arts
- Maastricht Centre for Systems Biology, Maastricht University, Maastricht, Netherlands
| | - John Penders
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, Netherlands
| |
Collapse
|
|
2
|
Acharyya BC, Das P, Mukhopadhyay M. Validating a novel scoring system for the assessment and treatment of functional gastrointestinal disorders in children. World J Clin Pediatr 2025; 14:101476. [DOI: 10.5409/wjcp.v14.i3.101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 02/13/2025] [Accepted: 03/25/2025] [Indexed: 06/16/2025] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs), defined as ‘Disorders of Gut-Brain Interaction’, are now considered a global health problem. There is a dearth of concepts and scales to assess the severity of the different symptoms encountered while dealing with the variety of FGIDs as described in the ROME IV classification. We introduced a novel scoring system with the incorporation of 16 different symptoms called Bacharyya’s Questionnaire Scale and started using it while dealing with children suffering from FGIDs.
AIM To verify the usefulness and applicability of this recently developed scale, this study was undertaken with the objectives to establish the validity of this scoring system in assessing the severity of symptoms associated with a specific FGID in children and to determine the scoring system's applicability in assessing the treatment response.
METHODS The study included children aged 5 to 18 years diagnosed with any FGID based on ROME IV criteria. They completed the newly developed scale and a Visual Analog Scale at initial diagnosis and after a 2-month treatment period. A control group without FGID participated for comparative baseline purposes. Treatment response was defined as a less than or equal to 50% reduction in the total score, which is statistically significant.
RESULTS Results from a comprehensive cohort of 190 cases and 90 controls indicated a female preponderance (57.9%) and prevalent disorders such as functional constipation (28%) and functional abdominal pain, not otherwise specified (21%). The grade of FGID (mild, moderate, severe) experienced by the patients was also derived. Post-treatment, 96 children demonstrated symptom improvement. The Spearman rank correlation coefficient for pre (r = 0.72, 95%CI: 0.65-0.77, P value < 0.0001) and post (r = 0.49, 95%CI: 0.3-0.64, P value < 0.0001) treatment data showed positive results with significant P values.
CONCLUSION The novel scoring system shows high comprehensibility and gives an objective view of the symptomatology of FGIDs. The use of this novel score in clinical settings will be helpful to typify the FGIDs and may significantly improve decision-making processes to initiate appropriate treatment.
Collapse
Affiliation(s)
- Bhaswati Chakrabarti Acharyya
- Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India
- Department of Pediatric Gastroenterology and Hepatology, Manipal Hospital, Kolkata 700099, West Bengal, India
| | - Pritha Das
- Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India
| | - Meghdeep Mukhopadhyay
- Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India
| |
Collapse
|
|
3
|
Chatpermporn K, Chongpison Y, Ngoenmak T, Treepongkaruna S, Sintusek P. Validity and reliability of the Thai “Rome IV diagnostic questionnaires” for functional gastrointestinal disorders in neonates and toddlers. World J Clin Cases 2025; 13:105022. [DOI: 10.12998/wjcc.v13.i23.105022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 04/04/2025] [Accepted: 04/25/2025] [Indexed: 06/04/2025] Open
Abstract
BACKGROUND The Rome Foundation’s questionnaires, including the latest version, Rome IV diagnostic criteria since 2016, are widely used globally for diagnosing functional gastrointestinal disorders (FGIDs). However, a tailored Thai version for diagnosing FGIDs in neonates and toddlers is yet to be developed.
AIM To develop and validate the Thai version of the Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers.
METHODS This study was conducted at a tertiary hospital in Bangkok. The Rome IV diagnostic questionnaire for neonates and toddlers was translated into Thai following Rome Foundation guidelines. Validity was assessed using item-objective congruence. The final version was administered to 65 caregivers of children under 4 years. Reliability was evaluated using Cronbach’s alpha and intraclass correlation coefficient based on test-retest responses collected over a 4-15 day interval.
RESULTS A total of 58 complete questionnaires were returned. The median interval between the first and second time was 7 days (range: 4 days to 15 days). The item-objective congruence index for the Thai-adapted Rome IV diagnostic questionnaire was 0.74. Internal consistency, as indicated by Cronbach’s alpha, was 0.753, 0.712, and 0.750 for the three respective sections. The intraclass correlation coefficients for test-retest reliability were 0.782, 0.782, and 0.807.
CONCLUSION The Thai Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers demonstrates acceptable validity and reliability, supporting its use in future clinical and research applications.
Collapse
Affiliation(s)
| | - Yuda Chongpison
- Research Affairs, Chulalongkorn University, Bangkok 10330, Thailand
| | - Thitima Ngoenmak
- Department of Pediatrics, Naresuan University Hospital, Naresuan University, Phitsanulok 65000, Thailand
| | - Suporn Treepongkaruna
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Palittiya Sintusek
- Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
|
4
|
Claeyssens C, Witters P, Segers H, De Koster J, Levtchenko E, Vermeersch P. An unusual case of neuroblastoma presenting with prolonged watery diarrhea in a pediatric patient. Biochem Med (Zagreb) 2025; 35:020901. [PMID: 40520658 PMCID: PMC12161515 DOI: 10.11613/bm.2025.020901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 03/31/2025] [Indexed: 06/18/2025] Open
Abstract
Neuroblastomas represent a diverse group of neuroblastic tumors characterized by variability in their clinical progression and degree of differentiation. In rare cases, patients with neuroblastoma may present with paraneoplastic syndromes, such as watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome), linked to the secretion of vasoactive intestinal peptide (VIP). We report a case of a 14-month-old girl presented with a three-week history of watery diarrhea and signs of dehydration with no other symptoms. The patient's medical history was unremarkable, and no medication use was reported. Venous blood gas analysis revealed a normal anion gap metabolic acidosis with severe hypokalemia. The patient was referred to our hospital 48 hours post-admission due to persistent hypokalemic metabolic acidosis, unresponsive to intravenous fluid therapy. The primary causes of normal anion gap metabolic acidosis in young children are gastrointestinal bicarbonate loss due to diarrhea and renal bicarbonate loss. Semi-quantitative urine organic acid analysis, reported 48 hours after admission, revealed increased vanillylmandelic acid (VMA) (89 mmol/mol creatinine) and homovanillic acid (HVA) (21 mmol/mol creatinine), raising the suspicion of a neuroblastoma. Subsequent analysis of an acidified urine sample confirmed a more than threefold increase in VMA, HVA, normetanephrine, norepinephrine, and 3-methoxytyramine concentrations. In addition, VIP was markedly elevated (1994 ng/L) in a blood sample. The diagnosis of neuroblastoma was confirmed through imaging and histological examination. This case illustrates that chronic diarrhea with metabolic dysregulation (e.g. hypokalemia) can be the first and only symptom in patients with VIP-secreting neuroblastoma which can result in delayed diagnosis of neuroblastoma.
Collapse
Affiliation(s)
- Claire Claeyssens
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Peter Witters
- Clinical Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Heidi Segers
- Clinical Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jan De Koster
- Clinical Department of Pediatrics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Elena Levtchenko
- Clinical Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Belgium
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| |
Collapse
|
|
5
|
Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders. World J Clin Pediatr 2025; 14:103323. [PMID: 40491742 PMCID: PMC11947882 DOI: 10.5409/wjcp.v14.i2.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 12/14/2024] [Accepted: 01/02/2025] [Indexed: 03/18/2025] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health. AIM To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions. METHODS A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts. RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children's vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress. CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
Collapse
Affiliation(s)
- Mohammed Al-Beltagi
- Department of Paediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin K Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 26671, Bahrain
- Medical Microbiology Section, Department of Pathology, The Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel S Bediwy
- Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
| |
Collapse
|
|
6
|
Kildegaard H, Bliddal M, Ernst MT, Sander SD, Wesselhoeft R, Gingrich JA, Pottegård A, Margolis KG, Talati A. Prenatal exposure to selective serotonin reuptake inhibitors and risk of disorders of gut-brain interaction in children. Mol Psychiatry 2025; 30:2448-2456. [PMID: 39658704 DOI: 10.1038/s41380-024-02848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 12/12/2024]
Abstract
Preclinical data suggest that gestational exposure to selective serotonin reuptake inhibitors (SSRI) alter gut innervation, and delays colonic motility. In this study we investigated associations between gestational SSRI exposure and offspring disorders of gut-brain interaction (DGBI). Using population-based registries, we included all single-birth Danish children born 1997-2015 with follow-up until outcome occurrence, age 15 years, death, emigration, or December 2018. Children to mothers who continued SSRIs during pregnancy and children to mothers who discontinued SSRI use before pregnancy were compared using Cox regression. Main outcomes were the first diagnosis of a childhood DGBI (functional nausea and vomiting, functional abdominal pain disorders, functional diarrhea, and functional constipation), or a physician-prescribed laxative. Among 1,158,560 children, 21,969 children (1.9%) were exposed to SSRIs prenatally and 30,174 children (2.6%) were born to mothers who discontinued SSRIs before pregnancy. Overall, the estimated 15-year cumulative incidence of any DGBI was 15.5% (95% CI, 14.9-16.2) in the SSRI-exposed group and 14.7% (14.0-15.3) in the unexposed group. SSRI-exposed children had an overall increased risk of DGBIs (HR 1.08, [1.02-1.14]), which was driven by functional constipation (HR 1.19, [1.10-1.28]) rather than functional nausea and vomiting (HR 0.97, [0.83-1.13]) or functional abdominal pain disorders (HR 0.90, [0.81-1.00]). These data suggest that prenatal SSRI exposure is associated with an increased risk of developing functional constipation. These findings are also consistent with extensive preclinical data supporting key roles for serotonin in gut development and function. Together findings support the need for further investigation of the long-term impact of maternal depression and SSRI exposure on development of common gastrointestinal disorders.
Collapse
Affiliation(s)
- Helene Kildegaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mette Bliddal
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Stine D Sander
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Rikke Wesselhoeft
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Southern Denmark, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Jay A Gingrich
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kara G Margolis
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, USA
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Ardesheer Talati
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA.
| |
Collapse
|
|
7
|
Nordgaard M, Kjelsvik M, Husby VKS. The troublesome bowel: A qualitative study of intensive care nurses' experiences with constipation in critically ill children in a pediatric intensive care unit. J Pediatr Nurs 2025; 82:123-129. [PMID: 40068364 DOI: 10.1016/j.pedn.2025.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Revised: 02/18/2025] [Accepted: 03/03/2025] [Indexed: 05/13/2025]
Abstract
PURPOSE The purpose of this study was to explore nurses' experiences and perceptions of constipation in a pediatric intensive care unit (PICU) in Norway. DESIGN AND METHODS A qualitative approach using a reflexive thematic analysis was employed. Two focus group interviews were conducted using a semi-structured interview guide. RESULTS Three themes were identified: challenging individual assessment of bowel function, high responsibility and knowledge gaps in managing constipation for severely ill children, and challenges in maintaining dignity when a child requires assistance with bowel movements. CONCLUSION The study's most important findings were the uncertainty surrounding constipation treatment, the challenges nurses face with critically ill children that affect prevention and treatment, and the lack of timely treatment initiation. PRACTICE IMPLICATIONS Risk scoring and protocols for treating constipation in critically ill children should be established. Enhancing staff knowledge about constipation and the administration of various medications in the intensive care setting are essential.
Collapse
Affiliation(s)
- Marie Nordgaard
- Children's Clinic, Department of Intensive Care, Trondheim University Hospital, Postbox 3250, Torgarden 7006, Trondheim, Norway; Department of Health Sciences Ålesund, Norwegian University of Science and Technology, Postbox 1517, 6025 Ålesund, Norway
| | - Marianne Kjelsvik
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology, Postbox 1517, 6025 Ålesund, Norway
| | - Vigdis Kvitland Schnell Husby
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology, Postbox 1517, 6025 Ålesund, Norway; Clinic of Orthopaedy, Rheumatology and Dermatology, Department of Orthopaedic Surgery, Trondheim University Hospital, Postbox 3250, Torgarden 7006, Trondheim, Norway.
| |
Collapse
|
|
8
|
Cenni S, Colucci A, Salomone S, Pacella D, Casertano M, Buono P, Martinelli M, Miele E, Staiano A, Strisciuglio C. The prevalence of constipation in children with new diagnosis of inflammatory bowel disease: A retrospective study. J Pediatr Gastroenterol Nutr 2025; 80:799-806. [PMID: 39935294 DOI: 10.1002/jpn3.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/05/2024] [Accepted: 01/10/2025] [Indexed: 02/13/2025]
Abstract
OBJECTIVES Functional constipation (FC) is a common problem in childhood and the first-line therapy is macrogol. The role of FC in the onset of inflammatory bowel disease (IBD) is poorly understood. Our main aim was to investigate the prevalence of FC in children before the diagnosis of IBD. METHODS This is a cross-sectional observational study in pediatric IBD-patients. We collected data on demographics, clinical and endoscopic characteristics at IBD diagnosis, and on the presence of FC and its treatment before IBD diagnosis. RESULTS A total of 238 children with IBD, 104 (44%) with Crohn disease (CD), 130 (56%) with ulcerative colitis (UC) and 4 (0.016%) with IBD Unclassified (IBD-U) were enrolled. The mean age was 174 ± 47 months, 56% were male. Forty-seven out of 238 (19.7%) had a FC history before the IBD diagnosis and 31 out of these 47 patients (65%) received macrogol therapy. In the FC group, we found a delay in the diagnosis of IBD compared to the group with no FC [median (interquartile range [IQR]): 5 months (2.5-9.5) and 2 months (0-4), respectively, p ≤ 0.001]. The difference in terms of endoscopic localization was statistically significant in UC patients presenting FC (p = 0.026) with a prevalence of proctitis and left side colitis (30% and 15%, respectively). CONCLUSION In conclusion our study highlighted a prevalence of constipation in pediatric IBD patients at diagnosis of 19.7%, which must be taken into account to avoid diagnostic delay and which is associated with limited extent of disease in UC pediatric patients.
Collapse
Affiliation(s)
- Sabrina Cenni
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Colucci
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Salomone
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Marianna Casertano
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pietro Buono
- Directorate general of health, Campania Region, Naples, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
|
9
|
Vadlapudi SS, Poddar U, Srivastava A, Sarma MS. Efficacy of Home-Based Versus Hospital-Based Disimpaction with Polyethylene Glycol in Pediatric Functional Constipation: A Randomized Control Study. Dig Dis Sci 2025:10.1007/s10620-025-09048-1. [PMID: 40237902 DOI: 10.1007/s10620-025-09048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 04/07/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND/AIMS Functional constipation (FC) is the most common cause of childhood constipation. Children with FC and fecal impaction need to undergo disimpaction. Polyethylene glycol (PEG) is commonly used for disimpaction either in a hospital setting as a continuous lavage or in a home-based setting over 3-6 days. Randomized control trials comparing the two regimens are not available. The study objectives were to compare the efficacy, side effects, cost-effectiveness, and parental satisfaction of home- and hospital-based disimpaction. METHODS Consecutive children attending our hospital (age: 1-18 years) and diagnosed to have FC as per ROME IV and requiring disimpaction were enrolled. Fecal impaction was established clinically (per-abdomen or per-rectal examination) or radiologically (X-ray abdomen- Barr criteria). Stratified block randomization was done. PEG was administered accordingly in a hospital-based or a home-based setting. The side effects, patient acceptability as per the treatment satisfaction questionnaire for medications (TSQM) and cost incurred were noted. RESULTS One hundred and fifteen children (hospital-based [n = 58], home-based [n = 57]) were enrolled. Successful disimpaction in hospital- and home-based disimpaction arm was 100% and 94.7%, respectively (p = 0.12). Vomiting (27.6% vs 5.3%, p = 0.001) and abdominal distension (31% vs 3.5%, p < 0.001) were higher in patients undergoing hospital-based disimpaction. Cost of treatment was higher in hospital-based disimpaction arm (INR 6,250 [2,228-15,585] vs INR 3,355 [850-18,350], p = < 0.001). Parental satisfaction was greater in home-based disimpaction. CONCLUSIONS Home-based disimpaction using PEG is as effective as hospital-based disimpaction. Disimpaction in a friendlier home environment, at a lower cost and with fewer side effects makes home-based disimpaction preferable in children.
Collapse
Affiliation(s)
- Srinivas Srinidhi Vadlapudi
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| |
Collapse
|
|
10
|
Brown JM, Baran JV, Lamos L, Beacker J, Florio J, Oliveros LV, Fabbrini AL, Farrar AA, Wilsey MJ. Infant Colic Symptoms and Amino Acid Formula: Insights from a Prospective Cohort Study. Nutrients 2025; 17:1302. [PMID: 40284167 PMCID: PMC12029966 DOI: 10.3390/nu17081302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 03/17/2025] [Accepted: 03/31/2025] [Indexed: 04/29/2025] Open
Abstract
Background/Objectives: Infant functional disorders, including colic, irritability, and sleep disturbances, often overlap with symptoms of cow's milk protein allergy (CMPA). While extensively hydrolyzed formulas are commonly used to address these issues, the short-term efficacy of amino acid formulas (AAF) for managing colic remains understudied. This secondary analysis of a previously published prospective cohort, the largest of its kind in the United States, evaluated the short-term impact of AAF in improving colic and associated symptoms in infants under six months of age with suspected CMPA. Methods: This real-world prospective cohort study analyzed data from 138 infants with suspected CMPA initiated on AAF at Visit 1. After excluding 34 infants due to incomplete data or treatment changes, 104 infants were included in the final analysis. Symptom severity and resolution were assessed through outcomes across two visits, with care provided by general pediatricians (82%) and pediatric gastroenterologists (18%). Results: At baseline, the most common symptoms were colic (n = 83), gassiness (n = 72), fussiness (n = 66), and sleep disturbances (n = 58). By the next follow-up visit (Visit 2), parents reported symptom improvements in colic (94%), gassiness (81%), fussiness (83%), and sleep disturbances (86%). Complete symptom resolution was observed in 73% of infants with colic, 68% with gassiness, 65% with fussiness, and 81% with sleep difficulties. By Visit 2, no infants had severe symptoms, with only mild residual symptoms reported. Conclusions: AAF was associated with significant short-term improvements in colic and related symptoms in infants with suspected CMPA. These preliminary findings highlight AAF as a promising dietary intervention during early infancy. Larger controlled studies are necessary to confirm these results and explore long-term outcomes.
Collapse
Affiliation(s)
- Jerry M. Brown
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL 33431, USA; (J.M.B.); (J.V.B.); (L.L.); (J.B.); (J.F.)
| | - Jessica V. Baran
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL 33431, USA; (J.M.B.); (J.V.B.); (L.L.); (J.B.); (J.F.)
| | - Luke Lamos
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL 33431, USA; (J.M.B.); (J.V.B.); (L.L.); (J.B.); (J.F.)
| | - Jesse Beacker
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL 33431, USA; (J.M.B.); (J.V.B.); (L.L.); (J.B.); (J.F.)
| | - Jared Florio
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL 33431, USA; (J.M.B.); (J.V.B.); (L.L.); (J.B.); (J.F.)
| | - Lea V. Oliveros
- Office of Medical Education, Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA;
| | - Abigail L. Fabbrini
- Office of Medical Education, Kansas City University College of Osteopathic Medicine, Kansas City, MO 64106, USA; (A.L.F.); (A.A.F.)
| | - Andrew A. Farrar
- Office of Medical Education, Kansas City University College of Osteopathic Medicine, Kansas City, MO 64106, USA; (A.L.F.); (A.A.F.)
| | - Michael J. Wilsey
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA
| |
Collapse
|
|
11
|
Bloem MN, Baaleman DF, Thapar N, Roberts SE, Koppen IJN, Benninga MA. Prevalence of functional defecation disorders in European children: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2025; 80:580-597. [PMID: 39775925 PMCID: PMC11959110 DOI: 10.1002/jpn3.12437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 11/19/2024] [Accepted: 11/26/2024] [Indexed: 01/11/2025]
Abstract
OBJECTIVES Functional defecation disorders (FDDs) are common among children worldwide. The prevalence of these disorders has not been clearly described in Europe. This study performed a systematic review and meta-analysis on the prevalence of FDD in European children and assessed geographical, age, and sex distribution and associated factors. METHODS PubMed, Embase, Psycinfo, Cochrane Library, and Cinahl were searched from 1999 to July 2023. Included studies were (1) prospective or cross-sectional studies of European population-based samples; (2) reporting the prevalence of infant dyschezia (ID) according to Rome II, III, or IV criteria or functional constipation (FC) or functional non-retentive fecal incontinence (FNRFI) according to Rome III or IV criteria; (3) aged 0-18 years; and (4) published in English, Dutch or Spanish. PRISMA guidelines for extracting data and assessing data quality were followed. RESULTS Twenty-eight studies were included. Pooled prevalence was 6.9% (95% confidence interval [CI]: 3.1%-11.9%) for ID in infants 0-12 months (9 studies, n = 5611), 8.17% (95% CI: 6.33%-10.22%) for FC in children <4 years (25 studies, n = 35,189), 11.39% (95% CI: 9.34%-14.11%) for FC in children 4-18 years, and 0.24% (95% CI: 0.07%-0.49%) for FNRFI in children 4-18 years (7 studies, n = 16,873). No sex predominance was found for FC. FC prevalence did not differ significantly when diagnosed according to Rome III versus IV. FC prevalence differed between countries, with greatest rates in Italy, Germany, and Spain. No meta-analysis could be performed on other factors associated with FDD. CONCLUSIONS FDD is common in European children. Future longitudinal studies are needed to provide better insight into associated factors in pathogenesis.
Collapse
Affiliation(s)
- Michelle N. Bloem
- Department of Pediatric Gastroenterology and NutritionEmma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMCAmsterdamthe Netherlands
| | - Desiree F. Baaleman
- Department of Pediatric Gastroenterology and NutritionEmma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Nikhil Thapar
- Department of Gastroenterology, Hepatology, and Liver TransplantQueensland Children's HospitalBrisbaneQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Centre for Childhood Nutrition ResearchQueensland University of TechnologyBrisbaneQueenslandAustralia
| | | | - Ilan J. N. Koppen
- Department of Pediatric Gastroenterology and NutritionEmma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and NutritionEmma Children's Hospital, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| |
Collapse
|
|
12
|
Tomé TM, Lima ABDM, Machado JM, Aires MT, Carvalho SDR, Junqueira JCDF, Francesconi CF. Protocol for translation and cross-cultural adaptation of diagnostic questionnaires for pediatric disorders of gut-brain interaction. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2025; 43:e2024191. [PMID: 40136122 PMCID: PMC11940709 DOI: 10.1590/1984-0462/2025/43/2024191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 11/21/2024] [Indexed: 03/27/2025]
Abstract
OBJECTIVE To describe the protocol used for translation and cross-cultural adaptation of the questionnaires developed by the Rome Foundation for the diagnosis of disorders of gut-brain interaction in the pediatric population. METHODS The protocol was proposed based on a narrative review of the literature on the cultural adaptation process of measurement instruments in epidemiology, analyzing its stages, and verifying its use and feasibility. The guidelines for the cross-cultural adaptation of diagnostic instruments developed by the Rome Foundation, which defines and periodically reviews diagnostic criteria, were incorporated into the protocol. RESULTS The proposed protocol includes: (i) preparation; (ii) forward translation; (iii) reconciliation; (iv) backward translation; (v) review of the backward translation; (vi) cognitive debriefing; (vii) final review; (viii) calculation of the item content validity index; and (ix) approval by the Rome Foundation. CONCLUSIONS The methodological steps described in this protocol may contribute to future translations and cross-cultural adaptations of diagnostic questionnaires of disorders of gut-brain interaction and other materials from the Rome Foundation, enabling their use in epidemiological studies.
Collapse
Affiliation(s)
- Thaís Moreno Tomé
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Ana Beatriz de Menezes Lima
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Janaína Mezzonato Machado
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Mariana Tschoepke Aires
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Silvio da Rocha Carvalho
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | | | | |
Collapse
|
|
13
|
Labib H, Shirinskiy IJ, Roelofs JJTH, van der Voorn JP, van Schuppen J, Oosterlaan J, van Heurn LWE, Benninga MA, Derikx JPM. Diagnosing Hirschsprung Disease in Children Older than Six Months of Age: Complications After Rectal Biopsy, Insight in Final Diagnoses and Factors Associated With Hirschsprung Disease. J Pediatr Surg 2025; 60:162066. [PMID: 39608087 DOI: 10.1016/j.jpedsurg.2024.162066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 11/04/2024] [Accepted: 11/08/2024] [Indexed: 11/30/2024]
Abstract
INTRODUCTION It is challenging to distinguish between patients with Hirschsprung disease (HD) and patients with other causes of defecation problems based on clinical presentation in patients older than six months. Pathological examination of the rectal biopsy is the gold standard for the diagnosis of HD. The aim of this study was to gain insight into 1) the prevalence and severity of complications following rectal biopsy, 2) the final diagnoses of patients referred for biopsy, and 3) clinical factors associated with HD in patients older than six months. METHODS Children suspected of HD above the age of six months referred for biopsies were analyzed retrospectively. Severity of complications of rectal suction biopsy (RSB) and full thickness biopsy (FTB) were assessed using Clavien-Madadi (CM) grading. Factors associated with HD were tested using multivariate logistic regression analysis. RESULTS From 2000 to 2022, 234 children older than six months of age underwent biopsies because of defecation problems (median age of 47.2 months (IQR = 17.2-87.2)). Of these, 130 out of 234 children underwent RSB and 112 out of 234 children underwent FTB. One patient (0.4 %) developed a complication following RSB (CM1-A): fever without evident cause. Two patients (0.9 %) had ongoing rectal bleeding following FTB. One patient did not require an intervention (CM1-A), the other received rectal spongostan to stop the bleeding and erythrocyte transfusion (CM2). The most frequent final diagnoses were functional constipation (n = 179, 76.5 %), HD (n = 25, 10.6 %) and food intolerance (n = 5, 2.1 %). Associated factors for HD were distended abdomen (OR 5.41, CI 2.05-14.31), vomiting (OR 4.14, CI 1.64-11.85) and no abdominal pain (OR 0.14, CI 0.03-0.65) (model R2 = 0.278). CONCLUSION In children older than six months suspected of HD, presenting with distended abdomen, vomiting and no abdominal pain, we advise obtaining a rectal biopsy in case other causes of constipation are ruled out, because a rectal biopsy is a safe procedure with only minor complications. The most common diagnosis in patients older than six months of age referred for rectal biopsy was functional constipation. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- H Labib
- Amsterdam UMC Location University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - I J Shirinskiy
- Amsterdam UMC Location University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J J T H Roelofs
- Amsterdam UMC Location University of Amsterdam, Department of Pathology, Meibergdreef 9, Amsterdam, The Netherlands
| | - J P van der Voorn
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan 1117, Amsterdam, The Netherlands
| | - J van Schuppen
- Amsterdam UMC Location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - J Oosterlaan
- Amsterdam UMC Location University of Amsterdam, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - L W E van Heurn
- Amsterdam UMC Location University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - M A Benninga
- Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Meibergdreef 9, Amsterdam, The Netherlands
| | - J P M Derikx
- Amsterdam UMC Location University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
|
14
|
Gordon M, de Geus A, Banasiuk M, Benninga MA, Borrelli O, Boruta M, Darbari A, Dore-Stites D, Gould M, Hawa J, Jones KB, Khlevner J, Kilgore A, Mousa H, Nurko S, Sinopoulou V, Tabbers M, Thapar N. ESPGHAN and NASPGHAN 2024 protocol for paediatric functional constipation treatment guidelines (standard operating procedure). BMJ Paediatr Open 2025; 9:e003161. [PMID: 39904543 PMCID: PMC11795385 DOI: 10.1136/bmjpo-2024-003161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 01/23/2025] [Indexed: 02/06/2025] Open
Abstract
INTRODUCTION Functional constipation is common in childhood, with chronicity leading to a significant impact on patients and their families. There is a significant range of therapies available to healthcare professionals for this condition, with many novel or recently studied. There is a need for an update to the joint European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines last released in 2014. We present the prospectively agreed operating procedure and technical review protocol in this manuscript. METHODS 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) will be used for all phases of this guideline development. The Guideline Development Group is formed by paediatric gastroenterologists from both the ESPGHAN as well as the NASPGHAN. A prospective exercise will agree on key outcomes, thresholds of magnitude that are significant at small, moderate and large levels. Systematic evidence searches, selection, extraction, appraisal and analysis will be performed following Cochrane guidance and GRADE guidance for objectively agreeing the certainty of findings. Additional use of network meta-analysis will identify areas of broad triangulation in the evidence. Summary of findings tables will be produced and inform evidence to decision frameworks. These will guide GRADE recommendations with voting to reach a consensus.
Collapse
Affiliation(s)
| | - Anna de Geus
- Peadiatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marcin Banasiuk
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warszawa, Poland
| | - Marc A Benninga
- Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Mary Boruta
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Anil Darbari
- Children's National Hospital, Washington, District of Columbia, USA
| | - Dawn Dore-Stites
- Pediatric Psychology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Michelle Gould
- Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Juliette Hawa
- Physical Therapy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kirsten Brooke Jones
- Clinical nutrition and Lactation, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Julie Khlevner
- Pediatric Gastroenterology, Hepatology and Nutrition, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Alexandra Kilgore
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hayat Mousa
- Gastroenterology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samuel Nurko
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Merit Tabbers
- Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Nikhil Thapar
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| |
Collapse
|
|
15
|
Tran DL, Nguyen Trong Tran P, Susantitaphong P, Phinyo P, Sintusek P. Value of transabdominal ultrasonography for diagnosing functional constipation in children: a systematic review and meta-analysis. Clin Exp Pediatr 2025; 68:127-135. [PMID: 39533722 PMCID: PMC11825114 DOI: 10.3345/cep.2024.00927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/19/2024] [Accepted: 08/30/2024] [Indexed: 11/16/2024] Open
Abstract
Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and metaanalysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, Embase, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD and anterior wall thickness using transabdominal ultrasonography in children with versus without FC. Metaanalyses were performed using random-effects models to calculate the weighted mean differences (MDs) in RD and anterior wall thickness. Comprehensive Meta-Analysis ver. 3, R, and Review Manager ver. 5.4.1 software were used to assess the optimal cutoff, sensitivity, specificity, and area under the curve (AUC). Fourteen studies involving 1,255 children (mean age, 6.21±2.3 years) were included. The mean RD was significantly larger in constipated children versus controls (MD, 10.35 mm; 95% confidence interval [CI], 6.97-13.74; P<0.001; I2=94%). A meta-regression showed no significant effects of age, weight, or height on RD. An optimal RD cutoff point of 31 mm was suggested by a pooled analysis with an AUC of 0.86 (95% CI, 0.8-0.91; P<0.001), sensitivity of 0.75 (95% CI, 0.59-0.86), and specificity of 0.84 (95% CI, 0.68-0.93). The mean anterior rectal wall thickness was greater among constipated children than among controls (MD, 0.44; 95% CI, -0.26 to 1.13; P=0.22), but this difference was not statistically significant. RD measured using transabdominal ultrasonography with a cutoff point of 31 mm exhibited good diagnostic accuracy for diagnosing FC in children.
Collapse
Affiliation(s)
- Duc Long Tran
- Clinical Sciences Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Phu Nguyen Trong Tran
- Clinical Sciences Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Palittiya Sintusek
- Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI), Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
16
|
Kilgore AL, Rogers Boruta MK, Ambartsumyan L, Suarez RG, Patel D, Wood RJ, Darbari A, Rodriguez L. Evaluation and management of pediatric refractory constipation: Recommendations from the NASPGHAN neurogastroenterology and motility committee. J Pediatr Gastroenterol Nutr 2025; 80:353-373. [PMID: 39741384 DOI: 10.1002/jpn3.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 08/21/2024] [Accepted: 10/01/2024] [Indexed: 01/03/2025]
Abstract
Refractory constipation (RC) in pediatric patients should be recognized as a distinct condition with long-term impacts on patient and family quality of life. RC requires a more targeted diagnostic evaluation and complex management strategy that may involve management by pediatric neurogastroenterology and motility specialists and multidisciplinary teams including surgeons. Currently, there is a lack of a clear definition, evaluation, and management strategies for RC. This is the first North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper to address pediatric RC regarding its definition, evaluation, and management.
Collapse
Affiliation(s)
- Alexandra L Kilgore
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Roberto Gomez Suarez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nemours Children's Hospital, Orlando, Florida, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anil Darbari
- Pediatric Gastroenterology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
|
17
|
Jönsson S, Bouchene S, Mazzei P, Borella E, Piana C, Tagliavini A, Koletzko S, Werkstetter K, Capriati A, Pellacani A, Karlsson MO, Jonsson EN. Population pharmacokinetic and dose-response models of nepadutant, a selective antagonist of the NK 2 receptors, in infants with colic. Br J Clin Pharmacol 2025; 91:386-396. [PMID: 39327792 DOI: 10.1111/bcp.16230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/26/2024] [Accepted: 08/12/2024] [Indexed: 09/28/2024] Open
Abstract
AIMS The aim of the current analyses was to develop a population pharmacokinetic model for nepadutant in infants with colic, and a pharmacokinetic-pharmacodynamic model based on observations of duration of crying and fussing following oral nepadutant administration in infants (3-25 weeks) with colic. METHODS The models were developed based on data obtained at baseline and following treatment with placebo, nepadutant 0.1 mg/kg or nepadutant 0.5 mg/kg administered for 7 days. A continuous response variable, duration of crying and fussing in minutes within 2 h interval, was assembled based on records from "baby's day" diary. RESULTS The pharmacokinetics of nepadutant was described by a one-compartment model with first-order absorption and elimination with body weight as a structural covariate incorporated allometrically. For an infant weighing 5.3 kg, the estimated apparent clearance was 68.6 L/h (12% relative standard error) and exhibited large variability (78% coefficient of variation). The pharmacokinetic-pharmacodynamic model described (i) a circadian rhythm in the response with lowest and highest observations at 4 a.m. and 9 p.m., respectively, (ii) a placebo effect increasing and flattening out with time in an exponential manner, and (iii) a statistically significant (P < .01) linearly increasing response with dose. The observed and model predicted relative change in response from baseline was -35% and -28% (95% prediction interval -36%; -19%) following placebo, and -44% and -36% (-46%; -27%) after 0.5 mg/kg. CONCLUSIONS Population pharmacokinetic and dose-response models were successfully developed characterizing the available nepadutant pharmacokinetics and duration of crying and fussing data in infants.
Collapse
Affiliation(s)
| | - Salim Bouchene
- Pharmetheus AB, Uppsala, Sweden
- UCB Pharma, Braine l'Alleud, Belgium
| | - Paolo Mazzei
- Menarini Ricerche S.p.A-Menarini Group, Florence, Italy
| | - Elisa Borella
- Menarini Ricerche S.p.A-Menarini Group, Florence, Italy
| | - Chiara Piana
- Menarini Ricerche S.p.A-Menarini Group, Florence, Italy
| | | | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Katharina Werkstetter
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | | | | | | | | |
Collapse
|
|
18
|
Indrio F, Masciari E, Marchese F, Rinaldi M, Maffei G, Gangai I, Grillo A, De Benedetto R, Napolitano EV, Beghetti I, Corvaglia L, Di Mauro A, Aceti A. Functional gastrointestinal disorders predictors in neonates and toddlers: A machine learning approach to risk assessment. Heliyon 2025; 11:e41516. [PMID: 39834435 PMCID: PMC11743318 DOI: 10.1016/j.heliyon.2024.e41516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 12/16/2024] [Accepted: 12/25/2024] [Indexed: 01/22/2025] Open
Abstract
Background Functional Gastrointestinal Disorders (FGIDs) can pose a great burden on affected children, their families, and the healthcare system. Due to the lack of knowledge about the precise pathophysiology of FGIDs, a proper identification of children at risk to develop FGIDs has never been attempted. The research aims to identify early-life risk factors for FGIDs such as infantile colic, regurgitation, and functional constipation, within the first year of life. Methods This prospective observational cohort study enrolled both term and preterm infants from a tertiary care university hospital between January 1, 2020, and December 31, 2022. The study employed both traditional statistical methods and artificial intelligence (AI) techniques, specifically a random forest classification model, to identify key risk factors associated with the development of FGIDs. Based on these findings, an AI-based predictive model will be developed, along with a user-friendly, web-based interface designed for practical risk assessment. Results 6060 infants were enrolled. 8.1 % were born preterm. According to random forest classification model by AI, birth weight (BW), cord blood pH, and maternal age were the most relevant variables linked to development of FGIDs in the first year of life. Some discrepancies between potential risk factors identified through conventional statistics and AI were detected. Conclusion For the first time machine learning allowed to identify BW, cord blood pH and maternal age as important variable for risk prediction of FGIDs in the first year of life. This practical risk assessment tool would help clinicians to identify infants at risk of FGIDs who would benefit from a tailored preventive approach.
Collapse
Affiliation(s)
- Flavia Indrio
- Department of Experimental Medicine School of Medicine University of Salento, Lecce, Italy
| | - Elio Masciari
- Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, University Federico II, Naples, Italy
| | - Flavia Marchese
- Department of Medical and Surgical Science Pediatric Section, University of Foggia, 71100, Foggia, Italy
| | - Matteo Rinaldi
- Department of Neonatology and NICU, Ospedali Riuniti Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Gianfranco Maffei
- Department of Neonatology and NICU, Ospedali Riuniti Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Ilaria Gangai
- Department of Medical and Surgical Science Pediatric Section, University of Foggia, 71100, Foggia, Italy
| | - Assunta Grillo
- Department of Medical and Surgical Science Pediatric Section, University of Foggia, 71100, Foggia, Italy
| | - Roberta De Benedetto
- Department of Medical and Surgical Science Pediatric Section, University of Foggia, 71100, Foggia, Italy
| | - Enea Vincenzo Napolitano
- Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, University Federico II, Naples, Italy
| | - Isadora Beghetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Corvaglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, ASL BA, BARI, Italy
| | - Arianna Aceti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
|
19
|
Keihanian F, Maleknejad S, Saeidinia A, Soltanipour S, Pirooz A. Comparison of Ziziphus jujube Mill. Syrup versus polyethylene glycol in children with functional constipation: a randomized clinical trial. Sci Rep 2025; 15:1674. [PMID: 39799261 PMCID: PMC11724880 DOI: 10.1038/s41598-025-85801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 01/06/2025] [Indexed: 01/15/2025] Open
Abstract
Functional constipation is a common disorder of the gastrointestinal tract in children without specific treatment. Ziziphus jujuba has been used in traditional medicine for various diseases such as constipation. A safe and inexpensive treatment with few side effects can be used as an effective alternative to current medications. In this study, we sought to compare Ziziphus jujuba syrup (ZS) with polyethylene glycol (PEG) for the treatment of pediatric functional constipation. A double-blind, randomized clinical trial was performed on children aged 2-10 years with functional constipation who were referred to the gastroenterology clinic of the 17-Shahrivar Hospital in Rasht, Iran. Eligible patients were randomized into two groups: PEG group; 1-5 cc/kg/day (40% w/v solution without electrolytes; average dose: 0.2-1 g/kg), and ZS group; 1-5 cc/kg/day (average dose: 5-25 mg/kg). All patients were followed up for three months, every 2 weeks in the first month, and then monthly for 2 months. At the beginning and end of the study, liver and kidney function tests and blood sugar levels were checked. Data were analyzed using SPSS software version 19 at a significance level of 0.05. Out of 90 eligible children, 32 patients in the PEG group and 30 patients in the ZS group completed the follow-up visits. The mean age of the subjects was 4.31 ± 1.97 years. There was no significant difference between the two groups in terms of age (P = 0.181), gender (P = 0.218), age at onset of constipation (P = 0.083), and weight (P = 0.199). The average therapeutic response score in the ZS group improved prominently compared to the PEG group (P < 0.05). The average number of encopresis and visual analog scale pain scores significantly decreased in the ZS group compared to the PEG group (P < 0.05). Other indices, including frequency of defecation, and medication adherence in the ZS group were significantly improved compared to the PEG group (P < 0.05). Only in the PEG group, a few cases reported self-limiting side effects. ZS can be a treatment choice for functional constipation without any adverse events or liver or kidney injury in children. However, further studies are necessary to find potential side effects.
Collapse
Affiliation(s)
- Fatemeh Keihanian
- Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Shohreh Maleknejad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Amin Saeidinia
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pediatric, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Soltanipour
- Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Pirooz
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
|
20
|
de Graaf K, Kwakman YEP, de Kruijff I, Tromp E, Staal IIE, Katch LE, Burkhardt T, Benninga MA, Roseboom TJ, Vlieger AM. Validation of the Dutch Infant Crying and Parent Well-Being Screening Tool in Parents of Infants Less than 12 Months of Age. J Pediatr 2025; 276:114326. [PMID: 39343132 DOI: 10.1016/j.jpeds.2024.114326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 08/29/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVE To evaluate reliability and validity of the Dutch version of the Infant Crying and Parent Well-Being (ICPW) tool in identifying parents struggling with infant crying in the first year of life. STUDY DESIGN The original ICPW tool was translated into Dutch following established guidelines. The internal consistency and criterion validity of the Dutch ICPW tool were evaluated using a cross-sectional design. The translated ICPW tool and validated questionnaires on parental depression, stress, anxiety, and parenting balance were presented to parents of infants under 12 months during child health care visits and online. RESULTS The survey was completed by 488 parents, 400 mothers and 88 fathers. Of these, 172 participated after a child health care visit and 316 via online platforms. The Dutch ICPW showed satisfactory internal consistency (α = 0.69) and excellent criterion validity with parental mental health measures (r = 0.53-0.85). ICPW scores demonstrated positive correlations with parental depression, stress, and anxiety levels, and a negative correlation with parenting balance. Both mothers and fathers with a positive ICPW screen (≥3) reported significantly higher levels of parental mental health issues compared with those with a negative screen (P < .001). The ICPW was positive in 32% of the parents (n = 155), with consistent total scores regardless of the infant's increasing age (r = -0.024, P = .59). The ICPW tool exhibited a strong negative predictive value (93%) for diagnosing postpartum depression. CONCLUSIONS The Dutch ICPW tool is a reliable and valid screening instrument for identifying parents struggling with infant crying.
Collapse
Affiliation(s)
- Karola de Graaf
- Department of Pediatrics, St. Antonius Hospital, Utrecht, The Netherlands.
| | - Yael E P Kwakman
- Department of Pediatrics, St. Antonius Hospital, Utrecht, The Netherlands
| | - Ineke de Kruijff
- Department of Pediatrics, St. Antonius Hospital, Utrecht, The Netherlands
| | - Ellen Tromp
- Department of Epidemiology, General Health Care, Utrecht, The Netherlands
| | - Ingrid I E Staal
- Dutch Knowledge Center for Youth Health, NCJ, Utrecht, The Netherlands
| | - Leslie E Katch
- Department of Early Childhood Education, National Louis University, Chicago, IL
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Utrecht, The Netherlands
| |
Collapse
|
|
21
|
Jonker CAL, van der Zande JMJ, Benninga MA, de Jong JR, Di Lorenzo C, Lu PL, Tabbers MM, de Vries R, Koppen IJN, Gorter RR. Antegrade Continence Enemas for Pediatric Functional Constipation: A Systematic Review. J Pediatr Surg 2025; 60:161952. [PMID: 39389879 DOI: 10.1016/j.jpedsurg.2024.161952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/09/2024] [Accepted: 09/17/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Despite optimal conservative and medical treatment, some children with functional constipation (FC) continue to experience symptoms. Antegrade continence enema (ACE) surgery has been suggested as the primary surgical option after less invasive pharmacological and non-pharmacological interventions have not been effective. The purpose of this systematic review was to assess the outcomes of ACE for children with FC. METHODS Electronic databases were searched (inception-March 2024) for studies evaluating ACE surgery performed in children with FC. The primary outcome was treatment success (as defined in the original manuscript), including at least defecation frequency and/or fecal incontinence frequency. Secondary outcomes were cessation of ACE, complications, health-related quality of life (HRQoL) and patient/parent satisfaction. Quality of evidence was evaluated based on tools from the New-Ottawa Scale and Joanna Bridge Institute. RESULTS Thirteen studies were included, representing 477 children with FC treated with either an appendicostomy or a cecostomy. Reported treatment success rates varied widely, ranging from 32% to 100%. ACE treatment was stopped in 15% due to treatment success and in 8% due to treatment failure, leading to more invasive surgery. Complication rates ranged from 6% to 100%, requiring surgical intervention in 0% to 34%. An improvement in HRQoL following ACE treatment was reported in all three studies that assessed HRQoL. The two studies assessing patient/parent satisfaction, reported high satisfaction rates. CONCLUSION Reported treatment success and complication rates following ACE surgery for children with FC vary widely. This systematic review highlights the necessity for uniform definitions and treatment guidelines for ACE surgery in children with FC. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Charlotte A L Jonker
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Julia M J van der Zande
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Ralph de Vries
- Medical Library, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| |
Collapse
|
|
22
|
Moreno-Villares JM, Andrade-Platas D, Soria-López M, Colomé-Rivero G, Catalan Lamban A, Martinez-Figueroa MG, Espadaler-Mazo J, Valverde-Molina J. Comparative efficacy of probiotic mixture Bifidobacterium longum KABP042 plus Pediococcus pentosaceus KABP041 vs. Limosilactobacillus reuteri DSM17938 in the management of infant colic: a randomized clinical trial. Eur J Pediatr 2024; 183:5371-5381. [PMID: 39390276 PMCID: PMC11527960 DOI: 10.1007/s00431-024-05806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 09/24/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024]
Abstract
We aimed to compare the efficacy of Bifidobacterium longum KABP042 + Pediococcus pentosaceus KABP041 (BL + PP) vs. Limosilactobacillus reuteri DSM17938 (LR) in alleviating the symptoms of infant colic, as commercially available formulations. A randomized, multicenter, parallel, single-blind (investigator) trial was conducted in 112 colicky infants diagnosed as per Rome IV criteria and randomly allocated to receive BL + PP orally (109 colony-forming units [CFU]/day, n = 55) or LR (108 CFU/day, n = 57) for 21 days. Primary study outcomes were percentage of responders (≥ 50% reduction in crying and fussing time from baseline, as reported by parents in a structured diary) and daily crying and fussing time (minutes/day) on days 7, 14, and 21 after randomization. Study groups were comparable at baseline. Responder rate was significantly higher in BP + PP group vs. LR group at days 7 (61.1% vs. 37.5%, p = 0.013) and 14 (84.6% vs. 59.3%, p = 0.004). Crying and fussing time (median [IQR]) became significantly lower in BL + PP group vs. LR group on day 7 (119 [60-210] vs. 180 [110-270]; p = 0.028), day 14 (60.0 [30-105] vs. 120 [60-180]; p = 0.017), and day 21 (29 [0-85] vs. 67 [30-165]; p = 0.011). No significant differences were found in the number of adverse events between the groups. CONCLUSION The specific formulation of B. longum KABP042 and P. pentosaceus KABP041 achieved a higher response rate and a larger reduction in crying and fussing time in colicky infants. Both probiotic interventions were well tolerated. TRIAL REGISTRATION The study was retrospectively registered as NCT05271747 on February 28th, 2022. WHAT IS KNOWN • L. reuteri DSM17938 (LR) is the most researched probiotic strain for infant colic against placebo in randomized, controlled clinical trials, and is recommended in various guidelines. A novel probiotic combining strains B. longum KABP042 and P. pentosaceus KABP041 (BL + PP) has also demonstrated efficacy in infant colic against placebo. WHAT IS NEW • This randomized study provides the first direct comparison of two probiotics for infant colic. BL + PP seems to be superior to LR in reducing crying time.
Collapse
Affiliation(s)
| | | | - M Soria-López
- Gastroenterology and Pediatric Nutrition, Hospital HM Puerta del Sur, Madrid, Spain
| | | | - A Catalan Lamban
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - J Valverde-Molina
- Department of Pediatrics, Hospital Universitario de Sta Lucia, Cartagena, Spain
| |
Collapse
|
|
23
|
Bui HM, Trinh OTH, Lin SH, Nguyen-Hoang A, Le NQK, Nguyen NT, Nguyen NTK. Unveiling the applicability of the Brussels Infant and Toddler Stool Scale for hard stool in young children: A South Asian perspective. J Gastroenterol Hepatol 2024; 39:2609-2615. [PMID: 39308220 DOI: 10.1111/jgh.16741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/04/2024] [Accepted: 09/02/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND AND AIM The Rome IV criteria, the standard for diagnosing functional constipation (FC), deem the Bristol Stool Scale (BSS) unsuitable for assessing stool consistency in young children. Hence, the Brussels Infant and Toddler Stool Scale (BITSS) was developed. We aimed to validate and test the reliability of BITSS for hard stools and FC among infants and toddlers, where there is limited evidence in Asian populations. METHODS The research evaluated FC in children aged 0-48 months who came for medical examination using Rome IV criteria. Stool properties provided by caregivers were assessed sequentially through three methods: the BSS, the BITSS, and caregiver reports. RESULTS A total of 370 responses were received, with an average age of 26.2 months. Substantial agreement was observed between the BITSS and caregiver reports for hard stools (concordance rate: 91.9%, κ = 0.75), while near-perfect agreement was found between BITSS and BSS (concordance rate: 93.5%, κ = 0.81). The BITSS exhibited higher sensitivity than the BSS in assessing hard stools (95.3% vs 87.5%, P < 0.001). And the BITSS (23.5%) identified the highest prevalence of FC than the BSS (20.5%) and caregiver report (18.7%), with near-perfect agreement. Moderate agreement was reported when evaluating the test-retest reliability between BITSS and caregiver reports (concordance rate: 86.2%, κ = 0.44). CONCLUSIONS The BITSS, more sensitive than the BSS in identifying abnormal, especially hard stools, aids in early FC detection in young children. These findings support using BITSS over BSS for evaluating hard stools in infants and toddlers, both in Vietnam and globally.
Collapse
Affiliation(s)
- Hung Manh Bui
- Nutrition and Non-Communicable Disease, Center for Diseases Control of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Oanh Thi Hoang Trinh
- Department of Epidemiology, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Shyh-Hsiang Lin
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- School of Food Safety, Taipei Medical University, Taipei, Taiwan
| | - Anh Nguyen-Hoang
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Nguyen Quoc Khanh Le
- In-Service Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- AIBioMed Research Group, Taipei Medical University, Taipei, Taiwan
| | - Nha Tran Nguyen
- Nutrition and Non-Communicable Disease, Center for Diseases Control of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngan Thi Kim Nguyen
- Undergraduate Program of Nutrition Science, School of Life Science, National Taiwan Normal University, Taipei, Taiwan
| |
Collapse
|
|
24
|
Ye YM, Wei MH, Lv KN, Xue XH, Shen R, Liu JH. Effects of an anti-inflammatory diet (AID) on maternal and neonatal health outcomes in pregnant Chinese patients with inflammatory bowel disease treated with infliximab (IFX). Scand J Gastroenterol 2024; 59:1297-1305. [PMID: 39520284 DOI: 10.1080/00365521.2024.2423828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 10/23/2024] [Accepted: 10/27/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effects of an anti-inflammatory diet (AID) combined with Infliximab (IFX) therapy on maternal and neonatal health outcomes in pregnant Chinese patients with inflammatory bowel disease (IBD). METHODS IBD patients treated with steady IFX maintenance therapy at the time of conception were randomly assigned to either the IBD-AID group (n = 49), which received an anti-inflammatory diet intervention during the third trimester, or the habitual diet group (n = 49). Primary outcomes included assessments of disease activity, inflammatory markers, and neonatal health. Secondary outcomes included health-related quality of life (HRQoL) in patients and functional gastrointestinal disorders (FGIDs) in infants. RESULTS The IBD-AID intervention significantly reduced disease activity scores in IBD patients at 4 weeks post-intervention and 1 month postpartum compared to the habitual diet group, and also improved HRQoL. Serum C-reactive protein (CRP) and fecal calprotectin (FC) levels were significantly lower in the IBD-AID group at these times, with a trend towards lower levels at 6 months postpartum. Birth weight and Apgar scores were higher in the IBD-AID group but did not reach statistical significance. The incidence of at least one FGID in infants was significantly lower in the IBD-AID group (24.5%) compared to the habitual diet group (46.9%, p = 0.034). CONCLUSION The IBD-AID intervention combined with IFX therapy significantly improved disease activity, inflammatory markers, and QoL in maternal IBD patients, and was associated with a lower incidence of FGIDs in infants, indicating benefits for both maternal and neonatal health.
Collapse
Affiliation(s)
- Yong-Mei Ye
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mei-Hao Wei
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai-Ni Lv
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Hui Xue
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Shen
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing-Han Liu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
|
25
|
Bahbah WA, Abo Hola AS, Bedair HM, Taha ET, El Zefzaf HMS. Serum eosinophil-derived neurotoxin: a new promising biomarker for cow's milk allergy diagnosis. Pediatr Res 2024; 96:1812-1821. [PMID: 38802610 PMCID: PMC11772247 DOI: 10.1038/s41390-024-03260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Cow's Milk Allergy (CMA) diagnosis is often a challenge due to the non-specific nature of symptoms and lack of a confirmatory diagnostic test. To our knowledge no previous studies investigated serum Eosinophil-Derived Neurotoxin (sEDN) in CMA. So, we aimed to assess the role of sEDN in CMA diagnosis. METHODS Forty-five infants with CMA were compared to 45 infants with functional gastrointestinal disorders (FGIDs) and 45 healthy controls. For all participants, Cow's Milk-related Symptom Score (CoMiSS) was documented, and sEDN level with hematological parameters were measured before starting elimination diet. RESULTS Receiver operation characteristic (ROC) curve identified sEDN > 14 ng/mL and CoMiSS > 9 as the optimal cut-off points to discriminate CMA from other groups with sensitivity 86.67%, 97.78% and specificity 60.00%, 78.89% respectively. Additionally, absolute neutrophil count (ANC) showed the highest sensitivity and specificity (80.0% and 78.89%) among hematological parameters. Although CoMiSS and ANC showed a significant positive correlation with sEDN in CMA group, CoMiSS was the only significant predictor for sEDN in multivariate linear regression. CONCLUSIONS sEDN showed high sensitivity in discriminating infants with and without CMA. Therefore, it is suggested as a potential biomarker for CMA diagnosis. Also, ANC should be closely monitored in these infants. IMPACT CMA presents with high heterogeneity, which complicates the diagnosis especially non-IgE-mediated and mixed types. So, oral food challenge continues to be the gold standard for its diagnosis. ROC curve identified CoMiSS > 9 as the best cut-off point to identify CMA. However, CoMiSS is a good awareness tool for CMA but not a diagnostic tool. sEDN level was significantly higher in infants with CMA with a good diagnostic performance in differentiating them than those without CMA. So, it is suggested as a potential biomarker for CMA diagnosis. ANC could have a role in CMA diagnosis and differentiating it from FGIDs.
Collapse
Affiliation(s)
- Wael A Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Ahmed S Abo Hola
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Hanan M Bedair
- Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | - Eman T Taha
- Ministry of Health, Shebin El-Kom, Menoufia, Egypt
| | - Heba M S El Zefzaf
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.
| |
Collapse
|
|
26
|
Vos JMBW, Bloem MN, de Geus A, Leeflang MMG, Spijker R, Koppen IJN, Baaleman DF, Benninga MA. Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis. Pediatr Radiol 2024; 54:2227-2242. [PMID: 39545958 PMCID: PMC11638420 DOI: 10.1007/s00247-024-06083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Functional constipation is common in children and accurate diagnostic methods are essential for early diagnosis and effective management. The diagnostic accuracy of transabdominal ultrasound to diagnose functional constipation is unclear. OBJECTIVE To evaluate the diagnostic accuracy of transverse rectal diameter measurement via transabdominal ultrasound in diagnosing children with functional constipation and in identifying fecal impaction. MATERIALS AND METHODS Electronic databases were searched from inception to March 2023. Original studies investigating the diagnostic accuracy of measuring transverse rectal diameter via transabdominal ultrasound, including children with and without functional constipation, or with and without fecal impaction were included. Data extraction and quality assessment were performed independently by two reviewers. RESULTS Sixteen studies were included (n = 1,801 children, 0-17 years). Thirteen studies investigated the diagnostic accuracy for functional constipation, and five for fecal impaction. High risk of bias was found across the majority of studies mainly due to un-blinded case-control designs. Cut-off transverse rectal diameter values to diagnose functional constipation ranged from 2.4 cm to 3.8 cm. Meta-analysis (seven studies, n = 509 children) estimated mean sensitivity and specificity to diagnose functional constipation were 0.68 (95% confidence interval (CI) 0.55-0.78) and 0.81 (95% CI 0.71-0.88), respectively. Meta-analysis of diagnostic accuracy of identifying fecal impaction was not feasible. Studies reported a sensitivity and specificity ranging between 68-100% and 83-100%, respectively. CONCLUSION Transabdominal ultrasound may be a valuable non-invasive diagnostic tool to diagnose functional constipation by measuring transverse rectal diameter and identifying fecal impaction in children. Heterogeneous study methods and lack of age-dependent normal values impair current clinical recommendations. Future research should focus on separating age groups and developing a standardized protocol.
Collapse
Affiliation(s)
- Johanna M B W Vos
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Michelle N Bloem
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Anna de Geus
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Amsterdam Public Health, Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Desiree F Baaleman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| |
Collapse
|
|
27
|
Szczuko M, Duliban G, Drozd A, Sochaczewska D, Pokorska-Niewiada K, Ziętek M. The Association of Short-Chain Fatty Acids with the Occurrence of Gastrointestinal Symptoms in Infants. Int J Mol Sci 2024; 25:12487. [PMID: 39684199 DOI: 10.3390/ijms252312487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/12/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Short-chain fatty acids (SCFAs) are produced by the fermentation of undigested polysaccharides; they are a group of metabolites resulting from the activity of intestinal bacteria. The main SCFAs are acetic, butyric, propionic, valeric, and caproic acid, and their levels and proportions depend on various factors. The aim of this study was to investigate the relationship between the concentration of SCFAs and the occurrence of specific gastrointestinal symptoms in infants. This study was conducted using faecal samples obtained at 1, 3, 6, and 12 months of age. The SCFA content was measured using gas chromatography. At 1 month, an association was found between butyric acid and flatulence. At 3 months, an association was found between butyric acid and flatulence/gas and between 3,4-methylovaleric acid and mucus in the stool. At 6 months, an association was found between butyric and valeric acids and flatulence. By 12 months, the gastrointestinal symptoms had decreased significantly. This study confirms that there is an association between SCFA levels and the presence of bloating, gas, mucus in the stool, and constipation in the gastrointestinal tract. Higher levels of butyric and valeric acids may lead to an increase in troublesome symptoms, such as flatulence and gas, in the first few months of life but are not associated with the occurrence of intestinal colic. The level of 3,4-methylovaleric acid is associated with the presence of allergies, whereas a decrease in acetic acid and an increase in isovaleric acid may exacerbate defecation problems in infants.
Collapse
Affiliation(s)
- Małgorzata Szczuko
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
- Department of Human Nutrition and Bromatology, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Gabriela Duliban
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | - Arleta Drozd
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | - Diana Sochaczewska
- Department of Neonatology, Pomeranian Medical University in Szczecin, 72-009 Police, Poland
| | - Kamila Pokorska-Niewiada
- Department of Toxicology, Dairy Technology and Food Storage, West Pomeranian University of Technology in Szczecin, 71-459 Szczecin, Poland
| | - Maciej Ziętek
- Department of Perinatology, Obstetrics and Gynecology Pomeranian Medical University in Szczecin, 72-009 Police, Poland
| |
Collapse
|
|
28
|
Shen H, Zhang L, Zhang Y, Huang Y, Xu B, Yu M. Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study. Front Pediatr 2024; 12:1417389. [PMID: 39444711 PMCID: PMC11496162 DOI: 10.3389/fped.2024.1417389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 09/24/2024] [Indexed: 10/25/2024] Open
Abstract
Background Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions. Methods A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis. Results Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services. Conclusion Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.
Collapse
Affiliation(s)
| | | | | | - Yan Huang
- Department of Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | | | | |
Collapse
|
|
29
|
Garrido L, Rodrigues I, Lyra P, Proença L, Botelho J, Frota S, Mendes JJ, Machado V. Perceived Infant Discomfort Linked to Lower Maternal Oral Health Quality of Life: Results from a Cross-Sectional Study. J Clin Med 2024; 13:5931. [PMID: 39407991 PMCID: PMC11477590 DOI: 10.3390/jcm13195931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 09/25/2024] [Accepted: 10/03/2024] [Indexed: 10/20/2024] Open
Abstract
Aim: We aimed to explore whether there is an association between maternal perceived infant discomfort due to suggestive gastrointestinal alterations and oral-health-related quality of life (OHRQoL) through a survey. Materials and Methods: The present study included two main phases involving Portuguese-speaking parents with full-term infants aged 2-12 weeks old who were not previously hospitalized in a neonatal nursery. First, the original French Infant Colic Questionnaire (ColiQ) was translated, cross-culturally adapted and validated to Portuguese (ColiQ-PT). Then, a survey was distributed, and included sociodemographics, the ColiQ-PT, an oral health value scale, OHRQoL, self-perceived periodontal status, and smoking and oral health habits. Data were analyzed through inferential, correlation and multivariate logistic models in this cross-sectional study. Results: The ColiQ-PT revealed reliability and validity. From a total of 421 responses, higher infant discomfort was correlated with less maternal professional dental care prioritization (ρ = -0.096, p < 0.05). Self-perceived periodontitis correlated with all items of OHRQoL (p < 0.001), all seven OHIP-14 domains, and with the physical (p < 0.001), psychological (p = 0.006), and social (p = 0.011) super-domains. While the infant-related score was associated with baby age (p = 0.023) and physical pain (p = 0.040) related to OHRQoL, the parent score was associated with education (p = 0.005), unemployment (p = 0.035), and physical pain (p = 0.017). The total ColiQ-PT score was significantly associated with more deteriorated social disability related to maternal OHRQoL (ρ = -0.130, p < 0.05). Conclusions: Perceived infant discomfort seems to be linked to maternal deteriorated OHRQoL. This finding highlights the importance of prioritizing oral health in postpartum care. Further research is needed to explore the mechanisms underlying this association and to develop targeted interventions.
Collapse
Affiliation(s)
- Lisetty Garrido
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| | - Inês Rodrigues
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| | - Patrícia Lyra
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| | - Luís Proença
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| | - João Botelho
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| | - Sónia Frota
- Center of Linguistics, School of Arts and Humanities, University of Lisbon, 1600-214 Lisboa, Portugal;
| | - José João Mendes
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| | - Vanessa Machado
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal; (L.G.); (I.R.); (P.L.); (L.P.); (J.B.); (J.J.M.)
| |
Collapse
|
|
30
|
Pinon A, Trentesaux C, Chaffaut C, Lemaire M, Parere X, Lecerf JM, Schnebelen-Berthier C. Infant growth and tolerance with a formula based on novel native demineralized whey: A randomized double-blind pilot study. J Pediatr Gastroenterol Nutr 2024; 79:905-914. [PMID: 38988234 DOI: 10.1002/jpn3.12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/22/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES The aim of the study was to evaluate the effects on infant growth and tolerance of a Test infant formula based on a novel whey extraction and demineralization process, compared to a Standard formula and a breastfed reference arm. METHODS Healthy term infants (n = 61) aged up to 21 days were randomized to Test or Control formula. A breastfed group (n = 39) served as a reference. Growth, tolerance, adverse events, and sleep were evaluated every month until 6 months of age. Plasma amino-acid concentrations at 3 months of age were measured in a subgroup population. RESULTS Growth curves of all infants globally agreed with World Health Organization standards across the 6-month period study. Regarding tolerance, no difference between the formula-fed groups was observed on daily number of crying episodes, intensity or time to onset of regurgitations, and stool frequency or consistency, except at 5 months with infants in the Control group having more watery stools. Plasma concentration of some amino acids differed between the groups, especially tryptophan concentration which was higher in infants fed with the Test formula. In parallel, total sleep duration was longer in these infants at 2, 3, and 5 months of age, corresponding to an increase in daytime sleep. CONCLUSIONS Test formula supported an adequate infant growth from birth to 6 months of age and was well-tolerated by all infants. An increase in total sleep at several months was also observed with the Test formula.
Collapse
Affiliation(s)
- Anthony Pinon
- Clinical Research Department, Centre Prévention Santé Longévité - Institut Pasteur de Lille, Lille, France
| | - Claire Trentesaux
- Clinical Research Department, Centre Prévention Santé Longévité - Institut Pasteur de Lille, Lille, France
| | | | - Marion Lemaire
- Research & Innovation Center, Sodiaal Group, Rennes, France
| | - Xavier Parere
- Research & Innovation Center, Sodiaal Group, Rennes, France
| | - Jean-Michel Lecerf
- Clinical Research Department, Centre Prévention Santé Longévité - Institut Pasteur de Lille, Lille, France
| | | |
Collapse
|
|
31
|
Ateş Beşirik S, Geçkil E. The effect of therapeutic touch on colic symptoms in infantile colic infants: A randomised controlled study. J Paediatr Child Health 2024; 60:569-578. [PMID: 39143930 DOI: 10.1111/jpc.16646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/26/2024] [Accepted: 08/04/2024] [Indexed: 08/16/2024]
Abstract
AIM This study aimed to examine the effects of therapeutic touch (TT) on infantile colic symptoms (Infant Colic Scale (ICS) score, crying time and sleep time). METHODS This randomised controlled trial included infants aged 4-12 weeks diagnosed with infantile colic in a pediatric unit of a hospital. Infants were assigned to intervention or control groups using a stratified randomisation method. The intervention group received TT sessions six times, 3 days a week, in addition to usual care for 2 weeks. The control group received the usual care. Data were collected using Mother-Infant Information Form, ICS, Crying and Sleep Time Follow-Up Forms. The infants were followed up for two weeks. RESULTS A total of 64 infants who met the criteria were included in the study, including intervention (n = 32) and control (n = 32) groups. There was a statistically significant difference between the groups (intervention and control) in terms of ICS scores (U = 4.5; P < 0.001; d = 3.252; 95% confidence interval (CI) = 2.505-3.999), crying time (F = 57.097; ŋp 2 = 0.461; P < 0.001) and sleep time (F = 17.884; ŋp 2 = 0.211; P < 0.001). When the intervention group was compared with the control group at all time points, the size of the effect (group × time interaction) was found to be high. CONCLUSIONS TT effectively relieved symptoms, decreased crying time and increased sleep time in infants with infantile colic. TT is recommended to relieve colic in infants.
Collapse
Affiliation(s)
- Selda Ateş Beşirik
- Department of Nursing, Department of Pediatric Nursing, Bucak School of Health, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Emine Geçkil
- Department of Pediatric Nursing, Nursing Faculty, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
|
32
|
Nau AL, Bassan AS, Cezar AB, de Carlos GA, Deboni M. Lactase for infantile colic: A systematic review of randomized clinical trials. J Pediatr Gastroenterol Nutr 2024; 79:855-862. [PMID: 38720550 DOI: 10.1002/jpn3.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 10/02/2024]
Abstract
Infantile colic is excessive crying for no apparent reason in an otherwise healthy infant. Although its physiopathology is not completely understood, therapies usually target gastrointestinal symptoms. This systematic review of randomized controlled trials (RCTs) analyzes the efficacy of lactase supplementation in infantile colic. PubMed, Embase, and Cochrane were searched for RCTs evaluating lactase supplementation in infants up to 6 months old with infantile colic. Out of six RCTs including 394 patients, three reported a significantly shorter crying time in the lactase group than in the placebo group, while the other three found no significant difference between groups. Of the two studies that performed the hydrogen breath test, only one reported a significant reduction in exhaled hydrogen levels. The pharmacological approach to infantile colic remains debatable, and new studies with standardized diagnostic criteria and outcomes are required to guide lactase supplementation in clinical practice.
Collapse
Affiliation(s)
- Angélica Luciana Nau
- Division of Pediatric Gastroenterology, Hospital Jaraguá, Jaraguá do Sul, Brazil
| | | | | | | | - Mariana Deboni
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
|
33
|
Chen XL, Jiang MZ. [Research progress of metabolomics in children with irritable bowel syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:989-994. [PMID: 39267517 PMCID: PMC11404471 DOI: 10.7499/j.issn.1008-8830.2404130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by symptoms such as abdominal pain, diarrhea, constipation, and indigestion. Given its unclear etiology and pathogenesis, and the absence of specific biomarkers, clinical diagnosis and treatment of IBS continue to pose significant challenges. In recent years, metabolomics technology, known for its non-invasive, high-throughput, high-precision, and highly reproducible features, has been widely applied in the diagnosis, treatment, and prognosis of various diseases. Therefore, metabolomics technology is expected to offer novel insights and methodologies for the biological mechanism research, diagnosis, and treatment of IBS. This article reviews recent advancements in the application of metabolomics to IBS, exploring its potential value in the clinical diagnosis and treatment of children with this condition.
Collapse
Affiliation(s)
- Xiao-Long Chen
- Department of Gastroenterology and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health/National Children's Regional Medical Center, Hangzhou 310052, China
| | | |
Collapse
|
|
34
|
Homan M, Jones NL, Bontems P, Carroll MW, Czinn SJ, Gold BD, Goodman K, Harris PR, Jerris R, Kalach N, Kori M, Megraud F, Rowland M, Tavares M. Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023). J Pediatr Gastroenterol Nutr 2024; 79:758-785. [PMID: 39148213 DOI: 10.1002/jpn3.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Evolving epidemiological data and increasing antibiotic resistance mandate an update of the European and North American Societies of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. METHODS Certainty of evidence and strength of recommendations were rated by experts according to the Grading of Recommendation Assessment, Development, and Evaluation approach. PICO (patient population, intervention, comparator, and outcome) questions were developed and voted on by the group. Recommendations were formulated using the Evidence to Decision framework. RESULTS The current literature supports many of the previous recommendations and several new recommendations. Invasive testing with strain antimicrobial susceptibility analysis is recommended for the diagnosis and selection of eradication therapy for H. pylori infection. Molecular methods are acceptable for detection of infection and of antibiotic resistance in gastric biopsy specimens. Reliable, noninvasive tests can be used as a screening method for children with history of gastric cancer in a first-degree relative. When investigating causes of chronic immune thrombocytopenic purpura, testing for H. pylori is no longer recommended. When investigating other diseases such as inflammatory bowel disease, celiac disease, or eosinophilic esophagitis, specific diagnostic biopsies for H. pylori infection are not indicated. However, if H. pylori is an incidental finding, treatment may be considered after discussing the risks and benefits. Treatment should be based on antibiotic antimicrobial susceptibility testing and, if unavailable, regimens containing clarithromycin should be avoided. CONCLUSIONS Due to decreasing prevalence of infection, increasing challenges with antibiotic resistance, and emerging evidence regarding complications of infection, clinicians must be aware of these recommended changes to appropriately manage H. pylori infection and its clinical sequelae in children.
Collapse
Affiliation(s)
- Matjaž Homan
- Faculty of Medicine, Children's Hospital in Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Nicola L Jones
- Division of Gastroenterology Hepatology and Nutrition, SickKids, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Université Libre de Bruxelles, Hôpital Unversitaire des Enfants Reine Fabiola, Hôpitaux Universitaires de Bruxelles, Brussels, Belgium
| | - Matthew W Carroll
- Division of Gastroenterology and Nutrition, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J Czinn
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Benjamin D Gold
- GI Care for Kids, LLC, Children's Center for Digestive Healthcare LLC, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Karen Goodman
- Faculty of Medicine and Dentistry, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Paul R Harris
- Department of Pediatric Gastroenterology and Nutrition, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Robert Jerris
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicolas Kalach
- Department of Pediatrics, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University of Lille, Lille, France
| | - Michal Kori
- Pediatric Gastroenterology, Kaplan Medical Center, Rehovot, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Marion Rowland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Marta Tavares
- Unidade de Gastroenterologia, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| |
Collapse
|
|
35
|
Beaudry-Bellefeuille I, Ramos-Polo E. Improving Participation in Toileting Routines in a Child with Functional Constipation: A Case Study Using the Integrated Sensory Toileting® Approach. Occup Ther Health Care 2024:1-12. [PMID: 39177311 DOI: 10.1080/07380577.2024.2394947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 08/18/2024] [Indexed: 08/24/2024]
Abstract
This article presents a case report of a three and half year-old boy with functional constipation and sensory hyperreactivity. The Integrated Sensory Toileting® approach was used to guide clinical reasoning and identify the sensory underlying factors that were impacting the child's ability to acquire age-appropriate toileting habits and gastrointestinal health. The six months of treatment in occupational therapy and gastroenterology, as well as six months of follow-up are described. Improvements in sensory reactivity are documented using the Sensory Processing Measure-2 and the Toileting Habit Profile Questionnaire-Revised and corroborate with improvements in the child's ability to participate in toileting routines and improved gastrointestinal health.
Collapse
|
|
36
|
Du W, Yan C, Wang Y, Li Y, Tian Z, Liu Y, Shen W. Association between dietary copper intake and constipation in US adults. Sci Rep 2024; 14:19237. [PMID: 39164414 PMCID: PMC11336257 DOI: 10.1038/s41598-024-70331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
Dietary micronutrients are integral to the development and progression of constipation; however, the specific relationship between dietary copper intake and constipation has not been thoroughly investigated. This study aims to examine the correlation between dietary copper intake and constipation among U.S. adults, thereby offering novel insights and recommendations for the clinical management and prevention of constipation. Bowel health data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2010 were analyzed. Subjects' dietary information was collected through questionnaire records. Multivariate logistic regression analysis, subgroup analysis, and curve fitting analysis were used to assess the correlation between dietary copper intake and chronic constipation. After adjusting for all possible confounders, each unit increase in dietary copper intake (converted to natural logarithms) was associated with a 20% reduction in the prevalence of constipation (OR = 0.80; 95% CI 0.65-0.98; P = 0.037). The interaction P-values for all subgroups were greater than 0.05, indicating that the findings were stable and consistent across subgroups. The present study showed a significant negative association between dietary copper intake and chronic constipation in adults. This finding raises clinical and healthcare professionals' awareness of the impact of dietary trace elements on intestinal health and has important implications for the development of personalized meal plans and rational supplementation of trace copper in patients with constipation.
Collapse
Affiliation(s)
- Wenyi Du
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chen Yan
- Medical Imaging Centre, Tengzhou Central People's Hospital, Jining Medical College, Shandong, China
| | - Yinkang Wang
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yunfan Li
- Department of General Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhiqiang Tian
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yuan Liu
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China.
| | - Wei Shen
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China.
| |
Collapse
|
|
37
|
Al Khashram N, Al Abdulqader AA, Alarfaj HM, Bu Bshait MS, Kamal AH, Zakaria OM, Albarqi MN, Almulhim MA, Almousa MA, Almaqhawi A. Exploring Community Perspectives on Functional Paediatric Habitual Constipation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1017. [PMID: 39200628 PMCID: PMC11354896 DOI: 10.3390/ijerph21081017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024]
Abstract
(1) Background: Functional habitual constipation (FC) in children is a common gastrointestinal problem. This study aimed to explore the local community's view on this problem, emphasising the challenges that parents face in managing the condition and its impact on the child's quality of life. (2) Methods: A prospective, cross-sectional, community-based study was conducted between March and July 2023. The survey received 933 responses. The target population was adults over 18 years of age living in the Eastern Province of Saudi Arabia. An electronically distributed questionnaire was designed in the Arabic language. (3) Results: The mean knowledge scores were significantly higher in females than males, with t (931) = -2.701 and p = 0.007. The Bonferroni post hoc test results indicated that participants between 20 and 29 years exhibited significantly higher levels of knowledge scores compared to those between 30 and 39 years. Furthermore, the results revealed that those with three or more children had significantly higher knowledge scores compared to those with only one child. (4) Conclusions: This study demonstrated that parents in the local community have a good perceived knowledge of FC, but it needs to be linked with practice. They tended to report high levels of perception and demonstrated better practices. These results emphasise the importance of exploring the local community's view on constipation among children.
Collapse
Affiliation(s)
- Nawaf Al Khashram
- Department of Biomedical Sciences, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Ahmad A. Al Abdulqader
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Haytham Mohammed Alarfaj
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Mohammed Saad Bu Bshait
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Ahmed Hassan Kamal
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Ossama M. Zakaria
- Departments of Surgery, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | - Mohammed Nasser Albarqi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| | | | | | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
| |
Collapse
|
|
38
|
Solasaari T, Korpela K, Lommi S, Hyvönen S, Gardemeister S, Merras-Salmio L, Salonen A, de Vos WM, Kolho KL. Bowel function in a prospective cohort of 1052 healthy term infants up to 4 months of age. Eur J Pediatr 2024; 183:3557-3565. [PMID: 38819500 PMCID: PMC11263225 DOI: 10.1007/s00431-024-05625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
The purpose of this study is to describe the defecation pattern of healthy infants up to 17 weeks of age. We included 1052 healthy term infants from the prospective HELMi cohort (NCT03996304). Parents filled in recurring online questionnaires on feeding, gastrointestinal function, and crying weekly for the first 17 weeks of life. Defecation frequency was highest at the age of 3 weeks (a median of 4 times/day, interquartile range (IQR) 2.9-5). At each time point, the median defecation frequency of breastfed infants was higher than that of infants receiving formula (e.g., at week 17 a median of 2 times/day, IQR 0.9-3.6, and a median of 1.1, IQR 0.6-1.4, respectively). The dominant color of the stool was most often yellow or light brown. Nearly black stools were reported in the first week of life in 3.4%. Nearly half (47.4%) of the infants had green stool color dominating for at least 1 week, with comparable frequency among breastfed (47.7%) and formula-fed (45.2%) infants. Green stools were associated with a higher defecation frequency (linear mixed-effect model p < 0.0001). Occasional blood in stool was reported in 9.3% and recurrent blood in 5.2% of the infants with no difference in stool consistency. Hard stools were rare (≤ 1%). Conclusion: This study enlightens the spectrum of defecation patterns in healthy term infants during the first 17 weeks of life. A better understanding of bowel function helps healthcare professionals distinguish normal from abnormal when addressing defecation, the color of stools, and the type of feeding. What is Known: • Breastfed infants have more frequent and more yellow-colored stools than formula-fed infants. • Stools with green color are often suggested by the parents or even by medical professionals to indicate disease or discomfort in early life. What is New: • Nearly half of the healthy term infants had green stool dominating for at least one week during the first 17 weeks and occasional blood was reported in almost 10% of the infants during this period. • Data on normal variation in bowel function and stool may serve primary health care professionals when educating the families and caretakers of infants.
Collapse
Affiliation(s)
- Terhi Solasaari
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Clinic, Social Services and Health Care Division, Helsinki, Finland
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sohvi Lommi
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Sanni Hyvönen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | | | | | - Anne Salonen
- Laboratory of Microbiology, Wageningen University, Wageningen, the Netherlands
| | - Willem M de Vos
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Laboratory of Microbiology, Wageningen University, Wageningen, the Netherlands
| | - Kaija-Leena Kolho
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Children's Hospital, University of Helsinki and HUS, Helsinki, Finland.
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
| |
Collapse
|
|
39
|
Engel B, Diestelhorst J, Hupa-Breier KL, Kirchner T, Henjes N, Loges S, Yuksel M, Janczyk W, Lalanne C, Zachou K, Oo YH, Gournay J, Pape S, Drenth JPH, Renand A, Dalekos GN, Muratori L, Socha P, Ma Y, Arikan C, Baumann U, Manns MP, Wedemeyer H, Junge N, Jaeckel E, Taubert R. Detection of polyreactive immunoglobulin G facilitates diagnosis in children with autoimmune hepatitis. Hepatol Int 2024; 18:1214-1226. [PMID: 38976227 PMCID: PMC11297808 DOI: 10.1007/s12072-024-10695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/26/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE The detection of autoantibodies is essential to diagnose autoimmune hepatitis (AIH). Particularly in children, specificity of autoantibodies decreases due to lower titers being diagnostic and being present not only in AIH but also in other liver diseases. Recently, quantification of polyreactive IgG (pIgG) for detection of adult AIH showed the highest overall accuracy compared to antinuclear antibodies (ANA), anti-smooth muscle antibodies (anti-SMA), anti-liver kidney microsomal antibodies (anti-LKM) and anti-soluble liver antigen/liver pancreas antibodies (anti-SLA/LP). We aimed to evaluate the diagnostic value of pIgG for pediatric AIH. DESIGN pIgG, quantified using HIP1R/BSA coated ELISA, and immunofluorescence on rodent tissue sections were performed centrally. The diagnostic fidelity to diagnose AIH was compared to conventional autoantibodies of AIH in training and validation cohorts from a retrospective, European multi-center cohort from nine centers from eight European countries composed of existing biorepositories from expert centers (n = 285). RESULTS IgG from pediatric AIH patients exhibited increased polyreactivity to multiple protein and non-protein substrates compared to non-AIH liver diseases and healthy children. pIgG had an AUC of 0.900 to distinguish AIH from non-AIH liver diseases. pIgG had a 31-73% higher specificity than ANA and anti-SMA and comparable sensitivity that was 6-20 times higher than of anti-SLA/LP, anti-LC1 and anti-LKM. pIgG had a 21-34% higher accuracy than conventional autoantibodies, was positive in 43-75% of children with AIH and normal IgG and independent from treatment response. CONCLUSION Detecting pIgG improves the diagnostic evaluation of pediatric AIH compared to conventional autoantibodies, primarily owing to higher accuracy and specificity.
Collapse
Affiliation(s)
- Bastian Engel
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany.
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.
| | - Jana Diestelhorst
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Nephrology, Hepatology and Metabolic Disorders, Hannover Medical School, Hannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University Clinic for Haematology, UKRUB, University of Bochum, Minden, Germany
| | - Katharina Luise Hupa-Breier
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Theresa Kirchner
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Nicole Henjes
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Stephanie Loges
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Muhammed Yuksel
- Institute of Liver Studies, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College Hospital, King's College London, London, UK
- Koç University Research Centre for Translational Medicine (KUTTAM)-Liver Immunology Lab, Istanbul, Turkey
- Department of Biomedical Sciences, College of Liberal Arts and Life Sciences, University of Westminster, London, UK
| | - Wojciech Janczyk
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Claudine Lalanne
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Kalliopi Zachou
- Institute of Internal Medicine and Hepatology, Larissa, Greece
- l University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ye H Oo
- Centre for Liver and Gastro Research, National Institute of Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, The Medical School, Birmingham, United Kingdom & Liver transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jérôme Gournay
- Institut Des Maladies de L'Appareil Digestif (IMAD), Nantes Université, CHU Nantes, Hépato-Gastro-Entérologie, Inserm CIC 1413, 44000, Nantes, France
| | - Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Amédée Renand
- Center for Research in Transplantation and Translational Immunology, Nantes Université, UMR 1064, Inserm, 44000, Nantes, France
| | - George N Dalekos
- Institute of Internal Medicine and Hepatology, Larissa, Greece
- l University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Luigi Muratori
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Piotr Socha
- Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Yun Ma
- Institute of Liver Studies, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College Hospital, King's College London, London, UK
| | - Cigdem Arikan
- Koç University Research Centre for Translational Medicine (KUTTAM)-Liver Immunology Lab, Istanbul, Turkey
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Koç University School of Medicine, Istanbul, 34010, Turkey
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Nephrology, Hepatology and Metabolic Disorders, Hannover Medical School, Hannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Norman Junge
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Nephrology, Hepatology and Metabolic Disorders, Hannover Medical School, Hannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Ajmera Transplant Center, Toronto General Hospital, United Health Network, University of Toronto, Toronto, Canada
| | - Richard Taubert
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, HepatologyHannover, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| |
Collapse
|
|
40
|
Faruga-Lewicka W, Bielaszka A, Staśkiewicz-Bartecka W, Opiołka S, Kiciak A, Kardas M. Evaluation of Diet and Symptom Severity in Disorder of Gut-Brain Interaction. J Clin Med 2024; 13:4132. [PMID: 39064172 PMCID: PMC11277627 DOI: 10.3390/jcm13144132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Disorders of gut-brain interaction are chronic or recurrent symptoms originating in the gastrointestinal tract that cannot be substantiated by the results of standard clinical tests, such as radiologic studies, morphologies, or endoscopic examination. The diagnosis of these disorders is mainly based on symptoms and the standardized Rome IV criteria. These criteria classify functional disorders of the gastrointestinal tract according to anatomical location and define each disorder according to a set of symptoms. Methods: This study was conducted between October 2021 and February 2022. Participants in the study were patients of a gastroenterology outpatient clinic with a functional disease diagnosed by a gastroenterologist. A questionnaire was used to conduct the study, with questions regarding perceived functional discomforts of the gastrointestinal tract, dietary changes to alleviate discomforts, and frequency of consumption of various food groups. Results: Based on the study, statistical significance was demonstrated between the gender of the respondents and the severity of gastrointestinal complaints after the consumption of legumes and alcohol. The analysis performed confirmed the correlation between the age of the respondents and the severity of complaints when consuming raw vegetables and fruits, brassica vegetables, legumes, fried products, and spicy products. There was also a significant correlation between the body mass index (BMI) of the respondents and the severity of complaints after alcohol consumption. Conclusions: The results identify abdominal pain, bloating, and constipation as the most commonly reported gastrointestinal symptoms among participants. The association between the consumption of certain foods, such as milk and dairy products, as well as fried and fatty foods, and the severity of disorders of gut-brain interaction symptoms was confirmed. Despite this, the majority of respondents did not eliminate any food products to alleviate the discomfort.
Collapse
Affiliation(s)
- Wioleta Faruga-Lewicka
- Department of Food Technology and Quality Evaluation, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-808 Zabrze, Poland; (A.B.); (W.S.-B.); (S.O.); (A.K.); (M.K.)
| | | | | | | | | | | |
Collapse
|
|
41
|
Haiden N, Savino F, Hill S, Kivelä L, De Koning B, Kӧglmeier J, Luque V, Moltu SJ, Norsa L, De Pipaon MS, Verduci E, Bronsky J. Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr 2024; 79:168-180. [PMID: 38766683 DOI: 10.1002/jpn3.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high β-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding.
Collapse
Affiliation(s)
- Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Linz, Austria
| | - Francesco Savino
- Department of Patologia e cura del bambino "Regina Margherita" Regina Margherita Children Hospital, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Susan Hill
- Nutrition and Intestinal Failure Division, Gastroenterology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Laura Kivelä
- Celiac Disease Research Center, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland; Research Institute, University of Oslo, Oslo, Norway
| | - Barbara De Koning
- Department of Pediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jutta Kӧglmeier
- Unit of Nutrition and Intestinal Failure Rehabilitation, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Veronica Luque
- Serra Húnter Fellow, Paediatric Nutrition and Development Research Unit, Universitat Rovira i Virgili-IISPV, Tarragona, Spain
| | - Sissel J Moltu
- Department of Neonatal Intensive Care, Oslo University Hospital, Norway Pediatric, Oslo, Norway
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Miguel Saenz De Pipaon
- Neonatology Hospital La Paz Institute for Health Research - IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elvira Verduci
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | - Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| |
Collapse
|
|
42
|
Kilgore A, Khlevner J. Functional Constipation: Pathophysiology, evaluation, and management. Aliment Pharmacol Ther 2024; 60 Suppl 1:S20-S29. [PMID: 38925548 DOI: 10.1111/apt.17852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND Functional constipation (FC), a disorder of the gut-brain interaction of multifactorial pathophysiology that is prevalent in paediatrics. It is associated with bothersome symptoms, increased healthcare costs, disgruntled caregivers and impaired health-related quality of life. Paediatric FC is a clinical diagnosis based on the Rome IV criteria and is characterised by decreased bowel movement frequency and/or hard, painful stools and can be complicated by retentive faecal incontinence. Stressful life events, difficult temperaments and emotional and behavioural challenges have been implicated in increasing risk of developing paediatric FC. AIMS To provide current concepts in pathophysiology, evaluation and management of paediatric FC. METHODS We reviewed pertinent literature after a comprehensive search utilising PubMed with keywords FC, chronic childhood constipation and paediatric FC. RESULTS In the last decade, advances in our understanding of paediatric FC have changed the landscape of diagnosing and treating this disorder. Although polyethylene glycol is the first-line treatment for maintenance of FC, the armamentarium of therapeutics has expanded including the first Food and Drug Administration- agent, linaclotide, for children 6-17 years of age in conjunction with more emphasis on behavioural and physical therapy interventions. CONCLUSIONS Treatment approach to paediatric FC should be individualised and integrated focusing on parental education, lifestyle and behavioural modifications, and pharmacological therapy to maximise therapeutic success. This review highlights advances in pathophysiology, diagnosis and treatment of FC in children.
Collapse
Affiliation(s)
- Alexandra Kilgore
- Digestive Health Institute, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| |
Collapse
|
|
43
|
Carson RA, Lyles JL. Cognitive Bias in an Infant with Constipation. J Pediatr 2024; 270:113996. [PMID: 38432294 DOI: 10.1016/j.jpeds.2024.113996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Rebecca A Carson
- Clinical Assistant Professor, Conway School of Nursing, The Catholic University of America, Washington, DC
| | - John L Lyles
- Assistant Professor of Pediatrics, Division of Gastroenterology/Hepatology/Nutrition, Duke University School of Medicine, Durham, NC.
| |
Collapse
|
|
44
|
Sinopoulou V, Gordon M, Rajindrajith S, Hathagoda W, Rane AB, Sedghi A, Tabbers M, Di Lorenzo C, Saps M, Benninga MA. How do we define therapy-resistant constipation in children aged 4-18 years old? A systematic review with meta-narrative synthesis. BMJ Paediatr Open 2024; 8:e002380. [PMID: 38844387 PMCID: PMC11163682 DOI: 10.1136/bmjpo-2023-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/17/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Therapy-resistant constipation often is a frustrating clinical entity recognised by the persistence of infrequent and painful bowel movements faecal incontinence and abdominal pain despite intensive treatment. It is important to clearly define therapy-resistant constipation before children are subjected to invasive diagnostic and therapeutic procedures. AIM To conduct a systematic review determining how paediatric interventional studies define therapy-resistant constipation. METHOD We searched CENTRAL, MEDLINE, Embase, WHO ICTR and ClinicalTrials.gov. Studies that included patients with therapy-resistant constipation were identified. Data were extracted on criteria used for defining therapy-resistant constipation and reported using a meta-narrative approach highlighting areas of convergence and divergence in the findings. RESULTS A total of 1553 abstracts were screened in duplicate, and 47 studies were included in the review. There were at least seven definitions used in the paediatric literature to define medically resistant constipation. The term intractable was used in 24 articles and 21 used the term refractory to describe therapy-resistant constipation. Out of them, only 14 articles have attempted to provide an explicit definition including a predefined time and prior therapy. There were 10 studies without a clear definition for therapy-resistant constipation. The duration before being diagnosed as therapy-resistant constipation varied from 1 months to 2 years among studies. Seven studies employed the Rome criteria (Rome III or Rome IV) to characterising constipation while five adopted the Rome III and European and North American paediatric societies definition of paediatric gastroenterology, hepatology and nutrition guideline of management of constipation in children. CONCLUSION The current literature has no explicit definition for therapy-resistant constipation in children. There is a need for a detailed consensus definition to ensure consistency of future research and to avoid unnecessary and maybe even harmful, invasive diagnostic and therapeutic interventions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Miguel Saps
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marc A Benninga
- Department of Pediatrics, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| |
Collapse
|
|
45
|
Zeevenhooven J, Zeevenhooven L, Biesbroek A, Schappin R, Vlieger AM, van Sleuwen BE, L'Hoir MP, Benninga MA. Functional gastrointestinal disorders, quality of life, and behaviour in adolescents with history of infant colic. Acta Paediatr 2024; 113:1435-1443. [PMID: 38535502 DOI: 10.1111/apa.17215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 06/09/2024]
Abstract
AIM To assess the prevalence of functional gastrointestinal disorders (FGIDs), health-related quality of life (HRQOL), and behavioural problems in a cohort of adolescents with a history of infant colic (IC), as defined by Wessel's criteria. METHODS 388 adolescents, aged 15-18 years, who participated in a randomised controlled trial for infants with colic, were invited for our observational follow-up study. Prevalence of FGIDs was assessed with the Rome IV Questionnaire on Paediatric Gastrointestinal Disorders (RIV-QPGD), HRQOL through self-report of the Paediatric Quality of Life Inventory (PedsQL), and behavioural problems through parent-report of the child behaviour checklist (CBCL). Multivariable models were used to compare prevalence rates of FGIDs and HRQOL scores. RESULTS 190 (49%) adolescents with a history of IC (cases) and 381 controls were included (median age 17.0 [IQR 16.0-17.0] and 16.0 [15.0-17.0] years, respectively). Cases had a significantly higher risk for postprandial distress syndrome compared to controls (aOR 2.49 (95%CI 1.18-5.25), p = 0.002). After multivariable regression, total, physical and school HRQOL scores were significantly lower in cases compared to controls (p = 0.003, 0.001, and 0.009). CONCLUSION Adolescents with a history of IC demonstrate higher prevalence rates of postprandial distress syndrome compared to controls. However, conclusions should be made with caution due to attrition and information bias.
Collapse
Affiliation(s)
- Judith Zeevenhooven
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucas Zeevenhooven
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela Biesbroek
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske Schappin
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Monique P L'Hoir
- Nutrition and Health over the Lifecourse, Wageningen University & Research, Wageningen, The Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
|
46
|
Abstract
Diet plays an important role in human health and disease. Of all human diseases, diarrheal illnesses bring diet into sharp focus as it has a direct causal and therapeutic relationship. With the advent and widespread use of next generation sequencing, significant advances have been made in unraveling the etiologies of congenital diarrheas and enteropathies, some of which are eminently treatable with dietary modification. Early institution of appropriate dietary therapy is lifesaving in congenital osmotic diarrheas. Chronic diarrhea in older children and adolescents often have an underlying dietary basis, depending on the etiology. Identification and exclusion of the offending food in the diet results in dramatic improvement in symptoms. It is equally important to be prudent and cautious in the use of exclusion diets in management of chronic diarrhea as it is associated with micronutrient deficiencies, needless escalation of cost and enable maladaptive food intake behaviors. In this review, authors discuss etiology specific dietary management of diarrhea in children with emphasis on congenital diarrheas and enteropathies.
Collapse
Affiliation(s)
- Sahana Shankar
- Division of Pediatric Gastroenterology, Department of Pediatrics, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India.
| | - Emmany Durairaj
- Department of Clinical Nutrition and Dietetics, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India
| |
Collapse
|
|
47
|
Tóbi L, Prehoda B, Balogh AM, Nagypál P, Kovács K, Miheller P, Iliás Á, Dezsőfi-Gottl A, Cseh Á. Transition is associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer in pediatric-onset inflammatory bowel disease patients: results of a longitudinal, follow-up, controlled study. Therap Adv Gastroenterol 2024; 17:17562848241252947. [PMID: 39156978 PMCID: PMC11327998 DOI: 10.1177/17562848241252947] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/15/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Despite the continuously rising rate of pediatric-onset inflammatory bowel diseases (PIBD), there are no consensus transitional guidelines or standardized practices. OBJECTIVES We aimed to examine: (1) the determinants of a successful transfer, (2) the effects of the transfer versus transition on the disease course and patient compliance, (3) the unique characteristics of PIBD patients, that need special attention in adult care. DESIGN Longitudinal, follow-up, controlled study conducted between 2001 and 2022, with retrospective data collection until 2018, thence prospective. METHODS Three hundred fifty-one PIBD patients enrolled in the study, of whom 152 were moved to adult care, with a mean post-transfer follow-up time of 3 years. Seventy-three patients took part in structured transition, whereas 79 self-transferred to adult care. The main outcome measures were disease activity (defined by PCDAI, PUCAI, CDAI, and Mayo-scores) and course, hospitalizations, surgeries, IBD-related complications, including anthropometry and bone density, patient compliance, medication adherence, and continuation of medical care. RESULTS Patients who underwent structured transition spent significantly more time in remission (83.6% ± 28.5% versus 77.5% ± 29.7%, p = 0.0339) and had better adherence to their medications (31.9% versus 16.4% non-adherence rate, p = 0.0455) in adult care, with self-transferred patients having a 1.59-fold increased risk of discontinuing their medical care and a 1.88-fold increased risk of experiencing a relapse. Post-transfer the compliance of patients deteriorated (38.5% versus 29%, p = 0.0002), with the highest lost-to-follow-up rate during the changing period between the healthcare systems (12.7%), in which female gender was a risk factor (p = 0.010). PIBD patients had experienced IBD-related complications (23.4%) and former surgeries (15%) upon arriving at adult care, with high rates of malnutrition, growth impairment, and poor bone health. CONCLUSION Structured transition plays a key role in ensuring the best disease course and lowering the lost-to-follow-up rate among PIBD patients. BRIEF SUMMARY Structured transition plays a key role in ensuring the best disease outcome among PIBD patients, as in our study it was associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer.
Collapse
Affiliation(s)
- Luca Tóbi
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Post Office Box 2, Budapest 1428, Hungary
| | - Bence Prehoda
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Anna M. Balogh
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Petra Nagypál
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Krisztián Kovács
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Miheller
- Department of Surgery, Transplantation, and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Ákos Iliás
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Antal Dezsőfi-Gottl
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Áron Cseh
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| |
Collapse
|
|
48
|
Petropoulos A, Anesiadou S, Michou M, Lymperatou A, Roma E, Chrousos G, Pervanidou P. Functional Gastrointestinal Symptoms in Children with Autism and ADHD: Profiles of Hair and Salivary Cortisol, Serum Leptin Concentrations and Externalizing/Internalizing Problems. Nutrients 2024; 16:1538. [PMID: 38794776 PMCID: PMC11124526 DOI: 10.3390/nu16101538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Functional Gastrointestinal Disorders (FGIDs) present a higher prevalence in individuals with Neurodevelopmental Disorders (NDDs). The Stress System and the Gut-Brain axis (GBA) may mediate these relations. We aimed to assess the prevalence and profile of FGIDs in a clinical sample of children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) compared to typically developing children (TD) as well as to investigate possible relations between stress-related biomarkers and internalizing/externalizing problems in children with NDDS. METHODS In total, 120 children, aged between 4 and 12 years old, formed three groups (N = 40, each): ADHD, ASD and TD. Salivary cortisol, hair cortisol and serum leptin were measured. RESULTS The ASD group had more FGID problems than the TD group (p = 0.001). The ADHD and ASD groups had higher total internalizing/externalizing problems than the TD group (p < 0.0001, p < 0.0001, p = 0.005, respectively). Children with FGIDs showed more total, internalizing and externalizing problems compared to children without FGIDs (p < 0.0001, p < 0.0001, p = 0.041, respectively). The ADHD group showed lower AUCg values (p < 0.0001), while the hair cortisol was higher for the TD group (p < 0.0001). CONCLUSION In conclusion, children with NDDs had more FGID symptoms and present higher internalizing and externalizing problems. Children with ADHD and FGIDs had more internalizing problems compared to those without FGIDs. No differences in stress-related biomarkers were shown to differentiate children with NDDs with and without FGIDs. Future prospective studies including a greater number of children may elucidate the biological pathways linking these comorbidities.
Collapse
Affiliation(s)
- Andreas Petropoulos
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - Sophia Anesiadou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - Maria Michou
- Human Ecology Laboratory, Department of Home Economics and Ecology, Harokopio University, 17676 Athens, Greece;
| | - Aikaterini Lymperatou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- Postgraduate Program “The Science of Stress and Stress Promotion”, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Eleftheria Roma
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - George Chrousos
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
- Postgraduate Program “The Science of Stress and Stress Promotion”, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
| |
Collapse
|
|
49
|
潘 云, 吴 敏, 林 茜. [Research status and prospects of probiotics in functional gastrointestinal disorders in infants and toddlers]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:529-534. [PMID: 38802916 PMCID: PMC11135062 DOI: 10.7499/j.issn.1008-8830.2401141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/07/2024] [Indexed: 05/29/2024]
Abstract
Functional gastrointestinal disorders (FGIDs) are common digestive system diseases in children, which can severely affect the growth and development of infants and toddlers. Probiotics therapy, as a relatively safe treatment method, have attracted the attention of researchers. However, their effectiveness in treating FGIDs in infants and toddlers is still unclear. This article reviews the mechanisms of probiotics in treating FGIDs in infants and toddlers, explores the reasons for the inconsistency in various research results, and aims to provide assistance for the clinical treatment of FGIDs in infants and toddlers and future research.
Collapse
|
|
50
|
Howe-Heyman A. Systematic Reviews to Inform Practice, May/June, 2024. J Midwifery Womens Health 2024; 69:427-435. [PMID: 38768070 DOI: 10.1111/jmwh.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Abby Howe-Heyman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|