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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: closed (10 October 2022) | Viewed by 21079

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Special Issue Editors

Prof. Dr. Jaroslaw Kierkus

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Guest Editor

Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
Interests: inflammatory bowel disease; celiac disease; clinical nutrition; endoscopy; pancreatitis

Prof. Dr. Dariusz M. Lebensztejn

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Guest Editor

Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
Interests: liver; nonalcoholic fatty liver disease; metabolic liver diseases; autoimmune hepatitis; diseases of the gallbladder; food allergy; eosinophilic esophagitis; inflammatory bowel disease; biomarkers

Special Issue Information

Dear Colleagues,

The knowledge of disorders in gastroenterology is constantly growing. The spectrum of the gastrointestinal and liver diseases in paediatric patients is very broad and varies from asymptomatic or mild disturbances to severe and even life-threatening pathologies. In recent years, a huge progress in paediatric gastroenterology has been made in both the diagnostics and treatment as well as in experimental and basic science research. However, there are still many gaps in the knowledge of pathogenesis, diagnostics and management of these diseases.

The aim of this Special Issue is to collect and publish original research articles and reviews demonstrating recent advances in pathogenesis, diagnostics and treatment in the field of paediatric gastroenterology. Since, your expertise is closely related to this Special Issue, we are pleased to invite you for the upcoming issue on “Recent Advances in Paediatric Gastroenterology”.

We look forward to receiving your contribution.

Prof. Dr. Jaroslaw Kierkus
Prof. Dr. Dariusz M. Lebensztejn
Guest Editors

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Keywords

Paediatric gastroenterology
gastrointestinal disorders
esophagus
stomach
small and large intestine
liver and bile ducts
pancreas
gastrointestinal procedures
diagnostics
treatment

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Published Papers (6 papers)

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Research

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9 pages, 243 KiB

Open AccessArticle

A New Viscous Budesonide Formulation for the Treatment of Eosinophilic Esophagitis in Children: A Preliminary Experience and Review of the Literature

by Joanna Warzecha, Marcin Dziekiewicz, Alicja Bieńkowska-Tokarczyk, Maciej Małecki and Aleksandra Banaszkiewicz

J. Clin. Med. 2022, 11(22), 6730; https://doi.org/10.3390/jcm11226730 - 14 Nov 2022

Cited by 1 | Viewed by 3207

Abstract

Eosinophilic esophagitis (EoE) is a chronic disease, characterized clinically by esophageal disfunction. Topical corticosteroids (tCS), predominantly fluticasone and budesonide, are considered the effective first line treatment, as well as an option of maintenance therapy in EoE. The way that tCS are administered significantly affects their effectiveness. There is still no ready-to-use steroid drug to be applied topically to the esophagus in children—a few experimental viscous slurries (mainly of budesonide) have been shown in trials to be more effective than steroids administered via metered dose inhalers (MDIs) and swallowed. The best examined steroid solvent of all is sucralose, a high-intensity artificial sweetener. Although it has been shown in a critical review that it is non-toxic and safe for all consumers, there are still some concerns among patients about its potential adverse effect on humans. Due to that fact, we developed a new viscous formulation and evaluated its effectiveness in the treatment of children with EoE. In an open, prospective, single-center study, we administered our new formulation of viscous budesonide twice daily for 8 weeks in patients with an active EoE. After treatment, we performed a control gastroscopy with the collection and evaluation of histopathological samples. We have proven our formulation effectiveness at 64%, as far as histological remission is concerned. We have also shown a reduction in the mean endoscopic reference score (EREFS) from 3.1 points at the beginning of the study to 1.6 points at the end of the study. Bearing in mind how important the acceptance of the solvent is for long-time compliance, especially among children, we also decided to assess the taste of the formulation. Therefore, we asked 46 adults and 10 children to swallow a sample of the solvent and fill in a short anonymous questionnaire about its taste, smell, consistency and easiness of swallowing. General acceptance for the proprietary solvent was high, reaching 7.5/10 among adults and 6.5/10 in children. To be able to compare the results of our preliminary experience, we reviewed the studies which evaluated substances that have been used so far as steroid solvents for the treatment of EoE. The overall effectiveness of the oral viscous budesonide (OVB) ranged from 65% to 90%, which is consistent with the results obtained in our study. Unfortunately, the high heterogeneity of the studies did not allow us to draw reliable conclusions. Full article

(This article belongs to the Special Issue Recent Advances in Paediatric Gastroenterology)

9 pages, 261 KiB

Open AccessFeature PaperArticle

Analysis of Sphingolipids in Pediatric Patients with Cholelithiasis—A Preliminary Study

by Katarzyna Zdanowicz, Anna Bobrus-Chcociej, Karolina Pogodzinska, Agnieszka Blachnio-Zabielska, Beata Zelazowska-Rutkowska, Dariusz Marek Lebensztejn and Urszula Daniluk

J. Clin. Med. 2022, 11(19), 5613; https://doi.org/10.3390/jcm11195613 - 23 Sep 2022

Cited by 6 | Viewed by 1821

Abstract

(1) Background: Disturbances in the sphingolipid profile are observed in many diseases. There are currently no data available on the evaluation of sphingolipids and ceramides in cholelithiasis in children. The aim of this study was to evaluate the concentrations of sphingolipids in the sera of pediatric patients with gallstones. We determined their relationship with anthropometric and biochemical parameters. (2) Methods: The concentrations of sphingolipids in serum samples were evaluated using a quantitative method, ultra-high-performance liquid chromatography–tandem mass spectrometry. (3) Results: The prospective study included 48 children and adolescents diagnosed with gallstones and 38 controls. Serum concentrations of total cholesterol (TC); sphinganine (SPA); ceramides—C14:0-Cer, C16:0-Cer, C18:1-Cer, C18:0-Cer, C20:0-Cer and C24:1-Cer; and lactosylceramides—C16:0-LacCer, C18:0-LacCer, C18:1-LacCer, C24:0-LacCer and C24:1-LacCer differed significantly between patients with cholelithiasis and without cholelithiasis. After adjusting for age, gender, obesity and TC and TG levels, we found the best differentiating sphingolipids for cholelithiasis in the form of decreased SPA, C14:0-Cer, C16:0-Cer, C24:1-LacCer and C24:0-LacCer concentration and increased C20:0-Cer, C24:1-Cer, C16:0-LacCer and C18:1-LacCer. The highest area under the curve (AUC), specificity and sensitivity were determined for C16:0-Cer with cholelithiasis diagnosis. (4) Conclusions: Our results suggest that serum sphingolipids may be potential biomarkers in pediatric patients with cholelithiasis. Full article

(This article belongs to the Special Issue Recent Advances in Paediatric Gastroenterology)

13 pages, 454 KiB

Open AccessArticle

Helicobacter pylori Infection in a Pediatric Population from Romania: Risk Factors, Clinical and Endoscopic Features and Treatment Compliance

by Oana-Maria Rosu, Nicoleta Gimiga, Gabriela Stefanescu, Carmen Anton, Gabriela Paduraru, Elena Tataranu, Gheorghe G. Balan and Smaranda Diaconescu

J. Clin. Med. 2022, 11(9), 2432; https://doi.org/10.3390/jcm11092432 - 26 Apr 2022

Cited by 9 | Viewed by 2765

Abstract

Background and Objectives: The aim of this study was to investigate the association between H. pylori positivity with specific symptoms, risk factors and endoscopic patterns among the pediatric population in northeastern Romania. Materials and Methods: A prospective study was performed in 18 months on 185 children aged 6–18 years with an indication for upper digestive endoscopy. Demographic, anamnestic, symptomatic, endoscopic and histologic data were recorded. Results: Of 116 H. pylori-positive children, the most affected group was 15–17 years. Most (65.5%) of them were girls, with a significant association (p < 0.001). The majority (66.4%) lived in a rural area and 47.4% of children had an unsafe source of water and lived in overcrowded houses with no basic sanitary comfort. The most frequent symptom was epigastric pain (56.9%), and the main endoscopic appearance was nodularity and hyperemia. Patients diagnosed with H. pylori started triple-therapy treatment for 14 days. Only 13.8% stopped the treatment, mainly because of a misunderstanding of the treatment protocol (9.5%). Conclusions: Romanian teen girls living in rural areas are at high risk for H. pylori infection. Epigastric pain and endoscopic nodularity of the gastric mucosa were associated with the infection. As the resistance of the bacteria is unknown in our country, future research is needed in order to improve the eradication rate. Full article

(This article belongs to the Special Issue Recent Advances in Paediatric Gastroenterology)

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11 pages, 454 KiB

Open AccessArticle

Combination of HLA-DQ2/-DQ8 Haplotypes and a Single MSH5 Gene Variant in a Polish Population of Patients with Type 1 Diabetes as a First Line Screening for Celiac Disease?

by Marta Wysocka-Mincewicz, Artur Groszek, Filip Ambrozkiewicz, Agnieszka Paziewska, Michalina Dąbrowska, Anna Rybak, Ewa Konopka, Agnieszka Ochocińska, Natalia Żeber-Lubecka, Jakub Karczmarski, Joanna B. Bierła, Ilona Trojanowska, Agnieszka Rogowska, Jerzy Ostrowski and Bożena Cukrowska

J. Clin. Med. 2022, 11(8), 2223; https://doi.org/10.3390/jcm11082223 - 15 Apr 2022

Cited by 1 | Viewed by 2697

Abstract

Patients with type 1 diabetes (T1D) are at increased risk for developing celiac disease (CD). The aim of the study was to assess the usefulness of celiac-specific human leukocyte antigen (HLA) haplotype and the rs3130484 variant of MSH5 gene, a previously described non-HLA variant associated with CD in the Polish population as a first-line screening for CD in T1D pediatric patients. Serological CD screening performed in the T1D group (n = 248) and healthy controls (n = 551) allowed for CD recognition in 20 patients (8.1%) with T1D (T1D + CD group). HLA-DQ2, HLA-DQ8 and the rs3130484 variant were genotyped with TaqMan SNP Genotyping Assays. The T1D + CD group presented a higher, but not statistically significant, frequency of HLA-DQ2 in comparison with T1D subjects. Combining the rs3130484 with HLA-DQ2/HLA-DQ8 typing significantly increased the sensitivity of HLA testing from 32.7% to 68.7%, and the accuracy of estimating CD prediction from 51.7% to 86.4% but decreased the specificity from 100% to 78.2%. The receiver operating characteristic curve analysis confirmed the best discrimination for the combination of both genetic tests with an area under curve reaching 0.735 (95% CI: 0.700–0.7690) in comparison with 0.664 (95% CI: 0.632–0.696) for HLA typing alone. Results show the low utility of HLA-DQ2/HLA-DQ8 typing for CD screening in T1D pediatric patients. Combination of the rs3130484 variant of the MSH5 gene and HLA testing increases both the sensitivity and the predictive value of the test accuracy, but still, the obtained values are not satisfactory for recommending such testing as the first-line screening for CD in T1D patients. Full article

(This article belongs to the Special Issue Recent Advances in Paediatric Gastroenterology)

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Review

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16 pages, 4548 KiB

Open AccessReview

Congenital Hyperinsulinaemic Hypoglycaemia—A Review and Case Presentation

by Sylwia Krawczyk, Karolina Urbanska, Natalia Biel, Michal Jakub Bielak, Agata Tarkowska, Robert Piekarski, Andrzej Igor Prokurat, Malgorzata Pacholska and Iwona Ben-Skowronek

J. Clin. Med. 2022, 11(20), 6020; https://doi.org/10.3390/jcm11206020 - 12 Oct 2022

Cited by 4 | Viewed by 2600

Abstract

Hyperinsulinaemic hypoglycaemia (HH) is the most common cause of persistent hypoglycaemia in infants and children with incidence estimated at 1 per 50,000 live births. Congenital hyperinsulinism (CHI) is symptomatic mostly in early infancy and the neonatal period. Symptoms range from ones that are unspecific, such as poor feeding, lethargy, irritability, apnoea and hypothermia, to more serious symptoms, such as seizures and coma. During clinical examination, newborns present cardiomyopathy and hepatomegaly. The diagnosis of CHI is based on plasma glucose levels <54 mg/dL with detectable serum insulin and C-peptide, accompanied by suppressed or low serum ketone bodies and free fatty acids. The gold standard in determining the form of HH is fluorine-18-dihydroxyphenyloalanine PET ((18)F-DOPA PET). The first-line treatment of CHI is diazoxide, although patients with homozygous or compound heterozygous recessive mutations responsible for diffuse forms of CHI remain resistant to this therapy. The second-line drug is the somatostatin analogue octreotide. Other therapeutic options include lanreotide, glucagon, acarbose, sirolimus and everolimus. Surgery is required in cases unresponsive to pharmacological treatment. Focal lesionectomy or near-total pancreatectomy is performed in focal and diffuse forms of CHI, respectively. To prove how difficult the diagnosis and management of CHI is, we present a case of a patient admitted to our hospital. Full article

(This article belongs to the Special Issue Recent Advances in Paediatric Gastroenterology)

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16 pages, 753 KiB

Open AccessReview

Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria)

by Angharad Vernon-Roberts, India Alexander and Andrew S. Day

J. Clin. Med. 2021, 10(21), 5087; https://doi.org/10.3390/jcm10215087 - 29 Oct 2021

Cited by 32 | Viewed by 5443

Abstract

Functional gastrointestinal disorders (FGID) are common among children and may cause a significant symptom burden. The Rome criteria are symptom-based guidelines for the assessment of FGID among children and adults. The aim of this systematic review was to estimate the prevalence of FGID utilizing the revised Rome IV criteria. Nine health databases were searched. The inclusion criteria were: prospective FGID prevalence data using the Rome IV criteria for children up to 18 years, and the exclusion criteria were: cohorts with known gastrointestinal or organic conditions. The data were presented as a percentage of children experiencing at least one FGID, as well as in individual categories. The searches identified 376 papers, with 20 included in the final analysis, providing a pooled cohort of 18,935 children. The median prevalence of FGID for children aged up to four years was 22.2% (range 5.8–40%), and aged four–eighteen years was 21.8% (range 19–40%). The most common FGID for children aged 0–12 months was infant regurgitation, the most common FGID for those aged 13–48 months were functional constipation and cyclic vomiting, and, for those aged over four years, functional constipation, functional dyspepsia, and irritable bowel syndrome. This reported overall incidence of FGID may be used as a benchmark of normative data among the general population and comparative data for those with comorbid disease. Full article

(This article belongs to the Special Issue Recent Advances in Paediatric Gastroenterology)

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