Paeds Gastrointestinal Disorders

Shigellosis is an intestinal infection causing severe and often life-threatening diarrheal disease, with high prevalence in children under five years of age in low- and middle-income countries. Given the rise of antimicrobial resistance to Shigella, the World Health Organization has included this pathogen among those for which the development of new interventions is a global health priority. No vaccines against Shigella are licensed yet, but several candidates based on the O-antigen portion of...

Collagenous gastritis is a rare pediatric disease characterized by chronic gastritis with superficial, irregular mucosal involvement, focal atrophy of the gastric glands, an inflammatory infiltrate predominantly composed of lymphocytes and plasma cells, and areas of epithelial erosion. Focal collagen deposition in the subepithelial region of the lamina propria is a hallmark feature. Gastric epithelial erosions can cause hematemesis and, more generally, occult gastrointestinal bleeding, leading...

CONCLUSION: Residual fecal lactose, when interpreted alongside microbial and metabolic profiles, may serve as a non-invasive indicator associated with secondary lactose intolerance in infants. These findings delineate microbiota-metabolism features consistent with SLI pathophysiology and provide a conceptual framework for future validation studies and the development of nutritional or probiotic interventions.

CONCLUSIONS: Mn(3)O(4)/QD@LM confirms the synergistic role of multi-enzyme activities and STING pathway activation in potentiating sonodynamic immunotherapy, and provides an innovative strategy to overcome TME-mediated therapy resistance.

CONCLUSIONS: IBS is the most common FAPD in children. Though often managed by general practitioners, it remains unclear how they diagnose and treat these cases. The Rome Criteria appear to be rarely used, and diagnosis frequency varies, suggesting some children may be overlooked or misclassified. Follow-up is infrequent, and it is unclear whether a biopsychosocial approach is used. More research is needed to understand and improve care in this setting.

CONCLUSIONS AND RELEVANCE: In this analysis of children presenting for ED care with vomiting, younger children and those unwell for 24 to 48 hours with 10 or more episodes of vomiting at presentation were more likely to have persistent vomiting after discharge. Based on these findings, these children are most likely to benefit from being provided ondansetron for home administration.

CONCLUSION: Compound heterozygous variants of the MUTYH gene probably underlay the pathogenesis of FAP in these patients. Above findings have enriched the mutational spectrum of the MUTYH gene.

Transcriptomic analyses reveal the status of cells, tissues, or organisms, across states of health and disease. RNA velocity adds a temporal dimension to single cell analyses, predicting future transcriptomic and phenotypic states, based on the current spliced and unspliced mRNA of each cell. We hypothesized that RNA velocity could be adapted to predict future clinical state of individuals with acute and chronic illnesses, using their whole-blood transcriptomes. We developed VeloCD, a method for...

CONCLUSION: Serum prolactin is a reliable biomarker for assessing cirrhosis severity and predicting complications. It complements the Child-Pugh scoring system and may guide early interventions in high-risk patients.

CONCLUSIONS AND INFERENCES: Findings demonstrate the role of digital social attention in illness reinforcement, which complicates social support during the peritraumatic period. This avenue for peer reinforcement should be considered in treatment planning and discussions of family guidelines for managing symptoms.

CONCLUSIONS: A multidisciplinary aerodigestive approach improves respiratory outcomes in children with medical complexity by reducing the need for respiratory support, facilitating decannulation, and decreasing hospitalizations.

Nutrition has both a supportive and therapeutic role in the management of many gastrointestinal (GI) diseases [...].

Background and Objectives: The incidence of colorectal cancer (CRC) in developed Western countries is constantly growing. CRC represents the third most common cancer and the second leading cancer-related cause of death worldwide. Innate and adaptive immunity play a pivotal role in the tumor response, but many of these interactions are still not well understood. Granulysin (GNLY) is an effector, cytolytic molecule, present in human cytotoxic granules of different lymphocyte subpopulations, mainly...

Post-appendectomy intra-abdominal abscess (PAA) is a common and problematic complication in children with perforated appendicitis, contributing to prolonged hospitalization, readmissions, and increased healthcare costs. Despite advances in surgical and antimicrobial management, substantial heterogeneity persists in definitions, risk stratification, and treatment strategies. This narrative review aims to synthesize current evidence regarding the pathophysiology, risk factors, diagnostic pathways,...

CONCLUSION: IL-6 may serve as one of the markers for distinguishing UA from CA, although no clear association was found regarding its independent predictive value. Future prospective studies with larger sample sizes are warranted to establish higher-level evidence.

CONCLUSION: Proximal SBA was independently associated with preterm delivery. Prenatal identification may facilitate appropriate perinatal management and parental counseling.

Background: Exclusive enteral nutrition (EEN) is the recommended first-line therapy for induction of remission in pediatric mild-to-moderate Crohn's disease (CD), but its restrictive nature often limits adherence and long-term sustainability. A modified version of the Crohn's Disease Exclusion Diet (CDED), integrating Mediterranean dietary principles, was developed to offer a more acceptable alternative while preserving therapeutic efficacy. Methods: We conducted a retrospective, single-center...

CONCLUSIONS: Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.

CONCLUSION: Children with UC exhibit significant gross motor deficits, even during clinical remission. These cross-sectional findings indicate that clinically well children may still have impaired motor proficiency compared to healthy peers. However, longitudinal studies are needed to determine whether these deficits predate diagnosis, emerge during active disease, or persist despite remission.

CONCLUSIONS: EO-NEC and LO-NEC differ in infant maturity and perinatal exposures but not in overall severity or mortality.

Neutrophil dysfunction and neutropenia are burdensome findings in glycogen storage disease type Ib (GSDIb). Treatment with granulocyte-colony stimulating factor (G-CSF) often corrects neutropenia but fails to improve clinical symptoms like inflammatory bowel disease (IBD). Recently, empagliflozin (EMPA) was shown to correct the neutrophil dysfunction and its clinical consequences. It is increasingly used as first-line monotherapy, but long-term, real-world data are lacking. This nation-wide...

Mesenteric tissue in Crohn's disease is associated with the severity of intestinal fibrosis. However, the role of hypertrophic mesenteric adipose tissue in the pathogenesis of CD, especially in the progression of postoperative anastomotic recurrence, remains unknown. Exosomes were isolated from hypertrophic mesenteric adipose tissue from diseased bowel (HtMAT) and macroscopically normal mesenteric adipose tissue from surgical margins (nMAT) of patients with CD. Using a surgical model in IL10...

INTRODUCTION: Very early-onset inflammatory bowel disease (VEO-IBD) is frequently triggered by monogenic defects in the pathways responsible for immune system regulation, including mutations in the interleukin-10 receptor alpha (IL-10RA) gene. Patients often show severe and refractory clinical manifestations. Thalidomide has shown immunomodulatory effects in pediatric IBD; however, its immunological effects in IL-10RA-associated VEO-IBD remain poorly defined.

The link between salt intake and the risk of gastric cancer remains uncertain, and a causal relationship has not been established. Therefore, clarifying the causal effect of salt intake on the risk of gastric cancer using reliable causal inference methods is necessary. The aim of this study was to assess the causal association between salt intake and cancer by integrating summary-level genome-wide association study (GWAS) data. Two-sample Mendelian randomization (MR) analyses were performed...

CONCLUSION: This study highlights the role of dietary inflammation in increasing UGI cancer risk and suggests that promoting anti-inflammatory dietary patterns may serve as an effective preventive measure in high-risk populations.

CONCLUSIONS AND IMPLICATIONS: This work provides contextual information on UK SLT practice with school-aged children with neurodisability and oropharyngeal dysphagia who require mealtime assistance. Further work is required to support research into practice implementation (e.g., assessments), alongside exploration and evaluation of meal mat use and potential SLT consultation styles. These findings contribute to a project creating a resource to improve SLT-family-carer working.

Necrotizing enterocolitis (NEC) is a devastating condition that affects premature infants and remains one of the leading causes of death in neonatal intensive care units worldwide. Current approaches to the diagnosis and treatment of NEC have changed minimally in the past 30 years, in part due to an incomplete understanding of the biological mechanisms of the disease, and a lack of treatment options. Importantly however, recent research advances have improved our understanding of the...

CONCLUSION: The administration of formula pre-digested by the ILC improved clinical sickness, gut appearance, and histologic severity of NEC compared to placebo. These findings support further investigation of the ILC as a non-invasive, preventive therapy for NEC in humans.

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract characterized by relapsing and remitting disease activity. Despite decades of research, a definitive cure for IBD remains elusive, as cycles of remission and flare-ups mark the disease course and often relies on long-term pharmacologic and supportive strategies. Increasing evidence indicates that diet and nutrition play an important role in modulating the outcomes of IBD. Although a wide range of...

Appendicitis is the most common emergency surgical presentation and is particularly prevalent in the paediatric population. At present, the majority of children are managed with surgical removal of the inflamed appendix, a procedure that was established centuries ago, before the widespread availability of antibiotics. There are anecdotal historical cases of non-operative management of appendicitis, particularly in geographically remote areas. In recent decades, there has been increasing interest...

CONCLUSION: Malnutrition is a complex condition with multifactorial causes, including socioeconomic factors besides the deficiencies in protein, energy, and essential micronutrients. In developing countries, EE is recognized as a significant contributor to the burden of malnutrition percolating their response to the nutritional rehabilitation program. Non-responders to nutritional rehabilitation program should be referred for endoscopy to confirm the diagnosis of EE.

Toll-like receptor 1 (TLR1), a member of the TLR family, assumes a pivotal role in pathogen recognition and the activation of innate immunity. In this study, we have identified a homozygous truncating TLR1 variant associated with immune dysregulation and colitis. Peripheral blood mononuclear cells derived from the patient manifested robust inflammatory signatures and defective TLR1 signaling responses. TLR1-deficient cells demonstrated impaired production of a wide-spectrum of inflammatory...

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Although epigenetic alterations are common in CRC, the epigenetic changes that occur during colorectal carcinogenesis remain unclear. Thus, we sought to elucidate the role of NOS1 methylation in colorectal carcinogenesis, which is essential for understanding disease pathology. We used the UCSC Xena database to comparatively analyze NOS1 expression and methylation status between tumour and adjacent normal tissues...

CONCLUSION: Stool TIMP-2 emerges as a novel predictor of disease progression in CD.

CONCLUSION: The epidemiology of IBD in Korea is rapidly evolving, with increasing incidence, younger onset, and an urban-rural divide. Targeted strategies for adolescents and urban populations are needed.

CONCLUSION: Pediatric IBD-associated AILDs represent a heterogeneous and high-risk group of disorders. Multimodal diagnostic strategies and immunosuppressive therapy are central to management; however, effective treatments for PSC remain lacking, highlighting major unmet clinical needs.

CONCLUSIONS: The standardized cell culture-based RV-ICA supports the detection of live rotaviruses from fecal specimens over the commercial Ag-ELISA and RT-qPCR, thus helps identify samples suitable for rotavirus isolation.

Celiac disease (CeD) is a chronic autoimmune enteropathy triggered by dietary gluten in genetically predisposed individuals. Currently, a gluten-free diet (GFD) is the only available treatment, being effective in improving mucosal health and symptoms. However, a considerable percentage of celiacs continue to exhibit residual mucosal damage and symptoms. In addition, dietary lapses, and social and nutritional problems pose difficulties with the GFD. Hence, there is an unmet need for new...

CONCLUSION: 2 RV1 doses appear to provide fair protection in this very high burden setting. Additional vaccination strategies should continue to be pursued for children in this and similar locations.

Congenital intestinal webs of the bowel are an exceedingly rare cause of mechanical bowel obstruction in adults. Their presentation beyond the neonatal period is rare and may represent a diagnostic challenge. We report a case of multiple intestinal webs in an adolescent patient who initially presented with chronic abdominal pain, constipation and iron deficiency anaemia refractory to oral supplementation. The patient underwent evaluation for multiple gastrointestinal pathologies, including...

This review offers information and practical guidance for professionals who care for patients with disorders of gut-brain interaction (DGBI). It summarizes evidence-based psychosocial approaches for adult and pediatric populations, organized into 4 sections: background, assessment, management, and training. The review begins by establishing a biopsychosocial framework, highlighting the bidirectional influences of biological and psychosocial factors on gut physiology and brain mechanisms. It then...

CD4+ Th1 cells migrate to sites of inflammation, where they are indispensable for eliminating intracellular pathogens. The lineage-defining transcription factor T-bet establishes the T-helper 1 (Th1) transcriptional program, directing IFN-γ to drive effector responses and inducing subordinate transcription factors to shape the Th1 phenotype. Aberrant Th1 cell activity drives the pathogenesis of multiple autoimmune diseases, but the detailed mechanisms by which Th1 cells maintain or lose their...

INTRODUCTION: Environmental enteropathy (EE) is a syndrome affecting the gut characterised by villus blunting, reduced nutrient absorption and microbial translocation in children and adults experiencing a high burden of enteric infection due to inadequate access to clean water and sanitation.

Increasing evidence implicates mitochondrial dysfunction in the pathogenesis of inflammatory bowel disease (IBD), with the IBD-associated pathobiont adherent-invasive E. coli-LF82 (AIEC) promoting epithelial mitochondrial depolarization and fragmentation and a concomitant reduction in barrier function. We hypothesized that the anti-inflammatory cytokine interleukin-10 (IL-10), essential for enteric homeostasis, would protect against AIEC-induced mitochondrial disruption. Mitochondrial...

CONCLUSIONS AND RELEVANCE: In this cohort study, the incidence of EO mADC increased mainly among patients with multiple metastatic sites and those with peritoneum rather than liver or lung involvement. Net survival improved over time except for peritoneal involvement. These results suggest that intensive treatment is needed for young adults with EO mADC when the peritoneum is involved.

BACKGROUND: Exclusive enteral nutrition (EEN) is commonly used in paediatric Crohn's disease patients as a first-line therapy for inducing remission. Despite advances in immunosuppressive and biologic treatments, 23%-47% of patients with Crohn's disease will require surgery, with approximately 22% needing repeat surgeries. Potential suggested benefits of EEN in the perioperative setting include reduced steroid usage, reduced operative complications, and reduced need for stoma formation.

Childhood maltreatment has been associated with an increased risk of irritable bowel syndrome (IBS) in adulthood, but the longitudinal relationship and underlying mechanisms remain underexplored. Using data from the UK Biobank, this cohort study investigated the association between childhood maltreatment and the onset of IBS in adulthood and explored potential mediating pathways. A total of 108,365 participants (mean age: 34.57 [SD: 4.81] years; 57.2% were female) were followed up from age 30...

CONCLUSION: Single-site laparoscopy was found to be a viable approach for treating neonatal congenital intestinal atresia, it was associated with a reduced incidence of postoperative complications.

Enteric duplication cysts are rare congenital malformations of gastrointestinal tract that are characterised by the presence of epithelial lining of intestinal mucosa, a layer of smooth muscle and a common wall with the GI tract that may or may not show communication with the gut lumen. On the basis of structural classification, enteric duplication cysts can be either cystic or tubular. This case report is about a two year-old boy who presented to the Outpatient Department of Paediatrics at the...

Optimizing nutrition in children with medical complexity is a crucial preoperative task for clinicians. A comprehensive nutrition assessment should include the evaluation of coexisting gastrointestinal conditions that affect nutritional status, as well as detailed physical, anthropometric, and laboratory assessments. Using this comprehensive evaluation and assessment, personalized nutrition plans that include oral and enteral nutrition support can be developed. Since nutrition interventions take...