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Aim: Infant gastroesophageal reflux is mostly benign; however, when associated with complications like failure to thrive, it may be indicative of gastroesophageal reflux disease. There are currently several unmet needs pertaining to the management of infant gastroesophageal reflux (disease). Reflux in infants is mostly composed of breast milk or formula, so this population is significantly different to older children and adults. The objective of this Delphi consensus was to establish recommendations based on published literature and the experience of clinical experts in paediatric gastroenterology in the context of infant gastroesophageal reflux (disease). Methods: The Delphi methodology was used to obtain a consensus on 18 statements relating to clinical aspects of infant gastroesophageal reflux (disease). Results: The expert panel comprising paediatric gastroenterology clinical specialists reached a consensus for all statements by means of an online, anonymised voting system. Conclusion: It was highlighted that there is generally low awareness of or adherence to guidelines in clinical practice and that acid suppression therapy should not be indicated for non‐acid reflux, which constitutes a significant proportion of total gastroesophageal reflux episodes among infants. Furthermore, it was emphasised that there is an unmet medical need for therapy for some symptomatic infants with non‐acid reflux disease. [ABSTRACT FROM AUTHOR]

The management of pediatric Peutz–Jeghers Syndrome (PJS) focuses on the prevention of intussusception complicating small intestinal (SI) polyposis. This hinges on the accurate appraisal of the polyp burden to tailor therapeutic interventions. Video Capsule Endoscopy (VCE) is an established tool to study SI polyps in children, but an in-depth characterization of polyp burden in this population is lacking. Methods: We performed a retrospective longitudinal cross-sectional analysis of VCE studies in pediatric PJS patients at our institution (CMKC) from 2010 to 2020. Demographic, clinical, and VCE findings reported by three reviewers in tandem were accrued. Polyp burden variables were modeled as functions of patient and study characteristics using linear mixed models adjusted for clustering. Results: The cohort included 15 patients. The total small bowel polyp count and largest polyp size clustered under 30 polyps and <20 mm in size. Luminal occlusion correlated closely with the estimated polyp size. Polyp distribution favored proximal (77%) over distal (66%) small bowel involvement. The adjusted largest polyp size was greater in males. Double Balloon Enteroscopy was associated with a decreased polyp burden. Conclusions: The polyp burden in pediatric PJS patients favors the proximal third of the small intestine, with relatively small numbers and a polyp size amenable to resection through enteroscopy. Male gender and older age were related to an increased polyp burden. [ABSTRACT FROM AUTHOR]

Objectives: Solid tumors of the stomach in children are rare, adenocarcinoma being most frequently reported. Risk factors and clinical presentation are poorly understood. We undertook a nationwide database analysis to evaluate pediatric CA stomach presentation, comorbidities, and metastatic pattern. Methods: The Cerner Health Facts Database® (CHFD) was queried for pediatric age range (1–21) patients, 2010–2017 inclusive. The pediatric gastric cancer cohort was defined by ICD9 and ICD 10 CM diagnoses attributable to primary (non-GIST, non-hematologic) solid tumors of the stomach limited to diagnosis priority < 5 and validated by filtering for supportive diagnoses. Demographic characteristics, comorbidities, before and throughout the medical record were analyzed and compared to the base population. Results: The cohort included 333 patients from a base population of 9.6 million children. The M:F ratio was 1.15:1, mean age at diagnosis was 11.8 years. Stomach cancer was most prevalent in non-Hispanic whites, less in Asians and African Americans. Symptoms included abdominal pain, vomiting, anemia, diarrhea and weight loss. Reflux symptoms, esophagitis, gastritis, including H. pylori and duodenitis were reported in 10.2%. Obesity, obesity-related comorbidities, tobacco exposure and family history of colonic polyps, gastrointestinal and breast cancer were all more prevalent (P < 0.0001) in the cohort. Discussion: We defined patient demographic characteristics, anatomic distribution in a large cohort of children with solid tumors of the stomach. Reported symptoms in our cohort are similar to those observed in adults. Associated comorbidities which may reflect risk factors include obesity, tobacco exposure and family history of intestinal polyps and malignancy. [ABSTRACT FROM AUTHOR]

A recent meta-analysis analyzed BCG vaccine-associated complications in patients with primary immunodeficiency, most frequently in those with severe combined immunodeficiency (SCID), chronic granulomatous disease (CGD), and Mendelian susceptibility to mycobacterial disease [[1]]. BCG vaccine-associated complications have previously been reported in patients with activated PI3K delta syndrome (APDS), which like PHTS is associated with increased cellular PI3K signaling. For patients with APDS, it has been recommended that BCG vaccination should be avoided until the risks of adverse reactions are better understood; our data suggest a cautious approach should also be adopted for patients with PHTS. The report of two adverse reactions to BCG vaccination in PHTS is significant, especially in the context of overactive PI3K signaling in APDS being associated with persistent local BCG vaccine-associated complications. [Extracted from the article]

Summary: Background: Coeliac disease is one of the most prevalent immune‐mediated gastrointestinal disorders in children. Aim: To review the incidence and prevalence of paediatric coeliac disease, and their trends, regionally across Europe, overall and according to age at diagnosis. Methods: Systematic review and meta‐analysis from January 1, 1950 to December 31, 2019, based on PubMed, CINAHL and the Cochrane Library, searches of grey literature and websites and hand searching of reference lists. A total of 127 eligible studies were included. Results: The prevalence of previously undiagnosed coeliac disease from screening surveys (histology based) ranged from 0.10% to 3.03% (median = 0.70%), with a significantly increasing annual trend (P = 0.029). Prevalence since 2000 was significantly higher in northern Europe (1.60%) than in eastern (0.98%), southern (0.69%) and western (0.60%) Europe. Large increases in the incidence of diagnosed coeliac disease across Europe have reached 50 per 100 000 person‐years in Scandinavia, Finland and Spain. The median age at diagnosis increased from 1.9 years before 1990 to 7.6 since 2000. Larger increases in incidence were found in older age groups than in infants and ages <5 years. Conclusions: Paediatric coeliac disease incidence and prevalence have risen across Europe and appear highest in Scandinavia, Finland and Spain. The most recent evidence shows large increases in incidence in most regions, but stabilisation in some (notably Sweden and Finland). Sharp increases in the age at diagnosis may reflect increases in milder and asymptomatic cases diagnosed since reliable serology testing became widely used, through endomysial antibodies after 1990 and tissue transglutaminase antibodies around 2000. [ABSTRACT FROM AUTHOR]

Background and Aim: Current understanding of specific, therapeutic procedure‐associated complications in pediatric patients remains limited. This study aims to determine the frequency of significant complications in pediatric age‐range subjects following the principal therapeutic endoscopic procedures. Methods: This study used retrospective multi‐institutional, ICD‐9‐CM, Clinical Transaction Classification, and Current Procedural Terminology based database (Pediatric Hospital Information System) analysis. This study included demographic, chronic comorbidity, procedure type, and post‐procedure outcomes defined through mortality, unplanned direct admission, emergency room, and inpatient admission and inpatient therapeutic events. Results: During the study period, 18 018 patients underwent therapeutic endoscopy; 132 required direct (0.16%) or emergency room/inpatient (0.58%) admission within 5 days following the procedure; mortality was 0.01%. Most (50.75%) complications presented on the day of or 1 day post‐procedure. Hispanic race and coexisting chronic comorbidities, especially gastrointestinal conditions, were identified risk factors for significant complications. Endoscopic dilatation and variceal ablation were most frequently associated with complications. Abdominal pain, gastrointestinal bleeding, and esophageal stricture were the most common diagnoses: 9.0% required intravenous antibiotics, 36.63% underwent chest imaging, 27.27% abdominal imaging, and 0.75% required blood transfusion. Readmission following esophageal dilatation was most likely to result in prolonged admission. Conclusion: In the pediatric population undergoing therapeutic endoscopy in the ambulatory setting, significant postoperative complications resulting in unplanned admission are rare. Complications can be anticipated in medically frail patients especially with gastrointestinal chronic illness. Procedures involving variceal ablation and esophageal dilatation entail the highest risk. [ABSTRACT FROM AUTHOR]

Background and Aim: Increased access to endoscopic procedures have entrenched these investigative tools in routine pediatric gastroenterology practice. Patient outcomes following endoscopy therefore are topical in the decision toward endoscopy. We studied the likelihood and patient characteristics of children admitted following ambulatory endoscopy. Methods: Hospitalization data were obtained from the Pediatric Hospital Information System including 49 tertiary children's hospitals in the USA. Children who underwent ambulatory diagnostic endoscopy between October 1, 2005 and September 25, 2015 were included. The primary outcomes were post‐procedure events resulting in unplanned admission (not for inflammatory bowel disease management) or emergency room visit within 5 days. Unadjusted, univariate analyses were followed by multivariable analysis of the associations between patient characteristics and outcome using the R statistical package, v. 3.2.3. Results: During the study period, 217 817 patients underwent diagnostic endoscopy; 101 (0.05%) patients were admitted directly; 1314 (0.60%) were admitted to the same facility's emergency department with either a respiratory or a gastrointestinal complication as a primary diagnosis within 5 days. None of the procedures resulted in death; female patients were more likely to experience adverse outcomes (P < 0.001), as were patients from an urban setting (P = 0.0004), whereas White, non‐Hispanic patients were less likely to represent (P < 0.0001). Patients with chronic comorbidities were more likely to experience complications. The most frequent diagnoses at admission were abdominal pain (30.5%), other gastroenterologic processes (26.8%), respiratory disorders (17.1%), gastrointestinal hemorrhage (8.3%), and fever (4.5%). Conclusions: Ambulatory pediatric endoscopy is safe; significant adverse outcomes are rare but more likely in female, non‐White or Hispanic patients and in patients with significant chronic comorbidities. [ABSTRACT FROM AUTHOR]

This Executive summary of the Guideline on pediatric gastrointestinal endoscopy from the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) refers to infants, children, and adolescents aged 0 - 18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; endoscopic management of corrosive ingestion and stricture/stenosis; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) have been dealt with in other Guidelines and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance will be addressed in an imminent sister publication. [ABSTRACT FROM AUTHOR]