26 results on '"Borrelli, Osvaldo"'
Search Results
2. Intestinal Pseudo-Obstruction
- Author
-
Saliakellis, Efstratios, Rybak, Anna, Borrelli, Osvaldo, Guandalini, Stefano, editor, and Dhawan, Anil, editor
- Published
- 2022
- Full Text
- View/download PDF
3. Esophageal Achalasia
- Author
-
Saliakellis, Efstratios, Rybak, Anna, Borrelli, Osvaldo, Guandalini, Stefano, editor, and Dhawan, Anil, editor
- Published
- 2022
- Full Text
- View/download PDF
4. Italian guidelines for the management of irritable bowel syndrome in children and adolescents: Joint Consensus from the Italian Societies of: Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Pediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM)
- Author
-
Di Nardo, Giovanni, Barbara, Giovanni, Borrelli, Osvaldo, Cremon, Cesare, Giorgio, Valentina, Greco, Luigi, La Pietra, Michele, Marasco, Giovanni, Pensabene, Licia, Piccirillo, Marisa, Romano, Claudio, Salvatore, Silvia, Saviano, Michele, Stanghellini, Vincenzo, Strisciuglio, Caterina, Tambucci, Renato, Turco, Rossella, Zenzeri, Letizia, and Staiano, Annamaria
- Subjects
CELIAC disease diagnosis ,THERAPEUTIC use of probiotics ,IRRITABLE colon diagnosis ,IRRITABLE colon treatment ,FECAL analysis ,MEDICAL protocols ,CONSENSUS (Social sciences) ,IRRITABLE colon ,ANTIDIARRHEALS ,RIFAXIMIN ,MENTAL illness ,CALCIUM-binding proteins ,BRAIN ,ABDOMINAL pain ,PIPERIDINE ,GASTROINTESTINAL system ,ANTIGENS ,PARASYMPATHOLYTIC agents ,DIETARY fiber ,POLYETHYLENE glycol ,ALTERNATIVE medicine ,COMORBIDITY ,C-reactive protein ,CONSTIPATION ,COLONOSCOPY ,NEUROTRANSMITTERS ,SYMPTOMS ,ADOLESCENCE ,CHILDREN - Abstract
The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Chronic Intestinal Pseudo-Obstruction in Childhood
- Author
-
Saliakellis, Efstratios, Borrelli, Osvaldo, Thapar, Nikhil, Guandalini, Stefano, editor, Dhawan, Anil, editor, and Branski, David, editor
- Published
- 2016
- Full Text
- View/download PDF
6. Esophageal Achalasia
- Author
-
Saliakellis, Efstratios, Lindley, Keith J., Borrelli, Osvaldo, Guandalini, Stefano, editor, Dhawan, Anil, editor, and Branski, David, editor
- Published
- 2016
- Full Text
- View/download PDF
7. Long-term outcomes of Heller’s myotomy and balloon dilatation in childhood achalasia
- Author
-
Saliakellis, Efstratios, Thapar, Nikhil, Roebuck, Derek, Cristofori, Fernanda, Cross, Kate, Kiely, Edward, Curry, Joseph, Lindley, Keith, and Borrelli, Osvaldo
- Published
- 2017
- Full Text
- View/download PDF
8. Optimizing nutrition IN pediatric intestinal pseudo‐obstruction syndrome.
- Author
-
Pescarin, Matilde, Day, Hannah, Thapar, Nikhil, Jackman, Lucy, Saliakellis, Efstratios, Lindley, Keith J., Nikaki, Kornilia, Hill, Susan, Kӧglmeier, Jutta, Rybak, Anna, and Borrelli, Osvaldo
- Subjects
CHILD nutrition ,NUTRITIONAL requirements ,NUTRITIONAL assessment ,NUTRITIONAL status ,INTESTINES ,SHORT bowel syndrome - Abstract
Background: Pediatric intestinal pseudo‐obstruction (PIPO) encompasses a variety of rare, heterogeneous, and disabling disorders that severely affect gastrointestinal motility and are associated with high morbidity and mortality. PIPO management is complex and focuses on maintaining an optimal nutritional status, improving gut function, relieving symptoms, and treating complications. Nutritional issues prevail, and PIPO patients often experience severe undernutrition and faltering growth. Thus, nutritional management plays a pivotal role for achieving the most favorable clinical outcomes. The calorie and nutrient intake of each patient needs to be tailored to age, extent and severity of gut involvement and nutritional needs to support an optimal nutritional status. After defining the extent and severity of gut dysmotility, an experienced team should perform a careful nutritional assessment. An oral diet should always be encouraged and might include bite and dissolve solids, liquid diet or simple oral stimulation. If oral caloric intake is inadequate, liquid gastric feeds should provide the subsequent step. In the presence of severe gastric dysmotility, continuous post‐pyloric feeding represents a viable option. In the most severe cases, parenteral nutrition (PN) is required to meet appropriate nutritional requirements. Purpose: Pediatric data on this topic are scarce and mainly extrapolated from adult studies. In this review, we discuss current evidence and knowledge regarding nutritional options, implications of the use of different feed types, including a blended diet, and the use of PN. Moreover, based on our experience and the evidence from the literature, we propose a flow chart to guide the nutritional management of PIPO patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
9. Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study.
- Author
-
Blasi, Elisa, Stefanelli, Ettore, Tambucci, Renato, Salvatore, Silvia, Angelis, Paola De, Quitadamo, Paolo, Pacchiarotti, Claudia, Nardo, Giovanni Di, Crocco, Fanj, Felici, Enrico, Giorgio, Valentina, Staropoli, Nicoletta, Sestito, Simona, Saliakellis, Efstratios, Borrelli, Osvaldo, and Pensabene, Licia
- Subjects
PROTON pump inhibitors ,PHENOTYPES ,CHEST pain ,PARASYMPATHOLYTIC agents - Abstract
Background/Aims Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. Methods Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. Results Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. Conclusions FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
10. Colonic Function Investigations in Children: Review by the ESPGHAN Motility Working Group
- Author
-
Rybak, Anna, Martinelli, Massimo, Thapar, Nikhil, van Wijk, Michiel P., Vandenplas, Yvan, Salvatore, Silvia, Staiano, Annamaria, Benninga, Mark A., Borrelli, Osvaldo, Rybak, Anna, Martinelli, Massimo, Thapar, Nikhil, Van Wijk, Michiel P, Vandenplas, Yvan, Salvatore, Silvia, Staiano, Annamaria, Benninga, Mark A, Borrelli, Ovaldo, Clinical sciences, Growth and Development, and Pediatrics
- Subjects
Paediatric Gastroenterology ,Colon ,Gastroenterology ,Pediatrics, Perinatology and Child Health ,Humans ,Colonic Function Investigations ,ESPGHAN Motility Working Group ,Pediatrics, Perinatology, and Child Health ,Child ,Gastrointestinal Motility ,Gastrointestinal Transit ,Children ,Constipation ,Disorders of colonic motility - Abstract
Disorders of colonic motility, most often presenting as constipation, comprise one of the commonest causes of outpatient visits in pediatric gastroenterology. This review, discussed and created by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Motility Working Group, is a practical guide, which highlights the recent advances in pediatric colonic motility testing including indications, technical principles of the tests, patient preparation, performance and basis of the results' analysis of the tests. classical methods, such as colonic transit time (cTT) with radiopaque markers and colonic scintigraphy, as well as manometry and novel techniques, such as wireless motility capsule and electromagnetic capsule tracking systems are discussed.
- Published
- 2022
11. Role of inflammation in pediatric irritable bowel syndrome.
- Author
-
Di Nardo, Giovanni, Cremon, Cesare, Staiano, Annamaria, Stanghellini, Vincenzo, Borrelli, Osvaldo, Strisciuglio, Caterina, Romano, Claudio, Mallardo, Saverio, Scarpato, Elena, Marasco, Giovanni, Salvatore, Silvia, Zenzeri, Letizia, Felici, Enrico, Pensabene, Licia, Sestito, Simona, Francavilla, Ruggiero, Quitadamo, Paolo, Baldassarre, Mariella, Giorgio, Valentina, and Tambucci, Renato
- Subjects
IRRITABLE colon ,INFLAMMATORY bowel diseases ,CHILD patients ,CELIAC disease ,INFLAMMATION - Abstract
Background: IBS affects a large number of children throughout the world and is thought to be the result of disturbed neuroimmune function along with the brain–gut axis. Although the underlying pathophysiologic mechanisms are not clear, the role of low‐grade inflammation and mucosal immune activation in IBS symptom generation has become evident also in subsets of pediatric patients. Animal models provided meaningful insight in the causal relationship between abnormal mucosal immune activation and changes in gastrointestinal (GI) sensory‐motor function. Likewise, the development of long‐standing GI symptoms fulfilling the current criteria for functional GI disorders after infection gastroenteritis and in patients with IBD or celiac disease in remission further supports this hypothesis. Immune activation, its impact on gut sensory‐motor function, and potential implications for symptom generation emerged in both children and adults with IBS. Purpose: The aim of this review is to summarize the main evidence on the presence of low‐grade inflammation and immune activation in children with IBS, its possible role in symptom generation, and its potential implication for new therapeutic strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
12. Is there a relationship between joint hypermobility and gastrointestinal disorders in children?
- Author
-
Quitadamo, Paolo, Thapar, Nikhil, Di Nardo, Giovanni, Pescarin, Matilde, Bertelli, Luca, Tortora, Clelia, Borrelli, Osvaldo, Giorgio, Roberto De, and Staiano, Annamaria
- Abstract
Background. The main aim of the study was to assess the association between joint hypermobility (JH) and gastrointestinal (GI) disorders in children. Methods. All children aged 4-17 years attending the clinics of the participating Pediatric Gastroenterology Centres for functional GI disorders (FGIDs) and inflammatory bowel disease (IBD) were screened for joint laxity. JH diagnosis was inferred using the Beighton Score. JHS diagnosis was inferred based on the Brighton Criteria. Rome III Diagnostic Criteria were used to diagnose possible FGIDs. Ulcerative colitis and Crohn's disease diagnoses were made according to the Porto Criteria. Age and sex-matched healthy children were enrolled as controls. Results. One-hundred-seventy children with GI disorders (70 with FGIDs, 50 with Crohn's disease, and 50 with ulcerative colitis) and 100 healthy controls were enrolled in the study. JH was reported in 7/70 (10%) children with FGIDs (p=0.26 compared to controls), 4/50 (8%) children with Crohn's disease (p=0.21 compared to controls) and 15/50 (30%) children with ulcerative colitis (p=0.09 compared to controls; p=0.01 compared to FGIDs; p=0.01 compared to Crohn's). Conclusions. JH is more prevalent in patients suffering from ulcerative colitis compared to the healthy general population, yet the difference did not reach statistical significance. Likely, a proportion of children with ulcerative colitis and JH may show connective tissue abnormalities. However, whether JH can be considered a possible feature of pediatric GI disorders deserves further investigation. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
13. Characterization of the colonic response to bisacodyl in children with treatment‐refractory constipation.
- Author
-
Heitmann, Paul T., Wiklendt, Lukasz, Thapar, Nikhil, Borrelli, Osvaldo, Di Lorenzo, Carlo, Yacob, Desalegn T., Baaleman, Desiree F., Vriesman, Mana H., Nurko, Samuel, El‐Chammas, Khalil, Kaul, Ajay, Benninga, Marc A., Koppen, Ilan J.N., Wattchow, David A., Brookes, Simon J.H., and Dinning, Phil G.
- Subjects
CONSTIPATION ,NEUROMUSCULAR system physiology ,CHILDREN'S hospitals ,SURGICAL indications ,DEFECATION - Abstract
Background: Colonic manometry with intraluminal bisacodyl infusion can be used to assess colonic neuromuscular function in children with treatment‐refractory constipation. If bisacodyl does not induce high‐amplitude propagating contractions (HAPCs), this can be an indication for surgical intervention. A detailed characterization of the colonic response to intraluminal bisacodyl in children with constipation may help to inform clinical interpretation of colonic manometry studies. Methods: Studies were performed in five pediatric hospitals. Analysis included identification of HAPCs, reporting HAPCs characteristics, and an area under the curve (AUC) analysis. Comparisons were performed between hospitals, catheter type, placement techniques, and site of bisacodyl infusion. Results: One hundred and sixty‐five children were included (median age 10, range 1‐17 years; n = 96 girls). One thousand eight hundred and ninety‐three HAPCs were identified in 154 children (12.3 ± 8.8 HAPCs per child, 0.32 ± 0.21 HAPCs per min; amplitude 113.6 ± 31.5 mm Hg; velocity 8.6 ± 3.8 mm/s, propagation length 368 ± 175 mm). The mean time to first HAPC following bisacodyl was 553 ± 669 s. Prior to the first HAPC, there was no change in AUC when comparing pre‐ vs post‐bisacodyl (Z = −0.53, P =.60). The majority of HAPCs terminated in a synchronous pressurization in the rectosigmoid. Defecation was associated with HAPCs (χ2(1)=7.04, P <.01). Site of bisacodyl administration, catheter type, and hospital location did not alter the response. Conclusions and Inferences: Intraluminal bisacodyl induced HAPCs in 93% of children with treatment‐refractory constipation. The bisacodyl response is characterized by ≥1 HAPC within 12 minutes of infusion. The majority of HAPCs terminate in a synchronous pressurization in the rectosigmoid. Optimal clinical management based upon colonic manometry findings is yet to be determined. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
14. Esophageal pH-impedance monitoring in children: position paper on indications, methodology and interpretation by the SIGENP working group.
- Author
-
Quitadamo, Paolo, Tambucci, Renato, Mancini, Valentina, Cristofori, Fernanda, Baldassarre, Mariella, Pensabene, Licia, Francavilla, Ruggiero, Di Nardo, Giovanni, Caldaro, Tamara, Rossi, Paolo, Mallardo, Saverio, Maggiora, Elena, Staiano, Annamaria, Cresi, Francesco, Salvatore, Silvia, and Borrelli, Osvaldo
- Abstract
Multichannel intraluminal impedance pH (MII-pH) monitoring currently represents the gold standard diagnostic technique for the detection of gastro-esophageal reflux (GER), since it allows to quantify and characterize all reflux events and their possible relation with symptoms. Over the last ten years, thanks to its strengths and along with the publication of several clinical studies, its worldwide use has gradually increased, particularly in infants and children. Nevertheless, factors such as the limited pediatric reference values and limited therapeutic options still weaken its current clinical impact. Through an up-to-date review of the available scientific evidence, our aim was to produce a position paper on behalf of the working group on neurogastroenterology and acid-related disorders of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) on MII-pH monitoring technique, indications and interpretation in pediatric age, in order to standardise its use and to help clinicians in the diagnostic approach to children with GER symptoms. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
15. Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge.
- Author
-
Pensabene, Licia, Salvatore, Silvia, Turco, Rossella, Tarsitano, Flora, Concolino, Daniela, Baldassarre, Maria Elisabetta, Borrelli, Osvaldo, Thapar, Nikhil, Vandenplas, Yvan, Staiano, Annamaria, and Saps, Miguel
- Subjects
LOW-FODMAP diet ,ABDOMINAL pain in children ,PATHOLOGICAL physiology ,RANDOMIZED controlled trials - Abstract
Copyright of Jornal de Pediatria is the property of Sociedade Brasileira de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2019
- Full Text
- View/download PDF
16. Gastro-Esophageal Reflux in Children.
- Author
-
Rybak, Anna, Pesce, Marcella, Thapar, Nikhil, and Borrelli, Osvaldo
- Subjects
GASTROESOPHAGEAL reflux in children ,GASTROESOPHAGEAL reflux ,ESOPHAGUS diseases ,HEARTBURN ,PEDIATRIC gastroenterology - Abstract
Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
17. Long-term outcomes of Heller's myotomy and balloon dilatation in childhood achalasia.
- Author
-
Thapar, Nikhil, Saliakellis, Efstratios, Cristofori, Fernanda, Lindley, Keith, Borrelli, Osvaldo, Roebuck, Derek, Cross, Kate, Kiely, Edward, and Curry, Joseph
- Subjects
ESOPHAGEAL achalasia ,ESOPHAGEAL motility disorders ,DEGLUTITION disorders in children ,JUVENILE diseases ,LAPAROSCOPIC surgery ,RANDOMIZED controlled trials ,FUNDOPLICATION ,THERAPEUTICS - Abstract
Achalasia is a rare esophageal motility disorder: its optimal treatment in children is still a matter of debate. Records of children treated for achalasia, over an 18-year period, were reviewed.Forty-eight children (median age at diagnosis 10 years; range 3-17 years) were identified. Twenty-eight patients were initially treated with Heller's myotomy (HM) and 20 with balloon dilatation (BD). At last follow-up (median 3 years; range 1-5.5 years), 43.8% (21/48) of children were symptom free. The number of asymptomatic children was significantly higher among those treated initially with HM compared to BD (HM 15/28, 53.6% BD 6/20, 30%, p < 0.05). All children who underwent BD required HM due to symptom recurrence. The median (range) total number of procedures was significantly higher in the BD group (BD 3 (1-7); HM 1 (1-5); p < 0.05) with a shorter time to the second intervention (BD 14 months, 95%CI 4-24; HM 58 months, 95%CI 38-79; p < 0.05). Of 108 procedures, esophageal perforation occurred in two children after HM (two out of 48 HM procedures in total, 4%) and one child after BD (1/60, 1.7%).
Conclusion: Less than half of children with achalasia are symptom free after initial treatment with either BD or HM. HM, however, when performed as first procedure, provided longer symptom-free period and reduced need for subsequent intervention. What is Known: • Balloon dilatation (BD) and Heller's myotomy (HM) are safe and effective treatment options for achalasia. • Controversy, however, exists regarding the most effective initial therapeutic approach. What is New: • HM with or without fundoplication may represent the initial therapeutic approach of choice. • Initial BD may negatively affect the outcome of a subsequent HM. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
18. The evaluation and management of recurrent abdominal pain in childhood.
- Author
-
Kakotrichi, Aikaterini, Borrelli, Osvaldo, and Thapar, Nikhil
- Subjects
DIAGNOSIS of abdominal pain ,TREATMENT of abdominal pain ,BRAIN physiology ,CENTRAL nervous system physiology ,EDUCATION of parents ,PSYCHOLOGY of the sick ,ABDOMINAL pain ,GASTROINTESTINAL system ,HYPNOTISM ,INDIGESTION ,INFLAMMATORY bowel diseases ,SMALL intestine ,MATHEMATICAL models of psychology ,DISEASE relapse ,PROBIOTICS ,TREATMENT effectiveness ,CHILDREN ,PSYCHOLOGY - Abstract
Recurrent abdominal pain (RAP) is a common complaint in children. Previously considered a single entity, RAP is now used as a descriptive term and sub-classified in the recently published Rome IV criteria, into four functional abdominal pain disorders (FAPD), including functional dyspepsia and irritable bowel syndrome. All share common pathogenic mechanisms of visceral hypersensitivity and central hypervigilance, resulting from disruption of the microbiota–gut–brain axis and abnormal enteric neuro–immune interactions. Although FAPDs are benign in nature, the persistence of symptoms and effects on everyday life can have significant secondary effects including psychosocial morbidity. The diagnosis of FAPDs is based on careful history and examination looking for ‘alarm signs’, although a limited battery of laboratory investigations to screen for organic disease may be of value. The management of FAPDs should be multidisciplinary and based on the bio-psychosocial model of care with careful education and engagement of patients/parents. There is currently little evidence to support the routine use of pharmacotherapy, probiotics or diet and a significant placebo effect should be considered when assessing treatment effect. Hypnotherapy has been shown to be an effective therapy. Approximately 50% of FAPDs cases will achieve resolution, especially those that have engaged with the appropriate model of management. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
19. Pharmacological interventions on early functional gastrointestinal disorders.
- Author
-
Salvatore, Silvia, Barberi, Salvatore, Borrelli, Osvaldo, Castellazzi, Annamaria, Di Mauro, Dora, Di Mauro, Giuseppe, Doria, Mattia, Francavilla, Ruggiero, Landi, Massimo, Martelli, Alberto, Miniello, Vito Leonardo, Simeone, Giovanni, Verduci, Elvira, Verga, Carmen, Zanetti, Maria Assunta, and Staiano, Annamaria
- Subjects
GASTROINTESTINAL diseases ,MEDLINE ,CHILDREN - Abstract
Background: Functional gastrointestinal disorders (FGIDs) are chronic or recurrent gastrointestinal symptoms without structural or biochemical abnormalities. FGIDs are multifactorial conditions with different pathophysiologic mechanisms including altered motility, visceral hyperalgesia, brain-gut disturbance, genetic, environmental and psychological factors. Although in most cases gastrointestinal symptoms are transient and with spontaneous resolution in infancy multiple dietary changes and pharmacological therapy are often started despite a lack of evidence-based data. Our aim was to update and critically review the current literature to assess the effects and the clinical appropriateness of drug treatment in early (occurring in infants and toddlers) FGIDs. Methods: We systematically searched the Medline and GIMBE (Italian Group on Medicine Based on Evidence) databases, according to the methodology of the Critically Appraised Topics (CATs). We included reviews, clinical studies, and evidence-based guidelines reporting on pharmacological treatments. Systematic reviews and randomized controlled trials (RCTs) concerning pharmacologic therapies in children with early FGIDs were included, and data were extracted on participants, interventions, and outcomes. Results: We found no evidence-based guidelines or systematic reviews about the utility of pharmacological therapy in functional regurgitation, infant colic and functional diarrhea. In case of regurgitation associated with marked distress, some evidences support a short trial with alginate when other non pharmacological approach failed (stepped-care approach). In constipated infants younger than 6 months of age Lactulose is recommended, whilst in older ages Polyethylene glycol (PEG) represents the first-line therapy both for fecal disimpaction and maintenance therapy of constipation. Conversely, no evidence supports the use of laxatives for dyschezia. Furthermore, we found no RCTs regarding the pharmacological treatment of cyclic vomiting syndrome, but retrospective studies showed a high percentage of clinical response using cyproheptadine, propanolol and pizotifen. Conclusion: There is some evidence that a pharmacological intervention is necessary for rectal disimpaction in childhood constipation and that PEG is the first line therapy. In contrast, for the other early FGIDs there is a lack of well-designed high-quality RCTs and no evidence on the use of pharmacological therapy was found. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
20. Paediatric GI emergencies.
- Author
-
Saliakellis, Efstratios, Borrelli, Osvaldo, and Thapar, Nikhil
- Subjects
GASTROINTESTINAL diseases ,PEDIATRICS ,PEDIATRIC emergencies ,JUVENILE diseases ,FOREIGN bodies - Abstract
Paediatric GI emergencies constitute a wide range of gut pathologies ranging from those that are common, easily diagnosed and treated to conditions that are rarer, often more severe and challenging to manage. Among a myriad of ordinary clinical symptoms and signs physicians have to identify the child with a serious, life-threatening pathology and initiate the appropriate diagnostic and therapeutic pathway. The aim of the review is to present and discuss a selection of key paediatric GI emergencies that provide challenges in diagnosis and treatment. These conditions are classified by their presentation or pathogenesis and include inflammatory conditions, those presenting with GI obstruction or haemorrhage and the ingestion of foreign bodies or caustic substances. The most recent advances regarding the management of these entities are discussed along with key areas of clinical practice and future research. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
21. Oesophageal mucosal intercellular space diameter and reflux pattern in childhood erosive and non-erosive reflux disease.
- Author
-
Mancini, Valentina, Ribolsi, Mentore, Gentile, Massimo, de’Angelis, Gianluigi, Bizzarri, Barbara, Lindley, Keith J., Cucchiara, Salvatore, Cicala, Michele, and Borrelli, Osvaldo
- Subjects
GASTROESOPHAGEAL reflux in children ,MUCOUS membranes ,TRANSMISSION electron microscopy ,ENDOSCOPY ,BIOPSY ,PHENOTYPES ,IMPEDANCE spectroscopy ,CONTROL groups - Abstract
Abstract: Background and aims: We sought to compare intercellular space diameter in children with non-erosive and erosive reflux disease, and a control group. We also aimed to characterize the reflux pattern in erosive and non-erosive reflux disease patients, and to explore the relationship between intercellular space diameter values and reflux parameters. Methods: Twenty-four children with non-erosive reflux disease, 20 with erosive reflux disease, and 10 controls were prospectively studied. All patients and controls underwent upper endoscopy. Biopsies were taken at 2–3cm above the Z-line, and intercellular space diameter was measured using transmission electron microscopy. Non-erosive and erosive reflux disease patients underwent impedance-pH monitoring. Results: Mean intercellular space diameter values were significantly higher in both non-erosive (0.9±0.2μm) and erosive reflux disease (1±0.2μm) compared to controls (0.5±0.2μm, p <0.01). No difference was found between the two patient groups. Acid exposure time, the number of acid, weakly acidic and weakly alkaline reflux events did not differ between the two patient groups. No difference was found in the mean intercellular space diameter between non-erosive reflux disease children with and without abnormal acid exposure time (1±0.3 vs. 0.9±0.2μm). No correlation was found between any reflux parameter and intercellular space diameter values. Conclusions: Dilated intercellular space diameter seems to be a useful and objective marker of oesophageal damage in paediatric gastro-oesophageal reflux disease, regardless of acid exposure. In childhood, different gastro-oesophageal reflux disease phenotypes cannot be discriminated on the basis of reflux pattern. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
22. Pediatric Esophageal High-Resolution Manometry: Utility of a Standardized Protocol and Size-Adjusted Pressure Topography Parameters.
- Author
-
Goldani, Helena A. S., Staiano, Annamaria, Borrelli, Osvaldo, Thapar, Nikhil, and Lindley, Keith J.
- Subjects
INTERVENTIONAL radiology equipment ,PHYSICIAN practice patterns ,DRUG delivery devices ,ESOPHAGEAL motility disorders ,CHILDREN - Abstract
OBJECTIVES:Esophageal high-resolution manometry (EHRM) has evolved rapidly from a research tool to a routine investigation in adult clinical practice. This study proposes and evaluates a standardized EHRM protocol for use in pediatric clinical practice.METHODS:Thirty pediatric patients underwent unsedated EHRM. Indications for EHRM were dysphagia, feeding difficulty, or pre-fundoplication assessment. Two 20-channel customized water-perfused silicone catheters, with an outside diameter of 3.8 mm (MuiScientific, Ontario, CA), were used. The catheters had one distal gastric channel, five channels 0.5 cm apart for the e-sleeve, and 14 proximal channels either 1 cm (for children <5 years) or 2 cm apart (for children >5 years). Single wet swallows, multiple rapid swallows (MRS), and solid swallows were systematically studied.RESULTS:The median age was 10 years (range 6 months–15 years). The esophageal motor findings were normal peristalsis (n=15), peristaltic dysfunction (n=12), achalasia (n=3), and spasm on consumption of solid food (n=2). The distal contractile integral adjusted for esophageal length (DCIa) of patients with peristaltic dysfunction was significantly lower than that of patients without peristaltic dysfunction (P<0.001). On MRS, aperistalsis with lack of esophagogastric junction (EGJ) relaxation was observed in patients with achalasia, and aperistalsis with complete EGJ relaxation was observed in patients with severe peristaltic dysfunction. On consumption of solid food, esophageal spasm associated with bolus impaction was observed in two patients.CONCLUSIONS:This study provides objective information with regard to topography pressure parameters in esophageal motility disorders of childhood while using a standardized EHRM protocol. The new DCIa variable may be useful for the assessment of patients with peristaltic dysfunction. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
23. Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure.
- Author
-
Rybak, Anna, Sethuraman, Aruna, Nikaki, Kornilia, Koeglmeier, Jutta, Lindley, Keith, and Borrelli, Osvaldo
- Abstract
Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
24. Role of inflammation in pediatric irritable bowel syndrome
- Author
-
Giovanni, Di Nardo, Cesare, Cremon, Annamaria, Staiano, Vincenzo, Stanghellini, Osvaldo, Borrelli, Caterina, Strisciuglio, Claudio, Romano, Saverio, Mallardo, Elena, Scarpato, Giovanni, Marasco, Silvia, Salvatore, Letizia, Zenzeri, Enrico, Felici, Licia, Pensabene, Simona, Sestito, Ruggiero, Francavilla, Paolo, Quitadamo, Mariella, Baldassarre, Valentina, Giorgio, Renato, Tambucci, Chiara, Ziparo, Pasquale, Parisi, Maria Raffaella, Barbaro, Giovanni, Barbara, Di Nardo, G., Cremon, C., Staiano, A., Stanghellini, V., Borrelli, O., Strisciuglio, C., Romano, C., Mallardo, S., Scarpato, E., Marasco, G., Salvatore, S., Zenzeri, L., Felici, E., Pensabene, L., Sestito, S., Francavilla, R., Quitadamo, P., Baldassarre, M., Giorgio, V., Tambucci, R., Ziparo, C., Parisi, P., Barbaro, M. R., Barbara, G., Di Nardo, Giovanni, Cremon, Cesare, Staiano, Annamaria, Stanghellini, Vincenzo, Borrelli, Osvaldo, Strisciuglio, Caterina, Romano, Claudio, Mallardo, Saverio, Scarpato, Elena, Marasco, Giovanni, Salvatore, Silvia, Zenzeri, Letizia, Felici, Enrico, Pensabene, Licia, Sestito, Simona, Francavilla, Ruggiero, Quitadamo, Paolo, Baldassarre, Mariella, Giorgio, Valentina, Tambucci, Renato, Ziparo, Chiara, Parisi, Pasquale, Barbaro, Maria Raffaella, and Barbara, Giovanni
- Subjects
irritable bowel syndrome ,food allergy ,children ,Endocrine and Autonomic Systems ,Physiology ,low-grade inflammation ,post-infection IBS ,Gastroenterology - Abstract
Background: IBS affects a large number of children throughout the world and is thought to be the result of disturbed neuroimmune function along with the brain-gut axis. Although the underlying pathophysiologic mechanisms are not clear, the role of low-grade inflammation and mucosal immune activation in IBS symptom generation has become evident also in subsets of pediatric patients. Animal models provided meaningful insight in the causal relationship between abnormal mucosal immune activation and changes in gastrointestinal (GI) sensory-motor function. Likewise, the development of long-standing GI symptoms fulfilling the current criteria for functional GI disorders after infection gastroenteritis and in patients with IBD or celiac disease in remission further supports this hypothesis. Immune activation, its impact on gut sensory-motor function, and potential implications for symptom generation emerged in both children and adults with IBS. Purpose: The aim of this review is to summarize the main evidence on the presence of low-grade inflammation and immune activation in children with IBS, its possible role in symptom generation, and its potential implication for new therapeutic strategies.
- Published
- 2022
25. Anorectal Manometry in Children: The Update on the Indications and the Protocol of the Procedure
- Author
-
Caterina Strisciuglio, Marcin Banasiuk, Silvia Salvatore, Osvaldo Borrelli, Annamaria Staiano, Michiel Van Wijk, Yvan Vandenplas, Marc A. Benninga, Nikhil Thapar, Strisciuglio, C., Banasiuk, M., Salvatore, S., Borrelli, O., Staiano, A., Van Wijk, M., Vandenplas, Y., Benninga, M. A., Thapar, N., Pediatric surgery, Strisciuglio, Caterina, Banasiuk, Marcin, Salvatore, Silvia, Borrelli, Osvaldo, Staiano, Annamaria, Van Wijk, Michiel, Vandenplas, Yvan, Benninga, Marc A, Thapar, Nikhil, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, Clinical sciences, Growth and Development, and Pediatrics
- Subjects
procedure ,Manometry ,Gastroenterology ,Rectum ,Anal Canal ,anorectal function ,Review Literature as Topic ,Rectal Diseases ,children ,high-resolution anorectal manometry ,Pediatrics, Perinatology and Child Health ,Humans ,Pediatrics, Perinatology, and Child Health ,Anorectal Manometry ,Child ,Fecal Incontinence - Abstract
Anorectal disorders are common in children. They are related to structural and/or functional abnormalities of the anorectum or pelvic floor with a variety of symptoms. Therefore, diagnostic tests to evaluate anorectal function can help to better understand the underlying pathophysiology and aetiology as well as facilitate patient management. During the past decades substantial efforts have been made to improve anorectal function testing, however more advanced investigations might lead to difficulties in interpretation. Additionally, a great diversity of equipment and protocols are used among centres, which may lead to heterogeneous interpretation of results. More studies to standardize methods of testing and validate reference values are strongly recommended in children. This review updates on the current indications and the protocol of anorectal manometry.
- Published
- 2022
26. An ESPGHAN Position Paper on the Use of Breath Testing in Paediatric Gastroenterology
- Author
-
Rut Ann Thomassen, Jernej Dolinsek, Carmen Ribes-Koninckx, Erasmo Miele, Christos Tzivinikos, Corina Pienar, Javier Martín-de-Carpi, Emmanuel Mas, Marc A. Benninga, Osvaldo Borrelli, Ilse Broekaert, Mike Thomson, University Hospital of Cologne [Cologne], Great Ormond Street Hospital for Children [London] (GOSH), University medical centre Maribor (UKC Maribor), Hospital Sant Joan de Déu [Barcelona], Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe, Oslo University Hospital [Oslo], Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, VU University Medical Center [Amsterdam], SEGUIN, Nathalie, Broekaert, Ilse Julia, Borrelli, Osvaldo, Dolinsek, Jernej, Martin-de-Carpi, Javier, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Ribes-Koninckx, Carmen, Thomassen, Rut, Thomson, Mike, Tzivinikos, Christo, Benninga, Marc, and Hospital Universitari i Politècnic La Fe
- Subjects
medicine.medical_specialty ,Malabsorption ,Consensus ,Carbohydrate malabsorption ,030309 nutrition & dietetics ,MEDLINE ,carbohydrate malabsorption ,small intestinal bacterial overgrowth ,Helicobacter pylori infection ,Helicobacter Infections ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,children ,Internal medicine ,Small intestinal bacterial overgrowth ,medicine ,breath testing ,Humans ,Intensive care medicine ,Exocrine pancreatic insufficiency ,Child ,Children ,0303 health sciences ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,Gastroenterology ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Hepatology ,medicine.disease ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,3. Good health ,Fat malabsorption ,Breath testing ,Systematic review ,Breath Tests ,Pediatrics, Perinatology and Child Health ,Position paper ,030211 gastroenterology & hepatology ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Systematic Reviews as Topic - Abstract
International audience; Objectives: Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety. Methods: Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes. During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors. Results: A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2-lactose breath testing, H2-fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro-caecal transit time (OCTT) or to diagnose and follow-up on celiac disease. Conclusions: Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.
- Published
- 2021
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.