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SummaryBackground Little data are available regarding the effectiveness and associated microbiome changes of faecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) in children, especially in those with inflammatory bowel disease (IBD) with presumed underlying dysbiosis. Aim To investigate C. difficile eradication and microbiome changes with FMT in children with and without IBD. Methods Children with a history of recurrent CDI (≥3 recurrences) underwent FMT via colonoscopy. Stool samples were collected pre-FMT and post-FMT at 2–10 weeks, 10–20 weeks and 6 months. The v4 hypervariable region of the 16S rRNA gene was sequenced. C. difficile toxin B gene polymerase chain reaction was performed. Results Eight children underwent FMT for CDI; five had IBD. All had resolution of CDI symptoms. All tested had eradication of C. difficile at 10–20 weeks and 6 months post-FMT. Pre-FMT patient samples had significantly decreased bacterial richness compared with donors (P = 0.01), in those with IBD (P = 0.02) and without IBD (P = 0.01). Post-FMT, bacterial diversity in patients increased. Six months post-FMT, there was no significant difference between bacterial diversity of donors and patients without IBD; however, bacterial diversity in those with IBD returned to pre-FMT baseline. Microbiome composition at 6 months in IBD-negative patients more closely approximated donor composition compared to IBD-positive patients. Conclusions FMT gives sustained C. difficile eradication in children with and without IBD. FMT-restored diversity is sustained in children without IBD. In those with IBD, bacterial diversity returns to pre-FMT baseline by 6 months, suggesting IBD host-related mechanisms modify faecal microbiome diversity.

In adults, vitamin D deficiency is common in patients with nonalcoholic fatty liver disease (NAFLD) and has been associated with the severity of histology. There are known differences between adult and pediatric NAFLD, with little data regarding the relation between vitamin D and pediatric NAFLD. The aim of the present study was to examine the relation between vitamin D levels and NAFLD in children.Clinical and histological data were used from children ages 2 to 18 years with biopsy-proven NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network studies. 25(OH) vitamin D levels were measured from serum. Data examined included demographics, anthropometrics, laboratory markers, and liver histology. Data were analyzed using 3 categories of vitamin D level: deficient (≤ 20 ng/mL), insufficient (21-29 ng/mL), and sufficient (≥ 30 ng/mL).A total of 102 children were studied. There was a high prevalence (80/102, 78%) of vitamin D deficiency or insufficiency; however, there were no significant associations between vitamin D level and the histological characteristics or severity of NAFLD. Significantly higher levels of triglycerides were found in those with vitamin D deficiency (P = 0.004), but there was no association with other features of the metabolic syndrome.There is a high prevalence of vitamin D deficiency and insufficiency in children with biopsy-proven NAFLD; however, no association was found between vitamin D deficiency and the severity of disease on biopsies. This differs from adult NAFLD studies in which vitamin D deficiency correlates with histological severity, suggesting differences in the risk factors for or consequences of pediatric NAFLD.

Objectives: To assess how often obesity is acknowledged at pediatric gastroenterology outpatient visits. Methods: A retrospective chart review was performed to identify obese children seen at a gastroenterology subspecialty clinic over a 1-year period of time; 132 children were identified. Demographics, obesity comorbidities, reasons for referral, diagnosis of obesity, and a plan to address obesity were abstracted. Chi-square or Fisher’s exact tests were used to examine statistical associations. Results: Only 49% of children were given a diagnosis of obesity. In total, 52% of children were given a body mass index reduction plan. Those diagnosed with obesity were more likely to receive a body mass index reduction plan (p

Adults with inflammatory bowel disease (IBD) have a high prevalence of Clostridium difficile infection (CDI). CDI in children with IBD may differ from adults. We aim to compare the prevalence of CDI in hospitalized pediatric and adult IBD patients and patients without IBD. The rates of CDI per 1,000 IBD and non-IBD hospitalizations between 1993 and 2012 were examined using the Maryland Health Services Cost Review Commission database. Age, sex and calendar year adjusted incidence rate ratios comparing CDI in pediatrics and adults by type of IBD and with patients without IBD were calculated. p values for trend identifying changes in rates over time were calculated. Among children, the rate of CDI was over 12 times greater in IBD than non-IBD hospitalizations (p

BACKGROUND Adults with inflammatory bowel disease (IBD) have a high prevalence of Clostridium difficile carriage, but little data exist regarding pediatric patients with IBD. Serum antibody responses to C. difficile toxins in correlation with organism carriage are not described in IBD. This study determines the prevalence of C. difficile carriage and compares serum antibody responses to C. difficile toxins in pediatric outpatients with IBD and controls. METHODS Fecal and serum samples were prospectively collected from pediatric outpatients with IBD (n = 85) and age-matched controls (n = 78). Initial and follow-up stool samples were tested using cytotoxigenic C. difficile culture and PCR to detect the toxin B gene. Pulsed-field gel electrophoresis determined the strain type. Enzyme-linked immunosorbent assay determined serum immunoglobulin responses to C. difficile toxins. RESULTS Asymptomatic C. difficile carriage was significantly greater in IBD (17%) versus controls (3%) (P = 0.012). IBD type, disease severity, IBD therapy, recent antibiotics, and hospitalizations were not associated with carriage. Proton pump inhibitor use was significantly higher in patients with C. difficile carriage (54% versus 25%, P < 0.05). North American pulsed-field (NAP) strain carriage varied over time in patients colonized with C. difficile. A significantly greater proportion of patients with IBD had a positive serum antibody response to toxin A (69%) compared with controls (53%) (P < 0.05). CONCLUSIONS Asymptomatic toxigenic C. difficile carriage was increased in pediatric outpatients with IBD compared with controls. Proton pump inhibitor use was associated with increased carriage. Antibody responses to C. difficile toxins were increased in IBD, potentially promoting asymptomatic colonization. Future studies should identify the risk factors for symptomatic C. difficile in pediatric IBD.

Gastrointestinal (GI) sarcoidosis is uncommon, with duodenal involvement rarely occurring. Diagnosis of sarcoidosis may be difficult, especially if no other typical features are present. Here we present a case of duodenal sarcoidosis with hemorrhage, which exemplifies the rarity of the condition and the diagnostic dilemma of differentiating sarcoidosis from Crohn disease.

understanding of the relationships between the intestinal microbiota and disease development. By enrolling twin pairs (n=14) in our study, we found a difference in bacterial families of intestinal microbiota composition (0-12 months) existed in dizygotic twins although they lived in the same environment. Among infants from twin (n=14) or singleton (n=7) pregnancy, the initial colonizer was restricted to bacteria from Proteobacteria (Escherichia/Shigella or Sphingopyxis) and Firmicutes (Bacillus or Staphylococcus). During the study period, 52.4% of these subjects developed allergic symptoms, mainly nasal and skin manifestations. Most importantly, we found a distinctive feature of gut microbiota pattern in allergic infants (n= 11) as compared with the healthy babies (n=10). The former harbored relative abundance of Firmicutes bacteria, particularly those from families Clostridiaceae and Lachnospiraceae of Firmicutes. Increasing Clostridiaceae in allergic subjects (72.7%) was observed from 1st to 6th month after birth, and thereafter declined gradually to an undetectable level at 12th month ; whereas the presence of Clostridiaceae in healthy babies was maintained in low frequency from 1st to 12thmonths (p

Background: Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhea in the USA and is increasing in prevalence. Evidence from the adult literature has demonstrated that patients with inflammatory bowel disease (IBD) have a higher prevalence of CDI than the general population. There is a paucity of literature regarding CDI in pediatric patients with IBD, which may differ from adults. The prevalence of CDI in hospitalized pediatric IBD patients compared with adult IBD patients is unknown. Aim: To compare the prevalence of CDI in hospitalized pediatric IBD patients, adult IBD patients and hospitalized patients without IBD. Methods: The rates of CDI per 1,000 hospitalizations for patients with and without IBD in the state of Maryland between 1993 and 2011 were examined using the Maryland Health Services Cost Review Commission database. ICD-9-CM codes in any diagnostic position for CDI (008.45), ulcerative colitis (UC; 556) and Crohn's disease (CD; 555) were used to identify hospitalizations. A hospitalization without a code for 555 or 556 was considered a non-IBD hospitalization. Pediatric patients were defined as less than 18 years of age on admission. Incidence rate ratios with robust variances comparing CDI in pediatrics and adults by type of IBD and with patients without IBD were calculated for all years and the most recent year using Stata 11. Results: Among patients with IBD, the rate of CDI was 30.5 per 1,000 hospitalizations compared with 7.8 per 1,000 hospitalizations in patients without IBD (p,0.001). Among adults, the rate of CDI was 3 times greater in IBD hospitalizations than non-IBD hospitalizations (p,0.001) and among pediatric patients, the rate of CDI was over 20 times greater in IBD than non-IBD hospitalizations (p,0.001). In 2011, children with CD had a 2.5 times greater rate of CDI than adults with CD (p,0.001). In 2011, children with UC had a 44% decreased rate of CDI than adults with UC (p=0.01). There was no difference in the rate of CDI between pediatric CD and UC during 1993-2011 (p=0.39). However, in 2011, pediatric CD patients had a 3.5 times greater rate than pediatric UC patients (p,0001). Conclusions: Our study shows that hospitalized children with IBD have a significantly greater prevalence of CDI than hospitalized children without IBD. Moreover, children with CD have a greater rate of CDI during hospitalization than adults with CD, although the opposite is true with UC, potentially suggesting different risk factors for CDI in the pediatric IBD population.