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1. Isolated Crohn's Colitis: Is Localization Crucial? Characteristics of Pediatric Patients From the CEDATA–GPGE Registry

Author

Lotta Elonen, Lena Wölfle, Jan de Laffolie, Carsten Posovszky, the CEDATA–GPGE-Study-Group, Tobias Schwerdt, Rainer Ganschow, Stefan Trenkel, Burkhard Rodeck, Stefan Wirth, Marlen Zurek, Matthias Heiduk, Michael Paulussen, Gunter Flemming, Ekkehard Sturm, Axel Enninger, Söhnke Dammann, Henning Böhme, Michael Melter, Thomas Lang, Philip Bufler, Thomas Lücke, Markus Knuf, Norbert Wagner, Thomas Kaiser, Ralf Pallacks, Andre Hörning, Jens Klinge, Steffen Reinsch, Rüdiger Adam, Stefan Buderus, Markus Richter, Antje Ballauf, Ilse Broekaert, Lars Heerdts, Carolin Blüml, Sabine Peitzsch, Andreas Krahl, Simone Jedwilayties, Maik Heine, Marko Reitmann, Kai Nils Pargac, Jutta Kringel, Anke Dick, Patrick Gerner, Michael Friedt, Enno Iven, Gunter Burmester, Anke Esser, Olaf Raecke, Kerstin Ehrentraut, Esther Schmidt, Jan Däbritz, Stefan Sgoll, Ahlke Willenborg, Sebastian Horn, Ralph Melchior, Rüdiger Kardoff, Martina Kohl-Sobania, Benedikt Pircher, Christoph Ehrsam, Daniela Nolkemper, Adrian Lieb, Almuth Hauer, Markus Prenninger, Martin Laaß, and Dieter Furthner

Subjects
IBD, pediatric, Crohn's disease, ulcerative colitis, Crohn's colitis, isolated colonic Crohn's, Pediatrics, RJ1-570
Abstract

IntroductionPediatric patients with inflammatory bowel disease (IBD) are classified into Crohn's disease (CD), ulcerative colitis (UC), and unclassifiable (IBD-U). However, data provide evidence that ileal CD (L1) is distinct from colonic CD (L2). The aim of this study was to investigate the clinical features of isolated Crohn's colitis in a pediatric population.Material and MethodsChildren who were prospectively included in the CEDATA–GPGE registry on diagnosis were compared according to the diagnosis of CD with L2 vs. L1 and ileocolonic (L3) involvement pattern as well as IBD-U and UC. The clinical significance of L2 was investigated with regard to extraintestinal manifestations, treatment, surgery, and disease activity.ResultsFifty-two patients with L2 CD at a median age of 13.4 years (±3.8 SD) were compared with 182 L1 (13.8 ± 2.9 SD), 782 with L3 (12.8 ± 3.3 SD), 653 with UC (12.7 ± 3.8 SD), and 111 patients with IBD-U (11.9 ± 4.7 SD). Bloody stools at diagnosis were more common in L2 (44%) than in L1 (19.7%) and L3 (28.8%), but not as common as in UC (66.5%) and IBD-U (61.3%). Fewer CD patients with L2 (10.2%) received exclusive enteral nutrition therapy (EEN) as induction than patients with L1 (34.3%) and L3 (33.3%). After induction therapy, 42.3% of patients with L2 received immunosuppressants and 21% biologicals during follow-up (L1 56.5/10.5%; L3 59/21%; CU 43.5/11.9%; IBD-U 26.1/12.6%). Extraintestinal manifestations were more frequent in L2 (23.1%) vs. L1 (18.7%), L3 (20.2%), CU (15.8%), and IBD-U (11.7%). The number of patients requiring surgery did not differ within the CD subgroups and was significantly lower in UC and IBD-U. Perianal fistula surgery was significantly more common in L2 (44%) than in L1 (4.8%) or L3 (21.7%). In addition, the frequency of surgery for perianal abscesses was also more frequent in L2 (55.6%) than in L1 (12.7%) or L3 (38.4%).ConclusionsThe consideration of pediatric Crohn's colitis as a distinct disease seems necessary as it is characterized by extraintestinal manifestations (EIMs) with mainly joint involvement and perianal fistulas or abscesses requiring surgery and biologic therapy. Thus, colonic Crohn's disease may have an influence on the therapeutic stratification and should be addressed in further studies.

Published
2022
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2. Microbiome analysis and fecal microbiota transfer in pediatric gastroenterology — a structured online survey in German-speaking countries

Author

Alicia Brenig, Ilse Broekaert, Patrick Gerner, Carsten Posovszky, Christoph Hünseler, and Alexander Joachim

Subjects
Gastroenterology
Abstract

Purpose To assess the current attitude and the status quo towards the use of microbiome analysis and fecal microbiota transfer (FMT) in pediatric patients in German-speaking pediatric gastroenterology centers. Methods A structured online survey among all certified facilities of the German-speaking society of pediatric gastroenterology and nutrition (GPGE) was conducted from November 01, 2020, until March 30, 2021. Results A total of 71 centers were included in the analysis. Twenty-two centers (31.0%) use diagnostic microbiome analysis, but only a few perform analysis frequently (2; 2.8%) or regularly (1; 1.4%). Eleven centers (15.5%) have performed FMT as a therapeutic approach. Most of these centers use individual in-house donor screening programs (61.5%). One-third (33.8%) of centers rate the therapeutic impact of FMT as high or moderate. More than two-thirds (69.0%) of all participants are willing to participate in studies assessing the therapeutic effect of FMT. Conclusions Guidelines for microbiome analyses and FMT in pediatric patients and clinical studies investigating their benefits are absolutely necessary to improve the patient-centered care in pediatric gastroenterology. The long-term and successful establishment of pediatric FMT centers with standardized procedures for patient selection, donor screening, application route, volume, and frequency of use is highly required to obtain a safe therapy.

Published
2023

3. Helicobacter pylori-negative Chronic Gastritis in Children

Author

Amit Assa, Osvaldo Borrelli, Ilse Broekaert, Marco Deganello Saccomani, Jernej Dolinsek, Javier Martin-de-Carpi, Emmanuel Mas, Erasmo Miele, Sara Sila, Mike Thomson, Christos Tzivinikos, Marc A. Benninga, Pediatric surgery, Paediatric Gastroenterology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Reproduction & Development (AR&D), Assa, Amit, Borrelli, Osvaldo, Broekaert, Ilse, Saccomani, Marco Deganello, Dolinsek, Jernej, Martin-de-Carpi, Javier, Mas, Emmanuel, Miele, Erasmo, Sila, Sara, Thomson, Mike, Tzivinikos, Christo, and Benninga, Marc A

Subjects
Adult, Cross-Sectional Studies, Helicobacter pylori, Gastritis, Pediatrics, Perinatology and Child Health, Eosinophilia, Gastroenterology, Humans, Child, Enteritis, Helicobacter Infections
Abstract

OBJECTIVES: To systematically review the current evidence on Helicobacter pylori-negative chronic gastritis including natural history, available therapies and outcomes. METHODS: Articles providing data on the prevalence, treatment or outcomes of Helicobacter pylori-negative gastritis were identified through a systematic search in the MEDLINE and EMBASE databases. All original research articles from human studies until October 31, 2021, were included. RESULTS: A total of 54 studies were included consisted of eosinophilic gastritis (n = 9), autoimmune gastritis (n = 11), collagenous gastritis (n = 16), focally enhanced gastritis (n = 6), lymphocytic gastritis (n = 5) and other causes including idiopathic gastritis and chronic renal failure related (n = 7). Most of the included studies were either cross-sectional or longitudinal cohorts except for collagenous gastritis, which mainly included case reports and case series. The prevalence of paediatric eosinophilic gastritis ranges between 5 and 7/100,000 and patients have generally favourable outcome with 50% to 70% clinical and histological response to either corticosteroids or elimination diets. Autoimmune gastritis and collagenous gastritis are extremely rare entities, commonly present with refractory iron deficiency anaemia, while lymphocytic gastritis is relatively common (10%-45%) in children with coeliac disease. Data on treatments and outcomes of autoimmune, collagenous, and focally enhanced gastritis are lacking with limited data implying poor response to therapy in the former 2 diagnoses. CONCLUSIONS: Helicobacter pylori-negative gastritis is uncommonly reported, mainly in small cohorts, mixed adult-paediatric cohorts or as sporadic case reports. As common symptoms are not specific, thus not always result in an endoscopic evaluation, the true prevalence of these distinct disorders may be underestimated, and thus under reported.

Published
2022

5. Systematic review and meta‐analysis: the incidence and prevalence of paediatric coeliac disease across Europe

Author

Osvaldo Borrelli, Christos Tzivinikos, Corina Pienar, Carmen Ribes-Koninckx, John Williams, Kym Thorne, Ilse Broekaert, Stephen E. Roberts, Javier Martín-de-Carpi, Ann John, Emmanuel Mas, Nikhil Thapar, Marc A. Benninga, Rut Anne Thomassen, Mike Thomson, Jernej Dolinsek, Sian Morrison-Rees, Erasmo Miele, Roberts, Stephen E, Morrison-Rees, Sian, Thapar, Nikhil, Benninga, Marc A, Borrelli, Osvaldo, Broekaert, Ilse, Dolinsek, Jernej, Martin-de-Carpi, Javier, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Ribes-Koninckx, Carmen, Thomassen, Rut A, Thomson, Mike, Tzivinikos, Christo, Thorne, Kymberley, John, Ann, Williams, John G, Swansea University, Great Ormond Street Hospital for Children [London] (GOSH), University College of London [London] (UCL), Children’s Health Queensland [Brisbane] (CHQ), University of Amsterdam [Amsterdam] (UvA), University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu [Barcelona, Spain], 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, Oslo University Hospital [Oslo], University of Sheffield [Sheffield], Al Jalila Children's Specialty Hospital, and European Society for Paediatric Gastroenterology Hepatology and Nutrition

Subjects
Pediatrics, medicine.medical_specialty, MEDLINE, Age at diagnosis, Cochrane Library, Asymptomatic, Coeliac disease, Serology, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Prevalence, medicine, Humans, Pharmacology (medical), Child, Aged, Autoantibodies, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, Hepatology, business.industry, Incidence, Incidence (epidemiology), Gastroenterology, Infant, medicine.disease, 3. Good health, Europe, Celiac Disease, Child, Preschool, Meta-analysis, 030211 gastroenterology & hepatology, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

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

Published
2021

6. The Use of Fecal Calprotectin Testing in Paediatric Disorders: A Position Paper of the European Society for Paediatric Gastroenterology and Nutrition Gastroenterology Committee

Author

Paolo Lionetti, Ilse Broekaert, Carmen Ribes Koninckx, Alexandra Papadopoulou, Erasmo Miele, Nikhil Thapar, Frédéric Gottrand, Ester Donat, Rok Orel, Corina Pienar, Michela G. Schäppi, Michael Wilschanski, Kaija-Leena Kolho, Marc A. Benninga, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, Koninckx, Carmen Ribe, Donat, Ester, Benninga, Marc A, Broekaert, Ilse J, Gottrand, Frederic, Kolho, Kaija-Leena, Lionetti, Paolo, Miele, Erasmo, Orel, Rok, Papadopoulou, Alexandra, Pienar, Corina, Schäppi, Michela G, Wilschanski, Michael, Thapar, Nikhil, Children's Hospital, and HUS Children and Adolescents

Subjects
medicine.medical_specialty, Constipation, Gastrointestinal Diseases, Inflammatory bowel disease, Coeliac disease, Infantile colic, Helicobacter Infections, Feces, 03 medical and health sciences, 0302 clinical medicine, inflammatory bowel disease, 3123 Gynaecology and paediatrics, 030225 pediatrics, Internal medicine, Small intestinal bacterial overgrowth, medicine, Humans, Child, intestine, ulcerative colitis, Helicobacter pylori, business.industry, Infant, Newborn, Gastroenterology, Crohn disease, medicine.disease, Ulcerative colitis, fecal calprotectin, 3. Good health, inflammation, 3121 General medicine, internal medicine and other clinical medicine, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, 030211 gastroenterology & hepatology, Calprotectin, medicine.symptom, business, Leukocyte L1 Antigen Complex, position paper
Abstract

Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schonlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.

Published
2021

7. Kleine Magnete mit großer Wirkung

Author

M. Dübbers, Ilse Broekaert, and C. Hünseler

Subjects
medicine.medical_specialty, Pediatrics, business.industry, Pediatrics, Perinatology and Child Health, Pediatric surgery, medicine, Child and adolescent psychiatry, Surgery, business
Published
2021

8. Drugs in Focus: Proton Pump Inhibitors

Author

Alexandra Papadopoulou, Nikhil Thapar, Carmen Ribes-Koninckx, Michael Wilschanski, Rok Orel, Frédéric Gottrand, Ilse Broekaert, Marc A. Benninga, Mike Thomson, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and ARD - Amsterdam Reproduction and Development

Subjects
safety, medicine.medical_specialty, Protein digestion, 03 medical and health sciences, 0302 clinical medicine, children, 030225 pediatrics, Pancreatic cancer, medicine, Humans, Child, Intensive care medicine, Eosinophilic esophagitis, Adverse effect, Prescribed drugs, Sensitization, acid suppression, indications, business.industry, Gastrointestinal microbiota, Gastroenterology, Proton Pump Inhibitors, medicine.disease, medicine.anatomical_structure, Increased risk, Pharmaceutical Preparations, Pediatrics, Perinatology and Child Health, adverse effects, 030211 gastroenterology & hepatology, proton pump inhibitors, business
Abstract

Proton pump inhibitors (PPIs) are amongst the most commonly prescribed drugs in infants and children with the last decades witnessing a dramatic rise in their utilization. Although PPIs are clearly effective when used appropriately and have been regarded as safe drugs, there is growing evidence regarding their potential adverse effects. Although, largely based on adult data it is clear that many of these are also relevant to pediatrics. PPI use potentially affects gastrointestinal microbiota composition and function, decreases defence against pathogens resulting in increased risk for infections, interferes with absorption of minerals and vitamins leading to specific deficiencies and increased risk for bone fractures as well as interferes with protein digestion resulting in increased risk of sensitization to allergens and development of allergic diseases and eosinophilic esophagitis. An association with gastric, liver and pancreatic cancer has also been inferred from adult data but is tenuous and causation is not proven. Overall, evidence for these adverse events is patchy and not always compelling. Overall, the use of PPIs, for selected indications with a good evidence base, has significant potential benefit but carries more caution in infants and children. Pediatricians should be aware of the concerns regarding the potential adverse events associated with their use.

Published
2021

9. Jejunalsonden bei Kindern und Jugendlichen

Author

Almuthe C. Hauer, Christine Schwarz, Ilse Broekaert, Annette Brunert, Anjona Schmidt-Choudhury, and Victor Bildheim

Subjects
0301 basic medicine, Gynecology, 03 medical and health sciences, medicine.medical_specialty, 030109 nutrition & dietetics, 0302 clinical medicine, business.industry, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Medicine, Surgery, business
Abstract

ZusammenfassungDie Ernährung über eine jejunale Sonde wird immer häufiger bei jenen Kindern notwendig, deren kalorischer Bedarf durch gastrale Ernährung nicht ausreichend gedeckt werden kann. Ursächlich hierfür können die Intoleranz gastral zugeführter Nahrung oder eine ausgeprägte gastroösophageale Refluxkrankheit (GÖRK) sein. Da nach Anlage der Jejunalsonde häufig regelmäßige Sondenwechsel notwendig werden, ist eine jejunale Sonde oft nur eine vorübergehende Lösung bis zur perkutanen Anlage eines Jejunostomas (mit oder ohne Antirefluxoperation) oder als Alternative vor einer etwaigen Antirefluxoperation.Bevor eine jejunale Sonde gelegt wird, sollte eine Nahrungsintoleranz aufgrund anatomischer oder nicht gastrointestinal bedingter Probleme ausgeschlossen werden.Die Versorgung eines Kindes, bei dem die Anlage einer jejunalen Sonde geplant ist, sollte durch ein multidisziplinäres Team, bestehend aus u. a. einem Kindergastroenterologen/einer Kindergastroenterologin, einer Ernährungsfachkraft, einem Psychologen/einer Psychologin und einem Logopäden/einer Logopädin, erfolgen. Das multidisziplinäre Team sollte bereits vor Indikationsstellung die Nahrung anpassen, das Kind logopädisch evaluiert haben und die Familie psychologisch und medizinisch mitbetreuen.Eine adäquate Planung, welche auch ethische Aspekte beinhaltet, garantiert, dass sowohl der Patient/die Patientin, die Eltern und Betreuungspersonen wie auch das behandelnde Team ein klares Verständnis der Indikation und Gründe für die Anlage einer jejunalen Sonde haben. Dabei sollten auch die Fortsetzung einer möglichen oralen Ernährung und eine Sondenentwöhnung diskutiert werden.Diese Übersicht beinhaltet Handlungsempfehlungen zur Indikationsstellung für den Einsatz jejunaler Sonden, gepaart mit praktischen Überlegungen, welche die Verwendung und die Sicherheit der jejunalen Sondenernährung im Kindes- und Jugendalter optimieren sollen.

Published
2020

10. Crohnʼs Disease Exclusion Diet (CDED) als Alternative zur exklusiven Ernährungstherapie bei Kindern und Jugendlichen mit Morbus Crohn? Stellungnahme der Arbeitsgemeinschaften CEDATA und Ernährung/Diätetik/Ernährungsmedizin der Gesellschaft für pädiatrische Gastroenterologie und Ernährung e. V

Author

Carsten Posovszky, Annette Simon, Tobias Schwerd, Jan de Laffolie, Maren Pauli, Anjona Schmidt-Choudhury, Martin Classen, Ilse Broekaert, and Ernährungsmedizin der Gpge

Subjects
0301 basic medicine, Gynecology, 03 medical and health sciences, medicine.medical_specialty, 030104 developmental biology, 0302 clinical medicine, business.industry, Gastroenterology, medicine, 030211 gastroenterology & hepatology, business
Abstract

ZusammenfassungEpidemiologische und klinische Beobachtungen sowie Tiermodelle weisen auf die Ernährung als Risikofaktor für die Entwicklung einer chronisch entzündlichen Darmerkrankung (CED) hin. Die exklusive enterale Ernährungstherapie (EET) ist das Musterbeispiel einer effektiven Entzündungskontrolle durch eine rein diätetische Intervention. Ausgehend davon haben Patienten, Familien und betreuende Fachkräfte des Gesundheitswesens ein großes Interesse, andere Ernährungsmodifikationen in der Behandlung von CED-Patienten einzusetzen, zum Beispiel eine partielle Ernährungstherapie (PET) mit spezifischer Diät wie die Crohnʼs Disease Exclusion Diet. Die folgende Stellungnahme fasst die aktuelle Datenlage zusammen und gibt Orientierung für Praxis und weitere Forschung.

Published
2020

11. Safety of Thiopurine Use in Paediatric Gastrointestinal Disease

Author

Jernej Dolinsek, Christos Tzivinikos, Rut Ann Thomassen, Erasmo Miele, Carmen Ribes-Koninckx, Nikhil Thapar, Rok Orel, Corina Pienar, Ilse Broekaert, Mike Thomson, Emmanuel Mas, Marc A. Benninga, 'Federico II' University of Naples Medical School, University of Amsterdam [Amsterdam] (UvA), University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), 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), University Medical Centre Ljubljana [Ljubljana, Slovenia] (UMCL), Victor Babeş University of Medicine and Pharmacy (UMFT), Hospital Universitari i Politècnic La Fe, Oslo University Hospital [Oslo], NHS Foundation Trust [London], The Royal Marsden, Al Jalila Children's Specialty Hospital, University College of London [London] (UCL), Queensland Paediatric Infectious Diseases Laboratory [Australia], University of Queensland [Brisbane]-Children's Health Research Centre, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, Miele, E., Benninga, M. A., Broekaert, I., Dolinsek, J., Mas, E., Orel, R., Pienar, C., Ribes-Koninckx, C., Thomassen, R. A., Thomson, M., Tzivinikos, C., and Thapar, N.

Subjects
Infliximab therapy, medicine.medical_specialty, Autoimmune hepatitis, Inflammatory bowel disease, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Gastrointestinal Agents, [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Recurrence, inflammatory bowel disease, 030225 pediatrics, Steroid sparing, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Immunologic Factors, 6-mercaptopurine, Adverse effect, Intensive care medicine, Child, azathioprine, Thiopurine methyltransferase, biology, autoimmune hepatitis, Crohn disease, business.industry, Mercaptopurine, thiopurines, Gastroenterology, medicine.disease, Inflammatory Bowel Diseases, 3. Good health, Gastrointestinal disease, Pediatrics, Perinatology and Child Health, biology.protein, adverse effects, 030211 gastroenterology & hepatology, business, Immunosuppressive Agents, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Thiopurines, alone or in combination with other agents, have a pivotal role in the treatment of specific gastrointestinal and hepatological disorders. In inflammatory bowel disease and autoimmune hepatitis thiopurines have proven their value as steroid sparing agents for the maintenance of remission and may be considered for preventing postoperative Crohn disease recurrence where there is moderate risk of this occurring. Their use with infliximab therapy reduces antibody formation and increases biologic drug levels. The routine clinical use of thiopurines has, however, been questioned due to a number of potential adverse effects. The aim of this article is to provide information regarding the use, and in particular, safety of these agents in clinical practice in the light of such potentially severe, albeit rare, effects.

Published
2020

12. Evaluation of a Europe-wide Survey on Paediatric Nutrition Training

Author

Iva Hojsak, Joerg Jahnel, Ilse Broekaert, Hubert P. J. van der Doef, Nicolette Moes, and Christos Tzivinikos

Subjects
medicine.medical_specialty, Training time, education, SOCIETY, CHILDREN, Enteral administration, Syllabus, 03 medical and health sciences, 0302 clinical medicine, Enteral Nutrition, PROGRAMS, Paediatric gastroenterology, Multidisciplinary approach, nutrition course, 030225 pediatrics, MANAGEMENT, Medicine, Humans, Nutritional care, Fellowships and Scholarships, ESPGHAN COMMITTEE, HEPATOLOGY, Child, training, business.industry, EDUCATION, GASTROENTEROLOGY, Europe, multidisciplinary nutrition team, Nutrition training, Parenteral nutrition, Family medicine, Pediatrics, Perinatology and Child Health, 030211 gastroenterology & hepatology, Human medicine, syllabus, business, Child Nutritional Physiological Phenomena, POSITION PAPER
Abstract

Commissioned by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), we investigated how European physicians training in these fields are educated in nutrition. A survey on time spent in nutrition training, composition of multidisciplinary nutrition teams, and topics covered during training enrolled 50 participants. A median of 20% of training time was spent on nutrition training during fellowship. Fourteen (28%) had regular nutrition teaching. Thirty-four (68%) were part of a multidisciplinary nutrition team. Twelve (24%) used the ESPGHAN syllabus. Most frequent topics during nutrition training were diagnosis/investigation of failure to thrive, indications/contraindications for enteral feeds, and benefits/risks of enteral/parenteral nutrition. Twenty-seven (54%) had taken a formal nutrition course. Nutrition training in Europe varies and the ESPGHAN training syllabus is not yet implemented Europe-wide. ESPGHAN nutrition summer schools, and Web-based learning may provide appropriate training. We suggest that all patients necessitating nutritional care be treated by multidisciplinary nutrition teams.

Published
2020

13. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Position Paper on Training in Paediatric Endoscopy

Author

Ari Silbermintz, Mike Thomson, Filippo Torroni, Arun Urs, Isabelle Scheers, Claudio Romano, Christos Tzivinikos, Jorge Amil Dias, Henedina Antunes, Ilse Broekaert, Hubert P. J. van der Doef, Priya Narula, Sara Isoldi, Lorenzo Norsa, Marta Tavares, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, and UCL - (SLuc) Service de gastro-entérologie et hépatologie pédiatrique

Subjects
COLONOSCOPY, medicine.medical_specialty, paediatric, education, Y endoscopy, MEDLINE, endoscopy, Europe, pediatric, position paper, training, GUIDELINES, Pediatrics, COLORECTAL-CANCER, GASTROINTESTINAL ENDOSCOPY, 03 medical and health sciences, 0302 clinical medicine, Paediatric gastroenterology, Internal medicine, medicine, Humans, Child, Simulation Training, Societies, Medical, ASSESSMENT-TOOL, DIAGNOSTIC YIELD, medicine.diagnostic_test, business.industry, 4. Education, General surgery, Gastroenterology, Endoscopy, Hepatology, COMPETENCE, Perinatology, 3. Good health, QUALITY INDICATORS, and Child Health, Education, Medical, Graduate, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Position paper, 030211 gastroenterology & hepatology, LEARNING-CURVE, TECHNICAL SKILLS, business
Abstract

What Is Known - Endoscopy Training is becoming an integral part of Paediatric Gastroenterology Training within Europe. - There is a great degree of variation between European endoscopy training in terms of duration, content, procedural volume, assessment during and at the end of training. What Is New? - Achievement of milestones in training more accurately assesses competency compared with procedural number. - Train the trainers’ courses and educational material,such as e-learning and endoscopy simulator training improve a structuredapproachinendoscopy teaching. - Cooperation with the National Paediatric Gastroenterology, Hepatology and Nutrition Societies in Europe will facilitate dissemination, discussion and implementation of results of this position paper.

Published
2020

14. Phenotypic Variability in Siblings With Autosomal Recessive Polycystic Kidney Disease

Author

Ramona Ajiri, Kathrin Burgmaier, Nurver Akinci, Ilse Broekaert, Anja Büscher, Ismail Dursun, Ali Duzova, Loai Akram Eid, Marc Fila, Michaela Gessner, Ibrahim Gokce, Laura Massella, Antonio Mastrangelo, Monika Miklaszewska, Larisa Prikhodina, Bruno Ranchin, Nadejda Ranguelov, Rina Rus, Lale Sever, Julia Thumfart, Lutz Thorsten Weber, Elke Wühl, Alev Yilmaz, Jörg Dötsch, Franz Schaefer, Max Christoph Liebau, UCL - (SLuc) Département de pédiatrie, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Service de pédiatrie générale, and Ajiri R., Burgmaier K., Akinci N., Broekaert I., Büscher A., Dursun I., Duzova A., Eid L. A., Fila M., Gessner M., et al.

Subjects
Internal Diseases, LIVER, GENETICS, ARPKD, Medizin, CHILDREN, PKHD1, Sağlık Bilimleri, İç Hastalıkları, Clinical Medicine (MED), CONGENITAL HEPATIC-FIBROSIS, UROLOGY & NEPHROLOGY, Health Sciences, Fibrocystin, Klinik Tıp (MED), ÜROLOJİ VE NEFROLOJİ, PRENATAL-DIAGNOSIS, Internal Medicine Sciences, Klinik Tıp, RENAL-TRANSPLANTATION, MUTATIONS, PKD, Dahili Tıp Bilimleri, CLINICAL MEDICINE, Ciliopathies, Tıp, CLINICAL-EXPERIENCE, Nefroloji, Nephrology, DZIP1L, Medicine
Abstract

© 2022 International Society of NephrologyIntroduction: Autosomal recessive polycystic kidney disease (ARPKD) is a rare monogenic disorder characterized by early onset fibrocystic hepatorenal changes. Previous reports have documented pronounced phenotypic variability even among siblings in terms of patient survival. The underlying causes for this clinical variability are incompletely understood. Methods: We present the longitudinal clinical courses of 35 sibling pairs included in the ARPKD registry study ARegPKD, encompassing data on primary manifestation, prenatal and perinatal findings, genetic testing, and family history, including kidney function, liver involvement, and radiological findings. Results: We identified 70 siblings from 35 families with a median age of 0.7 (interquartile range 0.1–6.0) years at initial diagnosis and a median follow-up time of 3.5 (0.2–6.2) years. Data on PKHD1 variants were available for 37 patients from 21 families. There were 8 patients from 7 families who required kidney replacement therapy (KRT) during follow-up. For 44 patients from 26 families, antihypertensive therapy was documented. Furthermore, 37 patients from 24 families had signs of portal hypertension with 9 patients from 6 families having substantial hepatic complications. Interestingly, pronounced variability in the clinical course of functional kidney disease was documented in only 3 sibling pairs. In 17 of 20 families of our cohort of neonatal survivors, siblings had only minor differences of kidney function at a comparable age. Conclusion: In patients surviving the neonatal period, our longitudinal follow-up of 70 ARPKD siblings from 35 families revealed comparable clinical courses of kidney and liver diseases in most families. The data suggest a strong impact of the underlying genotype.

Published
2022

15. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. Amir, Javier Ampuero, Noha Anas, Pietro Andreone, Soa Fy Andriamandimby, Mahmoud Anees, Peltec Angela, Manal Antonios, Wael Arafat, Jose Moreno Araya, Juan Armendariz-Borunda, Matthew J. Armstrong, Hassan Ashktorab, Patricia Aspichueta, Fathia Assal, Mira Atef, Dina Attia, Hoda Atwa, Reham Awad, Mohyeldeen Abd Elaziz Awad, Sally Awny, Obafemi Awolowo, Yaw Asante Awuku, Ibrahim Ayada, Than Than Aye, Sherif Ayman, Hedy Ayman, Hesham Ayoub, Hosny M. Azmy, Romiro P. 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Hasan, F, Hashim, A, Hassan, I, Hassan, A, Hassan, E, Hassan, M, Hassanin, F, Hassnine, A, Haukeland, J, Hawal, A, He, J, He, Q, He, Y, He, F, Hegazy, M, Hegazy, A, Henegil, O, Hernandez, N, Hernandez-Guerra, M, Higuera-de-la-Tijera, F, Hindy, I, Hirota, K, Ho, L, Hodge, A, Hosny, M, Hou, X, Huang, J, Huang, Y, Huang, Z, Huang, A, Huang, X, Hui-ping, S, Hunyady, B, Hussein, M, Hussein, O, Hussien, S, Ibanez-Samaniego, L, Ibdah, J, Ibrahim, L, Ibrahim, M, Ibrahim, I, Icaza-Chavez, M, Idelbi, S, Idilman, R, Ikeda, M, Indolfi, G, Invernizzi, F, Irshad, I, Isa, H, Iskandar, N, Ismaiel, A, Ismail, M, Ismail, Z, Ismail, F, Iwamoto, H, Jack, K, Jacob, R, Jafarov, F, Jafri, W, Jahshan, H, Jalal, P, Jancoriene, L, Janicko, M, Jayasena, H, Jefferies, M, Jha, V, Ji, F, Ji, Y, Jia, J, Jiang, C, Jiang, N, Jiang, Z, Jin, X, Jin, Y, Jing, X, Jingyu, Q, Jinjolava, M, Jong, F, Jucov, A, Julius, I, Kaddah, M, Kamada, Y, Kamal, A, Kamal, E, Kamel, A, Kao, J, Karin, M, Karlas, T, Kashwaa, M, Katsidzira, L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022

16. Drugs in Focus: Octreotide Use in Children With Gastrointestinal Disorders

Author

Osvaldo Borrelli, Erasmo Miele, C Ribes Koninckx, Rut Ann Thomassen, J Martin de-Carpi, Marc A. Benninga, Ilse Broekaert, Jernej Dolinsek, Christo Tzivinikos, Corina Pienar, Emmanuel Mas, Mike Thomson, 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), Great Ormond Street Hospital for Children [London] (GOSH), University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), 'Federico II' University of Naples Medical School, Victor Babeş University of Medicine and Pharmacy (UMFT), University of Amsterdam [Amsterdam] (UvA), Vall d'Hebron University Hospital [Barcelona], Hospital Universitari i Politècnic La Fe, Oslo University Hospital [Oslo], Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, and VU University Medical Center [Amsterdam]

Subjects
medicine.medical_specialty, Gastrointestinal bleeding, Gastrointestinal Diseases, Octreotide, Lymphangiectasia, somatostatin, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Gastrointestinal Agents, children, Chylous ascites, Internal medicine, chylous ascites, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Child, business.industry, Chylothorax, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, bleeding, 3. Good health, Clinical trial, diarrhoea, Pancreatitis, Pharmaceutical Preparations, ocreotide, 030220 oncology & carcinogenesis, [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, Acute Disease, Pediatrics, Perinatology and Child Health, Acute pancreatitis, 030211 gastroenterology & hepatology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

International audience; Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".

Published
2021

17. 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

18. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper

Author

Matjaž Homan, Nikhil Thapar, Mike Thomson, Christos Tzivinikos, Lissy de Ridder, Amani Mubarak, Emmanuel Mas, Marc A. Benninga, Ilse Broekaert, Corina Pienar, Jernej Dolinsek, Erasmo Miele, University Medical Center [Utrecht], Emma Children’s Hospital, University Hospital of Cologne [Cologne], University medical centre Maribor (UKC Maribor), 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), Great Ormond Street Hospital for Children [London] (GOSH), Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, Eramus MC-Sophia Children’s Hospital, Partenaires INRAE, Nestle SA, Danone Nutricia, Mubarak, Amani, Benninga, Marc A, Broekaert, Ilse, Dolinsek, Jernej, Homan, Matjaž, Mas, Emmanuel, Miele, Erasmo, Pienar, Corina, Thapar, Nikhil, Thomson, Mike, Tzivinikos, Christo, de Ridder, Lissy, Paediatric Gastroenterology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, SEGUIN, Nathalie, and Pediatrics

Subjects
medicine.medical_specialty, MEDLINE, [SPI.MAT] Engineering Sciences [physics]/Materials, Asymptomatic, [SPI.MAT]Engineering Sciences [physics]/Materials, Eating, 03 medical and health sciences, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, Electric Power Supplies, Esophagus, 0302 clinical medicine, SDG 3 - Good Health and Well-being, 030225 pediatrics, Internal medicine, medicine, Humans, endoscopy, Child, Intensive care medicine, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, medicine.diagnostic_test, Impaction, business.industry, Gastroenterology, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Guideline, Hepatology, Foreign Bodies, foreign body, esophageal perforation, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 3. Good health, Endoscopy, caustic ingestion, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, medicine.anatomical_structure, pediatric, Pediatrics, Perinatology and Child Health, Position paper, 030211 gastroenterology & hepatology, medicine.symptom, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

International audience; Button batteries (BB) remain a health hazard to children as ingestion might lead to life-threatening complications, especially if the battery is impacted in the esophagus. Worldwide initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably 12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (

Published
2021

19. Drugs in Focus: The Use of Racecadotril in Paediatric Gastrointestinal Disease

Author

Emmanuel Mas, Ilse Broekaert, Erasmo Miele, Christos Tzivinikos, Jernej Dolinsek, Carmen Ribes-Koninckx, Marc A. Benninga, Corina Pienar, Rut Anne Thomassen, Nikhil Thapar, Rok Orel, Mike Thomson, Victor Babeş University of Medicine and Pharmacy (UMFT), Emma Children’s Hospital Academic Medical Centre, University Hospital of Cologne, University medical centre Maribor (UKC Maribor), 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), Università degli studi di Napoli Federico II, University Medical Centre Ljubljana [Ljubljana, Slovenia] (UMCL), Hospital Universitario y Politécnico La Fe, Oslo University Hospital [Oslo], NHS Foundation Trust, Al Jalila Children's Specialty Hospital, UCL Great Ormond Street Institute of Child Health [London, UK], Great Ormond Street Hospital, Partenaires INRAE, Queensland Children's Hospital, Pienar, Corina, Benninga, Marc A, Broekaert, Ilse J, Dolinsek, Jernej, Mas, Emmanuel, Miele, Erasmo, Orel, Rok, Ribes-Koninckx, Carmen, Thomassen, Rut-Anne, Thomson, Mike, Tzivinikos, Christo, Thapar, Nikhil, Paediatric Gastroenterology, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, Amsterdam Reproduction & Development (AR&D), ProdInra, Migration, University of Naples Federico II = Università degli studi di Napoli Federico II, and Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe

Subjects
Diarrhea, Drug, Thiorphan, [SDV.BIO]Life Sciences [q-bio]/Biotechnology, Gastrointestinal Diseases, medicine.drug_class, media_common.quotation_subject, medicine.medical_treatment, Pharmacology, Racecadotril, 03 medical and health sciences, 0302 clinical medicine, adjuvant, 030225 pediatrics, Antidiarrhoeal, medicine, Humans, Antidiarrheals, Child, Adverse effect, Neprilysin, media_common, racecadotril, business.industry, digestive, oral, and skin physiology, Gastroenterology, medicine.disease, Small intestine, [SDV.BIO] Life Sciences [q-bio]/Biotechnology, 3. Good health, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, medicine.anatomical_structure, Pharmaceutical Preparations, Gastrointestinal disease, Pediatrics, Perinatology and Child Health, 030211 gastroenterology & hepatology, business, gastroenteritis, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, Adjuvant, medicine.drug
Abstract

International audience; Acute diarrhoea is a leading cause of morbidity and mortality in the paediatric population. Racecadotril is an antisecretory drug recommended as an adjuvant anti-diarrhoeal treatment.In the small bowel, the enzyme neutral endopeptidase (NEP) inhibits the action of enkephalins, which prevent water and electrolyte hypersecretion. By inhibiting NEP, racecadotril allows enkephalins to exhibit their antisecretory effects. Consequently, racecadotril reduces the secretion of water and electrolytes in the small intestine, without having an effect on intestinal motility. No serious adverse events related to racecadotril have been reported.Racecadotril has proven its efficacy as an adjuvant anti-diarrhoeal drug with a good safety profile. Its addition to oral rehydration solution (ORS) appears clinically beneficial and potentially leads to health care savings.

Published
2020

21. Infantile Anterior Segment Disorders

Author

Ilse Broekaert, Francesco Buonfiglio, Adrian Gericke, Ken K. Nischal, Sarah Zwingelberg, Ilse Broekaert, Francesco Buonfiglio, Adrian Gericke, Ken K. Nischal, and Sarah Zwingelberg

Subjects
Ophthalmology
Abstract

This book provides a practical overview of infantile anterior segment disorders in a clear and concise format. Genetics, new diagnostics, and surgical options for anterior segment disorders in children are highlighted with numerous high-quality illustrations as well as the pediatric spectrum of systemic diseases based on the experience of internationally active experts. Infantile Anterior Segment Disorders is an essential resource for all ophthalmologists seeking an easy-to-use resource for optimizing clinical expertise and outcomes related to these conditions.

Published
2024

23. Gastrointestinal Perspective of Coronavirus Disease 2019 in Children-An Updated Review

Author

Christos Tzivinikos, Javier Martín de Carpi, Emmanuel Mas, Jernej Dolinsek, Mike Thomson, Marco Deganello Saccomani, Ilse Broekaert, Erasmo Miele, Amit Assa, Osvaldo Borrelli, Marc A. Benninga, Assa, Amit, Benninga, Marc A, Borrelli, Osvaldo, Broekaert, Ilse, de Carpi, Javier Martin, Saccomani, Marco Deganello, Dolinsek, Jernej, Mas, Emmanuel, Miele, Erasmo, Thomson, Mike, Tzivinikos, Christos, Ben-Gurion University of the Negev (BGU), University of Amsterdam [Amsterdam] (UvA), Great Ormond Street Hospital for Children [London] (GOSH), University Hospital of Cologne [Cologne], University of Barcelona, University of Verona (UNIVR), University medical centre Maribor (UKC Maribor), 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, Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, Università degli studi di Verona = University of Verona (UNIVR), and SEGUIN, Nathalie

Subjects
Diarrhea, Abdominal pain, paediatric, Gastrointestinal Diseases, medicine.medical_treatment, coronavirus, Peritonitis, Review Article, Liver transplantation, Inflammatory bowel disease, gastrointestinal manifestations, 03 medical and health sciences, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, 0302 clinical medicine, Immune system, 030225 pediatrics, Medicine, Humans, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, SARS-CoV-2, Gastroenterology, COVID-19, medicine.disease, Systemic Inflammatory Response Syndrome, 3. Good health, Systemic inflammatory response syndrome, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Pediatrics, Perinatology and Child Health, Immunology, multisystem inflammatory disease, Pancreatitis, 030211 gastroenterology & hepatology, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.

Published
2021

24. [Crohn's Disease Exclusion Diet - an alternative to exlusive enteral nutritional therapy in children and adolescents with Crohn's disease? Statement of the GPGE working groups CEDATA and Nutrition/Nutrition Medicine]

Author

Jan, de Laffolie, Tobias, Schwerd, Annette, Simon, Maren, Pauli, Ilse, Broekaert, Martin, Classen, Carsten, Posovszky, and Anjona, Schmidt-Choudhury

Subjects
Enteral Nutrition, Adolescent, Crohn Disease, Practice Guidelines as Topic, Humans, Child, Inflammatory Bowel Diseases, Societies, Medical, Diet
Abstract

Epidemiological an clinical observations as well as results from animal studies indicate that nutrition can play a role in the development of inflammatory bowel disease (IBD). Exclusive enteral nutrition therapy represents an example for modulating inflammatory responses solely through diet modification. Therefore, caretakers, patients, families, doctors and nutritionists seek for more dietary options to control IBD. These options include partial enteral nutrition therapy as for example the socalled Crohn's disease exclusion diet. The following statement summarizes existing data and provides recommendations for the current management of enteral nutrition therapy in pediatric Crohn's disease.Epidemiologische und klinische Beobachtungen sowie Tiermodelle weisen auf die Ernährung als Risikofaktor für die Entwicklung einer chronisch entzündlichen Darmerkrankung (CED) hin. Die exklusive enterale Ernährungstherapie (EET) ist das Musterbeispiel einer effektiven Entzündungskontrolle durch eine rein diätetische Intervention. Ausgehend davon haben Patienten, Familien und betreuende Fachkräfte des Gesundheitswesens ein großes Interesse, andere Ernährungsmodifikationen in der Behandlung von CED-Patienten einzusetzen, zum Beispiel eine partielle Ernährungstherapie (PET) mit spezifischer Diät wie die Crohnʼs Disease Exclusion Diet. Die folgende Stellungnahme fasst die aktuelle Datenlage zusammen und gibt Orientierung für Praxis und weitere Forschung.

Published
2020

25. A systematic review and meta-analysis of paediatric inflammatory bowel disease incidence and prevalence across Europe

Author

John Williams, Christos Tzivinikos, Corina Pienar, Stephen E. Roberts, Ilse Broekaert, Ann John, Marc A. Benninga, Nikhil Thapar, Rok Orel, Kym Thorne, Emmanuel Mas, Mike Thomson, Erasmo Miele, Jernej Dolinsek, Sian Morrison-Rees, Carmen Ribes-Koninckx, Roberts, S. E., Thorne, K., Thapar, N., Broekaert, I., Benninga, M. A., Dolinsek, J., Mas, E., Miele, E., Orel, R., Pienar, C., Ribes-Koninckx, C., Thomson, M., Tzivinikos, C., Morrison-Rees, S., John, A., Williams, J. G., Swansea University, Great Ormond Street Hospital for Children [London] (GOSH), King Saud University [Riyadh] (KSU), Queensland Children's Hospital, Partenaires INRAE, University Children's Hospital, Emma Children's Hospital, University medical centre Maribor (UKC Maribor), 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), University of Naples Federico II, University Medical Centre Slovenia, Victor Babeş University of Medicine and Pharmacy (UMFT), Hospital Universitario y Politécnico La Fe, Sheffield Children's NHS Foundation Trust, Al Jalila Children's Specialty Hospital, and European Society for Paediatric Gastroenterology Hepatology and Nutrition

Subjects
Pediatrics, medicine.medical_specialty, Population, Disease, Cochrane Library, Inflammatory bowel disease, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Prevalence, medicine, Humans, 030212 general & internal medicine, Child, Prospective cohort study, education, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Gastroenterology, General Medicine, medicine.disease, Ulcerative colitis, 3. Good health, Europe, Paediatric, Meta-analysis, Colitis, Ulcerative, 030211 gastroenterology & hepatology, Trends, business, Needs Assessment, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background and AimsInflammatory bowel disease [IBD] is often one of the most devastating and debilitating chronic gastrointestinal disorders in children and adolescents. The main objectives here were to systematically review the incidence and prevalence of paediatric IBD across all 51 European states.MethodsWe undertook a systematic review and meta-analysis based on PubMed, CINAHL, the Cochrane Library, searches of reference lists, grey literature and websites, covering the period from 1970 to 2018.ResultsIncidence rates for both paediatric Crohn’s disease [CD] and ulcerative colitis [UC] were higher in northern Europe than in other European regions. There have been large increases in the incidence of both paediatric CD and UC over the last 50 years, which appear widespread across Europe. The largest increases for CD have been reported from Sweden, Wales, England, the Czech Republic, Denmark and Hungary, and for UC from the Czech Republic, Ireland, Sweden and Hungary. Incidence rates for paediatric CD have increased up to 9 or 10 per 100 000 population in parts of Europe, including Scandinavia, while rates for paediatric UC are often slightly lower than for CD. Prevalence reported for CD ranged from 8.2 per 100 000 to approximately 60 and, for UC, from 8.3 to approximately 30.ConclusionsThe incidence of paediatric IBD continues to increase throughout Europe. There is stronger evidence of a north–south than an east–west gradient in incidence across Europe. Further prospective studies are needed, preferably multinational and based on IBD registries, using standardized definitions, methodology and timescales.

Published
2020

26. Management of Gastrointestinal and Nutritional Problems in Children With Neurological Impairment: A Survey of Practice

Author

Alexandra Papadopoulou, Myriam Van Winckel, Jiri Bronsky, Claudio Romano, Luigi Dall'Oglio, Valeria Dipasquale, Jessie M. Hulst, Michael Wilschanski, Ilse Broekaert, Iva Hojsak, Michela Schaeppi, Nikhil Thapar, Rok Orel, Peter B. Sullivan, Frédéric Gottrand, and Nataša Fidler Mis

Subjects
medicine.medical_specialty, medicine.medical_treatment, MEDLINE, Fundoplication, Pilot Projects, Disease, Enteral administration, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Surveys and Questionnaires, medicine, Humans, Child, business.industry, cerebral palsy, enteral nutrition, gastrointestinal diseases, nutrition, paediatrics, Gastroenterology, Nutrition Disorders, Anthropometry, medicine.disease, Gastrostomy, nutrition, Family medicine, Pediatrics, Perinatology and Child Health, GERD, Gastroesophageal Reflux, Position paper, 030211 gastroenterology & hepatology, business
Abstract

Objectives The main aim of this study was to determine the impact on clinical practice of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper on the diagnosis and management of nutritional and gastrointestinal problems in children with neurological impairment (NI). Methods In this pilot-study, a web-based questionnaire was distributed between November, 2019 and June, 2020, amongst ESPGHAN members using the ESPGHAN newsletter. Fifteen questions covered the most relevant aspects on nutritional management and gastrointestinal issues of children with NI. A descriptive analysis of responses was performed. Results A total of 150 health professionals from 23 countries responded to the survey. A considerable variation in clinical practice concerning many aspects of nutritional and gastrointestinal management of children with NI was observed. The most frequently used method for diagnosing oropharyngeal dysfunction was the direct observation of meals with or without the use of standardised scores (n = 103). Anthropometric measurements were the most commonly used tools for assessing nutritional status (n = 111). The best treatment for gastroesophageal reflux disease (GERD) was considered to be proton pump inhibitor therapy by most (n = 116) participants. Regarding tube feeding, nearly all respondents (n = 114) agreed that gastrostomy is the best enteral access to be used for long-term enteral feeding. Fundoplication was indicated at the time of gastrostomy placement especially in case of uncontrolled GERD. Conclusions More studies are required to address open questions on adequate management of children with NI. Identifying knowledge gaps paves the way for developing updated recommendations and improving patient care.

Published
2020

27. Acute Gastroenteritis in Children of the World: What Needs to be Done?

Author

Ilse Broekaert, Andrea Lo Vecchio, Lori R. Holtz, Rodrigo Vazquez-Frias, Juliet Aguilar, Andrea Smarrazzo, Bhupinder Sandhu, Sean R. Moore, Suporn Treepongkaruna, James A. Berkley, Alfredo Guarino, Juan Francisco Rivera Medina, Hania Szajewska, and Toufik Meskini

Subjects
medicine.medical_specialty, Sanitation, media_common.quotation_subject, purl.org/pe-repo/ocde/ford#3.03.04 [https], Psychological intervention, Developing country, Disease, medicine.disease_cause, Rotavirus Infections, Article, 03 medical and health sciences, 0302 clinical medicine, prevention, Hygiene, 030225 pediatrics, Rotavirus, Health care, medicine, Humans, Child, Intensive care medicine, implementation, media_common, purl.org/pe-repo/ocde/ford#3.02.03 [https], business.industry, purl.org/pe-repo/ocde/ford#3.02.19 [https], Vaccination, Infant, Newborn, Rotavirus Vaccines, Gastroenterology, Infant, Rotavirus vaccine, Gastroenteritis, rotavirus, Pediatrics, Perinatology and Child Health, Fluid Therapy, 030211 gastroenterology & hepatology, Emergency Service, Hospital, business, gastroenteritis
Abstract

The incidence of gastroenteritis has greatly reduced due to improved hygiene conditions in developing countries and the use of rotavirus vaccine. Still thousands of children, however, die from gastroenteritis, most of them in poor countries. Yet gastroenteritis management is simple, inexpensive, and effective and is largely the same all over the world. Universal guidelines for gastroenteritis guide the management and include simple interventions put forward early in the course of the disease. Treatment includes rehydration, continuing oral feeding, and anti-infective drugs in selected clinical conditions related to the symptoms or to host-related risk, and possible additional drug treatment to reduce the duration and severity of symptoms. There may be minor geographical differences in the treatment applied due to health care organizations that do not substantially change the standard universal recommendations. Prevention is recommended with sanitation interventions and rotavirus universal immunization. Implementation of those interventions through educational initiatives and local programs in target areas are needed. A series of recommendations for interventions, education, and research priorities are included here with the aim of reducing the burden of gastroenteritis, to be pursued by scientists, physicians, policy makers, and stakeholders involved. They include the need of recommendations for the management of gastroenteritis in malnourished children, in those with chronic conditions, in neonates, and in emergency settings. A reference system to score dehydration, the definition of optimal composition of rehydration solution and the indications for anti-infective therapy are also included. Rotavirus immunization should be actively promoted, and evidence-based guidelines should be universally implemented. Research priorities are also indicated.

Published
2020

28. Mutations in plasmalemma vesicle-associated protein cause severe syndromic protein-losing enteropathy

Author

Friederike Körber, Ilse Broekaert, Jörg Dötsch, Sebahattin Cirak, Christoph Hünseler, Holger Thiele, Ingo Gottschalk, Peter Nürnberg, Janine Altmüller, and Kerstin Becker

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Pathology, Protein-Losing Enteropathies, medicine.disease_cause, 03 medical and health sciences, Fatal Outcome, Exome Sequencing, Genetics, medicine, Humans, Enteropathy, Gene, Genetics (clinical), Exome sequencing, Mutation, Genetic heterogeneity, business.industry, Homozygote, Protein losing enteropathy, Infant, Newborn, Membrane Proteins, medicine.disease, 030104 developmental biology, Medical genetics, Carrier Proteins, business, Rare disease
Abstract

BackgroundProtein-losing enteropathy (PLE) is characterised by gastrointestinal protein leakage due to loss of mucosal integrity or lymphatic abnormalities. PLE can manifest as congenital diarrhoea and should be differentiated from other congenital diarrhoeal disorders. Primary PLEs are genetically heterogeneous and the underlying genetic defects are currently emerging.ObjectivesWe report an infant with fatal PLE for whom we aimed to uncover the underlying pathogenic mutation.MethodsWe performed whole exome sequencing (WES) for the index patient. Variants were classified based on the American College of Medical Genetics and Genomics guidelines. WES results and our detailed clinical description of the patient were compared with the literature.ResultsWe discovered a novel homozygous stop mutation (c.988C>T, p.Q330*) in the Plasmalemma Vesicle-Associated Protein (PLVAP) gene in a newborn with fatal PLE, facial dysmorphism, and renal, ocular and cardiac anomalies. The Q330* mutation is predicted to result in complete loss of PLVAP protein expression leading to deletion of the diaphragms of endothelial fenestrae, resulting in plasma protein extravasation and PLE. Recently, another single homozygous stop mutation in PLVAP causing lethal PLE in an infant was reported.ConclusionsOur findings validate PLVAP mutations as a cause of syndromic PLE. Prenatal anomalies, severe PLE and syndromic features may guide the diagnosis of this rare disease.

Published
2018

29. Chapter 3. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition in Recent Years

Author

Ilse Broekaert, Raanan Shamir, Berthold Koletzko, and Riccardo Troncone

Subjects
medicine.medical_specialty, media_common.quotation_subject, Best practice, MEDLINE, Child Nutrition Sciences, History, 21st Century, Pediatrics, Child health, 03 medical and health sciences, 0302 clinical medicine, Promotion (rank), Paediatric gastroenterology, 030225 pediatrics, Internal medicine, medicine, Humans, Child, Societies, Medical, media_common, Enthusiasm, business.industry, Gastroenterology, Hepatology, Europe, Friendship, Family medicine, Pediatrics, Perinatology and Child Health, 030211 gastroenterology & hepatology, business
Abstract

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition has experienced an amazing development in the 50 years of its existence. It grew from a small group of 36 friends who held an informal meeting with some 20 oral presentations to share and discuss their clinical and research work, to a large, multiprofessional society that sets widely recognized standards for clinical care and policy and hosts the world's largest congress of Paediatric Gastroenterology, Hepatology and Nutrition with more than 4500 delegates from 100 countries. However, the Society's mission has remained the same: to promote the health of children with special attention to the gastrointestinal tract, liver, and nutritional status, through knowledge creation, the dissemination of science based information, the promotion of best practice in the delivery of care and the provision of high-quality education. The European Society for Paediatric Gastroenterology Hepatology and Nutrition's success is based on the enthusiasm and engagement of its membership that contribute extensive volunteer work to support child health, while maintaining a positive spirit of collaboration and friendship, which characterises this Society. This article aims at describing recent developments and the current situation of the European Society for Paediatric Gastroenterology Hepatology and Nutrition.

Published
2018

30. Peritoneal drainage in pneumoperitoneum in extremely low birth weight infants

Author

Daisy Schulten, Titus Keller, Angela Kribs, Christoph Hünseler, Martin Dübbers, and Ilse Broekaert

Subjects
Male, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, Birth weight, Infant, Premature, Diseases, 03 medical and health sciences, 0302 clinical medicine, Pneumoperitoneum, Interquartile range, 030225 pediatrics, Laparotomy, Statistical significance, medicine, Humans, 030212 general & internal medicine, Retrospective Studies, business.industry, Infant, Newborn, Gestational age, medicine.disease, Low birth weight, Treatment Outcome, Infant, Extremely Low Birth Weight, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, Drainage, Female, medicine.symptom, business, Infant, Premature
Abstract

The aim was to determine if peritoneal drainage (PD) is a suitable treatment for pneumoperitoneum in extremely low birth weight (ELBW) infants. A retrospective chart review of 42 ELBW infants with pneumoperitoneum at the University Hospital of Cologne between November 2014 and April 2017 was performed. Forty-two infants with a median birth weight of 645 g (interquartile range (IQR) 550, 806) and a median gestational age of 24.3 weeks (IQR 23.2, 25.6) were treated for pneumoperitoneum. Twenty-six (62%) received PD, and in ten (38%), the drain could be removed without further intervention. Infants in the PD group were of significantly lower birth weight (622g vs. 750 g), age (4.5 vs. 10.0 days), and weight at diagnosis (538 vs. 778 g). The mortality in the PD group was 15% at 90 days of life, but no patient deceased in the primary laparotomy group.We suggest PD with close evaluation of drainage and clinical course as an alternative treatment for pneumoperitoneum in ELBW infants allowing bridging the vulnerable first days of life until these infants are in a more stable condition. Despite not reaching statistical significance in our series, PD showed the trend towards higher mortality. What is known: • Pneumoperitoneum is traditionally treated with laparotomy, but placement of peritoneal drainage (PD) is a valuable treatment option. • Previous randomized controlled trials have shown no significant differences in mortality for PD versus laparotomy. What is new: • In our cohort, 38% of the infants with PD could be saved from secondary laparotomy, but in the PD group there was a trend towards higher mortality. • PD allows bridging the vulnerable first days of life until ELBW infants are in a more stable condition for possible laparotomy.

Published
2018

31. Empfehlungen zur Jejunalsondenernährung bei Kindern und Jugendlichen

Author

Christine Schwarz, Ilse Broekaert, Victor Bildheim, Almuthe C. Hauer, Annette Brunert, and Anjona Schmidt-Choudhury

Subjects
medicine.medical_specialty, Pediatrics, business.industry, Pediatrics, Perinatology and Child Health, Pediatric surgery, Child and adolescent psychiatry, Medicine, Surgery, business
Published
2020

32. Evaluation of a European-wide survey on paediatric endoscopy training

Author

Christos Tzivinikos, Jorge Amil Dias, Ilse Broekaert, Hubert P. J. van der Doef, Joerg Jahnel, Angela Ernst, Mike Thomson, and Nicolette Moes

Subjects
medicine.medical_specialty, FELLOWSHIP PROCEDURAL GUIDELINES, medicine.medical_treatment, education, SOCIETY, Colonoscopy, IMPROVEMENT, Computer-assisted web interviewing, Education, GASTROINTESTINAL ENDOSCOPY, 03 medical and health sciences, 0302 clinical medicine, Paediatric gastroenterology, Internal medicine, medicine, Intubation, 030212 general & internal medicine, Competence (human resources), THERAPEUTIC ENDOSCOPY, ASSESSMENT-TOOL, Hepatology, medicine.diagnostic_test, business.industry, COMPETENCE, GASTROENTEROLOGY, Endoscopy, PERFORMANCE-MEASURES, Family medicine, Therapeutic endoscopy, 030211 gastroenterology & hepatology, LEARNING-CURVE, Human medicine, business
Abstract

ObjectiveTo evaluate quality of paediatric endoscopy training of Young members of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).MethodsAn online questionnaire designed by the Young ESPGHAN Committee was sent to 125 Young ESPGHAN members between February 2014 and September 2015. The questionnaire comprised 32 questions addressing some general information of the participants and the structure of their paediatric gastroenterology, hepatology and nutrition programmes; procedural volume and terminal ileal intubation (TII) rate; supervision, assessments, participation in endoscopy courses and simulator training; and satisfaction with endoscopy training and self-perceived competency.ResultsOf 68 participants, 48 (71%) were enrolled in an official training programme. All alumni (n=31) were trained in endoscopy. They completed a median of 200 oesophagogastroduodenoscopies (OGDs) and 75 ileocolonoscopies (ICs) with a TII rate of >90% in 43%. There is a significant difference in numbers of ICs between the TII rate groups >90%, 50%–90% and ConclusionsDespite reaching the suggested procedural endoscopy volumes, a rather low TII rate of >90% calls for end-of-training certifications based on the achievement of milestones of competency.

Published
2019

33. The Use of Jejunal Tube Feeding in Children: A Position Paper by the Gastroenterology and Nutrition Committees of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2019

Author

Luigi Dall'Oglio, Jackie Falconer, Michael Wilschanski, Carmen Ribes-Koninckx, Michela Schaeppi, Eunice Goto, Iva Hojsak, Alexandra Papadopoulou, Brigitte Kochavi, Jiri Bronsky, Frédéric Gottrand, Jessie M. Hulst, Ilse Broekaert, Steven L. Werlin, Nikhil Thapar, and Pediatrics

Subjects
medicine.medical_specialty, Gastrointestinal Diseases, medicine.medical_treatment, Jejunostomy, MEDLINE, Gastroenterology, law.invention, 03 medical and health sciences, Enteral Nutrition, 0302 clinical medicine, Randomized controlled trial, law, 030225 pediatrics, Internal medicine, Humans, Medicine, Child, Grading (education), Societies, Medical, business.industry, nutrition, Jejunal tube feeding, Nutritional Requirements, Hepatology, Europe, Jejunum, Systematic review, Parenteral nutrition, Practice Guidelines as Topic, Pediatrics, Perinatology and Child Health, Position paper, 030211 gastroenterology & hepatology, Child Nutritional Physiological Phenomena, business
Abstract

Objectives: Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety. Methods: A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed. A systematic literature search was performed from 1982 to November 2018 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 finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors. Results: A total of 33 recommendations were voted on using the nominal voting technique. Conclusions: JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.

Published
2019

34. Role of Polyethylene Glycol in the Treatment of Functional Constipation in Children

Author

Paolo Lionetti, Michael Wilschanski, Frédéric Gottrand, Carmen Ribes-Koninckx, Nikhil Thapar, Marc A. Benninga, Rok Orel, Alexandra Papadopoulou, Ilse Broekaert, Ilan J.N. Koppen, Graduate School, Amsterdam Reproduction & Development (AR&D), Amsterdam Gastroenterology Endocrinology Metabolism, and Paediatric Gastroenterology

Subjects
Drug, medicine.medical_specialty, Constipation, Drug Compounding, media_common.quotation_subject, medicine.medical_treatment, Laxative, macromolecular substances, Polyethylene glycol, peg, Gastroenterology, Polyethylene Glycols, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, children, Randomized controlled trial, law, 030225 pediatrics, Internal medicine, PEG ratio, medicine, Humans, Drug Dosage Calculations, Child, Adverse effect, media_common, business.industry, Contraindications, Drug, technology, industry, and agriculture, constipation, medicine.disease, Treatment Outcome, chemistry, Laxatives, polyethylene glycol, Pediatrics, Perinatology and Child Health, Functional constipation, 030211 gastroenterology & hepatology, medicine.symptom, business
Abstract

According to international guidelines, polyethylene glycol (PEG) is the laxative of first choice in the treatment of functional constipation in children, both for disimpaction and for maintenance treatment. PEG acts as an osmotic laxative and its efficacy is dose dependent. PEG is highly effective, has a good safety profile, and is well tolerated by children. Only minor adverse events have been reported. Overall the use of PEG in children has been reported to be safe, although in patients predisposed to water and electrolyte imbalances monitoring of serum electrolytes should be considered.

Published
2017

35. Mo1988 THE PEDIATRIC ENDOSCOPY PRACTICE IN EUROPE: PRELIMINARY RESULTS OF A WEB-BASED SURVEY ON BEHALF OF THE ENDOSCOPY SPECIAL INTEREST GROUP OF EUROPEAN SOCIETY OF GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION (ESPGHAN)

Author

Raoul I. Furlano, Mike Thomson, Osvaldo Borrelli, Lorenzo Norsa, Salvatore Oliva, Lissy de Ridder, Frédéric Gottrand, Jorge Amil Dias, Marta Tavares, Erasmo Miele, Corina Pienar, Paola De Angelis, Jérôme Viala, Víctor Manuel Navas-López, Christos Tzivinikos, Samy Cadranel, Marco Deganello Saccomani, Ilse Broekaert, Noam Zevit, Gloria Dominguez-Ortega, Patrick Bontems, Ron Shaoul, Oren Ledder, Saskia Vande Velde, Claudio Romano, Nikhil Thapar, Nicolas Kalach, Fadhel Alateeqi, Alghamdi a. Alghamdi, Carolina Gutiérrez-Junquera, Eyal Zifman, Yvan Vandenplas, Rana Bitar, Shlomi Cohen, Caterina Strisciuglio, Mike Cosgrove, Michal Kori, and Aglaia Zellos

Subjects
medicine.medical_specialty, Pediatric endoscopy, medicine.diagnostic_test, business.industry, Gastroenterology, Hepatology, Special Interest Group, Endoscopy, Family medicine, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, business, Web based survey
Published
2020

37. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment

Author

Peter B. Sullivan, Nikhil Thapar, Jessie M. Hulst, Frédéric Gottrand, Luigi Dall'Oglio, Iva Hojsak, Rok Orel, Alexandra Papadopoulou, Ilse Broekaert, Jiri Bronsky, Michael Wilschanski, Claudio Romano, Michela Schaeppi, Myriam van Wynckel, Nataša Fidler Mis, and Pediatrics

Subjects
medicine.medical_specialty, Pediatrics, cerebral palsy, gastrointestinal diseases, nutrition, Body Composition, Body Weights and Measures, Child, Diet Therapy, Enteral Nutrition, Gastrointestinal Diseases, Humans, Myofunctional Therapy, Nervous System Diseases, Nutrition Assessment, Nutrition Disorders, Nutrition Policy, Nutritional Requirements, Prognosis, Pediatrics, Perinatology and Child Health, Gastroenterology, Gastrointestinal Diseases, Disease, Gastroenterology, Cerebral palsy, Nutrition Policy, 03 medical and health sciences, 0302 clinical medicine, Enteral Nutrition, Paediatric gastroenterology, 030225 pediatrics, Internal medicine, medicine, Humans, Body Weights and Measures, Child, Myofunctional Therapy, cerebral palsy, business.industry, Nutritional Requirements, Neurological Impairment, Hepatology, Perinatology and Child Health, medicine.disease, Micronutrient, Prognosis, Nutrition Disorders, Osteopenia, Malnutrition, nutrition, Nutrition Assessment, Pediatrics, Perinatology and Child Health, Body Composition, Nervous System Diseases, business, Neurological impairment, 030217 neurology & neurosurgery, Diet Therapy
Abstract

Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment.Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.

Published
2017

38. Young ESPGHAN: Who Are We?

Author

Ilse Broekaert, Hubert P. J. van der Doef, Joerg Jahnel, Nicolette Moes, and Christos Tzivinikos

Subjects
medicine.medical_specialty, Biomedical Research, business.industry, Nutritional Sciences, Gastroenterology, Pediatrics, Europe, Family medicine, Pediatrics, Perinatology and Child Health, medicine, Medicine, Human medicine, Nutritional science, business, Societies, Medical
Published
2016

39. An international consensus report on a new algorithm for the management of infant diarrhoea

Author

Carlos H. Lifschitz, Marc A. Benninga, Yvan Vandenplas, Frédéric Gottrand, Michael Wilschanski, Raanan Shamir, Carmen Ribes-Koninckx, Silvia Salvatore, Alexandra Papadopoulou, Ilse Broekaert, Nikhil Thapar, Rok Orel, Alfredo Guarino, Annamaria Staiano, Paolo Lionetti, Andrea Lo Vecchio, Jackie Falconer, Hania Szajewska, Michela Schäppi, Growth and Development, Clinical sciences, LO VECCHIO, Andrea, Vandenplas, Yvan, Benninga, Marc, Broekaert, Ilse, Falconer, Jackie, Gottrand, Frederic, Lifschitz, Carlo, Lionetti, Paolo, Orel, Rok, Papadopoulou, Alexandra, Ribes Koninckx, Carmen, Salvatore, Silvia, Shamir, Raanan, Schäppi, Michela, Staiano, Annamaria, Szajewska, Hania, Thapar, Nikhil, Wilschanski, Michael, Guarino, Alfredo, and Paediatric Gastroenterology

Subjects
Diarrhea, medicine.medical_specialty, Pediatrics, infant diarrhoea, Psychological intervention, Breast milk, Algorithm, Dehydration, Gastroenteritis, Infant diarrhoea, Prolonged diarrhoea, Pediatrics, Perinatology and Child Health, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, 030225 pediatrics, Internal medicine, Nominal group technique, Humans, Medicine, 030212 general & internal medicine, Intensive care medicine, book, Pediatric gastroenterology, Medicine(all), algorithm, business.industry, Infant, dehydration, General Medicine, Perinatology and Child Health, Hepatology, Child, Preschool, Acute Disease, Pediatric Infectious Disease, Fluid Therapy, book.journal, prolonged diarrhoea, gastroenteriti, business, Breast feeding, Algorithms
Abstract

AIM: Implementing international guidelines guarantees high standards of clinical care. A group of experts developed an algorithm to drive the management of common gastrointestinal symptoms in infancyby paediatricians and general practitioners. METHODS: The algorithm started from the evidence-based recommendations of the European Society of Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Infectious Diseases and an updated review of the literature. We used the structured quantitative method of nominal group technique to reach a consensus. RESULTS: A practical algorithm for the management of infants with acute diarrhoea was designed based on theconsensus reached for each statement. The management of an infant with acute diarrhoeashould include a sequence of actions: 1) a semi-quantitative estimate of infant dehydration through validated clinical scores, 2) rehydration therapy and early re-feedingwith breast milk or regular formula and 3) effective agents to reduce the severity and duration of the diarrhoea. Finally, in children with prolonged diarrhoea, the search for aetiology should include persistent infections or reinfections, cows' milk protein allergy and celiac diseases. Lactose should always be withdrawn. CONCLUSION: This algorithm provides an evidence-based sequence of interventions to optimisethe management of infants with acute diarrhoea. This article is protected by copyright. All rights reserved.

Published
2016

40. Chronic thrombocytopenia and skeletal dysplasia in a 14-year-old girl with cystic fibrosis

Author

Thorsten Simon, Jan C. Thomassen, Ilse Broekaert, Friederike Körber, Silke van Koningsbruggen-Rietsche, and Ernst Rietsche

Subjects
medicine.medical_specialty, business.industry, Dysplasia, media_common.quotation_subject, medicine, General Medicine, General Chemistry, Girl, medicine.disease, business, Dermatology, Cystic fibrosis, media_common
Published
2016

41. Functional gastro-intestinal disorder algorithms focus on early recognition, parental reassurance and nutritional strategies

Author

Alexandra Papadopoulou, Nikhil Thapar, Yvan Vandenplas, Marc A. Benninga, Alfredo Guarino, Rok Orel, Carlos H. Lifschitz, Frank M. Ruemmele, Frédéric Gottrand, Ilse Broekaert, Raanan Shamir, Michael Wilschanski, Silvia Salvatore, Michela Schäppi, Hania Szajewska, Annamaria Staiano, Paolo Lionetti, Carmen Ribes-Koninckx, Jackie Falconer, Vandenplas, Y, Benninga, M, Broekaert, I, Falconer, J, Gottrand, F, Guarino, Alfredo, Lifschitz, C, Lionetti, P, Orel, R, Papadopoulou, A, Ribes Koninckx, C, Ruemmele, Fm, Salvatore, S, Shamir, R, Schäppi, M, Staiano, Annamaria, Szajewska, H, Thapar, N, Wilschanski, M., Growth and Development, and Clinical sciences

Subjects
Pediatrics, medicine.medical_specialty, Functional disorder, Constipation, Colic, Gastrointestinal Diseases, Primary health care, Milk allergy, Organic disease, Infantile colic, 03 medical and health sciences, 0302 clinical medicine, Cows' milk allergy, Regurgitation, Pediatrics, Perinatology and Child Health, 030225 pediatrics, medicine, Parental reassurance, Humans, Parenting, business.industry, Cow, Infant, General Medicine, Perinatology and Child Health, medicine.disease, milk allergy, gastro-intestinal disorder, Regurgitation (digestion), 030211 gastroenterology & hepatology, medicine.symptom, Milk Hypersensitivity, business, Algorithm, Algorithms
Abstract

UNLABELLED: Up to 50% of infants present with symptoms of regurgitation, infantile colic and/or constipation during the first 12 months of life. Although they are often classed as functional disorders, there is an overlap with cows' milk allergy. We present practical algorithms for the management of such disorders, based on existing evidence and general consensus, with a particular focus on primary health care. Management consists of early recognition of warning signs of organic disease, parental reassurance and nutritional strategies. CONCLUSION: The proposed algorithms aim to help healthcare providers manage frequent gastrointestinal and cows' milk-related symptoms in infants safely and effectively.

Published
2016

42. Is the Crying Behaviour in Infants up to the Age of 3 Months Influenced by the Type of Early Nutrition?

Author

S. Schiess, S. Verwied-Jorky, Doris Oberle, Anna Reith, Ilse Broekaert, and Berthold Koletzko

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Crying, Parallel study, medicine.disease, Obesity, Childhood obesity, Double blind, Clinical trial, Medicine, medicine.symptom, business, Infant crying
Abstract

Introduction: Colic is a frequent problem for parents and paediatricians. Objective of this study is to investigate whether the prevalence of colic is influenced by the type of early nutrition in children up to the age of 3 months. The study is embedded in the EU Childhood Obesity Programme, a double blind randomised clinical trial with two parallel study groups of formula-fed infants and a control group of breastfed children (www.childhood-obesity.org).

Published
2005

43. Young Researchers’ Workshop

Author

Ilse Broekaert and Elvira Larqué

Subjects
Multidisciplinary approach, medicine, Engineering ethics, Early feeding, Biology, medicine.disease, Cholesterol biosynthesis, Childhood obesity, Fat mass
Abstract

Research in Europe needs multidisciplinary approaches and young researchers should get the opportunity to become familiar with new perspectives and future research topics. The workshop focused on some particular topics of research: new nutrients in infant formulas biochemical mechanisms of metabolic programming influence of early feeding on childhood obesity.

Published
2005

44. Appetite Control in Breastfed and Formula Fed Infants

Author

Veronica Luque, M. Giovannini, Jerzy Socha, A. Sengier, Berthold Koletzko, Dariusz Gruszfeld, Roman Janas, R. Closa Monasterolo, Ilse Broekaert, D. Brasseur, and Carlo Agostoni

Subjects
medicine.medical_specialty, Pediatrics, Appetite control, Leptin receptor, business.industry, Leptin, media_common.quotation_subject, Appetite, medicine.disease, University hospital, Childhood obesity, Pediatric department, Endocrinology, Internal medicine, medicine, business, Formula fed, media_common
Abstract

D. Gruszfeld; R. Janas; J. Socha; B. Koletzko, I. Broekaert; D. Brasseur ; A. Sengier; M. Giovannini, C. Agostoni ; R. Closa Monasterolo, V. Luque, EU Childhood Obesity Study Team Children’s Memorial Health Institute, Warszawa, Poland; Children's University Hospital, Ludwig Maximilians University, Munich, Germany; Hopital Universitaire des Enfants Reine Fabiola, Unite de Nutrition, Bruxelles, Belgium; Pediatric Department, Ospedale San Paolo, Milano, Italy; Pediatric Unit, University Rovira i Virgili, Tarragona, Spain

Published
2005

45. Visual Evoked Potentials in Infants after Dietary Supply of Docosahexaenoic Acid and 5-Methyltetrahydrofolate during Pregnancy

Author

Berthold Koletzko, C. Campoy, Ilse Broekaert, C. Iznaola, B. Hoffmann, and W. Müller-Felber

Subjects
medicine.medical_specialty, Pregnancy, genetic structures, business.industry, food and beverages, 5-Methyltetrahydrofolate, Visual evoked potentials, Placebo, medicine.disease, medicine.anatomical_structure, Endocrinology, Docosahexaenoic acid, Internal medicine, Placenta, medicine, Gestation, lipids (amino acids, peptides, and proteins), business, Visual resolution
Abstract

Introduction: Docosahexaenoic acid (DHA) plays an important role in the visual development of infants and is preferentially transferred across the placenta. Supplementation with folic acid in pregnancy might enhance placental DHA transfer. Methods: Women recruited in Spain (S) and Germany (G) were randomized to 4 supplementation groups: 0,5 g DHA and 0,4 mg 5-methyl-tetrahydrofolate (5MTHF)/d, 0,5 g DHA/d, 0,4 mg 5-MTHF/d or placebo from week 20 of gestation until birth. Infants not fully breastfed were supplied with formulae +DHA according to the nutritional code assigned. Cortical visual evoked potentials (VEPs) were obtained at the age of 8 weeks. 249 pregnant women (152 S, 97 G) were recruited and in 109 children (77 S, 32 G) cortical VEPs suitable for evaluation were obtained. Results: No significant differences in latencies, amplitudes and calculated minimal angle of resolution were detected between the 4 supplementation groups (S and G both separately and combined). The analysis of combined groups with DHA and without DHA showed a significant difference in the minimal angle of resolution between the DHA vs. non-DHA groups (1.4’+7.7’ vs. 3.0’+4.9’, p

Published
2005

46. Protein intake in the first year of life: a risk factor for later obesity? The E.U. childhood obesity project

Author

Berthold, Koletzko, Ilse, Broekaert, Hans, Demmelmair, Jeanette, Franke, Iris, Hannibal, Doris, Oberle, Sonja, Schiess, Blanca Troy, Baumann, and Sabine, Verwied-Jorky

Subjects
Risk Factors, Child, Preschool, Infant, Newborn, Humans, Infant, Infant Food, Dietary Proteins, Obesity, Child, Infant Nutritional Physiological Phenomena, Randomized Controlled Trials as Topic, Substrate Specificity
Abstract

Effective strategies for primary prevention are urgently needed to combat the rapidly increasing prevalence of childhood obesity. Evidence accumulates that early nutrition programmes later obesity risk. Breast feeding reduces the odds ratio for obesity at school age, adjusted for biological and sociodemographic confounding variables, by some 20-25%. We propose that the protective effect of breast feeding is related in part by the induction of a lower weight gain in infancy, which is related to differences in substrate intake. Protein intake per kg bodyweight is some 55-80% higher in formula fed than in breast fed infants. We hypothesize that high early protein intakes in excess of metabolic requirements enhance weight gain in infancy and increase later obesity risk (the "early protein hypothesis"). The European Childhood Obesity Programme tests this hypothesis in a randomized double blind intervention trial in 1150 infants in five European centres. Infants that are not breast fed are randomized to formulae with higher or lower protein content and followed up to school age. If an effect of infant feeding habits on later obesity risk should be established, there is great potential for effective preventive intervention with a significant potential health benefit for the child and adult population.

Published
2005

47. Insulin Like Growth Factor Regulation of Body Mass in Breastfed and Milk Formula Fed Infants

Author

Anna Dobrzańska, Ricardo Closa Monasterolo, Roman Janas, Berthold Koletzko, M. Giovannini, Méndezs G, D. Brasseur, Ilse Broekaert, Carlo Agostoni, A. Sengier, and Piotr Socha

Subjects
Pediatrics, medicine.medical_specialty, business.industry, medicine.medical_treatment, Milk formula, medicine.disease, University hospital, Obesity, Childhood obesity, Pediatric department, Insulin-like growth factor, Insulin resistance, Endocrinology, Internal medicine, medicine, Pediatric unit, business
Abstract

P. Socha, R. Janas, A. Dobrzanska, B. Koletzko, I. Broekaert, D. Brasseur, A. Sengier, M. Giovannini, C. Agostoni, R. Closa Monasterolo, G. Mendez, EU Childhood Obesity Study Team Children's Memorial, Health Institute, Warszawa, Poland, Children's University Hospital, Ludwig Maximilians University, Munich, Germany, Unite de Nutrition, Hopital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgium, Pediatric Department, Ospedale San Paolo, Milano, Italy, Pediatric Unit, University Rovira i Virgili, Tarragona, Spain

Published
2005

48. Protein Intake in the First Year of Life: A Risk Factor for Later Obesity?

Author

Doris Oberle, Hans Demmelmair, Jeanette Franke, S. Verwied-Jorky, Blanca Troy Baumann, Iris Hannibal, Ilse Broekaert, S. Schiess, and Berthold Koletzko

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Confounding, Odds ratio, medicine.disease, Obesity, Childhood obesity, law.invention, Randomized controlled trial, law, Medicine, medicine.symptom, Risk factor, business, Weight gain, Breast feeding
Abstract

Effective strategies for primary prevention are urgently needed to combat the rapidly increasing prevalence of childhood obesity. Evidence accumulates that early nutrition programmes later obesity risk. Breast feeding reduces the odds ratio for obesity at school age, adjusted for biological and sociodemographic confounding variables, by some 20–25 %. We propose that the protective effect of breast feeding is related in part by the induction of a lower weight gain in infancy, which is related to differences in substrate intake. Protein intake per kg bodyweight is some 55–80 % higher in formula fed than in breast fed infants. We hypothesize that high early protein intakes in excess of metabolic requirements enhance weight gain in infancy and increase later obesity risk (the “early protein hypothesis”). The European Childhood Obesity Programme tests this hypothesis in a randomized double blind intervention trial in 1150 infants in five European centres. Infants that are not breast fed are randomized to formulae with higher or lower protein content and followed up to school age. If an effect of infant feeding habits on later obesity risk should be established, there is great potential for effective preventive intervention with a significant potential health benefit for the child and adult population.

Published
2005

49. O0068 VISUAL EVOKED POTENTIALS IN INFANTS AFTER DIETARY SUPPLY OF DOCOSAHEXAENOIC ACID AND 5-METHYL-TETRAHYDROFOLATE DURING PREGNANCY

Author

C. Campoy, Ilse Broekaert, Berthold Koletzko, C. Iznaola, B. Hoffmann, and W. Mueller-Felber

Subjects
medicine.medical_specialty, Pregnancy, Endocrinology, Docosahexaenoic acid, business.industry, Internal medicine, Pediatrics, Perinatology and Child Health, Gastroenterology, medicine, Visual evoked potentials, medicine.disease, business
Published
2004

50. PC55 DOCOSAHEXAENOIC ACID (DHA) AND/OR 5-METILTETRAHIDROFOLATE (MTHF) SUPPLEMENTATION DURING PREGNANCY AND THEIR EFFECTS ON THE PATTERN REVERSAL VEPC IN SPANISH 2-MONTHS-OLD INFANTS

Author

J. A. Saez, M. C. Iznaola, Berthold Koletzko, C. Robles, P. Sierra, M. T. Miranda, Ilse Broekaert, and C. Campoy

Subjects
Pregnancy, Pattern reversal, business.industry, Docosahexaenoic acid, Pediatrics, Perinatology and Child Health, Gastroenterology, Medicine, Physiology, business, medicine.disease
Published
2004

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