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Background: Primary lactose intolerance (PLI) is characterized by the inability to digest lactose. Homozygotes for the lactase gene polymorphisms (CC or GG) are considered to be genetically predisposed to PLI. Still, symptoms may only be present later in life. The evidence supporting a link between PLI, dairy intake, and quality of life (QoL) is limited in children. Aim: This study investigates the link between LCT polymorphisms and suggestive symptoms and the influence of the genetic predisposition to PLI on dairy intake and QoL in Romanian children. Materials and methods: We recruited consecutive children evaluated in our ambulatory clinic. We asked all participants to complete a visual-analog symptoms scale, a dairy intake, and a QoL questionnaire. We used strip genotyping to identify genetic predisposition to PLI. Results: 51.7% of children had a CC genotype, and 34.5% also had a GG genotype. Most children reported no or mild symptoms. Dairy intake and QoL were similar across study groups. Conclusions: Our study shows that genetic predisposition does not necessarily assume the presence of specific symptoms. Genetic predisposition to PLI did not lead to dairy avoidance, nor did it negatively influence our children’s QoL.

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

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.

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.

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".

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.

Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favourable acoustic windows in children makes US the first line of investigation for evaluation of pleural and chest wall abnormalities.In the first part of the topic the technical requirements were explained and the use of ultrasound in the lung and pleura in paediatric patients were discussed. In the second part lung parenchymal diseases with their subpleural consolidations are reflected. In the third part, the use of ultrasound for chest wall, mediastinum, diaphragmatic diseases, trachea, interventions and artifacts in paediatric patients are summarized.

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 (

Primary lactose intolerance is caused by a genetically programmed loss in lactase production after 5-6 years of age. Milk and dairy products are often incriminated as a cause of gastrointestinal symptoms. Recent studies show that lactase persistence in adult life correlates with higher anthropometric indexes and an altered metabolic profile. We aimed to assess whether the presence of gene polymorphisms for primary lactose intolerance has an influence on the anthropometric and metabolic profile of children. We conducted a cross-sectional study, recruiting consecutive children evaluated at the 2nd Pediatric Clinic, Timisoara from May to August 2016. We enrolled 87 children aged 6-17 years [mean age 10.64±3.51 years; 45 (51.72%) girls]. Subjects were asked to complete an analogue visual scale of symptoms. We measured weight, height, blood pressure and calculated body mass index. The metabolic profile included fasting blood glucose, triglycerides and HDL cholesterol levels. We used strip genotyping to identify gene polymorphisms for primary lactose intolerance. According to the results, our study population was grouped into lactose tolerant (n=42) and lactose intolerant (n=45) groups. No differences were found in regards to weight, height, body mass index and blood pressure between the two study groups. Glucose, triglycerides and HDL cholesterol were similar in the lactose intolerant and lactose tolerant children. The presence of gene polymorphisms for primary lactose intolerance did not influence the children's anthropometric and metabolic profile.

Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favorable acoustic windows in children makes US the first line of investigation for the evaluation of pleural and chest wall abnormali-ties. Lung parenchyma was previously thought to be inaccessible to ultrasound due to the presence of the air and bony thorax. The change in attitude and growing awareness of the diagnostic possibilities has led to lung ultrasound (LUS) being accepted as a valuable point of care method. In addition, the application of LUS has widened with improvements in technology such as higher resolution transducers, harmonic imaging and contrast-enhanced ultrasound. In the current World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) paper series the topic will be introduced, the technical requirements explained and the use of ultrasound in the lung and pleura in pediatric patients are discussed.

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.

Familial adenomatous polyposis (FAP) is a well-described inherited syndrome, characterized by the development of hundreds to thousands of adenomas in the colorectum, with implications in children and adolescents. Almost all adult patients will develop colorectal cancer if they are not identified and treated early enough. Identifying and screening for FAP commences in adolescence. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the adenomatous polyposis (APC) gene. This European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper provides a guide for diagnosis, assessment, and management of FAP in children and adolescents.This is the first position paper regarding FAP published by ESPGHAN. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, these of the recommendations are supported on expert opinion. This position paper will instruct on the appropriate management and timing of procedures in children and adolescents with FAP.

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.

Crohn’s disease (CD) is an inflammatory bowel disease (IBD) of multifactorial etiology that affects all segments of the gastrointestinal tract and is associated with multiple extra-intestinal manifestations. Spondyloarthropathies are the most common extra-digestive manifestation of IBD’s. Spondyloarthropathies primarily involve the axial skeleton, but mai also be associated with peripheral symptoms such as synovitis, dactylitis or enthesitis. Objectives Case presentation of a teenager, aged 14, diagnosed with CD A1 L3L4B1p-score PCDAI 45, (November 2018) that presented with joint manifestations as a form of onset. Case presentation The patient exhibits joint pain at the level of large joints of self-limiting character, as well as pain at the level of the costochondral joints associated with fever spikes. In recent history, over a period of two months, the patient presented up to 10 stools/day, without pathological features, with consecutive weight loss. An infectious etiology was suspected and empiric antibiotic treatment was instituted, with the evolution being unfavorable. She is admitted to the clinic for further investigation and treatment. Biologically she presented: marked inflammatory syndrome, reactive thrombocytosis, hypochromic microcytic anemia, positive calprotectin. The suspicion of an IBD, is raised, multiple biopsies from the upper digestive tract being performed. The macro and microscopic appearance suggested Crohn’s disease in the stage of active lesions. Induction therapy with exclusive enteral nutrition (EEN) is established, as well as azathioprine, to maintain remission. Evolution is favorable with the remission of joint symptoms in the first 2 weeks of EEN. Conclusion In some cases, patients with Crohn’s disease, due to chronic inflammatory syndrome, may develop symptoms similar to those encountered in spondyloarthropathies.

Applied Sciences 8(6), 944 - (2018). doi:10.3390/app8060944 special issue: "Special Issue "Ultrasound Elastography" / Guest Editor: Prof. Dr. med. Christoph F. Dietrich, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany", Published by MDPI, Basel

Introduction Esophageal atresia(AE) is the most frequent congenital anomaly of the oesophagus. Although the survival rate of patients with AE has increased significantly in recent decades, postoperative morbidity is still high, anastomotic stenosis being the most common complication. Objective Endoscopic management in a case with esophageal anastomotic stenosis following surgical intervention for AE. Case presentation We present the case of a 9 year old girl, diagnosed on the first day of life with AE (distal esophageal-tracheal fistula – Vogt III B). The patient underwent a surgical procedure with the ligation of the fistula and end-to-end esophageal anastomosis, the immediate postoperative evolution being favourable. 4 months later,during a hospitalisation for aspiration pneumonia, the diagnosis of post-operative oesophageal stenosis is established, the patient being guided towards II nd Paediatrics Clinic Cluj-Napoca where one session of dilation of the oesophageal stenosis was performed(5 mm Savary dilator). The family didn’t comply with medical recommendations, further endoscopic treatment being cancelled. After another 9 months she is again hospitalised for an episode of aspiration pneumonia. The infant presented dysphagia for liquids and solids, being fed exclusively with formula milk. The underlying condition and the respiratory morbidities negatively influenced the nutritional status. Endoscopic dilatation of the post-operative esophageal stenosis was reinitiated. We performed 4 sessions of dilatation, 7–10 days apart, gradually increasing the diameter of the Savary dilators. Endoscopic passage at the level of stenosis was achieved and the infant tolerates now 2 soft meals/day. Conclusions The endoscopic management of anastomotic stenosis after AE surgery requires consistency and interdisciplinary collaboration.

Background Cystic fibrosis (CF) is the most frequent monogenic autosomal recessive disease with lethal potential, manifested by a great clinical polymorphism. Cystic fibrosis associated liver disease(CFLD) is the second non-pulmonary cause of death in cystic fibrosis, witch, beside pulmonary disease, became on of the most important management issue. Lung function and CFLD is influenced by the nutritional status, being well known that a positive correlation between increase body mass index (BMI) and respiratory disease exists; therefore the effect of the nutritional grade would be important to be assessed. Objectives The aim of this study is to evaluate the effect of the nutritional status on the cystic fibrosis associated liver disease-CFLD evolution. Methods Study included fifty-nine patients with cystic fibrosis prospectively monitored for seven years. They were routinely followed-up by clinical assessment, liver biochemical tests, ultrasound examinations and in several cases elastography. CFLD was diagnosed using ECFS criteria. All patients with CFLD received ursodeoxycholic acid and enzymes supplementation according to our guideline. Body mass index was used to evaluate the nutritional status expressed by percentages and z -scores. Results 62.7% were diagnosed with CFLD and weight deficit, without significant gender gap. About 7% of patients leave the study. Underweighted children associated various vitamins deficiency and the reduced BMI was a significant risk factor for the development of CF severe liver disease (p Conclusion Most of our children with cystic fibrosis liver disease associated an important percent of weight deficit. If the malabsorbtion is the main cause of poor nutritional status or if other features like CF liver disease are more important remain to be studied in the future. The eternal question of’ the egg or hen’ as CFLD associates low BMI or if the weight deficit determine the CFLD rate is still disputable. Further measures should be taken for the improvement of nutrition of the CF children and the prolongation of a good life for these cystic fibrosis children.

Background Primary lactose intolerance (PLI) is a frequent condition caused by a genetically programmed and progressive loss of lactase expression. It is considered that PLI is the ancestral variant, while lactase persistence is caused by 2 polymorphisms: the dominant C/T13910 and G/A22018. Homozygotes (CC or GG) have undetectable lactase levels. In clinical practice only half of people with PLI have symptoms. However, some studies showed that PLI subjects have lower dairy intake. Aim To investigate whether genetic predisposition to PLI influences the quality of life and dairy intake in a group of Romanian children. Material and methods We conducted a prospective study, recruiting consecutive children evaluated in our unit in May-August 2016. Our study population included 87 children aged 6–17 years (mean age 10.64±3.51 years), 45 (51.72%) girls. We used strip genotyping to identify genetic predisposition to IPL. Subjects were asked to complete a validated quality of life questionnaire and a dairy intake questionnaire. We used Spearman’s test to evaluate the correlation between IPL and quality of life and dairy intake. Results 45 (51.7%) subjects had a CC genotype. 30 (34.5%) subjects had a GG genotype. Our results were consistent with Hardy-Weinberg equilibrium. We found no correlation between homozygosity for PLI and dairy intake (CC: r=−0.06, p=0.54; GG: r=−0.01, p=0.86). We found no correlation between either CC, or GG homozygosity and quality of life (r=−0.11, p=0.3 and r=−0.1, p=0.34). Conclusions In our group genetic predisposition to IPL followed European trends. It did not influence quality of life and dairy intake.

Introduction FPIES (Food Protein-Induced Enterocolitis Syndrome) is a rare form of food allergy, non IgE mediated, described in the infant and toddler. Contributing factors/triggers are not clearly defined,entering into discussion the allergy to cow milk protein or soy,a deficiency of cell-mediated immunity. Objective To present a case whose history overlaps FPIES diagnosis. Case presentation Male patient aged 3 years and 11 months, diagnosed in the neurology service in 2015 with febrile seizures and in 2016 with ‘shape belt’ myodistrophy. Previously hospitalised in the paediatric service, the child showed multiple episodes of acute diarrheal disease, associating severe vomiting and dehydration. Symptomatology appeared after 5 months of age, apparently linked to the consumption of cow’s milk protein. Up to 5 months of age, the child was fed naturally.Episodes of severe diarrhoea and dehydration repeated, having a similar clinical picture, without a clearly defined food trigger. The child presented an unsatisfactory stature-weight development. Clinical status at the time of admission: apathy, adinamy, abdominal pain around the navel, diarrhoea (4 stools in 3 hours time), weakness in stature-weight (G=14 kg, T=100 cm, BMI=14 kg/ sqm, P10). Biological investigations carried excluded: an infectious cause (negative stool, Rotavirus and Laboratory exams carried out excluded an infectious cause – negative stool culture, Rotavirus and Adenovirus negative coproantigens, negative sweat test for cystic fibrosis, as well as negative antibodies for the detection of celiac disease. However, immunophenotyping revealed low levels of CD8 +(half the normal value). The hospital was done balancing electrolyte subsequently induced restricted diet for protein from cow’s milk and soy, with the reintroduction of progressive nutrition and other basic foods: potatoes, wheat, root vegetables, poultry and beef, domestic fruit(apple, pear ). The subsequent evolution was favourable, with normalisation of intestinal transit. The patient was discharged with the recommendation to consult a food diary. Conclusions FPIES is a clinical syndrome with allergic substrates, non IgE mediated and without well defined biomarkers. The case presented corresponds with observations from the literature. Whatever the etiological substrate is, FPIES represents a maximum emergency.

Background The evaluation of liver fibrosis is of utmost importance in managing paediatric liver diseases. Currently, liver biopsy remains the golden standard for assessing liver fibrosis in children. Still, new non-invasive tools for liver fibrosis evaluation are emerging. Aim To compare the measurements acquired with the linear and convex probe and to assess the intra-observer reproducibility of a two dimensional shear wave elastography (2D-SWE GE) technique. Material and methods: We conducted a prospective study that included 70 children (age range: 3–17 years, 37.1% girls, mean body mass index 24.73±7.2 kg/m 2 ). Our study population consisted of obese children (n=35) and a control group: normal weight children without liver disease (n=35). Liver stiffness measurements were performed using 2D-SWE.GE (Logiq E9, GE Healthcare, Chalfont St Giles- UK). For each child one examiner performed 10 liver stiffness measurements with both a linear and a convex probe. To assess the intra-observer reproducibility, we calculated, for each probe, the medians for the first five and the last five measurements, respectively. We then calculated the interclass correlation coefficients (ICCs) for the two medians. Results Overall, we found significantly higher measurement values for the linear probe: 7.8±5.1 kPa vs 4.1±0.9 kPa, p=0.001. The measurements were also higher for the linear probe, both in obese and controls: 9.9±6.1 kPa vs 4.2±0.8 kPa, p=0.01 and 6.5±4 kPa vs 3.9±1 kPa, p=0.235. As for the intraobserver reproducibility, we found no differences between the two sets of measurements for both the linear (8.2±5.8 kPa vs 8.1±5.6 kPa, p=0.25) and the convex probe (4.2±0.9 kPa vs 4.3±0.9 kPa, p=0.33). The agreement between measurements was excellent for both probes: ICC=0.956 (95% CI: 0.922–0.975) and ICC=0.927 (95% CI: 0.883–0.955). Conclusion Measurements acquired with the linear and convex probe are not superimposable. 2D-SWE GE is a reproducible method for liver stiffness measurements in children.

The aim of the study described here was to evaluate the reproducibility of a new shear-wave elastography (SWE) technique, 2-D SWE.GE, and the impact of ultrasound experience in acquiring reliable measurements, as no official recommendations are available for this system. Elastographic measurements (EMs) were obtained in 60 patients using 2-D-SWE with the GE Logiq E9. Three examiners with different levels of experience in ultrasound-based elastography performed 10 valid EMs on each subject: a novice (C.P.) who had no experience in liver elastography and had performed fewer than 50 ultrasound examinations; an elastography expert (A.M.S.) who had more than 1 y of liver elastographic experience in four elastographic methods and had performed more than 1000 ultrasonography examinations; and an ultrasound expert (T.M.) who had no experience in liver elastography and had performed more than 1000 ultrasound examinations. Medians and interquartile ranges were calculated (m/s). We used the inter-class correlation coefficient and Bland–Altman plots with 95% lower and upper limits of agreement to assess the inter- and intra-observer reproducibility of 2-D-SWE.GE measurements. The final study group included 60 patients, 56.7% women and 43.3% men, with a mean age of 33.08 ± 13.83 y and mean body mass index of 22.85 ± 4.04 kg/m2. In this group, 73.3% were healthy volunteers and 26.7% had compensated liver cirrhosis. We did not find significant differences between EMs taken by the examiners overall and across study groups. The overall agreement between examiners was excellent: 0.915 (95% confidence interval [CI]: 0.870–0.946). The agreement between the novice and the experienced examiners, respectively, was good to excellent (novice and ultrasound expert: 0.908, 95% CI: 0.846–0.945; novice and elastography expert: 0.885, 95% CI: 0.808–0.931). The intra-observer reproducibility for each of the examiners was excellent; however, the inter-class correlation coefficients were higher for the examiners more experienced in elastography: 0.936 (95% CI: 0.896–0.963) versus 0.966 (95% CI: 0.943–0.980) versus 0.984 (95% CI: 0. 973–0.991). The good ICCs for the median values indicate that 2-D-SWE.GE is a reproducible method. Ultrasound experience did not significantly influence the results.

The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with B and C chronic hepatopathies, using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment. Subjects and methods: the study included 228 consecutive subjects with chronic hepatopathies (26% HBV, 74% HCV) from whom 51% had liver cirrhosis. Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. For TE 10 valid LS measurements were performed for each patient and the median value was calculated. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10 LS measurements with a success rate ≥60% and an interquartile range

Aims. To provide growth references for school-aged children in western Romania, to compare them with other national and international growth charts and evaluate the prevalence of overweight and obesity. Methods. A total of 3731 children, aged 7-19 years, from Timis county, were examined by medical students, between February 2010-June 2011. Growth references for height, weight, and body mass index (BMI) were constructed with LMS method and LMSChartMaker software. The Romanian 3rd, 50th and 95th percentile for height and BMI were compared with national and international growth references. The prevalence of overweight and obesity was determined with IOTF definition. Results. Crude and smoothed percentiles for weight, height and BMI were shown for this population. The comparison provided data regarding the variation of growth models in different populations. Our results demonstrated a high prevalence of overweight (18.2%) and obesity (7.2%) in our population, higher in boys versus girls. Conclusions. Our study constructed growth references for a Romanian population. The comparison with other growth references reflected the regional differences in growth patterns between populations.

Aim: To evaluate the performance of 2D shear-wave elastography from General Electric (2D-SWE.GE) for the noninvasiveassessment of liver fibrosis and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosisusing Transient Elastography (TE) as the reference method. Material and method: We included 331 consecutive subjectswith or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastographic techniques:TE and 2D-SWE.GE. Reliable LS measurements were defined for TE as the median value of 10 measurements with a successrate of ≥60% and an interquartile range (IQR)