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Ten developments in pediatric GI conditions
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Recent study data on pediatric gastrointestinal conditions have been abundant, particularly among presentations at the many gastroenterological society meetings this fall.
Here are ten highlights of pediatric GI research recently presented by Healio Gastroenterology and Infectious Diseases in Children.
1. Biopsy-proven acute rejection during immunosuppression withdrawal was reversible in pediatric liver transplant recipients
Veena L. Venkat
Among children who received liver transplant, biopsy-proven acute rejection during protocolized and supervised immunosuppression withdrawal was reversed with steroids and tacrolimus, according to data presented at The Liver Meeting.
“By 44 weeks, all but one [patient] … had resolved rejection,” Veena L. Venkat, MD, from the department of pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, said. “These data suggest that highly structured and supervised immunosuppression withdrawal is safe in the short term for selected pediatric liver transplant recipients.” Read more
2. High-level, high-volume centers were linked to lower mortality in very low-birth-weight infants, especially those with necrotizing enterocolitis
Zachary J. Kastenberg
Very low-birth-weight infants not born in high-level, high-volume centers had poorer outcomes than their peers born in such centers, according to a study by Zachary J. Kastenberg, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues, published in JAMA Pediatrics.
“Outcomes for VLBW infants continue to be suboptimal when they are not born into high-level, high-volume centers,” the researchers wrote. “In a dynamic period of continued deregionalization, the necrotizing enterocolitis population is a particularly high-risk subgroup of the VLBW population for whom regionalized neonatal intensive care will be beneficial.” Read more
3. Among children, associations between H. pylori, asthma and related diseases differed across ethnic groups
Wouter J. den Hollander
Helicobacter pylori positivity was associated with physician-diagnosed asthma in children up to age 6 years, but had an inverse association with ever wheezing and eczema in children of non-Western ethnicity, according to data presented at UEG Week.
“In young children, the association between H. pylori and asthma or related disease may differ across ethnic groups,” Wouter J. den Hollander, MD, from the department of gastroenterology and the Generation R Study Group at Erasmus Medical Center in the Netherlands, told Healio Gastroenterology. “Why these trends appear opposite is not clear so far, but may be due to differences in the gut microbiome composition.” Read more
4. HBV and HCV in mothers led to increased risk for neurological outcomes in infants
Jason L. Salemi
Hepatitis B and hepatitis C virus infections in mothers were associated with an increased risk for neonatal neurological outcomes in infants, according to study data published in the Journal of Viral Hepatitis.
“We already have evidence that perinatal transmission of HBV and HCV has adverse effects on offspring, including low birth weight, preterm birth and congenital anomalies,” Jason L. Salemi, PhD, of the Department of Family and Community Medicine at Baylor College of Medicine, told Healio.com/Hepatology. “This study suggests that maternal HBV and HCV infection may be similar to other sexually transmitted infections (eg, HIV) in negatively impacting neonatal neuropathology.” Read more
5. NAFLD was associated with high BP and hypertension in children
Jeffrey Schwimmer
Pediatric patients with nonalcoholic fatty liver disease were more likely to have high blood pressure and persistent high blood pressure compared with children without nonalcoholic fatty liver disease, according to recent study data.
“Parents and doctors need to be aware of the health risks of children who have NAFLD. The sooner high [BP] is identified and treated in this patient population, the healthier they will be as they transition in to adulthood,” Jeffrey Schwimmer, MD, of the department of pediatrics, UC San Diego School of Medicine, said in a press release. Read more
6. Canadian immigrants and their children were less likely to develop IBD than natives
Eric Benchimol
Immigrants to Canada, and the children of those immigrants, are less likely to develop inflammatory bowel disease than non-immigrants, with increased risk associated with younger age at immigration, according to a presenter at the Advances in IBD meeting.
“The Canada-born children of immigrants from some regions such as Europe, North Africa, the Middle East and South Asia, had a similar risk of IBD as the Canada-born children of non-immigrants,” Eric Benchimol, MD, PhD, FRCPC, of the CHEO Inflammatory Bowel Disease Centre, Children’s Hospital of Eastern Ontario, told Healio Gastroenterology. “Therefore, early exposure to the Canadian environment seemed to result in a high incidence of IBD in those people.” Read more
7. Disease control 'remains paramount' in limiting growth impairment in pediatric Crohn's disease
Using mid-parental height estimates in estimating growth potential of a child with inflammatory bowel disease is accurate and physicians can monitor ongoing progress via skeletal maturity levels, but in Crohn’s disease, control of the condition best ensures improved growth, according to a presenter at the Advances in IBD meeting.
“Mid-parental heights appear to be a very robust method of predicting child height. … Relative changes in skeletal maturity need ongoing monitoring,” Thomas D. Walters, MD, of Hospital of Sick Children in Ontario, Canada, said in a presentation. “Regardless of that, our data today should serve as a reminder to us all that effective, continuous disease control remains paramount in the management of children with Crohn’s disease and their impaired linear growth.” Read more
8. Cortical thinning and school problems were associated with pediatric Crohn's disease
Two studies presented at the Advances in IBD meeting showed the potential neurological and psychological implications of treating pediatric Crohn’s disease, with these patients showing cortical thinning and more school problems than healthy counterparts.
“The potentially adverse effects of disease and treatment on brain and cognitive function carry clinical implications for the development of our young patients, particularly in the setting of recurring illness and increasingly younger ages of disease onset,” Christine Mrakotsky, PhD, assistant professor of psychology at Harvard Medical School, said during her presentation. “In short, we have to identify the patients that are at the highest risk for these cognitive brain outcomes early and begin appropriate interventions.” Read more
9. Enteral nutrition outcomes reveal a link between diet, the microbiome and IBD in children
Evidence supports partial enteral nutrition therapy and Crohn’s disease exclusion diet for treatment of pediatric Crohn’s disease, and these data can improve understanding of the link between diet, dysbiosis and pediatric IBD, according to a presenter at the Advances in IBD meeting.
In summary, there is evidence “to show that partial nutrition … is capable of keeping people in remission,” Robert N. Baldassano, MD, director of the Center for Pediatric IBD at the Children’s Hospital of Philadelphia, said in a presentation. “The challenge moving forward will be to provide evidence for dietary influences on the intestinal microbiome that have meaningful effects on human physiology. Changing the intestinal microbiome through dietary modifications may ultimately prove a powerful approach to disease prevention and therapy.” Read more
10. Prucalopride was ineffective for pediatric functional constipation
Prucalopride was well tolerated in children with functional constipation but not more effective than placebo, according to new research data.
“Despite the disappointing results of this clinical trial, the study may help to provide further insight to the differences in mechanisms underlying [functional constipation] in adults and children and the optimal design of randomized controlled trials in children,” Samuel Nurko, MD, from the Center for Motility and Functional and Gastrointestinal Disorders at Boston Children’s Hospital, and Miguel Saps, MD, a pediatric gastroenterologist from the Ann & Robert H. Lurie Children’s Hospital of Chicago, wrote in an accompanying editorial. Read more