[Extra-intestinal manifestations associated with Crohn's disease].

Extra-intestinal manifestations (EIM) associated with Crohn's disease (CD) are frequently observed and can manifest as either the initial symptom or develop later in the disease course following gastrointestinal symptoms. The most common EIM affect the joints, skin, or eyes, with some correlating with active CD activity while others may occur during periods of inactivity. EIM can affect both pediatric and adult CD patients, potentially reducing their quality of life if not promptly identified and treated.

Non-operative treatment of children with simple appendicitis: long-term follow-up (5 years) in a prospective cohort study.

Long-term results after non-operative treatment for children with simple appendicitis seem promising, possibly avoiding appendicectomy in 70 per cent of children after a median follow-up of 5 years. The need for delayed appendicectomy more than 2 years after the initial treatment is rare (0–5 per cent) and no complications occurred past 1 year, including children who underwent delayed appendicectomy.

Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children.

Background & Aims: The incidence of tube feeding dependency seems to increase worldwide, and these children may remain on prolonged tube feeding for many months to years. The multidisciplinary clinical hunger provocation (CHP) program is an intensive inpatient intervention of usually 2-3 weeks, aimed at weaning children from tube feeding. CHP has been proven highly effective on the short term (80-86%), particularly when applied before the age of two years but long-term data are lacking.

Intranasal treatment of vitamin B deficiency in children.

Vitamin B deficiency is traditionally treated with intramuscular injections of cobalamin, which are stressful events for children. In adults, studies have shown adequate absorption of intranasally administered vitamin B. To date, data concerning efficacy of intranasal administration of vitamin B in children are lacking.

[Faecal transplants for children with recurrent infections].

Background: Clostridioides difficile infection is a relatively rare cause of diarrhoea in children, but there are frequent recurrences when it occurs, despite targeted antibiotic treatment.

Case Descriptions: A 2-year-old boy with concomitant motility disorder and a 14-year-old girl with Down syndrome experienced several infections with C. difficile, respectively after the use of antibiotics for otitis media and extended use of antibiotics in addition to chemotherapy.

[An infant with prolonged jaundice].

Background: In every neonate presenting with prolonged jaundice persisting beyond day 21 of life, neonatal cholestasis should always be excluded even if the infant is breast fed. Pale stools are an alarm symptom and additional tests for neonatal cholestasis should be carried out directly.

Case Description: We describe the case of a five-week-old girl of Chilean origin who was referred with conjugated hyperbilirubinaemia.

Variability of core microbiota in newly diagnosed treatment-naïve paediatric inflammatory bowel disease patients.

Background & Aims: Intestinal microbiota is considered to play a crucial role in the aetiology of inflammatory bowel disease (IBD). We aimed to describe faecal microbiota composition and dynamics in a large cohort of children with de novo (naïve) IBD, in comparison to healthy paediatric controls (HC).

Methods: In this prospective study, performed at two tertiary centres, faecal samples from newly diagnosed, treatment-naïve paediatric IBD patients were collected prior to bowel cleansing for colonoscopy (t0) and 1, 3 and 6 weeks and 3 months after initiation of therapy.

Outcome of initially nonoperative treatment for acute simple appendicitis in children.

Purpose: To compare the outcome of initially nonoperative treatment with immediate appendectomy for simple appendicitis in children.

Methods: Between September 2012 and June 2014 children aged 7-17 years with a radiologically confirmed simple appendicitis were invited to participate in a multicentre prospective cohort study in which they were treated with an initially nonoperative treatment strategy; nonparticipants underwent immediate appendectomy. In October 2015, their rates of complications and subsequent appendectomies, and health-related quality of life (HRQOL) were assessed.

Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children.

Aim: Percutaneous endoscopic gastrostomy (PEG) is the standard for placing gastrostomy in children needing long-term enteral nutrition, with major and minor complications reported in up to 19% and 47.7% of children, respectively. We reviewed our experience with PEG, concentrating on the efficacy of antibiotic prophylaxis in reducing infectious complications.

Sniffing Out Paediatric Gastrointestinal Diseases: The Potential of Volatile Organic Compounds as Biomarkers for Disease.

The diagnostic work-up and follow-up of paediatric functional gastrointestinal disorders and organic conditions usually includes invasive tests, carrying a high burden on patients. There is a place, therefore, for novel, noninvasive disease-specific biomarkers. Volatile organic compounds (VOCs), originating from (patho)physiological metabolic processes in the human body, are excreted as waste products through all conceivable bodily excrements.

Characterization of Microbiota in Children with Chronic Functional Constipation.

Objectives: Disruption of the intestinal microbiota is considered an etiological factor in pediatric functional constipation. Scientifically based selection of potential beneficial probiotic strains in functional constipation therapy is not feasible due to insufficient knowledge of microbiota composition in affected subjects. The aim of this study was to describe microbial composition and diversity in children with functional constipation, compared to healthy controls.

Spontaneous Gastric Perforation in a Case of Collagenous Gastritis.

Collagenous gastritis is an extremely rare disease, both in children and adults. Symptoms vary depending on the extent of collagenous changes in the bowel. In most of the children, iron deficiency anemia and abdominal pain are the presenting symptoms.

A scoring system to predict the severity of appendicitis in children.

Background: It appears that two forms of appendicitis exist. Preoperative distinction between the two is essential to optimize treatment outcome. This study aimed to develop a scoring system to accurately determine the severity of appendicitis in children.

Clinical tube weaning supported by hunger provocation in fully-tube-fed children.

Background: Children with congenital malformations, mental retardation, and complex early medical history frequently have feeding problems. Although tube feeding is effective in providing the necessary energy and nutrients, it decreases the child's motivation to eat and may lead to oral aversion. In this study, we sought to confirm our previous results, showing that a multidisciplinary clinical hunger provocation program may lead to quick resumption of oral feeding.

Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study.

Background: Initial antibiotic treatment for acute appendicitis has been shown to be safe in adults; so far, not much is known about the safety and efficacy of this treatment in children. The aims of this study were to investigate the feasibility of a randomized controlled trial (RCT) evaluating initial antibiotic treatment for acute appendectomy in children with acute simple appendicitis and to evaluate the safety of this approach.

Methods: In a multicenter, prospective cohort study patients aged 7-17 years with a radiologically confirmed simple appendicitis were eligible.

Defecation patterns in infants: a prospective cohort study.

Introduction: Data regarding prevalence and natural history of infant dyschezia, defined by the Rome III criteria as straining and crying for at least 10 min before successful passage of soft stools, are lacking.

Objective: We aimed to investigate prevalence and natural history of infant dyschezia.

Study Design: In 2003, 124 youth healthcare doctors participated in a national study on defecation patterns of infants.

Validation of the Rome III criteria and alarm symptoms for recurrent abdominal pain in children.

Objectives: Rome criteria were formulated to define functional gastrointestinal disorders (Rome III criteria, 2006) excluding organic diagnoses when alarm symptoms were absent. The aims of the study were to validate the Rome III criteria as to their capacity to differentiate between organic and functional abdominal pain and to assess the role of alarm symptoms in this differentiation.

Methods: During 2 years all of the patients (ages 4-16 years) presenting with recurrent abdominal pain (Apley criteria) and referred to secondary care were included.

European pediatricians' approach to children with GER symptoms: survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines.

Objective: The aim of this study was to evaluate the current implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, and to assess proton pump inhibitors' (PPIs) prescribing patterns among pediatricians from different European countries.

Methods: A randomly identified sample of general pediatricians distributed across 11 European countries. They were asked to complete a case report-structured questionnaire investigating their approaches to infants, children, and adolescents with symptoms suggestive of gastroesophageal reflux.

Occult constipation: faecal retention as a cause of recurrent abdominal pain in children.

Unlabelled: Recurrent abdominal pain (RAP) in children is generally believed to be functional. In practice, many children with RAP become pain-free with laxative therapy. The aims of the study were to establish the role of (occult) constipation in RAP and to investigate whether patients diagnosed with (occult) constipation could be identified by history and physical examination.

[Perianal fistulae and abscesses in children: consider Crohn's disease].

While perianal fistulae and abscesses in infants usually occur as an isolated phenomenon, in older children Crohn's disease might be the underlying etiologic factor. We present four children of different ages with recurrent perianal fistulae and abscesses. Only after the diagnosis Crohn's disease was established and adequate treatment was initiated, the perianal lesions disappeared without further surgical treatment.

[One guideline for diagnosing cow milk allergy; for primary, secondary and tertiary care in the Netherlands].

The aims of the new Dutch guideline 'Diagnosing Cow Milk Allergy in Children in the Netherlands' are to provide an evidence-based instrument for the reliable and safe diagnosis of cow milk allergy and to improve the collaboration between health care professionals at well-baby clinics, general practices and hospitals. The double-blind, placebo-controlled cow-milk provocation test is the only test available for establishing an allergy to cows' milk. The double-blind provocation test in children at a low risk of severe reactions may be performed at the better-equipped well-baby clinics and at all general practices, thereby shifting care from secondary to primary care.

Long-term follow-up of children exposed intrauterine to maternal thiopurine therapy during pregnancy in females with inflammatory bowel disease.

Background: Inflammatory bowel disease (IBD) affects a substantial number of female patients in their reproductive years. Therefore, many physicians face the dilemma whether thiopurines, prescribed to maintain remission, can be taken safely during pregnancy. Data on long-term development outcome of children exposed to maternal thiopurine therapy are very limited.

Composition and diversity of the duodenal mucosa-associated microbiome in children with untreated coeliac disease.

Background: Intestinal microbiome may play a role in the pathogenesis of coeliac disease (CD). Studies comparing intestinal microbiome in children with and without CD are contradictory.

Aim: To compare the composition and diversity of the duodenal mucosa-associated microbiome in children with untreated CD and control children without CD and to identify specific gut bacteria associated with CD at diagnosis.

[A girl with an itchy skin disease].

A 10-year-old girl presented with chronic, itchy papulo-vesiculous skin lesions. Diagnosis of dermatitis herpetiformis was established based on elevated IgA endomysium and transglutaminase type 2 antibodies, and histological findings on skin biopsy. Dermatitis herpetiformis is the cutaneous expression of celiac disease.