Publications by authors named "Robert M Issenman"

Article Synopsis
  • Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) involve sudden bouts of nausea, vomiting, and abdominal pain, significantly impacting patients' quality of life and often requiring emergency care.
  • This paper reviews various treatment strategies for managing acute episodes of CVS and CHS, including both pharmacological options like triptans and antiemetics, as well as nonpharmacological methods like reducing stimuli and hot water baths.
  • The authors emphasize the need for further research to create personalized treatment plans and advocate for compassionate emergency care for patients experiencing severe symptoms.
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Background: Upper gastrointestinal (GI) contrast studies are frequently requested to aid superior mesenteric artery syndrome diagnosis, a rare entity. Compression of the third duodenal part is expected to be mid-to-left of the midline where the superior mesenteric artery arises from the aorta; however, a duodenal impression to the right of the midline due to normal anatomic impression by the inferior vena cava (IVC) is often encountered and frequently misdiagnosed.

Objective: The purpose of this study was to determine the frequencies of (1) normal right-of-midline duodenal impressions and (2) mid-to-left of midline compressions in upper GI studies in a tertiary pediatric referral center.

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Background: Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues.

Purpose: To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with IBD.

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Objectives: The aims of the study were (1) to determine how frequently patients with cyclic vomiting syndrome (CVS) present to the pediatric emergency department (ED) with CVS-related symptoms, (2) to identify variables in clinical presentation that occur frequently in patients with multiple ED visits, and (3) to compare ED management of CVS with recommended guidelines.

Methods: This study is a retrospective chart review of all ED visits for CVS between April 1, 2008, and April 1, 2018, at a single center. Patients were identified from a master list of patients diagnosed with CVS in a pediatric gastroenterology clinic at the same center between June 1, 2004, and June 19, 2018.

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Article Synopsis
  • Biologic agents are important medications for treating inflammatory bowel disease (IBD), but there's limited guidance on when to start them, especially in kids.
  • A study reviewed the medical charts of 198 pediatric IBD patients over 14 years to see how initial disease characteristics affected the timing of biologic therapy.
  • Results showed that older patients with more severe disease and lower serum albumin levels were more likely to start biologic therapy sooner, suggesting that recognizing these traits could help doctors decide on earlier treatment.
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Purpose: This study aimed to synthesize qualitative and quantitative data on the diagnosis and effective management of cannabinoid hyperemesis syndrome (CHS) in the adolescent population.

Methods: Using keywords, 1,334 studies published between December 1954 and December 2019 were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library. Studies were evaluated by two independent reviewers using predetermined inclusion and exclusion criteria.

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The increasing recognition of cyclic vomiting syndrome (CVS) in adults prompted the development of these evidence-based guidelines on the management of CVS in adults, which was sponsored by the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA). GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was used and a professional librarian performed the literature search. The expert committee included the President of the CVSA who brought a patient perspective into the deliberations.

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Background: This evidence review was conducted to inform the accompanying clinical practice guideline on the management of cyclic vomiting syndrome (CVS) in adults.

Methods: We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and focused on interventions aimed at prophylactic management and abortive treatment of adults with CVS. Specifically, this evidence review addresses the following clinical questions: (a) Should the following pharmacologic agents be used for prophylaxis of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, or mitochondrial supplements? (b) Should the following pharmacologic agents be used for abortive treatment: triptans or aprepitant?

Results: We found very low-quality evidence to support the use of the following agents for prophylactic and abortive treatment of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, and mitochondrial supplements.

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Cannabis is commonly used in cyclic vomiting syndrome (CVS) due to its antiemetic and anxiolytic properties. Paradoxically, chronic cannabis use in the context of cyclic vomiting has led to the recognition of a putative new disorder called cannabinoid hyperemesis syndrome (CHS). Since its first description in 2004, numerous case series and case reports have emerged describing this phenomenon.

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Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS.

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The objectives of this study were to (i) assess sedentary time and prevalence of screen-based sedentary behaviors of children with a chronic disease and (ii) compare sedentary time and prevalence of screen-based sedentary behaviors to age- and sex-matched healthy controls. Sixty-five children (aged 6-18 years) with a chronic disease participated: survivors of a brain tumor, hemophilia, type 1 diabetes mellitus, juvenile idiopathic arthritis, cystic fibrosis, and Crohn's disease. Twenty-nine of these participants were compared with age- and sex-matched healthy controls.

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Background: Children with Crohn's disease (CD) suffer from malnutrition. Understanding substrate utilization during exercise may help patients with CD sustain a healthy active lifestyle without compromising nutrition. The aim of this study was to determine whether substrate utilization and bioavailability during exercise are altered in children with CD compared with controls.

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Objective: To examine exercise capacity in youth with Crohn's disease (CD) and ulcerative colitis (UC).

Study Design: Eleven males and eight females with CD and six males and four females with UC participated. Patients performed standard exercise tests to assess peak power (PP) and mean power (MP) and peak aerobic mechanical power (W(peak)) and peak oxygen uptake (VO(2peak)).

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Cyclic vomiting syndrome (CVS) is a disorder noted for its unique intensity of vomiting, repeated emergency department visits and hospitalizations, and reduced quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. Because no accepted approach to management has been established, the task force was charged to develop a report on diagnosis and treatment of CVS based upon a review of the medical literature and expert opinion.

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Introduction: The association of inflammatory bowel disease (IBD) with decreased bone mineral density is well recognized. In the adult population, up to 50% of IBD patients are reported to have osteopenia, correlating with an increase in the incidence of fractures as compared with controls. The aim of this study was to determine the prevalence of fractures in a pediatric population with IBD as compared with healthy sibling controls (SC).

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Background: Endoscopic and radiologic studies are frequently required in inflammatory bowel disease (IBD) to determine disease activity, extent of disease, and delineating disease type. Positron emission tomography (PET) using fluorine-18-fluoro-deoxyglucose to identify metabolically active tissues may offer a simple noninvasive alternative to conventional studies in identification and localization of active intestinal inflammation in children with IBD. The aim of this study was to assess the value of PET in identifying active intestinal inflammation compared with conventional endoscopic and radiologic studies, including small bowel follow-through and colonoscopy.

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Background: Voice recognition software (VRS), with specialized medical vocabulary, is being promoted to enhance physician efficiency, decrease costs, and improve patient safety. This study reports the experience of a pediatric subspecialist (pediatric gastroenterology) physician with the use of Dragon Naturally Speaking (version 6; ScanSoft Inc, Peabody, MA), incorporated for use with a proprietary electronic medical record, in a large university medical center ambulatory care service.

Methods: After 2 hours of group orientation and 2 hours of individual VRS instruction, the physician trained the software for 1 month (30 letters) during a hospital slowdown.

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Article Synopsis
  • Pediatric patients with inflammatory bowel disease (IBD) often face serious issues like growth impairment and malnutrition, which can have long-term effects.* -
  • Recent studies have focused on the causes and prevalence of these nutritional problems to develop better strategies for preventing nutrient deficiencies in children.* -
  • There is growing interest in using specific nutrients and probiotics as treatments for IBD over the last 15 years, representing a promising area for improving patient outcomes.*
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Childhood obesity is a major health concern. Inactivity is a major cause of this epidemic. The Healthy Active Living Committee of the Canadian Paediatric Society sampled 1866 paediatricians across Canada to assess members' knowledge of healthy active living (HAL), how they currently use HAL materials, what new materials would be most useful, and who would be most likely to carry the messages forward.

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