Experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation: a descriptive phenomenological study

Objectives: To explore the experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation.Methods: Participants were recruited within 2 weeks of their child's transplant surgery using purposive sampling. Transcripts were analyzed using Colaizzi's descriptive analysis framework, with collaborative analysis conducted using NVivo 12 software and a post-traumatic growth model.Results: Five themes were identified: (a) experiencing a devastating blow, (b) cognitive reconstruction under overwhelming pain, (c) an arduous journey of decision-making, (d) rebirth in adversity and (e) post-traumatic growth. Parents undergo significant post-traumatic responses to their child's diagnosis of biliary atresia and liver transplantation, marking two major traumatic events. During the diagnostic stage, parents experience intense post-traumatic reactions characterized by emotional fluctuations and intrusive thoughts. The early treatment phase represents a crucial time for parents to transition from `denial of reality' to `accepting diseases'. The process of liver transplantation is also a significant traumatic event, accompanied by a final hope. Parents in the stable period after liver transplantation feel fortunate, hopeful and grateful, and their post-traumatic growth manifests gradually.Conclusions: Parents' experience of post-traumatic growth involves dynamic changes. Tailored intervention strategies should be developed for different stages to enhance their post-traumatic growth and psychological well-being. During the early treatment stage, mental health professionals could provide cognitive interventions to encourage parents to express their negative emotions and guide them to develop positive cognition toward traumatic events. The coping strategies and increasing personal growth are also important. In the postoperative stage, mental health professionals need to fully evaluate the coping styles of parents, and encourage them to establish effective internal coping strategies, while classic gratitude interventions could be given during the post-traumatic growth stage. Future research could involve a longitudinal qualitative study to explore parents' post-traumatic growth experiences at different stages of their children's transplantation process.

Orosomucoid 1 interacts with S100A12 and activates ERK signalling to expedite the advancement of bladder cancer

The research endeavors to expound the role of ORM1 in bladder cancer (BCa) and the implied response mechanism. RT-qPCR and Western blotting examined ORM1 and S100A12 expression. Functional experiments assessed the cellular phenotypes. HDOCK and Co-IP confirmed the interaction of ORM1 and S100A12. Western blotting tested apoptosis- and ERK signaling-associated proteins. ORM1 and S100A12 were abundant in the BCa cells. ORM1 or S100A12 loss impaired cell proliferation, migration, and invasion, and aggravated cell apoptosis. ORM1 interacted with S100A12. ORM1 knockdown down-regulated S100A12 expression and inactivated ERK signaling.S100A12 overexpression or ERK activator reversed the impacts of ORM1 interference on ERK signaling and BCa cells. ORM1 mightdrive BCa via binding to S100A12 and activating ERK signaling.

Inpatient Nutritional Considerations in Inflammatory Bowel Disease

PURPOSE OF REVIEW

This review aims to explain the causes, diagnosis, and treatment of malnutrition in hospitalized patients with inflammatory bowel disease (IBD), focusing on both adults and children.

RECENT FINDINGS

Malnutrition is common among IBD patients, affecting up to 85% of individuals, and is linked to higher rates of illness, death, and longer hospital stays. Recent studies highlight the importance of early detection using tools like the Subjective Global Assessment (SGA) and handgrip strength tests. Nutritional interventions-such as exclusive enteral nutrition (EEN) and parenteral nutrition (PN)-have proven effective in inducing remission and improving patient outcomes, especially in pediatric Crohn's disease. New evidence suggests that optimizing nutrition before and after surgery, as well as using immunonutrition, may reduce postoperative complications. Early identification and management of malnutrition in hospitalized IBD patients may be important for improving clinical outcomes. Using appropriate nutritional screening tools and creating personalized nutrition plans can help with recovery, decrease hospital stays, and improve quality of life. Further research is needed to develop standard protocols for nutritional assessment and treatment in this patient population.

Explainable artificial intelligence for prediction of refractory ulcerative colitis: analysis of a Japanese Nationwide Registry

OBJECTIVE

Ulcerative colitis (UC) is a chronic inflammatory bowel disease for which remission is dependent on corticosteroid (CS) treatment. The diversity of disease pathophysiology necessitates optimal case-specific treatment selection. This study aimed to identify prognostic factors for refractory UC using a machine learning model based on nationwide registry data.

METHODS

The study included 4003 patients with UC with a Mayo score of ≥3 at the time of registration who had been using CS since their entry out of 79,096 newly registered UC cases in a nationwide registry from April 2003 to March 2012 (before the widespread use of biologic agents in Japan) with 3-year data. A pointwise linear (PWL) model was used for machine learning.

RESULTS

A PWL model, which was developed to predict long-term remission (lasting >3 years), had an area-under-the-curve (AUC), precision rate, recall rate, and F-value of 0.774, 0.55, 0.70, 0.62, respectively, in the test dataset from the time of registration to 2 years later. Furthermore, the presence of pseudopolyps at the time of registration was significantly and negatively correlated with remission, highlighting its importance as a prognostic factor.

CONCLUSIONS

In this study, we constructed a highly accurate prognosis prediction model for UC, in which inflammation persists for an extensive period, by training a machine learning model for long-term disease progression. The results showed that machine learning can be used to determine the factors affecting remission during the treatment of refractory UC.

Helicobacter pylori γ-glutamyltransferase is linked to proteomic adaptions important for colonization

Helicobacter pylori γ-glutamyltransferase (gGT) is a virulence factor that promotes bacterial colonization and immune tolerance. Although some studies addressed potential functional mechanisms, the supportive role of gGT for in vivo colonization remains unclear. Additionally, it is unknown how different gGT expression levels may lead to compensatory mechanisms ensuring infection and persistence. Hence, it is crucial to unravel the in vivo function of gGT. We assessed acid survival under conditions mimicking the human gastric fluid and elevated the pH in the murine stomach prior to H. pylori infection to link gGT-mediated acid resistance to colonization. By comparing proteomes of gGT-proficient and -deficient isolates before and after infecting mice, we investigated proteomic adaptations of gGT-deficient bacteria during infection. Our data indicate that gGT is crucial to sustain urease activity in acidic environments, thereby supporting survival and successful colonization. Absence of gGT triggers expression of proteins involved in the nitrogen and iron metabolism and boosts the expression of adhesins and flagellar proteins during infection, resulting in increased motility and adhesion capacity. In summary, gGT-dependent mechanisms confer a growth advantage to the bacterium in the gastric environment, which renders gGT a valuable target for the development of new treatments against H. pylori infection.

Validity and reliability of the Thai “Rome IV diagnostic questionnaires” for functional gastrointestinal disorders in neonates and toddlers

BACKGROUND

The Rome Foundation’s questionnaires, including the latest version, Rome IV diagnostic criteria since 2016, are widely used globally for diagnosing functional gastrointestinal disorders (FGIDs). However, a tailored Thai version for diagnosing FGIDs in neonates and toddlers is yet to be developed.

AIM

To develop and validate the Thai version of the Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers.

METHODS

This study was conducted at a tertiary hospital in Bangkok. The Rome IV diagnostic questionnaire for neonates and toddlers was translated into Thai following Rome Foundation guidelines. Validity was assessed using item-objective congruence. The final version was administered to 65 caregivers of children under 4 years. Reliability was evaluated using Cronbach’s alpha and intraclass correlation coefficient based on test-retest responses collected over a 4-15 day interval.

RESULTS

A total of 58 complete questionnaires were returned. The median interval between the first and second time was 7 days (range: 4 days to 15 days). The item-objective congruence index for the Thai-adapted Rome IV diagnostic questionnaire was 0.74. Internal consistency, as indicated by Cronbach’s alpha, was 0.753, 0.712, and 0.750 for the three respective sections. The intraclass correlation coefficients for test-retest reliability were 0.782, 0.782, and 0.807.

CONCLUSION

The Thai Rome IV diagnostic questionnaire for FGIDs in neonates and toddlers demonstrates acceptable validity and reliability, supporting its use in future clinical and research applications.

Non-invasive biomarkers for monitoring intestinal health in broilers - A systematic review

This systematic review aimed to identify and evaluate non-invasive biomarkers for assessing gut health in broilers, following PRISMA guidelines and using the PICO strategy. A comprehensive search was conducted in Web of Science, Scopus, and PubMed for papers written in English, Portuguese, and Spanish. After screening 1196 papers, 21 studies met the inclusion criteria and were included in the review. The studies, primarily conducted in Europe, Oceania, and North America, were published between 2003 and 2024. The review highlighted the intestinal microbiota as the most studied non-invasive biomarker, using excreta, cloacal swabs, poultry litter, and poultry dust as sample sources. Poultry litter and dust were identified as promising non-invasive alternatives for assessing gut microbiota, with excreta being the most commonly used sample type. Biomarkers like ovotransferrin, lipocalin-2, and calprotectin are under investigation for broiler gut health assessment. Cecal samples were frequently used as a gold standard for comparison. The choice of reference databases, such as SILVA and Greengenes, varied among studies, which may have influenced taxonomic classification and microbial group abundance. Methodological quality varied across studies, with a mix of observational and experimental designs. Many studies involved comparative analyses related to dietary and sanitary challenges, though inconsistencies in reporting diet composition and performance data were observed. In conclusion, many non-invasive biomarkers are under investigation for broiler gut health assessment, but challenges remain in validating these markers due to the complexity of the gut ecosystem. These challenges emphasize the need for rigorous study design, thorough data collection, and standardized protocols.

Reevaluating therapeutic strategies in Crohn’s disease: Comparing Modulen and budesonide

This article explores the significant implications of the study by Ovadia et al, which innovatively compares the efficacy of a nutritional intervention (Modulen) to conventional pharmaceutical therapy (budesonide) in promoting mucosal healing in Crohn’s disease. Highlighting the paradox of a well-established yet underutilized nutritional approach, the findings suggest that Modulen may offer comparable therapeutic benefits despite its high withdrawal rate due to adherence challenges. This advancement underscores the evolving paradigm in inflammatory bowel disease treatment, shifting focus toward non-pharmacologic alternatives that target both clinical remission and endoscopic healing. The article advocates for the development of integrative treatment strategies that balance efficacy, patient adherence, and long-term disease management, emphasizing the need for further research to refine and optimize the role of nutritional therapies in clinical practice.

Precisely edited gut microbiota by tungsten-doped Prussian blue nanoparticles for the treatment of inflammatory bowel disease

Inflammatory bowel disease (IBD) is characterized by recurring gastrointestinal inflammation, accompanied by a significant rise in global prevalence and disease severity. The overaccumulation of reactive oxygen and nitrogen species (RONS) in the intestinal environment disrupts redox homeostasis and drives pathological overgrowth of Escherichia coli, which are central to IBD pathogenesis. Herein, we designed a multifunctional nanozyme (W-PB) to enable sustained and targeted regulation of intestinal homeostasis through dual mechanisms: specific inhibition of E. coli overgrowth during colitis and efficient RONS clearance. To ensure colon-specific delivery, W-PB was encapsulated in an electrostatically crosslinked hydrogel composed of alginate and chitosan. This formulation protects W-PB from degradation in harsh gastrointestinal conditions and releases the nanoparticles selectively under weakly alkaline intestinal pH. The released tungsten ions suppress E. coli growth via competitive displacement of molybdenum in the molybdopterin cofactor, while W-PB simultaneously neutralizes excess RONS to shield intestinal cells from oxidative damage. In DSS-induced colitis models, the W-PB gel demonstrated significant therapeutic efficacy, achieved through intestinal microbiota remodeling and oxidative stress mitigation.

Comparison of 11 Formulas and Breastfeeding for Atopic Dermatitis and Growth in Pediatric Cow's Milk Protein Allergy: A Systematic Review and Network Meta-Analysis of 23 Randomized Controlled Trials

OBJECTIVE

This study aimed to evaluate the effectiveness of various formulas and the ability of breastfeeding with the exclusion of cow milk protein to reduce the Scoring Atopic Dermatitis (SCORAD) index and promote growth in infants with cow milk protein allergy.

METHODS

We conducted a systematic search of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure, WanFang Data, Weipu, and the China Biomedical Literature Database. The search period ranged from the inception of each database to December 2023 (with an update until January 15, 2025). We included randomized controlled trials (RCTs) comparing formulas and breastfeeding for cow's milk protein allergy in infants. Two independent reviewers extracted data via standardized methods and assessed the risk of bias via the revised Cochrane risk-of-bias 2.0 tool. We performed a network meta-analysis (NMA) via a Bayesian fixed-effects model in RStudio and assessed the certainty of the evidence via the Confidence in Network Meta-Analysis (CINeMA) online application. The protocol for this NMA was preregistered in PROSPERO (No. CRD42024504707).

RESULTS

This analysis included 23 RCTs involving 1997 children and assessed 12 interventions. Compared with the regular formula, the pectin-thickened amino acid formula (TAAF) might reduce the SCORAD index (-12.49, 95% confidence interval [CI] -20.38 to -4.48, low certainty). At ≤6 months of follow-up, compared with rice-hydrolyzed formula (RHF), breastfeeding might improve the length-for-age Z score (LAZ) (0.47, 95% CI 0.13-0.81, moderate certainty), and breastfeeding (0.39, 95% CI 0.02-0.77, low certainty) and extensively hydrolyzed formula (EHF) with probiotics (0.38, 95% CI 0.00-0.77, low certainty) might respectively improve the weight-for-age Z score (WAZ) and weight-for-length Z score (WLZ). At the 12-month follow-up, EHF might improve the LAZ (0.41, 95% CI 0.11-0.71, low certainty) and WLZ (0.37, 95% CI 0.18-0.56, low certainty) compared with RHF, whereas the amino acid formula (AAF) may improve the WAZ (0.33, 95% CI 0.02-0.63, low certainty).

CONCLUSIONS

Low-certainty evidence suggested that TAAF might reduce the SCORAD index. Moderate or low certainty evidence indicated that, at ≤6 months of follow-up, breastfeeding might improve the LAZ and WAZ, whereas EHF with probiotics might improve the WLZ. At the 12-month follow-up, EHF might improve the LAZ and WLZ, whereas AAF might improve the WAZ. However, further high-quality studies would be needed to confirm these findings and assess their safety and cost-effectiveness.

Predictors of dropout in self-guided internet-delivered cognitive behaviour therapy for obsessive-compulsive disorder: An exploratory study

OBJECTIVES

Self-guided internet-delivered cognitive behaviour therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD); however, there is little research investigating who dropouts of treatment. Therefore, the aim of this study was to conduct an exploratory study of predictors of dropout in self-guided ICBT for OCD. Given that definitions of dropout vary across ICBT studies, we conceptualized dropout in multiple ways: (1) early dropout (proportion of participants who did not complete the pre-treatment questionnaires); (2) proportion of participants who did not commence the intervention; (3) proportion of participants who did not complete the treatment; and (4) proportion of participants who did not complete the post-treatment questionnaires.

METHOD

This was a secondary data analysis of 323 participants with OCD symptoms who provided a successful screening assessment to commence an ICBT intervention. Binary logistic regression was used to predict dropout based on a number of exploratory variables.

RESULTS

Early dropout was predicted by the country of the participant (participants in the United Kingdom and India being more likely to dropout), as well as shorter symptom duration (explaining 7% of the variance). Medication use predicted non-completion of the intervention with those taking medication for OCD being less likely to complete the treatment (explaining 3% of the variance). Completion of the post-treatment questionnaires was predicted by higher contamination symptoms, lower depressive symptoms and higher pre-treatment conscientiousness (explaining 13% of the variance). There were no significant predictors of treatment commencement.

CONCLUSIONS

The study provides important preliminary information concerning which patients with OCD may be more likely to drop out of a self-guided ICBT intervention.

Understanding Role of Nutrition in Inflammatory Bowel Disease: A Comprehensive Review With Incorporation of AGA Update

This comprehensive review delves into the evolving landscape of nutrition's role in Inflammatory Bowel Disease (IBD), while incorporating transformative insights from the recently published American Gastroenterology Association (AGA) clinical practice update (CPU) on diet in IBD. Recent years have witnessed a paradigm shift, recognizing diet not only as an influencer in disease development but also as a disease-modifying factor and treatment avenue for IBD. The AGA CPU endorses a balanced Mediterranean-style diet, emphasizing the need for personalized recommendations tailored to individual patient characteristics, including disease course, surgical history, and pharmacotherapy. The implementation of complex nutritional strategies necessitates the involvement of both gastroenterologists and registered dietitians. Guidance for patients and caregivers is available through organizations such as Crohn's and Colitis Canada and Crohn's and Colitis Foundation. While animal models offer valuable insights, the review underscores their limitations in replicating the complexity of IBD biology observed in humans. It advocates for an exploration of nutrigenomics, utilizing molecular tools to analyze how diet-derived bioactive compounds influence gene expression for precision nutrition insights. Practical challenges in dietary intervention studies, including regional variations and complexities in food handling, require attention for enhanced comparability. Limited data exist on combined dietary and medical therapies, but promising outcomes suggest potential synergies. Precision treatments could develop through an understanding of the function of particular food metabolites in influencing inflammation. The objective of this review is to offer a summary of the present comprehension of diet, serving as both a potential factor contributing to and a therapeutic avenue for IBD. Clinical Trial Registration: This study is not a part of a clinical trial.

The follow-up of patients with celiac disease

Celiac disease (CD) is a very common immune-mediated enteropathy resulting from the interaction between dietary gluten and the immune system in genetically predisposed individuals. The immune response leads to intestinal damage, malabsorption and, ultimately, to a broad spectrum of both intestinal and extra-intestinal symptoms. According to current criteria, a proper diagnosis of CD requires an initial phase consisting of clinical case identification and serological screening that, over time, has increased in importance. In most adults and in selected children, the diagnosis is subsequently defined by histological evidence of intestinal damage as a confirmatory test, which usually returns to normal after a suitable period of a gluten-free diet (GFD). The clinical remission and disappearance of circulating antibodies after a GFD further confirm the diagnosis and represent a goal to be achieved to improve the quality of life and reduce the risk of long-term complications. However, although the diagnostic criteria for CD are well defined and described in specific guidelines, the monitoring of CD patients undergoing GFD has been less studied and, consequently, specific guidelines for this phase are still lacking. The aim of this report was to evaluate the classical tools used to monitor the adherence and response to GFD, other non-invasive biomarkers that have been proposed for CD monitoring, and the histological follow-up of CD patients in order to provide a starting point for future discussions on this specific topic.

Trajectories of change in pediatric functional abdominal pain disorders during Internet cognitive behavior therapy: A single case experimental study

Functional abdominal pain disorders (FAPDs) are prevalent in youth and affect daily life. Therapist-supported Internet-delivered cognitive-behavioral-therapy (ICBT) is promising, though the detailed trajectories of therapeutic effects unknown. This study aimed to analyze trajectories of effect and timing of changes in abdominal symptoms (primary outcome) and psychological factors (catastrophizing, avoidance and control behavior, pain acceptance (secondary outcomes)) in children and adolescents during 10 weeks of exposure-based ICBT for FAPDs in a randomized multiple-baseline single-case experimental design study in six children and six adolescents with FAPDs, referred from pediatric departments. Outcomes were assessed daily during baseline (A), treatment (B1: Main treatment components, B2: Training repeated exposures), and three-month follow-up (C). Effects were evaluated with visual analyses, Tau-U effect sizes for each individual, and multilevel modeling for group-level effects. All participants completed all treatment modules. Individually, treatment effectively reduced abdominal symptoms in half of the participants at three-month follow-up, following diverse trajectories with varying sequences of secondary outcome changes. At group-level, children demonstrated significant effects on estimated means of all outcomes at follow-up (P<0.05), while adolescents did on all outcomes (P<0.05) except one pain acceptance item (pain control). The group trajectories differed: children showed significant daily changes in abdominal symptoms during treatment B2, while adolescents exhibited significant slopes in most outcomes except one pain acceptance item (pain control) as early as during treatment B1. The findings support the effect of ICBT for FAPDs in youth, although with varying effect trajectories and differences in the timing of outcome changes across individuals and age-groups. PERSPECTIVES: This study provides evidence for the effect of ICBT in managing FAPDs in children and adolescents while uncovering individual and age-related differences in trajectories of changes in abdominal symptoms and psychological factors. Clinicians and researchers can use these findings to refine treatment protocols and explore mechanisms underlying these variations. CLINICAL TRIAL PREREGISTRATION: NCT05237882.

Impact of highly effective modulator therapy on gastrointestinal symptoms and features in people with cystic fibrosis

Highly effective modulator therapy (HEMT), particularly the triple combination elexacaftor-tezacaftor-ivacaftor (ETI), significantly improved clinical outcomes and quality of life in people with Cystic Fibrosis (pwCF). This review analyzes current knowledge on the impact of HEMTs on gastrointestinal (GI) symptoms and features in pwCF. A descriptive review of English literature until February 29, 2024, was conducted using medical databases. Observational studies and clinical trials addressing GI reflux disease (GERD), lower GI symptoms and pancreatic disease were considered. Studies report positive effects of HEMTs on pH levels and bicarbonate secretion as well as improvement on intestinal inflammation. HEMTs also demonstrated positive effects on GERD and lower GI symptoms or conditions CF related such as dysbiosis. Taking ETI during pregnancy could also allow resolution of meconium ileus in fetuses with CF. The best benefits were observed in pancreatic function, potentially delaying CF-related diabetes and recovering pancreatic function in some children on ETI. Larger trials, particularly in pediatric populations, need to confirm these findings and explore long-term effects.

The impact of anxiety and depression on quality of life in a cohort of inflammatory bowel disease patients from Northeastern of Brazil

OBJECTIVE

This study aims to assess whether the association between chronic pathologies and depressive and/or anxious disorders is high, resulting in a reduction in the patient's quality of life.

PATIENTS AND METHODS

This is a prospective cross-sectional study with a descriptive and analytical design. Sociodemographic data and lifestyle habits were collected. Subsequently, the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Hospital Anxiety and Depression Scale (HADS) were applied.

RESULTS

A total of 141 patients participated in the study, with a mean age of 45.78 (SD 16.01) years, of which 60.3% were female (n=85) and 39.7% were male (n=56). 58.9% had ulcerative colitis (UC) (n=83), and 41.1% had Crohn's disease (CD) (n=58). 16.5% of patients had a previous diagnosis of generalized anxiety disorder (GAD) and/or major depression (MD) (n=23). Regarding IBDQ scores, participants with anxiety had significantly lower mean scores in all IBDQ items (p<0.001), while the depression diagnosis obtained significantly lower mean values for systemic (p=0.015), emotional (p=0.001), and intestinal symptoms (p=0.005).

CONCLUSION

The results indicate that anxiety and depression negatively impact the quality of life of patients with IBD independently of the disease activity.

Analysis of Bacterial Diversity in Jersey Cow Colostrum and Mature Milk and the Study of the Probiotic Functions of Ligilactobacillus salivariusCR29

This study used 16S rDNA high-throughput sequencing to analyze the bacterial diversity of Jersey cow colostrum and mature milk, and evaluated the probiotic properties of Ligilactobacillus salivarius CR29 isolated from the samples. The bacterial community structure of the Jersey cow milk samples was analyzed, and lactic acid bacteria were isolated using MRS medium. The potential probiotic strains were evaluated for growth, acid production, hemolytic activity, antibacterial activity, antibiotic sensitivity, acid and bile tolerance, hydrophobicity, autoaggregation and coaggregation abilities, as well as their survival in a simulated gastrointestinal environment. The results showed that nine lactic acid bacterial strains isolated from the milk samples exhibited probiotic potential, among which Ligilactobacillus salivarius CR29 showed no hemolysis and had strong antibacterial activity, significantly inhibiting several pathogens compared to other strains. CR29 was sensitive to multiple antibiotics (such as tetracycline and rifampicin), and its survival rates under 0.3% bile salt and pH 2 conditions were 56.28% and 77.59%, respectively. Its survival rate after simulated gastrointestinal passage was 47.86%. In summary, Ligilactobacillus salivarius CR29 demonstrated excellent probiotic potential and may be applied in functional foods and health-related fields in the future.

Factors affecting response rates in patient-reported outcome measures in inflammatory bowel disease

BACKGROUND

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are associated with reduced quality of life (QoL). By using questionnaire tools called patient-reported outcome measures (PROM), patients' well-being and health-status can be measured. The aim of this study was to identify subgroups at risk of being missed in questionnaire monitoring and assess QoL and variability of responses over time.

METHODS

CD or UC, age ≥18 years, receiving biological treatment subcutaneously or intravenously, 01 August 2018 to 31 January 2020, at Karolinska University Hospital, were included. Patients completed standardised and validated questionnaires for QoL-measurements; Short Health Scale (SHS) and EuroQol 5-dimension-index (EQ5D).

RESULTS

412 patients, 287 (70%) Crohn's disease, 125 (30%) ulcerative colitis, 267 (65%) males, median age: 33 (range 18-85). Patients receiving subcutaneous treatment completed PROM questionnaires significantly less frequently compared with intravenous treatment (multiplicative factor 6.5, 5.7-7.5 95% CI). Reduced QoL was seen for intravenous treatment (multiplicative factor 2.0, 0.5-3.5 95% CI) and active disease (multiplicative factor -4.0, -6.1 to -1.9 95% CI). Greater variability in responses was seen in active disease, anaemia, faecal calprotectin ≥ 250 mg/kg.

CONCLUSIONS

Patients receiving subcutaneous treatment, equivalent to home-based treatment, completed significantly fewer PROM questionnaires and are therefore less monitored. It is therefore important to offer different modes of questionnaire administration when monitoring a heterogeneous patient population especially as we see a shift towards oral forms of therapy.

Prenatal exposure to selective serotonin reuptake inhibitors and risk of disorders of gut-brain interaction in children

Preclinical data suggest that gestational exposure to selective serotonin reuptake inhibitors (SSRI) alter gut innervation, and delays colonic motility. In this study we investigated associations between gestational SSRI exposure and offspring disorders of gut-brain interaction (DGBI). Using population-based registries, we included all single-birth Danish children born 1997-2015 with follow-up until outcome occurrence, age 15 years, death, emigration, or December 2018. Children to mothers who continued SSRIs during pregnancy and children to mothers who discontinued SSRI use before pregnancy were compared using Cox regression. Main outcomes were the first diagnosis of a childhood DGBI (functional nausea and vomiting, functional abdominal pain disorders, functional diarrhea, and functional constipation), or a physician-prescribed laxative. Among 1,158,560 children, 21,969 children (1.9%) were exposed to SSRIs prenatally and 30,174 children (2.6%) were born to mothers who discontinued SSRIs before pregnancy. Overall, the estimated 15-year cumulative incidence of any DGBI was 15.5% (95% CI, 14.9-16.2) in the SSRI-exposed group and 14.7% (14.0-15.3) in the unexposed group. SSRI-exposed children had an overall increased risk of DGBIs (HR 1.08, [1.02-1.14]), which was driven by functional constipation (HR 1.19, [1.10-1.28]) rather than functional nausea and vomiting (HR 0.97, [0.83-1.13]) or functional abdominal pain disorders (HR 0.90, [0.81-1.00]). These data suggest that prenatal SSRI exposure is associated with an increased risk of developing functional constipation. These findings are also consistent with extensive preclinical data supporting key roles for serotonin in gut development and function. Together findings support the need for further investigation of the long-term impact of maternal depression and SSRI exposure on development of common gastrointestinal disorders.

Evaluation of the effect of different infant formulas on Streptococcus mutans biofilm formation: an in-vitro study

Considering the increase in the prevalence of early childhood caries, the effect of various types of frequently consumed infant milk formulas on the development of Streptococcus mutans biofilm was examined. Three samples of cow's milk-based formula (Aptamil, Bebelac, Nan), two samples of soy-based formula (Biomil soy and Isomil soy), and three samples of formulas containing hydrolyzed proteins (Aptamil HA, Bebelac HA, Nan HA) were selected. After adding the formulas to the Streptococcus mutans (ATCC 35668) culture media, the degree of bacterial biofilm formation was explored by assessing the optical density (OD) of the Cristal Violet dye in the decolorizing solution using an ELISA reader device. The analysis of the data was conducted using independent sample T-tests, ANOVA, and subsequently Fisher's LSD test using SPSS 22 software. A statistically significant difference was observed in the average levels of biofilm formation of Streptococcus mutans for the three types of understudy formulas (P < 0.001). In the presence of cow's milk-based formulas, the mean amount of biofilm formation was significantly greater than that of the soy-based (P = 0.003) and protein hydrolysate (P < 0.0001) formulas. However, no significant statistical difference was detected between the soy-based and protein hydrolysate formulas (P = 0.42). Aptamil exhibited the highest amount of biofilm formation with a mean OD of 1.81 whereas Aptamil HA showed the lowest amount of biofilm formation (OD = 0.61). The level of biofilm formation by Streptococcus mutans when exposed to cow's milk-based formula was noted to be greater than that observed with the soy-based and protein hydrolysate formulas.

Role and mechanism of gut microbiota-host interactions in the pathogenesis of Crohn's disease

BACKGROUND

Crohn's disease (CD) is a chronic, nonspecific inflammatory bowel disease with a poor prognosis. Despite its increasing incidence, curing CD remains challenging due to its complex etiology and unclear pathogenesis.

METHODS

A comprehensive PubMed and Web of Science search was conducted using the keywords Crohn's disease, gut microbiota, dysbiosis, pathogenesis and treatment, focusing on studies published between 2014 and 2024.

RESULTS

Recent studies have demonstrated a close relationship between gut microbiota dysbiosis and the development of CD. Although many dysbioses associated with CD have not yet been proven to be causal or consequential, it has been observed that the gut microbiota in CD patients exhibits reduced diversity, a decrease in beneficial bacteria, and an increase in pathogenic bacteria. These changes may lead to decreased intestinal barrier function, abnormal immune responses, and enhanced inflammatory reactions, which are related to the disease's activity, phenotype, drug treatment efficacy, and postoperative therapeutic outcomes. Therefore, further exploration of the microbiota-host interactions and the pathogenesis of CD, the identification of biomarkers, and the development of targeted strategies for modulating the gut microbiota could offer new avenues for the prevention and treatment of CD.

CONCLUSIONS

This review highlights the pivotal role of gut microbiota dysbiosis in driving CD pathogenesis and its progression, while underscoring its potential as a therapeutic target through dietary modulation, microbial interventions, and integrative strategies to improve clinical management and prognostic outcomes.

The impact of probiotics on pulmonary, gastrointestinal, and growth outcomes in pediatric cystic fibrosis: a randomized controlled trial

OBJECTIVE

Cystic fibrosis (CF) is a fatal hereditary disorder that leads to respiratory infections and gastrointestinal inflammation with possible association with intestinal dysbiosis. The present study was conducted with the aim of investigating the effects of probiotic consumption in improving pulmonary, gastrointestinal, and growth symptoms in patients with CF.

MATERIALS AND METHODS

In this double-blind randomized clinical trial, 110 CF patients were examined. Patients were divided into two equal groups of 55 subjects. Patients in the probiotic group consumed Lactobacillus reuteri at the rate of 108 CFU/d for one month, and the control group received a placebo. Then, pulmonary, gastrointestinal, and growth-related outcomes as well as quality of life were assessed after one month of intervention as well as at three-month follow-up.

RESULTS

The results of our study showed that in both intervention and control groups, weight increases significantly after 12 weeks (P = 0.01). However, no remarkable difference was reported between the two groups after 12 weeks (P = 0.09). In addition, no significant changes were observed between the two groups after 4 and 12 weeks regarding BMI and FEV1. Based on the findings, the score of the CFQ questionnaire in the intervention group increased significantly in the 4th and 12th week. No significant differences were observed between the two groups in terms of factors related to lung function or exacerbations after 12 weeks.The only notable effect reported was related to pain attacks in the probiotic group compared to the placebo group after 4 weeks (P = 0.02).

CONCLUSION

In general, treatment with probiotics improved the quality of life in patients with CF. However, no significant effect was observed on pulmonary, gastrointestinal, and growth-related outcomes.

TRIAL REGISTRATION

This study was retrospectively registered IRCT registration number: IRCT20240105060622N1 (Registration date: 2024-08-16).

Association between weight fluctuation and the risk of metabolic dysfunction-associated steatotic liver disease

BACKGROUND

The global incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased in recent years. It has already been demonstrated that exercise and weight change are associated with the occurrence of MASLD; however, the association between weight fluctuation caused by different exercise intensities and the risk of MASLD remains to be studied.

AIM

To investigate the impact of weight fluctuation and physical activity intensity on the risk of MASLD prevalence.

METHODS

Data from the National Health and Nutrition Examination Survey database including five cycles from 2009 to 2018 were analyzed. The model included variables such as age, sex, and poverty income ratio. Weighted multivariate logistic regression was used to examine the influence of different weight fluctuation patterns within the two time intervals on the prevalence of MASLD. Nonparametric restricted cubic spline curves were used to analyze the non-linear relationship between net weight change and MASLD prevalence.

RESULTS

Among 3183 MASLD cases, the risk of MASLD increased with age for individuals transitioning from non-obese to obese or maintaining obesity, with odds ratio (OR) changing from 8.91 (95%CI: 7.40–10.88) and 11.87 (95%CI: 9.65–14.60) at 10 years before baseline to 9.58 (95%CI: 8.08–11.37) and 12.51 (95%CI: 9.33-16.78) at 25 years. Stable obesity correlated with age-dependent MASLD prevalence escalation, whereas increased physical activity attenuated MASLD risk in this group, with an OR changing from 13.64 (95%CI: 10.59–17.57) to 6.42 (95%CI: 4.24–9.72). Further analysis of the net weight changes revealed a paradoxical risk elevation with intensified physical activity during different time periods.

CONCLUSION

The risk of MASLD increases in individuals transitioning from non-obese to obese or maintaining obesity. High-intensity physical activity is beneficial for MASLD among individuals with stable obesity.

Registered clinical trials targeting type 2 diabetes remission with pharmacological interventions

Systematic reviews and meta-analyses indicate that dietary interventions and metabolic surgery lead to higher rates of type 2 diabetes (T2D) remission, improving beta-cell function and insulin sensitivity. There is limited data on the effectiveness of pharmacological interventions targeting T2D remission. We aimed to search clinical trial registries and perform a systematic mapping of registered randomized clinical trials of pharmacological interventions targeting T2D remission; summarizing the existing research space, and identifying gaps for future research. We searched three clinical trial registries: Clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform and the European Union Clinical Trials Information System on the 19th March 2024. Key outcomes included sample size, interventions, comparators, definition of T2D remission, follow-up duration, funding source, eligibility criteria, trial completion status, publication status, and availability of published results. The search yielded 1108 results, of which 34 trials were included. The majority were non-industry funded (70.6%, n = 24) and 88.2% (n = 30) of trials targeted remission of T2D diagnosed within 6 years. Approximately 56% (n = 19) of trials used pharmacological combination therapy with mainly metformin, insulin, and a glucagon-like peptide 1 (GLP-1) agonist. The majority of studies (35.3%, n = 12) did not register defined specific criteria to determine remission and there was a lack of consistency in methods of beta-cell function measurement. We suggest that future research use a standardized definition of T2D remission and the beta-cell function method. Future trials should focus on using GLP-1 receptor agonists and GIP analogs, and their role in weight loss and T2D.Registration: PROSPERO CRD42024511198.

Plasma Calprotectin and Myeloperoxidase as Biomarkers in Inflammatory Bowel Disease

BACKGROUND

Inflammatory bowel disease (IBD) is a relapsing-remitting illness requiring proactive monitoring of gut inflammation. We aimed to determine the correlations of plasma myeloperoxidase (pMPO) and calprotectin (pCal), two neutrophil proteins, with existing measures of disease activity.

METHODS

Adults with IBD undergoing ileocolonoscopy were recruited prospectively. Baseline assessments included blood tests (pMPO, pCal, and C-reactive protein ([CRP]), symptom questionnaires, and endoscopic indices (simple endoscopic score for CD [SES-CD] and UC endoscopic index of severity [UCEIS]). Active IBD was defined as SES-CD > 2 and UCEIS ≥ 2. Spearman's rank correlations assessed the associations between blood markers and endoscopic activity. The area under the receiver operating characteristics curves (AUROC) and univariable logistic regression assessed the ability of blood markers (at optimal thresholds) to identify active disease.

RESULTS

In total, 170 participants were included (female, n = 92; Crohn's disease [CD], n = 99; median age 46 years, IQR 35-58). Plasma biomarkers more accurately identified active IBD in individuals with UC (AUROCpMPO = 0.76, P < .001; AUROCpCal = 0.66, P < .05; AUROCCRP = 0.73, P < .001) than in CD (AUROCpMPO = 0.62, P > .05; AUROCpCal = 0.65, P < .01; AUROCCRP = 0.66, P < .01). In all patients with IBD, the addition of pCal (AUROC = 0.73, P < .001) and pMPO (AUROC = 0.73, P < .001) to CRP added benefit compared to CRP (AUROC = 0.70, P < .001) alone. Plasma myeloperoxidase > 13.86 ng/mL (odds ratio [OR] = 10.13, 3.4-30.16) and pCal > 961.72 ng/mL (OR = 3.38, 1.21-9.4) were associated with an increased odds of having endoscopically active UC.

CONCLUSIONS

Plasma MPO shows promise as a potential blood-based biomarker of IBD activity, especially in UC. The combined use of pMPO and CRP adds diagnostic utility in discriminating between active versus quiescent IBD.

Myeloperoxidase Enzyme Activity in Feces Reflects Endoscopic Severity in Inflammatory Bowel Disease

BACKGROUND

Concentrations of the neutrophil protein myeloperoxidase are elevated in the feces of individuals with endoscopically active inflammatory bowel disease (IBD). Its enzyme activity could give an immediate readout of endoscopic inflammation. We investigated whether fecal myeloperoxidase activity (fMPOa) is associated with IBD endoscopic inflammation. We also investigated whether myeloperoxidase promotes oxidative stress in IBD.

METHODS

Myeloperoxidase enzyme activity was measured using an enzyme-linked immunosorbent assay (ELISA fMPOa), a novel CM-sepharose extraction assay (CM-S fMPOa), or by quantifying urinary glutathione sulfonamide (GSA) by tandem mass spectrometry. GSA is a specific biomarker of myeloperoxidase activity. IBD activity was assessed using the ulcerative colitis endoscopic index of severity or the simple endoscopic score for Crohn's disease (SES-CD). Spearman's correlation and receiver operating characteristic curves evaluated biomarker utility.

RESULTS

IBD patients (n = 172) were recruited prospectively (ulcerative colitis, n = 72; Crohn's disease, n = 100). fMPO was mostly active. Its enzyme activity, measured either as ELISA fMPOa or CM-S fMPOa, correlated with endoscopic inflammation in both ulcerative colitis and Crohn's disease. Urinary GSA is also correlated with endoscopic disease inflammation. Correlations of urinary GSA with disease measures and other biomarkers were stronger in ulcerative colitis than in Crohn's disease.

CONCLUSIONS

Myeloperoxidase is active in IBD and its enzyme activity is a reliable marker of IBD endoscopic inflammation. Our results with the CM-S fMPOa assay demonstrate the potential for an immediate and accurate measure of fMPO enzyme activity as a robust, low-cost test for IBD activity. Myeloperoxidase may contribute to tissue damage in IBD.

Genomic insights into novel predatory myxobacteria isolated from human feces

Myxobacteria are Gram-negative, spore-forming predatory bacteria isolated from diverse environmental samples that feed on other microbes for their survival and growth. However, no reports of cultured representatives from the human gut have been published to date, although previous investigations have revealed the presence of myxobacterial operational taxonomic units (OTUs) in skin and fecal samples. In this study, three myxobacterial strains designated as O35, O15, and Y35 were isolated and purified from fecal samples of two inflammatory bowel disease (IBD) patients. The 16S rRNA gene sequence analysis and phylogeny identified the strains as Myxococcus spp. belonging to two different clades. Genome-based phylogeny and overall genome-related indices, i.e., average amino acid identity and percentage of conserved proteins, confirmed the heterogeneity within the genus and placed the three strains within two different clades separated at the level of different genera. Digital DNA-DNA hybridization and average nucleotide identity values indicated that they belonged to two novel Myxococcus spp. The analysis of meta-barcoding data from IBD and control cohorts detected OTU lineages closely affiliated to the three novel strains. Based on evidence from detailed structural and functional genomics, we propose the novel species Myxococcus faecalis sp. nov. O35T and a new genus Pseudomyxococcus gen. nov. to accommodate the novel species Pseudomyxococcus flavus sp. nov. Y35T. Overall, these findings provide new information about the occurrence of myxobacteria in the human gut and lay the foundations for a new classification scheme for myxobacterial taxa.IMPORTANCEMyxobacteria have been described from a variety of niches ranging from terrestrial to marine habitats and are known to harbor a diverse portfolio of bioactive molecules. However, to date, there has been no report of isolating culturable representatives from the human gut. This study describes novel myxobacteria from the human gut based on phylogenomics and phenotypic description. The findings are complemented by sequence-based data, wherein operational taxonomic unit (OTU) lineages closely affiliated with the isolated strains have been identified, thus opening a Pandora's box of opportunities for research into the microbial ecology and functional potential of these taxa in the gut ecosystem. Additionally, the study also seeks to establish a new systematic framework, expanding our understanding of myxobacterial taxonomy.

Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis

Inflammatory bowel disease (IBD) is an incurable disease of the digestive system; however, the therapeutic methods for IBD remain limited. The pathogenesis of IBD was systematically discussed and compared in this paper, primarily comprising Crohn’s disease and ulcerative colitis. This paper focused on six common aspects: (1) Dysregulated immune responses; (2) Gene function changes; (3) Intestinal microbes disorder and imbalance; (4) Microbial infections; (5) Associations between IBD and other inflammatory diseases; and (6) Other factors. In addition, the pathogenesis differences between these two forms of IBD were unraveled and clearly distinguished. These unique aspects of pathogenesis provide crucial insights for the precise treatment of both Crohn’s disease and ulcerative colitis. This paper illustrates the root causes and beneficial factors of resistance to IBD, which provides novel insights on early prevention, development of new therapeutic agents, and treatment options of this disease.

Comparative outcomes of laparoscopic and open surgery in inflammatory bowel disease in pediatric and young adult patients: a systematic review and meta-analysis

BACKGROUND

Pediatric inflammatory bowel disease (IBD), encompassing Crohn's disease, ulcerative colitis, and indeterminate colitis, often necessitates surgical intervention in cases of severe or refractory disease. Although biologic therapies have significantly reduced the need for surgery, operative management remains essential for certain patients. The choice between laparoscopic (laparoscopy group [LG]) and open conventional surgery (open group [OG]) continues to be a subject of debate. This meta-analysis aimed to compare the postoperative outcomes of LG and OG in pediatric patients with IBD.

METHODS

We conducted a meta-analysis of observational studies comparing LG and OG outcomes in pediatric patients with IBD. Key outcomes analyzed included major and minor postoperative complications, reoperations, readmissions, operative time, and length of hospital stay.

RESULTS

Seven studies met the inclusion criteria, analyzing 3417 patients, with 1399 (41%) undergoing OG and 2018 (59%) undergoing LG. Our analysis revealed no significant differences in major postoperative complications, reoperation, and readmissions between LG and OG (P = .114, P = .082, and P = .641, respectively). However, LG was associated with shorter hospital stays (6.04 vs 8.35 days; P < .05). Conversions from LG to open surgery amounted to a total of 153 (7.57%). Open surgery had a significantly shorter operative time (173.8 vs 195.5 min; P = .005).

CONCLUSION

Both laparoscopic and open conventional surgeries are safe, effective, and reliable in managing pediatric IBD. Although open surgery offers shorter operative times, laparoscopy reduces hospital stay and minor postoperative complications. The choice of approach depends on the surgeon's experience and patient-specific factors.

Sexual functioning in patients with inflammatory bowel diseases (IBD): prevalence, predictors, and potential benefits of cognitive behavioral therapy (CBT)

OBJECTIVES

Patients with inflammatory bowel diseases (IBD) express concerns about their disease's effects on intimacy and sexuality. This study assessed sexual dysfunction in IBD patients and indirect beneficial effects of IBD-specific cognitive behavioral therapy (CBT) on improving sexual functioning over time.

MATERIALS & METHODS

N = 118 patients participated in a multi-center randomized controlled trial (RCT) and were assigned to either an 8-week 'IBD-specific CBT' intervention or waitlist-control group. Standardized self-report measures assessed sexual functioning (the sexuality item of the Inflammatory Bowel Disease Questionnaire, IBDQ), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale: HADS), health-related quality of life (HRQoL; MOS Short-Form Health Survey: SF-36), and IBD symptoms/disease activity (Simple Clinical Colitis Activity Index: P-SCCAI, Harvey Bradshaw Index: P-HBI). Data were analyzed cross-sectionally and longitudinally by means of repeated measures and mediation analyses.

RESULTS

At baseline, nearly half of patients reported sexual problems, including 21.4% with moderate and 15.5% with (very) severe sexual problems, as well as 10.2% reporting sexual abstinence due to IBD. At baseline, sexual functioning was weakly to moderately associated with symptoms of depression or anxiety (r<-0.4) and physical health complaints (r=.3). Longitudinally, 'IBD-specific CBT' had positive effects on sexual functioning which were mediated by improved depressive symptoms (R2=32.9%).

CONCLUSIONS

Impairments in sexual functioning are common in IBD patients, which appears in part related to depressive symptoms. Addressing sexual problems in clinical care is crucial, and this study provided preliminary evidence that 'IBD-specific CBT' directed at mental health outcomes, such as depressive complaints, can parallelly help to alleviate sexual dysfunction.

[Clinical Ultrasound Part II - Sonopsychology or Psychological Interactions using Ultrasound]

In contrast to cross-sectional imaging using computed tomography, magnetic resonance imaging or positron emission tomography, ultrasound examinations enable direct real-time interaction between examiner and patient and their companions. In this review, we highlight general patient-relevant aspects, whereby endpoints such as emotional factors of general and physical stress caused by the examination are discussed. On the other hand, we take a closer look at specific psychosocial interactions during ultrasound examinations in primary care, gastroenterology, oncology, palliative care, pediatrics, obstetrics and gynecology. Furthermore, we consider ultrasound not only as an intervention in the sense of a needle-guiding procedure, but also as an opportunity to change relationships and initiate lifestyle modifications. The psychological impact of incidental findings and the importance of adequate communication of findings and prognosis is discussed from the patient's perspective.

Prevalence and possible causes of crying and mild gastrointestinal and skin symptoms in infants reported by healthcare professionals - worldwide data

OBJECTIVE

Many infants experience crying, mild gastrointestinal (GI) symptoms (such as regurgitation, constipation, and diarrhea) and skin symptoms during the first year of life. However, little is known about the prevalence and the management of these symptoms. The aim of this study was to gather insights in the experiences, prevalences, and potential causes of mild-to-moderate crying and GI and skin symptoms in healthy infants (< 12 months) as reported by health care professionals (HCPs) globally.

METHODS

The study was conducted among HCPs from six regions (China (CN), Europe (EU), Mexico (MX), Middle East (ME), Russia (RU), and the United States (US)). During qualitative interviews with selected experts, alignment on the definitions of crying and GI and skin symptoms and consensus on the survey were reached. The quantitative survey consisted of questions on the reported prevalence of study-defined symptoms in infants, potential causes, treatments, and the role of nutrition in these symptoms Descriptive statistics were used to describe the prevalence, potential causes, and management of study-defined symptoms.

RESULTS

Definitions of crying, GI, and skin symptoms were formulated, supported by 17 in-depth expert interviews. Survey responses from 1047 HCPs were analyzed. The prevalence of study-defined symptoms was reported to be 60%; gas/bloating (22%) was the most prevalent GI symptom, followed by regurgitation (19%) and unexplained crying/colic (18%). The not yet fully developed infants' GI tract and the type of infants' nutrition were reported as the main causes of study-defined symptoms. To address infants' symptoms, HCPs most often recommend changes in feeding regimen (volume, position of the infant, feeding scheme) or in infants' nutrition, followed by parental advice and/or education.

CONCLUSION

HCPs reported that more than half of the infants experience at least one symptom in the first year of life. The ongoing development of the infant's GI tract and infant's nutrition were reported to be the main causes of study-defined symptoms. To manage infants' GI symptoms, HCPs recommend a change in feeding regimen or infants' nutrition along with parental education. What is known? • Infants experience unexplained crying and gastrointestinal (GI) and skin symptoms in the first year of life. • The infant's gastrointestinal tract needs time to develop. What is new? • Health care professionals' (HCPs) consensus on the definitions of mild crying and GI and skin symptoms. • The reported prevalence of those symptoms is 60%, which is approximately twice as high as the prevalence of functional gastrointestinal diseases (FGIDs). - To manage those symptoms, HCPs give parental advice or education, or they recommend a change in feeding regimen or type of infants' nutrition.

Genetic Background of Eosinophilic Esophagitis and Esophageal Atresia in Children

BACKGROUND AND AIMS

The pathophysiology of eosinophilic esophagitis (EoE) is associated with a strong heritability and esophageal-specific genetic variants. Patients with esophageal atresia (EA) may be at higher risk of developing EoE considering the recently discovered genetic similarities between these disorders. This study aimed to identify genetic mutations associated with EoE, explore their potential role in susceptibility to concurrent EA, and evaluate the relationship between these mutations, clinical course, and treatment response.

METHODS

Whole-exome sequencing was performed to identify the potential genomic regions associated with an increased risk of these disorders, and the analysis was expanded for candidate genes.

RESULTS

A total of 35 cases (EA + EoE +; n = 7) were included. Pathogenic mutations in genes associated with EoE were identified in 2 cases, while likely pathogenic variants were identified in 5 cases. No polymorphisms were detected in 5 cases. Variants of uncertain significance (VUS) were identified in genes associated with EoE in 18 cases and in candidate genes in 7 cases. Patients with VUS exhibited a high percentage of associated EA, increased rates of atopy, and a notable response to treatment. The duration of the clinical response was significantly longer in individuals without genetic mutations (p-value:0.006). Among the isolated EoE cases, 50% had variants in genes previously associated with EoE, whereas in EA + EoE + cases, this rate increased to 71%, suggesting a stronger genetic predisposition in EA + EoE + cases.

CONCLUSION

Our study highlights the role of genetic mutations in the etiology of EoE. The identification of novel gene variants and new insights into etiopathogenesis are anticipated to enhance diagnosis, screening, and treatment strategies.

Systematic Review: Practices and Programs in Inflammatory Bowel Disease Transition Care

BACKGROUND

Adolescents with inflammatory bowel disease (IBD) transitioning to adult care is often deemed a challenging period for patients, their carers, and practitioners. The use of structured transition programs is increasingly incorporated into standards of care, yet the optimal format remains unknown. The aim of this study is to carry out a systematic review of structured transition programs and their components to assess the impact on disease-specific and transition-related outcomes.

METHODS

A systematic review (PROSPERO ID: CRD42023380846) was performed across 4 databases (PubMed, CINAHL, CENTRAL, and EMBASE) and relevant publications up to March 2023 were reviewed. Studies evaluating either a structured transition program or targeted intervention which also measured a transition- and/or disease-related outcomes were included for evaluation in accordance with the PRISMA statement.

RESULTS

Three thousand four hundred and thirty-two articles were identified and 29 included in the final review. A structured transition program was reported in 21 studies and 8 investigated discrete transition-related interventions. The key transition-related outcomes included knowledge, self-efficacy, adherence, clinic attendance, and transition readiness which overall improved with the use of structured transition programs. Similarly, interventions consistently improved relapse/admission rates and corticosteroid use across most studies, although the benefit in hospitalization and surgical rates was less evident. Methodological limitations alongside heterogeneity in study design and outcome measures impacted on the quality of the evidence as assessed by the GRADE rating.

CONCLUSIONS

Transition- and medical-related outcomes for adolescents with IBD have been shown to benefit from structured transition programs but practices vary greatly between centers. There is no current standardized transition model for patients with IBD prompting further research to guide future development of guidelines and models of care.

Influence of Familial Inflammatory Bowel Disease History on the Use of Immunosuppressants, Biological Agents and Surgery in Patients with Pediatric-Onset of the Disease in the Era of Biological Therapies. Results from the ENEIDA Registry

Background: Pediatric-onset familial inflammatory bowel disease (IBD) may differ from sporadic pediatric-onset IBD in its genetic and environmental background and may have distinct clinical and therapeutic implications. Objective: To evaluate the influence of a positive family history of IBD on the use of medical therapies and surgical interventions in adult patients with pediatric-onset IBD. Methods: Retrospective case-control study using the Spanish ENEIDA registry, including adults diagnosed with pediatric-onset IBD since 2006. Familial forms (FFs) (defined by a first-degree relative with IBD) and sporadic forms (SF) (with no relatives of any grade with IBD) were matched 1:4 by type of IBD, sex, age at IBD diagnosis, disease location, disease pattern, development of perianal disease and smoking status at diagnosis. The study outcomes were the use of immunomodulators, biological therapies, intestinal surgery, and perianal surgery during follow-up. Results: Six-hundred and fifty-five Crohn's disease (CD) (131 FF) and 440 ulcerative colitis (UC) (88 FF) patients were included. Immunomodulators, biological therapy, and intestinal surgery were used evenly among FF and SF patients for both UC and CD. However, a higher requirement for perianal surgery among FF-CD patients (18.3% vs. 10.5%, p = 0.014), together with a shorter time to perianal surgery (11 vs. 20 months, log-rank p = 0.004), was observed. Conclusions: Patients with FF of pediatric-onset IBD do not exhibit an increased use of immunomodulators, biological agents, or intestinal surgery, but do exhibit a higher need for perianal surgery, as compared to patients with SF pediatric-onset IBD.

Pseudoascites Due to Celiac Disease in a Patient with Type 1 Diabetes

Ascites presenting in a patient with type 1 diabetes is usually due to cardiac, hepatic, or renal disease. With these conditions, aspiration of the peritoneal cavity will result in a sample of peritoneal fluid being obtained. However, if there is under 25 ml or no fluid is present in the peritoneal cavity, the diagnosis is that of pseudoascites. Herein, we describe the first case of pseudoascites due to celiac disease occurring not only in an adult with type 1 diabetes but also in any adult. Since celiac disease is eight times more common in patients with type 1 diabetes, on the basis of this report, we recommend that patients with type 1 diabetes and abdominal symptoms be serologically screened at least once for celiac disease, as well as every patient with type 1 diabetes .

Diagnostic biomarkers and immune infiltration profiles common to COVID-19, acute myocardial infarction and acute ischaemic stroke using bioinformatics methods and machine learning

BACKGROUND

COVID-19 is a disease that affects people globally. Beyond affecting the respiratory system, COVID-19 patients are at an elevated risk for both venous and arterial thrombosis. This heightened risk contributes to an increased probability of acute complications, including acute myocardial infarction (AMI) and acute ischemic stroke (AIS). Given the unclear relationship between COVID-19, AMI, and AIS, it is crucial to gain a deeper understanding of their associations and potential molecular mechanisms. This study aims to utilize bioinformatics to analyze gene expression data, identify potential therapeutic targets and biomarkers, and explore the role of immune cells in the disease.

METHODS

This study employed three Gene Expression Omnibus (GEO) datasets for analysis, which included data on COVID-19, AMI and AIS. We performed enrichment analysis on the co-DEGs for these three diseases to clarify gene pathways and functions, and also examined the relationship between co-DEGs and immune infiltration. Machine learning techniques and protein-protein interaction networks (PPI) were used to identify hub genes within the co-DEGs. Finally, we employed a dual validation strategy integrating independent GEO datasets and in vitro experiments with human blood samples to comprehensively assess the reliability of our experimental findings.

RESULTS

We identified 88 co-DEGs associated with COVID-19, AMI and AIS. Enrichment analysis results indicated that co-DEGs were significantly enriched in immune inflammatory responses related to leukocytes and neutrophils. Immune infiltration analysis revealed significant differences in immune cell populations between the disease group and the normal group. Finally, genes selected through machine learning methods included: CLEC4E, S100A12, and IL1R2. Based on the PPI network, the top ten most influential DEGs were identified as MMP9, TLR2, TLR4, ITGAM, S100A12, FCGR1A, CD163, FCER1G, FPR2, and CLEC4D. The integration of the protein-protein interaction (PPI) network with machine learning techniques facilitated the identification of S100A12 as a potential common biomarker for early diagnosis and a therapeutic target for all three diseases. Ultimately, validation of S100A12 showed that it was consistent with our experimental results, confirming its reliability as a biomarker. Moreover, it demonstrated good diagnostic performance for the three diseases.

CONCLUSION

We employed bioinformatics methods and machine learning to investigate common diagnostic biomarkers and immune infiltration characteristics of COVID-19, AMI and AIS. Functional and pathway analyses indicated that the co-DEGs were primarily enriched in immune inflammatory responses related to leukocytes and neutrophils. Through two machine learning approaches and the PPI network, and subsequent validation and evaluation, we identified S100A12 as a potential common therapeutic target and biomarker related to immune response that may influence these three diseases.

Partial Enteral Nutrition in the Management of Crohn's Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Exclusive enteral nutrition is an established treatment for active Crohn's disease but the role of partial enteral nutrition (PEN) in the broader management of the disease is less clear. This systematic review and meta-analysis reviewed the literature on the role of PEN in Crohn's disease management.

METHODS

This review was conducted following Cochrane recommendations. The protocol was registered on PROSPERO. Findings were reported following the PRISMA guidelines.

RESULTS

Sixty-four articles were identified, of which 11 reported data from randomized control trials. Good quality evidence suggests that PEN may be used as a maintenance and induction therapy, particularly at high dosages and/or alongside exclusion diets. A higher dosage of PEN is associated with a lower risk of subsequent disease relapse, with benefits observed at intakes above 35% of energy requirements (35%-50% PEN: OR [95% confidence intervals (CI)]: 0.42 [0.27-0.65]; > 50% PEN: OR [95% CI]: 0.27 [0.08-0.88]). Low-quality evidence suggests that postoperative use of PEN may prevent disease recurrence or enhance treatment outcomes when used as adjunct therapy to biologics. PEN can improve nutritional parameters, showing efficacy comparable to EEN in pediatric patients (weight: OR [95% CI]: -0.04 [-0.32, 0.25]). The effect of PEN on improving patients' quality of life is comparable to that of EEN and anti-tumor necrosis factor alpha therapies.

CONCLUSIONS

Partial enteral nutrition may help in various aspects of Crohn's disease management but much of the current evidence is of low quality. Well-designed randomized control trials are required to confirm findings from current literature and before clinical recommendations can be made.

The mediating role of psychological inflexibility on internalized stigma and patient outcomes in a sample of adults with inflammatory bowel disease

BACKGROUND

This study examined the relationship between psychological inflexibility, internalized stigma, and patient outcomes in adults with inflammatory bowel disease (IBD). It aimed to explore if psychological inflexibility mediated the relationship between internalized stigma and patient outcomes.

METHODS

Three hundred and eighty-two participants with IBD took part in a cross-sectional quantitative study conducted via an online survey from May to December 2020. Participants completed questionnaires that assessed psychological inflexibility, committed action, internalized stigma related to IBD, psychological distress, IBD self-efficacy, self-concealment, beliefs about emotions, and fatigue. Participants also completed a sociodemographic and clinical questionnaire in addition to a bespoke Covid-19 questionnaire. Pearson's correlations and exploratory simple mediation analyses were used to examine relationships between variables and the mediating effect of psychological inflexibility.

RESULTS

40.5% of participants experienced internalized stigma. Higher psychological inflexibility was associated with higher internalized stigma, lower committed action, poorer health-related quality of life, lower IBD self-efficacy, higher self-concealment, higher fatigue, and more negative beliefs about emotions. Psychological inflexibility partially mediated the relationship between internalized stigma and several patient outcomes (psychological distress, IBD health-related quality of life, IBD self-efficacy, and self-concealment) and completely mediated the relationship between internalized stigma and fatigue.

CONCLUSION

Psychological inflexibility significantly impacts the quality of life in individuals with internalized stigma related to IBD and mediates the relationship between internalized stigma and patient outcomes. Increasing psychological flexibility in adults with IBD may reduce distress and enhance quality of life. Longitudinal studies and trials of psychological interventions targeting psychological flexibility warrant exploration.

From traditional to artificial intelligence-driven approaches: Revolutionizing personalized and precision nutrition in inflammatory bowel disease

Inflammatory bowel disease (IBD), comprising ulcerative colitis and Crohn's disease, is a chronic inflammatory condition with global prevalence and varying incidence. The IBD pathogenesis involves intricate interactions among genetic, host and environmental factors, leading to dysregulated immune responses and chronic intestinal inflammation. Alongside elevated levels of inflammatory cytokines and altered miRNAs expression, more studies highlight significant dysbiosis in both fecal and ileal microbiota of IBD patients. This dysbiosis is characterized by an increase in pro-inflammatory and mucin-degrading bacteria (e.g., Fusobacterium spp., Escherichia spp.) and a decline in short-chain fatty acids (SCFAs) -producing microbes (e.g., Roseburia spp., Faecalibacterium spp.) which play a protective role in gut health. Diet emerges as a key environmental factor influencing IBD onset and progression and recent advancements in"omics" technologies, such as genomics, transcriptomics, and metabolomics, provide a deeper understanding of the molecular interactions between genes, gut microbiota (GM) and nutrition. Finally, new technologies like artificial intelligence (AI), further enhance findings by enabling data integration and personalized dietary strategies. In this scenario, this review aims to summarize accumulating data on the effects of dietary interventions in IBD patients and introduce the role of artificial intelligence (AI) in facilitating precision dietary approaches to improve IBD management.

Characterizing fermentable carbohydrate foods in the diets of children with abdominal pain-related disorders of gut-brain interaction and healthy children

OBJECTIVES

Restricting dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) can alleviate symptoms in children with disorders of gut-brain interaction (DGBI). Due to the restrictions of a low FODMAP diet (LFD), a less restrictive FODMAP Gentle diet (FGD) has been suggested. However, the types and amounts of high FODMAP foods and carbohydrates commonly consumed by children have not been studied. We aimed to identify the high FODMAP foods and proportions of FODMAP carbohydrates consumed by children with DGBI and healthy children (HC) and to determine which usually ingested FODMAPs would be restricted on the FGD.

METHODS

Three-day diet records from both children with DGBI and HC were analyzed and compared to assess the type and amount of high FODMAP foods and carbohydrates ingested. Additionally, the ingested FODMAPs that would be restricted on the FGD were determined.

RESULTS

Diet records from 77 children with DGBI and 64 HC were analyzed. The number of foods ingested daily was similar between children with DGBI and HC (12.3 ± 4.2 vs 12.9 ± 3.4, respectively); high FODMAP foods comprised most foods eaten in both groups. Children with DGBI (vs. HC) ate fewer high FODMAP foods per day (6.5 ± 2.3 vs 8.7 ± 2.4, P < 0.0001, respectively). Fructans were the most consumed FODMAP carbohydrate in both groups, and children with DGBI (vs. HC) consumed fewer fructans, lactose, fructose, and polyols (all P < 0.0001). The top 3 food categories consumed in both groups were wheat-containing foods, dairy, and fruits/ 100% fruit juices. In children with DGBI, 80.9% of the high FODMAP foods consumed would be limited on the FGD.

CONCLUSIONS

Children with DGBI consume fewer high FODMAP foods and carbohydrates than HC, with the top consumed FODMAP carbohydrates being fructans, lactose, and fructose. A FGD would restrict most high FODMAP foods consumed by children with DGBI.

Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review

BACKGROUND

Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the "brain-gut-lung axis." Accumulating evidence indicates that stroke triggers intestinal alterations through the brain-gut axis, while multiple studies confirm that gut-derived changes can mediate pneumonia through the gut-lung axis. However, the mechanisms connecting stroke-induced intestinal dyshomeostasis to SAP remain incompletely elucidated, and the multiorgan interaction mechanisms of the "brain-gut-lung axis" in SAP pathogenesis require further exploration.

REVIEW SUMMARY

This systematic literature review systematically searched databases, including PubMed, using the keywords "stroke," "gastrointestinal microbiome," and "bacterial pneumonia," incorporating 80 mechanistic studies. Key findings reveal that stroke initiates a cascade of "neuro-microbial-immune" pathway interactions along the brain-gut-lung axis, leading to intestinal dyshomeostasis characterized by microbiota and metabolite alterations, barrier disruption, immune dysregulation, inflammatory responses, and impaired gut motility. These intestinal perturbations ultimately disrupt pulmonary immune homeostasis, promoting SAP development. In addition, stroke directly induces vagus nerve injury through the brain-gut axis, resulting in impaired swallowing and cough reflexes that exacerbate aspiration-related pulmonary infection risks.

CONCLUSIONS

Elucidating the role of the brain-gut-lung axis in SAP pathogenesis provides critical insights into its underlying mechanisms. This paradigm highlights intestinal homeostasis modulation and vagus nerve stimulation as promising therapeutic strategies for SAP prevention and management, advancing a multitargeted approach to mitigate poststroke complications.

Protein-losing enteropathy and multiple vasculature dysplasia in LZTR1-related Noonan syndrome: A case report and review of literature

BACKGROUND

Protein-losing enteropathy (PLE) is a rare cause of hypoalbuminemia that can be attributed to intestinal lymphangiectasia. Patients with Noonan syndrome may present with disorder of lymph vessel formation. However, PLE is rarely reported with Noonan syndrome.

CASE SUMMARY

A 15-year-old female was hospitalized multiple times for recurrent edema and diarrhea secondary to hypoalbuminemia. Additional manifestations included a ventricular septal defect at birth, intermuscular hemangioma, slightly wide interocular and intermammary distances, and absence of the distal phalanx of the left little finger since birth. Abdominal computed tomography revealed cavernous transformation of the portal vein, and liver biopsy indicated “porto-sinusoidal vascular disease”. Whole exome and Sanger sequencing revealed a heterozygous mutation (exon9: C.850C>T:P.R284C) in leucine zipper-like transcription regulator 1, suggesting Noonan syndrome type 10. Further examinations revealed thoracic duct dysplasia and intestinal lymphangiectasia causing PLE in this patient. A multidisciplinary team decided to address thoracic duct dysplasia with outlet obstruction. Approximately two years after the microsurgical relief of the thoracic duct outlet obstruction, the patient achieved persistent normal serum albumin level without edema or diarrhea. Furthermore, the relevant literatures on Noonan syndrome and PLE were reviewed.

CONCLUSION

Herein, we reported the first case of PLE associated with Noonan syndrome caused by a rare genetic mutation in leucine zipper-like transcription regulator 1 (c.850C>T:P.R284C) with newly reported manifestations. This case presented the successful treatment of clinical hypoalbuminemia attributed to thoracic duct dysplasia, intestinal lymphangiectasia and PLE.

Practical Application of Evidence-Based Dietary Therapy in Inflammatory Bowel Disease: The DELECTABLE Program

BACKGROUND/OBJECTIVES

Exclusive Enteral Nutrition (EEN) and the Crohn's Disease Exclusion Diet (CDED) have been shown to induce remission in Crohn's disease. Low-sulphur, plant-based diets are being explored for ulcerative colitis, and wholefood, low-additive approaches are emerging as significant. Although Inflammatory Bowel Disease (IBD) patients modify their diet, evidence for tolerability and benefit outside clinical trials is limited. The DELECTABLE program aimed to assess satisfaction, adherence, and efficacy of dietary therapies as part of IBD care.

METHODS

In this dietitian-led, open-label, prospective study, patients with Crohn's disease were offered the CDED or a whole-food, additive-free diet (WFD), and patients with ulcerative colitis were offered a low-sulphur, plant-based diet (UCD) or WFD. Primary outcomes were 12-week diet satisfaction (modified DSAT-28) and diet adherence, including food additive intake. Secondary outcomes were quality of life (QoL) (IBDQ-9), disease activity (CDAI for Crohn's disease, partial Mayo score for ulcerative colitis), and biochemical markers (CRP, faecal calprotectin). Analyses were conducted within, rather than between, diet arms due to the non-random nature of the study. Diet adherence and disease activity change across time points (baseline, week 6, week 12) were assessed using repeated measures ANOVA or Friedman's test, with pairwise paired t-test or Wilcoxon Signed-Rank test. Diet satisfaction and quality of life changes across time (baseline/week 1, week 12) were assessed using a paired t-test or Wilcoxon Signed-Rank test.

RESULTS

Of 165 referrals, 76 patients enrolled, with 64 completing the 12-week program (CDED: n = 15, WFD: n = 42, UCD: n = 7). Diet satisfaction was initially high and remained stable over time on CDED (p = 0.212) and improved on WFD (p = 0.03). Patient- and dietitian-rated adherence was high at baseline and did not significantly decrease on any diet arm (p > 0.349). Food additive intake decreased on WFD (p = 0.009). QoL improved on CDED and WFD (p < 0.001). CRP, calprotectin, and CDAI were reduced on CDED (p < 0.045), and CDAI and partial Mayo were reduced on WFD (p < 0.027).

CONCLUSIONS

Well-balanced therapeutic diets are feasible and well-accepted by patients with IBD, with a promising impact on disease activity.

Oral microbiota signature predicts the prognosis of colorectal carcinoma

Emerging evidence links oral-derived gut microbes to colorectal cancer (CRC) development, but CRC prognosis-related microbial alterations in oral remain underexplored. In a retrospective study of 312 CRC patients, we examined the oral microbiota using 16S rRNA gene full-length amplicon sequencing to identify prognostic microbial biomarkers for CRC. Neisseria oralis and Campylobacter gracilis increased CRC progression risk (HR = 2.63 with P = 0.007, HR = 2.27 with P = 0.001, respectively), while Treponema medium showed protective effects (HR = 0.41, P = 0.0002). A microbial risk score (MRS) incorporating these species effectively predicted CRC progression risk (C-index = 0.68, 95% CI = 0.61-0.76). When compared to a model constructed solely from clinical factors, including tumor stage, lymphatic metastasis, and perineural invasion, the predictive accuracy significantly improved with the addition of the MRS, resulting in a C-index rising to 0.77 (P = 2.33 × 10-5). Our findings suggest that oral microbiota biomarkers may contribute to personalized CRC monitoring strategies, their implementation in clinical surveillance necessitates confirmatory studies.

Inflammatory Bowel Disease in the Post-STRIDE II Era: Epidemiology and Long-Term Clinical Outcomes from a Population-Based Study

Background/Objectives: Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC). The availability of an increasing number of new molecules approved for IBD treatment has increased our ability and aspirations to change the trajectory of the disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) II consensus (2018) is the current suggested strategy for IBD management, which recommends a treat-to-target approach. The primary objective of this study is to describe the clinical history of IBD in the post-STRIDE II era and to quantify the burden of IBD in terms of hospitalisation rate. The secondary objective is to estimate the 6-year risk of intestinal resection among IBD patients. Methods: A population-based time series analysis was conducted on administrative data; retrospective data from January 2011 to December 2021 were collected for the Local Health Authority "Roma 1" population (∼1.5 million residents). Hospitalisation and surgical events were prospectively recorded for patients newly diagnosed between January 2018 and February 2022 (n = 556), with follow-up throughout May 2024. A Kaplan-Mayer survivor analysis was performed to estimate the cumulative surgery risk. Results: In 2021, the IBD prevalence was 218.3 cases/100,000 people (77.2 CD, 141.1 UC). The incidence trend slowly increased during the last decade, up to 5.3 (CD) and 9.4 (UC) cases/100,000 ppl/year. The yearly hospitalisation rate remained stable, near 16.5%. The 6-year cumulative risk of surgery was 36% for CD and 20% for UC. Conclusions: The incidence of IBD has increased in the last few decades, with substantial stability in regard to the incidence of surgery and hospitalisations. Thus, the current IBD management approach has only had a small effect on changing the natural history of the disease.

The prevalence of constipation in children with new diagnosis of inflammatory bowel disease: A retrospective study

OBJECTIVES

Functional constipation (FC) is a common problem in childhood and the first-line therapy is macrogol. The role of FC in the onset of inflammatory bowel disease (IBD) is poorly understood. Our main aim was to investigate the prevalence of FC in children before the diagnosis of IBD.

METHODS

This is a cross-sectional observational study in pediatric IBD-patients. We collected data on demographics, clinical and endoscopic characteristics at IBD diagnosis, and on the presence of FC and its treatment before IBD diagnosis.

RESULTS

A total of 238 children with IBD, 104 (44%) with Crohn disease (CD), 130 (56%) with ulcerative colitis (UC) and 4 (0.016%) with IBD Unclassified (IBD-U) were enrolled. The mean age was 174 ± 47 months, 56% were male. Forty-seven out of 238 (19.7%) had a FC history before the IBD diagnosis and 31 out of these 47 patients (65%) received macrogol therapy. In the FC group, we found a delay in the diagnosis of IBD compared to the group with no FC [median (interquartile range [IQR]): 5 months (2.5-9.5) and 2 months (0-4), respectively, p ≤ 0.001]. The difference in terms of endoscopic localization was statistically significant in UC patients presenting FC (p = 0.026) with a prevalence of proctitis and left side colitis (30% and 15%, respectively).

CONCLUSION

In conclusion our study highlighted a prevalence of constipation in pediatric IBD patients at diagnosis of 19.7%, which must be taken into account to avoid diagnostic delay and which is associated with limited extent of disease in UC pediatric patients.