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Ginzburg G, Bujarska M, Moe D, Lerner D, Noe J, Chugh A. Diverticular Gastric Outpouching: A Rare Complication of Helicobacter pylori. J Pediatr Gastroenterol Nutr 2023; 77:e114. [PMID: 37548482 DOI: 10.1097/mpg.0000000000003906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Gila Ginzburg
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Malgorzata Bujarska
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - David Moe
- Division of Pediatric Radiology, Department of Radiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Diana Lerner
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Joshua Noe
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Ankur Chugh
- From the Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
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Giroux P, Palmer A, Thomas A, Camacho-Gomez SM. Helicobacter pylori Found Guilty of Obstructive Jaundice: A Pediatric Case Report. JPGN REPORTS 2023; 4:e348. [PMID: 38034451 PMCID: PMC10684119 DOI: 10.1097/pg9.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/15/2023] [Indexed: 12/02/2023]
Abstract
Pediatric Helicobacter pylori infection represents a small proportion of disease that is otherwise decreasing in the developed world. Typical presentations have been well-described in the literature. We report a 15-year-old male who presented with jaundice, anemia, dark urine, and poorly characterized abdominal pain and was found to have obstructive jaundice secondary to a duodenal ulcer resulting from H. pylori infection. Obstructive jaundice is a seldom reported complication of duodenal ulcer, particularly in children. This report reviews H. pylori infection, outlines complications of peptic ulcer disease, and illustrates the rarity of obstructive jaundice as a presenting sign of duodenal ulcer in children.
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Affiliation(s)
- Parker Giroux
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
| | - Andrew Palmer
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Aby Thomas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Sandra Mabel Camacho-Gomez
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
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3
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Munoz Abraham AS, Osei H, Martino A, Kazmi S, Saxena S, Fitzpatrick CM, Villalona GA. Incidence and Outcomes of Perforated Peptic Ulcers in Children: Analysis of the Kid's Inpatient Database and Report of Two Cases Treated by Laparoscopic Omental Patch Repair. J Laparoendosc Adv Surg Tech A 2019; 29:248-255. [DOI: 10.1089/lap.2018.0186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Armando Salim Munoz Abraham
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Hector Osei
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Alice Martino
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sakina Kazmi
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Saurabh Saxena
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Colleen M. Fitzpatrick
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Gustavo A. Villalona
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
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Sierra D, Wood M, Kolli S, Felipez LM. Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease. Pediatr Rev 2018; 39:542-549. [PMID: 30385583 DOI: 10.1542/pir.2017-0234] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | - Lina Maria Felipez
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children's Hospital, Miami, FL
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5
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Booker WA, Ananth CV, Wright JD, Siddiq Z, D'Alton ME, Cleary KL, Goffman D, Friedman AM. Trends in comorbidity, acuity, and maternal risk associated with preeclampsia across obstetric volume settings. J Matern Fetal Neonatal Med 2018; 32:2680-2687. [PMID: 29478359 DOI: 10.1080/14767058.2018.1446077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to characterize morbidity, acuity, and maternal risks associated with preeclampsia across hospitals with varying obstetric volumes. METHODS This retrospective cohort analysis used a large administrative data source, the Perspective database, to characterize the risk for preeclampsia from 2006 to 2015. Hospitals were classified as having either low (≤1000), moderate (1001-2000), or high (≥2000) delivery volume. The primary outcomes included preeclampsia, antihypertensive administration, comorbidity, and related severe maternal morbidity. Severe maternal morbidity was estimated using criteria from the Centers for Disease Control and Prevention. Comorbidity was estimated using an obstetric comorbidity index. Univariable comparisons were made with Chi-squared test. Adjusted log linear regression models were fit to assess factors associated with severe morbidity with risk ratios with 95% confidence intervals as the measures of effect. Population weights were applied to create national estimates. RESULTS Of 36,985,729 deliveries included, 1,414,484 (3.8%) had a diagnosis of preeclampsia. Of these, 779,511 (2.1%) had mild, 171,109 (0.5%) superimposed, and 463,864 (1.3%) severe preeclampsia. The prevalence of mild, superimposed, and severe preeclampsia each increased over the study period with severe and superimposed preeclampsia as opposed to mild preeclampsia increasing the most proportionately (53.2 and 102.5 versus 10.8%, respectively). The use of antihypertensives used to treat severe range hypertension increased with use of intravenous labetalol increasing 31.5%, 43.2%, and 36.1% at low-, medium-, and high-volume hospitals. Comorbid risk also increased across hospital volume settings as did risk for severe maternal morbidity. CONCLUSIONS Preeclampsia is increasing across obstetric care settings with preeclamptic patients demonstrating increasing comorbid risk, increased risk for severe morbidity, and more frequent need for treatment of acute hypertension.
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Affiliation(s)
- Whitney A Booker
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Cande V Ananth
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA.,b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Jason D Wright
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Zainab Siddiq
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Mary E D'Alton
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Kirstin L Cleary
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Dena Goffman
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Alexander M Friedman
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
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Abstract
There is a broad clinical spectrum of gastrointestinal bleeding in children, ranging from subtle laboratory findings to dramatic clinical presentations. This review provides a framework for the evaluation and management of gastrointestinal hemorrhage for pediatricians. It outlines strategies for obtaining a tailored patient history and conducting a thorough physical examination that can shed light on the location, severity, and likely etiology of bleeding. It appraises blood tests, radiologic tools, and endoscopic modalities frequently used to identify and control a source of bleeding.
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Affiliation(s)
- Anita K Pai
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Victor L Fox
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Matsuoka W, Kaku N, Hirata Y, Lee S, Akahoshi T, Sugimori H, Hayashida M, Souzaki R, Fujita N, Asayama Y, Taguchi T, Takada H, Maehara Y. Emergent transcatheter arterial embolization for norovirus-associated life-threatening ulcer bleeding to achieve successful hemostasis in 2-year-old boy. Acute Med Surg 2016; 3:415-418. [PMID: 29123826 DOI: 10.1002/ams2.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/05/2016] [Indexed: 11/08/2022] Open
Abstract
Case We report a 2-year-old boy with duodenal ulcer with active bleeding that occurred as a result of norovirus gastroenteritis. On admission, the patient presented with shock accompanied with vomiting and melena. Abdominal contrast enhanced computed tomography scan showed signs of duodenal bleeding. Outcome He was successfully treated with emergent transcatheter arterial embolization. After the treatment, endoscopic examination revealed duodenal ulcer and the stool norovirus antigen test was found to be positive. The patient recovered completely without any sequelae. Conclusion Life-threatening duodenal ulcer bleeding in children can be caused by viral gastroenteritis. When endoscopic therapy is unsuccessful or difficult, in cases of small children, angiographic intervention can be a safe alternative treatment option of gastrointestinal bleeding.
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Affiliation(s)
- Wakato Matsuoka
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan.,Department of Pediatrics Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Noriyuki Kaku
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan.,Department of Pediatrics Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yuichiro Hirata
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan.,Department of Pediatrics Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Sooyoung Lee
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan.,Department of Pediatrics Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Tomohiko Akahoshi
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan
| | - Hiroshi Sugimori
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan
| | - Makoto Hayashida
- Department of Pediatric Surgery Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Norihiro Fujita
- Department of Radiology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yoshiki Asayama
- Department of Radiology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Hidetoshi Takada
- Department of Pediatrics Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yoshihiko Maehara
- Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan
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Benninger MS, Holy CE. The impact of endoscopic sinus surgery on health care use in patients with respiratory comorbidities. Otolaryngol Head Neck Surg 2014; 151:508-15. [PMID: 24894312 DOI: 10.1177/0194599814536369] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Analyze health care needs and outcomes-defined by changes in health care utilization-in cohorts of patients with respiratory comorbidities and requiring sinus surgery for the treatment of chronic rhinosinusitis (CRS). STUDY DESIGN Retrospective database analysis. SETTING US-wide claims database (MarketScan). SUBJECTS AND METHODS All patients with endoscopic sinus surgery (CPT 31254-31288) in 2008 and at least 2 years of continuous enrollment prior and post surgery were analyzed for concurrent comorbidities (asthma, polyps, aspirin sensitivity, and allergies). Inpatient and outpatient events as well as prescriptions related to the treatment of CRS were analyzed for frequency and cost, based on respiratory comorbidities. RESULTS A total of 9105 patients were included and subdivided as following: no respiratory comorbidity (N = 4780), asthma only (N = 1167), polyps and asthma (N = 721), Samter's triad (N = 91), and additional subgroups based on various combinations of concurrent comorbidities. Before surgery, costs were flat, ranging from $296.4 (95% CI, $263.1-$329.8) per patient per year for patients in the no comorbidity group to $2189 (95% CI, $1449.2-$2930.1) for patients with Samter's triad. Surgery was preceded by at least 6 months of increased health care utilization (outpatient care and prescriptions). Following surgery, health care needs declined rapidly and reached baseline levels within 3 to 4 postoperative months. Patients with asthma received significantly more health care for CRS than patients without asthma through the entire study. CONCLUSIONS Patients with CRS incur continuous costs and health care needs, due to the chronic nature of their disease. All patients, regardless of comorbidity, experienced significant decline in health care needs following sinus surgery from their preoperative state.
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Holy CE, Ellison JM, Schneider C, Levine HL. The impact of balloon catheter dilation on frequency of sinus surgery in the United States. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:83-9. [PMID: 24855397 PMCID: PMC4011924 DOI: 10.2147/mder.s60054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Endoscopic sinus surgery for patients with chronic rhinosinusitis (CRS) unresponsive to medical therapy has traditionally been performed under general anesthesia and in the operating room. Balloons for catheter dilation of paranasal sinuses were introduced in 2005, allowing sinus surgery to be safely performed either in the operating room or the office care setting, under local anesthesia. This change in care setting has raised concerns of overuse or expanded indications for sinus surgery. This study was thus designed to evaluate changes in surgical volumes in the United States, for the period 2006-2011, and to evaluate the impact of the sinus balloons on surgical practice. METHODS The MarketScan(®) Commercial Claims and Encounter Database was queried for the period 2006 to 2011 using CRS International Classification of Diseases, Ninth Revision codes (473.X) and sinus surgery US-based Common Procedural Terminology (CPT) codes (endoscopic sinus surgery: CPT codes 31254-31294 and 31299; balloon catheter dilation: CPT codes 31295-31297). MarketScan's projection methodology was applied to estimate the nationwide prevalence of CRS and the incidence of sinus surgery. Procedural case mix and total average payment per surgery were analyzed. RESULTS From 2006 to 2011, the yearly prevalence of CRS and sinus surgery volume remained flat with ~430 patients with CRS per 100,000 in the employer-sponsored insured population, of which ~117/100,000 underwent surgery. In 2006, 2.69 paranasal sinuses (95% confidence interval [95% CI]: 2.65-2.71) were treated during each individual sinus surgery, with an additional 1.11 nasal procedures (95% CI: 1.08-1.13) performed concurrently. By 2011, the procedural case mix had expanded to 2.90 sinus (95% CI: 2.87-2.93) and 1.16 nasal procedures (95% CI: 1.14-1.85) per surgery. Payments increased from $7,011.06 (α=$6,378.30; β=3.1490) in 2006 to $9,090.11 (α=$8,350.20; β=2.9535) in 2011, in line with US medical inflation. CONCLUSION In the study population, approximately 1 in 3.7 patients diagnosed with CRS underwent sinus surgery. This ratio remained constant from 2006 to 2011. There was no evidence that the number of distinct sinus surgeries per 100,000 people increased despite the introduction and utilization of balloon catheter dilation tools that enabled migration of sinus surgery to the office.
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Affiliation(s)
| | | | | | - Howard L Levine
- Medical Affairs, Acclarent Inc., a Johnson & Johnson Company, Menlo Park, CA, USA
- Cleveland Nasal-Sinus and Sleep Center, Cleveland, OH, USA
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Benninger MS, Holy CE. Endoscopic Sinus Surgery Provides Effective Relief as Observed by Health Care Use Pre- and Postoperatively. Otolaryngol Head Neck Surg 2014; 150:893-900. [DOI: 10.1177/0194599814522419] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze the impact of endoscopic sinus surgery (ESS) on overall health care utilization for the treatment of chronic rhinosinusitis (CRS). Study Design Retrospective administrative database analysis. Setting All US-based primary and secondary sites of care. Subjects and Methods A cohort of patients with ESS ( Current Procedural Terminology codes 31254-31288) in 2008 and at least 5 years of continuous medical and drug plan enrollment were included (n = 9105). Inpatient and outpatient medical history (including prescriptions) was analyzed from weeks −104 to +104 postoperatively. Results Health care utilization was constant up to −6 months preoperatively, at a per-patient per-week (PPPW) average of $11.75 (prescriptions, $2.44 [95% confidence interval (CI), $2.32-$2.56]; inpatient care, $ 0.82 [95% CI, $ 0.43-$1.20]; outpatient care, $8.49 [95% CI, $7.90-$9.08]). At −26 weeks preoperatively, a continuous increase from baseline levels was observed up to week −3, reaching an average PPPW of $95.37 (prescriptions, $13.74 [95% CI, $12.51-$14.96]; inpatient care, $2.73 [95% CI, $1.76-$3.70]; and outpatient care, $78.90 [95% CI, 73.65-$84.14]). From week −3 to surgery, outpatient events and prescriptions increased significantly, suggesting a decision to operate and costs associated with preoperative management. Postoperatively, costs declined rapidly, reaching baseline levels by 13 weeks postoperatively. Adverse events were reported in 388 patients (2.94% cases of hemorrhage, 0.14% cases of cerebrospinal fluid leak, 0.58% cases of orbital complications), and 572 (6.28%) patients had revision surgery. Conclusion Patients with CRS incur ongoing, baseline levels of health care utilization. Preoperatively, CRS-related health care needs are more than 8-fold greater than those at baseline. Following ESS, health care needs declined rapidly and reached baseline levels within 13 weeks postoperatively.
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Abstract
Background. Peptic ulcer disease (PUD) in children is reported worldwide, although it is relatively rare as compared with adults. Helicobacter pylori (HP) infection is a common cause of PUD in the pediatric age. Other risk factors include the use of nonsteroidal anti-inflammatory agents (NSAIDs), steroids, immunosuppressive drugs, and stressful events. Aim. To critically review the evidence on epidemiology, diagnostic management, and available treatments for PUD in the pediatric age. Methods. A MEDLINE search was performed indicating keywords as “Peptic Ulcer Disease,” “Epidemiology,” “Pediatric,” “Helicobacter pylori,” “Gastric ulcer,” “Bulbar Ulcer,” and “Upper Gastrointestinal Bleeding.” A selection of clinical trials, systematic reviews, and meta-analyses within the time period 2002–2012 was performed. Results. PUD in children is reported worldwide with an estimated frequency of 8.1% in Europe and of 17.4% in the US. When the underlying cause of PUD is addressed, the prognosis is excellent. Standard triple therapy, bismuth-based quadruple therapy, and the sequential therapy represent the current recommended treatments for HP related ulcers. NSAIDs related ulcers are treated by stopping the causative medications and by administration of proton-pump inhibitors or antisecretory drugs. Conclusions. PUD still represents a major concern in the paediatric age. A careful differential diagnosis and an adequate treatment constitute an excellent prognosis.
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Clinical applicability of the incidence of pediatric peptic ulcer bleeding in the United States. J Pediatr Gastroenterol Nutr 2012; 54:718. [PMID: 22367340 DOI: 10.1097/mpg.0b013e318250a74d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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