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Lee KY, Bremner R, Hartley J, Protheroe S, Haller W, Johnson T, Whyte L. Long term outcomes in children with trichohepatoenteric syndrome. Am J Med Genet A 2024; 194:141-149. [PMID: 37753667 DOI: 10.1002/ajmg.a.63409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
Trichohepatoenteric syndrome (THES) is a rare autosomal recessive disorder caused by mutations in either TTC37 or SKIV2L, usually leading to congenital diarrhea as part of a multisystem disease. Here, we report on the natural history of the disease for the largest UK cohort of patients with THES from 1996 to 2020. We systematically reviewed the clinical records and pathological specimens of patients diagnosed with THES managed in a single tertiary pediatric gastroenterology unit. Between 1996 and 2020, 13 patients (7 female and 6 male) were diagnosed with THES either by mutation analysis or by clinical phenotype. Two patients died from complications of infection. All patients received parenteral nutrition (PN) of which six patients were weaned off PN. All patients had gastrointestinal tract inflammation on endoscopy. Almost half of the cohort were diagnosed with monogenic inflammatory bowel disease (IBD) by the age of 11 years, confirmed by endoscopic and histological findings. Protracted diarrhea causing intestinal failure improves with time in all patients with THES, but monogenic IBD develops in later childhood that is refractory to conventional IBD treatments. Respiratory issues contribute to significant morbidity and mortality, and good respiratory care is crucial to prevent comorbidity.
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Affiliation(s)
- Kwang Yang Lee
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
- Department of Paediatric Gastroenterology and Nutrition, Bristol Royal Hospital for Children, Bristol, UK
| | - Ronald Bremner
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
| | - Jane Hartley
- Liver Unit, Birmingham Children's Hospital, Birmingham, UK
| | - Sue Protheroe
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
| | - Wolfram Haller
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tracey Johnson
- Department of Nutrition and Dietetics, Birmingham Children's Hospital, Birmingham, UK
| | - Lisa Whyte
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
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Protheroe S, Sugarman I. Neonatal intestinal failure - improved outcomes. Frontline Gastroenterol 2022; 14:4-5. [PMID: 36561783 PMCID: PMC9763648 DOI: 10.1136/flgastro-2022-102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sue Protheroe
- Department of Paediatric Gastroenterology & Nutrition, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ian Sugarman
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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3
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Thomson M. Pediatric endoscopy training across Europe: a survey of the ESPGHAN National Societies Network 2016-2019. Endosc Int Open 2022; 10:E1371-E1379. [PMID: 36262519 PMCID: PMC9576335 DOI: 10.1055/a-1898-1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background and study aims The ability to perform endoscopy procedures safely and effectively is a key aspect of quality clinical care in Pediatric Gastroenterology, Hepatology and Nutrition (PGHN). The aim of this survey, which was part of a global survey on PGHN training in Europe, was to assess endoscopy training opportunities provided across Europe. Methods Responses to standardized questions related to endoscopy training were collected from training centers across Europe through the presidents/representatives of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition National Societies from June 2016 to December 2019. Results A total of 100 training centers from 19 countries participated in the survey. In 57 centers, the endoscopy suit was attached to the PGHN center, while in 23, pediatric endoscopies were performed in adult endoscopy facilities. Ninety percent of centers reported the availability of specialized endoscopy nurses and 96 % of pediatric anesthetists. Pediatric endoscopies were performed by PGHN specialists in 55 centers, while 31 centers reported the involvement of an adult endoscopist and 14 of a pediatric surgeon. Dividing the number of procedures performed at the training center by the number of trainees, ≤ 20 upper, lower, or therapeutic endoscopies per trainee per year were reported by 0 %, 23 %, and 56 % of centers, respectively, whereas ≤ 5 wireless capsule endoscopies per trainee per year by 75 %. Only one country (United Kingdom) required separate certification of competency in endoscopy. Conclusions Differences and deficiencies in infrastructure, staffing, and procedural volume, as well as in endoscopy competency assessment and certification, were identified among European PGHN training centers limiting training opportunities in pediatric endoscopy.
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | | | - Alastair Baker
- Pediatric Liver Center, Kingʼs College Hospital, London, United Kingdom
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Childrenʼs Hospital Agia Sofia, Athens, Greece
| | - Sue Protheroe
- Birmingham Childrenʼs Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and Inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah University Hospitals, Jerusalem, Israel
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Childrenʼs Hospital, Rotterdam, The Netherlands
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition, University Childrenʼs Hospital, Basel, Switzerland
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maria Fotoulaki
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Childrenʼs Hospital, Ljubljana, Slovenia
| | - Vaidotas Urbonas
- Vilnius University Clinic of Childrenʼs Diseases, Vilnius, Lithuania
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Miglena Georgieva
- 2nd Department of Pediatrics, Saint Marina University hospital, Varna, Bulgaria
| | - Mike Thomson
- Sheffield Childrenʼs Hospital NHS Foundation Trust, Sheffield, United Kingdom
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Koletzko B. Training in Paediatric Clinical Nutrition Across Europe: A Survey of the National Societies Network (2016-2019) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2022; 74:662-667. [PMID: 35135959 DOI: 10.1097/mpg.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES/BACKGROUND Disease-related malnutrition is common in patients with chronic diseases and has detrimental effects, therefore, skills in nutrition care are essential core competencies for paediatric digestive medicine. The aim of this survey, conducted as part of a global survey of paediatric gastroenterology, hepatology and nutrition (PGHN) training in Europe, was to assess nutrition care-related infrastructure, staff, and patient volumes in European PGHN training centres. METHODS Standardized questionnaires related to clinical nutrition (CN) care were completed by representatives of European PGHN training centres between June 2016 and December 2019. RESULTS One hundred training centres from 17 European countries, Turkey, and Israel participated in the survey. Dedicated CN clinics exist in 66% of the centres, with fulltime and part-time CN specialists in 66% and 42%, respectively. Home tube feeding (HTF) andhome parenteral nutrition (HPN) programmes are in place in 95% and 77% of centres, respectively. Twenty-four percent of centres do not have a dedicated dietitian and 55% do not have a dedicated pharmacist attached to the training centre. Even the largest centres with >5000 outpatients reported that 25% and 50%, respectively do not have a dedicated dietitian or pharmacist. Low patient numbers on HTF and HPN of <5 annually are reported by 13% and 43% of centres, respectively. CONCLUSIONS The survey shows clear differences and deficits in Clinical Nutrition training infrastructure, including staff and patient volumes, in European PGHN training centres, leading to large differences and limitations in training opportunities in Clinical Nutrition.
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Affiliation(s)
- Alexandra Papadopoulou
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | | | - Alastair Baker
- The Paediatric Liver Centre, King's College Hospital, London
| | - Maria Noni
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Eleni Koutri
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Maria-Vasiliki Karagianni
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Sue Protheroe
- The Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Alfredo Guarino
- The Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Emmanuel Mas
- The Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Michael Wilschanski
- The Paediatric Gastroenterology Unit, Department of Paediatrics, Hadassah University Hospitals, Jerusalem, Israel
| | - Enriqueta Roman
- The Paediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Johanna Escher
- The Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Raoul I Furlano
- The Division of Paediatric Gastroenterology and Nutrition, University Children's Hospital, Basel, Switzerland
| | - Carsten Posovszky
- The Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Ilse Hoffman
- The Department of Paediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium
| | - Gabor Veres
- The Paediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary
| | - Jiri Bronsky
- The Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Duska Tjesic-Drinkovic
- The University Hospital Center Zagreb - Division for Paediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maria Fotoulaki
- The 4th Department of Paediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rok Orel
- The Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children's Hospital, Ljubljana, Slovenia
| | - Vaidotas Urbonas
- The Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania
| | - Aydan Kansu
- The Division of Paediatric Gastroenterology, Department of Paediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Miglena Georgieva
- The 2nd Department of Paediatrics, Saint Marina University hospital, Varna, Bulgaria
| | - Berthold Koletzko
- The LMU - Ludwig Maximilians Universität Munich, Department of Paediatrics, Dr. von Hauner Children's Hospital, LUM University Hospitals, Munich, Germany
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5
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Lezo A, Diamanti A, Marinier EM, Tabbers M, Guz-Mark A, Gandullia P, Spagnuolo MI, Protheroe S, Peretti N, Merras-Salmio L, Hulst JM, Kolaček S, Ee LC, Lawrence J, Hind J, D’Antiga L, Verlato G, Pukite I, Di Leo G, Vanuytsel T, Doitchinova-Simeonova MK, Ellegard L, Masconale L, Maíz-Jiménez M, Cooper SC, Brillanti G, Nardi E, Sasdelli AS, Lal S, Pironi L. Chronic Intestinal Failure in Children: An International Multicenter Cross-Sectional Survey. Nutrients 2022; 14:nu14091889. [PMID: 35565856 PMCID: PMC9103944 DOI: 10.3390/nu14091889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The European Society for Clinical Nutrition and Metabolism database for chronic intestinal failure (CIF) was analyzed to investigate factors associated with nutritional status and the intravenous supplementation (IVS) dependency in children. Methods: Data collected: demographics, CIF mechanism, home parenteral nutrition program, z-scores of weight-for-age (WFA), length or height-for-age (LFA/HFA), and body mass index-for-age (BMI-FA). IVS dependency was calculated as the ratio of daily total IVS energy over estimated resting energy expenditure (%IVSE/REE). Results: Five hundred and fifty-eight patients were included, 57.2% of whom were male. CIF mechanisms at age 1−4 and 14−18 years, respectively: SBS 63.3%, 37.9%; dysmotility or mucosal disease: 36.7%, 62.1%. One-third had WFA and/or LFA/HFA z-scores < −2. One-third had %IVSE/REE > 125%. Multivariate analysis showed that mechanism of CIF was associated with WFA and/or LFA/HFA z-scores (negatively with mucosal disease) and %IVSE/REE (higher for dysmotility and lower in SBS with colon in continuity), while z-scores were negatively associated with %IVSE/REE. Conclusions: The main mechanism of CIF at young age was short bowel syndrome (SBS), whereas most patients facing adulthood had intestinal dysmotility or mucosal disease. One-third were underweight or stunted and had high IVS dependency. Considering that IVS dependency was associated with both CIF mechanisms and nutritional status, IVS dependency is suggested as a potential marker for CIF severity in children.
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Affiliation(s)
- Antonella Lezo
- Department of Clinical Nutrition, OIRM-S, Anna Hospital, Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Evelyne M. Marinier
- Service des Maladies Digestives et Respiratoires de l’Enfant, Centre de Référence des Maladies Digestives Rares, Hôpital R Debré, 75019 Paris, France;
| | - Merit Tabbers
- Emma Children’s Hospital/Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | - Anat Guz-Mark
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy, IRCCS G, Gaslini Institute, 16147 Genoa, Italy;
| | - Maria I. Spagnuolo
- Section of Paediatrics, Department of Translational Medical Science, University of Naples Federico II, 80138 Naples, Italy;
| | - Sue Protheroe
- Department of Gastroenterology and Nutrition, Birmingham Children’s Hospital NHS Trust, Birmingham B4 6NH, UK;
| | - Noel Peretti
- Paediatric Hospital “Femme Mère Enfant de Lyon”, 69677 Lyon, France;
| | - Laura Merras-Salmio
- Pediatric Gastroenterology Unit, Helsinki University Hospital, Children’s Hospital Helsinki, 00290 Helsinki, Finland;
| | - Jessie M. Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Sanja Kolaček
- Children’s Hospital Zagreb, Zagreb Medical University, 10000 Zagreb, Croatia;
| | - Looi C. Ee
- Queensland Children’s Hospital, Brisbane, QLD 4101, Australia;
| | | | - Jonathan Hind
- Paediatric Liver, GI and Nutrition Centre, King’s College Hospital, London SE5 9RS, UK;
| | - Lorenzo D’Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, “Papa Giovanni XXIII” Hospital, 24127 Bergamo, Italy;
| | - Giovanna Verlato
- Paediatric Nutrition Service-Neonatal Intensive Care Unit, University Hospital of Padova, 35128 Padova, Italy;
| | - Ieva Pukite
- University Children Hospital, LV-1004 Riga, Latvia;
| | - Grazia Di Leo
- Pediatric Department, University of Trieste, IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Tim Vanuytsel
- University Hospital Leuven, Leuven Intestinal Failure and Transplantation (LIFT), 3000 Leuven, Belgium;
| | | | - Lars Ellegard
- Sahlgrenska University Hospital, Institute of Medicine, Departement of Internal Medicine and Clinical Nutrition, University of Gothenburg, 41390 Gothenburg, Sweden;
| | | | - María Maíz-Jiménez
- Department of Endocrinology and Nutrition, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Sheldon C. Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK;
| | - Giorgia Brillanti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Anna S. Sasdelli
- Clinical Nutrition and Metabolism Unit, Center for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bolohna, Italy;
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford M6 8HD, UK;
| | - Loris Pironi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
- Clinical Nutrition and Metabolism Unit, Center for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bolohna, Italy;
- Correspondence:
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Papadopoulou A, Ribes-Koninckx C, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Baker A, Kelly D. Training in pediatric hepatology across Europe: a survey of the National Societies Network (2016-2019) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Ann Gastroenterol 2022; 35:187-193. [PMID: 35479583 PMCID: PMC8922256 DOI: 10.20524/aog.2022.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background The widely recognized burden of liver diseases makes training in pediatric hepatology (PH) imperative. The aim of this survey, which was part of a global survey on training in pediatric gastroenterology, hepatology and nutrition (PGHN) across Europe, was to assess the PH and liver transplantation (LT) infrastructure, staff and training programs in PGHN training centers. Method Standardized questionnaires were collected from training centers via the presidents/representatives of the National Societies Network of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) from June 2016 to December 2019. Results A total of 100 PGHN training centers participated in the survey (14/100 were national referral centers in PH and/or LT). Dedicated PH clinics were available in 75%, but LT clinics in only 11%. Dedicated beds for PGHN inpatients were available in 47/95 (49%) centers. Full-time or part-time specialists for PH care were available in 31/45 (69%) and 11/36 (31%) centers, respectively. Liver biopsies (LB) were performed in 93% of centers by: a PGHN specialist (35%); an interventional radiologist (26%); a pediatric surgeon (4%); or a combination of them (35%). Dividing the annual number of LBs in the centers performing LBs by the number of trainees gave a median (range) of 10 (1-125) per trainee. Transient elastography was available in 60/92 (65%) of centers. Conclusions The survey highlighted the differences and shortcomings in PH training across Europe. ESPGHAN should take initiatives together with National Societies to ensure the acquisition of PH knowledge and skills according to the ESPGHAN curriculum. An infographic is available for this article at: http://www.annalsgastro.gr/files/journals/1/earlyview/2022/Infographic-Hepatology-training-paper.pdf
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
- Correspondence to: Alexandra Papadopoulou, Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece, e-mail:
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain (Carmen Ribes-Koninckx)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Sue Protheroe
- Birmingham Women’s & Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy (Alfredo Guarino)
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and Inborn Errors of Metabolism, Children’s Hospital, Toulouse University Hospital, Toulouse, France (Emmanuel Mas)
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah University Hospitals, Jerusalem, Israel (Michael Wilschanski)
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain (Enriqueta Roman)
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands (Johanna Escher)
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition, University Children’s Hospital, Basel, Switzerland (Raoul I. Furlano)
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany (Carsten Posovszky)
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium (Ilse Hoffman)
| | - Gabor Veres
- Pediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary (Gabor Veres)
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic (Jiri Bronsky)
| | - Almuthe Christine Hauer
- Department of Pediatrics, Medical University of Graz, Graz, Austria (Almuthe Christine Hauer)
| | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia (Duska Tjesic-Drinkovic)
| | - Maria Fotoulaki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece (Maria Fotoulaki)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children’s Hospital, Ljubljana, Slovenia (Rok Orel)
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children’s Diseases, Vilnius, Lithuania (Vaidotas Urbonas)
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey (Aydan Kansu)
| | - Miglena Georgieva
- 2 Department of Pediatrics, Saint Marina University hospital, Varna, Bulgaria (Miglena Georgieva)
| | - Alastair Baker
- Pediatric Liver Center, King’s College Hospital, London, United Kingdom (Alastair Baker)
| | - Deirdre Kelly
- Birmingham Women’s & Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Thomson M, Benninga M, Thapar N, Kelly D, Koletzko B. Association of training standards in pediatric gastroenterology, hepatology and nutrition in European training centers with formal national recognition of the subspecialty: a survey of the ESPGHAN National Societies Network 2016-2019. Ann Gastroenterol 2022; 35:317-324. [PMID: 35599923 PMCID: PMC9062838 DOI: 10.20524/aog.2022.0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background This survey evaluated the effects of the recognition of pediatric gastroenterology, hepatology and nutrition (PGHN) on European PGHN training centers. Method Standardized questionnaires were collected from training centers via the presidents/representatives of the National Societies Network of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, from June 2016 to December 2019. Results A total of 100 training centers from 19 countries participated in the survey: 55 from 12 countries where PGHN is formally recognized (Group 1) and 45 from 7 countries where it is not (Group 2). Training centers in Group 2 were less likely to have an integrated endoscopy suite, a written training curriculum and a training lead (P=0.059, P<0.001 and P=0.012, respectively). Trainees in Group 2 were less likely to be exposed to an adequate number of diagnostic endoscopies, while no differences were found in relation to liver biopsies. Half of the training centers in both Groups do not have dedicated beds for PGHN patients, while in 64% and 58%, respectively, trainees do not participate in on-call programs for PGHN emergencies. Research training is mandatory in 26% of the centers. The duration of training, as well as the assessment and accreditation policies, vary between countries. Conclusions This study has revealed significant discrepancies and gaps in infrastructure and training programs, training leadership, and assessment of training and certification across European training centers in PGHN. Strategies to support the recognition of PGHN and to standardize and improve training conditions should be developed and implemented. An infographic is available for this article at: http://www.annalsgastro.gr/files/journals/1/earlyview/2022/Infographic_AG-6496.pdf
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
- Correspondence to: Alexandra Papadopoulou, Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece, e-mail:
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain (Carmen Ribes-Koninckx)
| | - Alastair Baker
- Pediatric Liver Center, King’s College Hospital, London, United Kingdom (Alastair Baker)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children’s Hospital Agia Sofia, Athens, Greece (Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Sue Protheroe
- Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy (Alfredo Guarino)
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and Inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France (Emmanuel Mas)
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah University Hospitals, Jerusalem, Israel (Michael Wilschanski)
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain (Enriqueta Roman)
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands (Johanna Escher)
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition, University Children’s Hospital, Basel, Switzerland (Raoul I. Furlano)
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany (Carsten Posovszky)
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium (Ilse Hoffman)
| | - Gabor Veres
- Pediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary (Gabor Veres)
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic (Jiri Bronsky)
| | - Almuthe Christine Hauer
- Department of Pediatrics, Medical University of Graz, Graz, Austria (Almuthe Christine Hauer)
| | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia (Duska Tjesic-Drinkovic)
| | - Maria Fotoulaki
- 4 Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece (Maria Fotoulaki)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children’s Hospital, Ljubljana, Slovenia (Rok Orel)
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children’s Diseases, Vilnius, Lithuania (Vaidotas Urbonas)
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey (Aydan Kansu)
| | - Miglena Georgieva
- 2 Department of Pediatrics, Saint Marina University hospital, Varna, Bulgaria (Miglena Georgieva)
| | - Mike Thomson
- Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, United Kingdom (Mike Thomson)
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (Marc Benninga)
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, Brisbane, Australia (Nikhil Thapar)
| | - Deirdre Kelly
- Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Sue Protheroe, Deirdre Kelly)
| | - Berthold Koletzko
- LMU – Ludwig Maximilians Universität Munich, Dept. Pediatrics, Dr. von Hauner Children’s Hospital, LUM University Hospitals, Munich, Germany (Berthold Koletzko)
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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Benninga M, Thapar N. Training in pediatric neurogastroenterology and motility across Europe: a survey of the ESPGHAN National Societies Network 2016-2019. Ann Gastroenterol 2022; 35:325-332. [PMID: 35599925 PMCID: PMC9062837 DOI: 10.20524/aog.2022.0710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/09/2022] [Indexed: 11/11/2022] Open
Abstract
Background Method Results Conclusions
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Affiliation(s)
- Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
- Correspondence to: Alexandra Papadopoulou, Division of Gastroenterology
and Hepatology, First Department of Pediatrics, University of Athens, Agia Sofia
Children’s Hospital, Thivon and Papadiamantopoulou, 11527 Athens, Greece, e-mail:
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology Unit, La Fe University Hospital,
Valencia, Spain (Carmen Ribes-Koninckx)
| | - Alastair Baker
- Pediatric Liver Centre, King’s College Hospital, London,
United Kingdom (Alastair Baker)
| | - Maria Noni
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Eleni Koutri
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Maria-Vasiliki Karagianni
- Division of Gastroenterology and Hepatology, First Department
of Pediatrics, University of Athens, Agia Sofia Children’s Hospital, Athens, Greece
(Alexandra Papadopoulou, Maria Noni, Eleni Koutri, Maria-Vasiliki Karagianni)
| | - Sue Protheroe
- Birmingham Children’s Hospital, NHS Foundation Trust,
Birmingham, United Kingdom (Sue Protheroe)
| | - Alfredo Guarino
- Department of Translational Medical Science, Section of
Pediatrics, University of Naples Federico II, Naples, Italy (Alfredo Guarino)
| | - Emmanuel Mas
- Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and
Inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse,
France (Emmanuel Mas)
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Department of Pediatrics,
Hadassah University Hospitals, Jerusalem, Israel (Michael Wilschanski)
| | - Enriqueta Roman
- Pediatric Gastroenterology Unit, University Hospital Puerta de
Hierro-Majadahonda, Madrid, Spain (Enriqueta Roman)
| | - Johanna Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia
Children’s Hospital, Rotterdam, The Netherlands (Johanna Escher)
| | - Raoul I. Furlano
- Division of Pediatric Gastroenterology and Nutrition,
University Children’s Hospital, Basel, Switzerland (Raoul I. Furlano)
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University
Medical Center Ulm, Ulm, Germany (Carsten Posovszky)
| | - Ilse Hoffman
- Department of Pediatric Gastroenterology, Leuven University
Hospital, Leuven, Belgium (Ilse Hoffman)
| | - Gabor Veres
- Pediatric Institute-Clinic, University of Debrecen, Debrecen,
Hungary (Gabor Veres)
| | - Jiri Bronsky
- Department of Pediatrics, University Hospital Motol, Prague,
Czech Republic (Jiri Bronsky)
| | - Almuthe Christine Hauer
- Department of Pediatrics, Medical University of Graz, Graz,
Austria (Almuthe Christine Hauer)
| | - Duska Tjesic-Drinkovic
- University Hospital Center Zagreb – Division for
Pediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of
Medicine, Zagreb, Croatia (Duska Tjesic-Drinkovic)
| | - Maria Fotoulaki
- 4 Department of Pediatrics, Aristotle University
of Thessaloniki, Thessaloniki, Greece (Maria Fotoulaki)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition,
Ljubljana University Children’s Hospital, Ljubljana, Slovenia (Rok Orel)
| | - Vaidotas Urbonas
- Vilnius University Clinic of Children’s Diseases,
Vilnius, Lithuania (Vaidotas Urbonas)
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of
Pediatrics, Ankara University School of Medicine, Ankara, Turkey (Aydan Kansu)
| | - Miglena Georgieva
- 2 Department of Pediatrics, Saint Marina
University hospital, Varna, Bulgaria (Miglena Georgieva)
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma
Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands (Marc Benninga)
| | - Nikhil Thapar
- Gastroenterology Department, UCL Great Ormond Street Institute
of Child Health, London, United Kingdom (Nikhil Thapar)
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Barclay AR, McGuckin C, Hill S, Protheroe S, Batra A. Exit strategies from the COVID-19 lockdown for children and young people receiving home parenteral nutrition (HPN): lessons from the BSPGHAN Intestinal Failure Working Group experience. Frontline Gastroenterol 2020; 12:348-353. [PMID: 34249323 PMCID: PMC8231427 DOI: 10.1136/flgastro-2020-101598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/24/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | - Susan Hill
- Great Ormond Street Hospital for Children, London, UK
| | | | - Akshay Batra
- Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University Hospital Southampton NHS Trust, Southampton, UK
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Lee KY, Johnson T, Protheroe S, Whyte L. P2.35: Outcomes of children with phenotypic diarrhoea. Transplantation 2019. [DOI: 10.1097/01.tp.0000576012.19212.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paisal V, Al-Abadi E, Protheroe S, Southwood T, Carruthers D, Situnayake D, Powell S, Mitton D. 061. Childhood Onset of Behçet's Disease Symptoms in an Adult Cohort of BD patients. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kyrana E, Beath S, Gabe S, Small M, Hill S, Basude D, Cosgrove M, Cunningham S, Davies I, Fagbemi A, Flynn D, Holden C, Koglmeier J, Naik S, MacDonald S, Puntis J, Protheroe S. Current practices and experience of transition of young people on long term home parenteral nutrition (PN) to adult services – A perspective from specialist centres. Clin Nutr ESPEN 2016; 14:9-13. [DOI: 10.1016/j.clnesp.2016.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
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Hartley JL, Zachos NC, Dawood B, Donowitz M, Forman J, Pollitt RJ, Morgan NV, Tee L, Gissen P, Kahr WHA, Knisely AS, Watson S, Chitayat D, Booth IW, Protheroe S, Murphy S, de Vries E, Kelly DA, Maher ER. Mutations in TTC37 cause trichohepatoenteric syndrome (phenotypic diarrhea of infancy). Gastroenterology 2010; 138:2388-98, 2398.e1-2. [PMID: 20176027 PMCID: PMC3166659 DOI: 10.1053/j.gastro.2010.02.010] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/31/2010] [Accepted: 02/09/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND & AIMS Trichohepatoenteric syndrome (THES) is an autosomal-recessive disorder characterized by life-threatening diarrhea in infancy, immunodeficiency, liver disease, trichorrhexis nodosa, facial dysmorphism, hypopigmentation, and cardiac defects. We attempted to characterize the phenotype and elucidate the molecular basis of THES. METHODS Twelve patients with classic THES from 11 families had detailed phenotyping. Autozygosity mapping was undertaken in 8 patients from consanguineous families using 250,000 single nucleotide polymorphism arrays and linked regions evaluated using microsatellite markers. Linkage was confirmed to one region from which candidate genes were analyzed. The effect of mutations on protein production and/or localization in hepatocytes and intestinal epithelial cells from affected patients was characterized by immunohistochemistry. RESULTS Previously unrecognized platelet abnormalities (reduced platelet alpha-granules, unusual stimulated alpha granule content release, abnormal lipid inclusions, abnormal platelet canalicular system, and reduced number of microtubules) were identified. The THES locus was mapped to 5q14.3-5q21.2. Sequencing of candidate genes showed mutations in TTC37, which encodes the uncharacterized tetratricopeptide repeat protein, thespin. Bioinformatic analysis suggested thespin to be involved in protein-protein interactions or chaperone. Preliminary studies of enterocyte brush-border ion transporter proteins (sodium hydrogen exchanger 2, sodium hydrogen exchanger 3, aquaporin 7, sodium iodide symporter, and hydrogen potassium adenosine triphosphatase [ATPase]) showed reduced expression or mislocalization in all THES patients with different profiles for each. In contrast the basolateral localization of Na/K ATPase was not altered. CONCLUSIONS THES is caused by mutations in TTC37. TTC37 mutations have a multisystem effect, which may be owing to abnormal stability and/or intracellular localization of TTC37 target proteins.
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Affiliation(s)
- Jane Louise Hartley
- Department of Medical and Molecular Genetics, School of Clinical and Experimental Medicine, University of Birmingham College of Medical and Dental School, Institute of Biomedical Research, Edgbaston, Birmingham, UK.
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Affiliation(s)
- D Devadason
- Department of Paediatric Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
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18
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Gupte GL, Beath SV, Protheroe S, Murphy MS, Davies P, Sharif K, McKiernan PJ, de Ville de Goyet J, Booth IW, Kelly DA. Improved outcome of referrals for intestinal transplantation in the UK. Arch Dis Child 2007; 92:147-52. [PMID: 16705017 PMCID: PMC2083317 DOI: 10.1136/adc.2005.090068] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To describe the outcome of children with intestinal failure referred to Birmingham Children's Hospital (BCH) for consideration of intestinal transplantation (ITx), to determine factors for an adverse outcome and to analyse the impact of post-1998 strategies on survival. SUBJECTS AND METHODS A retrospective analysis was performed of children referred for ITx assessment from January 1989 to December 2003. Children were assessed by a multidisciplinary team and categorised into: (a) stable on parenteral nutrition; (b) unsuitable for transplantation (Tx); and (c) recommended for Tx. To analyse the impact of the post-1998 strategies on survival, a comparison was made between the two eras (pre-1998 and post-1998). RESULTS 152 children with chronic intestinal failure were identified (63M:89F, median age 10 months (range 1-170)). After assessment, 69 children were considered stable on parenteral nutrition (5-year survival 95%); 28 children were unsuitable for Tx (5-year survival 4%); and 55 children were recommended for Tx (5-year survival 35%, which includes 14 children who died waiting for size-matched organs). Twenty three ITx and nine isolated liver transplants (iLTx) were performed. In a multivariate analysis, the following factors in combination had an adverse effect on survival: the presence of a primary mucosal disorder (p = 0.007, OR ratio 3.16, 95% CI 1.37 to 7.31); absence of involvement of a nutritional care team at the referring hospital (p = 0.001, OR ratio 2.55, 95% CI 1.44 to 4.52); and a serum bilirubin>100 micromol/l (p = 0.001, OR ratio 3.70, 95% CI 1.84 to 7.47). Earlier referral (median serum bilirubin 78 micromol/l in the post-1998 era compared with 237 micromol/l in the pre-1998 era, p = 0.001) may be a contributory factor to improved survival. The strategies of combined en bloc reduced liver/small bowel transplantation and iLTx resulted in fewer deaths on the waiting list in the post-1998 era (2 deaths in post-1998 era v 12 deaths in pre-1998 era). The overall 3-year survival in the post-1998 era (69%) has improved compared with the pre-1998 era (31%; p<0.001) CONCLUSION: The changing characteristics at the time of referral, including earlier referral and innovative surgical strategies have resulted in improved long-term survival of children referred for ITx.
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Affiliation(s)
- Girish L Gupte
- Liver Unit, Birmingham Children's Hospital, Birmingham, UK.
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19
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Rodrigues AF, van Mourik IDM, Sharif K, Barron DJ, de Giovanni JV, Bennett J, Bromley P, Protheroe S, John P, de Ville de Goyet J, Beath SV. Management of end-stage central venous access in children referred for possible small bowel transplantation. J Pediatr Gastroenterol Nutr 2006; 42:427-33. [PMID: 16641582 DOI: 10.1097/01.mpg.0000215311.71040.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED The 3-year survival after small bowel transplantation (SBTx) has improved to between 73% and 88%. Impaired venous access for parenteral nutrition can be an indication for SBTx in children with chronic intestinal failure. AIM To report our experience in management of children with extreme end-stage venous access. SUBJECTS The study consisted of 6 children (all boys), median age of assessment 27 months (range, 13-52 months), diagnosed with total intestinal aganglionosis (1), protracted diarrhea (1), and short bowel syndrome (4), of which gastroschisis (2) and malrotation with midgut volvulus (2) were the causes. All had a documented history of more than 10 central venous catheter insertions previously. All had venograms, and 1 child additionally had a magnetic resonance angiogram to evaluate venous access. Five of 6 presented with thrombosis of the superior vena cava (SVC) and/or inferior vena cava. METHODS Venous access was reestablished as follows: transhepatic venous catheters (5), direct intra-atrial catheter via midline sternotomy (4), azygous venous catheters (2), dilatation of left subclavian vein after passage of a guide wire and then placing a catheter to reach the right atrium (1), radiological recanalization of the SVC and placement of a central venous catheter in situ (1), and direct puncture of SVC stump(1). Complications included serous pleural effusion after direct intra-atrial line insertion, which resolved after chest drain insertion (1), displacement of transhepatic catheter needing repositioning (2), and SVC stent narrowing requiring repeated balloon dilatation. OUTCOME Four children with permanent intestinal failure on assessment were offered SBTx, 3 of which were transplanted and were established on full enteral nutrition; the family of 1 child declined the procedure. In the remaining 2 children in whom bowel adaptation was still a possibility, attempts were made to provide adequate central venous access as feeds and drug manipulations were undertaken. One of them received liver and SBTx nearly 3 years after presenting with end-stage central venous access, because attempts to achieve independence from parenteral nutrition had failed. The other child died immediately after a transhepatic venous catheter placement, possibly from a nutritional depletion syndrome as no physical cause of death was found. Direct intra-atrial catheters in transplanted children proved to be adequate for the management of uncomplicated transplantation, although the usual infusion protocol had to be modified considerably, and the lack of access would have been critical if massive blood transfusion had been required during the transplant procedure. CONCLUSION It was possible to reestablish central venous access in all cases. However, this was time consuming and difficult to assemble a skilled team consisting of one of more: surgeon, cardiologist, interventional radiologist, and transplant anesthetist. Small bowel transplantation is easier and safer with adequate central venous access, and we advocate liaison with an SBTx center at an early stage.
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Sharif K, de Ville de Goyet J, Beath SV, Protheroe S, John P. Transhepatic hickman line placement: improving line stability by surgically assisted radiologic placement. J Pediatr Gastroenterol Nutr 2002; 34:561-3. [PMID: 12050586 DOI: 10.1097/00005176-200205000-00017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Sharif
- Pediatric Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
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