Search

Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting. Resumen: La pancreatitis aguda (PA) y la pancreatitis aguda recurrente (PAR) son enfermedades cuya incidencia aparentemente va en incremento. A pesar de la creciente evidencia sobre el manejo de la PA en adultos y niños, aún se siguen teniendo conductas que potencialmente podrían impactar en un pronóstico no tan adecuado de estos pacientes, sobre todo en población pediátrica. Es por esto que la Asociación Mexicana de Gastroenterología convocó a un grupo de 24 gastroenterólogos pediatras expertos, de diferentes instituciones y de diferentes zonas geográficas de México, 2 nutriólogas pediatras, así como 2 especialistas en cirugía pediátrica para discutir sobre diferentes aspectos de la epidemiología, diagnóstico y tratamiento de la PA y PAR en población pediátrica. El objetivo de este documento es presentar los resultados obtenidos de este consenso. Se organizaron 6 mesas de trabajo con diferentes tópicos sobre la PA. Cada mesa de trabajo revisó la información y generó los enunciados/declaraciones que consideraron pertinentes para cada módulo, en tópicos que representaran recomendaciones o puntos de debate sobre cuestiones de abordaje diagnóstico o terapéutico. Se presentaron y discutieron todas las declaraciones. Posteriormente, se sometieron a evaluación mediante un proceso Delphi, de voto anónimo, vía electrónica, para conocer el nivel de acuerdo en los enunciados/declaraciones. Se elaboraron un total de 29 enunciados/declaraciones. Todas las declaraciones tuvieron un porcentaje de consenso mayor del 75% en la primera ronda de votación.

Resumen: La pancreatitis aguda (PA) y la pancreatitis aguda recurrente (PAR) son enfermedades cuya incidencia aparentemente va en incremento. A pesar de la creciente evidencia sobre el manejo de la PA en adultos y niños, aún se siguen teniendo conductas que potencialmente podrían impactar en un pronóstico no tan adecuado de estos pacientes, sobre todo en población pediátrica. Es por esto que la Asociación Mexicana de Gastroenterología convocó a un grupo de 24 gastroenterólogos pediatras expertos, de diferentes instituciones y de diferentes zonas geográficas de México, 2 nutriólogas pediatras, así como 2 especialistas en cirugía pediátrica para discutir sobre diferentes aspectos de la epidemiología, diagnóstico y tratamiento de la PA y PAR en población pediátrica. El objetivo de este documento es presentar los resultados obtenidos de este consenso. Se organizaron 6 mesas de trabajo con diferentes tópicos sobre la PA. Cada mesa de trabajo revisó la información y generó los enunciados/declaraciones que consideraron pertinentes para cada módulo, en tópicos que representaran recomendaciones o puntos de debate sobre cuestiones de abordaje diagnóstico o terapéutico. Se presentaron y discutieron todas las declaraciones. Posteriormente, se sometieron a evaluación mediante un proceso Delphi, de voto anónimo, vía electrónica, para conocer el nivel de acuerdo en los enunciados/declaraciones. Se elaboraron un total de 29 enunciados/declaraciones. Todas las declaraciones tuvieron un porcentaje de consenso mayor del 75% en la primera ronda de votación. Abstract: Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.

Introduction and aims: There are few studies that compare polyethylene glycol (PEG) 3350 and magnesium hydroxide (MH), as long-term treatment of functional constipation (FC) in children, and they do not include infants as young as 6 months of age. Our aim was to determine the efficacy, safety, and acceptability of PEG vs MH in FC, in the long term, in pediatric patients. Methods: An open-label, parallel, controlled clinical trial was conducted on patients from 6 months to 18 years of age, diagnosed with FC, that were randomly assigned to receive PEG 3350 or MH for 12 months. Success was defined as: ≥ 3 bowel movements/week, with no fecal incontinence, fecal impaction, abdominal pain, or the need for another laxative. We compared adverse events and acceptability, measured as rejected doses of the laxative during the study, in each group and subgroup. Results: Eighty-three patients with FC were included. There were no differences in success between groups (40/41 PEG vs 40/42 MH, p = 0.616). There were no differences in acceptability between groups, but a statistically significant higher number of patients rejected MH in the subgroups > 4 to 12 years and > 12 to 18 years of age (P = .037 and P = .020, respectively). There were no differences regarding adverse events between the two groups and no severe clinical or biochemical adverse events were registered. Conclusions: The two laxatives were equally effective and safe for treating FC in children from 0.5 to 18 years of age. Acceptance was better for PEG 3350 than for MH in patients above 4 years of age. MH can be considered first-line treatment for FC in children under 4 years of age. Resumen: Introducción y objetivo: Existen pocos estudios comparativos entre polietilenglicol (PEG) 3350 e hidróxido de magnesio (HM) para tratar el estreñimiento funcional (EF) a largo plazo en niños, y no incluyen lactantes desde 6 meses. El objetivo fue determinar la eficacia, la seguridad y la aceptabilidad de PEG vs HM en el EF a largo plazo en pacientes pediátricos. Métodos: Ensayo clínico controlado, paralelo, abierto, en pacientes de 6 meses a 18 años con diagnóstico de EF asignados aleatoriamente a PEG 3350 o HM durante 12 meses. Se definió éxito: ≥ 3 evacuaciones/semana, sin incontinencia fecal, impactación fecal, dolor abdominal o necesidad de otro laxante. Se compararon eventos adversos, así como la aceptabilidad, medida como dosis rechazadas del laxante durante el estudio en cada grupo y subgrupo. Resultados: Se incluyeron 83 pacientes con EF, sin que presentaran diferencias en éxito entre ambos grupos (40/41 PEG vs 40/42 HM, p = 0.616). No hubo diferencias en aceptabilidad entre ambos grupos, pero un número significativamente mayor de pacientes rechazó la leche de magnesia en los subgrupos de > 4 a 12 años y de > 12 a 18 años (p = 0.037 y p = 0.020, respectivamente). No hubo diferencias de eventos adversos entre ambos grupos y no se registraron eventos adversos clínicos ni bioquímicos graves. Conclusiones: Ambos laxantes fueron igualmente efectivos y seguros para tratar el EF en niños de 0.5 a 18 años. El PEG 3350 fue mejor aceptado que el HM por los pacientes mayores de 4 años. El HM puede ser considerado como tratamiento de primera línea para EF en niños menores de 4 años.

Resumen: Introducción y objetivo: Existen pocos estudios comparativos entre polietilenglicol (PEG) 3350 e hidróxido de magnesio (HM) para tratar el estreñimiento funcional (EF) a largo plazo en niños, y no incluyen lactantes desde 6 meses. El objetivo fue determinar la eficacia, la seguridad y la aceptabilidad de PEG vs HM en el EF a largo plazo en pacientes pediátricos. Métodos: Ensayo clínico controlado, paralelo, abierto, en pacientes de 6 meses a 18 años con diagnóstico de EF asignados aleatoriamente a PEG 3350 o HM durante 12 meses. Se definió éxito: ≥ 3 evacuaciones/semana, sin incontinencia fecal, impactación fecal, dolor abdominal o necesidad de otro laxante. Se compararon eventos adversos, así como la aceptabilidad, medida como dosis rechazadas del laxante durante el estudio en cada grupo y subgrupo. Resultados: Se incluyeron 83 pacientes con EF, sin que presentaran diferencias en éxito entre ambos grupos (40/41 PEG vs 40/42 HM, p = 0.616). No hubo diferencias en aceptabilidad entre ambos grupos, pero un número significativamente mayor de pacientes rechazó la leche de magnesia en los subgrupos de > 4 a 12 años y de > 12 a 18 años (p = 0.037 y p = 0.020, respectivamente). No hubo diferencias de eventos adversos entre ambos grupos y no se registraron eventos adversos clínicos ni bioquímicos graves. Conclusiones: Ambos laxantes fueron igualmente efectivos y seguros para tratar el EF en niños de 0.5 a 18 años. El PEG 3350 fue mejor aceptado que el HM por los pacientes mayores de 4 años. El HM puede ser considerado como tratamiento de primera línea para EF en niños menores de 4 años. Abstract: Introduction and aims: There are few studies that compare polyethylene glycol (PEG) 3350 and magnesium hydroxide (MH), as long-term treatment of functional constipation (FC) in children, and they do not include infants as young as 6 months of age. Our aim was to determine the efficacy, safety, and acceptability of PEG vs MH in FC, in the long term, in pediatric patients. Methods: An open-label, parallel, controlled clinical trial was conducted on patients from 6 months to 18 years of age, diagnosed with FC, that were randomly assigned to receive PEG 3350 or MH for 12 months. Success was defined as: ≥ 3 bowel movements/week, with no fecal incontinence, fecal impaction, abdominal pain, or the need for another laxative. We compared adverse events and acceptability, measured as rejected doses of the laxative during the study, in each group and subgroup. Results: Eighty-three patients with FC were included. There were no differences in success between groups (40/41 PEG vs 40/42 MH, p = 0.616). There were no differences in acceptability between groups, but a statistically significant higher number of patients rejected MH in the subgroups > 4 to 12 years and > 12 to 18 years of age (P = .037 and P = .020, respectively). There were no differences regarding adverse events between the two groups and no severe clinical or biochemical adverse events were registered. Conclusions: The two laxatives were equally effective and safe for treating FC in children from 0.5 to 18 years of age. Acceptance was better for PEG 3350 than for MH in patients above 4 years of age. MH can be considered first-line treatment for FC in children under 4 years of age.

Introduction and aim: Acute pancreatitis (AP) is the most common cause of pancreatic disease in children. Previous studies have described factors related to days of hospital length of stay (LOS) in children. Our aim was to identify factors associated with LOS in AP. Materials and methods: A retrospective study was conducted at the Hospital Infantil de México Federico Gómez in Mexico City, encompassing the time frame of January 1, 2017 and March 31, 2019. AP was confirmed by medical chart review, according to the INSPPIRE criteria at the time of hospital admission, in patients below 18 years of age. AP grade was classified, following the NASPGHAN guidelines. Demographic, clinical, biochemical, nutritional, and treatment data were collected. Prolonged hospital LOS was considered that which lasted 7 days or longer. Results: Fifty-one events (32 patients) were registered. Median LOS was 8 days (IQR 4–14 days). Antibiotic use was significantly associated with longer LOS (OR 31.71; 95% CI: 2.71–370.65; p = 0.006) and early feeding (EF) (within 72 h of admission) was associated with shorter LOS (OR 0.05; 95% CI: 0.001–0.63; p = 0.02). There was no association between LOS and the variables of age, recurrence, grade, etiology, comorbidities, complications, fluid resuscitation, parenteral nutrition, or biochemical characteristics upon admission. Conclusion: Our study, like others, corroborated the fact that EF in the management of AP was associated with fewer days of hospital LOS. Resumen: Introducción y objetivo: La pancreatitis aguda (PA) es la causa más común de enfermedad pancreática en niños. Estudios previos exponen factores relacionados con los días de estancia hospitalaria (EH) en niños. Nuestro objetivo fue identificar factores asociados con EH en PA. Material y métodos: Se realizó un estudio retrospectivo en el Hospital Infantil de México Federico Gómez de la Ciudad de México, del 1 de enero de 2017 al 31 de marzo de 2019. Se confirmó PA por revisión del expediente clínico, de acuerdo con los criterios INSPPIRE en pacientes menores de 18 años de edad al tiempo de su admisión. El grado de PA se clasificó de acuerdo con los lineamientos de la NASPGHAN. Se recabó información demográfica, clínica, bioquímica, nutricional y de tratamiento. Se consideró estancia hospitalaria prolongada (EHP) aquella mayor o igual a 7 días. Resultados: Se registraron 51 eventos (32 pacientes). La mediana de EH fue de 8 días (RIQ 4–14 días). El uso de antibióticos estuvo asociado significativamente con una mayor EH (RM 31.71; IC 95%: 2.71–370.65; p = 0.006) y la alimentación temprana (AT) (dentro de 72 horas del ingreso) se asoció con una disminución de EH (RM 0.05; IC 95%: 0.001-0.63; p = 0.02). No se encontró asociación entre edad, recurrencia, grado, etiología, comorbilidades, complicaciones, reanimación hídrica, uso de nutrición parenteral y características bioquímicas al ingreso y EH. Conclusión: En nuestro estudio, como en algunos otros, se corrobora que, en el manejo de la PA, la AT está asociada con una disminución de los días de EH.

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society’s member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon. Resumen: La alimentación complementaria (AC) se define como la alimentación de los lactantes que complementa a la lactancia humana o en su defecto, a la lactancia con un sucedáneo de la leche humana, y es un proceso que va más allá de simplemente una guía sobre qué y cómo introducir los alimentos. La información brindada por parte de los profesionales de la salud debe ser actualizada y basada en evidencia. Existen diferentes guías o documentos de posición a nivel internacional, que, aunque la mayoría de las recomendaciones pueden ser aplicables, hay algunas otras que requieren una regionalización o adecuación a las condiciones y realidad de cada zona. El grupo de trabajo de Nutrición de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica convocó a un grupo de expertos, representantes de cada uno de los países que conforman la sociedad, con el objetivo de desarrollar un consenso sobre AC, que incorporó cuando así fue posible, información local que se adapte a la realidad de la región. El objetivo de este documento es mostrar los resultados de dicho trabajo. A través de metodología Delphi, se evaluaron, discutieron y votaron un total de 34 declaraciones o enunciados con respecto a aspectos relevantes de la AC.

Resumen: Introducción y objetivo: La pancreatitis aguda (PA) es la causa más común de enfermedad pancreática en niños. Estudios previos exponen factores relacionados con los días de estancia hospitalaria (EH) en niños. Nuestro objetivo fue identificar factores asociados con EH en PA. Material y métodos: Se realizó un estudio retrospectivo en el Hospital Infantil de México Federico Gómez de la Ciudad de México, del 1 de enero de 2017 al 31 de marzo de 2019. Se confirmó PA por revisión del expediente clínico, de acuerdo con los criterios INSPPIRE en pacientes menores de 18 años de edad al tiempo de su admisión. El grado de PA se clasificó de acuerdo con los lineamientos de la NASPGHAN. Se recabó información demográfica, clínica, bioquímica, nutricional y de tratamiento. Se consideró estancia hospitalaria prolongada (EHP) aquella mayor o igual a 7 días. Resultados: Se registraron 51 eventos (32 pacientes). La mediana de EH fue de 8 días (RIQ 4-14 días). El uso de antibióticos estuvo asociado significativamente con una mayor EH (RM 31.71; IC 95%: 2.71-370.65; p = 0.006) y la alimentación temprana (AT) (dentro de 72 horas del ingreso) se asoció con una disminución de EH (RM 0.05; IC 95%: 0.001-0.63; p = 0.02). No se encontró asociación entre edad, recurrencia, grado, etiología, comorbilidades, complicaciones, reanimación hídrica, uso de nutrición parenteral y características bioquímicas al ingreso y EH. Conclusión: En nuestro estudio, como en algunos otros, se corrobora que, en el manejo de la PA, la AT está asociada con una disminución de los días de EH. Abstract: Introduction and aim: Acute pancreatitis (AP) is the most common cause of pancreatic disease in children. Previous studies have described factors related to days of hospital length of stay (LOS) in children. Our aim was to identify factors associated with LOS in AP. Materials and methods: A retrospective study was conducted at the Hospital Infantil de México Federico Gómez in Mexico City, encompassing the time frame of January 1, 2017 and March 31, 2019. AP was confirmed by medical chart review, according to the INSPPIRE criteria at the time of hospital admission, in patients below 18 years of age. AP grade was classified, following the NASPGHAN guidelines. Demographic, clinical, biochemical, nutritional, and treatment data were collected. Prolonged hospital LOS was considered that which lasted 7 days or longer. Results: Fifty-one events (32 patients) were registered. Median LOS was 8 days (IQR 4-14 days). Antibiotic use was significantly associated with longer LOS (OR 31.71; 95% CI: 2.71-370.65; P = .006) and early feeding (EF) (within 72 h of admission) was associated with shorter LOS (OR 0.05; 95% CI: 0.001-0.63; P = .02). There was no association between LOS and the variables of age, recurrence, grade, etiology, comorbidities, complications, fluid resuscitation, parenteral nutrition, or biochemical characteristics upon admission. Conclusion: Our study, like others, corroborated the fact that EF in the management of AP was associated with fewer days of hospital LOS.

Resumen: La alimentación complementaria (AC) se define como la alimentación de los lactantes que complementa a la lactancia materna o en su defecto, a la lactancia con un sucedáneo de la leche materna, y es un proceso que va más allá de simplemente una guía sobre qué y cómo introducir los alimentos. La información brindada por parte de los profesionales de la salud debe ser actualizada y basada en evidencia. Existen diferentes guías o documentos de posición a nivel internacional, que, aunque la mayoría de las recomendaciones pueden ser aplicables, hay algunas otras que requieren una regionalización o adecuación a las condiciones y realidad de cada zona. El grupo de trabajo de Nutrición de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica convocó a un grupo de expertos, representantes de cada uno de los países que conforman la sociedad, con el objetivo de desarrollar un consenso sobre la AC, que incorporó cuando así fue posible, información local que se adapte a la realidad de la región. El objetivo de este documento es mostrar los resultados de dicho trabajo. A través de metodología Delphi, se evaluaron, discutieron y votaron un total de 34 declaraciones o enunciados con respecto a aspectos relevantes de la AC. Abstract: Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Introduction: Health-disease processes are established and programmed in the first 1500 days of life, a period in which nutrition and the microbiota play a fundamental role. Feeding practices vary, according to regional sociocultural characteristics. The Early Nutrition Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) established the goal of identifying the main feeding practices in the first 1500 days that were recommended by health professionals in Latin America. Materials and methods: A survey was conducted on the aspects of maternal-infant and young child nutrition during the first 1500 days of life. An open invitation was extended to Latin American healthcare professionals to anonymously answer the online survey. Results: A total of 1284 surveys from participants in 18 Latin American countries were analyzed. The mean age of the participants was 37.14 ± 11.1 years, 75.7% were women, 64.7% were physicians, and the rest were nutritionists/nutriologists. A total of 71.4% were familiar with the concept of the first 1000 days of life, 95% answered that exclusive breastfeeding should be carried out up to 6 months of age, and 34.3% responded that complementary feeding should be begun between 4 and 6 months of age. There was scant knowledge regarding nutrition in the pregnant woman. Adherence to traditional complementary feeding practices was evident. Conclusions: In a group of Latin American healthcare professionals, knowledge about nutrition in the first 1000–1500 days of life of an individual is still incomplete and insufficient, showing the need for continued training of healthcare professionals, with respect to those themes. Resumen: Introducción: En los primeros 1500 días de vida se establecen y programan procesos de salud-enfermedad y donde la nutrición y la microbiota tienen un papel fundamental. Las prácticas de alimentación varían acorde a características socioculturales regionales. El Comité de Nutrición Temprana de la SLAGHNP/LASPGHAN estableció el objetivo de identificar las principales prácticas de alimentación en los primeros 1500 días recomendadas por profesionales de la salud en Latinoamérica. Materiales y Métodos: Se trató de una encuesta de aspectos de nutrición materno-infantil durante los primeros 1500 días de vida. Se invitó de forma abierta a profesionales de la salud de Latinoamérica para que la contestaran de forma electrónica y completamente anónima. Resultados: 1284 encuestas de 18 países de la región fueron analizadas. La edad promedio de los participantes 37.14±11.1, 75.7% fueron mujeres. El 64.7% de los encuestados fueron médicos y el resto nutriólogo/nutricionista. El 71.4% conoce el concepto de los primeros 1000 días de vida. El 95% identificó que la lactancia materna exclusiva es hasta los 6 meses de edad. El 34.3% respondió que el inicio de la alimentación complementaria puede realizarse entre los 4 y 6 meses de edad. Hay poco conocimiento sobre la nutrición de la mujer gestante. Aun es patente el apego a las viejas prácticas de alimentación complementaria. Conclusiones: Los conocimientos sobre nutrición en los primeros 1000-1500 días de vida de un individuo en un grupo de profesionales de salud de Latinoamérica aún son incompletos e insuficientes. Se requiere seguir capacitando al profesional de salud en estos temas.

The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications. Resumen: La Asociación Mexicana de Hepatología A.C. llevo a cabo el Consenso del manejo de las complicaciones de la cirrosis hepática en población pediátrica con el fin de proveer a los médicos de información útil para su tratamiento. Participaron un grupo de gastroenterólogos pediatras y expertos en nutrición, nefrología y enfermedades infecciosas, quienes revisaron la literatura médica. El método Delphi fue aplicado para obtener el nivel de acuerdo de los enunciados emitidos; estos fueron enviados a los participantes para ser analizados, votados y en sesiones virtuales fueron discutidos, obteniendo así, las declaraciones finales. Los resultados del consenso fueron emitir las indicaciones para el manejo de un niño con cirrosis hepática, con el fin de prevenir o controlar las complicaciones.

Resumen: Introducción: En los primeros 1500 días de vida se establecen y programan procesos de salud-enfermedad donde la nutrición y la microbiota tienen un papel fundamental. Las prácticas de alimentación varían acorde a características socioculturales regionales. El Comité de Nutrición Temprana de la SLAGHNP/LASPGHAN estableció el objetivo de identificar las principales prácticas de alimentación en los primeros 1500 días recomendadas por profesionales de la salud en Latinoamérica. Materiales y métodos: Se trató de una encuesta de aspectos de nutrición materno-infantil durante los primeros 1500 días de vida. Se invitó de forma abierta a profesionales de la salud de Latinoamérica para que la contestaran de forma electrónica y completamente anónima. Resultados: 1284 encuestas de 18 países de la región fueron analizadas. La edad promedio de los participantes 37.14+11.1, 75.7% fueron mujeres. El 64.7% de los encuestados fueron médicos y el resto nutriólogo/nutricionista. El 71.4% conoce el concepto de los primeros 1000 días de vida. El 95% identificó que la lactancia materna exclusiva es hasta los 6 meses de edad. El 34.3% respondió que el inicio de la alimentación complementaria puede realizarse entre los 4 y 6 meses de edad. Hay poco conocimiento sobre la nutrición de la mujer gestante. Aún es patente el apego a las viejas prácticas de alimentación complementaria. Conclusiones: Los conocimientos sobre nutrición en los primeros 1000-1500 días de vida de un individuo en un grupo de profesionales de salud de Latinoamérica aún son incompletos e insuficientes. Se requiere seguir capacitando al profesional de salud en estos temas. Abstract: Introduction: Health-disease processes are established and programmed in the first 1,500 days of life, a period in which nutrition and the microbiota play a fundamental role. Feeding practices vary, according to regional sociocultural characteristics. The Early Nutrition Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) established the goal of identifying the main feeding practices in the first 1,500 days that were recommended by health professionals in Latin America. Materials and methods: A survey was conducted on the aspects of maternal-infant and young child nutrition during the first 1,500 days of life. An open invitation was extended to Latin American healthcare professionals to anonymously answer the online survey. Results: A total of 1,284 surveys from participants in 18 Latin American countries were analyzed. The mean age of the participants was 37.14 ± 11.1 years, 75.7% were women, 64.7% were physicians, and the rest were nutritionists/nutriologists. A total of 71.4% were familiar with the concept of the first 1,000 days of life, 95% answered that exclusive breastfeeding should be carried out up to 6 months of age, and 34.3% responded that complementary feeding should be begun between 4 and 6 months of age. There was scant knowledge regarding nutrition in the pregnant woman. Adherence to traditional complementary feeding practices was evident. Conclusions: In a group of Latin American healthcare professionals, knowledge about nutrition in the first 1,000-1,500 days of life of an individual is still incomplete and insufficient, showing the need for continued training of healthcare professionals, with respect to those themes.

Resumen: La Asociación Mexicana de Hepatología A.C. llevó a cabo el consenso del manejo de las complicaciones de la cirrosis hepática en población pediátrica, con el fin de proveer a los médicos de información útil para su tratamiento. Participaron un grupo de gastroenterólogos pediatras y expertos en nutrición, nefrología y enfermedades infecciosas, quienes revisaron la literatura médica. El método Delphi fue aplicado para obtener el nivel de acuerdo de los enunciados emitidos; estos fueron enviados a los participantes para ser analizados, votados y en sesiones virtuales fueron discutidos, obteniendo así las declaraciones finales. Los resultados del consenso fueron emitir las indicaciones para el manejo de un niño con cirrosis hepática, con el fin de prevenir o controlar las complicaciones. Abstract: The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein. Resumen: La alergia a las proteínas de leche de vaca (APLV) constituye la causa más frecuente de alergia alimentaria en los primeros meses de vida. A pesar de la existencia de diferentes guías y recomendaciones sobre el manejo de niños con APLV, en Latinoamérica sigue observándose una gran variabilidad de criterios diagnósticos y terapéuticos. El grupo de trabajo de Alergia Alimentaria de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica se dio a la tarea de convocar a un grupo de expertos de la región, realizar un consenso y elaborar un documento con el objetivo de unificar criterios diagnósticos y terapéuticos para APLV. Se dividió el grupo en tres equipos bajo un coordinador para cada equipo, y los miembros de cada grupo formularon una serie de enunciados correspondientes a uno de tres módulos diferentes: a) manifestaciones clínicas; b) herramientas diagnósticas, y c) tratamiento. Se buscó la información en la literatura médica para sustentar la información de cada uno de ellos, y posteriormente se seleccionaron 28 enunciados, los cuales fueron discutidos y posteriormente evaluados por todos los expertos, a través de método Delphi, quienes emitieron su opinión sobre acuerdo o desacuerdo sobre las mismas de forma anónima. Todos los enunciados obtuvieron porcentajes de acuerdo mayores al 75%, por lo que permanecieron, y con base en ellos se elaboraron las recomendaciones y se presentan.

Resumen: La alergia a las proteínas de leche de vaca (APLV) constituye la causa más frecuente de alergia alimentaria en los primeros meses de vida. A pesar de la existencia de diferentes guías y recomendaciones sobre el manejo de niños con APLV, en Latinoamérica sigue observándose una gran variabilidad de criterios diagnósticos y terapéuticos. El grupo de trabajo de Alergia Alimentaria de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica se dio a la tarea de convocar a un grupo de expertos de la región, realizar un consenso y elaborar un documento con el objetivo de unificar criterios diagnósticos y terapéuticos para APLV. Se dividió el grupo en tres equipos bajo un coordinador para cada equipo, y los miembros de cada grupo formularon una serie de enunciados correspondientes a uno de tres módulos diferentes: a) manifestaciones clínicas; b) herramientas diagnósticas, y c) tratamiento. Se buscó la información en la literatura médica para sustentar la información de cada uno de ellos, y posteriormente se seleccionaron 28 enunciados, los cuales fueron discutidos y posteriormente evaluados por todos los expertos, a través de método Delphi, quienes emitieron su opinión sobre acuerdo o desacuerdo sobre las mismas de forma anónima. Todos los enunciados obtuvieron porcentajes de acuerdo mayores al 75%, por lo que permanecieron, y con base en ellos se elaboraron las recomendaciones y se presentan. Abstract: Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting., (Copyright © 2023 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Introduction and Aims: There are few studies that compare polyethylene glycol (PEG) 3350 and magnesium hydroxide (MH), as long-term treatment of functional constipation (FC) in children, and they do not include infants as young as 6 months of age. Our aim was to determine the efficacy, safety, and acceptability of PEG vs MH in FC, in the long term, in pediatric patients., Methods: An open-label, parallel, controlled clinical trial was conducted on patients from 6 months to 18 years of age, diagnosed with FC, that were randomly assigned to receive PEG 3350 or MH for 12 months. Success was defined as: ≥ 3 bowel movements/week, with no fecal incontinence, fecal impaction, abdominal pain, or the need for another laxative. We compared adverse events and acceptability, measured as rejected doses of the laxative during the study, in each group and subgroup., Results: Eighty-three patients with FC were included. There were no differences in success between groups (40/41 PEG vs 40/42 MH, p = 0.616). There were no differences in acceptability between groups, but a statistically significant higher number of patients rejected MH in the subgroups > 4 to 12 years and > 12 to 18 years of age (P = .037 and P = .020, respectively). There were no differences regarding adverse events between the two groups and no severe clinical or biochemical adverse events were registered., Conclusions: The two laxatives were equally effective and safe for treating FC in children from 0.5 to 18 years of age. Acceptance was better for PEG 3350 than for MH in patients above 4 years of age. MH can be considered first-line treatment for FC in children under 4 years of age., (Copyright © 2021 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon., (Copyright © 2022 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Objectives: Current irritable bowel syndrome (IBS) treatments have limited efficacy and probiotics like Bacillus clausii (B. clausii) were found to be effective in the management of several gastrointestinal disorders. This phase III trial assessed the efficacy and safety of adding B. clausii (four strains: O/C, N/R, SIN, T), versus placebo, to conventional treatment of pediatric IBS in Mexico., Methods: Patients aged 6-17 years 11 months with IBS (Rome IV) for at least 2 months were randomized to receive either B. clausii (oral suspension, total dose 4 billion spores/day) or placebo once daily for 8 weeks. All patients also received conventional treatment. The primary endpoint was the difference in the proportion of patients with clinical improvements at Week 8 (Global Assessment Questions [GAQ]). Secondary endpoints included responders by Subject's Global Assessment of Relief for Children with IBS (SGARC); number/consistency of stools; abdominal distention/bloating; abdominal pain/intensity; and IBS behavior., Results: 73.6% (95% confidence interval [CI] 67.3-80.0; B. clausii n = 129) and 78.5% (95% CI 72.5-84.4; placebo n = 130) of patients had symptom improvement (p = 0.8182). For Week 8 SGARC, 19.2% (B. clausii) and 20.9% (placebo) reported complete symptom relief. Stool evaluations, bloating, abdominal pain/intensity, and IBS behavior were similar between groups. Both treatments were well tolerated., Conclusion: No significant differences in efficacy between B. clausii and placebo were demonstrated in addition to conventional treatment. The sample size calculation was based on an expected placebo/conventional treatment response of 30-40%. However, the actual treatment response observed was 80% and, thus, a study with larger population would be warranted. In addition, this study was conducted during the COVID-19 pandemic, when such controlled social conditions may have resulted in better diet, greater family stability, less psychological stress, and lower risk of infections exacerbating IBS, thereby improving symptoms in both groups., Eudract Number: 2018-004519-31., (© 2022. The Author(s).)

Introduction and Aim: Acute pancreatitis (AP) is the most common cause of pancreatic disease in children. Previous studies have described factors related to days of hospital length of stay (LOS) in children. Our aim was to identify factors associated with LOS in AP., Materials and Methods: A retrospective study was conducted at the Hospital Infantil de México Federico Gómez in Mexico City, encompassing the time frame of January 1, 2017 and March 31, 2019. AP was confirmed by medical chart review, according to the INSPPIRE criteria at the time of hospital admission, in patients below 18 years of age. AP grade was classified, following the NASPGHAN guidelines. Demographic, clinical, biochemical, nutritional, and treatment data were collected. Prolonged hospital LOS was considered that which lasted 7 days or longer., Results: Fifty-one events (32 patients) were registered. Median LOS was 8 days (IQR 4-14 days). Antibiotic use was significantly associated with longer LOS (OR 31.71; 95% CI: 2.71-370.65; p = 0.006) and early feeding (EF) (within 72 h of admission) was associated with shorter LOS (OR 0.05; 95% CI: 0.001-0.63; p = 0.02). There was no association between LOS and the variables of age, recurrence, grade, etiology, comorbidities, complications, fluid resuscitation, parenteral nutrition, or biochemical characteristics upon admission., Conclusion: Our study, like others, corroborated the fact that EF in the management of AP was associated with fewer days of hospital LOS., (Copyright © 2022 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications., (Copyright © 2022 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Introduction: Health-disease processes are established and programmed in the first 1500 days of life, a period in which nutrition and the microbiota play a fundamental role. Feeding practices vary, according to regional sociocultural characteristics. The Early Nutrition Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) established the goal of identifying the main feeding practices in the first 1500 days that were recommended by health professionals in Latin America., Materials and Methods: A survey was conducted on the aspects of maternal-infant and young child nutrition during the first 1500 days of life. An open invitation was extended to Latin American healthcare professionals to anonymously answer the online survey., Results: A total of 1284 surveys from participants in 18 Latin American countries were analyzed. The mean age of the participants was 37.14 ± 11.1 years, 75.7% were women, 64.7% were physicians, and the rest were nutritionists/nutriologists. A total of 71.4% were familiar with the concept of the first 1000 days of life, 95% answered that exclusive breastfeeding should be carried out up to 6 months of age, and 34.3% responded that complementary feeding should be begun between 4 and 6 months of age. There was scant knowledge regarding nutrition in the pregnant woman. Adherence to traditional complementary feeding practices was evident., Conclusions: In a group of Latin American healthcare professionals, knowledge about nutrition in the first 1000-1500 days of life of an individual is still incomplete and insufficient, showing the need for continued training of healthcare professionals, with respect to those themes., (Copyright © 2021 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Introduction and Objectives: Pediatric inflammatory multisystem syndrome (PIMS) is a life-threatening complication in pediatric patients with SARS-CoV-2 infection. An increase in the association of gastrointestinal symptoms and the presence of PIMS has been observed. The objective of this study was to analyze whether pediatric patients with COVID-19, who debut with gastrointestinal symptoms, have a higher risk of developing PIMS., Material and Methods: An observational, analytical and retrolective study was carried out with a review of the records of patients diagnosed with COVID-19. Demographic, clinical and laboratory variables were recorded., Results: A total of 248 patients who met the selection criteria were included. Of Those 40% were female, with a mean age of 7 +/- 5.8 years. Gastrointestinal symptoms were the initial presentation in 103 patients, with vomiting being the most frequent symptom, followed by abdominal pain and diarrhea. In total 52 patients developed PIMS, 30 of whom presented with gastrointestinal symptoms. A RR of 1.57 (97% CI of 1.17-2.11) was found for the presentation of PIMS in patients positive for SARS-CoV-2 who present with gastrointestinal symptoms., Conclusions: There is an increased risk of developing pediatric multisystem inflammatory syndrome when there are gastrointestinal symptoms in pediatric patients with COVID-19., (Copyright © 2022 Jaramillo-Esparza and Vázquez-Frias.)

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein., (Copyright © 2022 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Infant formula is the only acceptable substitute for breastmilk from 0 to 6 months old when human milk cannot be provided in sufficient amounts. Manufacturers have developed options that intend to meet the changing needs of the child aged from six to twelve months (follow-on formulae) and after the age of one year (young child formulae). The international code for marketing breast milk substitute stipulates standards for marketing practices of these products. In Latin America there are local variations of marketing practices. Novel marketing strategies such as advertising through social media and influencers pose new threats for breastfeeding success in Latin America. This review aims to examine variations in local regulations for marketing of infant formulae and to analyze the emerging phenomenon of influencer advertising. We reviewed the local norms for Latin American countries and examined differences and possible gaps. Emerging evidence of influencer marketing was explored. The results indicate that national regulations differ among Latin American countries, particularly with respect to product labelling and the requirement to use a local native language, highlighting the cost of the product, and different regulations prohibiting certain messages and illustrations. Regarding new marketing strategies, there is limited evidence on advertising infant formula through social media influencers, where different categories of marketing strategies can be described. More transparent reporting of social marketing by formula providers and more independent research on novel marketing strategies are needed.