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Background/Aims Helicobacter pylori (H. pylori) infection is a significant cause of peptic ulcers and gastric cancer. Distinguishing H. pylori infection from functional gastrointestinal disorders in children can be challenging, often leading to delayed diagnosis. This study evaluates the effectiveness of non-invasive diagnostic tests for detecting H. pylori infections in the Korean pediatric population. Methods A retrospective review of medical records was conducted for children diagnosed with H. pylori infection at Kyung Hee University Hospital at Gangdong, Korea, from 2020 to 2023. Data on age at diagnosis, clinical symptoms, blood and stool tests, endoscopic findings were analyzed. Results Among the 25 children and adolescents diagnosed with H. pylori gastritis, the median age at diagnosis was 124 months (57-204). The common symptoms were abdominal pain and nausea (96%), followed by dyspepsia (56%), vomiting (48%), and diarrhea (28%). Gastroduodenal ulcers accompanied by severe anemia and gastrointestinal bleeding reported in two cases. The median serum IgG level in children with H. pylori infection was 20.4, with an average of 45.8 in the 80% of children who tested positive. In the 13 children with H. pylori-related ulcers in the stomach or duodenum, the average serum IgG level was 47.6, significantly higher than that in children with only gastritis (p<0.05). The mean fecal calprotectin level in all children with H. pylori infection was 180.6. Conclusion Non-invasive diagnostic tests including Helicobacter IgG, fecal antigen test, and fecal calprotectin have proven useful for early detection of H. pylori infections in Korean children and adolescents. Future research with larger cohorts are needed to improve these results and increase diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background/Aims Helicobacter pylori (H. pylori) is a well-known factor in the development of peptic ulcers and gastric cancer. Many Asian populations, in particular, face a high risk of gastric cancer development, underscoring the need for a practical eradication strategy targeting pediatric patients in the era of antimicrobial resistance. This study investigates trends and efficacy in the management of H. pylori infection in Korean children and adolescents. Methods A retrospective chart review was conducted on patients under 19 years old who were diagnosed with H. pylori infection through tests for active infection, including endoscopic examinations at 11 university hospitals between 2008 and 2023 in South Korea. Data were collected on clinical conditions at diagnosis, confirmative diagnostic methods, indications for eradication therapy, eradication regimen, and treatment response. Results A total of 725 participants (391 boys, 334 girls) was included, with a median age of 13.7 (range: 2.0~18.9) years. The primary indications for eradication therapy were H. pylori-associated gastritis/duodenitis with gastrointestinal symptoms (54.1%), peptic ulcers (33.2%), and iron deficiency anemia (10.5%). The overall eradication rate with the first-line regimen was 76.6%, and clarithromycin-based triple was the most common choice (42.3%) with recently decreased usage (p=0.018). Proton pump inhibitor-based triple therapy showed an eradication rate of 73.6%, bismuth-based quadruple therapy 81.7%, and sequential therapy 84.2%. The eradication rate of bismuth-based quadruple therapy has recently increased to 85.1% and the 14-day bismuth-based quadruple showed a significantly higher eradication rate compared to the 14-day clarithromycin-based triple therapy (87.3% vs. 73.7%, p=0.025). Conclusion This is the first large-scale study to analyze trends and efficacy of the treatment of H. pylori infection among pediatric population in South Korea over the past 10 years, recently revealing that bismuth-based quadruple is more effective regimen. [ABSTRACT FROM AUTHOR]

Background/Aims Chronic intestinal pseudo-obstruction (CIPO) is a clinically heterogenous syndrome which is characterized by compromised peristalsis and intestinal obstruction. Variants of the ACTG2 gene, encoding gamma 2 enteric actin, a protein crucial for correct enteric muscle contraction, have been found in CIPO patients. The aim of this study is to examine the clinical features and mutation spectrum of ACTG2 gene in Korean CIPO patients. Methods Eleven patients diagnosed with CIPO were tested for genetic analysis of ACTG2 genes. Genomic DNA from peripheral leukocytes was extracted. All coding exons and flanking introns of the ACTG2 gene were amplified using polymerase chain reaction. Direct sequencing was performed. Results ACTG2 gene mutations were found in five patients (45%). C.769C>T (R257C) was found in three patients, C.188G>A(R63Q) in one. A novel mutation, C.577A>T (p.Ile193Phe) was found in one patient. Current age ranges from 33 months to 26 years with a median of 11 years. Two patients presented at birth, two at 1 year, and one at 3 years of age. Among them, microcolon was found in two patients (40%), megacystis in five (100%). Two patients had done intermittent urinary catheterization. Four patients underwent multiple surgery, including colostomy, jejunostomy, and ileostomy and one underwent subtotal gastrectomy, cholecystectomy, and total colectomy. Three patients (60%) has been receiving long term home PN and one patient quit PN recently. Two of them had central line associated bloodstream infections. None had an intestinal transplantation. One patient has recurrent small intestinal bacterial overgrowth and is taking cyclic antibiotics. Two patients are taking oral pyridostigmine. Conclusions ACTG2 mutations are associated with megacystis and commonly found in Korean CIPO patients. Early diagnosis of CIPO through the ACTG2 genetic analysis can avoid unnecessary diagnostic interventions and reduce malnutrition and growth disorders with appropriate measures. [ABSTRACT FROM AUTHOR]

Background/Aims Many children suffer from ingestion of foreign body (FB) and sometimes require an emergency endoscopy or surgery. Up to now, few domestic data studies on FB ingestion in children by pediatric gastroenterologists has been reported. This study aims to investigate the clinical characteristics and outcomes of FB ingestion in children and clarify proper tools for evaluating FB patients. Methods Total of 338 children (184 girls) with FB ingestion who visited department of pediatrics at eight medical centers between January 2018 and December 2018 were reviewed. Our study include age, gender, time of accident, time to visit, route of arrival, presenting symptoms, type and size of FB, and therapeutic modalities with FB removal. Results The median age of diagnosis was 3.0 years (range, 0.3 to 18.3 years). Most common place was their home (89.7%). Coin (15%) was the most common gastrointestinal FB. Magnet (7.7%) and disc battery (8.3%) were also significant. The locations of impacted FB were the esophagus (13.6%), stomach (24.5%), small and large intestine (16.2%), respectively. Endoscopic and surgical removal were conducted in 25.7%. Among them, school-aged children (ages, 5 to 12 years) was identified most frequently in 36.8%. Nine children underwent operations due to failure to endoscopic FB removal and prevention of complications. Severe complications related FB ingestion were identified such as gastric or esophageal ulceration in four children, gastric laceration in one, small bowel (SB) or esophageal perforation in two, and SB bowel obstruction in one, respectively. Sharp, large (>3 cm), dangerous materials and multiple magnets showed significant differences (p<0.05) in children with surgery. Conclusions FB were very diverse with age, and mostly preventable in Korean children. Endoscopic evaluation is essential for investigating complications especially unwitnessed event, even in rare emergencies. In addition, more meticulous protocols about pediatric FB would be urgently needed. [ABSTRACT FROM AUTHOR]

Background/Aims The prevalence of severe obesity is increasing worldwide among children and adolescents. Although obesity in children has a relatively low risk of metabolic complications, those with more severe types of obesity may be at higher risk in adults. In many countries with moderate increase of the obesity epidemic, the association between metabolic complications and extremely severe obesity has been rarely reported in pediatric populations. This study aims to assess the prevalence of each metabolic complication related with extremely severe obesity using a nationally representative data in Korea. Methods A total of 790,653 students (380,580 females) aged 5 to 19 years were recruited from the Korean student health examination. Body mass index (BMI) reference was defined according to the World Health Organization Growth reference data. Obesity was defined as obesity (BMI ≥100% of 95th percentile), severe obesity (BMI ≥120%), and extremely severe obesity (BMI ≥140%). Results Comparing 2011 and 2018, the prevalence of severe obesity have increased by 63% and extremely severe obesity increased by 100%, whereas obesity increased by 28.7%. The adjusted odds ratios for extremely severe obesity were calculated according to each metabolic complication; hypertension was 12 times higher than non-obese, hyperglycemia was 2.6, hypercholesterolemia was 2.1, and elevated aminotransferase was 15.2. The mean numbers of metabolic complications in each obesity group was 1.14 in extremely severe obesity, and 0.29 in non-obese group. Conclusions We found that the prevalence of metabolic complications was dramatically increased with the severity of childhood obesity. Close monitoring of metabolic complications is important to track severe obesity. Further longitudinal studies are needed to verify extremely severe obesity in childhood at the highest metabolic risk. [ABSTRACT FROM AUTHOR]

Background/Aims Childhood obesity has been increased worldwide and many clinical and public interventions have been tried to reduce the morbidities. However, there was no reliable biomarkers to identify the high-risk groups or good response groups to specific interventions. The purpose of this study is to identify the metabolic signatures associated with interventions to control weight in obese children. Methods Forty obese children from "Intervention for Children and Adolescent Obesity via Activity and Nutrition study" were selected according to the response to the interventions. Half of the children were responders (n=20) and the others were non-responders (n=20). Physiological data and blood samples were collected at baseline, intervention after 6 months, and 18 months. Total 120 samples were collected and quantitative analysis of the metabolites of serum samples were applied using CE-TOFMS and the biocrates Absolute IDQ p180 kit with LC-TOFMS. Results Total 194 metabolites (111 metabolites in cation mode and 83 metabolites in anion mode) in 120 samples were detected on the basis of human metabolome technologies' standard library. Nine metabolites (1- or 3-Methylhistidine, 3-Hydroxypropionic acid, 8- or 2-Hydroxyoctanoic acid-1, alanine, asparagine, cystine, indole-3-acetic acid, N-acetylalanine, tyrosine) showed significant changes between baseline and 18months samples in responders and non-responders (p<0.05). Alanine, asparagine, cystine, indole- 3-acetic acid, tyrosine were also revealed relative areas of each metabolites in 0, 6, 18 months, respectively in metabolic pathway mapping. Conclusions Our study shows significantly different metabolomic profiling in responder and non-responder groups according to the interventions. This result calls for further researches about the biomarkers regarding to the responses to specific treatments or interventions to the larger group of obese children. [ABSTRACT FROM AUTHOR]

Background/Aims Pediatric autoimmune enteropathy (AIE) is a rare disease that causes intractable diarrhea in children. Through this study, we present seven cases of pediatric patients diagnosed with AIE. Our study aids in understanding the clinical and genetic characteristics of this rare genetic condition and the considerations in its management. Methods From December 1996 to September 2019, seven cases who were diagnosed as AIE in Seoul National University Children's Hospital were retrospectively analyzed. The clinical sources of all AIE cases were reviewed, including electronic medical records, histopathologic material, radiologic images, and laboratory findings. Results Initial symptoms were diarrhea (in six children) and hematochezia (in one patient). Later, all patients had severe diarrhea which started in the early months of life. Among the five patients tested on gene studies, forkhead box P3 (FOXP3) mutations were identified in four patients, and all of them were males. All patients initially received steroid treatment. Patients with a partial and transient response were considered for alternative agents. Three patients (42.9%) remained in remission under tacrolimus monotherapy, one patient (14.3%) with tacrolimus and prednisolone combination therapy, one patient (14.3%) with tacrolimus, prednisolone, and cyclosporine combination therapy, one patient (14.3%) had died of fulminant hepatitis, and one patient (14.3%) had died of septic shock. All patients were treated with tacrolimus for more than 1 year. Estimated glomerular filtration rate (eGFR) decreased in six patients (85.7%) and increased in one patient (14.3%). Conclusions In this study, all patients treated with tacrolimus showed amelioration of symptoms. However, histological characteristics did not correlate with symptom improvement. Therefore, the efficacy of treatment can be assessed by symptoms and frequent endoscopic biopsies are not required. For long-term use of tacrolimus, close observation of eGFR is recommended to detect nephrotoxicity early. [ABSTRACT FROM AUTHOR]