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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. ispartof: ANNALS OF GASTROENTEROLOGY vol:35 issue:2 pages:187-+ ispartof: location:Greece status: published

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

OBJECTIVES: The aim of the study was to assess clinical presentation, endoscopic findings, antibiotic susceptibility and treatment success of Helicobacter pylori (H. pylori) infected pediatric patients. METHODS: Between 2013 and 2016, 23 pediatric hospitals from 17 countries prospectively submitted data on consecutive H. pylori-infected (culture positive) patients to the EuroPedHP-Registry. RESULTS: Of 1333 patients recruited (55.1% girls, median age 12.6 years), 1168 (87.6%) were therapy naïve (group A) and 165 (12.4%) had failed treatment (group B). Patients resided in North/Western (29.6%), Southern (34.1%) and Eastern Europe (23.0%), or Israel/Turkey (13.4%). Main indications for endoscopy were abdominal pain or dyspepsia (81.2%, 1078/1328). Antral nodularity was reported in 77.8% (1031/1326) of patients, gastric or duodenal ulcers and erosions in 5.1% and 12.8%, respectively. Primary resistance to clarithromycin (CLA) and metronidazole (MET) occurred in 25% and 21%, respectively, and increased after failed therapy. Bacterial strains were fully susceptible in 60.5% of group A, but in only 27.4% of group B. Primary CLA resistance was higher in Southern and Eastern Europe (adjusted odds ratio [ORadj] = 3.44, 95% confidence interval [CI] 2.22-5.32, P, SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy. Methods: The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform. Results: Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children. H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence. Conclusions: H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.

OBJECTIVES: Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel. METHODS: pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected. RESULTS: A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age

Background and Aims An expanding number of monogenic defects have been identified as causative of severe forms of very early-onset inflammatory bowel diseases [VEO-IBD]. The present study aimed at defining how next-generation sequencing [NGS] methods can be used to improve identification of known molecular diagnosis and to adapt treatment. Methods A total of 207 children were recruited in 45 paediatric centres through an international collaborative network [ESPGHAN GENIUS working group] with a clinical presentation of severe VEO-IBD [n = 185] or an anamnesis suggestive of a monogenic disorder [n = 22]. Patients were divided at inclusion into three phenotypic subsets: Predominantly small bowel inflammation, colitis with perianal lesions, and colitis only. Methods to obtain molecular diagnosis included functional tests followed by specific Sanger sequencing, custom-made targeted NGS, and in selected cases whole exome sequencing [WES] of parents-child trios. Genetic findings were validated clinically and/or functionally. Results Molecular diagnosis was achieved in 66/207 children [32%]: 61% with small bowel inflammation, 39% with colitis and perianal lesions, and 18% with colitis only. Targeted NGS pinpointed gene mutations causative of atypical presentations, and identified large exonic copy number variations previously missed by WES. Conclusions Our results lead us to propose an optimised diagnostic strategy to identify known monogenic causes of severe IBD.

Epstein-Barr virus (EBV) causes the clinical syndrome commonly known as infectious mononucleosis (IM). Gastrointestinal manifestations are frequently present. These include abdominal pain, mild elevations of alanine (ALAT) and aspartate (ASAT) aminotransferases and hepatosplenomegaly. Less commonly hepatitis may occur. Severe hepatitis and liver failure have rarely been reported and are mostly related to immunodeficiency syndromes. This article presents two cases of EBV hepatitis in children and literature review of this disease.

In the last decade, scientific studies in the field of children’s gastroenterology performed in Lithuania explored different problems: pathology of Helicobacter pylori infection and food allergy. Our studies Helirevealed that children with atopic dermatitis had gastrointestinal complaints (abdominal pain, diarrhea, distension and unstable stool, which appeared with the exacerbation of skin rash) more often as compared to nonallergic children of the control group. Abdominal pain in children with atopic dermatitis with local rash was more frequent and lasted longer than in control group children, whereas children with extended rash had stools more frequently. Gastrointestinal disorders in children with atopic dermatitis statistically significantly did not depend on the extent of skin rash and severity of atopic dermatitis. In our scientific research on the importance of H. pylori infection on children’s gastrointestinal system, children with chronic dyspepsia were examined. Endoscopy, rapid urease test, biopsies from antrum and corpus of stomach and their histological examination as well as serologic tests were done. According to the results obtained, we recommend to examine children with chronic dyspepsia in a complex way: not only endoscopic examination, but H. pylori diagnostic tests should be performed as well. Serologic test is not suitable for screening H. pylori infection in children. Considering this, we recommend to use no fewer than two different methods to diagnose this infection. The highest frequency of H. pylori infection was found in children with duodenal ulcer; histological changes in their gastric pylorus and corpus mucosa were greatest. More than half of children with nonulcer dyspepsia were infected with H. pylori [...].

Background Transition programmes are designed to prepare adolescent inflammatory bowel disease [IBD] patients for transfer to adult care. It is still unclear which outcome parameters define ‘successful transition’. Therefore, this study aimed to identify outcomes important for success of transition in IBD. Methods A multinational Delphi study in patients, IBD nurses, and paediatric and adult gastroenterologists was conducted. In stage 1, panellists commented on an outcome list. In stage 2, the refined list was graded from 1 to 9 [least to very important], by an expert and a patient panel. In stage 3, the expert panel ranked important outcomes from 1 to 10 [least to most important]. Descriptive statistics and Mann–Whitney U-tests were performed. Results The final item list developed in stage 1 was tested by the expert [n = 74 participants, 52.7% paediatric] and patient panel [n = 61, aged 16–25 years, 49.2% male]. Respectively, ten and 11 items were found to be important by the expert and patient panel. Both panels agreed on eight of these items, of which six reflected self-management skills. In stage 3, the expert panel formed a top-ten list. The three most important items were: decision-making regarding IBD [mean score 6.7], independent communication [mean score 6.3] and patient satisfaction [mean score 5.8]. Conclusion This is the first study identifying outcomes that IBD healthcare providers and patients deem important factors for successful transition. Self-management skills were considered more important than IBD-specific items. This is a first step to further define success of transition in IBD and subsequently evaluate the efficacy of different transition models.

Tyrimo objektas. Celiakija yra labai dažna virškinimo trakto liga. Jos paplitimas Europoje ir Šiaurės Amerikoje 1 iš 100-300 suaugusių ir vaikų. Lietuvoje duomenų apie celiakijos paplitimą nėra, ši liga diagnozuojama tik pavieniais atvejais [29]. Sergantieji imumoglobulino A (IgA) deficitu 10 kartų dažniau serga celiakija negu sveikieji. Viršutinių kvėpavimo takų ir virškinimo trakto infekcijos, autoimuninės ligos ir onkologiniai susirgimai taip pat dažnesni sergantiesiems IgA deficitu [143, 163-168]. Lietuvoje duomenų apie IgA deficito paplitimą nėra [29]. Darbo tikslas. Nustatyti Vilniaus miesto 11-13 m. vaikų celiakijos ir IgA deficito paplitimą. Tyrimo medžiaga ir metodai. Gavus Lietuvos bioetikos komiteto leidimą nuo 2009 metų sausio mėnesio iki 2010 metų kovo mėnesio ištirta 1000 vaikų nuo 11 iki 13 metų amžiaus, kurie mokėsi šešiose lietuviškose Vilniaus miesto mokyklose. Mokyklos pasirinktos atsitiktiniu atrankos būdu. Jose buvo išdalintos asmens informavimo formos (tėvams priedas nr. 1 ir vaikams priedas nr. 2), kuriose buvo aprašytas biomedicininis tyrimas, jo eiga ir nauda. Vaikams, kurių tėvai sutiko atlikti celiakijos tyrimą, buvo nustatomi audinių transgliutaminazės IgA klasės (aTG IgA) antikūnai ir bendras IgA kiekis kapiliarinio kraujo laše. Tyrimo metu buvo naudojami Biocard TM celiakijos testai (Ani Biotech OY, Suomija). Tyrimo atsakymas buvo gaunamas ir įvertinamas po 5 min. Nustačius aTG IgA klasės antikūnus, vaikai buvo nukreipti į Vilniaus universitetinę... [toliau žr. visą tekstą] Object. Coeliac disease is one of the most prevalent gastrointestinal disorder. It‘s prevalence in Europe and North America is 1 of 150-300 adults and children. In Lithuania there are no data on prevalence of coeliac disease but it‘s seems that there is hypodiagnosis [29]. IgA-deficient individuals have a tenfold risk for coeliac disease compared with the general population. Patients with IgA deficiency have a tendency to develop recurrent sinopulmonary and gastrointestinal infections, allergies, autoimmune diseases and malignancies [148-154]. There are no data on the prevalence of IgA deficiency in Lithuania [29]. The aim. To determine the prevalence of coeliac disease and IgA deficiency among 11-13 years children in Vilnius. Material and methods. From January 2009 to March 2010 we investigated 1000 children (11-13 years of age) for coeliac disease and immunoglobulin A (IgA) deficiency from six Vilnius secondary schools. We examined capillary blood for tissue transglutaminase IgA class antibodies (tTG IgA) and total IgA with Biocard TM test (Ani Biotech OY, Finland) for children whose parents agreed to do this test. The results were evaluated after 5 min. Children with positive test results (tTG IgA positive or total IgA deficiency) underwent small bowel endoscopy with biopsies at Vilnius University Children Hospital to confirm or deny the diagnosis of coeliac disease. We get permission for this study from Lithuanian Bioethics Committee. Results. Two of 1000 children were... [to full text]

Object. Coeliac disease is one of the most prevalent gastrointestinal disorder. It‘s prevalence in Europe and North America is 1 of 150-300 adults and children. In Lithuania there are no data on prevalence of coeliac disease but it‘s seems that there is hypodiagnosis [29]. IgA-deficient individuals have a tenfold risk for coeliac disease compared with the general population. Patients with IgA deficiency have a tendency to develop recurrent sinopulmonary and gastrointestinal infections, allergies, autoimmune diseases and malignancies [148-154]. There are no data on the prevalence of IgA deficiency in Lithuania [29]. The aim. To determine the prevalence of coeliac disease and IgA deficiency among 11-13 years children in Vilnius. Material and methods. From January 2009 to March 2010 we investigated 1000 children (11-13 years of age) for coeliac disease and immunoglobulin A (IgA) deficiency from six Vilnius secondary schools. We examined capillary blood for tissue transglutaminase IgA class antibodies (tTG IgA) and total IgA with Biocard TM test (Ani Biotech OY, Finland) for children whose parents agreed to do this test. The results were evaluated after 5 min. Children with positive test results (tTG IgA positive or total IgA deficiency) underwent small bowel endoscopy with biopsies at Vilnius University Children Hospital to confirm or deny the diagnosis of coeliac disease. We get permission for this study from Lithuanian Bioethics Committee. Results. Two of 1000 children were positive for IgA tTG and small bowel biopsy revealed coeliac disease in both (mucosal abnormalities Marsh III). Four of 1000 children were IgA deficient. Conclusions. 1. The prevalence of celiac disease among 11-13 years children in Vilnius 1:500 (0,2%, 95% CI 0,055-0,726). 2. The prevalence of coeliac disease found in this study is much higher than in the previous preliminary studies. 3. The prevalence of IgA deficiency among 11-13 years children in Vilnius 1:250 (0,4%, 95% CI 0,156-1,024).