Pediatric Gastroenterology and Hepatology in Italy before and after the COVID-19: Lessons learned and management changes by SIGENP

Around the world, the 2019 Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised serious public health problems and major medical challenges. The Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) published several papers on the impact of COVID- 19 on the current management, diagnosis, and treatment of acute and chronic gastrointestinal, hepatic, immunemediated, and functional disorders. The present article summarizes the most relevant SIGENP reports and consensus during and after the peak of the COVID-19 outbreak, including the diagnosis and treatment of inflammatory bowel disease (IBD), indications and timing of digestive endoscopy, and insights into the novel hepatitis

Scoring Endoscopy in Pediatric Inflammatory Bowel Disease. A Way to Improve Quality

Objectives and study: There is a large interobserver variability in evaluating mucosal lesions of inflammatory bowel disease (IBD), especially in pediatric patients. This multicenter prospective observational study aims to evaluate interobserver agreement (IOA) among pediatric endoscopists in assigning validated IBD endoscopic scores in children. Methods: Fifteen videos of follow-up ileocolonoscopies in children with IBD were recorded and selected as cases. Eleven pediatric endoscopists from different centers blindly evaluated all videos and calculated scores: either Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or Simple Endoscopic Score for Crohn Disease (SES-CD). Scores from all reviewers were compared in order to calculate IOA for general videos and specific sections. Scores from an expert adult reader were used to calculate possible reviewer's characteristics affecting scores' reliability. Results: Intraclass correlation was 0.298 (95% confidence interval [CI]: 0.13-0.55) for ulcerative colitis (UC) and 0.266 (0.11-0.52) for Crohn disease (CD). When a disease activity categorization was adopted (remission, mild, moderate, severe activity) Fleiss kappa coefficient was 0.408 (0.29-0.53) for UC and 0.552 (0.43-0.73) for CD. When stratified by item, vascular pattern of UC was the most reliable item IC: 0.624 (0.321-0.854). In multivariable analysis, none of the reviewer's characteristics affected the readers' errors. Conclusions: This multicenter study shows low agreement among pediatric endoscopists in evaluating endoscopic scores in children with IBD. By using disease activity categorization, agreement slightly increased, mostly for CD. All readers showed a low-grade concordance with the expert adult gastroenterologist's evaluations. Future-specific training programs should be considered to increase IOA in using IBD endoscopic activity scores

Hypnotherapy in Pediatric Gastroenterology

: In several countries, gut-directed hypnotherapy is becoming an established and evidence-based treatment in pediatric gastroenterology. This article describes what hypnotherapy is, offers an overview of its effect in gut-brain disorders and explains its potential mode of action. Moreover, the use of hypnotherapy in other areas of pediatric gastroenterology, as a supportive tool to reduce pain, stress, depression, and anxiety and improve quality of life, will be also discussed. Guidance toward implementing hypnotherapy in clinical practice is provided, including examples of how you can explain hypnosis to patients with gastroenterological symptoms

Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper

: Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management

An ESPGHAN Position Paper on the Use of Low-FODMAP Diet in Pediatric Gastroenterology

International audienceExcluding oligo-, di-, monosaccharides and polyols (FODMAPs) from the diet is increasingly being used to treat children with gastrointestinal complaints. The aim of this position paper is to review the available evidence on the safety and efficacy of its use in children and provide expert guidance regarding practical aspects in case its use is considered. Members of the Gastroenterology Committee, the Nutrition Committee and the Allied Health Professionals Committee of the European Society for Pediatric Gastroenterology Hepatology and Nutrition contributed to this position paper. Clinical questions regarding initiation, introduction, duration, weaning, monitoring, professional guidance, safety and risks of the diet are addressed. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. The systematic literature search revealed that the low-FODMAP diet has not been comprehensively studied in children. Indications and contraindications of the use of the diet in different pediatric gastroenterological conditions are discussed and practical recommendations are formulated. There is scarce evidence to support the use of a low-FODMAP diet in children with Irritable Bowel Syndrome and no evidence to recommend its use in other gastrointestinal diseases and complaints in children. Awareness of how and when to use the diet is crucial, as a restrictive diet may impact nutritional adequacy and/or promote distorted eating in vulnerable subjects. The present article provides practical safety tips to be applied when the low-FODMAP diet is considered in children

The current status of pediatric endoscopy in Italy: a national survey

Background: The number and the features of pediatric endoscopy centers in Italy are unknown. Objectives: The aim of this study is to assess the current status of pediatric endoscopy in Italy and to evaluate number and characteristics of centers performing endoscopy in children. Methods: A survey-based study was designed using a web-based multi-item questionnaire. Centers performing pediatric endoscopy were invited to participate via an invitation e-mail sent to all the members of Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). The survey was composed of 28 questions. Main topics were: number of endoscopists per center, number of endoscopies per year and main indications, sedation techniques and suggestions to improve quality of pediatric endoscopy. Results: 26 centers submitted complete responses. In 17 (65%) centers endoscopies were performed by a pediatrician, whereas in 9 (35%) by an adult endoscopist. The number of endoscopies per center per year ranged from 20 to 2000 (median 200). The median number of procedures was 152 for upper endoscopy (range:20–1600) and 60 for colonoscopy (range: 0–700). The main indication for gastroscopy resulted Celiac disease (78%) whereas colonoscopy was mainly performed to rule out inflammatory bowel diseases (64%). In 79% of cases deep sedation was guaranteed by an anesthetist. Most of the operators suggested consensus guidelines and training programs. Conclusions: Data from this survey reveal a large variability between centers in Italy. In one third of them pediatric endoscopy is performed by an adult endoscopist. More resources are needed to improve standard of pediatric endoscopy in Italy

The pediatric endoscopy practice in Italy: A nationwide survey on behalf of the Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP)

Despite digestive endoscopy is a fundamental tool for pediatric gastroenterologists, an official and standardized program does not exist in Europe. Here, we report the results of a nationwide electronic survey realized on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). This study analyzed for the first time the pediatric endoscopy practice in Italy. Global data about the centers performing endoscopy in children have never been reported in our country. However, the number of participants (44 sites), the high response rate, the geographical distribution (16/20 regions) and the overall number of procedures examined suggest that the present data collection might be a reliable picture of the pediatric endoscopy in Ital

The pediatric endoscopy practice in Italy: A nationwide survey on behalf of the Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP)

Despite digestive endoscopy is a fundamental tool for pediatric gastroenterologists, an official and standardized program does not exist in Europe. Here, we report the results of a nationwide electronic survey realized on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). This study analyzed for the first time the pediatric endoscopy practice in Italy. Global data about the centers performing endoscopy in children have never been reported in our country. However, the number of participants (44 sites), the high response rate, the geographical distribution (16/20 regions) and the overall number of procedures examined suggest that the present data collection might be a reliable picture of the pediatric endoscopy in Ital