Prevalence of Non-erosive Esophageal Phenotypes in Children. A European Multicenter Study

Background/aims: Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. Methods: Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. Results: Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. Conclusions: FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment

Serum levels of obestatin and ghrelin in children with clinical symptoms indicative of gastroparesis

Ghrelin and obestatin are peptides secreted by the stomach. The gene of human ghrelin is located on chromosome 3p26-p25 and encodes a polypeptide called preproghrelin which undergoes a stepwise proteolytic cleavage generating ghrelin and subsequently obestatin. Ghrelin (GHR) is orexigenic and promotes gastrointestinal (GI) motility whereas obestatin (OB) exerts anorexigenic effects, decelerates gastric emptying time and small bowel activity and reduces body weight.Early satiety, bloating, nausea and vomiting are symptoms frequently encountered in pediatrics; delayed gastric emptying time (GET) has been implicated as an underlying pathophysiological mechanism for the abovementioned symptoms.We hypothesized that GHR and OB are implicated in the pathogenesis of gastroparesis (i.e. delayed GET in the absence of mechanical gastric outlet obstruction) in children presenting with symptoms of delayed GET that persist >6 months and for which no cause was identified.We conducted a cross-sectional, case-control study to determine pre- and post-prandial serum levels of total ghrelin and obestatin along with gastric emptying time (GET) in children with symptoms suggestive of gastroparesis, which were not attributable to any identifiable cause. The aim of this study was to assess GET as well as pre- and post-prandial levels of GHR and OB and examine their association.Nine of the out of 20 patients had delayed GET. Pre-prandial ghrelin and obestatin were significantly higher compared to controls. Post-prandial ghrelin was significantly decreased in the subgroup of patients with delayed GET. In conclusion gastric emptying time was found to be frequently delayed and obestatin and ghrelin were deranged in children with symptoms indicative of delayed GET of unexplained etiologyΗ γκρελίνη (GHR) και η ομπεστατίνη (OB) αποτελούν γαστρεντερικά πεπτίδια του άξονα γαστρεντερικό - εγκέφαλος τα οποία εκκρίνονται από το στόμαχο. Το γονίδιο της ανθρώπινης γκρελίνης εντοπίζεται στο χρωμόσωμα 3p26-p25 και κωδικοποιεί ένα πολυπεπτίδιο την πρε-προ- γκρελίνη. Η πρε-προ- γκρελίνη υφίσταται σταδιακή διάσπαση του μορίου της (πρωτεόλυση) από την οποία προκύπτουν τόσο η γκρελίνη όσο και η ομπεστατίνη. Η γκρελίνη έχει ορεξιογόνες ιδιότητες και αυξάνει την κινητικότητα του πεπτικού συστήματος, ενώ η ομπεστατίνη ασκεί ανορεξιογόνο δράση, ελαττώνει το σωματικό βάρος και επιβραδύνει το χρόνο γαστρικής κένωσης καθώς και την κινητικότητα του λεπτού εντέρου.Ο πρώιμος κορεσμός, το αίσθημα μεταγευματικής πληρότητας, η ναυτία και οι έμετοι αποτελούν συμπτώματα συχνά απαντούμενα στην Παιδιατρική. Ο καθυστερημένος χρόνος γαστρικής κένωσης έχει προταθεί ως πιθανός παθοφυσιολογικός μηχανισμός πρόκλησης των ανωτέρω συμπτωμάτων.Στην παρούσα μελέτη υποθέσαμε ότι ο χρόνος γαστρικής κένωσης είναι παρατεταμένος και ότι τα ολικά επίπεδα ορού γκρελίνης και ομπεστατίνης είναι διαταραγμένα σε παιδιατρικούς ασθενείς με επίμονα (διάρκεια >6 μήνες) δυσπεπτικά συμπτώματα ενδεικτικά γαστροπάρεσης τα οποία παρέμειναν ασαφούς αιτιολογίας παρά την εκτεταμένη κλινικο-εργαστηρική διερεύνηση.Για να ελέγξουμε την υπόθεση αυτή προσδιορίσαμε σπινθηρογραφικά το χρόνο γαστρικής κένωσης καθώς και τα προ- και μεταγευματικά επίπεδα ολικής γκρελίνης και ομπεστατίνης με την ποσοτική μέθοδο RIA στην ανωτέρω ομάδα παιδιατρικών αθενών.Εννέα από τους 20 ασθενείς είχαν παρατεταμένο χρόνο γαστρικής κένωσης. Τα προγευματικά επίπεδα γκρελίνης και ομπεστατίνης ήταν σημαντικά υψηλότερα στους ασθενείς συγκριτικά με την ομάδα ελέγχου. Τα μεταγευματικά επίπεδα γκρελίνης ήταν σημαντικά ελαττωμένα στους ασθενείς εκείνους οι οποίοι είχαν παρατεταμένο χρόνο γαστρικής κένωσης.Συμπερασματικά ο χρόνος γαστρικής κένωσης είναι συχνά παρατεταμένος και τα επίπεδα γκρελίνης και ομπεστατίνης διαταραγμένα σε παιδιά με ανεξήγητα δυσπεπτικά συμπτώματα ενδεικτικά γαστροπάρεσης

Effect of Bowel Cleansing on Colonic Transit Time Measurement in Children with Chronic Constipation

We evaluated the effect of bowel preparation on colonic transit time (CTT) measured by the radio-opaque marker test in children with constipation. All children underwent 2 radio-opaque marker-CTT tests, both in cleansed and uncleansed bowel state. Our findings confirm that the state of colonic fecal filling may significantly influence CTT

Paediatric Intestinal Pseudo-Obstruction: Evidence and Consensus-Based Recommendations from an ESPGHAN-Led Expert Group

Chronic intestinal pseudo-obstructive (CIPO) conditions are considered the most severe disorders of gut motility. They continue to present significant challenges in clinical care despite considerable recent progress in our understanding of pathophysiology, resulting in unacceptable levels of morbidity and mortality. Major contributors to the disappointing lack of progress in paediatric CIPO include a dearth of clarity and uniformity across all aspects of clinical care from definition and diagnosis to management. In order to assist medical care providers in identifying, evaluating and managing children with CIPO, experts in this condition within the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition as well as selected external experts, were charged with the task of developing a uniform document of evidence- and consensus-based recommendations