Differences in management of eosinophilic esophagitis in Europe : an assessment of current practice

Objectives:The aim of the study was to assess differences in the diagnosis and management of eosinophilic esophagitis (EoE) by European pediatric (PG) and adult gastroenterologists (AG), and their self-reported adherence to guidelines. Methods:A multiple-choice questionnaire gauged the diagnostic and management strategies of gastroenterologists treating children or adults in 14 European countries and the United Arab Emirates (UAE). Results:Questionnaires were completed by 465 PG and 743 AG. PG were significantly more likely to take biopsies in patients with symptoms of esophageal dysfunction (86.2% PG vs 75.4% AG, P<0.001) and to perform endoscopic follow-up (86.3% PG vs 80.6% AG, P<0.001). After failure of proton-pump inhibitors (PPIs), topical steroids were the preferred second-line therapy; however, PG opted more frequently for elimination diets (47.5% PG vs 13.7% AG, P<0.001). More PG than AG indicated having read recent guidelines (89.4% PG vs 58.2% AG, P<0.001). Geographic differences in practice were reported, with respondents from the United Kingdom, Portugal, and Spain more often adhering to recommended biopsy protocols. Physicians in the UAE, France, Lithuania, and Poland tended to opt for steroid therapy or elimination diets as first-line therapy, in contrast to most other countries. Conclusions:Significant differences in general practice between PG and AG were demonstrated with notable divergence from consensus guidelines. International practice variations are also apparent. Among other strategies, educational activities to highlight current recommendations may help harmonize and optimize clinical practice

Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN

The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre-and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options

Pediatric Gastrointestinal Endoscopy: European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and European Society of Gastrointestinal Endoscopy (ESGE) Guidelines

ABSTRACT: This Guideline refers to infants, children and adolescents aged 0–18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileo-colonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangio-pancreatography and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) has been dealt with in other Guidelines [1–3] and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this

O futuro da Acta Pediátrica Portuguesa deve ser debatido pela Pediatria portuguesa

A Acta Pediátrica Portuguesa (APP) vive uma crise de identidade e de missão. Após cinco anos de mudança de imagem, estrutura e processo editorial para torná-la numa revista moderna e com a qualidade e o rigor científicos adequados ao órgão oficial da Sociedade Portuguesa de Pediatria (SPP), é claro para todos que os principais objectivos fixados não foram atingidos e que dificilmente o serão, a curto e a médio prazo.Nomeadamente, o objectivo principal – a indexação – não foi atingido1-3 sendo muito pouco provável que seja alcançado. Faltam à Pediatria portuguesa e ao seu entorno massa humana com a dimensão crítica para manter uma revista científica de qualidade a funcionar nos moldes previstos para a APP4,5. Não há no País afluxo de manuscritos de qualidade ou número de revisores que se equipare ao de revistas internacionais congéneres, nem disponibilidade de editores com a capacidade de garantir a publicação de uma revista científica bimestral com o rigor que se ambiciona

Celiac Disease: What Do We Know in 2017

Celiac disease is one of the most prevalent digestive conditions. Diagnosis requires that strict criteria are used so that a life-long gluten-free diet may be correctly prescribed. Although genetic susceptibility has been known for a long time, there have been elusive environmental factors that lead to the occurrence of clinical disease. Many studies have addressed the identification of environmental modifiers, and different lines of research have been tried with variable success and even contradictory results. Infections and age of gluten introduction into the diet in the first few months of life have been evaluated, but a firm relationship could not be established. A recent paper addresses a fascinating hypothesis that could explain how some infectious agents might modulate the immune system and modify response to dietary antigens. Subsequently, animal models with genetic susceptibility were tested, and, indeed, there was abnormal response to gluten. These observations still do not provide final answers about the pathophysiology of celiac disease but certainly lead to progress in the knowledge of gluten sensitization and the role of some environmental factors

Documentos em discussão pública – Ponto de vista

A Comissão Nacional de Saúde da Criança e do Adolescente (CNSCA) publicou recentemente no seu site1 três importantes documentos sobre a Carta Hospitalar de Pediatria2, o Hospital de Dia Pediátrico3 e o Pediatra Consultor nos Agrupamentos de Centros de Saúde4.Estes documentos estão disponíveis para receber comentários públicos que são também publicados depois de analisados pela CNSCA. Contudo, verifica-se com surpresa que nem todos os comentários são divulgados nem os seus autores notificados das razões de recusa. Porque estes assuntos interessam a todos os pediatras e todas as colaborações devem ser bem vindas num fórum público e aberto, a Acta Pediátrica Portuguesa será talvez o local de eleição para que todos possam participar construtivamente. Nesse sentido, proponho algumas considerações sobre cada um dos documentos em análise