Characteristics of gastroesophageal reflux disease in children with interstitial lung disease.

BACKGROUND: Childhood interstitial lung disease (chILD) is a rare group of respiratory tract disorders. One of the factors suggested to be associated with its etiopathogenesis is microaspiration related to gastroesophageal reflux disease (GERD). The aim of the present study was to determine the frequency and characteristics of GERD in children with chILD, with a particular focus on proximal GER episodes. METHODS: This was a prospective cross-sectional study. Consecutive patients with chILD underwent 24-h multichannel intraluminal pH-impedance monitoring. Different types of gastroesophageal reflux episodes (GER) were recorded and compared with regard to the GERD diagnosis. RESULTS: Sixty-two children (median age of 1.22 years) were included. GERD was diagnosed in 20 (32.3%) of them. The GERD (+) and GERD (-) subgroups differed mainly in their esophageal exposure to acid content (2.9 vs. 1.0%, p = 0.02) and bolus exposure (3.0 vs. 1.4%, p < 0.0001), as well as total number of GER (72.5 vs. 42.0 p = 0.0004), acid GER (35.5 vs. 15.0 p = 0.004), and acid proximal GER (21.0 vs. 12.0 p = 0.02). There were no differences in the number of proximal GER comparing GERD (+) and GERD (-) subgroups. CONCLUSIONS: The frequency of GERD seems to be relatively high in the population of children with chILD used in this study. However, it has not demonstrated an association between proximal GER and GERD diagnosis in chILD, which casts uncertainty over the microaspiration theory proposed to link the two diseases. The latter conclusion, however, needs to be confirmed using more accurate aspiration assessment methods.

A New Viscous Budesonide Formulation for the Treatment of Eosinophilic Esophagitis in Children: A Preliminary Experience and Review of the Literature.

Eosinophilic esophagitis (EoE) is a chronic disease, characterized clinically by esophageal disfunction. Topical corticosteroids (tCS), predominantly fluticasone and budesonide, are considered the effective first line treatment, as well as an option of maintenance therapy in EoE. The way that tCS are administered significantly affects their effectiveness. There is still no ready-to-use steroid drug to be applied topically to the esophagus in children-a few experimental viscous slurries (mainly of budesonide) have been shown in trials to be more effective than steroids administered via metered dose inhalers (MDIs) and swallowed. The best examined steroid solvent of all is sucralose, a high-intensity artificial sweetener. Although it has been shown in a critical review that it is non-toxic and safe for all consumers, there are still some concerns among patients about its potential adverse effect on humans. Due to that fact, we developed a new viscous formulation and evaluated its effectiveness in the treatment of children with EoE. In an open, prospective, single-center study, we administered our new formulation of viscous budesonide twice daily for 8 weeks in patients with an active EoE. After treatment, we performed a control gastroscopy with the collection and evaluation of histopathological samples. We have proven our formulation effectiveness at 64%, as far as histological remission is concerned. We have also shown a reduction in the mean endoscopic reference score (EREFS) from 3.1 points at the beginning of the study to 1.6 points at the end of the study. Bearing in mind how important the acceptance of the solvent is for long-time compliance, especially among children, we also decided to assess the taste of the formulation. Therefore, we asked 46 adults and 10 children to swallow a sample of the solvent and fill in a short anonymous questionnaire about its taste, smell, consistency and easiness of swallowing. General acceptance for the proprietary solvent was high, reaching 7.5/10 among adults and 6.5/10 in children. To be able to compare the results of our preliminary experience, we reviewed the studies which evaluated substances that have been used so far as steroid solvents for the treatment of EoE. The overall effectiveness of the oral viscous budesonide (OVB) ranged from 65% to 90%, which is consistent with the results obtained in our study. Unfortunately, the high heterogeneity of the studies did not allow us to draw reliable conclusions.

C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center Study.

BACKGROUND This study aimed to evaluate the C-reactive protein-to-albumin (CRP/albumin) ratio at diagnosis of pediatric inflammatory bowel disease (IBD). MATERIAL AND METHODS Serum CRP/albumin ratio was calculated for patients with Crohn's disease (CD; n=186) and ulcerative colitis (UC; n=159) aged 3-18 years. RESULTS Patients with CD differed in CRP/albumin ratio at diagnosis in groups with quiescent, mild, moderate, and severe disease (P=0.011). CRP/albumin ratio at diagnosis was significant in differentiating patients with severe CD from quiescent disease at diagnosis (area under the curve (AUC)=0.94, odds ratio (OR)=63.4, 95% confidence interval (CI) 7.1-569.1, P<0.0001). CRP/albumin ratio at diagnosis could moderately differentiate penetrating from non-penetrating disease behavior in CD at diagnosis (AUC=0.73, OR=6.3, 95% CI 2.0-19.3, P<0.001). Furthermore, CRP/albumin ratio at diagnosis weakly differentiated IBD patients in need of biological treatment in a step-up procedure (AUC=0.58, OR=2.1, 95% CI 1.3-3.4, P=0.022) and in need of surgery (AUC=0.63, OR=3.1, 95% CI 1.4-7.2, P=0.006). For the IBD, CRP/albumin ratio at diagnosis was weakly correlated with age at first immunosuppressive treatment (rho=0.20, P=0.018), time from diagnosis to first biological treatment (rho=-0.37, P<0.001), days spent in hospital (rho=0.26, P=0.007), number of severe relapses (rho=0.31, P=0.001), and Pediatric Crohn's Disease Activity Index (rho=0.38, P=0.002). CONCLUSIONS The present findings add to previous studies carried out in adult patients and show that the CRP/albumin ratio at diagnosis was not significantly associated with the course of either CD or UC in children. However, CRP/albumin ratio could differentiate patients with severe CD from those with quiescent disease.

Early Enteral Nutrition in Paediatric Acute Pancreatitis-A Review of Published Studies.

Nowadays, nutrition is said to be an integral aspect of acute pancreatitis (AP) treatment. Early enteral nutrition (EEN) is safe and beneficial for patients. This was confirmed by clinical experience and can be found in guidelines on managing adults with AP. Furthermore, paediatric recommendations encourage EEN use in AP. However, paediatric guidelines are based exclusively on studies in adults. Therefore, we present a review of published studies on the time of nutritional interventions in children with AP. A search was independently conducted in April 2022 by two of the authors. Only full-text papers published in English involving children between 0-21 were considered. Only four papers met our inclusion criteria: one randomised-control trial (RCT), one prospective study with retrospective chart review, and two retrospective chart reviews. All studies supported EEN and there was no recommendation of any delay in its initiation. The results of all four papers suggested EEN with a regular, normal-fat diet. EEN is safe in children with mild or moderately severe AP and may decrease the length of hospitalisation. Unfortunately, all the conclusions are based on a small amount of heterogeneous data that are mostly retrospective. Future prospective RCTs are needed.

Three-dimensional High-resolution Anorectal Manometry in Children With Non-retentive Fecal Incontinence.

Background/Aims: Three-dimensional high-resolution anorectal manometry (3D-HRAM) is a precise tool to assess the function of the anorectum. Our aim is to evaluate children diagnosed with non-retentive fecal incontinence (NRFI) using 3D-HRAM. Methods: In all children diagnosed with NRFI, manometric parameters and 3-dimensional reconstructions of the anal canal subdivided into 8 segments were recorded. All data were compared to raw data that were obtained from asymptomatic children, collected in our laboratory and published previously (C group). Results: Forty children (31 male; median age, 8 years; range, 5-17) were prospectively included in the study. Comparison of the NRFI group and C group revealed lower values of mean resting pressure (74.4 mmHg vs 89.2 mmHg, P > 0.001) and maximum squeeze pressure (182 mmHg vs 208.5 mmHg, P = 0.018) in the NRFI group. In the NRFI group, the thresholds of sensation, urge and discomfort (40 cm3, 70 cm3, and 140 cm3, respectively) were significantly higher than those in the C group (20 cm3, 30 cm3, and 85 cm3, respectively; P > 0.001). In the NRFI group, 62.5% presented a mean resting pressure above the fifth percentile, and 82.5% of patients presented a maximum squeeze pressure above the fifth percentile. The comparisons between segments obtained from these patients and those obtained from the C group revealed several segments with significantly decreased pressure values in the NRFI group. Conclusions: Our study demonstrated lower pressure parameters in children with NRFI. In patients with normal resting pressures, 3D-HRAM may reveal segments with decreased pressures, which may play a potential role in the pathomechanism of incontinence.

Apolipoprotein E variants correlate with the clinical presentation of paediatric inflammatory bowel disease: A cross-sectional study.

BACKGROUND: It has been suggested that apolipoprotein E (APOE) polymorphisms are associated with the risk of developing inflammatory bowel disease (IBD) and the early age of disease onset. However, there are no reports regarding the relationship with clinical characteristics and disease severity. AIM: To summarise that APOE polymorphisms are associated with the risk of developing IBD and the early age of disease onset. METHODS: In total, 406 patients aged 3-18 with IBD (192 had ulcerative colitis and 214 had Crohn's disease) were genotyped using the TaqMan hydrolysis probe assay. Clinical expression was described at diagnosis and the worst flare by disease activity scales, albumin and C-reactive protein levels, localisation and behaviour (Paris classification). Systemic steroid intake with the total number of courses, immunosuppressive, biological, and surgical treatment with the time and age of the first intervention were determined. The total number of exacerbation-caused hospitalisations, the number of days spent in hospital due to exacerbation, the number of relapses, and severe relapses were also estimated. RESULTS: Ulcerative colitis patients with the APOEε4 allele had lower C-reactive protein values at diagnosis (P = 0.0435) and the worst flare (P = 0.0013) compared to patients with the APOEε2 allele and genotype APOEε3/ε3. Crohn's disease patients with the APOEε2 allele scored lower on the Pediatric Crohn's Disease Activity Index at diagnosis (P = 0.0204). IBD patients with APOEε2 allele spent fewer days in the hospital due to relapse (P = 0.0440). CONCLUSION: APOE polymorphisms are associated with the risk of developing IBD and the clinical expression of IBD. However, the clinical relevance of the differences identified is rather modest.

Faecal Microbiota Transfer - a new concept for treating cytomegalovirus colitis in children with ulcerative colitis.

INTRODUCTION: Cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD) is reactivated by the use of immunosuppressive drugs. CMV infection may produce IBD flares refractory to standard therapy. OBJECTIVE: The aim of our study was to assess the efficacy and safety of faecal microbiota transplantation (FMT) for the treatment of CMV colitis in patients with ulcerative colitis (UC) flare. MATERIAL AND METHODS: A total of 8 children, with mild to severe UC, positive for CMV PCR in colonic biopsies, received 50-100 ml FMT by nasogastric tube on 5 consecutive days in each of 2 weeks. During the study, the subjects were treated with 5ASA and FMT. Immunosuppressant therapy was withdrawn, when CMV colitis was diagnosed by positive DNA PCR in colonic tissues. The clinical response was defined as a decrease of Paediatric UC Activity Index by ≥20 points. RESULTS: At the 6th week of the study, negative colonic CMV DNA PCR was measured after 10 infusions in 7/8 patients. For one boy, 20 infusions were administered to assess CMV elimination from colonic biopsies. A clinical response was observed in 3/8 patients, with clinical remission in 3/8 patients. Faecal calprotectin decreased significantly in 3 patients. CRP normalized in 2 patients after 6 weeks. No serious adverse effects were observed during and after infusions. CONCLUSIONS: FMT seems to be an effective and safe treatment option for CMV colitis in children with UC. This is the first study to demonstrate the application of FMT as a new therapeutic option for CMV colitis.

Frequency of gastroesophageal reflux disease in adolescent girls with anorexia nervosa. / Czestosc choroby refluksowej u pacjentek z jadlowstretem psychicznym.

OBJECTIVES: The aim of the study was to assess the incidence of gastroesophageal reflux disease (GERD) in young females with anorexia nervosa (AN). METHODS: Participation in the study was proposed to young females with AN aged 12-18 who were hospitalized in the Department of Child Psychiatry, Medical University of Warsaw. Exclusion criteria were psychiatric disorders other than AN and treatment with prokinetic drugs and/or antacids (such as proton pump inhibitors or histamine receptor antagonists) in the last 2 weeks prior to the study. Patients were interviewed for gastrointestinal symptoms that can be related to GERD. Anthropometric measurements were obtained to assess the nutritional condition of the patients, and all of them were subjected to 24-hour pH-impedance monitoring. The pH-impedance recording was considered abnormal when the total number of reflux episodes exceeded 70 and/or the overall esophageal acid exposure time exceeded 6%. RESULTS: 23 female patients with AN were included in the study. They reported numerous symptoms, e.g., epigastric pain, nausea, vomiting, heartburn, chest pain, or excessive belching. However, only 2 of them (8.7%) were diagnosed with GERD on the basis of 24-hour pH-impedance monitoring. Both were suffering from a restrictive subtype of anorexia. CONCLUSIONS: Even if numerous gastrointestinal symptoms indicative of GERD are reported by patients with AN, diagnosis of the disease in this group should not be based on symptoms, but it should be confirmed in an objective examination, preferably pH-impedance test.

Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy.

OBJECTIVES: Recent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH. METHODS: This was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator. RESULTS: 38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs. CONCLUSION: It is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

Immune Response to Vaccination in Children and Young People With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis was to assess immune response to vaccination in children and young people with inflammatory bowel disease (IBD). In patients with IBDs, both the disease itself and its treatment can affect the vaccine response. METHODS: Medical databases were searched for relevant studies and statistical analysis was performed. As a result, 20 publications were included in the study, 9 of which met the criteria for the meta-analysis. RESULTS: The immune response to vaccination was better in healthy subjects (odds ratio = 0.73, 95% confidence interval = 0.45-1.17) and patients without immunosuppressive treatment (odds ratio  = 0.65, 95% confidence interval = 0.41-1.03), but did not reach statistical significance. CONCLUSIONS: Immunogenicity of vaccinations in children and young people with IBD is not significantly lower than it is in healthy ones. Immune response to vaccination in this group of patients is also not significantly lower in patients on immunosuppressive therapy than in those without it.

Awareness of smoking in adolescents with inflammatory bowel disease.

INTRODUCTION AND OBJECTIVES: Inflammatory bowel disease (IBD) is long life disease that results from an interaction between a polygenetic predisposition and environmental factors, including smoking. The aim of this study was to evaluate beliefs about and awareness of smoking among adolescents with IBD compared to healthy controls. MATERIAL AND METHODS: Patients with IBD, Crohn's disease (CD) and ulcerative colitis (UC), and healthy controls were asked to complete a questionnaire on demographic data and smoking status. The questionnaire also included data on beliefs and awareness of smoking-related health effects, including effects on IBD. RESULTS: A total of 139 IBD patients and 108 controls were enrolled in the study. Of the IBD patients, 17/139 (12.2%) were smokers compared to 18/108 (16.7%) of controls (p=0.3). Patients with IBD were nine times more likely to be everyday smokers than occasional smokers (OR=9.2, 95% CI: 1.9- 45.1, p=0.004). No difference was found between patients with CD and UC in their answers to the question of whether "smoking increases the risk for surgery in your type of IBD" (17/28 (60.7%) vs. 10/29 (34.5%), respectively (p=0.047). More patients with CD than UC were aware of the risks of smoking on their disease: extra-intestinal manifestations and disease exacerbation, OR=11.3 (95% CI: 4.1 - 30.9; p=0.000) and OR=19.3 (95% CI: 6.7 - 55.1; p=0.000), respectively. CONCLUSIONS: The data obtained demonstrated that adolescents with CD are much more aware of the role of smoking on CD than are their peers with UC; however, this awareness is still unsatisfactory. Therefore, there is an unmet need to implement better anti-smoking strategies for this group of patients.

Immune response to hepatitis B vaccination in pediatric patients with inflammatory bowel disease.

AIM OF THE STUDY: To evaluate the immune response rate in children with inflammatory bowel disease (IBD) who received the full hepatitis B vaccination course in infancy. We also evaluated rates of response to booster doses. MATERIAL AND METHODS: Participants were 1- to 18-year-old children with IBD, who received 3 doses of the hepatitis B vaccine in infancy. The study subjects were on no immunosuppressive therapy, on immunomodulators, on biological therapy, or received combo therapy. Anti-hepatitis B surface antibody (anti-HBs) level ≥ 10 mIU/ml was considered to be seroprotective. Patients with anti-HBs level < 10 mIU/ml received 1 or 3 doses of hepatitis B vaccine, and their post-vaccination anti-HBs levels were evaluated. RESULTS: In total, we included 157 subjects, with a median age of 14.5 years. Anti-HBs levels ≥ 10 mIU/ml were found in 84/157 (53.5%) patients and were not associated with age (p = 0.3), sex (p = 0.7), or IBD type (p = 0.9). There was no significant difference in the rate of seroconversion between IBD patients treated with no immunosuppressive drugs, immunomodulators, biologicals, and combo therapy (30.4% vs. 39.3% vs. 2.7% vs. 7.1%, respectively, p = 0.3). After the first and third dose of booster vaccine, anti-HBs levels ≥ 10 mIU/ml were as follows: 92% and 100%, respectively. CONCLUSIONS: The immune response in children with IBD, who received the full series of hepatitis B vaccinations in infancy was inadequate and did not depend on the type of therapy. The booster dose(s) of vaccine could help to protect this group of patients from hepatitis B virus.

Inflammatory bowel disease is associated with increased gut-to-blood penetration of short-chain fatty acids: A new, non-invasive marker of a functional intestinal lesion.

NEW FINDINGS: What is the central question of this study? 'Leaky gut' has been found in intestinal and extra-intestinal diseases. However, functional evaluation of intestinal permeability is not widely used as a diagnostic marker, possibly owing to significant limitations of currently used permeability assays. There is an unmet need for development of a new, non-invasive test to assess intestinal function. What is the main finding and its importance? We show that an increased blood-to-stool ratio of the concentration of gut bacteria-produced short-chain fatty acids may be used as a marker of gut permeability. Our findings lay the groundwork for establishing a new, non-invasive, risk-free diagnostic tool in diseases associated with intestinal barrier malfunction, such as inflammatory bowel disease. ABSTRACT: Intestinal diseases, such as inflammatory bowel disease (IBD), are characterized by an impaired gut-blood barrier commonly referred to as 'leaky gut'. Therefore, functional evaluation of the gut-blood barrier is a promising diagnostic marker. We hypothesized that short-chain fatty acids (SCFAs) produced by gut bacteria might serve as a marker in IBD. Animal experiments were performed on male Sprague-Dawley rats with acetic acid-induced colitis and in sham control animals. The gut-blood barrier permeability was determined by assessing the ratios of the following: (i) portal blood concentration of SCFAs (Cp ) to faecal concentration of SCFAs (Cf ); (ii) systemic blood concentration of SCFAs (Cs ) to faecal concentration of SCFAs (Cf ); and (iii) Cp and Cs of fluorescein isothiocyanate (FITC)-dextran administered into the colon. As a clinical study, we evaluated Cs , Cf and the Cs /Cf ratio of SCFAs in six paediatric patients with IBD, assessed as mild/moderate/severe by the Paediatric Ulcerative Colitis Activity Index (PUCAI) and the Paediatric Crohn's Disease Activity Index (PCDAI) at the time of sample collection, and nine age-matched healthy control subjects. Rats with histologically confirmed IBD had significantly increased ratios of Cp /Cf and Cs /Cf for SCFAs. This was positively correlated with the plasma FITC-dextran concentration. Likewise, IBD patients showed a significantly higher Cs /Cf ratio for SCFAs, including acetic, valeric, isocaproic, caproic and propionic acids, in comparison to control subjects. In conclusion, in the rats and in paediatric patients with IBD we found an increased blood-to-stool ratio of SCFAs, suggesting an increased gut-to-blood penetration of SCFAs. These findings pave the way for a new, non-invasive diagnostic tool in IBD and other diseases accompanied by intestinal barrier malfunction.

Dietary Beliefs and Behaviors Among Parents of Children with Inflammatory Bowel Disease.

Diet is regarded as one of the important environmental factors triggering inflammatory bowel disease (IBD). Many IBD patients avoid numerous types of foods in fear of disease exacerbation. The aim of the study was to investigate dietary beliefs and food avoidance among pediatric patients with IBD. This questionnaire-based study was conducted in three University-affiliated children's hospitals in Poland. Data were collected from parents of children who were diagnosed with IBD. A total of 155 parents of IBD patients participated in the survey: 104 (67.1%) had a child with Crohn's disease and 51 (32.9%) with ulcerative colitis. Parents of older children and those with longer disease duration predicted diet being considered one of the causative agents of IBD, and differences were statistically significant (P = .01 and P = .04, respectively). Also, patients with a shorter history of disease rarely shared food with other family members (P = .02). In total, 61.5% of patients avoided some kind of food in fear of disease flares. In the parent's opinion, the food the children liked but avoided included fried dishes, sweets (e.g., chocolate, cookies, cakes, candies, jellies), and fast food. Due to their dietary beliefs, parents of children with IBD commonly introduced dietary restrictions for their offspring. Frequent and unjustified food avoidance may influence not only nutritional status but also general well-being of pediatric patients. Our results underscore the urgent need for IBD patients and parents of ill children to receive reliable dietary advice based on strong scientific evidence.

A Two-Week Fecal Microbiota Transplantation Course in Pediatric Patients with Inflammatory Bowel Disease.

Dysbiosis plays a major role in the etiology of inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) is a new promising option for IBD treatment. We aimed to assess the effectiveness of a two-week FMT course in children with IBD. Ten patients, 10-17 years of age with moderate to severe IBD received a course of eight doses of freshly prepared FMT via a naso-duodenal tube or gastroscopy. All of the patients had pancolitis. There were eight cases of ulcerative colitis (UC) and two of Crohn's disease (CD). Disease activity was evaluated using the Pediatric UC Activity Index (PUCAI) and Pediatric CD Activity Index (PCDAI) for UC and CD, respectively, CRP, and fecal calprotectin on the day before the first infusion and then on the day before the next course of FMT. Clinical response, defined as a decrease of 15 points in either index, was observed in 9/10 patients (seven UC and two CD). Clinical remission, defined as a PCDAI score ≤ 10 and PUCAI score < 10 measured at the same time point, was observed in 3/8 UC patients and 2/2 CD patients. Side effects observed were self-limiting and benign. We conclude that a short, intensive course of FMT has a beneficial effect on UC and CD colitis. FMT was well-tolerated and safe. Nonetheless, an optimal protocol of FMT administration is crucial for treatment efficacy.

Values From Three-dimensional High-resolution Anorectal Manometry Analysis of Children Without Lower Gastrointestinal Symptoms.

BACKGROUND & AIMS: Three-dimensional high-resolution anorectal manometry (3DHRAM) provides a topographic image of pressure along the anal canal. We aimed to determine normal 3DHRAM values in children. METHODS: We performed a prospective study of 61 children (34 male; mean age, 8.28 years) without any symptoms arising from the lower gastrointestinal tract who were evaluated at the Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Poland. Manometry procedures were performed by using a rigid probe without medication. Pressure within the anal canal and 3D images of sphincters were measured. If possible, squeeze pressure and thresholds of sensation were evaluated. The population was divided into age groups of <5 years, 5-8 years, 9-12 years, and older than 12 years. RESULTS: The mean resting and squeeze sphincter pressures were 83 ± 23 mm Hg and 191 ± 64 mm Hg, respectively. The mean length of the anal canal was 2.62 ± 0.68 cm and correlated with age (r = 0.49, P < .0001). The mean rectal balloon volume to elicit rectoanal inhibitory reflex was 15.7 ± 10.9 cm(3). The first sensation, urge, and discomfort were observed at balloon volumes of 24.4 ± 23.98 cm(3), 45.9 ± 34.55 cm(3), and 91.6 ± 50.17 cm(3), respectively. The mean resting pressure of the puborectalis muscle was 69 ± 14 mm Hg, whereas the mean squeeze pressure was 124 ± 33 mm Hg. There was no statistically significant difference in pressure parameters between age groups. We observed a positive correlation between age and balloon volume needed to elicit discomfort (r = 0.49, P < .001). CONCLUSIONS: In a prospective study, we determined normal values from 3DHRAM analysis of children without symptoms arising from the lower gastrointestinal tract. There were no significant differences in pressure results between children of different sexes or ages. ClinicalTrials.gov number: NCT02236507.

Overweight and obesity in children with newly diagnosed inflammatory bowel disease.

PURPOSE: Determination of overweight and obesity prevalence in children with inflammatory bowel disease (IBD) at the time of diagnosis. MATERIAL AND METHODS: This was a multicenter retrospective study. The study group consisted of children with new cases of IBD diagnosed in 2005-2013 according to the Porto criteria. Hospital admission records were reviewed for demographic and clinical characteristics. BMI-for-age and gender percentile charts were used to define overweight as ≥85th BMI percentile and obesity as ≥95th BMI percentile. RESULTS: 675 patients were evaluated: 368 with Crohn's disease (CD) and 307 with ulcerative colitis (UC). Of these, 54.8% were boys and 45.2% were girls. There were no statistically significant differences in age, weight, height and disease activity between the CD and UC patients. The UC patients had higher BMI values than the CD patients. The prevalence of overweight and obesity was higher in the UC than the CD patients (4.89% CI95 2.76-7.93 vs. 2.45% CI95 1.12-4.59 and 8.47% CI95 5.61-12.16 vs. 1.9% CI95 0.77-3.88, respectively); the differences were statistically significant (-2.44% CI95 -5.45 to 0.49 and -6.57% CI95 -10 to -3.1, respectively). The risk of overweight/obesity was 3.5 times higher for patients with UC (OR=0.272, CI95 0.14-0.49, p=0.0004). CONCLUSIONS: The prevalence of overweight and obesity in newly diagnosed children with IBD was 8.4% and was higher in patients with UC than in patients with CD. The results of this study have shown that not only malnourished children may suffer from IBD but also children who are overweight or obese at the time of diagnosis.

Gastrointestinal motility disorders in patients with anorexia nervosa - a review of the literature.

Anorexia nervosa is a disease carrying havoc on many levels of the body functioning. The presence of numerous somatic complications as a consequence of starvation is an important part of the clinical picture of this disease. Symptoms of the gastrointestinal tract are one of the most common complaints reported by patients, especially in the initial period of realimentation. Most common symptoms are associated with gastrointestinal motility disorders. The available data show that as many as half of patients suffering from anorexia nervosa manifest significant gastrointestinal motility disorders (incomplete relaxation of the upper and lower oesophageal sphincter, impaired compliance of the stomach, delayed gastric emptying, intestinal transit extension, decreased motility of the rectum and anus). These disorders along with gastrointestinal tract ailments may impede the restoration of proper diet, if not detected early and treated. There are relatively few studies on gastrointestinal motility disorders in patients suffering from anorexia nervosa, which do not clearly answer the question whether these disorders are genetic, or result from cachexia and whether they disappear along with the restoration of the normal body weight. No reference of research results to the clinical practice, and the lack of standard procedures for diagnosis and treatment of gastrointestinal disorders in patients with anorexia nervosa are significant problems for specialists in the field of psychiatry and gastroenterology.