Endoscopic characterization of gastrointestinal manifestations in children with undifferentiated recurrent fever.

BACKGROUND AND STUDY AIMS: Systemic autoinflammatory diseases are characterized by recurrent or chronic inflammation, and monogenic forms are increasingly defined. However, a group of patients without genetic diagnosis is called the syndrome of undifferentiated recurrent fever (SURF). This study analyzed the clinical and endoscopic features of patients with SURF presenting with gastrointestinal (GI) symptoms. PATIENTS AND METHODS: Between 2019 and 2022, GI endoscopy were performed in patients with SURF who presented with GI symptoms. Clinical, genetic, laboratory, and endoscopy findings were analyzed. RESULTS: Fifteen patients were included in the study, eight (53.3 %) were girls. The mean age was 10.5 ± 5.80 years, and the median age at symptom onset was 4 (0.3-16) years. All patients experienced fever and abdominal pain. Thirteen patients (86.7 %) experienced diarrhea, 11 (73.3 %) reported myalgia, and 10 (66.7 %) had joint involvement. Lymphoid follicles in the terminal ileum mucosa were detected in 10 patients (66.7 %), and nodular lymphoid hyperplasia in the terminal ileum was the histopathological finding in 12 patients (80 %). CONCLUSIONS: The current study found that patients with SURF experiencing gastrointestinal symptoms have excessive lymph node formation in the terminal ileal mucosa due to an exaggerated inflammatory response. This may be the cause of their GI symptoms.

Effect of comorbid benign joint hypermobility and juvenile fibromyalgia syndromes on pediatric functional gastrointestinal disorders.

OBJECTIVES: Musculoskeletal pain has a considerable frequency in pediatric outpatients. Benign joint hypermobility (BJHS) and juvenile fibromyalgia syndrome (JFMS) are non-inflammatory causes of musculoskeletal pain. In these syndromes, pain is often accompanied by various symptoms such as fatigue, sleep difficulties, mood disorders, cognitive dysfunction, dizziness, headaches, abdominal pain, irritable bowel syndrome, and restless legs syndrome. Functional dyspepsia, functional vomiting, functional abdominal pain, functional constipation, and irritable bowel syndrome all together are termed functional gastrointestinal (GI) disorders. We aimed to evaluate the functional gastrointestinal disorders association of BJHS and JFMS. METHODS: Patients aged 10-18 years who were diagnosed with functional GI disorder in the pediatric gastroenterology department were included in the study. The findings of BJHS and JFMS were evaluated by the pediatric rheumatology department. Scales for anxiety, somatization, and depression were administered by a child psychiatrist. COMPASS 31 scoring was used in autonomic dysfunction. RESULTS: The prevalence of JFMS and BJHS was 64% and 32%, respectively in children with a functional GI disorder. Retrosternal chest pain, dysphagia, early satiation, nausea, vomiting, and regurgitation were common in JFMS (p = 0.007; p = 0.005; p = 0.018; p = 0.002, p = 0.013; p = 0.014, respectively). Gastrointestinal symptoms did not differ with BJHS. One hundred six (88.3%) and 99 (82.5%) had orthostatic intolerance and reflex syncope, respectively. One hundred three (85.6%) had anxiety symptoms, 101 (84.2%) had somatization symptoms, and 102 (85%) had depression symptoms. CONCLUSIONS: Functional GI disorders, JFMS, and BJHS are complex intertwined disorders influenced by emotional distress. Therefore, a multidisciplinary approach is necessary for the diagnosis and treatment process.

Multichannel Intraluminal Impedance and pH Monitoring are Complementary Methods in the Diagnosis of Gastroesophageal Reflux Disease in Children.

OBJECTIVE: Gastroesophageal reflux is considered to be a disease when reflux of gastric contents causes troublesome symptoms in infants and children. The aim of this study was to compare the diagnostic value of the multichannel intraluminal impedance monitoring and only pH monitoring in the diagnosis of gastroesophageal reflux disease in infants and children. MATERIALS AND METHODS: This prospective cross-sectional study consisted of pediatric patients aged between 1 month and 18 years old with symptoms suggestive of gastroesophageal reflux disease. Patients were divided into 2 groups as younger than 24 months (group 1) and older than 24 months (group 2). Twentyfour hours multichannel intraluminal impedance-pH monitoring was performed on the patients. RESULTS: This study included 50 pediatric patients. The mean age of the patients was 5.35 ± 4.92 years. In group 1, total reflux events were fewer than group 2 (P = .03) by pH monitoring. In group 1, the number of non-acid reflux events was higher than in group 2 and in group 2, the number of acidic reflux events was higher than group 1 (P = .04). Reflux was detected by multichannel intraluminal impedance-pH monitoring in 13 (40%) of 32 patients who were assessed as negative by pH monitoring. CONCLUSION: It was concluded that more reliable results were obtained when the 2 methods were used together in this study.