Hemosuccus Pancreaticus Following Acute Pancreatitis in a 12-years-old Boy Secondary to Pancreatic Pseudoaneurysm Treated With Endovascular Coil Embolization.

Hemosuccus pancreaticus is a very rare cause of upper gastrointestinal bleeding in children. It is defined as bleeding from the pancreatic or peripancreatic vessels into the main pancreatic duct and may be life-threatening. We present the case of a 12-year-old boy with hematemesis and severe anemia that developed following an episode of acute pancreatitis. Upper endoscopy did not reveal a bleeding source. An endoscopic retrograde cholangiopancreatography performed for the evaluation of common bile duct obstruction identified bleeding from the pancreatic duct. Subsequently, the bleeding source, a pseudoaneurysm of the splenic artery, was identified by conventional angiography and occluded with coil embolization. The diagnosis of hemosuccus pancreaticus may be difficult in children due to rare occurrence and the unusual anatomical site; hence, a high index of suspicion is needed in a patient with a history of pancreatitis who presents with intermittent upper gastrointestinal bleeding and normal upper endoscopy.

Outcomes from a 12-Week, Open-Label, Multicenter Clinical Trial of Teduglutide in Pediatric Short Bowel Syndrome.

OBJECTIVE: To determine safety and pharmacodynamics/efficacy of teduglutide in children with intestinal failure associated with short bowel syndrome (SBS-IF). STUDY DESIGN: This 12-week, open-label study enrolled patients aged 1-17 years with SBS-IF who required parenteral nutrition (PN) and showed minimal or no advance in enteral nutrition (EN) feeds. Patients enrolled sequentially into 3 teduglutide cohorts (0.0125 mg/kg/d [n = 8], 0.025 mg/kg/d [n = 14], 0.05 mg/kg/d [n = 15]) or received standard of care (SOC, n = 5). Descriptive summary statistics were used. RESULTS: All patients experienced ≥1 treatment-emergent adverse event; most were mild or moderate. No serious teduglutide-related treatment-emergent adverse events occurred. Between baseline and week 12, prescribed PN volume and calories (kcal/kg/d) changed by a median of -41% and -45%, respectively, with 0.025 mg/kg/d teduglutide and by -25% and -52% with 0.05 mg/kg/d teduglutide. In contrast, PN volume and calories changed by 0% and -6%, respectively, with 0.0125 mg/kg/d teduglutide and by 0% and -1% with SOC. Per patient diary data, EN volume increased by a median of 22%, 32%, and 40% in the 0.0125, 0.025, and 0.05 mg/kg/d cohorts, respectively, and by 11% with SOC. Four patients achieved independence from PN, 3 in the 0.05 mg/kg/d cohort and 1 in the 0.025 mg/kg/d cohort. Study limitations included its short-term, open-label design, and small sample size. CONCLUSIONS: Teduglutide was well tolerated in pediatric patients with SBS-IF. Teduglutide 0.025 or 0.05 mg/kg/d was associated with trends toward reductions in PN requirements and advancements in EN feeding in children with SBS-IF. TRIAL REGISTRATION: ClinicalTrials.gov:NCT01952080; EudraCT: 2013-004588-30.

Percutaneous endoscopic gastrostomy in children: a population-based study from iceland, 1999-2010.

AIM: The aim of this study was to review the indications and the results of percutaneous endoscopic gastrostomy (PEG) procedures in Icelandic children. PATIENTS AND METHODS: A retrospective review of all pediatric PEG procedures performed in Iceland in 1999-2010 was conducted. Diagnosis, demographics, complications, and body mass index were recorded. RESULTS: Ninety-eight children (51 girls) were included. Median age was 2 years (range, 1 month-17 years). The most common diagnosis was neurological disease (56%). Median length of stay was 4 days (range, 1-189 days). Extended length of stay was not related to PEG. Before surgery, median body mass index (BMI) was 14.5 kg/m(2) (range, 9.8-20.8 kg/m(2)), and the median BMI-for-age z-score was -1.4 (range, -5.9 to 3.0). One year after surgery, median BMI was 15.3 kg/m(2) (range, 11.2-22.1 kg/m(2)), and median BMI-for-age z-score was -0.5 (range, -5.1 to 3.8). The median weight increased significantly in 1 year by 1.0 standard deviation (P<.0001; 95% confidence interval, -1.4820 to -0.7387). One hundred sixty-six complications were recorded in 65 children; 96% were minor, with the most common being granuloma formation (19%) and superficial skin infection (25%). The rate of infection was not statistically different between those who received preoperative antibiotics versus no antibiotics (P=.296). Major complications were peritonitis (n=3), esophageal tear (n=1), buried bumper (n=1), and malposition of the gastrostomy tube (n=1). Median follow-up was 47 months (range, 1-152 months). Fourteen children died (at 1 month to 3 years), but no deaths were related to PEG insertion. Twenty-seven children were without gastrostomy at follow-up. Twelve children (14%) underwent fundoplication later; 11 of them were neurologically impaired. CONCLUSIONS: PEG is a safe technique with a high complication rate, but the majority of complications are minor and easily treatable. Gastrostomy is sometimes temporary. Enteral feeding results in significant weight gain in 1 year.

[Eosinophilic esophagitis in children. Two case reports]. / Raudkyrningabólga í vélinda í börnum. Tvö sjúkratilfelli.

Eosiniophilic Esophagitis (EoE) is a relatively new disease which was first reported in 1978 but increasingly diagnosed in the last 15 years. Initially EoE was mainly described in children but later also recognized in adults. In infants it presents as a food refusal, failure to thrive and vomiting. In older children and adults symptoms include chest pain dysphagia, oesophageal food impaction and even strictures on endoscopy. The etiology of EoE is often food allergy. Diagnosis is made on biopsies from the oesophagus and by excluding other causes of eosophageal eosinophilia. It is treated by eliminating the offending food groups or using local corticosteroids. We describe different presentation of eosinophilic esophagitis in two children and discuss diagnosis and treatment.

Inflammatory bowel disease in Icelandic children 1951-2010. Population-based study involving one nation over six decades.

AIM AND BACKGROUND. We describe the changes in incidence and disease location of inflammatory bowel disease (IBD) in children in one country over six decades. Iceland is an island with centralized health information. Children with IBD are cared for in only two hospitals. Iceland is therefore well suited for nationwide epidemiologic studies. MATERIAL AND METHODS. All IBD patients 16 years and younger diagnosed in Iceland from 1950-2010 were included. Patients were identified retrospectively from 1950-1989, and prospectively from 1990-2010, by reviewing pathology and charts for all patients diagnosed with IBD. Criteria for the diagnosis of ulcerative colitis (UC) were history of blood in stools for >3 weeks, characteristic endoscopic appearance of continuous inflammation of the colon, and histologic appearance of acute and chronic inflammation of the colon without granulomata. Criteria of Crohn's disease (CD) were history of abdominal pain, blood in stools, and endoscopic, radiologic, and histologic features of CD. RESULTS. One hundred and ten children were diagnosed with IBD, 61 with UC, 44 with CD, and 5 with indeterminate disease. The median age was 13.7 ± 2.6, with sex distribution varying from decade to decade. From 1980 until 2000, there was a dramatic increase in the incidence of IBD from 1.2 per 100,000 children <16 years of age to 5.6 per 100,000. However, in the past decade, the incidence has plateaued. CONCLUSION. In this population-based pediatric study, we report an increase in the incidence of IBD from 1950-2000. Incidence in Icelandic children is lower than in published studies from other Northern European countries.

Quality of life in children and adults with constipation.

This review summarises the literature on quality of life (QOL) assessments in both children and adults with functional constipation. Studies of adults with constipation include subjects from both tertiary care centres and population-based surveys whereas there are no population-based studies in children. The preponderance of evidence indicates that the adverse effects of chronic constipation on QOL in both children and adults are comparable to that seen in other chronic gastrointestinal and non-gastrointestinal disorders. There are no data on the effect of treatment of children with constipation with regard to QOL whereas several studies indicate that successful treatment of constipation in adults has a favourable effect on QOL. The emerging concept in the treatment of chronic constipation is to measure both objective measures such as frequency and ease of defecation and subjective parameters such as QOL.

Eosinophilic esophagitis: strictures, impactions, dysphagia.

Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with > 5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with > 20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5-20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if < 20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with > 20 eos/hpf.