Just when it looked like new treatments could eliminate/cure hepatitis C virus (HCV), it turns out that with the opioid epidemic, HCV infections are increasing at a rapid pace (TJ Liang, JW Ward. NEJM 2018; 378: 1169-71).
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Estimated number of new Hepatitis B and Hepatitis C Infections in the U.S. from CDC Data.
Briefly noted: S Miao et al. JPGN 2018; 66: 257-62. In this retrospective study, the authors examined the use of peroral endoscopic myotomy (POEM) in children. They , describe a successful outcome in all 21 patients (range 11 months to 18 years). Complications included subcutaneous emphysema (n=4), pneumoperitoneum (n=1), mediastinal emphysema ((n=4), pneumonia (n=1) and mucosal injury (n=1). The authors: “although Heller myotomy is still widely accepted as the standard treatment for achalasia in children, POEM …may provide a better treatment …due to less hospitalization, less trauma, …and long-term efficacy.”
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Amber Cove, Dominican Republic
Briefly noted: B Gonzalez-Suarez et al. IBD 24: 775-80.
In 47 patients with established (n=32) or suspected Crohn’s disease (n=15), MRE was first performed to exclude strictures and then subsequently capsule endoscopy (CE) (with patency capsule in 10 patients). Key finding: Small bowel lesions were found in 36 of 47 with CE compared with 21 of 47 with MRE (76.6% vs 44.7%, P=0.001)
Related blog post: Head-to-Head: Capsule endoscopy compared to colonoscopy
A recent retrospective study (K Queliza et al. JPGN 2018; 66: 620-23) describes seven patients with granulomatous disease in the upper GI tract who were diagnosed with ulcerative colitis.
This study examined patients at a single center between 2007-2016 with ages ranging from 2 years to 17 years. Median time of followup is not provided. Two patients required colectomy. All patients had non-casseating granulomas identified in either the stomach or duodenum (or both) along with moderate to severe pancolitis. All of the patients had extensive investigations, generally cross-sectional imaging (MRE or CT) or capsule endoscopy
Key point::
My take: This study highlights the confusion of the essentially binary classification of IBD into either Crohn’s disease or ulcerative colitis, when in fact there are hundreds of genetic mutations which give rise to inflammatory bowel disease. Given that granulomas are a hallmark of Crohn’s disease and there are no pathognomic features of ulcerative colitis, only time will tell if these patients have an ulcerative colitis phenotype. I wonder how many centers would take exception to this classification and describe these patients as ‘indeterminate’ colitis/IBDU (IBD unclassified).
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A recent retrospective study (AF Kane et al. J Pediatr 2018; 195: 73-9) with 640 VLBW infants found that the probiobiotic, Lactobacillus rhamnosus GG (LGG), was associated with an increased risk of necrotizing enterocolitis (NEC).
LGG supplementation was started at a median age of 6 days at a dose of 2.5 to 5 x 10 to the 9th CFU/day.
Key finding:
The authors note their findings are in contrast to findings from 38 randomized trials (10,520) which have found that probiotics lowered the risk of NEC.
My take: This study reinforces the need for further studies to identify which factors and probiotic strains are likely to lead to reduced rates of NEC.
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Briefly noted:
D Wendel et al. JPGN 2018; 66: 212-7. This single center retrospective review examined patients who received home TPN prior to liver transplantation. These 18 patients, which represented 41% of their entire transplant cohort of 44 between 2010-2015, all had biliary atresia. Key findings:
My take: While there is an increased burden of care with TPN, improved nutrition may improve long-term outcomes.
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Amber Cove, Dominican Republic
According to a recent study (M Saps et al. JPGN 2018; 66: 387-90), joint hypermobility is not associated with an increased risk of functional gastrointestinal disorders (FGIDs).
From a school-based study of 654 children from a public school in Cali, Columbia, 148 (22.6%) were identified as having an FGID. Among this group, 136 children participated in the study along with 136 age/sex-matched healthy controls. Joint laxity was assessed to establish a Beighton score.
Key finding:
The implication of this study is that previous associations between joint hypermobility (JH) and FGIDs could be due to selection bias at tertiary care centers. Alternatively, “it is possible that the association between FGIDs and JH exists, but it is only limited to a subset of patients that consult at specialized clinics.”
My take: This article challenges the idea that JH increases the risk of FGID. Based on this study, if JH is a risk factor, it is hard to detect in a general population.
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Amber Cove, Dominican Republic
A recent double-blind randomized study (A Repa et al. J Pediatr 2018; 194: 87-93) compared a mixed lipid emulsion (SMOFlipid) to a soybean-oil lipid in 223 extremely low birth weight infants. Median time on parenteral nutrition was ~23 days.
Key findings:
The authors note that even the control group had less cholestasis than previous cohorts and indicated that the use of probiotics and possibly more aggressive enteral feeds were at work.
My take (borrowed in part from authors): These results “cannot be generalized to infants with substantially longer time on PN.” However, this study shows that SMOFlipid alone will not prevent cholestasis, which is well-known to be multifactorial.
Sandy Springs
(L Wang, et al. Gastroenterol 2018; 154: 540-555, https://doi.org/10.1053/j.gastro.2017.10.006)
Using California’s Ambulatory Services Databases, the authors identified 1.58 million surveillance/screening colonoscopies (2005-2011) and compared complications to patients who underwent other ambulatory procedures like joint aspiration, arthroscopy and cataract surgery.
Availlable online: graphical abstract
Key findings:
Image available online: Figure 2
A recent correspondence (M Julsgaard et al.Gastroenterol 2018; 154: 752-65) shows that vedolizumab is detectable in varying concentrations in breastmilk. The authors collected samples from 5 mothers who were receiving vedolizumab (VDZ) for inflammatory bowel disease.
Key findings:
This study is in agreement with another study showing that levels in the breastmilk were minute (~1/100) of serum levels (A Lahat et al. J Crohns Colitis. 2018 Jan 5;12(1):120-123).
My take: These are low levels of VDZ –nevertheless further monitoring of infants to determine conclusively whether VDZ enterally causes any adverse effects is warranted.
Views from Mike O’Callahan -Pat Tillman Bridge
