A recent review elaborates on the newest methods for endoscopic control of bleeding. Topics included caplock clips, endoscopic suturing, and hemostatic sprays.
Full text: New Endoscopic Technologies and Procedureal Advances for Endoscopic Hemostasis (from Clinical Gastroenterology and Hepatology)
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As a pediatric specialist, I do not administer vaccines in our office; at times I wonder how the recommendations for immunizations may have changed. Relatively new vaccines include HPV and MenB. For those who want an up-to-date guidance for 2016 from CDC/ACIP:
In a Gastroenterology study from Taiwan, HBV vaccination has been shown to reduce the risk of Hepatocellular Carcinoma.
Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 105 person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6–9 years old, 10–14 years old, 15–19 years old, and 20–26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17–0.40), 0.34 (95% CI, 0.25–0.48), 0.37 (95% CI, 0.25–0.51), and 0.42 (95% CI, 0.32–0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992–2005 vs 1986–1992; P < .001 and 1986–1992 vs 1984–1986; P < .002). Transmission of HBV from highly infectious mothers and incomplete immunization were associated with development of HCC.
A recent study (GJ Lee et al. JPGN 2016; 63: 340-3) adds a little bit more information regarding hypertransaminasemia in newly diagnosed celiac disease. Some previous information was summarized in a previous blog: Celiac Hepatopathies (2013)
In this retrospective, single center study, 185 children had transaminases obtained at the time of celiac diagnosis (185/388 = 47.7%).
Key findings:
My take: This study indicates that elevated transaminases are common in children with celiac, particularly younger children. As with other studies, the majority resolve on a gluten-free diet. As there is a recognized association with autoimmune hepatitis, in those with elevated ALT, followup after institution of a gluten free diet seems prudent.
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Briefly noted:
B Fischler et al. JPGN 2016; 63: 288-94. This position paper by ESPGHAN suggests testing children with increased transaminases for hepatitis E virus (HEV) and notes that immunocompromised children with HEV may require treatment (with ribavirin or lowering immunosuppression). Best tests: serology for IgM and IgG and HEV RNA PCR.
F Huang et al Hepatology 2016; 64: 350-59. This study from China showed frequent Hepatitis E excreted in milk from infected cows and that this milk is capable of transmit infection when given to rhesus macaques, even if pasteurized. Also, the article notes that seroprevalence of HEV in recent years has been higher than prior estimates (21% from 1988-94 and 6% from 2009-2010).
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This study was covered widely including USA Today, NBC News and other outlets.
From NY Times, an excerpt:
The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.
The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today’s dietary recommendations, may have been largely shaped by the sugar industry…
he Sugar Association, paid three Harvard scientists the equivalent of about $50,000 in today’s dollars to publish a 1967 review of research on sugar, fat and heart disease. The studies used in the review were handpicked by the sugar group, and the article, which was published in the prestigious New England Journal of Medicine, minimized the link between sugar and heart health and cast aspersions on the role of saturated fat…
The New England Journal of Medicine did not begin to require financial disclosures until 1984.
Last week, this blog posted an abstract regarding the use of “real foods” for short gut kids. This post looks into whether certain foods may provoke an allergic response.
A large (n=105) single center retrospective study (C Duggan et al. JPGN 2016; 63: 336-39) examined the histology from 208 endoscopic procedures to determine the frequency of eosinophilic disease in children with intestinal failure.
Key findings:
While a strict elemental diet was not shown to be effective in this study, the limitations of the study design (eg. retrospective, small number on amino acid diet) preclude a definitive answer about the utility of these diets. Other confounders, including ongoing parenteral nutrition support, also ‘muddy’ the picture. A prospective study would be able to determine more conclusively how effective elemental diets are at minimizing eosinophilic inflammation and to allow for a more uniform definition of abnormal tissue eosinophilia.
Given the frequency of elemental diets early in life along with prior GI insults, the propensity to eosinophilic disease may have its origins well before this study period. In healthy children, the LEAP, LEAP-ON, and EAT studies indicated that earlier exposure to allergens reduces the risk of allergic disease.
My take: This study shows a high prevalence of GI eosinophilic inflammation among children with intestinal failure. Thus, in children with hematochezia and intestinal failure, eosinophilic colitis needs to be considered.
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N Singh et al. Inflamm Bowel Dis 2016; 22: 2121-25. Abstract:
Background: Though vedolizumab has received regulatory approval for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC) in adults, there is increasing off-label use in children.
Aims: To describe the experience with vedolizumab in pediatric inflammatory bowel disease (IBD) patients at 3 tertiary IBD centers and examine predictors of remission.
Methods: A retrospective review identified pediatric IBD patients (age < 18 yrs) receiving vedolizumab. Data on demographics, disease behavior, location, activity, and previous treatments/surgeries were collected. Disease activity was assessed using the weighted pediatric CD activity index or pediatric UC activity index. Primary outcome was week 14 remission, defined as pediatric UC activity index <10 or weighted pediatric CD activity index <12.5. Descriptive statistics and univariate analyses were performed to examine associations of clinical characteristics with efficacy.
Results: Fifty-two patients, 58% CD and 42% UC, initiated vedolizumab between June 2014 and August 2015. Median age at vedolizumab initiation was 14.9 (range 7–17) years. Ninety percent had failed ≥1 anti-tumor necrosis factor (TNF) agent. Week 14 remission rates for UC and CD were 76% and 42%, respectively (P < 0.05). Eighty percent of anti–TNF-naive patients experienced week 14 remission. At week 22, anti–TNF-naive patients had higher remission rates than TNF-exposed patients (100% versus 45%, P = 0.04). There were no infusion reactions or serious adverse events/infections.
Conclusions: Our results suggest that vedolizumab is efficacious and safe in pediatric IBD patients, with UC patients experiencing earlier and higher rates of remission than CD patients. Anti–TNF-naive patients experienced higher remission rates than those with anti-TNF exposure. Controlled clinical trial data are needed to confirm these observations.
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gutsandgrowth 