Food protein-induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available.

Biliary complications are important causes of morbidity and graft failure in patients after orthotopic liver transplantation. Nonanastomotic biliary strictures (NAS) are frequently the most challenging biliary complications. Hepatic artery stenosis (HAS) as a cause of biliary strictures has not been studied well systematically. We performed a retrospective cohort study of patients who underwent liver transplantation at our institution between 1995 and 2007 to determine the incidence of biliary strictures (nonanastomotic and anastomotic) with HAS. Forty patients were identified, and they were compared with 62 matched non-HAS controls. Overall, NAS and biliary anastomotic strictures were seen more frequently in patients with HAS (24/40 or 60%) versus control patients (6/62 or 9.67%, P < 0.000001). Cholangiographic evidence of NAS was seen in 10 of 40 study patients (25%) and in 1 of 62 control patients (2%, P < 0.0001), whereas evidence of biliary anastomotic strictures was seen in 14 of 40 study patients (35%) and in 5 of 62 control patients (8%, P ¼ 0.0006). The cold ischemia time was also found to be associated with the presence of NAS in patients with HAS (P ¼ 0.024). Patients with biliary strictures were generally managed successfully with endoscopic retrograde cholangiopancreatography balloon dilation/stenting, except for 4 NAS patients who had significant morbidity and mortality. In conclusion, the development of HAS, particularly with a prolonged cold ischemia time, may increase the NAS risk after liver transplantation. HAS is also associated with the development of biliary anastomotic strictures. Prospective studies of frequent arterial monitoring for the early detection of HAS and interventions to prevent biliary complications are needed.

Functional gastrointestinal disorders (FGIDs) commonly affect children and are associated with short- and long-term morbidity. Although the pathogenesis of pain-related FGIDs remains incompletely understood, most investigators agree on a multifactorial etiology and the presence of an altered brain-gut interaction. A continuous interplay of genetic and environmental factors appears to shape the development of the central and enteric nervous systems. The biopsychosocial model is the current operational framework for children with FGIDs, as it recognizes the interaction between social and environmental influences and psychological and physiologic processes. The biopsychosocial model proposes that specific permutations of genetic susceptibility, early life experiences, sociocultural issues, and coping mechanisms could explain the variability in clinical presentation and outcome among individuals.