No abstract

Background Pediatric intestinal pseudo‐obstruction (PIPO) encompasses a variety of rare, heterogeneous, and disabling disorders that severely affect gastrointestinal motility and are associated with high morbidity and mortality. PIPO management is complex and focuses on maintaining an optimal nutritional status, improving gut function, relieving symptoms, and treating complications. Nutritional issues prevail, and PIPO patients often experience severe undernutrition and faltering growth. Thus, nutritional management plays a pivotal role for achieving the most favorable clinical outcomes. The calorie and nutrient intake of each patient needs to be tailored to age, extent and severity of gut involvement and nutritional needs to support an optimal nutritional status. After defining the extent and severity of gut dysmotility, an experienced team should perform a careful nutritional assessment. An oral diet should always be encouraged and might include bite and dissolve solids, liquid diet or simple oral stimulation. If oral caloric intake is inadequate, liquid gastric feeds should provide the subsequent step. In the presence of severe gastric dysmotility, continuous post‐pyloric feeding represents a viable option. In the most severe cases, parenteral nutrition (PN) is required to meet appropriate nutritional requirements. Purpose Pediatric data on this topic are scarce and mainly extrapolated from adult studies. In this review, we discuss current evidence and knowledge regarding nutritional options, implications of the use of different feed types, including a blended diet, and the use of PN. Moreover, based on our experience and the evidence from the literature, we propose a flow chart to guide the nutritional management of PIPO patients.

GI bleeds requiring endoscopy (UGIB) and/or other emergency upper endoscopies (OEE). Cases were reported in REDCap. Results 28 centres provided denominator data with regard to the services they provide (covering 90% of the UK population). 22 provided prospective data for UGIB and 18 for OEE covering 70 and 60% of the UK population respectively. 98 cases were reported over a 6 month period: 34 UGIB, 55 OEE, (38 foreign body and 17 others); 9 less severe UGI bleeds not fitting the definitions were excluded from further analysis.Of 25 centres reporting, 14(56%) had 0 UGIB and 20/25 (80%) had £2 over the 6 months. Endoscopic interventions for GI bleed were undertaken in only 6/25 centres.The mean age of the UGIB group was 6.7 years, 29% were £1 year. 19(56%) had significant co-morbidities. Presenting symptoms were one or both of melaena and haematemesis. Of the 20 providing sufficient data for a Sheffield score, 25%(4/20) were high ( 8) at presentation (median score 2.5, range 1-24, interquartile range 3.25). Main findings at endoscopy; 8(24%) had no abnormalities, 14(41%) had UGI ulcers (6 duodenal, 6 gastric and 2 oesophageal), 9(26%) oesophagitis and gastritis, 8(24%) varices.13(38%) required endoscopic treatment, 6 for varices, 4 for GU, 2 DU, 1 for blood in upper GI tract. 3 required surgery. Two patients died, one within 48 hours of the bleed in PICU in the context of sepsis and multi-organ failure. 14 patients required inter-hospital transfer, median time from hospital presentation to endoscopy was 97 hours for patients needing transfer and 24 hours for those not.For the OEE (N=55), mean age was 6.3 years, 26% £1 year. 21(38%) had significant co-morbidities. Main indications were foreign bodies (25, 45%) -coins (15), battery (2), button battery (5), magnets and a toy. 13(24%) food bolus obstruction, 11(20%) caustic substance ingestion, 5 oesophageal stricture. 9/55(16%) endoscopies revealed no significant findings, 37(65%) required treatment at endoscopy. 50% (27 patients) had required inter-hospital transfer. Median time from first hospital presentation to endoscopy was 21 hours in those requiring transfer and 14 hours in those not. Conclusions This is the first national prospective study of its kind examining the most urgent and severe endoscopy cases in under 16s. These data indicate that very small numbers of centres are performing endoscopic treatments for severe UGI bleeds. Inter-hospital transfers appears to be much quicker for surgical indications than UGIB although we did not find evidence of poor outcomes in the UGIB due to delayed transfer. The planning, location and skill mix of national emergency endoscopy services require careful consideration.

The changes in all parameters and discontinuation rates in the two groups were compared after one and four months of the therapy. Results In total 71 patients were included in the study, 18 patients of them lots follow up during the study, while 53 continued. There were no significant differences in the baseline demographic and biochemical baseline data between the two groups (P>0.05).After one month, there was statistically significant difference between the two groups in the PGS as it decreased by <1.5x base line in the T-group compared to the C-group (P <0.02).After four months, there were statistically significant between the 2 groups regarding decreased ALT levels below 1.5x base line levels, AST, GGT and bile acid levels in favour of the T-group (P< 0.02, 0.047,0.026 and 0.001 respectively). Summary and ConclusionThe use of FF in combination with UDCA provided satisfactory clinical outcomes, which could be a promising alternative, but patients should be monitored closely as side effects may occur despite achieving improvements in pruritus.

No abstract