BACKGROUND Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children. AIM To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters. METHODS The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters. RESULTS Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group ( n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices . Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 ( P = 0.001) and 0.726 ( P = 0.014). CONCLUSION The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

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Background: Children with immunosuppression may be at risk of severe coronavirus disease 2019 . The outcomes of COVID-19 on pediatric liver transplant recipients (PLTR) are variable and there are limited data available in Thailand. This study aims to report the impact of COVID-19 on pLTR at the current transplant center. Methods: PLTR under 18 years old, who had COVID-19 infection from April 2020 to July 2022, were included. Data were retrospectively reviewed, including demographics, clinical presentation, laboratory, and treatment outcomes. Results: A total of 38 PLTR (50% male) with COVID-19 infection were identified. Ten (28%) received two doses of BNT162b2 and 14 (38%) did not vaccination. The median age was 7.1 (range, 4.2-10.1) years. The median time from transplantation to infection was 55.5 (range, 28.5-86) months. Twenty-nine patients (76.3%) were symptomatic. The most common symptoms were fever (65%), followed by sore throat (26%) and rhinorrhea (21%), respectively. There were neither gastrointestinal nor lower respiratory symptoms. The median AST and ALT were not different between pre-and post-infection. PLTR who received mycophenolate mofetil (MMF) developed lower total white blood cell count, compared with other regimens (2,320 [1780-3112] vs. 4,450 [3750-5316]/cu mm., P<0.001). Prednisolone, MMF and tacrolimus were used in 10%, 23%, and 80%, respectively. Immunosuppression was modified in 5.2% of patients after infection, all of which was MMF dose reduction. Three (7.8%) patients were hospitalized, two of whom were treated with favipiravir. The rest (35 patients, 82.8%) were treated with favipiravir outpatient. The median duration of symptoms was 2.3 (range, 0.7-3) days. All patients recovered without disease progression or liver graft dysfunction. No mortality was observed. Conclusions: PLTR receiving immunosuppression might not be at risk of severe COVID-19. COVID-19 in PLTR poses no significant impact on liver graft survival and morbidity. Immunosuppression dose adjustment may not be necessary.

Background: Half of the pediatric liver transplantation (LT) patients developed at least one episode of infection within 6 months after LT. However, few studies reported infections and outcomes after pediatric LT in Thailand. We aim to examine the characteristics of infections and determine the factors associated with infections and clinical outcomes after pediatric LT. Methods: A retrospective cohort study was conducted in patients aged <18 years who had LT. Medical records were reviewed in the first-year posttransplantation. The risk factors for developing an infection, factors associated with infections and clinical outcomes were evaluated using logistic regression. Results: From January 2009 to August 2021, 99 cases who had pediatric LT were analyzed. The median (interquartile range) age was 14 months (10-46 months). All patients, except for four patients, completed their follow-up. There were 464 infection episodes within the first-year posttransplantation. The predominant infection sites were in the bloodstream (120, 25.9%) and gastrointestinal tract (68, 14.7%). Overall, bacterial infections accounted for 166 infections (35.7%). The most common bacterial pathogen was Escherichia coli (22.9%). The mean (SD) operative duration was 10 (±1.8) hours and 61.6% took more than 10 hours which was a factor significantly associated with infection post LT (odds ratio, 5.5; 95% confidence interval, 1.0-29.0). The 1-year survival rate post LT was 96.0%. Out of the 4 deaths, three patients died due to infections. Conclusions: The most common site of infection was in the bloodstream and Gram-negative bacterial infections developed in one-third of the recipients. Prolonged operative duration significantly increased the risk of developing infections post-LT.