Purpose Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. Methods This clinical trial included 50 patients aged 3–18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. Results After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. Conclusion A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

Background Esophagogastroduodenoscopy (EGD) is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal bleeding (UGIB); however, the etiology of bleeding remains unknown in a subset of patients. This study aimed to evaluate the diagnostic yield of EGD in UGIB in pediatrics and determine the clinical predictors for positive endoscopic diagnosis. Methods A cross-sectional study was conducted at the pediatrics endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 children were included. They were referred for EGD due to overt UGIB in the form of hematemesis and/or melena. Full medical history, thorough physical examination, laboratory investigations, and endoscopic and histopathologic findings were documented. Results Forty-seven males and 54 females were included. Their ages ranged from 3 months to 15 years, with a median age of 4 years. Sixty-five percent presented with hematemesis only, 7% presented with melena only, and 28% presented with hematemesis and melena. An endoscopic diagnosis could be reached in 62% of cases, with Helicobacter pylori (H. pylori) gastritis (23%) and reflux esophagitis (11%) as the most common endoscopic diagnoses, with the former being the most common in children above 4 years and the latter for younger ones. Other diagnoses included non-specific gastritis (8%) and esophageal varices (4%). Presentation with melena only was a negative predictor to reach a diagnosis by EGD, while splenomegaly and thrombocytopenia were independent predictors of variceal bleeding. Conclusion EGD is the investigation of choice in children suffering from hematemesis especially in older age groups. Clinical and laboratory parameters might help in the prediction of the underlying etiology.

Background: Infant regurgitation is the most prevalent functional gastrointestinal disorder in infancy. Knowing the benign outcome of such condition helps to decrease the anxiety of parents and unnecessary prescriptions by physicians. Objectives: The aims of the current work were to detect the outcome of infant regurgitation among Egyptian infants diagnosed by Rome Ⅳ criteria and to detect its prevalence among the surveyed population. Patients and Methods: A prospective cohort study enrolling 280 healthy infants 1-4 months diagnosed as infant regurgitation according to Rome Ⅳcriteria by fulfilling a questionnaire and undergoing examination. Parents were reassured and educated then both were repeated after 3 months. According to the outcome, infants were divided into symptomatic infants, who were either partially improved or not-improved at all and asymptomatic infants who had stopped regurgitation. Results: The prevalence of regurgitation was 20.3% among the surveyed 1380 infants. On follow up 42.9% of infants became asymptomatic while 49.6% partially improved and only 7.5% didn't improve. Weight was properly gained for all patients except 3 who had failure to thrive, however that was not correlated with the outcome of regurgitation. Proton pump inhibitors were prescribed for 7.7% of cases, however, increasing age was the only predictor of total improvement after 3 months follow up with odds ratio=2.45 and confidence interval (1.57-3.84). Conclusion: Infant regurgitation diagnosed according to Rome Ⅳ criteria seems to be normal behavior in early infancy which resolves by time, just requiring parental , reassurance, and follow up, while no interventions are needed.

The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter. Methods: A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age-and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3 months of laxative therapy and behavioural modification. Results: Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3 cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3 cm for the former and >2.5 cm for the latter. After 3 months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter. Conclusions: Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.

Background: Acute pancreatitis (AP) is the most common pathological entity affecting the pancreas in children. Multi-organ failure and/or pancreatic necrosis, can result from a severe episode of AP. Early severity stratification can result in aggressive treatment and prevent the development of persistent organ damage and multiple organ dysfunction. Multiple studies have evaluated the relationship between AP severity and d-dimer but most of these studies involved only adult population.