搜索结果：Journal of pediatric gastroenterology and nutrition

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) ≥ 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score ≥+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of ≥20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.

This systematic review critically compares current international guidelines and recommendations from major medical organizations on the management of celiac disease (CD) in individuals with Down syndrome (DS), in light of the increased disease prevalence and the diagnostic challenges posed by overlapping clinical and immunological features. A comprehensive search of PubMed, Embase, Scopus, and international association websites (through June 1, 2025) identified guidelines, position papers, and expert statements endorsed by national or international bodies. Two reviewers independently screened and selected studies, and guideline quality was assessed using the AGREE II tool. Of 929 records identified, seven clinical practice guidelines, and two clinical practice reports were included. Recommendations varied widely, ranging from universal screening (e.g., British Society of Paediatric Gastroenterology, Hepatology and Nutrition [BSPGHAN], Down Syndrome Medical Interest Group [DSMIG], European Society for the Study of Coeliac Disease [ESsCD], European Society for Pediatric Gastroenterology, Hepatology, and Nutrition [ESPGHAN] and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition [NASPGHAN]) to symptom-based testing (e.g., American Academy of Pediatrics [AAP], American Gastroenterological Association [AGA], American College of Gastroenterology [ACG], and National Institute for Health and Care Excellence [NICE]). While there is consensus on serologic screening using tissue transglutaminase IgA (tTG-IgA) and total IgA, interpretation is complicated by the high prevalence of selective IgA deficiency in DS, often necessitating IgG-based testing. HLA genotyping is not generally recommended for routine screening but may help exclude CD in non-susceptible individuals and support biopsy-sparing diagnostic pathways. In conclusion, marked heterogeneity exists among current guidelines. Harmonized, evidence-based recommendations are needed. HLA-DQ2/DQ8 genotyping should be used primarily for its high negative predictive value to exclude CD in non-susceptible individuals with DS. This tiered approach offers a clinically actionable strategy to reduce diagnostic delays, minimize unnecessary procedures, and improve care equity for children with DS.

Improved long-term outcomes after pediatric liver transplantation (LT) necessitate a holistic approach to care that addresses physical, mental, and social-emotional health. The Pediatric Liver Transplant Quality of Life Questionnaire (PeLTQL) is a disease-specific Patient-Reported Outcome Measure (PROM) with self- and proxy-versions available; higher scores indicate better health-related quality of life (HRQOL), and scores &#x2264;&#x2009;62.5 denote anxiety risk. Limited data exist on specific patient concerns and dyad discrepancies in disease-specific PROMs for pediatric LT recipients. This study aimed to examine self- and proxy-PeLTQLs, factors influencing discrepancies, and their relationship to anxiety risk in pediatric LT recipients. Retrospective cohort review of all pen-paper PeLTQLs completed by patient-parent dyads (2013-2022). Clinical, laboratory, and radiologic data were recorded. PeLTQLs from 140 dyads were analyzed (median patient age at PeLTQL completion 11.1&#x2009;years, 48% male, 55% Caucasian and 44% Biliary Atresia). Twenty-two percent of patients were identified as "at-risk" for anxiety expressing larger concerns about their scar (61% vs. 27%, p&#x2009;<&#x2009;0.001) and future health (74% vs. 13%, p&#x2009;<&#x2009;0.001). Overall median self- and proxy PeLTQL scores were similar (73 vs. 72.1, p&#x2009;=&#x2009;0.7) but agreement was poor (ICC 0.44). Parents of at-risk for anxiety patients underestimated their child's concerns (median self 52.1 vs. proxy 66, p&#x2009;<&#x2009;0.001) principally about their future health. Integrating HRQOL assessment into routine surveillance care for pediatric LT recipients can identify anxiety risk and specific concerns in pediatric LT recipients. Poor patient-proxy agreement underscores the need to listen to the patient voice to optimize patient-centered care.

Hereditary polyposis syndromes in children are rare, heterogeneous disorders associated with significant morbidity and long-term risk of malignancy. Current data on their presentation, management, and outcomes in pediatric populations remain limited. We conducted a nationwide, multicenter, retrospective study that included children diagnosed with polyposis syndromes in eight pediatric gastroenterology centers in Israel. Demographic, genetic, clinical, endoscopic, and outcome data were collected. A total of 105 children were included: 30 with juvenile polyposis syndrome (JPS), 26 with familial adenomatous polyposis (FAP), 19 with Peutz-Jeghers syndrome, 16 with phosphatase and tensin homolog-hamartoma tumor syndrome, 8 with constitutional mismatch repair deficiency syndrome, 5 with hereditary mixed polyposis syndrome, and 1 with Lynch syndrome. The median age at diagnosis was 8 years (interquartile range 4.1-11.5). Overall, 43 (41%) were of Ashkenazi Jewish origin, and a family history of polyposis was present in 54 (51%). Genetic testing was performed in 91 (87%), identifying pathogenic variants in 77 (73%) of them. Gastrointestinal symptoms were reported in 60 (57%) and extra-intestinal manifestations in 48 (46%). Polyposis-related surgery was required in 22 (21%) children. Malignancy in eight children included two cases of colorectal carcinoma and glioblastoma multiforme, T cell lymphoma with Wilm's tumor, medulloblastoma, ganglioneuroblastoma, and abdominal adenocarcinoma. Three mortality events were recorded. Israeli children with hereditary polyposis syndromes present with diverse clinical and genetic features. Despite increasing use of genetic testing, morbidity and malignancy risks remain substantial, highlighting the need for early recognition, surveillance, and multidisciplinary care.

Foreign body (FB) ingestion is a relatively frequent occurrence in the pediatric population with multiple potential sequelae. Appropriate intervention may range from urgent endoscopic retrieval to watchful waiting, with multiple variables influencing the decision. The four key variables include the type of object ingested, the anatomical location of the FB, the presence and severity of symptoms, and the time since ingestion. In this position paper, we provide an evidence-based approach to the management of ingested foreign bodies, incorporating expert opinion where existent evidence alone is insufficient to guide clinical judgement. We offer a clear, clinically relevant guide, with user-friendly algorithms, to assist in real-time decision making. We also include practical tips from experts on how to safely and effectively perform endoscopic removal of an ingested FB.

Functional abdominal pain syndrome (FAPS) is a relatively uncommon functional gastrointestinal disorder. Recent years have witnessed substantial advancements in the study of FAPS; however, no bibliometric analyses have been conducted to date. This study systematically reviews current research and emerging issues in the field of FAPS using bibliometric methods to understand research trends and future development prospects. The foundational literature in the field of FAPS was sourced from the Web of Science database. Visual analysis was performed using CiteSpace and VOSviewer software, focusing on factors such as the number of published papers, countries (regions), research institutions, journals, authors, highly cited papers, and keywords. From 1996 to 2025, 996 publications were analyzed, showing a phased growth in annual publication volume peaking in 2021. The United States led in publications and centrality. The "Journal of Pediatric Gastroenterology and Nutrition" had the highest publication count. Marc A. Benninga authored the most articles, notably "Functional Disorders: Children and Adolescents." The prevalent keyword was "children." Research on FAPS focuses on evolving disease definitions, the "brain-gut interaction disorder" paradigm, the microbiota-gut-brain axis, children with irritable bowel syndrome, functional abdominal pain, and nonpharmaceutical therapies like probiotics, dietary interventions, and cognitive behavioral therapy. Pediatric populations and non-pharmacological interventions were the most prominent themes, whereas adult-specific research and biomarker-related studies appeared less frequently. This bibliometric study identified key research areas including the microbiota-gut-brain axis, pediatric populations, and non-pharmacological interventions, alongside emerging topics such as gut-brain interaction disorders. These findings suggest that future research should prioritize large-scale trials validating non-pharmacological therapies and biomarkers for central sensitization. Clinically, the development of age-specific diagnostic protocols and interdisciplinary management teams integrating gastroenterology, neurology, and psychology is warranted to improve patient outcomes.

To evaluate the diagnostic accuracy and clinical reasoning of three frontier large language models (LLMs) across standardized pediatric gastroenterology, hepatology, and nutrition (PGHN) clinical vignettes. In this cross-sectional study, 25 fictional PGHN vignettes were developed by one board-certified pediatric gastroenterologist and evaluated using three LLMs: Gemini 3.1 Pro, ChatGPT 5.4 Thinking, and Claude Sonnet 4.6 Extended. A conditional two-step prompting protocol was applied. Three blinded, PGHN-certified co-authors independently scored responses using a structured instrument covering four domains (diagnostic accuracy, management, patient safety, reference quality; 0-2 each) and a global quality of clinical reasoning (QCR) score (1-5 Likert scale). Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). Group differences were analyzed using the Kruskal-Wallis H test with Dunn post-hoc correction. Interobserver reliability was excellent (ICC: 0.98 for domains; 0.87 for QCR). All three models achieved perfect diagnostic accuracy (median 2.00, interquartile range: 2.00-2.00). Statistically significant intermodel differences were identified in reference quality (p&#x2009;=&#x2009;0.048) and QCR (p&#x2009;=&#x2009;0.049). Claude achieved significantly higher QCR scores than ChatGPT (p&#x2009;=&#x2009;0.043) and demonstrated the highest overall reference quality. Qualitative analysis revealed critical pharmacological dosing errors, contextual blindness, temporal obsolescence, and a high frequency of fabricated citations. While current LLMs demonstrate good diagnostic pattern recognition in PGHN, reproducible and potentially life-threatening failures in pharmacological reasoning and reference accuracy create a dangerous illusion of competence. These findings suggest that LLMs may support differential diagnosis brainstorming in PGHN but do not establish their safety in real-world clinical scenarios.

To evaluate the clinical characteristics, diagnostic modalities, and age-related variation of Meckel's diverticulum (MD) using data from a nationwide pediatric inpatient database and a single-center institutional cohort. The Kids' Inpatient Database (KID) for 2016 and 2019 was queried for patients with a principal diagnosis of MD. We additionally conducted a retrospective review of patients hospitalized with a primary diagnosis of MD at our institution over a 20-year period (January 1, 2005-May 1, 2025). Diagnosis was confirmed by surgical findings and pathology. A total of 1004 patients with a primary diagnosis of MD were identified in KID. More than half were diagnosed after 5 years of age (n&#x2009;=&#x2009;648, 64.8%). Similarly, among 147 patients identified in the single-center cohort, 63.2% (n&#x2009;=&#x2009;93) were diagnosed after 5 years of age. Within this single-center cohort, patients &#x2264;5 years more commonly presented with painless rectal bleeding (38.9%, p&#x2009;=&#x2009;0.017) and underwent Meckel's scintigraphy more frequently (48.1%, p&#x2009;<&#x2009;0.005). In contrast, patients >5 years more often presented with abdominal pain (61.3%) or vomiting (54.8%) and were more likely to undergo abdominal computed tomography (68.9%, p&#x2009;<&#x2009;0.0001). Length of stay (LOS) was longer in patients <5 years and shortest in those >15 years (p&#x2009;=&#x2009;0.04). More than half of pediatric patients with MD are diagnosed after 5 years of age. Presentation, LOS, and imaging patterns vary by age, with younger children more often presenting with bleeding and older children with obstructive symptoms and greater CT detection.

Since late 2025, precautionary recalls of specific infant and follow-on formula batches in Europe have occurred due to contamination with cereulide, a heat- and acid-stable emetic toxin produced by certain Bacillus cereus strains. Contamination was traced to arachidonic acid (ARA)-containing algal oil from a single supplier; no viable bacteria were detected in the affected products. The European Food Safety Authority established a conservative acute reference dose for infants, and available monitoring data indicate that detected concentrations were generally low and unlikely to pose significant health risks, although some batches may have exceeded precautionary thresholds. This commentary reviews the toxicological background, current risk assessment, analytical challenges, and clinical implications. While cereulide should not be present beyond unavoidable trace levels in infant formula, risk management must remain proportionate and avoid promoting nutritionally inadequate substitutes. Ensuring validated analytical surveillance, stringent raw material control, transparent communication, and continued provision of appropriately regulated formulas containing recommended long-chain polyunsaturated fatty acids, including docosahexaenoic acid (DHA) and ARA, is essential to safeguard infant health and maintain public confidence.

Nutritional management is crucial for improving outcomes in children on prolonged mechanical ventilation (PMV); but detailed data are lacking. This study aimed to investigate the nutritional management of children on PMV in China and to explore their association with clinical outcomes. This multicenter prospective observational cohort study enrolled children (aged 28 days to 18 years) who received mechanical ventilation for&#x2009;&#x2265;&#x2009;21 consecutive days (PMV) from 11 tertiary hospitals across China between April 2021 and September 2022. Data on demographics and nutritional indicators (including calorie intake, protein intake, and laboratory test) were collected at enrollment (Day 1), Day 14, and Day 28. Nutritional status was assessed using Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) screening tool and World Health Organization (WHO) age-specific Z-scores. The primary outcome was in-hospital mortality. Among 296 children, in-hospital mortality rate was 31.8%. All were at high nutritional risk at the time of enrollment, and 51.4% were malnourished. Non-survivors received full enteral nutrition significantly less frequently than survivors at all time points (e.g., 58.5% vs. 82.2% at Day 1, p&#x2009;<&#x2009;0.001). Linear mixed models showed non-survivors had persistently lower median caloric and protein intake (calories: 42.9 vs. 53.3&#x2009;kcal/kg/day; protein: 1.2 vs. 1.6&#x2009;g/kg/day; both p&#x2009;<&#x2009;0.05). Hemoglobin levels were persistently lower in non-survivors, with no significant difference in serum albumin. Children on prolonged mechanical ventilation are at high nutritional risk, with total parenteral nutrition, low caloric intake and protein intake, and low hemoglobin being more pronounced in non-survivors.

Malnutrition in patients with critical congenital heart disease (CCHD) is associated with worse outcomes, however, feeding challenges, and changes in metabolic demands obscure the relationship between nutrient intake and growth in this patient population. We examined the relationship between nutrition provision (caloric and protein intake) and anthropometric indices (weight-for-age z-score [WAZ], length-for-age z-score [LAZ], and occipital-frontal-circumference-for-age [OAZ]). A single-center prospective cohort study of infants admitted to cardiac intensive care at a tertiary care children's hospital with CCHD between January 2020 and August 2023. Changes in weekly anthropometric measures were modeled with weekly protein and energy intake using a generalized estimating equation model, controlling for relevant factors. The effects of meeting protein (at least 2&#x2009;g/kg/day) and energy (at least 120&#x2009;kcal/kg/day) goals on anthropometric z-scores were also assessed, with a significance threshold of p&#x2009;<&#x2009;0.05 and no corrections for multiple comparisons. Thirty-six patients were enrolled (18 male), including eight with single ventricle and 28 with biventricular physiology. Increased energy and protein intake were associated with greater expected improvements in growth parameters. Among patients who met the daily caloric goal of at least 120&#x2009;kcal/kg, there was a significant increase in change in LAZ. Meeting the protein goal of at least 2&#x2009;g/kg was not associated with changes in WAZ, LAZ, and OAZ. Increased energy and protein provision is associated with greater change in all anthropometric indices in neonates with CCHD demonstrating the importance of nutrition provision in this population.

Chronic constipation (CC) and fecal incontinence (FI) are significant problems for pediatric patients. Transanal irrigation (TAI) is a therapy that effectively relieves symptoms in patients with disorders of gut-brain interactions (DGBI) or organic CC/FI. This mixed-methods study aimed to identify predictive factors for TAI adherence and outcomes in pediatric patients. Out of 151 screened patients, 63 were eligible for enrollment, with a 60.3% response rate and 97.3% survey completion. We analyzed adherence, symptom severity, quality of life (QOL), and manometry data from 38 patients who initiated TAI at Nemours Children's Hospital (2017-2023). Additionally, seven parents of noninitiating patients were interviewed to assess barriers. No significant differences were found in TAI-related difficulties (pain, independence, and technical issues), though patients with DGBI etiologies reported slightly more psychological difficulties with TAI (p&#x2009;=&#x2009;0.077). Adherent patients showed fewer CC symptoms and higher QOL compared to nonadherent patients (p&#x2009;=&#x2009;0.002) at the time of interview. Attention-deficit/hyperactivity disorder (ADHD), diagnosed in 42.1% of patients, was a significant predictor of nonadherence, with these patients reporting more severe symptoms and lower psychosocial scores. Manometry results did not predict outcomes, indicating a need for improved diagnostics. Barriers to TAI initiation included insurance challenges, fear of trauma, and logistical obstacles. Patients with organic and DGBI CC/FI experienced similar challenges using TAI. Adherence was associated with improved symptoms and QOL. ADHD was a significant predictor of nonadherence, underscoring the need for tailored interventions. Future research should focus on long-term outcomes and strategies to enhance adherence, particularly for children with ADHD.

End-stage chronic liver disease in children is associated with sarcopenia and aberrant adipose tissue mass. We investigated correlations between liver pathology-associated gene pathways (fibrosis, inflammation and steatosis) and metabolic genes in muscle and adipose tissue. Liver, rectus abdominis muscle and subcutaneous adipose tissue were collected during liver transplant for microarray gene expression analysis. Patients underwent pre-transplant indirect calorimetry, anthropometry and laboratory assessments. Weighted gene co-expression network analysis identified highly correlated gene modules within each tissue and explored inter-tissue correlations. Nine patients were studied, three male:six female, age 7 months to 17 years. Liver gene clusters associated with fibrosis and ribosome function/protein secretion negatively correlated with muscle mitochondrial function genes and positively correlated with adipose tissue mitochondrial function genes. Notable correlations included a negative correlation between muscle growth hormone receptor (GHR) and liver ARID5B, MFGE8 and YWHAZ, and a positive correlation between adipose AKT1, ADG5, and SRM and liver RRAGA, YES1, EIF3M and COX3A. Liver inflammation-associated genes (vimentin, TIMP2, CXCL6 and endothelin-1) negatively correlated with adipose genes improving insulin sensitivity (THRSP) and fibrosis-related genes (KRT36, DMTN). Liver steatosis genes (ADRA2B) negatively correlated with adipose genes involved in adipogenesis (FGF10) and thyroid hormone metabolism (NHLH1). Genes related to liver fibrosis and protein secretion negatively correlated with muscle and adipose tissue metabolism/proliferation genes. Liver inflammation and steatosis gene clusters were associated with muscle and adipose metabolism genes. This pilot study highlights important inter-tissue gene correlations warranting further investigation in paediatric end-stage chronic liver disease.

To evaluate treatment outcomes of pediatric peptic ulcer disease (PUD) and to identify determinants of refractory ulcers, with emphasis on Helicobacter pylori (H. pylori) status. In this prospective study, 254 children (2-17 years) with endoscopically confirmed ulcers were enrolled at a tertiary center in Vietnam (2023-2024). H. pylori status and eradication were assessed according to European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) guidelines. Ulcer healing was evaluated at 6 weeks, with repeat endoscopy at 12 weeks for patients with persistent ulcers. Refractory PUD was defined as persistence of active or healing-stage ulcers at 12 weeks. Multivariable logistic regression was used to identify factors associated with refractory disease. Healing rates were 65.7% at 6 weeks and 76.4% at 12 weeks, and 23.6% of patients had refractory PUD. Healing rates did not differ according to H. pylori status. Eosinophilic gastritis was more frequent in refractory cases, particularly among H. pylori-negative patients. On multivariable analysis, eosinophilic gastritis (adjusted odds ratio [aOR] 6.12; 95% confidence interval [CI] 2.47-15.15), persistent H. pylori infection (aOR 4.04; 95% CI 1.67-9.76), and poor treatment adherence (aOR 8.12; 95% CI 3.69-17.87) were independently associated with refractory ulcers. Nearly one-quarter of children had delayed or incomplete ulcer healing at 12 weeks. Eosinophilic gastritis, persistent H. pylori infection, and poor treatment adherence were independently associated with refractory ulcers, supporting risk stratification and closer follow-up.

Recent guidelines provide insightful information on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection. The knowledge of the latest guidelines for European paediatric gastroenterologists is currently being discussed. This study aimed to evaluate the current knowledge regarding paediatric H. pylori management. Members from the National Societies of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were invited to complete an online questionnaire. Descriptive and statistical analyses were conducted using SPSS&#xae;. A questionnaire was completed by 508 paediatric healthcare professionals from 32 countries (60% were specialists, 82% worked in hospitals and 49% in university hospitals). Of these, 360 (71%) had a background in paediatric gastroenterology. In 30% of cases, the local prevalence of H. pylori was unknown. Primary testing indications included duodenal or gastric erosions (85%), oral iron-refractory anaemia (59%) and a positive family history of gastric cancer (41%), 7.5% complied with the guidelines. Fifty-seven per cent requested invasive diagnostic tests, including culture (66%) and molecular tests (34%). The test-and-treat strategy was considered by 43% of clinicians, and more than half of respondents would include probiotics in eradication. Amoxicillin-based therapies represented 77% of prescriptions, with 54% opting for clarithromycin for empirical treatment. Additionally, the eradication regimens varied significantly across different European regions, with limited/small differences by clinician category. This study among healthcare professionals revealed that H. pylori infection management does not entirely follow the guidelines regarding indications, testing and treatment regimens. There is a need for education in Europe to increase literacy and clinical updates.

Children with intestinal failure (IF) are vulnerable to adverse cognitive outcomes. We assessed intelligence quotient (IQ) and identified associated factors. Multicentre international cross-sectional study in children with IF and weaned children, treated at Erasmus MC Sophia Children's Hospital, Amsterdam UMC Emma Children's Hospital (both The Netherlands) and Birmingham Women's and Children's NHS Foundation Trust (UK). Primary outcomes were IQ outcomes using Wechsler's preschool and primary scale of intelligence (WPPSI-III), Wechsler intelligence scale for children (WISC-V) or Wechsler adult intelligence scale (WAIS-IV). Secondary outcomes were cognitive development outcomes, the correlation between IQ and possible related factors, and the linear relationship between the most influential factors and IQ outcomes using multiple linear regression. Fifty children were included: 50% boys; median age 9.1 (IQR 6.5-12.5) years; gestational age 34 (30-37) weeks; birth weight 2135 (1279-2545) grams; most common underlying condition was necrotising enterocolitis (28%); 21/50 children (42%) received home parenteral nutrition (PN), median PN-duration was 26.8 (7.5-66.5) months. Median IQ score was 92.0 (74.3-101.0), 15 children (30%) had very/extremely low IQ, both significantly different from the normal population (p&#x2009;<&#x2009;0.001). Parental occupational and educational levels, number of line infections, and total hospital admission duration showed the strongest correlations with IQ outcomes, with line infections remaining significant after correction for multiple analyses (rho -0.52, p&#x2009;<&#x2009;0.01). However, none were significant after multiple linear regression. Children with IF generally exhibit an average IQ but are at risk to have a below-average IQ. While separate factors were correlated with IQ outcomes, none remained significant after multiple linear regression. ClinicalTrials.gov identifier: MEC 2019-098, NL-OMON54827, https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON54827.

To assess the feasibility and efficacy of fecal microbiota transplantation (FMT) in adolescents (16-21 years) with refractory irritable bowel syndrome (IBS). Randomized controlled pilot trial. Thirty-two patients were included and randomized to receive two allogeneic or autologous FMTs. At baseline and after 6 weeks, two allogeneic or autologous FMTs were administered via a nasoduodenal tube. Feasibility outcomes included dropout rate. Clinical efficacy was evaluated by the proportion of responders (&#x2265;50 points reduction in total score of the IBS severity-scoring-system) at 12, 24, and 48 weeks follow-up. Secondary outcomes included health-related quality of life (QoL), depression and anxiety scores, and school/work absenteeism. One patient (3%) withdrew after randomization, due to lack of effect after the first FMT. Response rates 12 weeks after allogeneic and autologous FMTs were 40% and 38% (p&#x2009;=&#x2009;0.886). At 24 weeks, significantly more patients responded after allogeneic FMTs (60% vs. 25% autologous, p&#x2009;=&#x2009;0.048), without significant differences at 48 weeks (60% vs. 50%, p&#x2009;=&#x2009;0.576). Total QoL score was significantly better after allogeneic than autologous FMTs at 12, 24, and 48 weeks (p&#x2009;=&#x2009;0.028, p&#x2009;=&#x2009;0.007, p&#x2009;=&#x2009;0.011). In the allogeneic FMTs group, school/work absenteeism was 7% at 24 weeks (vs. 41% autologous, p&#x2009;=&#x2009;0.037). Allogeneic FMTs were feasible and resulted in high response rates and better QoL compared to autologous FMTs. These results provide preliminary evidence for the use of allogeneic FMTs in adolescents with refractory IBS. ClinicalTrials.gov identifier: NCT03074227 (https://clinicaltrials.gov/study/NCT03074227?id=NCT03074227&rank=1).

Infectious diseases remain a leading cause of morbidity and mortality among pediatric transplant recipients, despite significant advances in transplantation management. Vaccination is the most effective strategy to prevent infections; however, its efficacy is hindered in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, due to altered immune responses. Pediatric SOT candidates often have incomplete vaccination status prior to transplantation and reduced vaccine efficacy post-transplant due to immunosuppressive therapy. They are also at greater risk of vaccine-preventable infections compared to adults, leading to higher rates of hospitalization, graft loss, and death. In HSCT recipients, immune ablation and reconstitution result in the loss of immunologic memory, rendering both pre- and post-transplant vaccine strategies particularly challenging. Factors such as graft-versus-host disease, immunoglobulin therapy, and ongoing immunosuppression further complicate timing and effectiveness of vaccinations. Despite established guidelines emphasizing timely immunization, several studies report low vaccination coverage and inadequate protective immunity in both groups. Barriers include intercurrent illness, variation in national immunization schedules, vaccine hesitancy, and uncertainties regarding optimal vaccination timing. In this position statement, the European Reference Network Transplant Child Working Group conducted a comprehensive literature review on the most relevant studies on vaccinations in pediatric transplant candidates and recipients, with the aim of developing evidence-based recommendations tailored to pediatric SOT and HSCT recipients. This position paper outlines current challenges, summarizes existing evidence, and proposes recommendations to improve immunization practices in this high-risk population.

Feeding difficulties (FDs) in childhood are highly prevalent and a common reason for medical consultation. Historically, clinical approaches have been fragmented. The Pediatric Feeding Disorder (PFD) model provides a comprehensive framework that incorporates medical, nutritional, feeding skill, and psychosocial dimensions. Our aims were to (1) describe the current definitions of FDs in children, (2) identify their main risk factors and existing classifications, and (3) propose a clinical algorithm to guide the diagnostic and therapeutic approach from an interdisciplinary perspective. A narrative review was carried out by the Feeding Difficulties Working Group of the Latin American Society of Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN), reviewing the literature published between January 2000 and April 2025 from the PubMed, Scopus, SciELO, and LILACS databases. Three classification systems were identified: sensory-based, medical/nutritional, and functional. Risk factors included prematurity, gastrointestinal and neuromotor diseases, negative feeding experiences, inadequate feeding practices, and psychosocial factors. A comprehensive and interdisciplinary clinical algorithm was developed. Pediatric FDs require an interdisciplinary and family-centered approach, adapted to the Latin American context. Terminology standardization and clinical criteria harmonization are key steps for optimizing diagnosis, treatment, and research in the region. The development of a clinical algorithm outlining their approach is a first step toward this goal.