Summary Background Incidence rate and temporal trends in coeliac disease and coeliac disease autoimmunity incidence vary worldwide with most data available from North American and European countries. Aims To explore temporal trends in incidence of coeliac disease autoimmunity and their relation to increase in screening tests in Israel. Methods A large retrospective population‐based study was conducted in Maccabi Healthcare Services, a 2.3‐million‐member health maintenance organisation operating in Israel. The cohort included all patients with newly diagnosed coeliac disease autoimmunity based on first positive anti‐tissue transglutaminase type 2 IgA antibodies. Data were analysed for the years 2007‐2015. Results During the study period (17.3 million person‐years), a total of 403 283 patients were tested for coeliac disease autoimmunity, of whom 6444 were positive, representing an average incidence rate of 36.64 per 100 000 person‐years (95% CI: 35.74‐37.55). Incidence of coeliac disease autoimmunity increased from 25.4 per 100 000 in 2007 to 52.3 per 100 000 person‐years in 2015 (Incidence rate ratio of 2.06, 95% CI 1.81‐2.26). Coeliac disease autoimmunity incidence was highest in the paediatric age groups, especially in children aged 0‐5, and was 4 times higher than the incidence in adults aged 26‐55 (Incidence rate ratio of 0.24, 95% CI (0.22‐0.26). The increase in incidence surpassed the increase in testing for new patients. Positive trends in incidence were highest in small children, whereas the incidence in adults was stable over the years. Conclusions There was a steady increase in coeliac disease autoimmunity incidence in our cohort between the years 2007‐2015. The paediatric population was the only contributor to this trend.
Early dropout and treatment adherence are main challenges in the treatment of children with obesity. The aim of this study was to identify factors associated with attrition and adherence to weight loss intervention program. We retrospectively reviewed the medical records of all the children who entered the program for pediatric weight loss over 5 years and retrieved demographic and clinical characteristics. Attrition and adherence were documented. Ninety-two of the 248 enrolled children (52% women, mean age 11.1 ± 3.9 years, mean body mass index 31.1 ± 7 kg/m2) dropped out (37%). Dropping out correlated with male sex, low parental education, and self-referral to the clinic (P < .05 for all). Adherence correlated with older age and the mother's healthy lifestyle (P < .05 for all). Sex, parental education, and referral source may predict treatment attrition. Early recognition of children at risk of attrition may help to facilitate better care of those children.
Single or multiple polyps are frequently encountered during colonoscopy among children and adolescents and may be indicative of hereditary polyposis syndrome (HPS). The management of children with single or multiple polyps is guided by the number of polyps, their distribution and the histological findings. Children with HPS carry a high risk of complications, including intestinal and extra-intestinal malignancies. The goals of surveillance in pediatric HPS are to treat symptoms, monitor the burden of polyps and prevent short- and long-term complications. Therefore, the management of children with HPS is based on therapeutic endoscopy. The strategy of therapeutic endoscopy is a careful assessment and characterization of the polyps and performing polypectomies using advanced endoscopic techniques. A multidisciplinary approach, comprising clinical, interventional endoscopy, cancer surveillance and support of familial and emotional aspects is essential in the management of children with HPS.
Background: Data on the clinical course and outcomes of pediatric patients with cytomegalovirus (CMV) infection complicating acute severe ulcerative colitis (ASC) is very limited. The aim of our study was to compare the outcome of CMV-positive and negative pediatric ASC. Methods: This was a multicenter retrospective case-controlled study, from centers in Europe and Israel. We included CMV-positive pediatric patients hospitalized for acute severe colitis and compared their outcomes (rate of colectomy during hospitalization and up to 1 year from the hospitalization) to matched CMV-negative controls Results: A total of 56 children from 10 centers were included. The patient cohort included 23 (41.1%) males/ 33 (58.9%) females, with a median age of 11.5 (interquartile range (IQR) – 7–14) years. Fifty-two (92.9%) of the patients had extensive/pan-colitis colitis and the rest left sided colitis, with severe disease in 52 (92.9%) of the patients and moderate in 4 (7.1%). Fifteen patients were CMV-positive and 41 – CMV-negative. Significantly higher proportion of CMV positive patients were resistant to intravenous corticosteroids (p=0.009). After diagnosis of CMV infection, 14/15 patients were started on gancyclovir (5 mg/kg – 5/14 (35.7%) and 10 mg/kg – 9/14 (64.3%). During hospitalization, 3 (20%) CMV positive and 3 (7.8%) CMV-negative patients required colectomy (p=0.17). By 12 months of follow-up, 5 (33.3%) and 5 (12.5%) CMV positive and negative patients required colectomy, respectively (p=0.049). Previous anti-TNF exposure and Pediatric Ulcerative Colitis Activity Index score on index date were significantly associated with the risk of colectomy during hospitalization and by 12 months (p=0.037 and p=0.01 for previous anti-TNF exposure and p=0.021 for PUCAI) on univariate analysis, however none of the factors including CMV positivity retained significance on multivariate analysis. Conclusions: A higher prevalence of CMV positivity was found in pediatric UC patients who required colectomy within 12 months of index hospitalisation, however the difference was not statistically significant on multivariate analysis. Further studies are merited to clarify the impact of CMV infection on the outcome of acute severe colitis in pediatric patients
Introduction: Medium chain triglycerides (MCT) are often used as caloric supplement in preterm infants; commercial Canola oil (CO) (mostly comprised of long chain triglycerides) is at times used as an inexpensive alternative. The effect of fat supplementation to the diet of preterm infants upon fat absorption and energy expenditure (EE) has not been systematically investigated. Specifically, these 2 sources of fat (MCT and CO) have not been compared in this regard. The aim of this study was to compare intestinal fat losses and EE in healthy growing preterm infants supplemented with either CO or MCT oil. We hypothesized that inestinal fat losses and EE are lower in preterm infants supplemented with MCT oil than in those supplemented with CO. Methods: Six preterm infants were studied in a randomized, crossover design at the time they were able to tolerate full feeds (breastmilk or preterm infant formula). Gestational age ranged from 28–34 weeks, and birthweight from 920–1160g. Infants were randomized to supplementation with either 34Kcal (4g) CO/kg/day or 34Kcal (4.4g) MCT oil/kg/day for 3 days followed by 3 days of the other oil. EE was measured at baseline, after 3 days of the first oil supplementation and after 3 days of the alternate oil supplementation, using the Deltatrac II metabolic monitor (Datex-Omeda, Helsinki, Finand) based upon indirect calorimetry. Three 72-hours stool samples were collected: at baseline, and after each type of oil supplementation, for determination of fat content, using the method of Van de Kamer. Analyses are by paired Wilcoxon test, data are mean ± SD. Results: The coefficient of added fat absorption was 99.5±0.9% of the MCT oil, vs 90.0±16.2% of the CO (p=0.056). EE increased after CO supplementation (thermic effect of feeding) by 4.33±5.96 Kcal/kg/d and by 4.17±3.97 Kcal/kg/d after MCT (non significant). Thus, after correction for net additional energy intake (taking into account fat losses and thermic effect of feeding), energy retained from 34 Kcal/kg of added fat was 26.1±6.9 Kcal/kg/d after CO and 30.1±5.0 Kcal/kg/d after MCT (p=0.09). Conclusion: MCT oil is better absorbed then CO in growing preterm infants. The metabolic cost of absorption of MCT oil and CO are similar. Although energy retained from CO might be lower than that from MCT, the difference is biologically small, and CO might represent an inexpensive alternative to MCT.
