Center for Paediatric Gastroenterology

Sheffield, United Kingdom

Center for Paediatric Gastroenterology

Sheffield, United Kingdom
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Soccorso G.,Paediatric Surgery Unit | Grossman O.,Paediatric Surgery Unit | Martinelli M.,University of Naples Federico II | Marven S.S.,Paediatric Surgery Unit | And 3 more authors.
Archives of Disease in Childhood | Year: 2012

Swallowed button batteries (BB) which remain lodged in the oesophagus are at risk of serious complications, particularly in young children. The authors report a 3-year-old child, who rapidly developed an oesophageal perforation, following the ingestion of a 20-mm lithium BB which was initially mistaken for a coin. A thoracotomy and T-tube management of the perforation led to a positive outcome. BBs (20 mm) in children should be removed quickly and close observation is required as the damage initiated by the battery can lead to a significant injury within a few hours.


Thomson M.,University College London | Thomson M.,Center for Paediatric Gastroenterology | Rao P.,University College London | Rawat D.,University College London | Wenzl T.G.,Universitatsklinikum Aachen
World Journal of Gastroenterology | Year: 2011

AIM: To investigate the effects of percutaneous endo-scopic gastrostomy (PEG) feeding on gastro-oesoph-ageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII). METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were non-acidic. The total number of distal acid refux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058).Median number of non-acid GOR, average reflux height, total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant. CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children. © 2011 Baishideng. All rights reserved.


Venkatesh K.,Center for Paediatric Gastroenterology | Abou-Taleb A.,Center for Paediatric Gastroenterology | Cohen M.,Sheffield Childrens NHS Foundation Trust | Evans C.,Royal Hospital for Sick Children | And 4 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2010

Background and Aims: Confocal laser endomicroscopy (CLE) is a recent development that enables surface and subsurface imaging of living cells in vivo at 1000× magnification. The aims of the present study were to define confocal features of celiac disease (CD) and to evaluate the usefulness of the CLE in the diagnosis of CD in children in comparison to histology. Patients and Methods: Nine patients (8 girls) with a median age of 8.35 years (range 2-12.66 years) and a median weight of 28.3 kg (range 11-71 kg) were suspected with CD and 10 matched controls underwent oesophagogastroduodenoscopy using the confocal laser endomicroscope (EC3870CILK; Pentax, Tokyo, Japan). Histologic sections were compared with the confocal images of the same site by 2 experienced paediatric histopathologists and endoscopists, all of whom were blinded to the diagnosis. Results: The median procedure time was 17 minutes (range 8-25 minutes). Confocal features of CD were defined and a score was developed. A total of 1384 confocal images were collected from 9 patients and 10 controls. Five images from each patient and control were selected and compared with the biopsy specimen of the same site. The sensitivity, specificity, and positive predictive value for the confocal images in comparison to the histology were 100%, 80%, and 81%. The kappa inter-observer agreement between the 2 endoscopists was 0.769 (P = 0.018) and between the 2 histopathologists was 0.571 (P = 0.05). Conclusions: Confocal endomicroscopy offers the prospect of diagnosis of CD during ongoing endoscopy. It also enables targeting biopsies to abnormal mucosa and thereby increasing the diagnostic yield, especially when villous atrophy is patchy in the duodenum. © 2010 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Thomson M.,Center for Paediatric Gastroenterology | Venkatesh K.,Center for Paediatric Gastroenterology | Elmalik K.,Center for Paediatric Gastroenterology | Van Der Veer W.,VU University Amsterdam | Jaacobs M.,VU University Amsterdam
World Journal of Gastroenterology | Year: 2010

AIM: To assess the feasibility and utility of double balloon enteroscopy (DBE) in the management of small bowel diseases in children. METHODS: Fourteen patients (10 males) with a median age of 12.9 years (range 8.1-16.7) underwent DBE; 5 for Peutz-Jeghers syndrome (PJ syndrome), 2 for chronic abdominal pain, 4 for obscure gastrointestinal (GI) bleeding, 2 with angiomatous malformations (1 blue rubber bleb nevus syndrome) having persistent GI bleeding, and 1 with Cowden's syndrome with multiple polyps and previous intussusception. Eleven procedures were performed under general anesthesia and 3 with deep sedation. RESULTS: The entire small bowel was examined in 6 patients, and a length between 200 cm and 320 cm distal to pylorus in the remaining 8. Seven patients had both antegrade (trans-oral) and retrograde (transanal and via ileostomy) examinations. One patient underwent DBE with planned laparoscopic assistance. The remaining 6 had trans-oral examination only. The median examination time was 118 min (range 95-195). No complications were encountered. Polyps were detected and successfully removed in all 5 patients with PJ syndrome, in a patient with tubulo-villous adenoma of the duodenum, in a patient with significant anemia and occult bleeding, and in a patient with Cowden's syndrome. A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy, and in 1 with a discrete angioma which was treated with argon plasma coagulation. The source of bleeding was identi-fied in a further patient with varices. DBE was normal or revealed minor mucosal friability in the remaining 3 patients. Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. CONCLUSION: Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children, allowing endo-therapeutic intervention beyond the reach of the conventional endoscope. © 2010 Baishideng. All rights reserved.


Furman M.A.,Center for Paediatric Gastroenterology
Current Allergy and Clinical Immunology | Year: 2016

Over the past decade the incidence of eosinophilic oesophagitis (EoE) has risen significantly and has become a common condition seen in paediatric gastroenterology centres around the world. The association with atopic disease is well known, and treatment options remain concentrated on acid suppression, dietary eliminations and topical corticosteroids. One of the greatest challenges is planning long-term disease management. Currently there is little published data on maintenance treatment for EoE in children. Many children remain on long-term elimination diets or topical steroids and undergo multiple repeat endoscopies. Large multicentre studies are required to gain a better understanding of this challenging condition, to standardise maintenance treatment and to find better methods for reliable disease surveillance. © 2016, Allergy Society of South Africa. All rights reserved.


Thomson M.,Center for Paediatric Gastroenterology | Rao P.,Center for Paediatric Gastroenterology | Berger L.,Royal Free Hospital | Rawat D.,Imperial College London
Journal of Pediatric Gastroenterology and Nutrition | Year: 2012

Objective: The aim of this study was to assess whether power Doppler ultrasound (PDU) can serve as a reliable replacement for endoscopy in follow-up assessment of disease activity in children with Crohn disease. Methods: Nineteen children (13 boys), median age 14.8 (5.4-15.8) years, with macroscopically diagnosed Crohn disease were included in the study. Clinical parameters, histological evaluation, and graded PDU assessments were undertaken in all patients at diagnosis and following their initial treatment. Discriminant analysis was used to build predictive models from the PDU data for the histological evaluation. Results: The median Pediatric Crohn's Disease Activity Index (PCDAI) was 31.5 (15.5-42.0) at diagnosis. All clinical and ultrasonographic parameters and the histological evaluation showed an improvement between pre- versus posttreatment results; 1-way analysis of variance showed a significant difference because of treatment (P<0.005) for all variables apart from the superior mesenteric artery flow (SMA); paired sample t tests indicated that these differences were statistically significant (P<0.001), with the exception of SMA (P=0.178). There was a statistically significant correlation (P<0.001) between the platelet count and the bowel wall stratification (STRAT). Significant correlation was also observed between the histology findings and the mean mucosal, transmural, and segmental flow (MFL) and STRAT and between platelets and both MFL and small bowel thickening (SBT) (P<0.01 in all cases). There was a statistically significant correlation (P<0.05) between C-reactive protein and MFL and between histology and SBT, MFL, and STRAT. Discriminant analysis using discriminating factors SBT, STRAT, and MFL could assign 84.6% of cases to the correct classification of "no/mild inflammation" or "medium/severe inflammation." Conclusions: Results obtained using power Doppler ultrasonography and endoscopy showed statistically significant correlations. Power Doppler sonography, in the hands of an experienced examiner, can be used for follow-up assessment of disease activity in children with Crohn disease. Copyright © 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


PubMed | Center for Paediatric Gastroenterology
Type: Journal Article | Journal: Journal of pediatric gastroenterology and nutrition | Year: 2010

Confocal laser endomicroscopy (CLE) is a recent development that enables surface and subsurface imaging of living cells in vivo at 1000 x magnification. The aims of the present study were to define confocal features of celiac disease (CD) and to evaluate the usefulness of the CLE in the diagnosis of CD in children in comparison to histology.Nine patients (8 girls) with a median age of 8.35 years (range 2-12.66 years) and a median weight of 28.3 kg (range 11-71 kg) were suspected with CD and 10 matched controls underwent oesophagogastroduodenoscopy using the confocal laser endomicroscope (EC3870CILK; Pentax, Tokyo, Japan). Histologic sections were compared with the confocal images of the same site by 2 experienced paediatric histopathologists and endoscopists, all of whom were blinded to the diagnosis.The median procedure time was 17 minutes (range 8-25 minutes). Confocal features of CD were defined and a score was developed. A total of 1384 confocal images were collected from 9 patients and 10 controls. Five images from each patient and control were selected and compared with the biopsy specimen of the same site. The sensitivity, specificity, and positive predictive value for the confocal images in comparison to the histology were 100%, 80%, and 81%. The kappa inter-observer agreement between the 2 endoscopists was 0.769 (P = 0.018) and between the 2 histopathologists was 0.571 (P = 0.05).Confocal endomicroscopy offers the prospect of diagnosis of CD during ongoing endoscopy. It also enables targeting biopsies to abnormal mucosa and thereby increasing the diagnostic yield, especially when villous atrophy is patchy in the duodenum.

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