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Lerner A.,Gastroenterology and Nutrition Unit | Makhoul B.F.,Rambam Health Care Campus | Eliakim R.,Technion - Israel Institute of Technology
European Neurological Journal | Year: 2012

Celiac disease (CD) is a common, life-long, autoimmune condition, affecting the small intestine of genetically susceptible individuals. The classical clinical picture is disappearing as awareness progresses and the extra-intestinal presentation is emerging. Skin, endocrine, hepatic, skeletal, hematological, gynecological, infertility, dental, and behavioral abnormalities are emerging. Among the new growing domains is the extra-intestinal presentation of CD affecting the peripheral and central neurological systems. This review highlights neurological presentations in these patients, focusing on the clinical signs/symptoms in the pediatric and the adult age group, separately. Source

Diamanti A.,Gastroenterology and Nutrition Unit
Nutritional Therapy and Metabolism | Year: 2010

There are a wide variety of nutritionally complete pediatric feeds available for enteral nutrition; the correct choice should be based on the following aspects: gut function, age, specific nutrient requirement, and route of feeding administration. In patients with normal gut function, the choice of feeding formula depends on age and specific requirements; in patients > 1 year of age, polymeric formulas are preferred, and the employ of homemade/blenderized enteral feedings should be discouraged. Specific formulas are available in patients with special nutrient requirement and normal gut function. These formulas are modified by adding fiber and increasing caloric content or adapting to specific needs of patients' disease. If the enteral feeding is postpyloric, isotonic solutions are preferred. In patients with altered gut function, semi-elemental and elemental formulas are indicated, in spite of age, special nutritional needs, as well as route of administration. © 2010 SINPE-GASAPE. Source

Pironi L.,University of Bologna | Goulet O.,University of Paris Descartes | Buchman A.,Northwestern University | Messing B.,Pole des Maladies de lAppareil Digestif | And 9 more authors.
Clinical Nutrition | Year: 2012

Background & aims: Indications and timing for referral for intestinal transplantation (ITx) were investigated through a review of the literature on home parenteral nutrition (HPN) for benign intestinal failure and a benchmarking to the results of a prospective European survey which evaluated the appropriateness of the current indications for ITx. Methods: Manuscripts reporting outcomes of adults and children on HPN were retrieved through a PubMed search. Data from the European survey were compared with those on HPN reported in the literature, and with those on ITx reported by the USA registry and by the Pittsburgh center. Results: HPN is a safe treatment with a high probability of survival. The risk of death during HPN is increased by the absence of a specialist team, and appears greater during the early period of treatment. Survival probability is decreased in patients with: age >40 or <2 years, very short bowel remnant, presence of a stoma, chronic intestinal pseudo-obstruction of myopathic origin, systemic sclerosis, radiation enteritis, intra-abdominal desmoids, necrotizing enterocolitis, congenital mucosal diseases. Liver failure is the HPN-related complication with the greatest risk of death. Death related to venous catheter complications is rare. The benchmarking supported the results of the European survey. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source

Aloi M.,University of Rome La Sapienza | Lionetti P.,Gastroenterology and Nutrition Unit | Barabino A.,G Gaslini Institute For Children | Guariso G.,University of Padua | And 15 more authors.
Inflammatory Bowel Diseases | Year: 2014

Background: Early-onset (EO) pediatric inflammatory bowel diseases (IBD) seem to be more extensive than those with a later onset. To test this hypothesis, we examined the phenotype and disease course of patients with IBD diagnosis at 0 to 5 years, compared with the ranges ± to 11 and 12 to 18 years. Methods: Anatomic locations and behaviors were assessed according to Paris classification in 506 consecutive patients: 224 Crohn's disease, 245 ulcerative colitis, and 37 IBD-unclassified. Results: Eleven percent of patients were in the range 0 to 5 years, 39% in ± to 11 years, and 50% in 12 to 18 years. Ulcerative colitis was the most frequent diagnosis in EO-IBD and in 6- to 11-year-old group, whereas Crohn's disease was predominant in older children. A classification as IBDunclassified was more common in the range 0 to 5 years compared with the other groups (P < 0.005). EO Crohn's disease showed a more frequent isolated colonic (P < 0.005) and upper gastrointestinal involvement than later-onset disease. Sixty-two percent of the patients in the 0 to 5 years range had pancolonic ulcerative colitis, compared with 38% of ± to 11 years (P = 0.02) and 31% of 12-18 years (P = 0.002) range. No statistical difference for family history for IBD was found in the 3-year age groups. Therapies at the diagnosis were similar for all children. However, at latest follow-up, a significantly higher proportion of younger children were under steroids compared with older groups (P < 0.05). Surgical risk did not differ according to age. Conclusions: EO-IBD exhibits an extensive phenotype and benefit from aggressive treatment strategies, although surgical risk is similar to later-onset disease. A family history for IBD is not common in EO disease. Copyright © 2014 Crohn's & Colitis Foundation of America, Inc. Source

Degraeuwe P.L.J.,Maastricht University | Beld M.P.A.,Maastricht University | Ashorn M.,University of Tampere | Canani R.B.,University of Naples Federico II | And 9 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2015

Objectives: The diagnostic accuracy of faecal calprotectin (FC) concentration for paediatric inflammatory bowel disease (IBD) is well described at the population level, but not at the individual level. We reassessed the diagnostic accuracy of FC in children with suspected IBD and developed an individual risk prediction rule using individual patient data. Methods: MEDLINE, EMBASE, DARE, and MEDION databases were searched to identify cohort studies evaluating the diagnostic performance of FC in paediatric patients suspected of having IBD. A standard study-level meta-analysis was performed. In an individual patient data meta-analysis, we reanalysed the diagnostic accuracy on a merged patient dataset. Using logistic regression analysis we investigated whether and how the FC value and patient characteristics influence the diagnostic precision. A prediction rule was derived for use in clinical practice and implemented in a spreadsheet calculator. Results: According to the study-level meta-analysis (9 studies, describing 853 patients), FC has a high overall sensitivity of 0.97 (95% confidence interval [CI] 0.92-0.99) and a specificity of 0.70 (0.59-0.79) for diagnosing IBD. In the patient-level pooled analysis of 742 patients from 8 diagnostic accuracy studies, we calculated that at an FC cutoff level of 50 mg/g there would be 17% (95% CI 15-20) false-positive and 2% (1-3) false-negative results. The final logistic regression model was based on individual data of 545 patients and included both FC level and age. The area under the receiver operating characteristic curve of this derived prediction model was 0.92 (95% CI 0.89-0.94). Conclusions: In high-prevalence circumstances, FC can be used as a noninvasive biomarker of paediatric IBD with only a small risk of missing cases. To quantify the individual patients' risk, we developed a simple prediction model based on FC concentration and age. Although the derived prediction rule cannot substitute the clinical diagnostic process, it can help in selecting patients for endoscopic evaluation. © 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Source

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