Eosinophilic esophagitis is a newly recognized disease first described about 50 years ago.The definition,diagnosis,and management have evolved with new published consensus guidelines and newly approved treatment avail...Eosinophilic esophagitis is a newly recognized disease first described about 50 years ago.The definition,diagnosis,and management have evolved with new published consensus guidelines and newly approved treatment available to pediatricians,enabling a better understanding of this disease and more targeted treatment for patients.We describe the definition,presentation,and diagnosis of eosinophilic esophagitis including management,challenges,and future directions in children.The definition,diagnosis,and management of eosinophilic esophagitis have evolved over the last 50 years.Consensus guidelines and newly approved biologic treatment have enabled pediatricians to better understand this disease and allow for more targeted treatment for patients.We describe the definition,presentation,diagnosis,management,and treatment in addition to the challenges and future directions of eosinophilic esophagitis management in children.展开更多
When oral feeding cannot provide adequate nutritional support to children,enteral tube feeding becomes a necessity.The overall aim is to ultimately promote appropriate growth,improve the patient’s quality of life and...When oral feeding cannot provide adequate nutritional support to children,enteral tube feeding becomes a necessity.The overall aim is to ultimately promote appropriate growth,improve the patient’s quality of life and increase carer satisfaction.Nasogastric tube feeding is considered appropriate on a short-term basis.Alternatively,gastrostomy feeding offers a more convenient and safer feeding option especially as it does not require frequent replacements,and carries a lower risk of complications.Gastrostomy tube feeding should be considered when nasogastric tube feeding is required for more than 2-3 wk as per the ESPEN guidelines on artificial enteral nutrition.Several techniques can be used to insert gastrostomies in children including endoscopic,image guided and surgical gastrostomy insertion whether open or laparoscopic.Each technique has its own advantages and disadvantages.The timing of gastrostomy insertion,device choice and method of insertion is dependent on the local expertise,patient requirements and family preference,and should be individualized with a multidisciplinary team approach.We aim to review gastrostomy insertion in children including indications,contraindications,history of gastrostomy,insertion techniques and complications.展开更多
Coronavirus disease 2019(COVID-19)typically presents with fever and respiratory symptoms in children.Most children develop an asymptomatic and mild illness,with a minority requiring specialist medical care.Gastrointes...Coronavirus disease 2019(COVID-19)typically presents with fever and respiratory symptoms in children.Most children develop an asymptomatic and mild illness,with a minority requiring specialist medical care.Gastrointestinal manifestations and liver injury can also occur in children following infection.The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion,immune response,or medication effects.Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease.However,the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes.On the other hand,the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor.Respiratory,hemodynamic,and nutritional supportive therapies are the mainstay of management.Vaccination of children at increased risk of developing severe COVID-19 disease is indicated.This review describes the liver manifestations in children with COVID-19,detailing its epidemiology,basic mechanisms,clinical expression,management,and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.展开更多
文摘Eosinophilic esophagitis is a newly recognized disease first described about 50 years ago.The definition,diagnosis,and management have evolved with new published consensus guidelines and newly approved treatment available to pediatricians,enabling a better understanding of this disease and more targeted treatment for patients.We describe the definition,presentation,and diagnosis of eosinophilic esophagitis including management,challenges,and future directions in children.The definition,diagnosis,and management of eosinophilic esophagitis have evolved over the last 50 years.Consensus guidelines and newly approved biologic treatment have enabled pediatricians to better understand this disease and allow for more targeted treatment for patients.We describe the definition,presentation,diagnosis,management,and treatment in addition to the challenges and future directions of eosinophilic esophagitis management in children.
文摘When oral feeding cannot provide adequate nutritional support to children,enteral tube feeding becomes a necessity.The overall aim is to ultimately promote appropriate growth,improve the patient’s quality of life and increase carer satisfaction.Nasogastric tube feeding is considered appropriate on a short-term basis.Alternatively,gastrostomy feeding offers a more convenient and safer feeding option especially as it does not require frequent replacements,and carries a lower risk of complications.Gastrostomy tube feeding should be considered when nasogastric tube feeding is required for more than 2-3 wk as per the ESPEN guidelines on artificial enteral nutrition.Several techniques can be used to insert gastrostomies in children including endoscopic,image guided and surgical gastrostomy insertion whether open or laparoscopic.Each technique has its own advantages and disadvantages.The timing of gastrostomy insertion,device choice and method of insertion is dependent on the local expertise,patient requirements and family preference,and should be individualized with a multidisciplinary team approach.We aim to review gastrostomy insertion in children including indications,contraindications,history of gastrostomy,insertion techniques and complications.
文摘Coronavirus disease 2019(COVID-19)typically presents with fever and respiratory symptoms in children.Most children develop an asymptomatic and mild illness,with a minority requiring specialist medical care.Gastrointestinal manifestations and liver injury can also occur in children following infection.The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion,immune response,or medication effects.Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease.However,the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes.On the other hand,the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor.Respiratory,hemodynamic,and nutritional supportive therapies are the mainstay of management.Vaccination of children at increased risk of developing severe COVID-19 disease is indicated.This review describes the liver manifestations in children with COVID-19,detailing its epidemiology,basic mechanisms,clinical expression,management,and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.
