Genetic risk stratification of inflammatory bowel disease-associated venous thromboembolism:An Asian perspective

The utilisation of polygenic scoring models may enhance the clinician’s ability to risk stratify an inflammatory bowel disease patient’s individual risk for venous thromboembolism(VTE)and guide the appropriate usage of VTE thromboprophylaxis,yet there is a need to validate such models in ethnically diverse populations.

Epidemiological characteristics of Asian children with inflammatory bowel disease at diagnosis: Insights from an Asian-Pacific multicentre registry network

BACKGROUND There remains a dearth of Asian epidemiological literature for paediatric inflammatory bowel disease(PIBD).AIM To describe the presenting features of PIBD from 7 Asia-Pacific pediatric gastroenterology centers via a central standardised electronic data platform.METHODS Clinical,endoscopic and radiologic data at diagnosis from the registry were extracted between 1^(st) January 1995 to 31^(st) December 2019.Disease phenotypic characteristics were classified as per the Paris classification system.RESULTS There was a distinct rise in new PIBD cases:Nearly half(48.6%)of the cohort was diagnosed in the most recent 5 years(2015-2019).The ratio of Crohn’s disease(CD):Ulcerative colitis(UC):IBDUnclassified was 55.9%:38.3%:5.8%.The mean age was 9.07 years with a high proportion of very early onset IBD(VEO-IBD)(29.3%)and EO-IBD(52.7%).An over-representation of the Indian/South Asian ethnic group was observed which accounted for 37.0% of the overall Singapore/Malaysia subcohort(6.8%-9.0%Indians in census).Indian/South Asian CD patients were also most likely to present with symptomatic perianal disease(P=0.003).CD patients presented with significantly more constitutional symptoms(fever,anorexia,malaise/fatigue and muscle-wasting)than UC and higher inflammatory indices(higher C-reactive protein and lower albumin levels).CONCLUSION We observed a high incidence of VEO-IBD and an over-representation of the Indian ethnicity.South Asian CD patients were more likely to have symptomatic perianal disease.

Paediatric gastrointestinal endoscopy in the Asian-Pacific region:Recent advances in diagnostic and therapeutic techniques

There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade,with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal(GI)diseases.Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess,and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes.Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region.Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion,with the emergence of inflammatory bowel disease(IBD)and eosinophilic GI disease as increasingly common endoscopic diagnoses.Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed,with a declining incidence of GI bleeding.However,the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases.Helicobacter pylori infection,particularly that of multidrug-resistant strains,remains a highly prevalent problem in specific regions.Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres,hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms.GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies,intestinal polyposis or oesophageal strictures requiring dilation.Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers.Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction,particularly in East Asian centres,as invaluable diagnostic and therapeutic tools in the management of IBD,obscure GI bleeding and intestinal polyposis.State of the art endoscopic diagnostics and therapeutics,including the use of artificial intelligence-aided endoscopy algorithms,real-time confocal laser endomicroscopy and peroral endoscopic myotomy,are expected to gain more utility in paediatrics.As paediatric gastroenterology matures as a subspecialty in Asia,it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards,and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy.This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific,with the relevant clinical outcomes.

Cyclical vomiting syndrome: Recognition, assessment and management

Cyclical vomiting syndrome(CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary between different individuals. The vomiting is intense often bilious, and accompanied by disabling nausea. Identifiable precipitating factors for CVS include psychosocial stressors, infections, lack of sleep and occasionally even food triggers. Often, it may be difficult to distinguish episodes of CVS from other causes of acute abdomen and altered consciousness. Thus, the diagnosis of CVS remains largely one of exclusion. Investigations routinely done during the work-up of a child with suspected CVS include both blood and imaging modalities. Plasma lactate, ammonia, amino acid and acylcarnitine profiles as well as urine organic acid profile are indicated to exclude inborn errors of metabolism. The treatment remains challenging and targeted at prevention or shortening of the attacks and can be considered as abortive, supportive and prophylactic. Use of nonpharmacological therapy is also part of the management of CVS. The prognosis of CVS is variable. More insight into the pathogenesis of this disorder as well as role of non-pharmacological therapy is needed.