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Advances in Pediatric Gastroenterology
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Advances in Pediatric Gastroenterology

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Gastroenterology and Nutrition".

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 5437

Special Issue Editors

Dr. Rajmohan Dharmaraj

E-Mail Website
Guest Editor
Division of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USA
Interests: inflammatory bowel disease; pediatric nutrition; endoscopic procedures
Special Issues, Collections and Topics in MDPI journals
Dr. Razan H. Alkhouri

E-Mail Website
Guest Editor
Division of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USA
Interests: inflammatory bowel disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The field of pediatric gastroenterology is constantly evolving. Pediatric patients experience a wide range of gastrointestinal and liver diseases, from asymptomatic or mild issues to severe and potentially life-threatening conditions. In recent years, there have been significant advancements in basic science research, diagnostics, and treatment in pediatric gastroenterology. However, there are still many gaps in our knowledge concerning the pathogenesis, diagnostics, and management of these diseases. This Special Issue aims to gather and publish original research articles and reviews that highlight recent advances in these areas within pediatric gastroenterology. Given your expertise in this field, we are pleased to invite you to contribute to the upcoming Special Issue titled “Advances in Pediatric Gastroenterology”.

We look forward to receiving your submissions.

Dr. Rajmohan Dharmaraj
Dr. Razan H. Alkhouri
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • inflammatory bowel disease
  • celiac disease
  • functional gastrointestinal disorders (disorders of gut–brain interaction)
  • gastroesophageal reflux disease
  • eosinophilic gastrointestinal diseases
  • food allergies
  • nutritional disorders
  • liver diseases in children

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (7 papers)

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Research

21 pages, 2112 KiB  
Article
Carbon Dioxide and Hemoglobin at Presentation with Hypertrophic Pyloric Stenosis—Are They Relevant? Cohort Study and Current Opinions
by Ralf-Bodo Tröbs, Hiltrud Niggemann, Grigore Cernaianu, Andreas Lipphaus and Matthias Nissen
Children 2025, 12(7), 885; https://doi.org/10.3390/children12070885 (registering DOI) - 4 Jul 2025
Abstract
Background: Recurrent vomiting in infantile hypertrophic pyloric stenosis (IHPS) leads to metabolic alkalosis and a respiratory-driven compensatory hypercapnia. Alkalosis has been identified as the main causal factor for respiratory depression on admission. The value of contribution of hemoglobin and carbon dioxide partial pressure [...] Read more.
Background: Recurrent vomiting in infantile hypertrophic pyloric stenosis (IHPS) leads to metabolic alkalosis and a respiratory-driven compensatory hypercapnia. Alkalosis has been identified as the main causal factor for respiratory depression on admission. The value of contribution of hemoglobin and carbon dioxide partial pressure to this phenomenon will be evaluated. Materials and Methods: A retrospective cohort study was conducted on 105 infants with IHPS. The acid/base status, including levels of hemoglobin and lactate, were recorded. Statistical comparisons, correlation analysis, linear regression and multivariate regression analysis were applied. Results: Hypercapnia was associated with hemoconcentration. We found a positive correlation was found between pCO2 and hemoglobin (p = 0.042). The multivariate linear regression analysis showed that pCO2 is dependent on hemoglobin (p = 0.002). Lactate, which is used as a marker for anaerobic glycolysis, showed no systematic correlation with pCO2. Conclusions: An increase in carbon dioxide cannot easily be attributed to a reduced transport function of carbon dioxide due to hemoglobin deficiency. Further investigation is needed to determine the extent to which low hemoglobin levels and increased pCO2 interact with hemoconcentration to contribute to respiratory problems. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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9 pages, 4551 KiB  
Article
Pediatric Heterotopic Gastric Mucosa of the Cervical Esophagus (Inlet Patch): Case Series with Clinical, Endoscopic, and Histopathological Correlation
by Javier Arredondo Montero, Samuel Sáez Álvarez, Andrea Herreras Martínez, Ana Fernández-García and Cristina Iglesias Blázquez
Children 2025, 12(6), 752; https://doi.org/10.3390/children12060752 - 10 Jun 2025
Viewed by 288
Abstract
Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with [...] Read more.
Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with IP between 2018 and 2025. Sociodemographic and clinical data were collected. A blinded pathologist assessed the presence and severity of inflammation within the IP. Results: Nine patients (median age, 12 years; range, 6–14 years) were included, with 78% beingmale. Cervical esophageal symptoms were identified in 67%, primarily dysphagia and gastroesophageal reflux disease-related complaints, although concomitant conditions such as eosinophilic esophagitis were frequently present. Three patients had symptoms potentially attributable to IP (33%). Endoscopic examination revealed characteristic well-demarcated salmon-red plaques in all patients, with multiple lesions observed in three cases. Histology confirmed gastric heterotopia with varying degrees of chronic inflammation in all cases. A potential association was observed between the severity of gastritis in the stomach, the severity of inflammation in the IP, and the presence of H. pylori, with 75% of patients with moderate-to-severe IP inflammation also exhibiting gastric H. pylori-associated gastritis. All patients except one received proton pump inhibitors, and symptoms improved in all cases. Conclusions: A thorough and targeted examination of the cervical esophagus significantly increased IP detection at our center, with most cases (89%) being diagnosed in the last 12 months. While mostly asymptomatic and incidental, IP can be symptomatic. In this case, series, we found a possible association between the severity of inflammation in the IP, the severity of gastritis, and the presence of H. pylori. Further studies are needed to define the clinical significance of pediatric IP and optimal management. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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18 pages, 1503 KiB  
Article
Pediatric Inflammatory Bowel Disease in Romania: The First Epidemiological Study of the North-West Region (2000–2020)
by Georgia Valentina Tartamus (Tita), Daniela Elena Serban, Cristina Rebeca Fogas and Marcel Vasile Tantau
Children 2025, 12(4), 403; https://doi.org/10.3390/children12040403 - 22 Mar 2025
Cited by 2 | Viewed by 519
Abstract
Background: Inflammatory bowel disease (IBD) represents a group of disorders with increasing incidence in the pediatric population worldwide. There are limited data on pediatric IBD (pIBD) epidemiology in Eastern Europe and none so far from Romania. The aim of our study was [...] Read more.
Background: Inflammatory bowel disease (IBD) represents a group of disorders with increasing incidence in the pediatric population worldwide. There are limited data on pediatric IBD (pIBD) epidemiology in Eastern Europe and none so far from Romania. The aim of our study was to evaluate incidence rates and time trends for pIBD in the north-west region of Romania and to compare them with results from studies on the same topic published worldwide. Methods: We performed a retrospective study of patients under 18 years of age diagnosed with pIBD in the time frame between 1 January 2000 and 31 December 2020 at the Emergency Clinical Hospital for Children in Cluj-Napoca. Age-adjusted incidence rates, annual percentage change (APC), average annual percentage chance (AAPC) and their corresponding 95% confidence intervals (CIs) were calculated for pIBD, Crohn’s disease (CD) and ulcerative colitis (UC). Temporal trends were plotted using Joinpoint regression. Results: Ninety-four patients were identified. For the entire studied period, the incidence rate for pIBD was 0.79/105 (±0.74), 0.4/105 for CD (±0.42) and 0.34/105 for UC (±0.4). Time trends for incidence were positive, but statistical significance was found only for pIBD and CD. The APC observed for pIBD, CD and UC was 12 (95% CI: 6.5–17.7), 13.1 (95% CI: 8–18.5) and 5.67 (95% CI: 1.5–13.4), respectively. Comparison to other similar studies placed Romania among the countries with the lowest incidence of pIBD. Conclusions: Although pIBD incidence in our region appears to be low, there has been an important and significant increase in the incidence of overall pIBD and especially CD. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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9 pages, 982 KiB  
Article
Do Most Children with Functional Constipation Meet the Commonly Used Clinical Trial Endpoints?
by Samantha Arrizabalo, Carlos Alberto Velasco-Benitez, Daniela Alejandra Velasco-Suarez, Rafael Giner and Miguel Saps
Children 2025, 12(2), 234; https://doi.org/10.3390/children12020234 - 15 Feb 2025
Viewed by 730
Abstract
Background/Objectives: Functional constipation (FC) is diagnosed using the Rome IV criteria, which require at least two of seven symptoms for diagnosis. Clinical trials evaluating FC treatments commonly use bowel movement frequency, stool consistency, and fecal incontinence as primary endpoints. However, there is limited [...] Read more.
Background/Objectives: Functional constipation (FC) is diagnosed using the Rome IV criteria, which require at least two of seven symptoms for diagnosis. Clinical trials evaluating FC treatments commonly use bowel movement frequency, stool consistency, and fecal incontinence as primary endpoints. However, there is limited data on whether these endpoints accurately represent the symptom distribution in children with FC. This study assessed the frequency of each criterion in a large children’s community sample to determine whether commonly used clinical trial endpoints accurately reflect symptom distribution. Methods: A cross-sectional study of school children aged 8–18 years was conducted across seven Colombian cities. Participants completed the Pediatric Gastrointestinal Symptoms Rome IV Questionnaire (QPGS-IV). The prevalence of FC and the distribution of diagnostic criteria were analyzed, calculating the percentage of each criterion. Results: 6611 children completed the questionnaires. FC was diagnosed in 12.8% of participants, making it the most common disorder of gut–brain interaction. The most reported criteria were fewer than two stools per week (66.1%) and painful bowel movements (65%), while fecal incontinence was uncommon (6.9%). 60.5% of participants met only two criteria, with two or fewer defecations per week and painful bowel movements being the most common combination. Conclusions: This study reveals significant variability in Rome IV criteria prevalence for FC, highlighting disparities between the most common endpoints in clinical trials and symptom distribution in a community-based cohort. Painful bowel movements emerged as a critical diagnostic component but remain underutilized as an endpoint in pediatric trials. These findings suggest the possible need to reassess endpoint selection in clinical trials. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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8 pages, 544 KiB  
Article
Colonic Manometry in Pediatric Patients with Spina Bifida: Results from a Retrospective Cohort Study
by Albert Yuh Chyuan Shan, Barry Duel, Timothy Phillips, Paula Buchanan, Leonel Rodriguez and Dhiren Patel
Children 2025, 12(2), 184; https://doi.org/10.3390/children12020184 - 4 Feb 2025
Viewed by 741
Abstract
Background/Objectives: Patients with spina bifida (SB) commonly experience neurogenic bowel dysfunction, characterized by defecation-related symptoms. While anorectal dysfunction and slow transit constipation (STC) have been implicated, the role of colonic motility in SB remains unclear. This study aimed to evaluate colonic motility in [...] Read more.
Background/Objectives: Patients with spina bifida (SB) commonly experience neurogenic bowel dysfunction, characterized by defecation-related symptoms. While anorectal dysfunction and slow transit constipation (STC) have been implicated, the role of colonic motility in SB remains unclear. This study aimed to evaluate colonic motility in SB patients with refractory bowel dysfunction. Methods: This retrospective cohort study included SB patients who failed the repeated optimization of a bowel regimen including stimulant laxatives and subsequently underwent anorectal manometry (ARM), colonic transit time (CTT) studies, or colonic manometry (CM). Diagnostic findings were analyzed alongside treatment outcomes. Results: A total of 13 patients with myelomeningocele were included; one declined further treatment, and 12 underwent treatment optimization, with four achieving bowel continence. Of the five patients who proceeded with advanced motility testing, two had abnormal ARM findings, one of three had abnormal CTT results, and all five had normal CM findings. Conclusions: These findings suggest that anorectal dysfunction or STC may play a larger role in refractory bowel symptoms, while colonic motility appears to be preserved, and this highlights the importance of maximizing conservative therapies, particularly with stimulant laxatives, before pursuing invasive tests or surgical interventions for bowel dysfunction in this population. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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10 pages, 868 KiB  
Article
Risk Factors and Outcome of Pneumatosis Intestinalis in Children
by Noha Heikal, Alessandra Mari and Jutta Köglmeier
Children 2025, 12(2), 137; https://doi.org/10.3390/children12020137 - 26 Jan 2025
Cited by 1 | Viewed by 1074
Abstract
Objectives: Pneumatosis intestinalis (PI) is rare in childhood. The aetiology remains poorly understood. Our aim was to assess its associated risk factors and outcome. Methods: Retrospective data collection of all children (>1 month of age) with radiological evidence of PI identified from 1991 [...] Read more.
Objectives: Pneumatosis intestinalis (PI) is rare in childhood. The aetiology remains poorly understood. Our aim was to assess its associated risk factors and outcome. Methods: Retrospective data collection of all children (>1 month of age) with radiological evidence of PI identified from 1991 to 2021 in a large children’s hospital. Poor outcome was defined as loss of enteral autonomy, or death within one month of PI diagnosis. Results: A total of 31 patients (21 male, 67.7%) were included, with a median age of 5 years. The underlying diagnosis was heterogenous. Cerebral palsy and acute lymphocytic leukaemia (ALL) were most common (5/31 for each, 16.13%). A share of 12/31 (38.7%) developed PI 2–15 months post-bone marrow transplantation (BMT). Most patients (n = 15, 48.4%) had no pre-existing gastroenterological disorder. In the majority (11/31, 35.5%), PI was an incidental finding. Abdominal pain was the most common presentation in symptomatic children (7/31, 22.6%). All (31/31, 100%) were managed conservatively with gut rest and antibiotics, and 6/31 (19.4%) had a poor outcome (1/31 permanent feeding intolerance, 5/31 died). When comparing patients who did well (group 1) to those with a poor outcome (group 2), worse prognosis was associated with a lower platelet count (p = 0.016), raised CRP (p = 0.008), higher creatinine (p = 0.006), and higher urea (p = 0.013). Conclusions: The overall prognosis of PI in childhood is good but associated with significant morbidity and mortality in a small number of patients. Our data suggest that lower platelet count, and higher urea, creatinine, and CRP levels might be risk factors. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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13 pages, 1422 KiB  
Article
Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD): Trends, Mortality, and Socioeconomic Disparities in the U.S., 1998–2020
by Paul Wasuwanich, Joshua M. So, Mustafa Sadek, Chaowapong Jarasvaraparn, Songyos Rajborirug, Ruben E. Quiros-Tejeira and Wikrom Karnsakul
Children 2025, 12(1), 71; https://doi.org/10.3390/children12010071 - 8 Jan 2025
Cited by 1 | Viewed by 1519
Abstract
Background/Objectives: We aim to describe the changing inpatient epidemiology of NAFLD in the U.S. and identify major risk factors associated with mortality in the disease among hospitalized pediatric patients. Methods: Hospitalization data from the 1998–2020 National Inpatient Sample were utilized. ICD-9 and ICD-10 [...] Read more.
Background/Objectives: We aim to describe the changing inpatient epidemiology of NAFLD in the U.S. and identify major risk factors associated with mortality in the disease among hospitalized pediatric patients. Methods: Hospitalization data from the 1998–2020 National Inpatient Sample were utilized. ICD-9 and ICD-10 codes were used to identify pediatric patients (age less than 18 years old) with NAFLD, and risk factors for mortality were analyzed by logistic regression. Results: We identified 68,869 pediatric hospitalizations involving NAFLD. Among those, 970 (1.4%) died during hospitalization. Hospitalization rates have been rapidly increasing from 1998 to 2020 (incidence rate ratio (IRR): 1.07; 95% CI: 1.06–1.07; p < 0.001). There was a significant difference in mortality based on the type of hospital (rural, non-teaching urban, or teaching urban) in pediatric patients with NAFLD (p < 0.05). Coagulopathy was significantly associated with increased odds of mortality, while age ≥ 12 years, diabetes and obesity were associated with decreased odds of mortality (p < 0.05). Sex, race/ethnicity, hepatitis B, hepatitis C, HIV, and IV drug use were not significantly associated with mortality. Conclusions: Our study has shown ever increasing hospitalization rates for NAFLD in pediatric populations and well as significant risk factors associated with mortality. Further studies should be performed as more data on this patient population are collected. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)
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