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Gastroenterology

Anal Sphincter Botox Injections for Children With Severe Constipation
 Anal Sphincter Botox Injections for Children With Severe Constipation 1024 680 Mary Bates, PhD
By:
Close up color photo of little boy holding hands on his belly

The treatment is safe and effective for many children with Hirschsprung disease and, to a lesser extent, functional constipation. In a new prospective study, researchers at Nationwide Children’s evaluated children with severe, refractory constipation treated with anal sphincter botulinum toxin (Botox) injection. They found the treatment can be effective in patients with both Hirschsprung disease…

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Do Symptom Scores and pH Impedance Correlate in Infants Treated for Gastroesophageal Reflux?
 Do Symptom Scores and pH Impedance Correlate in Infants Treated for Gastroesophageal Reflux? 1024 683 Lauren Dembeck
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Gastroesophageal reflux (GER) — the passage of gastric contents into the esophagus — is a physiologic process that can be considered normal or abnormal depending on whether troublesome symptoms and/or complications also occur. In infants, it is difficult for clinicians to distinguish between GER and pathophysiologic GER disease (GERD). “Current diagnostic criteria for GERD are…

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How Do Children With IBD and Their Caregivers Perceive Biosimilars?
 How Do Children With IBD and Their Caregivers Perceive Biosimilars? 640 427 JoAnna Pendergrass, DVM
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Many pediatric patients with inflammatory bowel disease and their caregivers are unaware of biosimilars, creating an opportunity for providers to educate patients and their families about this effective and less expensive treatment option. Infliximab is a biologic therapy that effectively manages inflammatory bowel disease (IBD) in adult and pediatric patients. However, biologic therapies are expensive,…

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Is 3D Anorectal Manometry Preferable to Traditional Anorectal Manometry in Children With Functional Constipation?
 Is 3D Anorectal Manometry Preferable to Traditional Anorectal Manometry in Children With Functional Constipation? 1024 680 Mary Bates, PhD
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Close up color photo of little boy holding hands on his belly

Study finds 3D-ARM is less comfortable and does not provide additional information compared to traditional ARM.   In a recent pilot study, researchers from Nationwide Children’s compared outcomes and patient experience of a new three-dimensional (3D) anorectal manometry (ARM) technique compared to regular ARM in children with functional constipation. They found that the use of…

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Stress Increases Systemic Inflammation and Anxiety in Mouse Model of IBD
 Stress Increases Systemic Inflammation and Anxiety in Mouse Model of IBD 150 150 Mary Bates, PhD
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Exposure to stress did not induce a relapse in colitis in the mice. In a new study, researchers at Nationwide Children’s Hospital and the Abigail Wexner Research Institute tested whether exposure to stress would lead to flares of intestinal inflammation in a mouse model of inflammatory bowel disease. They found stress did not exacerbate colitis…

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Polyethylene Glycol 3350 Does Not Lead to Behavior Changes in Animal Model
 Polyethylene Glycol 3350 Does Not Lead to Behavior Changes in Animal Model 1024 683 Mary Bates, PhD
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Ross Maltz, MD

The laxative affected stool consistency and gut bacteria but did not alter anxiety-like behavior in mice. Polyethylene glycol 3350 (PEG3350) is a laxative commonly used to treat constipation in children. Over the years, the Food and Drug Administration has received some reports of neuropsychiatric symptoms in children administered PEG3350, including anxiety, aggression and obsessive-compulsive behaviors.…

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Addition of a Radiation-Free Evaluation and Parent-Chosen Feeding Method Leads to Superior Outcomes for Infants With Swallowing Difficulties
 Addition of a Radiation-Free Evaluation and Parent-Chosen Feeding Method Leads to Superior Outcomes for Infants With Swallowing Difficulties 150 150 Katie Brind'Amour, PhD, MS, CHES
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A recent NIH-NIDDK-funded study suggests that application of novel high-resolution manometry along with guided parental involvement can improve oral feeding success for infants with swallowing difficulties. The prevalence of swallowing difficulties among neonatal intensive care graduates is increasing.  Swallowing difficulties or dysphagia in infants are associated with airway and digestive consequences often presenting with signs…

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A Patient-Centered Medical Home for Pediatric Inflammatory Bowel Disease
 A Patient-Centered Medical Home for Pediatric Inflammatory Bowel Disease 1024 683 Mary Bates, PhD
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The Center for Pediatric and Adolescent IBD serves as a case study for comprehensive, multidisciplinary care. In a new paper published in Inflammatory Bowel Disease, researchers from Nationwide Children’s describe the multidisciplinary care model at the Center for Pediatric and Adolescent Inflammatory Bowel Disease as an example of a pediatric specialty medical home. The researchers…

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Lubiprostone Found to be Safe, as Effective as Placebo in Children With Constipation
 Lubiprostone Found to be Safe, as Effective as Placebo in Children With Constipation 1024 680 Mary Bates, PhD
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Close up color photo of little boy holding hands on his belly

The medication, FDA-approved for adults, may benefit older pediatric patients with less of a behavioral component to their constipation. Pediatric functional constipation, though common, remains challenging to treat. Lubiprostone is a medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of constipation and irritable bowel syndrome with constipation in adults. In…

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Study Highlights Relationship Between SI Gene and Chronic, Idiopathic Loose Stool in Some Children
 Study Highlights Relationship Between SI Gene and Chronic, Idiopathic Loose Stool in Some Children 1024 680 Abbie Miller
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Close up color photo of little boy holding hands on his belly

Researchers conducted one of the largest prospective, multicenter trials in pediatrics looking at the connection between SI variants and common gastrointestinal symptoms. The SI gene codes for the sucrase-isomaltase enzyme, which is expressed in the intestinal brush border. This enzyme is important to the digestion of sucrose, and without it, maldigestion and poor absorption of…

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Unraveling Intractable Functional Constipation: Manometries Are Still the Gold Standard
 Unraveling Intractable Functional Constipation: Manometries Are Still the Gold Standard 1024 680 Natalie Wilson
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Close up color photo of little boy holding hands on his belly

Cine-MRI recordings can’t replace colonic manometries when assessing motility among children with functional constipation, but they may offer additional information. And conducting both MRIs and manometries simultaneously is feasible. While functional constipation (FC) is common in childhood, and most children who experience it respond well to behavioral interventions or treatment with laxatives, some children continue…

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Calls to Poison Centers About High-Powered Magnets Increased by 444% After Ban Lifts
 Calls to Poison Centers About High-Powered Magnets Increased by 444% After Ban Lifts 1024 521 Laura Dattner
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cube made of ball magnets in the palm of a hand

High-powered magnets are small, shiny and made from powerful rare earth metals. Since they started showing up in children’s toys in the early 2000s and then later in desk sets in 2009, high-powered magnets have caused thousands of injuries and are considered to be among the most dangerous ingestion hazards in children. When more than one…

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More Data on Rare GI Diseases, With Less Work
 More Data on Rare GI Diseases, With Less Work 1024 535 Katie Brind'Amour, PhD, MS, CHES
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Collage of health technology tools

Electronic health record systems can drive knowledge acquisition in rare gastrointestinal conditions — and other orphan diseases — without the burden of duplicative data entry. Rare diseases often remain poorly understood and inefficiently treated due to a lack of objective knowledge on their natural history, pathophysiology or clinical outcomes in response to various therapies. Collecting…

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What Puts Adolescent Patients With IBD at Risk for Suboptimal Transitions?
 What Puts Adolescent Patients With IBD at Risk for Suboptimal Transitions? 1024 673 JoAnna Pendergrass, DVM
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Psychosocial-related factors, such as mental health diagnoses and public insurance, have been shown to increase the risk of suboptimal transitions in adolescent patients with inflammatory bowel disease. Between ages 18 and 22, adolescent patients transition from pediatric to adult care. Ideally, at the time of transition, patients have the skills to manage their disease and…

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Early Intervention is Key to Avoid Hospitalization for Cyclic Vomiting Syndrome
 Early Intervention is Key to Avoid Hospitalization for Cyclic Vomiting Syndrome 1024 683 Mary Bates, PhD
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Health care provider talking to male teen patient

Study finds that waiting to go to the emergency department for treatment increases likelihood of hospitalization. Cyclic vomiting syndrome is a functional gastrointestinal disorder characterized by periodic episodes of intense nausea and vomiting lasting hours to days. During episodes, some children become very sick and require emergency department care and hospitalization to manage symptoms and…

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Reducing Opioid-Induced Constipation in Patients After Orthopedic Spine Surgery
 Reducing Opioid-Induced Constipation in Patients After Orthopedic Spine Surgery 1024 575 JoAnna Pendergrass, DVM
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In pediatric patients undergoing orthopedic spine surgery, a step-wise bowel management plan can effectively reduce opioid-induced constipation and unplanned emergency department visits after surgery. Orthopedic spine surgery can generate pain in the immediate post-surgery period. Opioids are needed to mitigate this pain but commonly cause constipation and other gastrointestinal side effects. Opioid-induced constipation causes abdominal…

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Exploring the Use of Complementary and Alternative Medicine in Pediatric Functional Abdominal Pain Disorders
 Exploring the Use of Complementary and Alternative Medicine in Pediatric Functional Abdominal Pain Disorders 1024 680 Mary Bates, PhD
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Close up color photo of little boy holding hands on his belly

A survey finds most children with functional abdominal pain disorders use at least one form of complementary and alternative medicine. Functional abdominal pain disorders, which include functional dyspepsia, irritable bowel syndrome and abdominal migraine, are influenced by both biological and psychosocial factors. The underlying mechanisms are complex and largely unknown, making treatment challenging. Researchers from…

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Probiotics are Safe and Feasible for Gastrointestinal Symptoms in Autism Spectrum Disorders
 Probiotics are Safe and Feasible for Gastrointestinal Symptoms in Autism Spectrum Disorders 150 150 Mary Bates, PhD
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A pilot trial found a trend toward improvements in quality of life in patients treated with probiotics. Gastrointestinal disorders and anxiety symptoms are commonly reported in children with autism spectrum disorder (ASD). Recent research in rodent models and neurotypical humans has demonstrated that changing the gut microbiota can improve gastrointestinal (GI) symptoms. Some studies even…

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Advances in Neonatal GERD
 Advances in Neonatal GERD 1024 683 Mary Bates, PhD
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Dr. Jadcherla

New studies from the Jadcherla Lab provide insights into diagnosing, classifying and treating GERD in infants. Differentiating gastroesophageal reflux (GER), which is defined as the passage of gastric contents into the esophagus, from GER disease (GERD), when reflux is associated with troubling symptoms, remains a challenge in infants. Symptom-based diagnosis and treatment of GERD has…

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Redo Surgery After Anorectal Malformation Repair Can Improve Functional Outcomes
 Redo Surgery After Anorectal Malformation Repair Can Improve Functional Outcomes 1024 575 Mary Bates, PhD
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A reoperation can improve continence and quality of life in children still struggling with fecal incontinence following ARM repair. In a new study, researchers from Nationwide Children’s Hospital show that redo surgeries are   safe and may be an effective option for patients with fecal incontinence after an anorectal malformation repair. For many patients, a reoperation…

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Exploring the Link Between Cystic Fibrosis and Celiac Disease
 Exploring the Link Between Cystic Fibrosis and Celiac Disease 1024 575 Lauren Dembeck
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Overlapping symptoms can cause delayed diagnosis of celiac disease in patients with cystic fibrosis. Physician scientists at Nationwide Children’s Hospital have recently identified three cases of patients with cystic fibrosis, all of whom had the same genotype, were treated with the CFTR modulator, ivacaftor, and were diagnosed with celiac disease. This adds to a novel body…

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New Celiac Care Index Improves Adherence to Care Guidelines
 New Celiac Care Index Improves Adherence to Care Guidelines 1024 575 Lauren Dembeck
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The recent implementation of a Celiac Care Index (CCI) at Nationwide Children’s Hospital resulted in improved adherence to published care guidelines, reduced variability in baseline evaluations, and indicated potentially unnecessary baseline laboratory tests for further evaluation. The study, which was published in The Journal of Pediatrics, describes the quality improvement (QI) strategy implemented at the hospital.…

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Botox Appears Safe for Treatment of Defecation Disorders
 Botox Appears Safe for Treatment of Defecation Disorders 150 150 Kevin Mayhood
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Anal botulinum toxin injections (Botox) have increasingly been used in children with functional anorectal and colonic disorders during the past 15 years. A study at Nationwide Children’s Hospital, combined with a review of published literature, shows this off-label use of Botox is safe and complications are rare. Complications occurred in less than 0.7% of 1332…

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From Clinician Ideas to Commercially-Available Clinical Devices
 From Clinician Ideas to Commercially-Available Clinical Devices 150 150 Kevin Mayhood
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Pressure wounds were a common complication following a tracheostomy, often resulting in advanced-stage wounds, national studies showed. Nationwide Children’s Hospital was no different but Kris Jatana, MD, and Charles Elmaraghy, MD, surgeons in the Department of Otolaryngology, knew they could improve these outcomes. Brendan Boyle, MD, and Alex Green, DO, were fellows in the Division…

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Rethinking Gastroesophageal Reflux Disease (GERD) in Infants
 Rethinking Gastroesophageal Reflux Disease (GERD) in Infants 150 150 Lauren Dembeck
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Novel use of existing technology points to other causes of GERD-like symptoms. While typically attributed to gastroesophageal reflux disease (GERD), supra-esophageal symptoms, such as cough, back arching and gagging, can be temporally associated with aerophagia, according to a new study by researchers at Nationwide Children’s Hospital. The findings come from the novel implementation of standard…

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Type of Anorectal Malformation at Birth is Predictive of Fecal Continence
 Type of Anorectal Malformation at Birth is Predictive of Fecal Continence 150 150 Kevin Mayhood
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Study also finds fecal continence rates for children born with ARMs are lower than previously reported. Recently published research shows the rate of fecal continence among 4-year-olds who underwent surgery for an anorectal malformation (ARM) as infants averages 40%, and the type of malformation — which reflects severity — is predictive of the outcome. Though…

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A New Therapeutic Era in Pediatric Functional and Motility Disorders
 A New Therapeutic Era in Pediatric Functional and Motility Disorders 150 150 Katie Brind'Amour, PhD, MS, CHES
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20 years ago, treatment options were limited for children with functional gastrointestinal (GI) and motility disorders. Now, a growing list of drugs, behavioral and dietary care plans, and an advanced, forward-looking technique – neuromodulation – are transforming pediatric GI care. Gastrointestinal (GI) disorders are notoriously difficult to diagnose. Virtually all functional and motility-related GI problems…

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Development of a Patient Reported Experience and Outcomes Measure in Pediatric Patients
 Development of a Patient Reported Experience and Outcomes Measure in Pediatric Patients 150 150 Lauren Dembeck
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Researchers develop a questionnaire that enables them to assess the burden of treatment compared to the burden of the disease. Researchers have developed a rigorous, patient reported experience and outcomes questionnaire for pediatric patients undergoing an intensive bowel management program (BMP). The report was published online in the Journal of Pediatric Gastroenterology and Nutrition. “Often physicians…

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How Similar Is Chronic Pancreatitis Among Pediatric and Adult Patients?
 How Similar Is Chronic Pancreatitis Among Pediatric and Adult Patients? 150 150 Lauren Dembeck
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A large, international study highlights room for improvement in care and transition of patients ages 17 to 24 years old. A new study that compared adult patients with pancreatic disease starting when they were children with pediatric patients with pancreatic disease revealed remarkable similarities in the cause of the disease and progression to chronic pancreatitis.…

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Worth It: Why Wrestling Through the Logistical Challenges of a Multidisciplinary Colorectal Center Matters
 Worth It: Why Wrestling Through the Logistical Challenges of a Multidisciplinary Colorectal Center Matters 150 150 Jeb Phillips
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Consider the complex case of a girl born with rectal, vaginal and urinary tracts fused into a common channel – a cloacal malformation. The child needs reconstructive procedures across three different organ systems and three different surgical specialties. It could take months or years to manage the surgeries needed for the colorectal portion, then the…

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Acid Suppression Should Not Be the First Treatment for Infants With Reflux
 Acid Suppression Should Not Be the First Treatment for Infants With Reflux 150 150 Mary Bates, PhD
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Gastroesophageal reflux (GER) is common in infants. Many show no symptoms more serious than agitation and frequent regurgitation, and most cases resolve on their own by the time the child is 1 year old.

Despite a paucity of well-controlled clinical trials, acid suppression medications are commonly prescribed for infants with GER. In a paper published in Pediatric Drugs, physician researchers from Nationwide Children’s Hospital review the data regarding acid suppressants for infants as well as clinical practice guidelines for how and when to use these medications.

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Chronic Constipation: What Manometry Tells Us About Gastro-Colonic Response and Pathophysiology
 Chronic Constipation: What Manometry Tells Us About Gastro-Colonic Response and Pathophysiology 150 150 Katie Brind'Amour, PhD, MS, CHES
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Saving Constipation Treatment Costs With a Bowel Management Program
 Saving Constipation Treatment Costs With a Bowel Management Program 1024 575 Jeb Phillips
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Simple illustrated diagram of the GI track with organs colorized and body outline and background in blue

A protocolized approach significantly reduced ED visits and hospital admissions for children with chronic constipation – and became a driver for surgical referrals. If hospitals are willing to foot the bill for staffing and start-up costs, a structured bowel management program for children with chronic severe constipation likely saves both individual and institutional health care…

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Race, Insurance, and ED Visits for Pediatric Crohn’s Disease
 Race, Insurance, and ED Visits for Pediatric Crohn’s Disease 1024 680 Jeb Phillips
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Close up color photo of little boy holding hands on his belly

Black children and children insured by Medicaid make more repeat emergency department visits for Crohn’s disease than their white and privately insured peers. In what appears to be the first nationally representative study evaluating the impact of race and insurance status on emergency department treatment for Crohn’s disease, a team of physicians and researchers at…

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New Guidelines Offer Practical Tools to Treat GI Reflux
 New Guidelines Offer Practical Tools to Treat GI Reflux 150 150 Jeb Phillips
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An international committee’s new recommendations reflect shifting opinions about acid-suppressive medications and include an expanded diagnostic algorithm. While reflux-related complaints are heard often by pediatric gastroenterologists and primary care physicians, it can be difficult to tell when gastroesophageal reflux (GER) crosses the line into gastroesophageal reflux disease (GERD) — or how that disease should be…

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Quality Improvement Boosts Use of Enteral Therapy in Patients With Crohn’s Disease
 Quality Improvement Boosts Use of Enteral Therapy in Patients With Crohn’s Disease 1024 575 Kevin Mayhood
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Color image of enteral complete liquid nutritional products of several brands

Refined procedures, tools and support promote this proven alternative to steroids. A team of researchers found that employing quality-improvement methods increased use of exclusive enteral nutrition (EEN) to induce remission in children with Crohn’s disease at Nationwide Children’s Hospital. By increasing awareness of the therapy, standardizing procedures and providing support, EEN usage increased from less…

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Children With Autism and Abdominal Pain Have Distinctive Bacterial Profiles
 Children With Autism and Abdominal Pain Have Distinctive Bacterial Profiles 150 150 Kevin Mayhood
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The microbiome may harbor causes of abdominal and behavioral issues and potential targets for relief. Children with autism spectrum disorder (ASD) and functional abdominal pain may have a distinct microbiome-neuroimmune profile compared to kids with gastrointestinal disorders (GI) and those with no GI illness. Building on others’ research showing that Clostridia bacteria in the gut are altered…

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How to Solve Feeding Disorders Without a G-Tube
 How to Solve Feeding Disorders Without a G-Tube 1024 575 Jeb Phillips
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Babies in a neonatal intensive care unit must have a safe way of receiving nutrition in order to go home. Full oral feeding is ideal, of course. But for those patients with persistent difficulty feeding by mouth, there were two primary options before 2002 to guarantee nutrients by the time of discharge. Both had their…

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Diagnosing GERD in Neonates? Be Cautious
 Diagnosing GERD in Neonates? Be Cautious 150 150 Jeb Phillips
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Gastroesophageal reflux disease is likely over-diagnosed in neonates, leading to unnecessary and harmful treatment. Approximately 10 percent of infants born preterm in the United States are diagnosed with gastroesophageal reflux disease (GERD). But it’s almost certain that not all of those babies actually have GERD, say neonatologists at Nationwide Children’s Hospital. The probable over diagnosis leads to…

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One Dose Probiotic Biofilm Protects Against NEC
 One Dose Probiotic Biofilm Protects Against NEC 150 150 Kevin Mayhood
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Probiotic biofilm enables the beneficial bacteria to withstand stomach acid, promote microbial activity and decrease intestinal inflammation. A single dose of a probiotic biofilm grown on microspheres prevented or significantly reduced the severity of necrotizing enterocolitis (NEC) in animal models of the disease, researchers show. This delivery method not only appears to protect against NEC…

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When Should Kids With Severe Functional Constipation Have Surgery?
 When Should Kids With Severe Functional Constipation Have Surgery? 150 150 Jeb Phillips
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A protocol developed by pediatric surgeons and gastroenterologists allows patients to receive specific surgical interventions that will be most beneficial – and allows many patients originally referred for surgery to avoid it altogether. Children with severe functional constipation are most often referred for surgery after failure of medical management. But there’s a problem with this…

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InSight: Restoring Normal Habits
 InSight: Restoring Normal Habits 471 285 Tiasha Letostak, PhD
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SACRAL NERVE STIMULATION (SNS) is a new treatment that helps control urinary incontinence and fecal soiling. For some children, the nerves that control urination and bowel movements do not work correctly. The SNS unit consists of a small, safe battery and wire under the skin and sends signals to the sacral nerve. The signals help restore…

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Enteral Therapy Thursday: Professionals Sharing the Patient Experience
 Enteral Therapy Thursday: Professionals Sharing the Patient Experience 150 150 Jennifer Smith, MS, RD, CSP, LD, LMT
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A multidisciplinary team puts themselves on enteral nutrition for a day to gain insights into the patient experience. Enteral nutrition for Crohn’s disease is a well-established practice using liquid formulas to treat Crohn’s disease.  Patients who choose this form of treatment either drink the prescribed amount of formula or receive the formula via a feeding…

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Colorectal Cancer Screening and the Pediatric Subspecialist
 Colorectal Cancer Screening and the Pediatric Subspecialist 150 150 Katie Brind'Amour, PhD, MS, CHES
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Screening a 15-year-old for pre-cancerous polyps may seem a bit unusual, as colon cancer is widely considered an adult disease. But for children with a family history of Lynch syndrome, a hereditary condition that increases the risk of colon and other cancers, life-threatening malignancies can develop as early as the mid-teens. Fewer than one in…

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Delays and Difficulties: Fecal Microbiota Transplants as Therapy
 Delays and Difficulties: Fecal Microbiota Transplants as Therapy 150 150 Katie Brind'Amour, PhD, MS, CHES
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Use of fecal microbiota transplantation to treat a wide range of disorders is in limbo while the FDA decides how to regulate the therapy. Between 1997 and 2007, Clostridium difficile bacterial infections among U.S. children more than doubled and its mortality rate among all U.S. cases more than quadrupled. Clinicians are turning to a number of treatment…

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Using Zinc for Growth Delays in Babies Born Preterm
 Using Zinc for Growth Delays in Babies Born Preterm 150 150 Katie Brind'Amour, PhD, MS, CHES
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Zinc supplementation in extremely low birth-weight (ELBW) infants with chronic lung disease improves weight gain and linear growth, according to a retrospective study performed at Nationwide Children’s Hospital. The study is one of the first to look at the association between zinc supplementation and growth in ELBW babies with chronic lung disease, also known as bronchopulmonary dysplasia.…

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