Clinical and Experimental Pediatrics

Clinical Note

Gastroenterology

Abdominal pain in a young girl: a twist in the tale

Upasana Ghosh, Ankit Agrawal, Umesh Shukla, Vikas Jain, Deeksha Bhalla

Clin Exp Pediatr. 2025;68(5):395-397. Published online March 11, 2025

· Chronic abdominal pain caused by a gastric trichobezoar is extremely rare among children.
· An indentable epigastric mass is characteristic and upper gastrointestinal endoscopy is diagnostic of a gastric trichobezoar.
· Symptomatic large trichobezoars usually require surgery.
· Neuropsychiatric disorders are often associated with gastric trichobezoar, making a psychiatric evaluation of paramount importance.

DOI: https://doi.org/10.3345/cep.2024.01949

Review Article

Gastroenterology

Anxiety disorders presenting as gastrointestinal symptoms in children – a scoping review

Anjali Kumar, Pramodh Vallabhaneni

Clin Exp Pediatr. 2025;68(5):344-351. Published online January 13, 2025

A positive bidirectional relationship between gastrointestinal disorders and anxiety, but with no clear aetiology, was identified. Factors such as somatisation and pain catastrophising resulted in poorer pain-related outcomes in children. Further studies are required to understand this relationship in order to have targeted treatments and ensure better long term outcomes.

DOI: https://doi.org/10.3345/cep.2024.01732

Clinical Note

Gastroenterology

Congenital antral web: rare cause of gastric outlet obstruction successfully managed with endoscopic balloon dilatation

Upasana Ghosh, Ujjal Poddar, Srinivas Srinidhi Vadlapudi, Moinak Sen Sarma, Anshu Srivastava

Clin Exp Pediatr. 2025;68(3):266-268. Published online January 13, 2025

DOI: https://doi.org/10.3345/cep.2024.01242

Original Article

Gastroenterology

Outcome of pediatric inflammatory bowel disease in Asian children: a multinational 1-year follow-up study

Pornthep Tanpowpong, Suporn Treepongkaruna, James Guoxian Huang, Kee Seang Chew, Karen Sophia Calixto Mercado, Almida Reodica, Shaman Rajindrajith, Wathsala Hathagoda, Yoko Kin Yoke Wong, Way Seah Lee, Marion Margaret Aw

Clin Exp Pediatr. 2025;68(3):247-256. Published online November 13, 2024

Web of Science 1 Crossref 1

Question: Short-term (1-year) follow-up data in pediatric patients with inflammatory bowel disease (IBD), especially in Southeast Asian countries, are limited.
Finding/Meaning: Abdominal pain and pallor rates remained high at 1 year after IBD diagnosis. Three independent factors of 1-year clinical remission for Crohn disease were oral prednisolone, antibiotic, and immunomodulator use at 1-year follow-up. A history of weight loss at diagnosis was the only independent risk factor of IBD flare.

DOI: https://doi.org/10.3345/cep.2024.01144

Review Article

Gastroenterology

Practical concepts and strategies for early diagnosis and management of eosinophilic gastrointestinal disorders in East-Asian children

Byung-Ho Choe

Clin Exp Pediatr. 2025;68(3):185-198. Published online November 13, 2024

Eosinophilic gastrointestinal disorders (EGIDs) often coexist with functional gastrointestinal disorders (FGIDs) and other IgE or non-IgE mediated GI diseases. Diagnosing EGIDs requires a high index of suspicion and a comprehensive approach to differentiate them from conditions like inflammatory bowel disease. Tests such as fecal calprotectin and biopsies aid in severe cases. Maintaining a food diary helps identify triggers for long-term elimination. Awareness and education are key to effective management.

DOI: https://doi.org/10.3345/cep.2024.01165

Original Article

Gastroenterology

Differences in immune cells and gene expression in human milk by parity on integrated scRNA sequencing

Dae Yong Yi, Hong-Jai Park, Min Sun Shin, Hyoungsu Kim, Sang Jin Lee, Insoo Kang

Clin Exp Pediatr. 2025;68(2):141-152. Published online January 10, 2025

Question: Is there a difference in immune cells in human breast milk by parity?
Finding: There were higher proportions of monocytes and T/B cells in the primiparous and multiparous group, respectively. The expression of genes with a direct role in the infant immune system and immune response-related genes were highest in the primiparous group
Meaning: There were parity-dependent differences in the expression of genes between innate and adaptive immune cells.

DOI: https://doi.org/10.3345/cep.2024.01585

Review Article

Gastroenterology

Value of transabdominal ultrasonography for diagnosing functional constipation in children: a systematic review and meta-analysis

Duc Long Tran, Phu Nguyen Trong Tran, Paweena Susantitaphong, Phichayut Phinyo, Palittiya Sintusek

Clin Exp Pediatr. 2025;68(2):127-135. Published online November 13, 2024

Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and metaanalysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, Embase, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD...

DOI: https://doi.org/10.3345/cep.2024.00927

Letter to the Editor

Gastroenterology

Pediatric abdominal ultrasound training program for pediatricians

Soon Chul Kim

Clin Exp Pediatr. 2024;67(9):474-476. Published online August 20, 2024

DOI: https://doi.org/10.3345/cep.2024.00451

Review Article

Gastroenterology

High-resolution anorectal manometry in children

Yogesh Waikar

Clin Exp Pediatr. 2024;67(2):57-63. Published online June 14, 2023

Web of Science 2 Crossref 4

· Anorectal manometry is safe in children.
· Defecation Dyssynergia is one of the commonest cause of chronic constipation.
· Positive Rectoanal inhibiory reflex rules out Hirschsprung's Disease

DOI: https://doi.org/10.3345/cep.2022.01242

Original Article

Gastroenterology

Risk factors of prolonged diarrhea in children under 2 years old

Dedy Rahmat, Agus Firmansyah, Ina S. Timan, Saptawati Bardosono, Joedo Prihartono, Pramita Gayatri

Clin Exp Pediatr. 2023;66(12):538-544. Published online November 16, 2023

Web of Science 3 Crossref 4

Question: What are the risk factors for prolonged diarrhea in children under 2 years old?
Finding: History of antibiotic use, zinc deficiency, and elevated fecal alpha-1 antitrypsin levels were the main risk factors of prolonged diarrhea in children under 2 years old with acute diarrhea.
Meaning: Rational antibiotic usage is necessary as well as thorough testing of serum zinc level and fecal alpha-1 antitrypsin levels.

DOI: https://doi.org/10.3345/cep.2023.00668

Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta-analysis

Gilbert Sterling Octavius, Michelle Imanuelly, Johan Wibowo, Nadia Khoirunnisa Heryadi, Melanie Widjaja

Clin Exp Pediatr. 2023;66(11):477-484. Published online June 14, 2023

Web of Science 2 Crossref 2

Question: The inferior vena cava to aorta (IVC/Ao) ratio measured via ultrasound has been touted as a promising noninvasive technique to assess clinically significant dehydration in pediatric patients.
Finding: Our meta-analysis found that IVC/Ao ratio had a positive likelihood ratio of 3.2 (95% confidence interval [CI], 2.1–5.1) and negative likelihood ratio of 0.18 (95% CI, 0.12–0.28).
Meaning: Hence, IVC/Ao ratio is insufficient to exclude or confirm significant dehydration in pediatric patients.

DOI: https://doi.org/10.3345/cep.2022.01445

Editorial

Gastroenterology

Noninvasive and simple, but accurate? Meta-analysis of evidence-based point-of-care ultrasound for assessing dehydration in children

Jin-Hee Oh

Clin Exp Pediatr. 2023;66(11):475-476. Published online July 11, 2023

· Point-of-care ultrasound imaging, including measurement of the inferior vena cava/aorta ratio, is powerful for evaluating the hemodynamic status of pediatric patients.
· Owing to the limited feasibility of randomized clinical trials and insufficient data in children, imaging tools require validation.
· Objective validity meta-analyses of imaging studies can affect clinical decision-making and serve as a cornerstone for evidence-based practice in pediatrics.

DOI: https://doi.org/10.3345/cep.2023.00745

Original Article

Gastroenterology

Relationship between nonalcoholic fatty liver disease and hyperandrogenemia in adolescents with polycystic ovary syndrome

Ozlem Kara, Hanife Aysegul Arsoy, Murat Keskin

Clin Exp Pediatr. 2023;66(9):395-402. Published online June 14, 2023

Web of Science 7 Crossref 5

Question: Is polycystic ovary syndrome (PCOS) a risk factor for nonalcoholic fatty liver disease (NAFLD) in adolescents?
Finding: The frequency of NAFLD did not increase in adolescents with PCOS. However, hyperandrogenemia was a risk factor for NAFLD.
Meaning: Adolescents with PCOS and hyperandrogenemia should be closely monitored for hepatic steatosis.

DOI: https://doi.org/10.3345/cep.2023.00353

Review Article

Gastroenterology

Prevalence, risk factors, and treatment of small intestinal bacterial overgrowth in children

Yu Kyung Cho, Jin Lee, Chang Nyol Paik

Clin Exp Pediatr. 2023;66(9):377-383. Published online August 21, 2023

Web of Science 5 Crossref 6

· Pediatric small intestinal bacterial overgrowth (SIBO) manifestations range from nonspecific abdominal symptoms to malabsorption or malnutrition.
· SIBO is prevalent in children and adolescents with functional abdominal pain disorders.
· Predisposing factors include disturbed intestinal motility, altered anatomy, and/or abnormal body defense systems against intestinal bacteria.
· Breath tests are safe and noninvasive.
· Treatment principles include managing predisposing conditions, nutritional support, symptom control, and antibiotics.

DOI: https://doi.org/10.3345/cep.2022.00969

Original Article

Gastroenterology

Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics

Hasan M. Isa, Fatema A. Alkharsi, Fatema A. Salman, Maryam S. Ali, Zahra K. Abdulnabibi, Afaf M. Mohamed

Clin Exp Pediatr. 2023;66(7):296-306. Published online June 14, 2023

Web of Science 1 Crossref 2

Question: What causes childhood constipation, and what can predict organic constipation?
Finding: Constipation represents 14.7% of gastroenterology visits. Functional constipation is more common among constipation types, while organic constipation is more common in young children and those with a low body weight, stunted growth, mucus in the stool, and associated diseases.
Meaning: Younger children and those with lower growth or mucus in the stool should be assessed for underlying organic causes of constipation.

DOI: https://doi.org/10.3345/cep.2022.01298

Editorial

Gastroenterology

Gut microbiota’s impact on obesity

Sujin Jeong

Clin Exp Pediatr. 2023;66(7):294-295. Published online June 14, 2023

Web of Science 1 Crossref 1

· An imbalance of the gut microbiota with a relative increase in Firmicutes versus Bacteroidetes is associated with the pathogenesis of obesity.
· Dysbiosis is associated with microbial genes associated with short-chain fatty acids (SCFA) production and increased colonic SCFA levels. SCFAs have also been shown to regulate appetite and satiety hormones, which can affect food intake and energy balance.
· A dietary high-fat intake is reportedly associated with increased plasma lipopolysaccharide. Altered Toll-like receptor-4 signaling leads to propagating the cascade of further inflammation and promoting insulin resistance.

DOI: https://doi.org/10.3345/cep.2023.00458

Recent advances in epigenetic mechanisms, diagnosis, and treatment of pediatric gastrointestinal allergic disorders

Eell Ryoo

Clin Exp Pediatr. 2023;66(6):250-251. Published online May 19, 2023

· Epigenetic mechanisms are involved in rapidly increasing food allergy.
· There is still no definitive way to diagnose food allergy.
· Early introduction of peanuts, eggs, and cow’s milk reduces food allergy incidence.
· Administration of probiotics such as Lactobacillus rhamnosus GG, Bifidobacterium bifidum can partially reduce the occurrence of allergic symptoms.

DOI: https://doi.org/10.3345/cep.2023.00136

Review Article

Gastroenterology

Update on eosinophilic gastrointestinal disease beyond eosinophilic esophagitis in children

Hye Ran Yang

Clin Exp Pediatr. 2023;66(6):233-239. Published online January 3, 2023

Web of Science 4 Crossref 3

· Eosinophilic gastrointestinal disease (EGID) is uncommon, with a prevalence of 1–30/100,000 in the general population; however, it is increasing worldwide.
· The diagnosis of EGID is based on histopathological findings of endoscopic mucosal biopsy in which tissue eosinophils are counted in each gastrointestinal tract segment of patients with chronic or recurrent gastrointestinal symptoms.
· Individualized treatment strategies, including adequate dietary and pharmacological therapy, may help improve outcomes of children with EGID.

DOI: https://doi.org/10.3345/cep.2022.01046

Role of social media use in onset of functional gastrointestinal disorders in children

Mauro Cinquetti, Vanessa Dargenio, Michele Fingerle, Carolina Marchiotto, Marco Biasin, Massimo Pettoello Mantovani, Flavia Indrio

Clin Exp Pediatr. 2023;66(6):226-232. Published online December 21, 2022

Web of Science 3 Crossref 4

· Social media use can cause adverse health outcomes, including gastrointestinal disorders, in children and adolescents.
· Recent findings have shown a high prevalence of social media use and decreased well-being in patients with functional gastrointestinal disorders.
· The biopsychosocial nature of functional gastrointestinal disorders and the clear influence of social media on the psychosocial lives of children suggests the likely involvement of social media in their development.

DOI: https://doi.org/10.3345/cep.2022.00843

Editorial

Gastroenterology

Is there a link between social media usage and functional gastrointestinal disorders in children?

Hae Jeong Lee

Clin Exp Pediatr. 2023;66(4):169-170. Published online March 23, 2023

Crossref 1

Social media use has potential benefits and risks, including links to adverse health problems in children such as functional gastrointestinal disorders (FGIDs). Screen time control, emotional support, and parental guidance can help children navigate social media safely and reduce the risk of developing FGIDs.

DOI: https://doi.org/10.3345/cep.2023.00143

Review Article

Gastroenterology

High-resolution esophageal manometry in children

Yogesh Waikar

Clin Exp Pediatr. 2023;66(4):155-160. Published online October 17, 2022

Web of Science 2 Crossref 2

High-resolution esophageal manometry can be safely performed in children where recurrent vomiting and persistent dysphagia is the working diagnosis after excluding nonluminal and structural obstructive pathologies using pediatric upper gastrointestinal endoscopy. Normal manometry values are available. Clinical picture, biochemical tests, radiological interpretation, and endoscopic findings with manometry completes the analysis of patients with recurrent vomiting and dysphagia.

DOI: https://doi.org/10.3345/cep.2022.00787

Liver fibrosis in children: a comprehensive review of mechanisms, diagnosis, and therapy

Elif Ozdogan, Cigdem Arikan

Clin Exp Pediatr. 2023;66(3):110-124. Published online December 19, 2022

Web of Science 12 Crossref 13

· Chronic liver diseases in children are heterogenous but converge in the common pathway of fibrosis.
· Much of the literature on mechanisms of fibrogenesis focus on adults but pediatric physiology has documented differences.
· Understanding of these distinctions are necessary to define, treat, and prevent fibrosis.
· Current management of liver fibrosis relies heavily on liver biopsy. Multiple tools have shown high diagnostic performance in pediatric and adult populations. Large, multicenter studies are needed for validation.

DOI: https://doi.org/10.3345/cep.2022.00367

Original Article

Gastroenterology

Association between maternal weight gain during pregnancy and child’s body mass index at preschool age

Jeewon Shin, Yoowon Kwon, Ju Hee Kim, Su Jin Jeong

Clin Exp Pediatr. 2023;66(2):76-81. Published online November 30, 2022

Web of Science 2 Crossref 2

Question: What are the risk factors of newborn birth weight? Does gestational weight gain and prepregnancy body mass index affect childhood weight?
Finding: Excess maternal weight gain increases the risk of overweight/obesity, newborn birth weight, and child body mass index at 4–6 years.
Meaning: Maternal weight control before and during pregnancy should be well controlled.

DOI: https://doi.org/10.3345/cep.2022.01158

Review Article

Gastroenterology

Current diagnosis and image-guided reduction for intussusception in children

Jisun Hwang, Hee Mang Yoon, Pyeong Hwa Kim, Ah Young Jung, Jin Seong Lee, Young Ah Cho

Clin Exp Pediatr. 2023;66(1):12-21. Published online July 4, 2022

Web of Science 9 Crossref 10

· Intussusception, the most common cause of small bowel obstruction in young children, has an overall incidence in Korea of 28.3 cases per 100,000 person-years.
· Its cause is idiopathic inmost cases, although viral or bacterial gastroenteritis has beenpostulated as a cause. Approximately 4% of children have pathological lead points for intussusception, and Meckel’s diverticulum is the most common cause.
· Intussusception in preterm infants is extremely rare. Older children (>5 years of age) are at increased risk of pathological lead points.

DOI: https://doi.org/10.3345/cep.2021.01816

Original Article

Gastroenterology

Ability of polymicrobial probiotic and mono-strain probiotic to reduce functional abdominal pain in children: a randomized clinical trial

Seyed Sajad Jafari, Seyed Mojtaba Hashemi, Bahman Sadeghi, Amir Almasi-Hashiani

Clin Exp Pediatr. 2022;65(12):589-594. Published online October 31, 2022

Web of Science 4 Crossref 3

· This study compared the ability of 2 probiotics to reduce and improve functional abdominal pain (FAP) in children.
· In the polymicrobial probiotic (PMP) group, 10.34% of children reported no pain; in the mono-strain probiotic (MSP) group, all patients reported low-degree pain. The mean pain score decreased significantly over time in both groups.
· The use of both PMP and MSP is recommended to reduce pain in patients with FAP.

DOI: https://doi.org/10.3345/cep.2022.00339

Editorial

Gastroenterology

Ability of probiotics to reduce functional abdominal pain in children

Ji Sook Park

Clin Exp Pediatr. 2022;65(12):585-586. Published online October 6, 2022

· The ability of probiotics to relieve pain caused by functional abdominal pain disorders (FAPD) in children is unclear.
· Lactobacillus reuteri may effectively reduce pain caused by childhood FAPD.
· Since the routine use of probiotics cannot be recommended due to a lack of clinical evidence, research into probiotic mixtures or symbiotics remains necessary.

DOI: https://doi.org/10.3345/cep.2022.00913

Original Article

Gastroenterology

Probiotics added to maternal nutrition affect ınfantile colic symptoms and fecal microbiota profile: a single-blind randomized controlled study

Aysu Yıldız Karaahmet, Gülümser Dolgun, Metehan Özen

Clin Exp Pediatr. 2022;65(11):547-554. Published online September 23, 2022

Web of Science 2 Crossref 2

Question: Do probiotics added to maternal nutrition affect infantile colic symptoms and intestinal microbiota?
Finding: Infants whose mothers ingested probiotics demonstrated decreased crying frequency and intensity and significantly increased bacterial diversity in the stools. The bacterial variety was substantially affected by the added probiotic product.
Meaning: The addition of probiotics to maternal nutrition in early infancy could play an important role in preventing infantile colic.

DOI: https://doi.org/10.3345/cep.2022.00766

Review Article

Gastroenterology

Factors influencing development of the infant microbiota: from prenatal period to early infancy

Sujin Jeong

Clin Exp Pediatr. 2022;65(9):439-447. Published online December 23, 2021

Web of Science 31 Crossref 30

∙ Microbial colonization primarily occurs after birth but there may be some colonization in utero, although this remains highly controversial.
∙ Maternal factors during pregnancy affect the infant microbiota: diet, weight, gestational weight gain, and antibiotic usage.
∙ Microbes are passed from mother-to-infant during and after birth. Delivery mode, breastfeeding, early life antibiotic, and proton pump inhibitor treatment have the largest effects on microbial composition in early life.
∙ The early life gut microbiome plays an important role in the development of the immune system and metabolism.

DOI: https://doi.org/10.3345/cep.2021.00955

Clinical importance of immunonutrition in infants: a review of the recent literature

Ji Sook Park

Clin Exp Pediatr. 2022;65(7):337-343. Published online February 17, 2022

Web of Science 3 Crossref 3

Nutrients are important in the developing immune system. Human milk supplies diverse bioactives to prevent acute infection or chronic inflammation. Immunoglobulins, lactoferrin, and glutamine in human milk decrease gastrointestinal and respiratory infection. Human milk oligosaccharides promote the growth of intestinal microbiota, the gut barrier, and antimicrobial or antiviral activity. Micronutrients act as anti-inflammatory immunonutrients, too. However, the toxicity of some nutrients from an overdose should be considered.

DOI: https://doi.org/10.3345/cep.2021.00570

Upper gastrointestinal tract involvement of Crohn disease: clinical implications in children and adolescents

Eun Sil Kim, Mi Jin Kim

Clin Exp Pediatr. 2022;65(1):21-28. Published online September 10, 2021

Web of Science 5 Crossref 7

· Clinical manifestations of upper gastrointestinal (UGI) tract involvement in Crohn's disease (CD) are common but often clinically underestimated.
· Diagnosing CD by confirming inflammation of the UGI tract histologically is challenging because macroscopic and microscopic findings overlap with those of other diseases.
· Ongoing efforts are needed to enable a standardized assessment of UGI CD in the future.

DOI: https://doi.org/10.3345/cep.2021.00661

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