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BackgroundGiven the high prevalence and complication risks of acid gastroesophageal reflux (GERD) in the first months of life in infants with esophageal atresia, the ESPGHAN/NASPGHAN consensus statement recommends systematic treatment with proton pump inhibitors (PPIs) until the age of 1 year and checking for acid GERD thereafter. However, these recommendations have not been evaluated.MethodsThis prospective study was conducted from 2007 to 2016. We evaluated the prevalence of acid GERD in 100 consecutive infants presenting with esophageal atresia/tracheoesophageal fistula after the age of 18 months when PPI treatment was stopped. The diagnosis of acid GERD was based on positive pH-metry and/or evidence of complications (e.g., peptic esophagitis, need for jejunal nutrition, or antireflux surgery). Those with acid GERD at a median age of 18 months received a control examination every year or adapted to their clinical situation.ResultsThe prevalence rates of acid GERD were 64.3% at 18 months and 22.8% at the last follow-up (median age 65 months).There is no risk factor for acid GERD identified.ConclusionsThis study shows a high prevalence of acid GERD in late infancy and supports the recommendation of systematic checking for acid GERD when treatment with PPI is stopped.ImpactAcid gastroesophageal reflux disease (GERD) is a frequent complication of esophageal atresia in infants. The ESPGHAN/NASPGHAN consensus, which is based on expert opinion, recommends systematic treatment of children with PPI until the age of 1 year.The prevalence rates of acid GERD were 64.3% at 18 months and 22.8% at the last follow-up. This study shows a high prevalence of acid GERD in late infancy and supports the recommendation of systematic checking for acid GERD when treatment with PPI is stopped.

One-step button percutaneous endoscopic gastrostomy (B-PEG) is a method for gastrostomy placement. Few studies have described complications associated with T-fasteners. This study aimed to assess the incidence and risk factors of post-gastrostomy T-bar retention. Children who underwent one-step button percutaneous endoscopic gastrostomy (B-PEG) placement in our tertiary center between 2009 and 2020 were included in this retrospective study. Patient characteristics, comorbidities, complications, and potential risk factors were analyzed. All post-procedure radiological examinations, T-bar numbers, and durations post-procedure were collected. T-bar retention was considered at least one T-bar after 6 weeks post-B-PEG. A total of 679 children (337 boys; median age at B-PEG, 1.7 years) were included. Among 483 patients with radiological examinations analyzed, 361 (74.7%) had at least one T-bar impaction at the first radiological examination (median time after B-PEG, 0.55 years). Younger age at B-PEG was a risk factor for T-bar impaction (odds ratio [OR]: 2.82, 95% confidence interval [CI]: [1.71–4.66], P  < .0001). Nearly 75% of children presented T-bar impaction. These data indicate that to avoid gastropexy complications, discussion of early removal of T-fasteners post-B-PEG is warranted.

ObjectivesTo identify the risk factors for anastomotic, refractory and recurrent strictures and to establish whether anastomotic stricture is associated with antireflux surgery.DesignThis prospective national multicentre study included all infants born with oesophageal atresia (OA) over an 8-year period. Data on OA and complications were collected at birth and at 1 year old. Univariate and multivariate analyses were conducted.Results1082 patients from 37 centres were included in the study. The prevalence of anastomotic stricture at 1 year old was 23.2%. Anastomosis under tension (defined by the surgeon at the time of repair) and delayed anastomosis (defined as anastomosis performed more than 15 days after birth, excluding delays due to prematurity or severe cardiac diseases) were found to be independent risk factors for anastomotic stricture (2.3 (1.42–3.74) and 4.02 (2.12–7.63), respectively). Patients with anastomotic stricture had a 2.3-fold higher rate of fundoplication compared with others (p=0.001). Anastomosis under tension and delayed anastomosis were found to be independent risk factors for recurrent stricture (1.92 (1.10–3.34) and 5.73 (2.71–12.14), respectively), while delayed anastomosis was the only risk factor for refractory stricture (8.30 (3.34–20.64)). There was a 2.39-fold (1.42–4.04) higher rate of fundoplication in the anastomotic stricture group than in the group without anastomotic stricture (p=0.001).ConclusionsPatient-related anatomical factors leading to anastomosis under tension and delayed anastomosis increase the risk of anastomotic stricture.

Tube feeding is a therapeutic intervention that is aimed at providing nutritional support and is important in the nutritional and gastrointestinal management of children with neurological disability (ND) worldwide. Since the publication of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) consensus paper in 2017, some aspects of tube-feeding modalities have attracted the interest of the scientific community more than others, including the type of enteral formulas, enteral access, and the challenging practice of tube weaning. The purpose of this review was to report on the most recent hot topics and new directions in tube-feeding strategies for children with ND.

No biological treatment has been approved for pediatric eosinophilic esophagitis (EoE) in France. For patients refractory to conventional treatments, although compassionate use of monoclonal antibodies has developed, experience remains limited. We conducted a national multicenter study across French pediatric tertiary care centers where children (younger than 18 years) who presented with EoE were treated with biological therapies between January 2015 and December 2023. The main objective was to characterize this patient population, and the indications for prescribing biologics. The secondary goals were to assess these patients' clinical, endoscopic, and histologic finding, as well as patient tolerance, and to compare our cohort at baseline with pediatric patients from two European registers of EoE treated with conventional therapies. Thirty-six patients were prescribed 37 biologics (omalizumab, n = 1; mepolizumab, n = 6; dupilumab, n = 30). At diagnosis, the mean patient age was 7.4 (±4.4) years, and most patients had at least one atopic comorbidity (91.7%, n = 33). Failure of first-line treatments was the main reason for starting biological therapy (75.7%, n = 28), prescribed as compassionate use (54.1%, n = 20). Dupilumab showed significant clinical (48%, p < 0.01) and histological (82.6%, p < 0.01) improvement. Compared with children treated with conventional therapies, patients in our cohort at baseline presented significantly more asthma, food allergies, and atopic dermatitis, as well as more fibrostenotic phenotype and digestive symptoms. No severe side effect was reported within a 6-12-month follow-up. Dupilumab is the most frequently prescribed, and appears to be the most effective biotherapy, regarding clinical and histologic remission. All biologics were well-tolerated. Pending marketing authorization, biological therapies for pediatric eosinophilic esophagitis are mainly prescribed after failure of first-line treatments and on a compassionate basis in France. Dupilumab is the biotherapy most frequently used, is associated with clinical and histological efficacy and is well-tolerated. Children and adolescents requiring biologics appear to be younger and more severe at diagnosis than naive pediatric patients in Europeans registries.

To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. A retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤ 7 days after the procedure), late complications (> 7 days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. At least 1 year of follow-up was available for 513 patients. Median follow-up duration was 2.8 years (interquartile range 1.0–4.9 years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03–5.30], p  = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37–0.92], p  = .019).   Conclusion : B-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with significant morbidity and require particular attention in young and premature infants. What is Known: • Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG). What is New: • T-fastener complications were not rare, and underlying neurologic disease was a protective factor. A very low rate of stomal infection was described, and young age at the time of PEG placement was a risk factor. The B-PEG is a safe method with fewer major complications than P-PEG in children.

IntroductionThe TransEAsome project, funded by the Agence Nationale de la Recherche, aims to evaluate the long-term outcomes of patients with oesophageal atresia (OA) between 13 and 14 years old and establish multiomics profiles using data from the world’s biggest OA registry.Methods and analysis TransEAsome is a national multicentre population-based cohort study recruiting participants from all qualified French centres for OA surgery at birth. The primary objective is to assess the prevalence of gastro-oesophageal reflux disease in adolescence among patients with OA, with several secondary objectives including the identification of risk factors and multiomic profiles from oesophageal biopsies and blood samples collected between 13 and 14 years old, compared with a control group. This comprehensive characterisation of phenotype and omic profiles aims to enhance the understanding of disease evolution in patients with OA and inform tailored care management strategies.Ethics and disseminationThe study, coconstructed with input from patients, parents and research-expert adolescents, has obtained approval from the ethics research committee: Comité de protection des personnes Est II. Findings will be disseminated to various target audiences, including the scientific community, research participants, the patient community, the general public, regulatory authorities and policymakers. Data will be made available in a Findable, Accessible, Interoperable, Reusable format on the France Cohortes platform on study completion.Trial registration number NCT05995171:Clinical trial