Advocacy in pediatric gastroenterology: An academic clinician's impact and guide.

The current state of policy-making necessitates clinicians and their organizations to be more engaged. This article provides practical examples of how to engage in various levels of advocacy within pediatric gastroenterology.

Trends of Magnet Ingestion in Children, an Ironic Attraction.

BACKGROUND AND OBJECTIVES: Ingestion of rare earth magnets is a serious ongoing hazard for pediatric patients. Our study aims to investigate whether 2012 Consumer Product Safety Commission (CPSC) policy action, in coordination with efforts from consumer and physician advocacy groups, decreased the incidence of magnet ingestions in children in the United States since 2012. METHODS: Data from the National Electronic Injury Surveillance System (NEISS) was used to evaluate trends in emergency department (ED) encounters with pediatric patients (<18 years) who presented with suspected magnet ingestions (SMI) from 2010 to 2015. National estimates of SMI were made using the NEISS-supplied weights and variance variables. RESULTS: An estimated 14,586 children (59% male, 50% age <5 years) presented to the ED for SMI from 2010 to 2015. A significant upward trend in magnet-related ED visits preceded the CPSC action, with the peak ingestions of 3167 (95% confidence interval, 1612-4723) recorded in 2012. This was followed by a steady decrease in the rate of SMI to 1907 (95% confidence interval, 1062-2752) in 2015, an average annual decrease of 13.3%. Most importantly, post-federal action estimates demonstrated a downward trend in overall SMI ED visits (P = 0.03). CONCLUSIONS: The frequency of magnet ingestions continued to rise from 2010 and then peak in 2012, followed by a decline in magnet ingestion ED visits during the post-federal action years. This down trend emphasizes the importance of advocacy on decreasing magnet ingestions in children. Further study will be required to determine the impact of the court decision to lift the magnet ban in 2016.

Thickened gastrointestinal wall findings on computed tomography in children: a reason for endoscopy?

OBJECTIVES: Bowel wall thickening on computed tomography (CT) scans in children may raise concern for inflammatory bowel disease (IBD). The significance of this radiological finding is unclear. Our purpose was to evaluate the clinical outcomes with regard to IBD in children with no known underlying disease, presenting with abdominal pain and thickened bowel wall on CT scan. METHODS: A retrospective analysis of pediatric patients with abdominal pain and CT findings of thickened bowel wall was performed between 2006 and 2010. Endoscopic findings, clinical variables, and follow-up assessments were evaluated. RESULTS: Fifty-six patients presenting with abdominal pain and thickened bowel wall findings on CT scan were identified. Overall, 30 (54%) had terminal ileum wall thickening, 17 (30%) had isolated colonic wall thickening, and 9 (16%) had other small bowel wall thickening. Of the 56 patients, 21 (38%) underwent endoscopy, of which 14 (67%) had positive findings-11 (79%) had histologic evidence of chronic colitis, and 5 (36%) had duodenitis/ileitis. Ultimately, 11/56 (20%) were diagnosed as having IBD, 8/56 (14%) with functional abdominal pain/constipation, 9/56 (16%) appendicitis, 10/56 (18%) infectious gastroenteritis, and 18/56 (32%) with miscellaneous diagnoses. Median levels of erythrocyte sedimentation rate, C-reactive protein, albumin, and platelet count were significantly abnormal in the IBD group compared to the non-IBD group. Additional follow-up of those who did not undergo endoscopic evaluation revealed no new diagnoses of IBD. CONCLUSIONS: The presence of thickened bowel wall on CT scans is a nonspecific finding in children. Laboratory evaluation may help distinguish which patients require additional evaluation and endoscopy.

Magnet ingestions in children presenting to US emergency departments, 2002-2011.

BACKGROUND AND OBJECTIVE: In the last 10 years, there have been an increasing number of case reports concerning gastrointestinal injury related to magnet ingestions; however, the magnitude of the problem remains to be clearly defined. The aim of the study was to examine the epidemiology of magnet ingestion-related emergency department (ED) visits among children in the United States. METHODS: We performed a trend analysis using a nationally representative sample from the US Consumer Product Safety Commission, National Electronic Injury Surveillance System (NEISS) database for ED visits involving magnet ingestion in children younger than 18 years from 2002 to 2011. RESULTS: A national estimate of 16,386 (95% CI 12,175-20,598) children younger than 18 years presented to EDs in the United States during the 10-year study period with possible magnet ingestion. The incidence of visits increased 8.5-fold (from 0.45/100,000 to 3.75/100,000) from 2002 to 2011 with a 75% average annual increase per year. The majority of patients reported to have ingested magnets were younger than 5 years (54.7%). From 2009 to 2011 there was an increase in older children ingesting multiple small and/or round magnets, with a mean average age of 7.1 ± 0.56 years during the study period. CONCLUSIONS: There has been an alarming increase in ED visits for magnet ingestion in children. Increased public education and prevention efforts are needed.

Prospective evaluation of 1-day polyethylene glycol-3350 bowel preparation regimen in children.

OBJECTIVES: The aim of the present study was to evaluate efficacy, safety, and tolerability of a pediatric colonoscopy bowel preparation regimen composed of polyethylene glycol-3350 (PEG-3350) and a sports drink completed in a few hours. METHODS: A prospective, open-label trial of a colonoscopy bowel preparation in children ages 8 to 18 years that included 238 g of PEG-3350 mixed with 1.9 L of Gatorade completed in a few hours. Efficacy was determined using the Boston Bowel Preparation Scale. Basic metabolic profiles and questionnaires were obtained that assessed for safety, adverse effects, tolerability, and patient acceptability. RESULTS: Forty-six patients completed the study. Patients were predominately boys (56.5%) with a mean age of 14.50 years (SD ± 2.9 years). Forty-three (93.5%) were able to complete the regimen. All of the colonoscopies were completed to the cecum and 84% had terminal ileum visualization. Seventy-seven percent were found to be effective preparations. Nausea/vomiting were the most common reported adverse effect (60%) followed by abdominal pain/cramping (44%) and fatigue/weakness (40%). Overall, the regimen was acceptable with 1 exception being the large volume to drink. There were no clinically significant changes in basic metabolic profiles, although there was a statistically significant decrease in the mean potassium (0.16 mEq/L; P = 0.016), blood urea nitrogen (2.68 mg/dL; P < 0.0001), and carbon dioxide (1.89 mmol/L; P < 0.0001). CONCLUSIONS: This study demonstrated that PEG-3350 + Gatorade administered in a few hours is an effective, safe, and moderately tolerable bowel preparation regimen for colonoscopy in children.

The Pacific Island Health Care Project (PIHCP): experience with rheumatic heart disease (RHD) from 1998 to 2006.

Rheumatic heart disease (RHD) continues to be a major health problem in developing countries. The burden of disease in many countries, especially those of Oceania, is very high and is still the leading cause of heart-related deaths. Several factors contribute to the prevalence of RHD in the Pacific Basin including poverty, poor access to care, distance for travel, and limited resources. The Pacific Island Health Care Project (PIHCP) at Tripler Army Medical Center (TAMC) is a unique program which provides indigenous, medically under-served peoples in the United States Associated Pacific Islands (USAPIs) with definitive medical and surgical care. The program has been an important source of patients to enhance Graduate Medical Education (GME) at TAMC. Beginning in 1998, a secure, Web-based, store-and-forward telemedicine network was developed. It was ultimately deployed to 11 sites in the USAPIs. This unique platform has facilitated the selection and definitive care of Pacific Islanders at TAMC. The purpose of this study was to review our experience with RHD in patients referred from the USAPIs utilizing a unique telemedicine system. All patient records that were archived in the PIHCP database were retrospectivelyreviewed for the diagnosis of RHD from 1998 (telemedicine program began) to 2006. Descriptive analysis of the data is displayed in a tabular format. Of the 150 patient consults with RHD in the PIHCP 76 were accepted for care at TAMC and 74 came to Honolulu. Most patients were younger than 40 years of age. Almost all patients evaluated at TAMC had mitral valve involvement, and 81% of patients underwent a surgical procedure to correct the valvular disease. Our experience with RHD and its management illustrates a number of challenges that must be addressed by those who attempt to provide technically advanced care to persons from the developing world. In the case of RHD, patient selection, choice of intervention, and early return of the patient home are critical to the success of any such program. Despite these problems the PIHCP has restored many patients to health and returned them to their island homes as contributing members of society.

Home treadmill injuries in infants and children aged to 5 years: a review of Consumer Product Safety Commission data and an illustrative report of case.

Approximately 8700 injuries from home exercise equipment occur annually in children in the United States. Home treadmills, which have been growing steadily in popularity during the past decade, pose a specific hazard to infants and children aged 5 years or younger, a population at increased risk of injury to the upper extremities (ie, arm, forearm, wrist, hand, and fingers). The authors also provide an illustrative report of case of a 2-year-old boy whose hand injury resulted from a home treadmill. Analysis and frequency reporting of United States Consumer Product Safety Commission data for home treadmill injuries in this demographic group are presented. From January 1, 1996, to September 30, 2000, the number of home treadmill injuries reported to the National Electronic Injury Surveillance System was 1009. Three hundred of these (29.7%) were in infants and children aged to 5 years. Abrasions or contusions (or both) of the upper extremities were the most common injury. Although the number of home treadmill injuries to children being reported is low, the potential for costly and serious complications has been demonstrated previously. The authors conclude that additional home treadmill safety measures and guidelines must be established.