Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio.

Eosinophilic esophagitis (EoE) disease activity can be caused by treatment non-adherence. Medication possession ratio (MPR) is an established metric of medication adherence. A higher MPR correlates with better outcomes in several chronic diseases, but MPR has not been investigated with respect to EoE. A retrospective cohort study was performed using an established EoE registry for the years 2005 to 2020. Treatment periods were identified, MPRs were calculated, and medical records were assessed for histologic remission (<15 eos/hpf), dysphagia, food impaction, stricture occurrence, and esophageal dilation that corresponded to each treatment period. In total, 275 treatment periods were included for analysis. The MPR in the histologic remission treatment period group was 0.91 (IQR 0.63-1) vs. 0.63 (IQR 0.31-0.95) for the non-remission treatment period group (p < 0.001). The optimal MPR cut-point for histologic remission was 0.7 (Sen 0.66, Spec 0.62, AUC 0.63). With MPRs ≥ 0.7, there were significantly increased odds of histologic remission (odds ratio 3.05, 95% confidence interval 1.79-5.30) and significantly decreased odds of dysphagia (OR 0.27, 95% CI 0.15-0.45), food impaction (OR 0.26, 95% CI 0.11-0.55), stricture occurrence (OR 0.52 95% CI 0.29-0.92), and esophageal dilation (OR 0.29, 95% CI 0.15-0.54). Assessing MPR before repeating an esophagogastroduodenoscopy may decrease unnecessary procedures in the clinical management of eosinophilic esophagitis.

You Are What You Eat: A Review on Dietary Interventions for Treating Pediatric Nonalcoholic Fatty Liver Disease.

As the obesity pandemic worsens, cases of pediatric nonalcoholic fatty liver disease (NAFLD) and complications of this disease, such as progressive liver failure, in young adults will continue to rise. Lifestyle changes in the form of dietary modifications and exercise are currently first-line treatments. Large pediatric-specific randomized controlled trials to support specific interventions are currently lacking. A variety of dietary modifications in children with NAFLD have been suggested and studied with mixed results, including low-sugar and high-protein diets, the Mediterranean diet, and the Dietary Approach to Stop Hypertension (DASH). The roles of dietary supplements such as Vitamin E, polyunsaturated fatty acids (PUFAs), ginger, and probiotics have also been investigated. A further understanding of specific dietary interventions and supplements is needed to provide both generalizable and sustainable dietary recommendations to reverse the progression of NAFLD in the pediatric population.

Quantitative Analysis of Tug Sign: An Endoscopic Finding of Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by esophageal inflammation and dysfunction, with a rising incidence affecting approximately 1:1000 individuals worldwide.1,2 Chronic inflammation can lead to tissue remodeling in the esophagus with fibrosis in the lamina propria that is partially responsible for symptoms and complications of EoE.3,4 At times, a firmness to the esophagus can be appreciated with a noticeable force required to obtain biopsies from EoE. This sensation has been described as the "tug" or "pull" sign.5,6 Recently, with the advent of endoscopic functional luminal impedance, the fibroelastic properties of the esophagus, including diminished compliance and distensibility, have been described in patients with EoE.7 Quantification of these fibroelastic properties of the esophagus may aid in diagnosis and prognosis of EoE. To this date, a method to quantitatively measure the "tug sign" has not been developed. The primary objective of this study was to measure if a quantifiable difference in force is required to obtain endoscopic esophageal biopsies in patients with EoE compared with those without.

Toilet Injuries Presenting to Emergency Departments, 2000-2019: A Different Game of Thrones.

OBJECTIVE: Toilet training is a major developmental milestone. Unsupervised periods combined with immature gross and fine motor skills may lead to toddler injuries during toilet training. Our aim was to investigate toilet-related injuries (TIs) in children. METHODS: Data from the National Electronic Injury Surveillance System were used to evaluate emergency department encounters of children ages 0 to 6 years with TI from 2000 to 2019. RESULTS: There were an estimated 142,606 children (95% confidence interval, 115,599-168,613) who presented to the emergency department for TI. Toilets were involved in 95% of injuries, and other potty chairs (PCs) involved 5% of injuries. Children had higher odds of sustaining head injury while using a toilet versus PC (adjusted odds ratio = 1.91; 95% CI, 1.06-3.45). CONCLUSIONS: Toilet-related injuries present a high burden of risk to young children. Our data support that the safest vessel for use in toilet training is a PC/training seat as opposed to the toilet.

Proton Pump Inhibitors in Children: the Good, the Bad, and the Ugly.

PURPOSE OF REVIEW: The evidence supporting or contesting the prescription of proton pump inhibitors (PPIs) for children and updates on side effects are reviewed. RECENT FINDINGS: PPIs remain an important therapeutic option for esophagitis and gastritis. However, recent studies demonstrate no benefit when prescribing PPIs for chronic cough, infantile reflux, asthma, or functional gastrointestinal disorders. Recent studies suggest adverse effects on microbiome diversity and immune function, resulting in increased rates of gastrointestinal infections, bone fractures, and atopic disorders. PPIs influence a variety of cell types within the in the innate and adaptive immune systems. PPI prescriptions in children may be indicated for select conditions; however, multiple side effects and immune effects have been described. While most of these side effects are rare and mild, some studies suggest enduring adverse effects. Future studies to elucidate the mechanism behind some of these immune and infectious complications will be beneficial.

Pediatric Ingestions of Christmas Past, Present, and Future: A Review of Holiday Trends, 1997 to 2015.

During the observance of Christmas, many families display decorations, which increases the risk of unfettered access and subsequent ingestion of small objects by children in the home. Our aim was to characterize the epidemiology of Christmas foreign body ingestion (CFBI) by children. National Electronic Injury Surveillance System data from 1997 to 2015 were obtained for children aged 0 to 17 years who presented to United States Emergency Departments matching "ingested" for "artificial Christmas trees"; "Christmas tree lights"; "Christmas tree stands or supports"; "Christmas decorations, nonelectric"; and "Christmas decorations, electric" (excluding tree lights). An estimated 22 224 children (95% confidence Interval = 18 107-26 340) presented to the emergency department for CFBI over the study period. Children aged 2 years and younger ingested Christmas objects most frequently ( P < .001). CFBI visits demonstrated a seasonal trend ( P < .001). Christmas decoration ingestions are a frequent reason for children to present to the ED, which require dedicated awareness for appropriate diagnosis and care.

Esophageal squamous papillomas with focal dermal hypoplasia and eosinophilic esophagitis.

Focal dermal hypoplasia (FDH) is a rare disorder of the mesodermal and ectodermal tissues. Here we present an eight-year-old female known to have FDH who presents with poor weight gain and dysphagia. She was diagnosed with multiple esophageal papillomas and eosinophilic esophagitis. She was successfully treated with argon plasma coagulation and ingested fluticasone propionate, which has not been described previously in a child.