Sleep Patterns, Pain, and Emotional Functioning in Youth with Inflammatory Bowel Disease.

Objective: Youth with inflammatory bowel disease (IBD) may be at increased risk for sleep difficulties due to the painful and inflammatory nature of their disease. Moreover, children and adolescents with IBD experience impairment across a variety of psychosocial domains. However, researchers have yet to investigate the complex interplay between sleep, disease-related symptoms, and psychosocial factors in this population. The purpose of this study was to examine sleep patterns, pain, and mood in pediatric IBD. Methods: A sample of 25 children and adolescents with IBD (Mage = 14.24, Range = 10-18 years; 56% male) were recruited from a pediatric gastroenterology clinic. Youth wore an actigraphy watch and completed daily measures of affect and pain over the course of 14 days. Statistical analyses involved repeated measures general estimating equations. Results: No significant association for sleep with negative affect was demonstrated. Despite majority of this sample being in disease remission, results revealed that increased sleep onset latency was associated with presence of next day pain and pain was associated with better next night sleep efficiency. Conclusions: Findings of the current study suggest youth with IBD experience poor sleep quality, which is significantly related to the pain they experience. Consequently, healthcare providers should screen for and address sleep quality to optimize outcomes in their pediatric patients. Objectively assessing sleep patterns (e.g., actigraphy) may prove useful for pediatric IBD samples; however, additional research is needed to determine actigraphy's feasibility and efficacy in assessing sleep patterns in real world settings (e.g., pediatric medical clinics).

Persistent Vomiting and Weight Loss Leading to the Diagnosis of Barrett's Esophagus in an Adolescent.

Barrett's esophagus in children with peptic strictures has not been well characterized, and its prevalence is unknown. We report a case of peptic esophageal stricture with Barrett's esophagus in an adolescent patient who presented with dysphagia with recurrent episodes of vomiting and limited medical history. A 13-year-old male with mild intellectual disability was transferred to our facility due to a two-month history of dysphagia with recurrent episodes of vomiting and intolerance to both solids and liquids. Physical examination and laboratory values were within normal limits, including complete blood count and differential, serum electrolytes, glucose, amylase, lipase, liver and kidney function tests, and thyroid-stimulating hormone level. Barium esophagram revealed persistent focal narrowing of the proximal and mid-esophagus. An esophageal endoscopy revealed a snug circumferential stricture and biopsy consistent with erosive esophagitis. The patient was started on high dose pantoprazole and underwent serial endoscopic guided balloon dilations with marked improvement in symptoms. Peptic stricture with Barrett's esophagus is rare in children. It should be included in the differential diagnosis of a child with the common symptom of vomiting in the setting of developmental delay. Vigorous treatment with endoscopic balloon dilation and proton pump inhibitors is necessary to prevent the progression into adenocarcinoma.