Journal of Pediatric Gastroenterology and Nutrition

02/17/2026

🧠🩺 CKRT in pediatric acute liver failure: biochemical success vs survival impact

This invited editorial provides critical context to new data on CKRT in pediatric acute liver failure, asking a central question: Does improving ammonia levels translate into better outcomes?

📌 Key points:
• Ammonia reduction is important—but likely only part of PALF pathophysiology
• Survival depends on etiology, systemic inflammation, and multiorgan failure
• Timing, patient selection, and combination extracorporeal therapies remain unresolved
• Calls for multicenter, prospective studies to guide practice

🧠 Take-home: CKRT is a valuable supportive tool, but survival in PALF likely requires a broader, etiology-driven and multimodal approach.

🔗 https://doi.org/10.1002/jpn3.70225?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

Click on the article title to read more.

02/17/2026

🩺🧠 Continuous kidney replacement therapy (CKRT) in pediatric acute liver failure

In this large single-center retrospective study, early initiation of CKRT for non-renal indications (hyperammonemia and hepatic encephalopathy) in pediatric acute liver failure led to improved biochemical control—but did not significantly improve survival.

📌 Key findings:
• Significant reduction in ammonia levels by Day 4
• Lower bilirubin levels in the CKRT group
• Trends toward higher native liver and overall survival, though not statistically significant
• Early CKRT was feasible and safely implemented in critically ill children

🧠 Take-home: CKRT effectively improves metabolic parameters in PALF, but biochemical improvement alone may not be sufficient to change survival outcomes.

🔗 https://doi.org/10.1002/jpn3.70226?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/16/2026

🧩👧 Case Image Challenge

An 8-year-old girl presents with months of hematochezia. Standard colonoscopic views appear unremarkable—but one additional maneuver reveals the culprit.

❓ What diagnosis was made?
❓ What endoscopic technique was essential to finding it?
❓ How was it treated?

Click to see the images, pathology, and key teaching points 👇
🔗 https://doi.org/10.1002/jpn3.70206?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/16/2026

🟡👶 New global guidance on diagnosing cholestatic liver disease in infants

This FISPGHAN position paper offers an updated, practical framework for evaluating neonatal cholestasis, with a strong emphasis on early detection of biliary atresia (BA) and equitable use of diagnostic resources worldwide.

📌 Key points:
• Universal screening for BA (stool color cards or direct bilirubin) is strongly supported
• Any infant with direct bilirubin ≥1 mg/dL requires prompt evaluation
• Multimodal diagnosis (clinical, labs, imaging, histology, genetics) guides decisions for cholangiography & surgery
• Next-generation sequencing is transforming diagnosis—local flexibility is essential given global resource variation

🌍 A timely, internationally informed roadmap to improve early diagnosis and outcomes in infants with cholestasis.

🔗 https://doi.org/10.1002/jpn3.70207?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/15/2026

🔄🤢 New NASPGHAN diagnostic guidance for pediatric cyclic vomiting syndrome (CVS)

These 2025 evidence-based guidelines from North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition clarify how to diagnose CVS and distinguish it from cannabinoid hyperemesis syndrome (CHS).

📌 Key takeaways:
• No evidence to support broad, exhaustive diagnostic testing
• Recommended baseline screening: serum & urine labs + upper GI series
• CVS attacks defined by timing & pattern (≥4 episodes/year, 2 h–7 days, ≥1 week apart)
• CHS recognized as a related but distinct entity, linked to chronic cannabis exposure

💡 A focused, symptom-based approach improves accuracy while reducing low-value testing.

🔗 https://doi.org/10.1002/jpn3.70193?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/15/2026

🥦👶 Vegan diets in children: what does the evidence say?

This ESPGHAN Nutrition Committee Position Paper, based on a systematic literature search, evaluates whether a strict vegan diet can support healthy growth and nutritional adequacy in infants, children, and adolescents.

📌 Key points:
• Current evidence is inconclusive regarding adequacy of growth on a vegan diet
• No proven health benefits of a vegan diet in childhood
• Height and BMI z-scores were not consistently different vs omnivorous peers
• Regular monitoring is essential, with close attention to protein, iron, calcium, omega-3s, and mandatory vitamin B12 supplementation

🧠 Take-home: Vegan diets in children require expert dietary counselling, pediatric follow-up, and targeted supplementation. High-quality prospective studies are urgently needed.

🔗 https://doi.org/10.1002/jpn3.70182?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/14/2026

🔬🩺 Endoscopic mucosal resection (EMR) in children: 10 years of experience

In this single-center study spanning a decade, pediatric EMR—including hot and cold snare, band-assisted EMR (B-EMR), and underwater EMR—was shown to be feasible, safe, and highly effective in children and young adults.

📌 Key findings:
• 95% complete resection rate across a wide range of lesions (6–80 mm)
• Successful EMR throughout the GI tract, including colon, duodenum, and esophagus
• Band-assisted EMR safely applied to subepithelial lesions
• No delayed complications reported

🧠 Take-home: With appropriate expertise and multidisciplinary support, EMR can be a valuable therapeutic option for complex pediatric GI lesions.

🔗 https://doi.org/10.1002/jpn3.70194?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/14/2026

🩺🧪 Early kidney injury in children with intestinal failure on parenteral nutrition

In this single-center study of children with intestinal failure, cystatin C (Cys-C) identified subclinical renal impairment in patients receiving long-term parenteral nutrition (PN)—even when creatinine and urea were still normal.

🔍 Key findings:
• 25% of children on PN had elevated Cys-C, vs none after PN weaning
• Higher Cys-C levels were associated with greater daily parenteral fluid volumes
• Conventional renal tests and imaging were normal at the time of assessment

📌 Take-home: Cystatin C may serve as an early, sensitive marker of kidney stress in pediatric intestinal failure, supporting closer renal monitoring before overt dysfunction develops.

🔗 https://doi.org/10.1002/jpn3.70188?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/13/2026

🍼🧬 Does alpha-lactalbumin–enriched infant formula improve immune outcomes?

In this randomized controlled trial of healthy term infants, investigators compared low-protein formulas enriched with alpha-lactalbumin (α-lac) to standard formula, with breast-fed infants as a reference group.

🔍 Key findings:
• IL-6 levels were lower in breast-fed infants than in all formula-fed groups
• Increasing α-lac to breast-milk–like levels did not alter cytokine profiles
• No meaningful reduction in infection-related morbidity with α-lac enrichment
• Minor differences were seen in antibiotic use between select groups

📌 Take-home: While breast-fed infants showed lower IL-6, α-lactalbumin enrichment alone did not replicate immune benefits of breastfeeding.

🔗 https://doi.org/10.1002/jpn3.70189?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/13/2026

🧒🍔 Screening for MASLD in children with obesity: keep it simple

In a large multicenter Italian study of >2800 youths with overweight/obesity, investigators evaluated whether the triglyceride–glucose (TyG) index improves detection of metabolic dysfunction–associated steatotic liver disease (MASLD) compared with ALT alone.

🔍 Key findings:
• MASLD was present in 45% of participants
• Optimal ALT cut-offs: ≥26 IU/L in boys, ≥22 IU/L in girls
• TyG-based indices (TyG-BMI, TyG-WC, TyG-ALT) did not outperform ALT alone

📌 Take-home: ALT remains a practical, effective screening tool for MASLD in pediatric obesity.

🔗 https://doi.org/10.1002/jpn3.70201?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/12/2026

🧒🏽🩺 Do children with moderate acute malnutrition have liver injury?

In a large secondary analysis from a randomized trial in Burkina Faso, investigators examined liver function tests in infants and toddlers with moderate acute malnutrition (MAM).

🔍 Key findings:
• Liver enzymes were largely within normal ranges
• No biochemical evidence of overt liver damage at the group level
• Higher bilirubin levels were seen in children with stunted growth, suggesting possible subclinical liver involvement

These data help clarify hepatic risk in MAM and point toward the need for imaging-based studies in children with both stunting and malnutrition.

🔗 https://doi.org/10.1002/jpn3.70177?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer

02/12/2026

🧪 Is inflammation part of pediatric exocrine pancreatic insufficiency (EPI)?

In this large pediatric cohort, investigators measured interleukin-8 (IL-8) directly in pancreatic fluid and found a strong association with pancreatic enzyme deficiency.

🔍 Key findings:
• IL-8 was elevated in 30% of children with EPI vs 6% with normal pancreatic function
• IL-8 levels strongly correlated with enzyme deficiency
• Symptoms such as diarrhea, constipation, and weight loss were common but overlapped across groups

These results suggest that IL-8 may act as an inflammatory mediator in pediatric EPI, offering new insight into disease mechanisms and potential future biomarkers.

🔗 https://doi.org/10.1002/jpn3.70192?utm_source=fb_page&utm_medium=Journal+of+Pediatric+Gastroenterology+and+Nutrition&utm_campaign=publer