Avsnitt
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JPGN Journal Club is again here for you! No, no point in all that applause, although we’re grateful: Remember, we can’t hear it.
As always, we’re glad to be back and we hope that you’re glad to have us back. Dr Jake Mann has chosen for today from Aliment Pharmacol Ther, by Ricciuto et al., Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD) : A matched analysis from the Paediatric PSC Consortium. And the consortium? Centres, 54 ; PSC patients, 1,362 ; PSC-IBD patients, 1061 ; PSC patients studied, 113. In matched cohorts, vancomycin recipients’ endoscopic and clinical-biochemistry indices of IBD improved substantially over control; no mention of how “liver numbers” responded. Fewer bacteria, less inflammation: Seems reasonable enough.
Closer to ESPGHAN home is Jake’s next selection – from J Pediatr Gastroenterol Nutr – Lacaille et al., Awareness, referral and age at Kasai surgery for biliary atresia in Europe : A survey of the Quality‐of‐Care Task Force of ESPGHAN. Between 2015 and 2019, what referral patterns did 26 European hepatology centres see for 785 children with extrahepatic biliary atresia (EHBA)? Detection of jaundice by age 2wk to 3wk, with referral, is the goal – the reality, 55d (8wk ! ), hepatic portoenterostomy at age 61d, just past the 60d end of the period during which one can reasonably hope for good results. Education campaigns thus far seem ineffective. How to improve them? Also surveyed, 392 French paediatricians, a 20% response rate: Has introduction of stool-colour cards changed your handling of infantile cholestasis? Do you use the cards, do you feel that you understand cholestasis in infants? The faintly bilious answers, perhaps tinged with Gallic scepticism: Possibly ; Yes ; and . . . Frankly, no. Too early to say if referral in France, and portoenterostomy results, will improve – card distribution, était-il battre l’eau avec un baton?
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Dr Alex Knisely today is speaking with Prof Isabelle Scheers of Louvain, Belgium, on pancreatitis in children. She has proposed three articles for discussion – from a coalition that she led, drawing on collaborators in Canada, the United States, and almost the full bank of Eurovision Song Contest participant nations, a summary and review, Autoimmune Pancreatitis in Children : Characteristic Features, Diagnosis, and Management ; a personal “position paper”, Inherited Pancreatic Exocrine Insufficiency and Pancreatitis : When Children Transition to Adult Care ; and a rara avis case report with others from her home institution, Cinacalcet Sustainedly Prevents Pancreatitis in a Child with a Compound Heterozygous SPINK1 / AP2S1 Mutation. One woman, but a pancreatic-disease panopticon, and if you don’t know that last word, hello Google ! She begins with the satisfaction through successful diagnosis and treatment that came her way when, as a junior doctor, she sorted out disease in the subject of her case report ; she takes us through how her need to educate herself to deal with the patients referred to her with pancreatic problems, an ever-growing stream, led her abroad for specialty training as she established a network of not only referrers but also advisers ; and she sketches for us how she became a pancreatologist who, through collaboration with other paediatricians and with adult pancreatologists, has helped us all by describing and defining what is to be expected in various types of pancreatitis in childhood, and, of course, how children in this as indeed in so many other things differ from adults. Follow along, and remember, after the podcast is over : Shared experience, shared through ESPGHAN, brings us all much further than any of us can go alone, and not just in pancreatitis !
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Saknas det avsnitt?
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JPGN Journal Club is in your ears again! We’re glad to be back and we hope that you’re glad to have us back. Dr Jake Mann has chosen for today from Gut, by Guo et al., early-life diet and risk of inflammatory bowel disease: A pooled study in two Scandinavian birth cohorts. This is the sort of thing that – thanks to the record-keeping in which the Northlands specialise – can’t be duplicated elsewhere but that indicates for us all how we can effectively address an aspect of disease. Fish, veggie and no sweet, sweet fizzy drinks for those babies if you want to reduce risk! It’s open-access so check it out -- you’ll be glad that you did.
Closer to ESPGHAN home is Jake’s next selection – from J Pediatr Gastroenterol Nutr – Raghu et al., Impact of early immunosuppression on pediatric liver transplant outcomes within 1 year. This collaborative effort among a double handful of North American centres permits a rather sad compare-and-contrast exercise with states of care in Scandinavia and in the USA (yes, one Canadian participant). Medical provision on a scattershot, pick-and-mix basis is almost by whim in North America, it seems, whilst the Nordic lands offer co-ordinated, well-reasoned, and well-assessed interventions that enable supranational fine-tuning. One wonders what a similar look-back in Europe would discover, nation by nation and centre by centre, and what the discoveries would permit setting right. Not that our bedside tables aren’t already stacked with enough to read, mind you, but at the top of that teetering pile should be the most recent number of JPGN. Please grab it and read the Raghu et al. article. It’s a call to action. May European hepatologists soon answer that call!
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Dr. Alex Knisely is talking today to Dr. Rut Anne Thomassen, of Oslo, who is a senior dietitian – one of only a few in the councils of ESPGHAN – and whose recent remit from ESPGHAN was to pull together a position paper that sets out for us all what is known in paediatric patients about a form of elimination-and- reïntroduction diet called FODMAP, an acronym that lists the classes of foodstuffs to be withdrawn. Some say that it works in some patients with irritable bowel syndrome . . . but consensus among caregivers as set out in Dr. Thomassen’s work is first, that one has to identify those patients carefully, and second, that how to do so is still unclear. Are you under pressure from families who want something, anything done, including the FODMAP diet, to help their children with abdominal pain – or with primary-care referrers who want something, anything done, including the FODMAP diet, to make those children your patients? Seek consultation from a dietitian, Dr. Thomassen advises, speaking for ESPGHAN. He or she can help you with screening those patients for FODMAP suitability, with educating families in what might be reasonably expected, and with guarding against inappropriate deployment of FODMAP – which carries its own not insubstantial risks.
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Dr Alex Knisely today in JPGN Journal Club is in a dogfight against Dr Jake Mann – it’s Jake’s first solo flight as Journal Club pilot, will he be shot down? Jake first offers us, out of Berlin, with co-authors from European and Israeli centres, and published in J Pediatr Gastroenterol Nutr : Kalveram et al., Noninvasive scores are poorly predictive of histological fibrosis in pediatric fatty liver disease. Then he steers away from the sunlit uplands of JPGN and into the dark and stormy clouds of basic science, with, out of Aurora / Denver, Colorado, and claiming a double handful of co-authors on that side of the Atlantic and this, published in J Exp Med : Lui et al., A partial human LCK defect causes a T cell immunodeficiency with intestinal inflammation.
A tip of the school cap to Molesworth, N., here – and as any paediatric hepatopathologist would predict, the Berlin- based consortium found that clinical parameters and values for various biomarkers, assessed in differing combinations, did not identify or correctly stratify liver fibrosis, and that the proper set of tests to use in non-invasive diagnosis of liver fibrosis still awaits definition in paediatric fatty liver disease. To be regretted – in this histopathologist’s opinion – is that the extent of fibrosis was not verified by a review team ; that is, the co-authors contributed not glass slides bearing tissue sections but copies of reports. Not the firmest of foundations, then . . . Well, however they got there, the conclusion of the study was prima facie correct : Keep those biopsy specimens coming !
The Coloradans and their co-workers report from Immunology World, in which evaluation of two brothers, born to first-cousin parents, for features of immunodeficiency found that they harboured a novel variant in LCK, encoding lymphocyte-specific protein tyrosine kinase (LCK). The effects of the variant included chronic diarrhoea ; histopathologic assessment of bowel mucosa is not reported. In knock-in mice with the same variant in Lck, however, chronic intestinal mucosal inflammation was present – not a feature in Lck knock-out mice. Immunophenotyping in the siblings and in the mice found selective deficiency in numbers of regulatory T-cells. The lads were successfully treated with bone-marrow transplantation. The mice could be successfully treated by topping up regulatory T-cells or by depleting CD4-expressing T-cells. Aside from the effects that the variant had on orderly development of T-cell subsets, the report interested Jake (and our listeners, we hope!) because of parallels that can be drawn with genetic contributions to chronic inflammatory intestinal disease. Patients like these have a lot to teach us, Jake maintains, as – like every British boy’s hero, “Biggles” – he returns safely to his home airfield, mission accomplished and Alex foiled.
As always, happy listening – and happy reading !
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Dr. Alex Knisely is talking today to Dr. Kaija-Leena Kolho, of Helsinki — they’ve orbited around each other for years, co-authoring this and that, but never met . . . in person or electronically, not until today, when they become good friends whilst discussing this podcast’s theme: Calprotectin. What is it? What does it do, in the body and in the diagnostic work-up? How can it be mis-used or mis-interpreted? And what superpowers does calprotectin confer upon the paediatric gastroenterologist who is confronted with YET ANOTHER sullen adolescent? Coming up: Calprotectin chat!
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Dr Alex Knisely today is speaking with Dr Sami Wali, of Riyadh, Saudi Arabia, senior attending gastroenterologist and chief of transplant hepatology at Prince Sultan Military Medical City. Dr Wali rose through the Saudi educational and medical-education systems, training at several Riyadh hospitals, with specialisation in paediatrics and in paediatric gastroenterology and hepatology that culminated in a year in Ontario at McMaster University and Hospital for Sick Children, Toronto – he is one of Prof Eve Roberts’ “old boys”. In Saudi Arabia many children with liver disease have metabolic disorders. Dr Wali has made large contributions to elucidating and to differentiating the features of these diseases, some of which were until recently unrecognised. Clinical, histopathologic, and genetic correlations in this field have been his specialty.
At the 2023 ESPGHAN annual meeting in Vienna he presented his experience with the forms of intrahepatic cholestasis encountered in patients with tight junction protein 2 disease, a disorder unfamiliar to many but of great interest in hepatic pathophysiology. He shares that experience with us now.
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Today we are speaking with Prof Thomas Attard, of the University of Missouri and Children’s Mercy Hospital of Kansas City, Missouri, where he directs gastrointestinal endoscopy services and leads the hereditary gastrointestinal polyposis multidisciplinary clinic. He is from Malta, where he studied medicine, although by far most of his career has been in the United States. At the 2023 ESPGHAN annual meeting in Vienna this May he presented his and his institution’s experience with video-capsule endoscopy in children with Peutz- Jeghers syndrome, in which hamartomatous polyps develop from stomach through large bowel, complicated by intussusception with obstruction of the lumen. A good double handful of interesting observations – particularly that one should not wait till trouble occurs to evaluate these patients endoscopically.
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Today we are not only speaking with Kassel’s best, Dr Andreas Jenke, but also with Dr Jake Mann, pride of Birmingham and the Channel Islands – that’s right, double trouble. We say thank you and goodbye to Andreas, thank you and hello to Jake, who is stepping into Andreas’ shoes as primary Journal Club discussant. Andreas leads off with Predicting Insulin Resistance in a Pediatric Population With Obesity, a JPGN article from Portugal, by Daniela Arauj́ o and colleagues, using non-invasive parameters to identify children at increased metabolic-syndrome risk and thereby perhaps opening restricted-prescription gateways for early pharmacologic intervention. Jake is next up at bat, with a non-JPGN entry (Hepatology Communications) from Sagar Mehta et al. at Toronto’s Hospital for Sick Children – Severe Acute Hepatitis of Unknown Etiology in a Large Cohort of Children, a look at the recent purported worldwide spike in numbers of such patients. Was it really all about adeno-associated virus infection ? The tiller then returns to Andreas, who steers us safely into port aboard Peter Osgood and co-workers’ Intrapyloric Botulinum Toxin Injection for Refractory Nausea and Vomiting in Pediatric Patients, again in JPGN, from Chicago and Cleveland – will you follow these authors’ lead when confronted with what well may be functional disorders ? Both the discussants appraise the articles – why are they important ? How could they be better ? What might come next in these corners of our field ? – two perspectives for one in this podcast, and an interesting change from the approach employed thus far. What do you think ? Should Jake invite guest co-discussants now that he is in charge ? Let us know : Comments on a postcard, please (sorry, wrong century ! By e-mail), via the ESPGHAN main office.
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Dr Jake Mann, of the Children’s Hospital of Birmingham and the University of Birmingham is our guest today – Dr Mann’s second contribution to these podcasts. At the annual meeting of ESPGHAN in Vienna this May Dr Mann presented information on the potential relevance of genetic variants “of unknown significance”, the sort of thing that often is uncovered in exomic or genomic studies of children with hepatobiliary disease; one can’t pin the hepatobiliary disease on those variants, not exactly, but what is one to do with them? – to abnormalities in biomarker values assessed in adults. Indeed such variants and such abnormalities co-map, suggesting rôles for the variants as loci minoris resistentiae that may confer adverse prognoses. Worth our attention, although neither easy reading nor easy listening : As Mark Twain famously had Huckleberry Finn say of The Pilgrim’s Progress, “The statements was interesting, but tough.” But who can better explicate Dr Mann’s statements, which indeed are both interesting and tough, than Jake himself, despite all the impedimenta that Alex tries to cast in his way?
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Dr Alex Knisely today in JPGN Journal Club is bantering happily with Dr Andreas Jenke, who for discussion has chosen two articles and a pair of Letters to the Editor, thrust and parry, attack and defence. He believes that correspondence of this sort often affords insight into what is at issue in the matter addressed – and he may well be right. Along with those, we have a contribution from Dr S Bonilla of Boston Children’s Hospital – Helicobacter pylori Antimicrobial Resistance Using Next-Generation Sequencing in Stool Samples in a Pediatric Population – and another from Dr B Özer Bekmez of Ankara City Hospital – Antenatal Neuroprotective Magnesium Sulfate in Very Preterm Infants and Its Association With Feeding Intolerance.
Dr Özer Bekmez and her team compared the courses of pre-term infants who received magnesium sulfate (MgSO4) for neuroprotective purposes and pre-term infants who did not receive MgSO4. Findings included “a significant difference in intrauterine growth retardation (IUGR), preterm premature rupture of membranes, and the usage of antenatal steroids between the groups” – those receiving MgSO4 had worse IUGR, were more likely to have suffered from rupture of membranes, and were more likely to have been exposed to steroids ; they also went on to have more bronchopulmonary dysplasia and to require longer mechanical ventilation, with greater incidences of necrotising enterocolitis, feeding intolerance, and delay in enteral feeding. The authors posit these adverse outcomes as consequent on MgSO4 exposure. Were the dice loaded, though, given the more troubled antenatal course of those receiving MgSO4 ? Might MgSO4 administration have made no difference to outcome ?
The study design with Dr Bonilla and team was less questionable, perhaps. Although few patients were studied, when stool yielded enough microbial DNA for evaluation, results of next-generation sequencing correlated well with those of antibiotic sensitivity
testing in cultured gastric-biopsy material. Regrettable, though, that the authors made so little of potential benefits of speed – if DNA test results were in hand substantially before results of standard culture, selective antibiotic therapy might begin more quickly than possible at present, a boon to all.
Now for the letter pair, with Ms A Aloysius and colleagues writing in regard to the recent ESPGHAN Preterm Enteral Nutrition Position Paper (2022)—Issues of Oral Feeding on CPAP and Dr N Embleton offering a response on behalf of the position-paper authorial team. The initial letter says, in effect, “We as speech and language therapists believe that this position paper does not adequately address transition to oral feeding ! ” – the response says, “Erm, we rather think that we did, and here are the parts of our text in which we did, but whatever – yes, this is an important aspect of care, and one best approached in a multidisciplinary manner.” Fewer fireworks than in the best correspondential wars, and one must read the position paper to see if the speech and language therapists’ discipline truly was shortchanged.
As always, happy listening – and happy reading !
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Todays guests are Prof Marc Benninga and Dr Klaartje de Bruijn, both of Amsterdam’s Academisch Medisch Centrum. Prof Benninga is visiting these podcasts for a second time ; Dr de Bruijn is facing her baptism of fire. Their topic? Shudder and thrill – faecal transplantation. In 2020 their group published a protocol for faecal transplantation in adolescents with refractory irritable-bowel syndrome (PMID : 32864480), midway through the study described. In nuce : Healthy- donor stool or recipient’s own stool, delivered by nasoduodenal sonde immediately after irrigating the bowel clean from above, two doses six weeks apart ; both clinical well-being and stool microbiome assessed ; one-year follow-up. At the annual meeting of ESPGHAN in Vienna this May Dr de Bruijn presented study results : Thirty recipients of healthy-donor stool felt better and experienced shifts in stool microbiome, changes that persisted throughout the year of follow-up. In effect, if this were a field-hockey match, the Dutch national team against irritable-bowel syndrome, we would all now be screaming Gooooooaaaaaalllllll! (Those who heard Prof Benninga’s initial contribution know that his love for field hockey is rabid – well, so is Dr de Bruijn’s) Listen, and follow Prof Benninga and Dr de Bruijn as they swap the informational ball back and forth, bringing it downfield despite Alex’s rhetorical backsticks, foot-advancing, and, yes, even high- sticks, to notch up a fantastic win – score – goooaaallll!
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Dr Alex Knisely today in JPGN Journal Club is – as usual ! -- speaking with Dr Andreas Jenke, who for discussion has chosen the three articles Budd-Chiari Syndrome – A Single-Centre Experience from the United Kingdom, contributed by the Birmingham paediatric team ; Body Composition and Physical Activity in Pediatric Intestinal Failure, from London’s Great Ormond Street ; and Thiopurines Maintenance Therapy in Children with Ulcerative Colitis, the work of several medical centres in Israel. Budd-Chiari syndrome in children . . . a quarter of a century and 25 cases, but as soon as you think “I’ll never see that” you’ll be called to Accident & Emergency for your first patient with, yes, you guessed it. Good to have this review to read on your mobile telephone as you walk down to A&E. Our London mates remind us that the body-composition shifts-to-fat so usual in intestinal failure do not go away on their own once parenteral feeding no longer is required : One take-home message may be that children who never could develop a habit of exercise when they were catheter-tethered need to be prodded into physical activity (and their parents to learn to see the children as suited for physical activity). Finally, from Israel, a confirmation that the old ways may still be the best ways : Whilst the tendency nowadays is to carpet-bomb ulcerative colitis into submission, calling out the F16s (uhm, those are the biological agents) at presentation, traditional tactics of ground warfare (those are the thiopurines) both regain and hold territory very adequately indeed – less expensively and with far greater knowledge of What To Expect. Happy listening – and reading !
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Our todays guest is Prof. Anil Dhawan of King’s College Hospital in London, leader of the paediatric liver service there, about Prof. Dhawan’s lifelong especial interest within paediatric hepatology: Acute liver failure. In May, 2023, at the annual meeting of ESPGHAN, he sketched – from his personal vantage point – the horrorshow with which this clinical diagnosis confronted caregivers thirty-plus years ago; what steps have been taken to improve the prognosis of children with acute liver failure (they’re doing better now); and what remains to be accomplished for these children in both the near term and the longer term. He believes that “bridge transplantation”, using hepatocytes administered intraperitoneally, holds out particular promise for many patients, maintaining them until liver recovery or liver transplantation more definitively resolves the crisis situation that acute liver failure still represents. In this podcast he shares anecdotes, perspectives, and hard data on acute liver failure and what can be, what should be, done for patients with that disorder. This mix is refracted through a unique and commanding personality – both informative and entertaining ? Well, have a listen, see what you think!
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Dr Alex Knisely today in JPGN Journal Club is – as usual ! -- speaking with Dr Andreas Jenke, who for discussion has chosen two full-size articles, call them “mains”, and a pair of linked items from among the “starters”, that is, a letter to the editors of the journal and a response from ESPGHAN. The two “mains” are Efficacy and Safety of Teduglutide in Infants and Children With Short Bowel Syndrome Dependent on Parenteral Support, from a coalition of Japanese, British, and Finnish centres supported by Takeda Yakuhin, makers of teduglutide, and, from Boston Children’s Hospital (USA), Gastric Intestinal Metaplasia in Children – Natural History and Clinicopathological Correlation. The “starters” ? Liver Histology Before Treatment Withdrawal in Autoimmune Hepatitis – Is It Time to Review the ESPGHAN Recommendations ?, a Franco-Italian défi, and, réponse à cette provocation, Liver Biopsy is Indicated Before Attempting Treatment Withdrawal in Children with AIH – Commentary by the ESPGHAN HepCom. The mains may leave you wanting a bit more ; the teduglutide data draw on very few patients, the intestinal-metaplasia data yield no very firm conclusions ; but both offer at least reassurance. Mind you, if you are about to spend €100.000,00 on a year of teduglutide for one of your patients, you’ll be well-advised to do it in a manufacturer-supported study with firm guidelines for use and assessment – yes, a registry is needed. And the starters ? Highly spiced ! But, with a J Hepatol article from the Franco-Italian group (summarised in the Commentary, but which you must seek out on your own), they certainly fill the plate. Whose arguments are more convincing ? What will you say to the next teenager with treated AIH and “good numbers” who is desperate to abandon steroids and the like ? Prudence seems in order . . .
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Today we are talking to Prof. (and Dr.) Richard Thompson, of London’s King’s College Hospital, who there for twenty-five years has broadened and heightened his leading role in studies of the genetics, physiology, and treatment of forms of intrahepatic cholestasis, disorders that come to clinical attention principally in childhood. Richard and Alex for fifteen years were on the same team at King’s, sometimes shoulder to shoulder, sometimes pushmi-pullyu, but always having fun. Their chat today, after rather a lot of reciprocal congratulation, touches on clinicogenetic correlations in Wilson disease, moving thence to bile salt export pump deficiency – first, with its spectrum of manifestations, as a paradigm of the falsity of Mendelian genetics ; second, with its responses to drugs that inhibit ileal bile acid transport, as a paradigm of how without fixing a programme’s basic code one can apply patches that substantially improve the programme’s utility (that is, how knowledge of clinicogenetic correlations permits patient-tailored choices among surgical and pharmacologic therapies, with earlier and more satisfactory improvements in health). Be warned : You won’t take on board in one hearing what Richard has to share. Make time, then, for a couple of listen-throughs. They will reward you well.
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Dr Alex Knisely today is speaking with Dr Andreas Jenke – it’s Journal Club again. Dr Jenke has chosen from the August, 2023, number of JPGN three articles for discussion – from Brisbane (Queensland), Australia, and, in India, Lucknow, Jodhpur, and Rishikesh (a thousand-kilometre span across the centre and north of the subcontinent ! ), Oral Tacrolimus in Steroid-Refractory and - Dependent Pediatric Ulcerative Colitis - a Systematic Review and Meta-Analysis ; from a group in San Diego, California, with contributions from a group at Columbia University in New York City, An Open Label, Randomized, Multicenter Study of Elafibranor in Children with Nonalcoholic Steatohepatitis ; and from Edmonton (Alberta), Canada, Clinical Features of Children with Serology-Negative, Biopsy-Positive Celiac Disease. The Indian / Australian study is a meta-analysis and review rather than primary work ; it concludes that tacrolimus may allow caregivers to temporise, with an initially good response that rather rapidly tails off, and that it may be less effective in the steroid-refractory child. The elafibranor study holds out promise – but that promise is based on findings in only a few children and adolescents. (The study was ended early, with enrolment curtailed when drug- company sponsorship was withdrawn after elafibranor failed to meet expectations in adult patients.) Does seronegative coeliac disease differ clinically from seropositive coeliac disease ? Well, maybe. Hypogammaglobulinaemia A is more frequent in the former, albeit not universally found. But overall no particular feature, no single clinical-laboratory biomarker, emerged as both sensitive and specific for either form of coeliac disease : The search continues.
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Today we are talking to Prof. Dr. Tobias Cantz, of Hanover / Hannover, Germany, on a topic that offers the chance to re-work many approaches to both acquired and inborn disease not just of the liver but also of the biliary tree. Prof. Cantz is a regenerative hepatologist, conducting research into how hepatocellular or cholangiocellular organoids – or, more complexly, organoids that include all the components of the differentiated and polarised and vascularised hepatic lobule – can be used to examine and to dissect how gene variants contribute to clinical disease, and how administration of organoids can contribute to repair of hepatobiliary injury. His presentation in Vienna this May, at the annual meeting of ESPGHAN, was a wonder ; the things that can be done already using these “organoids”, these miniature versions of components of an organ, are mind-boggling, and the feats to date really are only the start of what Prof. Cantz envisions. Perhaps his intensity, his devotion, and his determination to take our field forward can be appreciated, at least in part, in this conversation. Not easy listening, better suited for a quarter-hour in a lay-by during which you can concentrate on the abundance of information that he presents than for dodging delivery- van traffic – well, if you have to get to work, then listen to it not just on the way in but also again on the way home, to be sure you grasp it all.
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Dr Alex Knisely today is speaking with Dr Andreas Jenke – it’s Journal Club again. Skipping over the June, 2023, number of JPGN, Dr Jenke has chosen from the July number not two but three articles for discussion – from a Scandinavian consortium, Risk Factors of Cancer in Pediatric-Onset Inflammatory Bowel Disease in Denmark and Finland ; from a group in California, Prevalence of Elevated ALT in Adolescents in the US 2011-2018; and from a group in Birmingham, England, Liver Disease inGLIS3 Mutations: Transplant Considerations and Bile Duct Paucity on Explant Histology. Interviewer and interviewee alike consider the Danish / Finnish study a lovely piece of work, the Californian study rather risky in respect of over-medicalisation of a questionably abnormal biomarker value, and the English study as . . well, as questionable. What will your opinions be?
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Today we are talking to Dr. Andreas Jenke — Journal Club again! Two articles of particular interest and significance from the May, 2023, number of JPGN are discussed. From Eva Karbaum and colleagues in Hamburg (Protocol Biopsies in Pediatric Liver Transplantation Recipients Improve Graft Histology and Personalize Immunosuppression) we learn that using protocol-biopsy findings to fine-tune liver transplant recipients’ drug regimens, either increasing them or decreasing them, on follow-up biopsy is demonstratedly safe or even beneficial; from Rachel Levy and colleagues at several Israeli medical centres (Trough Concentration Response in Infliximab and Adalimumab Treated Children With Inflammatory Bowel Disease Following Treatment Adjustment: A Pharmacokinetic Model) we learn that perhaps we need not wait for clinical disease to manifest before fine- tuning drug regimens – to respond to trough drug levels may permit us to intervene proactively. Dr. Jenke assesses the weaknesses and strengths of the studies reported. Will you and he reach the same conclusions? Read the articles, listen to the podcast, and find out!
- Visa fler
