Tugba Koca

Purpose: Foreign body ingestion is a common pediatric emergency, particularly in young children, and may lead to a wide spectrum of clinical outcomes ranging from asymptomatic presentation to life-threatening complications. The type of ingested object, patient age, and timing of intervention are key determinants of management strategy and prognosis. To retrospectively evaluate the demographic and clinical characteristics, management strategies, and complications of pediatric foreign body ingestion cases presenting to a tertiary care center.Materials and methods: Medical records of children aged 0-18 years who presented with foreign body ingestion between January 2017 and December 2024 were retrospectively reviewed. Demographic characteristics, clinical presentation, type and location of the ingested foreign body, management approach, and complications were analyzed.Results: The mean age of the patients was 58.7±39.2 months, with 62% being between 1 and 5 years of age. Most patients were asymptomatic at presentation (89.6%, n=276), and diagnosis was primarily based on caregiver suspicion. The most commonly ingested objects were coins (38.0%), blunt objects (24.4%), and sharp or pointed objects (14.0%). Button batteries accounted for 8.4% of all cases. Endoscopic intervention was performed in 74 patients (24.0%), with a success rate of 91.9%. Intestinal perforation occurred in two cases: one following ingestion of a sewing needle that had passed beyond the stomach and was not visualized during endoscopic evaluation, and the other after simultaneous ingestion of multiple magnets and a button battery.Conclusion: Most pediatric foreign body ingestions are asymptomatic and detected through caregiver awareness. The notable proportion of button battery ingestions underscores the need for improved preventive measures, including product safety and caregiver education. Furthermore, ingestion of multiple magnets poses a substantial risk for severe complications. A guideline-based, multidisciplinary management approach tailored to institutional experience is crucial to optimize outcomes and reduce morbidity.

Background: Congenital sucrase–isomaltase deficiency (CSID) may mimic functional gastrointestinal disorders (FGIDs) and is likely underrecognized in pediatric practice. This study aimed to determine the frequency of sucrase–isomaltase (SI) gene variants among children with FGIDs and to evaluate genotype–phenotype associations and treatment-related quality-of-life outcomes. Methods: In this prospective cross-sectional study, children aged 0–18 years diagnosed with FGIDs according to Rome IV criteria were enrolled between May 2022 and January 2023. All patients underwent next-generation sequencing for SI gene variants. Clinical characteristics, FGID subtypes, and anthropometric data were recorded. Variant-positive patients received dietary sucrose restriction, and selected patients were treated with sacrosidase enzyme replacement. Symptom severity was assessed using the Numeric Rating Scale, and quality of life was evaluated with the Pediatric Quality of Life Inventory (PedsQL 4.0). Results: Among 290 children with FGIDs, SI gene variants were identified in 17 patients (5.9%). Variants were more frequently detected in children with irritable bowel syndrome–like symptoms. Clinical presentation was heterogeneous, and no consistent genotype–phenotype correlation was observed. Dietary intervention was associated with symptom improvement in compliant patients, while sacrosidase therapy led to significant improvements in both child- and parent-reported PedsQL scores. Conclusions: Sucrase–isomaltase deficiency is not uncommon among children with FGIDs and should be considered, particularly in those with IBS-like symptoms or diet-related complaints. Integrating genetic evaluation with targeted dietary and enzyme-based therapy may improve symptom control and quality of life in selected pediatric patients.

Background/Objectives: Pediatric malnutrition is associated with loss of muscle mass and impaired physical function. While anthropometric measurements are widely used for diagnosis, functional indicators that reflect early changes in nutritional status are limited in children. Handgrip strength has been proposed as a simple and objective marker of muscle function; however, pediatric data remain scarce. Methods: In this prospective controlled study, 55 children aged 3–17 years diagnosed with malnutrition and 50 age- and sex-matched healthy controls were evaluated. Anthropometric measurements and muscle strength assessments, including handgrip and pinch grip strength, were performed in both groups. Muscle strength values were additionally converted to age- and sex-adjusted standard deviation scores (SDS). In the malnutrition group, measurements were repeated at 2 and 8 weeks following individualized nutritional therapy to assess treatment response. Results: Children with malnutrition had significantly lower body weight, body mass index, mid-upper arm circumference, triceps skinfold thickness, and lean body mass compared with controls (p < 0.05 for all). Both dominant and non-dominant handgrip strength values were also significantly reduced in the malnutrition group. When adjusted for age and sex, handgrip strength SDS values remained significantly lower in children with malnutrition, whereas pinch grip strength SDS values did not differ significantly between groups. During follow-up, nutritional therapy was associated with significant improvements in anthropometric parameters and absolute muscle strength measurements. However, SDS-based analyses demonstrated that these changes were not uniform across all parameters, suggesting that observed improvements may only partly exceed expected physiological growth. Conclusions: Handgrip strength appears to reflect nutritional status in children, and its association with malnutrition persists after adjustment for growth-related factors. These findings support its potential role as a complementary functional marker. However, longitudinal changes in standardized scores indicate that recovery is variable, and interpretation should consider the influence of normal growth and development. Further large-scale, age-standardized studies are needed to better define their role in clinical practice.

Background: Epstein–Barr virus (EBV) infection is common in childhood and frequently accompanied by liver enzyme abnormalities. Although hepatic involvement is generally self-limited, pediatric data on predictors of hepatitis and biochemical recovery dynamics remain limited. This study aimed to evaluate the frequency and severity of hepatic involvement in children with primary EBV infection and identify clinical and laboratory features associated with hepatitis. Methods: This retrospective cohort study included children aged 0–18 years with serologically confirmed primary EBV infection at a tertiary center between January 2015 and November 2024. Patients with cytomegalovirus co-infection, hepatotropic viral infections, chronic liver disease, hepatotoxic drug exposure, or incomplete records were excluded. Demographic, clinical, and laboratory data were collected. Hepatic involvement was defined as ALT elevation above age-adjusted upper limits. Group comparisons utilized appropriate parametric and non-parametric tests, and logistic regression assessed predictors of hepatitis. Results: A total of 294 patients were included (median age: 6.1 years), of whom 48.6% were male. Hepatitis occurred in 59.2% of cases. Children with hepatitis were older than those without (median 6.7 vs. 5.3 years, p < 0.001). Logistic regression demonstrated that increasing age independently predicted hepatitis (odds ratio per year increase: 1.010; 95%CI 1.005–1.015; p < 0.001). Median time to ALT normalization was 20 days, and no patient developed acute liver failure. Conclusions: Hepatic involvement is common in pediatric EBV infection and is more frequent in older children. Despite significant biochemical abnormalities, all patients recovered fully with supportive care. Recognizing age-related risk and typical recovery patterns may reduce unnecessary investigations and guide appropriate management in pediatric EBV hepatitis.

Background: Secondary hepatic dysfunction is a frequent yet often under-recognized complication in critically ill children. It commonly arises as a consequence of systemic processes—particularly sepsis, hypoperfusion, hypoxia, and multiorgan dysfunction—rather than primary hepatobiliary disease. This study aimed to determine the incidence, clinical characteristics, and prognostic significance of secondary hepatic dysfunction in a pediatric intensive care unit (PICU) cohort, and to evaluate its relationship with PRISM III and PELOD-2 scores. Methods: This retrospective study included patients hospitalized in a tertiary PICU between January 2022 and December 2024. Children with pre-existing liver disease or primary acute liver failure were excluded. Hepatic dysfunction was defined by elevations in age-adjusted biochemical markers. Demographic variables, clinical interventions, laboratory values, and outcomes were recorded. Mortality risk and prolonged PICU stay (>7 days) were analyzed in relation to hepatic dysfunction, PRISM III, and PELOD-2 scores. Results: Among 567 PICU admissions, 50 patients (8.8%) met criteria for secondary hepatic dysfunction. The cohort had a median age of 57.5 months and 66% were male. Hepatocellular injury predominated (96%), while cholestatic patterns were less common (4%). Overall mortality was 22%. Mortality was significantly associated with sepsis (p = 0.04), mechanical ventilation (p < 0.01), and inotropic support (p < 0.01). Both PRISM III and PELOD-2 scores were higher in non-survivors on day 1 and day 7 (p ≤ 0.01). ALT ≥ 2 × ULN and total bilirubin > 2 mg/dL were not independently predictive of mortality. Conclusions: Secondary hepatic dysfunction is relatively common in critically ill children and is associated with adverse clinical outcomes. Its prognostic relevance appears to extend beyond conventional severity scores, particularly with respect to morbidity-related outcomes such as prolonged PICU stay, suggesting that routine hepatic assessment may contribute to early risk stratification in the PICU setting.

Objective: The aim of the study is to evaluate of the children who came to our hospital with the complaint of foreign body (FB) ingestion and were treated. Methods: A retrospective evaluation was made of the records of children who presented at our institution between January 2014 and August 2021 with the complaint of FB ingestion. Results: Evaluation was made of 297 children, comprising 121 female children (40.7%) with a mean age of 61.1 ± 50.3 months (range, 4–202 months). The ingested FB most frequently was coins (n = 88, 29.6%). The most common complaint on presentation was vomiting in 47 cases (15.8%). Endoscopy was applied to 75 cases (25.3%), and most common FB was removed from the upper esophagus in 31 cases (41.3%). The most frequently removed FB was coins at the rate of 40%. Of the 211 cases left to a spontaneous course, 117 were in the intestines, 22 in the stomach, and in 72 cases localization could not be determined on conventional radiography as the FB was not opaque. In 7 cases with a bolus of food caught in the esophagus, 3 had corrosive esophagus stricture (1 case with colon transposition), 2 had operated esophagus atresia, 1 had eosinophilic esophagitis, and 1 had congenital esophagus stricture. Conclusions: Although there can be serious outcomes, there is spontaneous expulsion in most cases. However, a significant proportion requires a timely endoscopic procedure. Attention must be paid to underlying diseases when FBs, such as a food bolus, are in the esophagus.

Body composition,children,fat,obesity

It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.

Objective: To evaluate the diagnostic impact of gastrointestinal symptoms (GIS) in pediatric patients with inflammatory bowel disease and polyps detected by colonoscopy. Material and Methods: Results of Colonoscopy performed on children younger than 18 years, between 2010 and 2015 in our clinic were retrospectively reviewed. All colonoscopy procedures were performed using a Fujinon EC 530LP IC657K068 video-colonoscope. Data regarding age, gender, indications, complications, and final diagnoses were collected and analyzed. Results: One hundred and thirty-six children undergoing 121 colonoscopies and 15 sigmoidoscopies were enrolled. Seventy-five patients (55.1%) were boys, with a mean age of 11.8 ± 4.1 years (1-18 years). The most common indication was chronic abdominal pain (42.1%, n=51), followed by lower gastrointestinal bleeding (37.2%, n=45), and chronic diarrhea (10.8%, n=13). Conclusive diagnosis relied on endoscopic imaging and/or histology in 75 (62%) patients, including nonspecific colitis (23.9%, n=29), polyp (19%, n=23), inflammatory bowel disease (IBD) (8.2%, n=10), which had normal (38%, n=56) findings. The sensitivity of the rectal bleeding in predicting the presence of polyp was 86.9%, specificity 74.49%. Chronic diarrhea and iron deficiency IBD predictive sensitivities (40%, 20%, respectively) and positive predictive value (30.77%, 20%, respectively) was low, while specificity (91.89%, 92.79%, respectively) and negative predictive value (94.44%, 92.79%, respectively) was found to be high. Conclusion: It is very important to diagnose according to GIS symptoms. Rectal bleeding was found to be the most sensitive symptom for polyps. Chronic diarrhea was the most specific symptom in predicting the diagnosis of IBD. In order to make the most accurate diagnosis with colonoscopy in children, GIS symptoms must be taken into consideration.