Francesca Sbravati

This observational retrospective study describes the rate and time of symptom resolution in celiac disease (CD) in a cohort of pediatric patients following a gluten-free diet (GFD). We evaluated the rate and time to symptom resolution after starting a GFD, as well as associated predictive factors (age, gender, comorbidities, familial history, IgA anti-transglutaminase antibodies (TGA-IgA) at diagnosis, dietary adherence), in children diagnosed with CD between 2014 and 2022 at the Gastroenterology Unit of Maggiore Hospital, Bologna. The minimum follow-up period was 6 months. Of 421 symptomatic patients at diagnosis, 77.4% presented gastrointestinal symptoms (GIs) (40.6% recurrent abdominal pain, 19.5% diarrhea, 21.6% constipation, 17.3% bloating), 47.5% extra-intestinal symptoms (EISs) (16.4% neurological symptoms, 9.0% anemia), and 33.5% growth retardation (31.6% failure to thrive, 17.8% short stature). 96.7% had a high GFD adherence through follow-up. The overall symptom resolution rate was 84.8% (GIs 89.0%, EISs 92.6%, growth retardation 87.4%). Constipation had a significantly lower resolution rate compared to other GIs (p = 0.02) or diarrhea (p = 0.03). In total, 81.7% of patients achieved symptom resolution within 12 months. Short stature and anemia resolved more slowly compared to other symptoms. TGA-IgA normalization and GFD adherence were significant predictors of symptom resolution. Most symptoms resolved within the first year of diagnosis. The lower resolution rate for constipation compared to other GIs suggests a functional etiology, while the delayed recovery of anemia and short stature likely reflects their complex etiology. Serological normalization and GFD adherence are confirmed as predictors of clinical remission. • Time to clinical remission in celiac children after starting a gluten-free diet may vary between different symptoms. • Clinical remission is associated with serological normalization and adherence to diet. • Constipation has a significantly poorer rate of resolution among other gastrointestinal symptoms, due to its functional etiology, while anemia and short stature resolve slightly slower. • Most patients reach clinical remission within the first year on a gluten-free diet; serological normalization and diet adherence are confirmed to be predictors of clinical remission.

Background: Exclusive enteral nutrition (EEN) is the recommended first-line therapy for induction of remission in pediatric mild-to-moderate Crohn’s disease (CD), but its restrictive nature often limits adherence and long-term sustainability. A modified version of the Crohn’s Disease Exclusion Diet (CDED), integrating Mediterranean dietary principles, was developed to offer a more acceptable alternative while preserving therapeutic efficacy. Methods: We conducted a retrospective, single-center study comparing short- and long-term outcomes of a Mediterranean-adapted CDED (M-CDED) with partial enteral nutrition (PEN) versus standard EEN in children with mild-to-moderate CD. Clinical remission was assessed after 8 and 16 weeks, while long-term outcomes were assessed after 1 and 2 years. Results: Data collected from thirty-two patients were analyzed (EEN, 14; M-CDED, 18). Clinical remission rates were comparable after 8 weeks (92.8% EEN vs. 94.4% M-CDED) and 16 weeks (100% in both groups). However, at 12 and 24 months, M-CDED was associated with significantly higher rates of clinical and biochemical remission and a markedly lower need for biologic drugs (12-month biologic initiation: 50% EEN vs. 11.1% M-CDED; p = 0.01). Adherence to M-CDED was excellent throughout follow-up. Conclusions: M-CDED with PEN appears to be as effective as EEN for remission induction, with improved long-term disease control and reduced therapeutic escalation. These findings support the feasibility of M-CDED as a sustainable option for long-term management of pediatric CD. Prospective studies are needed to confirm these results.

Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care.

Current practice regarding complementary feeding (CF) is influenced by socio-cultural background. Our group already investigated the Italian approach to CF in the years 2015–2017. Our aim was to update those data by finding out: if the habits have changed nationwide, how the trends changed in each area, and if the differences between regions still exist. We devised and submitted to Italian primary care paediatricians (PCP) a questionnaire consisting of four items regarding the suggestions they gave to families about CF and compared the results to the ones from our previous survey. We collected 595 responses. Traditional weaning was the most recommended method, with a significant reduction compared to the period of 2015–2017 (41% vs. 60%); conversely, the proportion of PCP endorsing baby-led weaning (BLW) or traditional spoon-feeding with adult food tastings has increased, while the endorsement of commercial baby foods dropped. BLW is still more popular in the North and Centre compared to the South (24.9%, 22.3%, and 16.7%, respectively). The age to start CF and the habit of giving written information have not changed over time. Our results highlighted that Italian paediatricians encourage BLW and traditional CF with adult tastings more than in the past, at the expense of traditional spoon-feeding.