In the absence of nutritional supplements, food intake is inadequate for many nutrients in many children with IBD.

Male sex and higher Pediatric Ulcerative Colitis Activity Index score at diagnosis are independent risk factors for colectomy.

In our cohort, a substantial high proportion of pediatric onset IBDU patients were later re-diagnosed as CD. Only a family history of CD and hypoalbuminemia could predict reclassification among IBDU patients.

Background/Aims Colorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort. Methods We retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study. Results A total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon. Conclusions Single left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

What Is KnownEndoscopy Training is becoming an integral part of Paediatric Gastroenterology Training within Europe. There is a great degree of variation between European endoscopy training in terms of duration, content, procedural volume, assessment during and at the end of training. What Is New?Achievement of milestones in training more accurately assesses competency compared with procedural number. 'Train the trainers' courses and educational material, such as e-learning and endoscopy simulator training improve a structured approach in endoscopy teaching. Cooperation with the National Paediatric Gastroenterology, Hepatology and Nutrition Societies in Europe will facilitate dissemination, discussion and implementation of results of this position paper. E ndoscopy Training is an integral part of paediatric gastroenterology training within Europe as mentioned in the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) training syllabus (1). National training programmes are often at least partly based on the ESPGHAN syllabus, however, there are a number of countries where endoscopy training is not included in Paediatric Gastroenterology, Hepatology and Nutrition (PGHN) training. There is increasing evidence that achievement of milestones in training more accurately assesses competency compared with procedural number (2,3). The updated ESPGHAN Syllabus has been approved by the European Union of Medical Specialists (UEMS), suggesting that countries with National PGHN society should comply with the syllabus. The ESPGHAN syllabus lists the endoscopic procedures to be fulfilled in order to certify for paediatric gastroenterologist and does not specify procedural volume anymore (4). A group of experts within the ESPGHAN was tasked to define milestones of competency in diagnostic and therapeutic endoscopy by the Endoscopy Special Interest Group (SIG). In addition, other areas of possible