ObjectiveFaecal microbiota transplantation (FMT) has proved to be an extremely effective treatment for recurrent Clostridioides difficile infection, and there is interest in its potential application in other gastrointestinal and systemic diseases. However, the recent death and episode of septicaemia following FMT highlights the need for further appraisal and guidelines on donor evaluation, production standards, treatment facilities and acceptable clinical indications.DesignFor these consensus statements, a 24-member multidisciplinary working group voted online and then convened in-person, using a modified Delphi approach to formulate and refine a series of recommendations based on best evidence and expert opinion. Invitations to participate were directed to Australian experts, with an international delegate assisting the development. The following issues regarding the use of FMT in clinical practice were addressed: donor selection and screening, clinical indications, requirements of FMT centres and future directions. Evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.ResultsConsensus was reached on 27 statements to provide guidance on best practice in FMT. These include: (1) minimum standards for donor screening with recommended clinical selection criteria, blood and stool testing; (2) accepted routes of administration; (3) clinical indications; (4) minimum standards for FMT production and requirements for treatment facilities acknowledging distinction between single-site centres (eg, hospital-based) and stool banks; and (5) recommendations on future research and product development.ConclusionsThese FMT consensus statements provide comprehensive recommendations around the production and use of FMT in clinical practice with relevance to clinicians, researchers and policy makers.

Students with chronic illness generally have higher school needs than their healthy peers. The research to date examining school support for these needs has been limited to qualitative methods. We collected quantitative data to compare the school needs and supports received by 192 students with chronic illness and 208 students without chronic illness using parent-completed surveys. We assessed school experiences and receipt of school support across academic, social-emotional, and medical domains and school attendance. We analyzed the data using logistic regression. Students with chronic illness were 3.8 times more likely to have repeated a grade, 3.6 times more likely to have parent-reported academic challenges, and 4.9 times more likely to have recent illness-related school absenteeism than healthy students. Parents of students with chronic illness were 2.2 times more likely to report their child to have moderate-high emotional distress, and 4.6 times more likely to report that their child had low social confidence compared with parents of healthy students. Students with chronic illness did not receive more schoolbased tutoring, home-based tutoring, or support from a teacher's aide or school psychologist than healthy students. Students with chronic illness receive insufficient support to address their academic and social-emotional needs or high rates of school absenteeism. Evidence-based educational services must be developed and delivered to meet the needs of students with chronic illness at school and while recovering at home.

Probiotics consist of yeast or bacteria, especially lactic acid bacteria. They are available as capsules, powder, fermented milks or yoghurts. Probiotics exhibit strain‐specific differences in their resistance to acid and bile, ability to colonise the gastrointestinal tract, clinical efficacy, and benefits to the health of the host. There is level I evidence for the use of probiotics in treating acute infectious diarrhoea and preventing antibiotic‐associated diarrhoea, with Lactobacillus rhamnosus GG and Saccharomyces boulardii having the most evidence to support their use for these conditions. There is level II evidence that S. boulardii combined with high‐dose vancomycin is more effective than the antibiotic alone in preventing recurrent Clostridium difficile diarrhoea. There is level I evidence that probiotics prevent traveller's diarrhoea. There is level I evidence for use of the high‐potency probiotic VSL#3 in preventing pouchitis, and level II evidence for this agent in preventing relapse in patients with ulcerative colitis. Probiotics are generally regarded as safe and well tolerated. Some probiotics may be contraindicated in patients who are immunocompromised or have severe underlying illness, as they have been reported to cause fungaemia and bacteraemia.

Students with chronic illness may disengage from school, adversely affecting their school outcomes. Positive education targets students’ social–emotional well-being (school well-being), which can increase engagement with school. We compared the relationship among positive educational practices, school well-being, and engagement with school as reported by parents of students with and without chronic illness. We used a convergent mixed-methods cross-sectional design. We collected data from 215 parents of school-age children with chronic illness and 212 parents of children without chronic illness. Data assessed positive educational practices, school well-being, and engagement with school, which we analyzed using regression and structural equation models. Forty-nine parents of students with chronic illness completed a telephone interview about their child’s school experiences, which we analyzed using content analysis. School well-being was significantly lower among students with chronic illness, compared with students without chronic illness (p = .05). Higher student well-being (p ≤ .001) and higher levels of positive educational practices (p = .002) were associated with higher engagement with school. School well-being mediated the relationship between positive educational practices and engagement with school for students with chronic illness but not students without chronic illness. Parents of children with chronic illness described how positive educational practices and their child’s school well-being promoted their child’s engagement with school. Parents also reported the negative consequences of low school well-being. Positive educational practices alone may not be sufficient to increase engagement with school in students with low school well-being. Combined preventative and early intervention psychosocial support may best promote engagement with school in students with chronic illness.

Aim: To determine the nature and extent of interactions between retail pharmacists and families of infants concerned about functional gastrointestinal disorders. Methods: A 15-question online survey was developed that could be completed by retail pharmacists in approximately 5 min. This survey aimed to obtain information relating to the frequency of interactions with parents of infants seeking advice and/or information about colic, gastrooesophageal reflux (GOR) or constipation in pharmacies; what recommendations and/or advice was given by the pharmacists; from where the pharmacists obtained their information and what guidelines/recommendations they would value; and demographic information. Results: A total of 362 pharmacists from every state and territory within Australia completed the survey. Conversations with parents/carers about constipation at least once a week were reported by 85% of pharmacists, with the equivalent percentages for GOR and colic both being 76%. In the case of constipation, medication was recommended in 70% of cases, and a nutritional approach was recommended in 67% of cases. Medication was recommended in 81% of cases of suspected colic, significantly greater than nutritional advice at 50%. For possible GOR, recommendations were similar, with medication being suggested in 66% and nutritional advice in 68%. GOR guidelines were the most sought after, with 42% of pharmacists placing such guidelines as their number one need. Conclusions: This survey indicates the need for greater emphasis to be given to reassurance by health-care professionals involved in the management of functional gastrointestinal disorders in infancy, as well as consideration of the construction of easily accessible, evidence-based national guidelines.

<b><i>Background:</i></b> The inflammatory bowel diseases cover a diverse range of conditions generally grouped into Crohn’s disease (CD) or ulcerative colitis (UC) based on clinical, laboratory, radiological, endoscopic, and histological criteria. However, inflammatory bowel disease unclassified (IBDU) is used when there are clinical and endoscopic signs of chronic colitis without specific features of UC or CD but features of both. Conjecture exists regarding IBDU, especially in children, as to whether it represents a unique childhood phenotype or whether it reflects the difficulties in assigning an IBD subtype at an early age. <b><i>Summary:</i></b> This review examines the current understanding of pediatric IBDU and assesses the evidence supporting IBDU as a distinctive disease entity on the spectrum of inflammatory bowel disease. <b><i>Key Messages:</i></b> Pediatric-onset IBDU is more common than adult-onset IBDU. Therefore, an understanding of IBDU in this age group assumes more importance. However, there remains a paucity of information and a lack of exclusive longitudinal studies on pediatric IBDU. Subsequently there is significant disparity in the reported prevalence, clinical course, reclassification trends, and treatment responses around pediatric IBDU. Therefore, it remains challenging to chart the natural history of pediatric IBDU and consequently form an accurate understanding of where pediatric IBDU sits on the spectrum of disease.

Objectives: Children with celiac disease (CD) follow a lifelong gluten-free diet. This restrictive diet may be associated with nutritional compromise. Our objectives were, therefore, to evaluate the dietary composition (energy, macronutrients and micronutrients, and fiber) in children with CD compared with healthy controls (HC) and relationship between dietary composition and socioeconomic status. Methods: This cross-sectional, case-control study recruited children with CD ages 2 to 18 years and HC matched for age, sex, and socioeconomic status. Clinical, sociodemographic, and dietary information were collected. A false discovery rate correction was applied to the P-value for multiple comparisons (q-value). Results: Sixty-five CD children were matched with 65 HC (mean [SD] age: 10.2 [3.6] vs 10.1 [3.7] years, P = 0.96). Compared with HC, CD children had higher intakes of energy (2413.2 [489.9] vs 2190.8 (593.5) kcal/day, P = 0.02), total fat (818.1 ± 180.9 vs 714.3 ± 212.2 kcal/day, q = 0.018), and subtypes of fat (saturated, polyunsaturated, and monounsaturated). There were no differences in other macronutrients, sugar, micronutrients, or fiber between CD and HC, and no difference in dietary intake among CD between socioeconomic disadvantage versus advantage. Children with CD had lower weight z-scores (−0.06 [1.05] vs 0.47 [0.96], P = 0.003) and body mass index (BMI) z-scores (−0.02 [0.88] vs 0.41 [1.09], P = 0.02) than HC. Conclusions: Children with CD had higher calorie and fat intake compared with HC. Despite this, CD children had lower weight and BMI z-scores compared with HC.

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