Compared with other patients, those with PAD underestimated the high risk of cardiovascular events associated with PAD and the benefits of cholesterol-lowering therapy. These findings may help explain the low rates of CVD risk factor control previously reported in patients with PAD.

Proton pump inhibitor therapy in adults with asthma results in a small, statistically significant improvement in morning PEF rate. The magnitude of this improvement, however, is unlikely to be of meaningful clinical significance. There is insufficient evidence to recommend empirical use of PPIs for routine treatment of asthma.

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents. Keywords children; cognitive-behavioral therapy; dietary therapy; functional abdominal pain; irritable bowel syndrome; pharmacotherapy; psychosocial intervention; recurrent abdominal pain Functional abdominal pain (FAP) and irritable bowel syndrome (IBS), both of which typically present with chronic abdominal pain, are common complaints in the pediatric population. Estimates on the prevalence of abdominal pain are varied, but community-and school-based studies have reported that as many as 13-38% of children and adolescents experience abdominal pain weekly, with up to 24% of children reporting symptoms persisting longer than 8 weeks [1,2]. For the vast majority of patients, an underlying inflammatory, anatomic, metabolic or neoplastic cause for recurrent abdominal discomfort is not found on evaluation [3]. A significant proportion of these patients are subsequently diagnosed with FAP or IBS. Both entities are included under the larger heading of functional gastrointestinal disorders (FGIDs), which are characterized by chronic or recurrent gastrointestinal symptoms that are not explained by structural or biochemical abnormalities [4]. The diagnosis of FAP or IBS is symptom-based and new criteria have been defined by the Rome III group (BOX 1) [4]. In addition to recurrent abdominal pain, children with IBS also experience disturbances in defecation, ranging from lumpy or hard stools to loose, watery stools or both. Adult patients †

Background Oropharyngeal (OP) pH monitoring has been developed as a new way to diagnose supraesophageal gastric reflux (SEGR), but has not been well-validated. Our aim was to determine the correlation between OP pH and gastroesophageal (GER) events detected by multichannel intraluminal impedance-pH (MII-pH). Methods Fifteen patients (11 Males, median age 10.8 yrs) with suspected GER were prospectively evaluated with ambulatory 24-h OP pH monitoring (positioned at the level of the uvula) and concomitant esophageal MII-pH monitoring. Potential OP events were identified by the conventional pH threshold of <4, and by the following alternative criteria: 1) relative pH drop >10% from 15-min baseline and 2) absolute pH drop below thresholds of <5.5, 5.0, and 4.5. The 2-min window preceding each OP event was analyzed for correlation with an episode of GER detected by MII-pH. Key Results A total of 926 GER events were detected by MII-pH. Application of alternative pH criteria increased the identification of potential OP pH events; however, a higher proportion of oropharyngeal events had no temporal correlation with GER (45-81%), compared to the conventional definition of pH<4 (40%). A total of 306 full-column acid reflux episodes were dectected by MII-pH, of which 10(3.3%) were also identified by OP pH monitoring. Conclusions & Inferences Use of extended pH criteria increased the detection of potential SEGR events, but the majority of decreases in OP pH were not temporally correlated with GER. Oropharyngeal pH monitoring without concurrent esophageal measurements may over-estimate the presence of SEGR in children.

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominal pain and are among the most commonly diagnosed medical problems in pediatrics. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Based on the biopsychosocial model of functional disease, the Rome III criteria have helped frame FAP and IBS in terms of being a positive diagnosis and not a diagnosis of exclusion. However, the lack of a single, proven intervention highlights the complex interplay of pathologic mechanisms likely involved in the development of childhood FAP and IBS and the need for a multidisciplinary, integrated approach. This article discusses the epidemiology, proposed mechanisms, clinical approach and therapeutic options for the management of FAP and IBS in children and adolescents.

Objective: Pediatric aerodigestive programs appear to be rapidly proliferating and provide multidisciplinary, coordinated care to complex, medically-fragile children. Pediatric subspecialists are considered essential to these programs. This study evaluated the state of these programs in 2017 by surveying their size, composition, prevalence, and the number of patients that they serve. Methods: The North American Society for Pediatric Gastroenterology Hepatology and Nutrition Aerodigestive Special Interest Group leadership distributed an 11-question survey to the Pediatric Gastroenterology International Listserv. The mean time of the programs' existence, number of half-day clinics, number of procedure days, number of patients evaluated and the lead primary specialty were evaluated. Results: Thirty-four programs responded. Twenty-five were based in academic centers. 31 programs were located across the United States. The average time of program existence was 5.3 years (SD 4.3 range 1-17 years). 64.7% were started in the past five years. Twelve programs were based in the division of gastroenterology. The average number of gastroenterologists serving aerodigestive programs was 2 (SD 1.1). The mean number of half-day clinic sessions and procedure days were 2.8 (SD 2.9) and 2.6 (SD 2) respectively. New and follow-up visits per year in each program averaged 184 (SD 168, range 10-750).

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