Nutrition is involved in several aspects of pediatric inflammatory bowel disease (IBD), ranging from disease etiology to induction and maintenance of disease. With regards to etiology, there are pediatric data, mainly from case-control studies, which suggest that some dietary habits (for example consumption of animal protein, fatty foods, high sugar intake) may predispose patients to IBD onset. As for disease treatment, exclusive enteral nutrition (EEN) is an extensively studied, well established, and valid approach to the remission of pediatric Crohn’s disease (CD). Apart from EEN, several new nutritional approaches are emerging and have proved to be successful (specific carbohydrate diet and CD exclusion diet) but the available evidence is not strong enough to recommend this kind of intervention in clinical practice and new large experimental controlled studies are needed, especially in the pediatric population. Moreover, efforts are being made to identify foods with anti-inflammatory properties such as curcumin and long-chain polyunsaturated fatty acids n-3, which can possibly be effective in maintenance of disease. The present systematic review aims at reviewing the scientific literature on all aspects of nutrition in pediatric IBD, including the most recent advances on nutritional therapy.

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patients, after switching from d4T to TDF and from PI to EFV, show most of the changes in anthropometry and body composition associated with normal growth and no frankly pathological change in metabolic parameters.

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Dieulafoy lesion is a vascular anomaly predominantly found in the stomach, which represents a rare cause of gastrointestinal bleeding and life-threatening haemorrhages in pediatric age with few cases reported in the literature. We experienced a 7-year-old previously healthy boy with hematemesis endoscopically diagnosed and successfully treated for a Dieulafoy lesion in the stomach. This case report illustrates the initial diagnostic workup and the possible differential diagnosis in presence of an acute episode of hematemesis in children. It focuses on an uncommon cause of gastrointestinal bleeding that is probably underestimated because of missing diagnosis. Any unusual and acute case of upper gastrointestinal bleeding should raise the suspicion of Dieulafoy lesion also in children, especially in those who have a past medical history negative for peptic disease and varices due to portal hypertension: a promptly endoscopy can provide visual diagnostic criteria and ensure an adequate hemostasis that is generally the definitive treatment of the lesion.

Purpose: To investigate the relationship between software quantified terminal ileal (TI) motility and histopathological activity grading, a standardised MRI activity score Crohns Disease MRI Index (CDMI) and faecal calprotectin.Methods: A review of a tertiary referral paediatric hospital imaging database was performed to identify subjects with Crohns disease or unclassified inflammatory bowel disease (IBDU) who underwent dynamic MRI Enterography (MRE) bowel motility assessment. Dynamic imaging for 25 patients (median age 12, range 5 to 16) was analysed, blind to any clinical data, with a previously validated motility assessment algorithm (GIQuant®, Motilent, London, UK).A region of interest was placed in the terminal ileum (TI) within 3cm of the ileocecal valve and the motility score derived. The primary SoR was TI histopathological Endoscopic biopsy Assessment of Inflammatory Activity (eAIS) occurring within 40 days of the MRI. Our secondary SoRs were: 1) the Crohns Disease MRI Index (CDMI), a standardised MRI activity score validated against eAIS and 2) faecal calprotectin (FC) levels within 3 months of MRE.Results: MR Enterography derived median motility score was 0.17 (interquartile range, IQR 0.12 to 0.25) and median CDMI was 3 (IQR 0 to 5.5). Based on the primary SoR, 43% of patients had active disease (eAIS>0) with the median eAIS score of 0 (IQR 0 to 2; range 0 to 5).Correlation between eAIS and motility was r = -0.58 (p = 0.004, N = 23) and between CDMI and motility was r = -0.42 (p = 0.037, N = 25). Motility score was lower in those with active disease (median 0.12 vs 0.21, p = 0.020) while CDMI was higher (median 5 vs 1, p = 0.04). In a subset of 12 patients with faecal calprotectin within 3 months of MRE, correlation between and motility was r = -0.27 (p = 0.4). Conclusion:Quantified terminal ileal motility is significantly negatively correlated with histopathological activity, reproducing findings in adult populations. TI motility also shows a