A few studies of long-term outcomes for pediatric functional abdominal pain (FAP) have assessed acute non-abdominal pain at follow-up, but none has assessed chronic pain. We followed a cohort of pediatric patients with FAP (n = 155) and a well control group (n = 45) prospectively for up to 15 years. Participants ranged in age from 18 to 32 years at a follow-up telephone interview. FAP patients were classified as Resolved (n = 101) versus Unresolved (n = 54) at follow-up, based on whether they reported symptoms consistent with the adult Rome III criteria for a functional gastrointestinal disorder. Headache symptoms and reports of chronic non-abdominal pain also were assessed at follow-up. In the Unresolved group, 48.1% reported one or more sites of chronic non-abdominal pain at follow-up, compared to 24.7% in the Resolved group and 13.3% in the control group, p < 0.01. More than half (57.4%) of the Unresolved group endorsed symptoms consistent with International Headache Society criteria for headache, compared to 44.6% of the Resolved group and 31% of controls, p < 0.05. One-third of the Unresolved group reported both headache and one or more sites of chronic non-abdominal pain at follow-up, compared to 17.8% of the Resolved group and 4.4% of controls. Youth with FAP that persists into adulthood may be at increased risk for chronic pain and headache. Examination of central mechanisms that are common across chronic pain disorders may enhance understanding of this subgroup of FAP.

Background & Aims Little is known about long-term health outcomes of children with dyspeptic symptoms. We studied the natural history of pediatric patients with dyspeptic symptoms, with and without histologic reflux, compared to healthy controls. Methods We performed a prospective study of consecutive new patients, ages 8–16 years, who underwent evaluation for dyspepsia, including upper endoscopy. Patients were assigned to groups with histologic evidence of reflux esophagitis (n=50), or normal histology results (n=53). Healthy children were followed as controls (n=143). Patients and controls were evaluated 5–15 years later. They provided self reports on severity of dyspeptic symptoms, use of acid suppression, quality of life, anxiety, and depression. Results When the study began, the groups with histologic evidence for esophagitis and normal histologies did not differ in severity of dyspeptic symptoms, functional disability, or depression. After a mean 7.6-year follow-up period, each group had significantly lower quality of life scores and more severe dyspeptic symptoms and functional disability than controls, but did not differ significantly from each other; both groups were significantly more likely than controls to meet criteria for an anxiety disorder. At time of follow-up, use of acid suppression medication was significantly greater in the group with histologic evidence for esophagitis, compared with patients that had normal histology findings when the study began. Conclusion Among pediatric patients with dyspepsia evaluated by endoscopy and biopsy, those with histologic evidence for esophagitis or normal histology findings are at increased risk for chronic dyspeptic symptoms, anxiety disorder, and reduced quality of life in adolescence and young adulthood.

Cytomegalovirus (CMV) is the most common congenitally acquired viral infection in the United States and is associated with significant morbidity and mortality. Primary CMV enterocolitis is well documented in immunocompromised patients, but remains rare in congenitally acquired infections. There are no universally accepted recommendations for the treatment of CMV enterocolitis in the pediatric population. Case reports show varied dosing and length of treatment of either intravenously administered ganciclovir, orally administered valganciclovir, or a combination of both. We present a congenitally infected infant with primary CMV enterocolitis who was successfully treated with orally administered valganciclovir.

Background Eighty-eight patients suffering from juvenile idiopathic arthritis (JIA) with inadequate response to methotrexate therapy (MTX) have received etanercept +/- MTX since the year 2000 in Vienna. They were retrospectively analysed. They were suffering from various categories of JIA (systemic JIA, persistent or extended oligoarthritis, seronegative or seropositive polyarthritis or from psoriatic arthritis). The data were collected in three pediatric outpatient units. Results The mean age at diagnosis was 8,1±4,5 years (from 8,9 months to 16,2 years), there were 25 boys (28,4%) and 63 girls (71,6%) (ratio 1: 2,5). The mean period of time from diagnosis until the onset of a therapy with methotrexate (MTX) was 1,6 years (sd ± 2,1, from 0,8 months to 11,1 years). All patients were treated with MTX for 3,1 years (sd ± 2,8, from 3,0 months to 12,8 years). Currently 27 patients are still treated with MTX. The mean period of time from diagnosis to etanercept therapy was 4,5 years (sd ± 3,5, from 4,0 months to 15,0 years). Patients were treated with Etanercept for 1,7 years (sd ± 1,0, from 1,0 months to 4,1 years). In september 2011, there were still 62 patients (70,5%) treated with Etanercept. 20 patients (32,3%) are in remission, 16 (25,8%) have active arthritis, 3 (4,8%) have at least one tender joint (POM = pain of motion), 16 (25,8%) have at least one limited joint (LOM = limitation of motion) and 7 (11,3%) could not be evaluated. At the time of diagnosis there were 1 – 38 joints (mean 12,7) affected, at the time of onset of the MTX therapy there were 1 – 38 joints (mean 8,3) affected. In september 2011, there is a significant decrease in the number of affected joints (0 – 22 joints; mean 3,0; p<0,05). Conclusions Our data show that the patients showed a remission after an average of 6,1 months (sd ± 7,1; 0,7 months – 2,8 years). 33 (37,5%) of these patients are stilll in remission (16 on therapy with etanercept, 4 on therapy with etanercept + MTX, one on therapy with MTX and 12 are off therapy) and this status persists for 2,4±1,2 years after withdrawal of etanercept. Disclosure of Interest None Declared

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