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Nagelkerke SCJ, Bakx R. Re: Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review. Eur J Pediatr Surg 2023. [PMID: 37437595 DOI: 10.1055/a-2127-5751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- Sjoerd C J Nagelkerke
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - R Bakx
- Department of Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
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Demirok A, Nagelkerke SCJ, Benninga MA, Köglmeier J, Mutanen A, Arnell H, Felcht J, Guimber D, Wahlstedt C, Avitzur Y, Lambe C, Tabbers MM. Development of a core outcome set for pediatric chronic intestinal failure. JPEN J Parenter Enteral Nutr 2023; 47:364-371. [PMID: 36546585 DOI: 10.1002/jpen.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In research on pediatric chronic intestinal failure, heterogeneity in reported definitions and outcomes exists. This leads to a risk of reporting bias and impossibility of evidence synthesis. Also, reported outcomes should be relevant to both healthcare providers and patients and their parents. Therefore, the aim of this study is to create a core outcome set (COS) to be used in studies on pediatric chronic intestinal failure. METHODS Candidate outcomes were selected from a recent systematic review. A three-round Delphi study among key stakeholders and a consensus meeting with an expert panel were undertaken to achieve consensus on the COS. RESULTS Seventy-two stakeholders (79%) completed all three rounds of the Delphi process. Ninety-eight outcomes were assessed, and five new outcomes were added after the first round. Ten outcomes were included in the final COS: weaning from parenteral nutrition, growth, mortality, central line-related infection, central line longevity, sepsis not related to central line infection, central line-related thrombosis, intestinal failure-associated liver disease, (serious) adverse events, and health-related quality of life. CONCLUSION This pediatric chronic intestinal failure COS consists of 10 outcomes important for all key stakeholders. Usage of this set in future research should minimize outcome heterogeneity and enhance the value of evidence synthesis. This will lead to better management in this field of rare gastrointestinal conditions.
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Affiliation(s)
- Aysenur Demirok
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center University of Amsterdam, Amsterdam, the Netherlands
| | - Sjoerd C J Nagelkerke
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center University of Amsterdam, Amsterdam, the Netherlands
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center University of Amsterdam, Amsterdam, the Netherlands
| | - Jutta Köglmeier
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Annika Mutanen
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Arnell
- Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Judith Felcht
- Pediatric Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dominique Guimber
- Pediatric Gastroenterology, Hepatology and Nutrition, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Christina Wahlstedt
- Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cécile Lambe
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, Hôpital Necker-Enfants Malades, Université Paris Cité, Paris, France
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center University of Amsterdam, Amsterdam, the Netherlands
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Nagelkerke SCJ, Poelgeest MYV, Wessel LM, Mutanen A, Langeveld HR, Hill S, Benninga MA, Tabbers MM, Bakx R. Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review. Eur J Pediatr Surg 2022; 32:301-309. [PMID: 33663008 DOI: 10.1055/s-0041-1725187] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The aims of the study are to systematically assess and critically appraise the evidence concerning two surgical techniques to lengthen the bowel in children with short bowel syndrome (SBS), namely, the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP), and to identify patient characteristics associated with a favorable outcome. MATERIALS AND METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception till December 2019. No language restriction was used. RESULTS In all, 2,390 articles were found, of which 40 were included, discussing 782 patients. The median age of the patients at the primary bowel lengthening procedure was 16 months (range: 1-84 months). Meta-analysis could not be performed due to the incomparability of the groups, due to heterogeneous definitions and outcome reporting. After STEP, 46% of patients weaned off parenteral nutrition (PN) versus 52% after LILT. Mortality was 7% for STEP and 26% for LILT. Patient characteristics predictive for success (weaning or survival) were discussed in nine studies showing differing results. Quality of reporting was considered poor to fair. CONCLUSION LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. Homogenous, prospective, outcome reporting is necessary, for which an international network is needed.
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Affiliation(s)
- Sjoerd C J Nagelkerke
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
| | | | - L M Wessel
- Department of Pediatric Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - A Mutanen
- Department of Pediatric Surgery, The New Children's Hospital, University of Helsinki, Helsinki, Finland
| | - H R Langeveld
- Erasmus MC, Sophia's Children's Hospital, Department of Pediatric Surgery, Rotterdam, The Netherlands
| | - S Hill
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - M A Benninga
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - M M Tabbers
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - R Bakx
- Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Vlug LE, Delhanty PJD, Neelis EG, Huisman M, Visser JA, Rings EHHM, Wijnen RMH, Nagelkerke SCJ, Tabbers MM, Hulst JM, de Koning BAE. Ghrelin Levels in Children With Intestinal Failure Receiving Long-Term Parenteral Nutrition. Front Nutr 2022; 9:896328. [PMID: 35634374 PMCID: PMC9131070 DOI: 10.3389/fnut.2022.896328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Children with intestinal failure (IF) require parenteral nutrition (PN). Transition to oral and enteral nutrition (EN) can be difficult also due to abnormal gastrointestinal motility. The gut hormone ghrelin is increased in states of negative energy balance, functioning to preserve euglycemia, and also has appetite stimulating and prokinetic properties. We aimed to evaluate and compare ghrelin levels in children with IF, and to assess the relationship with PN-dependency. Methods In this exploratory prospective multicenter study, plasma acylated (AG) and unacylated (UAG) ghrelin levels were measured in children with short bowel syndrome (SBS) and with functional IF (pseudo-obstruction or any enteropathy) and compared with healthy control subjects. Spearman’s rho (rs) was used to assess correlations of AG and UAG with PN-dependency (%PN) and parenteral glucose intake. Results Sixty-four samples from 36 IF-patients were analyzed. Median baseline AG and UAG levels were respectively 279.2 and 101.0 pg/mL in children with SBS (n = 16), 126.4 and 84.5 pg/mL in children with functional IF (n = 20) and 82.4 and 157.3 pg/mL in healthy children (n = 39). AG levels were higher in children with SBS and functional IF than in healthy children (p = 0.002 and p = 0.023, respectively). In SBS, AG positively correlated with %PN (rs = 0.5, p = 0.005) and parenteral glucose intake (rs = 0.6, p = 0.003). These correlations were not observed in functional IF. Conclusion Children with IF had raised AG levels which could be related to starvation of the gut. The positive correlation between AG and glucose infusion rate in SBS suggests an altered glucoregulatory function.
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Affiliation(s)
- Lotte E. Vlug
- Division of Gastroenterology, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Patric J. D. Delhanty
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Esther G. Neelis
- Division of Gastroenterology, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martin Huisman
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jenny A. Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Edmond H. H. M. Rings
- Division of Gastroenterology, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Gastroenterology, Department of Pediatrics, Willem Alexander Children’s Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - René M. H. Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sjoerd C. J. Nagelkerke
- Division of Gastroenterology, Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Merit M. Tabbers
- Division of Gastroenterology, Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Jessie M. Hulst
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
| | - Barbara A. E. de Koning
- Division of Gastroenterology, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: Barbara A. E. de Koning,
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Nagelkerke SCJ, Draijer LG, Benninga MA, Koot BGP, Tabbers MM. The prevalence of liver fibrosis according to non-invasive tools in a pediatric home parenteral nutrition cohort. Clin Nutr 2020; 40:460-466. [PMID: 32636112 DOI: 10.1016/j.clnu.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Liver biopsy is no viable tool to routinely screen for liver fibrosis in children suffering from chronic intestinal failure (IF). We aim to assess the prevalence of liver fibrosis in a cohort of children with chronic IF by non-invasive tests: transient elastography (TE), aspartate-aminotransferase-to-platelet-ratio-index (APRI) and enhanced liver fibrosis (ELF) score. METHODS Cross sectional study where patients with chronic IF, receiving parenteral nutrition (PN) for at least 3 months, were enrolled. TE, APRI and ELF score were measured. Using Spearman's rank correlation coefficient and Kruskal-Wallis H test, the correlation between TE, APRI, ELF score and known risk factors for development of intestinal failure-associated liver disease (IFALD) were calculated. RESULTS 32 patients were included (50% female), median age was 8 years and 4 months, median PN duration was 45 months. Six patients (21%) had TE ≥6.5 kPa, indicating significant fibrosis. Twelve patients (38%) had APRI ≥.5, indicating fibrosis. ELF score indicated moderate fibrosis in 17 patients (63%) and significant fibrosis in 10 patients (37%). TE and APRI correlated significantly with known risk factors for IFALD, but ELF showed poor correlation with known risk factors for IFALD. CONCLUSION In a cohort of pediatric patients suffering from chronic IF, TE measurement, APRI and ELF test show a varying, but substantial proportion of subjects with fibrosis. The diagnostic value of these tests and their role in the management of pediatric IF must be determined in larger cohorts with liver biopsy as reference standard. TRIAL REGISTRATION Academic Medical Center medical ethics committee number: METC 2017_185.
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Affiliation(s)
- Sjoerd C J Nagelkerke
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, the Netherlands.
| | - Laura G Draijer
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, the Netherlands
| | - Marc A Benninga
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, the Netherlands
| | - Bart G P Koot
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, the Netherlands
| | - Merit M Tabbers
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, the Netherlands
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Vlug LE, Nagelkerke SCJ, Jonkers-Schuitema CF, Rings EHHM, Tabbers MM. The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients. Nutrients 2020; 12:nu12010172. [PMID: 31936271 PMCID: PMC7019598 DOI: 10.3390/nu12010172] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/02/2020] [Accepted: 01/04/2020] [Indexed: 12/15/2022] Open
Abstract
Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.
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Affiliation(s)
- Lotte E. Vlug
- Erasmus Medical Center, Department of Pediatric Gastroenterology, Erasmus University Rotterdam, Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Correspondence: (L.E.V.); (S.C.J.N.)
| | - Sjoerd C. J. Nagelkerke
- Amsterdam UMC, Department of Pediatric Gastroenterology, University of Amsterdam, Emma Children’s Hospital, Hepatology and Nutrition, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (L.E.V.); (S.C.J.N.)
| | - Cora F. Jonkers-Schuitema
- Amsterdam UMC, Department of Pediatric Gastroenterology, University of Amsterdam, Emma Children’s Hospital, Hepatology and Nutrition, 1105 AZ Amsterdam, The Netherlands
| | - Edmond H. H. M. Rings
- Erasmus Medical Center, Department of Pediatric Gastroenterology, Erasmus University Rotterdam, Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Department of Pediatric Gastroenterology, Leiden University Medical Center, University of Leiden, Willem Alexander Children’s Hospital, 2300 RC Leiden, The Netherlands
| | - Merit M. Tabbers
- Amsterdam UMC, Department of Pediatric Gastroenterology, University of Amsterdam, Emma Children’s Hospital, Hepatology and Nutrition, 1105 AZ Amsterdam, The Netherlands
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Browne PD, Nagelkerke SCJ, van Etten-Jamaludin FS, Benninga MA, Tabbers MM. Pharmacological treatments for functional nausea and functional dyspepsia in children: a systematic review. Expert Rev Clin Pharmacol 2018; 11:1195-1208. [PMID: 30360666 DOI: 10.1080/17512433.2018.1540298] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/22/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Chronic idiopathic nausea (CIN) and functional dyspepsia (FD) cause considerable strain on many children's lives and their families. Areas covered: This study aims to systematically assess the evidence on efficacy and safety of pharmacological treatments for CIN or FD in children. CENTRAL, EMBASE, and Medline were searched for Randomized Controlled Trials (RCTs) investigating pharmacological treatments of CIN and FD in children (4-18 years). Cochrane risk of bias tool was used to assess methodological quality of the included articles. Expert commentary: Three RCTs (256 children with FD, 2-16 years) were included. No studies were found for CIN. All studies showed considerable risk of bias, therefore results should be interpreted with caution. Compared with baseline, successful relief of dyspeptic symptoms was found for omeprazole (53.8%), famotidine (44.4%), ranitidine (43.2%) and cimetidine (21.6%) (p = 0.024). Compared with placebo, famotidine showed benefit in global symptom improvement (OR 11.0; 95% CI 1.6-75.5; p = 0.02). Compared with baseline, mosapride versus pantoprazole reduced global symptoms (p = 0.011; p = 0.009). One study reported no occurrence of adverse events. This systematic review found no evidence to support the use of pharmacological drugs to treat CIN or FD in children. More high-quality clinical trials are needed. ABBREVIATIONS AP-FGID: Abdominal Pain Related Functional Gastrointestinal Disorders; BART: Biofeedback-Assisted Relaxation Training; CIN: Chronic Idiopathic Nausea; COS: Core Outcomes Sets; EPS: Epigastric Pain Syndrome; ESPGHAN: European Society for Pediatric Gastroenterology Hepatology and Nutrition; FAP: Functional Abdominal Pain; FD: Functional Dyspepsia; GERD: Gastroesophageal Reflux Disease; GES: Gastric Electrical Stimulation; H2RAs: H2 Receptor Antagonists; IBS: irritable bowel syndrome; NASPGHAN: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; PDS: Postprandial Distress Syndrome; PPIs: Proton Pump Inhibitor; PROMs: Patient Reported Outcome Measures; RCTs: Randomized Controlled Trials; SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants.
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Affiliation(s)
- Pamela D Browne
- a Emma Children's Hospital, Amsterdam UMC , University of Amsterdam, Pediatric Gastroenterology , Amsterdam , The Netherlands
| | - Sjoerd C J Nagelkerke
- a Emma Children's Hospital, Amsterdam UMC , University of Amsterdam, Pediatric Gastroenterology , Amsterdam , The Netherlands
| | | | - Marc A Benninga
- a Emma Children's Hospital, Amsterdam UMC , University of Amsterdam, Pediatric Gastroenterology , Amsterdam , The Netherlands
| | - Merit M Tabbers
- a Emma Children's Hospital, Amsterdam UMC , University of Amsterdam, Pediatric Gastroenterology , Amsterdam , The Netherlands
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