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UEG Standards and Guidelines

Position Paper

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Summary

Fecal microbiota transplantation (FMT) is becoming part of the treatment algorithms against recurrent Clostridium difficile infection (rCDI) both in adult and pediatric gastroenterology practice. With our increasing recognition of the critical role the microbiome plays in human health and disease, FMT is also being considered as a potential therapy for other disorders, including inflammatory bowel disease (Crohn disease, ulcerative colitis), graft versus host disease, neuropsychiatric diseases, and metabolic syndrome. Controlled trials with FMT for rCDI have not been performed in children, and numerous clinical and regulatory considerations have to be considered when using this untraditional therapy. This report is intended to provide guidance for FMT in the treatment of rCDI in pediatric patients.

Keywords: child; Clostridium difficile; fecal; fecal transplantation; microbiome; microbiota; pediatric

Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection and Other Conditions in Children

Zev Davidovics, Sonia Michail, Maribeth Nicholson, Larry Kociolek, Nikhil Pai, Richard Hansen, Tobias Schwerd, Aldo Maspons, Raanan Shamir, Hania Szajewska, Nikhil Thapar, Tim G. de Meij, Alexis Mosca, Yvan Vandenplas, Stacy Kahn, Richard Kellermayer

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Gut Microbiota Immunology Paediatrics

Citation

JPGN 2019;68: 130–143

Published

2019

UEG Podcast Episode

Journal Podcast

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Risk factors, epidemiology and prognosis of cholangiocarcinoma

Iago Rodríguez-Lago 1, Nina Barner-Rasmussen 2

1 Hospital Universitario de Galdakao, Bilbao, Spain

2 Helsinki University Hospital, Finland

Topics

Hepatobiliary

Published

2022

UEG Podcast Episode

Journal Podcast

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Episode 4: UEG Journal August Spotlight

Mohsan Subhani, Maria Manuela Estevinho, Umair Kamran, Nigel Trudgill

Published

2025

UEG Podcast Episode

Journal Podcast

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UEGJ Best Paper Award: Work productivity in DGBIs

Åsa Frändemark, Ahsen Ustaoglu, Haluk Tarik Kani

Published

2024

UEG Mistakes In Articles

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Diarrhoea, acute or chronic, is a common gastrointestinal symptom in healthcare. In most cases, acute diarrhoea in healthy individuals requires limited diagnostic and therapeutic efforts, except for the replacement of fluid electrolytes, and stool culture in severe occurrences. Acute diarrhoea is often self-limiting due to short-lived reactions to food intake and bacterial or viral infections. However, diarrhoea can persist and fulfil definitions of chronicity when a month or more has passed since the onset. Here we discuss some basic mistakes that should be avoided when managing unexplained non-bloody diarrhoea that persists beyond the acute setting. In this context, the term 'unexplained' refers to a patient without apparent alarm features and where initial consultations have failed at making a diagnosis. We used an evidence-based approach and included aspects predominantly based on clinical experience when appropriate.

Mistakes in the management of unexplained diarrhoea and how to avoid them

Magnus Simrén, Hans Törnblom

Topics

Neurogastroenterology & Motility

Citation

Törnblom H and Simrén M. Mistakes in the management of unexplained diarrhoea and how to avoid them. UEG Education 2022; 22: 16–19.

Published

2022

UEG Mistakes In Articles

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Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

Topics

Primary Care

Published

2025

UEG Standards and Guidelines

Position Paper

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Abstract

Objectives

Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety.

Methods

Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).

A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors.

Results

A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2-lactose breath testing, H2-fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro-caecal transit time (OCTT) or to diagnose and follow-up on celiac disease.

Conclusions

Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.

An ESPGHAN Position Paper on the Use of Breath Testing in Paediatric Gastroenterology

Ilse Broekaert

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Paediatrics

Citation

Journal of Pediatric Gastroenterology and Nutrition, 74: 123-137

Published

2021

UEG Week 2025: Relive the Highlights

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