A decade of research on gluten-related disorders (GRDs) is reviewed in this study, with a particular emphasis on celiac disease (CD) and non-celiac gluten sensitivity (NCGS). GRDs are triggered by the ingestion of gluten and gluten-like proteins found in wheat, barley, and rye. These proteins lead to intestinal damage in celiac disease, an autoimmune condition characterized by villous atrophy and a variety of gastrointestinal and extraintestinal symptoms. More enigmatic and less understood, NCGS involves symptoms similar to CD but without the immunological reaction or intestinal damage. Recent years have seen advances in the understanding of GRDs, particularly in connection to how intestinal microbiota influences disease progression and patient outcomes. The gluten-free diet (GFD) is still the standard therapy recommended for GRDs despite significant challenges, as discussed in this article. Precise diagnostic methods, patient education and dietary counseling are critical for improving patients’ quality of life. The purpose of this review is to provide a more clear and up-to-date understanding of GRDs, and to help further research on this important topic.

Background/Objectives: Researchers have proposed two novel impedance-pH parameters, mean nocturnal baseline impedance (MNBI) and the post-reflux swallow-induced peristaltic wave (PSPW) index, to enhance the diagnosis of gastroesophageal reflux disease (GERD) and enable better predictions of the effectiveness of anti-reflux therapies. This systematic review aims to synthesize the available evidence on the utility of the PSPW index and MNBI as diagnostic tools for pediatric GERD. Methods: A systematic search of studies reporting PSPW index and MNBI values in patients with GERD was performed in PubMed, Embase, Clarivate, Scopus, Cochrane and Google Scholar databases from their beginning until April 2024. The following terms were used: GERD, children, pediatric, PSPW and MNBI. Results: Eight studies were included, describing 479 patients ranging from 2 months to 17 years old over an 8-year period in 12 pediatric centers. Four studies demonstrated that children with pathological acid exposure have a significantly lower MNBI, with a good discriminatory ability to diagnose GERD. The PSPW index showed lower values in patients with reflux hypersensitivity (RH) compared to those with functional heartburn (FH). Conclusions: Patients with pathological acid exposure tend to exhibit lower MNBI and PSPW index values compared to those with normal acid exposure. MNBI and the PSPW index show promise as diagnostic tools in distinguishing between different GERD phenotypes. Further research is needed to establish standardized diagnostic criteria and optimize the clinical applicability in GERD diagnosis and management.

(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5–18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients.

(1) Background: Multichannel intraluminal impedance–pH (MII-pH) monitoring is commonly used to diagnose gastroesophageal reflux disease (GERD). The mean nocturnal baseline impedance (MNBI) is an important parameter, reflecting the esophageal mucosal integrity and improvement in GERD. This study aims to evaluate the correlation between conventionally measured MNBI and a recently described simple MNBI measurement method in diagnosing pediatric GERD. (2) Methods: This prospective observational study enrolled 64 children aged one month to 18 years who underwent 24 h MII-pH monitoring. Conventional MNBI was measured during stable 10 min intervals at night, while the simple MNBI method averaged impedance throughout the nocturnal supine period. (3) Results: Strong correlations were found between conventional and simple MNBI values across all impedance channels in both infants (r > 0.85) and older children (r > 0.9). Conventional and simple MNBIs in the most distal channel (Z6) effectively differentiated non-erosive reflux disease (NERD) from other phenotypes, with AUCs of 0.864 and 0.860, respectively. The simple MNBI demonstrated good diagnostic performance with similar sensitivity and specificity to the conventional MNBI. (4) Conclusions: Including MNBI measurements into routine MII-pH monitoring may enhance GERD diagnosis and reduce the need for more invasive procedures.

Background and Objectives: Psychomotor developmental delay is a frequent comorbidity in children with congenital heart defects (CHD), especially after surgical correction of the CHD and exposure to risk factors such as anesthesia, cardiopulmonary bypass and postoperative complications. Yet psychomotor delay is present in these patients before surgical correction but is under-recognized. Evidence focusing solely on unrepaired CHD remains limited. Materials and Methods: This prospective cross-sectional study evaluated 153 and included 77 children under 6 years of age with unrepaired CHD, stratified into cyanotic (n = 31) and non-cyanotic (n = 46) CHD, admitted to a pediatric cardiology department over a period of 5 years. Psychomotor development was assessed using the Denver Developmental Screening Test II (DDST-II), standardized for pediatric population. Associations with clinical, perinatal, and demographic factors were analyzed using univariate and multivariate methods. Results: Developmental delay was identified in 97% of cyanotic and 54% of non-cyanotic patients. Compared to healthy norms, CHD patients had significantly lower global developmental scores (p = 0.03). Gross motor and personal-social domains were most frequently affected. Prenatal CHD diagnosis correlated with better global developmental scores (p = 0.012), and breastfeeding was associated with improved outcomes compared with formula or mixed feeding (p = 0.008). Conclusions: Infants and young children with CHD are at increased risk of early psychomotor developmental delay, particularly in the gross motor and personal–social domains, even before exposure to surgical or intensive care damaging factors. Systematic psychomotor surveillance, integration of protective factors such as prenatal diagnosis and breastfeeding, and timely access to multidisciplinary interventions are essential to optimize long-term outcomes in this vulnerable population.

Irritable bowel syndrome (IBS) and mental health disorders represent common and significant health concerns in pediatric populations. Objectives: This study aimed to evaluate psychological and social risk factors associated with IBS in children and to identify correlations with their gastrointestinal symptoms. Materials and Methods: Children aged 4 to 18 years diagnosed with IBS according to Rome IV criteria were eligible for inclusion. Both patients and parents completed a comprehensive questionnaire detailing gastrointestinal symptom characteristics. Additionally, all children underwent psychological assessment. Results: The study included 24 children with IBS, with a mean age of 12.7 ± 3.4 years. Anxiety was present in 54.2% of cases, and depression in 12.5%. Comparing children with IBS and anxiety to those without these, no statistically significant differences emerged regarding the duration and frequency of abdominal pain; however, abdominal pain intensity was significantly higher in children without anxiety (p = 0.04). The duration of IBS symptoms did not significantly differ in children with or without anxiety (p = 0.21). Impaired emotional self-regulation was identified in 54.2% of participants, and 41.6% exhibited vegetative symptoms in response to stress. Furthermore, 70.8% of parents and/or children reported experiencing a negative family event. Conclusions: The findings suggest that psychological characteristics and adverse family events are important risk factors associated with pediatric IBS. These factors should be systematically considered as integral components of clinical assessment and management.