Food protein induced gastrointestinal allergies are difficult to characterise due to the delayed nature of this allergy and absence of simple diagnostic tests. Diagnosis is based on an allergy focused history which can be challenging and often yields ambiguous results. We therefore set out to describe a group of children with this delayed type allergy, to provide an overview on typical profile, symptoms and management strategies. This retrospective analysis was performed at Great Ormond Street Children’s Hospital. Medical notes were included from 2002 – 2009 where a documented medical diagnosis of food protein induced gastrointestinal allergies was confirmed by an elimination diet with resolution of symptoms, followed by reintroduction with reoccurrence of symptoms. Age of onset of symptoms, diagnosis, current elimination diets and food elimination at time of diagnosis and co-morbidities were collected and parents were phoned again at the time of data collection to ascertain current allergy status. Data from 437 children were analysis. The majority (67.7%) of children had an atopic family history and 41.5% had atopic dermatitis at an early age. The most common diagnosis included, non-IgE mediated gastrointestinal food allergy (n = 189) and allergic enterocolitis (n = 154) with symptoms of: vomiting (57.8%), back-arching and screaming (50%), constipation (44.6%), diarrhoea (81%), abdominal pain (89.9%), abdominal bloating (73.9%) and rectal bleeding (38.5%). The majority of patients were initially managed with a milk, soy, egg and wheat free diet (41.7%). At a median age of 8 years, 24.7% of children still required to eliminate some of the food allergens. This large retrospective study on children with food induced gastrointestinal allergies highlights the variety of symptoms and treatment modalities used in these children. However, further prospective studies are required in this area of food allergy.

Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options.

Congenital diarrhoeas and enteropathies (CODE) are a heterogeneous group of disorders. Many affected infants present with catastrophic dehydration in the first few days of life, although the clinical phenotype is variable. Advances in the understanding of underlying pathomechanisms and genetic testing, as well as improved management, in particular intravenous nutrition support, have allowed affected patients to survive well beyond childhood. Awareness and understanding of these rare diseases are hence needed, both amongst paediatricians and adult physicians. In this review, we discuss the different groups of disorders based on a review of the current literature and provide a diagnostic and therapeutic approach. Many of the subtypes of CODE result in the need for prolonged or indefinite parenteral nutrition. Further research is needed to identify new CODE to improve the recognition and management of these children, which can assist in developing new targeted therapies and potentially a long-term cure.

Background/Objectives: Paediatric intestinal pseudo-obstruction (PIPO) is a disorder of gut motility in childhood, frequently leading to intestinal failure (IF). Consensus on optimum nutrition management (oral, enteral, intravenous feeding exclusively or in combination) is lacking. Our aim was to investigate the current approach to the nutrition support of children (<18 years) with PIPO managed in Gastroenterology centres in the United Kingdom (UK) and long-term mode of feeding. Methods: An electronic questionnaire was sent to the members of the British Society of paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN). The data collected (October–November 2023) included patient demographics, disease phenotype, age at symptom onset and mode/type of feeding. Results: A total of 36 patients fulfilled criteria for PIPO; 22/36 (61.1%) patients were female, and 25/36 (69.4%) were white British. A total of 15/36 (41.6%) became symptomatic during the neonatal period and 23/36 (63.8%) within the first year of life. A total of 5/36 (13.9%) was eating a normal solid diet: 2/36 (5.5%) of these never required artificial feeding, 2/36 (5.5%) were started on a normal diet after short-term parenteral nutrition (PN) in the first year of life, and 1/36 (2.8%) re-established oral eating after 10 years of total PN following small bowel transplantation. A total of 31/36 (86.1%) required permanent artificial feeding (enteral and/or parenteral) after an average time of symptoms of 14 months. A total of 2/36 (5.5%) was exclusively on enteral nutrition (EN), and 4/36 (11.1%) was on total PN. A total of 25/36 (69.4%) received a combination of PN and oral diet (normal, or bite and dissolve, or normal but minimal intake) and/or EN. Conclusions: The results show that how and with what children with PIPO are fed in the UK varies widely. Larger studies are needed to make evidence-based recommendations on the best nutrition approach.