Significant advances have been made in the care of children with inflammatory bowel disease (IBD). We aimed to describe the trends during the last 3 decades in the clinical presentation, management, and outcome of pediatric IBD at a single center. Medical records of children with IBD referred to a pediatric gastroenterology unit from January 1981 to December 2011 were reviewed retrospectively. A total of 483 children were diagnosed with IBD, with mean age at diagnosis of 9.6 years (range 6 months – 18 years). Ulcerative colitis (UC) was diagnosed in 267 (55.2%), Crohn’s disease (CD) in 167 (34.5%), and IBD unclassified (IBDU) in 49 (10.1%). Children with UC and IBDU were younger than those with CD [mean age at diagnosis 9.2, 8.9, and 10.5 years respectively; P (UC vs. CD)<0.01 and P (IBDU vs. CD)=0.028]. Patients received 5-ASA (96.6%), steroids (77.0%), thiopurines (50.2%), biological agents (14%), and 10% underwent surgical intervention. The cohort was divided into three subgroups according to the date of diagnosis; Group A: 1981-1989, Group B: 1990-1999, and Group C: 2000-2011. During the last two decades a significant increase in CD (Group A 18.5%, Group B 23.8%, Group C 48.8%; P<0.01) compared with the first decade with parallel decrease in UC (Group A 79.6%, Group B 71.9%, Group C 33.2%; P<0.001) was observed. Most children received 5-ASA, steroids, and immunomodulators. Patients with UC and IBDU were younger than those with CD. A significant increase in CD with parallel decrease in UC during the last decade was found.

Background and Clinical significance: Cowden syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in the PTEN tumor suppressor gene. It is characterized by multiple hamartomas and an increased lifetime risk of malignancies affecting the breast, thyroid, endometrium, and gastrointestinal (GI) tract. Pediatric presentations may include macrocephaly, scrotal tongue, and intellectual disability. Gastrointestinal involvement is frequent, with juvenile-like hamartomatous polyps occurring in at least half of patients and distributed throughout the GI tract, posing a risk for malignant transformation. Early diagnosis and surveillance are crucial for improving patient outcomes. Case Presentation: We report a case of a 10-year-old Caucasian female with Cowden syndrome, with a history of a malignant germ cell tumor of the ovary consisting of a yolk sac tumor and low-grade immature teratoma diagnosed at age six, and thyroidectomy at age nine. The patient has mild intellectual disability. Routine radiological surveillance revealed a right colon intraluminal mass, prompting referral for pediatric gastroenterology evaluation. Endoscopy identified multiple polyps throughout the colon, stomach, and small intestine. Polypectomy of larger lesions was performed, and histopathology confirmed juvenile-like hamartomatous polyps without dysplasia or malignancy. This case highlights the necessity of comprehensive gastrointestinal evaluation in pediatric Cowden syndrome patients. Endoscopic surveillance is essential for early detection and management of polyps. Conclusions: Given the multisystem involvement and elevated cancer risk associated with PTEN mutations, a multidisciplinary approach that includes genetic counseling, dermatologic evaluation, and ongoing oncologic monitoring is recommended. Increased awareness of gastrointestinal manifestations enables timely intervention and may reduce morbidity and mortality in this high-risk population.

Background and Clinical Significanc: Congenital duodenal diaphragm (CDD) is a rare congenital condition causing partial or complete obstruction of the duodenum, most frequently located in the second part of the duodenum. It is a rare but important cause of intestinal obstruction in infants and young children. Clinically, it often presents with persistent vomiting and failure to thrive. Diagnosis can be made through abdominal X-ray showing the characteristic “double bubble” sign, upper gastrointestinal (GI) series, or gastroscopy. Case Presentation: A 17-month-old female infant with known psychomotor retardation was admitted for evaluation of inadequate weight gain and intermittent postprandial vomiting, both present since birth. Laboratory investigations, including metabolic and electrolyte panels, were within normal limits. Given the persistent clinical symptoms, an upper gastrointestinal series was performed to assess for possible anatomical abnormalities. Imaging revealed a significant delay in the passage of contrast into the second portion of the duodenum, with marked prestenotic dilatation. Subsequent gastroscopy identified a duodenal diaphragm nearly occluding the duodenal lumen at the same site, impeding the passage of the endoscope. Associated findings included gastritis and the presence of food debris in the stomach and proximal duodenum, indicating impaired gastric emptying. The patient underwent successful surgical management via duodenotomy with resection of the septum. Postoperative recovery was uneventful. Conclusions: In infants or young children with persistent postprandial vomiting and inadequate weight gain, anatomical causes such as duodenal diaphragm/web should be considered in the differential diagnosis. Once identified, treatment should be initiated promptly, either endoscopically or surgically, depending on the severity and anatomical characteristics of the obstruction.

Background and Clinical Significance: Turner syndrome is associated with an increased prevalence of autoimmune disorders, particularly celiac disease, and is also associated with impaired bone health. The coexistence of Turner syndrome, celiac disease, and ulcerative colitis is rare and represents a challenging clinical scenario requiring multidisciplinary management; Case Presentation: We report the case of a 7-year-old girl referred for short stature who was diagnosed with celiac disease based on positive serology and duodenal histology (Marsh 3a/3c). Cytogenetic analysis revealed 46,X,i(X)(q10) Turner syndrome. Despite strict adherence to a gluten-free diet, persistent growth impairment led to initiation of recombinant human growth hormone therapy. At 14 years of age, she developed bloody diarrhea, weight loss, iron-deficiency anemia, and elevated inflammatory markers. Colonoscopy and histology confirmed extensive ulcerative colitis. During follow-up, dual-energy X-ray absorptiometry demonstrated reduced bone mineral density (lumbar spine Z-score −2.7; whole-body Z-score −2.5). At 16 years of age, treatment with azathioprine and 5-aminosalicylic acid was complicated by pancreatitis, with recurrence of pancreatic enzyme elevation following sequential drug reintroduction, leading to discontinuation of both agents. Infliximab therapy was subsequently initiated, resulting in sustained clinical, endoscopic, and near-complete histological remission. The patient was later transitioned to adult multidisciplinary care; Conclusions: The coexistence of Turner syndrome, celiac disease, ulcerative colitis, and low bone mineral density is an exceptionally rare combination of genetic susceptibility, autoimmunity, and chronic inflammation. This case highlights the importance of lifelong multidisciplinary surveillance in patients with Turner syndrome, including monitoring for additional autoimmune disorders, growth impairment, and skeletal complications.

Background and Clinical Significance: Collagenous gastritis (CG) is a rare disorder characterized by subepithelial collagen deposition, typically presenting in children with iron deficiency anemia (IDA) and abdominal pain. Its pathogenesis remains unclear, and no standardized treatment exists. Case Presentation: A female patient developed IDA at 4.5 years of age, requiring repeated intravenous iron infusions, and recurrent epigastric pain. CG was diagnosed at 13.5 years, with marked gastric eosinophilia (peak 685 eosinophils/mm²) and subepithelial collagen thickening (103.6 μm). Extensive evaluation excluded alternative causes. Proton pump inhibitor (PPI) therapy failed to meaningfully improve symptoms, endoscopic findings, or histology. A 10-week course of oral systemic corticosteroids resolved abdominal pain and normalized hemoglobin and ferritin levels, but endoscopic abnormalities persisted, histologic improvement was limited, and pain recurred after withdrawal. Dupilumab was initiated as a steroid-sparing, histology-targeted therapy. Over 15 months, the patient remained asymptomatic, hemoglobin and ferritin levels remained normal without intravenous iron or routine oral iron supplementation, and endoscopic abnormalities improved although residual histologic abnormalities persisted. Dupilumab achieved a decrease in gastric eosinophil counts and subepithelial collagen thickness by 41% and 33%, respectively; steroids achieved decreases of 17% and 13%, respectively, and PPIs achieved decreases of 23% and 0.6%, respectively. Conclusions: Dupilumab was associated with sustained clinical and hematologic remission together with gradual endoscopic and histologic improvement in pediatric CG with prominent eosinophilic inflammation. To our knowledge, this is the first reported pediatric case of CG treated with dupilumab. These findings suggest that dupilumab may represent a promising steroid-sparing therapeutic option and support further evaluation in larger case series and controlled studies.

Background and Clinical Significance: Annular pancreas is a rare congenital anomaly in which pancreatic tissue partially or completely encircles the duodenum, potentially causing duodenal obstruction. Clinical presentation varies from asymptomatic cases to persistent vomiting, feeding intolerance, and failure to thrive, often leading to delayed diagnosis. Case Presentation: We report a 2-year and 10-month-old girl with a long-standing history of intermittent, recurrent vomiting since the neonatal period, without growth impairment or other alarming symptoms. Initial imaging suggested proximal duodenal dilation, with suspicion for superior mesenteric artery (SMA) syndrome. Endoscopy revealed mechanical obstruction at the second portion of the duodenum. Contrast-enhanced CT confirmed annular pancreas partially encircling the duodenum. The patient underwent duodeno-duodenostomy with an uneventful postoperative course and complete resolution of symptoms. This case illustrates the diagnostic challenges of annular pancreas in older children with atypical presentations. Multimodal imaging is crucial for accurate diagnosis. Surgical bypass remains the definitive treatment, offering excellent long-term outcomes. Conclusions: Persistent or recurrent vomiting in children, even without classic signs such as bilious vomiting or failure to thrive, should prompt consideration of annular pancreas. Early recognition and timely surgical intervention can prevent prolonged morbidity and ensure normal growth and development.