Background: Pediatric Short bowel syndrome (SBS) is the leading cause of intestinal failure and is characterized by persistent dysbiosis that negatively impacts intestinal adaptation and growth. Although microbiota modulation via pre-, pro-, and synbiotics represents a promising strategy, current evidence remains fragmented. This narrative review aims to critically assess the efficacy and safety of such interventions in the management of pediatric SBS. Methods: A structured literature search was conducted on PubMed up to November 2025. Fourteen relevant studies were included, comprising clinical trials, preclinical animal models, and significant case reports regarding the use of biotics in SBS. Results: The analysis reveals a microbiological dichotomy based on nutritional status: parenteral nutrition (PN)-dependent patients exhibit an excess of Proteobacteria associated with infectious risk, whereas weaned patients present a metabolic risk of D-lactic acidosis due to carbohydrate fermentation. Regarding efficacy, long-term synbiotic treatments (>12 months) demonstrated significant improvements in growth and nutritional status, likely mediated by increased production of short-chain fatty acids (SCFAs) and mucosal adaptation, unlike short-term probiotic cycles. However, serious adverse events (Lactobacillus sepsis and D-lactic acidosis) were reported, predominantly in patients with central venous catheters or malabsorption. Conclusions: Biotics offer therapeutic potential for intestinal failure, but their use cannot be empirical. The safety profile should be carefully selected, especially in central venous catheter (CVC) carriers. Future strategies must evolve towards precision medicine, prioritizing non-D-lactate-producing strains and personalized protocols based on the patient’s nutritional phase.

Celiac disease (CeD) is a common immune-mediated condition that occurs in genetically predisposed individuals. In this study, we examined the trajectory of tissue transglutaminase IgA (tTG-IgA) antibodies in a prospective longitudinal cohort of over 500 children at risk of developing CeD due to having a first-degree relative with CeD. We identified 34 subjects from our cohort and examined tTG-IgA titers at seroconversion and 6 months before tTG-IgA seroconversion. We found that all subjects had normal tTG-IgA 6 months before seroconversion. Thus, we conclude that tTG-IgA elevation in subjects with CeD is a sudden event and its trajectory cannot be used as a marker to predict seroconversion in this population.

Background: Growth impairment is a major component of pediatric inflammatory bowel disease (IBD), yet the prognostic role of baseline nutritional status remains debated. We assessed the impact of nutritional status at diagnosis on subsequent medical and surgical disease course. Methods: We retrospectively studied 183 children with IBD (84 Crohn’s disease, 99 ulcerative colitis) followed for at least 18 months. Patients were classified at diagnosis using BMI Z-scores as underweight (n = 35), normal weight (n = 123), or overweight/obese (n = 25). Multivariable regression models—adjusted for diagnosis, biological sex, age at diagnosis, and extraintestinal manifestations/comorbidities—evaluated relapse burden, surgical resection, and longitudinal anthropometric recovery at last follow-up. Results: Baseline underweight status was not independently associated with a higher relapse burden or time to first relapse. A sensitivity analysis excluding surgically resected patients showed higher estimated relapse rates for underweight patients, though these did not reach statistical significance. In exploratory analyses, baseline underweight showed a borderline, non-significant association with subsequent surgical resection (adjusted OR 2.68, 95% CI 0.97–7.27; p = 0.056), warranting validation in larger prospective cohorts. Exploratory VEO-IBD analyses were limited by small subgroup size; within UC, a higher crude resection frequency was observed in VEO-UC than in older-onset UC (15.0% vs. 1.3%), but this finding should be interpreted cautiously. At follow-up, 85.7% of initially underweight patients reached normal weight. Higher baseline BMI Z-score was independently associated with higher follow-up BMI Z-score, whereas therapeutic escalation and total relapse burden were not independently associated with follow-up BMI Z-score. Persistent stunting was very rare (1.9%), precluding multivariable analysis. Conclusions: Baseline underweight showed a suggestive but non-significant association with subsequent surgical resection, warranting confirmation in larger prospective cohorts, while it was not independently associated with medical disease instability. Substantial weight recovery occurred during pediatric IBD follow-up. Baseline BMI Z-score was associated with BMI Z-score at follow-up, although substantial between-patient variability remained unexplained.