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Academic Journal

How useful are the biochemical tests in guiding the diagnostic workup of infantile cholestasis? Background: The objective of our study was to determine whether biochemical tests, frequently requested at first presentation of infants with cholestasis, have a role in focusing investigations toward certain disease entities. Methods: All infants with cholestasis (2008 to 2020) were identified and reviewed for final diagnosis and serum levels of alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), lactate, cholesterol, ferritin, alpha-fetoprotein (AFP), total bile acids (TBAs), and hypoglycemia at first presentation. Results: ALT levels were normal in all infants with Dubin–Johnson syndrome. A normal TBA (0–10 μmol/L) in an infant with normal-GGT cholestasis was consistent with bile acids synthesis disorders (BASDs). There was a dichotomy pattern of "high-GGT cholestasis" [associated with biliary obstruction, Alagille syndrome, ciliopathies, mitochondrial hepatopathies] and "low GGT cholestasis", [associated with mutations in ATP8B1 , ABCB11 , TJP2 , USP53 , LSR , MYO5B , VIP AS39 , NR1H4 , BASD, galactosemia, gestational alloimmune liver disease (GALD), and endocrine causes]. Plasma lactate level was significantly elevated in infants with mitochondrial hepatopathies and hemophagocytic lymphohistiocytosis (HLH) [median 5.8 mmol/L and 7.7 mmo/L, respectively; P < 0.001]. The highest ferritin concentrations were in infants with HLH and GALD [medians 4883 μg/L and 2098 μg/L, respectively; P < 0.001]. The most marked elevation of AFP was consistent in all infants with mitochondrial hepatopathies, tyrosinemia, and GALD (median: 99637 ng/mL, 40000 ng/mL; 22566 ng/mL) as compared to causes of biliary obstruction (median: 3662 ng/mL). Hypoglycemia with preserved liver synthetic function was associated with metabolic or endocrine disorders. Conclusion: Although none of these biochemical tests is diagnostic in itself, they can be actionable

Subjects: *Predictive tests; *Ferritin; *Alpha fetoproteinsSaudi Arabia

  • Source: Saudi Journal of Gastroenterology. Nov/Dec2025, Vol. 31 Issue 6, p373-382. 10p.

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Academic Journal

Eating behaviors in childhood eosinophilic esophagitis: A retrospective case-controlled study Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease in the esophagus. It is associated with feeding difficulties. We aimed to assess eating behaviors in patients with EoE and compare them with controls. Methods: This case-controled study enrolled children aged 0–16 years where their eating/behavior scores were measured. Child Behavior Frequency Scores (CBFS) >61, Parents Feeling/strategies Frequency Score (PFSFS) >20 and the Total Behavioral Pediatric Feeding Assessment Scores (BPFAS) >84 were considered as abnormal results. Results: The study involved 80 children with 40 in the EoE group and 40 in the control group. The mean age of EoE diagnosis was 6.4 ± 4.0 years, while the mean age of the control group was 8.4 ± 4.0 years. Fifty four of the 80 patients (67.5%) were male. There was a significant difference between the EoE patients and the controls regarding child feeding difficulties. The mean scores were as follows: problems chewing food, 2.4 ± 1.6 in EoE vs. 1.3 ± 0.7 in controls, P < 0.001; drinking more than eating, 2.6 ± 1.7 in EoE vs. 1.6 ± 1.2 in controls, P = 0.002; taking longer than 20 min to finish a meal, 3.3 ± 2.0 in EoE vs. 2.2 ± 1.5 in controls, P = 0.008; and parents get frustrated or anxious when feeding the child, 2.8 ± 1.7 in EoE vs. 1.3 ± 0.8 in controls, P < 0.001. Our results confirmed that the mean frequency score for parent feelings and strategies was significantly higher in the EoE group compared to controls (24.2 ± 7.4 vs. 18.9 ± 7.6); 95% confidence interval (CI), 2.0–8.7, P = 0.002. Additionally, the mean frequency score for Child behavior was 60.3 ± 16.9 in EoE vs. 43.5 ± 12.7 in controls; 95% CI, 10.2–23.4, P < 0.001. Furthermore, the total BPFA frequency mean score was 84.5 ± 22.7 in EoE vs. 62.3 ± 19.3

Subjects: *Age of onset; *T-test (Statistics); *Fisher exact testSaudi Arabia

  • Source: Saudi Journal of Gastroenterology. Nov/Dec2025, Vol. 31 Issue 6, p367-372. 6p.

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