Updates on bone health in children with gastrointestinal diseases

Hye Ran Yang 대한소아내분비학회 2020 Annals of Pediatirc Endocrinology & Metabolism Vol.25 No.1

Chronic gastrointestinal diseases such as inflammatory bowel disease, malabsorption syndromes (e.g., intestinal lymphangiectasia, celiac disease, congenital chloride diarrhea, cystic fibrosis), and postsubtotal gastrectomy state or short-bowel syndrome after extensive bowel resection are related to poor bone health in pediatric patients due to increased risks of low bone mineral density, osteoporosis, and fractures. The pathophysiology of abnormal bone health in pediatric gastrointestinal diseases may present from inflammation to malabsorption. In children with chronic gastrointestinal diseases at high risk of poor bone health, routine evaluation using dual-energy X-ray absorptiometry and appropriate prevention or treatment strategies are needed.

Role of Tumor Necrosis Factor-${\alpha}$ Promoter Polymorphism and Insulin Resistance in the Development of Non-alcoholic Fatty Liver Disease in Obese Children

Yang, Hye-Ran,Ko, Jae-Sung,Seo, Jeong-Kee The Korean Society of Pediatric Gastroenterology 2012 Pediatric gastroenterology, hepatology & nutrition Vol.15 No.1

Purpose: Tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) polymorphism has been suggested to play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) in obese adults, and known to be a mediator of insulin resistance. In this study, we evaluated the role of TNF-${\alpha}$ promoter polymorphisms and insulin resistance in the development of NAFLD in obese children. Methods: A total of 111 obese children (M:F=74:37; mean age, $11.1{\pm}2.0$ yrs) were included. The children were divided into 3 groups: controls (group I, n=61), children with simple steatosis (group II, n=17), and children with non-alcoholic steatohepatitis (group III, n=33). Serum TNF-${\alpha}$ levels, homeostasis model assessment of insulin resistance (HOMA-IR), and TNF-${\alpha}$ -308 and -238 polymorphisms were evaluated. Results: There were no differences in TNF-${\alpha}$ polymorphism at the -308 or the -238 loci between group I and group II + III ($p$=0.134 and $p$=0.133). The medians of HOMA-IR were significantly different between group I and group II + III ($p$=0.001), with significant difference between group II and group III ($p$=0.007). No difference was observed in the HOMA-IR among the genotypes at the -308 locus ($p$=0.061) or the -238 locus ($p$=0.207) in obese children. Conclusion: TNF-${\alpha}$ promoter polymorphisms at the -308 and -238 loci were not significantly associated with the development of NAFLD in children; nevertheless, insulin resistance remains a likely essential factor in the pathogenesis of NAFLD in obese children, especially in the progression to NASH.

Updates on the Diagnosis of Helicobacter pylori Infection in Children: What Are the Differences between Adults and Children?

Yang, Hye Ran The Korean Society of Pediatric Gastroenterology 2016 Pediatric gastroenterology, hepatology & nutrition Vol.19 No.2

Helicobacter pylori infection is acquired mainly during childhood and causes various diseases such as gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphoma, and iron deficiency anemia. Although H. pylori infection in children differs from adults in many ways, this is often overlooked in clinical practice. Unlike adults, nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. Histopathological findings of gastric tissues are also different in children due to predominance of lymphocytes and plasma cells and the formation of gastric MALT. Although endoscopy is recommended for the initial diagnosis of H. pylori infection, several non-invasive diagnostic tests such as the urea breath test (UBT) and the H. pylori stool antigen test (HpSA) are available and well validated even in children. According to recent data, both the $^{13}C$-UBT and HpSA using enzyme-linked immunosorbent assay are reliable non-invasive tests to determine H. pylori status after eradication therapy, although children younger than 6 years are known to have high false positives. When invasive or noninvasive tests are applied to children to detect H. pylori infection, it should be noted that there are differences between children and adults in diagnosing H. pylori infection.

Updates on the Diagnosis of Helicobacter pylori Infection in Children: What Are the Differences between Adults and Children?

Hye Ran Yang 대한소아소화기영양학회 2016 Pediatric gastroenterology, hepatology & nutrition Vol.19 No.2

Helicobacter pylori infection is acquired mainly during childhood and causes various diseases such as gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphoma, and iron deficiency anemia. Although H. pyloriinfection in children differs from adults in many ways, this is often overlooked in clinical practice. Unlike adults, nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. Histopathological findings of gastric tissues are also different in children due to predominance of lymphocytes and plasma cells and the formation of gastric MALT. Although endoscopy is recommended for the initial diagnosis of H. pylori infection, several non-in-vasive diagnostic tests such as the urea breath test (UBT) and the H. pylori stool antigen test (HpSA) are available and well validated even in children. According to recent data, both the 13C-UBT and HpSA using enzyme-linked im-munosorbent assay are reliable non-invasive tests to determine H. pylori status after eradication therapy, although children younger than 6 years are known to have high false positives. When invasive or noninvasive tests are applied to children to detect H. pylori infection, it should be noted that there are differences between children and adults in diagnosing H. pylori infection.

Screening of Korean Medicinal Herbs for Hormonal Activities using Recombinant Yeast Assay and MCF-7 Human Breast Cancer Cells

Yang, Se-Ran,Hong, Hee-Do,Cho, Sung-Dae,Ahn, Nam-Shik,Jung, Ji-Won,Park, Joon-Suk,Jo, Eun-Hye,Hwang, Jae-Woong,Sun-bo,Park, Jung-Ran,Lee, Seong-Hun,Jung, Ji-Youn,Choi, Changsun,Kang, Kyung-Sun,Lee, Yo 한국식품위생안전성학회 2005 한국식품위생안전성학회지 Vol.20 No.1

약용식물내 에스트로겐성과 항-에스트로겐성을 조사하고 항암인자를 발견하기 위하여, 본연구는 에탄올추출로 제조된 9종류의 한국산 약용식물에 대하여 재조합효모와 MCF-7 사람유방암세포주를 이용하여 스크리닝하고 비교하였다. 재조합효모를 이용한 실험결과, 7종류의 약용식물에서 에스트로겐성이 나타났고, 4종류에서 안드로겐성이 나타났다. 또한 MCF-7 사람유방암세포주를 이용한 실험결과, 8종류의 추출물이 MCF-7 세포의 성장을 억제하는 것으로 확인되었으며 비스페놀 A와 동시 처치한 경우에도 유의적으로 억제하는 것으로 나타났다. 또한 Clyeyrrhiza uralensis, Cassia tora, Syringa velutina, Zingiber officinale, Malva verticillata, Panax ginseng C.A. Meyer는 식물성 에스트로겐으로서 에스트로겐에 양성인 사람유방암세포의 증식을 유의적으로 억제시티는 흥미로운 결과가 제시되었다. 따라서 이번 연구는 한국산 약용식물이 식물성 에스트로겐과 항암인자로서 이용될 수 있으며, 에스트로겐의 활성을 조사하는데 유용하게 이용될 수 있을 것으로 사료된다. To investigate whether there are estrogenic and anti-estrogenic activities in various medicinal herbs and discover prominent chemo-preventive agents, eye screened and compared the ethanol extracts of 9 plants through the recombinant yeast assay and MCF-7 human breast cancer cell assay. In recombinant yeast assay. seven medicinal herbs showed estrogenicity, and tour extracts showed androgenecity. In MCF-7 proliferation assay. the growth of MCF-7 cells was inhibited by eight extracts before and even alter co-treatment with bisphenol A. It is interesting that the extracts of Glyeyrrhiza uralensis, Cassia tora, Syringa velutina, Zingiber officinale, Malva verticillata, and Ponax ginseng C.A. Meyer exhibited inhibitory effects as phytoestrogens in estrogen-responsive human breast cancer cells. This study suggests that some Korean medicinal herbs might be considered as phytoestrooens and be useful to further analyze those plants which contain the estrogenic effect in order to identify the active principles.

Review : Recent Concepts on Cyclic Vomiting Syndrome in Children

( Hye Ran Yang ) 대한소화관운동학회 2010 Journal of Neurogastroenterology and Motility (JNM Vol.16 No.2

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder that can occur in both children and adults. Clinical courses of CVS manifesting recurrent severe vomiting episodes and interval illness may affect the Long-term quality of Life in children with CVS. Therefore, we should be careful in accessing a patient suggestive of CVS. Accurate diagnosis based on diagnostic criteria for CVS and the exclusion from other organic diseases mimicking clinical manifestations of cyclic vomiting is absolutely required. In patients diagnosed as CVS, optimal therapy should be performed to improve symptoms and to reduce complications in prodromal phase and emetic phase, and Long-term prophylactic therapy should be tried to prevent the development of vomiting episodes. The identification of triggering factors which induce vomiting episodes might be helpful in preventing vomiting attacks. Systematic approach should be recommended to improve clinical outcome of CVS.(J Neurogastroenterol Motil 2010;16:139-147)

How to Manage the Pediatric Nutritional Support Team: Updates

Yang, Hye Ran The Korean Society of Pediatric Gastroenterology 2012 Pediatric gastroenterology, hepatology & nutrition Vol.15 No.2

Pediatric patients in hospital are at risk of malnutrition at admission and even during their hospitalization. Although the concept of nutritional support team (NST) was introduced to hospitals for optimal nutritional care since 1960s and the benefits of pediatric NST have been proven by many studies and reports in terms of patient clinical outcome and cost saving, the pediatric NST is not widespread yet. The pediatric NST composed of pediatricians, dieticians, pharmacist, and nutrition support nurses as core members dedicated to nutritional care in children should be independent of central NST or other disciplines, but closely cooperate with other teams in hospitals. There is no doubt that a multidisciplinary NST is an effective way to provide appropriate nutritional support to an individual patient. Therefore, the implementation of the pediatric NST in hospitals should be recommended to provide optimum nutritional support including enteral tube feeding and parenteral nutrition and to assess pediatric patients at risk of malnutrition.

Update on eosinophilic gastrointestinal disease beyond eosinophilic esophagitis in children

Yang Hye Ran 대한소아청소년과학회 2023 Clinical and Experimental Pediatrics (CEP) Vol.66 No.6

Eosinophilic gastrointestinal disease (EGID) is an emerging condition worldwide in both children and adults, although it is considered rare. EGID has been underestimated owing to its underdiagnosis in the past, and its prevalence has recently increased. The diagnosis of EGID is based on histopathologic findings of endoscopic mucosal biopsy in which the total number of infiltrating eosinophils in each segment of the gastrointestinal tract is determined in patients with chronic or recurrent gastrointestinal symptoms despite a lack of consensus or guidelines on the definition of tissue eosinophilia except for eosinophilic esophagitis. Laboratory findings, including peripheral eosinophilia and increased fecal calprotectin levels, may be additional clues for detection of EGID in practice. Individualized treatment strategies, including adequate dietary modification and pharmacological therapy, may improve clinical outcomes of pediatric patients with EGID.

How to approach feeding difficulties in young children

Yang, Hye Ran The Korean Pediatric Society 2017 Clinical and Experimental Pediatrics (CEP) Vol.60 No.12

Feeding is an interaction between a child and caregiver, and feeding difficulty is an umbrella term encompassing all feeding problems, regardless of etiology, severity, or consequences, while feeding disorder refers to an inability or refusal to eat sufficient quantities or variety of food to maintain adequate nutritional status, leading to substantial consequences, including malnutrition, impaired growth, and possible neurocognitive dysfunction. There are 6 representative feeding disorder subtypes in young children: infantile anorexia, sensory food aversion, reciprocity, posttraumatic type, state regulation, and feeding disorders associated with concurrent medical conditions. Most feeding difficulties are nonorganic and without any underlying medical condition, but organic causes should also be excluded from the beginning, through thorough history taking and physical examination, based on red-flag symptoms and signs. Age-appropriate feeding principles may support effective treatment of feeding difficulties in practice, and systematic approaches for feeding difficulties in young children, based on each subtype, may be beneficial.

What should we do to prevent and manage obesity in children and adolescents?

Yang, Hye Ran The Korean Pediatric Society 2019 Clinical and Experimental Pediatrics (CEP) Vol.62 No.1