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Objectives: Recent guidelines provide insightful information on the diagnosis and treatment of Helicobacter pylori infection. The knowledge of the latest guidelines for European paediatric gastroenterologists is currently being discussed. This study aimed to evaluate the current knowledge regarding paediatric H. pylori management.

Methods: Members from the National Societies of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were invited to complete an online questionnaire. Descriptive and statistical analyses were conducted using SPSS®.

Results: A questionnaire was completed by 508 paediatric healthcare professionals from 32 countries (60% were specialists, 82% worked in hospitals and 49% in university hospitals). Of these, 360 (71%) had a background in paediatric gastroenterology. In 30% of cases, the local prevalence of H. pylori was unknown. Primary testing indications included duodenal or gastric erosions (85%), oral iron-refractory anaemia (59%) and a positive family history of gastric cancer (41%), 7.5% complied with the guidelines. Fifty-seven per cent requested invasive diagnostic tests, including culture (66%) and molecular tests (34%). The test-and-treat strategy was considered by 43% of clinicians, and more than half of respondents would include probiotics in eradication. Amoxicillin-based therapies represented 77% of prescriptions, with 54% opting for clarithromycin for empirical treatment. Additionally, the eradication regimens varied significantly across different European regions, with limited/small differences by clinician category.

Conclusions: This study among healthcare professionals revealed that H. pylori infection management does not entirely follow the guidelines regarding indications, testing and treatment regimens. There is a need for education in Europe to increase literacy and clinical updates.

Plant based diets are gaining popularity in accordance with international recommendations regarding health and sustainability. More adults following vegetarian diets leads to more parents choosing vegetarian diets for their children. However, little is known about parents' experiences of raising their children on vegetarian diets, vegan diet in particular. This study aimed to describe parents' experiences of raising their children on a vegan diet and explore differences over time. Parents of children fed a vegan diet were interviewed in two cohorts, in 2016 (n = 8) and 2025 (n = 14), using semi-structured interviews. The interviews were analyzed using qualitative content analysis. One overarching theme, building a sense of security, was abstracted from what was described as an evolving process as a parent. Regardless of initial status, the sense of security evolved over time. Parents described the choice of diet as natural, but they experienced lingering insecurities and internalization. They faced these insecurities by striving to do things right and found foundations for security in societal shifts and safe environments. There were large similarities between cohorts with the main difference being that the 2025 cohort encountered less questioning reactions. The findings suggest that choosing a vegan diet for one's children adds an additional layer of anxiety related to worry over hostile reception and own concerns for the children's health. Healthcare can facilitate the process of building a sense of security or add to stigmatization. This highlights the importance of relationship-building aspects of the professional meeting, and the necessity of evidence-based knowledge regarding alternative diets.

Objectives: The aim of this follow-up was to investigate how reduced iron concentration and added bovine lactoferrin in infant formula affect neurodevelopment, iron status, and growth at 12 months of age.

Methods: Swedish healthy term formula-fed infants (n = 180) were randomly assigned to receive, from 6 weeks to 6 months of age, a low-iron formula (2 mg/L) fortified with bovine lactoferrin (1.0 g/L) (Lf+, n = 72), the same formula without lactoferrin fortification (Lf−, n = 72) or a control standard formula with 8 mg/L and no lactoferrin (CF, n = 36). Breast-fed infants were recruited as a reference (n = 72). At 12 months of age, Bayley Scales of Infant and Toddler Development-III (BSID-III), iron status, and anthropometrics were assessed.

Results: There were no intervention effects on BSID-III. Explored outcomes were unaffected by lactoferrin and the two low-iron groups (Lf+ and Lf−) were combined. The low-iron group had lower hepcidin (37.8 vs. 49.4 ng/mL, p = 0.027), compared to the CF group. Furthermore, they had iron status indicators more similar to the breast-fed reference group. The prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) was low with no significant differences among groups. Weight and length were unaffected by intervention, however head circumference was minimally higher in infants fed low-iron formula compared to CF with mean difference (95% confidence interval) of 0.3 (0.0–0.6) standard-deviation-scores, p = 0.03.

Conclusions: Infant formula iron concentration at 2 mg/L was adequate in this population of infants with low risk of ID. Adding bovine lactoferrin did not affect the explored long-term clinical outcomes.

Introduction: Infant formulas with reduced iron levels and lactoferrin (Lf) supplementation might mimic the beneficial effects of breast milk on the oral microbiome. This study aimed to investigate the impact of a bovine Lf-supplemented and iron-reduced formula on the oral microbiota in infants at 4, 6 and 12 months.

Methods: In a double-blind controlled trial, 6-week-old formula-fed infants were randomized to receive either a formula with reduced iron levels (2 mg/L) and Lf supplementation (1 g/L) (n = 72), the same formula without Lf (n = 72), or a standard formula (8 mg iron/L) (n = 36). A breast-fed reference group (n = 72) was also included. The oral microbiota was analyzed at 4 (n = 244), 6 (n = 216) and 12 (n = 229) months of age using the Oxford Nanopore Technology of the 16S rRNA gene annotation (eHOMD database).

Results: Neither the within- or between-group diversities nor overall microbiota pattern assessment revealed any statistically significant differences in microbiota composition between the formula groups. However, single species were significantly associated with specific formula-fed groups. At 6 months, breast-fed infants exhibited significantly lower species richness and distinct microbiota composition compared to the formula-fed groups.

Conclusions: The effects of reduced iron levels and lactoferrin supplementation of infant formula on the oral microbiome were inconclusive.

Aim: To examine how reduced iron content and added bovine lactoferrin in infant formula affect the antibody response following routine immunisation.

Methods: In this randomised controlled trial, 180 Swedish formula-fed infants received, from 6 weeks to 6 months of age, a 2 mg/L iron formula with (n = 72) or without (n = 72) bovine lactoferrin, or a control formula with 8 mg/L iron and no lactoferrin (n = 36). Another 72 infants were recruited as a breastfed reference. Serum immunoglobulin G (IgG) levels against Haemophilus influenzae type b (Hib), diphtheria and tetanus were assessed at four, six and 12 months of age.

Results: With an equal gender distribution, 180 + 72 term infants were included with a mean age of 7.0 ± 0.7 weeks. At 12 months, infants fed low iron formula showed a significantly higher geometric mean Hib IgG (1.40 μg/mL [1.07–1.83]) compared to the control formula infants (0.67 μg/mL [0.42–1.07]). For all three vaccines, breastfed infants had significantly lower IgG levels at six and 12 months of age.

Conclusion: Except for higher Hib IgG levels at 12 months in infants fed low iron formula, the interventions did not affect vaccine IgG response. Unexpectedly, breastfed infants had significantly lower vaccine IgG levels compared to formula-fed infants.

Aim: To evaluate red flags as an instrument to distinguish other medical conditions from Functional Gastrointestinal Disorders (FGID) in children with long-term abdominal pain.

Methods: In a retrospective follow-up, data were collected from 317 children who were referred for medical assessment due to long-term abdominal pain between the years 2011 and 2012 at three Swedish paediatric open clinic units in Sweden. Throughout the review of medical records, any documented red flags at the primary consultation and finally set diagnosis after 1 year were noted for all cases.

Results: A non-FGID disease was diagnosed in 32 cases (10.1%). The sensitivity of red flags to predict inflammatory bowel disease (IBD) was 100% and the specificity 64.1%. The sensitivity of red flags to predict celiac disease was 45.5% and the specificity 63.7%. The sensitivity of red flags to predict any non-FGID disease was 59.4%, and the specificity was 65.6%.

Conclusion: The use of red flags is a sensitive instrument to identify patients with IBD but less applicable when identifying celiac disease and other organic diseases. Specificity is generally low and future biomarkers for assessing children with long-term abdominal pain is needed.

Background: Erythroferrone (ERFE) has been identified as a hepcidin-regulating hormone synthetized by erythroblasts correlating to the erythropoietic activity and the needs for iron substrate in bone marrow of adults. The present study aimed to assess the ERFE serum concentrations and its predictors in infants.

Methods: ERFE was explored at 4 time points during the first year of life in 45 healthy, breastfed, normal birth weight (NBW) infants, and 136 marginally low birth weight infants (LBW, 2000–2500 g) receiving iron (N = 58) or placebo (N = 78) between 6 weeks and 6 months of age.

Results: ERFE concentrations were low at birth, increasing gradually during the first year of life. In NBW infants, reference ranges (5th to 95th percentile) were at 6 weeks <0.005–0.99 ng/mL and at 12 months <0.005–33.7 ng/mL. ERFE was higher in LBW infants at 6 weeks but lower at 12 months compared to NBW and minimally affected by iron supplementation among LBW infants. Correlations of ERFE with erythropoietic and iron status markers were weak and inconsistent.

Conclusions: The role of ERFE in the crosstalk of erythropoiesis and iron homeostasis remains unclear in infants and further studies on ERFE in infants and older children are warranted within the framework of the erythropoietin–ERFE–hepcidin axis.

Impact: Normal range of erythroferrone in healthy infants is described for the first time. Erythroferrone in infants lacks correlation to iron status and markers of erythropoiesis. The findings indicate differences in infant regulation of iron homeostasis as compared to adults. The findings point to a need to study infant erythropoiesis separately from its adult counterpart. The findings may have clinical impact on management strategies of iron-loading anemia in infancy.

Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare, severely disabling genetic disorder of progressive heterotopic ossification (HO). The single-arm, open-label, phase 3 MOVE trial (NCT03312634) assessed efficacy and safety of palovarotene, a selective retinoic acid receptor gamma agonist, in patients with FOP. Findings were compared with FOP natural history study (NHS; NCT02322255) participants untreated beyond standard of care. Patients aged ≥4 years received palovarotene once daily (chronic: 5 mg; flare-up: 20 mg for 4 weeks, then 10 mg for ≥8 weeks; weight-adjusted if skeletally immature). The primary endpoint was annualized change in new HO volume versus NHS participants (by low-dose whole-body computed tomography [WBCT]), analyzed using a Bayesian compound Poisson model (BcPM) with square-root transformation. Twelve-month interim analyses met futility criteria; dosing was paused. An independent Data Monitoring Committee recommended trial continuation. Post hoc 18-month interim analyses utilized BcPM with square-root transformation and HO data collapsed to equalize MOVE and NHS visit schedules, BcPM without transformation, and weighted linear mixed-effects (wLME) models, alongside prespecified analysis. Safety was assessed throughout. Eighteen-month interim analyses included 97 MOVE and 101 NHS individuals with post-baseline WBCT. BcPM analyses without transformation showed 99.4% probability of any reduction in new HO with palovarotene versus NHS participants (with transformation: 65.4%). Mean annualized new HO volume was 60% lower in MOVE versus the NHS. wLME results were similar (54% reduction fitted; nominal p = 0.039). All palovarotene-treated patients reported ≥1 adverse event (AE); 97.0% reported ≥1 retinoid-associated AE; 29.3% reported ≥1 serious AE, including premature physeal closure (PPC)/epiphyseal disorder in 21/57 (36.8%) patients aged <14 years. Post hoc computational analyses using WBCT showed decreased vertebral bone mineral density, content, and strength, and increased vertebral fracture risk in palovarotene-treated patients. Thus, post hoc analyses showed evidence for efficacy of palovarotene in reducing new HO in FOP, but high risk of PPC in skeletally immature patients.

What is this summary about?

This is a plain language summary of an article originally published in the Journal of Bone and Mineral Research. People with fibrodysplasia ossificans progressiva (FOP) become physically disabled over time as new bone forms in places where it is not usually found, such as in muscles and ligaments. Until recently, there were no treatments for FOP that had been proven through clinical trials; however, a drug called palovarotene has been tested in clinical trials and may be effective. Here, we describe the MOVE trial, which investigated how effectively palovarotene works, as well as its safety in treating patients with FOP.

What were the results?

Results from MOVE suggest that palovarotene may reduce extra bone formation outside the normal skeleton. Patients with FOP who took palovarotene formed less new bone than those who did not take palovarotene. The most common side effects involved the skin, and included dryness and irritation. Some children who were still growing when they took palovarotene had a side effect that resulted in the (normal) growth of their skeleton stopping too soon.

What do the results of the trial mean?

Palovarotene may be a useful treatment option for FOP. Patients, caregivers, and doctors would need to consider the benefits and risks of treatment with palovarotene, particularly with growing children.

OBJECTIVES: Compared to formula-fed infants, breastfed infants have a lower risk of infections. Two possible reasons for this are the presence of the anti-infective and anti-inflammatory protein lactoferrin and the lower level of iron in breast milk. We explored how adding bovine lactoferrin and reducing the iron concentration in infant formula affect immunology and risk of infections in healthy infants.

METHODS: In a double-blind controlled trial, term formula-fed (FF) Swedish infants (n = 180) were randomized to receive, from 6 weeks to 6 months of age, a low-iron formula (2 mg/L) with added bovine lactoferrin (1.0 g/L) (Lf+; n = 72); low-iron formula with no added lactoferrin (Lf-; n = 72); and standard formula at 8 mg/L iron and no added lactoferrin (control formula [CF]; n = 36). Cytokines, infections, and infection related treatments were assessed until 12 months of age.

RESULTS: No adverse effects were observed. There were no apparent effects on transforming growth factor beta (TGF-β)1, TGF-β2, tumor necrosis factor alfa (TNF-α) or interleukin2 (IL-2) at 4, 6, or 12 months, except of higher TGF-β2 at 6 months in the CF group in comparison to the low iron groups combined (P = 0.033). No significant differences in otitis, respiratory infections, gastroenteritis, or other monitored infections and treatments were detected for any of the study feeding groups during the first 6 months and only a few and diverging effects were observed between 6 and 12 months.

CONCLUSIONS: Adding bovine lactoferrin and reducing iron from 8 to 2 mg/L in infant formula was safe. No clinically relevant effects on cytokines or infection related morbidity were observed in this well-nourished and healthy population.