Dr. Hubert P. J. van der Doef of Beatrix Children’s Hospital and the University Medical Centre Groningen, The Netherlands, trained in Utrecht and completed a fellowship in paediatric gastroenterology, hepatology, and nutrition at Groningen. He initially worked on cystic fibrosis but has since focused on vascular complications in pediatric liver transplantation, particularly how to identify and manage issues related to the hepatic artery and portal vein.

Dr. van der Doef emphasizes the importance of multi-institutional collaborations and supranational registries to understand the factors that influence clinical outcomes. Using data from the HEPATIC and PORTAL registries, supported by Delphi analysis, he contributes to developing standardized core outcome sets and evidence-based clinical guidelines for managing vascular complications in pediatric liver transplantation.

Selected Literature:

• de Ville de Goyet J et al. European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children. Hepatology 2022;75(3):634–645.

• Stevens JP et al. Portal vein complications and outcomes following pediatric liver transplantation: Data from the Society of Pediatric Liver Transplantation. Liver Transpl 2022;28(7):1196–1206.

• Li W et al. Treatment strategies for hepatic artery complications after pediatric liver transplantation: A systematic review. Liver Transpl 2024;30(2):160–169.

  Dr. Van der Doef´s favourite song: Joost Klein - Europapa

  ESPGHAN favourite Songs can be found on Spotify https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Prof Dr Yvan Vandenplas, Associate Editor of Nutrients, trained in medicine with specialty training in paediatrics at the Free University of Brussels. From the completion of his paediatric training in 1986, he moved seamlessly into an appointment in 1987 as head of the University Hospital Brussels unit for paediatric gastroenterology and nutrition. He served as Chair of Paediatrics there from 1994 to 2021.

When he stepped down from that position, what had marked every other caesura in his professional life occurred once again: he was simply too good to let wander away. He now serves as consultant and emeritus professor within the same complex of institutions in which he has spent fifty highly productive years.

Prof Vandenplas has led the recent work of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications, addressing the supplementation of infant formula with biotics, including prebiotics, probiotics, postbiotics, synbiotics, and manufactured human milk oligosaccharides. These efforts have resulted in a series of technical reviews and recommendations that are poised to serve as practical clinical guidelines; the bibliographic list appears below.

He challenges listeners: with this literature as your guide, would you recommend adding “biotics” to infant formula—and why or why not? Which biotics would you choose? And with regard to human milk oligosaccharides, do you believe a “more-is-better” shotgun approach is preferable, or should specific oligosaccharides be selected and modified to address allergy risk or to mirror shifts in breast milk composition as the infant ages?

In short, the future is already here, and caregivers would do well to keep pace.

Titles

Recommendations on the Health Outcomes of Infant Formula Supplemented with Bioticsby the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications

Technical Review by the ESPGHAN Special Interest Group on Gut Microbiota and Modifications on the Health Outcomes of Infant Formula Supplemented with Postbiotics

Literature

Dinleyici EC et al. Technical review by the ESPGHAN special interest group on gut microbiota and modifications on the health outcomes of infant formula supplemented with probiotics. J Pediatr Gastroenterol Nutr. 2025 May 12. doi: 10.1002/jpn3.70068. Online ahead of print. PMID: 40356343.

Hojsak I et al. Technical review by the ESPGHAN special interest group on gut microbiota and modifications on the health outcomes of infant formula supplemented with manufactured human milk oligosaccharides. J Pediatr Gastroenterol Nutr. 2025 Mar 24. doi: 10.1002/jpn3.70032. Online ahead of print. PMID: 40123480.

Mihatsch W et al. Technical review by the ESPGHAN special interest group on gut microbiota and modifications on the health outcomes of infant formula supplemented with prebiotics. J Pediatr Gastroenterol Nutr. 2025 May 19. doi: 10.1002/jpn3.70064. Online ahead of print. PMID: 40384260.

Salvatore S et al. Technical review by the ESPGHAN special interest group on gut microbiota and modifications on the health outcomes of infant formula supplemented with synbiotics. J Pediatr Gastroenterol Nutr. 2025 Mar 21. doi: 10.1002/jpn3.70031. Online ahead of print. PMID: 40114538.

Dr. Vandenplas´s favourite song: Louis Neefs - Wat Een Leven

ESPGHAN favourite Songs can be found on Spotify https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

A round of applause, dear readers: We’ve made it into, good Heavens, 2026! Breasted the tape? Or limped across the finish line? No matter. To mis-quote Scripture, that is of course Stephen Sondheim: We’re still here.

Among the “we,” and our lodestar, is Dr Jake Mann. He’s selected two articles for consideration: From Jezequel M et al., in work done at Lille, J Pediatr Gastroenterol Nutr brings us – Splenic stiffness does not predict esophageal varices in children with portal hypertension; and from a cluster of Parisian institutions, by Grimaud E et al. and published in Hepatology – Serum bile acid levels predict the development of portal hypertension and high-risk esophageal varices following successful Kasai in biliary atresia. In short: How to foretell the variceal future.

What sorts of cohorts were assembled, and what data were collected? How were those data analysed? All-comers in Lille, in Paris persons with a certain disorder treated in a certain way with a certain age and meeting certain clinical criteria… A lot to sort out here, and the comparisons and contrasts are better listened to than read, you’ll agree. Or:

Back to Sondheim, in the tale of Sweeney Todd, the demon barber of Fleet Street, who shaved the faces of gentlemen / Who never thereafter were heard of again…

What happened next?Well, that’s the play –And he wouldn’t want us to give it away.

Happy listening! Enjoy ESPGHAN Journal Club – enjoy the play!

Literature

Grimaud E et al. Serum bile acid levels predict the development of portal hypertension and high-risk esophageal varices following successful Kasai in biliary atresia. Hepatology 2025 Oct 23. DOI: 10.1097/HEP.0000000000001592. Online ahead of print. PMID: 41129338

Jezequel M et al. Splenic stiffness does not predict esophageal varices in children with portal hypertension. J Pediatr Gastroenterol Nutr 2026 Jan; 82(1):156–164. DOI: 10.1002/jpn3.70247. Epub 2025 Oct 27. PMID: 41144851. PMCID: PMC12780471

Dr. Christos Tzivinikos graduated in 1999 from the Medical School of the Aristotle University of Thessaloniki, Greece. After several years serving as a medical officer aboard ships in the Greek navy, he began specialty training in paediatrics in the United Kingdom in 2005. Further training in gastroenterology followed between 2012 and 2015, culminating in a consultancy at Alder Hey Children’s Hospital in Liverpool, which he held until 2018. He then moved to Dubai, United Arab Emirates, to establish a paediatric gastroenterology, hepatology, and nutrition department at Al Jalila Children’s Specialty Hospital.

Dr. Tzivinikos shares his expertise on foreign-body ingestion in children, focusing particularly on button batteries and rare-earth magnets. This discussion addresses three key questions: How dangerous are rare-earth magnets? When and how should ingested magnets be removed? Are current efforts sufficient for advocacy and awareness?

Literature

• Online course – Paediatric Gastroenterology: Management of Foreign Body Ingestion in Children: https://www.futurelearn.com/courses/paediatric-gastroenterology-management-of-foreign-body-ingestion-in-children/1

• Nugud A et al. Pediatric magnet ingestion, diagnosis, management, and prevention: A European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper. J Pediatr Gastroenterol Nutr. 2023 Apr 1;76(4):523-532. doi: 10.1097/MPG.0000000000003702. Epub 2023 Mar 22. PMID: 36947000

• Furlano RI et al. Mistakes in paediatric foreign body ingestion and how to avoid them. UEG Education. 2024;24:1-7. Non-indexed journal.

  Dr. Tzivinikos´s favourite song: Theodorakis ‘s song - Aprilis

  ESPGHAN favourite songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

In 1990, Prof. Holm Uhlig entered the School of Medicine at the University of Leipzig – a city in Saxony with a long and turbulent history. The University, founded in 1409, had survived centuries of upheaval, including the Battle of Leipzig in 1813, when Napoleon’s forces were defeated and King Frederick Augustus I of Saxony was taken prisoner. Studying medicine in Leipzig during the 1990s meant navigating a period of significant transition following German reunification, yet Dr. Uhlig successfully completed his medical degree.

Following his studies, he conducted research in paediatric immunology in Leipzig before spending three years at the Sir William Dunn School of Pathology in Oxford. He later returned to Leipzig to work in paediatrics from 2004 to 2010, then returned to Oxford, where he currently serves as Professor of Paediatric Gastroenterology and Director of the Centre for Human Genetics.

Dr. Uhlig’s foundational work, completed during his first stay in Oxford, identified interleukin-23 as a key promoter of intestinal inflammation. This discovery has enabled the development of therapies targeting the alpha subunit of interleukin-23, modulating mucosal inflammatory activity. His team continues to unravel the complex pathophysiology of inflammatory bowel disease (IBD), using molecular-genetic analysis to identify monogenic contributions. Their ultimate goal is to develop genetics-based, patient-specific therapies.

Dr. Uhlig suggests correlated reading (see below) and invites reflection on key questions: What is the genetic basis of inflammatory bowel disease? How can research in genetics and immunology improve patient care? What are the most exciting recent developments in the field?

Literature

• Bolton C et al. An integrated taxonomy for monogenic inflammatory bowel disease. Gastroenterology. 2022 Mar;162(3):859-876. doi: 10.1053/j.gastro.2021.11.014. Epub 2021 Nov 13. PMID: 34780721. PMCID: PMC7616885; erratum, Gastroenterology. 2022 Jun;162(7):2143. doi: 10.1053/j.gastro.2022.04.007. Epub 2022 Apr 11. PMID: 35421357

• Kammermeier J et al. Genomic diagnosis and care coordination for monogenic inflammatory bowel disease in children and adults: Consensus guideline on behalf of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition. Lancet Gastroenterol Hepatol. 2023 Mar;8(3):271-286. doi: 10.1016/S2468-1253(22)00337-5. Epub 2023 Jan 9. PMID: 36634696

• Griffin H et al. Neutralizing autoantibodies against interleukin-10 in inflammatory bowel disease. N Engl J Med. 2024 Aug 1;391(5):434-441. doi: 10.1056/NEJMoa2312302. PMID: 39083772. PMCID: PMC7616361

  Prof Uhlig´s favourite song: J.S. Bach – Suite Nr. 1 für Violoncello Solo in G-Dur

  ESPGHAN favourite songs can be found on Spotify:https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Dr. Agata Stróżyk, a dietitian at the Medical University of Warsaw, shared her expertise on the “food ladder” in both theory and practice, providing insights for clinicians, patients, and families. She addresses questions such as:

• Could you explain what a food ladder is?

• What steps does a child typically go through during the food ladder process?

• What are the key benefits of milk and egg reintroduction for patients and families?

• What positive outcomes do you observe clinically?

• At the same time, what are the most common barriers and facilitators to successful reintroduction, and how important is it to monitor each step of the ladder carefully to ensure safety and build confidence in both the child and the caregivers?

• As a dietitian, what practical advice would you give to clinicians conducting an oral food challenge with baked milk or egg? For example, how can existing recipes be adapted to match a child’s individual food preferences or their stage of oral-motor development?

• What would you suggest if a child with a food allergy is also a picky eater or has multiple food allergies – such as to both milk and wheat?

Below are references she has selected to guide listeners in addressing these questions.

Literature

• Venter C et al. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP – an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy. 2017 Aug 23;7:26. doi: 10.1186/s13601-017-0162-y. eCollection 2017. PMID: 28852472; cf. also Correction to: Venter C et al. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP – an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy. 2018 Jan 25;8:4. doi: 10.1186/s13601-017-0189-0. eCollection 2018. PMID: 29416848

• Meyer R et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guideline update – VII: Milk elimination and reintroduction in the diagnostic process of cow's milk allergy. World Allergy Organ J. 2023 Jul 24;16(7):100785. doi: 10.1016/j.waojou.2023.100785. eCollection 2023 Jul. PMID: 37546235. PMCID: PMX10401347

• Gibson V et al. Barriers and enablers of dietary reintroduction following negative oral food challenge: A scoping review. J Allergy Clin Immunol Pract. 2025 Apr;13(4):851-860.e7. doi: 10.1016/j.jaip.2025.01.012. Epub 2025 Jan 17. PMID: 39828135

  Dr. Stróżyk´s favourite song is: Małomiasteczkowy - Dawid Podsiadło

  ESPGHAN favourite songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo

Your ESPGHAN podcast team are collecting expertise from as many learnèd, skilled, and experienced paediatric gastroenterologists and hepatologists as possible! Oh, and from dietitians… they’re among the most important links in the chain between gastroenterologist and the universal goal – a healthy child and a happy family.

Today’s note accompanies an encounter with Dr Elin Malmberg Hård af Segerstad, whose principal interests lie in the origins and management of the immune dysregulation manifest as coeliac disease.

In a person with an inherited susceptibility to coeliac disease, what triggers the development of that disease? Can triggers be avoided, and if so, how? After diagnosis and treatment, how can a patient with coeliac disease be monitored for compliance with dietary regimens? Who is best positioned to monitor such patients?

Dr Hård af Segerstad poses questions on three points as an armature for discussion:

1. What rôle does diet play in the development of coeliac disease in children? Can dietary modifications prevent coeliac disease?

2. How can gluten-free diet adherence be best assessed in children with coeliac disease? How does clinical practice at present fall short in this regard?

3. What is the rôle of the dietitian in the management of coeliac disease in children? Should all children with coeliac disease have access to an experienced dietitian?

In addressing these questions, she builds on three articles listed below – consensus summaries of best practice. But she also goes into detail on particular aspects of dietetic care not covered in those articles, so listen carefully!

• Mearin ML et al. ESPGHAN position paper on management and follow-up of children and adolescents with celiac disease. J Pediatr Gastroenterol Nutr 2022 Sep 1; 75(3):369–386.Doi: 10.1097/MPG.0000000000003540. Epub 2022 Jun 27. PMID: 35758521

• Luque V et al. Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. J Pediatr Gastroenterol Nutr 2024 Apr; 78(4):973–995.Doi: 10.1002/jpn3.12079. Epub 2024 Jan 30. PMID: 38291739

• Szajewska H et al. Early diet and the risk of coeliac disease: An update 2024 position paper by the ESPGHAN special interest group on coeliac disease. J Pediatr Gastroenterol Nutr 2024 Aug; 79(2):438–445.Doi: 10.1002/jpn3.12280. Epub 2024 Jun 7. PMID: 38847232

  Dr. Malmberg´s favourite song: Måns Zelmerlöw - Heroes

  ESPGHAN favourite songs can be found on Spotify: https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo