JPGN Journal Club September 2023: Teduglutide in Pediatric Short Bowel Syndrome, Gastric Intestinal Metaplasia, and AIH Biopsy Debates

Dr Alex Knisely today in JPGN Journal Club is – as usual ! -- speaking with Dr Andreas Jenke, who for discussion has chosen two full-size articles, call them “mains”, and a pair of linked items from among the “starters”, that is, a letter to the editors of the journal and a response from ESPGHAN. The two “mains” are Efficacy and Safety of Teduglutide in Infants and Children With Short Bowel Syndrome Dependent on Parenteral Support, from a coalition of Japanese, British, and Finnish centres supported by Takeda Yakuhin, makers of teduglutide, and, from Boston Children’s Hospital (USA), Gastric Intestinal Metaplasia in Children – Natural History and Clinicopathological Correlation. The “starters” ? Liver Histology Before Treatment Withdrawal in Autoimmune Hepatitis – Is It Time to Review the ESPGHAN Recommendations ?, a Franco-Italian défi, and, réponse à cette provocation, Liver Biopsy is Indicated Before Attempting Treatment Withdrawal in Children with AIH – Commentary by the ESPGHAN HepCom. The mains may leave you wanting a bit more ; the teduglutide data draw on very few patients, the intestinal-metaplasia data yield no very firm conclusions ; but both offer at least reassurance. Mind you, if you are about to spend €100.000,00 on a year of teduglutide for one of your patients, you’ll be well-advised to do it in a manufacturer-supported study with firm guidelines for use and assessment – yes, a registry is needed. And the starters ? Highly spiced ! But, with a J Hepatol article from the Franco-Italian group (summarised in the Commentary, but which you must seek out on your own), they certainly fill the plate. Whose arguments are more convincing ? What will you say to the next teenager with treated AIH and “good numbers” who is desperate to abandon steroids and the like ? Prudence seems in order . . .