bluuebunny/crossref_metadata_2025 huggingface dataset:
Antroduodenojejunal Manometry in the Diagnosis of Chronic Idiopathic Intestinal Pseudoobstruction in Children
Authors: Cucchiara S. , Annese V. , Minella R. , Franco M. T. , Iervolino C. , Emiliano M. , Auricchio S.
Published: January 2024

We analyzed the antroduodenojejunal (ADJ) manometric patterns in a group of 19 consecutive children (mean age, 53 months; range, 5 months to 14 years) referred for suspected chronic idiopathic intestinal pseu‐doobstruction. Diagnosis was based on typical symptoms, absence of extraintestinal diseases, and structural lesions of the gut at endoscopy and radiology. Surgical full‐thickness intestinal biopsies were evaluated in nine patients. Manometry of the stomach and small bowel was performed in the fasting and fed state with a multilumen perfused probe. All patients showed severe abnormalities of ADJ motor activity that were not seen in the eight controls (mean age, 38.2 months; range, 1–9 years). In 12 patients, manometric patterns suggesting neuropathic disease were detected with fasting and/or fed sustained and incoordinated duodenojejunal phasic waves, aberrant propagation and/or configuration of phase III of the inter‐digestive motility complex, inability of a meal to convert a fasting into a fed pattern, and prolonged groups of fasting and fed nonpropagated phasic waves. In seven of these patients, histology revealed marked changes of the intrinsic neurons. In four cases, manometry disclosed features suggestive of a myogenic disease, including severe fasting and fed infrequent low‐amplitude contractions, sometimes with some degree of propagation; in two of these cases, histology showed morphological abnormalities of smooth muscle cells of the gut wall. In three patients, manometry revealed signs suggestive of mechanical obstruction of the gut, such as repetitive post‐feeding clusters and simultaneous repeated broad‐based waves; in these patients, more detailed x‐ray studies showed organic obstructive causes (ileal lymphoma, Hirschsprung's disease, and intestinal malrotation). We conclude that, in children with symptoms suggesting chronic intestinal pseudoobstruction, manometry of the stomach and small bowel reveals severe gut dysmotility and can help establish the diagnosis and distinguish the underlying disease process.
Endomysial Antibody Screening in Children
Authors: Chan K. N. , Phillips A. D. , Mirakian R. , Walker‐Smith J. A.
Published: January 2024

It has been suggested that endomysial antibodies are specific markers for coeliac disease. In a 13‐month study, we examined the usefulness of screening for these antibodies in the diagnosis of coeliac disease in children. Twenty‐one of 223 (9.4%) serum samples [or 17 of 192 (9%) children undergoing investigation for GI disorders] were found to be positive for serum IgA class endomysial antibodies. These included eight strong positives, eight positives, and five weak positives. One‐hundred‐thirty‐four children had small bowel biopsies performed. Endomysial antibodies were found in all children with severe villous atrophy on a gluten‐containing diet who were diagnosed as having coeliac disease. Three children with positive and four with weak‐positive results did not have coeliac disease. One had partial villous atrophy consistent with the diagnosis of cow‐milk‐sensitive enteropathy and the others had a normal small bowel mu‐cosa. This study confirms a strong association between endomysial antibodies and coeliac disease; however, not all cases with positive antibodies had the disease. At the present time, small bowel biopsy remains essential for the diagnosis of coeliac disease.
Distinct Features of Upper Gastrointestinal Endoscopy in the Newborn
Authors: de Boissieu D. , Dupont C. , Barbet J. P. , Bargaoui K. , Badoual J.
Published: January 2024

Between January 1987 and December 1990, 293 upper GI endoscopic procedures were performed in 219 neonates <1 month of age. No lesion was found in 57 cases (26%; group 1), whereas esophagitis was present in 158 cases, alone in 45 cases (20.6%; group 2) and associated with gastritis in 113 cases (51.8%; group 3). The association of esophagitis with gastritis seems to be a specific feature of neonates and not older children. The presence of gastritis with esophagitis suggests that a primary peptic mechanism is unlikely to explain all endoscopic findings, although the presence of such a mechanism secondary to esophagitis could contribute to the esophageal lesions. Acute fetal distress was more frequent in group 3 than in the other groups. Symptoms associated with endoscopic lesions in groups 2 and 3 were, respectively, malaise (38 and 42%), hematemesis (4 and 35%), frequent regurgitation (45 and 26%), and difficult feeding and/or failure to thrive (26 and 24%). In Group 3, minor symptoms often led to the diagnosis of severe mucosal lesions, and antireflux therapy elicited prompt relief of clinical symptoms. The causes of neonatal esophagogastritis remain unknown. Wide use of en‐doscopy in the presence of discrete clinical abnormalities is likely to considerably improve the clinical condition of some children in their first days of life.
Bolus Versus Continuous Feedings Stimulate Small‐Intestinal Growth and Development in the Newborn Pig
Authors: Shulman Robert J. , Redel Carol A. , Stathos Theodore H.
Published: January 2024

Although bolus and continuous tube feedings are common, little is known about their effect on the developing small intestine. To compare their effect on small‐intestinal growth and differentiation, six pairs of 3‐day‐old piglet littermates were randomized to receive similar volumes of sow milk replacer, either by bolus (four times daily, group B) or continuous feedings (over 24 h, group C) for 7 days. The piglets were then killed and small‐intestinal length, weight, protein mass, and disac‐charidase activities were determined. Small‐intestinal mucosal weight and ileal protein mass were greater in group B than in group C (p = 0.0024 and 0.019, respectively). No differences were noted between groups in jejunal mucosal protein mass. Ileal maltase activity alsc was greater in group B than group C (p = 0.02). Although ileal lactase activity in group B was twice that in group C the differences did not quite reach statistical significance (p = 0.11). No differences between groups were noted in ileal or jejunal sucrase activity. Our study demonstrated that bolus feedings increased mucosal mass, protein mass, and maltase activity to a greater degree than continuous feedings. These results may have clinical significance for infants receiving long‐term tube feedings.
Reflux Esophagitis in Infants and Children
Authors: Vandenplas Yvan
Published: January 2024

In this article, the Working Group on Gastro‐Oesophageal Reflux of the European Society of Paediatric Gastroenterology and Nutrition presents and discusses a definition of reflux esophagitis and recommends a diagnostic approach and therapeutic management for this condition. Histologic criteria for reflux esophagitis, modified and adapted to the particular needs of infants and children, are suggested. Upper gastrointestinal en‐doscopy is recommended as the technique of choice in infants and children presenting with symptoms suggestive of reflux esophagitis. Prokinetics, although still a relatively new drug family, have already established a definitive place in the treatment of gastroesophageal reflux disease in infants and children and could also be used in the treatment of nonulcerative esophagitis, as suggested in the literature. If the esophagitis is more severe (ulcerative), treatment should initially consist of H2 blockers and then be continued with prokinetics. New drugs, such as omeprazole, are suggested in cases refractory to H2 blockers. Surgery is indicated in life‐threatening conditions or if the esophagitis is resistant to adequate medical management.
Evaluation of the Effects of Varying Solute Content on the Efficacy of Oral Rehydration Solutions in a Rat Model of Secretory Diarrhoea
Authors: Pillai G. V. , Brueton M. J. , Burston D. , Sandhu B. K.
Published: January 2024

A series of in vivo steady‐state perfusion studies in cholera toxin‐induced secreting rat intestine were carried out to investigate net water, sodium, and potassium absorption and water influx and efflux from a range of oral rehydration solutions (ORSs) in which the glucose content had been partially replaced by amino acids or food supplements and the sodium content had been reduced to 60 m M. The reference solution used was the World Health Organization formula. There was a significant correlation between the osmolality of the ORS and the net water absorption (r = −0.911; p < 0.02). The greatest net water absorption occurred using comminuted chicken‐ and tapioca‐supplemented ORS.
Balloon Catheter Dilatation of Peptic Pyloric Stenosis in Children
Authors: Chan K. L. , Saing Htut
Published: January 2024

In the past 3 years, three children (ages 2, 4, and 8 years) suffering from peptic pyloric stenosis and repeated vomiting were treated in our department with balloon dilatation followed by H2‐receptor antagonist therapy. After the dilatation, all three patients could take solid food without vomiting. There were no complications as a result of the procedures. During a mean follow‐up of 17 months (range, 5–30) there was no recurrence of symptoms. The method of dilatation is described, and we recommend it as an option for the initial nonoperative treatment of pediatric peptic pyloric stenosis. The long‐term results of balloon dilatation of peptic pyloric stenosis will, however, require further evaluation.
Localization of the Intestinal Biopsy Capsule in Children by Color‐Coded Duplex Sonography
Authors: Scholbach T. , Künzel R.
Published: January 2024

In 21 children from 3 months to 10 years and 5 months old, the position of the biopsy capsule before suction biopsy of the small intestine was examined by means of x‐ray studies and both conventional and color‐coded duplex sonography. In all cases, the biopsy capsule was correctly positioned under sonographic guidance. The sonographic finding was always confirmed by x‐ray film and the histology of the tissue sample. The main obstacle for imaging the biopsy tube and capsule was intestinal gas due to crying and/or restlessness of infants under examination. However, it was always possible to define the position of the biopsy capsule sufficiently. These promising results allow us to recommend sonographic control of the intestinal tube before intestinal suction biopsy in infants and children. The advantages of this approach include lack of irradiation, which is especially important if the tube is an incorrect position after the first trial, bedside availability of sonographic equipment, lower risk of dislocation of the tube owing to shorter transport time, and continuous contact of medical staff with the infant.
Allergic Colitis in Infancy
Authors: Machida Helen M. , Catto Smith Anthony G. , Gall D. Grant , Trevenen Cynthia , Scott R. Brent
Published: January 2024

This study prospectively evaluated 35 consecutive infants who presented with fresh blood mixed with stools. The mean age at onset of bleeding was approximately 4 weeks. All infants were otherwise asymptomatic and exhibited normal growth and physical examinations. None had evidence of a bleeding diathesis, viral or bacterial enteritis, or necrotizing enterocolitis. Con sent for limited colonoscopy and biopsy was obtained for 34 infants. Twenty‐five had macroscopic colitis and 10 infants had marked nodular lymphoid hyperplasia. Thirty‐one infants had histopathological evidence of colitis characterized by a marked eosinophilic infiltrate. Compared with 19 controls (age, 4.1 ± 3.6 months) the mean number of eosinophils per high‐power field was greater in the patients with colitis. Patients with colitis also had an elevated mean absolute peripheral eosinophil count and a low mean serum albumin compared to control values.

The 31 infants with colitis were receiving solely breast milk (10), cow's milk formula (9), soya formula (9), breast milk with cow's milk formula (2), or nutramigen (1) at the time of presentation. Nineteen infants had rapid resolution of frank bleeding and gradual correction of serum albumin with dietary change. While limited colonoscopy and biopsy were useful in establishing a definitive diagnosis, a low serum albumin and high peripheral eosinophil count suggested the diagnosis. Colitis characterized his‐tologically by >20 eosinophils per high‐power field is a common cause of rectal bleeding in otherwise healthy young infants. Resolution of bleeding and increase in serum albumin after dietary change suggest that this is an allergic colitis: however, the pathogenesis of this disorder needs further clarification.
Optimization of Gene Transfer into Intestinal Epithelial Cells Using a Retro viral Vector
Authors: Noel R. Adam , Shukla Pramila , Henning Susan J.
Published: January 2024

Somatic gene therapy has been proposed as a method of treating various metabolic diseases and conditions associated with a deficiency in secretory proteins. The intestine, because of its accessibility, large size, rapid rate of cell turnover, and known location of stem cells, is an attractive site for retro viral gene therapy. Stem cells in the intestine are known to reside in the crypts of Lieberkühn. In this study the IEC‐6 cell line, derived from rat intestinal crypt cells, was used as an in vitro model to study the feasibility and dynamics of retroviral gene transfer in intestinal cells. Using a replication‐deficient retrovirus, we delivered a reporter gene, bacterial β‐galactosidase (β‐gal) into NIH‐3T3 fibroblasts and IEC‐6 cells. Successful transduction was measured by X‐gal histochemistry. Viral titers on IEC‐6 cells were lower than on NIH‐3T3 cells but were within the same order of magnitude. Gene transfer increased linearly with retroviral concentration up to a 1:5 dilution of retroviral supernatant. With undiluted viral medium, gene transfer was inhibited and this effect was more pronounced with the IEC‐6 cells. The negative effect of the undiluted retroviral supernatant was minimized by decreasing the harvest time from the packaging cell line. An optimal plating density 12 h prior to infection was found to be approximately 105 cells/6‐cm dish in both cell lines. The infection rate was proportionally enhanced by the use of multiple infections. In conclusion, under ideal conditions, the IEC‐6 cells were infected at similar levels of efficiency as NIH‐3T3 cells. The conditions established should be helpful in devising strategies for gene transfer into intestinal epithelium using retroviral vectors.
Use of Whole‐Gut Lavage to Measure Intestinal Immunity in Healthy Sierra Leonean Children
Authors: Hodges Mary , Kingstone Kathleen , Brydon W. Gordon , Sallam J. , Ferguson Anne
Published: January 2024

In view of the potential roles of intestinal immunodeficiency and hypersensitivity in the infection/diarrhea/malnutrition cycle, we need a safe and ethical method to study intestinal immunity of children in the developing world. Work in adults has shown that the fluid obtained by whole‐gut lavage (WGLF), essentially a gut perfusate, can be used to assess intestinal immunity, inflammation, and gut losses of protein and blood. Gut lavage was successfully performed in 24 of 25 “normal” children aged 6–9 years, from Freetown, Sierra Leone, with parental informed consent. WGLF was treated with protease inhibitors, stored at −20°C, and transferred to Edinburgh for laboratory studies. These showed that no child had occult blood loss but four had evidence of protein‐losing enteropathy. Compared with values for Scottish adults, WGLF from the Sierra Leonean children had significantly higher concentrations of IgA and IgM and of IgA and IgM antibodies to dietary antigens and to Salmonella typhi lipopolysaccharide. In three children, very low levels of IgA and IgA antibody were present: Two of these were the only cases with detectable sIL2R in lavage fluid, indirect evidence of intestinal T cell activation; tumor necrosis factor was not detectable. Substantial information on childrens' intestinal immunity can be obtained by the method described.
Manometrical Evaluation in Visceral Neuropathies in Children
Authors: Boige N. , Faure C. , Cargill G. , Mashako L. M. N. , Cordeiro‐Ferreira G. , Viarme F. , Cezard J. ‐P. , Navarro J.
Published: January 2024

Manometrical recordings were made at three levels of the digestive tract in 20 children with chronic intestinal pseudoobstruction (CIPO) defined clinically and histopathologically by deep biopsies showing a neuropathic process. Duodenal manometry showed severe abnormalities with hypomotility in all cases and absence of migrating motor complex in 13 of 20 cases. There was no relation between the histopathologic type and the motility pattern, but the most severe abnormalities were seen in the patients with extensive involvement of the digestive tract and the most severe clinical course. Esophageal manometry was abnormal in 18 of 19 patients, with altered peristalsis consisting of simultaneous, short‐lasting, or low‐amplitude waves. Rectoanal manometry showed the presence of the rectosphincteric inhibitory reflex in all patients. In conclusion, there is a high frequency of small bowel manometrical abnormalities in CIPO which seem to correlate with the extent of the pathological process and the prognosis of the disease. Esophageal manometry is useful for defining the extent of dysmotility and confirming the diagnosis of CIPO in some cases.
Evolution of Helicobacter pylori Positivity in Infants Born From Positive Mothers
Authors: Blecker Uwe , Landers Sophie , Keppens Eddy , Vandenplas Yvan
Published: January 2024

To evaluate the mother‐child transmission of anti‐Helicobacter pylori antibodies, we investigated 562 pregnant women by means of a commercially available second‐generation enzyme‐linked immunosorbent assay for the detection of anti‐H. pylori IgG (Malakit Helicobacter pylori). One hundred twenty‐eight of the 562 women had a positive serology for H. pylori. 13C‐Urea breath tests were performed in 85 seropositive and in 65 randomly selected seronegative subjects. These breath tests were positive in 82 of the 85 (96.5%) seropositive and in none of the seronegative subjects, reflecting the actual presence of H. pylori in the gastric mucosa of the seropositive women. Cord blood levels for the Malakit Helicobacter pylori were positive in all infants born to seropositive mothers and negative in those born to seronegative mothers. In all infants the previously positive titers had turned negative by the age of 3 months. At the age of 12 to 15 months 13C‐urea breath tests were performed in 67 infants born to seropositive mothers. These breath tests were positive in only one infant. By the time the 13C‐urea breath tests were performed, the serology had turned negative in all infants with the exception of the one with the positive breath test. We conclude that the IgG antibodies against H. pylori cross the placental barrier and that, despite the present H. pylori infection in the mothers, infants born to these H. pylori‐positive women do not appear to have an increased risk of developing a H. pylori‐associated gastritis during the first year of life.
The Effects of Omeprazole on the Ultrastructure of Gastric Parietal Cells
Authors: Kato Seiichi , Fujii Toshiyuki , Nakano Kazuo , Naganuma Hiroshi , Nakagawa Hiroshi
Published: January 2024

This study was designed to investigate ultra‐structural changes in parietal cells during treatment with omeprazole. Endoscopic biopsies were performed in patients treated with omeprazole (n = 2) and cimetidine (n = 4) and in normal controls (n = 3). In the patients who received omeprazole, many parietal cells (90.9 and 66.6%) were in the “stimulated” or “partially stimulated” stage. As reported previously, our results suggest that omeprazole fails to prevent the morphological transition of parietal cells to an actively secreting phase, although it strongly inhibits acid secretion. The altered cells frequently demonstrated more marked dilation of the secretory canaliculi, compared with those of normal controls and cimetidine‐treated patients. Vacuolation was found in one patient given omeprazole and one given cimetidine. In the former patient, initial famotidine treatment also led to the vacuolation of parietal cells. However, this change does not seem to imply serious parietal cell degeneration. There were no adverse morphological changes in mitochondria and nuclei in any of the groups. In conclusion, vacuolation is not specific to omeprazole. Moreover, if omeprazole is administered at a pharmacologically effective dosage for a short period of time, it may not have serious effects on the ultrastructure of human parietal cells.
The Nutritional Management of Acute Diarrhea in Young Infants
Authors: Wall C. R. , Webster J. , Quirk P. , Robb T. A. , Cleghorn G. J. , Davidson G. P. , Shepherd R. W.
Published: January 2024

To compare the efficacy of a low‐lactose hydrolyzed milk formula, a lactose‐free corn syrup‐based milk formula, and a standard lactose‐containing formula during refeeding after rehydration in infants with gastroenteritis, 135 patients older than 2 years were studied by randomized trial. Clearly demonstrated disadvantages in terms of early weight loss and longer duration of diarrhea were observed with the lactose‐based formula compared with early weight gains on both the low‐lactose formulae, and thus the lactose‐containing formula was discontinued after 91 patients. The early weight loss with the lactose‐containing formula was statistically significantly related to the degree of relative (rehydrated) underweight. The two low‐lactose formulae were further compared in the remaining 44 patients. Early weight gain (48 h) was significantly greater with the lactose‐hydrolyzed formula compared with the corn syrup‐based formula, but no statistically significant differences were observed in duration of diarrhea, energy intake, treatment failures, or late weight gain. We conclude that the routine use of a low‐lactose formula during refeeding after rehydration in infants with gastroenteritis may have some advantages in underweight infants and toddlers in whom it is important to prevent further weight loss.
Selenium and Glutathione Peroxidase Status in Paediatric Health and Gastrointestinal Disease
Authors: Thomas A. G. , Miller V. , Shenkin A. , Fell G. S. , Taylor F.
Published: January 2024

To examine the effect of paediatric GI disease on selenium concentration in plasma and glutathione peroxidase activity in plasma and red cells, results in children with Crohn's disease (n = 39), cystic fibrosis (n = 14), intractable diarrhoea (n = 13), and biliary atresia (n = 10) were compared with those from 86 healthy children undergoing routine operations. In Crohn's disease, plasma selenium concentrations were rarely low, but glutathione peroxidase activity was increased in the plasma and reduced in the red cells. Selenium concentration and glutathione peroxidase activity increased with steroid treatment but decreased with a selenium‐deficient elemental diet. Plasma selenium concentration was normal in children with cystic fibrosis but very low in severely malnourished children with biliary atresia and intractable diarrhoea. Selenium concentration and glutathione peroxidase activity should be monitored in children with severe malnutrition or requiring prolonged nutritional support. Supplementation is recommended in cases of severe selenium depletion.
Reduction in Virus‐Neutralizing Activity of a Bovine Colostrum Immunoglobulin Concentrate by Gastric Acid and Digestive Enzymes
Authors: Petschow Bryon W. , Talbott Robert D.
Published: January 2024

Bovine milk immunoglobulin concentrates have been proposed for inducing passive immunity against various enteric pathogens. In vitro digestion studies were conducted to evaluate the effect of gastrointestinal secretions on the virus‐neutralizing activity of a concentrate prepared from the colostrum of cows that were immunized with rotavirus. The proteolytic activity of human gastric and duodenal fluid specimens was used to design a two‐stage in vitro digestion model with commercial enzymes for estimating the individual impact of pepsin, gastric acid, and select pancreatic enzymes on antirotavirus activity in bovine milk immunoglobulin concentrates. The rotavirus‐neutralizing titer of concentrate was decreased by incubation with pepsin at pH 2, a pool of pancreatic enzymes at pH 7.5, or sequential digestion with pepsin (pH 2) and pancreatic enzymes (from initial titer of 55,210 to 2,030, 19,500, and 320, respectively). Reduction in rotavirus‐neutralizing titer after gastric‐phase digestion was primarily due to acidic conditions and not to proteolytic cleavage by pepsin. Although both trypsin and carboxypeptidase caused significant proteolysis of concentrate during duodenal‐phase digestion, only trypsin caused a significant reduction in rotavirus‐neutralizing titer. The extent of digestion was the same for concentrate suspended in water or skim milk. The results demonstrate that the biological activity of bovine milk antibodies is reduced by exposure to acid and trypsin in vitro and suggest that neutralization of both gastric acid and pancreatic trypsin may enhance the effectiveness and economic feasibility of passive oral immunoprophylaxis with bovine milk immunoglobulins.
Do H2 Receptor Antagonists Have a Therapeutic Role in Childhood?
Authors: Kelly Deirdre A.
Published: January 2024

Summary: Studies of the therapeutic efficacy and indications for the use of histamine (H2)‐receptor antagonists (H2RAs) in children are reviewed. In adequate dosages, both ranitidine and cimetidine reduce acid output and increase intragastric pH, and H2RAs have been shown to be effective in the treatment of acid‐peptic disease. Ranitidine is a more potent drug with a longer duration of action than cimetidine and thus requires less frequent administration. Dosage requirements vary according to age and clinical condition, and children require a relatively higher drug dosage (mg/kg) than adults. There is insufficient information on the long‐term paediatric use of famotidine to validate its use in children, and the endocrinological side effects associated with cimetidine therapy in adults essentially preclude its long‐term use in children. It is suggested that ranitidine administration is safe and effective in children with acid‐peptic disease and should be considered as first‐line treatment for children with severe oesophagitis or peptic ulceration and for the prophylaxis of stress ulceration and aspiration pneumonitis.
Effect of Orally Administered Epidermal Growth Factor on Intestinal Recovery of Neonatal Pigs Infected with Rotavirus
Authors: Zijlstra Ruurd T. , Odle Jack , Hall William F. , Petschow Bryon W. , Gelberg Howard B. , Litov Richard E.
Published: January 2024

The effect of oral epidermal growth factor (EGF) on histological and biochemical changes in epithelium in the small intestine was studied in colostrum‐deprived neonatal pigs. Forty‐eight pigs were infected at 4 days of age with 2 ± 107 plaque‐forming units of porcine group A rotavirus and orally fed a simulated sow‐milk diet supplemented with 0.0, 0.5, or 1.0 mg/L recombinant human EGF. Sixteen noninfected pigs were fed a diet without EGF supplementation. Infected pigs developed severe diarrhea; they also consumed 25% less food and gained 60% less weight than noninfected pigs. Pigs were killed 8 days postinfection to collect samples at seven equidistant points in the small intestine. Rotavirus infection decreased villus height by 37% and reduced specific activity of lactase by 54%, of leucine aminopeptidase by 43%, and of alkaline phosphatase by 54% in the small intestine, compared with noninfected pigs. Only the supraphysiological dose of EGF (1.0 mg/L) consistently increased villus height in the proximal and mid‐small intestine and lactase‐specific activity in the mid‐small intestine of rotavirus‐infected pigs. However, this dose was only partially effective in restoring intestinal mucosal dimensions and enzyme activities. Supplemental EGF did not hasten the resolution of diarrhea. These data indicate that high physiological levels of EGF are beneficial in stimulating recovery of epithelium in the small intestine following rotavirus infection.
Diagnostic Accuracy of a New Stick Micromethod with Which to Measure Antigliadin Antibodies
Authors: Cavataio F. , Iacono G. , Carroccio A. , Montalto G.
Published: January 2024

A new, simplified micromethod for semiquantitative determination of the antigliadin antibody (AGA) has been proposed. When the new stick method was used in a population of infants hospitalized for gastrointestinal problems, the results were virtually identical to those of the traditional method
Gastric Emptying in Children with Gastric Transposition
Authors: Ravelli Alberto M. , Spitz Lewis , Milla Peter J.
Published: January 2024

Using the noninvasive technique of electrical impedance tomography (EIT), gastric emptying was studied in 12 children, aged 9 months to 17 years, who had undergone gastric transposition (six with pyloroplasty) for oesophageal replacement (seven oesophageal atresia, five severe caustic or peptic damage). In two patients, gastric antral electrical control activity was also studied using surface electrogastrography. Nine patients had problems on oral feeds (respiratory symptoms, feeding difficulties, vomiting, abdominal pain, symptoms suggesting dumping), whilst three were asymptomatic. All 12 patients were tested with a milk meal; in addition four (two with and two without dumping symptoms) were tested with a hypertonic glucose drink; gastric emptying of the milk meal was expressed as the percentage of the meal remaining in the stomach at 60 min (R60). Mean (±2 SD) R60 was 54.6% (±17.4%) in 12 healthy controls and 59.8% (±83.2%) in the 12 patients. Gastric emptying was normal in one patient (R60, 42.6%), delayed in seven (mean R60, 91.2%; range, 74.4–100%), and accelerated in four (R60, 0%). The emptying rate was unrelated to the presence or absence of pyloroplasty. Furthermore, the emptying pattern was extremely irregular, suggesting that gastroesophageal as well as duodenogastric reflux episodes occurred in all patients. The hypertonic glucose drink induced dumping (50% of the meal emptied at 1–3 min) in all four patients, two of whom had delayed emptying of the milk meal, but the gastric antral electrical control activity occurred at the normal frequency of 0.05 Hz. The transposed stomach does not behave as a simple conduit; in most cases it retains its reservoir function. Irrespective of the patient's symptoms, the transposed stomach empties in an abnormal fashion, and the composition of the meal may considerably affect the emptying pattern.
Circulating Levels of Interleukin‐6, Interleukin‐8, and Tumor Necrosis Factor‐α in Children with Autoimmune Hepatitis
Authors: Maggiore Giuseppe , De Benedetti Fabrizio , Massa Margherita , Pignatti Patrizia , Martini Alberto
Published: January 2024

Circulating levels of the proinflammatory cytokines interleukin‐6 (IL‐6), IL‐8, and tumor necrosis factor‐α (TNF‐α) were measured in 13 children with autoimmune hepatitis (AIH) (seven with type 1 and six with type 2). In untreated children with type 1 AIH, TNF‐α, IL‐6, and IL‐8 levels were elevated when compared to those of healthy controls (p < 0.005, p < 0.02, p = 0.06, respectively), whereas in children with type 2 AIH, cytokine levels were normal in all except one sample. A significant decrease in circulating IL‐6, IL‐8, and TNF‐α was observed when patients were evaluated during a subsequent remission. We found no significant correlation of cytokine levels with alanine aminotransferase (ALT) activity, total serum γ‐globulins, or prothrombin activity. In patients with cirrhosis, serum IL‐8 and IL‐6 levels were higher (significantly in the case of IL‐8) than those of patients without cirrhosis. In conclusion, activation of the in vivo production of the proinflammatory cytokines IL‐6, IL‐8, and TNF‐α appears to be associated with type 1 but not with type 2 AIH.
Reversal of Indian Childhood Cirrhosis by D‐Penicillamine Therapy
Authors: Pradhan A. M. , Bhave S. A. , Joshi V. V. , Bavdekar A. R. , Pandit A. N. , Tanner M. S.
Published: January 2024

Serial liver biopsy changes have been reviewed in 30 patients with Indian childhood cirrhosis (ICC) who were randomly allocated to receive treatment with penicillamine in a dose of 20 mg/kg/day, 10 of whom also received prednisolone, and five receiving placebo. The latter died within 185 (mean, 149) days of starting treatment. Nine receiving penicillamine died within 540 (mean, 338) days, but the remainder are well 5.1–9.3 years after commencing treatment. Initial biopsies showed severe hepatocellular injury, pericellular fibrosis, inflammatory infiltration, and orcein‐staining granules. Second biopsies taken within 6 months of starting penicillamine usually showed persistence of inflammation and an increase in nodularity with thick and thin active sep‐tae. Subsequently the appearances were of an inactive micronodular cirrhosis, with reduction in septal inflammatory infiltrate, hepatocellular injury, and intensity of orcein staining. This further improved to a stage of incomplete fibrous septae. The last liver biopsies at 6–60 months (in 21 survivors) showed almost normal histology in four, incomplete fibrous septae in five, and inactive micronodular cirrhosis with thin septae in 12. Mean liver copper concentrations decreased from 1,407 (SEM, 121) (xg/g at presentation to 925 (183), 317 (100), and 127 (35) at 6, 6–18, and >18 months after starting treatment. By contrast, a second biopsy taken in the 6 months after diagnosis in placebo‐treated children showed persistence of ICC with increase in inflammation, fibrosis, and orcein staining.
In Vivo Study of Colonic Fermentation of Carbohydrate in Infants
Authors: Lifschitz Carlos H. , Carrazza Francisco R. , Feste Andrew S. , Klein Peter D.
Published: January 2024

Dietary carbohydrate in the colon is fermented and converted into short‐chain fatty acids. We studied the fate of carbohydrate that arrives in the colon under circumstances similar to those that occur during an episode of diarrhea and determined whether a quantitative correlation exists among certain indicators of colonic fermentation of carbohydrate arriving in the large bowel. A stable‐isotope method was used to estimate carbon scavenging by the colon. Fourteen infants with severe malnutrition and history of watery stools and/or increased numbers of stools in the preceding 20 days were studied. Infants underwent nasocecal intubation and a 60‐min infusion of 0.5 g/kg glucose containing 5 mg/kg of 13C‐glucose. Stools were assessed for carbohydrate‐fermenting bacteria, acetate, glucose, and 13C abundance; blood was assessed for acetate; and breath was assessed for hydrogen. Some of the infants eliminated the infusate per anus within 30 min of the infusion (group I; n = 5), while others did so 120 min or more after the infusion (Group II; n = 9). The volume of fecal output after the intracecal infusion differed significantly between group I and group II (57 ± 13 vs. 24 ± 4 ml; p < 0.05). Although baseline breath hydrogen (3 ± 1 vs. 10 ± 4 parts per million) and plasma acetate (41 ± 4 vs. 47 ± 9 μM) values were not significantly different between groups, breath hydrogen values at 45 min after start of infusion were significantly lower in group I than in group II (3 ± 1 vs. 19 ± 5 ppm; p = 0.008); 60 min after start of infusion, plasma acetate levels were significantly lower in group I than in group II (34 ± 8 vs. 69 ± 11μM; p = 0.02), and the difference remained significant throughout the study. Regression analyses indicated a significant association between time elapsed from start of intracolonic infusion and plasma acetate (p = 0.014) and breath hydrogen (p = 0.04) levels for group II. Although we found good correlation between two indicators of colonic fermentation, blood acetate and breath hydrogen, these values did not correlate well with carbon scavenging or fecal bacterial counts. It is possible that the way the colon handles the infusate—i.e., water absorption and/or secretion—may affect carbohydrate fermentation.
Hepatic Toxicity Associated with 2′‐3'Dideoxyinosine in Children with AIDS
Authors: Lacaille Florence , Ortigao Maria Beatriz , Debré Marianne , Rouzioux Christine , Brousse Nicole , Blanche Stéphane
Published: January 2024

Among 34 children with AIDS enrolled in a trial with 2′‐3'dideoxyinosine (ddl), six (aged 1–6 years) developed liver abnormalities within 2–18 months after institution of ddl. Two children died of fulminant hepatic failure (one had also an adenovirus infection), and four had a striking elevation of alkaline phosphatases (AP: 1120–7000 IU/L). All of them received sulfa drugs and antifungic treatment with ketoconazole or fluconazole. Three had a serology positive for hepatitis C virus. The evolution of liver enzymes following withdrawal and re‐challcngc with ddl in the children with elevated AP was an indication of drug‐induced toxicity in two patients. In both of the others, readministration of ddl did not cause any subsequent problems. Liver histology in the patients with fulminant hepatitis showed an extensive hepatic necrosis. Liver biopsy done in two other patients revealed a mild granulomatous hepatitis in one and nonspecific changes (i.e., steatosis and a mild inflammation) in the other. Hepatic toxicity has been described with ddl and other nucleoside analogs in adult patients. These six children had many potential causes of liver disease. It may be that ddl is not hepatotoxic per se but that it precipitates liver disease in predisposed patients. We recommend that liver functions be carefully monitored when using this drug.
Immunochemical Characterization of Neural Cell Adhesion Molecule (NCAM), Nitric Oxide Synthase, and Neurofilament Protein Expression in Pyloric Muscle of Patients with Pyloric Stenosis
Authors: Kobayashi Hiroyuki , O'Briain D. Sean , Puri Prem
Published: January 2024

The etiology of hypertrophic pyloric stenosis (HPS) is not known. We made an immunocytochemical examination of pyloric muscle from 18 patients with HPS and 10 controls using specific monoclonal antibodies to neural cell adhesion molecule (NCAM) as well as neurofilament protein and NADPH‐diaphorase histochemistry. In HPS, bundles of hypertrophic muscle fibers expanded the circular muscle layer. The longitudinal muscle also appeared hypertrophic but to a less marked degree. The most striking difference between HPS and the control tissues was that NCAM, NADPH‐diaphorase, and neurofilament protein immunoreactive fibers were absent or markedly reduced within the hypertrophied circular and longitudinal musculature. In contrast, NCAM, NADPH‐diaphorase, and neurofilament protein immunoreactivity was preserved in the myenteric plexus where nerve fibers and ganglion cells were stained. The lack of expression of NCAM, NADPH‐diaphorase, and neurofilament protein on nerve fibers within the circular and longitudinal muscle in patients with pyloric stenosis suggests that the smooth muscle is not innervated in this condition.
Application of Organ Culture of Small Intestine to the Investigation of Enterocyte Damage by Equine Rotavirus
Authors: Batt R. M. , Embaye H. , van de Waal S. , Burgess D. , Edwards G. B. , Hart C. A.
Published: January 2024

We used organ culture of jejunal mucosal explants obtained from ponies aged between 2 and 12 months to study enterocyte damage by group A strains of equine rotavirus. Electron microscopy of jejunal explants maintained for 48 h in the presence of organ culture medium alone showed that entcrocytes were structurally intact and had a densely packed brush border and overlying mucus. Similarly, examination of explants maintained in the presence of rotavirus for 48 h revealed no apparent ultrastructural abnormalities. However, obvious replication and assembly of virus in enterocytes had occurred following exposure to equine rotavirus strains H2 (three of eight occasions), trypsinactivaled H2 (two of four), L338 (five of five), and EQ124 (two of two) although brush borders and intracellular organelles ap peared unaltered. Despite the absence of obvious ultra structural damage, analytical subcellular fractionatior showed that rotavirus infection can result in decreasec activities of microvillar membrane enzymes, with a par ticular loss of the main brush border peak of modal den sity 1.21 g/ml. These findings demonstrate that organ cul ture of small intestine may be applied to the investigatior of rotavirus pathogenicity; they further suggest that cer tain strains impair enterocyte function by affecting the turnover of microvillar membrane proteins.
Intestinal Microbial Bile Acid Transformation in Healthy Infants
Authors: Jönsson Gerd , Midtvedt Ann‐Christine , Norman Arne , Midtvedt Tore
Published: January 2024

Summary: Following the establishment of functionally active intestinal flora in three healthy Swedish children from birth up to 24 months of age, we investigated the development of different 24‐carbon bile acids. The fecal bile acids were group‐separated into unconjugated, glycine‐conjugated, taurine‐conjugated, and sulfated, so that we could follow the changes between the different fractions of conjugates. In meconium, most (55–63%) of the bile acids were conjugated with taurine; only 11–32% were conjugated with glycine. Deconjugation was the first sign of intestinal microbial activity on the bile acids. Already at 1 month of age, most of the bile acids were deconjugated; among the conjugated bile acids, the glycine‐conjugated dominated over the taurine‐conjugated. An unidentified conjugate of cholic and chenodeoxycholic acids (C, CDC) that separated with the sulfated bile acids was found. The unconjugated bile acids and those that arose from hydrolysis of existing conjugates were separated and identified by gas‐liquid chromatography coupled to mass spectrometry (GC‐MS). Twenty‐nine different bile acids were identified. In meconium, 16 different bile acids were identified. C and CDC were identified in all samples. The bile acid pattern changed during the course of the study. Many of the identified bile acids were only found in one or a few of the analyzed samples, and sometimes only in samples from one child. 6α‐hydroxylated bile acids, probably not microbially synthesized, were present at high percentages in the children. Child 2 was the first, at 6 months of age, to establish microbes with 7α‐dehydroxylase activity; at 24 months of age, the establishment was almost complete in all three children. At each sampling age, there was at least one sample containing bile acids with one or two hydroxyl groups that had been oxidized to oxo‐, or further reduced to a hydroxyl group in the p‐position. The sum of these metabolites varied between 0 and 26%, and no significant difference was found between meconium and the samples at 24 months of age.
New Views on the Pathogenesis of Kwashiorkor
Authors: Roediger W. E. W. , Waterlow J.
Published: January 2024

“We need to look again, without preconceived ideas, at the conditions of children in regions where the weaning diet is particularly low in protein”
Oxygen Radical Scavengers are Protective Against Indomethacin‐Induced Intestinal Ulceration in the Rat
Authors: Zahavi Ilan , Fisher Salvador , Marcus Hedva , Heckelman Bruria , Kiro Amnon , Dinari Gabriel
Published: January 2024

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used and may cause small intestinal inflammation and damage. Reactive oxygen metabolites are involved in various gastrointestinal inflammatory processes, but there is little information about their role in small intestinal mucosal damage induced by NSAIDs. We studied the effect of the oxygen radical scavengers superoxide dismutase (SOD), catalase (CAT), and allopurinol (ALLO) on indomethacin (INDO)‐induced intestinal ulceration in the rat. Ulceration was produced by s.c. injection of 30 mg/kg of INDO 30 min after refeeding 24 h‐fasted rats. Total ulcer area was measured 24 h after INDO administration. Study groups each consisted of eight animals which received either i.p. CAT, SOD, or both together, at a dosage of 5,000 U/kg each. All drugs were divided into five doses, given once an hour over a 4‐h period, starting at the time of INDO injection. Another group received 100 mg/kg ALLO in two doses. Total ulcer area was reduced by SOD from 228 ± 12 (sq mm, mean ± SEM) to 153 ± 12 (p < 0.001), by CAT to 179 ± 13 (p < 0.01), and by both together to 95 ± 5 (p < 0.0001). ALLO administration reduced the total ulcer area to 176 ± 7 (p < 0.003). The protective effect of oxyradical scavengers supports the hypothesis that oxygen radicals are involved in the pathogenesis of INDO‐induced small intestinal ulceration in the rat.
Effects of a Low Birthweight Infant Formula Containing Human Milk Levels of Docosahexaenoic and Arachidonic Acids
Authors: Koletzko Berthold , Edenhofer Sylvia , Lipowsky Gert , Reinhardt Dietrich
Published: January 2024

Long‐chain (LC) polyunsaturated fatty acids (PUFA) (LCP) are considered conditionally essential nutrients for low birth weight infants (LBWI). Therefore, enrichment of LBWI formulae with metabolites both linoleic (ω‐6) and α‐linolenic (ω‐3) acids at levels typical for human milk has been recommended. However, previous feeding trials with LCP‐enriched formulae evaluated only a dietary supplementation with ω‐3 LCP from fish oils alone or with both ω‐3 and ω‐6 LCP at levels considerably lower than usual human milk contents. We studied the effects of an LBWI formula providing the major ω‐3 and ω‐6 LCP, docosahexaenoic and arachidonic acids, in amounts similar to those in average human milk. Twenty‐seven LBWIs were enrolled in this study when they tolerated full enteral feeding (≥ 130 ml milk/kg/day). Infants either received their own mother's milk (n = 8, birth‐weight 1218 ± 146 g, gestational age 30.2 ± 1.5 weeks, mean ± SD) fortified with protein and minerals (FM‐85, Nestle Ag, Munchen, Germany; dosage 5 g/100 ml milk) or were randomly assigned to blinded batches of an LBWI formula (Prematil, Milupa AG, Friedrichsdorf, Germany) without LCP (n = 10, 1280 ± 229 g, 31.1 ± 3.1 weeks) or with LCP (n = 9, 1253 ± 334 g, 30.4 ± 3.3 wks.). During the study period of 21 days, the three feeding groups did not differ in growth and feeding tolerances as assessed by occurrence of gastric residuals, spitting, or abdominal distention; however, firms stools were noted more frequently in the two formula groups. Compared to infants fed human milk, those on formula without LCP showed significant depletion of plasma phospholipid arachidonic acid (reduced to 74% of levels found in infants fed human milk) and, even more marked, of docosahexaenoic acid (reduced to 64%) as well as total LCP (74%), within 3 weeks of full enteral feeding. In contrast, infants receiving the LCP‐enriched formula achieved an LCP status equal to that of human milk‐fed babies. Results indicate that LBWI absorb formula LCPs and incorporate them into endogenous phospholipids. There were no adverse effects of LCP enrichment on vitamin‐E status. We conclude that the LCP enrichment of the formula used in this study was well tolerated, did not interfere with short‐term growth or vitamin‐E status, and provided sufficient amounts of essential fatty acids to match the ω‐3 and ω‐6 LCP status of infants fed human milk.