bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Study of Lactose Absorption During Cancer Chemotherapy
Authors: Pettoello‐Mantovani Massimo , Guandalini Stefano , diMartino Lucio , Corvino Cecilia , Indolfi Paolo , Casale Fiorina , Giuliano Maria , Dubrovsky Larisa , Di Tullio Maria Teresa
Published: January 2024

Chemotherapy is a recognized cause of morphological alterations to the proximal intestine. Lactose malabsorption, the functional consequence of a small intestinal enzymatic derangement, has been shown to play an important role in causing gastrointestinal symptoms in subjects receiving chemotherapy. To establish a rational basis for the exclusion of lactose from the diet and to reduce the risk of developing gastrointestinal symptoms, we conducted a study of lactose absorption in 20 children during cancer chemotherapy. Because lactose is an important nutritional sugar, the tolerance of lactose provided by yogurt was examined. Lactose absorption was investigated by a hydrogen breath test (BT) after oral ingestion of milk (250 ml) containing physiological doses of lactose (12 g). The effect of yogurt supplementation was also tested by BT after meals of yogurt (450 g) also containing physiological doses of lactose (12.1 g). In 11 children, lactose malabsorption was detected by BT during the study before any gastrointestinal symptom revealed this status. Of these 11 children, no gastrointestinal discomfort developed in five receiving a lactose‐excluded diet. In contrast, in the six children not restricted in lactose intake, gastrointestinal symptoms were observed 4 to 13 weeks after lactose malabsorption was detected by BT. The findings of our study suggested the usefulness of dietary supplementation with yogurt, a lactose‐containing food, in children who developed lactose malabsorption. In fact, all lactose‐malabsorbent children showed good lactose absorption and tolerance when tested by yogurt BT. Furthermore, a yogurt‐supplemented diet was also successful in three subjects initially recognized as lactose intolerant. In conclusion, the data presented have important implications in reducing the risk of developing gastrointestinal symptoms in children receiving cancer chemotherapy.
Comparison of an Oral Rice‐Based Electrolyte Solution and a Glucose‐Based Electrolyte Solution in Hospitalized Infants with Diarrheal Dehydration
Authors: Guiraldes Ernesto , Trivino Ximena , Figueroa Guillermo , Parker Myriam , Gutiérrez Carmen , Vásquez Alicia , Harún Abdalla
Published: January 2024

Summary: This randomized trial compared the efficacy of a rice‐based (50 g/L) oral rehydration solution with the standard glucose‐based WHO/UNICEF solution in the treatment of 100 hospitalized infants, ages 3–18 months, with acute dehydrating diarrhea. The main outcomes examined were stool output and duration of diarrhea. Patients were placed on a “metabolic” bed so that intake and losses could be measured accurately throughout the study. Overall, 89% of patients were successfully rehydrated orally; the rehydration failure rate was similar in the two groups and it was significantly associated with infection by specific E. coli serotypes. Stool output in the first 24 h was 11% lower in the rice group (112 versus 126 ml/kg), but this difference was not significant. Neither stool output in the second 24 h nor total stool output were different between groups. The median duration of diarrhea was 3.8 days in the rice group and 3.9 days in the glucose group (p = NS). Other (secondary) outcomes, such as fluid intake, urine output, emesis losses, weight change, and electrolyte balance were also similar between the two groups. Some evidence of carbohydrate malabsorption was detected in 61% of the rice group versus 45% of the glucose group (p = NS) and was not associated with any particular treatment outcome. These results show that a rice‐based oral rehydration solution is as efficacious as, but not better than the standard glucose‐based solution in the treatment of infants with acute dehydrating diarrhea not associated with cholera.
Receptor‐Mediated Binding of Milk Lactoferrin to Nursing Piglet Enterocytes
Authors: Gíslason Jóhannes , Douglas Gordon C. , Hutchens T. William , Lönnerdal Bo
Published: January 2024

Lactoferrin, an iron‐binding glycoprotein that is abundant in milk of some species, has been suggested to play a key role in the absorption of iron in human infants. This hypothesis is based on the dominant role of lactoferrin as an iron‐binding component in human milk and on the occurrence of lactoferrin receptors in brush‐border membranes in infants' intestines. The piglet may be a useful model to evaluate the biological activity of lactoferrin because we have previously found the presence of a lactoferrin receptor in brush‐border membranes from suckling piglets. In this study, viable enterocytes were isolated from 6− to 20‐day‐old suckling piglets. Binding studies were performed at 4°C using 125I‐labeled porcine lactoferrin. Scatchard analysis of equilibrium binding data showed an apparent binding constant (Kd) of 2 x 10‐6M (SD = 0.6 x 10‐6). This affinity is in close agreement with previous results obtained using isolated brush‐border membrane vesicles. Bovine lactoferrin inhibited the binding of porcine lactoferrin. Porcine transferrin, however, did not affect porcine lactoferrin binding significantly. Thus, lactoferrin binding is highly specific. When enterocytes were incubated with 125I‐labeled lactoferrin at 37°C, the amount of cell‐associated radioactivity exceeded the surface binding capacity of the cells by almost fivefold. This finding agrees with the continuous binding and subsequent internalization of 125I‐labeled lactoferrin. The isolated piglet enterocyte seems to provide a useful model for further studies of the mechanism of receptor‐mediated absorption of lactoferrin.
Stated Versus Actual Lipase Activity in Pancreatic Enzyme Supplements
Authors: O'Hare M. M. T. , McMaster C. , Dodge J. A.
Published: January 2024

We have carried out an independent investigation of the lipase activity of several pancreatin preparations, including high‐lipase preparations of pancreatin that have recently become available. Six preparations from three pharmaceutical companies, Cilag, Duphar, and Merck, were analyzed during the recommended shelf life of the preparation and included a standard and a high‐lipase preparation from each manufacturer. All preparations studied showed lipase activity in excess of that which was stated on the packets, and in some cases it was more than twofold. This has important implications for patients and prescribers since changes in apparent enzyme requirements may reflect differences in the potency of batches with time. As it is impossible to evaluate capsule requirements with each new batch prescribed, the presence or relief of symptoms of malabsorption will probably continue to be the way in which most patients monitor their enzyme supplementation on a regular basis. We believe that clinicians need to be aware of the extent of possible intrinsic variation between individual prescriptions before attempting to define possible dose/symptom relationships.
Endomysial Antibodies as Unreliable Markers for Slight Dietary Transgressions in Adolescents with Celiac Disease
Authors: Troncone Riccardo , Mayer Marina , Spagnuolo Ferdinando , Maiuri Luigi , Greco Luigi
Published: January 2024

Adolescents with celiac disease often fail to adhere to a strict gluten‐free diet. The value of endomysial antibodies in assessing the dietary compliance of such adolescents has been assessed in 23 patients divided into four groups according to their daily gluten intake. Serum endomysial antibodies were absent in all subjects on a gluten‐free diet and consistently present in those ingesting >2 g/day of gluten. Only one of six and three of six teenagers with celiac disease with an intake of <0.5 and 0.5–2 g/day, respectively, had endomysial antibodies in their serum, despite the presence in three of six and five of six of significant changes in the mucosal architecture, as shown by computerized morphometry of jejunal biopsies. In conclusion, endomysial antibodies cannot be considered a valid marker for slight dietary transgressions.
Linear Growth After Colectomy for Ulcerative Colitis in Childhood
Authors: Nicholls S. , Vieira M. C. , Majrowski W. H. , Shand W. S. , Savage M. O. , Walker‐Smith J. A.
Published: January 2024

Eighteen children and adolescents, of a total of 90 treated in our unit between 1982 and 1992, underwent colectomy for ulceractive colitis. Six (6.7%) of the 90 patients had short stature, i.e., a height below the 3rd centile, and 8 of the 18 who had surgery had a subnormal height velocity, i.e., below the 25th centile for age at the time of surgery. Surgery was performed for resistance to medical therapy (n = 13) or toxic megacolon (n = 5). Surgery was followed by catch‐up growth, i.e., increasing height velocity, in eight subjects and cessation of the trend of diminishing height velocity, but without catch‐up growth, in five. In 11 of the subjects who were prepubertal, the median height velocity increased from 3.85 cm/ year preoperatively to 7.35 cm/year postoperatively (p < 0.01). One year after surgery, 14 of the 18 patients were either asymptomatic or substantially improved. Surgery therefore led to improved linear growth and a prolonged symptom‐free period in most of the children and adolescents with ulcerative colitis undergoing this treatment.
Microbes to Fight Microbes
Authors: Saavedra Jose M.
Published: January 2024

For centuries, fermentation of milk products using specific bacteria or cultures has been a way to preserve dairy foods. In 1908, Metchnikoff suggested that ingested lactobacilli could displace toxin‐producing microorganisms in the gastrointestinal (GI) tract and thus promote health and prolong life (1). In the latter half of this century, evidence mounted in support of the concept that the preservation of gut microflora in animals is necessary to prevent infections. It was recognized that germ‐free animals are more susceptible to infection than animals colonized with microflora (2) and that giving fecal suspensions orally to animals could prevent infection (3). Fecal enemas were successfully administered to humans to control C. difficile infection (4); conversely, it was recognized that antibiotics can alter intestinal flora and induce diarrhea. All this information led to the concept that a healthy or balanced microflora is necessary for maintaining the health of the host; one way to maintain balanced microflora is to ingest exogenous bacteria in order to incorporate them into the gut milieu. Many published observations have claimed a variety of health benefits from several microbial agents. Among the benefits attributed to the consumption of these organisms are improvement of lactose absorption and tolerance, control of intestinal infections, anticarcinogenic properties, anticholesterolemic effects, and improvement of GI motility (5,6). These attributions became part of the nutritional folklore that has conferred upon yogurt and other cultured milk products the status of “health foods.‘’
Helicobacter pylori‐Associated Gastroduodenal Disease in Symptomatic Chilean Children
Authors: Hodgson María Isabel , Pantoja Humberto , Latorre Juan Jose , Vial Pablo , Henríquez Alejandra , Wenger Jonny , Peña Alfredo , Siri maría Teresa , Guiraldes Ernesto
Published: January 2024

A newly developed enzyme‐linked immuno‐sorbent assay (ELISA) IgG serological assay for the diagnosis of Helicobacter pylori infection was used recently in two epidemiological surveys in Chile. To evaluate the diagnostic efficacy of this assay in a local symptomatic pediatric population, we studied 70 school‐age patients referred for upper gastrointestinal endoscopy because of complaints suggestive of gastroduodenal disease. Evidence for antral H. pylori infection was sought by three biopsy‐related methods: culture, histology, and urease activity. IgG anti‐H. pylori serum antibodies were determined by ELISA. Altogether, chronic antral gastritis was found in 55 patients and duodenal ulcers in nine; 11 subjects had normal histology. Sixty (86%) patients had H. pylori in the antrum. This group had significantly higher mean IgG optical density values when compared with the H. pylori‐negative group (1.860 versus 0.669; p < 0.001). The sensitivity and specificity of the assay in detecting antral H. pylori were both 90% the positive predictive value was 98% and the negative, 60%. Accuracy of the assay was superior in predicting the presence or absence of gastroduodenal lesions with a sensitivity of 96%, a specificity of 92%, a positive predictive value of 98%, and a negative predictive value of 86%. We conclude that the diagnostic efficiency of this assay renders it appropriate both to screen for H. Pylori‐associated gastroduodenal disease in individual patients and to be used in seroepi‐demiological surveys.
Evaluation of Fat Utilization in Paediatric Crohn's Disease Using 13C‐Labelled Fat
Authors: Odeka E. B. , Miller V.
Published: January 2024

Summary: Carbon‐13 breath tests provide a safe and non‐invasive way of assessing nutrient absorption and utilization. Disordered protein and carbohydrate metabolism have been reported in children with Crohn's disease, but little is known about their fat utilization. To assess fat oxidation, 13C‐Hiolein was administered to 11 children with active Crohn's disease (age range, 10.5–16.9 years; mean, 12.6) before and after treatment with steroids. Expired breath samples were collected at hourly intervals for 12 h, and 13CO2 excretion was measured by mass spectrometry. The mean 95% confidence interval (Cl) time to peak 13CO2 excretion was 9 h (range, 7.73–9.97) before treatment and 6.95 h (range, 5.75–8.15) after treatment (p < 0.02). Mean 95% Cl cumulative 13CO2 excretion up to peak time (7 h) was 47.53% (range, 24–69%) before treatment and 68.7% (range, 35–80.5%) after treatment with steroids (p < 0.02). Our results demonstrated impaired lipid utilization during active disease and improvement following steroid treatment. The oral 13C‐Hiolein test is simple and noninvasive, and its results are reproducible. It provides a new method for estimating fat utilization in paediatric patients, along with the possibility of discriminating between patients with and without impaired utilization during the acute phase of the disease.
Down Syndrome and Celiac Disease
Authors: Jansson U. , Johansson C.
Published: January 2024

Summary: Down syndrome is associated with immune‐related disorders such as hypothyroidism, insulin‐dependent diabetes mellitus, and celiac disease. In this study we determined antigliadin antibodies (AGA) in 54 patients with Down syndrome; 22 had AGA values above the cutoff limit. Nineteen patients underwent intestinal biopsy, and total or subtotal villous atrophy was found in nine. There was a total of 65 patients with Down syndrome in our area of southern Sweden; two were already known to have celiac disease. The minimum prevalence of celiac disease in Down syndrome in this area in southern Sweden was 11 of 65 or 16.9%.
Efficacy of Ursodeoxycholic Acid in the Treatment of Primary Sclerosing Cholangitis in Children
Authors: Gilger Mark A. , Gann Mary E. , Opekun Antone R. , Gleason Wallace A.
Published: January 2024

Background

Ursodeoxycholic acid (UDCA) has been shown to be beneficial in reducing disease activity in adult patients with primary sclerosing cholangitis (PSC). However, there has been little published regarding PSC in children and no studies investigating the efficacy of UDCA as a treatment for PSC.

Methods

This retrospective study included 10 children who were found to have the diagnosis of PSC during the past 15 years at the Texas Children's Hospital and Herman Hospital, both in Houston, Texas. The male:female ratio was 8:2, the median age of onset was 12 years (range, 1–17 years), and eight patients had coexistent inflammatory bowel disease (IBD; six ulcerative colitis, one Crohn's disease, one unspecified). At the time of diagnosis, five patients were asymptomatic, all of whom had IBD with elevated liver enzymes and three of whom had hepatomegaly. Nine patients were treated with UDCA. The one patient who did not receive UDCA was lost to follow‐up soon after diagnosis. The mean dose of UDCA was 17 mg/kg with the doses ranging from 9 to 37 mg/kg.

Results

There were no side effects from the medication recorded for any of the patients. These patients showed a significant reduction in alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and γ‐glutamyl transferase at 1, 3, 6, 15, and 20 months after treatment.

Conclusions

This study demonstrates that children with PSC treated with UDCA have significant improvements in liver biochemical indices. However, the long‐term effect of UDCA on clinical outcome is unknown.
Superoxide Dismutase and Glutathione Peroxidase Content of Human Milk From Mothers of Premature and Full‐Term Infants During the First 3 Months of Lactation
Authors: L'Abbe Mary R. , Friel James K.
Published: January 2024

Background

Human milk contains various bioactive compounds including numerous immunologic factors, enzymes, growth factors, and hormones. However, the change during the course of lactation in many of these compounds has not been fully characterized. Therefore, the objective of the present study was to measure the activity of the enzymes superoxide dismutase (SOD; Enzyme Commission number [EC] 1.15.1.1) and glutathione peroxidase (SeGSHPx; EC 1.11.1.9) in human milk, to record changes in enzyme activity over time and to determine whether there are differences in activity between the milk of mothers of full‐term (FT) and premature (PT) infants.

Methods

Nine samples were collected from each of 15 mothers (32 ± 4 years of age; mean ± standard deviation) of FT infants (gestational age, 40 ± 1 weeks; birth weight, 3544 ± 417 g) and 19 mothers (28 ± 5 years of age) of healthy PT infants (gestational age, 29 ± 4 weeks; birth weight, 1312 ± 479 g). Samples were collected within a week of birth (±1 day) and thereafter for 8 weeks, with a final collection at 12 weeks.

Results

During the 12‐week study period, in both groups, total milliunits of GHSPx and SeGHSPx per milligram protein and SOD per per milligram protein increased, whereas protein content declined. SeGHSPx per milliliter milk was higher in the PT group at week 1 (92 ± 30 mU/mL vs. 73 ± 21 mU/mL), week 2 (93 ± 28 mU/mL vs. 75 ± 24 mU/mL), and week 7 (85 ± 24 mU/mL vs. 68 ± 22 mU/mL). The SOD activity per milliliter milk and milligram protein was higher throughout the entire study in the FT milk.

Conclusions

Because mothers of PT infants may produce less milk than those of FT infants, PT infants may be at a disadvantage for antioxidant protection from these enzymes.
Human Leukocyte Antigen Class II Alleles in White Brazilian Patients With Celiac Disease
Authors: Silva Elza M. B. T. , Fernandes Maria I. M. , Galvão Livia C. , Sawamura Regina , Donadi Eduardo A.
Published: January 2024

Background

Celiac disease (CD) is a permanent gluten intolerance disorder characterized by malabsorption, intestinal mucosa villus atrophy, and crypt hyperplasia. Clinical and histologic features improve in persons consuming a gluten free diet. The pathogenesis of CD involves environmental, genetic, and immunologic factors.

Methods

The frequencies of human leukocyte antigen (HLA) class II alleles were evaluated in white Brazilian patients who had CD and compared with those observed in healthy individuals from the same geographical area (Ribeirão Preto, São Paulo) and of similar ethnic background. Twenty‐five patients with CD, 11 females and 14 males, and 91 control individuals were studied. The HLA class II alleles were typed using amplified DNA hybridized with sequence‐specific primers. Statistical analysis was performed using the two‐tailed Fisher exact test. The relative risk (RR), etiologic fraction (EF), and preventive fraction (PF) were also estimated. The EF represents the attributable risk for the development of CD at the population level, whereas PF represents the protective risk.

Results

The frequency of the HLA‐DRB1*03, HLA‐DRB1*07, and HLA‐DQB1*02 alleles was significantly increased in patients. The RR conferred by these alleles was 5.35, 7.15, and 10.6, respectively, and the EF was 48.7%, 44.7%, and 76%, respectively. The frequency of HLADQB1*06 alleles was significantly decreased in CD patients, conferring an RR of 0.08 and a PF of 48%.

Conclusions

The results show that HLA‐DRB1*03, HLA‐DRB1*07, and HLA‐DQB1*02 alleles conferred susceptibility to CD in Brazilian patients. In contrast, HLADQB1*06 alleles conferred protection against development of the disease.
Clinical Presentations and Predisposing Factors of Cholelithiasis and Sludge in Children
Authors: Wesdorp Isabel , Bosman Diederik , de Graaff Aafke , Aronson Daniël , van der Blij Frits , Taminiau Jan
Published: January 2024

Background

In contrast to adults, little is known about the epidemiology and the best therapeutic regimen for cholelithiasis and sludge in children.

Methods

Eighty‐two children with cholelithiasis detected by ultrasonography were studied from 0 to 18 years of age with regard to cause, symptomatology, and treatment outcome. Seventy‐five children with sludge within the same age group were studied as well.

Results

Idiopathic gallstones were found in 19 (23%) patients, and 32 (39%) had gallstones in association with a hemolytic disease. Predominant factors associated with the development of gallstones and clinical presentation differed with age. In patients with sludge, total parenteral nutrition and systemic infection or administration of antibiotics were most frequently found to be possible predisposing factors. Sludge can develop and disappear within a few days. Complications of cholelithiasis were observed in 13 patients. Cholecystectomy was performed in 41 patients and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction in 9 patients; 32 children were not treated. After a follow‐up (mean, 4.6 years) in 50 patients, 46% of the children who had cholecystectomy or therapeutic ERCP experienced clinical recurrence of abdominal symptoms. In the patients who did not receive surgical or endoscopic therapy during the follow‐up, no complications occurred, and only one patient experienced abdominal symptoms during follow‐up.

Conclusions

The difference in associated conditions may indicate that the pathogenesis of cholelithiasis and sludge differ as well. Furthermore, sludge should be viewed as a dynamic condition not predisposing for the development of gallstones, per se. Cholecystectomy should not be performed routinely but only after careful selection in patients at risk for complications.
Helicobacter pylori Infection in Recurrent Abdominal Pain
Authors: Frank Friederike , Stricker Tamar , Stallmach Thomas , Braegger Christian P.
Published: January 2024

Background

Helicobacter pylori is associated with chronic gastritis and peptic ulcer in adults and in children. The purpose of the present study was to analyze the association of recurrent abdominal pain and H. pylori infection in children and to evaluate the efficacy of antimicrobial treatment in patients with evidence of infection.

Methods

The clinical and histopathologic findings in children who underwent diagnostic upper endoscopy for recurrent abdominal pain were analyzed retrospectively. Patients with evidence of infection with H. pylori were treated with a combination of omeprazole, amoxicillin, and clarithromycin. Efficacy of treatment was assessed using the 13C‐urea‐breath test.

Results

H. pylori was found in histopathologic sections of 29 (40%) of 73 patients undergoing diagnostic endoscopy for recurrent abdominal pain. Five children (17%) were of Swiss ethnic origin, and 24 (83%) were non‐Swiss. All the infected patients had chronic gastritis and 4 (14%) had ulcerations in the duodenum. Treatment with omeprazole, amoxicillin, and clarithromycin resulted in eradication of the infection in all and in resolution of the clinical symptoms in 15 (80%) of 19 patients who had a follow‐up examination.

Conclusions

The presented data suggest that gastritis induced by H. pylori may be associated with recurrent abdominal pain and that in Switzerland infections with H. pylori primarily involve persons who are non‐Swiss. A combined therapy results in eradication of the bacterium and in improvement of the clinical symptoms in a significant majority of the patients.
Immune Response of Bangladeshi Children With Acute Diarrhea Who Subsequently Have Persistent Diarrhea
Authors: Azim Tasnim , Islam Laila N. , Sarker Mohammed S. , Ahmad Shaikh M. , Hamadani Jena D. , Faruque Shah M. , Salam Mohammed A.
Published: January 2024

Background

Because altered immune responses may be a risk factor for persistent diarrhea, various aspects of the immune response were examined to elucidate the underlying immune mechanisms that may be involved in the development of persistent diarrhea.

Methods

Children (7–12 months of age) with watery diarrhea for 6 to 8 days from the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), were enrolled. Children were classified as having acute diarrhea (AD) or persistent diarrhea (PD) if diarrhea resolved within 14 days or persisted for more than 14 days, respectively. Uninfected control children (n = 13), from the Nutrition Follow‐Up Unit of ICDDR,B were also enrolled. Of the 123 children with diarrhea who were enrolled, 85 had AD and 38 had PD. Comparisons were performed for clinical features, nutritional status (weight for age, plasma transferrin, and serum albumin levels), and immune responses: neutrophil function; peripheral blood mononuclear cell function, delayed‐type hypersensitivity (DTH) responses, plasma levels of immunoglobulins, tumor necrosis factor‐α, and interferon‐γ. Univariate analyses were conducted to assess differences among the three groups of children and between children with AD and PD. Logistic regression was performed to determine risk factors for PD.

Results

There were no differences in clinical features and nutritional status among the groups of children studied. More children in whom PD developed had a negative DTH response to tuberculin than those with AD (P = 0.021). Also, a negative DTH response to tuberculin was a significant risk factor for PD (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.5–9.9).

Conclusions

Children with acute diarrhea with a negative DTH response to tuberculin are more likely to have development of persistent diarrhea.
Vomiting and Gastric Motility in Infants With Cow's Milk Allergy
Authors: Ravelli Alberto M. , Tobanelli Pamela , Volpi Sonia , Ugazio Alberto G.
Published: January 2024

Background

Regurgitation and vomiting are common manifestations of cow's milk protein allergy (CMPA) in infants and are usually ascribed to gastroesophageal reflux (GER). Gastric anaphylaxis can induce antral dysmotility in the rat, and therefore the hypothesis for the current study was that cow's milk in sensitized infants may impair antral motility, thereby promoting GER and reflex vomiting.

Methods

Seven vomiting infants with CMPA and nine with primary GER underwent a challenge with cow's milk formula. Electrogastrography (EGG) was used to measure the spectral frequency (bradygastria = 1.5—2.4 cycles per minute [cpm], normogastria = 2.5–3.9 cpm, tachygastria = 4.0–9.0 cpm) and the postprandial‐to‐fasting power ratio of gastric electrical activity, whereas gastric half‐emptying time (T½) was measured by electrical impedance tomography (EIT).

Results

In CMPA and GER, respectively, during fasting, the frequency distribution (mean ± SD) of the EGG was as follows: normogastria 47.9% ± 12.5% versus 52.2% ± 9.8%, bradygastria 24.1% ± 5.7% versus 22.8% ± 8.3%, and tachygastria 28.0% ± 8.5% versus 25.0% ± 8.3%. In contrast, after the cow's milk challenge, the difference between the two groups was statistically significant: normogastria 33.1% ± 8.8% versus 70.6% ± 8.6% (P < 0.0001), bradygastria 38.0% ± 15.5% versus 15.7% ± 5.2% (P = 0.002), and tachygastria 28.9% ± 10.6% versus 13.4% ± 4.6% (P = 0.001. The postprandial/fasting power ratio (mean ± SD) was 3.2 ± 1.9 in CMPA and 8.1 ± 2.1 in GER (P < 0.0001). Gastric T½ (mean ± SD) of the cow's milk meal was 89.0 ± 26.3 minutes versus 54.0 ± 12.6 minutes (P = 0.003). In infants with GER all EGG parameters and gastric T½ were similar to that in 10 healthy control infants.

Conclusions

In sensitized infants, cow's milk induces severe gastric dysrhythmia and delayed gastric emptying, which in turn may exacerbate GER and induce reflex vomiting. Electrogastrography and EIT can be useful in the assessment of vomiting, GER, and CMPA in infants.
Bilirubin‐IXβ Is a Marker of Meconium, Like Zinc Coproporphyrin
Authors: Aziz Sina , Leroy Paul , Servaes Roger , Eggermont Ephrem , Fevery Johan
Published: January 2024

Background

Because meconium accumulates continuously in the fetal intestine, analysis of the postnatally excreted material could yield important information of intrauterine metabolism and maturation. Therefore, a study of the bilirubin pigments in meconium and in the first neonatal stools was carried out.

Methods

Meconium and stools from 37 neonates of various gestational ages were collected carefully, and stored at −20°C, protected by aluminium foil. Samples were defrosted, vortex mixed with an equal amount of dimethyl sulfoxide, centrifuged, and submitted to analysis by high‐pressure liquid chromatography using newly developed methods to identify and to quantitate the bilirubin‐IXα, ‐IXβ, ‐IXγ, and ‐IXδ isomers. In addition, samples were also submitted to diazo coupling with ethyl anthranilate. Total coproporphyrins and zinc coproporphyrin were assayed for comparison.

Results

Unconjugated bilirubin‐IXα and ‐IXβ were detected in meconium but not the ‐IXγ or the ‐IXδ isomer. Bilirubin‐IXβ was the predominant pigment and comprised 63% to 96% of the unconjugated bilirubins in the first sample of meconium excreted. Its amount decreased rapidly during the first 5 days in full‐term newborns, but this occurred more slowly in preterm neonates, especially in those with a gestational age less than 30 weeks. The decrease of bilirubin‐IXβ over time correlated with that of coproporphyrin.

Conclusions

Bilirubin‐IXβ is the prevailing bile pigment in the first excreted sample of meconium. It gradually decreases after birth and can be considered a biochemical marker of meconium, like zinc coproporphyrin.
Oroesophageal Motor Disorders in Pierre Robin Syndrome
Authors: Baujat Geneviève , Faure Christophe , Zaouche Abderhaman , Viarme Fabienne , Couly Gérard , Abadie Véronique
Published: January 2024

Background

Feeding disorders are one of the main clinical features in PRS, which combines a posterior U‐shaped cleft palate, retrognathia, and glossoptosis. The aim of this study was to evaluate the oral and esophageal motor function of children with PRS without additional neurologic symptoms.

Methods

All children hospitalized with Pierre Robin syndrome either isolated (n = 27) or associated with Stickler syndrome (n = 8) were included. Clinical evaluation of their oroesophageal disorders and systematic esophageal manometry were performed.

Results

Feeding disorders were always present, but type of disorder varied from one child to another. Esophageal disorders were frequent and seemed to be resistant to classic gastroesophageal reflux treatment. Eighty‐six percent of the children required nasogastric tube feeding for a mean duration of 8.6 months. Esophageal manometric abnormalities were noted in 50% of the children: lower esophageal sphincter hypertonia, failure of lower esophageal sphincter relaxation at deglutition, and esophageal dyskinesia. These clinical and manometric disorders showed a trend to spontaneous regression after 12 months.

Conclusion

In the current Pierre Robin syndrome series, clinical and manometric anomalies of oroesophageal motility were always present. The authors identified an unusual manometric pattern that has also been described in situations of neurovegetative instability. It could reflect dysregulation of the control of the central pattern generators of swallowing in the brain stem.
Nutritional Zinc Balance in Extremely Low‐Birth‐Weight Infants
Authors: Loui Andrea , Raab Andrea , Obladen Michael , Brätter Peter
Published: January 2024

Background

Zinc is important for metabolism, cell growth, immunity, and defense against oxygen radicals. Extremely low‐birth‐weight (< 1000 g) infants have higher nutritional needs, but information on zinc is scarce. The authors performed nutritional balances in 10 infants with birth weights of 500 to 999 g and who were fed with fortified human milk.

Methods

The authors collected infant feces, urine, and blood and human milk samples during 72 hours at 7 and 12 weeks of age. Zinc concentration was measured by inductively coupled plasma–mass spectrophotometry, atomic emission spectro‐photometry, and instrumental neutron activation analysis.

Results

Mean (SD) intake via human milk was 379 (± 373) μg · kg−1 · d−1 during both balances. Urinary excretion was high at 7 weeks of age, decreased to half at 12 week, and was negatively correlated (P < 0.01) with weight gain. Mean absorption was slightly positive at 7 weeks of age but zero or negative in most infants at 12 weeks of age. Retention was negative in all infants at both observation periods, except in one infant during the second balance. Clinical zinc deficiency developed in one infant at 12 weeks of age.

Conclusions

Zinc balances in extremely low‐birth‐weight infants are highly variable and usually negative. Controlled trials are needed to assess need for and benefits and risks of zinc supplementation.
The Effect of Antenatal Vitamin A and β‐Carotene Supplementation on Gut Integrity of Infants of HIV‐Infected South African Women
Authors: Filteau Suzanne M. , Rollins Nigel C. , Coutsoudis Anna , Sullivan Keith R. , Willumsen Juana F. , Tomkins Andrew M.
Published: January 2024

Background

Vitamin A is important for protection against diarrhea, and supplements may benefit gut function of infants of HIV‐infected mothers.

Methods

We studied 238 infants of HIV‐infected South African women participating in a randomized, double‐blind, placebo‐controlled trial of vitamin A during pregnancy (1.5 mg retinyl palmitate and 30 mg β‐carotene daily) plus 60 mg retinyl palmitate at delivery. The placebo group received identical placebo capsules at the same times. When infants were 1, 6, and 14 weeks of age, lactulose/mannitol dual sugar intestinal permeability tests were performed.

Results

Maternal vitamin A supplementation did not significantly affect infant gut permeability in the group as a whole at any time. By multiple regression analysis, HIV infection of the infant by 14 weeks was significantly associated with increased gut permeability at both 6 and 14 weeks. After controlling for birth weight, gestational age, current weight, feeding mode and recent morbidity, there was a trend toward an interaction between vitamin A supplementation and HIV infection (P = 0.086) at 14 weeks. Vitamin A made no difference to gut permeability of uninfected infants (lactulose/mannitol ratio for vitamin A group: 0.11, 95% confidence interval [CI] 0.08, 0.15, n = 73 and for placebo group: 0.09, 95% CI 0.06, 0.12, n = 76), but largely prevented the increase in the ratio of HIV‐infected infants (vitamin A group: 0.17, 95% CI 0.13, 0.23, n = 23; placebo group: 0.50, 95% CI 0.37, 0.68, n = 20). The effects on the lactulose/mannitol ratio were related to changes in lactulose, not mannitol, excretion. Vitamin A supplementation was associated with significantly lower lactulose excretion at 1 and 14 weeks, suggesting the major effect of vitamin A was on maintaining the integrity of gut tight junctions.

Conclusions

Vitamin A supplementation of HIV‐infected pregnant women may prevent the deterioration in gut integrity in the subgroup of their infants who themselves become infected. Improving vitamin A status of HIV‐infected infants may decrease their gastrointestinal morbidity.
Quality of Life in Inflammatory Bowel Disease: A Cross‐Cultural Comparison of English and Canadian Children
Authors: Richardson Gillian , Griffiths Anne M. , Miller Victor , Thomas Adrian G.
Published: January 2024

Background

Any disease and its treatment has an important impact on health‐related quality of life for affected individuals. There have been few previous studies on the quality of life for children with inflammatory bowel disease (IBD).

Methods

A cross‐cultural comparison was performed to determine whether the concerns of children with IBD in the United Kingdom are ranked similarly to those of children with IBD in Canada. An item reduction questionnaire, developed from interviews with Canadian children with IBD, was scored by 53 British children with IBD for importance and frequency, as a questionnaire had been scored previously by 117 Canadian children.

Results

There was a significant correlation between the mean scores (r = 0.831, P < 0.001) and ranks (r = 0.801, P < 0.001) for the 96 questions, and 43 of the 50 highest‐ranking concerns corresponded for both populations. Confidence interval analysis showed a significant difference between the mean values for 21 of the 96 items; 20 of these 21 were ranked higher in the United Kingdom than they had been in Canada, suggesting that the frequency and/or degree of concern was greater for the British children with IBD.

Conclusions

Health‐related concerns of British children with Crohn disease and ulcerative colitis correlate closely with those of Canadian children with those diseases. Further studies are needed to determine the sensitivity of individual questions, the most appropriate wording of these questions, and the optimal length for a proposed instrument to assess quality of life in children with IBD.
Familial and Community Environmental Risk Factors for Helicobacter pylori Infection in Children and Adolescents
Authors: Wizla‐Derambure Nathalie , Michaud Laurent , Ategbo Simon , Vincent Pascal , Ganga‐Zandzou Serge , Turck Dominique , Gottrand Frédéric
Published: January 2024

Background

The aim of the study was to identify familial and community environmental risk factors associated with Helicobacter pylori infection in a pediatric population.

Methods

Children requiring diagnostic upper endoscopy were included in the study during a 2‐year period. During endoscopy, five gastric biopsies were performed for the histologic or bacteriologic diagnosis, or both, of H. pylori infection. Epidemiologic data collected by a questionnaire were analyzed using the chi‐square test or Fisher test and stepwise logistic regression.

Results

The authors included 436 patients (242 boys), aged 2 days to 17.9 years (median, 2.7 years). H. pylori prevalence was 7.3%. Univariate analysis found H. pylori was more common in older patients (P < 0.00001), in children who had at least one parent born in a developing country (P < 0.02) or with a low socioeconomic status (P < 0.02), and in those living in crowded conditions (P < 0.02). Children whose mother worked at home were more frequently infected than children whose mother worked outside the home (P < 0.02). Attendance at nursery or school before the age of 6 years was not associated with infection. Logistic regression showed a strong association with H. pylori only for age and number of persons at home.

Conclusions

The source of H. pylori is intrafamilial rather than from a community, such as nursery and school attended at a young age. The number of persons in the home influences the infection status of children but not by the presence of the mother in home. These data suggest that H. pylori infection transmission occurs from siblings or the father rather than from mother.
Serologic Markers of Untreated Celiac Disease in Libyan Children: Antigliadin, Antitransglutaminase, Antiendomysial, and Anticalreticulin Antibodies
Authors: Ashabani Abdelhakim , Errabtea Haneva , Shapan Abdellatif , Tuckova Ludmila , Tlaskalova‐Hogenova Helena
Published: January 2024

Background

There are, as yet, no data available about the incidence of celiac disease in Libya. The aim of this study was to test the occurrence of serologic markers in a group of Libyan children with positive clinical and histologic findings indicative of celiac disease diagnosis.

Methods

Thirty‐nine children with untreated celiac disease and 50 healthy school children, all younger than 14 years, were included in the study. Enzyme‐linked immunosorbent assay for immunoglobulin G and immunoglobulin A (IgA) antigliadin, antitissue transglutaminase, and anticalreticulin antibodies was used to evaluate the serologic markers of the celiac patients. Immunoglobulin A antiendomysial antibodies were detected by indirect immunofluorescence using human umbilical cord tissue.

Results

Clinical symptoms at presentation were weight loss (82%), abdominal distension (61.5%), diarrhea or steatorrhea (59%), pallor (41%), abdominal pain (20.5%), constipation (15%), vomiting (10%), and short stature (7.7%). Most of these symptoms disappeared after introduction of a gluten‐free diet. Of 39 patients, only 23 (59%) were endomysium positive and positive also in all other serologic markers. The second group of patients with positive clinical and biopsy findings but antiendomysial antibody‐negative findings was subdivided into two subgroups according to the IgA antigliadin antibody results. Individuals in the IgA gliadin‐negative subgroup also lacked IgA autoantibodies.

Conclusions

The authors’ findings stress the importance of serologic testing not only for screening but also for confirmation of celiac disease.
Laparoscopic‐Assisted Versus Open Ileocolic Resection for Adolescent Crohn Disease
Authors: Diamond Ivan R. , Langer Jacob C.
Published: January 2024

Background

Laparoscopic‐assisted ileocolic resection for Crohn disease has been reported as an acceptable alternative to the open procedure in adults. We evaluated our experience with this procedure in the adolescent population.

Methods

All adolescents undergoing ileocolic resection for Crohn disease during a 3‐year period were retrospectively reviewed. Intraoperative and early postoperative results were analyzed, comparing those undergoing the laparoscopic‐assisted approach with those having open resection.

Results

Eleven patients (mean age, 15.6 years) underwent open and 12 patients (mean age, 16.5 years) underwent laparoscopic‐assisted resection. None had undergone previous resection. The two groups did not differ with respect to time from diagnosis to surgery, indications for surgery, preoperative medical therapy, operative time, or length of intestine resected. One patient in the laparoscopic‐assisted group was converted to an open procedure. There were no intraoperative complications in either group. Although no statistically significant differences were noted for number of days on narcotic, total dosage of narcotic, and time to regular diet, patients undergoing laparoscopic‐assisted resection were discharged 2.2 days earlier (5.4 vs. 7.6;P < 0.05). There was one wound infection and one intraabdominal abscess in the open resection group, and a single patient in the laparoscopic‐assisted group with postoperative fever and a wound infection.

Conclusions

Laparoscopic‐assisted ileocolic resection is a safe alternative to open surgery in adolescent patients with Crohn disease.
Vertical Transmission of Hepatitis C Virus in a Cohort of 2,447 HIV‐Seronegative Pregnant Women: A 24‐Month Prospective Study
Authors: Ceci Oronzo , Margiotta Marcella , Marello Fiorino , Francavilla Ruggiero , Loizzi Pasquale , Francavilla Antonio , Mautone Angela , Impedovo Luigi , Ierardi Enzo , Mastroianni Maria , Bettocchi Stefano , Selvaggi Luigi
Published: January 2024

Background

Mother to infant transmission of hepatitis C virus (HCV) has been extensively studied in mothers with human immunodeficiency virus (HIV) infection, whereas fewer data are available on the vertical HCV transmission in HIV‐negative women.

Methods

Between January 1995 and June 1997, 78 consecutive HCV‐positive/HIV‐negative women with their offspring entered this prospective study aimed to define the prevalence of and risk factors for HCV vertical transmission. Risk factors for HCV were carefully sought, and HCV viral load and genotype were determined in all positive mothers. The infants were tested for alanine aminotransferase (ALT) and HCV‐RNA at birth and at 4, 8, 12, 18, and 24 months of age.

Results

Eight of 60 (13.3%) infants born to HCV‐RNA positive mothers acquired HCV infection, but only 2 (3,3%) were still infected by the end of follow‐up. Infants' genotypes matched that of the mothers. ALT levels were in the normal range in all study subjects throughout the follow‐up. High maternal viral load (P < 0.05), possession of HCV risk factors (P < 0.004), and history of blood transfusion (P < 0.05) were associated with increased risk of HCV vertical transmission.

Conclusions

This long‐term prospective study shows that, although vertical transmission from HIV‐negative mothers occurs in 13% of cases, there is a high rate of spontaneous viral clearance (75%). High maternal viral load and mothers belonging to HCV risk categories were the only variables predictive of the vertical transmission.
Bacterial Translocation in Neonatal Rats: The Relation Between Intestinal Flora, Translocated Bacteria, and Influence of Milk
Authors: Yajima Masako , Nakayama Makiko , Hatano Seiko , Yamazaki Kumiko , Aoyama Yumi , Yajima Takaji , Kuwata Tamotsu
Published: January 2024

Background

A high incidence of bacterial translocation in neonates results not only from immaturity of host‐defense functions, but also from the dominant colonization of aerobic bacteria in the intestine. Bacterial colonization develops differently among breast‐fed, formula‐fed, premature, and full‐term infants. The purpose of this study was to examine the incidence of bacterial translocation and to identify the translocated bacterial species, relating these findings to the intestinal microflora and to the type of feeding in neonatal rats.

Methods

Animals were divided into three groups: breast‐fed normal pups (MR group), formula‐fed pups fed via an intragastric cannula implanted esophageally (AR group), and breast‐fed pups after the removal of the cannula (Sham group). Artificial rearing was achieved using a machine feeding system. Culture and identification of the bacteria in the intestine, mesenteric lymph nodes, liver, portal blood, and lungs were made using a simplified version of Mitsuoka's method.

Results

At 14 days of age, the dominant bacteria in the feces of the MR and Sham Groups were Enterobacteriaceae, Lactobacillus, and Enterococcus, but Enterobacteriaceae and Clostridium were significantly more common in the AR group than in the MR group. The dominant bacteria in the mesenteric lymph nodes were Enterobacteriaceae, Lactobacillus, and Staphylococcus. The extent of systemic bacterial translocation decreased earlier in the Sham group than in the AR group.

Conclusions

The frequency with which species of bacteria were cultured from mesenteric lymph nodes and other peripheral sites did not mirror the composition of the intestinal flora. Among the translocated bacteria, Staphylococcus may be especially hard to recognize and difficult for the host‐defense systems to destroy. Breast‐feeding inhibited systemic bacterial translocation in the suckling period of the rat.