bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac, Respiratory, and Arousal Responses to an Esophageal Acid Infusion Test in Near‐Term Infants During Active Sleep
Authors: Ramet Joseph , Egreteau Laurent , Curzi‐Dascalova Lilia , Escourrou Pierre , Dehan Michel , Gaultier Claude
Published: January 2024

This study was designed to determine the cardiac, respiratory, and arousal responses to an esophageal acid infusion test in near‐term infants free from neurological, gastroesophageal, and cardiopulmonary disease at time of testing during active sleep. Eight infants (gestational age 28–37.5 weeks, postconceptional age 36–40 weeks) were tested. Using standardized procedures and timing, we compared the cardiac, respiratory and arousal responses during a control period and during distal esophageal saline and acid infusion periods. The duration of each of these periods was 5 min. The pH of the acid infusion was 2.2. We found that this mild distal esophageal acid infusion test induced significant prolongation of the interval between successive electrocardiogram R waves compared with control and saline infusion periods (806.5± 145.7 ms, 478.8± 49.4 ms, and 468.8± 37.2 ms, respectively; p < 0.01) and of the duration of the respiratory cycle (2.9± 0.7 s, 1.5± 0.3 s, and 1.5± 0.2 s, respectively; p < 0.01). Esophageal acid infusion elicited significant electroencephalogram (EEG) arousal responses. The number of the EEG arousals was significantly increased during the acid period as compared with control and saline infusion periods (2.9± 1.4, 0.5± 0.5, and 0.4± 0.5, respectively; p < 0.01). Total arousal duration was significantly increased during acid as compared with control and saline infusion periods (42± 17.5 s,4.5± 5.1 s, and 3.5± 5.0 s, respectively; p < 0.01). We conclude that distal esophageal acid stimulation elicits significant cardiac, respiratory, and EEG arousal responses in near‐term infants during active sleep.
Nutritional Rehabilitation in Cystic Fibrosis
Authors: Dalzell A. M. , Shepherd R. W. , Dean B. , Cleghorn G. J. , Holt T. L. , Francis P. J.
Published: January 2024

Previously, we reported catch‐up weight gain, growth, and improved lung function in a group of malnourished cystic fibrosis (CF) children receiving aggressive nutritional supplementation for 1 year compared with a forced expiratory volume in 1 s (FEV1)‐, height‐, and sex‐matched comparison group receiving standard therapy. To evaluate long‐term effects, the clinical progress of both groups has been studied over a 5 year period. The supplemented group (n = 10) received supplements for a median of 1.35 years to achieve nutritional rehabilitation. Compared with the nonsupplemented group (n = 14), the previously supplemented group had lower mortality (2 vs. 4, N.S.) and significantly greater weight and height z scores at 4 and 5 years. The progression of pulmonary function abnormalities as measured by FEV1 and forced vital capacity (FVC) slopes was greater at 3 years in the nonsupplemented group (FEV1, p < 0.05) but no significant differences in rates of deterioration of pulmonary function were seen after 5 years in the two groups of survivors. We conclude that intensive nutritional support for 1 year has both short‐ and long‐term effects on nutrition and growth, still evident some years after the cessation of this therapeutic modality. Supplementation for periods of longer than 1 year may produce greater gains and possibly prolong the improvement in pulmonary function observed in the earlier study.
Volatile Fatty Acids, Lactic Acid, and pH in the Stools of Breast‐Fed and Bottle‐Fed Infants
Authors: Ogawa Kumiko , Ben Ricardo A. , Pons Silvina , Paolo María Isabel L. , Fernández Luis Bustos
Published: January 2024

We measured fecal pH, volatile fatty acids (VFA), and lactic acid concentrations in 67 healthy infants ranging in age from 1 to 5 months. The babies were divided into five groups according to their diet: group 1: human milk, with subgroups of 1 month of age (n = 8), and 2–5 months (n = 12); group 2: formula milk, with subgroups of 1 month of age (n = 9) and 2–5 months (n = 10); group 3; cow's milk, one group of 2–5 months of age (n = 12); group 4: human milk supplemented with formula milk, 2–5 months of age (n = 8); and group 5: human milk supplemented with cow's milk, 2–5 months of age (n = 8). Fecal VFA concentration and pH of bottle‐fed infants (groups 2 and 3) were significantly higher and lactic acid concentrations significantly lower than those of the breast‐fed group. Groups 4 and 5 showed significantly higher pH and propionic acid concentration, and lower lactic acid concentration than Group 1 did. There were no significant differences in the data on pH, VFA, and lactic acid concentrations between the feces of formula and cow's milk groups. On the other hand, the addition of formula or cow's milk to the human milk was sufficient to alter the profile of VFA, the pH, and the lactic acid concentration of breast‐fed infants stools. Low pH, low VFA, and high lactic acid concentrations make the colonic content of breast‐fed babies an environment favorable for Bifidobacteria growth, and this is probably the main protective factor against gastrointestinal infections.
Developmental Changes in Lactase‐Phlorizin Hydrolase Precursor Isoforms in the Rat
Authors: Dudley Mary A. , Shulman Robert J. , Reeds Peter J. , Rosenberger Judy N. , Putman Margaret , Johnston Pamela K. , Perkinson J. Scott , Nichols Buford L.
Published: January 2024

The purpose of this study was to determine whether the developmental decline in lactase specific activity ((μml mol/min/g protein) in the rat was associated with (a) changes in the relative quantities of immunoisolated precursor and mature forms of the enzyme purified by SDS‐PAGE and/or (b) immunohistologic changes in the jejunal mucosa. We studied 10− and 16‐day‐old suckling rat pups, 22‐day‐old weaned rat pups, and adult female rats (nongravid, pregnant, and lactating). Lactase activity was three‐ to fourfold higher in 10‐day‐old pups than in adult rats. Lactase activity was 27% greater in lactating compared with nongravid or pregnant rats. Three molecular forms of the enzyme that migrated identically in all animals were observed on SDS‐polyacrylamide gels stained with Coomassie blue: 140‐kDa (mature brush border form), 200‐kDa, and 220‐kDa (apparent precursor forms). There was a striking difference in the proportions of the three polypeptides at different ages that was unrelated to animal status, i.e., pregnant or lactating. As the animals aged, the relative amount of the 140‐kDa band declined from 86 ± 1.1% of the total immunoprecipitated lactase in 10‐day old suckling pups to 68 ± 0.7% in adults. Simultaneously, the relative concentration of the 200‐kDa band rose from 1.7 ± 0.4% in the 10‐day‐old to 19 ± 0.6% in adults. The relative concentration of the 220‐kDa polypeptide did not change as a function of age. In vivo radiolabel infusion studies using [3H]phenylalanine demonstrated that the isotope was first incorporated into the 200‐kDa band and later into the 140‐kDa band. Thyroxine treatment induced a precocious decrease in lactase activity and an increase in the relative concentration of the 200‐kDa precursor in the 16‐day‐old, but not the 10‐day‐old pup. Immunofluorescent microscopy demonstrated lactase in the brush border membranes of all animals. No staining of the crypt cells was observed in 10‐day‐old animals. By 16 days of age, faint crypt staining was seen, intensifying in the older animals.
Surfactant‐like Material in the Antral Gastric Mucosa of Children
Authors: Sbarbati Andrea , Deganello Antonio , Tamassia Gianni , Bertini Marina , Gaburro Dino , Osculati Francesco
Published: January 2024

It has been proposed that the hydrophobicity of the gastric mucosa is due to surfactant‐like material (SLM), mainly composed of phospholipid, adsorbed to the mucosal surface. Biochemical and physiological studies have been performed in different mammals but morphological data on children are lacking. In the present work, the presence of SLM on the antral gastric mucosa of children has been studied by electron microscopy. The results demonstrate that SLM is present and shows two different forms, lamellar bodies and lamellar layers. In the mucosae without endoscopic, histologic, and ultra structural alterations we have found SLM when the tannic acid method has been used but not when the tissue has been fixed only in glutaraldehyde. Our results suggest that in children with ultrastuctural alterations of the epithelium, the amount of gastric SLM is increased in respect to children with a normal mucosa and that the amount of SLM on the surface of the gastric antral mucosa is modified in pathologic conditions.
Selected Summaries
Authors: Sherman Philip M.
Published: January 2024

This paper outlines a study evaluating the effect of three different solutions administered rectally in left‐sided ulcerative colitis. The study was designed to increase the concentration of short‐chain fatty acids (SCFAs) in the colon. In the first trial, six adult patients with distal ulcerative colitis who had failed treatment with oral sulfasalazine, oral prednisone, and either rectal corticosteroids or 5‐aminosalicylates were treated for 2 weeks with an alkaline solution containing sodium hydroxide, polyvinylpyrolodine, p‐hydroxybenzoic acid esters, and glycine. In the second trial, nine different adult patients with distal colitis who were also unresponsive to the above‐mentioned medications were treated for 2 weeks with a solution containing sodium propionate and sodium butyrate. In the third trial, 12 additional patients with distal colitis unresponsive to oral sulfasalazine and rectal steroids or 5‐aminosalicylic acid (but not oral prednisone as in the other groups) were treated for 6 weeks with a solution containing sodium acetate, sodium propionate, and sodium butyrate and adjusted to pH 7.0. In each trial, the test solution was given as a 50 ml enema twice daily. In trial 1, there was no improvement in clinical symptoms, sigmoidoscopic appearance, or histology. In trial 2, five patients improved clinically, four demonstrated endoscopic evidence of improvement, and three showed histologic improvement in disease activity. Six patients had improvement in at least one parameter, but complete remission of clinical symptoms or histologic colitis did not occur in any patient. Of the 12 patients in trial 3, 1 dropped out because of complete remission of symptoms and another because of lack of improvement. Of the ten completing the 6 week course, 9 were “much improved.” Endoscopic improvement in colitis was observed in nine. All histologic scores also improved, with two becoming histologically normal and three “near normal.” One patient relapsed within a month of discontinuing treatment, one after 4 months, six patients continued in remission at 12 months, and two were lost to follow‐up.
EFFECTS OF CHOLECYSTOKININ RECEPTOR BLOCKADE ON PANCREATIC AND BILIARY FUNCTION IN HEALTHY VOLUNTEERS
Authors: Werlin Steven L. , Schwarzendrube J , Niederau M , Lutlen R , Neiderau C.
Published: January 2024

The role of exogenous cholecystokinin (CCK) in the regulation of pancreatic and biliary secretions was evaluated in healthy adult volunteers using loxiglumide (formerly compound CR‐1505), a specific CCK antagonist. Gastric contents were continuously removed by aspiration and the second part of the duodenum was perfused with a mixed, liquid test meal containing a non‐absorbable marker [polyethylene glycol (PEG) 3000]. Duodenal contents were then aspirated from the region of the ligament of Treitz and levels of trypsin, chymotrypsin, amylase, bilirubin, and PEG determined by standard methods. Venous blood samples were obtained at 20 min intervals for determinations of CCK (by bioassay), insulin, and C peptide (radioimmunoassay). Gallbladder volumes were determined by ultrasonography. The ability of loxiglumide to inhibit pancreatobiliary secretion stimulated by exogenous cerulein, a CCK agonist, was also determined using similar methods.

At a dose that mimics postprandial plasma CCK concentrations, loxiglumide inhibited the pancreatic and gallbladder responses to the test meal. Secretion of pancreatic enzymes was decreased by up to 75% compared with controls. Gallbladder contraction and bilirubin output were abolished. Loxiglumide also inhibited the secretion of pancreatic enzyme stimulated by exogenous cerulein. In contrast, loxiglumide failed to abolish changes in the plasma concentrations of glucose, insulin, and C peptide following the test meal.
Increased Serum IL‐2R Levels in Coeliac Disease Are Related to CD4 But Not CD8 Antigens
Authors: Blanco A. , Garrote J. A. , Arranz E. , Alonso M. , Clavo C.
Published: January 2024

Forty‐three coeliac children, ranging from 1 year and 3 months to 14 years and 9 months, were studied. Twenty‐eight patients were in an active phase of the disease, and 15 were in remission. The criteria of coeliac disease (CD) activity were established according to the results of IgA anti‐endomysial antibodies (IgA‐AEm). In‐terleukin 2 receptor (IL‐2R) and CD4 and CD8 antigens were measured in serum samples by an ELISA technique using two noncompetitive monoclonal antibodies. An‐tigliadin antibodies of IgG (IgG‐AGA) and IgA (IgA‐AGA) classes were also measured. The AEm‐positive coeliac patient group showed values of 1,860 ± 948 U/ml for IL‐2R, 430 ± 228 U/ml for CD8, and 36.8 ± 25.1 U/ml for CD4. AEm‐negative patients showed values of 980 ± 436 U/ml, 350 ± 243 U/ml, and 24.1 ± 20 U/ml, respectively. IL‐2R levels were the only ones significantly elevated (p < 0.005) in the active coeliac group. On the other hand, IgG‐AGA and IgA‐AGA were both clearly increased (p < 0.001). IL‐2R levels in active coeliac patients correlated with CD4 levels (p < 0.05), but not with CD8, IgG‐AGA, and IgA‐AGA levels. We also found a surprising negative correlation between AEm antibodies of IgA2 class with both IL‐2R (r = 0.471; p < 0.05) and CD8 (r = 0.616; p < 0.05). The results show that in CD there is a lymphocyte activation affecting mainly CD4 + cells and not correlated with serum AG A levels, suggesting an independence of both immunological phenomena and probably with different locations of origin.
Measured Resting Energy Expenditure in Children
Authors: Firouzbakhsh Shahin , Mathis Richard K. , Dorchester Wendy L. , Oseas Ronald S. , Groncy Paula K. , Grant Kenneth E. , Finklestein Jerry Z.
Published: January 2024

The majority of equations used to predict values for basal metabolic rates (BMRs) are the result of indirect calorimetry measurements performed in the 1930s and 1950s. To assess the reliability of these equations in predicting the resting energy expenditure (REE) of the children in our community, indirect calorimetry was performed on 92 male and 107 female healthy children 2–3 h postprandial. Each individual was measured for a duration of 15–20 min. The data for analysis were obtained from 5–15 min steady‐state periods. Subjects ranged in age from 5 to 16 years. The results were compared with BMRs calculated from the Harris‐Benedict equation (Harris J, Benedict F. A biometric study of basal metabolism in man. Washington, DC: Carnegie Institute of Washington, publication no. 279, 1919.), the Food and Agriculture Organization/World Health Organization/ United Nations University (FAO/WHO/UNU) equations, and the equations proposed by Schofield for use by the 1985 FAO/WHO/UNU Nutrition Committee. The values predicted by the FAO/WHO/UNU and Schofield equations were consistent with the measured resting values for all the children in the study population. Ninety‐two children weighed between 90–110% of their ideal body weight. When the measured REE and estimated BMR were compared by gender and age in these children, the Schofield equations provided the best estimates. Ninety‐four of the study subjects weighed >110% of their ideal body weight. The predicted estimates by all equations were consistent with the measured values in this subgroup of the population. We conclude that the FAO/ WHO/UNU and Schofield equations are reliable estimates of metabolic rate in healthy children when measurement of REE is not possible.
Endoscopic and Histologic Findings in the Upper Gastrointestinal Tract of Children with Coeliac Disease
Authors: Oderda Giuseppina , Forni Marco , Morra Isabella , Tavassoli Kaveh , Pellegrino Paolo , Ansaldi Nicoletta
Published: January 2024

Frequency of mucosal damage to the esophagus, stomach, and duodenum was investigated in 176 children with coeliac disease (CD) during 230 upper GI en‐doscopies performed to obtain duodenal biopsy specimens and was compared with findings in 230 age‐matched children who underwent endoscopy for upper GI complaints without CD (non‐CD patients). To evaluate a possible association with gluten ingestion, we then compared frequency of mucosal damage in patients on a gluten‐containing diet and those on a gluten‐free Diet (GFD). In children with CD, frequency of esophageal damage seen at endoscopy and of peptic esophagitis shown by histology were significantly lower than in non‐CD patients (p < 0.01) due to the very low frequency of mucosal damage in CD children on GFD; however, frequency of columnar metaplasia was significantly higher (p < 0.05). At endoscopy, CD children had a significantly lower frequency of gastric abnormalities, but histology showed a higher prevalence of superficial chronic gastritis (SCG; p < 0.01). SCG was associated with gluten ingestion, since its frequency in CD children on GFD was similar to the frequency in non‐CD patients. At endoscopy, frequency of duodenal mucosal damage was similar in CD and non‐CD patients. In addition to villous atrophy, histology showed a significantly higher frequency of duodenitis in CD children on a gluten‐containing diet (p < 0.001 vs. non‐CD patients; p < 0.05 vs. CD children on GFD). Our findings show that the mucosa of the whole upper GI tract can be damaged in CD patients and that the prevalence of some changes is higher with a gluten‐containing diet.
The Prevalence of Helicobacter pylori‐Positive Serology in Asymptomatic Children
Authors: Blecker Uwe , Hauser Bruno , Lanciers Sophie , Peeters Stefaan , Suys Bert , Vandenplas Yvan
Published: January 2024

Epidemiologic data are presented about the prevalence of Helicobacter pylori positivity as determined by serology in a large series of asymptomatic children (n = 466). Serology is now generally accepted as a valid noninvasive screening method for the detection of Helicobacter pylori infection. Blood samples were taken from 466 apparently healthy children (ages 2–14 years) who were admitted to our pediatric 1‐day clinic for elective surgery. The children originated from different ethnic backgrounds. All were born in Belgium and have been living there ever since. Thirty‐four (7.3%) had positive titers for Helicobacter pylori. There was a significant increase in the number of positive patients with advancing age (5.4% in the age group 2–8 years and 13.4% in the age group 8–14 years; p < 0.001). We also found a significant difference in the prevalence of Helicobacter pylori positivity between Caucasian Belgian children and non‐Caucasian children of different ethnic backgrounds. This relatively high prevalence of positive serology in asymptomatic older children (13.4%) should be considered in studies on the incidence or causative role of Helicobacter pylori in children with chronic abdominal complaints.
Transmission Electron Microscopy of Microvilli of Intestinal Epithelial Cells in Celiac Disease in Remission and Transient Gluten Enteropathy in Children After a Gluten‐Free Diet
Authors: Dyduch Antoni , Karczewska Krystyna , Grzybek Henryk , Kamiński Marcin
Published: January 2024

The structure of microvilli of intestinal epithelial cells was investigated in 70 children: 34 with celiac disease in remission, 28 with transient gluten enteropathy after a gluten‐free diet, and eight controls. Transmission electron microscopy was used to determine the mean thickness of the glycocalyx layer covering the microvilli, the mean length and width of microvilli, and the number of microvilli per 1 μm length of enterocyte surface. The structure of the glycocalyx was found to be intact, but in some children with treated celiac disease the layer of glycocalyx was either thin or absent on the surface of individual cell microvilli. In children with treated celiac disease, microvilli were statistically significantly shorter than those in children with transient gluten enteropathy and controls. Microvillous width in treated celiac disease was greater as compared with that in controls. There was no difference in the number of microvilli on the enterocyte surface in the three groups.
Growth Failure in Pediatric Inflammatory Bowel Disease
Authors: Markowitz James , Grancher Kathy , Rosa Joanne , Aiges Harvey , Daum Fredric
Published: January 2024

To assess whether children with inflammatory bowel disease (IBD) develop permanent impairment of linear growth, we analyzed records from 48 young adults who had IBD during childhood or early adolescence (Tanner I‐III; 11.8 ± 2.4 years old at diagnosis). All were fully grown (Tanner V; 21.1 ± 3.0 years) at last examination. Adult heights were predicted from data obtained at or shortly after the diagnosis of IBD by three methods: height for age percentile, the Bailey‐Pinneau (BP), and Roche‐Wainer‐Thissen (RWT) methods. Predicted adult heights were then compared with the actual ultimate height of each subject. Permanent growth failure occurred in 19–35% of subjects, depending upon the method used to assess growth. Overall, 31% (15 of 48) of the subjects had deficits of adult height identified by two or more methods, including 14 of 38 (37%) of those with Crohn's disease but only one of 10 with ulcerative colitis. Age at diagnosis of IBD, age at last examination, age at cessation of linear growth, and site of IBD did not differ between impaired and normal growth groups. Duration of corticosteroid use was longer (p < 0.05) in growth‐impaired subjects. In addition, although 60% of all subjects had periods of poor growth that put them in height‐for‐age percentiles two or more major growth channels below previous percentiles, only 19% remained at these levels upon achieving their final adult heights. Permanent impairment of linear growth leading to clinically meaningful deficits of ultimate adult height is common in patients with IBD in childhood or early adolescence. New therapeutic approaches are needed to address this problem.
Histological Comparison of Suction Capsule and Endoscopic Small Intestinal Mucosal Biopsies in Children
Authors: Granot Esther , Goodman‐Weill Michal , Pizov Galina , Sherman Yoav
Published: January 2024

Small intestinal biopsies are part of the routine evaluation of children with chronic diarrhea and malabsorption, and are commonly performed via suction capsule. Because this technique entails x‐ray exposure, longer procedure time, and technical failures, most small intestinal biopsies in adults are currently obtained via endoscopy. Endoscopy is believed to yield morphologically inferior specimens, and, therefore, its use for obtaining small intestinal biopsies in children has remained limited. The histological adequacy of biopsy specimens obtained in 30 children by endoscopy and in 30 children by suction capsule was compared. Biopsies were assessed for quality of orientation, size (length and depth), presence of Brunner's glands and crush artifact, and for the ability to confirm or exclude a mucosal abnormality. Small intestinal biopsies obtained via endoscopy were shown to yield tissue specimens that are histologically comparable to those obtained by suction capsule, and that are equally suitable for interpretation.
Ulcerative Colitis in Children 10 Years Old or Younger
Authors: Gryboski Joyce D.
Published: January 2024

The onset and course of ulcerative colitis diagnosed in 38 children at or before 10 years of age were reviewed. The mean age at onset was 5.9 years. A family history of inflammatory bowel disease was present in 24% of patients, and 13% had a history of cow milk allergy in infancy. Initially, by radiologic or colonoscopic studies, 71% had total colonic disease, 13% had left‐sided colitis, and 6% had proctitis: extensive examination was not performed in 4 patients. Four patients (11%) presented with severe colitis. 14 (37%) with moderate colitis, and 20 (53%) with mild colitis. The most frequent symptoms were abdominal pain (94%), diarrhea (84%), and rectal bleeding (84%). Between 2 and 10 years after diagnosis, 89% of children had total colonic disease and 11% had left‐sided disease. All four patients with severe disease at onset responded to medical therapy with one having a colectomy 15 years later with pathology consistent with Crohn's disease. Of those with moderate disease, half had infrequent moderate recurrences and half had intermittent mild disease. One patient had colectomy at 21 years for intractable disease. Of the 20 with mild disease, 16 continued to have intermittent mild recurrences, I had chronic mild disease. 2 had moderate recurrent disease, and 1 has remained asymptomatic for 5 years. Psychiatric disturbances requiring therapy were identified in 5 (13%) children. Results are encouraging: after the first 2 years of illness, two thirds of the children have had subsequent mild colitis with infrequent relapses and three quarters consider their life to be of good quality.
Breast‐Feeding Habits Among Jewish and Arab Mothers in Hadera County, Israel
Authors: Heldenberg D. , Tenenbaum G. , Weizer S.
Published: January 2024

A survey of breast‐feeding habits of Jewish and Arab mothers was carried out in Hadera county in Israel. Jewish mothers breast‐fed their babies ∼3 months, while Arab mothers did so for 5 months. The rate of breast‐feeding among Jewish and Arab mothers was 84% and 94.4%, respectively. The results indicated that education, previous experience, enjoyment, husband's encouragement, previous information about the importance of breast‐feeding, belief that breast‐feeding strengthens the mother‐child relationship, and the convenience of breast‐ over bottle‐feeding were all factors that had an impact on breast‐feeding habits among Jewish but not Arab mothers. Breast‐feeding as a means of birth control, religion, and impairment of the breast's shape were factors that had no effect on either Arab or Jewish mothers. Complications during pregnancy and cesarean delivery decrease the probability of breast‐feeding in Arab and Jewish mothers. Jewish mothers stopped breast‐feeding because of insufficient milk, fatigue, work obligations, and physician's recommendation. Among Arab mothers the main reasons were insufficient milk, physician's recommendation, baby's refusal, and nipple problems. Jewish mothers who decided not to breast‐feed stated that the reasons were previous experience with insufficient milk, nipple problems, and unpleasant feelings. The few Arab mothers who did not breast‐feed cited medical or nipple problems.
Smectite in Acute Diarrhea in Children
Authors: Madkour Ahmed A. , Madina Ekram M. H. , El‐Azzouni Omar E. Z. , Amer Maysa A. , El‐Walili Tarek M. K. , Abbass Tarek
Published: January 2024

Dioctahedral smectite (DS) a natural adsorbent clay capable of adsorbing viruses, bacteria, and other intestinal irritants in vitro, is claimed to possess beneficial “antidiarrheal” properties. This study tested the effect of DS on the duration of diarrhea and the frequency and amount of liquid stools. Ninety well‐nourished boys, aged 3–24 months, with acute watery diarrhea and mild, moderate, or severe dehydration were included in a randomized double‐blind, placebo‐controlled trial. After initial rehydration, they received DS or placebo (1.5 g freshly dissolved in 50 ml of water, four times daily for 3 days) along with oral rehydration solution (ORS) and adequate feeding. The clinical characteristics of both groups were comparable on admission.

Patients in the smectite group had a significantly shorter duration of diarrhea (mean ± SD, 54 ± 16 vs. 73 ± 13 h) and significantly fewer stools (2.6 ± 0.8 vs. 3 ± 0.7 on second day; 1.9 ± 0.7 vs. 2.4 ± 0.7 on third day; and 11.3 ± 3.2 vs. 13.8 ± 3 overall). The amount of liquid stools was not significantly reduced. Weight gain at 24, 48, and 72 h and on recovery was significantly higher in the smectite group despite the comparable fluid and food intake in both groups. These results suggest a beneficial effect of DS in shortening the duration of diarrhea and reducing the frequency of liquid stools in children rehydrated with ORS.
The Constitutive Exocytotic Pathway in Microvillous Atrophy
Authors: Phillips Alan , Fransen Jack , Hauri Hans‐Peter , Sterchi Erwin
Published: January 2024

Microvillous atrophy is a disorder within the intractable diarrhea of infancy syndrome. The disease is believed to stem from a transport defect that prevents exocytosis of brush border‐related material. We investigated this hypothesis by examining the direct constitutive exocytotic pathway using sucrase‐isomaltase as a representative protein. We also studied various other brush border and lysosomal marker enzymes. The biosynthesis and localization of selected intestinal epithelial enzymes were studied in small‐intestinal mucosal biopsy specimens from a total of nine children with microvillous atrophy by: (a) metabolic labeling in organ culture, (b) radioiodination and immunoprecipitation, (c) indirect im‐munoperoxidase immunocytochemistry, and (d) immunogold electron microscopy. The results demonstrated that brush border enzymes were synthesized normally and could be located in the apical brush border membrane and on microvillous membrane within microvillous inclusions. Brush border enzymes were not detected in the “secretory granules” that accumulated within the apical cytoplasm of epithelial cells. Lysosomal enzymes were only detected within lysosomal bodies. Thus, the direct constitutive pathway is not involved in microvillous atrophy, and a disturbance of endocytosis or the indirect constitutive pathway is unlikely. Any transport defect in the disease probably involves a different, unidentified exocytotic pathway.
Solubility of Calcium Salts and Carrageenan Used in Infant Formulas Did Not Influence Calcium Absorption in Rats
Authors: Koo Jaeok , Weaver Connie M. , Neylan Michael J.
Published: January 2024

Calcium absorption from tricalcium phosphate (TCP) was compared to that from calcium chloride, CaCl2, in the presence and absence of carrageenan in the rat model. There was no difference in percent calcium absorption as indicated by femur uptake of TCP or CaCl2 intrinsically labeled with 45Ca given by gavage (78.4 ± 9.6 vs. 80.0 ± 5.9, respectively). Thus, the difference in solubility of the two salts did not influence calcium absorption. When TCP was delivered by gavage in a solution containing 1% carrageenan, calcium absorption was not decreased compared to that of a control without carrageenan. In this model, calcium from TCP in the presence of up to 1% carrageenan is well absorbed
Percutaneous Endoscopic Placement of the “Button” Gastrostomy Tube as the Initial Procedure in Infants and Children
Authors: Treem William R. , Etienne Nancy L. , Hyams Jeffrey S.
Published: January 2024

Percutaneous endoscopic gastrostomy (PEG) tube placement is routinely performed in children with special nutritional needs. For convenience and cosmetic reasons, many parents prefer a skin‐level, nonrefluxing, (“button”) gastrostomy tube. After healing of the track, a button gastrostomy tube can replace a PEG but this requires a second procedure. This study assessed the technique and complication rate of placement of a button gastrostomy tube mounted for endoscopic placement as the initial procedure. Seventeen patients (10 males), ages 4 months to 12 years were studied. All patients underwent successful placement of the button under conscious sedation using a standard endoscopic push technique. In the first 10 patients, an 18 French device was used. Four patients developed migration of the device into the track between 9 and 55 days after placement and the button was removed. Migration was preceded or accompanied by a wound infection in 3 of the 4 patients. In the next 7 patients, a larger, 24 French button was used without any wound infections or migration of the device. In thirteen patients with successful placement, a follow‐up period of 110–450 days has revealed no further complications. Placement of the button gastrostomy tube in infants and children can be accomplished using standard endoscopic techniques. However, further study of the optimal size of the device and optimal placement procedure to prevent wound infection and migration should be undertaken.
Regulation of the Ontogenic and Regional Expression of Intestinal Aminooligopeptidase
Authors: Reisenauer Ann M. , Castillo Ricardo O.
Published: January 2024

Aminooligopeptidase (AOP) is the predominant peptidase in the small intestinal epithelium. During postnatal development in the rat, characteristic ontogenic and regional patterns of AOP activities become established: To investigate the molecular mechanisms regulating the maturational changes in AOP activity, we compared AOP synthesis and assembly in the jejunum of suckling (14‐day‐old) and weaned (28‐day‐old) rats. AOP synthesis was assessed in vivo by intraperitoneal labeling with [35S]methionine. Both AOP activity and AOP synthesis doubled at weaning, while its posttranslational processing remained unaltered. To examine the mechanisms responsible for generating the regional differences in AOP activity in weaned rats, we contrasted the de novo synthesis, kinetic properties, total immunoreactive protein, and degradation of the jejunal and ileal peptidases. Although AOP catalytic activity was significantly greater in the jejunum than in the ileum, its synthesis rate and substrate affinity (Km) were identical at both sites. However, the ileal peptidase was degraded more rapidly than the jejunal enzyme (t 1/2 = 4 and 10 h, respectively). In summary, our data show that increased synthesis accounts for the ontogenic rise in intestinal AOP activity but that altered enzyme turnover produces the jejunal‐ileal gradient in AOP activity in weaned rats. Thus the ontogenic and regional expressions of intestinal AOP are defined by transcriptional/translational and posttranscriptional regulatory mechanisms, respectively.
Effects of a Gluten‐Free Diet on Serum Lipids and Lipoprotein (a) Levels in a Group of Patients with Celiac Disease
Authors: Pillan Maria Nazzarena , Spandrio Sara , Sleiman Intissar , Meini Antonella , Scalvini Tiziano , Balestrieri Gian Paolo
Published: January 2024

SummaryThe influence of nutrient absorption, caloric content, and diet on lipoprotein (a) [Lp(a)J concentration is uncertain. To our knowledge, there are no reports on Lp(a) behavior in malabsorption. Serum lipids and Lp(a) concentrations were evaluated in 17 celiac patients (5 male and 12 female patients; age range, 1–24 years) when the diagnosis was established and after a 3‐month gluten‐free diet. Mean total and low‐density lipoprotein cholesterol did not show significant change, while mean high‐density lipoprotein cholesterol rose and triglycerides decreased significantly after the diet. The Lp(a) concentration remained unchanged in all patients (median values, 35 mg/L before and 40 mg/L after the diet). Our results suggest that, in our patients, the lipoprotein profile was influenced by the gluten‐free diet, while the Lp(a) concentration was not modified.
Simultaneous Determination of Retinol, α‐Tocopherol, and 25‐Hydroxyvitamin D in Human Serum by High‐Performance Liquid Chromatography
Authors: Aksnes Lage
Published: January 2024

Determination of the serum or plasma levels of retinol (vitamin A), 25‐hydroxyvitamin D, and α‐to‐copherol (vitamin E) are the most frequently used parameters to evaluate status of vitamin A, D, and E, and also to assess the gastrointestinal absorption of the vitamins. We present a simple and sensitive method for simultaneous determination of these vitamins in 0.5 ml human serum or plasma. The vitamins were extracted from serum by methanol/iso‐propanol (80/20, v/v) and n‐hexane. The n‐hexane phase was evaporated and injected to a reversed‐phase (C‐18) high‐performance liquid chroma‐tography system. Elution was performed with methanol/ water (85:15, v/v) for 25‐hydroxyvitamin D and retinol, and after that by methanol/water (98:2, v/v) for α‐tocoph‐erol. The eluate was monitored by a UV detector at 265 nm for detection of the vitamins. Baseline separation was obtained for all vitamins, and the system also permitted separate determinations of the D2 and D3 forms of 25‐hydroxyvitamin D. The limit of detection and interassay variation for determination in 0.5 ml serum were 6.0 nmol/L and 6.2% for 25‐hydroxyvitamin D2, 6 nmol/1 and 6.1% for 25‐hydroxyvitamin D3, 0.035 μmol/L and 5.0% for retinol, and 1.2 μmol/1 and 5.5% for α‐tocopherol.
Bone Mineral Content and Dietary Calcium Intake in Children Prescribed a Low‐Lactose Diet
Authors: Stallings Virginia A. , Oddleifson Nancy W. , Negrini Barbara Y. , Zemel Babette S. , Wellens Rita
Published: January 2024

Bone density is related to body size and other factors including dietary calcium intake. The purpose of this study was to determine the effect of a low‐lactose, low‐calcium diet on the bone mineral content (BMC) of prepubertal children with documented lactose intolerance. Radial BMC was determined by single‐photon absorptiometry. Dietary intake was assessed by 24‐h recall and two 3‐day food records, and weight and height were measured. The group of lactose‐intolerant children was compared with a group of healthy children of similar age, gender, race, and size and to the prediction equations based on body size from Chan's Utah children. Nineteen children, ages 9.6 + 1.9 years, participated in the study. They were relatively short compared with standards (height Z score, −0.30 + 0.83). BMC was 0.428 + 0.081 g/cm in the study group versus 0.440 + 0.116 g/cm in the comparison group (n = 19; p > 0.05). Both the study group and the size‐selected comparison group had lower BMC than the Utah children. The diet of the study group was low in calcium: 84% of the Recommended Dietary Allowance in children < 11 years old and 32% in children >11. Calcium intake was associated (p = 0.03) with BMC in the study group after adjusting for body size. The low‐lactose diet resulted in a low calcium intake, and BMC was associated with calcium intake in prepubertal children with lactose intolerance. Evaluation of dietary calcium intake should be considered in this group of patients, with follow‐up dietary counseling, calcium supplementation (diet or medication), and bone density assessment when clinically indicated.
A Prospective Study of Shiga‐Like Toxin‐Associated Diarrhea in a Pediatric Population
Authors: Bégué Rodolfo E. , Neill Marguerite A. , Papa Elaine F. , Dennehy Penelope H.
Published: January 2024

Although population‐based studies have shown that children have the highest age‐specific incidence of infection with the Shiga‐like toxin‐producing E. coli (SLTEC), these sporadic case series were not focused specifically on the pediatric age group. We undertook a prospective study to determine the frequency of detection of SLT in an exclusively pediatric population. The study design minimized ascertainment and referral bias by systematically defining the population by the presence of diarrheal symptoms rather than by specific diagnosis, previous submission of stool for culture, or referral to a diarrhea study. All children < 10 years of age hospitalized at a tertiary care pediatric hospital, irrespective of admission diagnosis, were surveyed prospectively at admission and for 2 days thereafter for the presence of defined diarrheal symptoms. From May 1, 1991, to April 30, 1992, 227 patients and 92 age‐ and season‐matched controls were enrolled. Fecal SLT was detected in six (2.6%) patients, three of whom had E. coli 0157:H7 organisms were isolated; SLT was not found in any of the controls. SLT was more commonly detected in children 2–10 years of age and in bloody stools. Salmonella was isolated in six (2.6%) cases, Shigella in five (2.2%), and Yersinia in three (1.3%); rotavirus was detected in 46 (20.3%). Two patients with SLT‐associated diarrhea had hemolytic uremic syndrome (HUS), and four had hemorrhagic colitis. SLT‐associated diarrhea occurred in the summer and fall months in contradistinction to that with rotavirus, which occurred in the winter and spring. Because enteric infection with SLTEC may have serious sequelae, such as HUS, and because it occurs with a frequency comparable to that of other bacterial entero‐pathogens, the evaluation of diarrhea in pediatric patients should include a search for SLTEC, particularly E. coli 0157:H7.
Exclusive Whole Protein Enteral Diet Versus Prednisolone in the Treatment of Acute Crohn's Disease in Children
Authors: Ruuska T. , Savilahti E. , Mäki M. , Örmälä T. , Visakorpi J. K.
Published: January 2024

Nineteen children with either newly diagnosed or relapsed Crohn's disease were enrolled in a randomized study in which the efficacy of enteral feeding with a whole protein‐based formula was compared to high‐dose corticosteroids in achieving clinical remission and normalization of laboratory measurements. Ten children were treated by enteral feeding (Nutrison Standard, Nutricia), and nine received corticosteroids. Both treatment regimens lasted 11 weeks. The activity of Crohn's disease was similar in both groups before the commencement of the treatment. Clinical symptoms and signs, as judged by the pediatric Crohn's disease activity index and measurements relating to inflammatory activity (erythrocyte sedimentation rate, C‐reactive protein, blood leukocyte and platelet count, and serum immunoglobulins G and A) and to nutritional status (concentrations of serum albumin, prealbumin, hemoglobin) improved rapidly and significantly with as little as 2 weeks' treatment in both treatment groups. In both groups, there was one relapse within 8 weeks after discontinuation of treatment, and one patient in both groups was operated on during the treatment period. During the routine follow‐up after the trial (0.3–2.5 years; mean, 1.3 years) five of the corticosteroid group experienced a clinical relapse, whereas only one from the enteral feeding group relapsed. No side effects of enteral feeding were seen. Enteral feeding with a whole protein‐based formula proved to be as effective as high‐dose corticosteroid in the treatment of the acute phase of Crohn's disease and may prove to be the treatment of choice in pediatric patients with acute Crohn's disease.
Cyclosporine as an Alternative to Surgery in Children with Inflammatory Bowel Disease
Authors: Benkov Keith J. , Rosh Joel R. , Schwersenz Audrey H. , Janowitz Henry D. , LeLeiko Neal S.
Published: January 2024

Summary: Five children with ulcerative colitis for whom surgery was recommended were treated with cyclosporine. The five had received corticosteroids for 1–24 months. The group included two patients with acute‐onset ulcerative colitis and three with acute exacerbations of intractable corticosteroid‐dependent chronic ulcerative colitis. The average age at initiation of cyclosporine therapy was 13.8 years (range, 11.5–16); all five patients were boys. Cyclosporine was initiated in the hospital by continuous i.v. infusion. Trough levels of 400–600 ng/dl (measured by radioimmunoassay) were achieved, at which point oral cyclosporine was given and oral dosage was adjusted to similar levels. Significant hypertension requiring medical attention was seen in one patient. Of the two recently diagnosed acute cases, one failed to respond and required subtotal colectomy after 2 weeks of treatment, and the other, despite an initial response, had a subtotal colectomy 10 months later. Of the three corticosteroid‐dependent children, none was able to be weaned from corticosteroids and all underwent subtotal colectomy. Our experience emphasizes that the appropriate role of cyclosporine as therapy for children with ulcerative colitis is yet to be determined. Cyclosporine was not effective as an alternative to surgery in our patients.
Use of Serological Markers as a Screening Test in Family Members of Patients with Celiac Disease
Authors: Vitoria J. C. , Arrieta A. , Astigarraga I. , García‐Masdevall D. , Rodriguez‐Soriano J.
Published: January 2024

Summary: That symptomatic celiac disease (CD) can occur in several members of a family has long been recognized. Given the possible complications of untreated CD, it is also important to diagnose those family members with “silent” disease, to offer them the benefit of a gluten‐free diet. We studied 642 first‐degree relatives of 210 patients with CD, two of the latter belonging to the same family. IgA and IgG antigliadin antibodies and IgA antiendomysium antibodies were studied in all. Jejunal biopsy was performed in 59 subjects, 47 with positive and 12 with negative serological markers. Celiac disease was diagnosed de novo in 18 cases (2.8%). Diagnosis in a symptomatic mother was made by jejunal biopsy despite the negativity of all immunological markers. We conclude that the risk of having CD is higher in siblings than in parents of patients with CD, that the most useful marker for diagnosis is the study of IgA antiendomysium antibodies, and that the absence of positive serological markers does not completely exclude the diagnosis of CD.
Oral Rehydration Solutions
Authors: Go Jacob T. , Harper Rita G. , Sia Concepcion G. , Teichberg Saul , Wapnir Raul A.
Published: January 2024

Viscosity‐enhancing agents such as carboxymethylcellulose (CMC) can alter absorption of solutes and fluid exchange in the small intestine. We investigated whether the standard World Health Organization oral rehydration solution (WHO‐ORS) with the addition of CMC would improve net water and sodium absorption in rats using an in vivo intestinal perfusion technique. Four WHO‐ORS, containing either 0, 2.5,5.0, or 10.0 g/L of CMC, were perfused in rats with a well‐tested model of cathartic‐induced chronic osmotic diarrhea (D) and in normal controls (C). In D rats, the ORSs with CMC improved sodium absorption at the three concentrations used (p < 0.01). The same effect was shown in C rats. Net water absorption was also enhanced in D rats given ORSs with CMC, although the changes in C animals were less marked. The improvement in sodium and water absorption in both C and D rats positively correlated with the log of relative ORS viscosity. Ultrastructural examination of tissues perfused with 10 g/L of CMC showed an extended brush border glycocalyx. This study indicates that CMC added to WHO‐ORS in the perfused rat jejunum improves the effectiveness of the solution by increasing sodium and water absorption.