bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Octreotide on Gastrointestinal Motility in Children with Functional Gastrointestinal Symptoms
Authors: Di Lorenzo Carlo , Lucanto Cristina , Flores Alejandro F. , Idries Shaheen , Hyman Paul E.
Published: February 2024

Background:

The somatostatin analogue octreotide has been proposed as a possible therapeutic agent in patients with abnormal gastrointestinal motility. This study was conducted to study the effects of 0.5 µg/kg and 1.0 µg/kg subcutaneous octreotide on antroduodenal motility in children with chronic gastrointestinal disorders.

Methods:

Twenty‐three children were studied, eight with intestinal pseudo‐obstruction, six with nonulcer dyspepsia, six with gastroesophageal reflux disease, and three with intractable constipation. After recording fasting motility for more than 4 hours, the children were randomized to receive 0.5 µg/kg or 1 µg/kg of subcutaneous octreotide. Motility was recorded for another hour after feeding in 12 children.

Results:

Phase III of the motor migrating complex was present in 13 of 23 children before and in 21 after octreotide (p < 0.02). All phase III episodes after administration of octreotide except one originated in the small intestine. Phase IIIs after octreotide were longer and were propagated faster than the spontaneous phase IIIs. There were no antral contractions during fasting after octreotide. There was a significant decrease in phase II intestinal motor activity in the hour after administration of octreotide (p < 0.001). There was no difference in effect between the two doses. After feeding, antral contractions were present in all children, and intestinal phase IIIs were not abolished.

Conclusions:

In children with chronic bowel disorders, subcutaneous octreotide induced phase IIIs that differed from spontaneous phase IIIs and were not inhibited by meals. Octreotide decreased antral motility during fasting and inhibited intestinal phase II. Feeding abolished the inhibitory effect of octreotide on antral motility.
Fecal Microflora in Healthy Infants Born by Different Methods of Delivery: Permanent Changes in Intestinal Flora After Cesarean Delivery
Authors: Grölund Minna‐Maija , Lehtonen Olli‐Pekka , Eerola Erkki , Kero Pentti
Published: February 2024

Background:

Newborn infants in modern maternity hospitals are subject to numerous factors that affect normal intestinal colonization‐for example, cesarean delivery and antimicrobial agents. To study the duration of the effect of external factors on intestinal colonization, two groups of infants with different delivery methods were investigated.

Methods:

The fecal flora of 64 healthy infants was studied prospectively. Thirty‐four infants were delivered vaginally, and 30 by cesarean birth with antibiotic prophylaxis administered to their mothers before the delivery. The fecal flora was cultured on nonselective and selective media in infants 3 to 5, 10, 30, 60, and 180 days of age. Gastrointestinal signs were recorded daily by the mothers for 2 months.

Results:

The fecal colonization of infants born by cesarean delivery was delayed. Bifidobacterium‐like bacteria and Lactobacillus‐like bacteria colonization rates reached the rates of vaginally delivered infants at 1 month and 10 days, respectively. Infants born by cesarean delivery were significantly less often colonized with bacteria of the Bacteroides fragilis group than were vaginally delivered infants: At 6 months the rates were 36% and 76%, respectively (p = 0.009). The occurrence of gastrointestinal signs did not differ between the study groups.

Conclusions:

This study shows for the first time that the primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after the birth. The clinical relevance of these changes in unknown, and even longer follow‐up is needed to establish how long‐lasting these alterations of the primary gut flora can be.
High Prevalence of Silent Celiac Disease in Preschool Children Screened with IgA/IgG Antiendomysium Antibodies
Authors: Korponay‐Szabó Ilma R. , Kovács Judit B. , Czinner Antal , Gorácz Gyula , Vámos Adrienn , Szabó Teréz
Published: February 2024

Background:

Because of the different sensitivity and specificity of serologic tests, the search for silent celiac disease is usually performed with the combined or sequential use of several tests. Among these, the IgA‐class endomysium antibody test has the highest specificity and positive predictive value, but it may overlook IgA‐deficient patients.

Methods:

To test a new one‐step screening approach, serum samples from 427 apparently healthy, 3‐ to 6‐year‐old Hungarian children were investigated for IgA‐class and IgG‐class endomysium antibodies using monkey esophagus and human jejunum as substrates.

Results:

Five new cases with flat mucosa were identified by strong endomysium antibody positivity and subsequent jejunal biopsy, yielding a celiac disease prevalence of 1:85. An additional child may have latent celiac disease (slight histologic changes at present). Two of the screening‐detected celiac patients exhibited only IgG‐class endomysium antibodies due to associated IgA‐deficiency. Despite the young age of the screened population, antigliadin antibodies were positive in only three of the five celiac patients.

Conclusions:

Prevalence of celiac disease in the study population was much higher than expected on the basis of antigliadin antibody‐based studies. The screening system used detected celiac cases in which there was IgA‐deficiency and those in which there was not and also those negative for antigliadin antibodies. The findings suggest the importance of the primary testing of autoantibodies in future celiac disease screening policies.
Identifying Immunoglobulin‐A‐Deficient Children and Adults Does Not Necessarily Help the Serologic Diagnosis of Coeliac Disease
Authors: Lock Robert J. , Unsworth David J.
Published: February 2024

Background:

Immunoglobulin A deficiency is more common in patients with coeliac disease and also in patients with other gastrointestinal diseases than in normal people. There is a concern, therefore, that routine serum immunoglobulin (Ig) A testing of all cases of suspected coeliac disease may lead to unnecessary biopsy.

Methods:

Four hundred eighty‐two routine consecutive samples from cases of suspected coeliac disease or malabsorption (109 children) were tested for IgA anti‐endomysium and total IgA. Four hundred twenty‐four sera samples also had IgG antigliadin checked for high‐titre antibody. Archived adult sera from 31 patients with coeliac disease and 52 disease control subjects were included in the study.

Results:

Seven routine cases with serum IgA less than 15% of the mean normal for age and four cases with undetectable IgA were identified. Four patients, including three of four with clear deficiency, underwent small bowel biopsy, and all four had normal histologic findings and normal intraepithelial lymphocyte counts. Only one of the seven had high‐titre IgG antigliadin antibody but that patient had normal histologic findings. One (3%) of 31 adults with established coeliac disease and 1 (2%) of 52 control subjects were IgA deficient.

Conclusions:

Of patients with IgA deficiency, only those with both IgA deficiency and high‐titre IgG antigliadin antibody should be routinely considered for biopsy.
S‐Fimbriae From Escherichia coli Bind to Soluble Glycoproteins From Human Milk
Authors: Schwertmann Annette , Schroten Horst , Hacker Jörg , Kunz Clemens
Published: February 2024

Background:

Escherichia coli (E. coli) strains, expressing S‐fimbriae, belong to the most common gram‐negative pathogens that cause sepsis and meningitis in neonates. The attachment of S‐fimbriae to the cell surface is mediated by membrane glycoconjugates, which often carry N‐acetylneuraminic acid.

Methods:

Binding studies were performed with glycoproteins from the whey fraction of human milk to investigate whether they exert a potential inhibitory effect on bacterial adhesion. Whey glycoproteins were separated according to their molecular weight by fast protein liquid chromatography gel filtration. After sodium dodecyl sulfate‐polyacrylamide gel electrophoresis, proteins were transferred to nitrocellulose membranes and incubated with isolated S‐fimbriae from recombinant E. coli strain HB (pANN 801‐4).

Results:

S‐fimbriae recognized four whey proteins with a molecular mass of more than 200 kDa, 170 to 150 kDa, and 80 kDa. Their glycosylation pattern was investigated using the lectins Sambucus nigra, Maackia amurensis, Galanthus nivalis, and Arachis hypogaea. Thus the presence of N‐ and O‐glycans in these proteins was confirmed. The preferential binding to N‐acetylneuraminic acid containing glycoproteins was demonstrated by a complete abolishment of these reactions by incubation with acidic lactose‐derived oligosaccharides. However, the cleavage of N‐acetylneuraminic acid from glycoproteins by mild acid hydrolysis revealed a second binding site for S‐fimbriae on milk proteins of a similar molecular weight range. Terminal galactose in human milk glycoconjugates were thought to react with S‐fimbriae as well.

Conclusion:

These data further support the opinion that glycoproteins from human milk are potential receptor analogues for certain bacteria that may prevent microbial adhesion to the epithelial cell surface.
Altered Intestinal Permeability to Mannitol in Diabetes Mellitus Type I
Authors: Carratù Romano , Secondulfo Mario , de Magistris Laura , Iafusco Dario , Urio Anna , Carbone Maria Grazia , Pontoni Gabriele , Cartenì Marilena , Prisco Francesco
Published: February 2024

Background:

Intestinal permeability has seldom been investigated in diabetes mellitus, even though patients frequently report gastrointestinal symptoms, and it has recently been shown that the prevalence of celiac disease associated with diabetes mellitus is higher than expected.

Methods:

Intestinal permeability to cellobiose and mannitol was investigated in 31 patients affected by type I uncomplicated diabetes mellitus. Values were compared with those obtained in 32 normal subjects.

Results:

The percentage of mannitol recovery was far higher than normal in two thirds of the investigated patients and correlated with the length of disease, even though the probes' ratio (cellobiose/mannitol) was in the normal range.

Conclusions:

A not previously reported increase of intestinal permeability to mannitol, clear‐cut and not associated with that of the larger probe, is found in type I uncomplicated diabetes mellitus. These results may describe a primary feature of type I diabetes mellitus and the initial steps of evolution of celiac disease.
Aluminum Contents of Human Milk, Cow's Milk, and Infant Formulas
Authors: Fernandez‐Lorenzo José R. , Cocho José A. , Rey‐Goldar M. Luz , Couce Mariluz , Fraga José M.
Published: February 2024

Background:

Aluminum toxicity is well documented and contamination of milk formulas has been implicated as the source of accumulation in bone and brain tissues. The purpose of the current study was to evaluate the aluminum contents of human milk, cow's milk, and infant formulas.

Methods:

Aluminum contents were determined by atomic absorption spectrometry in samples of human milk in the colostrum, intermediate, and mature stages; infant formulas from eight manufacturers; and various types and brands of commercially available cow's milk.

Results:

Mean aluminum concentration was lowest in human milk (23.4 ± 9.6 µg/l), and did not differ significantly between colostrum, intermediate‐stage and mature‐stage milk. Mean aluminum concentration was 70 µg/l in cow's milk, and 226 µg/l in reconstituted infant formulas. Aluminum concentrations in infant formulas differed markedly among manufacturers; concentration in milk from one of the manufacturers was particularly high (mean, 551 µg/l; range, 302‐1149 µg/l). These values are for milk reconstituted with aluminum‐free water under laboratory conditions; formulas prepared with tap water in the University Hospital's infant‐feeding unit had even higher aluminum content. Experiments showed that aluminum concentration in the high‐aluminum milk could be reduced by more than 70% at the manufacturing stage, by using low‐aluminum components.

Conclusions:

The results of the present study support the recommendations for infant formula manufacturers to strive to reduce aluminum concentration in their products.
Fish Oil Supplementation Does Not Impair the Gut Immune Response to Trichinella Spiralis Infection in Rats
Authors: Olivé Anthony P. , Dudley Mary , Harari Yael , Dudley Alden , Castro Gilbert A. , Lifschitz Carlos H.
Published: February 2024

Background:

Fish oil has been recommended as a source of ω‐3 fatty acids for preterm infants and for therapy of some inflammatory diseases.

Methods:

Because fish oil supplementation could downregulate the host's immune response, we studied the gut inflammatory response to an enteric infection in 72 rats assigned to three dietary groups with differing fatty acid profile: 1) fish oil, rich in eicosapentaenoic and docosahexaenoic acid; 2) olive oil, containing 71% monounsaturated fat; and 3) rat chow, containing 57% saturated fat. One half (n = 36) of the rats were infected with Trichinella spiralis larvae; the other half served as controls. The inflammatory response to initial infection (study 1), and type I hypersensitivity response to a subsequent parasite‐derived antigenic challenge (study 2) were assessed. Jejunal inflammatory cell infiltrate, mean villus height, disaccharidase levels, changes in short‐circuit current in response to glucose absorption, and chloride secretagogues (study 1) were measured 9 days after infection. Short‐circuit current changes induced by chloride secretion were measured when the proximal jejunum was challenged with T. spiralis‐derived antigen 40 days after infection (study 2).

Results:

In study 1, jejunal tissue from infected animals had more eosinophilic infiltrate, lower disaccharidase levels, and less glucose absorptive and chloride secretory capacity than tissue from noninfected animals. In study 2, the jejunum of infected animals showed an antigen‐induced chloride secretory response, whereas no response was obtained from jejunal tissue from noninfected animals. Type of diet did not affect the response in either study.

Conclusion:

Under the conditions of this experiment, fish oil supplementation did not interfere with the local intestinal inflammatory response after T. spiralis infection.
The Involvement of the Gastrointestinal Tract in Posttransplant Lymphoproliferative Disease in Pediatric Liver Transplantation
Authors: Younes Bassam S. , Ament Marvin E. , McDiarmid Sue V. , Martin Martin G. , Vargas Jorge H.
Published: February 2024

Background:

Posttransplant lymphoproliferative disease (PTLD) is a serious complication associated with the use of immunosuppression after transplantation. In a retrospective study the clinical features of PTLD located primarily in the gastrointestinal tract were analyzed.

Methods:

Three hundred ninety‐two consecutive pediatric patients who underwent orthotopic liver transplantation (OLT) during a 13‐year period with a survival of more than 6 months were reviewed. Two immunosupression protocols were used: cyclosporin A, or tacrolimus‐based primary therapy. Twenty‐nine randomly selected liver transplant recipients without PTLD were used for comparison of signs and symptoms of gastrointestinal PTLD.

Results:

Among the 30 patients identified with PTLD, 9 had gastrointestinal PTLD. The overall incidence density of PTLD was 1.8 per 100 patient‐years (30/392). Nine patients (30%) had involvement of the gastrointestinal tract, whereas 7 (23%) had the gastrointestinal tract as the only involved site. When compared with a cohort of liver transplant recipients without PTLD, only gastrointestinal bleeding, weight loss, hypoalbuminemia, and protein‐losing enteropathy were signs most likely associated with gastrointestinal PTLD. Hypoalbuminemia was the most sensitive sign of gastrointestinal PTLD. The lower tract (ileum and colon) was the most common site of involvement.

Conclusions:

Gastrointestinal involvement is common and occurs in 30% of all patients with PTLD. It may be the only affected organ in a subgroup of patients. Hypoalbuminemia, gastrointestinal bleeding, and weight loss are features that are characteristic of gastrointestinal PTLD. Patients with aggressive gastrointestinal signs and symptoms should undergo upper and lower gastrointestinal tract endoscopy with biopsy, to establish the diagnosis.
Growth Hormone and Insulin‐like Growth Factor‐I Therapy Promote Protein Deposition and Growth in Dexamethasone‐treated Piglets
Authors: Ward Wendy E. , Atkinson Stephanie A.
Published: February 2024

Background:

Dexamethasone treatment facilitates the weaning of premature infants from mechanical ventilation but impairs protein homeostasis, lean tissue deposition, and growth. The current study was conducted to investigate whether dexamethasone mediates these effects by reducing protein synthesis or elevating protein breakdown, and whether adjuvant growth hormone ± insulin‐like growth factor‐I therapy can attenuate such effects.

Methods:

Piglets (n = 24) were randomized to placebo, a tapered course of dexamethasone (0.5, 0.3, 0.2 mg/kg per day for 5, 5 and 4 days each, respectively), dexamethasone + growth hormone 0.1 mg/kg per day, or dexamethasone + growth hormone + insulin‐like growth factor‐I 0.1 mg/kg per day for 14 days. On day 13, 15N‐glycine was administered as a single oral dose, and urine was collected at timed intervals during the subsequent 48 hours.

Results:

Total urinary N and cumulative 15N excretion were higher in all dexamethasone groups than in control subjects. Protein synthesis was suppressed, whereas protein breakdown was unaltered by dexamethasone. Adjunctive growth hormone ± insulin‐like growth factor‐I therapy enhanced protein synthesis, but only combined therapy improved net protein gain compared with dexamethasone alone. Higher circulating insulin‐like growth factor‐I may have mediated the greater net protein gain. Blood urea nitrogen was elevated in all dexamethasone‐treated groups at days 6 and 11 but was normalized by day 15 with adjunctive growth hormone ± insulin‐like growth factor‐I. From a functional perspective, both adjunctive growth hormone and growth hormone ± insulin‐like growth factor‐I partially attenuated the dexamethasone‐induced reduction in weight and length gain but not in whole body lean and fat mass.

Conclusion:

Adjunctive growth hormone ± insulin‐like growth factor‐I therapy partially reverses the dexamethasone‐induced reduction in protein synthesis, resulting in improved growth when given concurrently with a low tapering dose of dexamethasone.
Prediction of Survival in Extrahepatic Biliary Atresia by Hepatic Duplex Sonography
Authors: Kardorff Rüdiger , Klotz Michael , Melter Michael , Rodeck Burkhard , Hoyer Peter F.
Published: February 2024

Background:

The clinical course of biliary atresia patients is extremely variable. To optimize conservative treatment and correctly schedule liver transplantation, noninvasive investigations that are predictive of individual survival and that can be performed regularly are needed. In this study, the prognostic value of Doppler sonography was investigated in these patients.

Methods:

Thirty biliary atresia patients (age range, 1 month to 15.2 years; mean, 4.0 years) and 38 control subjects underwent standardized Doppler sonography of liver and spleen. Biochemical tests of liver function and of fibrogenesis were performed in parallel. Individual clinical outcome was registered 1 and 2 years later.

Results:

In control subjects, maximum portal flow velocity (Vmax) was more than 16 cm/sec, and the hepatic vein flow pattern was triphasic. Among children with biliary atresia, those with diminished portal Vmax, a flattened hepatic vein flow curve, or a hepatic artery resistance index of 0.8 or more had significantly lower indices of hepatic protein synthesis (albumin, cholinesterase), higher bilirubin levels, and higher concentrations of markers of connective tissue turnover (procollagen peptides, laminin P1) than did those with normal Doppler sonography measurements. The rate of survival without transplantation during the following 2 years was significantly lower in children with abnormal Doppler findings. From portal and hepatic vein flow measurements, patient survival 2 years later could be predicted with an accuracy of 93%.

Conclusions:

In children with extrahepatic biliary atresia, Doppler sonography of the hepatic blood flow is a noninvasive indicator of disease severity. Moreover, it allows a highly accurate prediction of patient survival for the following 2 years.
Ineffectiveness of Breath Methane Excretion as a Diagnostic Test for Lactose Malabsorption
Authors: Myo‐Khin  , Bolin Terry D. , Khin‐Mar‐Oo  , Tin‐Oo  , Kyaw‐Hla S. , Thein‐Myint Thein
Published: February 2024

Background:

In clinical and field conditions, breath gas analysis has been widely used in evaluating carbohydrate digestion. A field study was performed to determine the prevalence of lactose malabsorption in Myanmar children and to evaluate the possibility of using breath methane excretion to indicate lactose malabsorption in a field situation.

Methods:

The study population consisted of 118 children aged 1 to 12 years. A hydrogen breath test after a lactose meal (2 g/kg, maximum 50 g) was used as a standard test.

Results:

Lactose malabsorption was detected in 16.7% of children aged 1 to 2.9 years, with the prevalence increasing with age from 40.5% of those aged 3 to 5.9 years to 88.5% of those aged 6 to 8.9 years and reaching 91.7% in those aged 9 to 11.9 years. Lactose malabsorption was more prevalent when children were weaned before 4 months of age (87.2 vs. 41.1%; p < 0.01). Compared with lactose‐tolerant children, those with lactose malabsorption had significantly higher concentrations of breath hydrogen excretion 60 minutes after the lactose test meal. Breath methane excretion was also significantly higher in samples at 120 minutes in children with lactose malabsorption. Breath methane excretion of greater than or equal to 2 parts per million at 180 minutes as a diagnostic test for lactose malabsorption had a sensitivity of 61.5% and a specificity of 84.6%.

Conclusion:

The breath methane test for lactose malabsorption has a lower sensitivity and specificity than the breath hydrogen test and therefore does not replace the lactose breath hydrogen test.
Ultrasound Measurements of Subcutaneous Adipose Tissue in Infants Are Reproducible
Authors: Flygare Annika , Valentin Lil , Karlsland‐Åkeson Pia , Flodmark Carl‐Erik , Ivarsson Sten‐A. , Axelsson Irene
Published: February 2024

Background:

The purpose of this study was to evaluate the ultrasound technique for measuring subcutaneous adipose tissue in infants.

Methods:

Twenty infants were investigated at 3, 6, and 12 months of age. All measurements were made by the same investigator in triplicate on the left side of the body at the triceps and subscapular anatomic landmarks and at the abdomen and thigh. An ultrasound system equipped with a linear 7.0‐MHz transducer was used.

Results:

The intraclass correlation coefficients were 0.88 to 0.99. Random errors ranged from 0.01 to 0.19 mm. For log‐transformed values, the random error ranged from 2.4% to 5.7%.

Conclusions:

Measurements of subcutaneous fat in infants using ultrasound are reproducible when performed by the same observer.
Lymphonodular Hyperplasia As a Sign of Food Allergy in Children
Authors: Kokkonen Jorma , Karttunen Tuomo J. , Niinimäki Aila
Published: February 2024

Background:

Lymphonodular hyperplasia of the gastrointestinal tract in children is a rare endoscopic finding of uncertain clinical significance. In this study, 12 children with lymphonodular hyperplasia of the duodenum from a series of 63 children were studied for recurrent abdominal pain. Four additional children with lymphonodular hyperplasia of the colon are described. All the patients with lymphonodular hyperplasia were also evaluated for food allergy.

Methods:

A gastroduodenoscopy was performed in the patients with recurrent abdominal pain and in the four in whom lymphonodular hyperplasia of the colon had been diagnosed by colonoscopy. An open oral elimination and challenge test to diagnose food allergies was scheduled for all subjects with lymphonodular hyperplasia or any suspicion of food allergy. The study design also included skin prick tests with common allergens and determination of serum immunoglobulin A and immunoglobulin E concentrations.

Results:

Lymphonodular hyperplasia of the duodenal bulb was the main finding in 12 (19%) of the 63 children. The condition was found to be associated with food allergy in nine subjects (75%), which was significantly more often than among the remaining 51, 12 (24%) of whom had food allergy by the same criteria. In an oral challenge, food allergy first manifested gastrointestinal symptoms in the subjects of both groups and, in all except one, on days 2 through 5 after the foodstuffs were administered in minimal doses. In a histologic study, the duodenal specimens revealed significantly more eosinophilic cells in the children with food allergy and lymphonodular hyperplasia than in the children with food allergy but no lymphonodular hyperplasia. The major symptoms in the four patients with lymphonodular hyperplasia of the colon had been anemia and blood in stool in two and abdominal pains with mucous loose stools in the remaining two. Colonoscopic examination showed one to have diffuse and the other three patchy lymphonodular hyperplasia of the colon. In an oral challenge, three reacted to milk and two to cereals.

Conclusions:

Preliminary observations showed that lymphonodular hyperplasia of the duodenum or the colon is related to the gastrointestinal type of food allergy to basic foodstuffs. Further research is needed to define this finding as a separate entity.
Enteral Insulin‐like Growth Factor‐I Augments Intestinal Disaccharidase Activity in Piglets Receiving Total Parenteral Nutrition
Authors: Park Yoo Kyoung , Monaco Marcia H. , Donovan Sharon M.
Published: February 2024

Background:

Partial enteral nutrition is administered to infants on parenteral nutrition to stimulate intestinal function. Herein, the hypothesis that supplementation of partial enteral nutrition with insulin‐like growth factor‐I would augment intestinal development was investigated.

Methods:

One‐day‐old piglets (n = 29) were randomly assigned to five dietary treatment groups: 100% of energy as enteral formula, 100% of energy as total parenteral nutrition, or 80% parenteral nutrition/20% enteral formula supplemented with either 0, 0.2, or 1 mg/kg insulin‐like growth factor‐I for 7 days. Weight gain, intestinal weight, morphology, protein, and DNA content and disaccharidase activity and mRNA expression were assessed.

Results:

Parenterally fed piglets had similar whole body weight gain and serum hormone concentrations but reduced intestinal mucosal weight, villus height, and sucrase and lactase activity compared with 100% enterally fed pigs. Partial enteral nutrition alone increased mucosal weight and protein content, villus height, and disaccharidase activity compared with 100% parenterally fed piglets. No effect of the lower dose of insulin‐like growth factor‐I (0.2 mg/kg per day) was observed, but supplementing partial enteral nutrition with 1 mg insulin‐like growth factor‐I/kg further increased villus width and cross‐sectional area and disaccharidase activity compared with partial enteral nutrition alone. Lactase mRNA expression was not affected by insulin‐like growth factor‐I, suggesting that the primary site of regulation of lactase by insulin‐like growth factor‐I occurs after transcription.

Conclusions:

Enteral insulin‐like growth factor‐I augmented intestinal morphology and disaccharidase activity in parenterally fed piglets over that observed with partial enteral nutrition alone. Thus enteral insulin‐like growth factor‐I may represent an efficacious clinical adjunct to promote intestinal development of parenterally fed neonates.
Gluten‐Free Diet Decreases Urinary Peptide Levels in Children with Celiac Disease
Authors: Ek J. , Stensrud M. , Reichelt K. L.
Published: February 2024

Background:

Increased urine secretion of peptides has been found in celiac disease, probably resulting from increased intestinal uptake of peptides caused by damage to the small gut mucosa.

Methods:

High‐performance liquid chromatography of low‐molecular‐weight peptides in the urine was performed over 6 months, before and after a gluten‐free diet was instituted in children who clinically improved while consuming the diet.

Results:

A significant decrease of peptide levels was observed in children consuming the gluten‐free diet. Certain peptide peaks thought to be gluten related decreased the most after the patients began the diet.

Conclusions:

Because the peptides decrease in patients consuming a gluten‐free diet, it is reasonable to conclude that such peptide have a mostly dietary origin.
Effect of Sequential Erythromycin and Octreotide on Antroduodenal Manometry
Authors: Di Lorenzo Carlo , Lucanto Cristina , Flores Alejandro F. , Idries Shaheen , Hyman Paul E.
Published: February 2024

Background:

In earlier studies, erythromycin stimulated but octreotide inhibited gastric antral contractions, as each drug induced phase 3‐like episodes.

Methods:

To assess the effect of erythromycin pretreatment on octreotide‐induced changes in antroduodenal motility, 16 patients were studied (mean age, 8.7 ± 1.5 years, 8 male): 6 with severe gastroesophageal reflux, 4 with cyclic vomiting, 3 with gastroparesis, 2 with chronic intestinal pseudo‐obstruction, and 1 with Crohn's disease and unexplained nausea and vomiting. After recording fasting antroduodenal motility for 3 hours, 1 mg/kg intravenous erythromycin was administered over 30 minutes. Sixty minutes after the erythromycin infusion, 0.5 µg/kg subcutaneous octreotide was administered, followed 1 hour later by a meal.

Results:

Phase 3 occurred spontaneously in 10 patients and after erythromycin in 12 patients. When administered after erythromycin, octreotide immediately induced phase 3s contractions in 15 patients, beginning in the antrum. In 7 children, some of the octreotide‐induced phase 3s did not propagate. After the meal, antral contractions continued in all patients. The fed pattern was replaced in 14 patients by alternating phase 3 and phase 1 activities.

Conclusions:

Pretreatment with erythromycin prevented octreotide‐induced inhibition of antral contractions. Inhibition of antral contractions by octreotide may be mediated through either a direct or indirect suppression of motilin release, because antral contractions persist after pretreatment with the motilin receptor agonist erythromycin.
Isolated Deficient α6β4 Integrin Expression in the Gut Associated with Intractable Diarrhea
Authors: Lachaux Alain , Bouvier Raymonde , Loras‐Duclaux Irène , Chappuis Jean‐Paul , Meneguzzi Guerino , Ortonne Jean‐Paul
Published: February 2024

Background:

An infant born with pyloric atresia had development of intractable diarrhea and was found to have total epithelial detachment of gastric and small and large bowel mucosa. She had no skin abnormalities. Parental consanguinity and pyloric atresia in a sibling who died without autopsy suggest an inherited origin for this disorder. The purpose of this study was to examine defects in intestinal and skin cell adhesion.

Methods:

Histologic, immunohistochemical, and ultrastructural characteristics of the skin and gut of the patient were compared with that of normal control subjects. Distribution of adhesion molecules was determined.

Results:

Immunofluorescent analysis of the digestive mucosa showed α6β4 integrin expression deficiency at the epithelial cell‐lamina propria junction. Ultrastructural examination of the digestive mucosa revealed a complete epithelial detachment with a cleavage plane lying between the lamina densa and the basal pole of the enterocytes. Consistent with the absence of skin blistering, integrin α6β4 was expressed at the dermal‐epidermal junction. Electron micrographs of skin biopsy specimens showed the presence of normal hemidesmosomes and the absence of dermal‐epidermal dysadhesion.

Conclusion:

It was postulated that this patient had protracted diarrhea related to epithelial detachment of the digestive mucosa as a consequence of a deficiency of an integrin α6β4 isoform specific to the gut.
Intussusception in a Tropical Country: Comparison Among Patient Populations in Jakarta, Jogyakarta, and Amsterdam
Authors: van Heek N. Tjarda , Aronson Daniel C. , Halimun Eddy M. , Soewarno Roesman , Molenaar Jan C. , Vos Anton
Published: February 2024

Background:

Intussusception is the most common cause of intestinal obstruction in young children, and high mortality rates remain a problem in developing countries. The purpose of this study was to describe and elucidate the differences in outcome become groups of children with intussusception in Indonesia, a developing country, and The Netherlands, a developed country.

Methods:

In this retrospective review, 176 patients were studied in three types of hospitals. A comparison was made among children treated at a primary care rural hospital in Indonesia, at a secondary care urban hospital in Indonesia, and at a tertiary care urban hospital in The Netherlands.

Results:

Children in the rural community hospital in Indonesia were more severely ill at arrival and had a significantly longer duration of symptoms, an increased incidence of nonviable bowel, and a mortality rate of 20%, in contrast to a mortality rate of 3% in the urban hospital in Indonesia and no deaths in the Dutch hospital.

Conclusions:

The mortality of children with intussusception in rural Indonesia is much higher than in urban Indonesia or in The Netherlands, probably because of delayed treatment, which results in more patients undergoing surgery in worse physical condition.
Use of Rifampin for Severe Pruritus in Children with Chronic Cholestasis
Authors: Yerushalmi Baruch , Sokol Ronald J. , Narkewicz Michael R. , Smith Debra , Karrer Frederick M.
Published: February 2024

Background:

Rifampin has been proposed to reduce pruritus in children and adults with chronic cholestasis; however, there is a paucity of published data regarding the use of rifampin in children.

Methods:

In an open trial, 24 children were evaluated during a 6‐year period. Diagnoses included 13 patients with extrahepatic biliary atresia (54%), six with Alagille's syndrome, three with Byler's disease, and one each with primary sclerosing cholangitis and α1‐antitrypsin deficiency. All patients had severe pruritus deficiency. All patients had severe pruritus that had not responded adequately to at least 2 months of therapy with ursodeoxycholic acid, diphenhydramine, or phenobarbital and local skin care measures. Treatment was initiated with rifampin, 10 mg/kg per day in two divided doses for 18 ± 20 months, and the effect on the severity of pruritus was assessed by a clinical scoring system.

Results:

Ten patients showed a complete response, 12 a partial response, and 2 no response. Complete response was more common in extrahepatic cholestasis (64% vs. 10%), whereas partial response was more common in intrahepatic cholestasis (80% vs. 29%). Treatment was associated with reduction of γ‐glutamyl transpeptidase. No clinical or biochemical toxicity of rifampin was observed.

Conclusions:

We conclude that for more than 90% of children with chronic cholestasis and severe pruritus unresponsive to other treatments, rifampin appears to be a safe and effective therapy.
Does the Size of Nasogastric Tubes Affect Gastroesophageal Reflux in Children?
Authors: Noviski Natan , Yehuda Yoram Ben , Serour Francis , Gorenstein Arkadi , Mandelberg Avigdor
Published: February 2024

Background:

To evaluate the effects of nasogastric tube insertion and different nasogastric tube sizes on gastroesophageal reflux in children.

Methods:

During a prospective randomized study, 29 patients aged 1 month to 4 years (median, 9 months) underwent 24 hours of continuous esophageal pH monitoring to rule out gastroesophageal reflux as the cause of severe pulmonary problems. Each patient was monitored without nasogastric tube for 16 hours (baseline), and thereafter the first nasogastric tube, small (8‐Fr) or large (10‐Fr or 12‐Fr), was placed. Four hours later, the original nasogastric tube was replaced by a new one of large (instead of small) size or of small (instead of large) size. We selected the times of wakefulness in these study periods and compared the number of reflux episodes (NREs), the number of reflux episodes that lasted more than 5 minutes (NRE > 5), and the percentage of time with esophageal pH less than 4 (PTP < 4).

Results:

The 12‐Fr group in comparison with the 8‐Fr group and baseline showed significant difference (P < 0.05) in the NRE>5 and PTP<4 parameters. No significant differences were found when comparing 8‐Fr versus 10‐Fr groups and baseline. In children with (n = 20) and without (n = 9) gastroesophageal reflux, comparison of the various reflux parameters between baseline and the different sizes of nasogastric tubes showed the same results.

Conclusions:

Size of the nasogastric tubes is a significant factor in predisposing the child to gastroesophageal reflux. Large nasogastric tubes interfere with the clearance of the refluxed acid from the esophagus.
A Successful Short‐Bowel Syndrome Model in Neonatal Piglets
Authors: Heemskerk Vincent H. , van Heurn Lodewijk W. E. , Farla Peter , Buurman Wim A. , Piersma Femke , ter Riet Gerben , Heineman Erik
Published: February 2024

Background:

With the higher survival rate of premature neonates as a result of improved neonatal intensive care, the incidence of necrotizing enterocolitis, and thus the incidence of short‐bowel syndrome, is increasing. An appropriate animal model resembling the (premature) neonate with short‐bowel syndrome suitable for clinically relevant neonatal bowel adaptation and intervention studies, is not available at present. The purpose of this study was the development of a short‐bowel syndrome model that mimics the clinical state of the affected neonatal patient.

Methods:

Sixteen 7‐day‐old piglets received either a small bowel transection (group A) or a 75% resection (group B). The piglets were fed 125 kcal/kg body weight per day, including additional electrolytes. The animals were weighed daily and were killed 28 days after surgery. Bowel samples were obtained at both time points.

Results:

Mortality rates in groups A and B were 0% and 8%, respectively. Body weight gain was significantly higher in group A than in group B (156% vs. 93%; P = 0.01). Jejunal villus length was higher in group B than in group A (74% vs. ‐2%; P = 0.006), and crypt depth was higher in group B in both jejunum (201% vs. 67%; P = 0.001) and ileum, (197% vs. 20%; P = 0.001), than in group A.

Conclusions:

In 7‐day‐old piglets 75% small bowel resection leads to a clinical short‐bowel syndrome, demonstrated by reduced weight gain and typical changes in bowel adaptation parameters. The excellent survival of the animals provides a possibility for the study of bowel adaptation in a neonatal model as well as in intervention studies.
Cytokine Release of Peripheral Blood Mononuclear Cells in Children With Chronic Hepatitis B Virus Infection
Authors: Hsu Hong‐Yuan , Chang Mei‐Hwei , Ni Yen‐Hsuan , Lee Ping‐Ing
Published: February 2024

Background:

Immune response to hepatitis B virus (HBV) antigens or mitogens in Asian children with chronic HBV infection who are mainly perinatally infected has not been studied in connection with the production of various cytokines, although these patients are considered to be less responsive to antiviral therapy.

Methods:

The production of the cytokines interferon (IFN)‐γ, lymphotoxin, interleukin (IL)‐4, tumor necrosis factor (TNF)‐α, and interleukin (IL)‐1β by peripheral blood mononuclear cells (PBMCs) was studied in 17 hepatitis B surface antigen (HBsAg) carrier children with raised alanine transferase levels (group 1), 17 HBsAg carrier children with normal alanine transferase levels (group 2), and 20 healthy noncarrier control subjects (group 3).

Results:

Hepatitis B core antigen (HBcAg)‐stimulated IFN‐γ production was significantly higher in group 1 than in groups 2 and 3, serum HBeAg cleared within 1 year in five of eight children in group 1 with stimulation indexes higher than 3, and HBcAg‐induced IL‐4 secretion was minimal in all groups. Interferon‐γ produced by PBMCs stimulated by purified HBsAg did not differ among the three groups. Higher lymphotoxin production by PBMCs stimulated by HBcAg was also noted in groups 1 and 2 than in group 3. Lipopolysaccharide (LPS)‐stimulated TNF‐α production by PBMCs was significantly higher in group 1 than in group 2. There was no association between HBeAg‐anti‐HBe status and production of various cytokines. No differences were seen in the profile of cytokines induced by HBV antigens or LPS in children of carrier mothers compared with children of HBsAg‐negative mothers.

Conclusion:

Increased IFN‐γ production resulting from HBcAg‐specific T‐helper lymphocyte type 1 response, and increased TNF‐α production may contribute to cell‐mediated antiviral immune response in children with chronic hepatitis B. In HBV carrier children, the ability to produce the studied cytokines is related to whether an endogenous immune attempt to eliminate HBV infection emerges in the patients but is not related to the different modes of acquisition of HBV infection.
Activation of the Gut‐Associated Lymphoid Tissue With Expression of Interleukin‐2 Receptors That Peaks During Weaning in the Rat
Authors: Masjedi Mohsen , Tivey David R. , Thompson Fiona M. , Cummins Adrian G.
Published: February 2024

Background:

Weaning exposes the intestinal mucosa to food and bacterial antigens at an age when the immune system is believed to be immature and functionally defective. The purpose of this study was to investigate changes in activation and phenotype of immune cells of the gut‐associated lymphoid tissue during weaning.

Methods:

Litters of infant rats were studied from pre‐ to postweaned life. The activation status, assessed by interleukin‐2 receptor (IL‐2R) expression, and phenotype of cells in the gut‐associated lymphoid tissue were examined by immunostaining.

Results:

Interleukin‐2 receptor expression peaked two to fourfold at midweaning (day 21) in mesenteric lymph nodes, jejunal lamina propria, Peyer's patches, and intraepithelial lymphocytes, compared with adult animals (day 70). CD45+ cells expanded in the lamina propria, epithelium, and lymphocyte‐filled villi. With CD45 as the denominator, 10% to 50% of lymphocytes in the lamina propria and epithelium were αβT‐cell receptor (TCR)+, but the remaining cells had a null phenotype, because there were low numbers of γδTCR+ T cells, B cells, and macrophages. Natural killer cells peaked at midweaning in the lamina propria (9%) and epithelium (20%) but were less than 5% of CD45+ cells after weaning.

Conclusions:

Rather than being immature or functionally inactive, the gut‐associated lymphoid tissue reacts appropriately during weaning with expression of IL‐2R and expansion of αβTCR+ T‐cells.
Antibodies to Gliadin, Endomysium, and Tissue Transglutaminase for the Diagnosis of Celiac Disease
Authors: Vitoria Juan Carlos , Arrieta Arantza , Arranz Cristina , Ayesta Arantza , Sojo Amaia , Maruri Natalia , García‐Masdevall Maria D.
Published: February 2024

Background:

Tissue transglutaminase has recently been identified as the main autoantigen recognized by antiendomysial antibodies in celiac disease. Serum immunoglobulin (Ig)A antibodies to tissue transglutaminase (tTG‐ab) determined by an enzyme‐linked immunosorbent assay (ELISA) technique have been reported to correlate closely with IgA antiendomysial antibodies (EMA). The purpose of this study was to assess the sensitivity, specificity, and predictive value of tTG‐ab measured by a commercially available ELISA technique, compared with those of EMA and IgA antigliadin antibodies (AGA) for the diagnosis of celiac disease.

Methods:

Twenty‐seven serum samples were obtained from patients with untreated celiac disease, 37 from patients who had had gluten withdrawn from their diets for varying time spans, and 34 from control subjects without celiac disease. All were younger than 14 years. Presence of tTG‐ab and AGA was determined by ELISA and of EMA by indirect immunofluorescence.

Results:

Twenty‐six of 27 serum samples obtained from patients at the time of diagnosis of celiac disease were AGA positive. All 27 (concordance rate 100%) were positive for EMA and tTG‐ab. Of the 34 control subjects, 1 was for AGA and 2 for tTG‐ab. All 34 were negative for EMA. Sensitivity, specificity, positive predictive value, and negative predictive value within this group were, for tTG‐ab: 100%, 94%, 93%, and 100%, respectively; for EMA: all four indexes were 100%; and for AGA: 96%, 97%, 96%, and 97%, respectively. Of the 37 with treated celiac disease, 2 were AGA positive, 9 were EMA positive, and 6 were tTG‐ab positive. The concordance rate between EMA and tTG‐ab was 100% in the group with untreated celiac disease, 94% in the control subjects, and 76% in the group with treated celiac disease.

Conclusions:

Immunoglobulin A antibodies to tissue transglutaminase are new, highly sensitive, and specific markers of celiac disease. They can be determined easily by an accurate, comparatively cheap technique and thereby may advantageously replace the EMA marker traditionally used.
Potential Uses for Quality‐of‐Life Measures in Childhood Inflammatory Bowel Disease
Authors: Koot Hans M. , Bouman Nico H.
Published: February 2024

Health‐related quality of life (HRQOL) in children with inflammatory bowel disease is clearly reduced in the physical as well as in the psychological and social functioning domains. However, very few studies of these children have been performed from a quality‐of‐life perspective. Multicenter studies on HRQOL are needed to answer questions about the impact of Crohn's disease and ulcerative colitis and their treatment and complications on HRQOL in children and adolescents and their association with outcome. This article describes perspectives from which quality of life studies may be performed, potential uses of HRQOL measures, and issues that should be accounted for in designing multicenter clinical studies on this topic.
Detection of Interferon Regulatory Factor‐1 in Lamina Propria Mononuclear Cells in Crohn's Disease
Authors: Clavell Mariaines , Correa–Gracian Hernan , Liu Zhiyun , Craver Randall , Brown Raynorda , Schmidt–Sommerfeld Eberhard , Udall John , Delgado Alberto , Mannick Elizabeth
Published: February 2024

Background:

The transcription factor, interferon regulatory factor (IRF)‐1, is stimulated by interferon‐γ and regulates the expression of several genes implicated in the pathogenesis of inflammatory bowel disease, including interleukin‐6, major histocompatibility complex class II molecules, and inducible nitric oxide synthase. Interferon regulatory factor‐1 also stimulates naive CD4+ T‐cells to differentiate into T‐helper‐1 cells, the T‐cell subset that appears to be upregulated in Crohn's disease. The purpose of this study was to examine the expression of IRF‐1 in the nuclei of lamina propria mononuclear cells in situ in colonoscopic biopsy specimens from pediatric patients with Crohn's disease, in patients with ulcerative colitis, and in control patients with no histopathologic abnormalities.

Methods:

Archival paraffin‐embedded tissue sections were obtained from 25 pediatric patients with Crohn's disease, 6 patients with ulcerative colitis, and 12 control patients who had undergone colonoscopy. Tissue sections were stained with polyclonal rabbit anti‐human antisera to IRF‐1 and horseradish‐peroxidase–conjugated, biotinylated, goat anti‐rabbit secondary antibody. Slides were scored and scores compared among patient groups using analysis of variance.

Results:

Patients with Crohn's disease had significantly higher IRF‐1 scores (95% confidence interval [CI], 1.70–2.04) than patients with ulcerative colitis (95% CI, 0.92–1.23) or control subjects (95% CI, 1.11–1.52).

Conclusions:

Increased expression of IRF‐1 in lamina propria mononuclear cells from patients with Crohn's disease may be relevant to the pathogenesis of Crohn's disease.