bluuebunny/crossref_metadata_2025 huggingface dataset:
15N‐Tracer Studies in Formula‐Fed Preterm Infants: The Role of Glycine Supply in Protein Turnover
Authors: Plath Christian , Heine Willi , Wutzke Klaus D. , Uhlemann Marlies
Published: February 2024

In preterm infants, protein‐turnover rates obtained by [15N]glycine as a tracer are known to be overestimated. This may reflect the insufficient supply of dietary glycine. In this randomized study, the influence of a glycine‐rich diet on whole body protein turnover rates in eight male preterm infants (29‐32 weeks, 1,200‐2,540 g birthweight) using the 15N‐tracer technique on days 21 and 28 of life was investigated to evaluate the necessity of supplementing preterm infant formulas with proteins rich in glycine. Before and during the study, the infants were alternately fed with a commercial available preterm infant formula (I, 2% protein, 40 mg glycine/dl) and a variety of this formulation with glycine‐rich proteins (II, 2% protein, 130 mg glycine/dl). The protein‐turnover rates were computed after 15N‐single‐pulse labeling with the help of the three‐compartment model (TCM) and the urinary ammonia end‐product method (AEPM). The tracer used was [15N]glycine (dosage: 2 mg 15N/kg). For the determination of 15N‐excess‐excretion kinetics, fractionated urine specimens were collected over a 36‐h period. The protein‐turnover rate calculated by TCM was 8.8 ± 1.6 g/kg/day (formula I) and 7.7 ± 2.0 g/kg/day (formula II); using AEPM, the rate was 8.7 ± 2.5 g/kg/day and 7.5 ± 1.5 g/kg/day, respectively. We conclude that the presaturation of the precursor pool by an adequate glycine intake minimizes drawbacks that may arise when using [15N]‐glycine as a tracer in preterm infants, and a protein concentration of 2%, as in formula I, and consequently, a 170% glycine content when compared with the same human milk volume, meets the glycine requirement.
Celiac Disease in Down's Syndrome with HLA Serological and Molecular Studies
Authors: Failla P. , Ruberto C. , Pagano M. C. , Lombardo M. , Bottaro G. , Perichon B. , Krishnamoorthy R. , Romano C. , Ragusa A.
Published: February 2024

The association between Down's syndrome (DS) and celiac disease (CD) has been confirmed by several authors. The sensitivity and specificity of antigliadin antibodies (AGAs), the clinical features of subjects with DS and CD (DS‐CD +), the incidence of CD, and the results of serological and molecular class I and II HLA typing were determined in a sample of 57 Sicilian subjects with DS. Six (10.5%) and 17 subjects (29.8%) showed high level of IgA AGAs and IgG AGAs, respectively. AGAs sensitivity and specificity were lower than in the population without DS. Ten people with DS were submitted to jejunal biopsy, and seven (12.2%) showed CD according to ESPGAN criteria. All seven patients were put on gluten‐free diet, followed by rapid disappearance of symptoms. Class I and II HLA serological and molecular typing was carried out in seven DS‐CD + subjects, 22 people with DS without CD (DS‐CD ‐), five subjects with CD without DS, and 20 controls. Between DS‐CD + and DS‐CD ‐ subjects, no statistically significant difference regarding serum HLA class I antigens was found. DQA1 *0101 allele appears significantly in DS‐CD + patients and deserves to be searched for in a larger sample to assess its meaning in the DS‐CD association.
Gastrointestinal Absorption of Insulinlike Growth Factor‐I in Neonatal Pigs
Authors: Xu Ruo‐Jun , Wang Tian
Published: February 2024

To determine if milk‐borne insulinlike growth factor‐I (IGF‐I) is absorbed in neonatal piglets, recombinant human IGF‐I was iodinated and then administered via an oral‐gastric tube to newborn and 3‐day‐old piglets together with fluorescent isothiocyanate dextran (FITC‐D70s, a macromolecular marker for assessment of gut closure). Results showed that total radioactivity and trichloroacetic acid (TCA)‐precipitable radioactivity rose significantly in the plasma of both newborn and 3‐day‐old piglets 1 hour after oral‐gastric administration of 125I‐IGF‐I, although the magnitude of increase was greater in newborns than in 3‐day‐old piglets. In contrast, significant absorption of FITC‐D70s was observed only in newborn piglets but not in 3‐day‐old piglets. Chromatographic analysis revealed that 125I‐IGF‐I represented up to 20% of total plasma radioactivity in the newborns and up to 10% in the 3‐day‐old piglets. The 125I‐IGF‐I found in the plasma was mostly bound to IGF‐binding proteins. These results indicate that milk‐borne IGF‐I can be absorbed in neonatal piglets and the absorption is independent of gut closure.
Prevalence of Helicobacter pylori Antibodies in Children in Bloemfontein, South Africa
Authors: Pelser H. H. , Househam K. C. , Joubert G. , van der Linde G. , Kraaij P. , Meinardi M. , McLeod A. , Anthony M.
Published: February 2024

Background:

An association of H. pylori infection with chronic gastritis, peptic ulceration and gastric cancer is known.

Methods:

Prevalence of IgG antibodies to Helicobacter pylori in children in the Bloemfontein, South Africa area was studied. Children attending the general pediatric out‐patient department at Pelonomi Hospital in Bloemfontein were grouped according to age. A minimum of 100 children was investigated in each age group. Baseline demographic and socioeconomic data were collected.

Results:

The study showed a high prevalence of H. pylori antibodies. Prevalence increased with age: 13.5% in children 3 months‐2 years, 48.5% at 2‐5 years, 67.3% at 5‐10 years and 84.2% at 10‐15 years. Investigation of the socioeconomic data in relation to the prevalence of H. pylori was inconclusive.

Conclusions:

This high prevalence needs further study.
Soy‐Polysaccharide‐Supplemented Soy Formula Enhances Mucosal Disaccharidase Levels Following Massive Small Intestinal Resection in Rats
Authors: Michail S. , Mohammadpour M. , Park J. H. Y. , Vanderhoof J. A.
Published: February 2024

Background:

Addition of soy polysaccharide to infant formulas has previously been shown to reduce the duration of diarrhea in infants with acute gastroenteritis. Fiber is metabolized to short‐chain fatty acids that have been shown to be beneficial in inducing adaptation in the small bowel. We therefore hypothesize that a soy‐polysaccharide‐supplemented infant formula may be potentially advantageous in the treatment of patients with short bowel syndrome and could have a trophic effect on the remaining small intestine.

Methods:

Male Spraque‐Dawley rats weighing 250 g were divided into two groups. One group received Isomil, a standard infant soy formula. The second group received Isomil supplemented with fiber, Isomil DF. Half the animals in each dietary group were subjected to 80% jejunoileal resection and the reminder were sham operated. Animals were pair‐fed one of two diets for 14 days. At the conclusion of the 14‐day period, mucosal weight and sucrase and lactase levels in the remaining duodenum and ileum were determined.

Results:

Resected animals fed fiber‐supplemented formulas had significantly higher sucrase and lactase levels in the proximal bowel. Comparable results were not observed in the sham‐operated animals.

Conclusions:

The addition of soy polysaccharide to infant formulas fed to children with short bowel syndrome might potentially improve small intestinal functional adaptation as well as positively affecting stool consistency.
Serum Levels of Osteocalcin and Type I Procollagen in Children with Celiac Disease
Authors: Pratico' G. , Caltabiano L. , Bottaro G. , Palano G. M. , Rotolo N. , Spina M.
Published: February 2024

Background:

Bone metabolism may be disturbed in children with celiac disease.

Methods:

Two markers of bone turnover were used: the level of osteocalcin (BGP) and the level of carboxylterminal peptide of type I procollagen (PICP). BGP and PICP were measured by radioimmunoassays in 18 untreated children with celiac disease (mean age: 22.9 ± 15.6 months) and in 15 control subjects (mean age 28.5 ± 21 months). All the patients were rechecked after 1 month and again after 3 months from beginning of a gluten‐free diet (GFD).

Results:

Compared with controls at diagnosis our patients had significantly lower serum levels of BGP and PICP (p = 0.003 and p = 0.018 by Student's t test, respectively). These levels increased markedly during the 1st 3 months of GFD.

Conclusions:

The alteration in calcium phosphate homeostasis caused by celiac disease directly affects the synthesis of both components of the connective matrix of bone. Measurements of BGP and PICP provide a reliable and rapidly obtainable index of normalization of the processes of bone growth which can be achieved with a GFD.
Assessment of Plasma Fibronectin in Malnourished Nigerian Children
Authors: Akenami Francis O. T. , Koskiniemi Marjaleena , Siimes Martti A. , Ekanem Emmanuel E. , Bolarin Debayo M. , Vaheri Antti
Published: February 2024

Background:

Severe malnutrition is associated with septic infections. The concentrations of fibronectin, albumin, and transferrin in plasma were measured in three groups of children with protein‐energy malnutrition, aged 1‐3 years, each group comprising 20 children. The aim of which was to test whether plasma fibronectin, being an opsonic protein, was reduced in such children, and if it was a useful index for assessing the severity of malnutrition.

Methods:

The concentrations of fibronectin, albumin, and transferrin in plasma were studied by enzyme immunoassay/immunoblotting, spectrophotometry and immunoturbidimetry respectively.

Results:

All values were significantly lower in the patients with malnutrition than in the age‐ and sex‐matched well‐nourished Nigerian reference children. Within the malnourished group, the fibronectin value was evenly reduced in all subgroups. Albumin and transferrin values were lowest in the patients with kwashiorkor, highest in the marasmic patients, and intermediate in the patients with marasmic kwashiorkor; the values correlated mutually in individual cases as well, but not with the fibronectin levels. Neither plasma fibronectin fragmentation nor tissue fibronectin was detected in any patient with malnutrition or in the reference subjects.

Conclusions:

The reduced plasma fibronectin values in these patients may be due to reduced synthesis by the liver, as evidenced by the equally reduced albumin and transferrin concentrations and/or to the multiple infections characteristic of the patients.
Ultrasound Studies of the Intestinal Wall in Patients with Cystic Fibrosis
Authors: Pohl M. , Krackhardt B. , Posselt H. G. , Lembcke B.
Published: February 2024

Background:

In 1994, first published reports described cystic fibrosis patients who experienced a then unknown complication‐ileocecal and colonic stenoses with submucosal proliferation requiring surgical intervention. To investigate a suspected correlation between increased intestinal wall diameter and high doses of pancreatic enzymes, we carried out a prospective study in our CF‐outpatient clinic.

Methods:

By ultrasound analysis we measured the intestinal wall diameter in 201 patients. One hundred ninety‐three patients treated with pancreatic enzymes had pancreatic insufficiency. Eight patients showed normal pancreatic function, seven of them had never been treated with pancreatic enzymes. The control group included 12 healthy children. Measuring points were the distal ileum, cecum, ascending, and descending colon. Measurements were made by the longitudinal and cross sectional cut. The following aspects of the patients' history were recorded (a) current type of pancreatic enzyme medication; (b) total dosage per day (with reference to lipase units); (c) duration of therapy with standard‐strength pancreatic enzyme (SSPE) preparations (≤10,000 lipase units per capsule) and HSPE preparations (≥20,000 lipase units per capsule); (d) gastrointestinal complication (distal intestinal obstruction syndrome, meconium ileus, abdominal surgery, intussusception), diabetes mellitus, and hepatobiliary complications.

Results:

The intestinal wall diamater in patients receiving HSPE therapy was greater (with prominent submucosal layer) than that in patients receiving SSPE therapy or in patients with pancreatic sufficiency. Healthy subjects had the smallest intestinal wall diameter. There was no correlation between patient history and increased intestinal wall thickness.

Conclusions:

Ultrasound detects characteristic ileocoecal wall lesions in the majority of cystic fibrosis patients on pancreatic enzymes. These lesions may lead to significantly increased ileocoecal wall thickness, which is correlated but not restricted to HSPE.
Abnormal Bile Acid Metabolism and Neonatal Hemochromatosis: A Subset with Poor Prognosis
Authors: Siafakas Constantinos G. , Jonas Maureen M. , Perez‐Atayde Antonio R.
Published: February 2024

Background:

Inborn errors of bile acid synthesis are newly recognized disorders that may cause the phenotypic appearance of neonatal hepatitis or neonatal cholestasis.

Methods:

This is a clinicopathologic study of two sets of siblings with cholestatic neonatal liver failure.

Results:

In 3 of the infants, diagnostic evaluation, including analysis of urinary bile salts, revealed a predominance of 7α‐hydroxy‐3‐oxo‐4‐cholenoic and 7α, 12α‐dihydroxy‐3‐oxo‐4‐cholenoic acids, a pattern consistent with Δ4‐3‐oxosteroid 5β‐reductase deficiency, which could be primary or secondary. The fourth infant died before such testing could be carried out. In addition, all 4 infants had histologically disseminated hemochromatosis and met diagnostic criteria for neonatal hemochromatosis. In the 3 infants studied, histologic examination of the liver disclosed giant cell hepatitis with extensive loss of hepatic parenchyma and rapid progression to cirrhosis. Early treatment with ursodeoxycholic acid and cholic acid, previously reported as effective therapy, was given to 2 siblings; it failed to reverse or halt the liver damage, and both infants died. One infant, with the original diagnosis of neonatal hemochromatosis, was treated with a variety of antioxidants and chelation therapy, as recently reported. No improvement was demonstrated, and he went on to liver transplantation.

Conclusions:

The presentation of Δ4‐3‐oxosteroid 5β‐reductase deficiency as neonatal hemochromatosis may represent a distinct subset of this disorder with an accelerated course, no response to therapy and poor prognosis.
Spermine Induces Maturation of the Immature Intestinal Immune System in Neonatal Mice
Authors: ter Steege Jessica C. A. , Buurman Wim A. , Forget Pierre‐Philippe
Published: February 2024

Background:

In mice, immunological adaptation of the gut to microbial and nutritional antigens occurs at weaning in parallel with biochemical and morphological maturation. Because oral administration of spermine to neonatal rats has been shown to induce biochemical and morphological maturation, we investigated whether spermine also affects maturation of the mucosal immune system.

Methods:

Swiss mice 7, 12, and 27 days old were given spermine orally (0.5 μmol/g body weight) during 3 days. Intestinal length was measured, and lactase and sucrase activities were determined. The phenotype of intraepithelial and lamina propria lymphocytes was assessed by FACS analysis using markers for CD3, TCRαβ, TCRγδ, CD4, CD8α, CD8β, CD5, CD18, CD54, and CD49d.

Results:

Similar to what occurs during natural development, spermine treatment of neonatal mice increased intestinal length, decreased lactase activity, and increased sucrase activity. The percentage of intraepithelial lymphocytes expressing TCRαβ, CD4, CD5, and CD54, as well as the levels of expression of these antigens, increased after spermine treatment on day 12, similarly to natural maturation. The increase in expression of CD3, TCRγδ, CD18, and CD49d did not reach statistical significance. No effect was observed on CD8 expression. The phenotype of lamina propria lymphocytes was not affected. Spermine administration to 7‐ and 27‐day‐old mice had no effect on the phenotype of either intraepithelial or lamina propria lymphocytes.

Conclusions:

Oral spermine administration to neonatal mice induced, in parallel with biochemical maturation, precocious maturation of the murine intestinal immune system and particularly affected differentiation of the intraepithelial lymphocyte population.
Is a Gastric Drainage Procedure Necessary at the Time ofAntireflux Surgery?
Authors: Brown Robin A. , Wynchank Sinclair , Rode Heinz , Millar Alastair J. W. , Mann Michael D.
Published: February 2024

Background

Gastroesophageal reflux is part of a generalized foregut motility disorder, which may also include delayed gastric emptying. With persistence of gastroesophageal reflux, or the presence of complications, including recurrent aspiration syndrome and esophageal stricture formation, surgical correction may be indicated. It is uncertain whether a procedure to resolve delayed gastric emptying is indicated at this time as well.

Methods

Sixty‐seven children with proven gastroesophageal reflux had preoperative gastric emptying assessed using 99Technetium‐Sn‐colloid labelled milk. Delayed gastric emptying was defined as a gastric residual activity of more than 40% at 2 hours after feeding. The antireflux operation was a partial anterior fundoplication. Postoperative milk scans assessed the effect of surgery on gastric emptying.

Results

Gastric emptying at 2 hours improved overall from a median of 22% before surgery to 17% after surgery. In 17 patients delayed gastric emptying was identified before surgery; in 15 of those it returned to within normal limits after surgery. In 50 children with normal gastric emptying before surgery (gastric residual activity at 2 hours 16%), 14 (28%) showed delayed gastric emptying in the postoperative scan.

Conclusions

Delayed gastric emptying is common in children who undergo surgery for gastroesophageal reflux disease. A partial anterior fundoplication antireflux operation improves gastric emptying to within normal limits in the majority (88%) in this group, rendering a synchronous gastric drainage procedure unnecessary.
Simultaneous Determination of Fecal Fat, Nitrogen, and Water by Near‐Infrared Reflectance Spectroscopy
Authors: Neumeister Volker , Henker Jobst , Kaltenborn Georg , Sprössig Christa , Jaross Werner
Published: February 2024

Background

Determinations of fecal fat and nitrogen reveal evidence of malabsorption and assist in estimating the efficacy of pancreatic enzyme treatment. Seventy‐two‐hour stool collection, with chemical analysis of fecal fat, and Kjeldahl's method for measurement of fecal nitrogen are generally accepted as standard methods for making these determinations. However, these traditional methods are expensive, timeconsuming, and cumbersome. This study evaluated the efficiency and validity of an alternative method, using nearinfrared reflectance spectroscopy (NIRS) and compared results with those of the standard methods.

Methods

Near‐infrared reflectance spectroscopy is a secondary method: The instrument first has to be calibrated with samples analyzed by the standard method. Sixty‐three stool samples with known fat content (range 4.79‐292.5 mg/g), 24 samples with known nitrogen content (range 5.36‐19.38 mg/g), and 24 samples with known water concentration (range 60.1‐82.22%) served for calibration. A further 69 samples were analyzed to validate the procedure.

Results

There was a satisfactory correlation between the measurements produced by near‐infrared reflectance spectroscopy and those produced by standard methods: fat r = 0.97; nitrogen r = 0.94; water r = 0.96.

Conclusions

Near‐infrared reflectance spectroscopy appears to be a reliable, simple, and rapid method of measuring different fecal components‐as precise and accurate as the standard methods. Stool samples should be analyzed immediately after collecting or stored only a few days before analyzing.
Outcome After Ileoanal Anastomosis in Pediatric Patients with Ulcerative Colitis
Authors: Durno Carol , Sherman Philip , Harris Kim , Smith Claire , Dupuis Annie , Shandling Barry , Wesson David , Filler Robert , Superina Riccardo , Griffiths Anne
Published: February 2024

Background:

To review the outcome after restorative proctocolectomy among children and adolescents with ulcerative colitis at a pediatric inflammatory bowel disease center.

Methods:

The records of all patients with ulcerative colitis undergoing colectomy and ileoanal anastomosis at The Hospital for Sick Children, Toronto, Canada, were reviewed. Questionnaires concerning functional results were sent to patients with restored transanal defecation.

Results:

Seventy three patients (mean age, 13.2 years; range, 2.6‐18.8 years) underwent ileoanal anastomosis (19 straight ileoanal anastomosis, 41 J pouch, 13 S pouch) between January 1980 and June 1995 and were observed 5.8 ± 3.3 years. The ileoanal anastomosis is nonfunctional in 19 (26%) patients. Excision rates according to type of restorative procedure were J pouch, 7% (3 of 41); S pouch, 32% (4 of 13); and straight ileoanal anastomosis, 32% (6 of 19). Failure was usually attributable to intractable diarrhea among patients with straight ileoanal anastomosis but was caused by anastomotic leak or pelvic‐perianal sepsis among patients with pouch procedures. Failure rates did not vary with age at ileoanal anastomosis. Among patients retaining ileoanal continuity, continence problems reported in the questionnaire were frequent and tended to be more extreme among younger patients. Overall, 90% of respondents reported satisfaction with the functional outcome of the restorative operation.

Conclusions:

The success rate of the ileoanal anastomosis/J‐pouch procedure is comparable to that in adult series. The ileoanal anastomosis/J‐pouch procedure is the operation of choice for children and adolescents who want ileoanal continuity restored after colectomy for ulcerative colitis.
The Gluten‐Free Diet: A Nutritional Risk Factor for Adolescents with Celiac Disease?
Authors: Mariani Paolo , Viti Maria Grazia , Montouri Monica , La Vecchia Alessandra , Cipolletta Elsa , Calvani Luisa , Bonamico Margherita
Published: February 2024

Background:

The gluten‐free diet is the standard therapy for patients affected by celiac disease, although compliance with the diet is not optimal in adolescents or adults. Moreover, the gluten‐free diet may induce nutritional imbalances.

Methods:

Alimentary habits and diet composition were examined in 47 adolescents with celiac disease and 47 healthy aged‐matched control subjects. All subjects compiled a 3‐day alimentary record that allowed determination of their energy intakes; the macronutrient composition of their diets; and their iron, calcium, and fiber intakes. To evaluate compliance with the gluten‐free diet, immunoglobulin A antigliadin and antiendomysium antibodies were assessed in all with celiac disease.

Results:

The analysis of the records and the results of antibody levels showed that 25 subjects strictly followed dietetic prescriptions (group 1A), whereas 22 patients consumed gluten‐containing food (group 1B). Those with celiac disease and control subjects (group 2) consumed a normocaloric diet. Lipid and protein consumption was high, however, and the consumption of carbohydrates low. Moreover, dietary levels of calcium, fiber, and especially in girls, iron, were low. These nutritional imbalances were significantly more evident in group 1A than in group 1B, as a consequence of poor alimentary choices. Moreover, in group 1A overweight and obesity were more frequent (72%) than in group 1B (51%) and in the control subjects (47%).

Conclusions:

In people with celiac disease, adherence to a strict gluten‐free diet worsens the already nutritionally unbalanced diet of adolescents, increasing elevated protein and lipid consumption. In the follow‐up of patients with celiac disease, considerable effort has yet to be made to improve compliance with a gluten‐free diet, and especially to control the nutritional balance of the diet in compliant patients.
Presence of Human Papillomavirus in Extrahepatic Biliary Atresia
Authors: Drut Ricardo , Drut Rosa Mónica , Gómez María Atilia , Rúa Eduardo Cueto , Lojo María Mercedes
Published: February 2024

Background:

In a previous study the human papillomavirus DNA was detected in seven cases of so‐called idiopathic neonatal giant cell hepatitis by using nested polymerase chain reaction. The purpose of the present study was to study the prevalence and possible common causes of human papillomavirus‐associated idiopathic neonatal giant cell hepatitis and extrahepatic biliary atresia.

Methods:

Formalin‐fixed, paraffin‐embedded archival tissues obtained in 18 cases of extrahepatic biliary atresia were studied for human papillomavirus DNA by nested polymerase chain reaction. In addition, in situ hybridization was performed on tissue obtained in 6 cases.

Results:

Tissue in 16 of the 18 cases studied showed amplified human papillomavirus DNA, whereas no human papillomavirus was amplified in any of 30 control samples. Main human papillomavirus detected were types 6 and 18. Punctate intranuclear positive signals were detected in the hepatocytes after in situ hybridization for human papillomavirus DNA.

Conclusions:

The high prevalence of human papillomavirus DNA in liver tissue in cases of extrahepatic biliary atresia suggests a strong correlation between this disorder and idiopathic neonatal giant cell hepatitis. It further suggests that this virus may be one of the causative agents in extrahepatic biliary atresia and may represent part of the spectrum of lesions associated with neonatal human papillomavirus‐induced hepatic damage.
Helicobacter pylori Reinfection Rates in Children After Eradication Therapy
Authors: Kato Seiichi , Abukawa Daiki , Furuyama Noriko , Iinuma Kazuie
Published: February 2024

Background:

There are few studies of Helicobacter pylori reinfection in childhood. In the current study the reinfection rate of H. pylori and ulcer recurrence were investigated during a follow‐up period of 12 months or more in children who had undergone eradication therapy.

Methods:

Twenty‐seven patients aged 5 to 16 years (6 with gastric ulcer, 13 with duodenal ulcer, and 8 with nodular gastritis) were studied. Biopsy‐based H. pylori tests performed 1 to 2 months after eradication therapy demonstrated that eradication was successful in 23 patients (5 with gastric ulcer, 11 with duodenal ulcer, and 7 with nodular gastritis) and unsuccessful in 4 (1 with gastric ulcer, 2 with duodenal ulcer, and 1 with nodular gastritis). Twenty‐three successfully treated patients were observed for a mean of 22 months (a total of 42.2 patient years of follow‐up). To assess H. pylori status, all 23 patients underwent a 13C‐urea breath test 1 year after eradication therapy. If the test result was negative, the patients underwent the follow‐up test once every year thereafter. In successfully and unsuccessfully treated patients, endoscopy was performed if a patient reported symptoms suggesting ulcer recurrence.

Results:

The initial follow‐up 13C‐urea breath tests showed that all 23 patients remained free of infection at 12 to 19 months. Among 17 patients, the second test confirmed reinfection in 1 at 28 months. In two patients studied, the third test showed a negative result. The reinfection rate was 2.4% per patient year. Over the follow‐up period, ulcer recurrence was found in 2 of 3 ulcer patients with eradication failure but in none of the 16 ulcer patients with successful eradication. The recurrence rate was significantly lower in successfully treated patients than in unsuccessfully treated patients (p < 0.05).

Conclusions:

Reinfection with H. pylori is rare in children aged more than 5 years, and successful eradication significantly reduces ulcer recurrence. This study supports the benefit of eradication therapy in older children.
Abdominal Migraine: Prophylactic Treatment and Follow‐up
Authors: Worawattanakul Mingmuang , Rhoads J. Marc , Lichtman Steven N. , Ulshen Martin H.
Published: February 2024

Background:

Abdominal migraine is a syndrome characterized by recurrent stereotypic episodes of paroxysmal abdominal pain and nausea and/or vomiting with wellness between episodes. It is often associated with a positive family history of migraine and no other apparent underlying disease. The purpose of this study was to report in patients diagnosed with abdominal migraine the outcome, the effect of prophylactic treatment, and the duration of treatment.

Methods:

The records of 53 patients who underwent treatment after a diagnosis of abdominal migraine were retrospectively reviewed. Responses to treatment were graded as excellent (cessation of recurrent abdominal pain), fair (persistence of symptoms but milder and less frequent), or poor (no response). Follow‐up data were available in 38 patients. Twenty‐four patients were treated with propranolol and 12 with cyproheptadine. Four were not treated because of mild and infrequent symptoms.

Results:

Among the children treated with propranolol, 18 (75%) had an excellent response, 2 (8%) had a fair response, and 4 (17%) had no response. In those treated with cyprohepatadine, 4 (33%) had an excellent response, 6 (50%) had a fair response, and 2 (17%) had no response. Patients were instructed to continue medication for 6 months or until cycles had stopped. However, 11 of 24 patients (46%) in the propranolol group took medication for less than 6 months and the remaining patients from 6 months 3 years. Six patients in the cyproheptadine group (50%) took medication less than 10 months and the remaining patients for 10 months to 3 years.

Conclusion:

Patients with abdominal migraine may benefit from prophylactic treatment with propranolol or cyproheptadine.
Dietary Lipids Influence Intestinal Adaptation After Massive Bowel Resection
Authors: Kollman Kathryn A. , Lien Eric L. , Vanderhoof Jon A.
Published: February 2024

Background:

Certain lipids, primarily long chain fatty acids and especially long chain polyunsatured fatty acids (LCPUFAs) from marine oils, stimulate gut adaptation after resection. The goal of this study was to define the degree of resection that provides an optimal model for adaptation and to determine if dietary LCPUFAs improve intestinal adaptation after resection.

Methods:

One hundred and fifty‐g male Sprague‐Dawley rats were divided into groups receiving 60%, 70%, and 80% bowel resection. After resection, each group was subdivided into two dietary groups and pair fed diets containing either safflower oil or docosahexaenoic acid (DHA) and arachidonic (AA).

Results:

After 2 weeks, mucosal mass, protein, DNA, and disaccharidase activity were measured in the remaining intestine. Rats receiving 80% resection responded with the highest level of intestinal adaptation. Within the 80% resection group, diet containing DHA and AA stimulated adaptation significantly more than safflower diet. A second study further evaluated the effect on LCPUFAs on intestinal adaptation. Diets included a control group 10% soy oil, and three diets differing in their AA‐DHA fat blend ratio at 5% AA and 3.3% DHA, 15% AA and 10% DHA, and 45% AA and 30% DHA. The addition of LCPUFAs to diets enhanced intestinal adaptation in a linear, dose‐dependent manner after an 80% small bowel resection. Rats fed a diet containing 30% DHA‐45% AA had significantly enhanced mucosal mass compared to rats fed a diet containing 10% soy oil, and considerably higher compared to rats fed 3.3% DHA‐5% AA.

Conclusions:

These studies suggest that modification of dietary LCPUFAs may enhance intestinal adaptation in short bowel syndrome.
Clinical Applications of Technetium Tc 99m Hexamethyl Propylene Amine Oxime Leukocyte Scan in Children with Inflammatory Bowel Disease
Authors: Del Rosario Marian A. , Fitzgerald Joseph F. , Siddiqui Aslam R. , Chong Sonny K. , Croffie Joseph M. , Gupta Sandeep K.
Published: February 2024

Background:

Labeled leukocyte imaging is a helpful diagnostic tool in the detection of inflammation and sepsis. The technetium TC 99m hexamethyl propylene amine oxime (99mTc HMPAO)‐labeled leukocyte scan has been found to be more sensitive than the Indium‐111 labeled leukocyte scan in detecting inflammatory bowel disease, with reported sensitivities of 95% to 100%. Experience with the 99mTc HMPAO‐labeled leukocyte scan was examined and its clinical applications evaluated in the immediate treatment of patients with inflammatory bowel disease.

Methods:

A retrospective chart review was undertaken that included pediatric patients who underwent 99mTc HMPAO‐labeled leukocyte scan at the James Whitcomb Riley Hospital for Children. The disease activity of patients with inflammatory bowel disease was assessed. The leukocyte scan was performed according to the manufacturer's specifications, and images were obtained 30 minutes and 2 hours after administration of the radiopharmaceutical.

Results:

During the period of July 1996 through November 1997, 41 scans were performed in 35 patients. Twenty‐nine patients had histologically proven inflammatory bowel disease: 24 with Crohn's disease, 4 with ulcerative colitis, and 1 with indeterminate colitis. Active inflammatory bowel disease was suspected in 24 patients when the leukocyte scan was performed. Twenty of the 24 patients (83% sensitivity) had abnormal findings in leukocyte scans that prompted more aggressive management in 15 (75%). Six of the 15 who were receiving maximum medical therapy underwent surgical resection of severely affected bowel segments, and medical treatment was intensified in the other 9. The remaining 5 patients were receiving optimal medical therapy, instituted at their recent visit, and did not require further medication adjustments. Four of the 24 patients with active inflammatory bowel disease had normal leukocyte scans (17% false‐negative rate), 3 of whom were receiving corticosteroid therapy at the time the scans were performed. All of the 11 patients in whom inflammatory bowel disease was in remission and 6 patients who did not have inflammatory bowel disease had normal findings in leukocyte scans (100% specificity).

Conclusions:

Although a tissue diagnosis is still recommended, obtained during upper and lower gastrointestinal endoscopic examinations, and contrast radiography of the small bowel for the initial work‐up of patients with suspected inflammatory bowel disease, the 99mTc HMPAO‐labeled leukocyte scan is a safe and useful diagnostic adjunct for subsequent evaluation of patients known to have inflammatory bowel disease. The results of 99mTc HMPAO‐labeled leukocyte scans directly influenced treatment of 75% of the study patients with active inflammatory bowel disease, which included the decision to refer patients for surgical intervention.
The Prevalence of Antibody to CagA in Children Is Not a Marker for Specific Disease
Authors: Mitchell Hazel M. , Hazell Stuart L. , Bohane Timothy D. , Hu Pinjin , Chen Minhu , Yuan Li Yu
Published: February 2024

Background:

In adults, a high prevalence of antibody to the cytotoxin‐associated antigen (CagA) of Helicobacter pylori has been linked to the development of more serious gastroduodenal disease. Few investigators have examined this association in children. The purpose of this study was to investigate the seroprevalence of antibody to the CagA antigen as well as other specific H. pylori antigens in children.

Methods:

By use of an immunoblot analysis kit, the immune response to specific H. pylori antigens in serum collected from 21 H. pylori‐positive symptomatic Australian children, 5 with peptic ulcer disease and 16 with nonulcer dyspepsia, and 33 H. pylori‐positive asymptomatic Chinese children. Sera from 20 H. pylori‐negative symptomatic Australian children were used as control subjects.

Results:

Antibody responses to the 26.5‐kDa, 30‐kDa, and 116‐kDa (CagA) antigens were found to be the most prevalent, with 81.5%, 79.6%, and 76% of children, respectively, mounting a response. In contrast, antibody responses to the 19.5‐kDa, 35‐kDa, 45‐kDa, 60‐kDa, 89 kDa (VacA), and 180‐kDa antigens occurred in 55.5%, 24%, 16.7%, 63%, 37%, and 7.4% of children, respectively. A higher prevalence of antibody response to CagA was found in the symptomatic Australian children with peptic ulcer disease (100%) compared with prevalence in those with nonulcer dyspepsia (56.3%), but the difference did not reach statistical significance. No significant difference was found between the prevalence of antibody to CagA in the Australian peptic ulcer disease group (100%) and that in the asymptomatic Chinese children (81.8%).

Conclusion:

These results suggest that in children CagA is not a marker of specific disease development.
Long‐term Follow‐up of Duodenal Ulcer in Children Before and After Eradication of Helicobacter pylori
Authors: Huang Fu‐Chen , Chang Mei‐Hwei , Hsu Hong‐Yuan , Lee Ping‐Ing , Shun Chia‐Tung
Published: February 2024

Background:

Helicobacter pylori is a well‐known cause of chronic antral gastritis and plays an important role in the pathogenesis of peptic ulcer disease in adults. However, because the relatively low incidence of duodenal ulcer in childhood, few studies have been directed specifically at the relation between the treatment of H. pylori infection and duodenal ulcer in children. An evaluation in a larger patient population is necessary to draw a conclusion.

Methods:

Twenty‐six children with duodenal ulcer and H. pylori antral gastritis received triple therapy (amoxicillin, bismuth, and metronidazole) to investigate whether eradication of the organisms can promote healing and prevent relapse of the ulcers in children. Endoscopic examinations were performed before, 2 months, and 12 months after the beginning of treatment.

Results:

H. pylori infection was eradicated in 25 (96%) of the 26 patients who underwent upper endoscopic follow‐up. Clinical improvement and ulcer healing were achieved in 24 (92%) of 26 children. During a mean follow‐up of nearly 2 years, the annual ulcer relapse rate was estimated to be 9%.

Conclusions:

Triple therapy is the treatment of choice for endoscopically proven duodenal ulcer and histologically proven H. pylori antral gastritis in children. It strongly supports a causal relation between H. pylori and duodenal ulcer disease in children.
Effect of Milk on Somatostatin Degradation in Suckling Rat Jejunum In Vivo
Authors: Rao Radhakrishna K. , Davis Thomas P. , Williams Catherine , Koldovsky Otakar
Published: February 2024

Background:

Somatostatin‐14 is present in breast milk, and intact somatostatin‐14 has been recovered from gastric lumen of infants. Studies have shown that somatostatin‐14 is metabolized in the intestinal luminal contents in vitro, which could be prevented by the presence of breast milk. In this study, the effect of milk on stability of somatostatin‐14 in suckling rat jejunum in vivo was examined.

Methods:

125I‐Somatostatin‐14[Tyr 11] was administered to the isolated jejunal loops in anesthetized suckling rats in the absence or presence of milk, fractions of milk, or known protease‐peptidase inhibitors. Structural integrity of 125I‐somatostatin‐14[Tyr 11] recovered from tissues at different intervals was analyzed by gel filtration and high‐performance liquid chromatography.

Results:

Radioactivity rapidly disappeared from the jejunal lumen with a 50% clearance achieved by 1.2 minutes. Gel filtration and high‐performance liquid chromatography analyses showed that 125I‐somatostatin‐14[Tyr 11] was rapidly degraded into smaller fragments. At 1 minute, jejunal luminal radioactivity was eluted in a major peak with retention time of 42.4 minutes, along with other minor peaks (retention time, 5.6, 8.0, 10.4, and 14.4 minutes); only a trace amount of intact 125I‐somatostatin‐14[Tyr 11] (retention time, 44.8 minutes) was present. Coadministration of rat's milk or its soluble fraction increased the level of intact 125I‐somatostatin‐14[Tyr 11] in the jejunal lumen and jejunal tissue. Presence of rat's milk‐casein or peptidase inhibitors (bestatin, phosphoramidon, or Bowman‐Birk inhibitor), however, failed to increase the level of intact 125I‐somatostatin‐15[Tyr 11].

Conclusion:

These results suggest that somatostatin‐14 is rapidly degraded in the jejunal lumen of suckling rats, and that milk‐borne peptidase inhibitors prevent this somatostatin‐14 degradation.
Evaluation of Enzyme‐Linked Immunosorbent Assay for the Diagnosis of Helicobacter pylori Infection in Children From Different Age Groups With and Without Duodenal Ulcer
Authors: de Oliveira Andreia Maria Rocha , Rocha Gifone Aguiar , Queiroz Dulciene Maria de Magalhães , Mendes Edilberto Nogueira , de Carvalho Anfrisina Sales Teles , Ferrari Teresa Cristina Abreu , Nogueira Ana Margarida Miguel Ferreira
Published: February 2024

Background:

Although enzyme‐linked immunosorbent assay (ELISA) is highly sensitive and specific for the diagnosis of Helicobacter pylori infection in adults, their performance in children is still controversial.

Methods:

A second‐generation ELISA was used to evaluate the IgG response to H. pylori in the serum of 130 consecutive children who underwent upper gastrointestinal endoscopy. The presence of H. pylori was determined in antral biopsy specimens by culture, urease test, and histologic analysis.

Results:

Sixty‐eight children (all of the 20 who had duodenal ulcer) were H. pylori positive by microbiologic test. Immunoglobulin G antibodies to H. pylori were detected in 79.4% of the infected children and in 8.1% of the noninfected ones. The sensitivity of the test was higher in patients with duodenal ulcer (100%) than in those without (70.8%). When used in children of different ages the test also presented differences in sensitivity: 44.4% in children 2 to 6 years old; 76.7% in children 7 to 11 years old, and 93.1% in children 12 to 16 years old (p = 0.006). The serum immunoglobulin G concentration was significantly higher (p = 0.0003) in children with duodenal ulcer than in those without and was higher in older children than in younger ones without duodenal ulcer (p = 0.05).

Conclusions:

The accuracy of the test in children with duodenal ulcer and in children more than 12 years old was good; however, in children up to 12 years of age without duodenal ulcer, the sensitivity of the test was too low to be used for screening purposes or to rule out the presence of infection.
Normal Ranges of 24‐Hour pH‐metry Established in Corrected Esophageal Atresia
Authors: Bergmeijer Jan‐Hein L. J. , Bouquet Jan , Hazebroek Frans W. J.
Published: February 2024

Background:

This study was undertaken to determine baseline values of 24‐hour pH‐metry in children who had undergone correction for esophageal atresia.

Methods:

A 24‐hour pH‐metry without medication was conducted in 13 patients with an uncomplicated postoperative course after correction of esophageal atresia. The pH‐metry was performed in the hospital with a flexible glass electrode.

Results:

The mean reflux index was 4.08%, the mean total number of reflux periods with a pH less than 4 was 21, and the mean number of periods of pH less than 4 lasting longer than 5 minutes was 2.5.

Conclusions:

Twenty‐four‐hour pH‐metry values in asymptomatic esophageal atresia patients are the same as in children from the same age group with normal anatomy.
Diet and Chronic Constipation in Children: The Role of Fiber
Authors: Roma Eleftheria , Adamidis Dimitris , Nikolara Rodopi , Constantopoulos Andreous , Messaritakis John
Published: February 2024

Background:

Chronic constipation is one of the most common disorders in Western countries and despite numerous clinical, pathophysiologic, and epidemiologic studies its cause is still unclear. Several hypotheses have been proposed and according to experimental studies and clinical observation, fiber intake could play a role in its pathogenesis. The purpose of this case‐control study was to examine the possible correlation of idiopathic chronic constipation in children and dietary intake, particularly fiber intake.

Methods:

A randomized sample of children (291 children with constipation and 1602 controls) aged 2 to 14 years was taken from three of the 52 counties of Greece. Stratification was performed on the basis of urban, rural, or suburban location and socioeconomic status. The nutritional data were obtained from a 3‐day dietary record and a dietary history. Statistical analysis was performed with multivariate tests, multivariate analysis of variance, discriminant analysis, and chi‐square analysis according to the characteristics of the correlated variables.

Results:

Constipated children had a lower caloric and nutrient intake (p < 0.001), lower body weight/height (p < 0.001), and higher prevalence of reported anorexia (p < 0.001). Discriminant analysis indicated that dietary fiber alone was independently negatively correlated with chronic constipation, despite the age and the age of onset of constipation. Relative risk also had a negative correlation with fiber intake (p < 0.001). Of the main fiber fractions only cellulose and pentose were independently correlated with chronic constipation.

Conclusions:

Lack of fiber may play an important role in the etiology of chronic idiopathic constipation in children.
Symptomatic Colonic Polyps in Childhood: Not So Benign
Authors: Hoffenberg Edward J. , Sauaia Angela , Maltzman Terese , Knoll Kirsten , Ahnen Dennis J.
Published: February 2024

Background:

The clinical spectrum of symptomatic polyps and the frequency of familial polyposis is not well defined in children. In the present study, a series of children with juvenile polyposis coli (JPC) and non‐JPC polyps were studied.

Methods:

Children with symptomatic colonic polyps and negative family history of polyps were ascertained by review of endoscopic records. Juvenile polyposis coli was defined as 10 or more juvenile polyps or any juvenile polyp in a relative of an index case of JPC. Polyps were tested for Ki‐ras mutations, p53 overexpression, and aneuploidy.

Results:

Seventy‐eight children (age range, 0.4‐18 years) were identified, all evaluated for lower gastrointestinal bleeding. Nine (12%) had JPC, 66 (84%) had isolated juvenile polyps, and 3 (4%) had other types of polyps. The JPC and non‐JPC groups were similar in age (p = 0.4) and symptom duration (p = 0.3). The JPC group had more polyps (p = 0.0001), and greater likelihood of anemia (p = 0.01), polyps with adenomatous change (p = 0.03), and right‐colon polyps (p = 0.001). In three of eight JPC families, polyps were identified in asymptomatic first‐degree relatives. No abnormalities in Ki‐ras, p53, or aneuploidy were identified.

Conclusions:

Juvenile polyposis coli is common in children with symptomatic polyps, and is associated with anemia, right‐colon polyps, and adenomas. The risk of polyps and of colorectal cancer in relatives of persons with JPC requires further study.