bluuebunny/crossref_metadata_2025 huggingface dataset:
Hormonal Regulation of the mRNA for Cysteine‐Rich Intestinal Protein in Rat Jejunum During Maturation
Authors: Needleman David S. , Leeper Lucy L. , Nanthakumar Nanda N. , Henning Susan J.
Published: January 2024

Cysteine‐rich intestinal protein (CRIP) has been implicated as an important zinc‐binding protein in the rat intestine. However, its specific role remains undefined. As an approach to the ultimate elucidation of the function of CRIP, we have explored the role of glucocorticoids and L‐thyroxine (T4) in the increase of CRIP mRNA that occurs during postnatal development. Hydrocortisone administration on day 10 elicited a precocious increase of CRIP mRNA. The response to hydrocortisone was readily detectable 12 h after injection. Lack of endogenous glucocorticoids in rat pups adrenalectomized on day 9 impeded but did not prevent the normal rise of CRIP mRNA. Furthermore, injections of dexamethasone (DEX) on days 10, 16, and 18 led to a loss of responsiveness of CRIP mRNA as the pups matured. The administration of T4 alone resulted in a small increase of CRIP mRNA, whereas when combined, T4 and DEX synergistically raised the concentration of CRIP mRNA. All of these patterns of response to hormone manipulation indicate the possibility that CRIP is a mediator of glucocorticoid action on the developing intestine. They do not appear to support the hypothesis that CRIP plays a role in zinc transport during the postnatal period. The potent effects of glucocorticoids and T4 on CRIP mRNA levels should provide useful tools for further investigations in this area.
Ingestion of Caustic Alkali Farm Products
Authors: Neidich Gary
Published: January 2024

Since the Poison Prevention Packaging Act took effect, the number of ingestions of caustic alkali from household products has been significantly reduced. Commercial caustic alkalis used on farms, however, were not included in this legislation. Fourteen children over a 5 year period were seen after ingestion of commercial caustic alkalis used on farms. Seven of the children had ingested liquid pipeline cleaners and seven had ingested solid agents used for a variety of reasons. Six of seven children ingesting liquid agents did so from nonoriginal containers into which the caustic had been transferred for convenience. All seven children ingesting solid agents did so from the original container. Eight of the 14 children were found to have second‐degree or worse esophageal involvement. Both solid and liquid caustic agents used commercially on farms can cause significant morbidity. Development of a child‐resistant container for daily transfer of liquid pipeline agents could be helpful in preventing injuries from liquid pipeline cleaners. Pediatric gastroen‐terologists as well as primary care physicians in rural areas should be familiar with this type of injury and should take an active role in instructing parents of children living on farms to prevent such injuries. Extension of the Poison Prevention Packaging Act to caustic alkalis used on farms needs to be considered.
Postnatal Growth in Infants Born Between 700 and 1,500 g
Authors: Cooke Richard J. , Ford Amy , Werkman Susan , Conner Cynthia , Watson Donna
Published: January 2024

Our purpose was to examine postnatal growth in very low birth weight (VLBW) infants (n = 54). A high frequency of intrauterine growth retardation was noted that was corrected by plotting birth weight against crown‐heel length and not gestational age. No differences in postnatal growth were noted between infants whose size was appropriate for gestational age (n = 37) and those small for gestational age (n = 17). Overall, growth tended to exceed that previously published. Weight but not length or head gain was less in the smaller (≤ 1,000 g) when compared to the larger (> 1,000 g) VLBW infant. Poorer weight gain could not be related to more “illness” or less nutrient intake in the smaller infants.
Duodenal Findings on Ultrasound in Children with Schonlein—Henoch Purpura and Gastrointestinal Symptoms
Authors: Kagimoto Seiichi
Published: January 2024

Abdominal ultrasonic examination was performed in 14 patients with Schonlein‐Henoch purpura (SHP). Thickening of the duodenal wall was observed in nine (82%) of the 11 with such gastrointestinal (GI) symptoms as severe abdominal pain or bleeding. The thickened duodenal wall showed a high echogenicity. Enlargement of the duodenal lumen was seen in seven (64%) patients with GI symptoms. These findings had been observed in four patients before SHP was diagnosed on the basis of the peculiar skin lesions. In three cases of SHP without GI symptoms, those changes were absent. Four cases of ulcerative colitis, three of bacterial enterocolitis (two Yersinia and one Klebsiella), and five without SHP and any GI problems did not exhibit such duodenal abnormalities. On subsequent endoscopic study, mucosal edema and multiple hemorrhagic erosions were seen, especially at the second portion of the duodenum in two cases of SHP. Biopsy specimens from the duodenum of those cases showed leukocytoclastic vasculitis, suggested by the ultrasound (US) findings. It is important to consider the duodenal changes carefully when US is performed in patients with severe GI symptoms of unknown origin. The characteristic duodenal findings described suggest the differential diagnosis of SHP, which usually requires no surgical intervention.
Serodiagnosis of Helicobacter pylori Infection in Children by an Indirect Immunofluorescence Test
Authors: Rocha Gifone Aguiar , de Magalhães Queiroz Dulciene Maria , Mendes Edilberto Nogueira , Teles de Carvalho Anfrisina Sales , Rocha de Oliveira Andreia Maria , de Moura Sílvia Beleza
Published: January 2024

The objective of this study was to evaluate the accuracy of an indirect immunofluorescence (IIF) test for serodiagnosis of Helicobacter pylori infection in children and to determine how the test is affected by the presence of antibodies against Campylobacter jejuni. We studied 65 consecutive children (two with endoscopically confirmed duodenal ulcer) and a series of 18 children with duodenal ulcer. Thirty children were H. pylori negative, as determined by culture, by the preformed urease test, and by carbolfuchsin‐stained smears. The microorganism was identified by microbiological methods in 35 of the 65 (53.85%) consecutive patients studied and in all children with duodenal ulcer. The titer of the IIF test was ≥1:20 in the sera of all children with duodenal ulcer and in the sera of 30 of 33 H. pylori‐positive children without duodenal ulcer. No H. pylori‐negative children had titers >1:10. A serum dilution of 1:20 discriminated between H. pylori‐infected and noninfected children. Absorption with C. jejuni did not change the levels of IgG against H. pylori. When five patients who had been successfully treated with metronidazole, amoxycillin, and furazolidone for 7 days were retested, a slight decrease in anti‐H. pylori IgG levels was noted from the third month on. The decrease was more significant 9 months after the eradication of the microorganism.
Use of Bioelectrical Impedance Analysis to Measure Total Body Water in Patients with Cystic Fibrosis
Authors: Azcue Maria , Fried Martin , Pencharz Paul B.
Published: January 2024

The purpose of this study was to measure whole‐body bioelectrical variables and to validate the technique of bioelectrical impedance analysis (BIA) as a measure of total body water (TBW) in patients with cystic fibrosis (CF). In 20 normally nourished males with CF, aged 7 to 39 years, bioelectrical impedance measurements were compared with TBW measured by isotopic distribution of H218O. The relationship between the two measurements was found to be highly significant (r = 0.96; p < 0.0001). The major genotype mutation F308 was found to have no effect on BIA. Comparison of the CF patients with 21 normal controls matched for age and TBW volumes as measured by H218O volume of distribution showed no difference in electrical parameters. However, the slope of the regression lines (H218O, H2/R) was significantly steeper for the CF subjects (p < 0.03) than for controls. These data show that BIA can be used to measure TBW in patients with CF. However, the predictive equations developed in healthy control subjects should not be used; rather, separate predictive equations for patients with CF will need to be developed.
Lipid and Apoprotein A‐I and B Levels in Obese School‐Age Children
Authors: Bellù Roberto , Ortisi Maria Teresa , Scaglioni Silvia , Agostoni Carlo , Salanitri Vincenzo Saitta , Riva Enrica , Giovannini Marcello
Published: January 2024

The association between lipids and apoproteins and indices of fat patterning was assessed in a sample of school‐age children of both sexes. The study included 361 children between 6 and 15 years of age in two urban centers in the Milan area. Ages, weights, and skin folds were recorded, and percentages of overweight and body mass index were derived. Total cholesterol (TC), high‐density lipoprotein cholesterol (C‐HDL), triglycerides (TRIGL), apoprotein A‐I (apoA‐I), and apoprotein B (apoB) were assayed. Low‐density lipoprotein cholesterol (C‐LDL) was calculated. The obese boys had significantly higher levels of TRIGL and apoB than nonobese boys. The obese girls had significantly higher TC, TRIGL, C‐LDL, and apoB levels than the nonobese girls, but lower C‐HDL. The LDL/apoB ratio was lower in obese than normal‐weight boys. The subscapular/tricipital fold ratio (S/T) was correlated positively with TRIGL and inversely with C‐HDL in boys, while in girls it was correlated with TRIGL and apoB. The subscapular/iliac fold ratio (S/I) was correlated with the C‐LDL/ apoB ratio only in girls. These data underline the importance of anthropometric parameters and indices of fat patterning in determining early cardiovascular risk factors.
Influence of Orally Administered Epidermal Growth Factor on Normal and Damaged Intestinal Mucosa in Rats
Authors: Petschow Bryon W. , Carter Dixie L. , D. Hutton Gary
Published: January 2024

The effect of orally administered epidermal growth factor (EGF) on the mucosal growth and hydrolase activity of normal and damaged small intestine was examined in rats. Adult rats fed EGF daily at 10 times the estimated daily intake of EGF from human milk showed increases in specific activity but not total activity of various brush‐border hydrolases with unaffected mucosal protein content and villus‐to‐crypt ratios through day 9. Ingestion of EGF for 13 days resulted in significant decreases in mucosal protein content without changes in villus height or hydrolase activity. The effect of oral EGF on recovery of damaged intestine was studied in rats fed a liquid diet supplemented with EGF at 0, 1, 10, or 20 times the estimated daily intake from human milk after treatment with methotrexate (MTX) to induce acute intestinal injury. Animals treated with MTX showed significant reductions in body weight and small intestinal villus height, mucosal protein content, and hydrolase activities through day 6 posttreatment. Daily ingestion of EGF did not affect the MTX‐induced reductions in mucosal protein content and hydrolase activity by day 3 but caused significant increases in mucosal disaccharidase and leucine aminopeptidasc activity by day 6 at the 1‐or 10‐times human milk EGF levels. Similar changes were not observed in MTX‐treated rats fed the 20‐times human milk level of EGF. These studies suggest that oral EGF is capable of modulating mucosal protein levels and stimulating entcrocyte hydrolase expression during repair of the intestinal mucosa.
Feeding Resistance and Gastroesophageal Reflux in Infancy
Authors: Dellert Susan F. , Hyams Jeffrey S. , Treem William R. , Geertsma M. Alex
Published: January 2024

Resistance to oral feedings occurring during the course of chronic gastroesophageal reflux (GER) in infants has received little attention in the literature. Accordingly, we reviewed the clinical courses of 600 infants of <24 months of age with GER seen over an 8‐year period to determine the prevalence and course of this problem. After excluding infants with severe neurologic disease, craniofacial disorders, or a history of esophageal surgery, 25 infants were found to have resistance to oral feedings that was severe enough to warrant tube feedings for nutritional support. Sixteen of these 25 infants had a history of resistance to oral feeding antedating a diagnosis of GER, whereas nine developed resistance to feeding during the course of therapy. Gestational age, age at onset of GER symptoms, severity of GER, presence/severity of esophagitis, type of medical therapy, need for fundoplication, or postfundoplication complications were similar in these two groups. When the clinical records of these 25 infants were compared to an age‐ and sex‐matched infant population with GER but without feeding resistance, no differences were noted in severity of GER or the presence/severity of esophagitis. However, failure to thrive and the need for fundoplication were significantly more common in the feeding resistance group (p < 0.001). Among those infants with neurodevelopmental evaluation, mild delay was seen more commonly in the infants with feeding resistance but fell short of statistical significance (p = 0.08). Our observations suggest that resistance to oral feedings is an uncommon but severe problem associated with GER in infancy. Future work will need to further characterize possible neurodevelopmental abnormalities or upper gastrointestinal dysmotility that might predispose patients to this type of feeding difficulty.
Dietary Intake and Nutritional Treatment in Childhood Crohn's Disease
Authors: Thomas A. G. , Taylor F. , Miller V.
Published: January 2024

Dietary intake was assessed in 24 children with active Crohn's disease. Seventeen of the children were sex and height matched with healthy siblings of other patients. The mean energy intake was 1,764 KJ/day (420 kcal/day) lower in patients during relapse than controls (p < 0.05). All 24 children entered a randomised controlled trial of high‐dose steroids compared to an elemental diet. The elemental diet was well tolerated orally in most cases; only one patient required nasogastric administration. There was a similar improvement in disease activity and duration of remission in both groups regardless of the site of disease. Subsequent growth velocity was significantly better in the group treated with the elemental diet despite a greater and more sustained increase in energy intake in the group treated with steroids. Reintroduction of specific foods in the elemental diet group initially caused symptoms in three children but were subsequently tolerated. During remission, there was no significant difference in energy intake, but vegetables were consumed significantly less frequently (p < 0.01) and confectionery significantly more frequently (p < 0.05) when patients were compared with their own siblings.
Relationship Between Plasma Triglycerides and Apolipoprotein CII in Infants During the First Year of Life
Authors: Boediman Dradjat , Murakami Ryusuke , Nakamura Hajime
Published: January 2024

Plasma triglyceride and apolipoprotein CII (apo CII) levels were measured in normal full‐term infants and low‐birth‐weight infants at birth (from umbilical cord blood at 0 weeks), as well as at 2, 3, 4, 8, 24, and 48 weeks of age, and the relationship between plasma triglyceride and apo CII levels was studied. In both full‐term and low‐birth‐weight infants, the plasma triglyceride and apoprotein CII levels were very low at birth, but they increased rapidly thereafter in the full‐term infants and somewhat more slowly in the low‐birth‐weight infants. Both triglyceride and apoprotein CII levels became stable from 3 weeks of age in full‐term infants and from 8 weeks in low‐birth‐weight infants. When the logarithmic values of triglyceride and apoprotein CII levels were compared, they showed a close correlation, and slopes of regression lines were 0.62 in full‐term infants aged 0–2 weeks, 1.04 in full‐term infants aged 3–48 weeks, 0.56 in low‐birth‐weight infants aged 0–4 weeks, and 1.04 in low‐birth‐weight infants aged 8–48 weeks. These results suggest that there may be some differences in triglyceride transport between full‐term infants aged 0–2 weeks and 3–48 weeks as well as between low‐birth‐weight infants aged 0–4 weeks and 8–48 weeks.
Development of Lipolytic Activity in Gastric Aspirates from Premature Infants
Authors: Lee Ping‐Cheung , Borysewicz Ryszard , Struve Mark , Raab Karlo , Werlin Steven L.
Published: January 2024

Neonates, having little or no pancreatic lipase, would have a compromised ability to digest lipids if not for lingual and gastric lipases. To document the postnatal developmental profile of preduodenal lipase activity, 350 premature infants who were at various gestational ages and who had an orogastric tube had their gastric aspirates collected. Two hundred one infants had their gastric aspirates collected within 12 h after delivery. Serial collections were performed in 25 infants at various postnatal ages. Gastric aspirates collected from premature infants had a pH activity profile similar to that of lingual and gastric lipase but different from that of pancreatic lipase, indicating that their origin was from the tongue and/or stomach. Lipolytic activity and pH of these aspirates were quite variable, but no correlation was found between pH and enzyme activity. At birth, lipase activity was lower in the younger infants (26 weeks, n = 13). It increased to a peak at 30–32 weeks of gestational age and then declined to a lower level at term (≥40 weeks, n = 40). Postnatally, a composite plot of the serially collected aspirates also showed a predominant peak at 28–33 weeks of age. Comparison among siblings in twins (n = 12 pairs) and triplets (n = 3) showed great variations in their lipolytic activities, suggesting that the hereditary factor is not a major determinant. Various combinations of antibiotic medications (ampicillin, cefotaxime, gentamicin, and vancomycin) and drugs (dexamethasone, heparin, furose‐mide, phenobarbital, albumin, and vitamin K) apparently had no effect on the level and development of gastric lipolytic activities. Continuous as opposed to intermittent parenteral alimentation with Intralipid, a soybean oil emulsion for intravenous use, appeared to promote the development of lipase activities in the gastric aspirates postnatally.
Polymorphonuclear Leukocytes and Human Colostrum
Authors: Buescher E. Stephen , Mcllheran Sarah M.
Published: January 2024

Polymorphonuclear leukocytes (PMN) from human colostrum were compared with blood and oral exudate PMN from the same donors for their locomotive, respiratory burst, phagocytic, and shape change (polarization) capabilities. Blood PMN were functionally superior to PMN from other sites. Colostrum PMN were similar to oral exudate PMN in all areas except locomotive responses. Exposure of blood PMN to aqueous human colostrum resulted in decreased stimulated adherence to plastic, decreased bactericidal activity against Staphylococcus aureus, reversible induction of cellular shape change, and reversible decreases in cellular deformability. The colostrum effects on PMN shape change and deformability were accompanied by significant increases in cytoskeleton‐associated actin. PMN isolated from colostrum have suppressed functions, consistent with their being exudate cells. In addition, the colostrum environment effectively suppresses multiple functions in PMN from blood, these effects being mediated in part by rapid cytoskeletal assembly. PMN in colostrum do not appear to be beneficial to the breast‐fed infant due to deficiencies in function.
Nutrient Absorption and Weight Gain in Persistent Diarrhea
Authors: Bhutta Zulfiqar A. , Molla A. M. , Issani Z. , Badruddin S. , Hendricks K. , Snyder J. D.
Published: January 2024

We prospectively studied clinical outcome and nutrition absorption in male children (6–36 months of age) with persistent diarrhea (PD) and severe protein‐energy malnutrition (mean z score for age, −4.2 × 0.8). Fifty‐one children were randomly allocated to receive a combination of khitchri, a rice‐lentil mixture, yogurt, and half‐strength buffalo milk (group A; n = 26) or full‐strength soy formula (group B; n = 25) for 14 days. The initial caloric intake (p < 0.02) and mean weight gain (p < 0.02) were greater in the group B patients. The mean stool volume and frequency were comparable between the two groups. Seven children in group A were considered clinical failures by criteria of weight loss and PD, compared to three in group B. The coefficients of absorption (COA) for protein were similar between the two groups, but group B patients had higher values of COA for energy and fat (p < 0.05) in the second week of nutritional rehabilitation. The majority (63%) of the children improved on the khitchri‐yogurt‐milk diet but the nutritional outcome was not as good as with the soy formula. These data indicate that a traditional diet can be successfully used in the dietary management of PD and severe malnutrition but that a more optimal composition, yielding a higher success rate, should be sought.
Serum Food Antibodies Analyzed by Enzyme‐Linked Immunosorbent Assay (ELISA) and Diffusion‐in‐Gel (DIG)‐ELISA Methods in Children with and without Celiac Disease
Authors: Fälth‐Magnusson Karin , Jansson Gunnar , Stenhammar Lars , Magnusson Karl‐Eric
Published: January 2024

Serum antibodies IgA, IgG, and IgM against gliadin, ovalbumin, and β‐lactoglobulin were analyzed at the time of 228 small bowel biopsies in 116 celiac children. These were compared to the antibody levels at the time of biopsies performed in 199 children, where the biopsy discarded a clinical suspicion of celiac disease. For antibodies against gliadin, the enzyme‐linked immunosorbent assay (ELISA) and diffusion‐in‐gel (DIG)‐ELISA methods were compared. It was found that the combined information from IgA and IgG antigliadin antibodies gave the highest specificity (94%) and sensitivity (89%). The antibody responses to food antigens decreased with age in both celiac and reference children. The ELISA and DIG‐ELISA methods gave comparable results and were equally efficient.
Absorption of Macronutrients from a High‐Protein Diet in Children During Convalescence from Shigellosis
Authors: Kabir Iqbal , Malek Mohammed A. , Mahalanabis D. , Rahman M. Mujibur , Khatun M. , Wahed M. A. , Majid N.
Published: January 2024

Absorption of macronutrients and energy intake were determined in 29 children aged 24–59 months, during convalescence from acute shigellosis. A 72 h metabolic balance study was performed to determine the absorption of carbohydrate, fat, and protein. Eighteen children received a high‐protein (5 g/kg/day) diet, and 11 children received a standard‐protein (2.5 g/kg/day) diet. The mean × SD energy intake was 612 × 38 kJ/kg/day for children receiving the high‐protein diet, compared with 633 × 50 kJ/kg/day for the standard‐protein group. The coefficient of carbohydrate absorption was 89 and 92% for the high‐protein and standard‐protein diets, respectively (p = 0.059). The coefficient of protein absorption was 80 and 71% for the high‐protein and standard‐protein groups, respectively, and was significantly higher in the high‐protein group (p < 0.01). Absorption of fat was similar in both groups. The results of the study show better absorption of protein from a high‐protein diet during convalescence, which may have a positive impact on catchup growth of children suffering from shigellosis.
Manometry, Profilometry, and Endosonography
Authors: Benninga M. A. , Wijers O. B. , van der Hoeven C. W. P. , Taminiau J. A. J. M. , Klopper P. J. , Tytgat G. N. J. , Akkermans L. M. A.
Published: January 2024

Normal anal manometric and profilometric values and normal endosonographic features of the anal canal are required for evaluation of pathological conditions such as slow‐transit constipation, anorectal outlet obstruction, and Hirschsprung's disease, status after surgery for imperforate anus, and other anal abnormalities. Anorectal manometry, profilometry (rapid‐pull‐through, three‐dimensional, eight‐channel radial manometry), and endosonography were carried out in 13 healthy children. A significant correlation was demonstrated between conventional manometric and profilometric maximal squeeze pressure of the external anal sphincter (EAS). However, the maximal anal resting tone of the sphincter complex in profilometry was twice as high as in manometry due to reflexive contraction of a pelvic floor muscle, probably the EAS. With profilometry a positive correlation was found between age and sphincter length. Endosonographically assessed thickness of the EAS, puborectal muscle, and levator ani complex showed a significant correlation with age. However, no correlation was demonstrated between age and internal anal sphincter thickness. Thus, the development of the essential structures of the anal canal in children is age dependent. In addition, these measurements of normal physiology and anatomy of the anal canal provide the basis for detecting pathological conditions of the anorectal region in children.
New Treatment for Rectal Impaction in Children
Authors: Gilger M. A. , Wagner M. L. , Barris J. O. , McCarroll L. R. , Healy W. M.
Published: January 2024

To determine the efficacy, comfort, and safety of the pulsed‐irrigation enhanced‐evacuation (PIEE) procedure in children, we evaluated 27 procedures performed on 24 consecutive children, 16 boys and 8 girls, 4–15 years old (mean, 8.7), with chronic constipation, encopresis, and rectal impaction. Children with known heart, lung, and/or neurologic diseases were excluded. Temperature, pulse, respiratory rate, and blood pressure were obtained prior to, during, and immediately after the procedure. Abdominal radiographs were obtained before and after the procedure, and the degree of disimpaction was estimated by a single radiologist. Patients graded the discomfort of the procedure at the time of speculum insertion and every 15 min from 1 to 5: 1, painless; 2, mild discomfort; 3, moderate discomfort; 4, severe discomfort; 5, extremely painful. Serum sodium, potassium, chloride, and bicarbonate values were obtained before, immediately after, and 90 min after the procedure and compared by paired Student t analysis. A digital rectal examination confirmed rectal impaction prior to insertion of the speculum. One course of pulsed irrigations was performed, typically lasting 25–30 min. No significant changes in vital signs were found during or after the procedure. In 18 of 23 (78%) procedures, there was at least a 50% emptying of feces from the colon immediately after the procedure. Patients continued to empty their colon up to 12 h later; thus, the procedure effectively disimpacted all patients. In terms of comfort, patients graded the PIEE a 2.6 × 0.75 (range, 1–5). Speculum insertion was the most uncomfortable factor and received a 2.7. No child had any indication of water intoxication. Serum sodium levels (mean × SD) before the procedure were 139.4 × 1.95 mM. Immediate postprocedure levels fell to 136.8 × 2.21 m M, p < 0.05; 90 min later, they returned to 137.9 × 2.67 m M, p < 0.05. The largest change in serum sodium pre‐ and postprocedure was 7 m M (from 139 to 132), found in two patients. No other electrolyte changes were noted. In conclusion, the PIEE procedure successfully disimpacted all patients, either immediately or within hours of completion. Patients accepted the procedure well, and no clinically significant electrolyte changes were noted. This new method of rectal disimpaction appears to be safe, effective, and acceptable to children.
Detection of Large Fragments of the Human Milk Mucin MUC‐1 in Feces of Breast‐Fed Infants
Authors: Patton Stuart
Published: January 2024

SummaryEvidence is growing that high‐molecular‐weight glycoproteins (mucins) of human milk bind to certain pathogenic microorganisms and thus could interfere with their colonization of the infant gut. This investigation sought to determine whether one of the two principal milk mucins, MUC‐1 (also known as PAS‐0 and episialin), persists into the feces. Fecal samples from seven breast‐fed and seven formula‐fed infants, aged from 20 days to 6 months, were analyzed. Glycoproteins in the specimens, solubilized with sodium dodecylsulfate, mercaptoethanol, and heat, were resolved by gel electrophoresis. The gels were blotted on nitrocellulose sheets that were immunostained with monoclonal antibodies specific for epitopes in the tandem repeat region of MUC‐1. Mucin fragments of ∼200,000 MW were detected in specimens from three of the seven breast‐fed subjects; only one of them showed evidence of the intact mucin. Four breast‐fed and all seven formula‐fed babies were negative for the mucin in their stools. While these results provide evidence of a variable degree of breakdown, we speculate that MUC‐1 resists degradation in the gut and thus may help bind host‐detrimental microorganisms and inhibit their colonizing and infecting actions.
Low Zinc Intake During Exclusive Breast‐Feeding Does Not Impair Growth
Authors: Salmenperä Leena , Perheentupa Jaakko , Näntö Veikko , Siimes Martti A.
Published: January 2024

We studied zinc nutrition in exclusively breast‐fed infants whose growth deviated from the norm. Their number fell from 200 at birth to 116 at the age of 6 months and 36 at the age of 9 months. The mothers received 0, 20, or 40 mg Zn+ + as sulfate daily. Breast milk intake and concentrations of zinc in milk as well as in maternal and infant serum were measured. Individual zinc concentrations in milk showed channeling. The 20‐mg supplement had no effect on the parameters measured. In contrast, 40 mg increased the maternal serum zinc concentration by 2 months and slowed the normal decline of milk zinc concentration by 6 months. Maternal supplementation had no effect on infant serum concen‐trations; they remained lower than adult levels throughout the 1st year of life. Zinc intake was low (about one‐tenth of RDA), but it seemed to be adequate; the serum concentrations of the infants were stable after the age of 2 months. Low zinc concentrations in serum were not associated with impaired growth. On the contrary, the infants with the highest rates of growth had the lowest zinc concentrations. The infant serum zinc concentrations were channeled, but they were also influenced by the zinc intake. Reference values for breast‐fed infants are given.
The Clinical Significance of a Prolonged Stable pH around 4.0 in 24‐h pH Monitoring
Authors: Watanabe Yasuhiro , Catto‐Smith Anthony G.
Published: January 2024

Esophageal acidity may remain stable for long periods at or near pH 4.0, potentially influencing the estimation of risk of esophagitis in esophageal pH monitoring assessment. Our aim was to determine the frequency and clinical significance of a prolonged stable pH around 4.0 (PSpH4) (pH 3.5–4.5) by retrospective examination of 503 pH records from children and by analysis of clinical information, pH parameters, motility studies, and esophageal biopsies. The frequency, duration, and proportion of total time with PSpH4 were quantified, and the ratio of the time for which the pH was <pH 4.0 during PSpH4 episodes to the total reflux time below pH 4.0 was calculated [stable/reflux (S/R) rate]. One hundred fifty‐eight PSpH4 episodes were identified in 80 records. The average duration was 60 min and the S/R rate was 30%. Sixty‐one percent of PSpH4 episodes started in the postprandial period (p < 0.05). Proportionally more episodes of PSpH4 occurred with an increased total percentage reflux time (p < 0.01). In recordings with PSpH4, the average number of reflux episodes remained normal, even when the percentage reflux time was ≥ 10%. No correlation was shown between PSpH4 and esophageal dysmotility, esophagitis, cardiorespiratory symptoms, or prematurity. PSpH4 did not occur in recordings obtained after fundoplication. We conclude that PSpH4 is common and may result in an overestimation of risk of esophagitis. Qualitative assessment of pH monitoring is necessary along with conventional quantitative measurements.
Prospective Evaluation of Upper Gastrointestinal Mucosal Lesions in Children with Ulcerative Colitis and Crohn's Disease
Authors: Ruuska T. , Vaajalahti P. , Arajärvi P. , Mäki M.
Published: January 2024

Eighty‐eight consecutive children with inflammatory bowel disease were studied, and upper gastrointestinal endoscopy was performed in 80 of them as one of the initial investigations before commencing medical or nutritional treatment. Forty‐one children were found to have Crohn's disease and 47, ulcerative colitis. Upper gastrointestinal endoscopy revealed pathology in 32 (80%) cases of Crohn's disease, esophagitis in 16, and esophageal ulcer in two, nonspecific gastritis in 22, duodenitis or duodenal ulcer in 18, and Helicobacter pylori infection in two cases. Granulomas were detected in 10 patients in the upper gastrointestinal tract: one esophageal, eight gastric, and three duodenal. Of the ulcerative colitis patients, seven had esophagitis, one had esophageal ulcer, 17 had nonspecific gastritis, two had gastric ulcers, two had duodenal ulcers, and five had H. pylori infection; altogether 30 (75%) yielded pathological findings. Radiological studies using barium meal revealed pathology in only eight of all inflammatory bowel disease cases. Symptoms at admission were not conclusive for definite diagnosis because 63% of patients with Crohn's disease had signs of colitis (such as diarrhea, bloody diarrhea) compared to 94% of ulcerative colitis patients. Upper gastrointestinal endoscopy may be used to achieve a specific diagnosis, thus being helpful when planning treatment. Also a considerable incidence of nonspecific gastritis, duodenitis, and esophagitis with or without concomitant H. pylori infection may be anticipated in children suffering from both ulcerative colitis and Crohn's disease.
Comparison of Weight‐Based Dosages of Enteric‐Coated Microtablet Enzyme Preparations in Patients with Cystic Fibrosis
Authors: Beker Leila T. , Fink Robert J. , Shamsa Falah H. , Chaney Hollis R. , Kluft Janet , Evans Eileen , Schidlow Daniel V.
Published: January 2024

Twenty‐one stable hospitalized cystic fibrosis patients with malabsorption syndrome participated in an open‐label crossover clinical trial to evaluate the efficacy of two‐period dosing regimens of a pancreatic microtablet enzyme preparation in the treatment of steatorrhea. Standard dosing consisted of 500 U lipase/kg body weight/ meal, 250 U lipase/kg body weight/snack; high dosing consisted of 1,500 U lipase/kg body weight/meal, 750 U lipase/kg body weight/snack. Doses were determined by units of lipase/kg body weight to provide dosing consistency among patients of varying size. Each patient was on a regular diet of – 100 g of fat per day. Two separate, 72‐h stool collections were performed between markers. A significant difference in mean percentage fat absorbed between the standard dose and the high dose was found (86% versus 91%, p < 0.05). Subjects were then stratified into two groups, based on the grams of fecal fat eliminated (GFFE) as follows: Group 1 with =s7 GFFE/24 h on both dosages (n = 7) and Group 2 with > 7 GFFE/24 h on either dose (n = 14). A significant difference (p < 0.05) between Group 1 (96%) and Group 2 (88%) was noted in the percentage fat absorbed while on the high dose. Fat absorption improved from 81% to 88%, (p < 0.05) in Group 2. During the study period, the adverse reactions of constipation or elevated serum uric acid levels were not observed. The increased doses of pancreatic enzymes resulted in improved correction of steatorrhea.
Plasma Carnitine Levels in Cystic Fibrosis
Authors: Kovesi Thomas A. , Lehotay Denis C. , Levison Henry
Published: January 2024

Plasma carnitine concentrations were measured in 43 children and adults with cystic fibrosis (CF), and values were compared with those from normal controls. Clinically significant abnormalities of plasma carnitine concentration were not found in CF patients. The concentration of free carnitine was slightly but significantly elevated in CF patients, and the acylcarnitine concentration and acylcarnitine/free‐carnitine ratio were slightly but significantly lower. Total carnitine concentrations were similar to those of controls. The CF patients did not have abnormal urinary acylcarnitines. Altered concentrations of free and esterified carnitine were not associated with nutritional status or with liver or pulmonary function.
Very Early Onset Nonorganic Failure to Thrive in Infants
Authors: Tolia Vasundhara
Published: January 2024

Nonorganic failure to thrive (NOFTT) occurs in absence of any gastrointestinal, endocrine, or other chronic diseases. It is usually associated with psychosocial deprivation, although behavior problems may also contribute to its occurrence in absence of maternal pathology. We report seven infants and children between the ages of 13 and 30 months at the time of presentation, who failed to consume adequate calories and suffered from delayed growth. All were born at term after normal pregnancies with birth weights and lengths between the 50th and 95th percentiles except in one. None had any history of perinatal problems. Decreased intake was encountered almost immediately after birth, with lack of interest in consuming adequate calories. The evaluations performed did not reveal any specific etiology for the decreased intake. None had any developmental delay nor were there any psychiatric conditions in mothers. Changes in formulas or psychologic intervention were unsuccessful in modifying feeding habits except in two infants. All were supplemented with enteral supplements (Pediasure‐five, Ensure‐one, and Osmolite‐one). Three did not consume enough orally and needed nasogastric tube infusions with eventual placement of gastrostomy tubes in two, and the third one has continued with nasogastric infusions. A significant increase in caloric intake caused improvement in growth percentiles. Height and weight percentiles improved in all and crept into the normal curve in four and five patients, respectively. Head circumference of two stayed at <5th percentile despite nutritional rehabilitation. Attempts at weaning off the supplements actually resulted in weight loss in all. Our data suggest that there is a critical need for early, aggressive nutritional intervention in such infants.
The Relationship between Stool Hardness and Stool Composition in Breast‐ and Formula‐Fed Infants
Authors: Quinlan P. T. , Lockton S. , Irwin J. , Lucas A. L.
Published: January 2024

“Constipation” and “hard stools” are associated with formula feeding of both term and preterm infants and, in the latter, can lead to life‐threatening complications. This study tested the hypothesis that stool hardness is related to excretion of fatty acid (FA) soaps in term infants, and in the extreme to milk bolus obstruction in premature infants. Stools (n = 44) were collected from 20 formula‐fed and 10 breast‐fed infants aged 6 weeks and were classified using visual charts for stool hardness on a 5‐point scale (1, watery; 5, hard). Stools were analysed for nitrogen, minerals, and lipid, the latter divided between the soap and nonsoap fractions. We explored the relationship between stool hardness or solids content and stool constituents, relative to both wet and dry weight. Calcium and FA soaps were the dominant factors significantly related to stool solids and hardness score across the breast‐ and formula‐fed groups. An 8% increase in stool dry weight FA soap content corresponded to a 1‐point change in stool hardness score. Stools from formula‐fed infants had a higher solids content and were classified as significantly harder than those from breastfed infants (hardness scores, 4.0 ± 0.5 versus 2.6 ± 0.7, mean ± SD) and on both a wet‐ and dry‐weight basis contained severalfold higher levels of minerals and lipid and considerably less carbohydrate. Differences in lipids between formula‐ and breast‐fed infants' stools were due almost entirely to FAs (mainly C16:0 and C18:0) excreted as soaps (27.7 ± 7.5% compared to 3.1 ± 4.1% of dry weight), suggesting the groups differed markedly in their handling of saturated FAs. An inspissated stool sample from a premature infant requiring surgical disempaction of an obstructed small intestine was found to be enriched in FA and calcium relative to the preterm formula. FA soaps, predominantly saturated, accounted for one third of the stool dry weight. These data support the hypothesis that calcium FA soaps are positively related to stool hardness; we speculate that this may, at least in part, explain the greater stool hardness in formula‐ versus breast‐fed infants and milk bolus obstruction in preterm infants. This conclusion is consistent with the physical properties of calcium FA soaps.
Bowel Habits of Normal Thai Children
Authors: Osatakul Seksit , Yossuk Panitan , Mo‐suwan Ladda
Published: January 2024

Bowel habits were assessed in 400 healthy Thai children aged 1–72 months. The study was undertaken principally because information concerning the bowel habits of children living on a non‐Western diet is lacking. Ninety‐four percent of the children moved their bowels at least once a day. Mean frequency of bowel actions per day was maximal in the newborn period (3.3 stools) and declined to once a day from ages of 48 to 72 months. Most infants younger than 2 months old produced running stools; however, a change in stool consistency from runny to formed was evident in most children by 4 months of age. With increasing age, children produced larger stools: mean volume of stool was 16.6 ± 2.3 ml at 1 month of age and increased to 35.4 ± 7.6 ml at 48–72 months. In comparison with Western children, it seems that Thai children pass larger, softer, and more frequent stools. That difference in the bowel habits between the two ethnic groups may reflect the difference in the amount of natural fiber in their diets.
Levels of Peptidoleukotriene E4 Are Elevated in Active Crohn's Disease
Authors: Kim Jae H. , Tagari Philip , Griffiths Anne Marie , Ford‐Hutchinson Anthony , Smith Claire , Sherman Philip M.
Published: January 2024

Summary: Proinflammatory mediators, including leukotriene (LT) B4, are elevated in the intestinal mucosa in active chronic inflammatory bowel diseases (IBD). LTE4 is the major peptidoleukotriene metabolite and it is stable in urine. The aim of this study was to measure LTE4 levels in the urine of 27 children with Crohn's disease and 27 control subjects including 12 children with functional recurrent abdominal pain and 15 unaffected siblings of IBD patients. LTE4 levels were measured in urine using high‐performance liquid chromatography separation and radioimmunoassay with specific antibody. The Pediatric Crohn's Disease Activity Index and physician global assessment were used to categorize patient groups. C‐reactive protein, orosomucoid, and erythrocyte sedimentation rate were employed as laboratory markers of mucosal inflammation. Urinary LTE4 levels were elevated in the 13 children with active Crohn's disease (160.5 ± 59.4 pg/ml; mean ± SEM) compared with both levels in the 14 patients with inactive disease (67.1 ± 18.1 pg/ml; p < 0.05) and controls (45.0 ± 10.9 pg/ml; p < 0.05). We conclude that measurement of urinary LTE4 is a useful test for monitoring the activation of peptidoleukotrienes in patients with Crohn's disease. It provides a noninva‐sive, objective adjunct for assessment of disease activity and could be employed in future trials examining the role of the leukotriene inhibitors in the medical therapy of IBD.
Cysteine Supplementation and Reduction of Total Parenteral Nutrition—Induced Hepatic Lipid Accumulation in the Weanling Rat
Authors: Narkewicz Michael R. , Caldwell Sherrie , Jones Gayle
Published: January 2024

Total parenteral nutrition (TPN)‐induced hepatic steatosis is the most common complication of TPN administration to humans. The mechanism of TPN‐induced hepatic steatosis has not been studied in young mammals. The goal of this study was to determine the mechanism of TPN‐induced hepatic steatosis in the weanling rat and the effect of supplementation of TPN with choline and/or cysteine on TPN‐induced hepatic steatosis. In the weanling rat, we investigated the effect of TPN administration on histologic hepatic steatosis, total hepatic lipid, hepatic acetyl‐CoA‐carboxylase (ACC—the rate limiting enzyme in fatty acid synthesis) specific activity, and total plasma lipids. TPN administration resulted in a threefold increase in hepatic lipid as compared with control and sham animals (TPN 138 ± 12 mg/g liver versus control 57 ± 1), an increase in histologic steatosis (TPN 3.7 versus control 1.3), and a decline in total plasma lipid (TPN 2.1 ± 0.3 g/L versus control 4.1 ± 0.3). TPN‐induced hepatic steatosis in the weanling rat was not associated with an increase in ACC specific activity (TPN 2.10 ± 0.33 nmol/min/mg protein versus control 2.85 ± 0.23). Supplementation of the TPN with choline (15 mg/day) did not significantly lessen hepatic steatosis; however, supplementation of TPN with cysteine (2.5 mg/day) or with cysteine and choline did result in a significant lessening of hepatic lipid content and of histologic steatosis and a normalization of total plasma lipid. Tritiated glycerol incorporation into media lipids secreted by hepatocytes isolated from TPN‐treated animals was 45% of that from cysteine‐supplemented animals, suggesting a defect in hepatic lipid secretion associated with TPN‐induced hepatic steatosis in the weanling rat that is partially corrected by cysteine supplementation.
Striking Differences in the Incidence of Childhood Celiac Disease Between Denmark and Sweden
Authors: Weile Birgitte , Cavell Bertil , Nivenius Kerstin , Krasilnikoff Peter A.
Published: January 2024

Among 771 children (381 Swedish and 390 Danish) investigated between 1972 and 1989 because of suspected celiac disease (CD), 179 proved to have the disease. Surprisingly only 24 CD patients were found among the Danish children, compared with 155 in the Swedish group, despite the close ethnic, geographical, and cultural background of the two populations. The Swedish CD children were diagnosed at an earlier age than the Danish children (mean, 1.5 vs. 5.5 years). The symptoms of the Swedish patients were dominated by failure to thrive (93 vs. 71%), whereas a higher proportion of the Danish CD patients suffered from stomach pain (21 vs. 5%). Breast‐feeding habits were comparable. The estimated content of gliadin in the officially recommended diets of the two countries in 1987 differed substantially, the Swedish diet containing more than 40 times more gliadin than the Danish (4,400 vs. 100 mg) at the age of 8 months, and 4 times more (3,600 vs. 900 mg) at the age of 12 months. The Danish infant diet differed significantly from the Swedish in containing a larger amount of the lower gluten‐containing rye flour. The earlier introduction of food items with a high gluten content in the Swedish compared with the Danish diet seems to be an obvious explanation for the great difference in incidence and symptomatology of CD between the two populations.