bluuebunny/crossref_metadata_2025 huggingface dataset:
Antiendomysial Antibody Test Reliability in Children With Frequent Diarrhea and Malnutrition: Is It Celiac Disease?
Authors: Gandolfi Lenora , Catassi Carlo , Garcia Steven , Modelli Ines Cristina , Campos Dioclecio , Pratesi Riccardo
Published: January 2024

Background

The aim of this study was to evaluate the specificity of the immunoglobulin A (IgA) antiendomysial antibody test in the diagnosis of celiac disease in a group of malnourished children with acute diarrhea, chronic diarrhea, or parasitosis, because the reliability of this test has been questioned when applied to this specific group of patients.

Methods

Serum IgA level, IgA antiendomysial antibody (EMA) test, and stool examination were performed in 315 children, ranging in age 6 months to 13 years (range, 41 ± 2.9 months), affected by malnutrition, isolated or in association with diarrhea or parasitosis. Independent of results, 33 children with a strong suspicion of celiac disease, also underwent IgA antitransglutaminase antibody test and jejunal biopsy.

Results

The EMA test was negative in 313 children, including the 43 with parasitosis, being positive in two patients in whom biopsy disclosed typical celiac mucosal abnormalities (1:157). The 31 children with negative EMA test who underwent biopsy also showed negative antitransglutaminase antibody results. Their biopsies disclosed normal mucosa in 1 patient, variable degree of jejunal atrophy (grade 1 and 2) in 27 patients, and grade 3 abnormalities in 3 patients. One of these three children, showing severe jejunal atrophy, died. The diagnosis of celiac disease was apparently not confirmed by a protracted gluten challenge in the other two children.

Conclusions

The specificity of the EMA test seems to be high also in children with chronic malnutrition and diarrhea. However, the possibility of false‐negative tests among immunologically compromised children cannot be excluded. In doubtful cases, the gluten challenge is required in malnourished children with clinical picture, biopsy finding, and evolution suggestive of celiac disease.
Late‐Onset Complications of Percutaneous Endoscopic Gastrostomy in Children
Authors: Ségal Delphine , Michaud Laurent , Guimber Dominique , Ganga‐Zandzou Patrice S. , Turck Dominique , Gottrand Frédéric
Published: January 2024

Purpose

The aim of this study was to report the late morbidity of percutaneous endoscopic gastrostomy (PEG) in a pediatric population and to identify possible risk factors for complications developing after PEG insertion.

Methods

A PEG was placed in 110 children between 1 May 1990 and 1 January 1997 using the pull technique. A retrospective study of late‐onset complications was performed, with a follow‐up period ranging from 1 to 8 years. All the complications occurring more than 6 days after PEG insertion were recorded, except for gastrostomy tube obstruction and accidental tube dislodgement.

Results

The prevalence of late‐onset complications related to PEG in our patients varied from 3.8 to 4.4 per 10 5 days. The overall rate of late‐onset complications was 44% (48 complications observed in 29 patients [26%]). Seventy‐five percent of the complications appeared during the first 2 years after PEG insertion. Nine different types of complication have been identified: intragastric buried or extruded gastrostomy (n = 24), gastric metaplasia granulation tissue around the site of gastrostomy (n = 8), intragastric pseudotumoral proliferative gastric mucosa (n = 4), intragastric mucosal ulceration (n = 3), cutaneous necrosis (n = 3), cologastric fistula (n = 2), gastrostomy closure delay after tube removal (n = 2), subcostal neuralgia (n = 1), and peritonitis (n = 1). Wilcoxon and chi‐square tests were used to compare the clinical characteristics of the patients and the type of material used in the two populations, with and without complications. No clinical risk factor for the development of complications could be identified. Intragastric buried or extruded gastrostomy appeared more frequently with the use of one type of button than with the use of tubes.

Conclusions

The authors' experience suggests that PEG is associated with significant late morbidity, which is mainly observed within the first 2 years after PEG insertion. However, no risk factor for the development of such complications could be identified.
Even Small Amounts of Gluten Cause Relapse in Children With Celiac Disease
Authors: Laurin Pia , Wolving Mats , Fälth‐Magnusson Karin
Published: January 2024

Background

Previously, a gluten challenge was customary to establish the diagnosis of celiac disease in children. There are no clear recommendations on how to perform this challenge or what markers to rely on for timing the biopsy after the challenge. The authors' aim was to monitor gluten intake, clinical symptoms, and antibody kinetics to evaluate the influence of gluten exposure during the challenge.

Methods

Twenty‐five children under investigation for suspected celiac disease were challenged. One child was excluded because blood samples, food records, or biopsy was lacking. Median age at the postchallenge biopsy was 3.8 (2.7–8.8) years. The families kept daily records of the children's gluten intake and of symptoms that occurred. Blood samples were taken monthly for analysis of antigliadin and endomysium antibodies and total immunoglobulin A (IgA). A third biopsy was performed when clinical symptoms suggested a relapse.

Results

All 24 children showed deterioration of the mucosa or elevated antibodies during gluten challenge. Median duration of the challenge was 13 (5–51) weeks, and mean gluten intake was 1.7 (0.2–4.3) g/d and 0.1 (0.02–0.26) g/kg daily.

Conclusions

Gluten intake during the challenge varied widely, and the parents were unable to give their children the recommended amount. Despite the small amounts given, all children showed signs of relapse at a clinical, laboratory, or histologic level. Much smaller amounts of gluten than previously suggested seem sufficient to cause relapse during gluten challenge in children.
Antitissue Transglutaminase Antibodies Outside Celiac Disease
Authors: Clemente Maria Grazia , Musu Maria Paola , Frau Fulvia , Lucia Cicotto , De Virgiliis Stefano
Published: January 2024

Background

Tissue transglutaminase enzyme‐linked immunosorbent assay (tTG‐ELISA) has recently been proposed as a simple and fast screening test for celiac disease (CD). The rate of false‐positive and false‐negative tests with tTG‐ELISA, however, has not been definitively established. Therefore, the aim of our study was to investigate anti‐tTG antibodies (TGA) not only in untreated patients with CD and in healthy controls, but also in a large group of patients with other autoimmune diseases.

Methods

The presence of TGA was investigated in sera from 111 patients with untreated CD, 96 patients with other autoimmune conditions (28 with autoimmune liver disease, 46 with insulin‐dependent diabetes mellitus, 10 with inflammatory bowel syndrome, 12 with type 1 polyglandular syndrome) and from 100 healthy controls using guinea pig tTG‐ELISA (gp‐TG/ELISA) and highly purified recombinant human tTG‐ELISA (h‐TG/ELISA). Western blotting with guinea pig tTG was also performed.

Results

Ninety‐four patients with CD who tested positive for antiendomysial antibodies (AEA) and one who tested negative for AEA showed antibodies against the gp‐TG. Among the controls, 50% of patients with autoimmune liver disease and 6.5% of patients with insulin‐dependent diabetes mellitus tested positive with gp‐TG/ELISA. Western blotting experiments revealed that the high rate of positive tests observed using ELISA among the control group sera is attributable to impurities in the gp‐TG preparation. However, h‐TG/ELISA tests were positive for the sera from all patients who tested positive for AEA and from one control who tested negative for AEA, whereas h‐TG/ELISA tests were negative for all CD patients who tested negative for AEA and for other controls who tested negative for AEA.

Conclusions

The frequency of false‐negative and false‐positive tests represents the major limit to the use of gp‐tTG/ELISA. However, because h‐TG/ELISA is both simple and fast, it could be used in large screening programs for CD.
Prevalence and Natural Course of Gastroesophageal Reflux Symptoms: A 1‐Year Cohort Study in Thai Infants
Authors: Osatakul Seksit , Sriplung Hutcha , Puetpaiboon Areeruk , Junjana Cha‐on , Chamnongpakdi Suthaporn
Published: January 2024

Background

Epidemiologic studies in adults suggest that the nature of gastroesophageal reflux may differ among various ethnic groups. Until recently, there has been limited information concerning the epidemiology of gastroesophageal reflux in non‐Western children. The objectives of this cohort study were to investigate the prevalence of symptoms related to gastroesophageal reflux in Thai infants and to describe the clinical course of reflux regurgitation during the first year of life.

Methods

A cohort study was performed in 216 healthy neonates who attended the well‐baby clinic of Songklanagarind Hospital between March and June 1998. All neonates were followed up, at regular well‐baby clinic visits, for 1 year for reflux symptoms and clinical progress. Information concerning gastroesophageal reflux symptoms was obtained by interviewing the parents and from their diary records. An infant who regurgitated at least 1 day per week was considered to have reflux regurgitation.

Results

No infant with clinical features of pathologic gastroesophageal reflux or other reflux symptoms apart from regurgitation were seen during this study period. Of 145 infants in a 1‐year cohort, the prevalence of reflux regurgitation peaked at 2 months at 86.9% and significantly decreased to 69.7% at 4 months, 45.5% at 6 months, and 22.8% at 8 months. At 1 year of age, only 7.6% of infants still had reflux regurgitation. Most Thai infants with gastroesophageal reflux had mild symptoms: 90% of them regurgitated only one to three times per day, and daily regurgitation was reported in a low percentage. Comparing infants with reflux regurgitation and those without, the standard deviation scores of body weight for age were similar. There was no significant difference in prevalence of reflux regurgitation between breast‐fed and bottle‐fed infants.

Conclusions

The nature of gastroesophageal reflux in Thai infants differs from that in Western infants. The prevalence of reflux regurgitation in Thai infants was very high at 1 to 2 months of age; however, many infants became symptom‐free by 6 months. The type of feeding (breast milk vs. bottle milk) had no influence on the prevalence of reflux regurgitation.
Does Ileal Reverse Segment in Rats With Short Bowel Syndrome Change Intestinal Morphology?
Authors: Şencan Aydin , Akçora Bülent , Mir Erol , Şencan Arzu , Günşar Cüneyt , Arslan Oğuz , Özer Erdener
Published: January 2024

Background

The primary goal of surgical therapy for short bowel syndrome is to increase intestinal absorptive capacity. Many surgical procedures have been described for this purpose. One of these is ileal reverse‐segment procedure. This procedure after massive small‐bowel resection is an alternative way to treat short bowel syndrome, but how it affects intestinal morphology in short bowel syndrome has not been investigated. The aim of this study is to investigate macroscopic and microscopic effects of reverse‐segment procedure on the short bowel.

Methods

Twenty rats underwent resection of 80% of the small bowel. The rats were separated into two groups (n = 10). In the first group (reverse group), a reverse segment was formed by twisting a 2‐cm ileal segment 180°, without damaging its vascularity. In the second group (control group), a 2‐cm ileal segment was resected, preserving its mesentery, and end‐to‐end anastomosis was performed to maintain the intestinal passage. The segment was not twisted 180°. The 2‐cm proximal (jejunal) and distal (ileal) segments of the resected bowel were reserved for histologic investigation. Two months later, the rats were killed and the jejunal and ileal segments were evaluated morphologically.

Results

In the reverse group, body weight and total intestinal length significantly increased (14% more than in the control group). The diameter of both proximal (jejunal) and distal (ileal) segments in the reverse group also increased 53.8% and 22.8%, respectively (P < 0.05). Histologically, crypt depth and villus height of the ileal segment in the reverse group increased 15.2% and 18.2% more than in the control group (P < 0.05). No histologic change was observed at the jejunal level except for intestinal muscle thickness.

Conclusions

Ileal reverse‐segment procedure in rats with short bowel syndrome 1) does not cause intestinal obstruction, 2) increases total bowel length and body weight, 3) increases the diameter of both jejunal and ileal segments, and 4) increases villus height and crypt depth only at the ileal level. For this reason, reverse‐segment procedure positively affects intestinal adaptation.
Does Interferon and Ribavirin Combination Therapy Increase the Rate of Treatment Response in Children With Hepatitis C?
Authors: Süoğlu Özlem D. , Elkabes Berna , Sökücü Semra , Saner Günay
Published: January 2024

Background

Interferon‐α was the first accepted treatment of chronic hepatitis C. In recent years, adding ribavirin has produced better response rates in adult patients than monotherapy with interferon‐α. Whether adding ribavirin also improves treatment results in pediatric patients remains unclear.

Methods

Twelve patients were given 3 million U/m2 subcutaneous interferon‐α three times weekly and 15 mg/kg oral ribavirin daily, and 10 patients were given only 3 million U/m2 subcutaneous interferon‐α three times weekly for a total of 12 months.

Results

The dropout rate was 22.8% (25% for patients receiving combination treatment versus 20% for those receiving monotherapy). At the end of treatment, viral clearance was achieved in 50% of the patients who received combination treatment versus 30% of those who received monotherapy. After 12 months of posttreatment follow‐up, sustained response rates were 30% and 41.7%, respectively. Of those who responded to treatment, 66.7% had received ribavirin whereas 37.5% of nonresponders had received ribavirin therapy.

Conclusion

Adding ribavirin to interferon treatment improved end‐of‐treatment response rates in children with chronic hepatitis C. Tolerance of treatment was similar to tolerance of monotherapy. However, studies of greater numbers of pediatric patients with longer follow‐up periods are necessary to determine prolonged sustained response.
Prolonged Esophageal pH Monitoring in the Evaluation of Gastroesophageal Reflux in Children With Chronic Tubotympanal Disorders
Authors: Rožmanic Vojko , Velepic Mitja , Ahel Vladimir , Bonifacic David , Velepic Marko
Published: January 2024

Background

Children with ear, nose and throat disorders are believed to have a high incidence of pathologic gastroesophageal reflux (GER). This study was designed to establish the frequency and ratio of pathologic GER in the development of chronic tubotympanal disorders.

Methods

Twenty‐seven children with chronic tubotympanal disorders (mean age, 2 to13 years; average age, 6.8 years) underwent 24‐hour continuous pH monitoring. Fourteen of the examined patients had secretory otitis, whereas 13 patients had recurrent otitis. From each 24‐hour pH monitoring, 12‐hour daytime and nighttime periods were selected. Eleven patients were tested using simultaneous dual pH monitoring (distal and proximal pH monitoring).

Results

Fifteen (55.6%) of 27 patients had pathologic GER. The authors did not find a relation between pathologic GER and different types of ear disorders. Daytime pH monitoring yielded significantly more episodes of reflux than did nighttime monitoring. The reflux index was substantially higher during the day. In the current study, distal pH monitoring showed that 6 of 11 patients had pathologic GER, whereas proximal pH monitoring showed that only only 3 of 11 patients had pathologic GER.

Conclusions

The authors recommend that a pH study be performed in children with chronic tubotympanal disorders when standard treatment is ineffective. The method of choice for the diagnosis of pathologic GER in patients with chronic tubotympanal disorders should be pH monitoring of the esophagus and throat.
Treatment of Helicobacter pylori Gastritis Improves Dyspeptic Symptoms in Children
Authors: Uc Aliye , Chong Sonny K. F.
Published: January 2024

Background

In adults, the treatment of Helicobacter pylori infection is only recommended for patients with active gastric or duodenal ulcers. It is not known whether similar guidelines can be applied to children because the prevalence of peptic ulcer disease in childhood is estimated to be much lower than in adults. The purpose of this study was to determine whether treatment of H. pylori gastritis would improve symptoms of dyspepsia in children.

Methods

Sixteen patients (5 boys, 11 girls) aged 14 ± 1.2 years who had symptoms of dyspepsia were evaluated using upper gastrointestinal endoscopy with biopsies to establish the diagnosis of H. pylori gastritis. They were treated for 2 weeks with clarithromycin, amoxicillin, and a proton pump inhibitor. Dyspepsia symptoms were evaluated by a questionnaire before and after treatment of the infection. The effect of H. pylori treatment on the total symptom score was analyzed with use of the Student t test. Values are presented as mean ± SEM.

Results

All patients had antral nodularity and chronic active gastritis with spiral‐shaped organisms but no evidence of peptic ulcer disease. Mean total symptom score decreased significantly at 2 to 4 weeks after treatment (12.6 ± 0.9 vs. 2.1 ± 0.5 P < 0.001), and it remained low (2.9 ± 0.7) at follow‐up 9.7 ± 1.4 months (range, 2–24 months later).

Conclusion

These results suggest that the treatment of H. pylori gastritis can improve dyspeptic symptoms in children.
Effect of Renutrition on Natural and Cell‐Mediated Immune Response in Infants With Severe Malnutrition
Authors: Vásquez‐Garibay Edgar , Campollo‐Rivas Octavio , Romero‐Velarde Enrique , Méndez‐Estrada Concepción , García‐Iglesias Trinidad , Alvizo‐Mora José Guadalupe , Vizmanos‐Lamotte Barbara
Published: January 2024

Background

The purpose of this study was to evaluate whether a 4‐week nutritional recovery period with a starting infant formula and 3.35 kJ/mL energy density would favorably affect the natural and cell‐mediated immune response in infants with severe and primary protein‐energy malnutrition.

Methodology

The study included 12 severely malnourished infants, 3 to 18 months of age. For 2 weeks, infants were fed a starting infant formula, with energy density increased to 0.8 kcal/mL, through a nasogastric tube. Infants were fed “ad libitum” for 2 more weeks. On the fifth day, 837 kJ/kg and 4 g/kg protein were given daily. At the beginning and at the end of the 4‐week period, weight, length, phagocytosis, microbicidal activity, chemotaxis, and cell proliferation indices were measured. Null hypothesis was rejected with a paired t test and a P value less than 0.05.

Results

After the 4‐week period of nutritional recovery, the weight and length indicators and the four immunologic assays showed significant increase (P < 0.005).

Conclusion

The study demonstrated that a 4‐week nutritional recovery period with a starting infant formula and 0.8 kcal/mL energy density favorably affected the natural and cell‐mediated immune response in infants with severe protein‐energy malnutrition.
Increased Rectal Nitric Oxide in Children With Active Inflammatory Bowel Disease
Authors: Ljung Tryggve , Beijer Eva , Herulf Max , Weitzberg Eddie , Lundberg Jon O. N. , Finkel Yigael , Hellström Per M.
Published: January 2024

Background

Luminal nitric oxide increases in ulcerative colitis and Crohn disease. The authors have previously used a minimally invasive method to demonstrate increased luminal nitric oxide in ulcerative colitis and Crohn disease of the colon. The aim of the current study was to determine whether this method could be applied to identify inflammatory activity in ulcerative colitis and Crohn disease in children.

Methods

Thirty‐six children (18 of whom had active disease) with inflammatory bowel disease localized to the colon were studied. The control group comprised 12 healthy children. To measure nitric oxide, a silicon catheter with an inflatable balloon was inserted into the rectum and inflated with 10 mL of nitric oxide–free air. After a 10‐minute incubation time, the air was withdrawn and nitric oxide concentrations were immediately analyzed using a chemiluminescence technique.

Results

Children with active ulcerative colitis and Crohn disease of the colon had greatly increased luminal nitric oxide concentrations in the rectum (8,840 ± 5,120 and 15,170 ± 4,757 parts per billion [ppb], respectively) compared with controls (77 ± 17 ppb) (P < 0.001). Children with nonactive ulcerative colitis or Crohn disease displayed low concentrations of rectal nitric oxide (356 ± 110 and 188 ± 55 ppb, respectively), which was not different from that of healthy controls.

Conclusion

Rectal nitric oxide measurement is a feasible and useful method for monitoring disease activity in inflammatory bowel disease, especially in children.
Polyethylene Glycol Without Electrolytes for Children With Constipation and Encopresis
Authors: Loening‐Baucke Vera
Published: January 2024

Background

Children with functional constipation and encopresis benefit from behavior modification and from long‐term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists.

Methods

Twenty‐eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long‐term treatment of functional constipation and encopresis. Children were rated as “doing well,” “improved,” or “not doing well,” depending on resolution of constipation and encopresis.

Results

At the 1‐, 3‐, 6‐, and 12‐month follow‐ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1‐month follow‐up, children on polyethylene glycol were soiling more frequently (P < 0.01) and fewer were improved (P < 0.01). At the 3‐ and 6‐month follow‐ups, both groups had similarly improved. At the 12‐month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P < 0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 ± 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects.

Conclusions

Polyethylene glycol without electrolytes is an alternative for long‐term management of children with constipation and encopresis.
Effect of Human Milk and Epidermal Growth Factor on Growth of Human Intestinal Caco‐2 Cells
Authors: Chang Chun‐Ju , Chao Jane C.‐J.
Published: January 2024

Background

Epidermal growth factor (EGF) in human milk has been thought to be mitogenic for cell growth. This study investigated the effects of human milk and EGF on the growth of human intestinal Caco‐2 cells to determine whether the action occurred through regulation of the cell cycle or through c‐jun expression.

Methods

Cells were incubated with 5% human milk, 0.375 nmol/L EGF (relevant to EGF concentration in 5% human milk, 0.05 × EGF), 7.5 nmol/L EGF (1 × EGF), or 75 nmol/L EGF (10 × EGF). Cell numbers; cellular RNA, DNA, and protein concentrations; DNA content in the cell cycle, and expressions of c‐Jun protein and mRNA were analyzed.

Results

Cell numbers increased in the 1 × and 10 × EGF groups at 48 hours. Cellular RNA increased in the 5% human milk and 10 × EGF groups. DNA and protein contents increased in the 1 × and 10 × EGF groups. The 1 × and 10 × EGF groups increased DNA content in the G1 phase compared with the 5% human milk group at 24 hours. The greatest c‐jun protein expression was 2.6, 1.4, 1.8, and 1.9 times the control, and the c‐jun mRNA increased by 202%, 14%, 150%, and 181%, respectively, in the 5% human milk, 0.05 ×, 1 ×, and 10 × EGF groups.

Conclusions

In a dose‐dependent manner, EGF stimulated intestinal growth in vitro, by increasing DNA content in the G1 phase and c‐jun mRNA expression. However, low concentrations of human milk (5%) and its equivalent EGF did not affect cell growth.
Management of Intractable Constipation With Antegrade Enemas in Neurologically Intact Children
Authors: Youssef Nader N. , Barksdale Edward , Griffiths Janet M. , Flores Alejandro F. , Di Lorenzo Carlo
Published: January 2024

Objectives

To assess the benefit of antegrade enemas in children with severe constipation who were referred to a tertiary care center.

Methods

From 1997 to 1999, 12 children (9 male, aged 8.7 ± 4.4 years) underwent cecostomy placement. All children were neurologically normal and had been extensively examined to rule out organic causes of constipation. Follow‐up included a questionnaire to interview caregivers 13.1 ± 8.5 months after cecostomy placement.

Results

For all children, antegrade enemas led to improvement in the number of bowel movements / week (7.1 versus 1.4, P < 0.005), number of soiling accidents / week (1.0 versus 4.7, P < 0.01), abdominal pain score (0.9 versus 2.9, P < 0.005), emotional health score (3.6 versus 1.9, P < 0.005), overall health score (3.6 versus 1.7, P < 0.005), number of medications used for constipation (0.8 versus 4.0, P < 0.005), number of missed school days / month (1.5 versus 7.5, P < 0.02), and number of physician office visits / year (9.2 versus 24.0, P < 0.05). Irrigation solutions used for the antegrade enemas included polyethylene glycol (67%), saline and glycerin solution (25%), and phosphate enema (8%), administered everyday in seven children and every other day in five children. Adverse events included skin breakdown and granulation tissue in one patient, leakage of irrigation solution in one patient, and dislodging of the tube in two patients. Five patients discontinued the use of antegrade enemas within a mean of 14.6 ± 9.1 months after beginning treatment.

Conclusion

Antegrade enemas through a cecostomy are a safe and satisfactory option for children who are neurologically intact and who have severe constipation that does not respond to medical treatment.
Cimetropium Bromide in the Treatment of Crisis in Infantile Colic
Authors: Savino Francesco , Brondello Cristina , Cresi Francesco , Oggero Roberto , Silvestro Leandra
Published: January 2024

Background

Treatment of infantile colic remains an open issue. In Italy, cimetropium bromide is used extensively to treat infantile colic. The aim of this randomized, double‐blind, placebo‐controlled clinical trial was to investigate the effectiveness and side effects of cimetropium bromide in the treatment of infants with colic crisis.

Methods

Ninety‐seven infants with colic were enrolled. The diagnosis of infantile colic in healthy infants with regular growth, aged 15 to 60 days was made according to the criteria of Wessel. The infants were divided into two groups, one treated with cimetropium bromide (1.2 mg/kg) and the other treated with placebo at onset of each crisis for 3 days. Duration of crying and side effects were recorded daily in a structured diary for the 3 days of therapy. Statistical analysis was performed using the chi‐square andttests.

Results

Eighty‐six infants completed the trial. The average duration of crying for each crisis was 17.3 ± 12.6 minutes in the cimetropium bromide group and 47.5 ± 28.5 minutes in the placebo group (P< 0.005). Response to cimetropium bromide was 74%. Response to placebo was 33% (P< 0.05). Side effects did not differ significantly between the two groups, except sleepiness, which increased in the infants treated with cimetropium bromide.

Conclusion

Cimetropium bromide was more effective than placebo in reducing the duration of crying in children with infantile colic. The use of the anticholinergic drugs, aside from the dicyclomine because of its dangerous side effects, should be revaluated for treating infantile colic.
Esophageal pH Monitoring and Impedance Measurement: A Comparison of Two Diagnostic Tests for Gastroesophageal Reflux
Authors: Wenzl Tobias G. , Moroder Christoph , Trachterna Morten , Thomson Mike , Silny Jiri , Heimann Gerhard , Skopnik Heino
Published: January 2024

Background

pH monitoring is the standard diagnostic tool for gastroesophageal reflux in infants. However, this method does not document the reflux of all kinds of fluid from the stomach into the esophagus, but only documents acid material. The parameters that define reflux episodes by pH monitoring have been derived empirically from observations of many infants considered healthy and ill. Acid reflux is a continuum, some reflux is normal and doubt exists as to how much reflux is abnormal. In this study, one of the standardized protocols for analyzing pH recordings was evaluated and compared with simultaneously obtained intraesophageal impedance measurement (IMP), a pH‐independent method of detecting bolus movement within the esophagus.

Methods

The esophagi of 50 infants with reflux symptoms were measured, using both standard pH probe and multiple‐site impedance measurement. A standard protocol for analyzing esophageal pH records was used. The sampling rate for pH values was 15/min. Acid reflux was defined as pH less than 4.0 (threshold pH) for at least 15 seconds (minimal duration) with at least 30 seconds (latency time) between separate episodes. The software used could adjust independently or in combinations the sampling rate and these reflux criteria. Thereby it was determined whether changes in the criteria for acid reflux improved the sensitivity and predictive value of pH monitoring when compared with reflux episodes defined by IMP.

Results

During 318 hours of recording in 50 infants, 1,887 episodes of reflux occurred according to IMP. Only 282 (14.9%) of the IMP‐determined episodes were acid reflux episodes. No alkaline reflux episodes occurred. Among the 270 pH probe–determined episodes using the standard criteria of acid reflux, only 153 (sensitivity, 54.3%; positive predictive value, 56.7%) were accompanied by unmistakable retrograde bolus movement using IMP measurements. Retrograde bolus movement did not accompany the other 117 episodes. Using a sampling rate of 15/min, a pH threshold of 4.0, a minimal duration of reflux episodes of 8 seconds, and a latency time of 60 seconds, the positive predictive value of pH probe results increased to 60.7%. Variations in the sampling rate or criteria for defining acid reflux did not significantly improve the accuracy of the pH probe results versus IMP‐defined episodes.

Conclusions

Most reflux episodes that occur in infants are undetectable by standard pH probe monitoring. pH monitoring does not detect all reflux in the esophagus but is useful for detecting acidity in the esophagus and determining the duration of its presence. Combining pH monitoring with impedance measurement is a valuable diagnostic tool for gastroesophageal reflux in infants.
Influence of Percutaneous Endoscopic Gastrostomy on Gastroesophageal Reflux: A Prospective Study in 68 Children
Authors: Razeghi Stefan , Lang Thomas , Behrens Rolf
Published: January 2024

Background

Among other complications, the development of or an increase of gastroesophageal reflux (GER) is considered to be associated with percutaneous endoscopic gastrostomy (PEG). However, the few studies performed to date show controversial results.

Methods

Continuous 24‐hour pH monitoring was performed prospectively in 68 patients before and at least 3 days after percutaneous endoscopic gastrostomy placement. None of the patients had been treated for gastroesophageal reflux.

Results

The percentage of patients with abnormal test results did not differ significantly before and after PEG insertion (22.1% versus 25%). Nor did the median reflux index change significantly before and after gastrostomy for the whole group of patients (2.6% versus 3.4%). The median reflux index increased significantly (from 1.8 to 5.4) only in patients who underwent PEG implantation in the antrum (n = 9). Clinical signs of GER correlated poorly with the results of pH monitoring.

Conclusions

Data in this study strongly suggest that, in general, percutaneous endoscopic gastrostomy does not provoke gastroesophageal reflux. Results also indicate that placement in the antrum may be unfavorable.
Astrovirus, Adenovirus, and Rotavirus in Hospitalized Children: Prevalence and Association With Gastroenteritis
Authors: Rodriguez‐Baez Norberto , O'Brien Rebbeca , Qiu Shi‐Qiang , Bass Dorsey M.
Published: January 2024

Background

Agents of viral gastroenteritis such as astrovirus, rotavirus, and adenovirus are common pediatric pathogens accounting for many physician visits, hospital admissions, and nosocomial infections. Previous hospital‐based prevalence studies have examined mainly symptomatic children.

Purpose

To evaluate the prevalence of astrovirus, rotavirus, and adenovirus infections among hospitalized children less than 6 years of age, regardless of symptoms, and determine association with gastroenteritis.

Methods

From September 1998 to June 2000, stool specimens were collected twice weekly from children less than five years of age admitted to two wards in a tertiary‐care children's hospital. A total of 480 samples were obtained from 309 hospitalizations. Stools were examined using antibody‐based ELISA for astrovirus, rotavirus, and adenovirus. Clinical data was abstracted from patient records.

Results

Twenty one percent of the children had gastroenteritis symptoms at some point during their hospitalizations (43% were hospital acquired). Astrovirus was detected in 5.2% of all children compared to 6.8% with rotavirus and 0.8% with adenovirus serotypes 40 or 41. Nosocomial acquisition was common. Seventy five percent of astrovirus infections and 90% rotavirus infections were symptomatic. Astrovirus infections were significantly more likely to occur in younger infants and in children with compromised immunity. Rotavirus infections were significantly more likely to cause dehydration. In a three‐year passive surveillance of gastroenteritis at the hospital, astrovirus and rotavirus infections peaked simultaneously in winter months.

Conclusions

Rotavirus and astrovirus are common symptomatic infections on pediatric wards and contribute greatly to inpatient morbidity. Adenoviruses played a limited role in gastroenteritis in hospitalized children in this study.
Indomethacin, Dexamethasone, and Intestinal Damage in Infant Rats
Authors: Patel Manish R. , DeMarco Vincent G. , Clare‐Salzler Michael , Li Yi Yu , Neu Josef
Published: January 2024

Background

Indomethacin is commonly used in the Neonatal Intensive Care Unit to induce closure of the patent ductus arteriosus and to prevent intraventricular hemorrhage. It is known that indomethacin causes intestinal ulceration in adults, but its effect in infants is less clear. In a preliminary experiment, it was found that the administration of 10 mg/kg/d of indomethacin, a dose that damages the adult rat intestine, had no detrimental effects on newborn suckling rats whereas dexamethasone at 0.25 mg/kg/d caused significant growth failure and villous blunting. It was then hypothesized that the lack of intestinal damage with indomethacin in infants was related to protection given by mother's milk.

Methods

Subsequent experiments were performed wherein 10 mg/kg/d of indomethacin was provided to infant mother‐reared, infant artificially fed, and adult rats. The expression of intestinal cyclooxygenases in the prostaglandin synthetic pathway of control rats was examined to initiate an exploration into a mechanism for the developmental response to indomethacin.

Results

Mother‐reared and artificially fed infant rats demonstrated resistance to the ulcerogenic effects of indomethacin, in contrast to the adults. A differential presence of cyclooxygenase‐1 and cyclooxygenase‐2 was not distinctly seen between infancy and adulthood.

Conclusions

The results indicate that a varying response to the damaging effects of indomethacin on the intestine occurs during development with the infant being less susceptible than the adult. This differed from the effects of dexamethasone administration, which caused significant intestinal atrophy in the infant rats. The intestinal protection to the effects of indomethacin in infants is not dependent on mother's milk or a developmental difference in the prostaglandin biosynthetic pathway.
Effect of Ursodeoxycholic Acid on the Expression of the Hepatocellular Bile Acid Transporters (Ntcp and bsep) in Rats With Estrogen‐Induced Cholestasis
Authors: Micheline Dumont , Emmanuel Jacquemin , Serge Erlinger
Published: January 2024

Objectives

Rats with ethinyl estradiol‐induced cholestasis have a decreased bile flow and a decreased expression of basolateral and canalicular hepatocyte membrane transporters. The bile acid ursodeoxycholic acid improves bile flow in these animals. The purpose of this study was to examine the effect of ursodeoxycholic acid on the expression of hepatocellular bile acid carriers.

Methods

Rats received either ethinyl estradiol (5 mg.kg−1 body wt. for 10 days) or ethinyl estradiol associated with ursodeoxycholic acid (1% in the diet). A third group of rats received ursodeoxycholic acid alone. Bile flow, bile acid, and glutathione biliary outputs were measured. Messenger RNA levels and protein expression of Na+‐dependent taurocholate co‐transporting polypeptide, and bile salt export pump were determined in basolateral and canalicular membrane preparations by Northern and Western blot analysis.

Results

Ursodeoxycholic acid restored bile flow in ethinyl estradiol‐treated rats by increasing bile acid secretion. It did not improve glutathione output nor bile acid‐independent flow. Na+‐dependent taurocholate co‐transporting polypeptide mRNA and protein were decreased by ethinyl estradiol and not restored by ursodeoxycholic acid. In contrast, canalicular bile salt export pump protein expression was decreased by ethinyl estradiol and fully restored to control levels by ursodeoxycholic acid.

Conclusions

Ursodeoxycholic acid increases bile flow in ethinyl estradiol‐treated rats by increasing bile acid secretion. This increase is possibly mediated by a normalization of the expression of the canalicular bile salt export pump.
Fat Laden Macrophages in Tracheal Aspirates as a Marker of Reflux Aspiration: A Negative Report
Authors: Krishnan Usha , Mitchell John D. , Tobias Vivian , Day Andrew S. , Bohane Timothy D.
Published: January 2024

Objectives

Refluxed gastric material aspirated into the lungs is an important cause of acute and chronic pulmonary disease. Currently, the presence of fat‐laden macrophages (FLM) in tracheobronchial secretions of children is a conventional marker for reflux aspiration. However, this assay is limited by its apparent lack of specificity. The aim of this study was to reevaluate the role of this assay in diagnosing reflux aspiration.

Methods

The tracheal aspirates of sixty‐four consecutive children with clinically significant gastroesophageal reflux undergoing upper gastrointestinal endoscopy under general anesthesia, and 34 other children from the routine operative schedule were evaluated. Both groups were further subdivided on the basis of presence or absence of associated respiratory symptoms. After intubation, tracheal aspirates were collected, fixed, and stained for FLM. By grading the amount of intracellular fat present, a semiquantitative lipid index was computed. Tracheal aspirates with a lipid index of 100 or greater were considered positive.

Results

Twenty‐four of the 64 children with reflux symptoms and 14 of 34 children without reflux symptoms were positive for FLM. Sixteen of 37 children with both gastroesophageal reflux and respiratory symptoms and 10 of 26 children negative for both tested positive for FLM. The mean lipid index of the subgroup of children with both reflux and respiratory symptoms was not significantly different from that of the subgroup that was negative for both conditions. Despite computing a semiquantitative lipid index, an index of 100 or greater only had a sensitivity of 38% and specificity of 59%.

Conclusion

Assay of FLM in the tracheal aspirates of children considered at risk of reflux aspiration is not a sensitive or specific as a marker for reflux aspiration.
Colon Mucosal Pathology in Infants Under Three Months of Age with Diarrhea Disorders
Authors: Chang Jei‐Wen , Wu Tzee‐Chung , Wang Ke‐Sheng , Huang I‐Fei , Huang Betau , Yu I‐Ting
Published: January 2024

Background

Diarrhea is a common disease in infants. It may result in catastrophic events, especially in early infancy. Sometimes it is difficult to point out the diagnosis after initial examination. Sigmoidoscopy with mucosal biopsy may help in assessing the nature of the disease. The goals of this study are to evaluate the colon mucosal pathology in young infants with unknown diarrhea disorders and the clinical courses of different etiologies.

Methods

We performed a retrospective analysis of 64 young infants (Mean ± SD: 1.68 ± 1.01 months) in whom a diagnosis of unknown diarrhea disorder had been made after an initial investigation. All infants received fiberoptic sigmoidoscopy and mucosal biopsy with consent obtained.

Results

The appearance of the colon mucosa under endoscopy were: 36 (56.2%) showing edema, 30 (46.8%) showing nodularity, 23 (35.9%) patients with focal erythema and friable mucosa, 11 (17.1%) showed erosion, 7 (10.9%) patients showing hemorrhage, and negative finding in one patient (1.6%). Colon mucosa pathologic findings were established: 40 (62.5%) had eosinophilic colitis (EC) and 19 (29.7%) had nonspecific colitis. The biopsies were normal in 5 cases; 81.5%(22/27) of patients with EC showed eosinophils in the stool smear which was significantly higher (P = 0.04) compared to the group II (9/17); 34 of 40 EC patients responded rapidly to changes in formula.

Conclusion

Sigmoidoscopy and mucosal biopsy may be useful in the pathologic diagnosis of unknown diarrhea disorders. Eosinophilic colitis accounts for over half of very young infants with diarrhea disorders suggesting for allergic etiology. Patients with allergic colitis may exhibit a dramatic response to elimination of the offending proteins from the diet.
Rethinking Growth Failure in Alagille Syndrome: The Role of Dietary Intake and Steatorrhea
Authors: Rovner Alisha J. , Schall Joan I. , Jawad Abbas F. , Piccoli David A. , Stallings Virginia A. , Mulberg Andrew E. , Zemel Babette S.
Published: January 2024

Objective

To characterize the energy and nutrient intake, and the degree of fat malabsorption in children with Alagille syndrome (AGS) and to examine their cross‐sectional associations with growth and nutritional status.

Methods

Prepubertal children with AGS were evaluated for dietary intake, growth, bone age, and body composition. Children and their families collected a three‐day, weighed diet record at home. Stools were collected for 72 hours and the coefficient of fat absorption (COA) was determined.

Results

Children (mean age 6.7 ± 3.6 years) with AGS (n = 26) had low height‐for‐age z‐scores (HAZ), weight‐for‐age z‐scores (WAZ) (−1.9 ± 1.3 and −1.7 ± 1.1, respectively), and delayed skeletal maturation (−1.4 ± 1.8 years). Fifty‐eight percent of the subjects were less than the 5th percentile for height and 54% were less than the 5th percentile for weight. At least 20% of children with AGS had low dietary intake for several nutrients including: calories, fat, calcium, vitamin D, and vitamin E. Children who consumed <2/3 Dietary Reference Intake (DRI) for calcium (n = 6) had a statistically significantly lower HAZ (−3.2 ± 1.3) than those who consumed >2/3 DRI (−1.5 ± 1.0), (P < 0.003). Ninety‐six percent of the subjects had steatorrhea with a mean COA of 75 ± 16%.

Conclusions

These data suggest that prepubertal children with AGS are at‐risk for poor nutrient intake which, compounded with steatorrhea, may have a negative effect on growth and nutritional status. Intervention studies to increase energy and nutrient intake are needed to determine the effect of improved dietary intake on growth and nutritional status of children with AGS.
Effect of Supplementation of Preterm Formula With Long Chain Polyunsaturated Fatty Acids on Mineral Balance in Preterm Infants
Authors: Martinez Francisco Eulógio , Sieber Vanessa Moura , Jorge Salim Moysés , Ferlin Maria Lúcia Silveira , Mussi‐Pinhata Marisa Márcia
Published: January 2024

Background

Incorporation of long chain polyunsaturated fatty acids (LCP) into formulas may interfere with mineral metabolism. We investigate mineral balance in preterm infants who were fed a formula with LCP.

Methods

Infants were randomized in a double‐blind manner, 20 infants in each group, to receive a formula with LCP (F+LCP) or without LCP (F) for 30 days. Plasma levels (at the beginning and after 30 days) and nutritional balance (after 1 week) for Ca, P, Mg, Zn, and Cu were obtained for all infants.

Results

Groups were similar regarding birth weight, gestational age, weight, and corrected age at study start. During the 30‐day study period, the groups had comparable milk intake and reached similar and satisfactory weight gains and longitudinal growth. Within each group, there was no change in plasma mineral concentrations over the course of the study, and there were no differences at each time point between groups. All values were within the normal range for age. No differences in mineral balance were detected between the F and F+LCP groups, with both groups demonstrating comparable intake, net retention, and fecal losses of each mineral.

Conclusions

Adding a content of LCP blend similar to that of human milk to a preterm formula caused no disturbance in Ca, P, Mg, Zn, or Cu nutritional balance.
Patient Web‐Resource Interest and Internet Readiness in Pediatric Inflammatory Bowel Disease
Authors: Cawdron R. , Issenman R. M.
Published: January 2024

Objective

The internet has been touted as a cost‐effective method of providing valuable patient education and support resources. However, little is known of the level of internet interest in or access to web‐based resources of most chronically ill populations generally, and pediatric populations in particular. Web‐based patient resources could be especially applicable to the pediatric inflammatory bowel disease (IBD) population given the potential appeal of an anonymous forum for this group.

Methods

Tertiary‐care clinic patients aged 8–18 years and diagnosed with IBD were surveyed by mail. χ2 and/or analysis of variance were used to compare demographic data from nonresponders and responders and for subgroup analyses.

Results

Of 162 eligible patients, 63 (38.9%) completed the survey. Responders did not differ significantly from nonresponders by age, sex, or distribution of disease. Overall, 98.4% of those surveyed had internet access, with 61.9% having access at school. Ninety‐five percent had used the internet, while 91% expressed interest in visiting a pediatric IBD website for general IBD information (83%), for support (73%), to pose questions (78%) or read (73%) or respond (60%) to questions, or to chat with others (46%). Despite expressed interest, far fewer had ever used the internet as an IBD information (52.4%) or support (9.5%) resource. Similarly, although 15.8% anticipated visiting a pediatric IBD site weekly, only 1.5% had done so in the week of the survey.

Conclusions

Reported levels of interest in web‐based patient resources are high among pediatric IBD patients, yet use may be infrequent.