bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Esophageal pH Recording on Physical Activity in Children
Authors: Michaud Laurent , Troadec Françoise , Béghin Laurent , Rifai Nahida El , Guimber Dominique , Turck Dominique , Gottrand Frédéric 
Published: May 2009

ABSTRACTObjectives:Twenty‐four‐hour pH‐metry represents the gold standard for the diagnosis of gastroesophageal reflux. Ambulatory esophageal pH recording provides a better reflection of occurrences under normal domestic living conditions, but it may influence physical activity. The aim of this study was to assess the influence of ambulatory esophageal pH recording on physical activity in children.Patients and Methods:This prospective study included 22 patients (18 boys, 4 girls) 3 to 15 years old (mean age 6.9 ± 2.3 years) who had been referred for ambulatory pH‐metry. The 24‐hour physical activity was measured twice in each child using a triaxial accelerometer 1 week before or after pH‐metry and during pH‐metry. Levels of intensity of physical activity (low: sedentary activities; moderate: walking; high: intense activities such as jumping, running, and sport) were compared by the paired nonparametric Wilcoxon test.Results:Physical activity was 53% lower during 24‐hour pH‐metry than when it was not present (P < 0.0005). The duration of low‐level physical activity was longer during pH‐metry (84% vs 73%; P < 0.01). The duration of moderate‐intensity and high‐intensity physical activity was shorter during pH‐metry (16% vs 24% and 0.2% vs 2.2%, respectively; P < 0.005 and P < 0.0001).Conclusions:Ambulatory 24‐hour esophageal pH recording substantially decreases physical activity, mainly high‐level physical activity. Whether such changes in activity decrease the sensitivity of pH‐metry and lead to false negative results in some children remains to be assessed.
Exocrine Pancreatic Function Testing in Patients With Cystic Fibrosis and Pancreatic Sufficiency: A Correlation Study
Authors: Weintraub Amir , Blau Hannah , Mussaffi Huda , Picard Elie , Bentur Lea , Kerem Eitan , Stankiewicz Halina , Wilschanski Michael 
Published: May 2009

ABSTRACTObjectives:Most patients with cystic fibrosis (CF) have pancreatic insufficiency; however, 15% of the patients are pancreatic sufficient (PS). Several laboratory tests have been developed to distinguish between pancreatic insufficiency and PS. The gold standard to determine pancreatic function apart from direct pancreatic stimulation test is the 72‐hour fecal fat excretion, expressed as coefficient of fat absorption (CFA). The aim was to test the correlation between 2 other tests, fecal elastase‐1 and serum immunoreactive trypsinogen (IRT), as compared with fecal fat excretion.Patients and Methods:21 patients with CF‐PS performed the 3 tests of fecal fat excretion, fecal elastase‐1, and IRT. Correlation between the tests was evaluated by the κ statistics test, sensitivity and specificity, and positive and negative predictive values.Results:CFA was abnormal in 5 patients, elastase was <200 μg/g in 4 patients, and IRT was <20 ng/mL in 2 patients. The correlation between CFA and IRT was negative (κ = −0.154), and between CFA and fecal elastase‐1 was poor (κ = 0.213). The sensitivity, specificity, and positive and negative predictive values of IRT versus CFA were 0%, 88%, 0%, and 78%, and for fecal elastase‐1 were 40%, 81%, 40%, and 81%, respectively.Conclusions:In CF‐PS, poor correlation was found between IRT, fecal elastase‐1, and CFA, therefore neither fecal elastase‐1 in the stool nor IRT in the serum reaches the sensitivity or the specificity of the fecal fat excretion. Thus, fecal fat excretion is required in patients with CF for evaluation of pancreatic function.
Matrix Metalloproteinases in the Urine and Tissue of Patients With Juvenile Polyps: Potential Biomarkers for the Presence of Polyps
Authors: Manfredi Michael A , Fox Victor L , Zurakowski David , Kutok Jeffery L , Glickman Jonathan N , Moses Marsha A 
Published: May 2009

ABSTRACTBackground and Aims:Juvenile polyps are the most common type of pediatric gastrointestinal polyp and are typically characterized as hamartomatous overgrowths. Juvenile polyps are highly vascularized tissues and display a markedly increased mucosal microcirculation. Matrix metalloproteinases (MMPs) are a family of zinc‐dependent enzymes that play an essential role in the physiological degradation of the extracellular matrix in normal development, tumor invasion, and metastasis, as well as angiogenesis. We hypothesized that the presence of these enzymes in urine may serve as clinical biomarkers of juvenile polyps.Patients and Methods:In this preliminary study, we analyzed 32 urine samples collected prospectively from 16 subjects with known or suspected juvenile polyps who presented to the endoscopy unit for colonoscopic evaluation and 16 age‐ and sex‐matched controls. Urinary MMPs were analyzed by zymography and their localized tissue expression was assayed via immunohistochemistry of tissue sections.Results:MMPs were detected in the urine of patients with juvenile polyps with significantly higher frequency when compared with urine of control subjects. In addition, immunohistochemistry demonstrated that high levels of MMPs were localized in the epithelium and lamina propria of polyp tissue when compared with colonic tissue collected from healthy control subjects.Conclusions:These data are the first to demonstrate that MMPs are present in the urine and tissue of patients with juvenile polyps, and these enzymes have the potential to serve as surrogate markers for the presence of polyps.
Diagnosis Scoring for Clinical Identification of Children With Heterozygous Familial Hypercholesterolemia
Authors: Benlian Pascale , Turquet Anne , Carrat Fabrice , Amsellem Sabine , Sanchez Lydie , Briffaut Dorothée , Girardet Jean Philippe 
Published: May 2009

ABSTRACTBackground:Familial hypercholesterolemia (FH) is a frequent monogenic condition characterized by progressive atherosclerosis requiring preventive therapy from childhood. In a pediatric setting, heterozygous FH (hFH) in children may not be identified from common forms of hypercholesterolemia (HC).Objective:To elaborate a clinical scoring system for the diagnosis of hFH, defined by the presence of a disease‐causing mutation of the gene for the low‐density lipoprotein receptor (LDLR).Patients and Methods:A total of 100 unrelated children (6 ± 3 years old, 43 boys, 57 girls) with type IIa HC (LDLC >130 mg/dL) and complete genetic testing (at loci for genes for LDLR, apolipoprotein B, proprotein convertase subtilisin‐like kesin type 9, and apolipoprotein E) were selected for score elaboration. Of 60 criteria from clinical records and family questionnaires, predictors of having hFH were estimated by logistic regression analysis. Scores were validated in 38 other unrelated children with HC.Results:Three independent predictors of hFH were identified according to the LDLR genotype (50Mut+/50Mut−): low‐density lipoprotein cholesterol before (262 vs 178 mg/dL, P < 0.001) and after (225 vs 142 mg/dL, P < 0.001) 3 months or more of a lipid‐lowering diet, combined with parental statin usage (odds ratio 6.2; 95% confidence interval 1.4–28.3; P = 0.018). High precision and accuracy of the scoring system (area under the receiver operating characteristic curve = 0.94; 95% confidence interval 0.91–0.98) were translated into 4 probability classes (definite/probable/possible/improbable hFH) with a false‐negative rate of 12%.Conclusions:A score distinguishing hFH from common HC provides a simple tool for appropriate clinical decision and care in high‐risk children.
Exclusion of EGFR, HRAS, DSP, JUP, CTNNB1, PLEC1, and EPPK1 as Functional Candidate Genes in 7 Families With Syndromic Diarrhoea
Authors: Fabre Alexandre , Roquelaure Bertrand , Lacoste Caroline , André Nicolas , Sarles Jacques , Breton Anne , Martinez‐Vinson Christine , Cezard Jean‐Pierre , Colomb Virginie , Goulet Olivier , Levy Nicolas , Badens Catherine 
Published: May 2009

ABSTRACTSyndromic diarrhoea (SD) is a rare disease associating intractable diarrhoea and hair abnormalities. In an attempt to identify the gene causative for SD, we studied several functional candidate genes, based on their implication in overlapping phenotypes in mice (EGFR) or in humans (HRAS, JUP, DSP EPPK1, PLEC1, and CTNNB1) in 8 patients affected by SD. Except for EGFR and HRAS, all selected genes encode for cell adhesion proteins. Using direct sequencing or linkage analysis, we excluded all of the candidate genes as the disease‐causing gene in our group of patients; however, the hypothesis of intercellular junctions defect in SD remains seductive.
Acid Gastroesophageal Reflux in Symptomatic Infants Is Primarily a Function of Classic 2‐phase and pH‐only Acid Reflux Event Types
Authors: Woodley Frederick W , Hayes John , Mousa Hayat 
Published: May 2009

ABSTRACTBackground:Combined esophageal pH monitoring (EPM) and multichannel intraluminal impedance (MII) reveal 4 unique acid gastroesophageal reflux (AGER) types in infants: classic 2‐phase, single‐phase, pH‐only events (POEs), and re‐reflux episodes. The extent to which different AGER event types contribute to AGER frequency, acid reflux exposure time (ARET), and the number of episodes lasting 5 minutes or longer, has never been reported. In this study, EPM/MII was used to assess AGER in symptomatic infants on the basis of these 4 AGER types.Materials and Methods:EPM/MII tracings from 12 symptomatic infants (<12 months old) were examined. Mean frequencies and durations of each AGER type, percentages of total ARET due to each AGER type, and percentages of different AGER types lasting 5 minutes or longer, were measured.Results:Of 926 total AGER events, 23.1%, 6.3%, 69.2%, and 1.5% were classic 2‐phase, single‐phase, POEs, and re‐reflux episodes, respectively. In 20.2 hours of combined ARET, 52.3%, 2.3%, 42.4%, and 3.0% occurred during classic 2‐phase, single‐phase, POEs, and re‐reflux episodes, respectively. Classic 2‐phase and POE events were both more frequent than single‐phase (P = 0.002 and P < 0.0001) and re‐reflux (P = 0.002 and P < 0.0001) episodes, respectively. Increasing numbers of AGER episodes were strongly correlated with POEs (P = 0.0001). Of the 35 total AGER episodes that lasted 5 minutes or longer, 94% were classic 2‐phase episodes or POEs (57% and 37%, respectively).Conclusions:In symptomatic infants, total AGER episodes, total ARET, and AGER episodes lasting 5 minutes or longer are largely a function of classic 2‐phase and pH‐only AGER types.
Fecal Calprotectin: Cutoff Values for Identifying Intestinal Distress in Preterm Infants
Authors: Campeotto Florence , Baldassarre Mariella , Butel Marie‐José , Viallon Vivian , Nganzali Flore , Soulaines Pascale , Kalach Nicolas , Lapillonne Alexandre , Laforgia Nicola , Moriette Guy , Dupont Christophe , Kapel Nathalie 
Published: May 2009

ABSTRACTThis study aimed to determine cutoff levels for fecal calprotectin as a marker of intestinal distress in preterm neonates. A total of 126 infants born at a median gestational age of 33 weeks (range 25.7–35 weeks) were enrolled. Samples (n = 312) were collected weekly from the end of the first week of life until the end of the first month and if any gastrointestinal event occurred. Receiver operating characteristic curves analysis gave cutoff values of 363 μg/g (sensitivity 0.65, specificity 0.82) and 636 μg/g (sensitivity 0.72, specificity 0.95) for the development of mild or severe enteropathy.
Geographic and Racial Patterns of Anemia Prevalence Among Low‐income Alaskan Children and Pregnant or Postpartum Women Limit Potential Etiologies
Authors: Gessner Bradford D 
Published: May 2009

ABSTRACTObjectives:The etiology of the 10‐fold increase in anemia and iron deficiency prevalence among Alaska Native individuals from the culturally traditional southwestern/northern Alaska regions remains unknown. The present study sought to determine anemia prevalence among people enrolled in the Alaska Women, Infant, and Children (WIC) program and reconcile results with etiological hypotheses, particularly nutritional iron deficiency and Helicobacter pylori infection.Patients and Methods:An analysis was conducted of 50,964 children 6 to 59 months of age and 30,154 pregnant or postpartum women enrolled in WIC during 1999 to 2006. Based on 3 regional groupings of residence and Alaska Native status, 6 strata were defined.Results:Southwestern/northern Alaska Native children—who are known to have high nutritional iron intake based on subsistence diets—had the highest anemia prevalence (35%). However, southwestern/northern residence increased anemia risk similarly for Alaska Native (relative risk 1.6) and non‐Native (relative risk 1.5) children. Anemia prevalence was highest among the youngest children and declined with increasing age at approximately the same rate regardless of race or residence. Alaska Native pregnant or postpartum women from all of the regions had higher anemia prevalences than non‐Native women; southwestern/northern residence conferred additional risk to Alaska Native women.Conclusions:A region‐specific environmental factor is supported by the increased risk seen among all of the children residing in the southwestern/northern regions. However, the observed patterns make nutritional iron deficiency or H pylori infection unlikely as the sole or major etiologies of the high anemia prevalences observed in some groups.
Influence of Age and Genetic Risk on Anti‐tissue Transglutaminase IgA Titers
Authors: Vécsei Andreas , Arenz Tina , Heilig Gaby , Arenz Stephan , Bufler Philip , Koletzko Sibylle 
Published: May 2009

ABSTRACTObjectives:False‐positive results of anti‐tissue‐transglutaminase (tTG) IgA autoantibodies have been reported in subjects with a genetic risk for celiac disease (CD). The aims of this retrospective study were to assess the prevalence of false‐positive tTG titers in patients at risk of CD compared with symptomatic children and to evaluate the influence of age and indication for testing on tTG titers.Patients and Methods:All tTG results measured in our institution during a 33‐month period were evaluated. Patients with known CD were excluded. Indications for testing were either symptoms suggestive of CD (group 1) or history of being at risk for CD (group 2). Duodenal biopsies were recommended if titers were positive (≥10 U/mL) and offered if borderline (≥4 to <10 U/mL).Results:The final analysis included 2056 patients, 1707 belonged to group 1, and 349 to group 2. All 65 patients with positive tTG results underwent biopsy (group 1: 57, group 2: 8). Celiac disease was confirmed in 61 subjects (median titer: 107.8 U/mL, range 12.0–1748 mL, NS between group 1 and 2), whereas 4 had normal histology (10.2–25.2 U/mL). Three out of 16 patients with borderline results underwent biopsy and had normal histology. Borderline titers were more common in group 2 patients (2.6% vs 0.4%, P = 0.001). Multiple regression analysis in patients with negative tTG results (n = 1975) revealed that titers were independently related to age (P < 0.05) and indication for testing (P < 0.001).Conclusions:The influence of age and genetic predisposition/risk has to be taken into account when interpreting tTG results.
Pharmacological Interventions for Nonalcoholic Fatty Liver Disease in Adults and in Children: A Systematic Review
Authors: Socha Piotr , Horvath Andrea , Vajro Pietro , Dziechciarz Piotr , Dhawan Anil , Szajewska Hania 
Published: May 2009

ABSTRACTBackground:Uncertainty exists regarding the treatment of patients with nonalcoholic fatty liver disease (NAFLD) who are unable to lose weight and/or change lifestyle. The present study assesses the effectiveness and safety of pharmacological and dietary supplement interventions for NAFLD.Methods:MEDLINE, EMBASE, and the Cochrane Library were searched for randomized controlled trials (RCTs) both in adults and in children.Results:Fifteen (2 pediatric patients and 13 adults) RCTs met the inclusion criteria. A significant effect on normalization of alanine transaminase was found in patients treated with metformin compared with vitamin E, and in those treated with high‐dose (3 g) carnitine vs diet. In contrast, there was no difference in patients treated with pioglitazone combined with vitamin E versus vitamin E alone, ursodeoxycholic acid (UDCA) combined with vitamin E or alone versus placebo, or UDCA versus combination of vitamin E and vitamin C, and in patients treated with vitamin E, probucol, N‐acetylcysteine, low doses of carnitine, or Yo Jyo Shi Ko compared with placebo. Aspartate aminotransferase normalization was significantly higher in those treated with UDCA combined with vitamin E versus UDCA alone or placebo, and in those treated with metformin. Small number of subjects, high drop‐out rates, and numerous interventions in 1 study limit the value of many studies. Only 7 RCTs analyzed biopsy specimens, but most of them have significant methodological limitations. Pioglitazone had reduced liver necrosis and inflammation in 1 large study.Conclusions:Limited data do not allow one to draw firm conclusions on the efficacy of various treatments for NAFLD.
Living‐related Donor Liver Transplantation for Children With Fulminant Hepatic Failure in Israel
Authors: Shouval Dror S , Mor Eytan , Avitzur Yaron , Shamir Raanan , Bar‐Nathan Nathan , Steinberg Ran , Schoenfeld Tommy , Ben‐Ari Ziv , Shapiro Rivka 
Published: May 2009

ABSTRACTBackground:Liver transplantation is considered the treatment of choice for most children with deteriorating fulminant hepatic failure (FHF). Living‐related donor liver transplantation (LDLT) has been suggested as an alternative to cadaveric liver transplantation to overcome the shortage of organ donors. However, experience with LDLT for children with FHF is limited in the Western world.Objective:To present the experience with LDLT for children with FHF in a major referral center in Israel.Methods:The files of all children who underwent primary LDLT for FHF were reviewed for demographic, clinical, and laboratory parameters before and after transplantation.Results:During 1996 to 2007, 13 children diagnosed with FHF underwent primary LDLT. Median age was 4 years (range 0.75–14 years); the causes of FHF were acute hepatitis A in 4 patients and were unknown in 9 patients. Short‐term complications, documented in 12 children, included mainly hepatic artery thrombosis (n = 5), which warranted retransplantation in 3 cases, and biliary leaks (n = 3). Three patients died within the first month after LDLT of severe intraoperative bleeding (n = 1), severe brain edema (n = 1), and multiorgan failure (n = 1). Long‐term complications were less common and included mainly ascending cholangitis (n = 3). Patient survival rate was 68% at 1 year and 57% at 5 years. None of the donors had long‐term complications.Conclusions:Among children with FHF, LDLT can serve as a timely and lifesaving alternative to cadaveric donation, and could reduce the dependence on cadaveric livers in this setting.
Changes in Intestinal Microflora in Obesity: Cause or Consequence?
Authors: Bäckhed Fredrik 
Published: May 2009

ABSTRACTObesity and the associated metabolic disorders, such as diabetes and metabolic syndrome, have become major public health issues worldwide. Obesity results from a positive energy balance and is associated with decreased microbial diversity in the human gut with lower levels of Bacteroidetes. However, whether changes in the gut microbiota are a cause or consequence in obesity remains to be definitively proven. Experiments using germ‐free mice have begun to reveal some mechanisms by which the gut microbiota may affect the development of obesity.
Screening and Surveillance Recommendations for Pediatric Gastrointestinal Polyposis Syndromes
Authors: Barnard John 
Published: May 2009

ABSTRACTInherited polyposis syndromes are relatively rare disorders in pediatric gastroenterology practice, even in busy academic settings. It is important, however, for pediatric gastroenterologists to be aware of the serious health risks for children and their families affected by these disorders. The diagnosis of a polyp syndrome is often made in the first or second decade of life, long before the risk of gastrointestinal neoplasia. Pediatric gastroenterologists must be prepared then to offer families predictive genetic screening as well as endoscopic surveillance when appropriately indicated. The current overview is designed to provide general guidelines and, whenever possible, evidence‐based recommendations for genetic testing, endoscopic surveillance and other screening approaches for children with inherited gastrointestinal polyposis syndromes. In this presentation, the focus is on screening for neoplastic change and complications in the gastrointestinal tract. It is important to understand that extraintestinal cancers are frequent in some of these disorders and the reader is referred to other authoritative sources (1) for additional information about comprehensive health screening outside the gastrointestinal system.
Colon in Food Allergy
Authors: Troncone Riccardo , Discepolo Valentina 
Published: May 2009

ABSTRACTThe colon is a site of allergic reaction to food proteins. The most common manifestation is allergic proctocolitis. Although frequent in infancy, it may also affect older children. The diagnosis of allergic proctocolitis is mainly based on clinical and histological grounds, but there is a risk of overdiagnosis; challenge is strongly recommended to avoid unnecessary and expensive formula or changes in maternal diet that may discourage continuation of breast‐feeding. The benign clinical course and the spontaneous resolution in most infants suggest the need for further prospective studies to validate markers that allow the identification of those children needing a dietary approach. It remains to be assessed whether lymphoid nodular hyperplasia of the colon is a manifestation of food allergy. Finally, allergic proctitis may present clinically with refractory constipation; the true prevalence of food allergy–related constipation remains to be assessed.
Pharmacotherapy for Functional Gastrointestinal Disorders in Children
Authors: Saps Miguel , Di Lorenzo Carlo 
Published: May 2009

ABSTRACTTherapy of pediatric functional gastrointestinal disorders is best done within the context of a multidisciplinary biopsychosocial approach. Pharmacotherapy is often sought by patients and families who hope to find a “pill” that will lead to rapid symptom relief. Yet, there is only scant published evidence for the efficacy of a variety of medical interventions in childhood functional abdominal pain and irritable bowel syndrome. This article reviews the pediatric studies that have addressed pharmacotherapy in children with pain predominant functional gastrointestinal disorders.
Novel and Alternative Therapies for Childhood Constipation
Authors: Coccorullo Paola , Quitadamo Paolo , Martinelli Massimo , Staiano Annamaria 
Published: May 2009

ABSTRACTConstipation is a common and distressing pediatric problem. Even if prevalence of this disorder has increased, treatment of constipation in children is still largely based on clinical experience rather than on evidence‐based studies. The currently recommended treatment includes education, disimpaction, and maintenance therapy, consisting of dietary changes, behavioral modification, and use of laxatives. Among osmotic agents, polyethylene glycol solutions appear to be the first‐line drug to use in pediatrics. Although these measures are effective in the majority of children, a sizable proportion needs long‐term therapy. Chronicity may significantly interfere with the child's emotional growth and development. Advances in the understanding of the gastrointestinal enteric nervous system and epithelial function have led to the development of new classes of drugs. These include substances that bind to serotonin receptors or are chloride channel activators. Further studies are needed to assess the benefits and the risks of these new drugs.