bluuebunny/crossref_metadata_2025_split huggingface dataset:
Omeprazole Maintenance Therapy for Gastroesophageal Reflux Disease After Failure of Fundoplication
Authors: Pashankar Dinesh , Blair Geoffrey K. , Israel David M. 
Published: January 2024

ABSTRACTBackgroundRecurrence of gastroesophageal reflux (GER) in children after failed fundoplication poses a therapeutic challenge. The authors report the experience with long‐term omeprazole for children with severe GER after failed fundoplication.MethodsThe authors reviewed the charts of all children who were treated with omeprazole for GER subsequent to failed fundoplication from 1990 to 1999. All underwent endoscopic and clinical assessment of the treatment at baseline, at 3–5 months, at 6–9 months, and annually.ResultsEighteen children presented with GER, after a total of 27 fundoplications. Ten had corrected esophageal atresia, 6 had neurologica impairment, and 2 had hiatal hernia. The mean age of presentation of children with recurrence of GER was 7.8 years, and symptoms of GER occurred 4.9 years (range, 0.6–13) after last fundoplication. Fifteen patients had a mean follow‐up of 4.4 years for omeprazole. Ten patients had grade III/IV esophagitis and 5 had grade II esophagitis at presentation after fundoplication. Marked improvement was noted in symptoms of GER and severity of esophagitis while taking omeprazole. Remission of esophagitis was maintained while the patient was taking omeprazole and none had further surgery. There was no recurrence of peptic strictures in eight of nine children on omeprazole, after initial esophageal dilatations. Except for benign gastric polyps in three patients, no clinical adverse effects were observed.ConclusionsOmeprazole is an effective long‐term drug for gastroesophageal reflux disease after failed fundoplication in children. Omeprazole was well‐tolerated by all children and should be tried before subsequent surgical intervention.
Residual Intestinal Disease After Milk Allergy in Infancy
Authors: Kokkonen Jorma , Tikkanen Sami , Savilahti Erkki 
Published: January 2024

ABSTRACTBackgroundThe subsidence of cow's milk allergy (CMA) has been a subject of controversy. In this study the authors examined whether children with this condition in infancy developed full tolerance or whether they continue to have vague gastrointestinal (GI) symptoms relating to the consumption of milk or dairy products and/or signs of mucosal lesion in the GI tract.MethodsThe authors reexamined 56 10‐year‐old subjects who manifested CMA before 1 year of age, and compared the results with a group of 204 randomly selected age‐matched school children. Fifty‐three and 90 subjects respectively attended a reexamination and were evaluated for growth, lactose tolerance, and immunoglobulin A (IgA)‐ and IgG‐class antibodies to whole cow's milk. The subjects reporting milk‐related GI symptoms were encouraged to do a 4‐week blind elimination‐challenge test with 1 week of low‐lactose milk flour. Sixteen of the 25 children were able to complete the trial.ResultsApproximately half the study subjects (45%) reported milk‐related GI symptoms, whereas the respective figure among the control subjects was 10%. Three of six study subjects and seven of 10 control subjects, although completing the challenge, responded with intestinal symptoms. The growth of the former CMA subjects was retarded compared with the control subjects, and the difference in height was most striking in those subjects still reporting milk‐related GI symptoms. However, all subjects had normal hemoglobin and whole‐blood folic acid levels. The CMA subjects had significantly (P = 0.014) lower concentrations of milk antibodies compared with the control subjects. Lactose malabsorption, defined as high counts in a hydrogen breath test and related clinical symptoms, was found in eight CMA subjects (14%) and six control subjects (3%).ConclusionsIn a certain proportion of subjects with CMA in infancy, GI intolerance seems to persist even after small‐dose tolerance has been achieved. The intestinal symptoms and the increased prevalence of lactose intolerance may be caused by a disturbance of the surface epithelial cells—a state to which the authors refer as residual intestinal disease.
The Interrelationship of Malnutrition and Diarrhea in a Periurban Area Outside Alexandria, Egypt
Authors: Wierzba Thomas F. , El‐Yazeed Remon Abu , Savarino Stephen J. , Mourad Ali S. , Rao Malla , Baddour Manal , El‐Deen A. Nour , Naficy Abdullah B. , Clemens John D. 
Published: January 2024

ABSTRACTBackgroundIn the developing world, children are often observed to have both diarrhea and malnutrition. This observation has led many researchers to speculate that diarrhea may produce malnutrition and that malnutrition may predispose to diarrhea. In this study, the interrelationship between diarrhea and malnutrition was investigated among 143 Egyptian children less than 3 years of age.MethodsFor 22 months, children were followed for diarrhea at twice weekly home visits and measured for nutritional status at approximately 3‐month intervals. Nutritional measurements were converted to z‐scores based on the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference population.ResultsThree hundred fifty‐eight diarrheal episodes were reported with only 1% of episodes lasting 14 days or more. Stunting, wasting, and low weight‐for‐age were found in 19%, 3%, and 7%, of these children, respectively. When testing whether malnutrition predisposes to diarrhea, a weight‐for‐age z‐score of <−2 standard deviations was associated with increased incidence of diarrhea (RR = 1.7, P < 0.01) but not height‐for‐age or weight‐for‐height. Diarrhea itself was associated with a subsequent attack of diarrhea (RR = 2.1, P < 0.001). During short intervals of follow‐up (approximately 3 months), an association was detected between diarrhea episodes and growth faltering for height‐for‐age z‐score (−0.16, P < 0.05). This association was reduced, however, when analyzed during 6‐month intervals, if no diarrhea was reported in either the first or second half of this interval.ConclusionsIn a population with moderate malnutrition, both low weight‐for‐age and diarrhea itself are associated with increased diarrhea risk. Diarrhea alone does not appear to contribute substantially to malnutrition when children have diarrhea‐free time for catch‐up growth.
Ursodeoxycholic Acid Ameliorates Ibuprofen‐Induced Enteropathy in the Rat
Authors: Lloyd–Still John D. , Beno David W. A. , Uhing Michael R. , Jiyamapa‐Serna Vanida A. , Kimura Robert E. 
Published: January 2024

ABSTRACTBackgroundThe objective of the study was to determine whether ursodeoxycholic acid (Ursodiol) is protective against ibuprofen (IBU)‐induced enteropathy.MethodsUsing the chronically catheterized rat model, IBU (60 mg/kg body weight per day) was infused via the gastric catheter twice daily. Pancreatic enzyme (PE; 10,000 U lipase/kg body weight per day) and Ursodiol (10 mg/kg body weight per day) in two doses were infused via the duodenal catheter. Rats were assigned to one of six treatment groups and were administered treatment for 20 days: control, IBU, PE, IBU + PE, IBU + Ursodiol, and IBU + PE + Ursodiol. The entire jejunum, ileum, cecum, and colon were available for histologic analysis using previously described techniques.ResultsAddition of Ursodiol to high‐dose IBU and normal doses of PE showed a significant reduction in the percentage of rats with ulcers (P < 0.05), total number of serositis events (P < 0.01), total number of severe ulcers (P < 0.001), and an absence of ulcers in the large intestine.ConclusionsUrsodiol, the drug of choice for the treatment of cystic fibrosis liver disease, may offer a safe method of using high‐dose IBU in these patients by ameliorating the enteropathy.
Is There a Relation between Docosahexaenoic Acid Concentration in Mothers' Milk and Visual Development in Term Infants?
Authors: Jørgensen Marianne Hørby , Hernell Olle , Hughes Elizabeth L. , Michaelsen Kim Fleischer 
Published: January 2024

ABSTRACTBackgroundDocosahexaenoic acid (DHA), present in high concentrations in the brain and retina, has a role in visual development. DHA is present in human milk, but not in most infant formulas. It is, however, under discussion whether DHA should be added to formulas intended for term infants. The concentration of DHA in human milk, which is influenced by maternal diet, varies considerably, but it is unknown whether this variation affects visual development in term infants.MethodsThe authors investigated 39 4‐month‐old fully breast‐fed term infants in a cross‐sectional study. Visual acuity was measured by swept visual evoked potentials, milk DHA was determined by gas chromatography, and maternal fish intake was assessed by a frequency questionnaire.ResultsFrequency of fish intake correlated positively to the DHA level in breast‐milk (P = 0.001). Mothers who ate fish the day before sampling had a milk DHA level higher than expected from habitual fish intake (P = 0.002). If this was taken into account, 57% of the variation in milk DHA could be explained by fish intake. Multiple linear regression analysis revealed a significant association between visual acuity and milk DHA (P = 0.02, R2 = 0.09).ConclusionThis finding suggests a cause‐and‐effect relationship between infant milk DHA intake and visual acuity. If these data are confirmed, there is a need to consider the optimal intake of DHA for the lactating mother.
Plasma Nitrate Concentrations in Children with Infectious and Noninfectious Diarrhea
Authors: Charmandari Evangelia , Meadows Nigel , Patel Mahesh , Johnston Atholl , Benjamin Nigel 
Published: January 2024

ABSTRACTBackgroundIn patients with intact renal function and low dietary nitrate intake, plasma nitrate concentrations reflect endogenous nitric oxide production and are shown to be increased during inflammatory processes. The aim of this study was to compare plasma nitrate concentrations and hence endogenous nitric oxide production in children with infectious and noninfectious diarrhea and to determine whether plasma nitrate concentrations could serve as a discriminant test between acute and chronic diarrhea in children.MethodsThree groups of patients were identified: 14 patients with acute gastroenteritis, 13 patients with chronic noninfectious diarrhea, and 14 patients with no evidence of gastrointestinal pathology and no underlying infectious process, who served as control subjects. Plasma nitrate concentrations were determined spectrophotometrically using the Greiss reaction before reduction to nitrite with a copper‐coated cadmium column.ResultsMean plasma nitrate concentrations were 405.3 μmol/L ± 281.6 μmol/L (standard deviation) in patients with infectious diarrhea, 134.7 μmol/L ± 77.0 μmol/L in patients with chronic diarrhea, and 54.1 μmol/L ± 20.1 μmol/L in control subjects (F = 42.6, P < 0.0001; analysis of variance). Plasma nitrate concentrations were significantly higher in the infectious diarrhea group compared with the noninfectious diarrhea and control groups (Student–Newman–Keuls test, P < 0.5).ConclusionsAlthough an optimal cutoff concentration cannot be defined, plasma nitrate concentrations in excess of 300 μmol/L are suggestive of an infectious process whereas values less than 100 μmol/L are indicative of noninfectious diarrhea.
Apoptotic Epithelial Cells in Biopsy Specimens from Infants with Streaked Rectal Bleeding
Authors: Kumagai Hideki , Masuda Tomoyuki , Maisawa Shunichi , Chida Shoichi 
Published: January 2024

ABSTRACTBackgroundHistologic studies of rectosigmoidal mucosal biopsies of infants with isolated blood‐streaked stool have shown many eosinophils and revealed aggregates of small dark granules (nuclear dust). However, no description of the nuclear dust has been made for this condition and the nature of the nuclear dust has not been thoroughly investigated. We determined the characteristics of these particles in biopsies from infants with streaked rectal bleeding.MethodsNineteen infants who were younger than 6 months old and had isolated rectal bleeding were studied, as were six age‐matched control infants. Rectosigmoidal mucosal biopsies were immunohistochemically assessed using anticarcinoembryonic antigen and macrophage‐associated antibodies and examined for apoptotic cells by modified in situ TdT‐mediated dUTP‐biotin nick‐end labelling. The number of apoptotic epithelial cells was compared between rectal bleeding and control groups.ResultsImmunohistochemistry showed that at least some of the nuclear dust consisted of apoptotic epithelial cells. Infants with rectal bleeding also showed nodular lymphoid hyperplasia (n = 16), abundant eosinophils (>20/high power field, n = 14) in the mucosa, and a significantly high number of apoptotic epithelial cells relative to the control group. Rectal bleeding disappeared at 6‐month follow‐up in 14 of 18 infants (one was lost to follow‐up) who were fed a different milk formula or breast‐fed (their mothers were restricted from having cow's milk and eggs).ConclusionsThe high number of apoptotic epithelial cells in rectosigmoidal mucosal biopsies of infants with streaked rectal bleeding is probably caused by accelerated epithelial cell turnover and apoptosis.
Thiamine, Riboflavin, Pyridoxine, and Vitamin C Status in Premature Infants Receiving Parenteral and Enteral Nutrition
Authors: Friel James K. , Bessie Jamie C. , Belkhode Suresh L. , Edgecombe Colin , Steele‐Rodway Merlee , Downton Geoff , Kwa Poh Gin , Aziz Khalid 
Published: January 2024

ABSTRACTBackgroundThere is a paucity of data about water soluble vitamin status in low birthweight infants. Therefore, the authors' objective was to assess current feeding protocols.MethodsThe authors measured serum concentrations for riboflavin, pyridoxine, and vitamin C and functional assays for thiamine and riboflavin longitudinally in 16 premature infants (birthweight, 1,336 ± 351 g; gestational age, 30 ± 2.5 weeks) before receiving nutrition (time 1, 2 ± 1 days), during supplemental or parenteral nutrition (time 2, 16 ± 10 days) and while receiving full oral feedings (time 3, 32 ± 15 days). In plasma, vitamin C was measured colorimetrically, and riboflavin and pyridoxine were measured using high‐performance liquid chromatography. The erythrocyte transketolase test as a functional evaluation of thiamine and the erythrocyte glutathione reductase test for riboflavin were measured colorimetrically.ResultsAt time 1, nutrient intake of vitamins were negligible because infants were receiving intravenous glucose and electrolytes only. Intakes differed between time 2 and time 3 for thiamine (510 ± 280 and 254 ± 115 μg · kg −1 · d −1 , respectively), riboflavin (624 ± 305 and 371 ± 193 μg · kg −1 · d −1 , respectively), and pyridoxine (394 ± 243 and 173 ± 85 μg/100 kcal, respectively), but not for vitamin C (32 ± 17 and 28 ± 12 mg · kg −1 · d −1 , respectively). Blood levels at times 1, 2, and 3 were for thiamine (4.9 ± 2.7%, 3.3 ± 6.6%, and 4.1 ± 9% erythrocyte transketolase test, respectively), riboflavin (0.91 ± 0.31, 0.7 ± 0.3, 0.91 ± 0.18 erythrocyte glutathione reductase test, respectively), riboflavin (19.5 ± 17, 23.3 ± 8.6, 17.6 ± 10 ng/mL, respectively), pyridoxine (32 ± 25, 40 ± 16, 37 ± 26 ng/mL, respectively), and vitamin C (5.2 ± 3, 5 ± 2.2, 10 ± 5 μg/mL, respectively) and did not differ at those times.ConclusionsCurrent intakes of these vitamins, except for possibly vitamin C, during parenteral and enteral nutrition seem to result in adequate plasma concentrations and normal functional indices.
Large‐Volume Paracentesis in the Management of Ascites in Children
Authors: Kramer Robert E. , Sokol Ronald J. , Yerushalmi Baruch , Liu Edwin , MacKenzie Todd , Hoffenberg Edward J. , Narkewicz Michael R. 
Published: January 2024

ABSTRACTBackgroundLarge‐volume paracentesis has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. There are no published data relating to the safety, efficacy, or methods of this procedure in children. The objective of this study was to characterize the authors’ initial experience with large‐volume paracentesis (> 50 ml/kg of ascites) for removal of tense abdominal ascites in the pediatric population.MethodsRetrospective chart review was performed of 21 large‐volume paracentesis sessions in seven children (ages 6 months–18 years) with tense ascites that did not respond to other measures.ResultsMean volume removed was 3,129 ± 2,966 ml (mean ± standard deviation) or 118 ± 56 ml/kg over 2.9 ± 3.7 hours by a 16‐gauge intravascular catheter in 6 sessions, by an 18‐gauge intravascular catheter in three sessions, and by a 15‐gauge fenestrated, stainless‐steel paracentesis needle in 12 sessions. Large‐volume paracenteses performed with the paracentesis needle had significantly shorter duration of drainage and faster flow rates than those performed with the intravascular catheter. The only complication encountered was decreased urine output in one session.ConclusionsLarge‐volume paracentesis is a safe and effective therapeutic method for managing tense abdominal ascites in children. The use of the paracentesis needle significantly improved the speed and efficiency of large‐volume paracentesis compared with the intravascular catheter.
Experience With an Anesthesiologist Interventional Model for Endoscopy in a Pediatric Hospital
Authors: Koh Jeffrey L. , Black Dennis D. , Leatherman Isabel K. , Harrison R. Dale , Schmitz Michael L. 
Published: January 2024

ABSTRACTBackgroundEndoscopy is now a routine part of the work‐up for many patients with gastrointestinal symptoms. Adults tolerate these procedures well, with either no sedation or a relatively light level. In contrast, children often require deep sedation or a general anesthetic to successfully perform these procedures. Therefore, pediatric endoscopies may require more time, personnel, and monitoring equipment to provide optimal conditions for the patient. The goals of this retrospective case series were to describe the anesthesia times and recovery duration of the different procedures, the types and amounts of medications commonly used, and the types and rates of complications experienced.MethodsPatients (2,306) who underwent endoscopy in the Arkansas Children’s Hospital endoscopy suite during a 4‐year period were identified. A random sample of 720 charts was reviewed retrospectively.ResultsPatients ranged in age from younger than 1 year to 29 years. Patients most often had abdominal pain or multiple gastrointestinal symptoms. Sixty‐eight percent of patients underwent esophagogastroduodenoscopies; 30% colonoscopy or a combination of the two. Ninety‐five percent of patients received a propofol‐based anesthetic. Midazolam, fentanyl, and alfentanil were frequently used as supplemental agents. Complications occurred infrequently and were airway related. All complications were easily treated, with no adverse sequelae.ConclusionsThis model of anesthesiologist‐provided sedation/anesthesia for gastrointestinal endoscopy procedures has been extremely successful in the Arkansas Children’s Hospital and has served to heighten awareness of many issues surrounding sedation and anesthesia outside of the operating room, while ensuring a high level of care is provided.
6‐Mercaptopurine Metabolite Levels in Children With Inflammatory Bowel Disease
Authors: Gupta Puneet , Gokhale Ranjana , Kirschner Barbara S. 
Published: January 2024

ABSTRACTObjectivesSome authors suggest that efficacy of 6‐mercaptopurine (6‐MP) in patients with inflammatory bowel disease correlates with circulating 6‐thioguanine (6‐TG) levels more than 235 pmol/8 × 10 8 red blood cells. The authors evaluated the relation between 6‐MP metabolite levels and disease activity in children and adolescents with inflammatory bowel disease.MethodsClinical status and hematologic and hepatic parameters were determined in 101 children with inflammatory bowel diseasefrom a single center and compared with 6‐MP metabolite levels.ResultsThere was a trend for higher 6‐TG levels among patients in remission than among those with active disease (217 vs. 173); however the difference was not statistically significant (P = 0.09). The likelihood of therapeutic response did not increase significantly at 6‐TG levels greater than 235 pmol/8 × 10 8 red blood cells (odds ratio 1.7;P = 0.1). In the current study, 58% of patients in remission had 6‐TG levels less than 235. However, serial measurements of 6‐MP metabolite levels in 50 patients with active disease showed that increasing 6‐TG levels correlated significantly with disease remission in patients followed up longitudinally (P = 0.04). Leukopenia was significantly associated with high 6‐TG levels (P = 0.03) but not with clinical response (P = 0.2).ConclusionsThese data suggest that the target range of 6‐TG levels previously described by others did not apply to 58% of the pediatric patients with IBD in remission. However, serial monitoring of 6‐MP metabolite levels in individual patients with active disease should allow dose escalation and induction of remission while minimizing the risk of toxicity.
Electrogastrographic Norms in Children: Toward the Development of Standard Methods, Reproducible Results, and Reliable Normative Data
Authors: Levy Joseph , Harris Jennifer , Chen Jiande , Sapoznikov Dan , Riley Benita , De La Nuez Wendy , Khaskelberg Anna 
Published: January 2024

ABSTRACTBackgroundSurface electrogastrography (EGG) is a noninvasive technique that detects gastric myoelectrical electric activity, principally the underlying pacemaker activity generated by the specialized interstitial cells of Cajal. Interest in the use of this methodology has grown because of its potential applications in describing functional gastrointestinal disorders, particularly as a tool in the evaluation of nausea, anorexia, and other dyspeptic symptoms.MethodsFifty‐five healthy volunteers (27 female), ranging in age from 6 to 18 years (mean, 11.7 years), were studied for a 1‐hour baseline preprandial period and a 1‐hour postprandial period after consumption of a standard 448‐kcal meal. Recordings were obtained with an EGG Digitrapper or modified Polygraph (Medtronic‐Synectics, Shoreview, MN). Spectral analysis by an autoregressive moving average method was used to extract numerical data on the power and frequency of gastric electrical activity from the EGG signal.ResultsThe authors present normative data for healthy children and adolescents studied under a standardized protocol. Mean dominant frequency was found to be 2.9 ± 0.40 cycles per minute preprandially and 3.1 ± 0.35 postprandially, with 80% ± 13% of test time spent in the normogastric range (2–4 cycles per minute) before and 85% ± 11% after the test meal. The response of several key parameters to meal consumption was considered, and the effects of age, gender, and body mass index (BMI) on the EGG were sought.ConclusionsThere is a postprandial increase in the rhythmicity and amplitude of gastric slow waves, as other investigators have shown in adults. Key normative values are not dependent on age, gender, or BMI. The authors discuss limitations in the data set and its interpretability. The authors establish a normative data set after developing a standardized recording protocol and test meal and show that EGG recordings can be obtained reliably in the pediatric population. Development of similar norms by investigators using the EGG is crucial for future exploration of the validity and clinical application of the EGG. Differences in test conditions of signal detection and analytic methods influence EGG results substantially, and caution should be used when comparing results across centers.