bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic Therapy in Cyclic Vomiting Syndrome
Authors: Forbes David , Withers Geoffrey 
Published: February 2024

Summary:The experience with prophylactic therapy for cyclic vomiting syndrome (CVS) at Princess Margaret Hospital for Children, Perth, Western Australia was retrospectively reviewed by questionnaire. Data was collected from 31 patients, aged 2.9‐21.75 years who reported a mean of nine attacks per year. Eleven patients had utilized prophylactic therapy. Parental assessment of benefit was recorded. Propranolol was the most effective agent with reported benefit in four of six cases, other antimigraine agents were deemed effective in two of seven cases. Anticonvulsants and antidepressants were not considered use ful. Homeopathic and vitamin supplements were thought to be beneficial in three of six cases. Prophylaxis was less likely to be beneficial in the more severe cases of CVS, but was of benefit in those patients whose attacks were precipitated by infection or who had features consistent with migraine. Prophylactic therapy with propranolol or serotonin receptor antagonists should be considered in children with frequent or severe symptoms.
Treatment of Cyclic Vomiting in Childhood with Erythromycin
Authors: Vanderhoof Jon A. , Young Rosemary , Kaufman Stuart S. , Ernst Laura 
Published: February 2024

Summary:Cyclic vomiting syndrome (CVS) is an unusual cause of episodic emesis in children. It manifests as intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. Dehydration necessitating intravenous fluid therapy may occur. Most therapeutic maneuvers have proven unsuccessful. We report the use of erythromycin as a prokinetic agent in the treatment of cyclic vomiting in 24 children (10 boys, 14 girls). Many patients had mild associated abdominal pain with their vomiting. Fourteen patients had previously been given metoclopramide but none responded. Two patients were mildly developmentally delayed. Twenty‐four patients were given oral erythromycin ethylsuccinate, approximately 20 mg/kg/ day, in two to four divided doses for 7 days. This dose was repeated as needed when symptoms reappeared. Eighteen of 24 patients reported total resolution of symptoms when re‐evaluated at 2 and 6 months. All males responded, eight of 18 responders were female, and all six with partial or no response to therapy were female. This uncontrolled trial suggests that erythromycin may be a useful prokinetic agent in the treatment of CVS in childhood. Because the study was uncontrolled, placebo effect cannot be excluded. Case‐controlled, double‐blinded prospective trials should be considered to evaluate the effectiveness of erythromycin in CVS.
Abdominal Migraine in Children With Neurofibromatosis Type 1: A Case Series and Review of Gastrointestinal Involvement in NF1
Authors: Heuschkel Robert , Kim Sarah , Korf Bruce , Schneider Gretchen , Bousvaros Athos 
Published: February 2024

ABSTRACTBackgroundSymptomatic involvement of the gastrointestinal tract in children with neurofibromatosis type 1 (NF1) is rare. Most reported complications in adults are caused by the presence of neurofibromas in the stomach, small bowel, or mesentery. In contrast, abdominal pain in children with NF1 may be the result of nonanatomic causes, such as migraine. There are no previous reports of an association between abdominal migraine and NF1.MethodsChildren with abdominal migraine were identified from a group of children with NF1, all of whom had been followed up for a minimum of 3 years. Medical records of cases were reviewed independently by two authors. MEDLINE was searched via PubMed for all reports of children with NF1 and any associated gastrointestinal involvement.ResultsSix children with NF1 and intermittent, episodic, severe abdominal pain are reported. Investigations for obstructive or inflammatory causes of abdominal pain were negative. All patients had previously been diagnosed with migraine headaches by a neurologist. In five of the six patients, propranolol (10–15 mg three times daily) resulted in relief of their abdominal pain within days of starting therapy. Our review identified 24 children in the medical literature with gastrointestinal complications of NF1, mostly secondary to visceral neurofibromas. In almost all of these cases, clinical examination and simple radiologic investigations led to the definitive diagnosis. There were no reports of abdominal migraine complicating NF1.ConclusionsAbdominal pain secondary to migraine is an unrecognized cause of abdominal pain in children with NF1 and may be more common than anatomic causes of abdominal pain in children with NF1. In children with NF1 and severe recurrent abdominal pain in whom an evaluation for anatomic lesions is negative, a trial of migraine therapy may be indicated.
Efficacy of Lansoprazole in the Treatment of Gastroesophageal Reflux Disease in Children
Authors: Tolia Vasundhara , Ferry George , Gunasekaran Thirumazhisai , Huang Bidan , Keith Roberta , Book Linda 
Published: February 2024

ABSTRACTObjectives:To assess the efficacy of lansoprazole for the relief of symptoms due to gastroesophageal reflux disease (GERD) in children 1 to 11 years of age. In addition, the efficacy in healing of erosive esophagitis (EE) was determined in those children with EE who were enrolled in the study.Methods:In this phase I/II, open‐label, multicenter (11 sites). U.S. study, children with symptomatic GERD, EE by endoscopy, and/or intraesophageal pH < 4 for greater than 4.2% of the time' based on 24‐hour pH testing were assigned, on the basis of body weight, to lansoprazole 15 mg (≤ 30 kg) or 30 mg (> 30 kg) once daily for 8 to 12 weeks. At the discretion of the investigator, the dosage of lansoprazole was increased up to 60 mg daily in children who continued to be symptomatic after 2 weeks of treatment. Symptom response was assessed by investigator interview and daily diary. Esophagitis healing was evaluated by repeat endoscopy after 8 and, if applicable, 12 weeks of treatment.Results:Sixty‐six children were enrolled. At week 8, 78% (21/27) of the children with EE at baseline had healed; the remaining six children were healed by week 12 (100%, 6/6). By investigator interview, 70% of children experienced resolution or improvement in their overall symptoms of GERD by their final visit. Statistically significant reductions from baseline in the severity of each symptom were reported with the exceptions of wheezing, hematemesis, and melena. Based on daily diary data, improvement in overall GERD symptoms was reported in 76% (47/62) of all children. With few exceptions, significant (P < 0.05) reductions from baseline occurred during each of the 2‐week treatment intervals of the study period in the percentage of days and the average daily severity of GERD symptoms, the percentage of days antacid was used, and the average number of antacid tablets used per day.Conclusion:In children 1 to 11 years of age, lansoprazole is efficacious in healing EE and in relieving GERD‐related symptoms.
Pharmacokinetics and Pharmacodynamics of Lansoprazole in Children with Gastroesophageal Reflux Disease
Authors: Gremse David , Winter Harland , Tolia Vasundhara , Gunásekaran Thirumazhisai , Pan Wei‐Jian , Karol Michael , Chiu Yi‐Lin , Pilmer Betsy , Book Linda 
Published: February 2024

ABSTRACTObjectives:To evaluate the pharmacokinetics and pharmacodynamics of lansoprazole in children between 1 and 11 years of age with gastroesophageal reflux disease (GERD).Methods:In a multicenter, open‐label trial of pediatric patients with symptomatic GERD, children were assigned, based on their weight, to receive lansoprazole 15 mg (patients weighing ≤30 kg) or lansoprazole 30 mg (patients weighing > 30 kg) once daily. The effects of lansoprazole on 24‐hour median intragastric pH, the percentages of time intragastric pH was above 3 and 4, and pharmacokinetic parameters were assessed at the day‐5 visit and compared to baseline.Results:Sixty‐six children were enrolled in the study. Mean lansoprazole Cmax values of 790.9 ng/mL and 898.5 ng/mL and Tmax values of 1.5 hours and 1.7 hours were observed in the ≤30 kg and the > 30 kg body weight treatment groups, respectively. AUC0‐24 values of 1707 ng‐h/mL and 1883 ng‐h/mL and T1/2 values of 0.68 hours and 0.71 hours were observed in the ≤ 30 kg and > 30 kg lansoprazole body weight treatment groups, respectively. There was no statistical significant difference in AUC0‐24 between the two groups (P = 0.2571). After 5 days of treatment lansoprazole produced significant increases in patients' 24‐hour mean intragastric pH and the percentages of time intragastric pH was above 3 and 4 compared to baseline.Conclusion:The observed pharmacokinetic properties of lansoprazole in children between 1 and 11 years of age with GERD were similar to those previously observed in healthy adult subjects. Lansoprazole significantly increased the mean 24‐hour intragastric pH and the percentages of time intragastric pH was above 3 and 4 when children were dosed with either 15 or 30 mg according to body weight.
Partial Protection against Dextran Sodium Sulphate Induced Colitis in Histamine‐Deficient, Histidine Decarboxylase Knockout Mice
Authors: Bene László , Sápi Zoltàn , Bajtai Attila , Buzás Edit , Szentmihályi Anna , Arató András , Tulassay Zsolt , Falus András 
Published: February 2024

ABSTRACTObjectives:Chemically induced mucosal inflammation in animal models is a suitable tool for studying factors in the pathogenesis of inflammatory bowel disease. The aim of this study was to determine whether absence of histamine has an effect on the development of experimental colitis.Methods:Histamine‐deficient, histidine decarboxylase (HDC) knockout Balb/c mice and genetically identical control animals with intact HDC were studied. Colitis was induced by the administration of 2% dextran sodium sulphate in drinking water. Mice were killed after 5 days and disease activity assessed by clinical, histologic, and immunohistologic parameters. Bacterial components of stool were examined.Results:Clinical disease activity was higher in the mice with intact HDC (disease activity index, 2.21) than in the histamine‐deficient knock‐out mice (1.88). Histologic findings were similar in the two groups. On day 5, the inflammation score of the HDC sufficient group was 5.25 (±1.055) and the crypt score was 5.00 (±1.128). The scores in the HDC knock‐out group were 4.667 (± 0.707) and 4.667 (± 0.86), respectively. There was a significant difference in the number of interleukin (IL‐10)–producing lymphocytes in colon mucosa. Large numbers of IL‐10–positive lymphocytes were observed in wild type mice both those with DSS induced colitis and untreated controls. Only sporadic IL‐10 positivity was found in histamine‐deficient mice. Significant differences were found in the composition of the fecal bacterial flora between the two groups.Conclusion:The reduced number of IL‐10–positive lymphocytes in the intestinal mucosa of histamine‐deficient, histidine decarboxylase knockout mice and the altered fecal bacterial flora in these animals suggest that histamine may play a role in the pathophysiology of inflammation in the colon of normal animals by upregulating local IL‐10 production and stimulating a local shift to Th2 response.
Oral Rehydration Solution Containing a Mixture of Non‐Digestible Carbohydrates in the Treatment of Acute Diarrhea: A Multicenter Randomized Placebo Controlled Study on Behalf of the ESPGHAN Working Group on Intestinal Infections
Authors: Hoekstra J. H. , Szajewska H. , Zikri M. Abu , Micetic‐Turk D. , Weizman Z. , Papadopoulou A. , Guarino A. , Dias J. A. , Oostvogels B. 
Published: February 2024

ABSTRACTObjective:A randomized, double‐blind, placebo‐controlled multicenter study to evaluate efficacy and safety of a mixture of non‐digestible carbohydrates (NDC) as an adjunct to oral rehydration therapy in treatment of acute infectious diarrhea in children with mild to moderate dehydration.Methods:144 boys aged 1 to 36 months with diarrhea defined as three or more watery stools per day for >1 day but <5 days with mild or moderate dehydration (World Health Organization criteria) were randomly assigned to receive hypotonic oral rehydration solution (ORS) (Na 60 mmol/L, glucose 111 mmol/L) with or without a mixture of NDC (soy polysaccharide 25%, α‐cellulose 9%, gum arabic 19%, fructooligosaccharides 18.5%, inulin 21.5%, resistant starch 7%).Results:Intention‐to‐treat analysis did not show significant differences in mean 48 hour stool volume (ESPGHAN‐ORS with NDC versus ESPGHAN‐ORS, 140 ± 124 g/kg versus 143 ± 114 g/kg; P = 0.41). Duration of diarrhea after randomization was similar in both groups (82 ± 39 hours versus 97 ± 76 hours, P = 0.24). There were no significant differences in the duration of hospital stay (111 ± 44 hours versus 126 ± 78 hours; P = 0.3). Unscheduled intravenous rehydration was similar in both groups (21.4% versus 16.2%, P = 0.42).Conclusion:In boys with acute non‐cholera diarrhea with mild to moderate dehydration a mixture of non‐digestible carbohydrates was ineffective as an adjunct to oral rehydration therapy.
Electrogastrography Reveals Post‐prandial Gastric Dysmotility in Children with Cystic Fibrosis
Authors: Schäppi Michela G. , Roulet Michel , Rochat Thierry , Belli Dominique C. 
Published: February 2024

ABSTRACTObjectives:Cystic fibrosis patients have a wide spectrum of gastrointestinal disorders. The aim of this study was to investigate the function of gastroenteric neuromusculature and its response to a prokinetic.Methods:14 CF children aged 8.6 + 1.3 years were studied by electrogastrography and compared to 10 age‐matched controls. A second recording was performed in CF patients after administration of cisapride (0.3 mg/kg). Parameters analyzed were percentage of normal gastric rhythm (2.0 to 4.0 cpm), percentage of tachygastria (4.0 to 9.0 cpm), dominant frequency instability coefficient and power ratio.Results:CF and control groups were not different in age, height or weight. A significant post‐prandial increase in percentage of tachygastria (26.7 + 4.5 versus 12.4 + 2.6; P < 0.05) was seen in CF patients, which was not corrected by cisapride. The power ratio showed a statistical increase in 3 cpm (3.7 + 0.8 versus 1.6 + 0.3; P < 0.05) and in tachygastria (5.3 + 1.2 versus 1.7 + 0.4; P < 0.03) in CF compared with controls. Cisapride had an effect on tachygastria power ratio (3.0 + 0.5; P < 0.04). Analysis of normal rhythm and the dominant frequency instability coefficient were not statistically different in CF and controls.Conclusion:This study provides evidence of gastric dysmotility in CF patients.
Extraction of Di‐ethylhexyl‐phthalate from Perfusion Lines of Various Material, Length and Brand by Lipid Emulsions
Authors: Loff Steffan , Subotic U. , Reinicke F. , Wischmann H. , Brade J. 
Published: February 2024

ABSTRACTBackground:The plasticizer di‐ethylhexyl‐phthalate (DEHP) is extracted especially by lipid emulsions from polyvinylchloride infusion systems. The aim of this study was to systematically examine the extraction from perfusion lines commonly used in our hospital for lipid emulsion infusions.Methods:Perfusion lines made from polyvinylchloride of various lengths and brands, polyethylene, polyvinylchloride/polyethylene (PVC/PE) and polyvinylchloride/polyurethane (PVC/PU), were perfused with lipid emulsions according to the circumstances of newborns on an intensive care unit, i.e. high temperature, 24‐hour duration and low quantities. Concentration of di‐ethylhexyl‐phthalate was determined with gas chromatograph mass spectrometry.Results:The lipid emulsions before perfusion had a contamination with DEHP of 0.82 μg/ml. Pure PVC lines of 1.5 m length leached between 74 μg/ml and 107 μg/ml. Sterilization of the lines did not influence DEHP extraction. After perfusion of DEHP‐free PVC lines and PVC‐free lines, the emulsions had a contamination with DEHP of 0.23 μg/ml and 0.11 μg/ml, respectively. PVC/PU co‐extruded lines leached 73 μg/ml. PVC/PE lines leached 41.6 μg/ml.Conclusions:Lipid emulsions contain a production‐inherent load of DEHP. Perfusion through PVC‐perfusion lines extracts a varying large amount of DEHP depending on length and brand of the perfusion lines. Co‐extruded PVC/PU and PVC/PE lines, intended to avoid DEHP contamination, leach a similar amount of DEHP and thus do not avoid the DEHP toxicity issue. The load accumulated by a baby on an intensive care unit easily reaches several milligrams of DEHP per day. As its effect upon biologic systems has been proven, and alternatives (PE or PU perfusion lines) are available, PVC and PVC co‐extruded perfusion lines should be abandoned for infusions, especially in babies.
Adult‐type Hypolactasia: Clinical, Morphologic and Functional Characteristics in Brazilian Patients at a University Hospital
Authors: Escoboza Patrícia Martins Luizari , Fernandes Maria Inez Machado , Peres Luiz César , Einerhand Alexandra Wilhelmina Carla , Galvão Lívia Carvalho 
Published: February 2024

ABSTRACTBackground:Adult‐type hypolactasia (AH) is the most common form of disaccharidase deficiency in humans, with a prevalence that varies among ethnic groups. In Brazil, the few available studies suggest a high prevalence of this condition. The objective of this study was to determine the prevalence of AH in Brazilian patients at the Ribeirão Preto University Hospital, and to study its morphologic and functional expression.Methods:One hundred fifteen patients between 5 and 60 years undergoing upper gastrointestinal endoscopy were included. Mucosal biopsy specimens were obtained from the second portion of the duodenum. AH was defined by the disaccharidase activity (lactase/sucrase ratio) of the duodenal mucosa. The morphologic expression of lactase was studied by immunohistochemistry.Results:The mean age of the subjects was 28.8 ± 14.8 years. Seventy of the 115 subjects (60.8% prevalence) had AH by enzyme activity measurements. Milk drinking was common and similar in patients with and without AH. Among the patients, 91.3% of the nonwhite and 53.2% of the white individuals had hypolactasia (P = 0.002). Immunohistochemistry revealed the presence of lactase in 73.3% of individuals with normal lactase activity. Two different expression patterns were found in patients with AH.Conclusions:The prevalence of AH was high in our subjects and similar to that reported in other Brazilian studies. Hypolactasia was more common among nonwhites. Immunohisto‐chemistry permitted the identification of two phenotypes of AH, the first characterized by the absence of both stainable lactase and lactase activity, and the second by the presence of stainable lactase without significant activity.
Dynamic Color Doppler Sonography of Intestinal Wall in Patients with Crohn Disease Compared with Healthy Subjects
Authors: Scholbach Th. , Herrero I. , Scholbach J. 
Published: February 2024

ABSTRACTObjective:Chronic inflammatory bowel diseases are characterized by inflammatory hyperperfusion of the intestinal wall in affected bowel segments. We applied a novel method to quantify color Doppler signals dynamically along a complete heart cycle inside the bowel wall. The aim was to describe bowel wall perfusion in Crohn disease patients in comparison with healthy probands and to compare a conventional activity index (Pediatric Crohn Disease Activity Index) with perfusion measurements as an indicator of inflammatory activity.Method:Color Doppler sonographic videos of bowel wall perfusion from 34 healthy children (aged 5 to 18 years) and from 14 patients with Crohn disease (aged 8.2 to 15.9 years) were recorded under defined conditions. Perfusion signals (color hue, color area) were automatically measured inside the bowel wall. Specific tissue perfusion was calculated as mean flow velocity of a region of interest during one full heart cycle. Bowel wall perfusion was compared using the Pediatric Crohn Disease Activity Index in 12 patients.Results:Specific bowel wall perfusion was significantly elevated in bowel segments of Crohn disease patients compared with healthy subjects (P < 0.001). Specific flow in small bowel was 0.025 cm/s in healthy probands and 0.095 cm/s in patients with Crohn disease, whereas large bowel wall perfusion of 0.012 cm/s in healthy probands clearly differed from 0.082 cm/s in patients with Crohn disease. No differences of perfusion between moderate and high Pediatric Crohn Disease Activity Index levels could be demonstrated despite a weak significant overall correlation.Conclusion:The new method of dynamic, automatic noninvasive perfusion quantification is useful to describe local inflammatory activity in bowel segments affected by Crohn disease and adds new information to activity evaluation by Pediatric Crohn Disease Activity Index. Specific wall perfusion in intestines of Crohn patients is significantly elevated and reaches up to sevenfold intensity compared with healthy subjects.
Glucagon‐like Peptide‐2 (GLP‐2) Response to Enteral Intake in Children During Anti‐Cancer Treatment
Authors: Andreassen B. U. , Pærregaard A. , Schmiegelow K. , Rechnitzer C. , Heilman C. , Hartmann B. , Holst J. J. , Michaelsen K. F. 
Published: February 2024

ABSTRACTBackground:Intestinal dysfunction is frequent in cancer and during anti‐cancer treatment. Glucagon‐like peptide‐2 (GLP‐2) is secreted in a nutrition‐dependent manner from the intestinal enteroendocrine L‐cells. It accelerates crypt cell proliferation and nutrient absorption, inhibits enterocyte apoptosis and decreases mucosal permeability. Lack of GLP‐2 may increase the risk of malabsorption and intestinal bacterial translocation. The aim of this study is to evaluate meal stimulated secretion of GLP‐2 in children with cancer undergoing anti‐cancer treatment.Methods:Plasma‐GLP‐2 analysis after an overnight fast and 1 hour after intake of a mixed test meal. Data on gastrointestinal toxicity, blood neutrophile counts and food records were included in the analysis.Results:Forty‐four meal stimulation tests were performed in 25 children (median age, 6.0 years; range, 2.5‐19) during anti‐cancer treatment. Median GI toxicity score was 5 (range, 0‐15), and mean energy intake was 62.4% of recommended values. P‐GLP‐2 values increased from mean (SD) 38 (18) to 63 (51) pmol/l (P < 0.0001). Twelve of the meal stimulation tests (28%) resulted in a p‐GLP‐2 increase >2 fold, which is assumed to be the lower limit of normal values. The increase was strongly dependent on the energy intake (r = 0.62, P < 0.0001), while toxicity score and neutrophile count had no significant influence (multiple regression).Conclusion:In children treated with anti‐cancer therapy, GLP‐2 secretion seems to be normal if the enteral energy intake is sufficient. Insufficient GLP‐2 secretion could influence the gastrointestinal problems seen in the children with a low enteral energy intake.