bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aluminum Contamination of Parenteral Nutrition and Aluminum Loading in Children on Long‐Term Parenteral Nutrition
Authors: Advenier Emmanuelle , Landry Caroline , Colomb Virginie , Cognon Cécile , Pradeau Dominique , Florent Maurice , Goulet Olivier , Ricour Claude , Corriol Odile 
Published: January 2024

ABSTRACTBackgroundChildren who are receiving parenteral nutrition are at risk of aluminum overload, which may contribute to such side effects as osteopenic bone disease. The aim of the present study is to determine the aluminum contamination of parenteral nutrition solutions and their components, and to assess the aluminum status of children on long‐term parenteral nutrition.MethodsAluminum concentrations were determined by graphite furnace absorption spectroscopy in components and in final parenteral nutrition solutions. The urinary aluminum excretion and plasma aluminum concentration were determined in 10 children on long‐term parenteral nutrition.ResultsThe mean aluminum concentration in the administered parenteral nutrition solutions was 1.6 ± 0.9 μmol × l−1(mean ± standard deviation (SD)). The resulting mean aluminum daily intake of the 10 patients was 0.08 ± 0.03 μmol × kg−1 × day−1.ConclusionsCompared to two previous studies performed in 1990 and in 1995 in our hospital, the aluminum contamination of parenteral nutrition solutions and the daily aluminum intake of the children seemed to decrease. However, the plasma aluminum concentration and daily urinary aluminum excretion of the children still remain above normal standards. The children had no clinical symptoms of bone disease but aluminum accumulation in tissue can not be excluded. To prevent this iatrogenic toxicity, the aluminum contamination of parenteral nutrition should be assessed regularly.
The Nature of Colitis in Chronic Granulomatous Disease
Authors: Schäppi Michela G. , Klein Nigel J. , Lindley Keith J. , Rampling Dyanne , Smith Virpi V. , Goldblatt David , Milla Peter J. 
Published: January 2024

ABSTRACTBackgroundPatients with chronic granulomatous disease (CGD) may have gastrointestinal manifestations, commonly colitis. The etiology, prevalence, and inflammatory process of CGD colitis are unclear.ObjectivesTo characterize the inflammatory process of CGD colitis and to compare it with other inflammatory bowel disorders.MethodsColonic mucosal biopsies from 8 CGD patients were immunostained for eosinophils, neutrophils, macrophages, and adhesion molecules (ICAM; VCAM, E‐selectin) and compared with normal and diseased controls (allergic colitis, ulcerative colitis, and melanosis coli). Cell types were counted and expressed as cell/mm2ResultsThe inflammatory infiltrate in CGD colitis differed from the normal controls by an increase in eosinophils (110; 48–176 [median and range] versus 14.5; 3–30;P < 0.005) and macrophages (291.5; 203–480 versus 38.5; 27–64;P < 0.005). There was a paucity of neutrophils compared to ulcerative colitis (10; 0–101 versus 315.5; 78–688;P < 0.005). Expression of HLA‐DR was increased in the epithelium and vascular endothelium in CGD compared with normal controls. Patterns of expression of the adhesion molecules differed significantly in CGD from those in other inflammatory bowel diseases: intracellular adhesion molecule‐1 was more strongly expressed in the lamina propria, vascular adhesion molecule‐1 was more patchily expressed, and E‐selectin was present only in the small vessels.ConclusionsThe mechanism of inflammation and profile of inflammatory mediators in CGD colitis differs from that in other inflammatory bowel diseases.
Autoimmune Thyroid Disease and Celiac Disease in Children
Authors: Ansaldi Nicoletta , Palmas Tiziana , Corrias Andrea , Barbato Maria , D'Altiglia Mario Rocco , Campanozzi Angelo , Baldassarre Mariella , Rea Francesco , Pluvio Rosanna , Bonamico Margherita , Lazzari Rosanna , Corrao Giovanni 
Published: January 2024

ABSTRACTBackground:Celiac disease (CD) may be associated with other immunologic disorders in adults and children. Previous studies linking CD and autoimmune thyroid disease in children have included very few patients with limited biochemical and immunologic screening tests. The aim of this multicenter study was to establish the prevalence of autoimmune thyroid involvement in a large series of pediatric patients with CD.Methods:Five hundred seventy‐three consecutive pediatric patients were enrolled from clinics in Torino, Bologna, Foggia, Rome (two clinics), Naples, and Bari. Three hundred forty‐three patients with CD were studied, 230 girls and 113 boys (median age, 8.5 years). Two hundred fifty‐six of the patients with CD (median age, 9 years) had been following a gluten‐free diet for 3 months to 16 years; 87 patients were untreated (median age, 6.2 years). The diagnosis of CD was made using the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. A control group of 230 subjects (median age, 8.3 years) was enrolled. Serum free triiodothyronine, free thyroxine, and thyroid‐stimulating hormone (TSH), antithyroperoxidase, antithyroglobulin, anti‐TSH receptor antibodies, and thyroid echographic pattern were considered.Results:Autoimmune thyroid disease was found in 90 of 343 (26.2%) patients with CD (62 on a gluten‐free diet) and in 20 (10%) of the control subjects (P = 0.001). Fifty‐four (15.7%) patients with CD and autoimmune markers had normal thyroid function (euthyroidism) as did 12 (6.0%) of the control subjects; hypothyroidism was observed in 28 (8.1%) patients with CD and in 7 (3.5%) of the control subjects. Hyperthyroidism was diagnosed in four patients with CD and in none of the control subjects with autoimmune markers. An abnormal echographic pattern was seen in 37 patients with CD (16.8%) and only in 1 (1.6%) of the control subjects (P = 0.002).Conclusions:The high frequency of autoimmune thyroid disease found among patients with CD, even those on a gluten‐free diet, may justify a thyroid status assessment at diagnosis and at follow‐up evaluation of children with CD. JPGN 37:63‐66, 2003.
Esophageal Eosinophilia In Children With Dysphagia
Authors: Cheung Ka Ming , Oliver Mark R. , Cameron Donald J. S. , Catto‐Smith Anthony G. , Chow Chung W. 
Published: January 2024

ABSTRACTObjectivesChildren occasionally have dysphagia in the absence of an apparent primary cause. Esophageal eosinophilia is sometimes seen in these patients at the time of upper endoscopy but its significance is not clear. Although eosinophilia is regarded by some as a histologic hallmark of childhood reflux esophagitis, it may in fact signal a primary eosinophilic esophagitis in children with dysphagia. Our aim was to evaluate esophagitis, acid reflux determined by pH probe, and esophageal eosinophilia in children with the primary complaint of dysphagia.MethodsA retrospective study was performed in 42 children, admitted for investigation of dysphagia, in whom no primary cause could be found. Twenty‐one children (mean age ± SD, 10.1 ± 4.0 years) had esophageal eosinophilia and 21 children (8.3 ± 4.7 years) did not. Clinical, endoscopic, manometric and esophageal pH parameters in these two groups were compared.ResultsPatients with esophageal eosinophilia were more often male (p<0.01) with a history of allergy (p<0.001) and food bolus obstruction (p<0.05) requiring endoscopic removal. Their esophageal mucosa appeared wrinkled and thickened at endoscopy with basal cell proliferation, and large numbers of eosinophils in esophageal mucosal biopsies. Continuous esophageal pH records and motility studies, when obtained, were similar in both groups and were within normal values.ConclusionChildren with dysphagia who have esophageal eosinophilia are unlikely to have pathologic gastroesophageal reflux.
A Randomized, Controlled Trial of Parenteral Glutamine in Ill, Very Low Birth‐weight Neonates
Authors: Thompson S. W. , McClure B. G. , Tubman T. R. J. 
Published: January 2024

ABSTRACTObjectiveThe role of “novel substrates” in neonatal nutrition has generated much interest in recent years. Glutamine has been recognized as a “conditionally essential” amino acid in critically ill adults, particularly for gut and immune function; however, its potential role in the neonate remains unclear. The authors examined the safety and benefits of parenteral glutamine in ill, preterm neonates.DesignRandomized controlled trial.MethodsThirty‐five ill preterm neonates of <1000 g birth‐weight were randomized to receive either glutamine‐supplemented parenteral nutrition (PN) (n = 17) or standard PN (n = 18).ResultsThere were no significant differences in birth‐weight, gestational age, male‐to‐female ratio, or Clinical Risk Index for Babies (CRIB) score between the two groups. During PN there were no significant differences between the groups in white cell count, differential white cell count, blood urea nitrogen, plasma ammonia, lactate, pyruvate, plasma glutamine, or glutamate. The median time to achieving full enteral nutrition (FEN) was shorter in the study group (13 days vs. 21 days, P < 0.05). The number of episodes of culture‐positive sepsis or age at discharge did not differ between groups.ConclusionsParenteral glutamine appears to be well tolerated and safe in the ill, preterm neonate. It may reduce the time to achieving FEN.
Gastroesophageal Reflux Disease and Helicobacter pylori Infection in Neurologically Impaired Children: Inter‐relations and Therapeutic Implications
Authors: Pollet Séverine , Gottrand Frédéric , Vincent Pascal , Kalach Nicolas , Michaud Laurent , Guimber Dominique , Turck Dominique 
Published: January 2024

ABSTRACTBackgroundThe aim of this retrospective study was to assess the relationship between Helicobacter pylori infection and gastroesophageal reflux disease in a high‐risk population of children.MethodsForty‐three neurologically impaired pediatric patients with H. pylori had upper gastrointestinal endoscopy between 1990 and 2000. Infection was confirmed by positive H. pylori culture or by identification of organisms in gastric biopsy specimens (fundus, n = 2; antrum, n = 3). Reflux esophagitis was diagnosed by ulceration of the esophageal mucosa at endoscopy. Four to 6 weeks after the completion of antibiotic treatment of H. pylori, a second endoscopy was performed and the gross appearance of the esophagus was recorded.ResultsAt the first endoscopy, esophagitis was noted in 14 of 43 patients. After treatment, H. pylori infection was eradicated in all 14 patients with esophagitis but in only 19 of 29 (66%) of those with normal esophagus (P = 0.01). Esophagitis was still present in 4 of 14 (29%) patients who had esophagitis at the first endoscopy. Persistent esophagitis was only related to the presence of esophagitis before treatment (P = 0.02). In 29 patients with a normal esophagus at the first endoscopy, only one case of esophagitis was observed after H. pylori eradication.ConclusionThe data suggest that treatment of H. pylori infection should be considered in children with concomitant GERD, and such treatment is unlikely to either induce or exacerbate peptic esophagitis.
Nutritional Status and Gastrointestinal Structure and Function in Children With Ichthyosis and Growth Failure
Authors: Fowler Ashley J. , Moskowitz David G. , Wong Anthony , Cohen Sharon P. , Williams Mary L. , Heyman Melvin B. 
Published: January 2024

ABSTRACTGrowth failure occurs in several of the ichthyoses, a heterogeneous group of inherited disorders characterized by thickened or scaly skin. This suggests that there may be common pathogenic mechanisms causing failure to thrive. Previous studies have proposed that a hypermetabolic state induced by epidermal inflammation and hyperproliferation or enteropathy leading to malabsorption and nutritional deficiencies might account for the growth failure in icthyosis.ObjectiveThe purpose of this study was to examine the extent of enteropathy and nutritional deficiency in children with severe ichthyosis and growth failure.MethodsTen children with different types of ichthyoses and growth failure were studied.ResultsEvaluation of gastrointestinal structure and function revealed few abnormalities other than mild fat malabsorption in two patients. Total caloric intake exceeded established requirements for age, height, and weight in all patients. Deficiencies of fat‐soluble vitamins were identified in a few subjects. Mild elevations in total calcium and magnesium blood level, elevated hematocrit levels, and constipation were observed in many patients.ConclusionsNutritional deficiencies and gastrointestinal abnormalities are uncommon in children with ichthyosis and failure to thrive. Chronic hypovolemia caused by impaired epidermal permeability barrier may be common in this population.
Growth and Safety in Term Infants Fed Reduced‐Protein Formula with Added Bovine Alpha‐Lactalbumin
Authors: Lien Eric L. , Davis Anne M. , Euler Arthur R. ,   Multicenter Study Group
Published: January 2024

ABSTRACTObjectiveTo assess growth, tolerance, and biochemical measures of protein status in term infants fed an experimental formula with reduced total protein concentration and enriched in bovine alpha‐lactalbumin prepared from an alpha‐lactalbumin dominant bovine whey.MethodsHealthy, term, exclusively formula‐fed infants ≤14 days postnatal age, between 10th and 90th percentiles in weight and length for age were studied in this randomized, masked, multicenter study. Infants received ad libitum feedings of either experimental or control formula for 12 weeks. Adverse events and acceptability of formulas were assessed every 2 weeks. Weight, length, and head circumference were measured at baseline and every 4 weeks. Serum creatinine, albumin, and blood urea nitrogen were assessed at baseline and study completion. Anthropometric measures were compared to Centers for Disease Control reference ranges using Z scores.ResultsOne hundred ninety‐three infants were enrolled. One hundred thirty‐four completed the protocol. Seventy‐two received experimental formula, and 62 received control formula. The mean baseline body weight was higher in infants fed experimental formula (P = 0.042), so baseline weight was used as a covariate in statistical analyses. There were no differences between groups in gains in weight, length, or head circumference during the study. Mean serum albumin and blood urea nitrogen (BUN) levels were similar at study initiation. At study completion, serum albumin levels were the same in both groups, whereas BUN was significantly higher in infants fed control formula (P = 0.0016). More infants fed control (n = 20) than experimental (n = 15) formula discontinued the study because of adverse events. There were no differences in the adverse event profiles of the groups completing the study. Most of the adverse events were mild and resolved without treatment or sequelae. Acceptability and tolerance of the experimental formula was greater than the control formula, except at 2 weeks. Unacceptable ratings ranged from 0% to 10% (mean, 4.1%) in the experimental formula group and from 1.6% to 14.1% (mean, 7.0%) in the control formula group.ConclusionsGrowth and serum albumin were comparable in infants fed experimental and control formulas for the first 12 weeks of life, suggesting adequate protein nutrition from the alpha‐lactalbumin–rich formula, despite its lower total protein content. Growth and adverse events data support the safety of the experimental formula. Fewer discontinuations and unsatisfactory ratings among infants fed the experimental formula suggest that it is better tolerated than control formula.
Patchy Villous Atrophy of the Duodenum in Childhood Celiac Disease
Authors: Bonamico Margherita , Mariani Paolo , Thanasi Enina , Ferri Mirella , Nenna Raffaella , Tiberti Claudio , Mora Barbara , Mazzilli Maria Cristina , Magliocca Fabio Massimo 
Published: January 2024

ABSTRACTObjectivesPatchy villous atrophy of the duodenal mucosa has been described in adults with untreated celiac disease (CD) but not in children. The authors evaluated the presence and the distribution of villous atrophy in children with celiac disease to see whether this histologic pattern exists in children.MethodsWe studied 95 children at diagnosis (Group 1) and seven during gluten challenge (Group 2). We measured anti‐endomysium antibodies (EMA) by immunofluorescence on monkey esophagus, antihuman‐tissue transglutaminase autoantibodies (anti‐tTG Abs) by radioimmunoprecipitation, and HLA‐DQ2/DQ8 heterodimers by polymerase chain reaction using specific primers. During upper intestinal endoscopy, at least five duodenal biopsy samples were obtained, one from the duodenal bulb and four from the distal duodenum.ResultsThirteen of 95 (13.7%) patients in Group 1 and in 3 of 7 (42.9%) in Group 2 had patchy villous atrophy of the duodenum. In all 16 patients, villous atrophy of the bulb was present. In four children from Group 1, villous atrophy was observed only in the bulb samples. EMA, anti‐tTG Abs, and HLA‐DQ2/DQ8 heterodimers were present in all patients. Fourteen of 16 had symptomatic CD, and two were silent, detected during screening in subjects at risk for CD.ConclusionsThis is the first study demonstrating that children with CD may have patchy villous atrophy of the duodenum. The bulb mucosa may be the only duodenal area involved, both at diagnosis and after gluten challenge. Therefore, multiple endoscopic biopsies should always be performed, not only in the distal duodenum, but also in the bulb.
Bone Mineral Assessment by Dual Energy X‐ray Absorptiometry in Children With Inflammatory Bowel Disease: Evaluation by Age or Bone Area
Authors: Ahmed S. F. , Horrocks I. A. , Patterson T. , Zaidi S. , Ling S. C. , McGrogan P. , Weaver L. T. 
Published: January 2024

ABSTRACTBackgroundAbnormal linear growth and deficient bone mineral acquisition may coexist in children with inflammatory bowel disease (IBD). Traditionally, bone mineral assessment by dual energy x‐ray absorptiometry (DXA) involves comparison to age‐ and gender‐matched reference ranges, and these studies in children with IBD show a high prevalence of osteopenia.AimsTo compare the prevalence of osteopenia using two methods of interpretation; one adjusted for age and gender and the other adjusted for bone size and gender.PatientsForty‐seven patients with Crohn disease (CD) and 26 patients with ulcerative colitis (UC) with a median age of 13.5 years (range, 5.5–18.2 years) were evaluated.MethodsLumbar spine (LS) and total body (TB) bone mineral content (BMC) were measured by DXA and converted to bone mineral density (BMD, g/cm2) corresponding to BMC divided by the bone area. Age and gender‐matched BMD standard deviation scores (SDS) were based on reference data providing age‐ and gender‐matched BMC and bone area. These data also allowed calculation of percentage of predicted bone area for age and gender (ppBone Area) and percentage of predicted BMC for Bone Area (ppBMC).ResultsPatients with CD were shorter than those with UC (median height, SDS, −0.9 v 0, P < 0.05). Median ppBone Area for LS and TB for the whole group was 85% (10th centile, 68; 90th centile 99) and 81% (10th centile 66; 90th centile, 97), respectively. The ppBone Area at both sites was directly related to height SDS and BMI SDS (r > 0.5; P < 0.005). Median BMD SDS for LS and TB was −1.6 (10th centile −3.6; 90th centile, −0.2) and −0.9 (10th centile, −2.4; 90th centile, 0.4), respectively. Median ppBMC for LS and TB was 98% (10th centile, 84%; 90th centile, 113%) and 101% (10th centile 94%; 90th centile, 107%), respectively. The ppBMC showed no relationship to ppBone Area (r = 0.1, NS). Failure to account for bone area led to a label of moderate or severe osteopenia in 65% of cases. After adjustment for bone area, the proportion of children with osteopenia fell to 22%.ConclusionsThe data suggest that children with IBD often have small bones for age because they have growth retardation. When DXA data are interpreted with adjustment for bone size, most children were found to have adequate bone mass. Correct interpretation of DXA is important for identifying children who may be at a real risk of osteoporosis.
The Hygiene Hypothesis of Atopic Disease—An Extended Version
Authors: Rautava Samuli , Ruuskanen Olli , Ouwehand Arthur , Salminen Seppo , Isolauri Erika 
Published: January 2024

ABSTRACTThe hygiene hypothesis of atopic disease suggests that environmental changes in the industrialized world have lead to reduced microbial contact at an early age and thus resulted in the growing epidemic of atopic eczema, allergic rhinoconjunctivitis, and asthma. The epidemiological findings have been combined with the Th1/Th2 paradigm of immune responsiveness to provide a coherent theory. Recent advances in epidemiology and immunology demonstrate, however, that the hygiene hypothesis may need to be extended in three respects. First, the importance of infections in causing immune deviance may be outweighed by other sources of microbial stimulation, perhaps most importantly by the indigenous intestinal microbiota. Second, immunomodulatory and suppressive immune responses complement the Th1/Th2 paradigm. Third, in addition to protection against atopy, protection against infectious, inflammatory, and autoimmune diseases may also depend upon healthy host‐microbe interactions implicated in the hygiene hypothesis.
Stool Antigen Test for Diagnosis of Helicobacter pylori Infection in Children With Symptomatic Disease: A Prospective Study
Authors: Elitsur Yoram , Lawrence Zandra , Hill Ivor 
Published: January 2024

ABSTRACTObjective:Noninvasive tests for the diagnosis of Helicobacter pylori (Hp) infection in children are limited by low accuracy rates and lack of validation. Existing studies indicate that the stool antigen test (HpSA) has an acceptable level of accuracy for the diagnosis of Hp infection in adults but not children. The aim of this study was to evaluate the accuracy of the HpSA test for the detection of Hp infection in U.S. children.Methods:Children requiring upper endoscopic procedures were prospectively recruited from two pediatric gastroenterology clinics. Stool samples were collected from each participant before endoscopy. The presence of Hp infection was determined by positive histologic findings and positive rapid urease test (RUT). The presence of Hp organisms in stool was determined by an enzyme‐linked immunosorbent assay using a commercially available polyclonal antibody kit (Meridian Diagnostics, Cincinnati, OH, U.S.A.). Results of the stool antigen test were compared with histology findings and RUT results.Results:One hundred twenty‐one children (mean age, 10.1 ± 3.7 years) participated, of whom 9 (7.4%) had Hp infection. Histologic findings and RUT results were concordant in 95% of the children. Per study protocol, HpSA had a sensitivity, specificity, positive and negative predictive value, and accuracy rate of 67%, 99%, 86%, 97%, and 96.5%, respectively.Conclusion:HpSA, a polyclonal antibody test, had a low sensitivity for infection in children in the United States and at present cannot replace histologic findings as the gold standard for the diagnosis of Hp infection in the pediatric population.