bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exclusive Whole Protein Enteral Diet Versus Prednisolone in the Treatment of Acute Crohn's Disease in Children
Authors: Ruuska T. , Savilahti E. , Mäki M. , Örmälä T. , Visakorpi J. K. 
Published: January 2024

SummaryNineteen children with either newly diagnosed or relapsed Crohn's disease were enrolled in a randomized study in which the efficacy of enteral feeding with a whole protein‐based formula was compared to high‐dose corticosteroids in achieving clinical remission and normalization of laboratory measurements. Ten children were treated by enteral feeding (Nutrison Standard, Nutricia), and nine received corticosteroids. Both treatment regimens lasted 11 weeks. The activity of Crohn's disease was similar in both groups before the commencement of the treatment. Clinical symptoms and signs, as judged by the pediatric Crohn's disease activity index and measurements relating to inflammatory activity (erythrocyte sedimentation rate, C‐reactive protein, blood leukocyte and platelet count, and serum immunoglobulins G and A) and to nutritional status (concentrations of serum albumin, prealbumin, hemoglobin) improved rapidly and significantly with as little as 2 weeks' treatment in both treatment groups. In both groups, there was one relapse within 8 weeks after discontinuation of treatment, and one patient in both groups was operated on during the treatment period. During the routine follow‐up after the trial (0.3–2.5 years; mean, 1.3 years) five of the corticosteroid group experienced a clinical relapse, whereas only one from the enteral feeding group relapsed. No side effects of enteral feeding were seen. Enteral feeding with a whole protein‐based formula proved to be as effective as high‐dose corticosteroid in the treatment of the acute phase of Crohn's disease and may prove to be the treatment of choice in pediatric patients with acute Crohn's disease.
Oral Rehydration Solutions
Authors: Go Jacob T. , Harper Rita G. , Sia Concepcion G. , Teichberg Saul , Wapnir Raul A. 
Published: January 2024

SummaryViscosity‐enhancing agents such as carboxymethylcellulose (CMC) can alter absorption of solutes and fluid exchange in the small intestine. We investigated whether the standard World Health Organization oral rehydration solution (WHO‐ORS) with the addition of CMC would improve net water and sodium absorption in rats using an in vivo intestinal perfusion technique. Four WHO‐ORS, containing either 0, 2.5,5.0, or 10.0 g/L of CMC, were perfused in rats with a well‐tested model of cathartic‐induced chronic osmotic diarrhea (D) and in normal controls (C). In D rats, the ORSs with CMC improved sodium absorption at the three concentrations used (p < 0.01). The same effect was shown in C rats. Net water absorption was also enhanced in D rats given ORSs with CMC, although the changes in C animals were less marked. The improvement in sodium and water absorption in both C and D rats positively correlated with the log of relative ORS viscosity. Ultrastructural examination of tissues perfused with 10 g/L of CMC showed an extended brush border glycocalyx. This study indicates that CMC added to WHO‐ORS in the perfused rat jejunum improves the effectiveness of the solution by increasing sodium and water absorption.
Prospective Study of Lactose Absorption During Cancer Chemotherapy
Authors: Pettoello‐Mantovani Massimo , Guandalini Stefano , diMartino Lucio , Corvino Cecilia , Indolfi Paolo , Casale Fiorina , Giuliano Maria , Dubrovsky Larisa , Di Tullio Maria Teresa 
Published: January 2024

SummaryChemotherapy is a recognized cause of morphological alterations to the proximal intestine. Lactose malabsorption, the functional consequence of a small intestinal enzymatic derangement, has been shown to play an important role in causing gastrointestinal symptoms in subjects receiving chemotherapy. To establish a rational basis for the exclusion of lactose from the diet and to reduce the risk of developing gastrointestinal symptoms, we conducted a study of lactose absorption in 20 children during cancer chemotherapy. Because lactose is an important nutritional sugar, the tolerance of lactose provided by yogurt was examined. Lactose absorption was investigated by a hydrogen breath test (BT) after oral ingestion of milk (250 ml) containing physiological doses of lactose (12 g). The effect of yogurt supplementation was also tested by BT after meals of yogurt (450 g) also containing physiological doses of lactose (12.1 g). In 11 children, lactose malabsorption was detected by BT during the study before any gastrointestinal symptom revealed this status. Of these 11 children, no gastrointestinal discomfort developed in five receiving a lactose‐excluded diet. In contrast, in the six children not restricted in lactose intake, gastrointestinal symptoms were observed 4 to 13 weeks after lactose malabsorption was detected by BT. The findings of our study suggested the usefulness of dietary supplementation with yogurt, a lactose‐containing food, in children who developed lactose malabsorption. In fact, all lactose‐malabsorbent children showed good lactose absorption and tolerance when tested by yogurt BT. Furthermore, a yogurt‐supplemented diet was also successful in three subjects initially recognized as lactose intolerant. In conclusion, the data presented have important implications in reducing the risk of developing gastrointestinal symptoms in children receiving cancer chemotherapy.
Receptor‐Mediated Binding of Milk Lactoferrin to Nursing Piglet Enterocytes
Authors: Gíslason Jóhannes , Douglas Gordon C. , Hutchens T. William , Lönnerdal Bo 
Published: January 2024

SummaryLactoferrin, an iron‐binding glycoprotein that is abundant in milk of some species, has been suggested to play a key role in the absorption of iron in human infants. This hypothesis is based on the dominant role of lactoferrin as an iron‐binding component in human milk and on the occurrence of lactoferrin receptors in brush‐border membranes in infants' intestines. The piglet may be a useful model to evaluate the biological activity of lactoferrin because we have previously found the presence of a lactoferrin receptor in brush‐border membranes from suckling piglets. In this study, viable enterocytes were isolated from 6− to 20‐day‐old suckling piglets. Binding studies were performed at 4°C using 125I‐labeled porcine lactoferrin. Scatchard analysis of equilibrium binding data showed an apparent binding constant (Kd) of 2 x 10‐6M (SD = 0.6 x 10‐6). This affinity is in close agreement with previous results obtained using isolated brush‐border membrane vesicles. Bovine lactoferrin inhibited the binding of porcine lactoferrin. Porcine transferrin, however, did not affect porcine lactoferrin binding significantly. Thus, lactoferrin binding is highly specific. When enterocytes were incubated with 125I‐labeled lactoferrin at 37°C, the amount of cell‐associated radioactivity exceeded the surface binding capacity of the cells by almost fivefold. This finding agrees with the continuous binding and subsequent internalization of 125I‐labeled lactoferrin. The isolated piglet enterocyte seems to provide a useful model for further studies of the mechanism of receptor‐mediated absorption of lactoferrin.
Stated Versus Actual Lipase Activity in Pancreatic Enzyme Supplements
Authors: O'Hare M. M. T. , McMaster C. , Dodge J. A. 
Published: January 2024

SummaryWe have carried out an independent investigation of the lipase activity of several pancreatin preparations, including high‐lipase preparations of pancreatin that have recently become available. Six preparations from three pharmaceutical companies, Cilag, Duphar, and Merck, were analyzed during the recommended shelf life of the preparation and included a standard and a high‐lipase preparation from each manufacturer. All preparations studied showed lipase activity in excess of that which was stated on the packets, and in some cases it was more than twofold. This has important implications for patients and prescribers since changes in apparent enzyme requirements may reflect differences in the potency of batches with time. As it is impossible to evaluate capsule requirements with each new batch prescribed, the presence or relief of symptoms of malabsorption will probably continue to be the way in which most patients monitor their enzyme supplementation on a regular basis. We believe that clinicians need to be aware of the extent of possible intrinsic variation between individual prescriptions before attempting to define possible dose/symptom relationships.
Endomysial Antibodies as Unreliable Markers for Slight Dietary Transgressions in Adolescents with Celiac Disease
Authors: Troncone Riccardo , Mayer Marina , Spagnuolo Ferdinando , Maiuri Luigi , Greco Luigi 
Published: January 2024

SummaryAdolescents with celiac disease often fail to adhere to a strict gluten‐free diet. The value of endomysial antibodies in assessing the dietary compliance of such adolescents has been assessed in 23 patients divided into four groups according to their daily gluten intake. Serum endomysial antibodies were absent in all subjects on a gluten‐free diet and consistently present in those ingesting >2 g/day of gluten. Only one of six and three of six teenagers with celiac disease with an intake of <0.5 and 0.5–2 g/day, respectively, had endomysial antibodies in their serum, despite the presence in three of six and five of six of significant changes in the mucosal architecture, as shown by computerized morphometry of jejunal biopsies. In conclusion, endomysial antibodies cannot be considered a valid marker for slight dietary transgressions.
Linear Growth After Colectomy for Ulcerative Colitis in Childhood
Authors: Nicholls S. , Vieira M. C. , Majrowski W. H. , Shand W. S. , Savage M. O. , Walker‐Smith J. A. 
Published: January 2024

SummaryEighteen children and adolescents, of a total of 90 treated in our unit between 1982 and 1992, underwent colectomy for ulceractive colitis. Six (6.7%) of the 90 patients had short stature, i.e., a height below the 3rd centile, and 8 of the 18 who had surgery had a subnormal height velocity, i.e., below the 25th centile for age at the time of surgery. Surgery was performed for resistance to medical therapy (n = 13) or toxic megacolon (n = 5). Surgery was followed by catch‐up growth, i.e., increasing height velocity, in eight subjects and cessation of the trend of diminishing height velocity, but without catch‐up growth, in five. In 11 of the subjects who were prepubertal, the median height velocity increased from 3.85 cm/ year preoperatively to 7.35 cm/year postoperatively (p < 0.01). One year after surgery, 14 of the 18 patients were either asymptomatic or substantially improved. Surgery therefore led to improved linear growth and a prolonged symptom‐free period in most of the children and adolescents with ulcerative colitis undergoing this treatment.
Helicobacter pylori‐Associated Gastroduodenal Disease in Symptomatic Chilean Children
Authors: Hodgson María Isabel , Pantoja Humberto , Latorre Juan Jose , Vial Pablo , Henríquez Alejandra , Wenger Jonny , Peña Alfredo , Siri maría Teresa , Guiraldes Ernesto 
Published: January 2024

Summary:A newly developed enzyme‐linked immuno‐sorbent assay (ELISA) IgG serological assay for the diagnosis of Helicobacter pylori infection was used recently in two epidemiological surveys in Chile. To evaluate the diagnostic efficacy of this assay in a local symptomatic pediatric population, we studied 70 school‐age patients referred for upper gastrointestinal endoscopy because of complaints suggestive of gastroduodenal disease. Evidence for antral H. pylori infection was sought by three biopsy‐related methods: culture, histology, and urease activity. IgG anti‐H. pylori serum antibodies were determined by ELISA. Altogether, chronic antral gastritis was found in 55 patients and duodenal ulcers in nine; 11 subjects had normal histology. Sixty (86%) patients had H. pylori in the antrum. This group had significantly higher mean IgG optical density values when compared with the H. pylori‐negative group (1.860 versus 0.669; p < 0.001). The sensitivity and specificity of the assay in detecting antral H. pylori were both 90% the positive predictive value was 98% and the negative, 60%. Accuracy of the assay was superior in predicting the presence or absence of gastroduodenal lesions with a sensitivity of 96%, a specificity of 92%, a positive predictive value of 98%, and a negative predictive value of 86%. We conclude that the diagnostic efficiency of this assay renders it appropriate both to screen for H. Pylori‐associated gastroduodenal disease in individual patients and to be used in seroepi‐demiological surveys.
Efficacy of Ursodeoxycholic Acid in the Treatment of Primary Sclerosing Cholangitis in Children
Authors: Gilger Mark A. , Gann Mary E. , Opekun Antone R. , Gleason Wallace A. 
Published: January 2024

ABSTRACTBackgroundUrsodeoxycholic acid (UDCA) has been shown to be beneficial in reducing disease activity in adult patients with primary sclerosing cholangitis (PSC). However, there has been little published regarding PSC in children and no studies investigating the efficacy of UDCA as a treatment for PSC.MethodsThis retrospective study included 10 children who were found to have the diagnosis of PSC during the past 15 years at the Texas Children's Hospital and Herman Hospital, both in Houston, Texas. The male:female ratio was 8:2, the median age of onset was 12 years (range, 1–17 years), and eight patients had coexistent inflammatory bowel disease (IBD; six ulcerative colitis, one Crohn's disease, one unspecified). At the time of diagnosis, five patients were asymptomatic, all of whom had IBD with elevated liver enzymes and three of whom had hepatomegaly. Nine patients were treated with UDCA. The one patient who did not receive UDCA was lost to follow‐up soon after diagnosis. The mean dose of UDCA was 17 mg/kg with the doses ranging from 9 to 37 mg/kg.ResultsThere were no side effects from the medication recorded for any of the patients. These patients showed a significant reduction in alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and γ‐glutamyl transferase at 1, 3, 6, 15, and 20 months after treatment.ConclusionsThis study demonstrates that children with PSC treated with UDCA have significant improvements in liver biochemical indices. However, the long‐term effect of UDCA on clinical outcome is unknown.
Superoxide Dismutase and Glutathione Peroxidase Content of Human Milk From Mothers of Premature and Full‐Term Infants During the First 3 Months of Lactation
Authors: L'Abbe Mary R. , Friel James K. 
Published: January 2024

ABSTRACTBackgroundHuman milk contains various bioactive compounds including numerous immunologic factors, enzymes, growth factors, and hormones. However, the change during the course of lactation in many of these compounds has not been fully characterized. Therefore, the objective of the present study was to measure the activity of the enzymes superoxide dismutase (SOD; Enzyme Commission number [EC] 1.15.1.1) and glutathione peroxidase (SeGSHPx; EC 1.11.1.9) in human milk, to record changes in enzyme activity over time and to determine whether there are differences in activity between the milk of mothers of full‐term (FT) and premature (PT) infants.MethodsNine samples were collected from each of 15 mothers (32 ± 4 years of age; mean ± standard deviation) of FT infants (gestational age, 40 ± 1 weeks; birth weight, 3544 ± 417 g) and 19 mothers (28 ± 5 years of age) of healthy PT infants (gestational age, 29 ± 4 weeks; birth weight, 1312 ± 479 g). Samples were collected within a week of birth (±1 day) and thereafter for 8 weeks, with a final collection at 12 weeks.ResultsDuring the 12‐week study period, in both groups, total milliunits of GHSPx and SeGHSPx per milligram protein and SOD per per milligram protein increased, whereas protein content declined. SeGHSPx per milliliter milk was higher in the PT group at week 1 (92 ± 30 mU/mL vs. 73 ± 21 mU/mL), week 2 (93 ± 28 mU/mL vs. 75 ± 24 mU/mL), and week 7 (85 ± 24 mU/mL vs. 68 ± 22 mU/mL). The SOD activity per milliliter milk and milligram protein was higher throughout the entire study in the FT milk.ConclusionsBecause mothers of PT infants may produce less milk than those of FT infants, PT infants may be at a disadvantage for antioxidant protection from these enzymes.
Human Leukocyte Antigen Class II Alleles in White Brazilian Patients With Celiac Disease
Authors: Silva Elza M. B. T. , Fernandes Maria I. M. , Galvão Livia C. , Sawamura Regina , Donadi Eduardo A. 
Published: January 2024

ABSTRACTBackgroundCeliac disease (CD) is a permanent gluten intolerance disorder characterized by malabsorption, intestinal mucosa villus atrophy, and crypt hyperplasia. Clinical and histologic features improve in persons consuming a gluten free diet. The pathogenesis of CD involves environmental, genetic, and immunologic factors.MethodsThe frequencies of human leukocyte antigen (HLA) class II alleles were evaluated in white Brazilian patients who had CD and compared with those observed in healthy individuals from the same geographical area (Ribeirão Preto, São Paulo) and of similar ethnic background. Twenty‐five patients with CD, 11 females and 14 males, and 91 control individuals were studied. The HLA class II alleles were typed using amplified DNA hybridized with sequence‐specific primers. Statistical analysis was performed using the two‐tailed Fisher exact test. The relative risk (RR), etiologic fraction (EF), and preventive fraction (PF) were also estimated. The EF represents the attributable risk for the development of CD at the population level, whereas PF represents the protective risk.ResultsThe frequency of the HLA‐DRB1*03, HLA‐DRB1*07, and HLA‐DQB1*02 alleles was significantly increased in patients. The RR conferred by these alleles was 5.35, 7.15, and 10.6, respectively, and the EF was 48.7%, 44.7%, and 76%, respectively. The frequency of HLADQB1*06 alleles was significantly decreased in CD patients, conferring an RR of 0.08 and a PF of 48%.ConclusionsThe results show that HLA‐DRB1*03, HLA‐DRB1*07, and HLA‐DQB1*02 alleles conferred susceptibility to CD in Brazilian patients. In contrast, HLADQB1*06 alleles conferred protection against development of the disease.
Clinical Presentations and Predisposing Factors of Cholelithiasis and Sludge in Children
Authors: Wesdorp Isabel , Bosman Diederik , de Graaff Aafke , Aronson Daniël , van der Blij Frits , Taminiau Jan 
Published: January 2024

ABSTRACTBackgroundIn contrast to adults, little is known about the epidemiology and the best therapeutic regimen for cholelithiasis and sludge in children.MethodsEighty‐two children with cholelithiasis detected by ultrasonography were studied from 0 to 18 years of age with regard to cause, symptomatology, and treatment outcome. Seventy‐five children with sludge within the same age group were studied as well.ResultsIdiopathic gallstones were found in 19 (23%) patients, and 32 (39%) had gallstones in association with a hemolytic disease. Predominant factors associated with the development of gallstones and clinical presentation differed with age. In patients with sludge, total parenteral nutrition and systemic infection or administration of antibiotics were most frequently found to be possible predisposing factors. Sludge can develop and disappear within a few days. Complications of cholelithiasis were observed in 13 patients. Cholecystectomy was performed in 41 patients and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction in 9 patients; 32 children were not treated. After a follow‐up (mean, 4.6 years) in 50 patients, 46% of the children who had cholecystectomy or therapeutic ERCP experienced clinical recurrence of abdominal symptoms. In the patients who did not receive surgical or endoscopic therapy during the follow‐up, no complications occurred, and only one patient experienced abdominal symptoms during follow‐up.ConclusionsThe difference in associated conditions may indicate that the pathogenesis of cholelithiasis and sludge differ as well. Furthermore, sludge should be viewed as a dynamic condition not predisposing for the development of gallstones, per se. Cholecystectomy should not be performed routinely but only after careful selection in patients at risk for complications.
Helicobacter pylori Infection in Recurrent Abdominal Pain
Authors: Frank Friederike , Stricker Tamar , Stallmach Thomas , Braegger Christian P. 
Published: January 2024

ABSTRACTBackgroundHelicobacter pylori is associated with chronic gastritis and peptic ulcer in adults and in children. The purpose of the present study was to analyze the association of recurrent abdominal pain and H. pylori infection in children and to evaluate the efficacy of antimicrobial treatment in patients with evidence of infection.MethodsThe clinical and histopathologic findings in children who underwent diagnostic upper endoscopy for recurrent abdominal pain were analyzed retrospectively. Patients with evidence of infection with H. pylori were treated with a combination of omeprazole, amoxicillin, and clarithromycin. Efficacy of treatment was assessed using the 13C‐urea‐breath test.ResultsH. pylori was found in histopathologic sections of 29 (40%) of 73 patients undergoing diagnostic endoscopy for recurrent abdominal pain. Five children (17%) were of Swiss ethnic origin, and 24 (83%) were non‐Swiss. All the infected patients had chronic gastritis and 4 (14%) had ulcerations in the duodenum. Treatment with omeprazole, amoxicillin, and clarithromycin resulted in eradication of the infection in all and in resolution of the clinical symptoms in 15 (80%) of 19 patients who had a follow‐up examination.ConclusionsThe presented data suggest that gastritis induced by H. pylori may be associated with recurrent abdominal pain and that in Switzerland infections with H. pylori primarily involve persons who are non‐Swiss. A combined therapy results in eradication of the bacterium and in improvement of the clinical symptoms in a significant majority of the patients.
Immune Response of Bangladeshi Children With Acute Diarrhea Who Subsequently Have Persistent Diarrhea
Authors: Azim Tasnim , Islam Laila N. , Sarker Mohammed S. , Ahmad Shaikh M. , Hamadani Jena D. , Faruque Shah M. , Salam Mohammed A. 
Published: January 2024

ABSTRACTBackgroundBecause altered immune responses may be a risk factor for persistent diarrhea, various aspects of the immune response were examined to elucidate the underlying immune mechanisms that may be involved in the development of persistent diarrhea.MethodsChildren (7–12 months of age) with watery diarrhea for 6 to 8 days from the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), were enrolled. Children were classified as having acute diarrhea (AD) or persistent diarrhea (PD) if diarrhea resolved within 14 days or persisted for more than 14 days, respectively. Uninfected control children (n = 13), from the Nutrition Follow‐Up Unit of ICDDR,B were also enrolled. Of the 123 children with diarrhea who were enrolled, 85 had AD and 38 had PD. Comparisons were performed for clinical features, nutritional status (weight for age, plasma transferrin, and serum albumin levels), and immune responses: neutrophil function; peripheral blood mononuclear cell function, delayed‐type hypersensitivity (DTH) responses, plasma levels of immunoglobulins, tumor necrosis factor‐α, and interferon‐γ. Univariate analyses were conducted to assess differences among the three groups of children and between children with AD and PD. Logistic regression was performed to determine risk factors for PD.ResultsThere were no differences in clinical features and nutritional status among the groups of children studied. More children in whom PD developed had a negative DTH response to tuberculin than those with AD (P = 0.021). Also, a negative DTH response to tuberculin was a significant risk factor for PD (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.5–9.9).ConclusionsChildren with acute diarrhea with a negative DTH response to tuberculin are more likely to have development of persistent diarrhea.