bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polyethylene Glycol Without Electrolytes for Children With Constipation and Encopresis
Authors: Loening‐Baucke Vera 
Published: January 2024

ABSTRACTBackgroundChildren with functional constipation and encopresis benefit from behavior modification and from long‐term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists.MethodsTwenty‐eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long‐term treatment of functional constipation and encopresis. Children were rated as “doing well,” “improved,” or “not doing well,” depending on resolution of constipation and encopresis.ResultsAt the 1‐, 3‐, 6‐, and 12‐month follow‐ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1‐month follow‐up, children on polyethylene glycol were soiling more frequently (P < 0.01) and fewer were improved (P < 0.01). At the 3‐ and 6‐month follow‐ups, both groups had similarly improved. At the 12‐month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P < 0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 ± 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects.ConclusionsPolyethylene glycol without electrolytes is an alternative for long‐term management of children with constipation and encopresis.
Effect of Human Milk and Epidermal Growth Factor on Growth of Human Intestinal Caco‐2 Cells
Authors: Chang Chun‐Ju , Chao Jane C.‐J. 
Published: January 2024

ABSTRACTBackgroundEpidermal growth factor (EGF) in human milk has been thought to be mitogenic for cell growth. This study investigated the effects of human milk and EGF on the growth of human intestinal Caco‐2 cells to determine whether the action occurred through regulation of the cell cycle or through c‐jun expression.MethodsCells were incubated with 5% human milk, 0.375 nmol/L EGF (relevant to EGF concentration in 5% human milk, 0.05 × EGF), 7.5 nmol/L EGF (1 × EGF), or 75 nmol/L EGF (10 × EGF). Cell numbers; cellular RNA, DNA, and protein concentrations; DNA content in the cell cycle, and expressions of c‐Jun protein and mRNA were analyzed.ResultsCell numbers increased in the 1 × and 10 × EGF groups at 48 hours. Cellular RNA increased in the 5% human milk and 10 × EGF groups. DNA and protein contents increased in the 1 × and 10 × EGF groups. The 1 × and 10 × EGF groups increased DNA content in the G1 phase compared with the 5% human milk group at 24 hours. The greatest c‐jun protein expression was 2.6, 1.4, 1.8, and 1.9 times the control, and the c‐jun mRNA increased by 202%, 14%, 150%, and 181%, respectively, in the 5% human milk, 0.05 ×, 1 ×, and 10 × EGF groups.ConclusionsIn a dose‐dependent manner, EGF stimulated intestinal growth in vitro, by increasing DNA content in the G1 phase and c‐jun mRNA expression. However, low concentrations of human milk (5%) and its equivalent EGF did not affect cell growth.
Management of Intractable Constipation With Antegrade Enemas in Neurologically Intact Children
Authors: Youssef Nader N. , Barksdale Edward , Griffiths Janet M. , Flores Alejandro F. , Di Lorenzo Carlo 
Published: January 2024

ABSTRACTObjectivesTo assess the benefit of antegrade enemas in children with severe constipation who were referred to a tertiary care center.MethodsFrom 1997 to 1999, 12 children (9 male, aged 8.7 ± 4.4 years) underwent cecostomy placement. All children were neurologically normal and had been extensively examined to rule out organic causes of constipation. Follow‐up included a questionnaire to interview caregivers 13.1 ± 8.5 months after cecostomy placement.ResultsFor all children, antegrade enemas led to improvement in the number of bowel movements / week (7.1 versus 1.4, P < 0.005), number of soiling accidents / week (1.0 versus 4.7, P < 0.01), abdominal pain score (0.9 versus 2.9, P < 0.005), emotional health score (3.6 versus 1.9, P < 0.005), overall health score (3.6 versus 1.7, P < 0.005), number of medications used for constipation (0.8 versus 4.0, P < 0.005), number of missed school days / month (1.5 versus 7.5, P < 0.02), and number of physician office visits / year (9.2 versus 24.0, P < 0.05). Irrigation solutions used for the antegrade enemas included polyethylene glycol (67%), saline and glycerin solution (25%), and phosphate enema (8%), administered everyday in seven children and every other day in five children. Adverse events included skin breakdown and granulation tissue in one patient, leakage of irrigation solution in one patient, and dislodging of the tube in two patients. Five patients discontinued the use of antegrade enemas within a mean of 14.6 ± 9.1 months after beginning treatment.ConclusionAntegrade enemas through a cecostomy are a safe and satisfactory option for children who are neurologically intact and who have severe constipation that does not respond to medical treatment.
Cimetropium Bromide in the Treatment of Crisis in Infantile Colic
Authors: Savino Francesco , Brondello Cristina , Cresi Francesco , Oggero Roberto , Silvestro Leandra 
Published: January 2024

ABSTRACTBackgroundTreatment of infantile colic remains an open issue. In Italy, cimetropium bromide is used extensively to treat infantile colic. The aim of this randomized, double‐blind, placebo‐controlled clinical trial was to investigate the effectiveness and side effects of cimetropium bromide in the treatment of infants with colic crisis.MethodsNinety‐seven infants with colic were enrolled. The diagnosis of infantile colic in healthy infants with regular growth, aged 15 to 60 days was made according to the criteria of Wessel. The infants were divided into two groups, one treated with cimetropium bromide (1.2 mg/kg) and the other treated with placebo at onset of each crisis for 3 days. Duration of crying and side effects were recorded daily in a structured diary for the 3 days of therapy. Statistical analysis was performed using the chi‐square andttests.ResultsEighty‐six infants completed the trial. The average duration of crying for each crisis was 17.3 ± 12.6 minutes in the cimetropium bromide group and 47.5 ± 28.5 minutes in the placebo group (P< 0.005). Response to cimetropium bromide was 74%. Response to placebo was 33% (P< 0.05). Side effects did not differ significantly between the two groups, except sleepiness, which increased in the infants treated with cimetropium bromide.ConclusionCimetropium bromide was more effective than placebo in reducing the duration of crying in children with infantile colic. The use of the anticholinergic drugs, aside from the dicyclomine because of its dangerous side effects, should be revaluated for treating infantile colic.
Esophageal pH Monitoring and Impedance Measurement: A Comparison of Two Diagnostic Tests for Gastroesophageal Reflux
Authors: Wenzl Tobias G. , Moroder Christoph , Trachterna Morten , Thomson Mike , Silny Jiri , Heimann Gerhard , Skopnik Heino 
Published: January 2024

ABSTRACTBackgroundpH monitoring is the standard diagnostic tool for gastroesophageal reflux in infants. However, this method does not document the reflux of all kinds of fluid from the stomach into the esophagus, but only documents acid material. The parameters that define reflux episodes by pH monitoring have been derived empirically from observations of many infants considered healthy and ill. Acid reflux is a continuum, some reflux is normal and doubt exists as to how much reflux is abnormal. In this study, one of the standardized protocols for analyzing pH recordings was evaluated and compared with simultaneously obtained intraesophageal impedance measurement (IMP), a pH‐independent method of detecting bolus movement within the esophagus.MethodsThe esophagi of 50 infants with reflux symptoms were measured, using both standard pH probe and multiple‐site impedance measurement. A standard protocol for analyzing esophageal pH records was used. The sampling rate for pH values was 15/min. Acid reflux was defined as pH less than 4.0 (threshold pH) for at least 15 seconds (minimal duration) with at least 30 seconds (latency time) between separate episodes. The software used could adjust independently or in combinations the sampling rate and these reflux criteria. Thereby it was determined whether changes in the criteria for acid reflux improved the sensitivity and predictive value of pH monitoring when compared with reflux episodes defined by IMP.ResultsDuring 318 hours of recording in 50 infants, 1,887 episodes of reflux occurred according to IMP. Only 282 (14.9%) of the IMP‐determined episodes were acid reflux episodes. No alkaline reflux episodes occurred. Among the 270 pH probe–determined episodes using the standard criteria of acid reflux, only 153 (sensitivity, 54.3%; positive predictive value, 56.7%) were accompanied by unmistakable retrograde bolus movement using IMP measurements. Retrograde bolus movement did not accompany the other 117 episodes. Using a sampling rate of 15/min, a pH threshold of 4.0, a minimal duration of reflux episodes of 8 seconds, and a latency time of 60 seconds, the positive predictive value of pH probe results increased to 60.7%. Variations in the sampling rate or criteria for defining acid reflux did not significantly improve the accuracy of the pH probe results versus IMP‐defined episodes.ConclusionsMost reflux episodes that occur in infants are undetectable by standard pH probe monitoring. pH monitoring does not detect all reflux in the esophagus but is useful for detecting acidity in the esophagus and determining the duration of its presence. Combining pH monitoring with impedance measurement is a valuable diagnostic tool for gastroesophageal reflux in infants.
Influence of Percutaneous Endoscopic Gastrostomy on Gastroesophageal Reflux: A Prospective Study in 68 Children
Authors: Razeghi Stefan , Lang Thomas , Behrens Rolf 
Published: January 2024

ABSTRACTBackgroundAmong other complications, the development of or an increase of gastroesophageal reflux (GER) is considered to be associated with percutaneous endoscopic gastrostomy (PEG). However, the few studies performed to date show controversial results.MethodsContinuous 24‐hour pH monitoring was performed prospectively in 68 patients before and at least 3 days after percutaneous endoscopic gastrostomy placement. None of the patients had been treated for gastroesophageal reflux.ResultsThe percentage of patients with abnormal test results did not differ significantly before and after PEG insertion (22.1% versus 25%). Nor did the median reflux index change significantly before and after gastrostomy for the whole group of patients (2.6% versus 3.4%). The median reflux index increased significantly (from 1.8 to 5.4) only in patients who underwent PEG implantation in the antrum (n = 9). Clinical signs of GER correlated poorly with the results of pH monitoring.ConclusionsData in this study strongly suggest that, in general, percutaneous endoscopic gastrostomy does not provoke gastroesophageal reflux. Results also indicate that placement in the antrum may be unfavorable.
Astrovirus, Adenovirus, and Rotavirus in Hospitalized Children: Prevalence and Association With Gastroenteritis
Authors: Rodriguez‐Baez Norberto , O'Brien Rebbeca , Qiu Shi‐Qiang , Bass Dorsey M. 
Published: January 2024

ABSTRACTBackgroundAgents of viral gastroenteritis such as astrovirus, rotavirus, and adenovirus are common pediatric pathogens accounting for many physician visits, hospital admissions, and nosocomial infections. Previous hospital‐based prevalence studies have examined mainly symptomatic children.PurposeTo evaluate the prevalence of astrovirus, rotavirus, and adenovirus infections among hospitalized children less than 6 years of age, regardless of symptoms, and determine association with gastroenteritis.MethodsFrom September 1998 to June 2000, stool specimens were collected twice weekly from children less than five years of age admitted to two wards in a tertiary‐care children's hospital. A total of 480 samples were obtained from 309 hospitalizations. Stools were examined using antibody‐based ELISA for astrovirus, rotavirus, and adenovirus. Clinical data was abstracted from patient records.ResultsTwenty one percent of the children had gastroenteritis symptoms at some point during their hospitalizations (43% were hospital acquired). Astrovirus was detected in 5.2% of all children compared to 6.8% with rotavirus and 0.8% with adenovirus serotypes 40 or 41. Nosocomial acquisition was common. Seventy five percent of astrovirus infections and 90% rotavirus infections were symptomatic. Astrovirus infections were significantly more likely to occur in younger infants and in children with compromised immunity. Rotavirus infections were significantly more likely to cause dehydration. In a three‐year passive surveillance of gastroenteritis at the hospital, astrovirus and rotavirus infections peaked simultaneously in winter months.ConclusionsRotavirus and astrovirus are common symptomatic infections on pediatric wards and contribute greatly to inpatient morbidity. Adenoviruses played a limited role in gastroenteritis in hospitalized children in this study.
Indomethacin, Dexamethasone, and Intestinal Damage in Infant Rats
Authors: Patel Manish R. , DeMarco Vincent G. , Clare‐Salzler Michael , Li Yi Yu , Neu Josef 
Published: January 2024

ABSTRACTBackgroundIndomethacin is commonly used in the Neonatal Intensive Care Unit to induce closure of the patent ductus arteriosus and to prevent intraventricular hemorrhage. It is known that indomethacin causes intestinal ulceration in adults, but its effect in infants is less clear. In a preliminary experiment, it was found that the administration of 10 mg/kg/d of indomethacin, a dose that damages the adult rat intestine, had no detrimental effects on newborn suckling rats whereas dexamethasone at 0.25 mg/kg/d caused significant growth failure and villous blunting. It was then hypothesized that the lack of intestinal damage with indomethacin in infants was related to protection given by mother's milk.MethodsSubsequent experiments were performed wherein 10 mg/kg/d of indomethacin was provided to infant mother‐reared, infant artificially fed, and adult rats. The expression of intestinal cyclooxygenases in the prostaglandin synthetic pathway of control rats was examined to initiate an exploration into a mechanism for the developmental response to indomethacin.ResultsMother‐reared and artificially fed infant rats demonstrated resistance to the ulcerogenic effects of indomethacin, in contrast to the adults. A differential presence of cyclooxygenase‐1 and cyclooxygenase‐2 was not distinctly seen between infancy and adulthood.ConclusionsThe results indicate that a varying response to the damaging effects of indomethacin on the intestine occurs during development with the infant being less susceptible than the adult. This differed from the effects of dexamethasone administration, which caused significant intestinal atrophy in the infant rats. The intestinal protection to the effects of indomethacin in infants is not dependent on mother's milk or a developmental difference in the prostaglandin biosynthetic pathway.
Effect of Ursodeoxycholic Acid on the Expression of the Hepatocellular Bile Acid Transporters (Ntcp and bsep) in Rats With Estrogen‐Induced Cholestasis
Authors: Micheline Dumont , Emmanuel Jacquemin , Serge Erlinger 
Published: January 2024

ABSTRACTObjectivesRats with ethinyl estradiol‐induced cholestasis have a decreased bile flow and a decreased expression of basolateral and canalicular hepatocyte membrane transporters. The bile acid ursodeoxycholic acid improves bile flow in these animals. The purpose of this study was to examine the effect of ursodeoxycholic acid on the expression of hepatocellular bile acid carriers.MethodsRats received either ethinyl estradiol (5 mg.kg−1 body wt. for 10 days) or ethinyl estradiol associated with ursodeoxycholic acid (1% in the diet). A third group of rats received ursodeoxycholic acid alone. Bile flow, bile acid, and glutathione biliary outputs were measured. Messenger RNA levels and protein expression of Na+‐dependent taurocholate co‐transporting polypeptide, and bile salt export pump were determined in basolateral and canalicular membrane preparations by Northern and Western blot analysis.ResultsUrsodeoxycholic acid restored bile flow in ethinyl estradiol‐treated rats by increasing bile acid secretion. It did not improve glutathione output nor bile acid‐independent flow. Na+‐dependent taurocholate co‐transporting polypeptide mRNA and protein were decreased by ethinyl estradiol and not restored by ursodeoxycholic acid. In contrast, canalicular bile salt export pump protein expression was decreased by ethinyl estradiol and fully restored to control levels by ursodeoxycholic acid.ConclusionsUrsodeoxycholic acid increases bile flow in ethinyl estradiol‐treated rats by increasing bile acid secretion. This increase is possibly mediated by a normalization of the expression of the canalicular bile salt export pump.
Fat Laden Macrophages in Tracheal Aspirates as a Marker of Reflux Aspiration: A Negative Report
Authors: Krishnan Usha , Mitchell John D. , Tobias Vivian , Day Andrew S. , Bohane Timothy D. 
Published: January 2024

ABSTRACTObjectivesRefluxed gastric material aspirated into the lungs is an important cause of acute and chronic pulmonary disease. Currently, the presence of fat‐laden macrophages (FLM) in tracheobronchial secretions of children is a conventional marker for reflux aspiration. However, this assay is limited by its apparent lack of specificity. The aim of this study was to reevaluate the role of this assay in diagnosing reflux aspiration.MethodsThe tracheal aspirates of sixty‐four consecutive children with clinically significant gastroesophageal reflux undergoing upper gastrointestinal endoscopy under general anesthesia, and 34 other children from the routine operative schedule were evaluated. Both groups were further subdivided on the basis of presence or absence of associated respiratory symptoms. After intubation, tracheal aspirates were collected, fixed, and stained for FLM. By grading the amount of intracellular fat present, a semiquantitative lipid index was computed. Tracheal aspirates with a lipid index of 100 or greater were considered positive.ResultsTwenty‐four of the 64 children with reflux symptoms and 14 of 34 children without reflux symptoms were positive for FLM. Sixteen of 37 children with both gastroesophageal reflux and respiratory symptoms and 10 of 26 children negative for both tested positive for FLM. The mean lipid index of the subgroup of children with both reflux and respiratory symptoms was not significantly different from that of the subgroup that was negative for both conditions. Despite computing a semiquantitative lipid index, an index of 100 or greater only had a sensitivity of 38% and specificity of 59%.ConclusionAssay of FLM in the tracheal aspirates of children considered at risk of reflux aspiration is not a sensitive or specific as a marker for reflux aspiration.
Colon Mucosal Pathology in Infants Under Three Months of Age with Diarrhea Disorders
Authors: Chang Jei‐Wen , Wu Tzee‐Chung , Wang Ke‐Sheng , Huang I‐Fei , Huang Betau , Yu I‐Ting 
Published: January 2024

ABSTRACTBackgroundDiarrhea is a common disease in infants. It may result in catastrophic events, especially in early infancy. Sometimes it is difficult to point out the diagnosis after initial examination. Sigmoidoscopy with mucosal biopsy may help in assessing the nature of the disease. The goals of this study are to evaluate the colon mucosal pathology in young infants with unknown diarrhea disorders and the clinical courses of different etiologies.MethodsWe performed a retrospective analysis of 64 young infants (Mean ± SD: 1.68 ± 1.01 months) in whom a diagnosis of unknown diarrhea disorder had been made after an initial investigation. All infants received fiberoptic sigmoidoscopy and mucosal biopsy with consent obtained.ResultsThe appearance of the colon mucosa under endoscopy were: 36 (56.2%) showing edema, 30 (46.8%) showing nodularity, 23 (35.9%) patients with focal erythema and friable mucosa, 11 (17.1%) showed erosion, 7 (10.9%) patients showing hemorrhage, and negative finding in one patient (1.6%). Colon mucosa pathologic findings were established: 40 (62.5%) had eosinophilic colitis (EC) and 19 (29.7%) had nonspecific colitis. The biopsies were normal in 5 cases; 81.5%(22/27) of patients with EC showed eosinophils in the stool smear which was significantly higher (P = 0.04) compared to the group II (9/17); 34 of 40 EC patients responded rapidly to changes in formula.ConclusionSigmoidoscopy and mucosal biopsy may be useful in the pathologic diagnosis of unknown diarrhea disorders. Eosinophilic colitis accounts for over half of very young infants with diarrhea disorders suggesting for allergic etiology. Patients with allergic colitis may exhibit a dramatic response to elimination of the offending proteins from the diet.
Rethinking Growth Failure in Alagille Syndrome: The Role of Dietary Intake and Steatorrhea
Authors: Rovner Alisha J. , Schall Joan I. , Jawad Abbas F. , Piccoli David A. , Stallings Virginia A. , Mulberg Andrew E. , Zemel Babette S. 
Published: January 2024

ABSTRACTObjectiveTo characterize the energy and nutrient intake, and the degree of fat malabsorption in children with Alagille syndrome (AGS) and to examine their cross‐sectional associations with growth and nutritional status.MethodsPrepubertal children with AGS were evaluated for dietary intake, growth, bone age, and body composition. Children and their families collected a three‐day, weighed diet record at home. Stools were collected for 72 hours and the coefficient of fat absorption (COA) was determined.ResultsChildren (mean age 6.7 ± 3.6 years) with AGS (n = 26) had low height‐for‐age z‐scores (HAZ), weight‐for‐age z‐scores (WAZ) (−1.9 ± 1.3 and −1.7 ± 1.1, respectively), and delayed skeletal maturation (−1.4 ± 1.8 years). Fifty‐eight percent of the subjects were less than the 5th percentile for height and 54% were less than the 5th percentile for weight. At least 20% of children with AGS had low dietary intake for several nutrients including: calories, fat, calcium, vitamin D, and vitamin E. Children who consumed <2/3 Dietary Reference Intake (DRI) for calcium (n = 6) had a statistically significantly lower HAZ (−3.2 ± 1.3) than those who consumed >2/3 DRI (−1.5 ± 1.0), (P < 0.003). Ninety‐six percent of the subjects had steatorrhea with a mean COA of 75 ± 16%.ConclusionsThese data suggest that prepubertal children with AGS are at‐risk for poor nutrient intake which, compounded with steatorrhea, may have a negative effect on growth and nutritional status. Intervention studies to increase energy and nutrient intake are needed to determine the effect of improved dietary intake on growth and nutritional status of children with AGS.