bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trophic Effect of Multiple Growth Factors in Amniotic Fluid or Human Milk on Cultured Human Fetal Small Intestinal Cells
Authors: Hirai Chie , Ichiba Hiroyuki , Saito Mika , Shintaku Haruo , Yamano Tsunekazu , Kusuda Satoshi 
Published: January 2024

ABSTRACTObjectivesTo evaluate the role of growth factors in amniotic fluid and in human milk on gastrointestinal adaptation of the fetus and very low‐birth‐weight infants, the effects of these fluids and multiple growth factors were investigated in a human fetal small intestinal cell line (FHs 74 Int).MethodsAfter FHs 74 Int cells were incubated with amniotic fluid, human milk, or recombinant growth factors, growth‐promoting activity was measured by [3H]‐thymidine incorporation into cells.ResultsIncubating cells with amniotic fluid or human milk promoted growth dose dependently. Genistein almost completely inhibited growth‐promoting activity in amniotic fluid P = 0.002), and growth was partially inhibited by antibodies against epidermal growth factor (EGF) (P = 0.047), insulin‐like growth factor‐1 (IGF‐1, P = 0.047), or fibroblast growth factor (FGF, P = 0.014). This activity in human milk was inhibited almost completely by genistein (P h 0.0001) and partially inhibited by antibodies against EGF (P = 0.036), IGF‐1 (P = 0.009), FGF (P = 0.004), hepatocyte growth factor (HGF, P = 0.001), or transforming growth factor‐α (TGF‐α, P = 0.001). Although recombinant EGF, IGF‐1, FGF, HGF, and TGF‐α elicited a synergistic trophic response on cultured cells, the response was much less than with amniotic fluid or with human milk.ConclusionIn aminiotic fluid and in human milk, EGF, IGF‐1, FGF, HGF, and TGF‐α have a strong trophic effect on immature intestinal cells and may be involved in perinatal gastrointestinal adaptation.
Supplementation of Infant Formula With the Probiotic Lactobacillus reuteri and Zinc: Impact on Enteric Infection and Nutrition in Infant Rhesus Monkeys
Authors: Kelleher Shannon L. , Casas Ivan , Carbajal Noris , Lönnerdal Bo 
Published: January 2024

ABSTRACTGut colonization by Lactobacillus reuteri may have beneficial effects on infant health or capacity to resist infectious disease. Zinc supplementation has also been proposed to increase infants' resistance to disease; however, many studies have yielded conflicting results.ObjectivesTo study effects of probiotic supplementation of infant formula (with or without supplemental zinc) on nutritional status, gut colonization and the ability to resist gastrointestinal infection in an infant rhesus monkey model.MethodsInfant monkeys were fed control infant formula (5 mg Zn/L), control formula with L. reuteri or control formula with L. reuteri and supplemental zinc (15 mg Zn/L) from birth to 4 months. Growth, nutritional status, mineral absorption, intestinal colonization and frequency and severity of enteropathogenic Escherichia coli‐induced gastroenteritis were monitored.ResultsGastrointestinal L. reuteri colonization was achieved and was associated with increased ileal villous surface area and improved hematocrit, with no adverse effects on growth or nutritional indices. Fortification to 15 mg Zn/L reduced plasma copper, erythrocyte Cu/Zn‐superoxide dismutase, hemoglobin, and iron absorption. Infants fed L. reuteri‐supplemented formula had reduced diarrhea severity throughout the study period and recovered more rapidly from acute diarrhea than the other groups.ConclusionL. reuteri‐supplementation of infant formula is safe, improves iron status and decreases diarrhea severity in infant rhesus monkeys and thus may help protect formula‐fed human infants from infection and nutritional deficiencies.
Immunoreactive Ghrelin in Human Cord Blood: Relation to Anthropometry, Leptin, and Growth Hormone
Authors: Chanoine Jean‐Pierre , Yeung Louisa PK , Wong Alfred CK , Birmingham Carl Laird 
Published: January 2024

ABSTRACTBackgroundGhrelin is secreted by the stomach, the hypothalamus, and the placenta in humans and has growth hormone–secreting and orexigenic properties. Leptin is secreted mainly by the adipocyte, plays a major role in energy balance, and reflects fat mass in infants as well as adults. Leptin and ghrelin central effects are mediated, at least partly, through the neuropeptide Y/Y1 receptor pathway in the hypothalamus.MethodsWe determined whether ghrelin is also present in the fetus and investigated its relationship to leptin, growth hormone, birth weight, and calf and abdominal circumferences in 90 full‐term neonates.ResultsImmunoreactive ghrelin was detected in all cord samples (mean ± SD, 187 ± 88 pmol/L; range, 66—594 pmol/L). In contrast to leptin, ghrelin concentrations of boys and girls were not statistically different. In female neonates, ghrelin is inversely correlated with anthropometric measures. In male neonates, ghrelin is positively correlated with leptin and negatively with growth hormone.ConclusionThe presence of significant ghrelin concentrations in all neonates before the first feeding is intriguing. Unlike the fairly constant concentrations and effects of leptin over the short term, the wide variability of ghrelin concentrations observed in newborns raises the possibility that ghrelin secretion causes short‐term changes in feeding behavior. We suggest that ghrelin may play a physiologic role in the initiation of feeding.
Clinical Response to Amino Acid‐Based Formula in Neurologically Impaired Children With Refractory Esophagitis
Authors: Miele Erasmo , Staiano Annamaria , Tozzi Arturo , Auricchio Renata , Paparo Francesco , Troncone Riccardo 
Published: January 2024

ABSTRACTObjectiveChronic gastrointestinal symptoms and histologic changes of the esophagus unresponsive to standard treatments for gastroesophageal reflux disease (GERD) may be improved by the use of elemental formulas. The aim of our study was to evaluate the efficacy of a dietary trial in neurologically impaired children unresponsive to medical and surgical therapy for GERD.MethodsNine children (three boys and six girls; median age, 44 months; range, 13–180 months) affected by cerebral palsy associated with severe mental retardation and with long‐standing history of GERD were fed the elemental formula, Neocate, for a minimum of 4 weeks. Before and after the dietary trial, each child underwent endoscopy with esophageal biopsy and a cellobiose/mannitol sugar permeability test. The diagnosis of GERD was based on the microscopic changes of the esophagus.ResultsBefore the dietary trial, according to conventional histologic criteria, esophagitis was considered moderate in seven children and mild in two. Five of nine patients also had abnormal sugar permeability test results. During and after the dietary trial, seven of nine patients experienced resolution of their long‐term symptom complaints. Furthermore, after the dietary trial, both endoscopic (P < 0.01) and histologic (P < 0.05) findings significantly improved. At 6‐month follow‐up, progressive reintroduction of individual dietary proteins, except for cow's milk protein, did not cause reappearance of the symptoms.ConclusionsIn neurologically impaired children unresponsive to conventional antireflux treatments, a course of a highly restricted diet with an amino acid–based formula may bring an immediate and sustained, endoscopically and histologically proven improvement in long‐standing gastrointestinal symptoms and esophagitis.
Childhood Gastroesophageal Reflux Symptoms in Adult Patients
Authors: Waring J. Patrick , Feiler Michael J. , Hunter John G. , Smith C. Daniel , Gold Benjamin D. 
Published: January 2024

ABSTRACTObjectivesGastroesophageal reflux (GER) and its esophageal (esophagitis, Barrett's esophagus) and extraesophageal (asthma, laryngeal disease) disease manifestations (GERD) are increasing common problems in children and adults. There are virtually no published longitudinal outcome studies that describe the natural history of childhood‐onset GER throughout a person's lifetime. The aim of this study was to compare the frequency of recalled childhood reflux symptoms in adult patients currently with and without GER symptoms.MethodsFour hundred adult patients were classified as refluxers (225 patients; 57%), nonrefluxers (154 patients; 38%), and those who claimed to not know if they had reflux (21 patients; 5%; excluded from analysis). Subjects were given a questionnaire asking them to recall childhood symptoms attributed to GER. Of the 225 refluxers, 141 (63%) recalled at least one childhood symptom, compared with 54 of the 154 nonrefluxers (35%) (P < 0.001).ConclusionsAdult refluxers were more likely to recall having developed GER symptoms at an earlier age, beginning at infancy and developing statistically significant GER compared with nonrefluxers after age 11. Adults suffering from GER were far more likely than nonrefluxers to recall having experienced GER symptoms during childhood. Well‐designed, population‐based epidemiologic studies are needed to more accurately assess the extent of GER in the overall population and the extent of its impact on health care in the United States.
Lactase Deficiency: Not More Common in Pediatric Patients With Inflammatory Bowel Disease Than In Patients With Chronic Abdominal Pain
Authors: Pfefferkorn Marian D. , Fitzgerald Joseph F. , Croffie Joseph M. , Gupta Sandeep K. , Corkins Mark R. , Molleston Jean P. 
Published: January 2024

ABSTRACTObjectiveLactase deficiency is commonly found in adults with inflammatory bowel disease (IBD). Our aim was to determine its prevalence in children with IBD.MethodsWe conducted a retrospective and descriptive analysis of patients with symptomatic IBD whose mucosal lactase activity was measured on duodenal biopsies obtained during gastrointestinal endoscopic evaluations. Age‐ and gender‐matched controls were chosen randomly from a group with chronic abdominal pain.ResultsOne hundred twelve patients with IBD were identified from January 1994 to December 2000. Seventy‐nine (71%) had Crohn disease, and 33 (29%) had ulcerative colitis. Forty‐five (40%) of all IBD patients (29 with Crohn disease and 16 with ulcerative colitis) had low lactase activity levels (< 15 μM/min/gm). The prevalence of lactase deficiency in patients with IBD was 37% (38 of 103) in white patients and 78% (7 of 9) in blacks. Thirty‐four of 112 controls (30%) had lactase deficiency. IBD patients were more likely to be lactase deficient than the controls, but the difference was not statistically significant (P = 0.162). Normal duodenal histology was found in 67% of lactase‐deficient IBD patients compared with 82% in lactase‐sufficient IBD patients. The frequency of duodenal inflammation did not differ significantly between lactase‐deficient and ‐sufficient patients with IBD (P = 0.068).ConclusionsMore than one third of pediatric patients with IBD have lactase deficiency, which is not significantly different from non‐IBD patients with chronic abdominal pain. The majority of lactase‐deficient patients with IBD have normal duodenal biopsy results. Lactase activity from small bowel biopsy specimens can be measured at the time of initial endoscopy. Reevaluation, either by small bowel biopsy or the breath hydrogen test, may then be considered during follow‐up of symptomatic patients.
Diagnosis and Management of MNGIE Syndrome in Children: Case Report and Review of the Literature
Authors: Teitelbaum J. E. , Berde C. B. , Nurko S. , Buonomo C. , Perez‐Atayde A. R. , Fox V. L. 
Published: January 2024

ABSTRACTMitochondrial neurogastrointestinal encephalomyopathy (MNGIE) syndrome is a rare disorder that presents in childhood; however, marked delay in diagnosis is common. We report a case and review the literature describing the typical features that should alert pediatricians to the diagnosis. We also describe a novel management strategy for providing symptomatic relief.
Azathioprine Metabolite Measurements in the Treatment of Autoimmune Hepatitis in Pediatric Patients: A Preliminary Report
Authors: Rumbo Carolina , Emerick Karan M. , Emre Sukru , Shneider Benjamin L. 
Published: January 2024

ABSTRACTPotential adverse effects of azathioprine (AZA), such as neutropenia and hepatotoxicity, make its use in autoimmune hepatitis (AIH) problematic.ObjectiveTo determine longitudinal AZA metabolite levels in a cohort of children with AIH, correlate them with therapeutic effects, medication‐induced toxicity and adherence.MethodsFrom January 2000 to January 2002, 122 blood samples from 30 pediatric patients with AIH were prospectively analyzed. Ten patients had previously been treated with AZA (mean dose of 1.3mg/kg/day) for an average of 30 months. At the outset, 24 patients were taking steroids and 10 had cirrhosis/hypersplenism. Routine biochemical studies, 6‐thioguanine (6‐TG) and 6‐methylmercaptopurine (6‐MMP) levels were assessed every 8 weeks. Red blood cell thiopurine methyltransferase (TPMT) enzyme activity was determined in each patient. AZA dose was adjusted to achieve a target 6‐TG level 235‐450 pmoles per 8 × 108 RBC.Results8/10 patients who had previously been treated with standard doses of AZA had 6‐TG below target levels. Increasing AZA mean dose by 50% in those patients resulted in 6/10 patients in target range; ALT levels and steroid requirements were reduced. AZA dosing was safely increased in patients with cirrhosis/hypersplenism. In spite of normal TPMT levels, 64% of patients did not make measurable concentrations of 6‐MMP. Inappropriately low 6‐TG levels revealed non‐adherence in 5 patients. Two patients were identified with AZA hepatotoxicity.ConclusionAZA metabolite testing in children with AIH is useful in identifying medication toxicity and non‐adherence. AZA dose escalation is safe and may be required in order to achieve 6‐TG target levels described for inflammatory bowel disease.
Growth Slowing After Acute Helicobacter pylori Infection Is Age‐Dependent
Authors: Passaro Douglas J. , Taylor David N. , Gilman Robert H. , Cabrera Lilia , Parsonnet Julie 
Published: January 2024

ABSTRACTObjectiveMost Helicobacter pylori infections occur during childhood, but the health effects of childhood infection are poorly understood. We investigated whether growth decreases in the 2 months after acute H. pylori seroconversion.MethodsWe performed a nested case‐control study among children 6 months to 12 years of age in a community on the outskirts of Lima, Peru. Health interviews were completed daily. Anthropometric measurements were taken monthly. Sera were collected every 4 months and tested for H. pylori immunoglobulin G. Two‐month height and weight gains of seroconverters were compared with gains of sex, age, and size‐matched seronegative controls.ResultsIn the 2 months after H. pylori infection, 26 seroconverters gained a median of 24% less weight than 26 matched controls (interquartile range, 63% less to 21% more). In multivariate analysis, H. pylori infection attenuated weight gain only among children aged 2 years or older. This decrease was not explained by increased diarrhea.ConclusionsH. pylori seroconversion is associated with a slowing of weight gain in children aged 2 years or older. Reasons for this finding merit additional study.
Effect of Lactobacillus GG and Breast‐feeding in the Prevention of Rotavirus Nosocomial Infection
Authors: Mastretta Emmanuele , Longo Patrizia , Laccisaglia Anna , Balbo Luciano , Russo Roberto , Mazzaccara Alfonso , Gianino Paola 
Published: January 2024

ABSTRACTBackgroundRotavirus is one of the leading etiologic agents of nosocomial infections among children. The development of preventive measures is therefore important. The efficacy of Lactobacillus GG in the treatment of rotavirus infection has been reported in literature, but there is only one recent study about its effectiveness in prevention of infection. The role of breast‐feeding in the prevention of rotavirus infection is still debated. The aim of our study was to assess the efficacy of Lactobacillus GG and breast‐feeding in the prevention of nosocomial rotavirus infections.MethodsIn a randomized, placebo‐controlled, double‐blind study, 220 children aged 1 to 18 months hospitalized from December 1999 to May 2000, received Lactobacillus GG (n = 114) at a dose of 1010 colony‐forming units or a comparable placebo (n = 106) every day of their hospital stay. Rotavirus testing on stool samples was performed for every patient on admission, during hospitalization, and after discharge.ResultsThe total incidence of nosocomial rotavirus infections was 27.7% (61 of 220 patients). The attack rate of rotavirus infections among the patients who received probiotic was 25.4% (29 of 114 patients), while for the placebo group it was 30.2% (32 of 106 patients). The difference is not significant (P = 0.432). Forty‐seven of 220 infants (21.4%) were breast‐fed, and 173 of 220 (78.6%) were non–breast‐fed. The attack rate of rotavirus infections among breast‐fed infants was 10.6% (5 of 47 infants), while for non–breast‐fed infants it was 32.4% (56 of 173 infants). The difference is significant (P = 0.003).ConclusionIn our study, Lactobacillus GG was ineffective in preventing nosocomial rotavirus infections, whereas breast‐feeding was effective.
Congenital Maltase‐Glucoamylase Deficiency Associated With Lactase and Sucrase Deficiencies
Authors: Nichols Buford L. , Avery Stephen E. , Karnsakul Wikrom , Jahoor Farook , Sen Partha , Swallow Dallas M. , Luginbuehl Ursula , Hahn Dagmar , Sterchi Erwin E. 
Published: January 2024

ABSTRACTBackgroundMultiple enzyme deficiencies have been reported in some cases of congenital glucoamylase, sucrase, or lactase deficiency. Here we describe such a case and the investigations that we have made to determine the cause of this deficiency.Methods and ResultsA 2.5 month‐old infant, admitted with congenital lactase deficiency, failed to gain weight on a glucose oligomer formula (Nutramigen®). Jejunal mucosal biopsy at 4 and 12 months revealed normal histology with decreased maltase‐glucoamylase, sucrase‐isomaltase, and lactase‐phlorizin hydrolase activities. Testing with a 13C‐starch/breath 13CO2 loading test confirmed proximal starch malabsorption. Sequencing of maltase‐glucoamylase cDNA revealed homozygosity for a nucleotide change (C1673T) in the infant, which causes an amino acid substitution (S542L) 12 amino acids after the N‐terminal catalytic aspartic acid. The introduction of this mutation into “wildtype” N‐terminus maltase‐glucoamylase cDNA was not associated with obvious loss of maltase‐glucoamylase enzyme activities when expressed in COS 1 cells and this amino‐acid change was subsequently found in other people. Sequencing of the promoter region revealed no nucleotide changes. Maltase‐glucoamylase, lactase, and sucrase‐isomaltase were each normally synthesized and processed in organ culture.ConclusionsThe lack of evidence for a causal nucleotide change in the maltase‐glucoamylase gene in this patient, and the concomitant low levels of lactase and sucrase activity, suggest that the depletion of mucosal maltase‐glucoamylase activity and starch digestion was caused by shared, pleiotropic regulatory factors.
Endoscopic Retrograde Cholangiopancreatography in Children and Adolescents
Authors: Pfau Patrick R. , Chelimsky Gisela G. , Kinnard Margaret F. , Sivak Michael V. , Wong Richard C. K. , Isenberg Gerard A. , Gurumurthy Priya , Chak Amitabh 
Published: January 2024

ABSTRACTObjectivesEndoscopic retrograde cholangiopancreatography (ERCP) is becoming a more frequently used diagnostic and therapeutic tool in children. We sought to determine the indications, feasibility, safety, and effect on patient management of ERCP in pediatric patients of varying age.MethodsAll ERCPs performed during a 4‐year period in patients aged 18 years or less at an academic hospital were retrospectively reviewed. The indications, type of anesthesia administered, type of duodenoscope used, diagnostic findings, therapeutic interventions, complication rate, and effect on management were compared between children (age 0–12 years) and adolescents (age 13–18 years).ResultsA total of 53 procedures were performed in 43 patients whose median age was 13.5 years. ERCP was successful in 50 of 53 cases (94%) with a complication rate of 6%. Endoscopic therapy was provided in 24 of 53 cases (45%). Compared with adolescents (n = 28), children (n = 25) were more likely to receive general anesthesia (96% vs. 29%;P < 0.001) and undergo ERCP with a pediatric duodenoscope (0% vs. 40%). ERCP affected management in 73% of cases, equally in both groups.ConclusionERCP is a successful and safe diagnostic and therapeutic modality in a variety of pancreatobiliary disorders that directly affects management in children of all ages.
Gastric Polyps and Nodules in Children Receiving Long‐Term Omeprazole Therapy
Authors: Pashankar Dinesh S. , Israel David M. 
Published: January 2024

ABSTRACTObjectiveMultiple gastric polyps have been reported to occur in adults receiving omeprazole therapy. There are little published data in children. We report our experience in monitoring the gross and histologic appearance of the stomach in children receiving long‐term omeprazole therapy.MethodsThis was a retrospective review of the charts of children who received omeprazole for more than 6 months for reflux esophagitis between 1989 and 1998. All patients had repeated endoscopic examinations until healing of the esophagitis was confirmed and then annually thereafter. At endoscopy, gastric mucosal swellings were classified as polyps or nodules based on histology.ResultsThirty‐one children had long‐term endoscopic follow‐up while receiving omeprazole. Seven of 31 children had gastric polyps and/or nodules, noted between 10 and 48 months (mean = 28 months) of omeprazole therapy. Four had nodules only, one had a sessile hyperplastic polyp, and two had both a polyp (one hyperplastic and one fundic gland polyp) and nodules. All lesions were found in the gastric body. Nodules in four of the six children disappeared spontaneously while the children continued to receive omeprazole. The polyps persisted. There were no dysplastic changes in the gastric mucosa or polyps in any of the patients. There were no significant differences between the 7 children with and the 24 without polyps/nodules with respect to age, gastrin concentrations, or dose and duration of omeprazole therapy.ConclusionsGastric polyps and nodules may be found in children receiving long‐term omeprazole therapy. The gastric changes in our patients were benign during the mean observation period of 31 months.