摘要:

To develop clinical and laboratory criteria to identify young children with gastroesophageal reflux (GER) who are at particular risk for esophagitis and then to monitor their clinical course we have prospectively studied 40 subjects (ages 2–22 months, mean 8 months) with persistent symptoms of GER with 18 h intraesophageal pH monitoring, endoscopy, and grasp and suction esophageal biopsies. Esophagitis was found in 16 of 20 patients under 7 months, 12 of 14 between 7 and 12 months, and five of six between 12 and 24 months. Esophagitis was equally frequent in those patients with or without poor weight gain, wheezing, or irritability. Only 15% of patients with esophagitis had occult blood in their stool. No parameter of intraesophageal pH monitoring was both sensitive and specific in identifying patients who were ultimately found to have either mild or severe esophagitis. Follow-up data (37 patients) revealed that fundoplication was eventually required in four of eight patients with severe esophagitis, three of 22 with mild esophagitis, and none of seven without esophagitis. Currently used clinical and laboratory assessments of GER have limited value in identifying those children with either normal esophageal mucosa or at risk for varying degrees of esophagitis. Preliminary observations suggest that the presence of severe histologic esophagitis at the time of initial evaluation may have prognostic value in identifying those patients most likely to fail medical therapy and require fundoplication.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Three children with peptic ulcer disease had recurrent symptoms unresponsive to cimetidine or ranitidine therapy alone. Acid secretory studies showed a marked basal acid hypersecretion, which was atropinesensitive in two of three patients and was best suppressed by ranitidine in combination with an anticholinergic drug. Marked reduction in acid output following intravenous atropine suggested that the hypersecretion was under vagal, muscarinic control. However, in one patient, large doses of the selective m1-muscarinic antagonist pirenzepine were ineffective in suppressing basal acid hypersecretion. Given the efficacy and safety of drug therapy used in these children over a 3-year period, we conclude that medical management is an effective alternative to surgery for pediatric patients with refractory or recurrent peptic ulcer disease.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

As an intravenous injection is not used in our premedication of infants and children for small bowel biopsy, we investigated what effects oral metoclopramide might have on small bowel biopsy procedure time and fluoroscopy time. Eighteen infants and children were randomized to receive 0.2 mg/kg metoclopramide or placebo orally, 40–45 min before starting the procedure, and the procedure was monitored for the time required for the biopsy capsule to reach the pylorus, to cross into the proximal duodenum, and to reach the biopsy site. Corresponding fluoroscopy times were recorded as well. Mean total procedure time was less for those treated with metoclopramide, 43.7 ± 11 min, than for controls, 86.5 ± 15.5 min (p < 0.005). Mean total fluoroscopy time was also less in treated patients (40.9 ± 11.5 s versus control 84.4 ± 17 s) (p < 0.005). The effect of metoclopramide occurred in the interval for the biopsy capsule to cross the pylorus (15.1 ± 2.7 min versus control 60.8 ± 16.6 min) (p < 0.005) and in fluoroscopy time required (15.1 ± 1.9 s versus control 46 ± 17 s) (p < 0.005). Oral metoclopramide is effective in reducing procedure time for small bowel biopsy, and its predictable action facilitates reduction in fluoroscopy exposure.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The effect of soy protein on the small bowel mucosa of 18 infants with acute gastroenteritis was studied. The infants were maintained on a protein hydro-lysate formula for 6–8 weeks, following which they were readmitted for soy protein challenge studies. Jejunal biopsy was performed before and 24 h after challenge. On the basis of the clinical and histological reaction to soy protein challenge, three groups were identified. Group 1 consisted of three infants who had clinical and histological reaction. There was associated depletion of mucosal enzymes, lactase, sucrase, malatase, alkaline phosphatase, and blood xylose levels. Group 2 consisted of seven infants who had histological reaction but no clinical symptoms. Two of these seven infants, however, developed clinical reaction when rechallenged with soy protein 2 and 90 days later. Following challenge, mucosal enzymes and blood xylose levels were depressed in five of the seven infants tested. Group 3 consisted of eight infants who did not have either a clinical or a histological reaction. The mucosal enzymes and blood xylose levels were not depressed in four infants tested. The present study shows that the small bowel mucosa of some young infants recovering from acute gastroenteritis remains sensitive to soy protein for a variable period of time. The feeding of soy protein to these infants may result in the persistence of mucosal damage and perpetuation of diarrhea. These findings have an important bearing in the nutritional management of infants recovering from AGE; the exclusion of soy protein from the diet of these infants, particularly during the period when the mucosa is damaged, may reduce the risk of the development of soy protein sensitive enteropathy and the attendant complication of protracted diarrhea.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The nutritional management of intractable diarrhea and short bowel syndrome remains a challenging problem. The advantage of continuous nasogastric infusion is undisputed, but what to feed remains in question, and no studies, to these authors' knowledge, have yet compared two widely used specially designed protein hydrolysate formulas. A randomized crossover trial of two periods of 7 days was carried out with Alfare and Pregestimil administered by a constant infusion pump in six malnourished infants aged 1–13 months. Two had intractable diarrhea, and four the short bowel syndrome. Identical quantities of calories were administered during the two periods. There was good tolerance for both formulas and satisfactory weight gain. Despite compositional differences related to osmolality, the source of the hydrolysates and their profile, and the qualitative pattern of the carbohydrates, no difference was observed with regard to stool weight, Na+and K+losses, and the enteral absorption of fat, carbohydrate-derived energy, and total energy. The percent absorption of nitrogen was somewhat higher (p < 0.01) with Pregestimil (83.8 ± 2.7) than with Alfare (77.3 ± 3.4), but nitrogen retention was unaffected. Energy absorption was the same on both formulas, but maldigested or malabsorbed carbohydrates accounted for 63% of total energy loss during Alfare feeding and 72% during the week of Pregestimil. These data call for studies with protein hydrolysate formulas reformulated with a lower concentration of carbohydrates and a higher one of fat.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Energy, nitrogen absorption, and nitrogen utilization of two commercial elemental diets, Vivonex and Vital, were compared in 10 teenage boys and girls with Crohn's disease. The diets were given in random order as overnight feedings and were the sole source of nutrients for two consecutive periods of 3 weeks each. Urine and stools were collected for 48 h at the end of each 3-week period. Energy absorption was slightly better on Vivonex (p < 0.05), although 95–100% of energy was absorbed with both formulas. Nitrogen absorption was not different for the two formulas, but nitrogen utilization was significantly better on Vital (28.6 ± 12.9% versus 9.7 ± 17.7%, p < 0.01). This difference may be attributable to the different concentrations of sulfur-containing and aromatic amino acids in the two formulas.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

At our institution, proctocolectomy with rectal mucosectomy and ileoanal anastomosis with endorectal pull-through is now the procedure of choice for young patients with chronic ulcerative colitis and familial polyposis. We have followed up 66 patients (37 male and 29 female, with a median age of 16 years) for at least 6 months after closure of the temporary ileostomy. The patients were seen regularly in follow-up or were sent a comprehensive questionnaire to assess their condition. Twenty-two patients had the construction of a J-pouch. and 44 had a straight ileo-anal pull-through. Stool frequency, day (median 4 to 7 stools) and night (median 1 to 3 stools), was similar in the two groups. Voluntary continence was excellent in both groups during waking hours. Occasional night-time incontinence in small volumes, mild perianal itching, and minimal bleeding from irritation were similar in both groups. Most of the patients could distinguish gas from stool. When medication was used, bulk agents were usually chosen, with a nonspecific anti-diarrheal agent taken occasionally. A few patients with the straight ileo-anal pull-through expressed some dissatisfaction early during the follow-up period: however, all but two patients expressed satisfaction later. Of the 66 patients, 41 had at least one complication during the postoperative period; however, in 26 the complications were minor. The more severe complications included small bowel obstruction (11 patients requiring surgical decompression), infection (one patient requiring surgery), and transient neuropathy (three patients).

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Motilin levels were measured by radioimmunoassay from umbilical cord blood obtained at birth from 38 term neonates (median gestational age 40 weeks, range 39–42 weeks). Birth weights of these neonates ranged from 2,840 to 4,593 G (median 3,600 G). Forty-two percent (16/38) of these neonates passed antenatal meconium.The median motilin level was 177 fmol/ml in those neonates who passed antenatal meconium and 111.5 fmol/ml in those neonates who did not pass meconium prior to birth (p < 0.01). Although fetal distress has been found to be associated with elevated motilin levels at birth, such an association was not found in this study. These data support an association between elevated motilin levels at birth and antenatal meconium passage.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Longitudinal changes in nutrient levels of human milk have been observed with the progression of lactation, but less is known about changes at different feedings during a 24-h period. In this study, calcium, magnesium, and zinc levels were examined in milk obtained from 49 women at every breast feeding during one 24-h period each month for the first 6 months of lactation. Magnesium and zinc concentrations showed significant diurnal variation at each stage of lactation examined, whereas calcium levels were relatively constant. Maximum variations of 7.5, 17, and 48% were observed within a 24-h period in mean levels of calcium, magnesium, and zinc, respectively. Irrespective of variability, zinc and magnesium concentrations in a single milk sample obtained between 10:00 a.m. and 2:00 p.m. were highly correlated with the mean value of samples collected at each feeding during a 24-h period.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Antimicrotubular drugs such as colchicine impair plasma protein secretion markedly less from developing liver than from mature tissue, suggesting the reduced participation of microtubules in hepatic protein secretion during liver development. In order to evaluate the possible contribution of microfilaments to protein export by immature liver, we incubated slices prepared from adult and gestation day 19 fetal rat liver for up to 4 h with the antimicrofilamentous agent cytochalasin B and with colchicine in various concentrations. In adult tissue, cytochalasin B did not reduce either the synthesis or secretion of [14C]leucine-labeled proteins and albumin. Cytochalasin B decreased apparent albumin synthesis by fetal liver, but otherwise, its effects on [14C]leucine incorporation did not differ from those observed in the adult. In contrast with leucine, the uptake of [3H]glucosamine into both adult and fetal liver was reduced by cytochalasin B. When this reduced uptake was normalized to that in corresponding control incubations, [3H]glucosamine incorporation into glycoproteins was markedly diminished in fetal slices, but was unaffected in the adult. Despite this age-dependent difference, cytochalasin B only minimally affected glycoprotein secretion in each group. Cytochalasin B never modified the antisecretory effects of colchicine. These results suggest that during early development, liver protein synthesis is more sensitive to toxic effects of cytochalasin B than during adulthood. However, microfilaments are not required for plasma protein export at either time.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID