ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background:Little information is available on the epidemiologic characteristics of antibiotic‐associated diarrhea (AAD) in children. The authors' aim was to evaluate the incidence of AAD in an outpatient pediatric population and to identify risk factors.Methods:Children aged 1 month to 15.4 years treated with oral antibiotics for a proven or suspected infection were enrolled from an ambulatory pediatric practice during an 11‐month period. Parents recorded the daily frequency and characteristics of stools using a diary during the antibiotic treatment and for 1 week after it was stopped. An episode of diarrhea was defined by at least 3 soft or liquid stools/d for at least 2 consecutive days. Risk factors for AAD—age, type of antibiotic treatment, type of combined treatment, and site of infection— were analyzed.Results:Of 650 children included, 11% had an episode of AAD, lasting a mean of 4.0 ± 3.0 days, beginning a mean of 5.3 ± 3.5 days after the start of antibiotic treatment. No child was hospitalized because of AAD. The incidence of AAD was higher in children less than 2 years (18%) than in those more than 2 years (3%;P< 0.0001). The incidence of AAD was particularly high after administration of certain antibiotics (amoxicillin/clavulanate, 23%;P= 0.003 compared with other antibiotics). The type of combined treatment and site of infection did not influence the onset of AAD.Conclusions:Antibiotic‐associated diarrhea was common in these outpatient children, especially for those aged less than 2 years and after the prescription of certain antibiotics, particularly, the combination of amoxicillin/clavulanate.JPGN 37:22‐26, 2003.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:The aim was to investigate the expression of cytokines, adhesion molecules, and activation and proliferation markers in duodenal biopsies from children with delayed‐type food allergy (FA).Methods:Seven children with untreated FA (uFA), seven children with treated FA (tFA) to cow milk and/or cereals, and five normal controls furnished duodenal biopsy specimens. Additionally, five pediatric patients with celiac disease were included, serving exclusively as positive controls forin situhybridization. Interferon‐&ggr; (IFN‐&ggr;), interleukin‐4 (IL‐4), adhesion molecules, and activation markers were detected by immunohistochemistry, and expression of IFN‐&ggr; and IL‐4 messenger RNA was revealed byin situhybridization.Results:uFA patients had a higher density of IFN‐&ggr; positive cells in the lamina propria than did tFA patients and controls (P= 0.053 andP= 0.018). Moreover, the uFA patients exhibited a higher proportion of crypt cells in mitosis than did tFA patients (P= 0.026), and stronger staining of HLA‐DR in the crypts and increased density of &ggr;&dgr;‐T cell receptor‐positive intraepithelial lymphocytes than did controls (P= 0.048 andP= 0.010). The densities of &agr;4&bgr;7positive cells in the lamina propria tended to be higher in controls than in uFA or tFA patients (P= 0.106,P= 0.073). Expression of IL‐4 mRNA was significantly higher in celiac patients than in the other study groups (uFAP= 0.006, tFAP= 0.010; controlsP= 0.029), and celiac patients showed higher expression of IFN‐&ggr; mRNA than did tFA patients or controls (P= 0.017 andP= 0.016).Conclusions:As expected, Th1 dominance was present in the lamina propria of children with delayed‐type FA. It may cause activation of epithelial cells and increase their turnover.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background:Patients with eating disorders can refer to a variety of gastrointestinal symptoms, sometimes to justify reduced food intake and vomiting. The authors investigated whether adolescent patients with eating disorders and dyspeptic symptoms have altered gastric electric activity and abnormal gastric emptying as assessed respectively by electrogastrography and scintigraphy.Methods:Twenty‐eight patients (18 with anorexia and 10 with bulimia) and 16 healthy volunteers underwent electrogastrography; 20 of the 28 patients (14 with anorexia and 6 with bulimia) underwent gastric emptying scintigraphy. Electrogastrography with bipolar recording lasted 1 hour, 30 minutes before and after a standard meal. Before gastric emptying scintigraphy, patients fasted overnight; during testing, they ingested a solid meal labeled with technetium‐99m sulfur colloid. The ratio of fasting to postprandial electrogastrographic variables was evaluated using the Wilcoxon matched‐pair test. The Mann‐Whitney test was used to compare absolute values for electrogastrographic data in each group. The Student pairedttest was used to compare scintigraphic results expressed as percentage of gastric emptying at 60 minutes and as the gastric emptying time (T½).Results:Patients with bulimia significantly differed from those with anorexia and control subjects regarding the amount of normal gastric electric activity and bradygastria, and from patients with anorexia only regarding tachygastria. These electrogastrographic variables did not differ significantly between patients with anorexia and control subjects. Gastric emptying time (T½) was significantly longer in patients with bulimia than in those with anorexia.Conclusions:Adolescent patients with bulimia who complain of dyspeptic symptoms have documentable abnormalities of gastric electric activity and emptying, whereas their counterparts with anorexia, probably owing to their shorter disease duration, do not.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:Cholecystokinin (CCK) plays an important role in postprandial gallbladder contraction and may also have pacifying behavioral effects, such as inducing satiety and calming in infants. The authors hypothesized that colicky infants have impaired CCK secretion, which contributes to their gallbladder hypocontractility (reported earlier) and excessive crying.Methods:Cholecystokinin levels of 40 colicky and 37 control infants were evaluated at a mean of age 5 weeks. Plasma CCK levels were drawn before, immediately after, and 1 hour after a regular milk feeding and analyzed using radioimmunoassay (RIA). The contraction of the gallbladder was calculated using ultrasound measurements before and 1 hour after the feeding. The two‐tailttest for independent samples was used to test continuous data.Results:The preprandial and 1‐hour postprandial plasma levels of CCK were lower in the colicky infants than in the control subjects (P< 0.05). The immediate postprandial CCK levels were also lower in the colicky infants, although this difference did not reach a statistical significance. The proportion of gallbladder contractions did not differ between the study groups.Conclusions:The authors conclude that low CCK levels in colicky infants may predispose them to excessive crying in the absence of the calming effect of CCK.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:The authors evaluated rectal manometry of children with sacral root abnormalities secondary to isolated sacral agenesis.Methods:The anorectal manometric recordings of seven patients with isolated sacral agenesis (four with partial agenesis and three with complete agenesis) were retrospectively evaluated and compared with tracings from healthy control subjects. Characteristics of the internal anal sphincter (IAS), the rectoanal inhibitory reflex (RAIR), voluntary external anal squeeze pressure, and threshold of rectal sensation to distension were analyzed. Characteristics of the patients' neurologic function with attention to urinary and fecal continence were obtained by chart review.Results:All seven patients had urinary and fecal incontinence. IAS resting pressure was the same in patients and control subjects. In the three patients with total sacral agenesis, IAS relaxation was more complete and lasted longer after balloon distention of the rectum. These patients also had significantly lower voluntary external anal squeeze pressure and blunted sensation of rectal distension.Conclusions:Abnormal parasympathetic innervation associated with sacral agenesis is associated with changes in anorectal function. Manometric findings suggest that there is modulation of the RAIR by extrinsic innervation, which may explain the fecal incontinence in these patients.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background:It is well known that chronic gastritis induced byHelicobacter pylorimay be associated with hypochlorhydria and may also be accompanied by low levels of vitamin C in plasma and gastric juice in adults. This study investigates the relationship betweenH. pyloriinfection and vitamin C levels in the blood, plasma and gastric juice and the gastric juice pH of Korean children.Methods:During a 5‐year period, multiple gastric antral biopsies were taken from 452 children who underwent gastroduo‐denoscopy. The biopsy specimen was inoculated into phenol red buffered urea broth and incubated for 48 hours to detect color changes. The histopathologic findings were evaluated using the Sydney System. Concentrations of vitamin C in whole blood, plasma, and gastric juice aspirate were measured using the 2,4‐dinitrophenylhydrazine method.Results:Four hundred fifty‐two patients (228 boys, 224 girls) aged 1 to 15 years were enrolled in this study.H. pyloriwas detected in 112 patients (24.8%) using histology, whereas it was found in 204 patients (45.1%) using the urease test. One hundred seven patients (23.7%) had active gastritis, and 421 patients (93.1%) had chronic gastritis. Vitamin C levels in whole blood, plasma, and gastric juice exhibited significant negative correlation with the age of patients, the histologic density ofH. pylori, the degree of active and chronic gastritis, and the severity ofH. pyloriinfection (based on urease positivity and histologic density ofH. pylori). Gastric juice pH was correlated with the degree of chronic gastritis and was significantly higher in urease‐positive patients.Conclusions:The data demonstrate that vitamin C levels in whole blood, plasma, and gastric juice and the gastric juice pH in Korean children are closely related to the severity ofH. pyloriinfection and the histologic changes in the stomach. These data suggest that vitamin C may play a role in determining infection and progression, and vitamin C supplementation may be an important axis for the management ofH. pyloriinfection in children.JPGN 37:53‐62, 2003.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background: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.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID