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Di Lorenzo C, Nurko S, Hyams JS, Rodriguez-Araujo G, Shakhnovich V, Saps M, Simon M. Safety and efficacy of linaclotide in children aged 7-17 years with irritable bowel syndrome with constipation. J Pediatr Gastroenterol Nutr 2024; 78:539-547. [PMID: 38504394 DOI: 10.1002/jpn3.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Linaclotide, a guanylate cyclase-C agonist, was recently approved in the United States for the treatment of children 6-17 years old with functional constipation. This study evaluated the safety and efficacy of various linaclotide doses in children 7-17 years old with irritable bowel syndrome with constipation (IBS-C). METHODS In this 4-week, randomized, double-blind, placebo-controlled, parallel-group, Phase 2 study, children with IBS-C were randomized to once-daily placebo or linaclotide (Dose A: 18 or 36 µg, B: 36 or 72 µg, and C: 72 µg or 145 µg, or 290 µg); those aged 7-11 years in a 1:1:1:1 allocation based on weight (18 to <35 kg:18 µg, 36 µg, or 72 µg; or ≥35 kg: 36 µg, 72 µg, or 145 µg), and those aged 12-17 years in a 1:1:1:1:1 allocation (the higher option of Doses A-C or 290 µg). The primary efficacy endpoint was a change from baseline in 4-week overall spontaneous bowel movement (SBM) frequency rate over the treatment period. Adverse events and clinical laboratory measures were also assessed. RESULTS Efficacy, safety, and tolerability were assessed in 101 patients. In the intent-to-treat population, numerical improvement was observed in overall SBM frequency rate with increasing linaclotide doses (A: 1.62, B: 1.52, and C: 2.30, 290 µg: 3.26) compared with placebo. The most reported treatment-emergent adverse events were diarrhea and pain, with most cases being mild and none being severe. CONCLUSIONS Linaclotide was tolerated well in this pediatric population, showing numerical improvement in SBM frequency compared with placebo.
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Affiliation(s)
- Carlo Di Lorenzo
- Department of Gastroenterology & Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Samuel Nurko
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey S Hyams
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Wong LC, Hsu CJ, Wu YT, Chu HF, Lin JH, Wang HP, Hu SC, Tsai YC, Tsai WC, Lee WT. Investigating the impact of probiotic on neurological outcomes in Rett syndrome: A randomized, double-blind, and placebo-controlled pilot study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231225899. [PMID: 38361371 DOI: 10.1177/13623613231225899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
LAY ABSTRACT Rett syndrome often involves gastrointestinal symptoms and gut microbiota imbalances. We conducted a study to explore the feasibility of probiotic Lactobacillus plantarum PS128 and the impact on neurological functions in Rett syndrome. The results of our investigation demonstrated that the supplementation of probiotic L. plantarum PS128 was feasible and well tolerated, with 100% retention rate and 0% withdrawal rate. In addition, there was only one participant who had loose stool after taking L. plantarum PS128. Further, there was a tendency to enhance overall cognitive developmental level, as assessed using Mullen Scales of Early Learning. In addition, it significantly improved dystonia, as assessed using the Burke-Fahn-Marsden Movement Scale, in comparison with the placebo group. This study provides a strong foundation for future research and clinical trials exploring the potential of L. plantarum PS128 probiotics as a complementary therapy for individuals with Rett syndrome.
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Affiliation(s)
- Lee Chin Wong
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Jui Hsu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University, Taipei, Taiwan
| | - Hsu-Feng Chu
- Biomedical Industry Ph.D. Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jui-Hsiang Lin
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Hsin-Pei Wang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital YunLin Branch, YunLin, Taiwan
| | - Su-Ching Hu
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Ying-Chieh Tsai
- Institute of Biochemistry and Molecular Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
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Rego RMP, Machado NC, Carvalho MDA, Graffunder JS, Fraguas C, Ortolan EVP, Lourenção PLTDA. Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children. Biomedicines 2024; 12:164. [PMID: 38255269 PMCID: PMC10813187 DOI: 10.3390/biomedicines12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child's quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interventions like neuromodulation. A subtype of neuromodulation, called Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS), comprises electrical stimulation at the ankle level, by means of electrodes fixed to the skin. TPTNS is a minimally invasive, easy-to-apply technique that can potentially improve constipation symptoms in the pediatric population by stimulating the sacral nerves. AIM To evaluate the clinical results and applicability of TPTNS as an adjuvant treatment for children and adolescents with functional constipation. METHODS Between April 2019 and October 2021, 36 patients diagnosed with functional constipation according to the Rome IV Criteria were invited to participate in the study. The study followed a single-center, uncontrolled, prospective cohort design. Patients received TPTNS for 4 or 8 weeks, with assessments conducted immediately after the periods of TPTNS and 4 weeks after the end of the intervention period. The data normality distribution was determined by the Shapiro-Wilk test. The Wilcoxon test and Student's t-test for paired samples were used to compare quantitative variables, and the McNemar test was used to compare categorical variables. RESULTS Of the 36 enrolled patients, 28 children and adolescents with intractable function constipation completed the study, receiving TPTNS for 4 weeks. Sixteen patients (57.1%) extended the intervention period for 4 extra weeks, receiving 8 weeks of intervention. TPTNS led to significant improvements in stool consistency, frequency of defecation, and bowel function scores, with a reduction in abdominal pain. Quality of life across physical and psychosocial domains showed substantial enhancements. The quality of life-related to bowel habits also improved significantly, particularly in lifestyle, behavior, and embarrassment domains. The positive effects of this intervention are seen relatively early, detected after 4 weeks of intervention, and even 4 weeks after the end of the intervention. TPTNS was well-tolerated, with an adherence rate of approximately 78%, and no adverse effects were reported. CONCLUSIONS TPTNS is an adjuvant treatment for intractable functional constipation, improving bowel function and quality of life. The effects of TPTNS were observed relatively early and sustained even after treatment cessation.
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Affiliation(s)
- Rebeca Mayara Padilha Rego
- Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (R.M.P.R.); (E.V.P.O.)
| | - Nilton Carlos Machado
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (N.C.M.); (M.d.A.C.)
| | - Mary de Assis Carvalho
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (N.C.M.); (M.d.A.C.)
| | - Johann Souza Graffunder
- Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil;
| | | | - Erika Veruska Paiva Ortolan
- Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (R.M.P.R.); (E.V.P.O.)
| | - Pedro Luiz Toledo de Arruda Lourenção
- Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (R.M.P.R.); (E.V.P.O.)
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de Bruijn CMA, Rexwinkel R, Vermeijden NK, Hoffman I, Tack J, Benninga MA. The Use of Pictograms in the Evaluation of Functional Abdominal Pain Disorders in Children. J Pediatr 2023; 263:113647. [PMID: 37517644 DOI: 10.1016/j.jpeds.2023.113647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To evaluate whether the use of pictograms improves symptom evaluation for children with functional abdominal pain disorders (FAPDs). STUDY DESIGN This survey study was conducted in 2 academic centers and included patients aged 8-18 years visiting the outpatient clinic for FAPD symptom evaluation. Patients were randomized to fill out the questionnaire without or with accompanying pictograms to assess gastrointestinal symptoms. Afterwards, patients underwent clinical health assessment by the healthcare professional (HCP). Subsequently, the HCP filled out the same questionnaire without pictograms, while blinded to the questionnaire completed by the patient. Primary outcome was the level of agreement between identified symptoms as assessed by patients and HCP. RESULTS We included 144 children (questionnaire without accompanying pictograms [n = 82] and with accompanying pictograms [n = 62]). Overall agreements rates were not significantly different (without pictograms median, 70% vs with pictograms median, 70%). Accompanying pictograms did not significantly improve the assessment of abdominal pain symptoms. Accompanying pictograms were beneficial for concordance rates for nausea and vomiting symptoms (without pictograms median, 67% vs with pictograms median, 100%; P = .047). Subgroup analyses for children aged 8-12 years of age revealed similar results (concordance on the presence of nausea and vomiting without pictograms median, 67% vs with pictograms median, 100%; P = .015). Subgroup analyses for children ages 12-18 years showed no significant differences in concordance rates. CONCLUSIONS Pictograms do not seem to improve the assessment of FAPDs. However, the use of pictograms improves the evaluation of nausea and vomiting, especially for children aged 8-12 years. Therefore, HCPs could consider using pictograms in that setting during consultations.
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Affiliation(s)
- Clara M A de Bruijn
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Robyn Rexwinkel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Nicolaas K Vermeijden
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands; Department of Pediatrics, St Antonius Ziekenhuis, Nieuwegein, The Netherlands.
| | - Ilse Hoffman
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Bajerova K, Salvatore S, Dupont C, Kuitunen M, Meyer R, Ribes-Koninckx C, Shamir R, Szajewska H, Staiano A, Vandenplas Y. Cow's Milk-Related Symptom Score (CoMiSS): From Bristol to Brussels Stool Scale. J Pediatr Gastroenterol Nutr 2023; 77:618-622. [PMID: 37668589 PMCID: PMC10583930 DOI: 10.1097/mpg.0000000000003932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/10/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The Cow's Milk-related Symptom Score (CoMISS) is an awareness tool for evaluating cow's milk-related symptoms in otherwise healthy infants <1 year of age. This study assessed whether replacing the Bristol Stool Form Scale (BSFS) with the Brussels Infants and Toddlers Stool Scale (BITSS) in non-toilet-trained infants would modify the overall CoMiSS and change the clinical approach regarding potential cow's milk allergy. METHODS Non-toilet-trained infants aged <13 months were assessed by CoMiSS using the 7 images from the BSFS (CoMiSS-BSFS) compared to the 4 images of stools from BITSS (CoMiSS-BITSS). The Wilcoxon signed-rank test and Pearson correlation coefficient were calculated. A post hoc analysis using identical tests was performed in subsets of CoMiSS-BSFS scores ≥10, ≥12, ≤5, and ≥6. RESULTS Eight hundred forty-four pairwise scores were collected. Applying the Wilcoxon test over the complete dataset, the difference between CoMiSS-BSFS and CoMiSS-BITSS was statistically significant ( P < 0.001). However, there was no significant difference in the subsets with CoMiSS-BSFS ≥10, ≥12, and ≥6 ( P = 0.84, P = 0.48, and P = 0.81, respectively). The significant difference remained restricted to the group with CoMiSS-BSFS ≤5, considered at low risk for CM-related symptoms ( P < 0.001). CONCLUSION Replacing BSFS with BITSS does not change the cutoff for awareness of possible CM-related symptoms and will not impact the use of CoMiSS in clinical practice. Changes in CoMiSS remained limited to the subgroup with a low risk for CM-related symptoms.
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Affiliation(s)
- Katerina Bajerova
- From the Department of Pediatrics, University Hospital Brno and Masaryk’s University, Brno, Czech Republic
- the Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk’s University, Brno, Czech Republic
| | - Silvia Salvatore
- the Department of Paediatrics, University of Insubria, Varese, Italy
| | - Christophe Dupont
- Paris Descartes University, France et Clinique Marcel Sembat, Boulogne-Billancourt, Ramsay Group, France
| | - Mikael Kuitunen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rosan Meyer
- the Department of Paediatrics, Imperial College London, London, UK
- the Department of Dietetics, Winchester University, Winchester, UK
- the Department of Medicine, KU Leuven, Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology, La Fe University Hospital & La Fe Research Institute, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and AriehPickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- the Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Annamaria Staiano
- the Department of Translational Medical Sciences, University of Naples “Federico II”, Napoli, Italy
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Holscher HD, Chumpitazi BP, Dahl WJ, Fahey GC, Liska DJ, Slavin JL, Verbeke K. Perspective: Assessing Tolerance to Nondigestible Carbohydrate Consumption. Adv Nutr 2022; 13:2084-2097. [PMID: 36041178 PMCID: PMC9776727 DOI: 10.1093/advances/nmac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/02/2022] [Accepted: 08/25/2022] [Indexed: 01/28/2023] Open
Abstract
Human intestinal enzymes do not hydrolyze nondigestible carbohydrates (NDCs), and thus, they are not digested and absorbed in the small intestine. Instead, NDCs are partially to completely fermented by the intestinal microbiota. Select NDCs are associated with health benefits such as laxation and lowering of blood cholesterol and glucose. NDCs provide functional attributes to processed foods, including sugar or fat replacers, thickening agents, and bulking agents. Additionally, NDCs are incorporated into processed foods to increase their fiber content. Although consumption of NDCs can benefit health and contribute functional characteristics to foods, they can cause gastrointestinal symptoms, such as flatulence and bloating. As gastrointestinal symptoms negatively affect consumer well-being and their acceptance of foods containing NDC ingredients, it is crucial to consider tolerance when designing food products and testing their physiological health benefits in clinical trials. This perspective provides recommendations for the approach to assess gastrointestinal tolerance to NDCs, with a focus on study design, population criteria, intervention, comparator, and outcome. Special issues related to studies in children and implications for stakeholders are also discussed. It is recommended that the evaluation of gastrointestinal tolerance to NDCs be conducted in randomized, blinded, controlled crossover studies using standard gastrointestinal questionnaires, with attention to study participant background diets, health status, lifestyle, and medications.
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Affiliation(s)
| | - Bruno P Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX, USA
| | - Wendy J Dahl
- Department of Food Science and Human Nutrition, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - George C Fahey
- Department of Animal Sciences, University of Illinois, Urbana, IL USA
| | | | - Joanne L Slavin
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, MN USA
| | - Kristin Verbeke
- Translational Research in Gastrointestinal Disorders, KU Leuven, Targid, Leuven, Belgium; and Leuven Food Science and Nutrition Research Centre, Leuven, Belgium
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Kappel SS, Sangild PT, Ahnfeldt AM, Jóhannsdóttir V, Soernsen LJ, Bak LB, Friborg C, Möller S, Zachariassen G, Aunsholt L. A Randomized, Controlled Study to Investigate How Bovine Colostrum Fortification of Human Milk Affects Bowel Habits in Preterm Infants (FortiColos Study). Nutrients 2022; 14:nu14224756. [PMID: 36432444 PMCID: PMC9696900 DOI: 10.3390/nu14224756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Human milk does not meet the nutritional needs to support optimal growth of very preterm infants during the first weeks of life. Nutrient fortifiers are therefore added to human milk, though these products are suspected to increase gut dysmotility. The objective was to evaluate whether fortification with bovine colostrum (BC) improves bowel habits compared to a conventional fortifier (CF) in very preterm infants. Methods: In an unblinded, randomized study, 242 preterm infants (26−31 weeks of gestation) were randomized to receive BC (BC, Biofiber Damino, Gesten, Denmark) or CF (FM85 PreNAN, Nestlé, Vevey, Switzerland) as a fortifier. Stools (Amsterdam Stool Scale), bowel gas restlessness, stomach appearance score, volume, and frequency of gastric residuals were recorded before each meal until 35 weeks post-menstrual age. Results: As intake of fortifiers increased, stools became harder in both groups (p < 0.01) though less in BC infants (p < 0.05). The incidence of bowel gas restlessness increased with laxative treatments and days of fortification in both groups (p < 0.01), but laxatives were prescribed later in BC infants (p < 0.01). With advancing age, stomach appearance scores improved, but more so in BC infants (p < 0.01). Conclusions: Although there are limitations, a minimally processed, bioactive milk product such as BC induced similar or slightly improved bowel habits in preterm infants.
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Affiliation(s)
- Susanne Soendergaard Kappel
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
| | - Agnethe May Ahnfeldt
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
| | - Valdis Jóhannsdóttir
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
| | - Line Juul Soernsen
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
| | - Lene Boejgaard Bak
- Department of Neonatology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Christel Friborg
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern, 5000 Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern, 5000 Odense, Denmark
| | - Lise Aunsholt
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-35-45-25-05
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Freeman AJ, Huang R, Heltshe SL, Gelfond D, Leung DH, Ramsey BR, Borowitz D, Sathe M. Association between stool consistency and clinical variables among infants with cystic fibrosis: Findings from the BONUS study. J Cyst Fibros 2022; 21:830-836. [PMID: 35585010 PMCID: PMC10056424 DOI: 10.1016/j.jcf.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Concerns related to stool consistency are common in the first year of life among children with cystic fibrosis (CF). However, normal stool patterns for infants with CF have not been described. METHODS Secondary analysis was completed from the previously described BONUS cohort which followed 231 infants with CF through the first 12 months of life. Pain, stool category, stool frequency, feeding type, PERT dose, acid suppression medication, antibiotics usage, stool softener usage and fecal calprotectin were described at 3, 6, and 12 months. Repeated measure ANOVA was used to test the difference in mean stool number. Generalized linear mixed models were used to investigate the relationship between stool characteristics and various factors. RESULTS The frequency of constipation was stable throughout the first year of life (10-13%) while watery stool significantly decreased from 21.3% at 3 months to 5.8% at 12 months (p=<0.001). The number of stools at months 6 (mean=2.40) and 12 (mean=2.50) are significantly lower than in month 3 (mean=2.83), p<0.025. Exclusive breast feeding was associated with an increased risk for constipation (OR=2.64 [1.60-4.37], p = 0.002) while exclusive formula feeding and acid suppression was associated with decreased risk for constipation (OR=0.40 [0.26-0.61], p=<0.0001 and OR=0.59 [0.39-0.89], p = 0.01 respectively). Pain was not significantly associated with stool consistency. CONCLUSION Stool frequency and consistency evolves in infant with CF in a fashion similar to that reported in non-CF infants over the first year. Constipation was not associated with pain and was less common among infants receiving acid suppression or exclusively formula feeding.
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Affiliation(s)
- A Jay Freeman
- Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA.
| | - Rong Huang
- Lead Biostatistician, Research Administration, Children's Medical Center Dallas, Dallas, TX, USA
| | - Sonya L Heltshe
- Associate Professor, Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA, USA and Division of Pulmonary Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Daniel Gelfond
- WNY Pediatric Gastroenterology and Volunteer Faculty, University of Buffalo School of Medicine, Buffalo, NY, USA
| | - Daniel H Leung
- Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Bonnie R Ramsey
- Vice Chair and Endowed Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Drucy Borowitz
- Emeritus Clinical Professor of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Meghana Sathe
- Associate Professor, Division Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern and Children's Health, Dallas, TX, USA
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Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R, Ribes-Koninckx C, Salvatore S, Shamir R, Szajewska H. The Cow's Milk Related Symptom Score: The 2022 Update. Nutrients 2022; 14:nu14132682. [PMID: 35807862 PMCID: PMC9268587 DOI: 10.3390/nu14132682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
CoMiSS® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow’s milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we aim to propose an updated CoMiSS. The evidence was reviewed, debated and discussed by 10 experts, of whom seven were part of the original group. The panel concluded that the cut-off previously proposed to indicate the likelihood that symptoms may be cow’s milk related should be lowered from ≥12 to ≥10. Data in healthy infants > 6 months are missing. Since the Brussels Infant and Toddlers Stool Scale (BITSS) was recently developed for non-toilet trained children, the Bristol Stool Scale was changed to the BITSS without changing the impact of stool characteristics on CoMiSS. Overall, CoMiSS raises awareness that symptoms might be cow’s milk related. New studies are needed to determine if the change in cut-off and other small adaptions improve its sensitivity and specificity. Data for CoMiSS is still needed in presumed healthy infants between 6 and 12 months old. There may also be regional differences in CoMiSS, in healthy infants as well as in those with cow’s milk allergy. Finally, we emphasize that CoMiSS is an awareness tool and not a diagnostic test.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan 101, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-475748794
| | - Katerina Bajerova
- Department of Pediatrics, University Hospital Brno and Masaryk’s University, 625 00 Brno, Czech Republic;
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk´s University, 625 00 Brno, Czech Republic
| | - Christophe Dupont
- Ramsay Group, France et Clinique Marcel Sembat, Paris Descartes University, Boulogne-Billancourt, 75004 Paris, France;
| | - Philippe Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland;
| | - Mikael Kuitunen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland;
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London SW7 2BX, UK;
- Department Dietetics, Winchester University, Winchester SO23 4NR, UK
- Department Medicine, KU Leuven, 3001 Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology, La Fe University Hospital, Instituto de Iinvestigacion Sanitaria La FE Valencia, 46026 Valencia, Spain;
| | - Silvia Salvatore
- Department of Paediatrics, University of Insubria, 21100 Varese, Italy;
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and Arieh Pickel for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel;
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, 02-014 Warsaw, Poland;
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Reducing Opioid-Induced Constipation Post-Cardiac Surgery: An Improvement Project in a Pediatric Cardiac Intensive Care Unit. J Nurs Care Qual 2022; 37:213-217. [PMID: 35051979 DOI: 10.1097/ncq.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain management with opioids and underutilization of prophylaxis for constipation can prolong a patient's hospital length of stay and impede pain management efforts. PROBLEM In pediatric postoperative cardiac patients, opioid therapy is a common approach to pain management but often places them at greater risk for constipation due to anatomy and age. METHODS A retrospective review of 50 patients' medical records for baseline data was conducted, and a survey evaluated providers' current knowledge and practice. INTERVENTIONS The intervention was an electronic order set that provided decision support. Additionally, prophylactic measures were supported by a validated assessment tool that created a common language to report constipation risk. RESULTS Although not statistically significant, postintervention data demonstrated a 21.5% decrease in postoperative constipation and a 57% increase in ordered bowel regimens. CONCLUSION More focus is needed toward prophylactic bowel regimens to reduce the risk in this already high-risk population.
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Lourenção PLTDA, Ortolan EVP, Rosa LLM, Angelini MC, Cassettari VMG, Terra SA, Rodrigues MAM. What should be the treatment for intestinal neuronal dysplasia type B? A comparative long-term follow-up study. J Pediatr Surg 2021; 56:1611-1617. [PMID: 33279216 DOI: 10.1016/j.jpedsurg.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To present the long-term follow-up outcomes of patients with intestinal neuronal dysplasia type B (IND-B) managed either conservatively or surgically. METHODS We conducted an ambispective, observational, longitudinal, and comparative study. Clinical data were reviewed at the start of treatment. After a minimum period of five years, the patients participated in semi-structured interviews in which the bowel function score (BFS) was applied to assess intestinal function, a proposed intestinal symptom index (ISI) to assess clinical symptoms, and a classification of clinical prognosis to assess treatment success. Comparisons between the two types of treatment were performed by evaluating pre- and post-treatment criteria. RESULTS Fifty patients diagnosed with IND-B were included in the study. Thirty-eight patients underwent surgical treatment (26 elective surgical treatment for primary colorectal resection and 12 emergency colostomies for intestinal obstruction or enterocolitis). Twelve patients were managed conservatively. With the exception of the patients who required an emergency operation (n = 12), the two groups were composed of patients with severe constipation who had similar clinical and functional characteristics at the time of IND-B diagnosis. A better clinical response was observed in patients submitted to conservative treatment, with a greater increase in the BFS (16.5 [-4/+18] versus 4 [-15/+17]; p = 0.001), indicating better bowel function and a more pronounced drop in ISI (-6 [-7/-4] versus -4 [-6/+1]; p = 0.015), suggesting fewer symptoms. The percentage of patients who had a successful treatment was higher in the group treated conservatively (72.7% versus 42.3%; p = 0.03). CONCLUSION Conservative management showed better long-term outcomes than surgical management in children with IND-B.
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Affiliation(s)
- Pedro Luiz Toledo de Arruda Lourenção
- Department of Surgery, Division of Pediatric Surgery, Botucatu Medical School, UNESP - São Paulo State University, Botucatu CEP 18618-687, SP, Brazil.
| | - Erika Veruska Paiva Ortolan
- Department of Surgery, Division of Pediatric Surgery, Botucatu Medical School, UNESP - São Paulo State University, Botucatu CEP 18618-687, SP, Brazil
| | | | - Marcos Curcio Angelini
- Department of Surgery, Division of Pediatric Surgery, Botucatu Medical School, UNESP - São Paulo State University, Botucatu CEP 18618-687, SP, Brazil
| | | | - Simone Antunes Terra
- Department of Pathology, Botucatu Medical School, UNESP - São Paulo State University, Botucatu, SP, Brazil
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de Deus Silva LC, Bianchini PM, Ortolan EVP, Hamamoto JF, Fermiano R, Rego RMP, Lyra JC, Benninga MA, de Arruda Lourenção PLT. Brazilian Portuguese version of the Amsterdam infant stool scale: a valid and reliable scale for evaluation of stool from children up to 120 days old. BMC Pediatr 2021; 21:64. [PMID: 33541308 PMCID: PMC7860020 DOI: 10.1186/s12887-021-02527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For newborns and infants wearing diapers the difficulties in characterizing the appearance of the stool are significant, since the changes in consistency, quantity, and color of the stool are higher than in other age groups. The Amsterdam Infant Stool Scale (AISS) was created and validated in 2009, providing a specific tool for the evaluation of the stool of children up to 120 days old. However, to be used in clinical practice and scientific investigations in Brazil, it is mandatory to perform the translation and cross-cultural adaptation process for Brazilian Portuguese language. Thus, we aim to perform the translation and cross-cultural adaptation of AISS into Brazilian Portuguese and to evaluate the psychometric properties of the translated version. METHODS The process of translation and cross-cultural adaptation was performed according to the internationally accepted methodology, including: translation, summary of translations, backtranslation, preparation of the pre-final version, application of the pre-test and determination of the final version. The evaluation of the psychometric properties was performed through the application of Brazilian Portuguese AISS, by five examiners (including child health field specialists and a literate adult lay on the subject), analyzing 238 stool photographs of children under 120 days old. The intra and inter-examiner agreement values were determined using kappa statistic. The validity of the criterion was investigated through correlation analysis (Kendall's coefficient) between the classifications determined by the non-specialist examiner and the expert examiners. RESULTS In all 30 tests performed between different examiners, there was an agreement considered as at least moderate (kappa values above 0.40). The intra-examiner reliability was considered as substantial (kappa> 0.6). There was a statistically significant correlation (p < 0.05) between the classifications determined by the examiners considered as specialists and the examiner considered as non-specialist. CONCLUSION The Brazilian Portuguese AISS version proved to be valid and reliable to be used by healthcare professionals and the general public in the evaluation of stool from children up to 120 days old.
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Affiliation(s)
| | | | - Erika Veruska Paiva Ortolan
- Department of Surgery and Orthopedics - Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Juliana Fattori Hamamoto
- Department of Pediatrics, Division of Neonatology, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Rosemary Fermiano
- Department of Pediatrics, Division of Neonatology, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | | | - João César Lyra
- Department of Pediatrics, Division of Neonatology, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Marc Alexander Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands
| | - Pedro Luiz Toledo de Arruda Lourenção
- Department of Surgery and Orthopedics - Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil.
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Coelho GM, Machado NC, Carvalho MDA, Rego RMP, Vieira SR, Ortolan EVP, Lourenção PLTDA. A protocol for an interventional study on the impact of transcutaneous parasacral nerve stimulation in children with functional constipation. Medicine (Baltimore) 2020; 99:e23745. [PMID: 33371132 PMCID: PMC7748169 DOI: 10.1097/md.0000000000023745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Transcutaneous parasacral nerve stimulation (TPNS) via electrodes placed over the sacrum can activate afferent neuronal networks noninvasively, leading to sacral reflexes that may improve colonic motility. Thus, TPNS can be considered a promising, noninvasive, and safe method for the treatment of constipation. However, there is no published study investigating its use in children with functional constipation. This is a single-center, prospective, longitudinal, and interventional study designed to assess the applicability and clinical outcomes of TPNS in functionally constipated children. PATIENT CONCERNS Parents or guardians of patients will be informed of the purpose of the study and will sign an informed consent form. The participants may leave the study at any time without any restrictions. DIAGNOSIS Twenty-eight children (7-18 years old) who were diagnosed with intestinal constipation (Rome IV criteria) will be included. INTERVENTIONS The patients will be submitted to daily sessions of TPNS for a period of 4 or 8 weeks and will be invited to participate in semistructured interviews at 3 or 4 moments: 1 week before the beginning of TPNS; immediately after the 4 and/or 8 weeks of TPNS; and 4 weeks after the end of the intervention period. In these appointments, the aspects related to bowel habits and quality of life will be assessed. OUTCOMES This study will evaluate the increase in the number of bowel movements and stool consistency, the decrease in the number of episodes of retentive fecal incontinence, and the indirect improvement in the overall quality of life. CONCLUSION we expect that this study protocol can show the efficacy of this promising method to assist the treatment of children with functional constipation.
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Affiliation(s)
| | - Nilton Carlos Machado
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition Botucatu Medical School, São Paulo State University (UNESP), São Paulo
| | - Mary de Assis Carvalho
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition Botucatu Medical School, São Paulo State University (UNESP), São Paulo
| | | | | | - Erika Veruska Paiva Ortolan
- Department of Surgery and Orthopedics - Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Pedro Luiz Toledo de Arruda Lourenção
- Department of Surgery and Orthopedics - Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
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Maasch JRMA, Arzika AM, Cook C, Lebas E, Pilotte N, Grant JR, Williams SA, Keenan JD, Lietman TM, Aiemjoy K. Rectal Swabs as an Alternative Sample Collection Method to Bulk Stool for the Real-Time PCR Detection of Giardia duodenalis. Am J Trop Med Hyg 2020; 103:1276-1282. [PMID: 32524959 PMCID: PMC7470573 DOI: 10.4269/ajtmh.19-0909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/02/2020] [Indexed: 12/19/2022] Open
Abstract
Though bulk stool remains the gold standard specimen type for enteropathogen diagnosis, rectal swabs may offer comparable sensitivity with greater ease of collection for select pathogens. This study sought to evaluate the validity and reproducibility of rectal swabs as a sample collection method for the molecular diagnosis of Giardia duodenalis. Paired rectal swab and bulk stool samples were collected from 86 children ages 0-4 years living in southwest Niger, with duplicate samples collected among a subset of 50 children. Infection was detected using a previously validated real-time PCR diagnostic targeting the small subunit ribosomal RNA gene. Giardia duodenalis was detected in 65.5% (55/84) of bulk stool samples and 44.0% (37/84) of swab samples. The kappa evaluating test agreement was 0.81 (95% CI: 0.54-1.00) among duplicate stool samples (N = 49) and 0.75 (95% CI: 0.47-1.00) among duplicate rectal swabs (N = 48). Diagnostic sensitivity was 93% (95% CI: 84-98) by bulk stool and 63% (95% CI: 49-75) by rectal swabs. When restricting to the lowest three quartiles of bulk stool quantitation cycle values (an indication of relatively high parasite load), sensitivity by rectal swabs increased to 78.0% (95% CI: 64-89, P < 0.0001). These findings suggest that rectal swabs provide less sensitive and reproducible results than bulk stool for the real-time PCR diagnosis of G. duodenalis. However, their fair sensitivity for higher parasite loads suggests that swabs may be a useful tool for detecting higher burden infections when stool collection is excessively expensive or logistically challenging.
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Affiliation(s)
| | | | - Catherine Cook
- Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Elodie Lebas
- Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts
| | - Jessica R. Grant
- Department of Biological Sciences, Smith College, Northampton, Massachusetts
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts
| | - Jeremy D. Keenan
- Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Thomas M. Lietman
- Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Kristen Aiemjoy
- Proctor Foundation, University of California San Francisco, San Francisco, California
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Chumpitazi BP, Lewis J, Cooper D, D’Amato M, Lim J, Gupta S, Miranda A, Terry N, Mehta D, Scheimann A, O’Gorman M, Tipnis N, Davies Y, Friedlander J, Smith H, Punati J, Khlevner J, Setty M, Di Lorenzo C. Hypomorphic SI genetic variants are associated with childhood chronic loose stools. PLoS One 2020; 15:e0231891. [PMID: 32433684 PMCID: PMC7239456 DOI: 10.1371/journal.pone.0231891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The SI gene encodes the sucrase-isomaltase enzyme, a disaccharidase expressed in the intestinal brush border. Hypomorphic SI variants cause recessive congenital sucrase-isomaltase deficiency (CSID) and related gastrointestinal (GI) symptoms. Among children presenting with chronic, idiopathic loose stools, we assessed the prevalence of CSID-associated SI variants relative to the general population and the relative GI symptom burden associated with SI genotype within the study population. METHODS A prospective study conducted at 18 centers enrolled 308 non-Hispanic white children ≤18 years old who were experiencing chronic, idiopathic, loose stools at least once per week for >4 weeks. Data on demographics, GI symptoms, and genotyping for 37 SI hypomorphic variants were collected. Race/ethnicity-matched SI data from the Exome Aggregation Consortium (ExAC) database was used as the general population reference. RESULTS Compared with the general population, the cumulative prevalence of hypomorphic SI variants was significantly higher in the study population (4.5% vs. 1.3%, P < .01; OR = 3.5 [95% CI: 6.1, 2.0]). Within the study population, children with a hypomorphic SI variant had a more severe GI symptom burden than those without, including: more frequent episodes of loose stools (P < .01), higher overall stool frequency (P < .01), looser stool form (P = .01) and increased flatulence (P = .02). CONCLUSION Non-Hispanic white children with chronic idiopathic loose stools have a higher prevalence of CSID-associated hypomorphic SI variants than the general population. The GI symptom burden was greater among the study subjects with a hypomorphic SI variant than those without hypomorphic SI variants.
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Affiliation(s)
| | - Jeffery Lewis
- Children’s Center for Digestive Health Care, Atlanta, GA, United States of America
| | - Derick Cooper
- QOL Medical, LLC, Vero Beach, FL, United States of America
| | - Mauro D’Amato
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - Joel Lim
- Children's Mercy Hospital, Kansas City, MO, United States of America
| | - Sandeep Gupta
- Sacramento Pediatric Gastroenterology, Sacramento, CA, United States of America
| | - Adrian Miranda
- Children’s Hospital of Wisconsin, Milwaukee, WI, United States of America
| | - Natalie Terry
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Devendra Mehta
- Arnold Palmer Children's Hospital, Orlando, FL, United States of America
| | - Ann Scheimann
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Molly O’Gorman
- Primary Children's Medical Center, Salt Lake City, UT, United States of America
| | - Neelesh Tipnis
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Yinka Davies
- Sacramento Pediatric Gastroenterology, Sacramento, CA, United States of America
| | - Joel Friedlander
- Children’s Hospital Colorado, Digestive Health Institute, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Heather Smith
- QOL Medical, LLC, Vero Beach, FL, United States of America
| | - Jaya Punati
- Children’s Hospital of Los Angeles, Los Angeles, CA, United States of America
| | - Julie Khlevner
- Columbia University Medical Center, New York, NY, United States of America
| | - Mala Setty
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Carlo Di Lorenzo
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
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Jadrešin O, Sila S, Trivić I, Mišak Z, Kolaček S, Hojsak I. Lactobacillus reuteri DSM 17938 is effective in the treatment of functional abdominal pain in children: Results of the double-blind randomized study. Clin Nutr 2020; 39:3645-3651. [PMID: 32362486 DOI: 10.1016/j.clnu.2020.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Possible therapeutic effect of Lactobacillus (L.) reuteri DSM 17938 has been reported in children with functional abdominal pain (FAP) but data are inconclusive. METHODS This is a randomized double-blinded controlled trial (RCT) which assessed effect of L. reuteri DSM 17938 (dose 108 CFU/day) in children (age 4-18 years) on FAP during an intervention period of 12 weeks and follow-up of 4 weeks. This study was performed after the interim analysis and had different labeling of products and a new randomization. Data presented here are results of this RCT and pooled data from both RCTs (before and after interim analysis). RESULTS This RCT included 46 children (median age 10.1 vs 10.6 years; 11 vs 13 girls). Abdominal pain was less severe in intervention group during the 4th month of the study and there was significant increase in the number of days without pain. Pooled data from both parts of the study included 101 children. Number of days without pain was significantly higher in the L. reuteri group (mean difference 26.42 days, 95% CI 22.47-30.17). Significant difference in the pain intensity was found after 2nd, 3rd and 4th month of the intervention. There was no difference between groups in the number of children in whom symptoms completely ceased (Risk Ratio 1.09, 95% CI 0.75-1.58). CONCLUSION Administration of L. reuteri DSM 17938 was associated with the reduction in the intensity of pain and with significantly increase in pain-free days in children with FAP.
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Affiliation(s)
- Oleg Jadrešin
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Sara Sila
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ivana Trivić
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Zrinjka Mišak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
| | - Sanja Kolaček
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia; University J.J. Strossmayer Osijek, School of Medicine, Osijek, Croatia.
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van Delden ALEQ, Band GPH, Slaets JPJ. A good beginning: study protocol for a group-randomized trial to investigate the effects of sit-to-stand desks on academic performance and sedentary time in primary education. BMC Public Health 2020; 20:70. [PMID: 31941471 PMCID: PMC6964001 DOI: 10.1186/s12889-019-8135-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sedentary behavior is associated with health risks and academic under-achievement in children. Still, children spend a large part of their waking hours sitting at a desk at school. Recent short-term studies demonstrated the potential of sit-to-stand desks to reduce sitting time in primary education. The program of "A Good Beginning" was conceived to assess the long-term effects of sit-to-stand desks on sitting time in primary education, and to examine how sit-to-stand desks versus regular desks relate to academic performance, and measures of executive functioning, health and wellbeing. The present paper describes the design of this group-randomized trial, which started in 2017 and will be completed in 2019. METHODS Children of two grade-three groups (age 8-9) following regular primary education in Leiden, The Netherlands, were recruited. A coin toss determined which group is the experimental group; the other group is the control group. All children in the experimental group received sit-to-stand desks. They are invited and motivated to reduce sedentary time at school, however, it is their own choice to sit or stand. Children in the control group use regular desks. Otherwise, both groups receive regular treatment. Outcomes are assessed at baseline (T0) and at five follow-up sessions (T1-T5) alternately in winter and summer seasons over three academic years. Primary outcome measures are academic performance, and the proportion of sitting time at school, measured with a 3D accelerometer. Secondary outcome measures are a number of measures related to executive functioning (e.g., N-back task for working memory), health (e.g., height and weight for BMI), and wellbeing (e.g., KIDSCREEN-52 for Quality of Life). DISCUSSION A Good Beginning is a two-and-a-half-year research program, which aims to provide a better understanding of the long-term effects of sit-to-stand desks on sedentary time at school and the relation between sitting time reduction and academic performance, executive functioning, health and wellbeing. The findings may serve as useful information for policy making and practical decision making for school and classroom environments. TRIAL REGISTRATION The program of "A Good Beginning" is registered at the Netherlands Trial Register (NTR, https://www.trialregister.nl), number NL6166, registration date 24 November 2016.
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Affiliation(s)
- A Lex E Q van Delden
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - Guido P H Band
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Joris P J Slaets
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Stobernack T, de Vries SPW, Rodrigues Pereira R, Pelsser LM, Ter Braak CJF, Aarts E, van Baarlen P, Kleerebezem M, Frankena K, Hontelez S. Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) - study protocol of an open-label trial to investigate the mechanisms underlying the effects of a few-foods diet on ADHD symptoms in children. BMJ Open 2019; 9:e029422. [PMID: 31694844 PMCID: PMC6858247 DOI: 10.1136/bmjopen-2019-029422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is the most common childhood behavioural disorder, causing significant impediment to a child's development. It is a complex disorder with numerous contributing (epi)genetic and environmental factors. Currently, treatment consists of behavioural and pharmacological therapy. However, ADHD medication is associated with several side effects, and concerns about long-term effects and efficacy exist. Therefore, there is considerable interest in the development of alternative treatment options. Double-blind research investigating the effects of a few-foods diet (FFD) has demonstrated a significant decrease in ADHD symptoms following an FFD. However, an FFD requires a considerable effort of both child and parents, limiting its applicability as a general ADHD treatment. To make FFD intervention less challenging or potentially obsolete, we need to understand how, and in which children, an FFD affects ADHD behaviour and, consequently, the child's well-being. We hypothesise that an FFD affects brain function, and that the nutritional impact on ADHD is effectuated by a complex interplay between the microbiota, gut and brain, that is, the microbiota-gut-brain axis. METHODS AND ANALYSIS The Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) study is an open-label trial with researchers blinded to changes in ADHD symptoms during sample processing and initial data analyses. ETHICS AND DISSEMINATION The Medical Research and Ethics Committee of Wageningen University has approved this study (NL63851.081.17, application 17/24). Results will be disseminated through peer-reviewed journal publications, conference presentations, (social) media and the BRAIN study website. A summary of the findings will be provided to the participants. TRIAL REGISTRATION NUMBER NCT03440346. STUDY DATES Collection of primary outcome data started in March 2018 and will be ongoing until 100 children have participated in the study. Sample data analysis will start after all samples have been collected.
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Affiliation(s)
- Tim Stobernack
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Stefan P W de Vries
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | | | | | - Cajo J F Ter Braak
- Biometris, Wageningen University and Research, Wageningen, The Netherlands
| | - Esther Aarts
- Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Peter van Baarlen
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Michiel Kleerebezem
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Klaas Frankena
- Adaptation Physiology, Wageningen University and Research, Wageningen, The Netherlands
| | - Saartje Hontelez
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
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Rego RMP, Machado NC, Carvalho MDA, Graffunder JS, Ortolan EVP, Lourenção PLTDA. Transcutaneous posterior tibial nerve stimulation in children and adolescents with functional constipation: A protocol for an interventional study. Medicine (Baltimore) 2019; 98:e17755. [PMID: 31702626 PMCID: PMC6855522 DOI: 10.1097/md.0000000000017755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION A vast majority of children with functional constipation respond to the standard medical treatment. However, a subset of patients may present with an unsatisfactory response and only minor improvement of symptoms. Transcutaneous posterior tibial nerve stimulation (PTNS) involves electrical stimulation of the posterior tibial nerve at the level of the ankle, transcutaneously through electrodes fixated on the overlying skin. Stimulation of the tibial nerve can modulate urinary and defecatory function through the stimulation of sacral nerves. Thus, transcutaneous PTNS can be considered a very promising, noninvasive, and safe method to be used in the pediatric age group. However, there is still no published study that has investigated its use in children for the treatment of intestinal constipation. This is a single-center, prospective, longitudinal, and interventional study designed to assess the applicability and clinical outcomes of transcutaneous PTNS in children with functional intestinal constipation. Children will be submitted to daily sessions of transcutaneous PTNS for a period of 4 weeks. All children will also be invited to participate in semistructured interviews, 1 in each of the 3 assessments: 1 week before the start of the intervention; immediately after the 4 weeks of intervention; and 4 weeks after the end of the intervention period. In these interviews, the aspects related to bowel habits and quality of life will be assessed. This project aims to evaluate the clinical outcomes of transcutaneous PTNS in children with functional intestinal constipation and the applicability of this kind of treatment. CONCLUSIONS This protocol intended to demonstrate the efficacy of this promising method to increase the number of bowel movements and the stool consistency, to reduce the number of episodes of retentive fecal incontinence, and to indirectly improve the overall quality of life.
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Affiliation(s)
| | - Nilton Carlos Machado
- UNESP - São Paulo State University, Botucatu Medical School, Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Division, Botucatu
| | - Mary de Assis Carvalho
- UNESP - São Paulo State University, Botucatu Medical School, Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Division, Botucatu
| | | | - Erika Veruska Paiva Ortolan
- UNESP - São Paulo State University, Botucatu Medical School, Department of Surgery and Orthopedics, Pediatric Surgery Division, Botucatu, SP, Brazil
| | - Pedro Luiz Toledo de Arruda Lourenção
- UNESP - São Paulo State University, Botucatu Medical School, Department of Surgery and Orthopedics, Pediatric Surgery Division, Botucatu, SP, Brazil
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20
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The importance of stool tests in diagnosis and follow-up of gastrointestinal disorders in children. Turk Arch Pediatr 2019; 54:141-148. [PMID: 31619925 PMCID: PMC6776453 DOI: 10.14744/turkpediatriars.2018.00483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/24/2018] [Indexed: 12/23/2022]
Abstract
Stool is not just a simple waste material. Some stool tests can be easily used in primary care in the differential diagnosis of disorders such as gastrointestinal infections, malabsorption syndromes, and inflammatory bowel diseases. Stool tests can prevent unnecessary laboratory investigations. Stool analyses include microscopic examination, chemical, immunologic, and microbiologic tests. Stool samples can be examined for leukocytes, occult blood, fat, sugars (reducing substances), pH, pancreatic enzymes, alpha-1 antitrypsin, calprotectin, and infectious causes (bacteria, viruses, and parasites). Stool should also be macroscopically checked in terms of color, consistency, quantity, shape, odor, and mucus.
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21
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Monkhouse K, Caldwell PH, Barnes EH. The relationship between urinary incontinence and obesity in childhood. J Paediatr Child Health 2019; 55:625-631. [PMID: 30328177 DOI: 10.1111/jpc.14256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/24/2018] [Accepted: 09/11/2018] [Indexed: 11/28/2022]
Abstract
AIM To explore associations between weight and type/frequency of urinary incontinence (UI) in children presenting to a tertiary hospital incontinence clinic. METHODS We retrospectively reviewed medical records of children who first attended the incontinence clinic at The Children's Hospital at Westmead between January 2004 and December 2014. A random sample of 1000 children was selected from 2022 patient records, and data were collected on weight, height, age, gender, UI parameters, bowel habits and medical history. Associations between predictors (weight categories, gender, snoring, constipation, faecal incontinence) and outcomes (daytime urinary incontinence (DUI) and nocturnal enuresis (NE)) were examined using χ2 tests and logistic regression analysis. RESULTS A total of 862 children were included in the study; 54% were male, and 28% were overweight/obese. No evidence of difference was found between the underweight/normal and overweight/obese weight children with NE (34 vs. 39%), DUI (7 vs. 9%) or combined NE and DUI (58 vs. 52.1%), P = 0.23. The frequency of NE (83 vs. 82%, P = 0.56) and DUI (52 vs. 58%, P = 0.20) was similar between the weight groups. CONCLUSION In a large cohort of children presenting to a tertiary incontinence clinic, weight was not associated with the type or frequency of UI.
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Affiliation(s)
- Krista Monkhouse
- Department of Paediatrics, John Hunter Childrens Hospital, New South Wales, Australia
| | - Patrina Hy Caldwell
- Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Children's Hospital at Westmead Clinical School, New South Wales, Australia
| | - Elizabeth H Barnes
- Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia.,National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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22
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Shah C, Grover AS, Dhore P, Shukla A, Abraham P, Bhatia SJ. Fecograph: A graphical representation of daily stool forms to subtype irritable bowel syndrome in office practice. JGH Open 2019; 3:224-227. [PMID: 31276040 PMCID: PMC6586574 DOI: 10.1002/jgh3.12143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM Interpreting stool form diaries for subtyping patients with the irritable bowel syndrome (IBS) is cumbersome; a picture showing a trend would be easier to interpret. METHODS Fifty-one consecutive adults with IBS (median age 35.5 years; 47 men), diagnosed using the Rome III criteria, were given a picture of the Bristol stool form scale (BSFS) and asked to record their stool frequency and form for 7 days. The numbers were plotted by a technician as dots on a chart. On the y axis, BSFS category 4 was marked as 0, harder stools as +1 to +3, and softer stools as -1 to -3; each bowel movement was represented on the x axis. A line graph was plotted by connecting the dots. Each "fecograph" was then given for visual interpretation to three gastroenterologists (observers). When most readings appeared to be 0, +1, or -1, it was to be reported as normal; most above +1 as IBS-constipation (IBS-C); most below -1 as IBS-diarrhea (IBS-D); and readings crossing 1 on either side as IBS-mixed (IBS-M). If no clear trend was noted, it was IBS-unclassified (IBS-U). Each observer reported all graphs in different orders twice, at 1-month intervals; thus, 306 reports were available. Interclass correlation coefficient (ICC) was calculated. RESULTS Eighteen patients had IBS-C, 13 IBS-D, 4 IBS-M, and 16 IBS-U. The 51 fecographs were reported in mean 20 min 36 s. ICC for intra- and interobserver reliability was 0.62 (0.50-0.73). CONCLUSION The fecograph is a reliable and easy-to-use tool to subtype patients with IBS.
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Affiliation(s)
- Chirag Shah
- Department of GastroenterologySeth GS Medical College, KEM HospitalMumbaiIndia
| | - Anumeet S Grover
- Department of GastroenterologySeth GS Medical College, KEM HospitalMumbaiIndia
| | - Prashant Dhore
- Department of GastroenterologySeth GS Medical College, KEM HospitalMumbaiIndia
| | - Akash Shukla
- Department of GastroenterologySeth GS Medical College, KEM HospitalMumbaiIndia
| | - Philip Abraham
- Division of GastroenterologyP D Hinduja HospitalMumbaiIndia
| | - Shobna J Bhatia
- Department of GastroenterologySeth GS Medical College, KEM HospitalMumbaiIndia
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23
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Brazilian Portuguese translation, cross‐cultural adaptation and reproducibility assessment of the modified Bristol Stool Form Scale for children. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Jozala DR, Oliveira ISDF, Ortolan EVP, Oliveira Junior WED, Comes GT, Cassettari VMG, Self MM, Lourenção PLTDA. Brazilian Portuguese translation, cross-cultural adaptation and reproducibility assessment of the modified Bristol Stool Form Scale for children. J Pediatr (Rio J) 2019; 95:321-327. [PMID: 29551322 DOI: 10.1016/j.jped.2018.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To translate and culturally adapt the modified Bristol Stool Form Scale for children into Brazilian Portuguese, and to evaluate the reproducibility of the translated version. METHODS The stage of translation and cross-cultural adaptation was performed according to an internationally accepted methodology, including the translation, back-translation, and pretest application of the translated version to a sample of 74 children to evaluate the degree of understanding. The reproducibility of the translated scale was assessed by applying the final version of Brazilian Portuguese modified Bristol Stool Form Scale for children to a sample of 64 children and 25 healthcare professionals, who were asked to correlate a randomly selected description from the translated scale with the corresponding representative illustration of the stool type. RESULTS The final version of Brazilian Portuguese modified Bristol Stool Form Scale for children were evidently reproducible, since almost complete agreement (k>0,8) was obtained among the translated descriptions and illustrations of the stool types, both among the children and the group of specialists. The Brazilian Portuguese modified Bristol Stool Form Scale for children was shown to be reliable in providing very similar results for the same respondents at different times and for different examiners. CONCLUSION The Brazilian Portuguese modified Bristol Stool Form Scale for children is reproducible; it can be applied in clinical practice and in scientific research in Brazil.
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Affiliation(s)
- Debora Rodrigues Jozala
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Medicina de Botucatu, Programa de Pós-graduação em Medicina, Botucatu, SP, Brazil
| | | | - Erika Veruska Paiva Ortolan
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Disciplina de Cirurgia Pediátrica, Botucatu, SP, Brazil
| | - Wilson Elias de Oliveira Junior
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Medicina de Botucatu, Programa de Pós-graduação em Bases Gerais da Cirurgia, Botucatu, SP, Brazil
| | - Giovana Tuccille Comes
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Medicina de Botucatu, Programa de Pós-graduação em Bases Gerais da Cirurgia, Botucatu, SP, Brazil
| | - Vanessa Mello Granado Cassettari
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Medicina de Botucatu, Programa de Pós-graduação em Bases Gerais da Cirurgia, Botucatu, SP, Brazil
| | - Mariella Marie Self
- Baylor College of Medicine, Department of Pediatrics, Houston, United States
| | - Pedro Luiz Toledo de Arruda Lourenção
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Faculdade de Medicina de Botucatu, Departamento de Cirurgia e Ortopedia, Disciplina de Cirurgia Pediátrica, Botucatu, SP, Brazil.
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25
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Fisher K, Hutcheon D, Ziegler J. Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review. Nutr Clin Pract 2019; 35:231-245. [PMID: 30937981 DOI: 10.1002/ncp.10269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Irritable bowel syndrome (IBS) is classified as a functional gastrointestinal (GI) disorder characterized by abdominal pain, bloating, and changes in bowel function. Although the pathophysiology of IBS is incompletely understood, fermentable carbohydrates are implicated as a potential cause of symptoms. An elimination diet, such as a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, represents a potential intervention for reducing GI symptoms in patients with IBS. The role of fermentable carbohydrates in symptom onset is well studied in adult patients with IBS; however, less research exists in the pediatric population. This review sought to explore evidence for the role of dietary fermentable carbohydrate elimination to reduce GI symptoms (abdominal pain, stool changes, abdominal bloating) in children and adolescents (4-19 years of age) diagnosed with IBS based on Rome III or IV criteria. Five studies of neutral to positive quality rating were identified and analyzed using the Academy of Nutrition and Dietetics Evidence Analysis Process. These studies demonstrate that dietary elimination of fermentable carbohydrates, such as through a low-FODMAP diet, reduces the severity of 1 or more GI symptoms in about one-quarter to one-half of pediatric patients with IBS. Patients without improvement are considered "nonresponders" and may require an alternative intervention. More research is needed to establish the best way to identify patients who would respond to elimination diets vs other IBS treatment strategies.
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Affiliation(s)
- Kelly Fisher
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Deborah Hutcheon
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
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26
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Aiemjoy K, Altan E, Aragie S, Fry DM, Phan TG, Deng X, Chanyalew M, Tadesse Z, Callahan EK, Delwart E, Keenan JD. Viral species richness and composition in young children with loose or watery stool in Ethiopia. BMC Infect Dis 2019; 19:53. [PMID: 30642268 PMCID: PMC6332554 DOI: 10.1186/s12879-019-3674-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/02/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Stool consistency is an important diagnostic criterion in both research and clinical medicine and is often used to define diarrheal disease. METHODS We examine the pediatric enteric virome across stool consistencies to evaluate differences in richness and community composition using fecal samples collected from children aged 0 to 5 years participating in a clinical trial in the Amhara region of Ethiopia. The consistency of each sample was graded according to the modified Bristol Stool Form Scale for children (mBSFS-C) before a portion of stool was preserved for viral metagenomic analysis. Stool samples were grouped into 29 pools according to stool consistency type. Differential abundance was determined using negative-binomial modeling. RESULTS Of 446 censused children who were eligible to participate, 317 presented for the study visit examination and 269 provided stool samples. The median age of children with stool samples was 36 months. Species richness was highest in watery-consistency stool and decreased as stool consistency became firmer (Spearman's r = - 0.45, p = 0.013). The greatest differential abundance comparing loose or watery to formed stool was for norovirus GII (7.64, 95% CI 5.8, 9.5) followed by aichivirus A (5.93, 95% CI 4.0, 7.89) and adeno-associated virus 2 (5.81, 95%CI 3.9, 7.7). CONCLUSIONS In conclusion, we documented a difference in pediatric enteric viromes according to mBSFS-C stool consistency category, both in species richness and composition.
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Affiliation(s)
- Kristen Aiemjoy
- Francis I. Proctor Foundation, University of California San Francisco, 513 Parnassus Avenue, MedSci S309, Box 0412, San Francisco, CA 94143 USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Eda Altan
- Blood Systems Research Institute, San Francisco, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, USA
| | | | - Dionna M. Fry
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Tung G. Phan
- Blood Systems Research Institute, San Francisco, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, USA
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, USA
| | | | | | | | - Eric Delwart
- Blood Systems Research Institute, San Francisco, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, USA
| | - Jeremy D. Keenan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, USA
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27
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Zollars JA, Armstrong M, Whisler S, Williamson S. Visceral and Neural Manipulation in Children with Cerebral Palsy and Chronic Constipation: Five Case Reports. Explore (NY) 2019; 15:47-54. [DOI: 10.1016/j.explore.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/21/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022]
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28
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Koppen IJN, Saps M, Lavigne JV, Nurko S, Taminiau JAJM, Di Lorenzo C, Benninga MA. Recommendations for pharmacological clinical trials in children with functional constipation: The Rome foundation pediatric subcommittee on clinical trials. Neurogastroenterol Motil 2018; 30:e13294. [PMID: 29380480 DOI: 10.1111/nmo.13294] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence for the efficacy of commonly used drugs in the treatment of childhood functional constipation (FC) is scarce, studies are often of low quality and study designs are heterogeneous. Thus, recommendations for the design of clinical trials in childhood FC are needed. PURPOSE Members of the Rome Foundation and a member of the Pediatric Committee of the European Medicines Agency formed a committee to create recommendations for the design of clinical trials in children with FC. KEY RECOMMENDATIONS This committee recommends conducting randomized, double-blind, placebo-controlled, parallel-group clinical trials to assess the efficacy of new drugs for the treatment of childhood FC. Pediatric study participants should be included based on fulfilling the Rome IV criteria for FC. A treatment free run-in period for baseline assessment is recommended. The trial duration should be at least 8 weeks. Treatment success is defined as no longer meeting the Rome IV criteria for FC. Stool consistency should be reported based on the Bristol Stool Scale. Endpoints of drug efficacy need to be tailored to the developmental age of the patient population.
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Affiliation(s)
- I J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - M Saps
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - J V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Mary Ann and J. Milburn Smith Child Health Research Program, Chicago, IL, USA.,Children's Hospital of Chicago Research Center, Chicago, IL, USA
| | - S Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA, USA
| | - J A J M Taminiau
- Member of the Pediatric Committee (PDCO) European Medicines Agency, London, UK
| | - C Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
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29
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Pancreatic Enzyme Replacement Therapy Use in Infants With Cystic Fibrosis Diagnosed by Newborn Screening. J Pediatr Gastroenterol Nutr 2018; 66:657-663. [PMID: 29176494 PMCID: PMC5866181 DOI: 10.1097/mpg.0000000000001829] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the study is to describe pancreatic enzyme practices during the first year of life in infants with cystic fibrosis (CF) and evaluate associations between dosing and outcomes, including growth and gastrointestinal (GI) symptoms. METHODS We analyzed data from a subset of infants who were in a prospective cohort study conducted at 28 US CF centers. Anthropometric measurements and medications were recorded at each visit. Diaries with infant diet, pancreatic enzyme replacement therapy (PERT) dosing, stool frequency and consistency, and pain were completed by a parent/guardian for 3 days before each visit. RESULTS Two hundred and thirty-one infants were enrolled in the main study; 205 of these met criteria for pancreatic insufficiency (PI). PERT dose between birth and 6 months was on average 1882 LU/kg per meal (range: 492-3727) and was similar between 6 and 12 months (mean: 1842 LU/kg per mean, range: 313-3612). PERT dose had a weak, negative association with weight z score at 3 and 6 months (r = -0.16, 95% confidence interval [CI] -0.29 to -0.02 and r = -0.18, 95% CI -0.31 to -0.04, respectively) but not at 12 months. There was not a clear relationship between PERT dosing and number of stools per day, stool consistency or pain. One hundred and forty-four infants (70%) were placed on acid suppression medication. Weight z score mean was 0.37 higher in infants using proton pump inhibitors (PPIs) exclusively versus those using histamine-2 blockers exclusively (95% CI -0.02 to 0.76, P = 0.06). CONCLUSIONS We did not observe that centers with a higher PERT dosing strategy yielded greater clinical benefit than dosing at the lower end of the recommended range.
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30
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Gulati R, Komuravelly A, Leb S, Mhanna MJ, Ghori A, Leon J, Needlman R. Usefulness of Assessment of Stool Form by the Modified Bristol Stool Form Scale in Primary Care Pediatrics. Pediatr Gastroenterol Hepatol Nutr 2018; 21:93-100. [PMID: 29713606 PMCID: PMC5915696 DOI: 10.5223/pghn.2018.21.2.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/10/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Rome criteria are considered the gold standard for diagnosing functional constipation. The modified Bristol stool form scale (m-BSFS) was validated to measure stool form in children. However, neither the potential use of the m-BSFS as a tool to facilitate the diagnosis of potential constipation, nor the agreement between m-BSFS and stool consistency by Rome has been studied. Our objective is to determine if m-BSFS is a reliable tool to facilitat detection of constipation; and the agreement between stool form by m-BSFS and hard stool criteria in Rome. METHODS A survey tool with the Rome III criteria and the m-BSFS was developed. A Likert-scale addressed frequency of each stool form on the m-BSFS. Responses to Rome III and m-BSFS were compared. RESULTS The sensitivity and specificity of the m-BSFS was 79.2% and 66.0% respectively; and in children <4 years. improved to 81.2% and 75.0% respectively. There was poor agreement between hard stools by m-BSFS and the painful or hard bowel movement question of Rome Criteria. CONCLUSION The potential utility of m-BSFS as a reasonably good tool to facilitate the diagnosis of potential constipation in children is shown. The poor agreement between painful or hard stool question in Rome III, and ratings for hard stool on the m-BSFS illustrates that one's perception may differ between a question and a picture. A useful pictorial tool to appraise stool form may, thus, be a favorable complement in the process of enquiry about bowel habits in well-child care.
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Affiliation(s)
- Reema Gulati
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arpitha Komuravelly
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stephen Leb
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Maroun J Mhanna
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Abdullah Ghori
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Janeen Leon
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert Needlman
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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31
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Francavilla R, Cristofori F, Verzillo L, Gentile A, Castellaneta S, Polloni C, Giorgio V, Verduci E, DʼAngelo E, Dellatte S, Indrio F. Randomized Double-Blind Placebo-Controlled Crossover Trial for the Diagnosis of Non-Celiac Gluten Sensitivity in Children. Am J Gastroenterol 2018; 113:421-430. [PMID: 29380821 DOI: 10.1038/ajg.2017.483] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/29/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Non-celiac gluten sensitivity (NCGS) is characterized by intestinal and extra-intestinal symptoms that are related to the ingestion of gluten in subjects who are not affected by either celiac disease (CD) or wheat allergy (WA). In this multicenter study, we aim for the first time to evaluate the prevalence of NCGS in pediatric subjects with chronic functional gastrointestinal symptoms associated with gluten ingestion using a double-blind placebo-controlled (DBPC) gluten challenge with crossover. METHODS Among 1,114 children with chronic gastrointestinal symptoms (negative CD and WA), those exhibiting a positive correlation between symptoms and gluten ingestion were eligible for a diagnostic challenge including the following phases: run-in, open gluten-free diet (GFD) and DBPC crossover gluten challenge. Patients were randomized to gluten (10 g/daily) and placebo (rice starch) for 2 weeks each, separated by a washout week. The gluten challenge was considered positive in the presence of a minimum 30% decrease of global visual analogue scale between gluten and placebo. RESULTS Out of 1,114 children, 96.7% did not exhibit any correlation with gluten ingestion. Thirty-six children were eligible; after the run-in and open GFD, 28 patients entered the gluten challenge. Eleven children (39.2%; 95% CI: 23.6-53.6%) tested positive. CONCLUSIONS This is the first demonstration of the existence of NCGS in children that reinforce the need for a DBPC for the diagnosis as the diagnosis is ruled out in >60% of cases. The registration identifier in ClinicalsTrials.gov is NCT02431585.
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Affiliation(s)
- R Francavilla
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - F Cristofori
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - L Verzillo
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - A Gentile
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
| | - S Castellaneta
- Department of Pediatrics, San Paolo Hospital, Bari Italy
| | - C Polloni
- Department of Pediatrics, Santa Maria del Carmine Hospital, Rovereto TN, Italy
| | - V Giorgio
- Department of Pediatrics, Catholic University, Rome, Italy
| | - E Verduci
- Department of Pediatrics, University of Milan, S. Paolo Hospital, Milan, Italy
| | - E DʼAngelo
- Department of Pediatrics, Santa Maria Incoronata dell'Olmo Hospital
| | | | - F Indrio
- Interdisciplinary Department of Medicine-Pediatric Section, University of Bari, Bari, Italy
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Aiemjoy K, Aragie S, Gebresillasie S, Fry DM, Dagnew A, Hailu D, Chanyalew M, Tadesse Z, Stewart A, Callahan K, Freeman M, Neuhaus J, Arnold BF, Keenan JD. Defining Diarrhea: A Population-Based Validation Study of Caregiver-Reported Stool Consistency in the Amhara Region of Ethiopia. Am J Trop Med Hyg 2018; 98:1013-1020. [PMID: 29488457 PMCID: PMC5928832 DOI: 10.4269/ajtmh.17-0806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diarrhea is a leading cause of death among children aged less than five years globally. Most studies of pediatric diarrhea rely on caregiver-reported stool consistency and frequency to define the disease. Research on the validity of caregiver-reported diarrhea is sparse. We collected stool samples from 2,398 children participating in two clinical trials in the Amhara region of Ethiopia. The consistency of each stool sample was graded by the child's caregiver and two trained laboratory technicians according to an illustrated stool consistency scale. We assessed the reliability of graded stool consistency among the technicians, and then compared the caregiver's grade with the technician's grade. We also tested if the illustrated stool consistency scale could improve the validity of caregiver's report. The weighted kappa measuring the agreement between the two laboratory technicians reached 0.90 after 500 stool samples were graded. The sensitivity of caregiver-reported loose or watery stool was 15.5% (95% confidence interval [CI]: 9.7, 24.2) and the specificity was 98.4% (95% CI 97.1, 99.1). With the illustrated scale, the sensitivity was 68.5% (95% CI: 58.5, 77.1) and the specificity was 86.1% (95% CI: 79.3, 90.9). The results indicate that caregiver-reported stool consistency using the terms "loose or watery" does not accurately describe stool consistency as graded by trained laboratory technicians. Given the predominance of using caregiver-reported stool consistency to define diarrheal disease, the low sensitivity identified in this study suggests that the burden of diarrheal disease may be underestimated and intervention effects could be biased. The illustrated scale is a potential low-lost tool to improve the validity of caregiver-reported stool consistency.
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Affiliation(s)
- Kristen Aiemjoy
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | | | | | - Dionna M Fry
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Adane Dagnew
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Mathew Freeman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Benjamin F Arnold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
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Chumpitazi BP, McMeans AR, Vaughan A, Ali A, Orlando S, Elsaadi A, Shulman RJ. Fructans Exacerbate Symptoms in a Subset of Children With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2018; 16:219-225.e1. [PMID: 28970147 PMCID: PMC5794652 DOI: 10.1016/j.cgh.2017.09.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Dietary fructans exacerbate symptoms in some, but not all, adults with irritable bowel syndrome (IBS). We sought to determine whether fructans worsen symptoms in children with IBS and whether clinical and psychosocial factors, and/or gas production, can identify those who are fructan sensitive. METHODS We performed a double-blind placebo-controlled (maltodextrin) cross-over trial of 23 children with IBS, based on pediatric Rome III criteria, from September 2014 through December 2016. At baseline, participants completed 1-week pain and stool diaries and a 3-day food record and psychosocial factors (depression, anxiety, and somatization) were measured. Subjects were randomly assigned to groups that were provided meals for 72 hours containing either fructans or maltodextrin (0.5 g/kg; maximum, 19 g). Following a washout period of 10 days or more, the subjects received the meal they were not given during the first study period (crossed over). Gastrointestinal symptoms and breath hydrogen and methane production were captured during each meal period. Fructan sensitivity was defined as an increase of 30% or more in abdominal pain frequency following fructan ingestion. RESULTS Subjects had more mean episodes of abdominal pain/day during the fructan-containing diet (3.4 ± 2.6) vs the maltodextrin-containing diet (2.4 ± 1.7) (P < .01), along with more severe bloating (P < .05) and flatulence (P = .01). Hydrogen (but not methane) production was greater while subjects were on the fructan-containing diet (617 ± 305 ppm∗h) than the maltodextrin-containing diet (136 ± 78 ppm*h) (P < .001). Eighteen subjects (78.2%) had more frequent abdominal pain while on the fructan-containing diet and 12 (52.2%) qualified as fructan sensitive. We found no difference between fructan-sensitive and fructan-insensitive subjects in baseline abdominal pain or bowel movement characteristics, dietary intake, psychosocial parameters, IBS subtype, or gas production. CONCLUSIONS In a randomized controlled trial of children with IBS, we found fructans to exacerbate several symptoms. However, fructan sensitivity cannot be identified based on baseline gastrointestinal symptoms, dietary intake, psychosocial factors, or gas production. Clinicaltrials.gov no: NCT02842281.
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Affiliation(s)
| | | | - Adetola Vaughan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amna Ali
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Shannon Orlando
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Ali Elsaadi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Robert Jay Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Children's Nutrition Research Center, Houston, Texas
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Assessing Children's Report of Stool Consistency: Agreement Between the Pediatric Rome III Questionnaire and the Bristol Stool Scale. J Pediatr 2017; 190:69-73. [PMID: 28912052 DOI: 10.1016/j.jpeds.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/12/2017] [Accepted: 07/05/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess the agreement between the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII) and the Bristol Stool Scale (BSS) in evaluating stool consistency and the diagnosis of functional constipation in children. STUDY DESIGN Children aged 8-18 years were asked to describe their stool consistency in the previous month according to the QPGS-RIII and the BSS. Stool consistency according to both instruments was categorized into 3 categories: "hard," "normal," and "liquid." The children's reported stool consistency using the QPGS-RIII and the BSS were compared, and the intrarater agreement between the 2 instruments was measured using the Cohen kappa coefficient (κ). The diagnosis of functional constipation was based on the Rome III criteria, incorporating the assessment of stool consistency according to the QPGS-RIII and the BSS. RESULTS A total of 1835 children were included. Only slight agreement existed between the QPGS-RIII and the BSS for assessing stool consistency (κ = .046; P = .022). Significantly more children reported hard stools on the BSS compared to the QPGS-RIII (18.0% vs 7.1%; P = .000). The prevalence of functional constipation was 8.6% using the QPGS-RIII and 9.3% using the BSS (P = .134). CONCLUSIONS Only slight agreement exists between the QPGS-RIII and the BSS in the evaluation of stool consistency in children. Better instruments are needed to assess the consistency of stools with a high degree of reliability, both in research and in the clinical setting.
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Translation to Polish, cross-cultural adaptation, and validation of the Bristol Stool Form Scale among healthcare professionals and patients. GASTROENTEROLOGY REVIEW 2017; 13:35-39. [PMID: 29657609 PMCID: PMC5894444 DOI: 10.5114/pg.2017.70610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/23/2017] [Indexed: 11/17/2022]
Abstract
Introduction The seven-point Bristol Stool Form Scale (BSFS), which refers to seven pictures of different forms of stool, is a commonly used instrument to assess stool consistency. Aim To translate, cross-culturally adapt, and validate the BSFS for its use in Poland. Material and methods The steps included forward translation, reconciliation, backward translation, comparison of the two English versions and validation of the translation, pilot testing, proofreading, approval of the final version of the target language BSFS, and validation. The latter process involved healthcare professionals (physicians and nurses), healthy adults, and adult patients with gastrointestinal disorders, who were asked to correlate images of seven types of stools with their descriptions. All available subjects were asked to repeat the survey to assess test-retest reliability. The primary outcome measures were validity (accuracy) and reliability (repeatability). Results A total of 320 subjects took part in the validation study (80/group). Overall, concordance between descriptions and pictures was 78.7%, and the overall κ index was good (0.75, 95% confidence interval (CI): 0.73 to 0.77). Test-retest assessment was performed in 170 (53.1%) subjects within a mean interval of 5.9 ±2.5 days. Overall, concordance between definitions and pictures for the re-testing phase was 90.7% with a κ index of 0.89 (95% CI: 0.87 to 0.91). Conclusions As a result of the translation and cultural adaptation process, a final Polish version of the BSFS was created. The substantial validity and reliability of this Polish version was demonstrated.
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Validation of a Simple Stool Diary Used by Caregivers to Document Diarrhea Among Young Children in a Low-Income Country. J Pediatr Gastroenterol Nutr 2017; 65:156-164. [PMID: 27861203 DOI: 10.1097/mpg.0000000000001462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was the development and validation of a simple stool diary for caretakers collecting data on stool frequency and consistency among young children in a low-income country. METHODS Focus group studies evaluated how diarrhea was understood by caregivers (content validity). The sensitivity, reliability, and correlations between dehydration and diary scores (construct validity) were tested in a clinical trial. RESULTS Caregivers recognized and understood the concept and severity of diarrhea. Stool frequency and liquid consistency decreased in children admitted with diarrhea (P < 0.0001 for both), confirming good sensitivity of the diary. High reliability was obtained after a few days of training. The caregiver intracorrelation coefficients were 0.66 (0.55-0.77) and 0.75 (0.66-0.84) after 2 and 7 days of training, respectively, and subjective staff evaluation of caregiver scores showed that ≤6% of caregivers had low scoring abilities after 3 days. The degree of dehydration (4-point score) was correlated with both increasing stool frequency and liquid stool consistency (+0.2 points [0.07-0.3], P = 0.0018 for 6 or more diarrheal stools, compared to 3 or more diarrheal stools per day, and +0.5 points (0.3-0.6), P < 0.0001 for diarrheal episodes with 3 or more watery stools/day compared with episodes with 3 or more "watery + abnormally loose + loose" stools per day). CONCLUSIONS The diary showed high validity, good reliability, and high sensitivity. After 3 days of training, caregivers with mainly no or limited education could report stool consistency with good reliability. Stool consistency, which correlated strongly with dehydration, may be considered an important marker of diarrhea severity in future research.
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Lourenção PLTDA, Ortolan EVP, Rosa LLM, Angelini MC, Terra SA, Rodrigues MAM. Long-term follow-up of patients with intestinal neuronal dysplasia type B: Protocol for an observational, ambispective, and comparative study. Medicine (Baltimore) 2017; 96:e7485. [PMID: 28700491 PMCID: PMC5515763 DOI: 10.1097/md.0000000000007485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intestinal neuronal dysplasia type B (IND-B) is a pathological entity of the group of gastrointestinal neuromuscular diseases characterized by complex alterations in the enteric nervous system. Patients typically present with intestinal constipation, sometimes complicated by episodes of intestinal obstruction. The 2 therapeutic modalities include conservative clinical treatment and surgical treatment. Nevertheless, the results of the different therapeutic modalities are conflicting, and follow-up studies are scarce and include only a limited number of patients.This is a single-center, ambispective, observational, longitudinal, and comparative follow-up study to compare the results of conservative clinical and surgical treatments in patients with IND-B. Sixty-three patients (<15 years) who received this diagnosis will be included. These patients will be divided into 2 groups according to the type of treatment that they previously received: 29 patients in the surgical treatment group and 34 patients in the conservative treatment group. Previous data will be recovered from the medical records of the study patients, including signs and symptoms present at the time of diagnosis, particularly those related to bowel habits, and treatments undergone. Later, these patients will be invited to participate in a semistructured interview during which aspects related to the long-term functional results of the bowel habit and quality of life will be investigated after a minimum interval of 5 years posttreatment.This project aims to assess the long-term clinical evolution of patients diagnosed with IND-B and compare the results obtained following conservative clinical and surgical treatments.This protocol will provide sufficient data to analyze the long-term clinical outcome obtained through the 2 treatment modalities proposed for patients with IND-B.
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Affiliation(s)
| | | | | | | | - Simone Antunes Terra
- Department of Pathology, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
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Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study. J Pediatr Gastroenterol Nutr 2017; 64:925-929. [PMID: 27906800 DOI: 10.1097/mpg.0000000000001478] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Beneficial therapeutic effect of probiotics has been reported in children with the irritable bowel syndrome (IBS) but not consistently in other functional abdominal pain-related disorders. The aim of the present study was to investigate the effect of Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain (FAP) and IBS in children. METHODS Children (age 4-18 years) referred to pediatric gastroenterologist at Children's Hospital Zagreb from May 2012 to December 2014, diagnosed as FAP or IBS, were randomized to receive L reuteri DSM 17938 10⁸ CFU daily or placebo. The study was a prospective, randomized, double-blind, placebo-controlled parallel study. Symptoms were evaluated using Wong-Baker FACES pain rating scale for pain and Bristol scale for stool shape and consistence. RESULTS Data were analyzed for 55 children (26 in the intervention group and 29 in the placebo group). Children in the intervention group had significantly more days without pain (median 89.5 vs 51 days, P = 0.029). Abdominal pain was less severe in children taking probiotics during the second month (P < 0.05) and fourth month (P < 0.01). The 2 groups did not differ in the duration of abdominal pain, stool type, or absence from school. Both groups experienced significant reduction in the severity of abdominal pain from first to fourth month, with the reduction more prominent in the intervention group (P < 0.001 vs P = 0.004). CONCLUSIONS Administration of L reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.
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Leung DH, Heltshe SL, Borowitz D, Gelfond D, Kloster M, Heubi JE, Stalvey M, Ramsey BW. Effects of Diagnosis by Newborn Screening for Cystic Fibrosis on Weight and Length in the First Year of Life. JAMA Pediatr 2017; 171:546-554. [PMID: 28437538 PMCID: PMC5731827 DOI: 10.1001/jamapediatrics.2017.0206] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Since the implementation of universal newborn screening (NBS) for cystic fibrosis (CF), the timing and magnitude of growth deficiency or its association with correlates of disease among infants with CF who underwent NBS has not been well described. OBJECTIVE To examine incremental weight gain, linear growth, and clinical features in the first year of life among infants with CF who underwent NBS. DESIGN, SETTING, AND PARTICIPANTS The Baby Observational and Nutrition Study (BONUS), a multicenter, longitudinal, observational cohort study, was conducted during regular CF clinic visits in the first 12 months of life at 28 US Cystic Fibrosis Foundation-accredited Care Centers from January 7, 2012, through May 31, 2015. Participants included 231 infants younger than 3.5 months who underwent NBS and had confirmed CF, with a gestational age of at least 35 weeks, birth weight of at least 2.5 kg, and toleration of full oral feeds. Of these, 222 infants (96.1%) had follow-up beyond 6 months of age and 215 (93.1%) completed 12 months of follow-up. EXPOSURE Cystic fibrosis. MAIN OUTCOME AND MEASURES Attained weight and length for age and World Health Organization normative z scores at ages 1 to 6 and 8, 10, and 12 months (defined a priori). RESULTS Of the 231 infants enrolled, 110 infants (47.6%) were female and 121 (52.4%) were male, with a mean (SD) age of 2.58 (0.69) months. BONUS infants had lower than mean birth weights (mean z score, -0.15; 95% CI, -0.27 to -0.04) and higher birth lengths (mean z score, 0.44; 95% CI, 0.26 to 0.62). They achieved normal weight by 12 months, a significant improvement over a prescreening cohort of newborns with CF from 20 years before the contemporary cohort (mean z score increase, 0.57; 95% CI, 0.37-0.77). However, length was lower than the mean at 12 months (mean z score, -0.56; 95% CI, -0.70 to -0.42). Only 30 infants (13.6%) were at less than the 10th percentile of weight for age, whereas 53 (23.9%) were at less than the 10th percentile of length for age at more than half their visits. Male sex, pancreatic insufficiency, meconium ileus, histamine blocker use, and respiratory Pseudomonas aeruginosa infection were associated with lower weight or length during the first year. Insulinlike growth factor 1 levels were significantly lower among low-length infants. Persistently low-weight infants consumed significantly more calories, and weight and length z scores were negatively correlated with caloric intake. CONCLUSIONS AND RELEVANCE Since initiation of universal NBS for CF, significant improvement has occurred in nutritional status, with normalization of weight in the first year of life. However, length stunting remains common.
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Affiliation(s)
- Daniel H. Leung
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Sonya L. Heltshe
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children’s Research Institute, Seattle, Washington,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle
| | - Drucy Borowitz
- Department of Pediatrics, University of Buffalo, Buffalo, New YorkCystic Fibrosis Foundation, Bethesda, Maryland
| | - Daniel Gelfond
- Division of Gastroenterology/Nutrition, Department of Pediatrics, University of Rochester, Rochester, New York
| | - Margaret Kloster
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children’s Research Institute, Seattle, Washington
| | - James E. Heubi
- Division of Gastroenterology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael Stalvey
- Department of Pediatrics, University of Alabama at Birmingham
| | - Bonnie W. Ramsey
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children’s Research Institute, Seattle, Washington,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle
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Tabori H, Arnold C, Jaudszus A, Mentzel HJ, Renz DM, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Mainz JG. Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings. PLoS One 2017; 12:e0174463. [PMID: 28472055 PMCID: PMC5417419 DOI: 10.1371/journal.pone.0174463] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/09/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND & AIMS Abdominal symptoms (AS) are a hallmark of the multiorgan-disease cystic fibrosis (CF). However, the abdominal involvement in CF is insufficiently understood and, compared to the pulmonary manifestation, still receives little scientific attention. Aims were to assess and quantify AS and to relate them to laboratory parameters, clinical findings, and medical history. METHODS A total of 131 patients with CF of all ages were assessed with a new CF-specific questionnaire (JenAbdomen-CF score 1.0) on abdominal pain and non-pain symptoms, disorders of appetite, eating, and bowel movements as well as symptom-related quality of life. Results were metrically dimensioned and related to abdominal manifestations, history of surgery, P. aeruginosa and S. aureus colonization, genotype, liver enzymes, antibiotic therapy, lung function, and nutritional status. RESULTS AS during the preceding 3 months were reported by all of our patients. Most common were lack of appetite (130/131) and loss of taste (119/131) followed by abdominal pain (104/131), flatulence (102/131), and distention (83/131). Significantly increased AS were found in patients with history of rectal prolapse (p = 0.013), distal intestinal obstruction syndrome (p = 0.013), laparotomy (p = 0.022), meconium ileus (p = 0.037), pancreas insufficiency (p = 0.042), or small bowel resection (p = 0.048) as well as in patients who have been intermittently colonized with P. aeruginosa (p = 0.006) compared to patients without history of these events. In contrast, no statistically significant associations were found to CF-associated liver disease, chronic pathogen colonization, lung function, CF-related diabetes, and nutritional status. CONCLUSION As the complex abdominal involvement in CF is still not fully understood, the assessment of the common AS is of major interest. In this regard, symptom questionnaires like the herein presented are meaningful and practical tools facilitating a wider understanding of the abdominal symptoms in CF. Furthermore, they render to evaluate possible abdominal effects of novel modulators of the underlying cystic fibrosis transmembrane (conductance) regulator (CFTR) defect.
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Affiliation(s)
- Harold Tabori
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
| | - Christin Arnold
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
| | - Anke Jaudszus
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
| | | | - Diane M. Renz
- Jena University Hospital, Pediatric Radiology, Jena, Germany
| | - Steffen Reinsch
- Jena University Hospital, Pediatric Gastroenterology, Jena, Germany
| | - Michael Lorenz
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
| | - Ruth Michl
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
| | - Andrea Gerber
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
| | - Thomas Lehmann
- Jena University Hospital, Institute of Medical Statistics, Jena, Germany
| | - Jochen G. Mainz
- Jena University Hospital, Cystic Fibrosis Center, Jena, Germany
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Korczak R, Kamil A, Fleige L, Donovan SM, Slavin JL. Dietary fiber and digestive health in children. Nutr Rev 2017; 75:241-259. [DOI: 10.1093/nutrit/nuw068] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/08/2016] [Indexed: 01/28/2023] Open
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Lactulose Breath Test Gas Production in Childhood IBS Is Associated With Intestinal Transit and Bowel Movement Frequency. J Pediatr Gastroenterol Nutr 2017; 64:541-545. [PMID: 27276436 PMCID: PMC5145773 DOI: 10.1097/mpg.0000000000001295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES In adults with irritable bowel syndrome (IBS), bacterial gas production (colonic fermentation) is related to both symptom generation and intestinal transit. Whether gas production affects symptom generation, psychosocial distress, or intestinal transit in childhood IBS is unknown. METHODS Children (ages 7-17 years) with pediatric Rome III IBS completed validated psychosocial questionnaires and a 2-week daily diary capturing pain and stooling characteristics. Stool form determined IBS subtype. Subjects then completed a 3-hour lactulose breath test for measurement of total breath hydrogen and methane production. Carmine red was used to determine whole intestinal transit time. RESULTS A total of 87 children (mean age 13 ± 2.6 [standard deviation] years) were enrolled, of whom 50 (57.5%) were girls. All children produced hydrogen and 51 (58.6%) produced methane. Hydrogen and methane production did not correlate with either abdominal pain frequency/severity or psychosocial distress. Hydrogen and methane production did not differ significantly by IBS subtype. Methane production correlated positively with whole intestinal transit time (r = 0.31, P < 0.005) and inversely with bowel movement frequency (r = -0.245, P < 0.05). Methane production (threshold 3 ppm) as a marker for identifying IBS-C had a sensitivity of 60% and specificity of 42.9%. CONCLUSIONS Lactulose breath test total methane production may serve as a biomarker of whole intestinal transit time and bowel movement frequency in children with IBS. In children with IBS, lactulose breath test hydrogen and methane production did not, however, correlate with abdominal pain, IBS subtype, or psychosocial distress.
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Mennini M, Tolone C, Frassanito A, Midulla F, Cucchiara S, Aloi M. Gelatin Tannate for Acute Childhood Gastroenteritis: A Randomized, Single-Blind Controlled Trial. Paediatr Drugs 2017; 19:131-137. [PMID: 28000174 DOI: 10.1007/s40272-016-0207-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oral rehydration therapy is the recommended treatment for acute childhood gastroenteritis. The aim of this study was to assess the efficacy and safety of gelatin tannate plus oral rehydration compared with oral rehydration alone. METHODS We conducted a multicenter, parallel, randomized, controlled, single-blind, prospective, open-label trial. A central randomization center used computer generated tables to allocate treatments. The study was performed in two medical centers in Italy. Sixty patients 3-72 months of age with acute gastroenteritis were recruited (median age 18 months; age range 3-66 months): 29 received an oral rehydration solution (ORS) and 31 an ORS plus gelatin tannate (ORS + G). The primary outcome was the number of bowel movements 48 and 72 h after initiating treatment. Secondary outcomes were: duration of diarrhea, stool characteristics and adverse events. RESULTS No patient was lost at follow-up. No significant difference in the number of bowel movements after 48 h was reported (2.7 ± 1.3 ORS + G; 3.2 ± 0.8 ORS; p = 0.06), although the ORS + G group showed a significant improvement in stool consistency (3.7 ± 1.0 vs. 4.3 ± 0.8; p = 0.005). At 72 h, a significant reduction in bowel movements was reported in the ORS + G group compared with the ORS group (1.0 ± 1.4 vs. 2.0 ± 1.7; p = 0.01). Mean duration of diarrhea was significantly lower in the ORS + G group than in the ORS only group (76.8 ± 19.2 vs. 108 ± 24.0 h; p < 0.0001). No adverse events were reported. CONCLUSIONS Gelatin tannate added to oral rehydration in children with acute diarrhea was associated with a significant decrease in bowel movements at 72 h, with an early improvement in the stool consistency and shorter disease duration. CLINICAL TRIAL REGISTRATION NCT02644200-Gelatin Tannate as Treatment for Acute Childhood Gastroenteritis ( https://www.clinicaltrials.gov ).
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Affiliation(s)
- Maurizio Mennini
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. .,Department of Pediatrics, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Carlo Tolone
- Department of Pediatrics, Second University of Naples, Viale Beneduce 10, 81100, Caserta, Italy
| | - Antonella Frassanito
- Department of Pediatrics, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabio Midulla
- Department of Pediatrics, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Salvatore Cucchiara
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Vandenplas Y, Szajewska H, Benninga M, Di Lorenzo C, Dupont C, Faure C, Miqdadi M, Osatakul S, Ribes-Konickx C, Saps M, Shamir R, Staiano A. Development of the Brussels Infant and Toddler Stool Scale ('BITSS'): protocol of the study. BMJ Open 2017; 7:e014620. [PMID: 28360250 PMCID: PMC5372036 DOI: 10.1136/bmjopen-2016-014620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed. Our aim is to develop a paediatric stool scale, the Brussels Infant and Toddler Stool Scale ('BITSS'), and to evaluate the interobserver agreement of stool assessment with the BITSS between the patient's parent and healthcare providers (physicians and nurses). METHODS AND ANALYSIS This study has two phases. In the first phase, 11 key-opinion leaders in the field of paediatric gastroenterology representing different areas of the world selected seven coloured photographs of infants and/or young children wearing diapers to match the original descriptors of the BSS. The selected photographs were used to create a new scale in which the drawings of stools of the BSS were replaced by infant/toddlers stool photographs. In phase II, we aim at demonstrating that parents, nurses and primary healthcare physicians interpret the stool-pictures of the BITSS with a high degree of consensus and that the agreement is independent of whether it is a parent or a healthcare provider. Interobserver variability of stool assessment with the BITSS between the patient's parent and healthcare providers will be assessed. ETHICS AND DISSEMINATION The study will be approved by the Ethics Committee of the participating centres. The findings of this study will be submitted to a peer-reviewed journal. Abstracts will be submitted to national and international conferences. TRIAL REGISTRATION NUMBER NCT02913950.
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Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Marc Benninga
- Department of Pediatrics, Emma Children's Hospital/AMC, Amsterdam, The Netherlands
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christophe Dupont
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Hôpital Necker Enfants Malades, Paris, France
| | - Christophe Faure
- Pediatric Gastroenterology, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | | | - Seksit Osatakul
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Carmen Ribes-Konickx
- Pediatric Gastroenterology and Hepatology Unit, La Fe University Hospital, Valencia, Spain
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Raanan Shamir
- Schneider Children's Medical Centre of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Abstract
This study was a randomized controlled trial aimed to find the impact of abdominal massage application on constipation and quality of life among patients. The sample included 30 intervention (abdominal massage) and 30 control subjects. To collect data, the following were utilized: Patient Information Form, Gastrointestinal Symptom Rating Scale, Constipation Severity Instrument, Bristol Scale Stool Form, Patient Assessment of Constipation Quality of Life (PAC-QOL) Scale, and European Quality of Life Instrument (EQ-5D). The data were collected from among patients in the morning and evening on the fourth, fifth, and sixth days postoperatively. No significant findings were discovered between experimental and control groups in terms of individual characteristics and characteristics that might influence constipation (p > .05). It was found that patients who received abdominal massage application defecated more often following their surgery than patients in the control group, which led to a statistically high level of significant difference between the groups (p ≤ .001). It was also found that the experimental group displayed higher average PAC-QOL and EQ-5D scores on discharge. Findings indicated that abdominal massage applied to patients diagnosed with postoperative constipation reduced symptoms of constipation, decreased time intervals between defecation, and increased quality of life.
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46
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Aquino A, Perini M, Cosmai S, Zanon S, Pisa V, Castagna C, Uberti S. Osteopathic Manipulative Treatment Limits Chronic Constipation in a Child with Pitt-Hopkins Syndrome. Case Rep Pediatr 2017; 2017:5437830. [PMID: 28251008 PMCID: PMC5306969 DOI: 10.1155/2017/5437830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/15/2017] [Indexed: 11/19/2022] Open
Abstract
Pitt-Hopkins Syndrome (PTHS) is a rare genetic disorder caused by insufficient expression of the TCF4 gene. Children with PTHS typically present with gastrointestinal disorders and early severe chronic constipation is frequently found (75%). Here we describe the case of a PTHS male 10-year-old patient with chronic constipation in whom Osteopathic Manipulative Treatment (OMT) resulted in improved bowel functions, as assessed by the diary, the QPGS-Form A Section C questionnaire, and the Paediatric Bristol Stool Form Scale. The authors suggested that OMT may be a valid tool to improve the defecation frequency and reduce enema administration in PTHS patients.
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Affiliation(s)
- Alessandro Aquino
- Research Department, Istituto Superiore di Osteopatia, 20126 Milan, Italy
- Department of Clinical Paediatrics & Obstetrics-Gynaecology, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Mattia Perini
- Department of Clinical Paediatrics & Obstetrics-Gynaecology, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Silvia Cosmai
- Department of Clinical Paediatrics & Obstetrics-Gynaecology, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Silvia Zanon
- Department of Clinical Paediatrics & Obstetrics-Gynaecology, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Viviana Pisa
- Research Department, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Carmine Castagna
- Research Department, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Stefano Uberti
- Research Department, Istituto Superiore di Osteopatia, 20126 Milan, Italy
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Saps M, van Tilburg MAL, Lavigne JV, Miranda A, Benninga MA, Taminiau JA, Di Lorenzo C. Recommendations for pharmacological clinical trials in children with irritable bowel syndrome: the Rome foundation pediatric subcommittee on clinical trials. Neurogastroenterol Motil 2016; 28:1619-1631. [PMID: 27477090 DOI: 10.1111/nmo.12896] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is little published evidence of efficacy for the most commonly used treatments. Thus, there is an urgent need to conduct clinical trials on existing and novel therapies. PURPOSE In order to address these issues the Rome Foundation and members of the Pediatric Committee of the European Medicines Agency formed a subcommittee on clinical trials to develop guidelines for the design of clinical trials in children with irritable bowel syndrome (IBS). The following recommendations are based on evidence from published data when available and expert opinion. KEY RECOMMENDATIONS The subcommittee recommends randomized, double-blind, placebo-controlled, parallel-group, clinical trials to assess the efficacy of new drugs. The combined endpoints for abdominal pain are a decrease in intensity of at least 30% compared with baseline and to meet or exceed the Reliable Change Index (RCI) for the sample. Stool consistency is measured with the Bristol Stool Scale Form (BSFS). The subcommittee recommends as entry criteria for abdominal pain a weekly average of worst abdominal pain in past 24 h of at least 3.0 on a 0-10 point scale or at least 30 mm in 100 mm Visual Analog Scale. For stool endpoints the committee recommends an average stool consistency lower than 3 in the BSFS during the run-in period for clinical trials on IBS-C and an average stool consistency greater than 5 in the BSFS during the run-in period for clinical trials on IBS-D. Changes in stool consistency are the primary endpoints for both IBS with diarrhea (IBS-D) and IBS with constipation (IBS-C).
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Affiliation(s)
- M Saps
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
| | - M A L van Tilburg
- Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
| | - J V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Mary Ann and J. Milburn Smith Child Health Research Program, Chicago, IL, USA.,Children's Hospital of Chicago Research Center, Chicago, IL, USA
| | - A Miranda
- Division of Pediatric Gastroenterology Hepatology & Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - J A Taminiau
- Member of the Pediatric Committee (PDCO) European Medicines Agency, London, UK
| | - C Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
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Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2016; 44:693-703. [PMID: 27492648 DOI: 10.1111/apt.13746] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/11/2016] [Accepted: 07/07/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Bristol Stool Form Scale (BSFS) is a 7-point scale used extensively in clinical practice and research for stool form measurement, which has undergone limited validity and reliability testing. AIM To determine the validity and reliability of the BSFS in measuring stool form in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome (IBS-D). METHODS One hundred and sixty-nine healthy volunteers provided a stool sample and used the BSFS to classify stool form, which was compared with measured stool water content and with values from 19 patients with IBS-D. Eighty-six volunteers used the BSFS to classify 26 stool models to determine accuracy and reliability. RESULTS Volunteers' classifications of stool type correlated with stool water (Spearman's rho = 0.491, P < 0.001), which increased in hard (Types 1-2), normal (Types 3-5) and loose stools (Types 6-7) (P < 0.001). The BSFS detected differences in stool form between healthy volunteers (mean 3.7, s.d. 1.5) and IBS-D patients (mean 5.0, s.d. 1.2) (P < 0.001). Overall, 977/1204 (81%) stool models were correctly classified (substantial accuracy, κ = 0.78), although <80% of Types 2, 3, 5 and 6 were classified correctly. On 852/1118 (76%) occasions, volunteers classified covert duplicate models to the same stool type (substantial reliability, κ = 0.72), but with only moderate reliability for Types 2 (63%, κ = 0.57) and 3 (62%, κ = 0.55). CONCLUSIONS The BSFS demonstrated substantial validity and reliability, although difficulties arose around clinical decision points (Types 2, 3, 5, 6) that warrant investigation in larger clinical populations. Potential for improving validity and reliability through modifications to the BSFS or training in its use should be explored.
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Affiliation(s)
- M R Blake
- Diabetes and Nutritional Sciences Division, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Nutrition and Dietetics, Monash University, Melbourne, Vic., Australia
| | - J M Raker
- Diabetes and Nutritional Sciences Division, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - K Whelan
- Diabetes and Nutritional Sciences Division, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Chumpitazi BP, Self MM, Czyzewski DI, Cejka S, Swank PR, Shulman RJ. Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterol Motil 2016; 28:443-8. [PMID: 26690980 PMCID: PMC4760857 DOI: 10.1111/nmo.12738] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rater reproducibility of the Bristol Stool Form Scale (BSFS), which categorizes stools into one of seven types, is unknown. We sought to determine reliability and agreement by individual stool type and when responses are categorized by Rome III clinical designation as normal or abnormal (constipation or diarrhea). METHODS Thirty-four gastroenterology providers from three institutions rated 35 stool photographs using the BSFS. Twenty rerated the photographs. KEY RESULTS 1190 individual stool type ratings were completed. Though only four photographs had absolute agreement (all Type 1 or Type 7), general agreement was high with 1132 (95.1%) of ratings being within one category type of the modal rating. Inter-rater and intra-rater reliability of the BSFS by individual stool type was excellent with intraclass correlations of 0.88 (95% CI: 0.86-0.90, p < 0.001) and 0.89 (95% CI: 0.86-0.91, p < 0.001), respectively. However, agreement decreased when using Rome III designations with 13 (37%) photographs having significantly diverging classifications (semi-interquartile range = 0.5). These 13 photographs were rated by the majority of raters as either type 2 vs type 3 or type 5 vs type 6 stools, representing the boundaries of normal vs abnormal stools. Inter-rater and intra-rater reliability of the BSFS by Rome III clinical categorization decreased with intraclass correlations of 0.75 (95% CI: 0.69-0.81, p < 0.001) and 0.65 (95% CI: 0.49-0.81, p < 0.001), respectively. CONCLUSIONS & INFERENCES The Bristol Stool Form Scale has excellent reliability and agreement when used to rate individual stool type by raters. However, BSFS reliability and agreement decreases when determining Rome III stool form categories.
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Affiliation(s)
- Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
| | - Mariella M. Self
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
| | - Sydney Cejka
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Paul R. Swank
- University of Texas School of Public Health, Houston, TX
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Section of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX,Children’s Nutrition Research Center, Houston, TX
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Surveillance of Food- and Smear-Transmitted Pathogens in European Soldiers with Diarrhea on Deployment in the Tropics: Experience from the European Union Training Mission (EUTM) Mali. BIOMED RESEARCH INTERNATIONAL 2015; 2015:573904. [PMID: 26525953 PMCID: PMC4619819 DOI: 10.1155/2015/573904] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/28/2023]
Abstract
Introduction. Since 2013, European soldiers have been deployed on the European Union Training Mission (EUTM) in Mali. From the beginning, diarrhea has been among the most “urgent” concerns. Diarrhea surveillance based on deployable real-time PCR equipment was conducted between December 2013 and August 2014. Material and Methods. In total, 53 stool samples were obtained from 51 soldiers with acute diarrhea. Multiplex PCR panels comprised enteroinvasive bacteria, diarrhea-associated Escherichia coli (EPEC, ETEC, EAEC, and EIEC), enteropathogenic viruses, and protozoa. Noroviruses were characterized by sequencing. Cultural screening for Enterobacteriaceae with extended-spectrum beta-lactamases (ESBL) with subsequent repetitive sequence-based PCR (rep-PCR) typing was performed. Clinical information was assessed. Results. Positive PCR results for diarrhea-associated pathogens were detected in 43/53 samples, comprising EPEC (n = 21), ETEC (n = 19), EAEC (n = 15), Norovirus (n = 10), Shigella spp./EIEC (n = 6), Cryptosporidium parvum (n = 3), Giardia duodenalis (n = 2), Salmonella spp. (n = 1), Astrovirus (n = 1), Rotavirus (n = 1), and Sapovirus (n = 1). ESBL-positive Enterobacteriaceae were grown from 13 out of 48 samples. Simultaneous infections with several enteropathogenic agents were observed in 23 instances. Symptoms were mild to moderate. There were hints of autochthonous transmission. Conclusions. Multiplex real-time PCR proved to be suitable for diarrhea surveillance on deployment. Etiological attribution is challenging in cases of detection of multiple pathogens.
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