Nutritional benefits in pediatric patients with percutaneous endoscopic gastrostomy placement

Gastrostomy is an enteral nutrition option. Indications for its placement are diverse, among them, the alteration in the mechanics of swallowing, frequently present in patients with neurological diseases. Nutritional recovery is the objective in these patients evaluating the nutritional status after the placement of a PEG in the pediatric population. This is a retrospective cohort conducted to evaluate nutritional recovery in pediatric patients with PEG placement. It was performed using anthropometric and biochemical parameters before and after placement. Forty-seven subjects were included, from which weight, height, and upper arm circumference were obtained, to evaluate nutritional recovery using BMI or W/L according to age. Significant nutritional improvement was demonstrated in a population of 39 patients, who had a mean follow-up of 7 months. In our population, PEG is an enteral nutrition strategy that has a significant positive impact on nutritional status in a mean of 7 months after its placement. Therefore, considering the evolution time of these patients will guide the clinician in making decisions regarding surveillance and monitoring parameters of the nutritional status.

Gut Microbiota in Mexican Children With Acute Diarrhea: An Observational Study

BACKGROUND

Acute diarrhea is the second leading cause of preventable mortality and morbidity in children worldwide. This study aimed to identify the main pathogens associated with acute diarrhea and to describe changes in gut microbiota in Mexican children.

METHODS

This single-center observational study included 30 children (6 months to 5 years old) with acute diarrhea who were referred to the Instituto Nacional de Pediatría of Mexico City and 15 healthy volunteers (control group). Stool samples at day 0 (D0) and day 15 (D15) were collected for identification of microorganisms (reverse transcriptase-polymerase chain reaction analyses with xTAG gastrointestinal pathogen panel multiplex assay) and microbiota analysis (16S gene amplification sequencing). Prescription decisions were made by the treating clinician.

RESULTS

The main pathogens identified were norovirus and Campylobacter jejuni (20% each). The majority of patients (n = 24) were prescribed Saccharomyces boulardii CNCM I-745 for treatment of acute diarrhea. Diarrheic episodes resolved within 1 week of treatment. Compared with D15 and control samples, D0 samples showed significantly lower alpha diversity and a clear shift in overall composition (beta diversity). Alpha diversity was significantly increased in S. boulardii-treated group between D0 and D15 to a level similar to that of control group.

CONCLUSIONS

In these children, acute diarrhea was accompanied by significant alterations in gut microbiota. S. boulardii CNCM I-745 treatment may facilitate gut microbiota restoration in children with acute diarrhea, mostly through improvements in alpha diversity.

Functional Constipation and the Gut Microbiome in Children: Preclinical and Clinical Evidence

Functional constipation is a common condition in childhood with significant impact on patients' quality of life and on health care resources. Functional constipation is characterized by decreased bowel movements and/or hard stools, which cause significant distress for children and their caregivers. While the term "functional" may imply the absence of organic causes with a focus on behavioral aspects, 40% of children continue to have symptoms beyond conventional management with one in four children continuing to experience constipation into adulthood. The refractory and chronic nature of constipation highlights the importance of considering a range of pathophysiological mechanisms, including the potential role of the gut microbiome. In this review, we provide an overview of preclinical and clinical studies that focus on the potential mechanisms through which the gut microbiome might contribute to the clinical presentation of functional constipation in pediatrics.

Ingestión de cuerpo extraño (batería de botón) con presentación atípica en el lactante. Reporte de caso y revisión de la bibliografía

ANTECEDENTES: El estridor es un sonido respiratorio, de tono alto, generado por el flujo turbulento de aire a través de una vía aérea estrecha, con diagnóstico diferencial que incluye procesos infecciosos y no infecciosos, incluida la ingestión de cuerpos extraños.CASO CLÍNICO: Lactante de 11 meses de edad, previamente sano, con estridor súbito y rechazo de la alimentación de 5 días de evolución. Recibió 2 esquemas antimicrobianos sin mejoría, de manera fortuita se detectó, en la radiografia de tórax, un objeto redondeado, radiopaco, localizado en el tercio superior del esófago. Por vía endoscópica se extrajo un cuerpo extraño, tipo pila de botón, que dejó una lesión ulcerada con áreas de necrosis (Zargar IIB). Se trató con antibióticos de amplio espectro, esteroides y nutrición parenteral. Su evolución fue satisfactoria, sin complicaciones. En la endoscopia de control a las 6 semanas se advirtió una cicatriz en la zona afectada.CONCLUSIONES: El estridor agudo y la tos acompañados de manifestaciones gastrointestinales: vómito y rechazo a la alimentación en lactantes y preescolares sin antecedente de infección, obligan a descartar la existencia de cuerpos extraños y a practicar estudios de extensión y extracción endoscópica oportuna, sobre todo en el caso de las baterías de botón.

Manejo de la ingesta de cuerpos extraños por vía digestiva

El tratamiento de pacientes pediátricos que de manera accidental ingieren cuerpos extraños es un reto para el médico general, pediatra, gastroenterólogo y endoscopista. La Asociación Americana del Centro de Control de Intoxicaciones reportó que 75% de más de 116,000 casos suceden en menores de 5 años (6 meses a 3 años) y 98% son accidentales. Principalmente: monedas, juguetes, partes de juguetes, pines, huesos, bolos de comida, joyería, imanes y baterías de botón.

A patient with esophageal achalasia and common variable immunodeficiency: A Case report and review of the literature

BACKGROUND: Esophageal achalasia is characterized by defective esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter secondary to degeneration of the myenteric plexus. The exact pathophysiological mechanism through which the myenteric plexus is damaged is not fully understood, but increasing evidence suggests that autoimmunity may play a role. Patients with primary immunodeficiencies often develop autoimmunity, and recent studies have shown an increased prevalence of autoimmune diseases in patients with esophageal achalasia.CLINICAL CASE: We present the case of an 18-year-old female with a history of common variable immunodeficiency and a high degree of autoimmunity (alopecia, vitiligo and autoimmune thyroiditis), who presented with rapidly progressive dysphagia, chest pain, and food regurgitation. A barium swallow and a high-resolution esophageal manometry were performed, and she was diagnosed with type III esophageal achalasia, the least common subtype (10%).CONCLUSION: Patients with primary immunodeficiencies often develop autoimmunity and may be at increased risk of developing esophageal achalasia. Further research is warranted in order to elucidate the role of autoimmunity in esophageal achalasia. 

Sobrecrecimiento bacteriano en el intestino delgado: una causa de dolor abdominal crónico en niños

El sobrecrecimiento bacteriano en el intestino delgado (SBID) es causa de dolor abdominal crónico, diarrea, distensión abdominal y flatulencias en la población pediátrica. El uso de inhibidores de bomba de protones, algunas anomalías anatómicas y alteraciones en la motilidad gastrointestinal son factores de riesgo de SBID. El diagnóstico se establece con base en la prueba de hidrogeniones y de metano, o por medio del cultivo del aspirado duodenal/yeyunal. El tratamiento consiste en: rifaximina, dieta con restricción de oligosacáridos, disacáridos, monosacáridos y polioles fermentables (FODMAPs), y probióticos.

Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review

Small intestinal bacterial overgrowth (SIBO) is a heterogenous and poorly understood entity characterised by an excessive growth of select microorganisms within the small intestine. This excessive bacterial biomass, in turn, disrupts host physiology in a myriad of ways, leading to gastrointestinal and non-gastrointestinal symptoms and complications. SIBO is a common cause of non-specific gastrointestinal symptoms in children, such as chronic abdominal pain, abdominal distention, diarrhoea, and flatulence, amongst others. In addition, it has recently been implicated in the pathophysiology of stunting, a disease that affects millions of children worldwide. Risk factors such as acid-suppressive therapies, alterations in gastrointestinal motility and anatomy, as well as impoverished conditions, have been shown to predispose children to SIBO. SIBO can be diagnosed via culture-dependant or culture-independent approaches. SIBO's epidemiology is limited due to the lack of uniformity and consensus of its diagnostic criteria, as well as the paucity of literature available. Antibiotics remain the first-line treatment option for SIBO, although emerging modalities such as probiotics and diet manipulation could also have a role. Herein, we present a state-of-the-art-review which aims to comprehensively outline the most current information on SIBO in children, with particular emphasis on the gut microbiota.

Blastocystis Hominis and Chronic Abdominal Pain in Children: Is there an Association between Them?

Chronic abdominal pain has many etiologies, one of them being parasites. The aim of this study was to find an association between chronic abdominal pain in children and Blastocystis hominis (Bh). Clinical files of patients with Bh and functional abdominal pain were reviewed. A comparison was made between patients who showed an improvement of their symptoms and those who did not. Out of the 138 patients who had functional abdominal pain and Bh, 37 patients did not receive any treatment (26.8%), while 101 received it and were treated with different antimicrobial agents (73.2%); regarding the improvement of symptoms, a statistically significant difference (p < 0.001) was observed. Chronic abdominal pain in children has different etiologies; however, we have documented through this work that it is appropriate to provide antimicrobial treatment for patients with Bh and chronic abdominal pain.

Métodos de evaluación de desnutrición intrahospitalaria en niños

OBJETIVO: Describir las distintas herramientas de cribado para el diagnóstico de desnutrición intrahospitalaria y comparar sus diferencias. MATERIAL Y MÉTODO: Estudio comparativo y retrospectivo de búsqueda bibliográfica en las bases de datos Scientific Electronic Library Online (SciELO), Red Informática de Medicina Avanzada (RIMA), Plataforma HIGHWIRE, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Medline. Las palabras clave de búsqueda fueron: herramientas de cribado nutricional, desnutrición intrahospitalaria y diagnóstico de malnutrición intrahospitalaria. RESULTADOS: Se encontraron seis herramientas de cribado pero ninguna estandarizada para la edad que valoran, miden diferentes parámetros y evalúan de distintas formas el riesgo de desnutrición intrahospitalaria. Ninguna puede considerarse patrón de referencia ni tampoco son comparables entre sí. La sensibilidad y especificidad que publica cada una de las herramientas no sustentan que alguna pruebe mejor o peor pronóstico en niños hospitalizados.CONCLUSIONES: Si bien todas las herramientas estudiadas pretenden orientar la conducta médica para lograr intervenciones dietéticas oportunas, todas son subjetivas y sumamente específicas para el lugar en el que se aplican. Desde luego que se requiere la estandarización que atienda las necesidades propias del lugar en donde van a aplicarse. El Instituto Nacional de Pediatría requiere una herramienta específica para las condiciones en que se labora en este hospital; por tanto, y con base en la variabilidad de las herramientas comparadas, se propone diseñar una herramienta de fácil aplicación que permita evaluar oportuna y rápidamente el riesgo nutricional de nuestros pacientes.PALABRAS CLAVE: Malnutrición; niños hospitalizados.

Childhood obesity in Mexico: social determinants of health and other risk factors

Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.

Constipación funcional en pediatría: Criterios de Roma IV, diagnóstico y tratamiento

La constipación (o estreñimiento) en pediatría es una de las entidades pediátricas más comunes que el médico general y el pediatra ven en la práctica diaria. Es la causa gastrointestinal más común que resulta en la derivación del paciente a especialistas, causa significativa de ansiedad en los padres. La constipación en pediatría es funcional en 90-95% de los casos. El diagnóstico continúa siendo basado en los criterios de Roma IV. El tratamiento consiste en una etapa de desimpactación y una de mantenimiento.

Constipación funcional en pediatría: Criterios de Roma IV, diagnóstico y tratamiento

La constipación (o estreñimiento) en pediatría es una de las entidades pediátricas más comunes que el médico general y el pediatra ven en la práctica diaria. Es la causa gastrointestinal más común que resulta en la derivación del paciente a especialistas, causa significativa de ansiedad en los padres. La constipación en pediatría es funcional en 90-95% de los casos. El diagnóstico continúa siendo basado en los criterios de Roma IV. El tratamiento consiste en una etapa de desimpactación y una de mantenimiento.