The pattern of gastroesophageal reflux in asthmatic children

The association between gastroesophageal reflux (GER) and asthma is not fortuitous. The objective of our study was to test a group of children with asthma by, 24 hr gastroesophageal pH monitoring and to relate the results to the patients medical history and clinical data. We studied 77 children aged from 39 to 170 months suffering from particularly recurrent and/or therapy-resistant asthma. Medical history data were collected for each patient and included: severity and characteristics of respiratory symptoms, presence, if any of allergy; presence, if any, of GER-related symptoms; and presence, if any, of esophagitis-related symptoms. Esophageal pH was measured by 24 hr computerized monitoring of the main measures in all patients. Forty-seven children were also examined by gastroesophageal endoscopy. The prevalence of GER was 61% on the basis of the reflux index (cutoff: 4.2%). Gastroesophageal reflux in these asthmatic children was characterized mainly by short-lasting daytime episodes. The patients tended to present GER mainly associated with vomiting but not with signs and symptoms of esophagitis. The short-lasting nature of the reflux episodes demonstrates good esophageal clearance. The time of onset of respiratory symptoms (day/night) was not associated with any particular type of GER, the severity of which tends to be proportional to the seriousness of the asthma. No correlation was found between GER and allergy. No statistically significant differences were found in clinical or medical history findings between patients with pathologic and nonpathologic GER.

[Current role of antidopaminergic drugs in pediatrics]

The treatment of gastrointestinal disorders in pediatrics is based on the use of prokinetic agents; amongst these prokinetic compounds, cholinomimetic drugs and dopamine antagonists (metoclopramide, domperidone) are principally available. Metoclopramide is an antidopaminergic benzamide with mainly antiemetic effects, due to the interaction with dopamine receptors in the central trigger zone. Another effect is to enhance the transit of material through the gastrointestinal tract. Disadvantages in the use of metoclopramide are neurological effects (asthenia, sleepiness), extrapyramidal dyskinetic reactions and/or neuroendocrine side effects (galactorrhea). Domperidone is a pure dopaminantagonist that accelerates gastric emptying. It is useful in the treatment of acute nausea and vomiting caused by different agents. There are adverse effects only if it is used in parenteral way.

[Approach to constipation in children]

This article presents a diagnostic and therapeutic approach to children with constipation. Causes of constipation can be organic or non-organic (functional). Functional constipation may lead to functional fecal retention. The history and physical examination are most important. Laboratory and radiologic examinations are not warranted in the majority of children.

Psychological problems connected to the dietary restrictions in the adolescent with coeliac disease

AIMS

To assess the influence of dietary restrictions on psychological development in adolescents with coeliac disease.

DESIGN

Statistical analysis on coeliac patients on gluten-free diet who agreed to answer the questionnaire.

SETTING

Children with coeliac disease on gluten-free diet followed by the Department of the Pediatric Division of the City Mayor Hospital, Chair of Paediatrics, Verona University.

SUBJECT

39 patients (15 male and 24 female) from 10 years old to 21 who chose to answer a questionnaire of 25 questions dealing with the psychological implications of coeliac disease and with the need of following a particular dietary regime, in the presence of a psychologist. The questionnaire was made up of 6 SIGNALLING questions, 15 EVALUATING questions, 4 FILTER questions. They also filled up an information sheet on the composition and social position of the family.

RESULTS

Fathers were on average 45.5 years old, mothers 43. Only 2 parents had no educational qualifications. Father's professions were of various kinds, 22 mothers were housewives. Only 4 patients were only children, 22 had one brother or sister. 13 patients only out of 39 claimed not to have been admonished by their parents, though, showed a conflictual relationship with food. The awareness of their difference from friends was: a) lack in children 10 to 12, b) uneasiness in adolescents 13 to 17, c) maturation and consensus in older patients. A significant number of patients feel different from their friends and these patients showed a latent envy to friends on free diet. A sense of latent envy towards the condition of independence was exhibited by patients who felt different from friends.

CONCLUSIONS

The acceptance of a gluten-free diet is problematic for the majority of coeliac children and adolescents, particularly for those between 12 and 17. In this group the search of an individual personality is disturbed. Difficulties connected with gluten-free diet seem to be absent in the family environment, whereas difficulties emerge significantly when relating with friends. The number of cases of our study was limited but we consider these conclusions quite significant.

DESCRIPTORS

Gluten-free diet, adolescents and children, relationship with parents, relationship with friends.

The intestinal ecosystem in chronic functional constipation

Chronic functional constipation is common in infants, and the bacterial composition of stools in this condition is not known. The study aims were to: (i) investigate the composition of the intestinal ecosystem in chronic functional constipation; (ii) establish whether the addition of the water-holding agent calcium polycarbophil to the diet induces an improvement in constipation; and (iii) determine the composition of the intestinal ecosystem after the use of this agent. In total, 42 children (20F, 22M; mean age: 8.6 +/- 2.9 y) were studied. Twenty-eight children with functional chronic constipation without anatomical disorders were treated double-blind in random sequence for 1 month with an oral preparation of calcium polycarbophil (0.62 g/twice daily) or placebo. Intestinal flora composition was evaluated by standard microbiological methods and biochemical assays on faecal samples collected before and after treatment. Fourteen healthy children were studied as controls. The results show that (i) the constipated children presented a significant increase in clostridia and bifidobacteria in faeces compared to healthy subjects--different species of clostridia and enterobacteriaceae were frequently isolated; no generalized overgrowth was observed; Clostridia outnumbered bacteroides and E. coli mean counts by 2-3log, while bacteroides and E. coli counts were similar (5-6 log10/g fresh faeces); these intestinal disturbances could be defined as a dysbiosis, i.e. a quantitative alteration in the relative proportions of certain intestinal bacterial species. (ii) Clinical resolution of constipation was achieved only in 43% of treated children and an improvement in 21% (one bowel movement every 2 d). (iii) Calcium polycarbophil treatment induced no significant changes in the composition of the intestinal ecosystem, nor in blood chemistry parameters.

The intestinal ecosystem in chronic functional constipation

Chronic functional constipation is common in infants, and the bacterial composition of stools in this condition is not known. The study aims were to: (i) investigate the composition of the intestinal ecosystem in chronic functional constipation; (ii) establish whether the addition of the water-holding agent calcium polycarbophil to the diet induces an improvement in constipation; and (iii) determine the composition of the intestinal ecosystem after the use of this agent. In total, 42 children (20F, 22M; mean age: 8.6 +/- 2.9 y) were studied. Twenty-eight children with functional chronic constipation without anatomical disorders were treated double-blind in random sequence for 1 month with an oral preparation of calcium polycarbophil (0.62 g/twice daily) or placebo. Intestinal flora composition was evaluated by standard microbiological methods and biochemical assays on faecal samples collected before and after treatment. Fourteen healthy children were studied as controls. The results show that (i) the constipated children presented a significant increase in clostridia and bifidobacteria in faeces compared to healthy subjects--different species of clostridia and enterobacteriaceae were frequently isolated; no generalized overgrowth was observed; Clostridia outnumbered bacteroides and E. coli mean counts by 2-3log, while bacteroides and E. coli counts were similar (5-6 log10/g fresh faeces); these intestinal disturbances could be defined as a dysbiosis, i.e. a quantitative alteration in the relative proportions of certain intestinal bacterial species. (ii) Clinical resolution of constipation was achieved only in 43% of treated children and an improvement in 21% (one bowel movement every 2 d). (iii) Calcium polycarbophil treatment induced no significant changes in the composition of the intestinal ecosystem, nor in blood chemistry parameters.

Respiratory quotient changes in full term newborn infants within 30 hours from birth before start of milk feeding

OBJECTIVE

To evaluate substrate utilization in full-term newborn infants, fed every 3-4 h with glucose 10% solution, within 30 h from birth.

DESIGN

Random.

SETTING

Full term newborn infants at the Paediatric Division City Major Hospital, Chair of Paediatrics, Verona University.

SUBJECTS

Forty-six newborn infants, 24 females and 22 males of 39+/-2 weeks gestational age.

METHODS

Oxygen consumption (VO2) and CO2 production (VCO2) were measured. Permitting the computation of the respiratory quotient (RQ), which expresses substrate oxidation, at 6 and 30 h from birth. An indirect calorimeter (Deltratrac TMII-MBM-200-DATEX) was used to measure components of energy-balance.

RESULTS

Energy expenditure calculated at 6 h was 8.130 (+/-1.5757) kJ/kg/h. At 30 h the value changed to 8.858 (+/-1.483) kJ/kg/h. Statistical evaluation (t-student) showed a significant (P=0.000) variation in RQ values (6 h: RQ=0.94; 30 h: R=0.88).

CONCLUSIONS

Respiratory quotient suggests an increase of energy derived from fat metabolism at 30 h from birth. Our data confirm that early breast feeding or formula milk feeding could represent a physiological approach to nutritional regimen of the newborn infant.

[Adolescents and celiac disease: psychological aspects]

Many studies have been carried out on different aspects of coeliac disease in children and adolescents. However, little has been done on how these patients experience their situation and how they cope with dietary treatment. A group of 39 children and adolescents with coeliac disease participated in a controlled questionnaire study. Conclusions are that the acceptance of a gluten-free diet is problematic for the majority of children and adolescents affected by coeliac disease; in particular in the 12 to 17 year old group, that is in that period of life in which the individual tends to oppose the adult world, in search of an individual personality. This search is disturbed in the majority of coeliac patients. The feelings of difficulty connected to the gluten-free diet appear to be almost absent in the family environment, whereas they emerge significantly at times of meeting and sharing with friends.

[Helicobacter pylori infection as a cause of recurrent abdominal pain in children]

Several reports indicate that Helicobacter pylori plays a role in recurrent abdominal pain in children and adolescents. The aim of our study is to determine the prevalence of H. pylori among Verona children with and without recurrent abdominal pain. 309 patients were tested for the presence of anti-H. pylori IgG in a blood sample. Among 43 children with recurrent abdominal pain, the prevalence of H. pylori infection was 25.58%, while the prevalence of H. pylori infection in children without abdominal symptoms was 4.88%. Sensitivity and specificity of serology were respectively 81.8% and 87.5%. We conclude that endoscopic examination cannot be replaced by serological test.

[Prevalence of HCV antibodies and vertical transmission of hepatitis C virus]

HCV infection is one of the most frequent causes of hepatitis in man. There are numerous means of infection, not all of which can be documented. In infancy HCV infection occurs particularly in children that have been multitransfused or are on dialysis. Vertical transmission of HCV infection is rare, and the times and means of occurrence are not as yet well defined. The present study sets out to establish the prevalence of HCV-Ab carriers within a population of 4,242 pregnant women in Verona (Italy). It also aims to assess the incidence of vertical transmission of HCV infection in a sample of newborns examined over a 15-months follow-up. Of the 4,242 pregnant women subjected to screening, 45 (1.06%) were HCV-Ab positive. In only 74% of the cases it was possible to identify an HCV infection risk factor. On the 45 children of the HCV positive mothers, at present 25 have completed the 15 months follow-up. Only one of these children has contracted the infection: the incidence of transmission is therefore 4%.

[Alpha-interferon in the treatment of chronic hepatitis C in children]

The hepatitis C virus is the main causative agent for sporadic as well as parenteral cases of non-A non-B hepatitis. Alpha interferon is a biologically active protein produced by B lymphocytes and monocytes which can be manufactured by recombinant DNA technology. Treatment of chronic hepatitis C with interferon in adults is associated with a sustained response in 20-25% of treated cases. First studies provide encouraging results for the use of interferon in the treatment of chronic hepatitis C in children, but controlled trials using this drug in a larger population of children are needed.

[A case of slowly resolving enteritis caused by Clostridium difficile]

Clostridium difficile is considered as the most important cause of severe antibiotic-associated diarrhea and pseudomembranous colitis. We describe the case of an one year old boy presenting C. difficile chronic diarrhea without previous antibiotic treatments.

Latex allergy in a child with banana anaphylaxis

Allergy to latex and to banana is probably uncommon. Cross-reactivity between these two antigens has been recently demonstrated, but the clinical association of allergic reactions to latex contact and banana ingestion is extremely rare. We report a 3-year-old boy who developed an anaphylactic reaction following banana ingestion and who presented an associated immediate hypersensitivity to latex.

[Gastroesophageal reflux and respiratory pathology: a study comparing radiology and intraesophageal pH measurement]

From November 1st, 1992 to August 31st, 1993 45 children with respiratory symptoms of gastroesophageal reflux (GER) were tested with barium esophagogram and 24 h intraesophageal pH-monitoring to determine their sensitivity in detecting gastric acid reflux and to document their usefulness as a prognostic indicators. Results showed that thirty-seven of these patients had GER on esophagograms and that 24 h intraesophageal pH monitoring was positive in thirty-nine patients. However, we found a high incidence of false-negative results of the upper gastrointestinal series when the pH monitoring was positive.

[Intraesophageal pH measurement in childhood: the technic and indications]

This review evaluates methodologic problems concerning esophageal pH monitoring in pediatric patients. Prolonged intraesophageal pH recording (twenty-two or twenty-four hour) is considered as the gold standard for all reflux investigations. The indications to pH monitoring and the interpretation of long-term pH studies data are discussed in details in the paper.

[Congenital hepatic fibrosis: a report of a case in a child with Down's syndrome]

An association of congenital hepatic fibrosis and Down syndrome in an 8-year-old boy is described. The child presented a form of congenital hepatic fibrosis with portal hypertension, splenomegaly and platelets loss. In the patient's family there are no manifestations of hepatic and renal disease.

[Gastroesophageal reflux and bronchial asthma: pH-metric patterns in non allergic children]

The presence of gastroesophageal reflux (GER) was studied, by computerized 24 hours intraesophageal pH monitoring, in 27 asthmatic children (16 M - 11 F; mean age 75.04 months) without allergy and in absence of medical treatment for at least ten days. Patient were divided in 3 groups: Group A (11 cases): subjects with Reflux Index (R.I. = percentage of time pH < 4) more than 4.2% and with GER percentage of time in standing position > supine position (p < 0.001). Group B (6 cases): subjects with R.I. more than 4.2% and with GER percentage of time in standing position < supine position (p = 0.05). Group C (10 cases): subjects with R.I. less than 4.2%. A group D (10 cases): normal children considered as control. The group A ("daily refluxes") resulted as the most numerous, in contrast to the studies up to now followed. The total number of refluxes resulted with no significant difference in groups A, B and C, but a significant prevalence of this number was noted in the group C against group D. Therefore, the parameter "Total number of refluxes in 24 hours" characterizes in our opinion, on the pH monitoring, children with bronchial asthma and without allergy.

[Clinical-etiological correlations in 94 cases of acute infantile diarrhea]

The Authors consider the clinical and etiological correlations in 94 children (0-36 months) with acute diarrhoea, hospitalised in 1989. They compare epidemiological data (sex, age, seasonality), clinical data (fever, vomiting, distinctive features of diarrhoea, abdominal pain) and laboratory data with the main etiological agents isolated.

[Hypertrophic pyloric stenosis. A unique familial case]

The paper reports the case of family in which the mother and sons were affected by hypertrophic pyloric stenosis. Epidemiological, etiopathogenetic and diagnostic aspects of the disease are taken into account.