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Van Arsdall MR, Nair S, Moye LM, Nguyen TT, Saleh ZM, Rhoads JM. Columnar Metaplasia of the Esophagus Presenting as Iron Deficiency Anemia in Children with Neurologic Impairment or Congenital Esophageal Atresia. Am J Case Rep 2022; 23:e937255. [DOI: 10.12659/ajcr.937255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Supriya Nair
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, USA
| | - Lindsay M. Moye
- Department of Pediatric Gastroenterology, Prisma Health, Greenville, USA
| | - Trinh T. Nguyen
- Department of Pediatrics, Baylor College of Medicine-Texas Children’s Hospital, Houston, USA
| | - Zeina M. Saleh
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, USA
| | - J. Marc Rhoads
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, USA
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Josyabhatla R, Tatevian N, Tchakarov AS, Cox CS, Van Arsdall MR. Chronic Diarrhea in an Infant With Malrotation: A Diagnostic Dilemma. JPGN Rep 2022; 3:e177. [PMID: 37168912 PMCID: PMC10158313 DOI: 10.1097/pg9.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/10/2022] [Indexed: 05/13/2023]
Abstract
In children, diarrhea has a global incidence of 2.7 episodes per child-year and contributes to significant disease burden and mortality in children under 5 years of age. Chronic diarrhea, defined as diarrhea lasting for more than 2 weeks, may be particularly challenging to evaluate and manage in children under 2 years of age. While most have infectious enteritis or cow milk protein intolerance, others have conditions such as malnutrition, anatomic abnormalities, or congenital enteropathies that can be challenging to diagnose and treat. We present here a complex case of chronic diarrhea in an infant and highlight such diagnostic and therapeutic challenges.
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Affiliation(s)
- Rohit Josyabhatla
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, UTHealth McGovern Medical School, Houston, TX
| | - Nina Tatevian
- Department of Pathology and Laboratory Medicine, UTHealth McGovern Medical School, Houston, TX; and
| | - Amanda S. Tchakarov
- Department of Pathology and Laboratory Medicine, UTHealth McGovern Medical School, Houston, TX; and
| | - Charles S. Cox
- Department of Pediatric Surgery, UTHealth McGovern Medical School, Houston, TX
| | - Melissa R. Van Arsdall
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, UTHealth McGovern Medical School, Houston, TX
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Alookaran J, Liu Y, Auchtung TA, Tahanan A, Hessabi M, Asgarisabet P, Rahbar M, Fatheree NY, Pearson DA, Mansour R, Van Arsdall MR, Navarro F, Rhoads JM. Fungi: Friend or Foe? A Mycobiome Evaluation in Children With Autism and Gastrointestinal Symptoms. J Pediatr Gastroenterol Nutr 2022; 74:377-382. [PMID: 34724444 PMCID: PMC8885784 DOI: 10.1097/mpg.0000000000003349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT Gastrointestinal (GI) symptoms often affect children with autism spectrum disorders (ASD) and GI symptoms have been associated with an abnormal fecal microbiome. There is limited evidence of Candida species being more prevalent in children with ASD. We enrolled 20 children with ASD and GI symptoms (ASD + GI), 10 children with ASD but no GI symptoms (ASD - GI), and 20 from typically developing (TD) children in this pilot study. Fecal mycobiome taxa were analyzed by Internal Transcribed Spacer sequencing. GI symptoms (GI Severity Index [GSI]), behavioral symptoms (Social Responsiveness Scale -2 [SRS-2]), inflammation and fungal immunity (fecal calprotectin and serum dectin-1 [ELISA]) were evaluated. We observed no changes in the abundance of total fungal species (alpha diversity) between groups. Samples with identifiable Candida spp. were present in 4 of 19 (21%) ASD + GI, in 5 of 9 (56%) ASD - GI, and in 4 of 16 (25%) TD children (overall P = 0.18). The presence of Candida spp. did not correlate with behavioral or GI symptoms (P = 0.38, P = 0.5, respectively). Fecal calprotectin was normal in all but one child. Finally, there was no significance in serum dectin-1 levels, suggesting no increased fungal immunity in children with ASD. Our data suggest that fungi are present at normal levels in the stool of children with ASD and are not associated with gut inflammation.
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Affiliation(s)
- Jane Alookaran
- Department of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Yuying Liu
- Department of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Thomas A. Auchtung
- Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, 68588, USA
| | - Amirali Tahanan
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Parisa Asgarisabet
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Mohammad Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Nicole Y. Fatheree
- Department of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Deborah A. Pearson
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Rosleen Mansour
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Melissa R. Van Arsdall
- Department of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - Fernando Navarro
- Department of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
| | - J. Marc Rhoads
- Department of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, 77030, USA
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Josyabhatla R, Kamdar AA, Armbrister SA, Daniel R, Boukas K, Smith KG, Van Arsdall MR, Kakarala K, Flores AR, Wanger A, Liu Y, Rhoads JM. Recognizing a MIS-Chievous Cause of Acute Viral Gastroenteritis. Front Pediatr 2021; 9:748368. [PMID: 34778138 PMCID: PMC8588082 DOI: 10.3389/fped.2021.748368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
Historically, children evaluated for vomiting and diarrhea secondary to viral enteritis have symptoms lasting 2-4 days and respond to supportive care, including oral rehydration and anti-emetics if required. Recently, within a 14-day timespan, we encountered three children with severe diarrhea who rapidly became dehydrated and went into hypotensive shock. Although SARS-CoV-2 molecular tests were negative by nasopharyngeal swab, all were later found to have MIS-C. This small case series underscores features reported in previous larger studies and emphasizes the rapid clinical evolution of this condition. We highlight the importance of early recognition of cardinal laboratory findings characteristic of MIS-C (i.e., lymphopenia, markedly elevated acute phase reactants, and hypoalbuminemia). We also show serologic evidence that the pathophysiological mechanism of SARS-CoV-2 related diarrhea may differ from other causes of dehydrating vomiting and diarrhea, with no serologic evidence of villus cell injury.
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Affiliation(s)
- Rohit Josyabhatla
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Ankur A Kamdar
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Shabba A Armbrister
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Rhea Daniel
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Konstantinos Boukas
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Critical Care Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Keely G Smith
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Melissa R Van Arsdall
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Kokila Kakarala
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anthony R Flores
- Children's Memorial Hermann Hospital, Houston, TX, United States.,Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Audrey Wanger
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yuying Liu
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jon Marc Rhoads
- Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Children's Memorial Hermann Hospital, Houston, TX, United States
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Ray P, Van Arsdall MR. Elevated Lipase during Initial Presentation of Ulcerative Colitis in a Pediatric Patient: Do We Check for It. Case Rep Gastroenterol 2016; 10:568-573. [PMID: 27920643 PMCID: PMC5121551 DOI: 10.1159/000450699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022] Open
Abstract
There are very few reports of elevated lipase in pediatric inflammatory bowel disease (IBD). Symptoms of pancreatitis may be masked by abdominal pain in pediatric IBD. During the initial presentation of IBD in our patient, lipase was elevated to more than 3 times the upper limit of normal. Normalization of values coincided with remission of IBD. This may be due to extraintestinal involvement of the pancreas as part of the inflammatory process or due to leakage of pancreatic enzymes from an inflamed gut or mediated by inflammatory cytokines. Checking pancreatic enzymes during initial presentation of IBD may, therefore, be important to determine if pancreatic involvement has resulted from the inflammation in IBD or as an adverse effect of therapy. If unchecked, recurrent subclinical pancreatitis may be masked by IBD symptoms and missed prior to starting IBD therapy. This may result in chronic pancreatic insufficiency as reported in 50% of adults with IBD. Early detection of elevated pancreatic enzymes in IBD may help direct the management strategy, as treatment of the underlying inflammation in IBD may be the most important management for resolution of pancreatitis instead of cessation of therapy for fear of iatrogenic medication-induced pancreatitis.
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Affiliation(s)
- Piyali Ray
- University of Texas Health Science Center, Houston, Tex., USA
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