Application of ursodeoxycholic acid in hepatobiliary scintigraphy for neonatal hyperbilirubinemia: comparison with phenobarbital

Early differentiation of biliary atresia from neonatal hepatitis is of utmost importance, since on time surgery of biliary atresia significantly improves the outcome. Hepatobiliary scintigraphy is an integral part of diagnosis work-up of these patients; however its specificity for diagnosis of biliary atresia is suboptimal. In this study we evaluated the value of ursodeoxycholic acid pre-treatment for improvement of hepatobiliary scintigraphy specificity. Thirty consecutive infants with direct heperbilirubinemia were included into the study. All infants underwent hepatobiliary scintigraphy with [99m]Tc-bromo iminodiacetic acid [[99m]Tc-BRIDA] twice [first after pre-treatment with phenobarbital and the other time after pre-treatment with ursodeoxycholic acid]. Of 30 patients included into our study 13 had final diagnosis of extrahepatic biliary atresia and 17 had neonatal hepatitis. Bowel was visualized in 11 patients with neonatal hepatitis after phenobarbital pre-treatment and in 16 after ursodeoxycholic acid pretreatment which amounts to 80% and 96.6% specificity for diagnosis of biliary atresia with phenobarbital and ursodeoxycholic acid respectively. All patients had complications of phenobarbital administration [lethargy, poor feeding, irritability, hypotonia, etc] to some extent. These findings decreased significantly after discontinuation of phenobarbital and were not present with ursodeoxycholic acid. Ursodeoxycholic acid is a safe and efficient drug for pre-treatment of patients with neonatal cholestasis syndrome who are going to undergo hepatobiliary scintigraphy. Compared to phenobarbital, this drug has fewer complications and is more efficient

[ effect of baclofen on treatment of infancy gastro-esophageal reflux disorder]

Transient lower esophageal sphincter relaxation [TLESR] is the major cause of gastro-esophageal reflux disorder [GERD] in patient with reflux disease. GERD is the most common esophageal disorder in children. The GABA agonist baclofen decreases acid reflux through the inhibition of TLESRs and should similarly decrease non-acid reflux. The aim of this study was to evaluate the effect of baclofen on GERD in children. Thirty children with GERD were included in this clinical trial. Baclofen 0.25 mg/kg was given for three months. End points were assessed for weeks and months. Baclofen significantly improved the weight gain pattern and the mean of weight gain demonstrated a significant difference between base line value and weight on consequent months after therapy [P<0.0001]. Restlessness showed a significant improvement between baseline and threes month after treatment [P<0.001].Vomiting significantly decreased on follow up visits [P<0.001]. It is also increased the time and volume of feeding significantly 3 month after treatment [P<0.001]. We have not found serious complications. Baclofen reduces the symptom of TLESRs and may have a role in treating GERD