Celiac Disease in South Jordan / 대한소아소화기영양학회지

PURPOSE: Celiac disease, an autoimmune enteropathy triggered by exposure to gluten, is not uncommon in South Jordan. However, its prevalence is underestimated due to lack of physician awareness of the diversity of disease presentation. The clinical spectrum includes classic gastrointestinal manifestations, as well as rickets, iron-deficiency anemia, short stature, elevated liver enzymes, and edema. Our goal was to evaluate celiac disease presentation in clinically diagnosed children. METHODS: Retrospective study included all children diagnosed with celiac disease between September 2009 and September 2015. Hospital charts were reviewed. Demographic data, clinical characteristics, and follow-up were recorded. RESULTS: Thirty-five children were diagnosed with celiac disease during the study period. Mean age±standard deviation was 6.7±3.8 years (range, 2.0–14 years). There were 17 (48.6%) female patients. The average duration between onset of symptoms and diagnosis was 16.3±18.7 months. Fifteen (42.9%) patients presented with classic malabsorption symptoms, whereas 7 (20.0%) patients presented with short stature. Positive tissue transglutaminase antibodies (tTg)-immunoglobulin A (IgA) was seen in 34 (97.1%) patients. The one patient with negative tTg-IgA had IgA deficiency. Although tTG-IgA values were not available for objective documentation of compliance, clinical data (resolution of presenting abnormalities and growth improvement) assured acceptable compliance in 22 (62.9%) patients. CONCLUSION: CD in children may present with diverse picture. Although of the small number, the non-classical presentations are not uncommon in our rural community. Gluten-free diet is the main strategy for treatment and associated with usually correction of laboratory abnormalities and improvement of growth.

Celiac Disease in South Jordan / 대한소아소화기영양학회지

PURPOSE: Celiac disease, an autoimmune enteropathy triggered by exposure to gluten, is not uncommon in South Jordan. However, its prevalence is underestimated due to lack of physician awareness of the diversity of disease presentation. The clinical spectrum includes classic gastrointestinal manifestations, as well as rickets, iron-deficiency anemia, short stature, elevated liver enzymes, and edema. Our goal was to evaluate celiac disease presentation in clinically diagnosed children. METHODS: Retrospective study included all children diagnosed with celiac disease between September 2009 and September 2015. Hospital charts were reviewed. Demographic data, clinical characteristics, and follow-up were recorded. RESULTS: Thirty-five children were diagnosed with celiac disease during the study period. Mean age±standard deviation was 6.7±3.8 years (range, 2.0–14 years). There were 17 (48.6%) female patients. The average duration between onset of symptoms and diagnosis was 16.3±18.7 months. Fifteen (42.9%) patients presented with classic malabsorption symptoms, whereas 7 (20.0%) patients presented with short stature. Positive tissue transglutaminase antibodies (tTg)-immunoglobulin A (IgA) was seen in 34 (97.1%) patients. The one patient with negative tTg-IgA had IgA deficiency. Although tTG-IgA values were not available for objective documentation of compliance, clinical data (resolution of presenting abnormalities and growth improvement) assured acceptable compliance in 22 (62.9%) patients. CONCLUSION: CD in children may present with diverse picture. Although of the small number, the non-classical presentations are not uncommon in our rural community. Gluten-free diet is the main strategy for treatment and associated with usually correction of laboratory abnormalities and improvement of growth.

Cow's milk protein allergy in south Jordan

Cow's milk protein allergy [CMPA] is the most common food allergy during infancy. Clinical presentation is of tremendous importance for diagnosis. Data from our part of the world is scarce. Our aim is to study the spectrum of symptoms, management and outcomes of children with CMPA in Jordan. A pre-validated clinical definition of CMPA was adopted. All patients with CMPA followed at our clinic during the study period [Nov 2009-June, 2013] were identified. Patients who met the definition were included; their medical charts were reviewed, regarding their demographics, clinical presentations, therapeutic intervention and outcome. Data were analyzed and presented as averages and percentages. Over the study period, 40 patients were identified. Twenty-five patients met the adopted definition. Sixteen patients [64%] were males. The average age of presentation was 4.7 mo. Twenty-four patients [96%] had at least one or more gastrointestinal symptom, while dermatological and respiratory involvement were seen in 8 patients [32%]. Three patients [12%] had elevated transaminases. The response rate to Soya-based formula was 76% while response to amino acid formula was 100%. CMPA is not uncommon. Clinical presentations are diverse. Gastrointestinal manifestations were the most common presentation in our cohort. Elevated liver enzymes can be unusual presentation of CMPA. Larger studies are needed to estimate the size of the problem in our population

Clinical Characteristics of Pediatric Constipation in South Jordan / 대한소아소화기영양학회지

PURPOSE: Constipation is a common pediatric problem worldwide. This study aims to describe the clinical characteristics of pediatric constipation in south Jordan according to gender and age group. METHODS: All patients with constipation managed at our pediatric gastroenterology service between September 2009 and December 2012 were included. Hospital charts were reviewed. Demographic data, clinical characteristics, and final diagnosis were recorded. Data were analyzed according to gender and the following age groups: infants, pre-school, school age, and adolescents. RESULTS: During the study period, 126 patients were enrolled. The number (percentage) of patients according to age were the following infants: 43 (34.1%), pre-school: 55 (43.7%), school age: 25 (19.8%), and adolescents: 3 (2.4%). Males made up 54.8% of the study population. There were no statistical gender differences in any age group. The most common symptom in all age groups was dry, hard stool. Infrequent defecation was found in almost one-half of the patients. Fecal incontinence was more common in school-aged children compared to pre-school-aged children and adolescents. Abdominal pain was seen in almost 40% of the constipated children. Abdominal pain was more prevalent in girls and older children. Fecal mass in the rectum was the most common physical finding, with constipated boys exhibiting higher rates. Functional constipation was the most common etiology. CONCLUSION: Clinical characteristics of constipation in children vary according to age group and gender. Older children had less frequent bowel motions, a longer duration of symptoms, and a higher prevalence of long-standing constipation compilations (fecal incontinence and abdominal pain).

Celiac crisis with severe hypokalemia and paraplegia as a first presentation of celiac disease in a child

Celiac disease is an autoimmune disorder, affecting the small intestine primarily, leading to severe villous loss. A celiac crisis is a rare complication of celiac disease, typically affecting children below two years of age, characterized by explosive watery diarrhea, impressive abdominal distension, dehydration, hypotension and lethargy. This severe picture is accompanied by profound electrolyte abnormalities including dangerously low potassium levels and severe acidosis. The awareness of the condition could lead to prompt diagnosis and prevent significant morbidity