Intestinal barrier integrity and function in infants with cholestasis

BACKGROUND/AIMS: The safety of the human body is maintained by effective monitoring of the mucosal surface integrity and protection against potentially harmful compounds. This function of the gut called intestinal barrier function can be affected by cholestasis and the absence of bile in the intestinal lumen. We aimed to determine whether the gut barrier integrity is impaired in infants with cholestasis by evaluation of the intestinal fatty acid binding proteins (I-FABP) and ileal bile acid binding protein (I-BABP) as markers of intestinal epithelial cell damage and plasma D-lactate level as a marker of gut wall permeability. METHODS: This case-control study included 53 infants with cholestasis and 29 controls. Serum levels of I-FABP, I-BABP, and D-lactate were measured in all subjects. RESULTS: Both groups of patients with neonatal hepatitis and biliary atresia showed significantly higher levels of I-FABP and I-BABP than the controls. There were no differences in the serum D-lactate level between the cases and controls. There was no difference between the two groups of patients (I and II) regarding any of the parameters studied. No significant correlations between serum levels of I-FABP, I-BABP, or D-lactate and total or direct bilirubin levels were found in the cholestatic infants. CONCLUSIONS: The intestinal epithelial barrier integrity is breached nearly in all parts of the intestine in infants with cholestasis. Further research is recommended to determine the impact of this finding on the management of these infants. The relationship between physical intestinal barrier damage and its functional failure remains subject for further research.

Clinico-laboratory study on children with auto-immune hepatitis in upper Egypt

Auto-immune hepatitis [AIH] in children is a rare chronic progressive liver disorder. It is characterized serologically by high aminotransferase levels, elevated immunoglobulin G [IgG] and the presence of autoantibodies. AIH is divided into two types according to the autoantibody profile. This study aims to assess frequency, clinical manifestations, biochemical features and outcome of AIH in children attending Assuit University Hospitals in Upper Egypt with acute icteric hepatitis and seronegative viral markers [anti-hepatitis A virus [HAV] IgM, HbsAg, anti-hepatitis C virus [anti-HCV] Ab]. The study includes 34 children with AIH, diagnosed on the basis of the International Scoring Criteria of Auto-immune Hepatitis, recruited from Assuit University Hospitals, during the period from January 2005 to December 2009. All patients received prednisolone 2 mg kg[-1] day[-1]. Follow-up was done for 1 year. Among 34 children diagnosed as AIH, 24 were females [70.5%] and 10 were males [29.5%]. Jaundice represented the most consistent finding in all patients. According to the autoantibody profile, 25 children were classified as type 1 and nine children were classified as type 2. Corticosteroid therapy was started. Complete remission was observed in 67.6% of patients and partial remission in 17.6%. There was no significant statistical difference in clinical and biochemical features of AIH in patients regarding the response to treatment. Mild side effects of steroid therapy were encountered in 48.2% of patients. After complete withdrawal of corticosteroids, six patients [20.7%] developed relapse. AIH type 1 was the main form of AIH in children referred to Assiut University Hospitals. Girls were more affected than boys. AIH type 1 exhibited a more active, ongoing immunologic process. Steroid alone can be used successfully in most cases. Children with AIH type 2 had a higher frequency of relapse after corticosteroid withdrawal. Further studies on a larger number of cases and long-term follow-up are recommended

Benign covuIsions with acute gastroenteritis in infants and young children

Seizures in diarrheic children may be due to several etiologies. However seizures may occur in the absence of an obvious cause which is called benign convulsions with gastroenteritis [BCWG]. The aim of this study is to describe the frequency, clinical characters and outcome of benign seizures with gastroenteritis in children attending Assiut University Children Hospital and its possible relationship to some pathogenic organisms. 62 patients with acute gastroenteritis and convulsions were recruited for the study and 35 children with acute gastroenteritis without convulsions were included as a control group They were 34 male and 28 female. The clinical data and electroencephalogram were recorded. Stool specimens from patients and controls were tested for Shigella spp, E. coil 0157. Stool radioimmunoassay for rotavirus was done. Follow up was done after recovery from seizure for one year in pediatric neurology outpatient clinic. The number of patients presented with seizures was 62 patients [34 boys and 28 girls]. Causes of convulsions could be detected in 29[46.8%] of the cases. in 33 cases [53.2%] of all studied patients no obvious causes for convulsions could be detected so they were considered as having BCWG. They were 11 girls and 22 boys. Rotavirus particles were present in 15 [45.5%] of BCWG cases and these cases had younger age, associated with more frequent motions, watery diarrhea, vomiting, thirst, more frequent seizures, earlier onset of seizures to onset of diarrhea and more frequent focal seizures. None of these patients showed recurrence of afebrile seizures later on and their developmental milestones remained normal during the one year follow up period. Benign convulsions with gastroenteritis are frequently associated with rotavirus infection, usually carry excellent prognosis and no need for prolonged antiepileptic therapy