Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Hematological findings among Jordanian children with celiac disease at presentation: a retrospective analytical study

To describe the hematological findings among children with celiac disease on presentation. This is a retrospective review which was conducted in the Pediatric Gastroenterology Department at Queen Rania Al Abdullah Hospital for Children. The records of children with celiac disease were reviewed between January 2006 and December 2012. The age of children included in the study was less or equal to 14 years on diagnosis. Complete blood count, serum ferritin, folate, vitamin B12, prothrombin time, partial prothrombin time, international normalized ratio, and tissue glutaminase antibody [IgA and IgG] were performed for all patients prior to the diagnosis. Upper gastrointestinal endoscopy was performed for all children included in the study and multiple duodenal biopsies samples were obtained during the procedure for routine histological analysis. A total of 111 children were included in the study; 53 [47.7%] were males and 58 [52.3%] were females. The mean age at diagnosis was 9 years. All children had positive tissue glutaminase antibody IgA, IgG, or both. Eleven children had leukopenia, 13 had lymphopenia, two had neutropenia, while eight had eosinophilia. Thirty four [30.4%] children had anemia. Twenty eight [25.2%] children had serum ferritin less than 7ng/ml, 30 [27%] had serum folate less than 5ng/ml and 9 [8.1%] children had vitamin B12 less than 200 pg/ml. Seventeen [60.7%] children who had serum ferritin less than 7ng/ml had also low serum folate [p=0.001]. Four [36.4%] out of eleven children with leukopenia had serum folate below 5ng/dl [p=0.2]. Vitamin B12 level in children with absolute lymphocyte count less than 1500/microL was significantly less than that of children with equal or more than 1500/microL [P value 0.02]. Twelve [10.8%] children had thrombocytosis. The mean hemoglobin level and serum ferritin were significantly lower in children with thrombocytosis than those with normal platelets [p<0.01]Celiac disease is associated with a diversity of hematological findings that include leukopenia, lymphopenia, neutropenia, and eosinophilia, as well as anemia, thrombocytopenia and thrombocytosis

Vipoma: a case report of uncommon cause of chronic diarrhea

The great majority of diarrhea episodes last for less than one week; when diarrhea persists for more than 14 days, it is called persistent, intractable, or chronic diarrhea. We are reporting a case of Ganglioneuroblastoma in a 16 months old girl, who was referred to King Hussein Medical Center for further evaluation of chronic diarrhea. This rare tumor has a yearly occurrence of less than 5 per 1.000.000 children. The child was successfully treated surgically and with chemotherapy with subsidence of diarrhea

Wilson's disease among children at King Hussein Medical Center

To describe the demographic characteristics and clinical presentation of 37 patients with Wilson's disease followed up at the Pediatric Gastroenterology Clinic. A specially designed data collection form was used to collect the relevant data; Medical history and a thorough clinical examination for patients who were diagnosed with Wilson's disease during the period between February 2000 and October 2010 at King Hussein Medical Center, Amman, Jordan was done. Laboratory investigations include ceruloplasmin level, liver enzymes, albumin, prothrombin time, partial thromboplastin time, international normalized ratio, complete blood count, urine analysis, abdominal ultrasound and liver biopsy. Simple descriptive statistics [frequency and percentage] were used to describe the study variables. A total of 37 patients diagnosed as Wilson's disease with age ranges between two and 13.5 years were included in this descriptive review. Out of 37 patients, 19 [51%] were males and 18 [49%] were females. Patients with affected siblings were 29 [78%]. Central nervous system involvement was found among 9 [24.3%] patients. The commonest presenting symptoms were jaundice [n=16, 43%], abdominal distension [n=13, 35%], fatigue and delayed school performance [n=12, 32.4%]. The most common clinical findings were hepatomegaly [n=26, 70%], jaundice [n=16, 43%], splenomegaly [n=14, 37.8%], Kayser-Fleischer ring [n=11, 29.7%], and lower limb edema [n=11, 29.7%] respectively. Low ceruloplasmin level was found in 34 [92%] patients, high liver enzymes in 23 [62%] patients, hemolytic anemia in 13 [35%] patients successively. Twenty-four hour urine collection average copper post D-penicillamine challenging test was above 230 micro g/dl. The most common ultrasound findings were hepatomegaly, abnormal echogenecity, splenomegaly and ascitis. Liver biopsies commonly showed liver fibrosis, however fatty liver changes, hepatosteatosis and liver cirrhosis were the least common finding. Family screening is needed once a child in the family is diagnosed. Full investigations to rule out Wilson's disease should be performed in any patient with unexplained elevation of liver enzymes, hepatomegaly, hemolytic anemia, jaundice or neurological/behavioral disturbances

Presenting symptoms of Celiac disease among children visiting the pediatric gastrointestinal clinic at king Hussein Medical Center

To determine the most common presenting symptoms of Celiac disease among children followed up at the Pediatric Gastrointestinal Clinic at King Hussein Medical Center. A retrospective review of 108 medical records of celiac disease patients followed up at the Pediatric Gastrointestinal Clinic at King Hussein Medical Center was conducted during a period of 10 years between 1996 to 2006. All patients' growth charts were reviewed at the time of presentation. All patients included in the study underwent an upper gastrointestinal endoscopy with duodenal biopsies and their histopathologic findings were consistent with the diagnosis of Celiac disease. Simple descriptive statistics [mean, frequency and percentage] were used to describe the study variables. Seventy-eight patients [72%] were females and 30[28%] were males. The youngest age at the time of presentation was 10 and 1/2 months and the eldest was 15 years with a mean age of 4yrs at the time of presentation. Twelve [11%] patients were found to have positive family history of Celiac disease. The growth charts of the patients showed body weight to be at or below the 5[th] centile except for 2, one was on the 25[th] centile and the other on the 50[th], and both of them presented with diarrhea and abdominal distention. Patients under 5 years of age were noticed to present mainly with gastrointestinal manifestations such as diarrhea and abdominal distension with failure to gain weight appropriately. Patients between 5 years to 12 years of age mostly presented with extraintestinal manifestations such as short stature and anemia, mostly iron deficiency anemia. Patients above 12 years of age mostly presented with short stature and some of them with pubertal delay. Early recognition of presenting symptoms of Celiac disease such as chronic diarrhea, failure to gain weight, anemia and short stature should prompt a thorough investigation for Celiac disease including serologic studies as well as upper gastrointestinal endoscopy with duodenal biopsy. Histology can provide the precise diagnosis after which glutean free diet should be started to improve the symptoms and avoid the complications

Evaluation of clinical and laboratory predictors in neonates and young infants at risk of serious bacterial infections

To identify serious bacterial infections among infants between 0 - 90 days of age. Also to test the validity of applying clinical evaluation and commonly used laboratory tests for the diagnosis of serious bacterial infections. Lastly to develop guidelines for the future care of febrile children from birth to 3 months of age. A total of 145 neonates and young infants 0 - 3 months of age with a rectal temperature 38C ° were enrolled in a prospective study at King Hussein Medical Center and two affiliated hospitals: [Prince Rashid Ben AI-Hassan and Prince Hashim Ben Al Hussein] during a 6 - month period to evaluate the validity of applying clinical and laboratory criteria for detection of serious bacterial infections [SBls]. Serious bacterial infections [SBls] were encountered in 54 patients. According to site, single infection or combination of infections were encountered in the 145 patients and were distributed as follow: septicemia in 31 patients 21.37%, urinary tract infection in 21 patients 14.48%, gastroenteritis in 38 patients 26.20%, soft tissue and joint infections in 10 patients 6.70%, meningitis in 12 patients 8.2%, and chest infection in 18 patients 12.4%. Application of clinical and laboratory criteria for detection of serious bacterial infection demonstrated that low risk criteria do identify a subset of febrile infants at a substantially lower risk for all SBls. However, the criteria do not reduce the risk to zero p=1.37% [using Fishers Exact Test]. Until we have more data, hospitalization and empirical antibiotic treatment of very young infants with fever is recommended because meticulous follow -up is often unfeasible

Chronic osteomyelitis of the mandible in a 4-year-old child: a case report

A case of chronic osteomyelitis of the mandible in a 4-year-old male patient is described. This was accompanied by spontaneous loss of the six lower anterior teeth, failure of soft tissue healing, and exposure of necrotic alveolar bone. The management of this case and the etiology of the disease are discussed