Clinical use of erythromycin in children with gastrointestinal dysmotility.

Intolerant feeding is a common symptom in gastrointestinal disorders which is commonly found in systemic diseases. Prokinetic drugs play a role in management. A low dose of erythromycin has an effect on improvement of antroduodenal motility and gastric emptying in children and adults. The objective of this study was to evaluate the efficacy of intravenous erythromycin in the treatment of GI dysmotility in children. Retrospective studies were performed in the Department of Pediatrics, Siriraj Hospital, Mahidol University between 1996 and 2000 in 22 patients with intolerance of feeding due to GI dysmotility. Their ages ranged from 11 days to 12 years (42.1 +/- 48.1 months). The patients were divided into 2 groups: 12 critically ill and 10 non-critically ill patients. Dosages of intravenous erythromycin were 1-3 mg/kg/dose every 6 hours. The result of treatment was evaluated as: good (tolerant feeding), fair (tolerant feeding but needing erythromycin for longer than 1 month) and failed (intolerant feeding). All non-critically ill patients had improved symptoms with 9 +/- 4.3 days duration of treatment. In the other group, 8 patients had good results with 10.9 +/- 6 days of treatment. Two patients needed the drug for longer than 1 month and the other 2 patients did not respond and died due to severe infection. Low dose intravenous erythromycin had good efficacy in the treatment of intolerant feeding related to GI dysmotility in children.

Upper gastrointestinal endoscopy in children with recurrent abdominal pain.

Over a 3 year period from 1992 to 1995, 62 patients with recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy showing normal findings in 30 patients (48.4%), gastroduodentis 17 (27.4%), H. pylori gastritis 11 (17.7%) and esophagitis 4 (6.5%). Duodenal or gastric ulcer was not found. This study demonstrated more evidence of increased prevalence of organic causes of RAP than previous reports. Duration of illness of more than one year and vomiting were more common in H. pylori gastritis. Other symptoms including diarrhea, constipation, nocturnal awakening and pain related to meals could not differentiate between organic and functional cause. Major cases of H. pylori gastritis and gastroduodenitis responded to triple drug therapy and H2 blockers respectively.

Helicobacter pylori infection in Thai children with recurrent abdominal pain.

Sixty-five children with recurrent abdominal pain underwent gastrointestional endoscopy which showed Hp gastritis without duodenal ulcer in 16.9 per cent of cases. The prevalences of infection in recurrent abdominal pain and asymptomatic children were not different. Either urease test or histological method was appropriate for diagnosis of this infection. Triple therapy including bismuth subcitrate, amoxicillin and metronidazole improved abdominal pain symptom in 72.7 per cent without any side effect.

The upper endoscopy in upper gastrointestinal hemorrhage of children.

Between 1992-1994, 20 children aged 3 months to 16 years who were admitted to Department of Pediatrics, Faculty of Medicine, Siriraj Hospital with problems of hematemesis and melena underwent gastrointestinal endoscopy. Thirteen children developed bleeding before admission and underlying diseases in 3 of these were chronic renal failure, pulmonary TB and malignant mesenchymoma. The main causes of hemorrhage in this group were gastritis (5 cases), esophagitis (3 cases) and esophageal varices (2 cases). The underlying disease of 7 children with hemoeehage during hospitalization were blood disease, SLE with renal failure and gastroesophageal reflux. The esophagitis, candida esophagitis, and gastric esosion were the etiologies of bleeding. Nine children needed blood transfusion and one had further investigations including meckel scan, tagged red cell scan and colonoscopy. Four patients died due to sepsis. The endoscopy had the value of establishing the etiology of upper gastrointestinal hemorrhage in 19 cases.

Recurrent abdominal pain in children at Siriral Hospital, etiology and relationship with lactase deficiency.

Fifty-seven children with recurrent abdominal pain at the Department of Pediatrics, Siriraj Hospital were studied. The children were of primary school-age (5-10 years). The ratio of boys to girls was 1:1.28. The pain suffered was, dull pain in 43.86, cramp-like in 26.32 percent. Pain was mostly in the epigastria and per umbilical regions. The specific cause was identified in just over a quarter of the children duodenitis and duodenal ulcer were the most common cause. The clinical signs and symptoms did not clearly distinguish the functional abdominal pain from specific organic cause. However dull pain is the major character of pain in the functional causes. Thirty out of the forty-one patients with functional disorders underwent lactose tolerance tests. Fifty-three percent of the 30 had lactose malabsorption and 6.6 percent were lactose intolerant compared to 56.6 percent of the control group which were not significantly different. After the period of follow up from 2 to 18 months all 57 children had recovered. These results suggest that lactose malabsorption is less likely a common cause of recurrent abdominal pain in Thai children.

Use of serum gamma glutamyl transpeptidase to differentiate between extrahepatic biliary atresia and neonatal hepatitis.

The differentiation between extrahepatic biliary atresia (EHBA) and neonatal hepatitis (NH) was studied in 53 Thai infants (39 males, 14 females) with obstructive cholangiopathy at the Department of Pediatrics, Siriraj hospital. Prevalence of EHBA was 25 per cent (13 of 15) overall. A higher prevalence of EHBA was found in females (8 of 13) while a higher prevalence of NH occurred in males (34 of 40). No difference was demonstrated in serum conjugated and total bilirubin, SGOT or alkaline phosphatase between EHBA and NH groups. The EHBA group had a significantly higher mean serum GGTP (184 +/- 77 IU/L) than the NH group (58 +/- 40 IU/L). The diagnostic usefulness of GGTP was confirmed, but variation in laboratory measurements could limit its generalizability.