Clinical trial of cellulose in treatment of functional constipation in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the efficacy and safety of cellulose for the treatment of functional constipation in children.</p><p><b>METHODS</b>A prospective, self-controlled, clinical trial using cellulose was conducted for 2 weeks in 34 children with functional constipation. The constipation symptoms and the characteristics of feces after the treatment were observed.</p><p><b>RESULTS</b>The characteristics of feces and the constipation symptoms were improved significantly after the treatment. The total efficacy rate was 37% 3 days after treatment, 87% 7 days after treatment and 90% 14 days after treatment. The satisfactory rates of doctors and children's parents on the therapeutic effects were 57% and 63%, respectively. No adverse events, such as abdominal distention, pain or diarrhea, were observed during the treatment.</p><p><b>CONCLUSIONS</b>Cellulose is effective and safe in the treatment of functional constipation in children.</p>

Application of double balloon enteroscopy in pediatric patients / 中华儿科杂志

<p><b>OBJECTIVE</b>Double balloon enteroscopy (DBE) is already an established modality of investigation in adults though its use in children has not yet been widely practiced. This study aimed to explore the method and safety of pediatric DBE and to evaluate its clinical value and applicability in the pediatric age group.</p><p><b>METHOD</b>During the period from December, 2006 to October, 2009 DBE was performed on a total of 22 patients (age 4 to 16 years) at the hospital. The indications included: gastrointestinal bleeding, chronic abdominal pain, suspected Crohn's disease and hypoalbuminemia. With the aid of a specially designed overtube, and the alternate inflation and deflation of the balloons at the tip of the endoscope and overtube, the enteroscope was advanced in the small intestine either antegrade or retrograde by telescoping the small intestine along its way. The range of intestine covered, pathology encountered, and tolerability of the examination by the subjects were recorded during the procedure.</p><p><b>RESULT</b>A total of 25 DBE's were performed: antegrade in 3 and retrograde in 22. In 3 patients, both antegrade and retrograde enteroscopy was performed. All the procedures were performed under anesthesia. Inclusive of anesthesia and post-procedure recovery, each procedure took approximately 90 to 120 minutes. The pathology was identified in 18 out of 22 patients (81.82%), including: 7 cases of Crohn's disease, 3 of Meckel's diverticulum, combined ileal and colonic polyp in one, intestinal lymphangiectasis in one, amebiasis in one, small intestinal hemorrhage in 3 and non-specific ileitis in 2. No serious complications such as aspiration pneumonia, perforation or hemorrhage occurred and all patients tolerated the procedures well.</p><p><b>CONCLUSION</b>DBE is a useful and feasible procedure in the pediatric patients. Young patients can tolerate the procedure well.</p>

cagA,vacA and iceA genotypes of Helicobacter pylori isolated from children in Shanghai / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate cagA, vacA and iceA genotypes of Helicobacter pylori (H. pylori) isolated from children suffering from gastric and duodenal diseases in Shanghai and to explore a possible genotype-phenotype correlation.</p><p><b>METHODS</b>From May 2007 to January 2008, 59 children were confirmed with Hp infection by gastroscopy. Biopsied specimens were taken from the gastric antrum. cagA, vacA and iceA genes were determined by PCR. The histological changes in the gastric mucosa were evaluated. The levels of IFN-gamma and IL-4 in the gastric mucosa were measured using ELISA.</p><p><b>RESULTS</b>cagA, vacAs1/m1, vacAs1/m2, iceA1 and iceA2 were found in 65%, 19%, 40%, 63% and 19% of H. pylori strains, respectively. Both iceA1 and iceA2 were detected in 9% of strains. There were no statistical differences in the distribution of various genotypes between the children with chronic gastritis and peptic ulcer. No association was observed between the genotypes and the degree of inflammation of gastric mucosa. There were no significant differences in levels of IFN-gamma and IL-4 in the gastric mucosa infected by different genotypes of H. pylori strains.</p><p><b>CONCLUSIONS</b>cagA/vacAs1/m2/iceA1 may be the commonest genotype combination of H.pylori in children from Shanghai. That there was no association between H.pylori genotypes and clinical variables suggests the potential role of host and environment factors in the development of clinical diseases at a later life.</p>

Forlax in the treatment of childhood constipation: a randomized, controlled, multicenter clinical study / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To determine the therapeutic effectiveness and safety of polyethylene glycol 4000 (forlax) in the treatment of constipation in children over 8 years old.</p><p><b>METHODS</b>This study was designed as a randomized, positive medicine (lactulose) controlled multicenter trial. A total of 216 children with constipation from 8-18 years old from 7 hospitals across China who were matched with a uniform entry criteria were enrolled in this study. The 216 patients were randomized to receive either oral forlax (20 g/d, n=105) or lactulose (15 mL/d, n=111) for 2 weeks. The therapeutic effects, including bowel movement frequency, stool consistency, clinical complete remission rate of constipation and abdominal symptoms, and the safety of forlax and lactulose were evaluated at 1 and 2 weeks of treatment.</p><p><b>RESULTS</b>The median weekly frequency of bowel movement in the forlax group increased by 4 and 5 times respectively after 1 and 2 weeks of treatment, and increased by 3 and 4 times in the lactulose group (P < 0.05). The stool consistency of the two groups was both improved significantly after treatment. The Bristol score of stool consistency of the forlax and lactulose groups were 3.41+/-1.11 and 3.64+/-1.33 respectively (P < 0.05) after 1 week of treatment, and were 4.26+/-0.89 and 3.63+/-1.33 respectively (P < 0.05) after 2 weeks of treatment. The clinical complete remission rate of constipation in the forlax and lactulose groups was 70% and 40% respectively (P < 0.05) by week 1 of treatment, and that was 72% and 41% respectively (P < 0.05) by week 2 of treatment. Abdominal pain disappeared in 75% of patients in the forlax group but in only 57% in the lactulose group by week 2 of treatment (P < 0.05). No serious adverse events happened and no abnormalities were found in laboratory tests and physical examinations in the two groups after medication.</p><p><b>CONCLUSIONS</b>Forlax is safe and effective in the treatment of constipation in children over 8 years old.</p>

Expression of Toll-like receptors in mononuclear cells from children with acute rotavirus diarrhea / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>Rotavirus is the single most common cause of severe dehydrating diarrhea in young children worldwide, but the pathogenesis and immunity against this disease are not completely understood. A prospective study was conducted to assess gene expression of toll-like receptors (TLR) in children with acute rotavirus diarrhea.</p><p><b>METHODS</b>Seventy-five children with acute rotavirus diarrhea and 38 control children were enrolled in this study from Sep. 2004 to Jan. 2005. All the 75 patients had detailed records of clinical characteristics. Rotavirus antigen was detected by ELISA from stools. Peripheral blood mononuclear cells (PBMC) were separated by Ficoll reagent and RNA was extracted by Trizol. The levels of mRNA for five TLRs in PBMC were examined by fluorescent quantitative RT-PCR.</p><p><b>RESULTS</b>Patients with acute rotavirus infection had elevated mean levels of TLR 2, 3, 4, 7, 8 mRNA expressions in PBMC within 3 days since onset of the disease, P less than 0.05. But only TLR 2, 3, 8 mRNA levels remained increased in patients within 7 or 14 days since onset (P less than 0.05). Mean levels of mRNA for TLR 4 in PBMC was higher in patients with more severe diarrhea including longer duration of diarrhea, more episodes of diarrhea per day and higher severity scores (P less than 0.05).</p><p><b>CONCLUSION</b>Manifold TLR may play roles in the start-up and regulation of immune responses in children with acute rotavirus diarrhea. These findings will be helpful to further recognize immune response in Chinese children with rotavirus diarrhea and, consequently, may provide directions and insights that could prove critical to the prevention or treatment of this important disease.</p>

Application of Transnasal Gastroscope in Children With Upper Gastrointestinal Tract Disorders / 实用儿科临床杂志

Objective To explore the property and diagnostic significancec of transnasal gastroscope(EG-470N5)in children with upper gastrointestinal tract disorders.Methods Sixty children with upper gastrointestinal tract disorders were examined by using EG-470N5.The scope was inserted either through nose(n=28)or via mouth(n=32).Beside the routine preparations,nasal spray of lidocaine or nasal drib of ephedrine was added to those who received nasal intubation.Results Examination of upper gastrointestinal tract subjects in all succed with no obvious side response in 28 cases(46.7%)who received the examination via nose,27 cases(45%)had mild nausea and 5 cases(8.3%)had serious nausea and dysphoria.Children with esophagostenosis and pyloristenosis and 2-day-old neonate were examined without adverse effect.Conclusions Transnasal gastroscope is preponderant to children due to its slim diameter and supple body,especially to those having swallow difficulty and confined tract.It is more favorable practical prospect than routine gastroscope.

Relationship between Characteristic of Pathohistology and Helicobater Pylori in Chronic Gastritis / 实用儿科临床杂志

Objective To further investigate the pathohistology of chronic gastritis in children and the relationship between helicobacter pylori(Hp) infection and mucosal chronic inflammatory.Methods Gastric antrum biopsies were carried out from children who had chronic gastritis confirmed by gastroendoscopy during the past 3 years in our hospital.The results of pathohistological observation were analyzed by retrospectire method.Results One thousand six hundred cases of chronic gastritis were included,in which 1007 cases without Hp infection,593 with Hp infection.Among the patients without Hp infection,mild inflammatory were much more than mode-(rate) or severe inflammatory(86% vs 14%).Although,in patients with Hp infection,mild inflammatory were the most common presentation(63%),moderate and severe inflammatory were more predominant in patients with Hp infection.The degree of inflammatory was increased with the quantity of Hp infection.The ratio of lymphocytes,neutrophils and lymphoid follicles in gastric mucosa was much higher in Hp positive group than negative one(94%,40%,22% vs 60%,11%,5%,respectively),and the difference was significant in statistic analysis.Gastric mucosal atrophy was found more in Hp positive group(16.5%) than negative one(7%).The proportion of intestinal metaplasia in cases with Hp infection was 1.5% compared with 0.1% in these children.Conclusion The study shows that there is a close relationship between Hp and antrun chronic inflammation and mucosal atrophy.

Eosinophilic Gastroenteritis in 11 Children / 实用儿科临床杂志

Objective To investigate clinical feature,diagnosis and prognosis of eosinophilic gastroenteritis(EG),and to analyze the causes of misdiagnosis.Methods Eleven children diagnosed as EG were studied.Their history,clinical manifestations,laboratory tests and endoscopies and treatment,follow-up data were analyzed.The data were analyzed by SPSS 10.0 software.Results 1.The children with EG usually had abdominal pain(5 cases),diarrhea(7 cases),hemafecia(5 cases) and sometimes with fever(2 cases).2.EG and allergy in children was closely related with disease(54.55%).3.Peripheral blood eosinophil(EOS) count increased significantly,and declined when symptoms eased(18.18%).4.Endoscopic manifestations were not specific,the mucosa could see sheet erosion,shallow ulcers,congestive spots or bleeding spots,mainly in antrum,duodenum,terminal ileum,ileocecal junction.The biopsy showed that a large number of EOS infiltration.5.Imaging were not specific,CT or gastrointestinal barium meal examination did not show special often(90.91%).When muscular wall was affected(9.09%),imaging presentations of EG could be partly obstructive.6.Glucocorticoid therapy could relieve symptoms and EOS.Symptoms probably recured by good prognosis.7.EG was a self-limiting allergic diseases,although the attack may be repeated.After long-term follow-up,most had good prognosis and without malignant.Conclusions Clinical and endoscopic presentations of EG are not specific,therefore the presence of EOS in gastrointestinal mucosa strongly indicate the diagnosis.It was easy to misdiagnosis.Biopsy pathology and cli-nical characteristics are the key to diagnosis.