Prevalence, Clinical Characteristics, and Management of Functional Constipation at Pediatric Gastroenterology Clinics

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother's care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.

Subclinical Vitamin D Insufficiency in Korean School-aged Children / 대한소아소화기영양학회지

PURPOSE: Recently, vitamin D insufficiency has increased and has been correlated to growth and puberty in children. This study was conducted to find the prevalence of subclinical vitamin D insufficiency and its influence on school-aged children in Korea. METHODS: The subjects of this study were 397 children aged 7 to 15 years who had been tested for 25-OH vitamin D3 among the outpatients of the Department of Pediatrics in Eulji General Hospital from March 2007 to February 2011. Data for age, sex, comorbidities, serum 25-OH vitamin D3, height, weight, body mass index (BMI), and sunlight exposure time were collected before and after 3 months of vitamin D administration, retrospectively. RESULTS: Vitamin D insufficiency was present in 343 (86%) of the subjects. In the vitamin D insufficient group, chronological age was 8.96+/-1.72 years, mean height (z-score [z]) was 0.51+/-1.26, mean BMI (z) was 0.81+/-2.20, and bone age was 10.26+/-1.75 years. In the vitamin D sufficient group, chronological age was 9.61+/-1.77 years, mean height (z) was-0.66+/-0.98, mean BMI (z) was-0.01+/-1.16, and bone age was 9.44+/-2.12 years. A paired t-test showed that three months after vitamin D administration, the mean 25-OH vitamin D3 level in the insufficient group increased to 24.38 +/-10.03 ng/mL and mean BMI (z) decreased to 0.67+/-1.06. CONCLUSION: In Korean school-aged children, vitamin D insufficiency were relatively higher and may be closely related with higher BMI. Insufficient rise of the level of vitamin D after supplementation suggest the new supplementation guidelines, especially for Korean children.

Polymorphisms of the Serotonin Transporter Gene and G-Protein beta3 Subunit Gene in Korean Children with Irritable Bowel Syndrome and Functional Dyspepsia

BACKGROUND/AIMS: Many candidate gene studies have revealed that polymorphisms of the 5'-flanking controlled SERT gene linked polymorphic region (5HTT-LPR) gene and G-protein beta3 C825T gene might be associated with functional dyspepsia (FD) and irritable bowel syndrome (IBS). This study was performed to investigate polymorphisms of the 5HTT-LPR gene and G-protein beta3 C825T gene in FD and IBS in Korean children. METHODS: In total, 102 patients with FD, 72 patients with IBS based on the Rome III criteria and 148 healthy controls without gastrointestinal symptoms were included in the study to analyze 5HTT-LPR and G-protein beta3 C825T polymorphisms. RESULTS: 5HTT-LPR genotype analysis revealed no signifi cant differences in FD and IBS patients compared with controls. The GNbeta3 C825T genotype distribution for CC, CT, and TT was 23.6%, 53.4%, and 23.0% in controls, 36.3%, 38.2%, and 25.5% in FD and 37.5%, 38.9%, and 23.6% in IBS, respectively. The CC genotype was more common in FD and IBS patients than controls (p<0.05). When the IBS patients were grouped according to IBS subtypes, CC genotype GNbeta3 C825T was common in diarrhea-dominant IBS, and the TT genotype was common in constipation-dominant IBS (p<0.05). CONCLUSIONS: The CC genotype of G-protein beta3 C825T may be associated with FD and diarrhea-predominant IBS. The TT genotype may be associated with constipation-predominant IBS.

Update on Genetic Studies of Functional Gastrointestinal Disorders / 대한소아소화기영양학회지

Childhood functional gastrointestinal disorders are defined as a variable combination of often age-dependent, chronic, or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. A better understanding of genetic background of these disorders would help to better identify their complex biology and make it possible to identify subgroups of patients who respond to customized therapies. Family and twin studies have shown a genetic component in irritable bowel syndrome. Candidate gene studies have identified a few genetic polymorphisms that may be associated with functional dyspepsia and irritable bowel syndrome. Studies of associations of spontaneous genetic variations and altered functions may provide novel insights of the mechanisms contributing to the disease.

Diagnosis of Functional Gastrointestinal Disorders with Rome III Criteria in Korean Pediatric and Adolescent Patients: Clinical Usefulness of QPGS / 대한소아소화기영양학회지

PURPOSE: We diagnosed pediatric functional gastrointestinal disorders in Korean children and adolescents using Rome III criteria and investigated the clinical validity of QPGS-Rome III. METHODS: Diagnosis based on QPGS was compared with the physician's diagnosis based on Rome III criteria. One hundred and thirty eight children and their parents completed the QPGS. Agreement rates were measured using Kappa method. RESULTS: In physician's diagnoses, the most prevalent disorders were functional dyspepsia (39.1%), irritable bowel syndrome (38.4%), and functional abdominal pain (18.8%). Among QPGS based diagnoses, the most prevalent disorders were irritable bowel syndrome (39.1%), functional dyspepsia (29.7%), and functional abdominal pain (21.7%). The agreement rate was substantial (kappa=0.72, p=0.00). Diagnostic disagreements probably resulted from different patient responses to bowel movement form and bowel frequency. CONCLUSION: Functional dyspepsia, irritable bowel syndrome, and functional abdominal pain were the most common disorders by Rome III criteria in the Korean pediatric and adolescent patients. The agreement rate between physician's diagnoses and QPGS based diagnoses supported the validity of the QPGS-Rome III in Korean pediatric and adolescent patients. QPGS seems to be useful in diagnosis of patients with functional gastrointestinal disorders by Rome III criteria.

The Prevalence of Obesity and Metabolic Abnormalities in Korean Pediatric Population / 대한소아소화기영양학회지

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.

A Case of Grayanotoxin Intoxication Presenting with Mental Changes and Vomiting / 대한소아소화기영양학회지

Rhododendron species is one of the largest and most diverse genera in the plant kingdom, comprising over 800 species and existing all over the globe. Grayanotoxin intoxication is caused by ingestion of honey and flowers. Grayanotoxin exists in honey, flowers, pollen, and nectar of the Rhododendron species. Grayanotoxin-intoxicated patients may present with nausea, vomiting, dizziness, weakness, hypotension, bradycardia, and syncope for several hours. We report a case of grayanotoxin intoxication associated with mental changes. A 9-year-old male presented with impaired consciousness and delirium 26 hours after eating about 10 rhododendron sclippenbachii flowers. A brain MRI and EEG were normal. Parenteral fluids were administered and these symptoms resolved completely in 17 hours.

A Case of Grayanotoxin Intoxication Presenting with Mental Changes and Vomiting / 대한소아소화기영양학회지

Rhododendron species is one of the largest and most diverse genera in the plant kingdom, comprising over 800 species and existing all over the globe. Grayanotoxin intoxication is caused by ingestion of honey and flowers. Grayanotoxin exists in honey, flowers, pollen, and nectar of the Rhododendron species. Grayanotoxin-intoxicated patients may present with nausea, vomiting, dizziness, weakness, hypotension, bradycardia, and syncope for several hours. We report a case of grayanotoxin intoxication associated with mental changes. A 9-year-old male presented with impaired consciousness and delirium 26 hours after eating about 10 rhododendron sclippenbachii flowers. A brain MRI and EEG were normal. Parenteral fluids were administered and these symptoms resolved completely in 17 hours.

Characteristics of functional gastrointestinal disorders in children with chronic abdominal pain / 소아과

PURPOSE: The aim of this study was to document the causes of chronic abdominal pain in children referred to a hospital setting and evaluate the frequency and characteristics of functional gastrointestinal disorder (FGID) classified by Rome III criteria. METHODS: One hundred thirty two patients with chronic abdominal pain were evaluated. Examinations were performed in order to find organic causes in patients when organic disease was suspected. RESULTS: Among the 132 patients, 20 patients (15.2%) had organic diseases and 112 patients (84.8%) were diagnosed as having FGIDs. Functional dyspepsia was the most common cause of FGIDs, followed by irritable bowel syndrome. Overlap of some FGIDs was observed in seven patients (5.3%). CONCLUSION: FGIDs are the main causes of chronic abdominal pain in children and functional dyspepsia was the most prevalent disorder.

Comparison of polyethylene glycol 4000 and lactulose for treatment of chronic functional constipation in children / 소아과

PURPOSE: The aim of this study was to compare 2 laxatives, namely, polyethylene glycol 4000 without electrolytes and lactulose, evaluating the efficacy and safety for the treatment of constipation in children. METHODS: Fifty-six children with chronic functional constipation were randomly assigned to receive polyethylene glycol 4000 (24 patients) or lactulose (32 patients). Patients or their parents reported defecation frequency, stool consistency, abdominal pain, stool incontinence and side effects after 1, 3, 6 and 12 months of treatment. Percentage of recovered patients were compared with each group. RESULTS: Defecation frequency, abdominal pain and stool incontinence were improved in each group. At 12 months of follow up, 60% of patients treated with polyethylene glycol and 57.7% of patients treated with lactulose were considered as recovered. CONCLUSION: In this study, both polyethylene glycol and lactulose were equally effective and safe in the long-term treatment of constipation in children. There were no significant differences in recovery rates between 2 groups.

Expression Patterns of Tumor Related Proteins for Differential Diagnoses of Intrahepatic Adenocarcinomas

Background : Differential diagnoses of intrahepatic adenocarcinomas (IHAC) play an important role in the detecting primary sites and the determining type of treatment and overall prognosis of the patient. However, histopathologic findings alone have limitations of differential diagnoses of IHAC. Methods : To clarify which tumor related proteins (TRP) are useful for differential diagnoses of IHAC, TRP expression were investigated immunohistochemically, using MUC5AC, MUC2, mAb 91.9H, MUC1, and pS2, and by high iron diamine (HID) staining in 61 clinically confirmed IHACs. Results : MUC5AC (9/18, p0.05) displayed the most frequent expression in cholangiocarcinomas, and MUC2 (11/18, p0.05) was expressed more often in pancreatic adenocarcinomas than other IHAC, while MUC2 and 91.9H were not expressed at all in pancreatic adenocarcinomas. The positivity of several TRP did not correlate with tumor differentiation. Conclusions : MUC5AC, MUC2, mAb 91.9H, and HID may be useful in differentiating cholangiocarcinomas from colorectal adenocarcinomas.

A Case of Gastric Anisakiasis with Recurrent Abdominal Pain in a Child / 대한소아소화기영양학회지

Anisakiasis is a accidental parasitic infection caused by nematode larvae belonging to the subfamily Anisakinae when a raw or inadequately cooked fish is ingested. The common clinical symptoms are severe colicky abdominal pain or epigastric full sensation, nausea, vomiting and fever, but hematemesis or melena is very rare. We report a case of a 11-year-old female child who developed severe epigastric pain recurrently for 2 months, and recalled that she had eaten the raw flesh of an Astroconger myriaster. Endoscopic examination showed the whitish worm invading the stomach wall. Clinical symptoms disappeared after endoscopic removal. This study may be the first pediatric case of gastric anisakiasis in korea.

Therapeutic Effect of Helicobacter pylori Eradication in Children with Recurrent Abdominal Pain Associated with H. pylori / 소아과

PURPOSE: In order to clarify the role of Helicobacter pylori(H. pylori) in recurrent abdominal pain, we investigated prospectively the effect of eradication of H. pylori based on symptom improvement in children with recurrent abdominal pain. METHODS: Children with recurrent abdominal pain were evaluated with diagnostic upper gastrointestinal endoscopy to rule out peptic ulcer disease, etc. During endoscopy, biopsies were taken and sent for CLO test and histologic evaluation with H-E stain and Alcian-Yellow stain. Twenty four out of 28 H. pylori infected children didn't have peptic ulcer disease. They underwent triple therapy with bismuth subcitrate, amoxicillin and clarithromycin. Four weeks after the end of the therapy, patients were evaluated with regard to their symptoms. RESULTS: In patients with H. pylori eradication, the mean total symptom score decreased significantly at four weeks' follow-up after the treatment(9.1+/-3.6 vs. 1.4+/-1.5; P<0.001). The frequency of abdominal pain per week also decreased significantly from 26.0+/-21.1 times/week to 1.4+/-1.5 times/ week after eradication of H. pylori(P<0.001). Age, duration of symptom and endoscopic findings did not prove to be positive predictive factors of significant improvement of symptoms after H. pylori eradication. CONCLUSION: We strongly recommend looking for H. pylori infection in children complaining of recurrent abdominal pain. Eradication of this organism will effectively and significantly reduce the extent of symptoms associated with recurrent abdominal pain.

The Usefulness of MRCP in the Evaluation of Pancreaticobiliary Diseases in Children

PURPOSE: Magnetic resonance cholangiopancreatography(MRCP) is a noninvasive method for imaging the pancreaticobiliary tree. The aim of this study was to evalute the usefulness of MRCP for the diagnosis of pancreaticobiliary diseases in children. METHODS: From October 1996 to May 2001, 67 patients with obstructive jaundice and three patients with chronic recurrent pancreatitis were evaluated with abdominal ultrasonography and MRCP. The final diagnosis was based on the operative and pathologic findings with biopsy specimen including clinical and laboratory findings. RESULTS: A total of 70 patients, consisting of 31 males and 39 females, with a mean age of 2.6+/-3.3 years were studied. The final diagnosis was biliary atresia in 25, neonatal cholestasis in 18, choledochal cyst without anomalous pancreatobiliary duct union(APBDU) in nine, choledochal cyst with APBDU in seven, cholestatic hepatitis in five, chronic recurrent pancreatitis in three, sclerosing cholangitis in two, and secondary biliary cirrhosis in one case. The overall diagnostic accuracy of abdominal ultrasonography was 75.7% and that of MRCP was 97.1%. The sensitivity and specificity of MRCP were 100% and 98% for biliary atresia, 87.5% and 100% for choledochal cyst with APBDU, 100% and 100% for choledochal cyst without APBDU, sclerosing cholangitis and chronic recurrent pancreatitis, respectively. CONCLUSION: MRCP is a fast, non-invasive and reliable method for diagnosing pancreaticobiliary diseases in children and will be the standard diagnostic procedure in the future.

A Case of Wilms Tumor with Thrombi which Invaded the Right Ventricule

Wilms tumor is the second most common malignant retroperitoneal tumor. Inferior vena cava and right atrial involvement is found in about 4-10% and 0.5-3% of cases, respectively. But, right ventricular involvement has not been reported. We experienced a case of Wilms tumor with right ventricular invasion in a 2 year-old male who presented intermittent hematuria and abdominal pain. Computed tomogram and echocardiogram showed a homogeneous mass extended to right ventricle via inferior vena cava. He received pre-operative chemotherapy followed by operation, radiation therapy including heart, and post-operative chemotherapy.

Analysis of Childhood Rapidly Progressive Glomerulonephritis

PURPOSE:Rapidly progressive glomerulonephritis (RPGN) is characterized by the rapid increase in serum creatitnin and crescents formation involving more than 50% of glomeruli. 10 patients who had been treated for RPGN were studied retrospectively for thier underlying diseases and clinical features. METHOD: Cilinical review was performed on 10 children who were diagnosed with RPGN by clinical features and renal biopsy and followed up at department of pediatrics during the last 10 years, from May 1990 to May 2000. RESULT: There were 6 males and 4 females between the ages of 2.1 and 14.3 years (mean 10.9+/-.8). 3 had Henoch-Sch nlein purpura nephritis; 2, idiopathic rapidly progressive glomerulonephritis; 2, lupus nephritis; 1, hemolytic uremic syndrome; 1, membranous glomerulonephritis and 1, microscopic polyangiitis. The most common chief complaints were gross hematuria and oliguria. Initial clinical features included proteinuria, edema, hypertension, nausea and arthralgia. Mean serum BUN was 74.2+/-39.1 mg/dL; mean serum creatinin, 3.2+/-1.8 mg/dL and mean creatinin clearance, 26.5+/-13.2 mL/min/1.73m2. Antineutrophil cytoplasmic antibody was positive only in microscopic polyangiitis. ANA and Anti-DNA antibody were positive in two lupus nephritis patients. Serum complements were decreased in 4 patients. All patients except Hemolytic uremic syndrome received steroid pulse therapy and immunosupressive agents. 3 patients were performed acute peritoneal dialysis and 2 patients were given plasmapheresis. At the last follow up, 1 patient was dead, 4 patients had elevated serum creatinin, 2 of these 4 patients were on chronic ambulatory peritoneal dialysis and 6 patients had normal renal function. CONCLUSION: Rapidly progressive glomerulonephritis is a medical emergency that requires very rapid diagnosis, classification, and therapy. Appropriate therapy selected on the basis of underlying disease mechanism can substantially improve renal survival.