Reinfection rate after successful Helicobacter pylori eradication in children

Reinfection rate of Helicobacter pylori after successful eradication is low in developed countries. This study was performed to determine the reinfection rate of H. pylori during a follow up period of 12 months in Iranian children. In this prospective study, children with H. pylori infection were treated with triple omeprazole based regimen. Patients with negative [13]C urea breath test [UBT] performed after 8 weeks of therapy, were followed up by the same test after 1 year. Thirty seven patients, aged 5 to 17 years, were studied. Among them 25 [67.5%] were boys. After eradication therapy of H. pylori, 34 patients had negative [13]C UBT. Reinfection occurred in 5 [14.7%] patients. Reappearance or continuing symptoms after treatment were associated with higher rate of recurrence [P=0.042]. Recurrence rate of H. pylori was high in our children. Successful eradication significantly decreased complaints and further symptoms. Follow up and reevaluation of patients is necessary especially when there are symptoms after eradication

Success rate of furazolidone-based triple therapy for eradication of helicobacter pylori in children

Helicobacter pylori [H. Pylori] is now recognized as a major etiological factor in the pathogenesis of gastritis and peptic ulcer disease. There is concrete evidence that eradication of the bacterium reverses histological gastritis, and results in significant reduction of duodenal and gastric ulcer recurrence. Poor compliance and antibiotic resistance are the main causes for failure of anti H. pylori therapy. In this study we determined efficacy of omeprazole based triple therapy with b.i.d. dosing of furazolidone, amoxicillin for 2 weeks and omeprazole in Iranian children. This prospective study included 37 children, in whom H. Pylori infection was diagnosed endoscopically. H.Pylori positive children were treated with a two weeks course of furazoidone [6 mg/kg/day] and amoxicillin [50 mg/kg/day] plus omeprazole [1-2 mg/kg/day]. Eradication was assessed by 13C UBT. Mean age of patients was 10.2 yr [5-15 yr], 25 [67.5%] patients were boys. H. Pylori was eradicated in 34 children [per patient 91.9%, per protocol 86%]. Side effects occurred in 3 [8.1%] patients, but these were mild and it was not necessary to discontinue treatment. Three children [8.1%] remained H. pylori positive. Our study showed that the association of furazolidone plus amoxicillin with a proton-pump inhibitor could be a valuable alternative for eradication of H. Pylori infection in children. It is an effective, affordable treatment that allows good compliance and produces low adverse effect rates

Cytomegalovirus infection in twin pregnancy and coincidence of type i tyrosinemia in one of twins

Cytomegalovirus [CMV] is the most common cause of congenital infection. Although most of the involved neonates are asymptomatic but virus can cause a range of problems from mild to severe illness with involvement of different organs like central nervous system, gastrointestinal and liver. Proneness to CMV is very high [up to 1% of neonates]. In the other hand trosinemia type I is a rare metabolic disorder with involvement of liver, neurologic, bone and other organs. A 3-month-old infant, product of twin pregnancy was hospitalized because of jaundice, FTT, hepatomegaly and sepsis. The other twin showed normal growth with no problems. Work up for cholestasis and FTT was suggestive of two different entities. Polymerase chain reaction for CMV in liver tissue and serum was positive. Meanwhile laboratory findings for metabolic disorder led to the diagnosis of type 1 tyrosinemia. The other twin was infected with CMV too. Although coexistence of two causes for cholestasis is very rare, it is sometimes necessary to study more to rule out other entities like metabolic disease including tyrosinemia [if any symptoms exist]

Embryonal biliary atresia with levocardia and situs inversus: a case report

Biliary atresia [BA] is a rare disease and the end result of a destructive inflammatory process in bile ducts, leading to fibrosis and liver cirrhosis. It has two forms: 1] syndromic or fetal or embryonic [10-35%] with various congenital anomalies, 2] non syndromic [70-90%], in which BA is an isolated anomaly. In this article we report on an infant with the first form of BA in which diagnosis and operation was not based on routine liver biopsy but on associated malformations and clinical features that were highly suggestive of embryonal form of biliary atresia. A 70-day old infant with syndromic BA, levocardia, situs inversus and polysplenia. He developed jaundice in 4th day of life, liver was not palpable. Kasai operation was not effective. He developed liver cirrhosis at 3 months of age. Syndromic type of EHBA is a very rare disease with a worse outcome than non syndromic type of BA. Early diagnosis is important and may be difficult as the liver sometimes could not be palpable because of its malposition