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Justification: Management practices of functional constipation are far from satisfactory in developing countries like India; availableguidelines do not comprehensively address the problems pertinent to our country.Process: A questionnaire-based survey was conducted among selected practising pediatricians and pediatric gastroenterologists inIndia, and the respondents agreed on the need for an Indian guideline on the topic. A group of experts were invited to present thepublished literature under 12 different headings, and a consensus was developed to formulate the practice guidelines, keeping in viewthe needs in Indian children.Objective: To formulate practice guidelines for the management of childhood functional constipation that are relevant to Indian children.Recommendations: Functional constipation should be diagnosed only in the absence of red flags on history and examination. Thosewith impaction and/or retentive incontinence should be disimpacted with polyethylene glycol (hospital or home-based). Osmoticlaxatives (polyethylene glycol more than 1 year of age and lactulose/lactitol less than 1 year of age) are the first line of maintenancetherapy. Stimulant laxatives should be reserved only for rescue therapy. Combination therapies of two osmotics, two stimulants or twoclasses of laxatives are not recommended. Laxatives as maintenance therapy should be given for a prolonged period and should betapered off gradually, only after a successful outcome. Essential components of therapy for a successful outcome include counselling,dietary changes, toilet-training and regular follow-up.
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Objective: To analyze the presentation and predictors of outcome of children with galactosemia. Methods: Analysis of clinical, laboratory, microbiological profile and outcome of patients fulfilling the diagnostic criteria: i) clinical setting; ii) reduced erythrocyte Gal-1-PUT enzyme activity; and iii) unequivocal response to lactose-free diet. Results: 24 patients; median age of symptom onset and diagnosis: 10 (3-75) d and 55 (15-455) days, respectively. 71% had uncorrectable coagulopathy; 71% systemic infections; and 54% had ascites. Outcome: consisted of 87.5% survival with normalization of liver function tests at 5.5 (1-24) months follow-up. Conclusion: Despite delayed referral, high Pediatric end-stage liver disease scores and systemic infections, long-term outcome in galactosemia is rewarding. A subset of children have developmental delay.
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BACKGROUND: We prospectively evaluated the usefulness of IgA tissue transglutaminase antibodies (IgA tTG) in the initial diagnosis of celiac disease (CD) and compared its diagnostic potential with that of IgA anti-endomysial antibodies (IgA EMA) and anti-IgA and IgG gliadin antibodies (AGA and AGG, respectively). METHODS: Sera of 23 untreated children fulfilling the revised ESPGHAN criteria for diagnosis of CD (Group I; mean age 10.8 y); 19 disease controls (Group II; mean age 8.5 y) presenting with chronic diarrhea, short stature or both; and 22 healthy children (Group III; mean age 8.8 y) were studied. These were tested in a blinded manner for AGA, AGG, IgA tTG (guinea pig as antigen) and IgA EMA. RESULTS: In Group I, IgA EMA was positive in 19, IgA tTG in 17, AGA in 14 and AGG in 17 patients. In Group II, these tests were positive in 1, 0, 2 and 14 patients, respectively and in Group III, in 0, 0, 0 and 1 child, respectively. Analyzing data from Group I and II, IgA EMA, IgA tTG, AGA and AGG had sensitivity rates of 83%, 74%, 61% and 74%, respectively; the specificity rates were 95%, 100%, 89% and 26%; positive predictive values were 95%, 100%, 88% and 55% and negative predictive values were 82%, 74%, 65% and 45%, respectively. CONCLUSION: IgA tTG is useful for the diagnosis of CD, with sensitivity and specificity rates comparable to those of EMA and this test is well suited for use in tropical countries like India.