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.

Relationship between Silent Gastroesophageal Reflux and Food Sensitization in Infants and Young Children with Recurrent Wheezing

It is known that early childhood wheezing associated with sensitization to allergens, including food, has an increased risk of developing asthma later during school age. Gastroesophageal reflux (GER) is well known to be associated with asthma. The purpose of this study was to determine whether there is an association between silent GER and food sensitization in infants and young children with recurrent wheezing. Eighty-five infants or young children with recurrent wheezing, and no gastrointestinal symptoms, underwent 24 hr esophageal pH monitoring, as well as total serum IgE and specific IgE testing for eggs and milk. Among the 85 subjects, 48.2% had significant GER. There was no significant difference in the GER between atopic and non-atopic recurrent wheezers (41.7% and 50.8%, respectively). The sensitization rate to food (eggs or milk) was 12.2% and 20.5% in the GER and non-GER groups, respectively and showed no statistically significant difference between the two groups (P=0.34). In conclusion, about half of infants and young children with recurrent wheezing and no gastrointestinal symptoms have silent GER. The silent GER may not contribute to food sensitization in infants and young children with recurrent wheezing.

Influence of Helicobacter pylori Infection on Gastric Motility in Children and Adolescents with Functional Dyspepsia / 대한소아소화기영양학회지

PURPOSE: In spite of many reports about Helicobacter pylori infection in children with functional gastrointestinal disorders, there are few reports about the influence of H. pylori infection to functional dyspepsia and gastric motility. Therefore, we studied the influence of H. pylori infection on gastric myoelectrical activity in children with functional dyspepsia. METHODS: Between August 2006 and December 2008 upper gastrointestinal endoscopies with biopsies, the rapid urease test and/or 13C urea breath test, and electrogastrography (EGG) were performed on 63 patients with histologic chronic gastritis; patients with chronic disorders were excluded. Comparisons about gastric myoelectrical activities were made between H. pylori-positive children (n=25) and H. pylori- negative children (n=38). RESULTS: The percentage of pre- and post-prandial normogastria was relatively lower in H. pylori-positive children than H. pylori-negative children (80% vs. 65%, and 80% vs. 68%, respectively). Compared to H. pylori-negative children, H. pylori-positive children had lower postprandial predominant power (8.18+/-22.36 dB and 32.20+/-24.18 dB, respectively; p<0.01) and a lower power ratio (deltaP; delta1.28+/-6.18 vs. +.62+/-5.93, respectively; p<0.01). CONCLUSION: It was suggested that the gastric myoelectrical activity in children with chronic gastritis can be influenced by H. pylori infection. Thus, this study indicates that H. pylori infection may be predictable in children with functional dyspepsia through analyzing the EGG parameters, and treatment may be considered in H. pylori-positive children with impaired gastric activity, especially in the lower prevalence area.

Weaning Food Practice and Assessment in Children with Iron Deficiency Anemia / 대한소아소화기영양학회지

PURPOSE: Recently, the favorable merits of breast feeding have received widespread attention and the number of breast feeding children is increasing. We investigated the weaning practices between breast feeding infants and non-breast feeding infants with respect to iron deficiency anemia (IDA). METHODS: Between March 2006 and January 2009, we surveyed 70 parents, the children of whom had been medically diagnosed with IDA, and 140 parents, the children of whom did not have IDA, about how they feed their children and how much they know about the weaning process. The infants and children were 6~36 months of age and attended the Inha University hospital. RESULTS: IDA patients started weaning later than non-IDA patients. Also, breast feeding in IDA patients was more frequent than in non-IDA patients (82% vs. 30%). The breast feeding group began weaning at approximately 6.4 months of age, which was statistically meaningfully compared to non-breast feeding infants. There were no differences in knowledge between the two groups of parents. CONCLUSION: According to our research, we assume that if weaning begins at 6 months, we cannot supply sufficient iron to meet the infant's needs, which increase sharply around 6 months of age because of depletion of stored iron. Thus, infants need to initiate weaning from breast feeding at 4 months of age to furnish an ample amount of iron or take iron-containing supplements. These methods would be expected to prevent IDA in breast feeding infants.

A Case of Acute Hepatitis with Mycoplasma pneumoniae Infection and Transient Depression of Multiple Coagulation Factors

We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depression of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normalization of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection.

The Usefulness of Scintigraphy for the Detection ofGastroesophageal Reflux and Pulmonary Aspiration / 대한소아소화기영양학회지

PURPOSE: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. METHODS: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a (99m)Tc-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. RESULTS: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). CONCLUSION: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.

Subclinical rickets in breastfed infants / 소아과

PURPOSE: The prevalence of rickets in the world is on the rise not only in developing but also in developed countries. In Korea, breastfeeding has increased. There have been few studies on the possible association of rickets with breastfeeding. The purpose of this study was to identify the development and the clinical presentation of subclinical rickets in breastfed infants. METHODS: We investigated patients who were breastfed and had hypovitaminosis D in the blood from May 2006 to April 2007, and who were diagnosed with vitamin D deficient rickets from May 2003 to April 2006. We evaluated the results of blood tests, x-rays and other relevant information in the medical record. A questionnaire that included questions on the diet of patients, the mothers activity during pregnancy and place of residence was administered. RESULTS: Twelve patients (66%: male, 34%: female) were enrolled in this study. There were eight in the asymptomatic and four in the symptomatic group. The median age for each group was 8 months (range 4-11 month) and 5.5 months (5-8 month). All patients in the symptomatic group were breastfed until diagnosed. In the asymptomatic group, they were breastfed for four to six months, and then weaned with only thin rice soup and vegetables. Nine patients had a vitamin D concentration below 20 ng/mL and three patients had levels between 20 and 29 ng/mL. Alkaline phosphatase (ALP) and parathyroid hormone (PTH) were elevated in both groups. There were statistically significant 25-OHD3 levels in the blood in both groups (P=0.008). Ten of the patients (83%) also had iron deficient anemia. CONCLUSION: Vitamin D deficiency and subclinical rickets has been identified in Korea. However, the prevalence of this disease has not been determined. The main limitation of this study was the small number of patients and the absence of a control group.

Analysis of Predictive Factors for Children with Abdominal Pain in Emergency Departments

PURPOSE: Abdominal pain is one of most common complaints in children who visit emergency department (ED), but sometimes it is very difficult in differential diagnosis between medical and surgical disease. This study was performed to collect and analysis of diagnositic scores of children with abdominal pain who could not definitely diagnosed as medical or surgical disease in ED. METHODS: This study reviewed 201 children who were visited for abdominal pain in ED at a tertiary hospital from January 2005 to June 2005. We reviewed the medical records and analysed clinical characteristics, laboratory findings, and radiologic findings retrospectively. We analyzed the diagnostic scores between medical and surgical disease group. RESULTS: The number of medical disease are 125 patients, and the number of surgical disease are 76 patients. Significant predictable factors for surgical diseases are right quadrant pain, vomiting, tenderness, rebound tenderness, leukocytosis and diagnostic score. The mean diagnostic score of medical diseases is 4.55+/-4.10 (mean+/-SD) and the mean score of surgical diseases is 16.22+/-3.48(mean +/-SD). CONCLUSION: For the diagnosis of children with abdominal pain which is uncertain either medical or surgical disease in ED, the diagnostic scores, careful observation and physical examination repeatedly are helpful for correct diagnosis and prompt treatment.

Severe hypernatremic dehydration in a breast-fed neonate / 소아과

Although it is a rare condition, breast-feeding may result in hypernatremic dehydration. However, incidences might be increasing with more mothers breast-feeding. Although the early detection and management of hypernatremic dehydration from breast-feeding is important, its prevention is even more important on account of its serious complications. In order to prevent hypernatremic dehydration secondary to breast-feeding, it is essential to educate mothers in successful breast-feeding methods. An early follow-up after discharge is recommended. We report a case of hypernatremic dehydration secondary to breast-feeding in a full-term newborn that was corrected without any complications.

An Unusual Case of Acute Pyelonephritis Caused by Shigella dysenteri in a Child

Shigella infection usually produces gastrointestinal symptoms but rarely causes urinary tract infection. A 7-year-old girl was admitted for fever, chills, right flank pain, and dysuria. She had no vomiting or diarrhea. There was mild tenderness in her right lower abdomen, and right CVA tenderness was also noted. Acute pyelonephritis was diagnosed by abdominal CT. She showed improvement with intravenous administration of antibiotics. The first urine culture grew 1 x 10(5) CFU/mL Shigella dysenteri. Although urinary tract infections due to Shigella species are extremely rare, Shigella species should be considered as a possible cause of pediatric urinary tract infection. We report the first case of urinary tract infection caused by S. dysenteri, which presented as acute pyelonephritis without gastrointestinal symptoms in a child.

A Case of Immotile Cilia Syndrome Diagnosed by Lack of Dynein Inner Arms on Electron Microscopy / 소아알레르기및호흡기학회지

Immotile cilia syndrome is an inherited disorder characterized by specific ultrastructural defects of cilia and associated impairment of ciliary motion and mucociliary clearance. Disorders of ciliary structure or function result in chronic sinopulmonary diseases manifested as chronic sinusitis, bronchitis, otitis media, nasal polyposis, and ultimately bronchiectasis. In addition, situs inversus, dextrocardia, and infertility can be associated with dysfunctional ciliary activity. We experienced a case of immotile cilia syndrome presenting with recurrent bronchitis, pneumonia, chronic sinusitis, otitis media, and bronchiectasis. She was diagnosed by lack of dynein inner arm on electron microscopy. Treatment included chest percussion, bronchodilators, antibiotics, and surgical intervention. She has been followed up at regular intervals. We report this case with related literatures.

A Case of Menetrier's Disease Associated with Cytomegalovirus Infection

We report the case of a 4 year-old boy with Menetrier's disease, who was presented with edema and hypoalbuminemia. Gastroduodenal endoscopy showed the characteristic features of giant hypertrophy of the gastric rugae and large quantities of adherent gelatinous material. Histologic findings revealed foveolar hyperplasia. The presence of CMV infection was identified by serology. His symptoms resolved spontaneously, and he has fared well.

Relationship of Air Pollution and Pediatric Respiratory Diseases in Incheon City / 소아알레르기및호흡기학회지

PURPOSE: It is generally accepted that the air pollution can cause acute respiratory diseases. This study was undertaken to investigate the relationship between the increase in the level of air pollutants and hospital visits for pediatric respiratory diseases in Incheon city. METHODS: We retrospectively reviewed the medical records of pediatric patients who visited the outpatient department(OPD) of Inha University Hospital for respiratory diseases(such as bronchial asthma, pneumonia, bronchitis, bronchiolitis and URI) from January 1 to December 31 1997. We converted the data into an average per day that included meteorologic data of air pollution(such as O3, CO, SO2, NO2, and PM10) and weather data(such as atmospheric temperature, relative humidity) in three different places in Incheon city. We used a Poisson distribution, selecting a lowess statistics model. We also used the S-PLUS statistics program. RESULTS: Ozone(O3), CO, and SO2 were all found to have significant associations with the OPD visits for pediatric respiratory diseases. After meteorologic variables(such as CO, SO2, NO2, PM10, atmospheric temperature, and relative humidity) controlled, we determined the relative risk between the increase in the OPD visits for respiratory diseases and every 0.01 ppm increase in O3. The relative risk was 1.16 and the 95% confidence intervals were 1.12-1.20. CONCLUSION: There was a significant relationship between the incidence of pediatric respiratory diseases and the increase in the level of air pollutants, especially O3, CO, and SO2 in Incheon city. Further studies on the effects of continuous daily exposure to low or ambient levels of air pollutants are needed.