Long-term outcome of botulinum toxin injection for the treatment of chronic anal fissure: a randomized controlled trial.

Background: Lateral internal sphincterotomy has been accepted as the gold standard for chronic anal fissure. Despite the effectiveness, it carries a risk of fecal incontinence. Non-operative management of chronic anal fissure has been used as alternative treatment. Objectives: Evaluate the efficacy and long-term outcomes of botulinum toxin injection for the treatment of chronic anal fissure. Material and method: A prospective randomized controlled trial was conducted on 40 patients diagnosed with chronic anal fissure who were assigned to undergo either botulinum toxin injection or lateral internal sphincterotomy. Results: The wound-healing rate at 12 weeks and the reduction of post-treatment-resting pressure was significantly better in the sphincterotomy group. Complications and the continence status were not different between the two treatment groups. None of the patients in the sphincterotomy group required additional treatment, while seven patients in the botulinum toxin injection group underwent subsequent sphincterotomy within three years. Conclusion: The long-term result of botulinum toxin injection for chronic anal fissure was inferior to lateral internal sphincterotomy.

Randomized control trial of live Lactobacillus acidophilus plus Bifidobacterium infantis in treatment of infantile acute watery diarrhea.

OBJECTIVE: To evaluate the effectiveness of live Lactobacillus acidophilus plus Bifidobacterium infantis in the treatment of acute watery diarrhea. DESIGN: Open, randomized control trial. SETTING: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: Seventy-one infants (aged 1-24 months) with acute watery diarrhea that presented at Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok were enrolled after parental signed informed consent. They were randomized into 2 groups. The Study group (n = 35) received live Lactobacillus plus Bifidobacterium (3 x 10(9) CFU) bid and ORS and the Control group (n = 36) received ORS only. All infants received lactose free milk. Case record forms were completed daily for 5 days by the parents. RESULTS: All 71 infants completed the present study. There was no difference of the patients'characteristics and baseline clinical symptoms between the study group and the control group. Live Lactobacillus plus Bifidobacterium shortened the diarrhea duration (1.6 +/- 0.7 days vs 2.9 +/- 1.7 days, p < 0.01) compared to controls. However the stool frequency and duration of hospitalization were not significantly different (p > 0.05, study group vs control group). CONCLUSION: Live Lactobacillus acidophilus plus Bifidobacterium infantis may be an effective treatment for acute watery diarrhea in infants. The 2-day course treatment can significantly shorten the duration of diarrhea.

Prevalence of CagA and VacA genotype of Helicobacter pylori in Thai children.

Seroprevalence of Helicobacter pylori infection in children is variable according to geographical location and family sanitation. A previous study in Bangkok showed an incidence of 25.5% in 1998. The higher incidence in the urban and rural area is predicted in lower economic classes and poor sanitation. OBJECTIVE: To study the occurance of CagA and VacA genotype in Thai children using the Western blot technique. MATERIAL AND METHOD: Sera of 159 Thai native children aged 0-15 year without associated abdominal pain from different provinces in 4 parts of the Kingdom of Thailand were tested with the rapid screening test for H. pylori. The positive specimen was further tested with the Western blot technique for determination of Urea A (p37), CagA (p116) and VacA (p89). RESULT: Fiftyfive andfifty two (34.6%) were tested positive by the rapid test while 32.7% were positivefor the band of current infection marker (CIM). The 28 selected positive sera with complete history of housing and water supply were analysed. Thai children living in urban areas have a higher prevalence and the CagA+, VacA+ are found in 96.43% of infected patients. The transmission may be through the water supply. CONCLUSION: A high prevalence of Helicobacter pylori infection was found in childhood period in urban areas and may be associated with the local water supply.

Gastrointestinal manifestations of cow's milk protein allergy during the first year of life.

BACKGROUND: Cow's milk protein sensitive enteropathy (CMPSE) is a common condition in the first year of life. Clinically CMPSE usually presents with symptoms like vomiting, chronic diarrhea, mucous bloody diarrhea and hematemesis. More unusual symptoms associated with CMPSE are infantile colic, gastroesophageal reflux and chronic constipation. The objective of this study was to assess the gastrointestinal manifestations and allergic march in CMPSE patients. METHOD: The authors reviewed the records of 10 CMPSE patients observed by the Gastrointestinal Unit at King Chulalongkorn Memorial Hospital from 1997-2001 including patient characteristics, laboratory investigations, endoscopy and follow-up outcome. RESULTS: Of 10 CMPSE patients, the median age of CMPSE onset was 3.5 months. The gastrointestinal manifestations were hematemesis (n = 6), mucous bloody diarrhea (n = 3) and chronic watery diarrhea (n = 2). Exclusively breast-fed infants seemed to have more delayed onset of symptoms than those who were not. Anemia (n = 3), high serum IgE (n = 4) and positive skin prick test for cow's milk (n = 5) were found. Neither peripheral eosinophilia nor hypoalbuminemia was found. Endoscopy revealed acute and chronic gastritis. Treatment was successful by changing to soy or extensive hydrolysate formula with mean duration of cow's milk intolerance of 24 months. In 2-year follow-up, three of ten patients who had high serum IgE level developed allergic rhinitis and eczema. CONCLUSION: CMPSE can be manifested in various symptoms. Exclusive breast feeding for more than 4 months can postpone the onset of CMPSE. Serum IgE or specific IgE level to cow's milk protein may identify the atopic career of CMPSE individuals.