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1.
Arq. gastroenterol ; 61: e23146, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1563979

ABSTRACT

ABSTRACT Background: Functional constipation (FC) is a common global high prevalence issue in children. Objective: The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. Methods: This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. Results: At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va­riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05). Conclusion: VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.


RESUMO Contexto: A constipação funcional (CF) é um problema comum de alta prevalência global em crianças. Objetivo: O objetivo do presente estudo é avaliar o efeito da manipulação visceral (MV) em crianças com CF crônica intratável, não responsiva ao tratamento padrão. Métodos: Este estudo foi conduzido como um ensaio clínico randomizado, controlado e cego. Cinquenta e duas crianças com CF crônica refratária, não responsivas ao tratamento médico padrão, foram randomicamente alocadas em dois grupos de 26 controle (cuidados médicos padrão (CMP)) e 26 intervenção (CMP com MV) por 4 semanas. Dor abdominal, defecação dolorosa, consistência das fezes, frequência de defecação e dose de laxante oral foram avaliadas antes e após o período de tratamento usando a Escala de Avaliação da Dor, Escala de Forma das Fezes de Bristol e relato do paciente/pais. Resultados: No final do tratamento, exceto pela dose de laxante oral no grupo controle, todos os resultados mostraram uma diferença significativa em ambos os grupos (P<0,05). A dose de laxante oral no grupo de intervenção diminuiu significativamente (P<0,05), entretanto, nenhuma mudança significativa foi observada no grupo controle (P>0,05). Na comparação do grupo de intervenção, diferenças estatisticamente significativas foram encontradas em todas as variáveis, exceto na Escala de Forma das Fezes de Bristol (P<0,05). A Escala de Forma das Fezes de Bristol após os tratamentos não foi diferente quando os grupos foram comparados (P=0,32), mas o número de indivíduos com consistência fecal normal aumentou significativamente no grupo de intervenção em comparação com o grupo controle (P<0,05). Conclusão: A MV pode ser considerada como um possível tratamento sem efeitos colaterais além dos CMP para o manejo da CF crônica. Mais estudos são necessários para investigar o efeito de longo prazo da MV.

2.
Arq. gastroenterol ; 59(2): 244-250, Apr.-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1383859

ABSTRACT

ABSTRACT Background: Investigation of the gut-specific bacterial strains including lactobacilli is essential for understanding the bacterial etiology of constipation. Objective: This study aimed to compare the prevalence and quantity of intestinal lactobacilli in constipated children and healthy controls. Methods: Forty children fulfilling Rome IV criteria for functional constipation and 40 healthy controls were recruited. Fecal samples were analyzed using species-specific polymerase chain reaction followed by random amplified polymorphic DNA-PCR and quantitative real-time PCR. Results: Totally, seven different species of lactobacilli were detected. Out of 80 volunteers, 65 (81.3%) were culture and species-specific PCR positive from which 25 (38.46%) constipated children and 40 (61.54%) healthy subjects. The most prevalent species were L. paracasei 21 (32.3%) followed by L. plantarum 18 (27.7%) among both healthy and patient groups. Analysis of the RAPD dendrograms displayed that strains isolated from constipated and non-constipated children have similarity coefficients of more than 90%. The qPCR assays demonstrated constipated children had a lower amount of total lactobacilli population (per gram of feces) than healthy controls. Conclusion: Our findings showed that the mere existence of various species of Lactobacillus in the gut does not enough to prevent some gastrointestinal disorders such as functional constipation, and their quantity plays a more important role.


RESUMO Contexto: A investigação das cepas bacterianas específicas do intestino, incluindo lactobacilos, é essencial para a compreensão da etiologia bacteriana da prisão de ventre. Objetivo: Este estudo teve como objetivo comparar a prevalência e a quantidade de lactobacilos intestinais em crianças constipadas e controles saudáveis. Métodos: Foram recrutadas quarenta crianças que preenchem os critérios de Roma IV para prisão de ventre funcional e 40 controles saudáveis. As amostras fecais foram analisadas utilizando-se uma reação da cadeia de polimerase específica da espécie, seguida por DNA polimórfico amplificado aleatório e PCR quantitativo em tempo real. Resultados: Foram detectadas sete espécies diferentes de lactobacilos. Dos 80 voluntários, 65 (81,3%) eram cultura em PCR específico de espécies, dos quais 25 (38,46%) crianças constipadas e 40 (61,54%) indivíduos saudáveis. As espécies mais prevalentes foram L. paracasei 21 (32,3%) seguidas por L. plantarum 18 (27,7%) entre grupos saudáveis e de pacientes. A análise dos dendrogramas do RAPD mostrou que cepas isoladas de crianças constipadas e não constipadas têm coeficientes de similaridade superiores a 90%. Os ensaios qPCR demonstraram que as crianças constipadas apresentavam uma quantidade menor de população total de lactobacilos (por grama de fezes) do que os controles saudáveis. Conclusão: Nossos achados mostraram que a mera existência de várias espécies de Lactobacillus no intestino não é suficiente para prevenir alguns distúrbios gastrointestinais, como a prisão de ventre funcional, e sua quantidade desempenha um papel mais importante.

3.
ABCD (São Paulo, Online) ; 35: e1709, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1419819

ABSTRACT

ABSTRACT BACKGROUND: Type of ostomy closure has connection with some complications and also cosmetic effects. AIMS: This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction. METHODS: In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant. RESULTS: Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear. CONCLUSION: Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.


RESUMO RACIONAL: A técnica de fechamento da ostomia tem relação com algumas complicações e também efeitos estéticos. OBJETIVOS: Comparar o resultado do fechamento da colostomia pelo método em bolsa versus método linear, em termos de infecção do sítio cirúrgico, tempo cirúrgico e satisfação do paciente. MÉTODOS: Foram incluídos 50 pacientes que não realizaram o fechamento da estomia em bolsa e 50 pacientes que foram submetidos ao fechamento linear. Os dois grupos foram comparados quanto ao tempo cirúrgico, infecção da ferida, satisfação do paciente, comprimento da cicatriz. Valor de p menor que 0,05 foi considerado significativo. RESULTADOS: A infecção da ferida não foi registrado no grupo de bolsa, em comparação com 10% no grupo linear (p=0,022). O comprimento da cicatriz foi de 24,09±0,1 mm no grupo de bolsa e 52,15±1,0 mm no grupo linear (p=0,033). O tempo de hospitalização foi significativamente menor no grupo em bolsa (6,4±1,1 dias) em comparação ao linear (15,5±4,6 dias, p=0,0001). A escala Patient and Observer Scar Assessment Scale para observador (p=0,038) e pais (p=0,045) foi mais favorável entre o grupo em bolsa, em relação ao linear. CONCLUSÕES: A técnica em bolsa apresentou infecção do sítio cirúrgico menos frequente, menor tempo de internação, menor comprimento da cicatriz e resultado cosmético mais favorável, em comparação com a técnica linear.

4.
Arq. gastroenterol ; 58(4): 520-524, Oct.-Dec. 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1350114

ABSTRACT

ABSTRACT BACKGROUND: Esophageal stenosis (ES) in children is a fixed intrinsic narrowing of the esophagus due to numerous aetiologies. OBJECTIVE: This study aimed to determine the clinical and nutritional impacts of endoscopic balloon dilation (EBD) in Iranian children with an esophageal stricture. METHODS: This retrospective study, pediatric patients (aged <18 years) who underwent EBD for esophageal stricture from April 2015 until March 2020 in Abuzar Children's Hospital (Ahvaz, Iran) were enrolled in the study. Outcome parameters were the frequency of dilations, nutritional status, complications, and clinical success rates. EBD was used in children with radiologic evidence of esophageal stenosis. The nutritional status was evaluated by weight-for-age (z-score). Clinical success was considered as no necessity of EBD for a minimum of one year and/or increasing interval among dilation and the frequency of EBD was less than four times per year. RESULTS: A total of 53 cases (mean age, 4.72±3.38 years) were enrolled. There were 25 (47.2%) females and 28 (52.8%) males. During follow-up, a total of 331 EBD sessions were performed, with an average of 6.24 sessions per patient. There was one case of perforation and one case of mediastinitis, while there was no other complication or mortality. The clinical success rate of EBD therapy was 62.3% (33/53). The mean standard deviation z-score weight-for-age of patients before and after endoscopic dilation was 2.78 (2.41) and 1.18 (1.87), respectively. The t-test showed a significant difference between the weights-for-age (z-score) before and after endoscopic dilation. The majority of the patients had raised weight-for-age (z-score) after EBD treatment. CONCLUSION: EBD attained a good clinical success rate and nutritional improvement in children with an esophageal stricture.


RESUMO CONTEXTO: Estenose esofágica (EE) em crianças é um estreitamento intrínseco fixo do esôfago devido a inúmeras etiologias. OBJETIVO: Este estudo teve como objetivo determinar os impactos clínicos e nutricionais da dilatação do balão endoscópico (DBE) em crianças iranianas com restrição esofágica. MÉTODOS: Foram inscritos neste estudo retrospectivo, pacientes pediátricos (com idade <18 anos) submetidos a DBE para restrição esofágica de abril de 2015 a março de 2020 no Hospital Infantil de Abuzar (Ahvaz, Irã). Os parâmetros de desfecho foram a frequência de dilatações, o estado nutricional, complicações e taxas de sucesso clínico. A DBE foi usada em crianças com evidência radiológica de estenose esofágica. O estado nutricional foi avaliado pelo peso-por-idade (escore z). O sucesso clínico foi considerado como não necessidade de DBE por um período mínimo de um ano e/ou aumento de intervalo entre dilatações e frequência inferior a quatro vezes por ano. RESULTADOS: Foram incluídos 53 casos (média de idade, 4,72±3,38 anos). Eram 25 mulheres (47,2%) e 28 homens (52,8%). Durante o acompanhamento, foram realizadas 331 sessões de DBE, com média de 6,24 sessões por paciente. Houve um caso de perfuração e um caso de mediastinite, enquanto não houve outra complicação ou mortalidade. A taxa de sucesso clínico da terapia de DBE foi de 62,3% (33/53). A média (escore z) peso-para-idade dos pacientes antes e depois da dilatação endoscópica foi de 2,78 (2,41) e 1,18 (1,87), respectivamente. O teste t mostrou uma diferença significativa entre os pesos por idade (escore z) antes e depois da dilatação endoscópica. A maioria dos pacientes havia aumentado o peso por idade (escore z) após o tratamento com DBE. CONCLUSÃO: A DBE atingiu boa taxa de sucesso clínico e melhora nutricional em crianças com restrição esofágica.

5.
Arq. gastroenterol ; 58(3): 329-336, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1345281

ABSTRACT

ABSTRACT BACKGROUND: There is limited research examining reasons causing refractory chronic constipation (RCC) in children. The effects of lead (Pb) and cadmium (Cd) exposures on this condition have been even less clear. However, some related factors may contribute to evaluation of blood lead levels (BLLs) and blood cadmium levels (BCLs). OBJECTIVE: The present study aimed to examine the relationship between Pb and Cd exposures and RCC in children living in the city of Ahvaz, Khuzestan Province, in Southwestern Iran. METHODS: This study was performed on a total number of 48 children aged 2-13 years, including 36 medically-diagnosed RCC cases and 12 controls referring to a pediatric clinic in the city of Ahvaz. Their BLLs and BCLs were then determined using a graphite furnace atomic absorption spectrophotometer. The data from the researcher-designed questionnaire were also recoded and the related risk factors were analyzed through Spearman's correlation and logistic regression analysis. RESULTS: The findings revealed that the geometric means of Pb and Cd in blood samples in the control group were 58.95 µg/dL and 0.45 µg/dL; respectively. These values in the case group were equally 45.26 µg/dL and 0.26 µg/dL; respectively. A significant difference was additionally observed between BCLs in the case and control groups (P<0.01). All children in both groups also had BLLs greater than the permissible limit endorsed by the World Health Organization (WHO) (≤10 µg/dL). On the other hand, 8.3% of the individuals in the case group and 33.3% of those in the control group had BCLs higher than the acceptable range mentioned by WHO (≤0.5 µg/dL). CONCLUSION: Pb and Cd exposures due to environmental pollution and susceptibility to heavy metals may not be associated with RCC in children living in the city of Ahvaz. Although this research was the first one providing data on BLLs and BCLs in children with RCC, the findings could be useful for designing future epidemiologic studies.


RESUMO CONTEXTO: Há limitadas pesquisas que procuram razões que causem constipação crônica refratária (CCR) em crianças. Os efeitos das exposições de chumbo (Pb) e cádmio (Cd) nesta condição têm sido ainda menos claros. No entanto, alguns fatores relacionados podem contribuir para a avaliação dos níveis de Pb no sangue (NPbSs) e dos níveis de Cd no sangue (NCdSs). OBJETIVO: O presente estudo teve como objetivo examinar a relação entre as exposições de Pb e Cd e a CCR em crianças residentes na cidade de Ahvaz, província de Khuzestan, no Sudoeste do Irã. MÉTODOS: Este estudo foi realizado em um número total de 48 crianças de 2 a 13 anos, incluindo 36 casos de CCR diagnosticados clinicamente, e 12 controles encaminhados a uma clínica pediátrica na cidade de Ahvaz. Seus NPbSs e NCdSs foram então determinados usando um espectrógrafo de absorção atômica do forno de grafite. Os dados do questionário projetado pelo pesquisador também foram recodificados, e os fatores de risco relacionados foram analisados por meio da análise de correlação e regressão logística de Spearman. RESULTADOS: Os achados revelaram que as médias geométricas de Pb e Cd em amostras de sangue no grupo controle foram de 58,95 μg/dL e 0,45 μg/dL; respectivamente. Esses valores no grupo constipação foram igualmente 45,26 μg/dL e 0,26 μg/dL; respectivamente. Observou-se diferença significativa entre os NCdSs nos grupos de caso e controle (P<0,01). Todas as crianças de ambos os grupos também apresentaram NPbSs maiores do que o limite permitido endossado pela Organização Mundial da Saúde (OMS) (≤10 μg/dL). Por outro lado, 8,3% dos indivíduos no grupo de casos e 33,3% dos do grupo controle apresentaram NCdSs superiores à faixa aceitável mencionada pela OMS (≤0,5 μg/dL). CONCLUSÃO: As exposições de Pb e Cd por poluição ambiental e suscetibilidade a metais pesados podem não estar associadas à CCR em crianças residentes na cidade de Ahvaz. Embora esta pesquisa tenha sido a primeira a fornecer dados sobre NPbSs e NCdSs em crianças com CCR, os achados poderiam ser úteis para a concepção de futuros estudos epidemiológicos.


Subject(s)
Humans , Child , Cadmium/analysis , Lead/analysis , Risk Factors , Constipation/chemically induced , Iran/epidemiology
6.
Rev. gastroenterol. Perú ; 40(2): 149-154, abr-jun 2020. tab
Article in English | LILACS | ID: biblio-1144653

ABSTRACT

ABSTARCT Background : Autoimmune hepatitis (AIH) is an auto-inflammatory liver disease of children and adults, affecting patients of any age, sex, race or ethnicity, with more prevalence in females. Objective : The aim of this study was to evaluate clinical manifestation, laboratory findings, and outcome of children with autoimmune hepatitis. Materials and methods : We evaluated 86 patients treated and followed with final diagnosis of AIH between years 2010 to 2018. Physical findings (including jaundice, hepatomegaly, splenomegaly and encephalopathy), liver enzymes, liver histology and autoantibodies (including ANA, Anti LKM-1 and ASMA) were extracted from medical files. Then the patients were followed for their final outcome (including response to medical treatment or successful treatment withdrawal, liver transplantation or death). Results : Among 86 patients with AIH with mean age 9.10±4.36 years old, 66.27% were females. Jaundice (75.6%) and hepatomegaly (46.5%) were the most frequent physical findings, followed by splenomegaly (32.6%) and encephalopathy (17.4%). Aminotransferases including AST and ALT were elevated at least 3 times more than upper limit of normal in most of the patients (61.6% and 55.81%, respectively). Autoantibodies were available in 53 of 86 patients, 24.5% had AIH-1, 3.8% had AIH-II and 67.9% were seronegative. Medical treatment including prednisolone and azathioprine was started for patients, 53 of 86 cases (61.6%) had remission and 11 of 86 (13.7%) tolerated medication withdrawal successfully. Among all cases, 26 (30.2%) patients needed liver transplantation. Mortality rate was 9 among 86 cases (10.5%). Conclusion : Jaundice and hepatomegaly was the most frequent clinical findings. Mortality rate was 10.5%.


RESUMEN Antecedentes : La hepatitis autoinmune (AIH) es una enfermedad hepática autoinflamatoria de niños y adultos, que afecta a pacientes de cualquier edad, sexo, raza u origen étnico, con mayor prevalencia en las mujeres. Objetivo : El objetivo de este estudio fue evaluar la manifestación clínica, los hallazgos de laboratorio y el resultado de los niños con hepatitis autoinmune. Materiales y métodos : Evaluamos 86 pacientes tratados y seguidos con el diagnóstico final de AIH entre los años 2010 a 2018. Los hallazgos físicos (incluyendo ictericia, hepatomegalia, esplenomegalia y encefalopatía), enzimas hepáticas, histología hepática y autoanticuerpos (incluidos ANA, Anti LKM-1 y ASMA) se extrajeron de las historias médicas. Luego, los pacientes fueron seguidos para su resultado final (incluida la respuesta al tratamiento médico o la retirada exitosa del tratamiento, el trasplante de hígado o la muerte). Resultados : Entre 86 pacientes con AIH con una edad media de 9,10 ± 4,36 años, el 66,27% eran mujeres. La ictericia (75,6%) y la hepatomegalia (46,5%) fueron los hallazgos físicos más frecuentes, seguidos de esplenomegalia (32,6%) y encefalopatía (17,4%). Las aminotransferasas que incluyen AST y ALT se elevaron al menos 3 veces más que el límite superior de la normalidad en la mayoría de los pacientes (61,6% y 55,81%, respectivamente). Los autoanticuerpos estaban disponibles en 53 de 86 pacientes, 24,5% tenían AIH-1, 3,8% tenían AIH-II y 67,9% eran seronegativos. Se inició tratamiento médico que incluyó prednisolona y azatioprina, 53 de 86 casos (61,6%) tuvieron remisión y 11 de 86 (13,7%) toleraron el retiro de medicamentos con éxito. Entre todos los casos, 26 (30,2%) pacientes necesitaron un trasplante de hígado. La tasa de mortalidad fue de 9 entre 86 casos (10,5%). Conclusión : la ictericia y la hepatomegalia fueron los hallazgos clínicos más frecuentes. La tasa de mortalidad fue del 10,5%.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Hepatitis, Autoimmune/diagnosis , Prognosis , Hepatitis, Autoimmune/therapy , Iran
7.
ABCD (São Paulo, Impr.) ; 33(3): e1538, 2020. tab, graf
Article in English | LILACS | ID: biblio-1141910

ABSTRACT

ABSTRACT Background: Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop ileostomy. Aim: To evaluate and compare clinical efficacy of Santulli and loop ileostomy in neonates with meconium ileus. Methods: In this retrospective study, 58 patients with meconium ileus were evaluated. After analyses of hospital records, 53 patients with completed hospital records were included. Demographic information, surgery parameters and postoperative complications were extracted from the hospital records or calling parents. Results: Skin excoriation (21.4% vs. 84%, p<0.001), ostomy prolapsed (0 vs. 28%, p=0.003), and surgical site infection (7.1% vs. 28%, p=0.044) was significantly lower in Santulli ileostomy group. Furthermore, ileostomy output in first week (70.53±15.11 ml vs. 144.6±19.99 ml, p<0.001) and in 4th week (2.14±4.98 ml vs. 18.4±17.95 ml, p<0.001) was significantly lower in Santulli ileostomy group as compared to loop ileostomy group. Finally, hospital stay in Santulli ileostomy group was 12±2.34 and in loop ileostomy 14.24±1.47 days (p<0.001). Conclusion: Santulli ileostomy is better than loop ileostomy due to significant less frequency of surgical site infection, skin excoriation, prolapse of ostomy, ileostomy volume output and hospitalization time.


RESUMO Racional: O íleo meconial é causa comum de obstrução intestinal em neonatos e diferentes métodos cirúrgicos foram descritos para seu manejo, como Santulli e ileostomia em alça. Objetivo: Avaliar e comparar a eficácia clínica de Santulli e ileostomia em alça em neonatos com íleo meconial. Métodos: Neste estudo retrospectivo, foram avaliados 58 pacientes. Após análise, 53 pacientes com prontuários hospitalares completos foram incluídos. Informações demográficas, parâmetros cirúrgicos e complicações pós-operatórias foram extraídos dos prontuários ou dos pais por telefone. Resultados: Escoriações cutâneas (21,4% vs. 84%, p<0,001), estomia prolongada (0 vs. 28%, p=0,003) e infecção do sítio cirúrgico (7,1% vs. 28%, p=0,044) foram significativamente menores no grupo ileostomia Santulli. Além disso, a produção de ileostomia na primeira semana (70,53±15,11 ml vs. 144,6±19,99 ml, p <0,001) e na quarta semana (2,14±4,98 ml vs. 18,4±17,95 ml, p<0,001) foi significativamente menor no grupo de ileostomia Santulli em comparação com o de ileostomia em alça. Finalmente, o tempo de internação no grupo de ileostomia de Santulli foi de 12±2,34 e na ileostomia de alça de 14,24±1,47 dias (p<0,001). Conclusão: A ileostomia de Santulli é melhor que a em alça, devido à menor frequência significativa de infecção do local cirúrgico, escoriação cutânea, prolapso da ostomia, volume da ileostomia e tempo de internação.


Subject(s)
Humans , Infant, Newborn , Ileostomy/methods , Meconium Ileus/surgery , Intestinal Obstruction/surgery , Postoperative Complications/epidemiology , Retrospective Studies , Length of Stay
8.
ABCD (São Paulo, Impr.) ; 33(3): e1545, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152621

ABSTRACT

ABSTRACT Background: Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung's disease. Aim: To compare circular and oblique anastomoses following Soave's procedure for the treatment of Hirschsprung's disease. Methods: Children who underwent Saove's pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. Results: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). Conclusion: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave's procedure.


RESUMO Racional: Vários tipos de complicações, incluindo constipação, secreção fecal, escoriação perianal foram relatadas entre diferentes tipos de operações para a doença de Hirschsprung. Objetivo: Comparar as anastomoses circulares e oblíquas realizadas no procedimento de Soave para o tratamento da doença de Hirschsprung. Métodos: Neste estudo, foram incluídas crianças submetidas ao procedimento pull-through de Saove com anastomoses oblíquas e circulares. A duração do acompanhamento foi de dois anos no pós-operatório. Complicações, como infecção da ferida, deiscência da ferida, peritonite, secreção fecal, escoriação perianal foram registradas para cada paciente. Resultados: Trinta e oito crianças foram submetidas à anastomoses oblíquas. As circulares foram realizadas em 32. Escoriação perianal foi observada em 57,89% e 46,87% das crianças nos grupos oblíquo e circular, respectivamente. Enterocolite foi mais frequente no grupo circular (40,62%) do que oblíquo (28,94%). A estenose anastomótica foi mais frequente na circular (15,62%) do que na oblíqua (7,89%). Conclusão: A escoriação perianal foi a complicação mais comum entre os pacientes nos dois grupos. A anastomose oblíqua teve menos complicações do que a anastomose circular e pode ser a opção adequada para o paciente submetido ao procedimento de Soave.


Subject(s)
Humans , Infant , Child , Digestive System Surgical Procedures/methods , Anastomosis, Surgical/methods , Constipation/etiology , Fecal Incontinence/etiology , Hirschsprung Disease/surgery , Postoperative Complications/epidemiology , Digestive System Surgical Procedures/instrumentation , Follow-Up Studies , Treatment Outcome , Proctocolectomy, Restorative/methods , Hirschsprung Disease/diagnosis
9.
ABCD (São Paulo, Impr.) ; 33(1): e1486, 2020. tab
Article in English | LILACS | ID: biblio-1130507

ABSTRACT

ABSTRACT Background: Esophageal atresia is congenital anomaly with high mortality. Surgical complications and changes in nutritional status are common problems after surgical correction. Aim: T o evaluate nutritional status, esophageal stenosis, and respiratory complications among children who had repaired esophageal atresia. Methods: Children aged >2 months old with repaired esophageal atresia were included in the current study. Gender, age, weight, and height were recorded for each case. Height for age and weight for age were calculated for each case. Results: According to weight for length percentile, 41.02% of the cases were underweight. Esophageal stenosis was seen in 54.76% of the obtained esophagograms. Conclusion: Underweight was present in 41.02 of the patients according to weight-for-height percentile.


RESUMO Racional: Atresia de esôfago é anomalia congênita com mortalidade alta. Complicações cirúrgicas e alterações no estado nutricional são problemas comuns após correção cirúrgica. Objetivo: Avaliar o estado nutricional, a estenose esofágica e as complicações respiratórias em crianças que tiveram a reparação de atresia de esôfago. Métodos: Crianças com idade> 2 meses de idade com atresia esofágica reparada foram incluídas no estudo atual. Sexo, idade, peso e altura foram registrados para cada caso. A altura por idade e o peso por idade foram calculados para cada caso. Resultados: De acordo com o peso para o percentil de comprimento, 41,02% dos casos estavam abaixo do peso. Estenose esofágica foi observada em 54,76% do esofagograma obtido. Conclusão: O baixo peso esteve presente em 41,02 dos pacientes, de acordo com o percentil peso/estatura.


Subject(s)
Humans , Infant , Malnutrition/etiology , Malnutrition/epidemiology , Esophageal Atresia/surgery , Esophageal Atresia/complications , Esophageal Stenosis/etiology , Esophageal Stenosis/epidemiology , Body Weight , Incidence
10.
ABCD (São Paulo, Impr.) ; 33(1): e1485, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130508

ABSTRACT

ABSTRACT Background: Meconium ileus is a common cause of intestinal obstruction in neonates that different surgical methods have been described for its management such as Santulli and loop ileostomy. Aim: To evaluate and compare clinical efficacy of Santulli and loop ileostomy in neonates with meconium ileus. Methods: In this retrospective study, 58 patients with meconium ileus were evaluated. After analyses of hospital records, 53 patients with completed hospital records were included. Demographic information, surgery parameters and postoperative complications were extracted from the hospital records or calling parents. Results: Skin excoriation (21.4% vs. 84%, p<0.001), ostomy prolapsed (0 vs. 28%, p=0.003), and surgical site infection (7.1% vs. 28%, p=0.044) was significantly lower in Santulli ileostomy group. Furthermore, ileostomy output in first week (70.53±15.11 ml vs. 144.6±19.99 ml, p<0.001) and in 4th week (2.14±4.98 ml vs. 18.4±17.95 ml, p<0.001) was significantly lower in Santulli ileostomy group as compared to loop ileostomy group. Finally, hospital stay in Santulli ileostomy group was 12±2.34 and in loop ileostomy 14.24±1.47 days (p<0.001). Conclusion: Santulli ileostomy is better than loop ileostomy due to significant less frequency of surgical site infection, skin excoriation, prolapse of ostomy, ileostomy volume output and hospitalization time.


RESUMO Racional: O íleo meconial é causa comum de obstrução intestinal em neonatos e diferentes métodos cirúrgicos foram descritos para seu manejo, como Santulli e ileostomia em alça. Objetivo: Avaliar e comparar a eficácia clínica de Santulli e ileostomia em alça em neonatos com íleo meconial. Métodos: Neste estudo retrospectivo, foram avaliados 58 pacientes. Após análise, 53 pacientes com prontuários hospitalares completos foram incluídos. Informações demográficas, parâmetros cirúrgicos e complicações pós-operatórias foram extraídos dos prontuários ou dos pais por telefone. Resultados: Escoriações cutâneas (21,4% vs. 84%, p<0,001), estomia prolongada (0 vs. 28%, p=0,003) e infecção do sítio cirúrgico (7,1% vs. 28%, p=0,044) foram significativamente menores no grupo ileostomia Santulli. Além disso, a produção de ileostomia na primeira semana (70,53±15,11 ml vs. 144,6±19,99 ml, p <0,001) e na quarta semana (2,14±4,98 ml vs. 18,4±17,95 ml, p<0,001) foi significativamente menor no grupo de ileostomia Santulli em comparação com o de ileostomia em alça. Finalmente, o tempo de internação no grupo de ileostomia de Santulli foi de 12±2,34 e na ileostomia de alça de 14,24±1,47 dias (p<0,001). Conclusão: A ileostomia de Santulli é melhor que a em alça, devido à menor frequência significativa de infecção do local cirúrgico, escoriação cutânea, prolapso da ostomia, volume da ileostomia e tempo de internação.


Subject(s)
Humans , Male , Female , Infant, Newborn , Ileostomy/methods , Meconium Ileus/surgery , Intestinal Obstruction/surgery , Postoperative Complications/epidemiology , Retrospective Studies , Length of Stay
11.
ABCD (São Paulo, Impr.) ; 33(3): e1537, 2020. tab
Article in English | LILACS | ID: biblio-1141901

ABSTRACT

ABSTRACT Background: Esophageal atresia is congenital anomaly with high mortality. Surgical complications and changes in nutritional status are common problems after surgical correction. Aim: To evaluate nutritional status, esophageal stenosis, and respiratory complications among children who had repaired esophageal atresia. Methods: Children aged >2 months old with repaired esophageal atresia were included in the current study. Gender, age, weight, and height were recorded for each case. Height for age and weight for age were calculated for each case. Results: According to weight for length percentile, 41.02% of the cases were underweight. Esophageal stenosis was seen in 54.76% of the obtained esophagograms. Conclusion: Underweight was present in 41.02 of the patients according to weight-for-height percentile.


RESUMO Racional: Atresia de esôfago é anomalia congênita com mortalidade alta. Complicações cirúrgicas e alterações no estado nutricional são problemas comuns após correção cirúrgica. Objetivo: Avaliar o estado nutricional, a estenose esofágica e as complicações respiratórias em crianças que tiveram a reparação de atresia de esôfago. Métodos: Crianças com idade> 2 meses de idade com atresia esofágica reparada foram incluídas no estudo atual. Sexo, idade, peso e altura foram registrados para cada caso. A altura por idade e o peso por idade foram calculados para cada caso. Resultados: De acordo com o peso para o percentil de comprimento, 41,02% dos casos estavam abaixo do peso. Estenose esofágica foi observada em 54,76% do esofagograma obtido. Conclusão: O baixo peso esteve presente em 41,02 dos pacientes, de acordo com o percentil peso/estatura.


Subject(s)
Humans , Infant , Malnutrition/etiology , Malnutrition/epidemiology , Esophageal Atresia/surgery , Esophageal Atresia/complications , Esophageal Stenosis/etiology , Esophageal Stenosis/epidemiology , Body Weight , Incidence
12.
Rev. gastroenterol. Perú ; 39(4): 323-328, oct.-dic 2019. ilus
Article in English | LILACS | ID: biblio-1144616

ABSTRACT

Introduction and aim: Functional abdominal pain (FAP) is one of the major gastrointestinal complaints in childhood. Studies have reported occult constipation (OC) as one of the leading causes of abdominal pain. Recent researches have proposed laxatives as potent therapeutic targets for abdominal pain in patients with OC. However, no study has compared effect of poly ethylene glycol (PEG) and lactulose on occult constipation. Materials and methods: 51 patients aged 4 to 18 years with abdominal pain who had OC (defined as fecal impaction in abdominal X ray) were studied. Demographic and clinical data including age, sex, body weight, height, abdominal pain duration, abdominal pain rate and fecal odor were registered. They were randomly assigned to receive PEG (1gr/kg) or Lactulose (1cc/kg) for at least two weeks. All patients were reevaluated by pain measurement scale after at least two weeks of treatment. Results: It is indicated that the efficacy of PEG for reducing abdominal pain in OC was 48% while it was 37% for Lactulose. This study indicated that this efficacy is not affected significantly by sex and fecal odor, however this efficacy is influenced by age, body weight, abdominal pain duration and abdominal pain rate for both PEG and Lactulose. Conclusion: It could be concluded that PEG is a more efficient drug for treating abdominal pain in occult constipation than Lactulose and its optimum effect can be achieved in elder patients with more severe abdominal pain.


Introducción y objetivo: El dolor abdominal funcional (FAP) es una de las principales molestias gastrointestinales en la infancia. Los estudios han informado que el estreñimiento oculto (OC) es una de las principales causas de dolor abdominal. Investigaciones recientes han propuesto laxantes como objetivos terapéuticos potentes para el dolor abdominal en pacientes con OC. Sin embargo, ningún estudio ha comparado el efecto del polietilenglicol (PEG) y la lactulosa sobre el estreñimiento oculto. Materiales y métodos: Se estudiaron 51 pacientes de 4 a 18 años con dolor abdominal que tenían OC (definida como impactación fecal en rayos X abdominales). Se registraron datos demográficos y clínicos que incluyen edad, sexo, peso corporal, altura, duración del dolor abdominal, tasa de dolor abdominal y olor fecal. Fueron asignados aleatoriamente para recibir PEG (1 gr/kg) o lactulosa (1 cc/kg) durante al menos dos semanas. Todos los pacientes fueron reevaluados por la escala de medición del dolor después de al menos dos semanas de tratamiento. Resultados: Se indica que la eficacia de PEG para reducir el dolor abdominal en OC fue del 48% mientras que fue del 37% para la lactulosa. Este estudio indicó que esta eficacia no se ve afectada significativamente por el sexo y el olor fecal, sin embargo, esta eficacia está influenciada por la edad, el peso corporal, la duración del dolor abdominal y la tasa de dolor abdominal tanto para PEG como para lactulosa. Conclusión: Se podría concluir que el PEG es un fármaco más eficaz para tratar el dolor abdominal en el estreñimiento oculto que la lactulosa y que su efecto óptimo se puede lograr en pacientes mayores con dolor abdominal más severo.Palabras clave: dolor abdominal, estreñimiento oculto, polietilenglicol, lactulosa.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Polyethylene Glycols/therapeutic use , Abdominal Pain/drug therapy , Constipation/drug therapy , Laxatives/therapeutic use , Fecal Impaction/drug therapy , Lactulose/therapeutic use , Time Factors , Body Weight , Pain Measurement/methods , Abdominal Pain/etiology , Sex Factors , Age Factors , Constipation/complications , Fecal Impaction/complications , Fecal Impaction/diagnostic imaging
13.
Rev. gastroenterol. Perú ; 39(4): 344-347, oct.-dic 2019. ilus, tab
Article in English | LILACS | ID: biblio-1144619

ABSTRACT

Background: Diabetes mellitus type 1 (T1DM) is one of the childhood diseases with growing prevalence. Various accompanying autoimmune diseases were seen with type 1 diabetes. The most common autoimmune diseases with T1DM are autoimmune thyroiditis and celiac disease. In some reports, autoimmune hepatitis has been reported in association with DM-1. Objectives: The aim of this study was to evaluate autoimmune hepatitis autoantibodies in children with T1DM. Materials and methods: In this crosssectional study, 202 children with T1DM were evaluated (47.5% were males and 52.5% were girls). Liver enzymes, autoimmune hepatitis related autoantibodies such as anti-nuclear antibodies (ANA), anti-smooth muscle (ASMA) and anti liver and kidney microsomal antibodies (LKM-1) were measured. Liver ultrasound was done for participants and biopsy of liver was taken for children with increased echogenicity of the liver, hepatomegaly or elevated liver enzymes. Results analyzed by statistical software spss-16, Descriptive statistics and chi-square test, paired T-TEST. Level of less than 5% was considered statistically significant. Results: In 6 patients ANA and in 4 patients (2%) ASMA was positive,1 patient was ASMA positive but ANA negative. None of the patients were Anti LKM-1 positive. 3 patients had positive ANA and ASMA, and increased liver echogenicity on ultrasound simultaneously. Histological evaluation was showed that 2 patients had findings in favor of autoimmune hepatitis. Conclusion: Auto antibodies were positive in 10 cases. ANA was positive in 6 (2.97%) of all cases. ASMA was positive in 4 (1.98%) cases. Increased echogenicity was found in 3 cases. Histological evaluation showed 2 patients had biopsy confirmed autoimmune hepatitis. AIH-2 was not seen among our cases.


Antecedentes: La diabetes mellitus tipo 1 (DM1) es una de las enfermedades infantiles con mayor prevalencia. Se observaron varias enfermedades autoinmunes acompañantes con diabetes tipo 1. Las enfermedades autoinmunes más comunes con DM1 son la tiroiditis autoinmune y la enfermedad celíaca. En algunos reportes, se ha encontrado hepatitis autoinmune en asociación con DM-1. Objetivos: El objetivo de este estudio fue evaluar los autoanticuerpos de hepatitis autoinmunes en niños con DM1. Materiales y métodos: En este estudio transversal, se evaluaron 202 niños con DM1 (47,5% eran hombres y 52,5% eran niñas). Se midieron las enzimas hepáticas, los autoanticuerpos autoinmunes relacionados con la hepatitis, como los anticuerpos antinucleares (ANA), el músculo liso (ASMA) y los anticuerpos microsomales hepáticos y renales (LKM-1). Se realizó una ecografía hepática para los participantes y se tomó una biopsia del hígado para niños con mayor ecogenicidad del hígado, hepatomegalia o enzimas hepáticas elevadas. Los resultados fueron analizados por el software estadístico spss-16 usando estadística descriptiva y prueba de chi-cuadrado, T-TEST pareado. Se consideró estadísticamente significativo un nivel menor del 5%. Resultados: En 6 pacientes con ANA y en 4 pacientes (2%) ASMA fue positiva, 1 paciente fue ASMA positiva pero ANA negativa. Ninguno de los pacientes fue anti LKM-1 positivo. 3 pacientes tuvieron ANA y ASMA positivas, y aumentaron la ecogenicidad hepática en la ecografía simultáneamente. La evaluación histológica mostró que 2 pacientes tenían hallazgos a favor de la hepatitis autoinmune. Conclusión: Los autoanticuerpos fueron positivos en 10 casos. ANA fue positivo en 6 (2,97%) de todos los casos. La ASMA fue positiva en 4 (1,98%) casos. Se encontró mayor ecogenicidad en 3 casos. La evaluación histológica mostró que 2 pacientes tenían biopsia confirmada de hepatitis autoinmune. AIH-2 no fue visto entre nuestros casos.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Young Adult , Autoantibodies/blood , Hepatitis, Autoimmune/immunology , Diabetes Mellitus, Type 1/immunology , Aspartate Aminotransferases/blood , Microsomes, Liver/immunology , Antibodies, Antinuclear/blood , Cross-Sectional Studies , Alanine Transaminase/blood , Kidney/immunology , Microsomes/immunology , Muscle, Smooth/immunology
14.
Arq. gastroenterol ; 56(1): 84-87, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1001316

ABSTRACT

ABSTRACT BACKGROUND: Ultrasonography has shown to be useful in the diagnosis of constipation. OBJECTIVE: The aim of this study was to compare the rectal diameter and rectal wall thickness in children with and without constipation. METHODS: Children with the diagnosis of constipation according to Rome III criteria were included in the study. The children underwent transabdominal sonography for the evaluation of rectal diameter and rectal wall thickness. Ultrasonography was performed with a full bladder. Children without constipation who underwent abdominal sonography were assigned to the control group. RESULTS: The rectal diameter was larger in children with constipation than in children without constipation (31.72±9.63 mm vs 19.85±4.37 mm; P=0.001). The rectal wall was thinner in children with constipation than in children without constipation (1.75±0.33 mm vs 1.90±0.22 mm; P=0.032). There was no significant difference between boys and girls with constipation in terms of rectal diameter (31.02±8.57 mm 32.77±11.35 mm; P=0.63). CONCLUSION: Transabdominal rectal diameter measurement may be useful in the diagnosis of constipation.


RESUMO CONTEXTO: A ultrassonografia tem sido demonstrada como útil no diagnóstico de constipação. OBJETIVO: O objetivo deste estudo foi comparar o diâmetro retal e a espessura da parede retal em crianças com e sem constipação. MÉTODOS: Foram incluídas no estudo crianças com diagnóstico de constipação de acordo com os critérios de Roma III. As crianças foram submetidas à ultrassonografia abdominal com bexiga cheia para avaliação do diâmetro retal e da espessura da parede retal. Crianças sem constipação que foram submetidas à ultrassonografia abdominal foram atribuídas ao grupo controle. RESULTADOS: O diâmetro retal foi maior em crianças com constipação do que em crianças sem constipação (31,72±9,63 mm vs 19,85±4,37 mm; P=0,001). A parede retal foi mais fina em crianças com constipação do que em crianças sem constipação (1,75±0,33 mm vs 1,90±0,22 mm; P= 0,32). Não houve diferença significante entre meninos e meninas com constipação em relação ao diâmetro retal (31,02±8,57 mm 32,77±11,35 mm; P=0,63). CONCLUSÃO: A medida do diâmetro retal por ultrassonografia abdominal pode ser útil no diagnóstico de constipação.


Subject(s)
Humans , Male , Female , Child , Rectum/anatomy & histology , Constipation/diagnostic imaging , Rectum/diagnostic imaging , Case-Control Studies , Ultrasonography
15.
Rev. gastroenterol. Perú ; 39(1): 7-11, ene.-mar. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1014120

ABSTRACT

Background: Esophageal stricture is one of the most important complication of the caustic ingestion. Objective: The aim of this study was to evaluate complications of balloon dilatation among children with esophageal stenosis. Material and methods: In this retrospective study 82 children were included. Children who underwent balloon dilatation for esophageal stenosis were included in our study. Duration of study was 14 year starting from 2001. Mean age of the cases was 3.95±0.4 year (Min: 15 days, Max: 14 year). Chart review and telephone calling were the methods of data collection. Data was analyzed using SPSS. Results: In this study, 47% of the patients were male and 53% of the cases were female. Caustic ingestion (33.7%) was the most common etiology for the esophageal stricture. Vomiting (87.8%) was the most common presenting symptom. Among our cases, 76.8% had no compliant after esophageal dilatation. Chest pain was the most common compliant after esophageal dilatation. Response rate was similar among boys and girls. Toddler age had the best treatment response after esophageal dilatation. Conclusion: Among our cases, 76.8% had no post procedural compliant after esophageal dilatation. Esophageal perforation was seen in 4.9% of the cases. Chest pain was the most common post dilatation complication.


Antecedentes: La estenosis esofágica es una de las más importantes complicaciones de la ingesta de caústicos. Objetivo: El objetivo del estudio fue evaluar las complicaciones de la dilatación endoscópica con balón en niños con estenosis esofágica. Material y métodos: En este estudio retrospectivo se incluyeron 82 niños. Se incluyeron todos los niños que se sometieron a una dilatación endoscópica con balón por estenosis esofágica. La duración del estudio fue 14 años iniciando en el año 2001. La edad media de los pacientes fue 3,95 +/- 0,4 años (Min. 15 días, Máx. 14 años). La recolección de datos se realizó revisando las historias clínicas y con llamadas telefónicas. Los datos se analizaron con el Sistema SPSS. Resultados: En este estudio, 47% de los casos fueron varones y 53% fueron mujeres. La ingesta de caústicos fue la causa más frecuente de estenosis esofágica (33,7%). El síntoma más común fueron los vómitos (87,8%). Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. El dolor torácico fue la molestia más común luego de la dilatación esofágica. La tasa de respuesta al tratamiento fue similar entre hombres y mujeres. Los niños pequeños tuvieron la mejor respuesta al tratamiento luego de la dilatación esofágica. Conclusiones: Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. La perforación esofágica se presentó en 4,9% de los casos. El dolor torácico fue la complicación más común posterior a la dilatación.


Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Chest Pain/etiology , Esophagoscopy/adverse effects , Dilatation/adverse effects , Esophageal Perforation/etiology , Esophageal Stenosis/therapy , Vomiting/etiology , Burns, Chemical/therapy , Esophageal Achalasia/complications , Retrospective Studies , Esophageal Stenosis/congenital , Esophageal Stenosis/chemically induced , Tertiary Care Centers/statistics & numerical data , Iran
16.
ABCD (São Paulo, Impr.) ; 32(1): e1421, 2019. tab, graf
Article in English | LILACS | ID: biblio-983670

ABSTRACT

ABSTRACT Background: Hirschsprung's disease is a congenital disorder that causes functional obstruction of large bowel. Aim: To evaluate complication and bowel function score of children with Hirschsprung's disease who underwent transabdominal Soave's procedure. Methods: In this study all the children with Hirschsprung's disease who underwent transabdominal Soave procedure were evaluated regarding bowel function and complication of trans-abdominal Soave's procedure. Results: Were enrolled 160 children. Enterocolitis and constipation were seen in 15% of the cases. Fecal incontinency was the least frequent study which was seen in 1% of the children. Conclusion: Constipation and enterocolitis was the most frequent complication following transabdominal Soave technique.


RESUMO Racional: A doença de Hirschsprung é um distúrbio congênito que causa obstrução funcional do intestino grosso. Objetivo: Avaliar as complicações e o escore de função intestinal de crianças com a doença submetidas ao procedimento transabdominal de Soave. Métodos: Neste estudo, todas as crianças com doença de Hirschsprung submetidas ao procedimento transabdominal de Soave foram avaliadas quanto à função intestinal e complicação do procedimento. Resultados: Foram incluídas 160 crianças. Enterocolite e constipação foram observadas em 15% dos casos. A incontinência fecal foi menos frequente e observada em 1% das crianças. Conclusão: Obstipação e enterocolite foram as complicações mais frequentes após a técnica de Soave transabdominal em crianças.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Postoperative Complications , Digestive System Surgical Procedures/adverse effects , Hirschsprung Disease/surgery
17.
Rev. gastroenterol. Perú ; 38(2): 125-127, abr.-jun. 2018. tab
Article in English | LILACS | ID: biblio-1014069

ABSTRACT

Introduction: The aim of this study was to evaluate complications after percutaneous endoscopic gastrostomy among children who underwent percutaneous endoscopic gastrostomy in Nemazee hospital. Materials and methods: All children who underwent percutaneous endoscopic gastrostomy were included in the current study. Place of the study was department of pediatric gastroenterology of Nemazee children hospital of Shiraz university of medical sciences. Duration of the study was 5 year starting from 2008. All drugs such as aspirin, NSAIDS, and heparin were discontinued 1-7 days before procedures. All patients were kept NPO 6-8 hours before procedure according to the age. Single dose antibiotic was prescribed for all cases before procedure. During procedure, all patients were sedated using propofol and or midazolam. Some patients required intubation. Results: Of 39 cases who underwent PEG, 4 (10.2%) patients showed complication. The most common indication for PEG insertion were neurologic problem (84.6%) and metabolic disease (10.2%). Of our patients, 84.6% of the cases had the weight below third percentile. Conclusion: The most common indication for percutaneous endoscopic gastrostomy was cerebral palsy. The complication rate in our study was 10.2%. Celulitis was the most common complication


Introducción: El objetivo de este estudio fue evaluar las complicaciones luego de una gastrostomía endoscópica percutánea (PEG) en niños realizada en el hospital Nemazee. Material y métodos: Se incluyeron al estudio todos los niños que se realizaron PEG en el hospital. El lugar del estudio fue el departamento de gastroenterología pediátrica del Hospital para niños Nemazee de la Universidad Shiraz de ciencias médicas. La duración del estudio fue cinco años, iniciando en el año 2008. Todas las drogas como aspirina, AINES y heparina fueron suspendidas entre 1 a 7 días previos al procedimiento. Todos los pacientes estuvieron entre 6 a 8 horas del examen en ayunas dependiendo de la edad. Se prescribió una dosis de antibioterapia profiláctica en todos los casos previo al procedimiento. Durante el procedimiento, todos los pacientes fueron sedados usando propofol y/o midazolam. Algunos pacientes necesitaron intubación. Resultados: De 39 casos que se sometieron a PEG, 4 (10,2%) tuvieron alguna complicación. La indicación más frecuente de PEG fueron los problemas neurológicos (84,6%) y luego las enfermedades metabólicas (10,2%). De nuestros pacientes, 84,6% de los casos estuvieron por debajo del tercer percentile. Conclusión: La indicación más común de gastrostomía endoscópica percutánea fue la parálisis cerebral. La tasa de complicación en nuestro estudio fue 10,2%. La celulitis fue la complicación más común


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Postoperative Complications/epidemiology , Gastrostomy/methods , Gastroscopy/methods , Postoperative Complications/diagnosis , Tertiary Care Centers , Iran
18.
Rev. gastroenterol. Perú ; 38(2): 128-130, abr.-jun. 2018. ilus
Article in English | LILACS | ID: biblio-1014070

ABSTRACT

Background: Helicobacter pylori infection which plays a major role in the etiology of chronic gastritis and duodenal ulcers in children and adults is one of the commonest chronic infection worldwide. Cure of the infection leads to healing of gastric inflammation and prevention of peptic ulcer. Objective: The aim of this study was to evaluate the efficacy of the sequential therapy for treatment of Helicobacter pylori infection. Materials and methods: In this study, 40 children with symptoms of H. Pylori that the infection was proved by endoscopy and biopsy and rapid urease test (UBT) were enrolled, and received sequential therapy (Lansoprazol, Amoxicillin) for 5 days and (Lansoprazol, Metronidazole and Clarithromycin) for next 5 days. The eradication rate of therapy was evaluated by stool antigen test 6 weeks after completion of therapy. This study was carried out in Pediatric Gastroenterology Clinic of Shiraz University of Medical Sciences, Shiraz, Iran. This study was approved by ethic committee of Shiraz University of Medical Sciences. Results: Forty children with mean age of (10.8±4 years) were evaluated. The most common symptom on first admission was epigastric pain (82.5%), with mean duration of symptoms (16±14.5 month). The most common endoscopic findings was redness and erosion of the antrum (55%) and the most pathologic findings was chronic gastritis (77.5%). The most drug adverse effect was nausea (22.5%). The eradication rate of sequential therapy was 82.5%. Conclusion: Eradication rate of sequential therapy was 82.5% among our cases.


Antecedentes: La infección por Helicobacter pylori, que juega un rol principal en la etiología de la gastritis crónica y las úlceras duodenales en niños y adultos, es una de las infecciones crónicas más comunes en el mundo. La cura de esta infección lleva a la cura de la inflamación gástrica y a la prevención de la úlcera péptica. Objetivo: Evaluar la eficacia de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori. Material y métodos: En este estudio, se enrolaron 40 niños con síntomas en los que la infección por H. pylori se demostró por endocopía con biopsia y prueba rápida de ureasa (UBT) y recibieron terapia secuencial (Lansoprazol, Amoxicilina) por 5 días y (lansoprazol, metronidazol y clarotromicina) por otros 5 días. La tasa de erradicación de la terapia se evaluó por prueba de antígeno en heces 6 semanas después de terminar la terapia. Este estudio se llevó a cabo en la Clínica de Gastroenterología Pediátrica de la Universidad de Ciencias Médicas de Shiraz, Irán. El estudio fue aprobado por el comité de ética de la Universidad de Ciencias Médicas de Shiraz. Resultados: Se evaluaron cuarenta niños con una edad media de (10,8±4 años). El síntoma más común al ingreso fue dolor epigástrico (82,5%) con una duración media de síntomas de (16±14,5 meses). El hallazgo endoscópico más común fue enrojecimiento y erosión del antro (55%) y el hallazgo patológico más común fue gastritis crónica (77,5%). El evento adverso más común fue náusea (22,5%). La tasa de erradicación de la terapia secuencial fue 82,5%. Conclusión: La tasa de erradicación de la terapia secuencial fue de 82,5% en nuestros casos.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Helicobacter pylori , Helicobacter Infections/drug therapy , Anti-Ulcer Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Drug Administration Schedule , Treatment Outcome , Clarithromycin/therapeutic use , Drug Therapy, Combination , Lansoprazole/therapeutic use , Amoxicillin/therapeutic use , Metronidazole/therapeutic use
19.
Arq. gastroenterol ; 55(1): 78-81, Apr.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-888242

ABSTRACT

ABSTRACT BACKGROUND: Celiac disease is an enteropathy caused by dietary gluten. The combination of serologic, genetic and histologic data has led to description of other categories of this disease. OBJECTIVE: There are a number of patients with iron deficiency anemia (IDA) that do not respond to iron treatment and may be repeated for many times, Therefore, we aimed to investigate celiac disease in this group. METHODS: In this cross sectional transverse prospective study from August 2011 to February 2013, in a Pediatric care clinic affiliated to Shiraz University of Medical Sciences, 184 children including 92 IDA patients who responded to treatment using iron supplement, 45 non-responding iron deficient patients, and 47 healthy individuals, with the maximum age of 18 years, with written consent from their parents, participated in serologic screening (with Anti-TTG antibody and anti-Endomysial antibody) for celiac disease. Patients with at least one positive serology test underwent multiple mucosal biopsy from bulb and duodenum. RESULTS: Among 184 participants, 19 (10.3%) subjects had positive serologic test for celiac disease, including 13 (28.9%) patients in the group with refractory IDA, 5 (5.4%) patients in the group with treated IDA, and 1 patient in the healthy group. The frequency of positive serologic test in the group with IDA resistant to treatment was prominently higher than the other two groups (P<0.001). Among the patients with positive serologic celiac test who underwent endoscopy and biopsy, no histologic evidence of celiac disease was seen. They were diagnosed as potential celiac disease. CONCLUSION: Frequency of potential celiac disease in patients with refractory IDA was higher than control the subjects. Therefore, we recommend serologic screening for early detection and minimizing the complications of celiac disease and repeated iron therapy for this group.


RESUMO CONTEXTO: A doença celíaca é uma enteropatia causada pelo glúten na dieta. A combinação de dados sorológicos, genéticos e histológicos proporcionou a descrição de outras categorias desta doença. OBJETIVO: Há pacientes com anemia por deficiência de ferro que não respondem ao tratamento com ferro mesmo que repetido por muitas vezes. O objetivo deste trabalho foi investigar a presença de doença celíaca nestes indivíduos. MÉTODOS: Realizado estudo prospectivo com cruzamento secional transversal, de agosto de 2011 a fevereiro de 2013, em uma clínica de cuidados pediátricos afiliados a Shiraz University Medical Sciences, com 184 crianças incluindo 92 pacientes com anemia por deficiência de ferro que responderam ao tratamento com ferro suplementar, 45 não respondedores e 47 indivíduos sadios, com idade máxima de 18 anos, todos com consentimento informado dos pais. Todos participaram da triagem sorológica (com anticorpos anti-TTG e anticorpo antiendomísio) para doença celíaca. Pacientes com pelo menos um teste de sorologia positiva foram submetidos a biópsia da mucosa múltipla do bulbo e duodeno. RESULTADOS: Entre os 184 participantes, 19 (10,3%) tinham teste sorológico positivo para doença celíaca, incluindo 13 (28,9%) pacientes no grupo com a anemia por deficiência de ferro refratária, 5 (5,4%) pacientes no grupo com anemia por deficiência de ferro tratados e respondedores e 1 paciente do grupo saudável. A frequência de teste sorológico positivo no grupo com anemia por deficiência de ferro resistente ao tratamento foi destacadamente maior do que os outros dois grupos (P<0,001). Entre os pacientes com teste sorológico positivo para doença celíaca submetidos a endoscopia e biópsia, não foi vista nenhuma evidência histológica de doença celíaca. Foram diagnosticados como potencial doença celíaca. CONCLUSÃO: Potencial frequência de doença celíaca em pacientes com anemia por deficiência de ferro refratária foi maior do que nos controles. Portanto, recomendamos testes sorológicos de triagem para a detecção precoce, minimizando as complicações da terapia de ferro repetidas para este grupo.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Celiac Disease/diagnosis , Celiac Disease/blood , Anemia, Iron-Deficiency/blood , Autoantibodies/blood , Biopsy , Serologic Tests/methods , Biomarkers/blood , Celiac Disease/immunology , Celiac Disease/pathology , Transglutaminases/blood , Cross-Sectional Studies , Prospective Studies , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/therapy , Duodenum/pathology , Intestinal Mucosa/pathology , Middle Aged
20.
Rev. gastroenterol. Perú ; 37(4): 323-328, oct.-dic. 2017. ilus, tab
Article in English | LILACS | ID: biblio-991274

ABSTRACT

Introduction: Celiac disease (CD) is increasingly diagnosed and weight changes are common after adoption of a gluten- free diet (GFD) and there is concern that patients might gain further weight on a GFD. Objectives: This study examined to evaluate the impact of a GFD on the body mass index (BMI), whether favorable or unfavorable. Materials and methods: In this retrospective study, we reviewed electronic records of 44 patients with serologic study and intestinal biopsy confirmed CD who was visited in Nemazee hospital, Shiraz. All patients were put on GFD for 2 years and followed closely by pediatric gastroenterologist. BMIs were categories to four group underweight, normal weight, overweight and obese. Initial BMI and follow-up BMI was comparing together and also compared with general population. Result: At diagnosis, 27.27% of subjects were underweight, 63.64% normal and 9.09% were obese. On a GFD, 66.66% of underweight patients gained weight and became normal weight and 25% of normal weight and 75% of obese patients had increase weight; and the rest of the patients, BMI remained stable. The follow-up BMIs were statistically higher than initial BMIs (mean 17.17 vs. 15.62, p <0.0001). Conclusion: Individuals with celiac disease have lower BMI than the regional population at diagnosis. On the GFD, BMI is increased significantly in all categories


Introducción: La enfermedad celiaca está siendo cada vez más diagnosticada y los cambios en el peso corporal son comunes después de ponerlos en una dieta libre de Gluten (DLG) y hay preocupación de que sigan ganando peso con esta dieta. Objetivos: Este estudio evalúa el impacto de la DLG en el índice de masa corporal (IMC) ya sea este favorable o desfavorable. Materiales y métodos: En este estudio retrospectivo se revisaron las historias de 44 pacientes con estudio serológico y biopsia intestinal confirmatorios de enfermedad celiaca que llegaron al hospital en Nemazee en Shiraz. A todos los pacientes se les puso en una DLG por 2 años y fueron seguidos por un gastroenterólogo pediatra. El IMC fue dividido en cuatro categorías, peso bajo, normal, sobrepeso y obesos. El IMC inicial y su seguimiento fueron comparados también con la población general. Resultados: Al momento del diagnóstico, el 27,27% estaban con bajo peso, el 63,64% con peso normal y el 9,09% eran obesos. En una DLG, el 66,66% de los pacientes con bajo peso llegaron a su peso normal y el 25% de los de peso normal y el 75% de los obesos también ganaron peso. Esta variación de IMC fue estadísticamente significativa (media 17,17 vs. 15,62, p <0,0001). El resto de los pacientes permaneció con su IMC estable. Conclusión: Las personas con enfermedad celiaca tienen el IMC más bajo que la población de la región al momento del diagnóstico. Puestas en la DLG, el IMC aumenta significativamente en todas las categorías


Subject(s)
Child , Child, Preschool , Female , Humans , Male , Body Mass Index , Celiac Disease/diet therapy , Diet, Gluten-Free , Thinness/epidemiology , Celiac Disease/diagnosis , Celiac Disease/epidemiology , Meta-Analysis as Topic , Prevalence , Retrospective Studies , Treatment Outcome , Overweight/epidemiology , Hospitals, Teaching , Iran/epidemiology
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