Prophylactic Therapy Response in Children with Abdominal Migraine:A Single Centre Experience in Oman / 대한소아소화기영양학회지

Purpose@#Abdominal migraine (AM) is a very common functional gastrointestinal disorder in children. This study reports the clinical features and response of AM to prophylactic treatment in children. @*Methods@#This retrospective study was conducted between January 2010 and December 2019 at the Royal Hospital in the Sultanate of Oman. This study included children aged ≤ 13 years with a diagnosis of AM based on the Rome IV criteria for functional diagnoses. Clinical, demographic, and treatment data were collected. @*Results@#Seventy-four children were identified, of which 43 were eligible for inclusion in this study. The median age at the onset of symptoms was 7 years (range, 2–12 years). The most frequent symptoms were headache (81.4%), nausea (79.1%), and vomiting (72.1%).Of the total cohort, 46.5%, 23.3%, and 6.9% received riboflavin, pizotifen, and propranolol monotherapy, respectively. Combination therapy was also used; 16.3% of children received pizotifen and propranolol, 4.7% received riboflavin and pizotifen, and 2.3% received riboflavin and propranolol. Patients treated with propranolol monotherapy showed 100% clinical improvement and those treated with riboflavin or pizotifen monotherapy showed 90% clinical improvement. Response to combination therapy with pizotifen and propranolol was 71.4%, and with riboflavin and pizotifen was 100%. In addition, treatment response was significantly associated with the presence of vomiting (p=0.039). @*Conclusion@#We found a favorable response to various modalities and combination treatments with riboflavin, pizotifen, and propranolol in children with AM. In addition, the presence of vomiting may predict treatment response.

Congenital glucose–galactose malabsorption: a descriptive study of clinical characteristics and outcome from Western Saudi Arabia

Congenital glucose galactose malabsorption [CGGM] is a rare autosomal recessive disorder caused by a defect in the sodium-coupled transport of glucose and galactose across the intestinal brush border presenting with neonatal diarrhoea. The aim of this study was to report the clinical and laboratory characteristics of patients with CGGM from the Western Saudi Arabia. This is a retrospective review of CGGM patients in three major hospitals in the city of Jeddah, Saudi Arabia, namely King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Centre, and Maternity Children Hospital in the period between November 2001 and October 2011. Twenty-four patients with CGGM have been described. The median age at diagnosis was 4.5 months. Twelve [50%] were males. Sixteen [66.7%] were Saudi and 8 [33.3%] were non Saudi [5 Arabs and 3 Asians]. Parents of 21 patients were consanguineous. Nine [37.5%] had affected siblings with CGGM. All presented with diarrhoea resulted in dehydration. Hypernatremia was seen in 7 [29.2%] patients, renal tubular acidosis in 4 patients. Renal stones and nephrocalcinosis were detected in 3 [12.5%] patients at 8 months. 12 months and 7 years, respectively. The median follow up was 41.6 months. All but three demonstrated normal weight gain. Five patients reported one or more symptoms of bloating [n = 3], diarrhoea [n = 3] and abdominal pain [n = 1] during follow up. All had normal development and none had neurological complications secondary to dehydration. Early recognition and management of this condition are crucial to prevent consequences of dehydration and death

Percutaneous endoscopic gastrostomy tube placement in children with neurodevelopmental disabilities. Parents' perspectives

To study the attitudes of parents toward percutaneous endoscopic gastrostomy [PEG] tube placement and identify contributing factors to their negative attitudes. Thirty consecutive parents were included retrospectively through a single endoscopy unit at the King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January to July 2012. A structured 25-item questionnaire was designed to examine their demographics, attitudes, and experience with the PEG procedure. Patients' ages were 3-19 years [mean: 10.2], mostly with severe cerebral palsy [77%]. Their PEG tubes were inserted 2-144 months [mean: 39] prior to the encounter. Only 43% of the parents felt informed and most [73%] had negative attitudes toward the procedure, which was associated with significant delays [p=0.016]. After the procedure, most parents [67%] reported a better-than-expected experience, which was associated with their information levels [p=0.03]. Most parents [80%] regretted not having the PEG tube placed earlier. This depended on their information level, as those who were not informed were more likely to have strong regrets when compared to those informed [82% versus 42%, p=0.008]. Most parents are not well-informed regarding the PEG procedure, which affects their expectations and experiences. Most parents found the experience better than what they expected and regretted not having carried it out earlier

Serological markers of inflammatory bowel disease in children from the western region of Saudi Arabia

Serological markers including peri-nuclear anti-neutrophil cytoplasmic antibodies [pANCA] and anti-Saccharomyces cerevisiae antibodies [ASCA] have been reported in relation to inflammatory bowel disease [IBD]. The aim of this study was to ascertain the prevalence and diagnostic accuracy of pANCA and ASCA antibodies in Saudi children with IBD. A retrospective case-control study of children with IBD seen at King Abdulaziz University Hospital, Jeddah, between September 2002 and February 2012. The study included 131 patients with IBD [86 Crohn's disease [CD] and 45 ulcerative colitis [UC]] and 67 non-IBD control subjects. Females comprised 51% of CD, 60% of UC and 52% of non-IBD controls. The mean age was 10.7 +/- 5.2 years for CD, 8.9 +/- 5 years for UC, and 11.2 +/- 6.8 years for the non-IBD controls. Positive ASCA-IgA and ASCA-IgG were detected in 35.8% and 35% of CD patients and in 5.8% and 3.7% of the non-IBD controls, respectively. The pANCA was detected in 28.9% of UC patients and in none of the non-IBD controls. The pANCA recognised the myeloperoxidase [MPO] antibody in 36.4% of the patients with UC. No significant difference in the frequency of pANCA between extensive disease and disease limited to the rectosigmoid colon [p = 0.48], and no significant difference in the ASCAs antibodies in patients with or without involvement of the terminal ileum [p = 0.81]. The prevalence of ASCA and pANCA antibodies was low in Saudi children with IBD. Therefore, it may not be useful as a screening tool for IBD but it may be employed to aid the diagnosis in clinically suspected cases

Anti-mitochondrial antibody positive autoimmune hepatitis triggered by EBV infection in a young girl

Autoimmune hepatitis [AIH] is rare in children. Two types of childhood autoimmune hepatitis are recognized: AIM type 1 which is characterized by the presence of smooth muscle [SMA] and/or antinuclear [ANA] antibodies; and AIH type 2 which is positive for anti-liver kidney microsomal type 1 [anti-LKM-1] antibody. Anti-mitochondrial antibody [AMA] is considered the hallmark for primary biliary cirrhosis [PBC] that occurs primarily in adult women and is characterized by destruction of the intralobular bile ducts and progression to cirrhosis and liver failure. Antimitochondrial-antibody-positive AIH is extremely rare in children. We report a 13 year old Saudi girl with type-1 AIH who had a strongly positive anti-mito-chondrial antibody and no evidence of small bile duct disease in the liver biopsy

Haematological manifestations of arthrogryposis-renal dysfunction-cholestasis [ARC] syndrome: a case report

Arthrogryposis multiplex congenita, renal dysfunction, and cholestasis [ARC] syndrome is a rare, fatal, multisystem disorder. Bleeding problems, which occur spontaneously and post organ biopsies, have been reported in these patients. We report the case of an infant who had life-threatening spontaneous nasal bleeding. A detailed assessment of her platelet function and morphology is presented

Childhood onset of Crohn disease: experience from a university teaching hospital in Saudi Arabia

Crohn disease [CD] is an increasingly recognized problem in Saudi Arabia. The aim of this study was to describe the clinical pattern in children and adolescents with CD seen at King Abdulaziz University Hospital [KAUH], Jeddah, Saudi Arabia. Retrospective hospital-based study conducted on data collected for the period between January 2001 and March 2010. Data for all children and adolescents diagnosed at KAUH with CD in the period were retrieved and analyzed. Ninety-six patients were identified. The median age at diagnosis was 11.3 years [range, 0.12-17.6 years]. Fifty [52.1%] were males. Sixty-four [66.7%] were Saudis. Nine [9.4%] had a first degree relative with inflammatory bowel disease. The most common presenting symptoms were diarrhea [88.5%], weight loss [84.2%] and anorexia [80.2%]. At least one extraintestinal manifestation occurred in 24% of patients. Forty-two percent were underweight and 19% had short stature. The most common distribution was ileocolonic [37.5%], followed by colonic in 31.2%. Twenty-five [26%] patients had perianal disease, 13 [13.5%] had strictures and 15 [15.6%] had penetrating disease. Laboratory investigations revealed anemia in 84.4%, thrombocytosis in 50%, hypoalbuminemia in 64.6%, elevated erythrocyte sedimentation rate [ESR] in 50% and elevated C-reactive protein in 58.3%. Induction of remission was achieved with enteral nutrition in 20% of patients and with corticosteroids in the remaining. The clinical pattern of CD in children from the Western Province of Saudi Arabia was found to be similar to reports from the West. Pediatricians should be aware of the varying presentations of CD. Early referral to specialized centers is crucial.

Prevalence of celiac disease in children with type 1 diabetes mellitus screened by anti-tissue transglutaminase antibody from western Saudi Arabia

To determine the prevalence of celiac disease [CD] in children and adolescents with type 1 diabetes mellitus [T1DM] using anti-tissue transglutaminase [anti-tTG] antibodies. A retrospective hospital record-based study of all children and adolescents with T1DM who were screened for CD was conducted at the Pediatric Diabetes Clinic of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia [KSA] between October 2002 and June 2011. A total of 430 children with T1DM were screened by anti-tTG antibody. The median age at screening was 10.7 years [range; 1.1-18]. The study cohort included 232 [54%] Saudi patients, and females constituted 58.8% of the total number. Anti-tTG antibody screening was positive in 91 [21.2%] patients. Forty-eight [11.2%] out of 430 children screened had biopsy-proven CD. Forty-two patients with CD [87.5%] were asymptomatic. Patients with CD had less weight for age [p=0.007], and height for age [p=0.03] z-scores than non-CD patients. They showed more association with anemia [p<0.001], low albumin level [p<0.001], and autoimmune thyroid disease [p=0.002]. There was no difference in the mean glycosylated hemoglobin level [p=0.38], or insulin requirements [p=0.74] between the 2 groups. The prevalence of CD in patients with T1DM from the Western region of KSA is considered among the highest reported. Therefore, routine screening through proper serological testing is recommended.

Hepatic-associated immunoglobulin-A nephropathy in a child with liver cirrhosis and portal hypertension

Hepatic-associated immunoglobulin A [IgA] nephropathy is a relatively common condition that occurs in adults with liver cirrhosis and portal hypertension. However, it is rare in children. This condition is characterized by the deposition of IgA in the renal glomeruli. The present report describes a 14-year-old boy with cryptogenic liver cirrhosis and portal hypertension who presented with hematuria and proteinuria associated with histological changes of IgA nephropathy

Impact of pharmacovigilance on adverse drug reactions reporting in hospitalized internal medicine patients at Saudi Arabian teaching hospital

To determine the incidence, diversity of [ADRs], and impact of pharmacovigilance on reporting. This prospective and retrospective study was carried out in the Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January to December 2011 in 600 patients of ADR. Data regarding age and gender distribution of the patients, incidence rate, drugs, body systems/organs involved in ADR, time of occurrence of adverse drug reactions, total number of drugs administered, and impact of pharmacovigilance on finding the incidence rate of ADR were recorded. Comparison of the 2 data was carried out to determine the impact of pharmacovigilance. Incidence rate of ADRs in retrospective study was 3.1% and 5.5% in the prospective study. The highest incidence of ADR [retrospective 15% and prospective 14.5%] was observed in both groups in patients receiving more than 10 drugs. The frequency of ADR in relation to age in both groups was highest in patients of age >60 years; it was 52.7% in retrospective study and 54.5% in prospective study. Antibiotics were the more frequently involved in ADR, [48.5% in prospective study and 36.9% in retrospective study]. The system most commonly involved in ADR was gastrointestinal tract 47.4% in retrospective study and 57.6% in prospective study. None of the ADR proved to be fatal. Low incidence of hospitalized ADR in our study [5.5%] is due to lack of awareness in healthcare professionals in reporting ADR. Undoubtedly, pharmacovigilance brought more patients with ADR to record

Celiac disease in children and adolescents at a singe center in Saudi Arabia

Celiac disease [CD] is an immune-mediated enteropathy, induced by gluten in genetically susceptible individuals. The objective of this study was to describe the clinical pattern of CD in children from the western region of Saudi Arabia. Retrospective, hospital-based. This study included children with a biopsy-proven diagnosis of CD made between September 2002 and July 2007. Children were admitted to the endoscopy unit for a small-bowel biopsy if they had gastrointestinal symptoms suggestive of CD or if they were positive for a CD-antibody screen performed for the high-risk groups. Eighty children were identified with a diagnosis of CD. Their mean [SD] age was 9.6 [4.9] years [range, 0.5-18 years]. There were 44 [55%] female patients. Forty-one [51%] patients were detected during screening of high-risk groups, while 39 [49%] patients had classical symptoms of malabsorption. The screening also detected asymptomatic patients. Of 65 patients tested, 11 [17%] had elevated liver function tests, which reverted to normal after introduction of a gluten-free diet [GFD] except in one case. Seventy-three [91%] patients were positive for anti-tissue transglutaminase antibodies, 18 [23%], for IgG anti-gliadin antibodies; and 46 [58%], for IgA anti-gliadin antibodies. Forty-one [56%] patients showed good adherence to GFD as assessed by dietary history and the decline in anti-tTG level. CD may present with classical symptoms or be identified through screening programs. Growth and laboratory abnormalities usually improve after introduction of a GFD. Adherence to a GFD remains a problem; therefore, thorough assessment and counseling at the time of diagnosis and ongoing care are crucial

Erosive gastritis mimicking watermelon stomach in a child

Watermelon stomach is the description usually given to the endoscopic appearance of gastric antral vascular ectasia. The classical histopathological features of gastric antral vascular ectasia include; hyperplasia of the surface epithelium and the fibromuscular layer of the lamina propria associated with the presence of dilated submucosal venous channels and thrombosed capillaries. This condition can be associated with liver cirrhosis, chronic renal failure and autoimmune disorders. Herein, we report the watermelon endoscopic appearance of the gastric mucosa in a 12-year-old Saudi girl with erosive gastritis

Ulcerative colitis in children and adolescents from the Western Region of Saudi Arabia

To examine the clinical pattern of pediatric ulcerative colitis [UC] at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia. In this retrospective study, we collected data from the medical and endoscopy records of pediatric ulcerative colitis patients between January 2001 and March 2010. The study took place in the Department of Pediatrics, Faculty of Medicine and King Abdul-Aziz University Hospital, King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia. Fifty-seven patients were investigated with mean age +/- SD at diagnosis of 8.8 +/- 4.9 years. The study population comprised of 54 [59.6%] females and 42 [73.7%] males. The most common symptoms identified were abdominal pain [93%], rectal bleeding [93%], and diarrhea [86%]. The extra-intestinal manifestations were observed in some patients [7%], and 2 [3.5%] had family history of first-degree relatives with inflammatory bowel disease [IBD]. The anatomical extent of UC was severe in 77.2%, left sided in 12.3%, and distal in 10.5%. The endoscopic assessment of mucosal inflammation was graded as moderate to severe. The disease pattern included chronic relapse type [50.9%], initial onset type [40.4%], and chronic continuous type with intermittent exacerbation [8.8%]. Laboratory results demonstrated the following symptoms such as anemia [86%], thrombocytosis [74.4%], hypoalbuminemia [54.4%], high erythrocyte sedimentation rate [83%] and high C-reactive protein [77.8%]. The incidence of UC in the western region of Saudi was found to be similar with reports from the Western population. Pediatricians should be conscious of such manifestations with early referral to specialized centers in order to avoid unnecessary delay in diagnosis and complications

Helicobacter pylori infection in Saudi children; clinical, endoscopic and pathological findings

Helicobacter pylori [H. pylori] infection is common in the Saudi paediatric population. The aim of this study was to describe the clinical presentation, endoscopic abnormalities and associated histopathological changes in a group of Saudi children with H. pylori infection. This is a chart review of all Saudi children diagnosed at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia, between September 2001 and July 2005 with H. pylori infection. A total of 230 children were identified. One hundred and thirty six [55%] were females. The mean age was 11 +/- 3.9 years [range, 2-7]. Thirty-two [14%] were underweight and 12 [5%] were stunted. The main symptom was epigastric pain in 128 [56%]. Nodular gastritis was the most frequent endoscopic finding in 94 patients [40%]. The histopathological findings in the antrum showed moderate chronic inflammatory activity in 65%, mild glandular atrophy in 14% and intestinal metaplasia in 2%. In the corpus, moderate chronic inflammatory activity was found in more than 50%, glandular atrophy in 7%, and cases with intestinal metaplasia. The density of H.pylori in the antrum was mild in 67% and moderate in 26% of cases. In the corpus, it was mild in 49% and moderate in 21% of patients. The mean gastritis score was 4.2 +/- 1.3 in the antrum and 3,4 +/- 1.3 in the corpus. Nodular gastritis was associated with the highest mean gastritis score of 4.9 +/- 1.2 in the antrum [ANOVA < 0.001]. The severity of gastritis in the antrum and the corpus was associated with higher density of H. pylori [ANOVA < 0.001]. Saudi children with H.pylori infection were commonly found to have abnormal endoscopic findings which were associated with significant gastric mucosal inflammation

Gastro-oesophageal reflux in children with cerebral palsy after percutaneous endoscopic gastrostomy: any predictors?

Gastro-oesophageal reflux [GER] is common in children with cerebral palsy [CP]. Such children often require percutaneous endoscopic gastrostomy [PEG] to alleviate feeding difficulty, yet GER may get worse following PEG. The aim of this study was to assess whether abnormal pH study and oesophagitis or delayed gastric emptying can predict worsening of GER after PEG. A chart review was conducted of 25 children with cerebral palsy [CP] who had PEG performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between September 2001 and May 2007. Data collected included pre-procedure 24-h pH study, gastric emptying nuclear scan, and histopathology of the oesophageal biopsy obtained at the time of PEG placement. Clinical symptoms of GER and the need for fundoplication were also recorded. Twenty-five patients with severe CP [21 male; mean age 6.0 +/- 5.3 years] were included. Thirteen [52%] had abnormal pH study. Six [24%] had delayed gastric emptying, and 10 [40%] had histological oesophagitis. Following PEG, 16 [64%] had persistent vomiting. Twelve were controlled with medical treatment. Four [16%] required fundoplication. There was no relation between abnormal pH study, delayed gastric emptying or oesophagitis and the development of persistent vomiting after PEG. There was no statistically significant difference between patients who required fundoplication and the remaining patients in either pH or gastric emptying study. An abnormal pH study and oesophagitis or the presence of delayed gastric emptying before PEG placement in children with CP did not predict worsening of GER or the need for fundoplication after PEG

Seroprevalence of hepatitis C infection in healthy children from the western region of Saudi Arabia

Community-acquired HCV infection was re garded as the main pattern of HCV infection especially after the implementation of the blood screening program in the Kingdom. Our aim was to determine the seroprevalence of community-acquired HCV infection in a group of healthy children from the western region of Saudi Arabia. Blood samples were collected from children attending the surgical clinics for minor surgery at King Abdulaziz University Hospital in Jeddah in the period between November 2001 to October 2003. Sera were tested for HCV antibody using a third-generation enzyme-linked immunosorbent assay. 1059 children screened, mean age +/- SD [7.4 +/- 3.7 years], range [1-18 years], 630 were males [60%]. Four children tested positive with a mean age +/- SD [7 +/- 3.1 years], range [4-11 years]. Giving a seroprevalence of 0.38%. There was no difference in seropositivity according to age groups, p values was 0.9. The seroprevalence of HCV infection in healthy children residing the western region of Saudi Arabia is loss, which may reflect the general improvement in the standard of living