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The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.
RESUMO
The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.
RESUMO
Introduction : The functional ovarian cyst remains a rare disease in the prepubertal population; it is however a leading cause of precocious pseudo-puberty. Precocious puberty results in significant changes marked by growth acceleration and premature closure of growth plates. We report in this article the case of a precocious pseudopuberty secondary to a functional ovarian cyst
Case presentation: A six and a half years old patient, consulted for a recent appearance of early breast development. Hormonal analysis revealed a distal hormonal secretion with suppression of the hypothalamic-pituitary axis. Pelvic ultrasound revealed the presence of a large right ovarian cyst, confirmed by pelvic MRI. The management of this patient consisted in a simple monitoring. After two months, a complete regression of the symptoms was noted as well as a complete disappearance of the ovarian cyst on ultrasound, and an elimination of the hypothalamic-pituitary axis suppression on hormonal analysis
Conclusion: Ovarian cysts are mostly self-limited and require no treatment with spontaneous regression. In rare cases surgery is necessary; it is important to consider a conservative intervention of ovarian tissue without affecting fertility. Ovarian cysts are rare in the pediatric population and with good prognosis in their majority; they require however the attention of the pediatrician, given the possible risk of malignancy
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The authors wish to make the following corrections to Table 4 and Fig. 3.
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This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added β-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.