Risk factors for cow's milk protein allergy in infants: a multicenter survey / 中国当代儿科杂志

OBJECTIVE@#To investigate the risk factors for cow's milk protein allergy (CMPA) among infants through a multicenter clinical study.@*METHODS@#A total of 1 829 infants, aged 1-12 months, who attended the outpatient service of the pediatric department in six hospitals in Shenzhen, China from June 2016 to May 2017 were enrolled as subjects. A questionnaire survey was performed to screen out suspected cases of CMPA. Food avoidance and oral food challenge tests were used to make a confirmed diagnosis of CMPA CMPA. A multivariate logistic regression analysis was used to investigate the risk factors for CMPA.@*RESULTS@#Among the 1 829 infants, 82 (4.48%) were diagnosed with CMPA. The multivariate logistic regression analysis showed that maternal food allergy (OR=4.91, 95%CI: 2.24-10.76, P6 months (OR=0.38, 95%CI: 0.17-0.86, P<0.05) were protective factors.@*CONCLUSIONS@#The introduction of complementary food at an age of <4 months, maternal food allergy, and antibiotic exposure during pregnancy are risk factors for CMPA in infants.

Clinical features of cow's milk protein allergy in infants presenting mainly with gastrointestinal symptoms: an analysis of 280 cases / 中国当代儿科杂志

OBJECTIVE@#To investigate the epidemiological and clinical features of cow's milk protein allergy (CMPA) in infants presenting mainly with gastrointestinal symptoms.@*METHODS@#A retrospective analysis was performed for the clinical data of 280 hospitalized infants, who were diagnosed with CMPA presenting mainly with gastrointestinal symptoms.@*RESULTS@#Among the 280 infants, 203 infants(72.5%) were aged of less than 6 months. Major manifestations included diarrhea in 171 infants (61.1%), hematochezia in 149 infants (53.2%), vomiting in 71 infants (25.4%), eczema in 57 infants (20.4%), malnutrition in 42 infants (15%) and constipation in 13 infants (4.6%). Of the 280 infants, 258 (92.1%) had mild-to-moderate CMPA and 22 (7.9%) had severe CMPA. Compared with the mild-to-moderate CMPA group, the severe CMPA group had a significantly higher incidence rate of malnutrition (50.0% vs 12.0%) and a significantly lower incidence rate of hematochezia (22.7% vs 55.8%). The breastfeeding CMPA group had significantly lower incidence rates of malnutrition (10.3% vs 24.6%) and severe CMPA (4.4% vs 18.0%) than the artificial feeding CMPA group, and the artificial feeding CMPA group had a significantly lower incidence rate of hematochezia than the breastfeeding and mixed feeding CMPA groups (37.7% vs 56.6%/59.0%).@*CONCLUSIONS@#CMPA presenting mainly with gastrointestinal symptoms is more common in infants aged of less than 6 months. Diarrhea and hematochezia are the most common manifestations at the time of onset. Most infants have mild-to-moderate allergy. Compared with breastfeeding, artificial feeding is more likely to cause malnutrition and severe CMPA.

Prognostic analysis of children with Henoch-Schonlein purpura treated by Helicobacter pylori eradication therapy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Helicobacter pylori (Hp) eradication therapy on prognosis in children with Henoch-Schonlein purpura (HSP).</p><p><b>METHODS</b>A total of 153 children with HSP were divided into Hp infection treatment group (n=22), Hp infection control group (n=21), and Hp infection-negative group (n=110). The Hp infection treatment group received one-week triple therapy for Hp eradication in addition to conventional treatment, while the Hp infection control group and Hp infection-negative group received conventional treatment. All patients were followed up for prognostic evaluation.</p><p><b>RESULTS</b>The response rates of the Hp infection treatment, control, and negative groups were 86% (19/22), 90% (19/21) and 85% (94/110), respectively (P>0.05). The recurrence rates of HSP in the Hp infection treatment, control, and negative groups were 14% (3/22), 24% (5/21) and 31% (34/110), respectively (P>0.05). The incidence of Henoch-Schonlein purpura nephritis (HSPN) in the Hp infection-negative group (36%, 40/110) and control group (33%, 7/21) was significantly higher than that in the Hp infection treatment group (5%, 1/22) (P<0.05 for both), but no significant difference in the incidence of HSPN was found between the control and negative groups (P>0.05).</p><p><b>CONCLUSIONS</b>One-week triple therapy for Hp eradication may be useful to reduce the incidence of HSPN in children with HSP infected with Hp.</p>

Roles of bile and gastrin in the pathogenesis of childhood gastroesophageal reflux disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To explore the incidence of acid and bile reflux in children with gastroesophageal reflux disease (GERD) and to study the roles of bile and gastrin in the pathogenesis of childhood GERD.</p><p><b>METHODS</b>Forty-two cases of GERD were divided into two groups according to endoscopic findings: reflux esophagitis (RE) and non-erosive reflux disease (NERD). The patients underwent 24-hr ambulatory esophageal pH and bilirubin monitoring. The serum concentration of gastrin was detected by radioimmunoassay. Thirteen children without gastroesophageal reflux symptoms, digestive tract disease and severe systemic organic disease served as the Control group.</p><p><b>RESULTS</b>Of the 42 cases of GERD, 24 cases were confirmed with RE, with esophageal mucosal lesions, and 18 were NERD without esophageal mucosal lesions by endoscopy. Both acid and bile reflux parameters, including the percentage of total time with pH < 4 and bilirubin absorbance >/= 0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 minutes, were significantly higher in the GERD patients than those in the Control group (P < 0.05). The time of esophageal acid exposure (pH < 4) and the percentage of total time with bilirubin absorbance >/= 0.14 increased significantly in the RE group compared with in the NERD group (P < 0.05). Sixteen RE patients had a mixed reflux of bile and acid (66.7%) but only 6 NERD patients (33.3%) had (P < 0.01). The serum concentration of gastrin in the RE group (125.12 +/- 45.06 pg/mL) and the NERD group (98.22 +/- 27.92 pg/mL) was significantly higher than that of the Control group (74.22 +/- 20.34 pg/mL) (P < 0.01, P < 0.05 respectively). A significant difference was noted in the serum concentration of gastrin between the RE and the NERD groups (P < 0.05).</p><p><b>CONCLUSIONS</b>Mixed reflux of bile and acid are common in children with GERD. Bile reflux may play a role in the development of GERD. Gastrin parasecretion may participate in the development of GERD. Gastrin and bile reflux may have synergistic effects on the development of childhood GERD.</p>

Acid and Bile Reflux in Children with Gastroesophageal Reflux Disease / 实用儿科临床杂志

Objective To investigate the role of acid and bile reflux in children with gastroesophageal reflux disease (GERD) and to evaluate the significance of detecting acid and bile reflux in diagnosing GERD in children.Methods Using ambulatory 24 h pH mo-(nitoring) and bilirubin monitoring technique, we simultaneously assessed the changes of intraesophageal pH and bile reflux in 23 subjects (including 11 healthy controls and 12 patients with GERD).Results The time of esophageal acid exposure (pH