Identification of underlying causes of chronic unspecific upper gastrointestinal-related symptoms in children, a pilot study

Upper gastrointestinal tract [GIT] symptoms are not disease specific and of limited value in the differentiation of GIT disorders. The present study aimed to determine the etiology of chronic unspecific symptoms in children and to test the need for upper endoscopy in diagnosis

This is a prospective study for 30 Egyptian children presented with chronic upper GIT symptoms for at least 2 months. History regarding severity and frequency of GIT symptoms were asked for. Children with known disorder that explains presenting symptoms were excluded. Upper GIT endoscopy was performed and 5 biopsies were obtained for pathological examination and for H pylori testing

The results showed that children age ranged between 2.5-18 years with mean +/- SD of 13.6 +/- 3.4 and 63.3% were females. The main complaints were epigastric pain in 43.3%, hematemesis in 30% and vomiting in 26.7%. Motility disorders were diagnosed in 66.7% children; in the form of GERD in 63.3% and achalasia in one. Complication of GERD in the form of erosive esophagitis was present in 15.8% children, while Barrett's esophagus was not observed. H. pylori infection was diagnosed in 80% histologically. Eosinophilic esophagitis was not detected

Hepatic blood flow during neonatal septicemia

Neonatal septicemia is one of the most important causes of mortality and morbidity . in NICU and NCCU. A few studies had been found in the midline regarding the hepatic functions during neonatal septicemia. The aim of this work is to investigate the impact of neonatal infection on hepatic function tests ,hepatic ultrasonography and hepatic blood flow in the hepatic artery, hepatic vein and portal vein.This study included forty newborn infants attended neonatal IC U due to neonatal sepsis as well as ten normal newborn .Cases had early and late manifestations of sepsis with laboratory picture of infection. All cases were subjected to complete history taking and clinical evaluation. Estimation of CBCCRP, blood gases,electrolytes, blood glucose and liver function tests .Abdominal ultrasound was done to evaluate liver and hepatic blood flow in the hepatic artery, hepatic vein and portal vein.Our results showed significant differences between control and septic group regarding postnatal age,P<0.016,total WBCs counts,P <0.001 and significant decrease in platelets counts,P<0.001, total protein, P0.015 .There was significant increase in total and direct bilirubin as P<0.001 and 0.006 respectively. There was significant elevation in the serumAlkaline phosphatase in the septic group,P <0.005 as well as the ALT P<0.029 and significant prolongation of PTamong two groups, P 0.055. Blood glucose showed non significant decrease from the control group.Our results showed also significant differences between early and late sepsis subgroups as there were; increase in the mean values of total Wbcs P< 0. 001, total protein P<0.0.009,albumin P< 0.001, direct bilirubin P <0.032.Regarding study on hepatic blood flow our results have shown a significant increase in the hepatic artery mean velocity mean values among septic group than the control group P.<0.002,this increase was significantly higher, during early infection than late infection cases, P <0.001.Hepatic vein blood flow mean values was significantly elevated than the control group P< 0.001 which may reflect decrease in the Resistivity Index[RI] among the septic group than control cases P<0.02.Portal vein Mv mean values was not significantly elevated among the all septic group ,but it was significantly higher among early septic cases than late septic cases, P 0.006 . We conclude that changes in the hepatic hemodynamic during infection may affect the metabolic and detoxification functions of the liver during neonatal septicemia .A reduction of drug doses may be of must, hepatic support also should be overlooked