Chronic diarrhea and abnormal serum immunoglobulin levels: a case report.

A 15-year-old Thai boy with multiple episodes of chronic diarrhea caused by giardiasis with hypogammaglobulin M and IgG4 subclass deficiency (but normal antibody response to rabies vaccine) is reported. Immune status follow-up is necessary for a definite diagnosis and proper management.

Intussusception associated with a relapsing nephrotic patient: a case report.

BACKGROUND: Gastrointestinal disturbances are encountered frequently in the course of the nephrotic syndrome but intussusception is a rare association. It may be the result of incoordinate motility and bowel wall edema. OBJECTIVE: To report a case of intussusception associated with relapsing nephrotic syndrome. CASE REPORT: The authors reviewed the case of a 5-year-old boy who had been diagnosed as having nephrotic syndrome at Queen Sirikit National Institute of Child Health for 1 year, who later presented with nephrotic symptoms and an acute abdomen. Abdominal ultrasonography and barium enema were performed which diagnosed ileo-colic intussusception. Resection of the ileum and appendectomy were performed while the relapsing nephrotic syndrome was treated by prednisolone. The patient's recovery was excellent. Percutaneous renal biopsy was done because of the frequent relapsing condition and showed mesangial proliferative glomerulonephritis consistent with IgM nephropathy. Intussusception should be included in the differential diagnosis of relapsing nephrotic syndrome presenting with acute abdominal pain. Abdominal ultrasonography is helpful in confirming this condition.

Childhood Helicobacter pylori infection, clinical presentations, endoscopic, histologic features and results of treatment.

OBJECTIVE: To study childhood Helicobacter pylori infection concerning the clinical presentations, endoscopic, histologic features and results of treatment. MATERIAL AND METHOD: A retrospective study conducted at the Gastroenterology and Nutrition Unit, Queen Sirikit National Institute of Child Health (QSNICH) was done from January 1993 to December 2002. All patients presented with recurrent abdominal pain, upper GI bleeding (non-variceal bleeding) chronic vomiting and dyspeptic symptoms who underwent upper GI endoscopy were included in this study. Positive urease test verified by biopsied specimens from the gastric antrum and body and/or finding the organisms from the specimens were the criteria for diagnosis of H. pylori infection. Clinical presentations, endoscopic, histologic features and results of treatment in H. pylori infected cases were described. RESULT: A total of 144 patients who underwent upper GI endoscopy were included in the study. 22 out of 144 cases proved to be infected by H. pylori. Ages ranged from 2.6 to 14 years (mean age 9 years). The male/female ratio was 1:1.2. Vomiting and epigastric pain were the leading symptoms. Endoscopic findings were divided into inflammation in the stomach 12 cases, both stomach and duodenum 6 cases and duodenal ulcer 4 cases. Nodular hyperplasia of gastric antrum was found in 8 out of 22 cases. Histologic evidence of chronic gastritis was present in 12 cases, chronic gastroduodenitis 6 cases and chronic duodenitis in duodenal ulcer cases. Treatment regimen consisted of one H2 blocker (ranitidine) initially which was changed to omeprazole in 2001 combined with 2 antibiotics (amoxycillin and metronidazole) for 14 days. CONCLUSION: This study group represented middle and low income groups from around Bangkok and many parts of Thailand. The prevalence of H. pylori infection in the present study was 15.3 per cent which reflects that H. pylori infection is a common health problem in Thailand. However, because this was only a descriptive study, the authors cannot specify the association between symptoms, endoscopic findings, histologic features and disease.