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1.
Am J Gastroenterol ; 116(8): 1727-1729, 2021 08 01.
Article in English | MEDLINE | ID: mdl-33927127

ABSTRACT

INTRODUCTION: Esophageal mucosa innervation in adults with nonerosive reflux disease (NERD) is more superficial compared with healthy volunteers. We delineated the esophageal mucosal innervation in pediatric NERD and controls. METHODS: Distal and proximal pediatric esophageal biopsies were immunohistochemically stained with calcitonin gene-related peptide and transient receptor potential cation channel subfamily V member 1. RESULTS: Mucosal innervation was assessed in 18 controls (9M:9F, median age: 9 years) and 11 NERD patients (6M:5F, median age: 5 years). Calcitonin gene-related peptide positive nerve fibers were lying deep in the mucosa in both groups, P > 0.05 and did not coexpress transient receptor potential cation channel subfamily V member 1. DISCUSSION: The pediatric esophageal mucosa in NERD displays deep lying nerve fibers, in contrast to adults.


Subject(s)
Esophageal Mucosa/innervation , Gastroesophageal Reflux/physiopathology , Biopsy , Child , Female , Humans , Male
2.
Neurogastroenterol Motil ; 32(9): e13882, 2020 09.
Article in English | MEDLINE | ID: mdl-32476213

ABSTRACT

BACKGROUND: High-resolution anorectal manometry (HR-ARM) is expected to be better than conventional manometry. Our aim was to characterize HR-ARM pressures in children with functional constipation (FC), with or without fecal incontinence (FI). METHODS: Children with diagnosis of FC, with or without FI, according to Rome-IV criteria, were enrolled. All patients underwent HR-ARM using 24-channel water-perfused catheter. RESULTS: Twenty-nine consecutive children (M/F: 21/8; mean age ± SD: 9.5 ± 3.1 years; range 4-15), of whom 21 affected by FC without FI (mean age ± SD: 9.3 ± 3.23 years) and 8 affected by FC with FI (mean age ± SD: 10.2 ± 3.08 years), were enrolled. No significant differences were found regard to gender and age. The analysis of HR-ARM 3D plots demonstrated asymmetry of the anal canal, with higher pressures in distal halves. Comparing pressures between the two groups, we found lower values in FC with FI than in FC without FI group, with a statistically significance for maximum and mean resting pressures (P = .032 and P = .008, respectively). When evaluating our study population respect to asymptomatic children, we found lower resting pressures, lower maximum squeeze pressure, and higher rectoanal inhibitory reflex (RAIR) values. CONCLUSIONS: Our data demonstrate that HR-ARM pressures at rest and during squeezing in FC with FI children are lower than FC without FI subjects, particularly in anteroposterior quadrants. Compared to children without lower gastrointestinal symptoms, children with FC with or without FI show lower pressures and higher values of RAIR.


Subject(s)
Anal Canal/physiopathology , Constipation/physiopathology , Fecal Incontinence/physiopathology , Rectum/physiopathology , Adolescent , Child , Child, Preschool , Constipation/complications , Fecal Incontinence/complications , Female , Humans , Male , Manometry , Prospective Studies
3.
Acta Paediatr ; 109(5): 1033-1039, 2020 05.
Article in English | MEDLINE | ID: mdl-31602697

ABSTRACT

AIM: Postural measures are frequently recommended for gastroesophageal reflux (GER) symptoms, despite limited evidence. This was the first study to assess the impact of upright and recumbent body positions on GER episodes in children and adolescents, not just infants. METHODS: We retrospectively assessed the pH-impedance parameters of paediatric patients referred for possible GER-related symptoms to two hospitals in Naples and Rome, Italy, from September 2016 to September 2018. Data were separately obtained for the time that the patients spent in upright and recumbent positions. RESULTS: Data from 187 patients under the age of 18 were collected, at a mean age of just over seven years. We found that the acid exposure time was stable irrespective of changes in body position (P > .05). The mean number of reflux episodes per hour was 2.99 during the upright position and 1.21 during the recumbent position (P < .05), and the mean oesophageal acid clearance time was 44.4 and 93.4 seconds, respectively (P < .05). CONCLUSION: Most paediatric patients experienced reflux in the upright rather than recumbent position, probably as a result of frequent transient lower oesophageal sphincter relaxations while they were awake. In particular, our findings provide new insights into postural measures for reflux in children and adolescents.


Subject(s)
Gastroesophageal Reflux , Patient Positioning , Adolescent , Child , Gastroesophageal Reflux/diagnosis , Humans , Hydrogen-Ion Concentration , Infant , Italy , Retrospective Studies
4.
Am J Med Genet A ; 176(5): 1253-1257, 2018 05.
Article in English | MEDLINE | ID: mdl-29681086

ABSTRACT

Pachydermoperiostosis (PDP), otherwise known as primary hypertrophic osteoarthropathy, is characterized by digital clubbing, pachydermia and subperiosteal new bone formation. Joint pain, polyarthritis, cutis verticis gyrata, seborrhea, and hyperhidrosis are frequently associated to this condition. We report a 17-year-old boy presented with pain and swelling of knees and ankles, and progressive thickening of skin face with seborrhea from about 4 years. At the admission he also showed digital clubbing of both hands and feet and palmoplantar hyperhidrosis. We hypothesized PDP and molecular analysis confirmed diagnosis showing a novel mutation in a homozygous state in the SLCO2A1 gene coding for prostaglandin transporter. He started therapy with hydroxychloroquine with a great improvement in joint pain and skin conditions. This is the first reported case of PDP who was successfully treated with hydroxychloroquine, with effects not only on arthralgia but also, surprisingly, on skin conditions.


Subject(s)
Genetic Association Studies , Genetic Predisposition to Disease , Homozygote , Mutation , Organic Anion Transporters/genetics , Osteoarthropathy, Primary Hypertrophic/diagnosis , Osteoarthropathy, Primary Hypertrophic/genetics , Phenotype , Adolescent , Alleles , Amino Acid Substitution , Bone and Bones/abnormalities , Bone and Bones/diagnostic imaging , Exons , Genetic Association Studies/methods , Humans , Hydroxychloroquine/therapeutic use , Male , Osteoarthropathy, Primary Hypertrophic/drug therapy , Radiography , Skin/pathology , Treatment Outcome
5.
J Clin Gastroenterol ; 51(1): e5-e10, 2017 01.
Article in English | MEDLINE | ID: mdl-27306945

ABSTRACT

GOALS: We assessed the efficacy of a probiotic mixture of Bifidobacterium infantis M-63, breve M-16V, and longum BB536 in improving abdominal pain (AP) and quality of life (QoL) in children with irritable bowel syndrome (IBS) and functional dyspepsia (FD). BACKGROUND: AP-associated functional gastrointestinal disorders, particularly IBS and FD, are common in pediatrics, and no well-established treatment is currently available. Although probiotics have shown promising results in adults, data in children are heterogeneous. STUDY: Forty-eight children with IBS (median age, 11.2 y; range, 8 to 17.9 y) and 25 with FD (age, 11.6 y; range, 8 to 16.6 y) were randomized to receive either a mixture of 3 Bifidobacteria or a placebo for 6 weeks. After a 2-week "washout" period, each patient was switched to the other group and followed up for further 6 weeks. At baseline and follow-up, patients completed a symptom diary and a QoL questionnaire. AP resolution represented the primary outcome parameter. RESULTS: In IBS, but not in FD, Bifidobacteria determined a complete resolution of AP in a significantly higher proportion of children, when compared with placebo (P=0.006), and significantly improved AP frequency (P=0.02). The proportion of IBS children with an improvement in QoL was significantly higher after probiotics than after placebo (48% vs. 17%, P=0.001), but this finding was not confirmed in FD. CONCLUSIONS: In children with IBS a mixture of Bifidobacterium infantis M-63, breve M-16V, and longum BB536 is associated with improvement in AP and QoL. These findings were not confirmed in FD subjects. Trial identifier: NCT02566876 (http://www.clinicaltrial.gov).


Subject(s)
Abdominal Pain/therapy , Bifidobacterium , Irritable Bowel Syndrome/therapy , Probiotics/therapeutic use , Quality of Life , Abdominal Pain/etiology , Abdominal Pain/microbiology , Adolescent , Child , Cross-Over Studies , Double-Blind Method , Dyspepsia/complications , Dyspepsia/microbiology , Dyspepsia/therapy , Female , Humans , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/microbiology , Male , Surveys and Questionnaires , Treatment Outcome
6.
J Crohns Colitis ; 10(5): 566-74, 2016 May.
Article in English | MEDLINE | ID: mdl-26733407

ABSTRACT

BACKGROUND AND AIMS: We sought to correlate hepcidin levels in inflammatory bowel disease [IBD] children with disease activity, inflammatory markers, and iron load test [ILT] and to compare IBD patients with coeliac and healthy patients. METHODS: Between December 2012 and June 2013, 145 subjects [50 IBD patients, 45 coeliac patients and 50 healthy controls] were included in the study. All patients underwent the following examinations: blood count, iron status, erythropoiesis parameters, serum hepcidin, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]. In order to evaluate the efficacy of iron absorption, ILT was performed in IBD patients. Disease activity indexes and IBD duration, localisation, and therapy were also evaluated, and a faecal sample for calprotectin collected. RESULTS: Serum hepcidin was significantly higher in IBD patients with active disease compared with both coeliac and healthy patients [p = 0.005, p = 0.003 respectively]. In a multivariate logistic regression model, having a Paediatric Crohn's Disease Activity Index [PCDAI] / Paediatric Ulcerative Colitis Activity Index [PUCAI] ≥ 30 resulted in the only variable independently associated with a positive serum hepcidin (odds ratio [OR] = 6.87; 95% confidence interval [CI] 1.4-33, p = 0.01]]. Patients with iron malabsorption [IM] showed higher values of ESR, CRP, and hepcidin [p = 0.02, p = 0.001, and p = 0.06, respectively]. Eight out of 12 [66.7%] children with IM showed an active disease compared with 6/31 [19.3%] children with normal ILT [p = 0.01]. Hepcidin levels correlated negatively with ILT [r = -0.451, p = 0.002], and positively with ferritin and CRP [r = 0.442, p = 0.0001; r = 0.243, p = 0.009, respectively] CONCLUSIONS: Our study demonstrates that serum hepcidin is increased in IBD children with active disease and it is responsible for IM.


Subject(s)
Anemia, Iron-Deficiency/etiology , Colitis, Ulcerative/complications , Crohn Disease/complications , Hepcidins/blood , Adolescent , Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/diagnosis , Biomarkers/blood , Case-Control Studies , Celiac Disease/blood , Child , Child, Preschool , Colitis, Ulcerative/blood , Crohn Disease/blood , Cross-Sectional Studies , Female , Ferritins/blood , Humans , Iron/blood , Logistic Models , Male , Prospective Studies , Severity of Illness Index
7.
J Pediatr Gastroenterol Nutr ; 59(6): 795-8, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25141229

ABSTRACT

OBJECTIVES: Hiatal hernia (HH) affects from 10% to 50% of adult population. The correlation between HH, gastroesophageal reflux disease, dyspeptic symptoms, and esophagitis has long been known in adults. The primary objective of our prospective observational study was to estimate the prevalence of HH in children undergoing esophagogastroduodenoscopy (EGD), irrespective of their symptoms. METHODS: We prospectively enrolled 111 consecutive children (48 boys and 63 girls; mean age 94.9 ± 52.3 months) referred for EGD. In all of the patients a symptomatic score assessment based on the Rome III criteria was used to measure frequency, severity, and duration of gastrointestinal symptoms. HH presence was endoscopically defined; esophagitis presence was evaluated either endoscopically and histologically. Children were divided in 2 age-range groups: <48 months (group 1) and >48 months (group 2). RESULTS: Twenty-three patients of 111 (20.7%) had evidence of a sliding HH at EGD. In children from group 2, we found a statistically significant association of HH with heartburn (P = 0.03, 95% confidence interval 1-9.3, r = 0.1) and regurgitation (P = 0.003, 95% confidence interval 1.7-20.4, r = 0.3). Regarding esophagitis presence, no association was found at any age either with defined esophagitis or with dilated intercellular spaces. CONCLUSIONS: Prevalence of HH in our study population was 20.7%. According to our data, HH correlates with the presence of heartburn and regurgitation in children, but not in toddlers. No association was found with esophagitis at any age.


Subject(s)
Dyspepsia , Hernia, Hiatal/epidemiology , Abdominal Pain , Adolescent , Child , Child, Preschool , Endoscopy, Digestive System , Esophagitis/complications , Female , Gastroesophageal Reflux/complications , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/diagnosis , Heartburn/complications , Hernia, Hiatal/complications , Hernia, Hiatal/diagnosis , Humans , Male , Prospective Studies
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