Multicentre Study Into the Use of Polyethylene Glycol With Electrolytes Over at Least 6 Months to Treat Constipation in Paediatric Populations.

Background: Constipation is a common clinical problem in children, for which the first-line therapeutic options are osmotic laxatives, mainly polyethylene glycol (PEG). These treatments are often prescribed for short or limited periods, with progressive treatment withdrawal often resulting in relapses. However, there are a few studies into the long-term use (≥6 months) of PEG 3350 with electrolytes (PEG+E) in terms of the patients' clinical evolution. Objectives: To assess bowel movement and other relevant symptoms in children with constipation receiving PEG+E (≥6 months), as well as parent/caregiver satisfaction with this treatment. Methods: A retrospective, observational, descriptive, longitudinal, and multicentre study was carried out on 74 children diagnosed with functional constipation (ROME IV criteria) who had received PEG+E (≥6 months). Bowel control was assessed using the Bristol stool scale, and the parent's/caregiver's perception of the treatment was also evaluated employing a nonvalidated questionnaire. Results: Children with an average duration of constipation >1 year experienced a significant improvement in bowel movements and stool consistency when using PEG+E. The mean duration of use was 18.6 (±13.4) months, without the need to adjust the dose for weight. All clinical symptoms improved significantly except bloating, and all the parents/caregivers confirmed these clinical improvements. Conclusions: Children treated with PEG+E (≥6 months) normalised their bowel movements, improving the clinical symptoms related to constipation in the absence of serious advert events or the need for dosage adjustments due to weight gain. Parents/caregivers reported good satisfaction with PEG+E treatment.

Efecto de la alimentación del lactante en la excreción de inmunopéptidos del gluten en heces / Influence of infant feeding on the excretion of gluten immunopeptides in feces

Introducción: la secreción de antígenos de la dieta en la leche materna ha sido ampliamente documentada. La transferencia de gliadina podría ser crítica para el desarrollo de una respuesta inmune. Objetivos: investigar la presencia de péptidos inmunogénicos de gluten en heces de lactantes alimentados con diversos regímenes. Material y métodos: estudio ciego, prospectivo, controlado, colaborativo entre tres centros hospitalarios y desarrollado entre septiembre de 2016 y enero de 2017. El protocolo del estudio fue aprobado previamente por el Comité de Ética de los hospitales de Sevilla. Resultados: se reclutaron 90 niños divididos en tres grupos de 30 niños. Un grupo experimental (edad media de 9,2 ± 2,8 semanas) con lactancia materna exclusiva; un grupo control1 (edad media 10,3 ± 3,3 semanas), alimentados con fórmula de inicio de forma exclusiva y en el que en ninguno de sus integrantes se detectó un test positivo del péptido 33-mer de gliadina en heces; y un grupo control2 con lactantes que consumían gluten en forma habitual (edades promedio 56 semanas ± 3,7 semanas) y que en un 23% (siete casos) tampoco excretaron en sus heces el PIG 33-mer. No se apreció diferencia en la cantidad de gluten ingerida por estos niños y por los que sí excretaron el péptido 33-mer en sus heces. Conclusiones: el hecho de no detectar gluten en heces de lactantes alimentados con leche materna exclusiva indica que probablemente este se encuentre por debajo de los límites para su detección. Hay niños sanos de un año de edad que, aunque consumen gluten, no lo excretan en heces

Introduction: the secretion of antigens from the diet into breast milk has been extensively documented. The transfer of gliadin could be critical for the development of an immune response. Objectives: to investigate the presence of immunogenic gluten peptides in the feces of infants fed with different diets. Material and methods: a blind, prospective, controlled, collaborative study was performed in three hospitals, between September 2016 and January 2017. The study protocol was approved by the Ethics Committee of the hospitals in Seville prior to starting the study. Results: the cohort was divided into three groups of 30 infants: an experimental group (average age 9.2 ± 2.8 weeks) with exclusive breastfeeding, a control group 1 (average age 10.3 ± 3.3 weeks) exclusively fed with onset formula and a control group 2 (average age 56 ± 3.7 weeks) with infants that consumed gluten on a regular basis. The peptide 33-mer of gliadin was negative in all feces samples from both the experimental and control group 1. With regard to control group 2, the peptide 33-mer of gliadin was negative in 23% of cases (seven children). There was no difference in the amount of gluten ingested by these children compared to those who excreted the 33-mer peptide. Conclusions: the failure to detect gluten in the feces of infants that were exclusively breastfed indicates that it is probably below the limits of detection. Healthy children who consume gluten may not excrete it in feces

Influence of infant feeding on the excretion of gluten immunopeptides in feces.

INTRODUCTION: the secretion of antigens from the diet into breast milk has been extensively documented. The transfer of gliadin could be critical for the development of an immune response. OBJECTIVES: to investigate the presence of immunogenic gluten peptides in the feces of infants fed with different diets. MATERIAL AND METHODS: a blind, prospective, controlled, collaborative study was performed in three hospitals, between September 2016 and January 2017. The study protocol was approved by the Ethics Committee of the hospitals in Seville prior to starting the study. RESULTS: the cohort was divided into three groups of 30 infants: an experimental group (average age 9.2 ± 2.8 weeks) with exclusive breastfeeding, a control group 1 (average age 10.3 ± 3.3 weeks) exclusively fed with onset formula and a control group 2 (average age 56 ± 3.7 weeks) with infants that consumed gluten on a regular basis. The peptide 33-mer of gliadin was negative in all feces samples from both the experimental and control group 1. With regard to control group 2, the peptide 33-mer of gliadin was negative in 23% of cases (seven children). There was no difference in the amount of gluten ingested by these children compared to those who excreted the 33-mer peptide. CONCLUSIONS: the failure to detect gluten in the feces of infants that were exclusively breastfed indicates that it is probably below the limits of detection. Healthy children who consume gluten may not excrete it in feces.

Guideline for wireless capsule endoscopy in children and adolescents: A consensus document by the SEGHNP (Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition) and the SEPD (Spanish Society for Digestive Diseases).

INTRODUCTION: Capsule Endoscopy (CE) in children has limitations based mainly on age. The objective of this consensus was reviewing the scientific evidence. MATERIAL AND METHODS: Some experts from the Spanish Society of Gastroenterology (SEPD) and Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP) were invited to answer different issues about CE in children. These sections were: a) Indications, contraindications and limitations; b) efficacy of CE in different clinical scenarios; c) CE performance; d) CE-related complications; e) Patency Capsule; and f) colon capsule endoscopy. They reviewed relevant questions on each topic. RESULTS: The main indication is Crohn's disease (CD). There is no contraindication for the age and in the event that the patient not to swallow it, it should be administered under deep sedation with endoscopy and specific device. The CE is useful in CD, for the management of OGIB in children and in Peutz-Jeghers syndrome (in this indication has the most effectiveness). The main complication is retention, which should be specially taken into account in cases of CD already diagnosed with malnutrition. A preparation regimen based on a low volume of polyethylene glycol (PEG) the day before plus simethicone on the same day is the best one in terms of cleanliness although does not improve the results of the CE procedure. CONCLUSIONS: CE is safe and useful in children. Indications are similar to those of adults, the main one is CD to establish both a diagnosis and disease extension. Moreover, only few limitations are detected in children.

Guideline for wireless capsule endoscopy in children and adolescents: a consensus document by the SEGHNP (Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition) and the SEPD (Spanish Society for Digestive Diseases)

INTRODUCTION: Capsule endoscopy (CE) in children has limitations based mainly on age. The objective of this consensus was reviewing the scientific evidence. MATERIAL AND METHODS: Some experts from the Spanish Society of Gastroenterology (SEPD) and Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP) were invited to answer different issues about CE in children. These sections were: a) Indications, contraindications and limitations; b) efficacy of CE in different clinical scenarios; c) CE performance; d) CE-related complications; e) Patency capsule; and f) colon capsule endoscopy. They reviewed relevant questions on each topic. RESULTS: The main indication is Crohn's disease (CD). There is no contraindication for the age and in the event that the patient not to swallow it, it should be administered under deep sedation with endoscopy and specific device. The CE is useful in CD, for the management of OGIB in children and in Peutz-Jeghers syndrome (in this indication has the most effectiveness). The main complication is retention, which should be specially taken into account in cases of CD already diagnosed with malnutrition. A preparation regimen based on a low volume of polyethylene glycol (PEG) the day before plus simethicone on the same day is the best one in terms of cleanliness although does not improve the results of the CE procedure. CONCLUSIONS: CE is safe and useful in children. Indications are similar to those of adults, the main one is CD to establish both a diagnosis and disease extension. Moreover, only few limitations are detected in children

[Evolution of bone mass in children and adolescents with type 1 diabetes mellitus]. / Evolución de la masa ósea durante la infancia y adolescencia en niños con diabetes mellitus tipo 1.

BACKGROUND AND OBJECTIVE: There is some controversy over bone mineral density (BMD) in children and teenagers with type 1 diabetes mellitus (DM1). We evaluated BMD by dual-energy X-ray absorptiometry (DXA) and correlated it with anthropometric, biochemical and hormonal parameters related to bone metabolism. PATIENTS AND METHOD: Sixty-six patients with DM1 (26 males and 40 females) aged between 3 and 17 years, and 327 controls with a similar age were studied. RESULTS: The BMD of all diabetic patients was not different from that of the controls. However, the subgroup of older males (between 15 and 17 years) had a significantly inferior BMD than controls of the same age: mean (standard deviation), 0.888 (0.13) versus 0.994 (0.11) (p = 0.027). BMD was inferior to -1 standard deviation (Z-score) in 21.2% of diabetic children. All the biochemical and hormonal parameters were within the normality rank. There was a negative correlation between the evolution time of the disease and the levels of 25-hydroxycholecalciferol (r = -0.345; p = 0.006). We did not observe any correlation between BMD and the remaining studied parameters. CONCLUSIONS: These results confirm that initially children and adolescents with non-complicated DM1 have no alteration of the bone mass. Yet the BMD physiological increase is smaller in the diabetic population than in controls during the adolescence period, which may cause a lower peak of bone mass in these patients.

Evolución de la masa ósea durante la infancia y adolescencia en niños con diabetes mellitus tipo 1 / Evolution of bone mass in children and adolescents with type 1 diabetes mellitus

Fundamento y objetivo: Son escasos y con resultados discrepantes los trabajos que valoran la densidad mineral ósea (DMO) en la población infantil y adolescente afectada de diabetes mellitus tipo 1 (DM1). El objetivo de este estudio ha sido valorar la DMO mediante absorciometría dual con rayos X (DXA) y relacionarla con parámetros antropométricos, bioquímicos y hormonales asociados al metabolismo óseo. Pacientes y método: Se ha estudiado a 66 pacientes con DM1 (26 mujeres y 40 varones), de edades comprendidas entre los 3 y 17 años, y a 327 controles sanos de edad comparable. Resultados: En el grupo con DM1 la DMO no fue, en conjunto, diferente de la de los controles, pero en el subgrupo de varones con DM1 de mayor edad (entre 15 y 17 años) fue significativamente inferior a la de los controles de su misma edad: media (desviación estándar) de 0,888 (0,13) frente a 0,994 (0,11), respectivamente (p = 0,027). En el 21,2% de los pacientes con DM1 la masa ósea (puntuación Z) era inferior a ­1 desviación estándar. Por otra parte, todos los parámetros bioquímicos y hormonales se encontraban dentro del intervalo de normalidad. Además, se halló una correlación negativa entre los valores de 25-hidroxicolecalciferol y el tiempo de evolución de la enfermedad (r = ­0,345; p = 0,006), pero no se observó correlación entre la DMO y los restantes parámetros estudiados. Conclusiones: Estos resultados confirman que los niños y adolescentes con DM1 no complicada no presentan inicialmente alteraciones de la masa ósea, pero durante la adolescencia el aumento normal de masa ósea consecutivo a la edad se enlentece en los diabéticos frente a los controles, lo que puede condicionar alteraciones en la consecución posterior del pico de masa ósea

Background and objective: There is some controversy over bone mineral density (BMD) in children and teenagers with type 1 diabetes mellitus (DM1). We evaluated BMD by dual-energy X-ray absorptiometry (DXA) and correlated it with anthropometric, biochemical and hormonal parameters related to bone metabolism. Patients and method: Sixty-six patients with DM1 (26 males and 40 females) aged between 3 and 17 years, and 327 controls with a similar age were studied. Results: The BMD of all diabetic patients was not different from that of the controls. However, the subgroup of older males (between 15 and 17 years) had a significantly inferior BMD than controls of the same age: mean (standard deviation), 0.888 (0.13) versus 0.994 (0.11) (p = 0.027). BMD was inferior to ­1 standard deviation (Z-score) in 21.2% of diabetic children. All the biochemical and hormonal parameters were within the normality rank. There was a negative correlation between the evolution time of the disease and the levels of 25-hydroxycholecalciferol (r = ­0.345; p = 0.006). We did not observe any correlation between BMD and the remaining studied parameters. Conclusions: These results confirm that initially children and adolescents with non-complicated DM1 have no alteration of the bone mass. Yet the BMD physiological increase is smaller in the diabetic population than in controls during the adolescence period, which may cause a lower peak of bone mass in these patients