ABSTRACT
Objective To study the presentation and treatment in two infants who presented with refractory Sandifer syndrome (SS). Study Design We retrospectively reviewed the cases of two infants who presented to our outpatient clinic with SS who were refractory to conventional treatment. Results We report two patients with refractory SS who responded to treatment with hypoallergenic formula. Conclusion It is important to consider a diagnosis of milk protein allergy responsive to hypoallergenic formula in patients with SS who are refractory to conventional antireflux treatment.
ABSTRACT
OBJECTIVE: To evaluate the response to rectal distension in children with chronic constipation and children with chronic constipation and encopresis. STUDY DESIGN: We studied 27 children, aged 3 to 16 years, with chronic constipation; 12 had encopresis. Anorectal motility was measured with a solid state catheter. When the catheter was located in the internal sphincter, the balloon was inflated to 60 mL with air. RESULTS: There were no differences in age, sex distribution, and duration of constipation in the two groups. Comparing groups, anorectal manometry showed no differences in the resting sphincter pressure, recovery pressure, the lowest relaxation pressure, and percent relaxation. However, time to maximum relaxation, time to recovery to baseline pressure, and duration of relaxation were significantly higher in patients with constipation and encopresis, compared with patients who had constipation alone. CONCLUSIONS: There may be an imbalance in neuromuscular control of defecation in constipated patients with encopresis that results in incontinence as a consequence of the increased time to recovery and duration of relaxation of the internal anal sphincter.
Subject(s)
Constipation/diagnosis , Encopresis/diagnosis , Gastrointestinal Motility , Adolescent , Age Factors , Anal Canal/abnormalities , Anal Canal/physiology , Child , Child, Preschool , Chronic Disease , Cohort Studies , Constipation/complications , Encopresis/complications , Female , Follow-Up Studies , Humans , Male , Manometry/methods , Rectum/abnormalities , Retrospective Studies , Risk Assessment , Sex FactorsABSTRACT
OBJECTIVES: We determined the occurrence of fructose malabsorption in pediatric patients with previous diagnoses of abdominal pain caused by a functional bowel disorder, whether the restriction of fructose intake changes the reporting of symptoms, the role of fructose dosage, and the severity of resultant symptoms. PATIENTS AND METHODS: We administered a fructose breath test to children presenting with persistent unexplained abdominal pain. Patients randomly received 1, 15, or 45 g fructose, and breath hydrogen was measured for 3 hours after ingestion. Test results were positive when breath hydrogen was 20 ppm greater than baseline and was accompanied by gastrointestinal symptoms. RESULTS: A total of 32 patients was enrolled, and none of the 9 who received 1 g had positive results. Three of 10 who received 15 g and 8 of 13 who received 45 g had positive results. All patients with positive test results restricted their fructose intake. Among the group with positive results, 9 of 11 had rapid improvement of their gastrointestinal symptoms. After 2 months, all 9 patients continued to report improvement. CONCLUSIONS: We concluded that fructose malabsorption may be a significant problem in children and that management of dietary intake can be effective in reducing gastrointestinal symptoms.
Subject(s)
Abdominal Pain/etiology , Fructose Intolerance/complications , Fructose Intolerance/diagnosis , Fructose/pharmacokinetics , Abdominal Pain/diagnosis , Abdominal Pain/pathology , Adolescent , Area Under Curve , Breath Tests/methods , Child , Cross-Over Studies , Dose-Response Relationship, Drug , Female , Fructose/metabolism , Fructose Intolerance/pathology , Humans , Intestinal Absorption , Male , Severity of Illness IndexABSTRACT
The term biliary dyskinesia commonly describes a motility disorder of the biliary tract that is divided into two main categories: gallbladder dyskinesia (GBD) and sphincter of Oddi dysfunction (SOD). SOD is further subdivided into biliary SOD and pancreatic SOD. GBD causes typical biliary colic without gallstones, whereas SOD typically presents with recurrent pancreatitis or chronic abdominal pain, usually after cholecystectomy. GBD and SOD are uncommon in children. Based on adult experience, this review discusses the diagnosis and treatment of GBD and SOD in the pediatric population.
Subject(s)
Biliary Dyskinesia/diagnosis , Biliary Dyskinesia/therapy , Biliary Dyskinesia/etiology , Child , Cholecystectomy , Endoscopy , HumansABSTRACT
We hypothesized that changes in the expression levels of genes in the mammalian target of rapamycin are involved in the hypoxia-induced growth retardation in the brain including hypomyelination. Microarray and proteomic studies showed a 2.3-fold increase in the expression levels of eukaryotic translation initiation factor 4E-binding protein-1 and a 3-fold decrease in the levels of FK506-binding protein-1 in a neonatal model of hypoxia, indicating a signal transduction impairment through mammalian target of rapamycin (mTOR). Analysis of hypoxic brain showed a marked decrease in the phosphorylation levels of 4E-binding protein-1, suggesting a reduction of mTOR activity. These data suggest that suppression of mTOR may be the mechanism underlying hypoxia-induced hypomyelination observed in the developing brain.
Subject(s)
Brain/pathology , Carrier Proteins/metabolism , Hypoxia-Ischemia, Brain/pathology , Nerve Fibers, Myelinated/pathology , Phosphoproteins/metabolism , Protein Kinases/metabolism , Signal Transduction/physiology , Adaptor Proteins, Signal Transducing , Animals , Brain/growth & development , Cell Cycle Proteins , Eukaryotic Initiation Factors , Mice , Oligonucleotide Array Sequence Analysis , Protein Array Analysis , TOR Serine-Threonine Kinases , Tacrolimus Binding Proteins/metabolismABSTRACT
OBJECTIVES: To determine the clinical presentation, radiographic, endoscopic and manometric findings, and clinical outcome of esophageal food impaction (EFI) in pediatric patients. METHODS: We retrospectively reviewed the clinical course of 12 pediatric patients with EFI over a 10-year period. RESULTS: All 12 patients described initially presented to our emergency department for care. Four patients (25%) required previous endoscopic intervention for disimpaction of EFI. Eleven required endoscopic removal of their EFI, and 1 patient's food impaction resolved spontaneously. The mean duration of food impaction was 20 hours prior to endoscopic intervention. Endoscopy demonstrated an esophageal stricture in 1 patient with a history of trisomy 21 and tracheoesophageal fistula repair. While there was no visual evidence of esophagitis in any patient, 5 of 7 had histologic evidence of esophagitis. Upper gastrointestinal series demonstrated the esophagus to be anatomically normal in 10 of 12 patients (83%); 1 patient had an esophageal stricture and another an esophageal web. Four of 8 patients studied had nonspecific esophageal motility abnormalities. CONCLUSIONS: EFI in children is not generally associated with underlying esophageal anatomic abnormalities. Esophagitis and nonspecific esophageal motility disorder abnormalities may be etiologic factors. Endoscopic removal of the EFI was safe and effective and is recommended as there is little likelihood of spontaneous resolution of EFI in children.
