ABSTRACT
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
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.
Subject(s)
Esophagus , Food , Foreign Bodies , Adolescent , Airway Obstruction/etiology , Child , Deglutition Disorders/etiology , Emergencies , Esophageal Motility Disorders/complications , Esophageal Stenosis/complications , Esophagoscopy , Female , Humans , Male , Manometry , Postoperative Complications , Retrospective Studies , Surgical Instruments , Tracheoesophageal Fistula/surgeryABSTRACT
Primary rectal lymphoma in childhood is rare. We report a case in a 10-year-old boy who presented with rectal bleeding and a single rectal polyp. Histologic examination, immunophenotyping and molecular genetic study of the polyp showed a diffuse B-cell lymphoma, Burkitt-like type. The literature on this topic is reviewed and pathologic examination of childhood rectal polyps is emphasized.
