Another cause of bloody diarrhoea in infancy: cytomegalovirus colitis in an immunocompetent child.

Although a ubiquitous pathogen, cytomegalovirus (CMV) is very rarely thought to be the cause of significant gastrointestinal infection in the immunocompetent child. We report the case of a 2-month-old infant who presented with bloody diarrhoea and severe dehydration, which was subsequently diagnosed as CMV enterocolitis and resolved spontaneously without antiviral treatment.

Portal vein thrombosis and pancreatic failure.

We report a case of a child with portal vein thrombosis presenting with protein losing enteropathy. He later developed exocrine and endocrine pancreatic failure. This association has not been reported before.

Diagnosis of Helicobacter pylori gastritis in children using the 13C urea breath test.

The clinical recognition of Helicobacter pylori gastritis in children with recurrent abdominal pain is difficult. We assessed the value of a simplified 13C urea breath test (13C-UBT) in a selected group of children with nocturnal waking and disruptive recurrent abdominal pain who fulfilled criteria for endoscopy. Gastric antral biopsies were examined histologically and by the quick urease test and were compared with H. pylori serology and the 13C-UBT in a prospective study of 50 children referred to a tertiary center. Thirty-two patients had gastritis and of these, 19 had histologically proven H. pylori gastritis. Seventeen of these 19 patients had a positive 13C-UBT. The sensitivity and specificity of the 13C-UBT compared with the histologic diagnosis of H. pylori was 89 and 90% respectively. The 13C-UBT was more specific than the H. pylori serology. The 13C-UBT using two breath collections is a reliable and noninvasive diagnostic test for H. pylori infection in children.

Ulceration of the small intestine in children with coeliac disease.

BACKGROUND: Ulceration of the small intestine in children has not been previously described. PATIENTS: Two children, aged 12 and 18 months, presented with a history of failure to thrive and intractable diarrhoea. RESULTS AND CONCLUSIONS: Upper gastrointestinal endoscopy showed multiple ulcers involving the first and second parts of the duodenum. Histology of biopsy specimens taken from these sites confirmed ulceration and showed other features consistent with a diagnosis of coeliac disease. They both showed pronounced clinical improvement and satisfactory linear growth on a gluten free diet. A year later the diagnosis of coeliac disease was confirmed on a biopsy controlled gluten challenge, and repeat endoscopy showed complete resolution of the intestinal ulceration.

Recurrent abdominal pain and Helicobacter pylori in a community-based sample of London children.

Helicobacter pylori is accepted as an important factor in the pathogenesis of peptic ulcer disease. Infection is probably most commonly acquired in early life but there is still limited information on the prevalence or symptomatology of H. pylori infection in childhood. The aim of the present study was to establish the prevalence of H. pylori infection in a large sample of urban school children and to determine its relationship, if any, to a history of recurrent abdominal pain. Using a commercial ELISA significant levels of anti-H. pylori IgG antibody were detected in 107/640 (16.7%) of school children (M, 383; F, 257; mean age 9.15 years, range 4-13). No relationship was demonstrated between H. pylori seropositivity and a personal or family history of recurrent abdominal pain or the nature of the pain.

A comparison of endoscopic and capsule small intestinal biopsy techniques in children with upper gastrointestinal disorders.

OBJECTIVE: To compare the adequacy for histological diagnosis and morphometric analysis of small intestinal biopsies obtained by either endoscopic forceps or a capsule technique. METHODOLOGY: Small intestinal biopsies from 176 children were reviewed, 92 obtained by endoscopy and 84 by capsule. RESULTS: The adequacy for making a histological diagnosis was 96 and 81% for endoscopic and capsule biopsies, respectively, and for morphometric analysis it was 86 and 71%. There were more tissue specimens from children who had endoscopic compared with capsule biopsies (2.3 vs 1.8 specimens per patient). CONCLUSIONS: Endoscopic biopsies provide better specimens for histological diagnosis and endoscopy has the advantage of allowing macroscopic assessment of the upper gastrointestinal tract which can be of value in recognizing unexpected pathology and in identifying patchy mucosal changes.

Studies of water movement across the gut using oral rehydration solutions in a rat perfusion model.

AIM: To measure water influx and efflux, as well as net water, sodium and potassium absorption from a range of oral rehydration solutions (ORS) in which the glucose content had been partially replaced with the amino acid leucine or with food supplements. METHODS: A series of in vivo steady-state perfusion studies in normal rat intestine. The oral rehydration solutions contained 60 or 90 mmol/L of sodium. The reference solution used was the World Health Organization (WHO) formula. RESULTS: There was a significant negative correlation between the oral rehydration solution osmolality and net water absorption (r = -0.722, P < 0.05). The highest net water absorption occurred using comminuted chicken supplemented oral rehydration solution containing 60 mmol/L sodium (P < 0.001). This oral rehydration solution also showed a significant increase in the rate of influx of water (P < 0.05) in comparison with the WHO formula containing 60 mmol/L sodium. CONCLUSION: This work provides further evidence that food-based oral rehydration solutions, including non-vegetable sources, may have a useful role to play in the management of patients with acute diarrhoea.

Evaluation of the effects of varying solute content on the efficacy of oral rehydration solutions in a rat model of secretory diarrhoea.

A series of in vivo steady-state perfusion studies in cholera toxin-induced secreting rat intestine were carried out to investigate net water, sodium, and potassium absorption and water influx and efflux from a range of oral rehydration solutions (ORSs) in which the glucose content had been partially replaced by amino acids or food supplements and the sodium content had been reduced to 60 mM. The reference solution used was the World Health Organization formula. There was a significant correlation between the osmolality of the ORS and the net water absorption (r = -0.911; p < 0.02). The greatest net water absorption occurred using comminuted chicken- and tapioca-supplemented ORS.

Plasma amino acid profiles in preterm infants receiving Vamin 9 glucose or Vamin infant.

Amino acid profiles were measured in 29 low-birth-weight infants receiving either Vamin 9 glucose (n = 18, group A) or Vamin Infant (n = 11, group B) as the amino acid source in parenteral nutrition; intake was otherwise identical. Infants were sampled when receiving 430 mgN/kg per day (3.2 g/kg per day amino acids) and 90 non-protein kcal/kg per day. There was no difference between groups in birth weight, gestational or postnatal age. The percentage N retention was similar in both (68 and 60%, groups A and B respectively). Phenylalanine and tyrosine levels were higher in those who received Vamin 9 glucose but 55% of infants given Vamin Infant had tyrosine levels below the lower limit of the target range. Cysteine levels were low in both groups. Further modification of the amino acid composition of parenteral solutions for the newborn is necessary. If sufficient non-protein energy can be provided the risk of abnormally high amino acid levels is reduced.

The effects of cisapride on gastro-oesophageal reflux in children with and without neurological disorders.

Cisapride was used to treat gastro-oesophageal reflux in seven children with neurodevelopmental disorders and in 15 children who were neurologically normal. 24-hour lower-oesophageal pH monitoring was carried out before and after treatment. The neurologically normal group had a statistically significant decrease after treatment in percentage time pH less than 4, but children with neurological abnormalities did not have a comparable improvement in reflux scores.

Concurrent pancreatic and growth hormone insufficiency in Johanson-Blizzard syndrome.

Exocrine pancreatic insufficiency is one of the recognised features of the Johanson-Blizzard syndrome; other features include hypothyroidism, sensorineural deafness, aplastic alae nasi, developmental delay, and growth retardation. Twenty-one cases of the syndrome have been described to date. The child reported here was diagnosed in the neonatal period, but despite early pancreatic and thyroid replacement therapy his growth remained poor. Anterior pituitary function studies demonstrated growth hormone deficiency, subsequent administration of growth hormone has resulted in an improvement in his growth velocity. This feature has not been well documented and should be considered as a factor contributing to the growth retardation which is a constant feature of this syndrome.

Energy and nutrient intakes in cystic fibrosis.

The diets of 20 children with cystic fibrosis were analysed for energy and nutrient content with simultaneous measurement of energy losses in stools. Median energy intakes were in excess of the WHO estimated daily requirements (118.2%) when expressed as MJ/kg/24 hours, the excess almost accounted for by energy losses in the stools. When expressed as MJ/24 hours, however, median energy intakes were 98.7% of that estimated for normal children of median weight for age. Compared with recently published data for normal school children the fat content of the diet was reduced (30.0%) as were intakes of iron and zinc. Children whose whole milk intakes were high had the greatest amount of fat and energy in their diets and were able to absorb energy in excess of that recommended. We conclude that many children with cystic fibrosis are still on low fat diets and whole milk is the single most useful food for the provision of extra dietary fat and energy.

Nonlipid formula components and fat absorption in the low-birth-weight newborn.

The relationship between nonlipid formula components and fat absorption in newborns is largely uninvestigated. Two formulas of identical fat blend but different protein quality and acid-base properties were fed to two groups of babies from birth and during 3-5 d balance periods in the third week of life. Babies receiving a formula of higher acidity containing predominantly curd protein absorbed a significantly lower percentage of their fat and nitrogen intake than babies receiving a curd-and-whey protein formula (fat absorptions of 73 +/- 11.0 and 85 +/- 8.0%, means +/- SD, p less than 0.04; N absorptions of 90 +/- 3.0 and 93 +/- 1.0%, p less than 0.03, respectively). The feces of the curd-formula babies contained a smaller proportion of long-chain, saturated fatty acids and a larger proportion of shorter-chain and unsaturated fatty acids. Fatty acid type and triglyceride structure are not the only factors influencing fat absorption in newborns. Other formula components may need modification to achieve maximum fat absorption.

Optimising oral rehydration solution composition in model systems: studies in normal mammalian small intestine.

Small intestinal perfusion studies have been carried out in animals to evaluate the role of the individual constituents of oral rehydration solution (ORS), in order to draw some conclusions relating to the optimal composition of ORS. Two commercially available ORS, Dioralyte and Rehidrat have also been compared to the World Health Organisation (WHO) standard solution. Maximum rate of water absorption occurred with the WHO solution and least with Rehidrat. The findings of the perfusion studies suggest that in the normal small intestine, optimal water absorption occurs from a solution containing 60 mmol/l of sodium and 80-120 mmol/l of glucose. The addition of bicarbonate and citrate at concentrations present in ORS does not appear to have a significant effect on water absorption. The addition of glycine and diglycine to the standard ORS reduced the net rate of absorption of sodium and water, probably because of the effect of increased osmoality.

Increased resting energy expenditure in cystic fibrosis.

To explore the hypothesis that there is an increased metabolic rate in cystic fibrosis, resting energy expenditure was measured by indirect calorimetry in 23 subjects with cystic fibrosis in a stable clinical state and in 42 normal control subjects. Resting energy expenditure was found to be elevated by an average of 0.45 MJ/24 h [95% confidence interval (CI) = 0.26-0.64, t = 4.91, P less than 0.001] (108 kcal/24 h), or 9.2% above expected values derived from the regression relating resting energy expenditure to whole body weight and sex in control subjects. When related to lean body mass, values were still elevated by 0.36 MJ/24 h (95% CI = 0.18-0.53, t = 4.15, P less than 0.001) (86 kcal/24 h), or 7.2%. The increased values were found to be independent of age, sex, or body size. There were significant correlations between increased values and poor pulmonary function as measured by the ratio of the forced expiratory volume in 1 s to forced vital capacity (r = -0.44, P less than 0.05) and subclinical infection as indicated by the blood leukocyte count (r = 0.40, P less than 0.05). However, the correlations were low, suggesting that other factors may contribute to the increased resting energy expenditure, possibly including the putative metabolic defect in cystic fibrosis.