ABSTRACT
Upper gastrointestinal tract (GIT) symptoms are not disease specific and of limited value in the differentiation of GIT disorders. The present study aimed to determine the etiology of chronic unspecific symptoms in children and to test the need for upper endoscopy in diagnosis. This is a prospective study for 30 Egyptian children presented with chronic upper GIT symptoms for at least 2 months. History regarding severity and frequency of GIT symptoms were asked for. Children with known disorder that explains presenting symptoms were excluded. Upper GIT endoscopy wa performed and 5 biopsies were obtained for pathological examination and for Hpylori testing. The results showed that children age ranged between 2.5-18 years with mean ± SD of 13.6 ± 3.4 and 63.3% were females. The main complaints were epigastric pain in 43.3%, hematemesis in 30% and vomiting in 26.7%. Motility disorders were diagnosed in 66.7% children; in the form of GERD in 63.3% and achalasia in one. Complication of GERD in the form of erosive esophagitis was present in 15.8% children, while Barrett's esophagus was not observed. H. pylori infection was diagnosed in 80% histologically. Eosinophilic esophagitis was not detected.
Subject(s)
Gastrointestinal Diseases/diagnosis , Upper Gastrointestinal Tract/pathology , Adolescent , Child , Child, Preschool , Chronic Disease , Female , Humans , Male , Pilot ProjectsABSTRACT
BACKGROUND: Hepatitis C virus (HCV) has a lower prevalence in children and knowledge is limited regarding the natural outcome of HCV infection in children. AIM: To study the risk factors of HCV acquisition and predictors of persistence in Egyptian children. METHODS: Children, 1-9 years of age, were evaluated for acquisition of HCV (anti-HCV positive regardless of viraemia) and persistence of HCV (anti-HCV and HCV-RNA positive) at two paediatric hepatology clinics in Cairo at enrollment and at 3 monthly intervals. Spontaneous clearance of HCV was defined as ≥ two positive anti-HCV antibody tests with negative HCV-RNA at least 6 months apart. RESULTS: Over a 33-month-period a total of 226 children <9 years of age were screened for HCV antibodies. Of those, 146 (65%) were anti-HCV positive of which 87 (60%) were HCV-RNA positive. The HCV acquisition was more likely to occur in older children (P = 0.003) with comorbid conditions (P < 0.01) compared to anti-HCV negative children. In a multivariate logistic regression analysis, the highest risk factors for HCV acquisition were surgical interventions [odds ratio (OR): 4.7] and blood transfusions (OR: 2.3). The highest risk factor for HCV persistence was dental treatment (OR: 16.9) and male gender (OR: 7.5). HCV persistence was also strongly associated with elevated baseline alanine aminotransaminase (ALT) levels (OR: 4.9) and fluctuating aspartate aminotransferase (AST) levels (OR: 8.1). CONCLUSION: Although surgical interventions and blood transfusion are significant risk factors for HCV acquisition in Egyptian children, dental treatment remains the highest risk factor for HCV chronic persistence in children.
Subject(s)
Hepatitis C/epidemiology , Hepatitis C/transmission , Age Factors , Child , Child, Preschool , Egypt/epidemiology , Female , Hepatitis C/genetics , Hepatitis C/immunology , Hepatitis C Antibodies/blood , Humans , Infant , Logistic Models , Male , Prevalence , RNA, Viral/genetics , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , Seroepidemiologic StudiesABSTRACT
OBJECTIVE: To evaluate safety and efficacy of Peg-INF combined with ribavirin for genotype 4 infected children. METHODS: Seven children were included, five were infected parentrally, One vertically and one had both exposures. Clinical and laboratory evaluation were undertaken as well as quantitative PCR for HCV RNA before therapy at, 12, 24 and 52 weeks during treatment and one year after therapy. Liver biopsy was performed before and at the end of therapy. Four children had low and three had moderate viremia. RESULTS: At twelve weeks, two children (28.6%) lost viremia. Another child lost viremia at 52 weeks. ETR was 42.9%. During follow up one relapsed, thus SVR was 28.6%. Children with SVR were the youngest, their mean duration of infection was 4.5 vs 12.7 years in the others. Side effects of both INF & ribavirin was mild, required no reduction in doses. CONCLUSION: Combination therapy of peg interferon-alpha with ribavirin is well tolerated in children and adolescents studied.
