ABSTRACT
Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.
Subject(s)
Pancreatitis , Adult , Humans , Child , Adolescent , Pancreatitis/diagnosis , Pancreatitis/therapy , Consensus , Acute Disease , Mexico/epidemiologyABSTRACT
The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.
Subject(s)
Liver Cirrhosis , Pediatrics , Humans , Child , Consensus , Liver Cirrhosis/complications , Liver Cirrhosis/therapyABSTRACT
INTRODUCTION AND AIMS: Peutz-Jeghers syndrome is an autosomal dominant inherited pathology characterized by gastrointestinal hamartomatous polyps, predominantly in the small bowel, and pigmented mucocutaneous lesions. Guidelines suggest polypectomy with a balloon-assisted enteroscope when polyps are larger than 10mm. Complications in adults can be as high as 6.8%, but there is little information on pediatric populations. Our aim was to describe the safety and efficacy of polypectomy in a group of pediatric patients with Peutz-Jeghers syndrome using balloon-assisted enteroscopy. MATERIALS AND METHODS: A retrospective study was conducted at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI on pediatric patients with Peutz-Jeghers syndrome that required balloon-assisted enteroscopy and polypectomy within the time frame of January 2010 and December 2015. Patients that underwent polypectomy with a push enteroscope were excluded from the study. RESULTS: A total of 35 polypectomies were performed on 4 patients (female/male: 3/1). The mean age of the patients was 13.7 years (range:11-16). Twelve enteroscopies were carried out, 8 of which were anterograde. A single-balloon enteroscope was used in 7 procedures and a double-balloon enteroscope in 5. The mean size of the polyps was 1.6cm (range: 1-4cm). A major complication (acute pancreatitis) presented in only one case (8.3%). No other major complications associated with the procedures were observed. CONCLUSION: Balloon-assisted enteroscopy with polypectomy in children is a safe and effective procedure, with complications similar to those reported in adults.
Subject(s)
Digestive System Surgical Procedures/methods , Double-Balloon Enteroscopy/methods , Intestinal Polyps/surgery , Intestine, Small/surgery , Peutz-Jeghers Syndrome/surgery , Adolescent , Child , Digestive System Surgical Procedures/adverse effects , Female , Humans , Intestine, Small/diagnostic imaging , Male , Peutz-Jeghers Syndrome/diagnostic imaging , Retrospective StudiesABSTRACT
El objetivo de este trabajo ha sido valorar el efecto de 20 factores de riesgo de las úlceras por presión en los pacientes críticos con el fin de determinar cuáles aparecen con más frecuencia en los pacientes que desarrollan estas lesiones que en los que no. Hemos realizado un estudio descriptivo prospectivo con pacientes que han estado 7 días o más ingresados, de los que se recogía diariamente la presencia o ausencia de factores de riesgo. De los 35 pacientes estudiados, ocho desarrollaron úlceras por presión (22,85 por ciento). Podemos clasificar los factores de riesgo en 2 grupos según su nivel de significación estadística: a) (p > 0,95) días de estancia, puntuación de Norton y puntuación de Glasgow, y b) (0,90 < p < 0,95) media diaria de cambios posturales, proporción de días sin tolerar los cambios, media de ocasiones diarias desaturado, de horas diarias sedado, de proteinemia y proporción de días con perfusión de dopamina (AU)
Subject(s)
Female , Male , Humans , Critical Care , Risk Factors , Age Factors , Sex FactorsABSTRACT
OBJECTIVE: Little is known about Helicobacter pylori infections and the immune response to urease and CagA in pediatric populations. Our aims were: 1) to validate serological assays for antibodies against whole cell extract, CagA, and urease of H. pylori; 2) to examine their role in diagnosis of infection in children with recurrent abdominal pain (RAP); and 3) to examine the antibody responses to CagA and urease in children. METHODS: An enzyme-linked immunosorbent assay (ELISA) for diagnosis of H. pylori infection using whole cell extracts was validated in 50 children with biopsy-confirmed infection. The IgG and IgA antibody responses against recombinant CagA and urease were compared by ELISA in 82 children with RAP and in 246 age- and sex-matched healthy children. RESULTS: The whole-cell extract ELISA had a sensitivity of 85 % and specificity of 87%. Children with RAP were more infected with H. pylori than were healthy control subjects; however, IgG and IgA CagA seropositivity was lower among those with RAP than among asymptomatic children (34% and 23% vs 76% and 55%, respectively; p < 0.0001). In both groups of children, the immune response to urease was low. CONCLUSION: A serodiagnosis of H. pylori infection using native strains was developed. The difference in the immune response between children with RAP and control subjects suggests that RAP occurs during the acute phase of H. pylori infection. Our results also suggest that urease is a poor immunogen.
Subject(s)
Antibodies, Bacterial/blood , Bacterial Proteins/immunology , Helicobacter Infections/diagnosis , Helicobacter pylori/immunology , Urease/immunology , Abdominal Pain/diagnosis , Adolescent , Antigens, Bacterial/immunology , Blotting, Northern/methods , Chi-Square Distribution , Child , Child, Preschool , Confidence Intervals , Enzyme-Linked Immunosorbent Assay/methods , Enzyme-Linked Immunosorbent Assay/standards , Enzyme-Linked Immunosorbent Assay/statistics & numerical data , Helicobacter pylori/enzymology , Humans , Molecular Weight , Odds Ratio , Recombinant Proteins/immunology , RecurrenceABSTRACT
The frequency of gastroesophageal reflux disease in pediatrics has increased. There is not a clear explanation, some believe there is more awareness of the disease, others believe that new formulas, which are richer in nutrients, may irritate the gastrointestinal tract of the infant. Clinically, children present with regurgitation-malnutrition, respiratory disease, and esophagitis. The medical treatment aims to improve the eating techniques, to decrease the gastric acid output, and to improve the motility function of the esophago-gastrointestinal tract. Surgical treatment is rarely needed.
