Genotypic and clinical differences of seropositive Helicobacter pylori children and adults in the Polish population.

Helicobacter pylori (H. pylori) plays an important role in the pathogenesis of the upper gastrointestinal tract diseases in both children and adults. The aim of this paper was to assess the differences between the clinical course of the disease in children and adults. This paper also presents an analysis of clinical symptoms, endoscopic and histopathological findings, H. Pylori cagA and vacA genotypes rates and analysis of the sensitivity of these strains to antibiotics in the Polish population, with possible practical and therapeutic implications. The multicenter study on the frequency of H. pylori infections assessed by the presence of antibodies in IgG class against H. pylori in serum was conducted in the years 2002 and 2003. The study group included 6565 children and adults, in 3827 of whom antibodies levels were above 24 U/mL. The authors analyzed clinical and endoscopic symptoms and in some patients with H. pylori seropositivity also histopathological changes, and cagA and vacA genes. Sensitivity of H. pylori strains to antibiotics were also analyzed. Differences between the frequency of infection between children and adults were determined. Endoscopic examination in adults revealed more frequent cases of gastropathy (P=0.003) and erosive gastritis (P=0.001), and in children-thick mucosal folds (P<0.0001). Histopathological examinations carried out in adults have revealed atrophic gastritis and intestinal metaplasia. In children, cagA(+) s1m1 was observed more frequently than in adults (34.0% versus 23.1%; P=0.02) contrary to cagA(-)s2m2 which occurred more frequently in adults (27.1% versus 14.0%; P=0.003). No effect of the infection on nausea, regurgitation, vomiting, heartburn, and abdominal pain in children was detected. However, adults infected with H. pylori suffered from more frequent episodes of heartburn and abdominal pain. The H. pylori strain exhibited a high resistance to metronidazole (higher in adults: 41.7% versus 27.4%; P=0.002), and to clarithromycin (higher in children: 20.2% versus 15.4%; P>0.05), and dual resistance to metronidazole and clarithromycin (higher in children: 9.9% versus 8.4%; P>0.05). Resistance of the H. pylori to amoxicillin and tetracycline was not detected. The conducted study indicated clinical differences in the H. pylori infection in children and adults. Among the differences in children, especially the more frequent infections by the cagA(+)s1m1/m2 strain could have an influence on further consequences of the infection. The obtained results could be useful in therapeutic decisions.

The clinical aspects of Helicobacter heilmannii infection in children with dyspeptic symptoms.

UNLABELLED: Helicobacter heilmannii (H. heilmannii) infection is a relatively rare causative agent of gastroduodenal diseases in children. However, H. heilmannii frequently colonizes gastric mucosa of animals, mainly cats and dogs, from where it can be transmitted to humans. The aim of the study was to evaluate the incidence of H. heilmannii infection in children with dyspeptic symptoms treated in our clinic. A number of 13,124 esophagogastroduodenoscopies in children aged 4 to 18 years were conducted from 1992 to 2010. The indications for examination were: chronic abdominal pain, nausea, vomiting, heartburn, anaemia, disturbances of intestinal absorption and other. In 11,023 cases microbiologic studies and cultures toward Helicobacter infection were carried out and in 22 children H. heilmannii infection was confirmed. H. heilmannii infection was diagnosed based on morphologic examination in direct microscopy of biopsy specimens from gastric mucosa. In children with H. heilmannii infection clinical symptoms, contact with animals, endoscopic findings of the upper gastrointestinal tract and results of diagnostic tests for Helicobacter pylori infection were assessed. In our studies H. heilmannii infection was diagnosed in 22 children. The rate of H. heilmannii infection was 0.2% in examination of gastric mucosa specimens. No sex-dependent difference in the rates was observed. Most of the children lived in cities and 54.5% had contact with dogs and/or cats. Children complained of chronic epigastric pain, nausea, vomiting and heartburn. Endoscopic studies most often revealed nodular gastritis and gastric or duodenal ulcer in two children. In three children result of the endoscopic study was normal. CONCLUSIONS: H. heilmannii infection in children is rare. However, it may be one of the causes of gastroduodenal diseases in children.

Eosinophilic esophagitis in children: frequency, clinical manifestations, endoscopic findings, and seasonal distribution.

PURPOSE: Eosinophilic esophagitis (EoE) is a chronic disease characterized by eosinophilic infiltration of the esophageal mucosa, which is associated with clinical and endoscopic manifestations. The objective of our study was to determine the frequency of EoE and to outline the clinical manifestations of EoE in Polish children. MATERIAL/METHODS: Ten large regional pediatric gastroenterology centers participated in the study. A database of endoscopy reports from January 2004 till December 2009 was reviewed. A total of 35,631 esophagogastroduodenal endoscopy studies in children, aged from 4 months to 18 years, were performed. Data pertaining to the children's age, gender, indications for endoscopy, clinical findings and histopathology diagnosis were made. RESULTS: In 84 children (20 girls and 64 boys), aged between 4 months and 18 years, EoE was diagnosed. This constituted one case per 424 endoscopic studies. In children with changes in the esophageal mucosa the frequency of EoE was higher and reached one case per 73 children. The most frequent symptoms of EoE differed between the younger (1-6 years old) and older children (aged 13-18 years old). Feeding aversion, vomiting and/or regurgitation were most frequently observed in the younger children, while in older children: abdominal pain, dysphagia and chest pain. Granular mucosa, longitudinal furrows, and mucosal rings belong to the findings most often observed in endoscopic studies. EoE was more frequently diagnosed in the spring (45.2%) and summer (28.5%). CONCLUSIONS: EoE was diagnosed in every age, with frequency of 1/424 gastrointestinal endoscopies, more frequently in boys than in girls.

High level of resistance to metronidazole and clarithromycin in Helicobacter pylori isolated from pediatric patients in Poland (1997-2001).

Resistance to metronidazole (Met), clarithromycin (Cla) and amoxycillin (Amo) was examined using H. pylori isolates from child patients before and after treatment in the period 1997-2001. The rate of Met and Cla resistance before treatment was 35.2 and 8.6%, respectively. Six weeks after treatment 48.4% of the isolated strains were resistant to Met and 17.6% to Cla. The highest rate of resistance to both antibiotics was determined in 2001 (before treatment, 46 and 15%, respectively, and after treatment, 57.8 and 26.3%, respectively). All the strains were susceptible to Amo. Strains resistant to Met were detected more frequently in girls than in boys.

[Evaluation of an atypical clinical presentation for pneumonia caused by Mycoplasma pneumoniae and Chlamydia sp in children]. / Ocena obrazu klinicznego atypowych zapalen pluc wywolanych przez Mycoplasma pneumoniae i Chlamydia sp. u dzieci.

Mycoplasma pneumoniae and Chlamydia sp. frequently cause atypical pneumonia in children. The study aim was the analysis of clinical picture of pneumonia caused by Mycoplasma pneumoniae and Chlamydia sp. in 278 children treated in the period of 1985-1998 in the IInd Clinic of Pediatrics and Gastroenterology, Medical Academy of Wroclaw. The influence of etiological factor and age of children for the clinical picture of the disease was estimated. The most characteristic clinical symptom of the atypical pneumonia in children was "staccato" cough observed in 89.9% of children. More severe course of the mycoplasmal pneumonia in comparison with that of Chlamydia origin was demonstrated. The most severe course of pneumonia was observed in infants. The afebrile course of the disease was observed in the group of Chlamydia pneumonia (in 26.3% of infants, 40% of children aged 1-6 years and 54.8% of children aged 7-15 years). None of children with mycoplasmal pneumonia had an afebrile course of the disease. The most characteristic radiological picture in children with atypical pneumonia were diffused, symmetrical interstitial inflammatory changes of the lungs. In the group of children with mycoplasmal pneumonia in over 50% of cases the enlargement of lymph nodes of the lungs hili were observed.

Early symptoms of Duchenne muscular dystrophy--description of cases of an 18-month-old and an 8-year-old patient.

The paper presents the description of Duchenne progressive muscular dystrophy in an 18-month-old and an 8-year-old boy. The diagnosis was established on the basis of clinical symptoms, such as impaired motor development, hypertrophy of leg muscles, difficulty in walking; elevated serum phosphocreatine kinase activity and pathologic electromyographic recordings. The authors emphasize that the disease is characterized by increased activity of such enzymes as: alanine and aspartate aminotransferases, lactate dehydrogenase and aldolase--observed as early as in the first weeks of life, with normal gammaglutamyltranspeptidase activity suggests progressive muscular dystrophy and makes it possible to establish early diagnosis. Early diagnosis of the disease allows to start rehabilitation earlier, to select an appropriate type of anesthesia in case of surgical treatment and to advise parents within the framework of genetic counseling.

Epidemiology and impact of rotavirus diarrhoea in Poland.

Hospital and laboratory data were analysed in three hospitals to estimate rotavirus disease burden in 1994-96. Community acquired gastroenteritis was diagnosed in 757 children of whom 41% tested positive for rotavirus. A total of 196 children had rotavirus nosocomial infections (39% of all rotavirus community-acquired and nosocomial cases). Infants less than 24 months old and children less than 3 months old comprised 74% and 11.9% of admissions for rotavirus, respectively. Almost 94% of children with rotavirus infection had severe gastroenteritis (score > or =11). The annual rate of rotavirus associated hospitalization in Poland in 1996 was 3.1/1000 children under the age of 60 months and 5.2/1000 infants under 24 months of age. The mean hospital stay was 9.5 d (+/-9.8 d). We estimated that 8918 children under 60 months of age were hospitalized for rotavirus gastroenteritis in 1996; they accounted for 84899 inpatient days. We conclude that rotavirus is a leading aetiological agent of severe gastroenteritis in young children in Poland and that the burden of this infection is significant. Rotavirus vaccine could significantly decrease the hospitalization rate and the financial impact of rotavirus gastroenteritis in Poland.

Clinical evaluation of food allergy and food intolerance dietary treatment in children.

Dietary treatment with Humana SL (33) or Prosobee (42) was administered to 75 children at the age from 1 month to 3 years with cow's milk allergy (36), coeliac disease (9), secondary enteropathy (30). The treatment time ranged from a few days (in case of intolerance symptoms) to 12 months. In 13 children intolerance symptoms or unwillingness to take food was observed: in 4 (12%) after the application of Humana SL and in 9 (21%) after Prosobee. Lack of improvement after Prosobee treatment was observed in 4 (10%) children, and in 4 (12%) children with Humana SL. The partial or total relief of symptoms was observed in others (Humana SL-76%, Prosobee-69%). Analysis showed good results of Humana SL and Prosobee treatment of food allergy and intolerance. Both are usually well tolerated by children, however Humana SL seems to taste better and be better accepted. Intolerance symptoms or lack of improvement were most often observed in children at the age of 1-2 months.

Bismuth concentration in blood and urine of children treated with ventrisol (polfa) preliminary study.

The bismuth concentration was measured in the blood and urine of 21 children from 8 to 17 years old (13.12 +/- 2.67) treated with Ventrisol (Polfa)-tripotassium dicitrato bismuthate (TDB). One tablet of TDB-equivalent to 120 mg Bi2O3. One tablet was given orally to the patients four times a day. Blood and urine was taken for measurement of bismuth concentration in the morning, on fasting, before the administration of Ventrisol on the 6-8 days, the 27-28 days of the therapy and in the 4-5, 8-9 weeks after TDB therapy. The reason for TDB treatment was chronic gastritis and/or duodenal ulcers, which were diagnosed by endoscopic examination. No bismuth in the blood and a very low concentration in the urine were determined in 19 children before TDB treatment. After 6-8 days of TDB treatment the bismuth concentration in the blood was 40.85 +/- 31.05 micrograms/L and 75.11 +/- 82.07 micrograms/L in the urine. In the 27-28 days of the treatment the bismuth concentration in the blood was 37.67 +/- 25.06 micrograms/L, and 163.56 +/- 181.86 micrograms/L in the urine. In the 4-5 weeks after the TDB treatment the bismuth concentration in the blood was 7.77 +/- 10.56 micrograms/L, and 15.72 +/- 9.87 micrograms/L in the urine. The bismuth concentration level in the urine rose together with the rise of the bismuth concentration level in the blood, the correlation factor was r = 0.68. No symptoms of side effects caused by the TDB treatment were observed. Before the treatment a high bismuth concentration was found in the blood of two patients. These cases are discussed later.

[Cancer of the renal parenchyma in a 14-year-old girl with horseshoe kidney]. / Rak miazszu nerki u 14-letniej dziewczynki z nerka podkowiasta.

A 14-year-old girl is reported in whom carcinoma of the parenchyma of the right kidney and horseshoe kidney were diagnosed. The right kidney with the neoplasm was removed (carcinoma was in stage I of development), Histological examination demonstrated clear cell carcinoma. The patient remains under follow-up observation and two years after the operation she is well and no signs of disease have been observed.