Evaluation of the string test in intestinal bacterial overgrowth.

To determine the efficacy in assessing bacterial overgrowth, the string test (EnteroTest-Pediatric) and duodenal aspiration were compared in 18 children with chronic diarrhea. Isolation and significance of organisms in the small intestine were identical with both methods in all patients. These data suggested that the string test is an accurate, simple, and safe method for assessment of small-intestinal microflora.

Serum Group I pepsinogens in children with recurrent abdominal pain.

Recurrent abdominal pain (RAP) is a common, frustrating problem in childhood. A commonly mentioned cause has been acid hypersecretion without evidence of actual ulceration. Recently, a radioimmunoassay specific for group I pepsinogens (PgI), one of two immunochemically distinct groups of human pepsinogens or precursor zymogens of pepsin, has been developed. Serum PgI levels have been demonstrated to reflect the acid secretory capacity of gastric mucosa, specifically the maximal and peak acid outputs (MAO, PAO), as well as the basal acid output (BAO), thus providing an accurate, tubeless determination of acid secretion. The present study of children with and without RAP has revealed no significant difference in serum PgI levels in these groups. These results suggest that acid hypersecretion cannot be demonstrated in RAP: therefore its relationship to RAP is questionable.

Infantile colic. Association with lactose and milk intolerance.

Intolerance to lactose and cow's milk protein was prospectively evaluated in 56 infants with apparent colic. A complete blood cell count, sedimentation rate, test for quantitative IgE level, radioallergosorbent test (performed in 15 patients), and at least three stool examinations for pH, presence of reducing substances, and occult blood were performed in 56 infants (46, appropriate size for gestational age; ten, small for gestational age) and results were within normal limits for age. This study suggests that tolerance to lactose and cow's milk protein does not have a significant role in infantile colic.

Primary intestinal lymphangiectasia. Case report with radiological and ultrastructural study.

A 16-year-old boy with primary intestinal lymphangiectasia presented with peripheral edema of 6 weeks duration. Laboratory and radiological studies included absolute lymphopenia, hypoalbuminemia, steatorrhea, abnormal stool 51Cr-albumin value, edema of small intestinal folds, dilated mesenteric lymphatics, as well as bilateral filling defects in external and common iliac lymph nodes. Abdominal CT scan revealed a possible periaortic mass. Small intestinal biopsies demonstrated normal villous architecture with dilated lacteals, and electron microscopy revealed enterocytes with normal as well as blunted microville, enlarged, dilated lacteals and intercellular vacuoles. An exploratory laparatomy was performed and revealed no masses but dilated serosal lymphatic vessels. Medical treatment, including marked restriction of long chain triglyceride intake, resulted in loss of peripheral edema, weight stabilization, and normal activity.

Gastric acid secretion and serum gastrin levels in children with recurrent abdominal pain, gastric and duodenal ulcers.

Basal and histalog-stimulated gastric acid secretion and serum gastrin levels before and after a standard protein meal were compared in eight children with active duodenal ulcer (DU), four with active gastric ulcer (GU), and in seven children with recurrent abdominal pain (RAP) of undetermined etiology. There was no discernible difference in the pattern of abdominal pain in DU, GU, and RAP. Basal acid output, peak and maximal acid output, whether expressed as milliequivalents per hour or as milliequivalents per kilogram per hour, were comparable in children with DU, GU, and RAP. In contrast, serum gastrin levels, 1 and 2 hours after standard protein meal, were significantly higher in the DU children than in the GU or RAP group. These studies have suggested that hypersecretion of gastric acid may not be associated with duodenal ulcer or gastric ulcer disease in children, and that increased gastrin secretion and possible reduced acid responsiveness coexist in children with duodenal ulcers.

The string test for gastroesophageal reflux.

The sensitivity of the string test for detection of gastroesophageal reflux was assessed in 15 infants and children, 5 months to 11 years of age (mean, 2.8 years), with vomiting, regurgitation, or lower respiratory tract symptoms, and compared with the barium esophagram, esophageal manometry, and the acid reflux test (pH probe). Barium esophagram showed reflux in 4/15 patients, pH probe in 7/15, and string test in 6/15. The string test is a simple, rapid, safe, and efficient screening method for patients with suspected gastroesophageal reflux.

Intractable diarrhea of infancy due to intestinal coccidiosis.

Intestinal coccidiosis in a 6-mo-old infant terminated fatally after 30 wk of continuous total parenteral nutrition, and proved refractory to treatment with antibiotics, hydrocortisone, and antimetabolic agents. Intestinal biopsies obtained at laparotomy revealed flattened mucosa infiltrated with coccidia at various stages of the parasites' life cycle. The course was characterized by severe diarrhea due to a cholera-like hypersecretion of intraluminal fluid. This case suggests that intestinal coccidiosis may be included among the small number of conditions responsible for authentic "intractable diarrhea of infancy."

Shwachman-Diamond sydnrome and chronic liver disease.

Clinically inapparent persistent chronic liver disease in a 15-month-old male patient with Shwachman-Diamond syndrome is presented. Cryptic hepatic involvement may be an unrecognized feature of the syndrome and should be evaluated in all cases.

Cholestyramine treatment of chronic diarrhea associated with immune deficiency syndrome.

A 5-year-old boy with known severe combined immunodeficiency disease presented with chronic diarrhea, malabsorption and retarded growth. Candida albicans was found in distal duodenal fluid, and invading the intestinal mucosa. Chronic diarrhea persisted after antimycotic therapy, but responded to treatment with cholestyramine. Repeated courses of cholestyramine resin over a 6-month period were required for complete resolution of the gastrointestinal symptomatology.

Disorders of defecation in children: evaluation and management.

In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ampulla. Laboratory and radiologic findings were nonspecific except in two of the three patients found to have congenital megacolon (Hirschsprung's disease). Rectal suction biopsy, performed in 69 patients, was diagnostic in all three with Hirschsprung's disease. Anorectal manometry, done in 11 patients, was of limited value. In general, treatment consists of patience and understanding on the part of physician and family, a regimen of orally administered (noncathartic) laxatives with dose gradually reduced over weeks to months, frequent telephone communication between physician and parents, and occasional office visits. Patients with nonretentive fecal incontinence require an intensive psychologic approach. A patient, empathetic, and available physician is one of the most important ingredients in the treatment regimen.

Recurrent abdominal pain in children: lactose and sucrose intolerance, a prospective study.

Thirty-eight consecutive children with recurrent abdominal pain underwent lactose tolerance tests; 28 of these were also given sucrose tolerance tests. Abdominal pain and abnormal lactose tolerance tests were noted in 11 of 38, while none of the 28 had an abnormal sucrose tolerance test; however, 1 had abdominal pain. Elimination diet for 4 weeks produced significant or total pain relief in 10 of 11 (lactose free) and 0 of 1 children (sucrose free). Lactose intolerance seems to play a contributory role in recurrent abdominal pain in children, while sucrose intolerance does not.