Nodular gastritis: an endoscopic indicator of Helicobacter pylori infection in children.

BACKGROUND: Helicobacter pylori (Hp) infection is a common and universally distributed bacterial infection. It is predominantly acquired in childhood. AIM: To assess the relationship between endoscopic nodular gastritis and Hp infection. METHODS: A retrospective study was conducted in children who underwent upper gastrointestinal endoscopy for chronic abdominal pain. All children who had five gastric biopsies for histologic analysis, urease test and Hp culture were included in the study. The Sensitivity and sensibility of nodular gastritis were determined and different parameters were studied according the presence or not of nodular gastritis(age, gender, Hp status, gastritis score and lymphoid follicles). RESULTS: 49 children, mean age 6.9 ± 3 years (range 1-12 years) were eligible for the analysis. Hp Infection was diagnosed in 35 out of the 49 children (71.5 %). Nodular gastritis was recorded in 16 out of 49 children and in 14 infected children and 2 out of 14 non infected children (p=0.07), 40% sensitivity, 85.7% specificity, 87.5% positive predictive value, and 36,4% negative predictive value. The parameters associated significantly to the presence of nodular gastritis were older age: (p=0.04), Hp infection: (p=0.01), chronic gastritis: (p=0.05), active gastritis: (p=0.02), follicular gastritis: (p=0.005), higher gastritis score: (p=0.005). Completely normal gastric mucosal histology was never found in infected children with antral nodularity. Among all infected children, the gastritis score was significantly higher when there was a nodular gastritis and follicular gastritis was significantly associated to nodular gastritis. CONCLUSION: The endoscopic pattern of antral nodularity identifies children with Hp infection, and active chronic follicular gastritis.

Prevalence and risk factors of overweight and obesity in elementary schoolchildren in the metropolitan region of Tunis, Tunisia.

BACKGROUND: Local data about prevalence of obesity in emerging countries are rather scarce. Risk factors for obesity, well known in most industrialized countries, are poorly understood in Tunisia. AIMS: To assess prevalence of overweight and obesity and to investigate associations with possible risk factors in a group of 6-12 year- old schoolchildren in Tunis, Tunisia. METHODS: A descriptive transversal study including a sample of 1335 schoolchildren (6-12 years; mean: 9.7 ± 1.5 years) was conducted in Tunis. Personal and parental data were collected by questionnaires completed by parents. Height and weight were measured and body mass index was calculated. Prevalence of overweight and obesity was defined based on international agreed cut-off points. RESULTS: Prevalence of overweight and obesity was 19.7% and 5.7%, respectively. Risk factors associated with overweight were: high degree- educated mother and father: 17.3% vs 11.7% (p=.01) (OR (95%CI): 1.58; 1.09-2.29) and 26% vs 17.4% (p=.002) (OR: 1.66; 1.21-2.29), respectively; mother, father high in occupational hierarchy: 7.2% vs 3.6% (p=0.009) (OR: 2.1; 1.2-3.7) and 14% vs 9% (p=.014) (OR: 1.6; 1.1-2.48), respectively. Overweight children had a significantly higher consumption of bread (p=.044), of snack intake (p=0.046) and of soft drink consumption (p=.035). CONCLUSIONS: Prevalence of overweight and obesity in this cohort are 19.7% and 5.7%, respectively. Substantial differences in food choices in families with the highest socio-economic status are among risk factors contributing to obesity development.

[Interventional endoscopy in the gastrointestinal tract in children]. / Activité endoscopique digestive interventionnelle chez l'enfant.

BACKGROUND: Interventional endoscopic procedures involving the gastrointestinal (GI) tract in children are very common. Over the last several years the number of procedures in this area has steadily increased. AIM: To study indications and results of GI interventional endoscopies performed in a Pediatric GI unit. METHODS: Retrospective study over a period of 10 years (1999-2008). Data were collected from endoscopic files. All procedures were performed endoscopically under general anesthesia. RESULTS: 185 interventional endoscopic procedures were done during this period in 96 patients (58 boys) median age: 4.9±4.7 years (1 month-13 years). Indications were as follows: esophageal stenosis (n=46; 47.9%), rectal polyp resection (n=21; 19.8%), esophageal varices ligation (n=19; 19.7%), foreign body extractions (n=8; 8.3%) and percutaneous endoscopic gastrostomy (n=2; 2.1%). One hundred and thirteen esophageal dilations (61.1% of procedures) were performed in 46 patients: caustic stenosis (n=22; 22.9%), peptic stenosis (n=13; 13.5%) and anastomotic stenosis (n=11; 11.4%). CONCLUSION: The main indication of interventional GI endoscopy in this series was oesophageal stenosis followed by rectal polyp resection, esophageal varices ligation and foreign body extractions.

[Thrombocytopenic idiopathic purpura: predictive factors for chronic disease]. / Facteurs predictifs de passage a la chronicite du purpura thrombopenique idiopathique.

UNLABELLED: THE AIM of this study is to determine factors predicting development of chronic thrombocytopenic idiopathic purpura. METHODS: It was a retrospective study, regarding the cases of PTI diagnosed in "service de medicine infantile C Hôpital d'Enfants de Tunis" during 11 years. A comparison was done between two groups: the first including acute PTI and the second including chronic and recurrent PTI. Factors predicting development of chronic disease were searched by the Fisher test which was significant when p < 0.05. RESULTS: 33 cases of PTI were diagnosed. The ratio sex was 1.06. The mean age was five years and a half. The disease onset was insidious in three cases; all of them have had a chronic course. An haemorrhagic personnel background was present in three cases. Counselling cause was always petechies and ecchymoses. The mean platelets rate was 14555.5/mm3. Therapeutics abstinence was carried out in five cases. 20 infants received an initial corticotherapy. The immunoglobulins were prescribed in nine cases, witch six associated to Corticotherapy. Three modes of outcome were discerned: acute PTI (n = 23), recurrent PTI (n = 4) and chronic PTI (n = 6). Factors predicting development of chronic disease were: haemorrhagic personnel background, an insidious disease onset and the failure of an initial therapeutic abstinence. CONCLUSION: Acute PTI is the most common. The disease had a chronic or recurrent outcome in 1/3 of cases. The search after factors predicting chronic disease allows an early prognosis. Thus, a best management of the disease can be achieved.

[Chronic gastritis in children]. / Les gastrites chroniques chez l'enfant.

BACKGROUND: Active gastritis, atrophic gastritis (AG) and intestinal metaplasia are lesions associated with Helicobacter pylori (H. pylori) infection in adults. AIM: To assess the prevalence of chronic gastritis, its histological characteristics and clinical features in children. METHODS: 345 children (M/F: 151/194, mean age: 8.6 +/- 3.7 years; range: 1-18 years) were enrolled, referred for upper gastrointestinal endoscopy (UGI endo) with clinical manifestations of gastritis, i.e., recurrent abdominal pain (n = 232, 67.2%), upper gastrointestinal bleeding (n = 59, 17.1%) and miscellaneous (n = 53, 15.3%). Four perendoscopic gastric biopsy specimens (antrum: 2, fundus: 2) were taken. Biopsies were assessed and graded according to the updated Sydney system. H. pylori infection was considered if 2 out 3 tests were positive (culture, histology and rapid urease test), whereas 3 concordant negative results identified H. pylori negative children. RESULTS: H. pylori infection and chronic gastritis were detected in 215/345 (62.3%) (M/F: 104/117, sex ratio M/F = 0.89) and 221/345 (64.05%) children, respectively. Recurrent abdominal pain (n = 149, 67.4%) was the main clinical features of chronic gastritis followed by vomiting (n = 43, 19.5%) and upper gastrointestinal bleeding (n = 41, 18.6%). Any clinical features were however found to be specific. UGI endo showed; nodular gastritis (n = 90, 40.72%), congestive gastritis (n = 84, 38%), gastric ulcer (n = 9), bulbar ulcer (n = 5) and normal (n = 47, 21.2%). Chronic gastritis was active in 115 cases (52%) and was significantly associated with nodular gastritis (p < 0.05). Thirty two chronic gastritis (14.4%) exhibited AG (M/F: 16/16, mean age: 9.4 +/- 3.4 years) and 30/32 (93.7%) were H. pylori positive. AG was significantly associated with H. pylori infection (p < 0.0001) and nodular gastritis (p < 0.005). Active, follicular and AG were significantly associated with H. pylori infection (p < 0.00001). Three patients exhibited intestinal metaplasia. CONCLUSION: Chronic gastritis is frequent in children. Any clinical features were found to be specific. It significantly associated H. pylori infection and nodular gastritis. Atrophic gastritis was found in 14.5% of children.

[Colorectal polyps in children. A study of 34 patients]. / Les polypes recto-coliques chez l'enfant. Etude de 34 cas.

AIM: To assess the frequency and the clinical features of polyps of the colon and rectum in children. METHODS: A total of 34 patients (20 boys and 14 girls, mean age: 5.4 years) were enrolled in this 14-years retrospective study. Diagnosis was done for almost all patients by colonoscopy (n=8) or recto-sigmoidoscopy (n= 19). After endoscopic polypectomy, polyp's type is determined by histological examination. RESULTS: Minimal and relapsing rectal bleeding was the most frequent finding of polyps of the colon and rectum (85.3%) followed by spontaneous emission of polyp (n=3), rectal prolapses (n=2), chronic constipation (n=1) and abdominal pain (n=1). The polyp was unique in all cases and with a mean size of 12 mm. The majority of polyps were localized in the rectum or sigmoid (97%) and were pediculate (81.2%). Endoscopic polypectomies concerned 26 polyps while two small polyps were left. Most of the polyps corresponded histologically to juvenile polyps (96.2%). The immediate post-op course was uneventful for 26 children. CONCLUSION: Our study suggests that rectal bleeding is the most frequent finding of polyps of the colon and rectum in childhood. Outcome after endoscopic polypectomy is good.

[Congenital hepatic fibrosis in children. Report of 9 cases and review of the literature]. / Fibrose hepatique congenitale chez l'enfant. A propos de 9 cas et revue de la litterature.

Congenital hepatic fibrosis is a recessive autosomic disease with two major risks: gastrointestinal haemorrhage caused by portal hypertension and cholangitis related to bacterial infection of dilated intrahepatic bile ducts.. The aim of our study is to define epidemiological features, the presenting symptoms, the diagnosis, the evolution and the management of this disease. Between January 1990 and December 2000, we reported the cases of nine children with this disease at children hospital of Tunis. Three were male and six female. The mild age was three years and six months. Consanguinity was present in five cases and similar cases were found in six cases. The FHC was revealed by portal hypertension in five cases, angiocholitis in one case and by portal hypertension and angiocholitis in three cases. Liver biopsy was done in seven children. Ultrasound examination of the liver and kidney revealed caroli syndrome in five cases and polykystose renal in two cases The intravenous pyelography was performed in four cases showing precalicial canalicular ectasia in four cases. Eosophageal endoscopy had shown oesophageal varices in six patients. The follow up had shown that three patients had gastrointestinal bleeding, three had angiocholitis. One patient died with multivisceral failure. The treatment of acute bleeding has needed blood transfusion in four cases. Primary prevention of bleeding was done by endoscopic sclerosis alone in one case and associated to betablokers in two cases. Secondary prevention of varices bleeding was done by sclerotherapic in two cases, by beta blokers alone in one case and by betablokers associated to elastic ligation of oesophageal varices in one case.

[Therapeutic management and clinical course of severe caustic oesophageal burns in children treated with methyl-prednisolone. Experience at a digestive endoscopic unit]. / Analyse des modalites therapeutiques et evolutives des oesophagites caustiques severes chez l'enfant traites par les bolus de methyl prednisolone. Experience d'une unite d'endoscopie digestive.

We reviewed the case histories of 28 children seen at children hospital from 31 December 1991 to 31 December 2001. These children has second and third degree oesophageal burns and they were treated by systemic Methylprednisolone (1000mg/1, 73/m2 SC). We divided the 26 children in four groups according to the time we began the steroids (before or beyond the 24th hours of the accident and according the number of steroids's bolus (less or more than 21 bolus). We analysed the number and the treatment of stricture in each group. High doses of methyl prednisolone seem to decrease the risk of oesophageal stricture. We found no difference between the children treated before the 24th hours and those treated after the 24 hours and those treated with less than 21 bolus and those with more than 21 bolus.

[Contribution of clinical, biological and radiological parameters in the diagnosis of urinary infection localization]. / Apport des parametres cliniques biologiques et radiologiques dans le diagnostic de localisation de l'infection urinaire.

Urinary infection was a problem in pediatrics. Currently the diagnosis is easy but it is hard to diagnosis the localisation of the infection. We have to go fast and precisely to treat correctly this infection and diminich the possibility of developing renal scars. Dimercaptosuccinic acid (DMSA) scintigraphy is a reference exam for detection acute renal lesions. We have realised a prospective study in 29 children presenting urinary tract infection. In whom a DMSA scintigraphy is realised between the one day and 30 days after the infection. We study the sensibility ans the specificity of clinical, biological and radiological parameter for the diagnosis of localisation of the infection. The better parameter of sensibility of upper urinary tract infection is of fever, and the better parameter of specificity is the association of fever, echo Doppler renal and VS.