Trichobezoar in a child with concomitant coeliac disease: a case report.

UNLABELLED: We report on a case of childhood coeliac disease presenting with tricophagia and trichobezoar. The combination of obstructive symptoms, severe hypoalbuminaemia and a large abdominal mass detected on CT scan warranted diagnostic gastroscopy and laparotomy, resulting in removal of a large gastric trichobezoar. Surgical recovery was uneventful although serologic studies for coeliac disease were abnormal. Coeliac disease was confirmed by subsequent biopsy. CONCLUSION: Concomitant trichobezoar and coeliac disease in a child is reported for the first time. It is postulated that the trichobezoar was a result of coeliac disease-induced pica.

Small bowel biopsy in Swedish paediatric clinics.

AIM: A correct diagnosis of coeliac disease, one of the most common chronic diseases in Swedish children, demands small bowel biopsy, which can be performed endoscopically or by means of a peroral capsule. Recently there was a debate among Swedish paediatric gastroenterologists, with some advocating the cessation of capsule biopsy in favour of endoscopic biopsies. To gain information on which to base a recommendation for which technique to use, the Swedish Working Group for Childhood Coeliac Disease was commissioned to carry out a national questionnaire study on current small bowel biopsy routines in Swedish paediatric clinics. METHODS: A questionnaire concerning biopsy routines in the year 2000 was sent to all paediatric clinics performing biopsies. A reply was obtained from 39 of 40 clinics, covering 98% of the Swedish population. RESULTS: Some 1400 biopsies were performed, 64% of which were capsule biopsies and 36% endoscopic. Three clinics performed all biopsies endoscopically and 11 clinics all via a capsule. At endoscopy all children were under deep sedation or full anaesthesia, while most children undergoing capsule biopsy were under light or deep sedation. The oxygen saturation was monitored during endoscopy but less often or never during routine capsule biopsy. The presence of the parents during biopsy varied according to the degree of sedation: at 97% of the clinics performing capsule biopsy on children under light sedation, the parents were present during the whole procedure, whereas no parents were present at clinics where the biopsy was performed endoscopically under anaesthesia. CONCLUSION: Compared with the results of a similar questionnaire concerning biopsy routines performed in the early 1990s, children are now more effectively sedated. Furthermore, there is an obvious trend from capsule towards endoscopic biopsy. Both the endoscopic and the capsule biopsy techniques are useful and satisfactory for obtaining small bowel mucosal samples providing that the children are effectively sedated. For practical and economic reasons the capsule biopsy technique will probably continue to be used, although to a lesser extent than today.

[Celiac disease in children on the two sides of the Sound]. / Morbus coeliacus hos børn på de to sider af Oresund.

Of 771 children (381 Swedish and 390 Danish) investigated during 1972-1989 because of suspected coeliac disease (CD), 179 proved to have the disease. Surprisingly only 24 CD patients were Danish whereas 155 were Swedish, despite the very similar ethnic, geographical, and cultural backgrounds of the two populations. The Danish CD children were diagnosed at an older age (mean 5.5 versus 1.5 years). Breastfeeding habits were comparable. The estimated content of gliadin in the officially recommended diets of the two countries in 1987 differed substantially, the Swedish diet containing more than 40 times more gliadin than the Danish (4400 mg versus 100 mg) at the age of eight months, and four times more (3600 mg versus 900 mg) at the age of 12 months. Compared to the Swedish diet, the Danish infant diet contained significantly larger amounts of rye flour, which is low in gluten. The earlier introduction of food items with a high gluten content in the Swedish as compared with the Danish diet could be a possible explanation for the great difference in incidence and symptomatology of CD between the two populations.

Striking differences in the incidence of childhood celiac disease between Denmark and Sweden: a plausible explanation.

Among 771 children (381 Swedish and 390 Danish) investigated between 1972 and 1989 because of suspected celiac disease (CD), 179 proved to have the disease. Surprisingly only 24 CD patients were found among the Danish children, compared with 155 in the Swedish group, despite the close ethnic, geographical, and cultural background of the two populations. The Swedish CD children were diagnosed at an earlier age than the Danish children (mean, 1.5 vs. 5.5 years). The symptoms of the Swedish patients were dominated by failure to thrive (93 vs. 71%), whereas a higher proportion of the Danish CD patients suffered from stomach pain (21 vs. 5%). Breast-feeding habits were comparable. The estimated content of gliadin in the officially recommended diets of the two countries in 1987 differed substantially, the Swedish diet containing more than 40 times more gliadin than the Danish (4,400 vs. 100 mg) at the age of 8 months, and 4 times more (3,600 vs. 900 mg) at the age of 12 months. The Danish infant diet differed significantly from the Swedish in containing a larger amount of the lower gluten-containing rye flour. The earlier introduction of food items with a high gluten content in the Swedish compared with the Danish diet seems to be an obvious explanation for the great difference in incidence and symptomatology of CD between the two populations.

Pediatric gastroenteritis in primary care and in hospitalized patients.

One-hundred and fifty-seven consecutive children below seven years of age (primary care n = 48, hospitalized patients n = 109) with acute gastroenteritis of assumed infectious origin were studied. Rotavirus was demonstrated by electron microscopy of faeces in 44% of all patients. The occurrence of rotavirus among patients in primary care, 15%, was significantly lower than among hospitalized patients, 57% (p less than 0.01). Adenovirus was isolated in six per cent and enterovirus in two per cent of the patients with no differences between the two groups. Yersinia enterocolitica and Campylobacter jejuni were demonstrated in each three per cent. Salmonella and Shigella spp. or Giardia lamblia were not found in any cases. Thus the cause of gastroenteritis was established in 58% of the patients. This figure was lower among patients in primary care (27%) than among hospitalized patients (72%), a difference mainly due to the high occurrence of rotavirus in the latter group. Clostridium difficile was recovered in 20 cases (12%), eight of which harboured one more enteropathogenic agent. Cultures from the nose and throat revealed Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis or group A, C and G streptococci in 58% of the patients with no differences regarding the occurrence of rotavirus in faeces. Neither Clostridium difficile nor respiratory tract pathogens were found to play a role in causation of gastroenteritis in the children investigated.