Determinants of adherence to gluten-free diet in Greek children with coeliac disease: a cross-sectional study.

BACKGROUND/OBJECTIVE: A strict and lifelong commitment to a gluten-free diet (GFD) remains one of the most challenging issues in children with coeliac disease. The present study aimed to record compliance rates and investigate the connection between dietary compliance and demographics, disease-related factors and parental knowledge. SUBJECTS/METHODS: Parents of 90 Greek children diagnosed with coeliac disease were recruited from the outpatient gastroenterology clinic of a children's hospital in Athens, Greece. Dietary compliance and a range of demographic and clinical data were obtained from parents through a specially constructed questionnaire. Further data included parental perceived and actual knowledge about coeliac disease and GFD. Compliant and noncompliant groups were compared for measured factors and a multivariate approach was followed to elicit independent effects of compliance determinants. RESULTS: Overall, 44.4% of children with coeliac disease were reported to be compliant to a strict GFD. A 1-year increase in the age of the child was associated with 15% lower odds of adhering to a strict diet after adjusting for other variables (odds ratio (OR)=0.85, 95% CI: 0.75-0.96). Parental perceived knowledge was also independently and significantly associated with dietary compliance (OR=3.3, 95% CI=1.1-9.8). No statistically significant correlation emerged between dietary compliance and other clinical or demographic variables. DISCUSSION: Low compliance rates to GFD were observed in children with coeliac disease. Information based on children's age and perceived parental knowledge can be used to develop risk profiles that health care professionals can utilise to identify children likely to be noncompliant and thus adjust their counselling strategy accordingly.

Biological agents in paediatric inflammatory bowel disease: a clinical observation study from Greece.

OBJECTIVES: Biological agents have contributed significantly in controlling inflammatory bowel disease during the last 15 years. This study aimed at recording and evaluating paediatric data regarding the efficacy and safety of infliximab and adalimumab during the last decade. PATIENTS AND METHODS: A total of 31 patients (43% males) with a mean age of 13.5 +/- 3.0 years were included and the majority (74%) had Crohn's disease (CD). Failure of previous treatment and steroid dependency were the main reasons for initiating anti-TNF-alpha therapy. Mean age at the first infusion was 11.0 +/- 2.8 years, while the mean disease duration at the introduction of infliximab was 2.6 +/- 2.7 years. The number of infusions per patient ranged from 1-25 (median 7, IQR: 4-13). RESULTS: Initial response was achieved in 82.8% of patients. After one year of treatment the estimated rate of remission was 53%. The rate of surgery-free disease at 12, 36 and 60 months, after the first dose of infliximab, was 89.6%, 89.6% and 74.7% respectively. The incidence of serious anaphylaxis was 4/268 infusions (1.5%) or 4/31 patients (12.3%). At three months after the first infusion only 2 children were on steroids. Adalimumab was administered to 5 patients for a mean duration of 7.4 months, as a second option after infliximab failure or infusion reaction. Two out of five patients failed to achieve remission with adalimumab and these two patients were also infliximab failures. CONCLUSION: Biological agents are valuable and safe options for children with refractory IBD. The results, so far, have been satisfactory, although, long-term outcomes remain yet to be determined.

Oral hygiene and periodontal treatment needs in children and adolescents with coeliac disease in Greece.

AIM: To evaluate the factors that influence the oral hygiene and the periodontal treatment needs of children and adolescents with coeliac disease (CD) in Greece. METHODS: The sample consisted of 35 children and adolescents, aged 4-18 years. The evaluation included consideration of the detailed medical history, the duration of CD and of gluten-free diet, the history of oral mucosal findings and a dental questionnaire that included information about oral hygiene habits, symptoms of periodontal disease and dental attendance. The clinical dental examination consisted of the simplified gingival index, the oral hygiene index and the periodontal screening and recording index. STATISTICS: The chi square and logistic regression analysis were performed in order to determine the factors or parameters that had a statistically significant (p ≤ 0.05) impact on oral hygiene and periodontal treatment needs of children and adolescents with CD. RESULTS: The periodontal treatment need of children and adolescents with CD were high and most of them needed treatment of gingivitis (60.01%) and only a few subjects had a healthy periodontium (34.29%). The periodontal treatment need index, the simplified gingival index and the hygiene index correlated statistically significantly with the presence of a coexisting disease, frequency of tooth brushing, bleeding upon brushing and oral malodor. CONCLUSION: The periodontal treatment need of children and adolescents with CD correlated with factors that related to the presence of a second medical condition and to the personal oral hygiene habits. Additionally, the oral hygiene level and periodontal status of children with CD do not have any specific characteristics but they have similarities to the oral hygiene level and periodontal status of the children of the general population.

Dietary compliance and life style of children with coeliac disease.

BACKGROUND: Coeliac disease (CD) is common and requires a permanent strict gluten-free diet (GFD). However, data concerning how the situation is experienced by children are limited. The present study aimed to investigate the compliance with a GFD and the impact of CD and GFD on the lifestyle of patients and their families, together with proposed recommendations for improvement of quality of life. METHODS: Children with biopsy confirmed CD were recruited consecutively from the outpatient gastroenterology clinic. Participants were evaluated by a special questionnaire for compliance with the GFD, patients' knowledge about CD, and the well-being and lifestyle of children and their families. Comparisons between discrete variables were performed by a chi-square test. RESULTS: Seventy-three children of median age 9.4 (interquartile range = 5-14.5) years were evaluated. Compliance to diet was reported by 58%. Reasons for noncompliance were: poor palatability (32%), dining outside home (17%), poor availability of products (11%), and asymptomatic disease diagnosed by screening (11%). The acceptance of the GFD was reported as good in 65%, whereas avoidance of travelling and restaurants was stated by 17% and 46% of families, respectively. Most families experienced difficulties detecting gluten from the food label. Proposed factors for improvement of quality of life were: better labelling of gluten-containing ingredients (76%) and more gluten-free (GF) foods in supermarkets (58%) and restaurants (42%). CONCLUSIONS: Children with CD have low compliance with the GFD. Better education about the disease, the availability of GF products, and appropriate food labelling could improve compliance and quality of life.

Poor endoscopic findings in children with non variceal upper gastrointestinal bleeding: is biopsy necessary?

BACKGROUND: Gastrointestinal bleeding in infants and children is a potentially serious condition in the practice of general pediatrics that requires investigation. The objective of this study is to describe the endoscopic and histopathological findings in children with upper gastrointestinal (UGI) bleeding of non variceal origin. PATIENTS AND METHODS: We performed a retrospective study of the medical records of 181 children, aged 1 month to 15.2 years, with non variceal UGI bleeding, who were admitted in our department over the period 1988-2008 and underwent upper GI endoscopy accompanied by histology. Patients were divided in 4 groups according to their age (=0-1 years, = 1-6 years, C=6-12 years, D= 12-16 years). RESULTS: An endoscopically evident bleeding source was detected in only 5% of all patients. Histological examination revealed increased incidence of eosinophilic infiltration in infants, in contrast to all other age groups, where non-specific or H. pylori related inflammation predominated. Peptic ulcer was found in 4.4% of all patients. CONCLUSION: Although an evident bleeding source was detected in only a small percentage of patients, the accompanying histological examination provided additional information regarding possible underlying diseases and contributed to the subsequent therapeutic management.

Is peptic ulcer a common cause of upper gastrointestinal symptoms?

UNLABELLED: The aim of the study was to investigate retrospectively a cohort of children with peptic ulcer disease during a period that covers the recent changes in diagnosis and management of the disease. Over a period of 9 years, 2550 children underwent upper gastrointestinal endoscopy for various reasons. All children, in whom a diagnosis of primary peptic ulcer was established, were included in the study. Previous and current medical history, family history, endoscopic and histological outcome were evaluated and the children were regularly followed-up on an out-patient basis. Primary peptic ulcer was diagnosed in 52 (10 gastric and 42 duodenal, 2%) out of 2550 children. The median age of children with gastric ulcer was 6.5 years, whereas of those with duodenal ulcer was 10.5 years (P=0.04). With regard to clinical symptoms no significant difference was found between children with and without ulcer. The prevalence of Helicobacter pylori infection was significantly higher in children with duodenal ulcer (62%) compared to those with gastric ulcer (20%; P < 0.001). At first follow-up visit, 1 month after the end of treatment, 19 symptomatic children underwent a repeat endoscopy, which showed ulcer healing in 95% and failure in H. pylori eradication in 27%. During the long-term follow-up (median 3.5 years), six children became symptomatic. Two of them had duodenal ulcer associated with positive H. pylori. CONCLUSION: Peptic ulcer disease is an uncommon disorder in childhood with non specific clinical features; it seems that efficient treatment and successful Helicobacter pylori eradication result in clinical improvement and cure as well as in long-term healing of ulcers.

Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain.

Over a 5-y period, 396 children complaining of recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy in order to identify any underlying organic pathology and determine the prevalence of Helicobacter pylori (H. pylori) infection. Histologically confirmed mucosal inflammation was found in 338 out of 396 children (85.4%); in 113 of 396 patients (28.5%), H. pylori was identified on the gastric mucosa. Significant discriminating factors between H. pylori positive and negative children with RAP included age (mean age for positive 11 y vs. 8.1 y for negative, p < 0.01) and gender (male gender predominance in the H. pylori positive, p < 0.001). No significant difference was found between H. pylori positive and negative groups regarding incidence and character of the presenting symptoms. All H. pylori positive children (100%) had abnormal histology compared with 225 out of 283 negative ones (79.5%). Histologically confirmed gastritis was the most prominent finding in H. pylori positive children compared with H. pylori negative (98.2% vs. 19%, p < 0.001). Conversely, oesophagitis was more common in H. pylori negative children (47.7% vs. 27.4%, p < 0.001). The incidence of peptic ulcer was higher in H. pylori infected patients than in the H. pylori negative group (5.3% vs. 1%, p < 0.05). Our data suggest that gastrointestinal pathology is more common than previously thought in children with RAP, while H. pylori infection is a relatively important factor in the etiology of upper gastrointestinal inflammation in RAP syndrome.