ABSTRACT
OBJETIVO: Evaluar la seguridad renal del tratamiento con polietilenglicol 3350 con electrolitos durante 1, 3 y 6 meses, la tolerancia digestiva y la dosis de eficacia. PACIENTES Y MÉTODOS: Fueron evaluados 3 grupos de 30 pacientes sanos, 2-10 años (media 6,2) con estreñimiento funcional (criterios de Roma III), con 1, 3 y 6 meses de tratamiento. La eficacia fue evaluada por el número de deposiciones/semana y la consistencia de las heces (escala de Bristol). La natriuria y la osmolaridad urinaria se midieron al inicio, 1, 3 y 6 meses. Los principios inmediatos en heces (análisis de reflexión de infrarrojos [FENIR]) y un test de hidrógeno espirado fueron efectuados en el grupo de un mes de tratamiento. RESULTADOS: La dosis efectiva fue de 0,37 g/kg/día (rango 0,18-0,8). El número de deposiciones/semana en la inclusión (2,4 ± 0,64) muestra diferencia significativa (p < 0,001) vs. (6,21 ± 1,5) tras el tratamiento. También se demostró una diferencia significativa en la puntuación en la escala de Bristol (1,9 ± 0,75 vs. 4,9 ± 1,1 [p < 0,001]). La ingesta media de sodio fue de 112 mg (5 mg/kg/día [rango de 4-12 mg/kg/día]). Los valores de sodio y osmolaridad en orina fueron normales en todos los grupos sin diferencia estadística con respecto a controles (90 niños sanos sin tratamiento). Los valores de FENIR fueron normales en todos los pacientes. La prueba de aliento con hidrógeno fue normal, con una media de 7 ppm. CONCLUSIÓN: No se observaron parámetros bioquímicos renales adversos ni alteraciones digestivas. La tolerancia y la eficacia demostraron ser óptimas. El polietilenglicol 3350 con electrolitos puede ser recomendado con seguridad para el tratamiento del estreñimiento funcional en los niños a corto y largo plazo
OBJECTIVE: To assess the renal safety of treatment with polyethylene glycol 3350 with electrolytes at 1, 3 and 6 months, its gastrointestinal tolerance and dose effectiveness. PATIENTS AND METHODS: Three groups of 30 healthy patient aged 2-10 years (mean 6.2 years) who suffered functional constipation (Rome III criteria) with 1, 3 and 6 months of treatment were evaluated. Efficacy was evaluated by the change in the number of stools per week and stool consistency (Bristol scale). Urine screens, sodium and osmolality, were performed at the beginning and after 1, 3 and 6 months of treatment. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed on the one-month treatment group. RESULTS: The mean dose was 0.37 g/kg/day (range 0.18 to 0.8) titrated according to age, weigh tand response. The number of stools per week during treatment (2.4±0.64) showed a significant difference (P<0.001) vs (6.21±1.5) after treatment. There was also a significant difference in the Bristol scale score (1.9±0.75 vs 4.9±1.1 [P<0.001]). The mean sodium intake was 112 mg (5 mg/kg/day [range 4-12 mg/kg/day]). The values of sodium and urine osmolality were normal in all groups with no statistical difference compared to normal control values (90 healthy children without treatment). NIRA values were normal in all patients. The hydrogen breath test was normal with a median of 7 ppm. CONCLUSION: There were no adverse renal biochemical parameters or gastrointestinal disorders. Tolerance and efficacy was shown to be optimal. Polyethylene glycol 3350 with electrolytes can be safely recommended for the treatment of functional constipation in children in the short and long term
Subject(s)
Humans , Male , Female , Child , Polyethylene Glycols/therapeutic use , Constipation/drug therapy , Patient Safety , Laxatives/therapeutic use , Time , Case-Control Studies , Kidney Function Tests , Drug ToleranceABSTRACT
OBJECTIVE: To assess the renal safety of treatment with polyethylene glycol 3350 with electrolytes at 1, 3 and 6 months, its gastrointestinal tolerance and dose effectiveness. PATIENTS AND METHODS: Three groups of 30 healthy patient aged 2-10 years (mean 6.2 years) who suffered functional constipation (Rome III criteria) with 1, 3 and 6 months of treatment were evaluated. Efficacy was evaluated by the change in the number of stools per week and stool consistency (Bristol scale). Urine screens, sodium and osmolality, were performed at the beginning and after 1, 3 and 6 months of treatment. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed on the one-month treatment group. RESULTS: The mean dose was 0.37g/kg/day (range 0.18 to 0.8) titrated according to age, weight and response. The number of stools per week during treatment (2.4±0.64) showed a significant difference (P<.001) vs (6.21±1.5) after treatment. There was also a significant difference in the Bristol scale score (1.9±0.75 vs 4.9±1.1 [P<.001]). The mean sodium intake was 112mg (5mg/kg/day [range 4-12mg/kg/day]). The values of sodium and urine osmolality were normal in all groups with no statistical difference compared to normal control values (90 healthy children without treatment). NIRA values were normal in all patients. The hydrogen breath test was normal with a median of 7ppm. CONCLUSION: There were no adverse renal biochemical parameters or gastrointestinal disorders. Tolerance and efficacy was shown to be optimal. Polyethylene glycol 3350 with electrolytes can be safely recommended for the treatment of functional constipation in children in the short and long term.
Subject(s)
Constipation/drug therapy , Polyethylene Glycols/therapeutic use , Potassium Chloride/therapeutic use , Sodium Bicarbonate/therapeutic use , Sodium Chloride/therapeutic use , Child , Child, Preschool , Cross-Sectional Studies , Drug Therapy, Combination , Humans , Longitudinal Studies , Polyethylene Glycols/adverse effects , Potassium Chloride/adverse effects , Prospective Studies , Retrospective Studies , Sodium Bicarbonate/adverse effects , Sodium Chloride/adverse effects , Time FactorsABSTRACT
Objetivo: Evaluar la utilidad de la resonancia magnética intestinal con contraste oral (RMI) para el estudio de extensión y actividad de la enfermedad de Crohn (EC) pediátrica, comparando los hallazgos con índices clínicos, tests biológicos, endoscopia y otras técnicas de imagen. Pacientes y métodos: Fueron valoradas las RMI efectuadas en pacientes menores de 18 años diagnosticados de EC. Para la preparación se administró 500-1000ml de polietilenglicol una hora antes de las imágenes (1,5-TMR). Se realizaron secuencias T2 HASTE con o sin Fat SAT, T2 true-FISP, T1 Fat-SAT VIBE pre/posgadolinio, HASTE dinámico y difusión. Se valoraron el engrosamiento de pared intestinal, la hipercaptación mucosa y las complicaciones extraintestinales. Se establecieron 5 patrones de RMI: normal, fibrosis, actividad leve, moderada y severa-transmural. Los hallazgos se compararon con PCDAI, parámetros inflamatorios, resultados endoscópicos e histológicos. Resultados: Incluimos para la evaluación 22 estudios. El 82% presentaba una distensión intestinal óptima. Observamos efectos secundarios leves en el 12% de los pacientes. Encontramos una relación significativa entre los patrones de RMI versus PCDAI (p=0,002), VSG (p=0,006) y PCR (p=0,047); no hallamos relación estadísticamente significativa (p=0,571) con la histología. La RMI valoró correctamente la extensión de la enfermedad a nivel ileal (80%) y a nivel cólico (66%). Un 86,4% de los estudios mostraron complicaciones extraintestinales, sin presentar relación estadística con la clasificación de RMI (p=0,274). Conclusiones: Existe una relación estadísticamente significativa entre nuestros patrones de RMI y PCR, VSG y PCDAI. La RMI presenta excelente concordancia con las ileoscopias. La RMI valora zonas no accesibles mediante endoscopia y permite el diagnóstico de complicaciones extraintestinales sin irradiación (AU)
Objective: To determine the usefulness of MRI enterography for assessing the extension and activity of paediatric Crohn's disease. MRI findings were compared with clinical, biological, endoscopic and other imaging data. Patients and methods: Studies of MRI enterography use in patients younger than 18 years of age were reviewed. Patients received 500-1000mL of polyethylene glycol one hour before examination (1.5-TMR). T2 HASTE sequences with or without fat saturation, T2 true-FISP, T1 with fat saturation, pre- and post gadolinium-enhanced VIBE sequences, and dynamic and diffusion HASTE were acquired. Thickening of the bowel wall, mucosal enhancement, and extra-luminal complications were evaluated. Five MRI patterns (normal, fibrosis, mild, moderate, and severe transmural activity) were defined. Findings were compared with PCDAI scores, inflammatory parameters, and endoscopic and histological results. Results: Twenty-two studies were reviewed. Optimal intestinal distension was present in 82% of the cases. Mild side effects were observed in 12% of patients. There was a significant relationship between MRI patterns and PCDAI scores (P=0.002), sedimentation rate (P=0.006) and serum PCR levels (P=0.047) and a non-significant relationship with the histology (P=0.571). MRI enterography correctly assessed the ileal (80%) and colonic (66%) extension. Extra-luminal complications unrelated to MRI classification (P=0.274) were reported in 86.4% of studies. Conclusions: There was a significant relationship between MRI patterns and PCR, sedimentation rate, and PCDAI scores. MRI enterography showed excellent agreement with ileoscopies, and allowed endoscopically non-accessible areas to be assessed, as well as the diagnosis of extra-luminal complications without irradiation (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Crohn Disease/diagnosis , Magnetic Resonance Spectroscopy/methods , Polyethylene Glycols , Intestines/pathology , Crohn Disease/complicationsABSTRACT
OBJECTIVE: To determine the usefulness of MRI enterography for assessing the extension and activity of paediatric Crohn's disease. MRI findings were compared with clinical, biological, endoscopic and other imaging data. PATIENTS AND METHODS: Studies of MRI enterography use in patients younger than 18 years of age were reviewed. Patients received 500-1000mL of polyethylene glycol one hour before examination (1.5-TMR). T2 HASTE sequences with or without fat saturation, T2 true-FISP, T1 with fat saturation, pre- and post gadolinium-enhanced VIBE sequences, and dynamic and diffusion HASTE were acquired. Thickening of the bowel wall, mucosal enhancement, and extra-luminal complications were evaluated. Five MRI patterns (normal, fibrosis, mild, moderate, and severe transmural activity) were defined. Findings were compared with PCDAI scores, inflammatory parameters, and endoscopic and histological results. RESULTS: Twenty-two studies were reviewed. Optimal intestinal distension was present in 82% of the cases. Mild side effects were observed in 12% of patients. There was a significant relationship between MRI patterns and PCDAI scores (P=.002), sedimentation rate (P=.006) and serum PCR levels (P=.047) and a non-significant relationship with the histology (P=.571). MRI enterography correctly assessed the ileal (80%) and colonic (66%) extension. Extra-luminal complications unrelated to MRI classification (P=.274) were reported in 86.4% of studies. CONCLUSIONS: There was a significant relationship between MRI patterns and PCR, sedimentation rate, and PCDAI scores. MRI enterography showed excellent agreement with ileoscopies, and allowed endoscopically non-accessible areas to be assessed, as well as the diagnosis of extra-luminal complications without irradiation.
Subject(s)
Crohn Disease/diagnosis , Magnetic Resonance Imaging , Adolescent , Diagnostic Techniques, Digestive System , Female , Humans , Male , Prospective StudiesABSTRACT
Introducción: El objetivo del trabajo ha sido evaluar la seguridad del PEG 3350 con electrolitos (PEG+E) a nivel renal y digestivo. Objetivo secundario: valorar su eficacia y dosis de efectividad. Pacientes y métodos: Quince pacientes con estreñimiento funcional (criterios de Roma III) y función renal normal fueron evaluados. La mediana de edad fue de 6,2 años (r=2-9). Sobres pediátricos de PEG+E fueron administrados durante 4 semanas (4ST) La dosis media administrada fue de 0,44g/kg/día. La natruria y osmolaridad urinaria se midieron al inicio y a las 4ST. La determinación de principios inmediatos en heces mediante FENIR (análisis de reflexión de infrarrojos) y una prueba de hidrógeno espirado fueron efectuadas a las 4ST. La eficacia del tratamiento fue evaluada mediante el cambio en el número de deposiciones por semana y la consistencia de las heces (escala de Bristol). Resultados: A las 4ST el número de deposiciones por semana fue de 5,29±1,68 vs 2,46±0,71 al inicio (p<0,001). La puntuación de la escala de Bristol fue de 4,5±0,91 tras 4TS vs 2,47±1,24 al inicio (p<0,001). No se encontraron diferencias estadísticas entre los valores de sodio y osmolalidad en orina al inicio vs 4ST. Los valores de FENIR fueron normales en todos los pacientes. La prueba del aliento de hidrógeno fue normal con una mediana de 7ppm. Conclusiones: No se observaron efectos adversos renales ni alteraciones digestivas. El PEG+E puede ser recomendado para el tratamiento del estreñimiento funcional en los niños (AU)
Introduction: Polyethylene glycol 3350 plus electrolytes (PEG+E) efficacy has been validated in some studies, but not many have evaluated its safety in children. The aim of our study was to evaluate the safety; renal, malabsorption or excessive production of gas and efficacy of PEG+E treatment in our paediatric population. Patients and methods: Fifteen patients who suffered functional constipation (Rome III criteria) were evaluated. Median age was 6.2 years (r 2-9). All patients had normal renal function. PEG+E were administered for 4weeks (4WP). The mean dose was 0.44g/kg/day, titrated according to age, weight and response. Urine screens (sodium and osmolality) were performed at the beginning and 4WP. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed at 4WP. To analyse the efficacy of the treatment, the number of stools per week and stool form type (Bristol stool scale) were recorded. Results: The number of stools per week was higher after 4weeks (2.46±0.71 vs 5.29±1.68, P<0.001), as well as the stool form score (2.47±1.24 vs 4.5±0.91, P<0.001). No statistical differences were obtained between urine sodium and urine osmolality values at the beginning and 4WP. After 4WP the NIRA median values were normal in all patients [fat 4.45% (range (r) 3.6-7.09); nitrogen 0.78% (r 0.4-1); sugars 1.4% (r 0.47-2.35) and water 68% (r 59-74)]. Median breath hydrogen test was 7ppm (r 2-18). Conclusions: No adverse effects on biochemistry values or gastrointestinal disturbances were observed. PEG+E can be recommended for the treatment of functional constipation in children (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Constipation/drug therapy , Polyethylene Glycols/pharmacokinetics , Laxatives/pharmacokinetics , Risk FactorsABSTRACT
INTRODUCTION: Polyethylene glycol 3350 plus electrolytes (PEG+E) efficacy has been validated in some studies, but not many have evaluated its safety in children. The aim of our study was to evaluate the safety; renal, malabsorption or excessive production of gas and efficacy of PEG+E treatment in our paediatric population. PATIENTS AND METHODS: Fifteen patients who suffered functional constipation (Rome III criteria) were evaluated. Median age was 6.2 years (r 2-9). All patients had normal renal function. PEG+E were administered for 4 weeks (4WP). The mean dose was 0.44 g/kg/day, titrated according to age, weight and response. Urine screens (sodium and osmolality) were performed at the beginning and 4WP. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed at 4WP. To analyse the efficacy of the treatment, the number of stools per week and stool form type (Bristol stool scale) were recorded. RESULTS: The number of stools per week was higher after 4 weeks (2.46 ± 0.71 vs 5.29 ± 1.68, P<.001), as well as the stool form score (2.47 ± 1.24 vs 4.5 ± 0.91, P<.001). No statistical differences were obtained between urine sodium and urine osmolality values at the beginning and 4WP. After 4WP the NIRA median values were normal in all patients [fat 4.45% (range (r) 3.6-7.09); nitrogen 0.78% (r 0.4-1); sugars 1.4% (r 0.47-2.35) and water 68% (r 59-74)]. Median breath hydrogen test was 7 ppm (r 2-18). CONCLUSIONS: No adverse effects on biochemistry values or gastrointestinal disturbances were observed. PEG+E can be recommended for the treatment of functional constipation in children.
Subject(s)
Constipation/drug therapy , Electrolytes/therapeutic use , Polyethylene Glycols/therapeutic use , Child , Child, Preschool , Electrolytes/adverse effects , Female , Humans , Male , Polyethylene Glycols/adverse effects , Prospective StudiesABSTRACT
INTRODUCTION: Individualised doses of azathioprine (AZA) may be prescribed by monitoring the levels of the enzyme thiopurine methyltransferase (TPMT). The measurements of thiopurine metabolites of AZA, 6-thioguanine (6-TGN) and 6-methylmercaptopurine (6-MMP), have also been reported as new markers of AZA activity. OBJECTIVES: To describe TPMT phenotype in our population and to establish a relationship between thiopurine metabolites,and therapeutic activity and adverse effects. MATERIAL AND METHODS: Data on TPMT were retrospectively collected from 107 patients, and 6-TGN and 6-MMP levels in 18 patients currently on treatment with AZA (Crohn's disease 5, ulcerative colitis 5, autoimmune hepatitis 5). RESULTS: Mean value of TPMT was 20.19U/ml. None of the patients had a TPMT activity<5U/ml. Of the 18 patients on treatment, 13 showed sub-therapeutic levels of 6-TGN (<235pmol/8x10(8) red blood cells). Clinical remission was maintained in 45% of patients. Mean levels of 6-TGN in patients with clinical remission were 259pmol/8x10(8) red blood cells versus 209pmol/8x10(8) red blood cells in non-responders (p=0.37). There was an inverse relationship (r=-0.28) between TPMT and 6-TGN levels. Toxic effects occurred in 6 of 18 patients, with leukopenia in 5 and hyperamylasemia in 1. CONCLUSIONS: Determination of TPMT and monitoring of thiopurine metabolites allows AZA treatment to be optimised, although further studies are necessary to establish therapeutic effectiveness and toxicity ranges.
Subject(s)
Azathioprine/administration & dosage , Hepatitis, Autoimmune/drug therapy , Hepatitis, Autoimmune/enzymology , Immunosuppressive Agents/administration & dosage , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/enzymology , Mercaptopurine/analogs & derivatives , Methyltransferases/metabolism , Thioguanine/metabolism , Adolescent , Female , Hepatitis, Autoimmune/metabolism , Humans , Inflammatory Bowel Diseases/metabolism , Male , Mercaptopurine/metabolism , Retrospective StudiesABSTRACT
Introducción: la determinación de la enzima tiopurina metiltransferasa (TPMT) nos permite pautar la dosis inicial individualizada de azatioprina (AZA). Las determinaciones de los metabolitos tiopurínicos de la AZA, la 6-tioguanina (6-TGN) y la 6-metilmercaptopurina (6-MMP) se han descrito como nuevos marcadores de la actividad del fármaco. Objetivos: describir el fenotipo de TPMT en nuestra población y relacionar los valores de los metabolitos tiopurínicos con la actividad terapéutica y los efectos adversos. Material y métodos: se recogieron retrospectivamente los valores de TPMT de 107 pacientes y de 6-TGN y 6-MMP de 18 pacientes en tratamiento con AZA (8 con enfermedad de Crohn, 5 con colitis ulcerosa y 5 con hepatitis autoinmune). Resultados: la media de determinación de TPMT fue 20,19U/ml. Ninguno presentó actividad de TPMT menor que 5U/ml. De los 18 pacientes, 13 mostraron concentraciones subterapéuticas de 6-TGN (<235pmol/8×108 hematíes). El 45% de los pacientes mantuvieron remisión clínica. La media de concentración de 6-TGN en los pacientes en remisión fue 259pmol/8×108 hematíes frente a 209pmol/8×108 hematíes en los no respondedores (p=0,37). Hay una relación inversa (r=−0,28) entre los valores de TPMT y los de 6-TGN. En 6/18 pacientes encontramos toxicidad: 5 con leucocitopenia y uno con hiperamilasemia. Conclusiones: la determinación de TPMT y la monitorización de los metabolitos tiopurínicos nos permite optimizar tratamiento con AZA, aunque son necesarios nuevos estudios que permitan el correcto conocimiento de los intervalos de efectividad terapéutica y toxicidad (AU)
Introduction: Individualised doses of azathioprine (AZA) may be prescribed by monitoring the levels of the enzyme thiopurine methyltransferase (TPMT). The measurements of thiopurine metabolites of AZA, 6-thioguanine (6-TGN) and 6-methylmercaptopurine (6-MMP), have also been reported as new markers of AZA activity. Objectives: To describe TPMT phenotype in our population and to establish a relationship between thiopurine metabolites,and therapeutic activity and adverse effects. Material and methods: Data on TPMT were retrospectively collected from 107 patients, and 6-TGN and 6-MMP levels in 18 patients currently on treatment with AZA (Crohns disease 5, ulcerative colitis 5, autoimmune hepatitis 5). Results: Mean value of TPMT was 20.19U/ml. None of the patients had a TPMT activity<5U/ml. Of the 18 patients on treatment, 13 showed sub-therapeutic levels of 6-TGN (<235pmol/8×108 red blood cells). Clinical remission was maintained in 45% of patients. Mean levels of 6-TGN in patients with clinical remission were 259pmol/8×108 red blood cells versus 209pmol/8×108 red blood cells in non-responders (p=0.37). There was an inverse relationship (r=−0.28) between TPMT and 6-TGN levels. Toxic effects occurred in 6 of 18 patients, with leukopenia in 5 and hyperamylasemia in 1. Conclusions: Determination of TPMT and monitoring of thiopurine metabolites allows AZA treatment to be optimised, although further studies are necessary to establish therapeutic effectiveness and toxicity ranges (AU)
Subject(s)
Humans , Process Optimization , Methyltransferases/metabolism , Azathioprine/therapeutic use , Antimetabolites/therapeutic use , Thioguanine/blood , Mercaptopurine/blood , Crohn Disease/drug therapy , Colitis, Ulcerative/drug therapy , Hepatitis, Autoimmune/drug therapy , Phenotype , Retrospective Studies , Crohn Disease/enzymology , Colitis, Ulcerative/enzymology , Hepatitis, Autoimmune/enzymologyABSTRACT
Introducción: La fibrosis quística puede cursar con inflamación de la mucosa intestinal y síndrome de hipercrecimiento bacteriano (SHB). Se ha argumentado que los probióticos actúan como inmunomoduladores, antiinflamatorios y reguladores de la microbiota. El objetivo del presente estudio es conocer la prevalencia de SHB en pacientes con fibrosis quística y tratar de optimizar la función intestinal mediante la administración de probióticos. Pacientes y método: Fueron valorados 20 pacientes afectados de fibrosis quística, con una edad media de 10,33 años (rango, 5-17 años). El estudio del SHB se efectuó en 10 pacientes mediante el test de hidrógeno espirado tras una sobrecarga de dextrosa al 20 %, a dosis de 2 g/kg. Tras la prueba se administró Lactobacillus rhamnosus LGG a dosis de1011 ufc dos veces al día durante 4 semanas. La determinación de grasa, nitrógeno, agua y azúcares en las heces se efectuó antes y después del tratamiento mediante análisis de reflexión de infrarrojos (FENIR). Resultados: Cinco pacientes (50%) presentaron SHB. En los valores de H2 se detectó una correlación positiva con respecto a las cifras de esteatorrea (R = 0,57) y de azúcares (R = 0,52). Los valores del FENIR pretratamiento frente a postratamiento, expresados en gramos, fueron: grasa 6,2 +/- 3,3 frente a 4,9 +/- 2,1 (p < 0,5), azúcares 6,7 +/- 3,6 frente a 5 +/- 2,6(p < 0,05) y nitrógeno 0,87 +/- 0,27 frente a 0,91 +/- 0,14 (NS). En 13 pacientes (81,25 %) se evidenció una mejoría de la comodidad intestinal y del aspecto de las deposiciones, yen 9 pacientes (56,25 %) disminuyó el número de deposiciones. Conclusiones: El tratamiento con probióticos mejora la función intestinal en los pacientes afectados de fibrosis quística desde el punto de vista clínico y bioquímico. Su administración podría ser pautada de una manera regular sobre todo en casos de SHB (AU)
Introduction: In some cases, cystic fibrosis may include intestinal inflammation and bacterial overgrowth. Probiotics are considered as immunomodulatory, anti-inflammatory and microbiotic regulator substances. The aim of our study is to determine the prevalence of bacterial overgrowth in cystic fibrosis patients and try to improve the intestinal function with the administration of probiotics. Patients and method: We examined 20 patients with cystic fibrosis (mean age10.33, range 5 to 17 years). The expired hydrogen test with a 2 g/kg of 20 % dextrose overload was performed on 10 patients. After the test, Lactobacillus rhamnosus LGG1011 CFU was administered twice daily for four weeks. Faecal near infrared spectroscopy (FENIR) of water, fat, nitrogen and sugar content in faeces was performed before and after probiotics administration. Results: Five patients (50 %) showed bacterial overgrowth. Weobtained a positive correlation between the hydrogen test and steator rhea (R = 0.57) and sugar in faeces (R = 0.52).The FENIR results pre-treatment vs post-treatment were: fat 6.2 g +/- 3.3 g vs. 4.9 g +/- 2.1 g (p < 0.05), sugar6.7 g +/- 3.6 g vs. 5 g +/- 2.6 g (p < 0.05) and nitrogen 0.87 g +/- 0.27 g vs. 0.91 g +/- 0.14 g (NS) respectively. Thirteen patients (81.25 %) had improved stool appearance and intestinal comfort and nine (56.25 %) decreased the number of daily stools. Conclusions: Probiotics improved not only clinical but also biochemical intestinal function in cystic fibrosis patients. These could be given as a regular treatment in this type of patients and in those with bacterial overgrowth (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Cystic Fibrosis/diet therapy , Cystic Fibrosis/diagnosis , Probiotics/metabolism , Probiotics/therapeutic use , Adjuvants, Immunologic/therapeutic use , Chromatography, Gas/methods , Glucose/therapeutic use , Glycoproteins/metabolism , Glycoproteins/therapeutic useABSTRACT
La macroamilasemia es una entidad que debe sospecharse ante cualquier paciente que presente concentraciones elevadas de amilasa plasmática sin datos clínicos ni de investigaciones complementarias que demuestren la existencia de una afección pancreática o parotídea. Se caracteriza por la elevación de amilasa plasmática debido a macrocomplejos circulantes de alto peso molecular, formados por una molécula de amilasa unida generalmente a una inmunoglobulina. En ausencia de enfermedad renal, una hiperamilasemia sin aumento de amilasuria orienta hacia este diagnóstico, que se confirma al identificar a los componentes de la macromolécula. Es una entidad infrecuente en pediatría. Se ha descrito como un hallazgo casual asociado a dolor abdominal y a enfermedad celíaca. Se presentan 2 casos pediátricos de macroamilasemia, así como las pruebas necesarias para su diagnóstico. El conocimiento de esta anomalía bioquímica permite distinguirla de otras situaciones que cursan con elevación de amilasa, con el fin de evitar exploraciones complementarias y tratamientos invasivos innecesarios (AU)
Macroamylasaemia should be considered in any patient with high plasma amylase, no clinical signs and negative additional investigations for pancreatic or parotid diseases. It is characterised by an increase in serum amylase due to circulating high molecular mass macrocomplexes, most often formed due the binding of the amylase to an immunoglobulin. With a normal renal function, a hyper-amylasaemia without an increase in urine amylase suggests the diagnosis, and is confirmed by identifying the macromolecular components. It is an uncommon entity in paediatrics. It has been described as a casual finding associated to abdominal pain and to celiac disease. We report two paediatric cases of macroamylasaemia, and a review of the tests needed for its diagnosis. The better understanding of this biochemical anomaly allows us to differentiate it from other situations associated to hiperamylasaemia, in order to avoid additional invasive explorations and unnecessary treatments (AU)
Subject(s)
Humans , Male , Female , Child , Hyperamylasemia/complications , Hyperamylasemia/diagnosis , Hyperamylasemia/therapy , Abdominal Pain/diagnosis , Abdominal Pain/therapy , Vomiting/complications , Vomiting/etiology , Immunoglobulin G/therapeutic use , Enteral Nutrition/methods , Amylases/analysis , Immunologic Deficiency Syndromes/diagnosis , Pancreatitis/complications , Deglutition Disorders/complications , Deglutition Disorders/etiology , Esophagitis/complications , Pneumococcal Infections/complications , Pneumococcal Infections/diagnosis , Streptococcus pneumoniae/pathogenicity , Gastrostomy/methodsABSTRACT
Macroamylasaemia should be considered in any patient with high plasma amylase, no clinical signs and negative additional investigations for pancreatic or parotid diseases. It is characterised by an increase in serum amylase due to circulating high molecular mass macrocomplexes, most often formed due the binding of the amylase to an immunoglobulin. With a normal renal function, a hyperamylasaemia without an increase in urine amylase suggests the diagnosis, and is confirmed by identifying the macromolecular components. It is an uncommon entity in paediatrics. It has been described as a casual finding associated to abdominal pain and to celiac disease. We report two paediatric cases of macroamylasaemia, and a review of the tests needed for its diagnosis. The better understanding of this biochemical anomaly allows us to differentiate it from other situations associated to hyperamylasaemia, in order to avoid additional invasive explorations and unnecessary treatments.
Subject(s)
Hyperamylasemia/diagnosis , Child , Child, Preschool , Female , Humans , MaleABSTRACT
INTRODUCTION: In some cases, cystic fibrosis may include intestinal inflammation and bacterial overgrowth. Probiotics are considered as immunomodulatory, anti-inflammatory and microbiotic regulator substances. The aim of our study is to determine the prevalence of bacterial overgrowth in cystic fibrosis patients and try to improve the intestinal function with the administration of probiotics. PATIENTS AND METHOD: We examined 20 patients with cystic fibrosis (mean age 10.33, range 5 to 17 years). The expired hydrogen test with a 2 g/kg of 20% dextrose overload was performed on 10 patients. After the test, Lactobacillus rhamnosus LGG 10(11) CFU was administered twice daily for four weeks. Faecal near infrared spectroscopy (FENIR) of water, fat, nitrogen and sugar content in faeces was performed before and after probiotics administration. RESULTS: Five patients (50%) showed bacterial overgrowth. We obtained a positive correlation between the hydrogen test and steatorrhea (R = 0.57) and sugar in faeces (R = 0.52). The FENIR results pre-treatment vs post-treatment were: fat 6.2 g +/- 3.3 g vs. 4.9 g +/- 2.1 g (p < 0.05), sugar 6.7 +/- g 3.6 g vs. 5 g +/- 2.6 g (p < 0.05) and nitrogen 0.87 g +/- 0.27 g vs. 0.91 g +/- 0.14 g (NS) respectively. Thirteen patients (81.25%) had improved stool appearance and intestinal comfort and nine (56.25%) decreased the number of daily stools. CONCLUSIONS: Probiotics improved not only clinical but also biochemical intestinal function in cystic fibrosis patients. These could be given as a regular treatment in this type of patients and in those with bacterial overgrowth.
Subject(s)
Cystic Fibrosis/therapy , Intestines/microbiology , Intestines/physiopathology , Probiotics/therapeutic use , Adolescent , Child , Child, Preschool , Cystic Fibrosis/physiopathology , Humans , Pilot ProjectsABSTRACT
INTRODUCTION: The aim of this study was to describe the clinical experience of our center of the use of infliximab in pediatric patients with inflammatory bowel disease. MATERIAL AND METHODS: We retrospectively reviewed all infliximab infusions administered in the Pediatric Gastroenterology Unit from October of 1999 to October of 2006. Fourteen patients (nine with Crohn's disease, three with ulcerative colitis, and two with indeterminate colitis) with a mean age of 9.6 years at diagnosis were treated with infliximab. Seventy-seven infusions were administered. RESULTS: Efficacy was analyzed according to inflammatory bowel disease. Crohn's disease: in severe cases (PCDAI > 30), clinical remission (PCDAI < 10) was obtained in 80 % of the patients at week 10, decreasing to 60 % at week 54. Corticosteroid therapy could be reduced in 89 % of the patients and was discontinued in 55.5 %. Ulcerative colitis: clinical remission (modified Truelove-Witts index < 10) was initially obtained in 100 % of the patients but only 33 % were still in clinical remission at the end of the study. In the two corticosteroid-dependent patients, corticosteroid therapy could be reduced and even discontinued in one (50 %). Indeterminate colitis: neither of the two patients achieved clinical remission. The most frequent adverse effects observed were acute infusional reactions (42.8 % of the patients and 10.3 % of infusions), one of which was severe, and infections (28.6 % of patients), one of which (ileal abscess) required surgery. CONCLUSIONS: The efficacy of infliximab seems to differ considerably in the distinct types of inflammatory bowel disease and is practically null in indeterminate colitis. Randomized controlled studies in children are required to assess the exact efficacy of infliximab in our patients.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infliximab , MaleABSTRACT
Introducción El objetivo de este artículo es describir la experiencia clínica de nuestro centro con infliximab en pacientes con enfermedad inflamatoria intestinal. Material y métodos Revisión retrospectiva de todas las infusiones de infliximab administradas en la Unidad de Gastroenterología Pediátrica desde su primera infusión en octubre de 1999 hasta octubre de 2006. Un total de 14 pacientes (9 de ellos con enfermedad de Crohn, 3 con colitis ulcerosa y 2 con colitis indeterminada), con una media de 9,6 años al diagnóstico, fueron sometidos a tratamiento con infliximab. Se administró un total de 77 infusiones. Resultados La eficacia se desglosó por tipo de enfermedad inflamatoria intestinal. Crohn: en las formas graves (índice de actividad de la enfermedad de Crohn pediátrica [PCDAI] > 30) se obtuvo una remisión clínica (PCDAI < 10) a la semana 10 del 80 %, que descendió al 60 % en la semana 54. Se pudo reducir la dosis de corticoides en el 89 % de los pacientes y suspenderla en el 55,5 %. Colitis ulcerosa: se obtuvo una remisión clínica (índice de Truelove-Witts modificado < 10) inicial del 100 %, pero tan sólo se mantuvo en el 33 % de los pacientes. Los dos pacientes con corticodependencia pudieron reducir la dosis corticoidea e incluso uno de ellos llegó a suspenderla (50 %). Colitis indeterminada: ninguno de los dos pacientes logró entrar en remisión clínica. Los efectos adversos más frecuentes observados fueron las reacciones infusionales agudas (42,8 % de los pacientes y 10,3 % de las infusiones), una de ellas grave, y las infecciones (28,6 % de los pacientes), una de las cuales (absceso ileal) requirió cirugía. Conclusiones La efectividad de infliximab parece diferir mucho por tipo de enfermedad inflamatoria intestinal, y es prácticamente nula en formas indeterminadas. Se requieren estudios controlados y aleatorizados en población pediátrica para definir de manera exacta la tasa de eficacia de infliximab en nuestros pacientes
Introduction The aim of this study was to describe the clinical experience of our center of the use of infliximab in pediatric patients with inflammatory bowel disease. Material and methods We retrospectively reviewed all infliximab infusions administered in the Pediatric Gastroenterology Unit from October of 1999 to October of 2006. Fourteen patients (nine with Crohn's disease, three with ulcerative colitis, and two with indeterminate colitis) with a mean age of 9.6 years at diagnosis were treated with infliximab. Seventy-seven infusions were administered. Results Efficacy was analyzed according to inflammatory bowel disease. Crohn's disease: in severe cases (PCDAI > 30), clinical remission (PCDAI < 10) was obtained in 80 % of the patients at week 10, decreasing to 60 % at week 54. Corticosteroid therapy could be reduced in 89 % of the patients and was discontinued in 55.5 %. Ulcerative colitis: clinical remission (modified Truelove-Witts index < 10) was initially obtained in 100 % of the patients but only 33 % were still in clinical remission at the end of the study. In the two corticosteroid-dependent patients, corticosteroid therapy could be reduced and even discontinued in one (50 %). Indeterminate colitis: neither of the two patients achieved clinical remission. The most frequent adverse effects observed were acute infusional reactions (42.8 % of the patients and 10.3 % of infusions), one of which was severe, and infections (28.6 % of patients), one of which (ileal abscess) required surgery. Conclusions The efficacy of infliximab seems to differ considerably in the distinct types of inflammatory bowel disease and is practically null in indeterminate colitis. Randomized controlled studies in children are required to assess the exact efficacy of infliximab in our patients
