Functional gastrointestinal disorders in children: a single centre experience.

Functional gastrointestinal disorders in childhood (FGIDs) constitute a significant time-consuming clinical problem for healthcare practitioners, and they carry an important psychosocial burden for patients and their families. The aim of this study was to characterize etiology, clinical features, and interventions in a paediatric cohort of patients with FGIDs, who were referred to a tertiary care university-affiliated centre. Methods A retrospective study of children aged 1-15 years old referred to the Clinic for Children's Diseases, University Clinical Center Tuzla, from January 2022 to December 2022, who fulfilled criteria for FGIDs (n=209), were divided in three groups: 0-3, 4-10 and 11-15 years old. Demographic characteristics, number of examinations, duration of symptoms, initial diagnosis, hospital evaluation and outcomes of each child were collected. Results During the study period, 670 patients were referred to a gastroenterologist, out of whom 209 (31.2%) fulfilled the criteria for FGIDs, with median age of 8.0 years. Females were predominant in all groups (p=0.0369). Children aged 4 to 10 years were significantly more frequent (p<0.0001). A median duration of symptoms was one year. Functional constipation was the most common diagnosis, 99 (47.4%), followed by functional abdominal pain not otherwise specified, 67 (37.2%), and functional dyspepsia, 25 (12.0%). Fifty-two percent of patients did not require further follow-up by the gastroenterologist. Conclusion Although FGDIs are frequent, they are not well accepted neither among patients nor physicians. Extensive diagnostic procedures are often unnecessary and the cessation of specialized care follow-up is possible in a significant number of cases.

Correlation between clinical outcomes and patients' satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects.

Aim To examine and quantify patients' satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique. Methods A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17 patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients' satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed. Results Pearson correlation coefficient between patients' satisfaction and clinical presentation was 0.534. Out of 510 (the highest summed score for patients' satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones. Conclusion Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.

Celiac disease in the Mediterranean area.

BACKGROUND: The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy. METHODS: By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers. RESULTS: The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol. CONCLUSIONS: This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.

Burden of celiac disease in the Mediterranean area.

AIM: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost. METHODS: For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries. RESULTS: In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550,000 symptomatic adults and about 240,000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600,000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls. CONCLUSION: In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.

Frequency of serological tests positive findings for celiac disease at the first relative of children with celiac disease.

GOAL: The research was undertaken with the aim to determine the frequency of positive findings of serological tests for celiac disease of the first relatives of children with celiac disease. MATERIALS AND METHODS: The study included 175 first relatives of 68 children suffering from celiac disease. Of that number, 75 (40 mothers and 26 fathers), 4 sisters and five brothers agreed to be tested for the presence of antibodies to celiac disease. For each subject were done tests on presence of anti-gliadin IgA, IgG antigliadin antibodies and IgA antibodies on tissue transglutaminase in the Polyclinic for Laboratory Diagnostics - Institute for Microbiology-Department of Immunology, University Clinical Centre (UCC) Tuzla. RESULTS: Of 175 first relatives of children with celiac disease 75 consented to serologic screening. Positive anti-gliadin IgG antibodies had 13.3%; anti-gliadin IgA antibodies had 2.6%, whereas antibodies on tissue transglutaminase were positive in 7.5% of respondents. With positive findings of anti-gliadin IgG were only two brothers. Fifteen subjects with positive findings of serological tests for celiac disease were confirmed by diagnosis of small bowel mucosal biopsy in 4%. CONCLUSION: In our study the incidence of positive serological tests for celiac disease among first relatives of children with celiac disease was 20%. All of our respondents with positive antibody findings had no symptoms that could indicate celiac disease. After establishing the diagnosis of celiac disease in children, it should be mentioned that testing must be done with the first relatives. This would, along with further diagnostic testing discover a significant number of asymptomatic patients and atypical forms of celiac disease.

[Ultrasonographic guidance of percutaneous drainage as a new method of treatment of echinococcal cysts]. / Perkutana drenaza pod kontrolom ultrazvuka novi nacin lijecenja ehinokokne ciste.

UNLABELLED: The aim of this work is to show possibilities of treating echinococcus cyst, with special emphasis on PAIR method, showing two different cases (hydatid and multilocular cyst). MATERIAL AND METHODS: In the period of three years in our department it has been treated 7 children who had cystic echinococcosis of different type, different localization, different number of cystic changes as well as different curing methods. Four patients were treated by PAIR method. Prior to all these patients were treated as per certain therapy scheme, conservatory by albendazole and then exposed to PAIR method. RESULTS: Two completely cured (Echinococcus granulosus), third(Echinococcus multilocularis) in final phase and fourth at the early beginning of cure treatment (E. granulosus). There were no complications such as febrile, rupture and possible dissemination. CONCLUSION: Hydatidosis is still primarily surgical disease but open surgical procedures are rapidly losing on their importance in therapy sense, comparing with new treating methods of percutaneous aspiration under sonographic and CT guidance, with pre-medication with albendazole.

[Association between chronic gastritis in childhood, Helicobacter pylori and ABO blood groups]. / Povezanost hronicnog gastritisa u djetinjstvu sa Helicobacter pylori i ABO krvnim grupama.

Gastritis can be defined in the simplest way such as inflammation of gastric mucous membrane. There are numerous causes of gastritis and the most often is Helicobacter pylori infection. Studying of the blood groups also includes the question of their connection with certain diseases. Up to date it has been explained the role that blood groups have in haemolytic disease of newborn infant but for other diseases we know little, it is insufficient or we know nothing. The aim of this work was to analyze connection of chronic gastritis in childhood, Helicobacter pylori and ABO blood groups. It has been treated 68 patients out of which 57 (83%) were Helicobacter pylori positive (Hp+) and 11 (17%) were Helicobacter pylori negative (Hp-). Thirty patients had chronic gastritis out of which 22 (73%) were Hp+ and 8 (27%) Hp-. It prevailed blood group A and O, comparing with other blood group phenotypes connected with gastritis.