Management with wrap disruption after Nissen fundoplication in a child with gastro-oesophageal reflux after congenital oesophageal atresia: A case report and minireview.

Pathological gastro-oesophageal reflux (GER) is one of the most common complications that results in the aftermath of treatment of congenital oesophageal atresia (EA). The aim of this study is to present a case of a 7-year-old girl with severe gastro-oesophageal reflux disease (GERD) operated on in the neonatal period due to EA with a lower tracheo-oesophageal fistula (TEF). The patient, despite the use of adequate conservative treatment, clinically and in the endoscopic examination was diagnosed with severe oesophagitis (LA-D in the Los Angeles classification). After a laparoscopic fundoplication by the Nissen method at the age of 4, a transient clinical improvement and a reduction of inflammatory lesions in the oesophagus were obtained. Three years after the procedure, the patient presented with deterioration of GERD clinical symptoms in the form of: regularly occurring vomiting with periodic admixture of fresh blood, recurrent cough, symptoms of dysphagia and failure to thrive. An upper gastrointestinal endoscopy (upper GI endoscopy) revealed significant progression of inflammatory changes in the oesophagus and the two-level oesophageal stricture together with endoscopic signs of wrap disruption. Based on the conducted diagnostics, the girl was qualified for surgical revision. The diagnosis was confirmed intraoperatively. During the 4-month postoperative period, a significant clinical improvement and resolution of symptoms were observed. The presented case indicates the need for close and long-term monitoring of patients after EA. In the case of a recurrent reflux oesophagitis in patients after anti-reflux surgery, the possibility of prolonged complications, such as a wrap disruption, herniation or slippage should be taken into consideration.

Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice.

Gastrointestinal tract symptoms such as abdominal pain, constipation, diarrhea, and fever are common reasons for which parents take children to the pediatrician. An increasing prevalence of chronic diseases of the gastrointestinal tract and a decrease in the median age of their onset indicate the need to search for new diagnostic methods for differentiating inflammatory bowel diseases (IBDs) from other gastrointestinal tract diseases. An example of a novel biomarker is fecal calprotectin (FC), which is considered a noninvasive and useful marker of intestinal inflammation. This review summarizes currently available information on the use of FC in the diagnosis and monitoring of IBD in children. Additionally, it attempts to determine the course of action depending on the concentration of FC. Application of FC determination within the framework of primary medical care can decrease the number of children unnecessarily referred either to endoscopic or radiologic examination. There is a double advantage of calprotectin screening; for patients, it reduces delays in diagnosis and unnecessary exposure to endoscopy, and for doctors, it reduces pressure on endoscopy testing and facilitates decision-making. We emphasize the role of FC as a noninvasive marker, primarily in patients with IBD, in monitoring disease activity, predicting relapse, monitoring therapy efficacy, and monitoring postoperative relapses.

[Vomiting as a symptom of epilepsy. Panayitopoulos Syndrome - review of the literature and own experience].

Vomiting is a common sign of illness in the pediatric population. Its etiology is diversified, ranging from mild functional disorders to severe life-threatening systemic diseases. Vomiting most often occurs in the course of gastrointestinal tract diseases, however, it may also coexist with numerous other ailments located outside the GI tract. Due to its diverse etiology encompassing various systems and organs, it can sometimes cause diagnostic difficulties. The present paper illustrates a case of Panayiotopoulos syndrome, which is an early-onset childhood occipital epilepsy (EOCOE). Characteristic of this syndrome are seizures with symptoms originating from the autonomic nervous system or the occurrence of vegetative status epilepticus. The dominant signs and symptoms are vomiting and nausea, which in the first place most frequently suggest inflammation of the stomach or intestines, migraine, or a proliferative process in the central nervous system. Rarely is the possibility of vomiting taken into account as an element of epileptic seizure in the differential diagnosis. The aim of this paper is to draw attention to the difficulty in defining the precise cause of recurrent vomiting. Many times, despite collecting a detailed medical history and extensive physical examination, it is only observation-based diagnosis that allows the doctor to make a final evaluation.