Chronic pancreatitis caused by a Homozygous SPINK1 c.194 + 2T > C variant and Pancreas Divisum in a 3-year-old child-case report.

Chronic pancreatitis (CP) is a rare disease in children. We describe the first case of a 3-year-old Caucasian patient with CP with the presence of a homozygous pathogenic variant c.194 + 2T > C in serine protease inhibitor, Kazal type 1 ( SPINK1 ) and pancreas divisum.

The course of acute pancreatitis in children and potential simple laboratory markers of severity - A single Centre retrospective study.

AIM: To evaluate the usefulness of routinely measured biochemical and complete blood count parameters as potential markers of the severity of paediatric acute pancreatitis (AP). METHODS: The retrospective study included children with AP hospitalised over a 3 years period. Demographic, clinical and laboratory data were collected. RESULTS: In total, 55 patients were enrolled in the study. Mild AP was diagnosed in 45 children (82%), moderately severe in 7 (13%), and severe in 3 patients (5%). Together 10 children (18%) were categorised into a single severe group. Children with severe AP had higher white blood cell and platelet counts on admission as well as a C-reactive protein (CRP) concentration after 48 h. The CRP concentration after 48 h (cut-off: 127.2 mg/L) and the white blood cell count on admission (cut-off: 13.5x103 /µl) were found to be statistically significant markers in predicting the severity of the disease. The CRP concentration after 48 h was demonstrated as an independent predictor. CONCLUSION: Severe AP is observed in a quite significant percentage of children. The white blood cell count on admission and the CRP concentration after 48 h (as an independent predictor) may be potential simple laboratory markers of the severity of the disease.

Autoimmune sclerosing cholangitis might be triggered by SARS-CoV-2 infection in a child - a case report.

The spectrum of liver involvement during coronavirus disease 2019 (COVID-19) is broad and mainly includes elevated liver enzymes and cholestasis. Severe acute respiratory syndrome corona- virus-2 (SARS-CoV-2) infection most often leads to a transient moderate increase in liver enzymes that is not accompanied by disturbances in the synthetic function of the liver. However, there is increasing evidence that SARS-CoV-2 infection is associated with the development of autoimmune disorders. The pathogenesis of autoimmune hepatobiliary diseases is not fully understood, taking into account genetic and environmental factors such as viral infections. We present a pediatric case of autoimmune sclerosing cholangitis (ASC), which was diagnosed 2 months after SARS-CoV-2 infection. To the best of our knowledge, ASC potentially triggered by COVID-19 has not been reported in pediatric patients. Further studies are needed to describe the clinical impact of the development of autoimmune liver diseases potentially associated with SARS-CoV-2 infection in pediatric patients. Our observations indicate that children with liver injury potentially caused by COVID-19 require long-term monitoring of liver function parameters.

SARS-CoV-2 Infection as a Cause of Acute Pancreatitis in a Child-A Case Report.

The novel coronavirus disease (COVID-19) was detected for the first time in China in December 2019. Soon after it was declared a pandemic. Main symptoms include fever, dyspnea, cough, muscle pain, headache, anosmia and ageusia, however a growing body of evidence shows that other organs can be affected. Gastrointestinal manifestations have been observed in a considerable number of patients and include abdominal pain, diarrhea and vomiting. The involvement of liver as well as pancreas has been also described, however there are only a few cases of acute pancreatitis reported in patients with COVID-19. Therefore, we present a case of 6-year-old child with mild acute pancreatitis and COVID-19 pneumonia.

Liver pathology in children with newly diagnosed celiac disease.

AIM OF THE STUDY: To evaluate the prevalence and the type of liver pathology in children at the time of diagnosis of celiac disease (CD). MATERIAL AND METHODS: Data from newly diagnosed children with CD hospitalized in the university hospital were retrospectively reviewed. Liver pathology was defined as elevated alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT) serum activity and/or pathological changes of the organ in ultrasound. RESULTS: Liver pathology was detected in 17 of 149 children (11.4%). Ten patients (6.7%) had an elevated ALT serum activity, whereas no child had an elevated GGT activity. Pathological changes of liver in ultrasound (mainly enlargement or steatosis of the organ) were found in 12 patients (8.1%), of whom 5 children (3.4%) had simultaneously elevated ALT serum activity. Children with liver pathology had lower iron (Fe) (p = 0.02) and folic acid (p = 0.01) concentrations compared to the rest of the patients. There were no statistically significant differences between liver pathology existence and age, sex, serum immunoglobulin A anti-tissue transglutaminase type 2 antibodies (IgA anti-TG2), ferritin, vitamin B12, or vitamin D concentrations. Moreover, a positive correlation between IgA anti-TG2 concentration and ALT serum activity was found (p < 0.01, R = 0.29). CONCLUSIONS: Liver pathology is present at diagnosis in a significant proportion of children with CD in the form of hypertransaminasemia and pathological changes of the organ in ultrasound. There is a correlation between IgA anti-TG2 concentration and ALT serum activity.

Hepatotoxicity caused by montelukast in a paediatric patient.

Montelukast is a selective and competitive cysteinyl leukotriene receptor antagonist (CystLTRA) which is increasingly used for the treatment of allergic asthma. Recently, hepatotoxicity has been reported with this drug in adult patients, but only one letter to the editor has reported a case of probable montelukast-induced hepatotoxicity in a child. We present a case of a 3.5-year-old boy, receiving treatment with montelukast, who developed hepatocellular injury. The exclusion of other causes of increased activity of aminotransferases (viral, metabolic, autoimmune), improvement after dechallenge, the morphological findings and previous reports of comparable cases support the diagnosis of montelukast-induced liver injury in this boy. Physicians should strictly analyse indications for this drug and be aware of potential drug-induced liver disease caused by this agent. Therefore, the periodical assessment of aminotransferases should be recommended during treatment with this leukotriene modifier.

[Frequency and causes for hospitalization of children with cholelithiasis - own observations]. / Czestosc i przyczyny hospitalizacji dzieci z kamica zolciowa - obserwacje wlasne.

THE AIM: of this study was to assess the incidence and the cause of hospitalization of children with cholecystolithiasis. MATERIAL AND METHODS: A retrospective analysis was carried out using medical data of children and adolescents treated in the Department of Pediatrics, Gastroenterology, and Pediatric Allergology of Bialystok Medical University. The analysis included causes of hospitalization, its course and accompanying illnesses. During the 4 years of analysis, 47 children (17 boys, 30 girls), aged from 7 months to 18 years, with the diagnosis of cholecystolithiasis were treated. The comprised 1.18% of children hospitalized with gastrointestinal disorders. RESULTS: Cholecystolithiasis without complications was diagnosed in 29 children (61.7%), with cholecystitis in 13 (27.7%), choledocholithiasis was diagnosed in 5 children (10.6%). In 11 children (23.4%) the complication presented in form of acute pancreatitis. In 23 children (48.9%) factors predisposing to chorocholelithiasis were identified. In 20, the following were considered to be a possible significant factor: in 7 children there was a positive family history (14.9%), in 6 children (12.8%) - it was obesity, in 3 children (6.4%) lipid metabolic errors: prematurity and parenteral feeding in 2 children (4.3%) and spherocytosis in 2 children (4.3%). Apart from the above, cholelithiasis was diagnosed in two children with hypothyreosis and in two with Down's Syndrome. In treatment of 20 children (42.6%) antibiotics were prescribed and in 4 children (8.5%) endoscopic sphincterotomy was performed. 25 children (53.2%) were referred for laparoscopic cholecystectomy. In 16 children (34.0%), treatment with ursodeoxycholic acid was recommended. CONCLUSIONS: Cholecystolithiasis is a rare cause of hospitalization in pediatric departments. However, it occurs in even the youngest children. It usually runs without complications, but there is a certain risk of serious complications. In the differential diagnosis of abdominal pain, cholelithiasis should be taken into account, even in the youngest children. Special consideration should be given to the premature, with low birth weight and extremely low birth weight.

Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.

AIM: histological evaluation of esophageal mucosa in children, with regard to the duration of primary acid gastroesophageal reflux (GER) and acid GER secondary to cow's milk allergy and/or other food allergy (CMA/FA) (prospective study). MATERIAL AND METHODS: 264 children of both sexes suspected of GER were enrolled in the study. The age of examined children was 1.5-102 months, mean age 20.78+/-17.23 months. Pathological acid GER was confirmed with pH-monitoring in 138 children (52.3%). Taking into consideration complex differential diagnosis, including oral food challenge test with potentially noxious nutrient (open or blind study), children were assigned into study groups 1 and 2 (primary and secondary GER). Group 1: 76 patients (28.8%) aged 4-102 months (x=25.2+/-27.28 months) with primary GER. Group 2: 62 patients (23.5%) aged 4-74 months (x=21.53+/-17.79 months) with GER secondary to CMA/FA. Children with GERD underwent preliminary and control (after 1 year and 2 years of GERD diagnosis) endoscopic examination of the upper gastroinestinal tract. RESULTS: Intensity of esophagitis was assessed initially in 25 children from group 1 (32.9%), in 29 children from group 2 (46.8%), and in 9 children from group 3 - reference group (28.1%). Histological evaluation revealed infiltration of inflammatory cells, mainly neutrophils and intraepithelial lymphocytes, and also eosinophils in 10 children (13.2%) with primary GER. Infiltration of eosinophils and lymphocytes was found in 5 children (8.1%) with secondary GER. In 8 children (25.0%) with food allergy there were only lymphocytes. Infiltration of neutrophils and lymphocytes and basal zone hyperplasia or infiltration of eosinophils and lymphocytes with elongation of lamina propria papillae was found in 10 children (13.1%) with primary GER and in 20 children (32.2%) with secondary GER. Differentiation of particular types of inflammatory cells in mucosal infiltration characterized histological picture in the following way: neutrophils in 21 children (27.6%) with primary GER, eosinophils in 22 children (35.5%) with secondary GER, lymphocytes in 15 children (19.7%) in children with primary GER and in 15 children (24.2%) with secondary GER. Histological examination of esophageal mucosa after 1 and 2 years of clinical observation and periodical conservative treatment in children with primary and secondary GER revealed significant alleviation of inflammatory abnormalities (with regard to the type of abnormalities and the number of particular types of inflammatory cells). CONCLUSIONS: The value of histological findings obtained in own studies comprises the role of food allergy in pathogenesis of GER and is related to GER's contribution, both direct (primary reflux) and indirect (secondary reflux), to triggering off morphological results and clinical outcomes of esophagitis.

[Endoscopic picture of esophagitis in children with primary and secondary acid gastroesophageal reflux]. / Obraz endoskopowy zapalenia przelyku u dzieci z kwasnym refluksem zoladkowo-przelykowym pierwotnym i wtórnym.

UNLABELLED: THE AIM OF THE STUDY was to assess the esophageal mucous membrane in children with pathological acid gastroesophageal reflux (GER) primary and secondary to cow's milk allergy and (or) food allergy (CMA/FA), dependent on the duration of the disease (prospective study). MATERIAL AND METHODS: 264 children of both sexes suspected of GER were enrolled in the study. The age of examined children was 1.5-102 months (mean age 20.78+/-17.23 moths). Pathological acid GER was confirmed in 138 children (52.3%) with pH-monitoring. Taking into consideration complex differential diagnosis, including elimination of noxious nutrient and oral food challenge test (open or blind study), acid GER was differentiated into primary and secondary. Children were assigned into study groups 1 and 2. Group 1: 76 patients (28.8%) aged 4-102 months (mean age 25.2+/-27.28 months) with primary GER. Group 2: 62 patients (23.5%) aged 4-74 months (mean age 21.53+/-17.79 months) with GER secondary to CMA/FA. Endoscopic examination of the upper gastrointestinal tract was performed in 138 children: preliminary and control examination (after one year and two years of GERD diagnosis. RESULTS: Esophagitis of different intensity (second - fourth degree) in macroscopic assessment was diagnosed in 25 children (32.9%) with group 1 and in 29 children (46.8%) with group 2 in preliminary study. Esophagitis was still present in macroscopic assessment after one year of conservative treatment in 13 children (17.1%) from group 1 and in 12 children (19.4%) from group 2. After two years of clinical observation and periodically administered conservative treatment mild esophagitis still persisted in 3 children (3.9%) from group 1, and in 3 children (4.8%) from group 2. CONCLUSION: Esophagitis of various intensity (second - fourth degree) was diagnosed in preliminary endoscopic examination in about 33% of children with group 1 and 47% of children with group 2.

[Electrogastrography in children with functional abdominal pain and gastritis]. / Badanie elektrogastrograficzne u dzieci z czynnosciowymi bólami brzucha i zapaleniem blony sluzowej zoladka.

UNLABELLED: Electrogastrography (EGG) is non-invasive method for diagnosis of gastric electrical activity. THE AIM OF STUDY: We analysed gastric activity in children with chronic abdominal pain and functional disorders of alimentary tract or gastritis. MATERIAL AND METHODS: Skin EGG with 30-minutes recordings in preprandial period and after standard meal were done in 155 children, mean age 11,6 +/- 3,6 years. We analyzed data in groups: 1-functional abdominal pain (FAP), 2-gastritis, Helicobacter pylori negative, 3-gastritis, Helicobacter pylori positive, 4-controls. RESULTS: EGG was in normal range in 32% of patients with FAP and in 27% of patients with gastritis. Abnormalities in gastric rhythm were noticed in highest percent in gr. 2 in fasting state. Normogastry was dominant in postprandial period in all groups. Statistical differences of some parameters of EGG (dominant frequency, dominant power) were found among study groups. We found higher percent of bradygastry in fasting state compared with postprandial period. CONCLUSIONS: We conclude that different abnormalities in gastric myoelectrical activity could exist in chronic abdominal pain; dominant preprandial rhythm is mainly affected. We couldn't find typical changes in electrogastrogram for differentiate FAP and gastritis.

[Motility disorders in oesophageal manometry in children with chronic abdominal pain]. / Zaburzenia motoryki przewodu pokarmowego w badaniu manometrycznym przelyku u dzieci z przewleklymi bólami brzucha.

Chronic abdominal pain in children can be dependent from motility disorders. The aim of the work was evaluation the frequency of changes in oesophageal manometry in children with chronic abdominal pain. Manometry studies were performed in 40 children with functional abdominal pain (group A, which was divided into subgroups: A1--functional dyspepsia, A2--irritable bowel syndrome, A3--nonspecific abdominal pain), in 11 children with gastritis (group B) and in 24 children as a control (group C). Disorders of lower oesophageal sphincter (LES) function were observed in 72.5% of group A and 45.5% of group B; transient lower oesophageal sphincter relaxations (TLESR) were noticed in 13.5%. Abnormalities of body function with the features of non-specific oesophageal motility disorders were observed in 62.5% in group A and 54.5% in group B during "dry" swallows and in 47.5% and 18.2% respectively during "wet" swallows. These changes were more frequent in dyspeptic children (85.7%). Statistical differences were established among values of resting LES pressure in analysed groups (group A or B versus group C; p < 0.05). In conclusion we mentioned that in oesophageal manometry abnormalities (LES and body function) were observed in children with functional abdominal pain and with gastritis. Characteristic features can not be defined in each group.