Relevance of CagA positivity to clinical course of Helicobacter pylori infection in children.

A potential virulence determinant of Helicobacter pylori is the cagA gene product. To determine the relevance of the expression of CagA to the clinical picture and outcome of H. pylori infection in children, we examined 104 consecutive children diagnosed with H. pylori infection. Serum samples were collected to test for the presence of immunoglobulin G (IgG) anti-CagA antibodies. Forty-five patients (43%) had antibodies to the CagA protein (group I), and 59 did not (group II). Seropositive patients had a longer prediagnostic history of abdominal pain (P = 0.02), more severe abdominal pain (defined as ulcer pain) (P = 0.05), a higher prevalence of duodenal ulcer (38 versus 7%; P<0.01), more active chronic gastritis (82 versus 32%; P<0.001), and a higher titer of serum IgG anti-H. pylori antibodies (P<0.001). Ninety percent of the patients were monitored for 27+/-18 months. On multivariate analysis, CagA-negative patients had a 3.8-fold-higher chance of achieving a disease-free state than CagA-positive patients (95% confidence interval, 1.5- to 9.5-fold). We conclude that infection with CagA-producing strains of H. pylori is a risk factor for severe clinical disease and ongoing infection.

The value of anti-Helicobacter pylori IgG antibodies in establishing eradication of infection in children.

The aim of this study was to evaluate the performance of anti-Helicobacter pylori (H. pylori) IgG antibodies in monitoring eradication of infection in children. Forty-seven H. pylori-infected children (aged 12.5 +/- 3.0 years, range 6.5-18 years) were followed for a mean of 30.3 months (range 6.66 months). Patients were divided into those with eradicated infection and those with ongoing infection, as determined by antral biopsy-related tests (histology, urease and culture). Anti-H. pylori antibodies (EIA) were tested at diagnosis and follow-up and changes of antibody titers were compared between the two groups. Twenty-five of 26 non-eradicated patients showed persistently high levels of antibodies throughout the study. One patient had non-detectable antibodies despite an ongoing infection for 12 months. Patients with eradicated infection showed a progressive fall of antibody levels from 52.9 +/- 32.4 U/ml at diagnosis to 17.5 +/- 4.1 U/ml at 6 months (p < 0.007) and 4.4 +/- 0.7 U/ml at > or = 12 months (p < 0.002). In 17 of 21 eradicated patients, serum antibodies normalized during the follow-up period; in 4 of the 21 patients, a decrease of > or = 40% of the initial value was observed during the 8-month follow-up. The validity of serology in the evaluation of H. pylori infection had a sensitivity of 100%, specificity of 96% and positive predictive and negative predictive values of 95% and 100% respectively. Our conclusion is that serial determination of anti-H. pylori antibodies is a reliable method for the follow-up and monitoring of H. pylori eradication in children and adolescents.

A lamb-meat-based formula for infants allergic to casein hydrolysate formulas.

Ten infants with colitis due to milk protein allergy, presenting as hematochezia, whose symptoms did not resolve with the use of hydrolyzed cow-milk-based formulas, were treated with a modular lamb-meat-based formula (LOP). The patients were followed up for 3 months to 5 years. Prompt resolution of symptoms was achieved. In three patients, increased levels of creatinine and blood urea nitrogen and mild metabolic acidosis were noted, all returning to normal after the protein intake was lowered. All patients had normal growth. Seven patients were able to tolerate cow milk protein or soy at age 9-15 months. The LOP formula is well tolerated and is a safe alternative formula for infants allergic to cow milk hydrolysate formula.

Basal and meal-stimulated pepsinogen secretion in preterm infants: a longitudinal study.

In order to establish longitudinal normal values for basal and meal-stimulated pepsinogen secretory function in preterm infants, we studied 44 preterm infants with gestational ages of 28-36 weeks during the period of nasogastric tube feeding. Three age groups were evaluated: gestational ages of 28-30, 31-33, and 34-36 weeks. Basal pepsinogen did not change with postnatal age in any of the groups. Significant meal-stimulated pepsinogen secretion appeared during the third postnatal week in infants of 28-30 weeks of gestation. In the groups of infants of 31-33 and 34-36 weeks of gestation, significant meal-stimulated pepsinogen secretion was apparent in the first postnatal week. This study suggests that maturation of pepsinogen secretion appears at 31 weeks of gestation, independent of early feeding.

Aplastic anaemia complicating adenovirus infection in DiGeorge syndrome.

An 18-month-old child with partial DiGeorge syndrome developed aplastic anaemia during an acute adenovirus infection. Assessment of the child's immune system revealed T-cell subset abnormalities consistent with DiGeorge syndrome. A possible link between the underlying immune deficiency and the observed complication is suggested.

Partial duplication of the lower limb with agenesis of ipsilateral kidney--a new syndrome: report of a case and review of the literature.

A detailed account is given of a 19-month-old female infant with partial duplication of the left lower limb and aplasia of the ipsilateral kidney, plus other congenital malformations. Although the etiology is unknown, we believe this constellation of findings, which has been reported previously, represents a new congenital malformation syndrome.

An unusual presentation of pancreatic carcinoma in childhood.

Carcinoma of the pancreas is rare in the pediatric population, with only 58 cases described in subjects under 16 years of age. The clinical presentation generally consists of abdominal pain and mass. We present a case of carcinoma of the pancreas in an 11-year-old girl, with abdominal pain and unusual behavior.