Recurrent abdominal pain in children: the utility of upper endoscopy and histopathology.

INTRODUCTION: To study the utility of upper gastrointestinal endoscopy with biopsy in the evaluation of children with clinically-significant recurrent abdominal pain. METHODS: Over a three-month period, children with three or more episodes of upper abdominal pain that was severe enough to impair their normal activity and required medical attention were included in the study. After complete history, physical examination and basic investigations, upper gastrointestinal endoscopy with biopsy was performed in all patients. RESULTS: Thirty-eight children were enrolled. Their average age was 10.5 years and 21 were female. Organic causes were identified in 44.7 percent of the cases, with Helicobacter pylori gastritis being the most common diagnosis (28.9 percent). No specific dyspeptic symptom was significantly associated with either organic cause of recurrent abdominal pain or Helicobacter pylori infection. Antral nodularity was the only endoscopic finding significantly associated with Helicobacter pylori infection (sensitivity 63.4 percent, specificity 85.2 percent). All patients improved after specific therapy was instituted. CONCLUSION: The organic causes of recurrent abdominal pain in children have been increasingly identified in our hospital, a tertiary care centre in Northern Thailand. One of the most common causes found in this study was Helicobacter pylori infection. Upper endoscopy was very helpful in identifying the underlying pathology.

Microvillus inclusion disease as a cause of severe protracted diarrhea in infants.

There are many etiologies responsible for severe intractable diarrhea in infancy, for instance, autoimmune enteropathy, microvillus inclusion disease, tufting enteropathy, food allergy, post-enteritis syndrome, chronic intestinal pseudo-obstruction, Hirschsprung's disease, intestinal lymphangiectasia, congenital sodium or chloride diarrhea, and congenital enzymatic deficiency. This article reports a case of microvillus inclusion disease in a Thai patient. He presented with severe intractable watery diarrhea with persistent metabolic acidosis. After extensive investigation, the diagnosis of microvillus inclusion disease was made, based on the ultrastructural findings of microvillus inclusions in the cytoplasm of the enterocyte on electron microscopic study. Various treatments were introduced to the patient without clinical improvement, including cholestyramine, metronidazole, probiotics, and octreotide. He was dependent on total parenteral nutrition and subsequently died from TPN-related complications. Even though it is a rare disease, it should be considered if an infant has chronic secretory diarrhea.

A case report: Alagille syndrome.

Alagille syndrome consists of 5 major features comprising paucity of interlobular bile ducts, characteristic facies, posterior embryotoxon, vertebral defects and peripheral pulmonic stenosis. The female patient in this report met 4 of the 5 major features except ocular abnormality. The first clinical presentations were prolonged jaundice and generalized ecchymoses. She was treated by plasma replacement and vitamin supplement, particularly vitamin K1, which produced clinical improvement. This report also reviews the literature of Alagille syndrome.

Colonic carcinoma: a case report in a child and review literature.

This article reports one case of child colonic carcinoma. This is a rare disease in children which usually occurs in predisposing conditions, e.g. ulcerative colitis, familial polyposis coli, Gardner's syndrome, Turcot's syndrome and Peutz-Jegher's syndrome. The patient in this report was 12 years old. He presented with chronic intermittent colicky abdominal pain and uncorrectable iron deficiency anemia for 7 months prior to definite diagnosis. This report also reviews the literature about colorectal carcinoma in children. Physicians can make an early diagnosis with a high index of suspicion if they cannot explain clearly what causes abdominal pain. Further investigations should be performed, thereby, avoiding delayed diagnosis and improving survival rate.

Effects of parity on breastfeeding: a study in the rural setting in northern Thailand.

UNLABELLED: This analysis was undertaken to see whether or not previous successful breastfeeding has any influence on subsequent breastfeeding behavior. Lactational outcomes were compared between those with and without breastfeeding experience. METHODS: Amount of breast milk transferred, frequency of breastfeeding, and time spent on the breast, as well as infant's weight, were recorded on days 15, 45, 90, 180, 270, and 360 postpartum in 30 primiparae and 30 multiparae. Outcomes of the primiparae were found to be similar to those of the more experienced breastfeeding multiparous mothers with respect to infant growth, amount of breast milk transferred, and the frequency of breastfeeding or number of attachments to the breast. Though primiparae took somewhat longer to transfer similar amounts of breast milk to their infants during the initial 45 to 90 days postpartum, feed duration after 90 days was similar to that of the multiparae. Lactation performance of the rural northern Thai mothers in our sample was highly successful with or without previous breastfeeding experience. It may be that a cultural pattern of breastfeeding on demand, strong family support, and traditional practices that encourage close contact between mother and her newborn compensate for the absence of lactational experience. Unlike reports from Western countries, previous breastfeeding does not appear to be an important predictor of successful and prolonged breastfeeding in our population.

Penicillium marneffei mesenteric lymphadenitis in human immunodeficiency virus-infected children.

UNLABELLED: Disseminated P. marneffei infection is one of the common opportunistic infections seen in HIV-infected patients in Southeast Asia. We report 3 cases of HIV-infected children with mesenteric lymphadenitis presented with prolonged fever and abdominal pain. The first two patients were diagnosed as peritonitis and acute appendicitis prior to exploratory laparotomy. Operative findings revealed multiple enlarged mesenteric lymph nodes. Histopathologic findings of mesenteric lymph nodes biopsy were characteristic for P. marneffei infection. Mesenteric lymphadenitis in the last patient was diagnosed by abdominal ultrasound. All three cases had positive blood and bone marrow cultures for P. marneffei. These patients were treated with amphotericin B. Fever declined in 3-6 days. The first two patients survived but the last one subsequently died from underlying hemophilia A (GI bleeding). CONCLUSION: Acute mesenteric lymphadenitis can be one of the unusual manifestations caused by P. marneffei. Southeast Asia is an endemic area for P. marneffei and is severely affected by acquired immunodeficiency syndrome epidemic. Therefore, mesenteric lymphadenitis should be considered in HIV-infected persons who present with prolonged fever and abdominal pain.

Successful sustained lactation following postpartum tubal ligation.

This study was undertaken to see whether tubal ligation performed within days postpartum, and associated with a delay in the initiation of breastfeeding, exerts a disruptive influence on successfully establishing lactation among the rural population of northern Thailand. Lactational performance of 12 rural northern Thai mothers was not affected by the delay in reunion of mothers with their babies as a result of postpartum tubal sterilization procedure when compared with a group of 8 other healthy mothers and babies. The volume of breast milk transferred, frequency of breastfeeding and the total feeding time spent on the breast were similar on days 15, 45, 90, 180 and 360 postpartum. This finding suggests that the pattern of intense breastfeeding activity as practiced by this group of mothers has a stronger influence on prolonged and successful lactation than early contact in the immediate postpartum period.