The Efficacy of Saccharomyces boulardii CNCM I-745 in Addition to Standard Helicobacter pylori Eradication Treatment in Children / 대한소아소화기영양학회지

PURPOSE: This study aims to investigate Saccharomyces boulardii CNCM I-745 during Helicobacter pylori eradication in children. METHODS: One hundred ninety-four H. pylori positive children were randomized in two groups. Therapy (omeprazole+clarithromycin+amoxicillin or omeprazole+clarithromycin+metronidazole in case of penicillin allergy) was given to both groups during two weeks. In the treatment group (n: 102) S. boulardii was added to the triple therapy, while the control group (n: 92) only received triple therapy. The incidence, onset, duration and severity of diarrhea and compliance to the eradication treatment were compared. A 13C urea breath test was done 4 weeks after the end of eradication therapy in two groups of 21 patients aged 12 years and older to test the H. pylori eradication rate. RESULTS: In the treatment group, diarrhea occurred in 12 cases (11.76%), starting after 6.25+/-1.24 days, lasting 3.17+/-1.08 days, and compliance to eradication treatment was 100%. In the control group, diarrhea occurred in 26 cases (28.26%), starting after 4.05+/-1.11 days, lasting 4.02+/-0.87 days, and in six cases eradication treatment was stopped prematurely (p<0.05). The 13C urea breath test showed successful H. pylori eradication in 71.4% of the patients in the treatment and in 61.9 % in the control group (not significant). CONCLUSION: S. boulardii has a beneficial effect on the prevention and treatment of diarrhea during H. pylori eradication in children. Although S. boulardii did only slightly increase H. pylori eradication rate, compliance to eradication treatment was improved.

[Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children: analysis of 4 cases].

OBJECTIVE: To explore an innovative technique that is aided by multi-disciplinary hybrid approach in identification and treatment of tracheoesophageal fistula (TEF) in children intraoperatively. METHOD: From April 2008 to October 2011, 4 patients with isolated TEF were presented with 2 H-type fistulas and 2 recurrent TEF. For all the four cases, with the cooperation of the gastroenterologists, respiratory physician and surgeon, methylene blue was first injected into the trachea for detecting the dye in the esophagus by the gastroscopy. Bronchoscopy was performed where the fistula tract was shown by the methylene blue and a guide wire was passed through the fistula. The patients underwent rigid gastroscopy and the guide wire was identified and brought out through the mouth by biopsy pliers. This created a wire loop through the fistula. X-ray was then used to identify the level of the fistula. According to the level of the fistula it was determined whether surgical incision and approach should be used. The fistula was then repaired successfully by surgery. RESULT: In the 4 patients, with the aid of gastroscopy and bronchoscopy, identification of the fistula intraoperatively was then facilitated by traction on the loop. The fistula was identified and repaired. There were no fistula recurrences. CONCLUSION: Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children is beneficial for the precise localization of the fistula. This new technique is an effective and definitive method in identification and treatment of TEF in children.