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1.
Pediatr Int ; 62(12): 1315-1331, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32657507

ABSTRACT

The Japan Pediatric Helicobacter pylori Study Group published the first guidelines on childhood H. pylori infection in 1997. They were later revised by the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (JSPGHAN). The H. pylori eradication rates, when employing triple therapy with amoxicillin and clarithromycin, currently recommended as the first-line therapy of H. pylori infection in Japan, have substantially decreased, creating an important clinical problem worldwide. In Japanese adults, the "test-and-treat" strategy for H. pylori infection is under consideration as an approach for gastric cancer prevention. However, the combined North American and European pediatric guidelines have rejected such a strategy for asymptomatic children. As risk for gastric cancer development is high in Japan, determining whether the "test-and-treat" strategy can be recommended in children has become an urgent matter. Accordingly, the JSPGHAN has produced a second revision of the H. pylori guidelines, which includes discussion about the issues mentioned above. They consist of 19 clinical questions and 34 statements. An H. pylori culture from gastric biopsies is recommended, not only as a diagnostic test for active infection but for antimicrobial susceptibility testing to optimize eradication therapy. Based upon antimicrobial susceptibility testing of H. pylori strains (especially involving clarithromycin), an eradication regimen including use of the antibiotics to which H. pylori is susceptible is recommended as the first-line therapy against H. pylori-associated diseases. The guidelines recommend against a "test-and-treat" strategy for H. pylori infection for asymptomatic children to protect against the development of gastric cancer because there has been no evidence supporting this strategy.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Proton Pump Inhibitors/therapeutic use , Adolescent , Amoxicillin/therapeutic use , Biopsy/methods , Child , Child, Preschool , Clarithromycin/therapeutic use , Delphi Technique , Drug Resistance, Bacterial , Drug Therapy, Combination , Gastroenterology , Helicobacter Infections/diagnosis , Humans , Infant , Japan , Microbial Sensitivity Tests/methods , Stomach Neoplasms/epidemiology
2.
Clin Pediatr Endocrinol ; 17(1): 1-7, 2008.
Article in English | MEDLINE | ID: mdl-24790355

ABSTRACT

Pain resulting from needle injection is a serious problem for patients that self-administer medication at home. We studied impressions of needle use by comparing PenNeedle® 32G Taper (NovoFine® 32G Tip), developed to reduce the sense of fear and pain of injection, with a conventional needle, in children self-injecting GH. A total of 34 patients self-injected themselves with needles coupled with Norditropin® NordiFlex® pre-filled recombinant human GH, and impressions of use were evaluated by a series of questionnaires. Compared to the conventional needle, PenNeedle 32G Taper was slightly less painful at time of insertion according to patient responses, though the difference was not statistically significant (P=0.06). PenNeedle 32G Taper has the same inner diameter as the conventional needle, thus there was no difference in the pain felt at time of injection between these two needles. Large differences in pain perception between the two needles were not seen probably due to their similar shape and appearance and as the subjects of this study were young. Nevertheless, based on the results of post-study questionnaires, significantly more patients (68%, P=0.02) expressed a desire to use PenNeedle 32G Taper for daily injections of GH. PenNeedle 32G Taper thus appears to be a superior needle which reduces insertion-associated pain in children receiving recombinant GH and improves patient QOL.

3.
Nihon Rinsho ; 64(6): 1168-72, 2006 Jun.
Article in Japanese | MEDLINE | ID: mdl-16768127

ABSTRACT

It has long been recognized that hepatic steatosis (fatty liver) occurs in obese children as in adults. Steatosis of any etiology can be associated with the development of necro-inflammation and fibrosis, so called steatohepatitis, and even cirrhosis. Nonalcoholic steatohepatitis (NASH) has been proposed as a component of insulin resistant syndrome and exists in pediatric population. The other etiology of NASH in children has not been clearly understood. In addition to obesity, adipose tissue distribution also appears to influence metabolic complications. Subjects with visceral fat adiposity appear to be at risk for fatty liver because of their ability to transport free fatty acids directly into the portal vein for conversion to triglycerides within the liver. A stronger relationship of serum ALT to visceral adiposity than BMI was demonstrated. Many metabolic diseases such as Wilson's disease, NICCD, OTC deficiency, carnitine deficiency have steatohepatitis and cirrhosis. It may play the important role to reveal the mechanism of progress to NASH.


Subject(s)
Fatty Liver/etiology , Child , Fatty Acids, Nonesterified/metabolism , Fatty Liver/diagnosis , Fatty Liver/physiopathology , Fatty Liver/therapy , Humans , Insulin Resistance , Intra-Abdominal Fat/metabolism , Liver/metabolism , Metabolic Diseases/complications , Obesity/complications , Prognosis , Risk Factors
4.
Dig Dis Sci ; 51(1): 99-104, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16416219

ABSTRACT

The purpose of this study was to determine whether Helicobacter pylori infection and mucosal inflammation result in gastric atrophy in Japanese children. A total of 196 patients ages 1-16 years were retrospectively studied: 131 patients were infected with H. pylori and 65 patients were uninfected. Antral (n = 196) and corpus biopsy specimens (n = 70) were investigated based on the Updated Sydney system. In both the antrum and corpus, H. pylori-infected patients showed significantly higher degrees of inflammation and activity of gastritis, compared with noninfected patients. The prevalence of grade 2 or 3 atrophy in the antrum was 10.7% in H. pylori-infected patients and 0% in the noninfected patients (P < .01) and in corpus 4.3% and 0%, respectively (P = .20). The frequency of intestinal metaplasia in the 2 study groups was 4.6% and 4.6% in the antrum and 0% and 4.2% in the corpus, respectively. Among H. pylori-infected patients, the antrum showed significantly higher degrees of H. pylori density, inflammation and activity of gastritis, and atrophy than the corpus. In the antrum, atrophy was significantly correlated with activity, whereas in the corpus, atrophy correlated with H. pylori density, inflammation, and activity. H. pylori-induced gastric inflammation can cause atrophy in Japanese children, predominantly in the antrum. It remains to be determined whether H. pylori-infected children with gastric atrophy are at increased risk for gastric cancer.


Subject(s)
Gastritis, Atrophic/etiology , Helicobacter Infections/complications , Helicobacter pylori/isolation & purification , Adolescent , Biopsy , Child , Child, Preschool , Female , Gastric Mucosa/microbiology , Gastric Mucosa/pathology , Gastritis, Atrophic/epidemiology , Gastritis, Atrophic/pathology , Helicobacter Infections/epidemiology , Helicobacter Infections/microbiology , Humans , Incidence , Infant , Japan/epidemiology , Male , Retrospective Studies , Risk Factors
5.
J Pediatr Surg ; 40(12): 1848-51, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16338303

ABSTRACT

BACKGROUND/PURPOSE: Laparoscopic pyloromyotomy has recently gained wide acceptance as the optimum treatment of infantile hypertrophic pyloric stenosis (IHPS). However, medical treatment may be superior to laparoscopic surgery in invasiveness. The efficacy of our regimen of intravenous atropine therapy for IHPS was assessed in comparison with surgical treatment. METHODS: Medical treatment was initially chosen for 52 (61%) of 85 infants with IHPS at our institute between 1996 and 2004. Atropine was given intravenously at 0.01 mg/kg 6 times a day before feeding. When vomiting ceased and the infants were able to ingest 150 mL/kg per day of formula after stepwise increases in the feeding volume, they were given 0.02 mg/kg atropine 6 times a day orally, and the dose was decreased stepwise. RESULTS: Of the 52 patients, 45 (87%) ceased projectile vomiting with treatment using intravenous (median, 7 days) and subsequent oral (median, 44 days) atropine administration. The median hospital stay was 13 days (6-36), and no significant complications were encountered during atropine therapy. The remaining 7 patients required surgery. Of 40 who underwent surgery, 4 had wound infections and 1 with hemophilia had postoperative hemorrhagic shock. The patients who underwent successful atropine therapy had body weights comparable with those who underwent surgery at the age of 1 year. CONCLUSIONS: The high success rate of intravenous atropine therapy for IHPS suggests that this therapy is an effective alternative to pyloromyotomy if the length of the hospital stay and the necessity of continuing oral atropine medication are accepted.


Subject(s)
Atropine/therapeutic use , Parasympathomimetics/therapeutic use , Pyloric Stenosis, Hypertrophic/drug therapy , Atropine/administration & dosage , Female , Humans , Infant , Infant, Newborn , Infusions, Intravenous , Laparoscopy , Male , Parasympathomimetics/administration & dosage , Postoperative Complications , Pyloric Stenosis, Hypertrophic/complications , Pyloric Stenosis, Hypertrophic/surgery , Retrospective Studies , Treatment Outcome , Vomiting/etiology
6.
Pediatr Surg Int ; 21(10): 850-2, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16189674

ABSTRACT

The authors present a neonatal case of allergic colitis, which manifested the difficulty of spontaneous defecation and irregular narrowing of distal rectum in contrast enema. Rectal suction biopsy showed positive acetylcholinesterase activity. These clinical, radiological and histological findings were indistinguishable from Hirschsprung's disease. Gastrointestinal symptoms were improved by the cessation of cow's milk formula. The present findings may impact on the less recognizable gastrointestinal manifestation of allergic colitis.


Subject(s)
Colitis/diagnosis , Hirschsprung Disease/diagnosis , Milk Hypersensitivity/diagnosis , Animals , Cattle , Colitis/etiology , Colitis/pathology , Diagnosis, Differential , Hirschsprung Disease/pathology , Humans , Infant , Male , Milk Hypersensitivity/complications , Milk Hypersensitivity/pathology
7.
Biosci Biotechnol Biochem ; 69(8): 1453-8, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16116271

ABSTRACT

Lipid vesicles are potentially useful as microcapsules for drug and/or gene delivery. We developed cationic lipid vesicles consisting mainly of sorbitan monooleate (Span 80) and cationic peptide lipid (CPL), and evaluated the CPL vesicles as gene transfection vectors. The optimum CPL concentration for gene transfection into HeLa cells was found to be 20 wt % of total lipid, and such CPL vesicles did not exhibit significant cytotoxicity. Co-culture of Poly-L-lysine and plasmids prior to making CPL vesicle-plasmid complexes was effective. Lipofection using LipofectAMINE was suppressed in 10% serum-supplemented medium. The transfection efficiency of 20 wt % CPL vesicles, however, was not affected by serum in the medium when plasmids were treated with poly-L-lysine.


Subject(s)
Lipids/chemistry , Peptides/chemistry , Transfection , Blood , Culture Media , HeLa Cells , Humans
8.
Helicobacter ; 9(6): 669-73, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15610082

ABSTRACT

BACKGROUND AND AIM: The stool antigen enzyme immunoassay (EIA) methods are widely used for diagnosing Helicobacter pylori infection. Recently, a novel, rapid stool antigen test, the lateral flow immunoassay (LFI) method, has been developed. The primary purpose of this study was to compare the EIA method with the LFI method for the diagnosis of H. pylori infection in children. MATERIALS AND METHODS: Stool specimens from children being evaluated for H. pylori infection were also examined using the LFI (ImmunoCard STAT! HpSA) and EIA methods (Premier Platinum HpSA). The sensitivity, specificity and accuracy of the test were based on the 13C-labeled urea breath test. RESULTS: One hundred and eighty-two children and adolescents, 3-17 years of age (mean 9.2 years), were studied. In addition, 29 patients who received eradication therapy were re-evaluated 2 or 3 months post-treatment. The 13C-labeled urea breath test was positive in 64 patients (35.2%). The sensitivity, specificity and accuracy of the LFI method were 90.6% (95% CI = 80.7-96.5%), 95.8% (92.1-99.4%), and 94.0% (90.5-97.4%), respectively and for the EIA method, sensitivity, specificity and accuracy were 96.8% (95% CI, 89.0-99.6%) and 99.2% (97.5-100%), and 98.3% (96.5-100%), respectively. There were no significant differences in results among the age groups 3-5, 6-10 and 11-17 years. As for the assessment of H. pylori eradication, the results of the LFI and EIA methods agreed with those of 13C-urea breath test in 27/29 and 29/29 patients, respectively. CONCLUSIONS: The LFI stool antigen method showed a good sensitivity, specificity and accuracy for diagnosing H. pylori infection in children. This novel method may be useful in clinical practice as an office-based test because it is rapid, reliable and easy to perform.


Subject(s)
Antigens, Bacterial/analysis , Feces/microbiology , Helicobacter Infections/diagnosis , Helicobacter pylori , Immunoassay , Immunoenzyme Techniques , Adolescent , Age Factors , Child , Child, Preschool , Female , Helicobacter pylori/isolation & purification , Humans , Japan , Male , Predictive Value of Tests , Sensitivity and Specificity , Urease/analysis
9.
J Gastroenterol ; 39(9): 838-43, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15565402

ABSTRACT

BACKGROUND: Large-scale clinical trials in children are lacking concerning Helicobacter pylori eradication therapies. The purpose of this study was to assess the efficacy of proton pump inhibitor (PPI)-based triple therapies in Japanese children. METHODS: This was a retrospective analysis of the first- and second-line PPI-based triple therapies from pediatric gastrointestinal units between 1996 and 2003. Data collected included doses and duration of regimens, drug compliance, success or failure of eradication, ulcer healing, and symptom response of those with dyspepsia and no ulcers. The results of antibiotic susceptibility tests were also reported in cases where these were performed. RESULTS: A total of 149 pediatric patients (mean age, 12.6 years) were studied, including 123 patients who received first-line therapy: 115 received a PPI plus amoxicillin and clarithromycin (PAC) and 8 received a PPI plus amoxicillin and metronidazole (PAM). Overall eradication rates of the first-line PAC and PAM therapies were 77.4% and 87.5%, respectively ( P = 0.68). All 14 patients with failed PAC therapy received the second-line PAM regimen, resulting in an eradication rate of 100%. Mild side effects were reported only in PAC regimens (13.8%). Primary resistance to amoxicillin, clarithromycin, and metronidazole was detected in 0%, 34.7%, and 12.5% of the strains, respectively. The PAC regimen showed a high eradication rate for clarithromycin-susceptible strains (91.7%), but was relatively ineffective for resistant strains (40.0%) ( P < 0.01). Eradication of H. pylori was associated with ulcer healing and symptomatic improvement among those with gastritis only (both; P < 0.001). Among 17 patients with iron-deficiency anemia, post-treatment hemoglobin levels were higher than the pretreatment levels ( P < 0.001). CONCLUSIONS: The PAC regimen is effective in children. Clarithromycin resistance is associated with eradication failure. Metronidazole is a good substitute for clarithromycin as the second-line option for children.


Subject(s)
Anti-Ulcer Agents/therapeutic use , Helicobacter Infections/drug therapy , Omeprazole/analogs & derivatives , Proton Pump Inhibitors , 2-Pyridinylmethylsulfinylbenzimidazoles , Adolescent , Amoxicillin/therapeutic use , Benzimidazoles/therapeutic use , Child , Child, Preschool , Clarithromycin/pharmacology , Clarithromycin/therapeutic use , Drug Resistance, Microbial , Drug Therapy, Combination , Humans , Infant , Lansoprazole , Metronidazole/pharmacology , Metronidazole/therapeutic use , Microbial Sensitivity Tests , Omeprazole/therapeutic use , Pantoprazole , Rabeprazole , Retrospective Studies , Sulfoxides/therapeutic use
10.
J Pediatr Gastroenterol Nutr ; 38(3): 317-23, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15076634

ABSTRACT

OBJECTIVES: Gastroesophageal reflux disease (GERD) is difficult to control with medical therapy in neurologically impaired children. The gamma-aminobutyric acid type B receptor agonist baclofen was recently reported to reduce reflux in adult patients with GERD by reducing the incidence of transient lower esophageal sphincter relaxations. The current study was undertaken to investigate the effects of baclofen on GERD in neurologically impaired children. METHODS: Eight neurologically impaired children with GERD between 2 months and 16 years were studied. Baclofen (0.7 mg/kg/day) was administered orally or via nasogastric tube in three divided doses 30 minutes before meals for 7 days. The frequency of emesis on and off baclofen were recorded as a measure of clinical impact. Twenty-four-hour esophageal pH monitoring was conducted before and on the seventh day of the administration of baclofen. RESULTS: The frequency of emesis was significantly decreased (P = 0.03). The total number of acid refluxes was significantly decreased both during the entire 24-hour period (P = 0.01) and during the postprandial period (P = 0.049). The number of acid refluxes longer than 5 minutes was significantly decreased during the 24-hour period (P = 0.02). The percentage total time of esophageal pH <4.0 and esophageal acid clearance time were not significantly different during the 24-hour period or during the postprandial period. No adverse effects were observed, except for a slight reduction in muscle tone in one subject. CONCLUSIONS: In this 1-week trial, repetitive administration of baclofen reduced the frequency of emesis and the total number of acid refluxes in neurologically impaired children with GERD.


Subject(s)
Baclofen/therapeutic use , GABA Agonists/therapeutic use , Gastroesophageal Reflux/drug therapy , Vomiting/drug therapy , Administration, Oral , Adolescent , Cerebral Palsy/complications , Child , Child, Preschool , De Lange Syndrome/complications , Esophagus/chemistry , Female , Gastric Acidity Determination , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/etiology , Humans , Hydrogen-Ion Concentration , Infant , Intubation, Gastrointestinal , Male , Monitoring, Ambulatory , Monitoring, Physiologic , Postprandial Period , Spasms, Infantile/complications , Treatment Outcome , Vomiting/epidemiology , Vomiting/etiology
11.
Chem Pharm Bull (Tokyo) ; 51(8): 1015-20, 2003 Aug.
Article in English | MEDLINE | ID: mdl-12913250

ABSTRACT

Synthesis of (1R,2S,5S,6R,8S)-3-azabicyclo[3.3.0]octane-2,6,8-tricarboxylic acid (2) from trans-4-hydroxy-L-proline (5) was attempted. A Diels-Alder reaction of 3,4-dehydroproline derivative 9 and cyclopentadiene afforded a single stereoisomer 11. The Diels-Alder adduct was smoothly converted to the hydrochloride of 2 (24) via RuO(4) oxidation. Although some racemization of the material or product was observed during the synthetic processes, the amino acid 24 proved to be optically pure.


Subject(s)
Octanes/chemical synthesis , Tricarboxylic Acids/chemical synthesis , Optical Rotation
12.
Am J Gastroenterol ; 97(7): 1668-73, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12135016

ABSTRACT

OBJECTIVES: In adults, the 13C-urea breath test (UBT) has been widely used as a noninvasive test of Helicobacter pylori infection because of its high sensitivity and specificity. However, this test is less well established in pediatric practice. The optimum cutoff value and test protocol of the 13C-UBT remains to be established in the pediatric population. The primary purpose of this study was to evaluate diagnostic accuracy of the 13C-UBT for children and to determine its optimum cutoff value. METHODS: A total of 220 Japanese children aged 2-16 yr (mean = 11.9) who underwent upper GI endoscopy and gastric biopsies were finally studied. Endoscopic diagnoses included gastritis (n = 131), gastric ulcer (n = 15), duodenal ulcer (n = 72), and combined ulcer (n = 2). H. pylori infection status was confirmed by biopsy tests including histology, urease test, and culture. With the 13C-UBT, breath samples were obtained at baseline and at 20 min after ingestion of 13C-urea without a test meal and were analyzed by isotope ratio mass spectrometry. Based on biopsy tests, a cutoff value was determined using a receiver operating characteristic curve. In 26 children (seven children infected and 19 noninfected), paired breath samples were also measured by nondispersive infrared spectometry (NDIRS). RESULTS: Biopsy tests demonstrated that 89 children (40%) were infected with H. pylori and 131 children were not infected. There were no statistical differences in mean delta 13C values at 20 min between male and female H. pylori-infected and noninfected patients. A receiver operating characteristic analysis defined the best cutoff value as 3.5 per thousand. The overall sensitivity and specificity at a cutoff value of 3.5 per thousand were 97.8% (95% CI = 92.1-99.7%) and 98.5% (95% CI = 96.4-100%), respectively: high sensitivity and specificity were demonstrated in all three age groups (< or =5, 6-10, and > or = 11 yr). There was a close correlation between the values with isotope ratio mass spectrometry and NDIRS methods (r = 0.998, p < 0.001). CONCLUSIONS: The 13C-UBT with a cutoff value of 3.5 per thousand is an accurate diagnostic method for active H. pylori infection. The test with the NDIRS method is inexpensive and might be widely applied in clinical practice.


Subject(s)
Breath Tests , Helicobacter Infections/diagnosis , Helicobacter pylori , Adolescent , Carbon Isotopes , Child , Child, Preschool , Female , Humans , Infant , Japan , Male , Mass Spectrometry , Reproducibility of Results , Sensitivity and Specificity , Spectrophotometry, Infrared
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