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1.
Eur J Pediatr ; 177(7): 1063-1070, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29717359

ABSTRACT

Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0-18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2-258) h. All children were ≤ 5 (median 1.4; IQR 0.9-2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%). CONCLUSION: Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required. What is Known: • Button battery ingestion may result in serious and fatal complications. • Serious and fatal complications after button battery ingestion are increasing worldwide. What is New: • Sixteen serious complications after button battery ingestion occurred during 2008-2016 in children in the Netherlands. • Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.


Subject(s)
Electric Power Supplies/adverse effects , Esophagus/injuries , Foreign Bodies/complications , Child, Preschool , Eating , Endoscopy/statistics & numerical data , Foreign Bodies/mortality , Humans , Infant , Netherlands , Survival Rate
2.
PLoS One ; 10(10): e0138062, 2015.
Article in English | MEDLINE | ID: mdl-26484665

ABSTRACT

BACKGROUND: Previous studies have suggested the existence of enteropathy in cystic fibrosis (CF), which may contribute to intestinal function impairment, a poor nutritional status and decline in lung function. This study evaluated enterocyte damage and intestinal inflammation in CF and studied its associations with nutritional status, CF-related morbidities such as impaired lung function and diabetes, and medication use. METHODS: Sixty-eight CF patients and 107 controls were studied. Levels of serum intestinal-fatty acid binding protein (I-FABP), a specific marker for enterocyte damage, were retrospectively determined. The faecal intestinal inflammation marker calprotectin was prospectively studied. Nutritional status, lung function (FEV1), exocrine pancreatic insufficiency (EPI), CF-related diabetes (CFRD) and use of proton pump inhibitors (PPI) were obtained from the medical charts. RESULTS: Serum I-FABP levels were elevated in CF patients as compared with controls (p<0.001), and correlated negatively with FEV1 predicted value in children (r-.734, p<0.05). Faecal calprotectin level was elevated in 93% of CF patients, and correlated negatively with FEV1 predicted value in adults (r-.484, p<0.05). No correlation was found between calprotectin levels in faeces and sputum. Faecal calprotectin level was significantly associated with the presence of CFRD, EPI, and PPI use. CONCLUSION: This study demonstrated enterocyte damage and intestinal inflammation in CF patients, and provides evidence for an inverse correlation between enteropathy and lung function. The presented associations of enteropathy with important CF-related morbidities further emphasize the clinical relevance.


Subject(s)
Cystic Fibrosis/complications , Intestinal Diseases/complications , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cystic Fibrosis/metabolism , Cystic Fibrosis/pathology , Fatty Acid-Binding Proteins/blood , Feces/chemistry , Female , Humans , Infant , Inflammation/complications , Inflammation/metabolism , Inflammation/pathology , Intestinal Diseases/metabolism , Intestinal Diseases/pathology , Leukocyte L1 Antigen Complex/analysis , Male , Middle Aged , Nutritional Status , Young Adult
3.
Scand J Gastroenterol ; 46(12): 1435-41, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22029621

ABSTRACT

OBJECTIVES: Addition of a non-invasive marker for intestinal damage to the currently used parameters for celiac disease activity (symptoms, serologic tests and biopsy) might further improve clinical management of celiac disease (CD). Intestinal fatty acid binding protein (I-FABP) is a cytosolic enterocyte protein and sensitive marker for enterocyte damage in the small intestine. We investigated whether serum I-FABP levels can reliably identify villous atrophy in children with a positive CD antibody screening. Moreover, the recovery of I-FABP levels after gluten free diet (GFD) was studied. METHODS: I-FABP levels were analyzed retrospectively in 49 children with biopsy proven CD and in 19 patients with a positive screening but without histological confirmation of CD. Blood was collected before biopsy and repeatedly after the onset of GFD. RESULTS: Initial I-FABP concentrations in CD (median 458 pg/ml) were significantly (p < 0.001) elevated compared to controls (median 20 pg/ml). In the control group, only two of 19 children were found to have elevated I-FABP levels, of which one was subsequently diagnosed with CD after gluten challenge. I-FABP concentrations correlated with severity of villous atrophy. In all CD patients, I-FABP levels decreased quickly after GFD and normalized in 80% of patients within 12 weeks. CONCLUSIONS: Elevated I-FABP levels accurately predict villous atrophy in children with a positive serologic test for CD (positive predictive value 98%). In addition, measurement of I-FABP enables monitoring the response to GFD.


Subject(s)
Celiac Disease/blood , Celiac Disease/pathology , Enterocytes/pathology , Enterocytes/ultrastructure , Fatty Acid-Binding Proteins/blood , Intestinal Mucosa/pathology , Adolescent , Area Under Curve , Atrophy/pathology , Biopsy , Celiac Disease/diet therapy , Child , Child, Preschool , Diet, Gluten-Free , Female , Humans , Infant , Male , Microvilli/pathology , Predictive Value of Tests , ROC Curve , Retrospective Studies , Severity of Illness Index
4.
J Clin Gastroenterol ; 43(8): 727-33, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19359998

ABSTRACT

BACKGROUND AND GOALS: In the clinical management of celiac disease, new noninvasive tools for evaluation of intestinal damage are needed for diagnosis and for follow-up of diet effects. Fatty acid binding proteins (FABP) are potentially useful for this purpose as these are small cytosolic proteins present in enterocytes and sensitive markers for intestinal mucosal damage. First, the distribution and microscopic localization of FABP in the healthy human intestine was examined. Second, levels of circulating FABP were measured in patients with celiac disease before and after introducing a gluten-free diet (GFD) and in healthy controls. STUDY: The distribution and microscopic localization of FABP in normal human intestinal tissue was assessed using surgical intestinal specimens of 39 patients. Circulating levels of intestinal (I)-FABP and liver (L)-FABP were determined in 26 healthy volunteers and 13 patients with biopsy proven celiac disease. Ten of these patients were reevaluated within 1 year after starting GFD. RESULTS: I-FABP and L-FABP are predominantly present in the small intestine, mainly the jejunum. Moreover, FABP are expressed in cells on the upper part of the villi, the initial site of destruction in celiac disease. Circulating levels of FABP are significantly elevated in untreated patients with biopsy proven celiac disease compared with healthy controls (I-FABP: 784.7 pg/mL vs. 172.7 pg/mL, P<0.001; L-FABP: 48.4 ng/mL vs. 10.4 ng/mL, P<0.001). In response to GFD, these concentrations normalize. CONCLUSIONS: Results of this pilot study strongly suggest that FABP can be used as a noninvasive method for assessment of intestinal damage in celiac disease. Besides an additional role in the diagnosis of celiac disease, FABP potentially enable noninvasive monitoring of the GFD effects.


Subject(s)
Celiac Disease/diagnosis , Celiac Disease/pathology , Fatty Acid-Binding Proteins/analysis , Intestinal Mucosa/pathology , Adolescent , Adult , Celiac Disease/diet therapy , Child , Child, Preschool , Diet, Gluten-Free/statistics & numerical data , Enterocytes/metabolism , Enterocytes/pathology , Fatty Acid-Binding Proteins/blood , Female , Humans , Infant , Infant, Newborn , Intestinal Mucosa/metabolism , Male , Middle Aged , Pilot Projects , Young Adult
5.
BMJ Case Rep ; 20092009.
Article in English | MEDLINE | ID: mdl-21887163

ABSTRACT

Anaemia due to obscure gastrointestinal blood loss remains a challenge to the clinician, especially when blood loss is severe enough to result in profound anaemia while further investigations fail to identify the cause of bleeding. A description of how wireless capsule endoscopy revealed a bleeding jejunal haemangioma in a 2.5-year-old boy with recurrent anaemia is given. New techniques such as wireless capsule endoscopy and double balloon enteroscopy are feasible and provide a valuable adjunct to the diagnostic investigation of children with obscure enteral blood loss.

7.
J Pediatr Surg ; 38(11): 1665-6, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14614721

ABSTRACT

Massive small bowel resection often leads to long-term parenteral nutrition. The authors present a term-born, 3-day-old boy with midgut volvulus in whom only 17 cm of small bowel was left after resection. This patient was weaned from parenteral nutrition after 7 months. Temporary parenteral nutrition-associated cholestasis was treated with ursodeoxycholic acid.


Subject(s)
Intestinal Volvulus/congenital , Short Bowel Syndrome/etiology , Anastomosis, Surgical , Breast Feeding , Cholagogues and Choleretics/therapeutic use , Cholestasis/drug therapy , Cholestasis/etiology , Diarrhea, Infantile/etiology , Humans , Infant, Newborn , Intestinal Volvulus/surgery , Intestines/pathology , Intestines/surgery , Liver Function Tests , Male , Necrosis , Parenteral Nutrition/adverse effects , Short Bowel Syndrome/therapy , Steatorrhea/etiology , Ursodeoxycholic Acid/therapeutic use
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