Upper gastrointestinal motor abnormalities in children with active celiac disease.

Although from the clinical point of view a GI motor disorder can be suspected in celiac disease, objective evidence for this is still lacking. We therefore conducted a study on children with active celiac disease to detect possible GI motor abnormalities in this disease. Fourteen children (age range, 1-13 years) were studied; they underwent fasting and fed manometric recordings in the gastroduodenojejunal area. Four patients were restudied after a 6-month gluten-free diet. Data were compared with those obtained in eight control children. As compared with controls, celiac disease patients showed a shorter duration of activity fronts (p < 0.01) and a significant (p < 0.01) reduction of the postprandial antral motility index; furthermore, > 90% of the patients displayed marked fasting and/or fed motor abnormalities, suggesting a neuropathic disorder. Interestingly, gut dysmotilities disappeared in the four subjects reassessed after the gluten-free diet. It is concluded that celiac disease frequently affects the motor behavior of the gut and that its effects may be reversed by appropriate diet.

Abnormal gastrointestinal motility in patients with celiac sprue.

No study to date has objectively investigated whether the motor behavior of the small bowel is abnormal in celiac sprue. The purpose of this study was to systematically address this topic by means of intraluminal pressure recordings in a series of such patients. Sixteen subjects (nine adults, seven children, age range 2-69 years) with celiac sprue were recruited and studied while untreated. Manometric examination was carried out for 6 hr during fasting and 3 hr after a meal. Adult celiac patients displayed a significantly (mean +/- SEM) greater frequency of migrating motor complexes in comparison to controls during fasting (4.44 +/- 1.6 vs 2.45 +/- 0.20, P < 0.01), whereas no differences were found in the pediatric group with respect to this variable. Fasting motor abnormalities, chiefly represented by discrete clustered contractions, giant jejunal contractions, and bursts of nonpropagated contractions, were discovered in a high percentage in both groups of celiac subjects (89% in adults and 44% in children, respectively). Similar abnormalities were observed in the postprandial period, especially in adults. In conclusion, patients with celiac sprue frequently display discrete gastrointestinal motor abnormalities, which though perhaps nonspecific may account for several symptoms complained of by such patients.

Anorectal manometric abnormalities and colonic propulsive impairment in patients with severe chronic idiopathic constipation.

Idiopathic chronic constipation is a frequent and disabling symptom, but its pathophysiological grounds are still poorly understood. In particular, there is little knowledge about the relationships between distal (anorectal area) and proximal (colonic area) motor abnormalities in this condition, especially concerning high-amplitude propagated colonic activity. For this purpose, we studied 25 patients complaining of severe idiopathic constipation and categorized them as normal- or slow-transit constipation according to colonic transit time. Twenty-five age-matched controls were also studied. Investigations included standard anorectal motility testing and prolonged (24-hr) colonic motility studies. Analysis of results showed that both groups of constipated patients displayed significantly different (P < 0.05) minimum relaxation volumes of the internal anal sphincter, defecatory sensation thresholds, and maximum rectal tolerable volumes with respect to controls. Patients with normal-transit constipation also showed lower internal anal sphincter pressure with respect to slow-transit constipation and controls (P < 0.001 and P < 0.02, respectively). The daily number of high-amplitude propagated contractions (mass movements) as well as their amplitude and duration, was significantly reduced in both subgroups of constipated patients (P < 0.02 vs controls). We conclude that (1) in normal-transit constipation, motor abnormalities are not limited to the anorectal area; (2) patients with slow-transit constipation probably have a severe neuropathic rectal defect; (3) prolonged colonic motility studies may highlight further the functional abnormalities in constipated subjects; and (4) an approach taking into account proximal and distal colon motor abnormalities might be useful to understand pathophysiological grounds of chronic constipation and lead to better therapeutic approaches.

[Abnormal synthesis of 1,25-dihydroxyvitamin D and hypercalcemia in children with tuberculosis]. / Abnorme sintesi di 1,25-diidrossivitamina D ed ipercalcemia in bambini con tubercolosi.

Three children with tuberculosis and hypercalcemia are reported. Before antitubercular treatment 1,25-dihydroxyvitamin D serum levels and urinary calcium excretion were elevated for age in all patients; vitamin D and 25-hydroxyvitamin D were in normal range whereas serum intact parathyroid hormone concentrations were suppressed. Low calcium diet and antitubercular treatment caused a normalization of serum calcium levels and urinary calcium excretion; 1,25-dihydroxyvitamin D concentrations returned in normal range after three months of antituberculosis therapy. When 1,25-dihydroxyvitamin D was normal, a reintroduction of a diet with normal calcium content did not determine new hypercalcemic episodes. These data suggest that an abnormal 1,25-dihydroxyvitamin D production sustains the hypercalcemia of children with tuberculosis. An ectopic and unregulated synthesis of 1,25-dihydroxyvitamin D by macrophages of granulomatous tissue is proposed.

Bone demineralization and impaired mineral metabolism in insulin-dependent diabetes mellitus. A possible role of magnesium deficiency.

Osteoporosis, a recognized complication of insulin-dependent diabetes mellitus (IDDM), may be related to this complex metabolic disorder; moreover, some data emphasize an altered vitamin D metabolism or parathyroid hormone secretion. Mineral homeostasis was studied in 29 children with IDDM (18 males, 11 females; 2.6-18.0 years). In 17 patients a stimulatory test (low-calcium diet) was performed for PTH and 1.25(OH)2D. Bone mineral content (BMC) and BMC/BW were lower in respect to our normal values; bone mineral loss was directly related to HbA1c levels and insulin requirements. A significant decrease of ionized calcium (p less than 0.001) and magnesium (p less than 0.001) was found; intact PTH values were in the low normal range but decreased for the ionized calcium values. 1.25(OH)2D levels were not significantly different from normal levels. 1.25(OH)2D and intact PTH did not rise during stimulatory test. The lack of 1.25(OH)2D and intact PTH increase after the stimulatory test may be due to the parathyroid gland's hyporesponsiveness related to hypomagnesemia which impaired PTH release and/or PTH action. Our data confirm an involvement of 1.25(OH)2D and PTH regulation in diabetic osteoporosis.

[Dynamic tests for calcium-regulating hormones in childhood. Evaluation of the incremental response in normal subjects]. / Tests dinamici per gli ormoni calciotropi in età pediatrica. Valutazione della risposta incretoria in soggetti normali.

Some tests to study the dynamic secretion of calcium-regulating hormones in childhood are presented. A low-calcium diet (less than or equal to 2 mg/kg/daily) for 1,25-dihydroxyvitamin D [1.25-(OH)-2D], ASU-eel-CT i.m. injection (80 U MRC/1.73 mq) for parathyroid hormone (PTH), and calcium infusion (2 mg/kg in 5') for calcitonin (CT) are employed. A significant increase in 1,25-(OH)-2D level (1 degree day: 47.0 +/- 6.7 pg/ml; 3 degree day: 73.2 +/- 6.9 pg/ml; p less than 0.001; n = 19), intact PTH values (basal: 29.7 +/- 7.5 pg/ml; +120': 68.2 +/- 7.8 pg/ml; p less than 0.001; n = 10) and monomeric CT concentrations (basal: 5.2 +/- 2.3 pg/ml; +10': 26.2 +/- 4.4 pg/ml; p less than 0.001; n = 18) have been observed. The employed tests are able to show a significant increase in calcium-regulating hormones in healthy children. These tests are a simple and reliable method without side-effects that may provide further information on the pathogenesis of some pediatric diseases with altered mineral homeostasis.

[Selective deficit of IgA and infantile rheumatoid arthritis. Case reports]. / Deficit selettivo di IgA ed artrite reumatoide infantile. Contributo clinico.

Three children with selective deficiency of serum IgA associated with oligoarticular juvenile rheumatoid arthritis (JRA) are presented. Before the appearance of JRA, all 3 children had shown frequently some respiratory infections. Indeed IgA deficiency may be asymptomatic or may cause a higher frequency of respiratory, gastrointestinal, allergic or autoimmune diseases, among which, JRA is one of the most important conditions.

Autonomic functions in type 1 (insulin-dependent) diabetes.

In juvenile type 1 diabetes a computer-aided orthoclinostatic test, giving information on central autonomic reactivity, shows a significant difference, vs control subjects, only in the ortho-to-clino transition (not in clino-to-ortho), while no differences emerge in peripheral autonomic functions. The correlations between the mean values of heart rate in lying and standing positions seem to indicate a different response of the baroceptor reflex in the two groups.