Utilidad de la calprotectina fecal en la enfermedad celiaca pediátrica / Usefulness of the faecal calprotectin on the pediatric coeliac disease

Introducción: El objetivo del presente estudio es analizar el comportamiento de la calprotectina fecal en los pacientes pediátricos con enfermedad celiaca, comparando sus niveles mientras recibían dieta con y sin gluten. También se han incluido en la comparación pacientes sanos y con diversas patologías digestivas no inflamatorias. Material y métodos: Se han recogido muestras de heces de pacientes celiacos con diagnóstico de novo (con gluten) y pacientes en seguimiento (sin gluten). Se incluyeron en el grupo control niños sanos sin patología digestiva y otros con diversos trastornos digestivos no diagnosticados de enfermedad inflamatoria intestinal. Resultados: La calprotectina fecal fue significativamente más alta en los pacientes celiacos que recibieron una dieta con gluten (119,2 ± 122,6 µg/g) que en los que recibieron una dieta sin gluten (21,5 ± 24,7 µg/g). Estos últimos presentaron valores similares al grupo control sano. Conclusiones: La calprotectina fecal está elevada en los pacientes celiacos con ingesta de gluten respecto a los celiacos con dieta sin gluten y los pacientes sanos. Este marcador podría usarse para la detección precoz de la ingesta de gluten (AU)

Introduction: The objective of the present research is to study the behavior of the faecal calprotectin in the pediatric coeliac disease, comparing its levels while receiving a diet with and without gluten. For the comparison, there were also included healthy children, and patients with diverse non-inflammatory digestive pathologies. Materials and methods: There have been collected stool samples from de novo coeliac patients (with gluten) and from follow-up coeliac patients (without gluten). As control groups, there were included healthy children without any digestive pathology and others with diverse digestive non-diagnosed disorders from the inflammatory bowel disease. Results: The faecal calprotectin was significantly higher in the coeliac patients with gluten (119.2 ± 122.6 µg/g) than in the patients with the gluten-free diet (21.5 ± 24.7 µg/g). The later showed similar values to those in the healthy control group. Conclusions: The faecal calprotectin is higher in the coeliac patients with gluten ingestion than in the coeliac patients with the gluten-free diet and in the healthy group. This could be used as a marker for early detection of gluten ingestion (AU)

Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome dedumping tras cirugía de Nissen laparoscópico / Modifications of the glucose curves and gastric voiding of children with dumping syndrome after laparoscopic nissen surgery

Introducción. Se ha asistido a una importante evolución del tratamiento quirúrgico en los últimos años por la generalización progresiva de la cirugía laparoscópica. Todas las técnicas disponibles pueden hacerse laparoscópicamente con similares resultados a los de la cirugía abierta. En 1978, Villet et al. describieron el síndrome de Dumping (SD) como una complicación frecuente de la fundoplicatura de Nissen. EL SD es un complejo de signos y síntomas que aparecen poco después de la cirugía, incluyendo dolor abdominal, palidez, sudoración, diarrea, náuseas, palidez, incluso pérdida de peso. Los síntomas se pueden diferenciar en dumping precoz, que ocurre entre 30 y 60 minutos después de la comida, y tardío, que ocurre entre 90-240 min. del período postprandial. Material y métodos. Se han estudiado 8 pacientes (3 niños y 5niñas) de edades comprendidas entre 3 y 12 años (media de 9 años) diagnosticados de síndrome de dumping tras la realización de Nissen-Rosseti laparoscópico. A todos ellos se les realizó un estudio de vaciadogástrico por gammagrafía tras administración de un volumen de leche adecuado a su peso marcado con Tc99 DTPA y Test de sobrecarga ora (..) (AU)

Introduction. There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet etal. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period (..) (AU)

[Modifications of the glucose curves and gastric voiding of children with Dumping syndrome after laparoscopic Nissen surgery]. / Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome de dumping tras cirugía de nissen laparoscópico.

INTRODUCTION: There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet et al. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period. MATERIAL AND METHODS: A total of 8 patients (3 boys and 5 girls) have been studied. Their ages ranged from 3 to 12 years (mean 9 years), and they were diagnosed of dumping syndrome after performing the laparoscopic Nissen-Rossetti. All underwent a gastric voiding study by scintigraphy after administration of a volume of milk adjusted to their weight labeled with 99Tc-DTPA and oral glucose overload test with 1.75 g/kg of glucose, determining the baseline glycemia and every 30 minutes post-intake, at 0, 30 and 90 minutes. Insulin was also measured to obtain the glucose/insulin ratio. This study was conducted for all patient diagnosed of dumping syndrome before and after laparoscopic Nissen-Rossetti surgery. RESULTS: The following results were obtained: Glucose Curve: 1. Maximum glycemia. PreNissen. The mean of the maximum glycemia values before surgery was 133.9+/-32.11 mg/dl. Post-Nissen. Mean maximum glycemias after surgery was 208.5 +/- 45.07 mg/dl with a range of 147-276 mg/dl. These differences of maximum glycemia were clearly significant with a p <0.002. Minimum glycemia. The mean value of the minimum glycemias after the surgery, compared with the previous value, did not show significant differences: 62.6+/- 11.51 mg/dl versus 71.8 +/- 28.04 mg/dl. Glucose/insulin ratio. The hyperinsulinism values after the intervention studied by means of the glucose/insulin ratio were abnormal in 70.5% (defined as ratio under 3). The mean value was also characteristic of hyperinsulinism (2.3 +/- 1.62). The mean value of the coefficient prior to the surgery was 4.6 with a deviation of 3.04, the differences not being statistically significant with a p= 0.097. Measurement of gastric voiding: The T1/2 (decay) value in post-Nissen patients was significantly lower than in pre-Nissen patients. The postsurgical mean and standard deviation was 29.74 +/- 7.92 min, while in the presurgical group, the mean and standard deviation was 73.75 +/- 28.34 min with p< 0.011; statistically significant. CONCLUSIONS: From the values obtained, we can state that a significant increase in maximum glycemia has been found in all children after surgery who were diagnosed of dumping syndrome and a significant decrease in the mean time of gastric voiding and therefore an increase in the acceleration of gastric voiding after the performance of the Nissen regarding the previous values. The dumping syndrome is a frequent side effect that we must keep in mind in patients who have been previously operated for anti-reflex surgery, the symptoms being greater in most of the transitory cases. Furthermore, it is important to keep in mind because it has an easy treatment that reverts the symptoms in a short time

Patrón gammagráfico del síndrome de dumping / Scintigraphic pattern of dumping syndrome

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