Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus.

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs. This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Awareness of food allergies: a survey of pediatricians in Kuwait.

BACKGROUND: Early diagnosis of food allergies (FA) is important for a favorable prognosis. This study aimed to determine the level of awareness of FA among pediatricians in Kuwait. METHOD: A 43-item self-administered questionnaire was designed and distributed to pediatricians working at 4 government hospitals in Kuwait. RESULTS: A total of 140 pediatricians completed the questionnaire, with a participation rate of 51.1% (81 males and 59 females). The mean age of participants was 40.81 years, and the mean number of years working in pediatrics was 13.94 years. The mean overall knowledge score was 22.2. The pediatricians' overall knowledge scores were found to be significantly associated with their age (older pediatricians had higher overall scores) and years of experience as a pediatrician but were independent from hospital site, gender, or rank. A multiple linear regression revealed pediatrician age and gender were the only variables that were significantly associated with the overall knowledge score. Only 16.4% of the participants answered at least 2/3 of the survey questions correctly. The questions that were correctly answered by ≤ 2/3 of the participants constituted 80% of clinical presentation questions, 66.6% of diagnostics questions, 77.7% of treatment questions, and 42.8% of prevention questions. Interestingly, among 68 pediatricians (48.5%) who determined that they felt comfortable evaluating and treating patients with FA, only 12 (17.6%) passed the questionnaire. CONCLUSIONS: This survey demonstrates that there is a noteworthy deficiency of pediatricians' awareness about FA. The implementation of strategies to improve pediatricians' awareness is critical to diagnose food allergy patients early and improve their health and outcomes.

Celiac disease in children: is it a problem in Kuwait?

BACKGROUND: Celiac disease (CD) is a chronic inflammatory disease of the small intestine triggered by gluten ingestion. The objective of this study is to describe our experience with CD children in Kuwait. METHODS: The records of children with CD seen in the pediatric gastroenterology unit between February 1998 and December 2010 were retrospectively reviewed. Patients were referred because of symptoms or positive CD antibody screening of a high-risk group (type 1 diabetes and Down syndrome). RESULTS: Forty-seven patients were diagnosed: 53% were symptomatic and 47% were identified by screening. The median age at diagnosis was 66 (range 7-189) months. All cases were biopsy-proven except one. The symptomatic patients were significantly younger than those identified following screening (P<0.004). In the whole group, 66% were females and 77% were Kuwaitis; 9% had a positive family history of CD. The estimated cumulative incidence was 6.9/10(5). The median duration of symptoms before diagnosis was 8.5 (range 2-54) months. Failure to thrive was the most common presenting complaint (72%) followed by diarrhea (64%) and abdominal distension (56%). Atypical manifestations were seen in 60% of patients. Underweight and short stature were confirmed in 19% and 17% of patients, respectively. Overweight and obesity were detected in 14% and 6%, respectively. CD serology was based on a combination of antiendomysial and antigliadin antibodies. The median follow up was 24 (range 12-144) months. All patients were commenced on a gluten free diet, but good compliance was only achieved in 78%. CONCLUSION: The low frequency of childhood CD in Kuwait could probably be attributed to either an underestimation of the atypical presentations or failure of proper screening. Also, adherence to a gluten free diet is a major problem in our population.

The rising tide of overweight among Kuwaiti children: study from Al-Adan Hospital, Kuwait.

OBJECTIVE: This study was designed to screen patients who sought medical services in the Pediatric Outpatient Department, Al-Adan Hospital, Kuwait for overweight. SUBJECTS AND METHODS: Body mass index (BMI) was used to screen 361 children (≤10 years old) for risk of overweight and overweight (BMI between 85th and 94th, and ≥95th percentile, respectively). Overweight children were fully examined and abdominal ultrasound was done for each of them. RESULTS: Of the 361 children, 52 (14.41%) and 77 (21.33%) were at risk of overweight and overweight, respectively. There was a slight male predominance for overweight (40 males, 51.95%, compared to 37 females, 48.05%) and within the overweight category; 28 males (70%) and 26 females (70.27%) were above 6 years of age. In overweight children over 6 years, 4 (7.41%) had hepatomegaly with fatty changes and 3 (5.56%) had blood pressure above the 95th percentile for age and sex. CONCLUSION: Childhood overweight at Al-Adan Hospital was high and increased with age. Hence childhood screening for overweight is recommended at an early age because it is an important risk factor of chronic diseases.

Homocystinuria with lower gastrointestinal bleeding: first case report.

OBJECTIVE: To report a rare complication of homocystinuria in a child and highlight the association of homocystinuria with lower gastrointestinal bleeding and intestinal thrombosis. CLINICAL PRESENTATION AND INTERVENTION: A 7-year-old boy with homocystinuria and poor compliance with treatment presented with abdominal pain and bloody stools. Doppler ultrasound showed superior mesenteric and middle colic vein thrombosis. Laparotomy demonstrated ischemic small bowel necessitating resection. The patient improved clinically following resection and the initiation of the anticoagulation with homocystinuria treatment and was discharged home. CONCLUSION: This case showed the need to sustain a high index of suspicion of thromboembolism in a patient with homocystinuria and lower gastrointestinal bleeding and the importance of compliance with treatment to avoid vascular complications.

Acute hepatic failure in pediatric H1N1 infection: a case report from Al-Adan Hospital, Kuwait.

Liver involvement in pediatric influenza A (H1N1) infection is rare. Focused clinical evaluation and laboratory tests can rule out or identify hepatic complications early on. Here we report on a 9-year-old boy treated by the Gastroenterology, Hepatology, and Nutrition Unit of Al-Adan Hospital's Pediatric Department. The patient, who was infected with H1N1 during the 2010 pandemic, showed symptoms of associated acute hepatic failure, was managed conservatively, and recovered completely following treatment. The author would like to draw the attention of pediatricians to the hepatic aspect of human H1N1 infection in order for them to recognize it early and treat it in a timely manner.