[Eosinophilic esophagitis. Clinical presentation, allergology and treatment: a series of 22 children]. / L'œsophagite à éosinophiles. Présentation, bilan allergologique et traitement : à propos de 22 cas.

BACKGROUND AND AIMS: Eosinophilic esophagitis (EE) is a disorder characterized by severe eosinophilic infiltration of the esophagus, with dysphagia and gastroesophageal reflux disease (GERD) symptoms unresponsive to acid blockade therapy but responsive to the removal of dietary antigens. We report information relating to children diagnosed with EE in Nice, France, over a 6-year period. PATIENTS AND METHODS: We conducted a retrospective study between January 1, 2004, and July 31, 2009, evaluating all children diagnosed with EE. Clinical and demographic data, endoscopic and histological findings, allergology data, and results of treatment were collected and evaluated. RESULTS: A total of 22 patients, 19 males, median age 9.5 years (range: 0.8-19 years) were reviewed: 7 presented isolated dysphagia, 6 presented GERD symptoms, and 9 both dysphagia and GERD symptoms. Endoscopically, 14 had multiple esophageal white plaques, 7 had linear furrowing, 5 had circular "tracheal" rings, and 5 esophageal narrowing. The median number of esophageal eosinophils/high power field (×400) was 30 (range: 15-80). Eosinophils were localized in the distal, middle, and upper esophagus. Immunoallergy analysis findings were: high peripheral eosinophil count (74%), high total IgE level (65%), high eosinophil cationic protein (ECP) level (90%) with a median value of 69.5 µg/l and high urinary leukotriene E4 (88%). Food antigen sensitization was positive in skin-prick testing in 11 of 18 and in atopy-patch testing in 9 of 17. Dietary restriction improved clinical symptoms in 5 of 10 and local corticotherapy with viscous budesonide improved clinical symptoms in 9 out of 10. CONCLUSION: EE diagnosis must be considered in children with dysphagia or GERD who do not respond to acid blockade therapy. ECP may be used to guide diagnosis. Local corticotherapy is effective.

Prevention of relapse by mesalazine (Pentasa) in pediatric Crohn's disease: a multicenter, double-blind, randomized, placebo-controlled trial.

AIM: This study aimed to test the efficacy of mesalazine in maintaining remission in pediatric Crohn's disease (CD) following successful flare-up treatment. METHODS: In this double-blind, randomized, placebo-controlled trial, 122 patients received either mesalazine 50mg/kg per day (n=60) or placebo (n=62) for one year. Treatment allocation was stratified according to flare-up treatment (nutrition or medication alone). Recruitment was carried out over two periods, as the first period's results showed a trend favoring mesalazine. Relapse was defined as a Harvey-Bradshaw score more than or equal to 5. Time to relapse was analyzed using the Cox model. RESULTS: The one-year relapse rate was 57% (n=29) and 63% (n=35) in the mesalazine and placebo groups, respectively. We demonstrated a twofold lower relapse risk (P<0.02) in patients taking mesalazine in the medication stratum (first recruitment period), and a twofold higher risk in patients taking mesalazine in the nutrition stratum (second recruitment period), compared with the other groups. None of the children's characteristics, which differed across the two recruitment periods, accounted for the between-period variation in mesalazine efficacy. One serious adverse event was reported in each treatment group. CONCLUSION: Overall, mesalazine does not appear to be an effective maintenance treatment in pediatric CD.

[Histiocytosis X and sclerosing cholangitis]. / Histiocytose X et cholangite sclérosante.

The case of a seven-year-old with multifocal (type II) Langheran's cell histiocytosis since the age of two years is reported. Despite therapy, biliary cirrhosis with portal hypertension developed gradually. Histologic studies of liver biopsy specimens, computed tomography, and transhepatic cholangiography disclosed dilatation of the bile ducts, suggesting sclerosing cholangitis, a specific complication of Langherans' cell histiocytosis which precipitates the development of biliary cirrhosis.

[Gastric acid secretion in children with duodenal ulcer]. / Sécrétion acide gastrique de l'enfant atteint d'ulcère duodénal.

Gastric acid secretion was studied in 17 children with primary duodenal ulcer (mean age: 10 yrs 4 mo, rang: 4-16). Eight of the 17 children with primary ulcer had chronic evolution and 10 of them had an affected first degree relative. Basal acid output (BAO) and peak acid output under pentagastrin (PAO) were not significantly different in the 17 children (0.094 +/- 0.085 mmol/kg/hr; 0.483 +/- 0.235 mmol/kg/hr) and in 32 adults with duodenal ulcer (0.073 +/- 0.010 mmol/kg/hr; 0.477 +/- 0.021 mmol/kg/hr). BAO and PAO were not significantly different between children with or without chronic ulcer. The BAO and PAO of children with an affected first degree relative were significantly higher than those of children without (p less than 0.05). This study shows that gastric acid secretions are similar in children and adults with duodenal ulcer. The chronicity of duodenal ulcer in childhood is not associated with increased acid secretion. Gastric acid secretion seems to be higher in children with an affected first degree relative than those without.

[Diagnosis and management of acute viral hepatitis in children]. / Diagnostic et conduite à tenir en présence d'une hépatite virale aiguë de l'enfant.

In a child presenting with acute viral hepatitis, one must answer 3 questions: does it occur on a former liver disease? is it a fulminant hepatitis? which virus is responsible for the hepatitis and which preventive measures are necessary? The responses can be provided through clinical data and simple biological tests.

[Value of barium transit of the small intestine in research on Meckel's diverticulum]. / Intérêt du transit baryté du grêle dans la recherche du diverticule de Meckel.

Twelve children were diagnosed as having a bleeding Meckel diverticulum upon laparotomy. Before surgery, barium small bowel examination was performed according to the Bret technique (J Radiol Paris [1980] 61, 753-758) in 8 cases; the Meckel diverticulum being apparent in all 8 cases. By contrast, a classical technique of barium small bowel examination used in 4 cases, and 99m TC pertechnate scan performed in 7 cases, yielded only negative results. We conclude that barium small bowel examination, when performed according to the Bret's technique, is a very effective method for the diagnosis of Meckel diverticulum.

[Stenosing gastroduodenal ulcer in children. Apropos of 3 cases]. / Ulcères gastro-duodénaux sténosants de l'enfant. A propos de 3 observations.

Three cases of stenosing peptic ulcers in young children (age 21 months, 6 years and 8 years) are reported. During infancy, peptic ulcer is the main cause of pyloric stenosis after pyloric hypertrophy. The stenosis reveals or complicates primary gastric or duodenal ulcers. A complete cure can only be obtained with medical treatment.

[Vaccination against hepatitis B virus]. / La vaccination contre le virus de l'hépatite B.

More than 200 million people infected with hepatitis B virus worldwide, with high risk of developing hepatic disease ranging from chronic hepatitis to hepatocellular carcinoma, underline an imperative need for an efficacious vaccine. Many studies have provided repeated assurance on the safety and efficacy of hepatitis B vaccines derived from plasma pooled from carriers. However, alternative methods for vaccine production are necessary and DNA recombinant vaccines are currently available. Recombinant hepatitis B vaccines are safe, antigenic, and free from side effects. The immunogenicity of yeast hepatitis B vaccine is similar to that of the plasma-derived vaccine. In the mammalian recombinant vaccine, pre-S2 region is added to S region and should confer quicker and stronger efficacy in hepatitis B protection.

Growth failure in cholestatic rats: the effect of malnutrition on insulin-like growth factor I.

Low IGF-I levels are found in patients with chronic liver disease, but it is not known whether these reductions in IGF-I are secondary to hepatic dysfunction or to malnutrition. To determine whether malnutrition associated with hepatic dysfunction causes the decrease in these levels, serum and liver IGF-I concentrations and liver IGF-I mRNA content were compared in three groups of Sprague-Dawley rats: 15 rats underwent bile duct obstruction; 10 rats were sham-operated and pair-fed with operated rats to control for nutritional status; and 12 rats were sham-operated controls fed ad libitum. In addition, IGF-I peptide and mRNA were compared with food intake, crude nitrogen balance, total wt gain, tail length increase and leg muscle wt. All the parameters were lower in cholestatic and nutritionally deprived animals than in control animals (p less than 0.001). There was no difference in serum and hepatic IGF-I and liver IGF-I mRNA values between the 10 cholestatic and pair-fed animals, despite lower crude nitrogen balance, tail length gains, and leg muscle wt in the bile duct-obstructed animals. These studies suggest that in chronic bile duct obstruction, the low serum and hepatic IGF-I levels are primarily due to decreased food intake and appear unrelated to cholestatic liver disease itself. However, factors in addition to suboptimal nutrition and decreased IGF-I levels must also contribute to cholestasis-induced growth failure.

[Idiopathic retroperitoneal hematoma. Apropos of a case]. / Hématome rétropéritonéal idiopathique. A propos d'une observation.

A 10 year-old girl presented with a progressive left ureteral colic with abdominal tenderness. Ultrasonography revealed pyelocalyceal dilatation and an intravenous pyelogram showed lateral deviation of the left ureter. Computed tomography confirmed retroperitoneal mass distinct from psoas. Laparotomy revealed an encapsulated retroperitoneal hematoma. No particular aetiology was found and the patient's health remained stable after treatment.

[Recurrent infections caused by Salmonella typhimurium]. / Infections récidivantes à Salmonella typhi murium.

We report the case of a 27 month-old girl with recurrent Salmonella typhi murium infections. The study of the neutrophil cells showed a transitory selective deficiency of the chemiluminescent response. After 5 months of pefloxacine therapy, recovery was obtained.

Familial extrahepatic biliary atresia.

Only a small number of cases with familial extrahepatic biliary atresia, suggesting a recessive autosomal inheritance, have been reported. However, the cases reported in twins are consistent with an acquired disease. Here the case of two brothers with familial atresia of the extrahepatic biliary system is studied. Diagnosis was confirmed by laparotomy and histologic study of biliary fibrous remnants. In the present cases parental consanguinity might suggest a recessive autosomal inheritance. However, clustering of cases in a family might also suggest a common exposure to responsible factors not so far identified.

[Congenital intrinsic factor deficiency. Apropos of 3 cases in a sibship]. / Déficit congénital en facteur intrinsèque. A propos de 3 cas dans une fratrie.

Three familial cases of congenital intrinsic factor deficiency are reported: the stress is put on the interest of gastric investigations and especially of the quantity of intrinsic factor in the gastric juice when investigating megaloblastic anemia due to vitamin B12 deficiency. The study of the level of intrinsic factor in the gastric juice is proposed as a test for identifying carriers.