Endoscopic drainage for pancreatic pseudocyst in children.

The authors report here the results of endoscopic cystogastrostomy performed on 3 children aged 11, 3, and 2.5 years with nonresolving pancreatic pseudocyst (PP) of 12, 9.5, and 7 cm in diameter. The etiology of PP was abdominal trauma in 2 and idiopathic acute pancreatitis in 1 case. Ultrasound and computed tomography scans confirmed the diagnosis and suitability for gastric drainage. After the puncture of cyst, a double pig-tail stent was placed for the permanent drainage of cystogastrostomy. Complete regression was confirmed by follow-up ultrasonography at 8, 6, and 7 weeks, respectively. There were no procedure-related complications, nor was there a recurrence of cyst during the 2 years of follow-up. This report suggests that children with nonresolving PP, that are anatomically accessible, can be treated successfully and safely by endoscopic drainage.

Colonoscopy: evaluating indications and diagnostic yield.

BACKGROUND: Colonoscopic procedure is an accepted modality for the evaluation of colonic disease. Open-access versus restricted-access colonoscopy has been argued over in the recent literature. The aim of this retrospective analysis is to identify the yield of the major indications for the procedure, and the pattern of colon pathology in our community. PATIENTS AND METHODS: We retrospectively analyzed our experience in 3000 colonoscopies over a five-year period. The patients comprised 1145 females (38%) and 1855 males (62%), and their ages ranged from 9 months to 95 years (mean 39.2). There were 2283 patients (76%) who were aged less than 55 years. Complete examination to the cecum was possible in 2850 cases (95%). RESULTS: Pathological findings were identified in 640 patients (21%). The diagnostic yield of patients referred for lower abdominal pain and surveillance was low, at 7% and 17%, respectively. The yield was high for those with lower gastrointestinal bleeding (47%), non-bloody diarrhea (35%), iron deficiency anemia (30%), mass lesions identified by radiology (53%), and polyps identified by radiology (70%). Inflammatory bowel disease was diagnosed in 220 patients, carcinoma in 64 patients, and colonic polyps in 139 patients. CONCLUSION: Colonic diseases are not uncommon in our part of the world. Colonoscopy is a rewarding procedure in those patients referred with lower gastrointestinal bleeding, mass lesions, polyps and diarrhea. The procedure is less rewarding in patients with lower abdominal pain and in those undergoing surveillance colonoscopy. Patient selection on the basis of the presenting complaint may help to utilize the limited resources available to gastroenterologists. About 63% of the procedures were done for indications found to have a low yield. Inflammatory bowel disease is seen with increasing frequency in our population.

The impact of brushing teeth on carbon-14 urea breath test results.

OBJECTIVE: The 14C urea breath test noninvasively detects the presence of the urease-producing bacteria Helicobacter pylori in the stomach. Several sources of errors have been identified to cause false or indeterminate results on the test. The objective of this study was to identify whether brushing teeth affects the test results. METHODS: We performed the 14C urea breath test on 168 patients, with breath samples counted at 10 and 20 min after oral administration of 2 microCi (74 kBq) 14C urea. Ninety-four patients brushed their teeth before the test while 74 did not. RESULTS: Thirty-six of the 74 patients (49%) who did not brush their teeth had positive results at 10 min, which became negative at 20 min. None of the 94 patients who brushed their teeth before testing showed this pattern with agreement of results at 10 and 20 min. CONCLUSION: We recommend brushing teeth before the 14C urea breath test since it significantly decreased the ambiguous results of the test in our laboratory.

Interferon-alpha plus ribavirin combination therapy for the treatment of chronic hepatitis C in interferon non-responders.

BACKGROUND/AIMS: Only a small fraction of patients with chronic hepatitis C have a sustained biochemical or virologic response to a standard course of alpha-interferon therapy. Thus, alternative treatments are needed particularly for non-responders. The main objective of this study was to evaluate the efficacy of alpha-interferon in combination with ribavirin in patients who had not responded to a previous course of alpha-interferon. METHODOLOGY: In this prospective open trial, 26 patients who had not responded to a previous course of interferon monotherapy, were treated for 6 months with a combination of alpha-interferon 2b, 5 MU thrice weekly, plus ribavirin 1000 or 1200 mg daily. They were followed-up for at least 6 months after therapy. RESULTS: At the end of treatment, 3 patients (12%) had normal aminotransferase levels and two (8%) tested negative for HCV-RNA in serum. After 6 months of follow-up, all patients had HCV viremia and only one (3.8%) was still in biochemical remission. One patient dropped out because of side effects and another was lost during follow-up. CONCLUSIONS: alpha-interferon-ribavirin combination is ineffective in treating patients who had had no response to interferon monotherapy.

Lack of transmission of hepatitis C virus following needlestick accidents.

Healthcare workers (HCWs) have an occupational risk of infection with hepatitis C virus (HCV). However, data regarding the magnitude of this risk are limited. We conducted a prospective study on a cohort of 24 HCWs who were exposed to HCV by needlestick injuries involving 25 patients. All source patients were viremic with a mean HCV-RNA level of 1.65 megagenomic equivalents per milliliter. At least 64% of patients were infected with HCV serotype 4 (Simmond's classification). After a follow up period of at least 6 months, none of the exposed HCWs acquired HCV. Thus, HCV does not seem to be easily transmitted by needlestick injuries. However, further large-scale studies are needed for a more accurate estimation of the risk of transmission.

Findings of colonoscopy in children: experience from Kuwait.

This report summarizes our retrospective analysis of 173 colonoscopic examinations performed on 159 children over a period of 9 years in Kuwait. Ninety-six children were males, with a male to female ratio of 1.5:1. The main indications for colonoscopy were rectal bleeding, polyps, and suspected inflammatory bowel disease. Examination was done under sedation or anaesthesia. One hundred and fifty-one (87 per cent) examinations were complete up to the caecum and 89 (51 per cent) up to the terminal ileum. The most common pathology was polyps in 42 children. All but one polyp were hamartomatous and mainly localized to the rectum and sigmoid colon. The majority had a single polyp. One child had adenomatous polyposis coli. One hundred and forty-two polyps were removed endoscopically with no complications. Inflammatory bowel disease was present in 34 (21 per cent) children (17 Crohn's disease, 11 ulcerative colitis, and 6 indeterminate colitis). Tuberculosis of the ileo-caecal region was diagnosed in two cases. Seven patients had rectal ulcers presenting as rectal bleeding. In 11 (7 per cent), the lesions were limited to the right side of the colon or terminal ileum. These results suggest that colonic pathology is not uncommon in children in Kuwait. The disease pattern is similar to that reported in western countries. As we have observed in adults, inflammatory bowel disease is seen in significant numbers among children in this region. In this survey we have observed a change in the disease frequency, Crohn's disease being more common that ulcerative colitis. Without adequate examination, the existence of inflammatory bowel disease and this possible changing pattern of disease would have gone unrecognized.

Helicobacter pylori-associated gastritis in Kuwait: endoscopy-based study in symptomatic and asymptomatic children.

Information is limited concerning the prevalence of Helicobacter pylori infection in asymptomatic children. Since January 1989, we have endoscoped 60 children for recurrent abdominal pain or for obtaining small-intestinal biopsy (their ages were a mean of 6.6 (range 9 months-13 years); there were 37 boys and 23 girls. Antral biopsies were obtained from all subjects and these were studied for the presence of gastritis and stained for H. pylori using modified Gram's stain. All biopsies were cultured for H. pylori. Children endoscoped for small-intestinal biopsy (n = 18) were used for comparison. Of the 42 children who had abdominal pain, 24 showed histological gastritis and 13 had H. pylori on microscopy (31% H. pylori-associated gastritis). In the compared group, five showed histological gastritis, and all had H. pylori on microscopy (27.7%). Culture was positive in 15; sensitivity was 85.7%. Six children, three pairs of siblings, had H. pylori gastritis supporting environmental etiology. Two had coinfection with intestinal giardiasis. Seven children were treated with daily oral amoxycillin (50 mg/kg) and tinidazole (20 mg/kg) for 6 weeks. In 3 (42.3%) H. pylori colonization cleared with healing of gastritis and resolution of symptoms. These results indicate that H. pylori gastritis is equally prevalent in symptomatic and asymptomatic children (31 and 27.7%, respectively; p > 0.05) in our population. It seems that the combination of oral amoxycillin and tinidazole is a poor choice in the treatment of H. pylori-associated gastritis in Kuwaiti children.

Cystic fibrosis and Helicobacter pylori gastritis, megaloblastic anaemia, subnormal mentality and minor anomalies in two siblings: a new syndrome?

Two siblings of consanguineous Arab parents were found to have cystic fibrosis and gastritis associated with Helicobacter pylori, folate deficiency megaloblastic anaemia, subnormal mentality and minor anomalies. The association of H. pylori and megaloblastic anaemia has not been described in patients with cystic fibrosis. H. pylori infection and gastritis is probably more common in patients with cystic fibrosis than appreciated. We believe that the constellation of features in the two sibs represent a possible new autosomal recessive cystic fibrosis-like syndrome.