Liver pathology in children with newly diagnosed celiac disease.

AIM OF THE STUDY: To evaluate the prevalence and the type of liver pathology in children at the time of diagnosis of celiac disease (CD). MATERIAL AND METHODS: Data from newly diagnosed children with CD hospitalized in the university hospital were retrospectively reviewed. Liver pathology was defined as elevated alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT) serum activity and/or pathological changes of the organ in ultrasound. RESULTS: Liver pathology was detected in 17 of 149 children (11.4%). Ten patients (6.7%) had an elevated ALT serum activity, whereas no child had an elevated GGT activity. Pathological changes of liver in ultrasound (mainly enlargement or steatosis of the organ) were found in 12 patients (8.1%), of whom 5 children (3.4%) had simultaneously elevated ALT serum activity. Children with liver pathology had lower iron (Fe) (p = 0.02) and folic acid (p = 0.01) concentrations compared to the rest of the patients. There were no statistically significant differences between liver pathology existence and age, sex, serum immunoglobulin A anti-tissue transglutaminase type 2 antibodies (IgA anti-TG2), ferritin, vitamin B12, or vitamin D concentrations. Moreover, a positive correlation between IgA anti-TG2 concentration and ALT serum activity was found (p < 0.01, R = 0.29). CONCLUSIONS: Liver pathology is present at diagnosis in a significant proportion of children with CD in the form of hypertransaminasemia and pathological changes of the organ in ultrasound. There is a correlation between IgA anti-TG2 concentration and ALT serum activity.

A safe "cut, tie and thread-pull" method for percutaneous endoscopic gastrostomy tube removal in children with congenital craniofacial anomalies and pharyngeal stenosis.

Percutaneous endoscopic gastrostomy (PEG) is a widely used method for tube feeding with enteral nutrition. Both PEG's insertion and PEG's removal are usually easy and uncomplicated. The latter can be, however, of substantial difficulty in children with distorted anatomy, such as pharyngeal stenosis or endured craniofacial trauma, when regular endoscopy is contraindicated. The aim of the study was to assess the very simple, but rarely used method for percutaneous removal of the tube by pulling the thread. Four children (4 males, mean age 4.1 year) were analyzed. In all of them the procedure was successful, quick and uncomplicated. To conclude, the thread method should be recommend in case the endoscopic removal is impossible.

La gastrostomía endoscópica percutánea (GEP) es un método muy utilizado para alimentación por sonda con nutrición enteral. Habitualmente tanto la inserción como la retirada de la sonda mediante GEP es fácil y sin complicaciones. Sin embargo, la segunda puede ser sustancialmente difícil en niños con una anatomía alterada como la estenosis faríngea o que haya sufrido un traumatismo craneofacial, en donde la endoscopia rutinaria está contraindicada. El propósito de este estudio fue evaluar un método muy sencillo pero rara vez usado como es la retirada percutánea de la sonda con el hilo. Se analizaron 4 niños (4 varones, edad media 4,1 años). En todos ellos el procedimiento fue exitoso, rápido y sin complicaciones. Para concluir, el método del hilo debería recomendarse en el caso de que la retirada endoscópica no sea posible.

A safe 'cut, tie and thread-pull' method for percutaneous endoscopic gastrostomy tube removal in children with congenital craniofacial anomalies and pharyngeal stenosis / Un método seguro para 'cortar, atar y tirar del hilo' para retirada de sonda mediante gastrostomía endoscópica percutánea en niños con anomalías craneofaciales y estenosis faríngea congénitas

La gastrostomía endoscópica percutánea (GEP) es un método muy utilizado para alimentación por sonda con nutrición enteral. Habitualmente tanto la inserción como la retirada de la sonda mediante GEP es fácil y sin complicaciones. Sin embargo, la segunda puede ser sustancialmente difícil en niños con una anatomía alterada como la estenosis faríngea o que haya sufrido un traumatismo craneofacial, en donde la endoscopia rutinaria está contraindicada. El propósito de este estudio fue evaluar un método muy sencillo pero rara vez usado como es la retirada percutánea de la sonda con el hilo. Se analizaron4 niños (4 varones, edad media 4,1 años). En todos ellos el procedimiento fue exitoso, rápido y sin complicaciones. Para concluir, el método del hilo debería recomendarse en el caso de que la retirada endoscópica no sea posible (AU)

Percutaneous endoscopic gastrostomy (PEG) is a widely used method for tube feeding with enteral nutrition. Both PEG’s insertion and PEG’s removal are usually easy and uncomplicated. The latter can be, however, of substantial difficulty in children with distorted anatomy, such as pharyngeal stenosis or endured craniofacial trauma, when regular endoscopy is contraindicated. The aim of the study was to assess the very simple, but rarely used method for percutaneousr emoval of the tube by pulling the thread. Four children(4 males, mean age 4.1 year) were analyzed. In all of them the procedure was successful, quick and uncomplicated. To conclude, the thread method should be recommend incase the endoscopic removal is imposible (AU)

Soluble adhesion molecules ICAM-1, VCAM-1, P-selectin in children with Helicobacter pylori infection.

AIM: To assess the sICAM-1, sVCAM-1, and sP-selectin levels in children with Helicobacter pylori (H pylori) infection and to evaluate their significance for the morphological changes found in gastric mucosa. METHODS: The study included 106 children: 59 children (55.7%) with chronic gastritis and positive IgG against H pylori, 29 children (27.3%) after previous H pylori infection without the bacterium colonization but with positive IgG against H pylori, and 18 children (17%) with functional disorders of the gastrointestinal system but with normal IgG against H pylori. Endoscopic and histopathological evaluation of gastric mucosa was performed based on the Sydney System classification. The evaluation of sP-selectin, sICAM-1, sVCAM-1 levels in the sera of children was carried out using ELISA test. RESULTS: The assessment of gastritis activity degrees indicated statistically significant values in the antrum and corpus (P<0.001) of children examined. Serum sVCAM-1 levels were higher in group with gastritis due to H pylori infection than in group without infection and differed statistically (P<0.05). Serum sVCAM-1 levels proved to be the highest among other adhesive molecules in infected children and decreased after eradication of H pylori. Serum sICAM-1 levels were similar in all examined groups. Serum sP-selectin levels were similar in children with and without H pylori infection. CONCLUSION: Assessment of adhesive molecules (sP-selectin, sICAM-1, sVCAM-1) in the sera of children with active H pylori infection can show the participation of sVCAM-1 in the pathogenesis of gastric mucosal inflammation. sP-selectin and sICAM-1 concentrations in the sera of children with H pylori infection after eradication cannot reveal any significant differences as compared to healthy children.

[Resistance to antibiotics used in Helicobacter pylori infection in children]. / Opornosc na antybiotyki stosowane w zakazeniu Helicobacter pylori u dzieci.

In literature and clinical findings, the attention has been turned to the resistance to the antibiotics used in Helicobacter pylori eradication, especially metronidazole and clarithromycin. Drug-resistance was evaluated in 50 children. Primary drug-resistance to the antibiotics used in eradications was determined in this group, and additionally, in 18 children who were subjected twice to unsuccessful eradicative therapy. The highest secondary resistance to metronidazole up to 72.0% was found among conventionally used antibiotics. Primary resistance of H. pylori rods to clarithromycin was also high and equaled 25.0%. However, in our study secondary resistance to macrolides was about 66.0%. In our study combined primary resistance to clarithromycin and metronidazole was about 7.2%. There was not H. pylori rods resistance to amoxicillin and tetracyclines.

[Clinical picture and morphological changes of upper intestinal tract mucosa in children with Helicobacter pylori infection]. / Obraz kliniczny i zmiany morfologiczne blony sluzowej górnego odcinka przewodu pokarmowego u dzieci zakazonych Helicobacter pylori.

The authors analysed clinical picture and morphological (macroscopic and histopathologic) changes in gastric and duodenal mucosa in 150 children diagnosed with Helicobacter pylori infection chosen randomly among the hospitalized in 1998-2000 years.