Serological markers identify histologically latent coeliac disease among first-degree relatives.

BACKGROUND AND AIM: Serological markers detect asymptomatic coeliac disease among first-degree relatives of patients with sprue. However, some relatives with coeliac disease-related antibodies have 'normal' jejunal mucosa by conventional histology. Whether these serological abnormalities represent false-positives or are consequences of gluten sensitivity is not known. Our aim was to evaluate, through quantitative histology, intestinal biopsies of asymptomatic relatives of probands seeking abnormalities consistent with latent coeliac disease. MATERIALS: Fifty-nine intestinal biopsies obtained from asymptomatic relatives were evaluated; 40 samples were suitable for histological quantification. Seven samples showed severe mucosal atrophy (coeliac disease) and 33 were considered as 'normals'. In the 'normal' group, nine samples were obtained from patients with one or more positive serological tests and 24 from those with negative tests. Morphometry was compared for samples obtained from healthy control individuals (n = 10) and for those from coeliac patients (n = 7). METHODS: Serological tests used were: antigliadin antibodies type immunoglobulin (Ig)A and IgG (enzyme-linked immunosorbent assay), antirrecticulin antibody (immuno-fluorescence) and endomysial antibody (immunofluorescence). Biopsy samples were obtained with endoscopic forceps from the distal duodenum (second portion). Quantitative histology of duodenal biopsies was performed with a computerized image analysis system. RESULTS: Relatives with positive serology showed shorter villi (P < 0.05) and higher number (P < 0.01) and numerical density (P < 0.01) of intraepithelial lymphocytes in crypts than healthy controls. Numerical density of intraepithelial lymphocytes in crypts in antibody-positive patients was significantly higher than that observed in relatives with negative serology (P < 0.03). Four of nine (44%) relatives with positive serology had a number of intraepithelial lymphocytes in crypts within the range of coeliac disease patients. However, only one patient with negative serology (4%) was in this range. CONCLUSION: Our study shows quantitative histological evidence that relatives of probands with positive coeliac disease-related serology are not false-positives, and that they should be considered as individuals with latent coeliac sprue.

Screening for asymptomatic celiac sprue in families.

We evaluated the reliability of IgA and IgG antigliadin antibodies (AGA-A, AGA-G), antireticulin antibody (ARA), endomysial antibodies (EmA), and alpha 1-antitrypsin clearance (alpha 1-AT CL) in the detection of celiac sprue (CS) in 59 first-degree asymptomatic relatives of celiac patients who had duodenal biopsy. Twenty-four relatives who had normal results of screening tests were selected at random for biopsy; 35 relatives with at least one abnormal test result were biopsied. Eleven relatives were noted to have villous atrophy at biopsy; the diagnosis of celiac sprue was confirmed by histological improvement after gluten-free diet in six. AGA-G, alpha 1-AT CL, and EmA had sensitivities of 73%, 73%, and 64%, respectively, with very high levels of specificity. Sensitivity was improved by the combination of two serological markers (AGA-G + alpha 1-AT CL = 91%; AGA-G + EmA = 82%; EmA + ARA = 82%). Furthermore, combination of EmA and ARA has shown the best specificity and positive predictive value. AGA-G, alpha 1-AT CL, and EmA are reliable individual markers for the detection of asymptomatic celiac sprue. However, a combination of two of them, including ARA, was more sensitive than the individual tests.

Helicobacter pylori y enfermedad gastroduodenal: metodología diagnóstica / Helicobacter pylori and gastroduodenal disease: diagnostic work-up

El Hp es agente causal común de gastritis antral y úlcera duodenal en el adulto. No existen en nuestro país estudios pediátricos que confirmen dicha relación. Con el objeto de determinar la presencia de Hp en la mucosa gástrica en niños y su relación con la clínica, laboratorio, endoscopía y anatomía patológica, se estudiaron 44 pacientes de 3 a 12 años (mediana 8), con DAR (n=24) y patología gastroduodenal (n=15). El grupo control fue de 5 pacientes. A todos se les realizó: a) serología para anticuerpos anti Hp IgA e IgG y b) endoscopía digestiva alta con biopsia de antro y cuerpo gástrico para histología, búsqueda de Hp por tinción, test de ureasa rápido y cultivo. Se consideraron infectados los pacientes que tuvieron cultivos positivos o detección histológica del Hp. Se halló Hp en el 33,5 por ciento de los pacientes con DAR, en el 33,3 por ciento de los niños con patología gastroduodenal y en ninguno del grupo de control. El 100 por ciento de los pacientes con gastritis nodular endoscópica fueron Hp positivo demostrando este hallazgo una alta especificidad. En relación a las gastritis histológicas fue hallado en el 76,4 por ciento y solamente en un paciente con DAR y mucosa normal. Esto sugiere una relación directa entre Hp y daño inflamatorio. La sensibilidad fue del 100 por ciento para la histología y del 92,8 por ciento para los anticuerpos. La especificidad fue del 100 por ciento para histología, cultivo y ureasa. Los autores sugieren la utilización de la serología para detectar Hp por tratarse de un método no invasivo con alto grado de sensibilidad y especificidad. (AU)

Helicobacter pylori y enfermedad gastroduodenal: metodología diagnóstica / Helicobacter pylori and gastroduodenal disease: diagnostic work-up

El Hp es agente causal común de gastritis antral y úlcera duodenal en el adulto. No existen en nuestro país estudios pediátricos que confirmen dicha relación. Con el objeto de determinar la presencia de Hp en la mucosa gástrica en niños y su relación con la clínica, laboratorio, endoscopía y anatomía patológica, se estudiaron 44 pacientes de 3 a 12 años (mediana 8), con DAR (n=24) y patología gastroduodenal (n=15). El grupo control fue de 5 pacientes. A todos se les realizó: a) serología para anticuerpos anti Hp IgA e IgG y b) endoscopía digestiva alta con biopsia de antro y cuerpo gástrico para histología, búsqueda de Hp por tinción, test de ureasa rápido y cultivo. Se consideraron infectados los pacientes que tuvieron cultivos positivos o detección histológica del Hp. Se halló Hp en el 33,5 por ciento de los pacientes con DAR, en el 33,3 por ciento de los niños con patología gastroduodenal y en ninguno del grupo de control. El 100 por ciento de los pacientes con gastritis nodular endoscópica fueron Hp positivo demostrando este hallazgo una alta especificidad. En relación a las gastritis histológicas fue hallado en el 76,4 por ciento y solamente en un paciente con DAR y mucosa normal. Esto sugiere una relación directa entre Hp y daño inflamatorio. La sensibilidad fue del 100 por ciento para la histología y del 92,8 por ciento para los anticuerpos. La especificidad fue del 100 por ciento para histología, cultivo y ureasa. Los autores sugieren la utilización de la serología para detectar Hp por tratarse de un método no invasivo con alto grado de sensibilidad y especificidad.

Correlacíon de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA - EMA-IgA) con la histologia indestinal en la enfermedad celíaca (E C) / Correlation of antigliadin, antiendomysial antibodies IgA class (AGA-IgA - EMA-IgA) with intestinal histology en celiac disease

Se evaluó la correlación de los AGA-IgA y EmA-IgA con la histología intestinal de pacientes celíacos en distintas etapas de la enfermedad a los fines de establecer su valor diagnóstico, de seguimiento y de control terapéutico. Se estudiaron 56 niños (27 mujeres y 29 varones)de m. a 12 años. 39 se hallaban en distintas etapas diagnósticas de la E.C. Los controles fueron 17 niños con biopsia normal que consultaron por síntomas compatibles con malabsorción. Se obtuvieron 60 muestras y se determinó AGA-IgA (ELISA) y EmA-IgA (inmunofluorescencia indirecta en cortes por congelación de 1/3 inferior de esófago do mono Rhesus). Simultáneamente se efectuó biopsia peroral de intestino delgado. De las 34 muestras con histología grado III-IV, sólo 2 fueron AGA-IgA negativo y 1 EmA-IgA negativo. De las 26 muestras con histología normal, se halló sólo 2 AGA-IgA positivo y 4 EmA-IgA positivo. De estas cifras resultan: EmA-IgA: sensibilidad 97% especificidad 84,6% valor predictivo positivo 89,2%, valor predictivo negativo 95%. AGA-IgA: sensibilidad 94,1%, especificidad 92,3, valor predictivo positivo 94,1% y valor predictivo negativo 92,3%. Los AGA-IgA y EmA-IgA tienen estrecha correlación con la histología intestinal y son complementarios para diagnóstico y seguimiento de la E.C. Orientan sobre la oportunidad de biopsia intestinal, permiten controlar el cumplimiento dietético y posibilitan la detección de familiares asintomáticos

Correlacíon de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA - EMA-IgA) con la histologia indestinal en la enfermedad celíaca (E C) / Correlation of antigliadin, antiendomysial antibodies IgA class (AGA-IgA - EMA-IgA) with intestinal histology en celiac disease

Se evaluó la correlación de los AGA-IgA y EmA-IgA con la histología intestinal de pacientes celíacos en distintas etapas de la enfermedad a los fines de establecer su valor diagnóstico, de seguimiento y de control terapéutico. Se estudiaron 56 niños (27 mujeres y 29 varones)de m. a 12 años. 39 se hallaban en distintas etapas diagnósticas de la E.C. Los controles fueron 17 niños con biopsia normal que consultaron por síntomas compatibles con malabsorción. Se obtuvieron 60 muestras y se determinó AGA-IgA (ELISA) y EmA-IgA (inmunofluorescencia indirecta en cortes por congelación de 1/3 inferior de esófago do mono Rhesus). Simultáneamente se efectuó biopsia peroral de intestino delgado. De las 34 muestras con histología grado III-IV, sólo 2 fueron AGA-IgA negativo y 1 EmA-IgA negativo. De las 26 muestras con histología normal, se halló sólo 2 AGA-IgA positivo y 4 EmA-IgA positivo. De estas cifras resultan: EmA-IgA: sensibilidad 97% especificidad 84,6% valor predictivo positivo 89,2%, valor predictivo negativo 95%. AGA-IgA: sensibilidad 94,1%, especificidad 92,3, valor predictivo positivo 94,1% y valor predictivo negativo 92,3%. Los AGA-IgA y EmA-IgA tienen estrecha correlación con la histología intestinal y son complementarios para diagnóstico y seguimiento de la E.C. Orientan sobre la oportunidad de biopsia intestinal, permiten controlar el cumplimiento dietético y posibilitan la detección de familiares asintomáticos (AU)

[Correlation of IgA class antigliadin and antiendomysial antibodies (IgA-AGA-IgA-EMA) with intestinal histology in celiac disease]. / Correlación de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA-EMA-IgA) con la histologia intestinal en la enfermedad celiaca (E C).

The aim of this work was to establish the diagnostic and follow up value of IgA-class antiendomysium (IgA-EmA) and IgA-class antigliadin (IgA-AGA) antibodies in celiac disease. Correlation with the intestinal histology at the different stages of the disease was evaluated, as well as its therapeutic monitoring ability. Fifty six children, twenty seven girls and twenty nine boys, aged six months to twelve years old, were studied. Thirty nine celiac children were al different diagnostic stages of the disease. Seventeen children with malabsorption symptoms and with normal intestinal histology were used as controls. Sixty blood samples were obtained simultaneously with the small intestinal biopsy. IgA-AGA (ELISA method) and IgA-EmA (immunofluorescent test performed over lower third Rhesus monkey esophagus) were determined in every blood sample. In 34 serum samples from patients with total or subtotal villous atrophy, two were negative for IgA-AGA and only one was negative for IgA-EmA. In 26 samples from patients with normal intestinal histology, two were positive for IgA-AGA and four were positive for IgA-EmA. The results for IgA-EmA had sensitivity 97%, specificity 84.6%, positive predictive value 89.2% and negative predictive value 95%. In the case of IgA-AGA were: sensitivity 94.1%, specificity 92.3%, positive predictive value 94.1%, negative predictive value 92.3%. IgA-AGA and IgA-EmA showed a high correlation with intestinal histology and are in combination powerful tools for the diagnosis and follow up of celiac patients. Besides, they provide a useful aid in the indication of a jejunal biopsy and in close monitoring of the dietary treatment compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlación de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA-EMA-IgA) con la histologia intestinal en la enfermedad celiaca (E C). / [Correlation of IgA class antigliadin and antiendomysial antibodies (IgA-AGA-IgA-EMA) with intestinal histology in celiac disease]

The aim of this work was to establish the diagnostic and follow up value of IgA-class antiendomysium (IgA-EmA) and IgA-class antigliadin (IgA-AGA) antibodies in celiac disease. Correlation with the intestinal histology at the different stages of the disease was evaluated, as well as its therapeutic monitoring ability. Fifty six children, twenty seven girls and twenty nine boys, aged six months to twelve years old, were studied. Thirty nine celiac children were al different diagnostic stages of the disease. Seventeen children with malabsorption symptoms and with normal intestinal histology were used as controls. Sixty blood samples were obtained simultaneously with the small intestinal biopsy. IgA-AGA (ELISA method) and IgA-EmA (immunofluorescent test performed over lower third Rhesus monkey esophagus) were determined in every blood sample. In 34 serum samples from patients with total or subtotal villous atrophy, two were negative for IgA-AGA and only one was negative for IgA-EmA. In 26 samples from patients with normal intestinal histology, two were positive for IgA-AGA and four were positive for IgA-EmA. The results for IgA-EmA had sensitivity 97

, specificity 84.6

, positive predictive value 89.2

and negative predictive value 95

. In the case of IgA-AGA were: sensitivity 94.1

, specificity 92.3

, positive predictive value 94.1

, negative predictive value 92.3

. IgA-AGA and IgA-EmA showed a high correlation with intestinal histology and are in combination powerful tools for the diagnosis and follow up of celiac patients. Besides, they provide a useful aid in the indication of a jejunal biopsy and in close monitoring of the dietary treatment compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

[The correlation of IgA-class antigliadin and antiendomysial antibodies (AGA-IgA--EmA-IgA) with the intestinal histology in celiac disease (CD)]. / Correlación de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA--EmA-IgA) con la histología intestinal en la enfermedad celíaca (EC).

The aim of this work was to establish the diagnostic and follow up value of IgA-class antiendomysium (IgA-EmA) and IgA-class antigliadin (IgA-AGA) antibodies in celiac disease. Correlation with the intestinal histology at the different stages of the disease was evaluated, as well as its therapeutic monitoring ability. Fifty six children, twenty seven girls and twenty nine boys, aged six months to twelve years old, were studied. Thirty nine celiac children were all different diagnostic stages of the disease. Seventeen children with malabsorption symptoms and with normal intestinal histology were used as controls. Sixty blood samples were obtained simultaneously with the small intestinal biopsy. IgA-AGA (ELISA method) and IgA-EmA (immunofluorescent test performed over lower third Rhesus monkey esophagus) were determined in every blood sample. In 34 serum samples from patients with total or subtotal villous atrophy, two were negative for IgA-AGA and only one was negative for IgA-EmA. In 26 samples from patients with normal intestinal histology, two were positive for IgA-AGA and four were positive for IgA-EmA. The results for IgA-EmA had sensitivity 97%, specificity 84.6%, positive predictive value 89.2% and negative predictive value 95%. In the case of IgA-AGA were: sensitivity 94.1% specificity 92.3%, positive predictive value 94.1%, negative predictive value 92.3%. IgA-AGA and IgA-EmA showed a high correlation with intestinal histology and are in combination powerful tools for the diagnosis and follow up of celiac patients. Besides, they provide a useful aid in the indication of a jejunal biopsy and in close monitoring of the dietary treatment compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlación de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA--EmA-IgA) con la histología intestinal en la enfermedad celíaca (EC). / [The correlation of IgA-class antigliadin and antiendomysial antibodies (AGA-IgA--EmA-IgA) with the intestinal histology in celiac disease (CD)]

The aim of this work was to establish the diagnostic and follow up value of IgA-class antiendomysium (IgA-EmA) and IgA-class antigliadin (IgA-AGA) antibodies in celiac disease. Correlation with the intestinal histology at the different stages of the disease was evaluated, as well as its therapeutic monitoring ability. Fifty six children, twenty seven girls and twenty nine boys, aged six months to twelve years old, were studied. Thirty nine celiac children were all different diagnostic stages of the disease. Seventeen children with malabsorption symptoms and with normal intestinal histology were used as controls. Sixty blood samples were obtained simultaneously with the small intestinal biopsy. IgA-AGA (ELISA method) and IgA-EmA (immunofluorescent test performed over lower third Rhesus monkey esophagus) were determined in every blood sample. In 34 serum samples from patients with total or subtotal villous atrophy, two were negative for IgA-AGA and only one was negative for IgA-EmA. In 26 samples from patients with normal intestinal histology, two were positive for IgA-AGA and four were positive for IgA-EmA. The results for IgA-EmA had sensitivity 97

, specificity 84.6

, positive predictive value 89.2

and negative predictive value 95

. In the case of IgA-AGA were: sensitivity 94.1

specificity 92.3

, positive predictive value 94.1

, negative predictive value 92.3

. IgA-AGA and IgA-EmA showed a high correlation with intestinal histology and are in combination powerful tools for the diagnosis and follow up of celiac patients. Besides, they provide a useful aid in the indication of a jejunal biopsy and in close monitoring of the dietary treatment compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlación de anticuerpos antigliadina y antiendomisiales clase IgA (AGA-IgA--EmA-IgA) con la histología intestinal en la enfermedad celíaca (EC). / [The correlation of IgA-class antigliadin and antiendomysial antibodies (AGA-IgA--EmA-IgA) with the intestinal histology in celiac disease (CD)]

The aim of this work was to establish the diagnostic and follow up value of IgA-class antiendomysium (IgA-EmA) and IgA-class antigliadin (IgA-AGA) antibodies in celiac disease. Correlation with the intestinal histology at the different stages of the disease was evaluated, as well as its therapeutic monitoring ability. Fifty six children, twenty seven girls and twenty nine boys, aged six months to twelve years old, were studied. Thirty nine celiac children were all different diagnostic stages of the disease. Seventeen children with malabsorption symptoms and with normal intestinal histology were used as controls. Sixty blood samples were obtained simultaneously with the small intestinal biopsy. IgA-AGA (ELISA method) and IgA-EmA (immunofluorescent test performed over lower third Rhesus monkey esophagus) were determined in every blood sample. In 34 serum samples from patients with total or subtotal villous atrophy, two were negative for IgA-AGA and only one was negative for IgA-EmA. In 26 samples from patients with normal intestinal histology, two were positive for IgA-AGA and four were positive for IgA-EmA. The results for IgA-EmA had sensitivity 97

, specificity 84.6

, positive predictive value 89.2

and negative predictive value 95

. In the case of IgA-AGA were: sensitivity 94.1

specificity 92.3

, positive predictive value 94.1

, negative predictive value 92.3

. IgA-AGA and IgA-EmA showed a high correlation with intestinal histology and are in combination powerful tools for the diagnosis and follow up of celiac patients. Besides, they provide a useful aid in the indication of a jejunal biopsy and in close monitoring of the dietary treatment compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ulcerative colitis in children. Levels of salicylazosulfapyridine and sulfapyridine during treatment]. / Colitis ulcerosa en niños. Niveles de salazosulfapiridina y sulfapiridina durante el tratamiento.

Salicylazosulfapyridine (SASP) is a drug used in the treatment of ulcerative colitis (UC) owing to the therapeutic action of the 5-aminosalicylic acid produced by the splitting of the molecule in the cecum, which also yields the absorbable compound Sulphapyridine (SP). The aim of our work was to assess the levels of the drug in blood (SASP and SP), to correlate them with undesirable effects in any, to verify their fluctuations in the dosing interval and to investigate the extent of the excretion of the drug in the children who were studied. 10 children (6 to 16 years) with UC, who were treated with SASP (dOsage schedule 0.5-2.0 g/day in a 12 hours interval), were studied. Blood levels of SASP and SP were assessed at 6 and 12 hours after doses, and total fecal excretion of SASP was determines in 24 hs specimens. All the determinations were performed according to Hansson and Sandberg. SP plasma levels were 17.7 +/- 9.0 ug/ml (range 6.8-36.3 ug/ml) at 6 hours after doses. and 14.1 +/- 7.2 ug/ml (range 5.7-25.0 ug/ml) at 12 hours after doses. SASP plasma levels were 15.5 +/- 15.4 ug/ml (range 2.1-53.4 ug/ml) at 6 hours after doses, and 14.0 +/- 20.4 ug/ml (range 3.9-70.7 ug/ml) at 12 hours after doses. The 24 hours fecal excretion was 17.4 to 236 mg. These values were correlated with the given doses (r = 0.88) calculated as SASP g/m2 body surface 24 hs. There was no statistical correlation between doses and SP or SASP levels in this group, and the respective levels of SASP and SP at 6 and 12 hours after doses showed no significative differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Colitis ulcerosa en niños. Niveles de salazosulfapiridina y sulfapiridina durante el tratamiento. / [Ulcerative colitis in children. Levels of salicylazosulfapyridine and sulfapyridine during treatment]

Salicylazosulfapyridine (SASP) is a drug used in the treatment of ulcerative colitis (UC) owing to the therapeutic action of the 5-aminosalicylic acid produced by the splitting of the molecule in the cecum, which also yields the absorbable compound Sulphapyridine (SP). The aim of our work was to assess the levels of the drug in blood (SASP and SP), to correlate them with undesirable effects in any, to verify their fluctuations in the dosing interval and to investigate the extent of the excretion of the drug in the children who were studied. 10 children (6 to 16 years) with UC, who were treated with SASP (dOsage schedule 0.5-2.0 g/day in a 12 hours interval), were studied. Blood levels of SASP and SP were assessed at 6 and 12 hours after doses, and total fecal excretion of SASP was determines in 24 hs specimens. All the determinations were performed according to Hansson and Sandberg. SP plasma levels were 17.7 +/- 9.0 ug/ml (range 6.8-36.3 ug/ml) at 6 hours after doses. and 14.1 +/- 7.2 ug/ml (range 5.7-25.0 ug/ml) at 12 hours after doses. SASP plasma levels were 15.5 +/- 15.4 ug/ml (range 2.1-53.4 ug/ml) at 6 hours after doses, and 14.0 +/- 20.4 ug/ml (range 3.9-70.7 ug/ml) at 12 hours after doses. The 24 hours fecal excretion was 17.4 to 236 mg. These values were correlated with the given doses (r = 0.88) calculated as SASP g/m2 body surface 24 hs. There was no statistical correlation between doses and SP or SASP levels in this group, and the respective levels of SASP and SP at 6 and 12 hours after doses showed no significative differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Clearance fecal de alfa-1-antitripsina en enteropatias perdedoras de proteínas en pediatría / Fecal alpha 1-antitrypsin clearance in protein-losing enteropathies in pediatrics

El clearance fecal de alfa-1-antitripsina fue realizado en 47 pacientes de edad pediátrica que presentaron diversas enfermedades digestivas: 6 con colitis ulcerosa, 5 con enfermedad celíaca, 6 con intolerancia a la proteína de la leche de vaca, 1 con linfagiectasia intestinal, 1 con giardiasis, 1 con colitis inespecífica, 1 con resección del íleon terminal, y 1 con talasemia mayor y dolor abdominal. Quince pacientes presentaron diarrea crónica inespecífica. Diez niños sin enfermedad digestiva fueron incorporados como grupo control. El 1er. grupo de niños presentó valores significativamente mayores (p < 0.05) del clearance fecal de alfa-1-antitripsina con respecto a los pacientes con diarrea crónica inespecífica y del grupo control. Solo un niño con intolerancia a la proteína de la leche de vaca tuvo un valor inferior a la media + 2 Desvío estandar. Todos los niños con diarrea crónica inespecífica presentaron valores similares a los del grupo control, con excepción de 1 que tuvo un resultado ligeramente aumentado, no hallándose diferencia significativa. El paciente con talasemia mayor y dolor abdominal presentó un valor muy elevado, desconociéndose el motivo de este hallazgo. El clearance fecal de alfa-1-antripsina es un método útil, simple, menos costoso y no invansivo que las técnicas tradicionales para el diagnóstico de enteropatía perdedora de proteínas en la infancia

Clearance fecal de alfa-1-antitripsina en enteropatias perdedoras de proteínas en pediatría / Fecal alpha 1-antitrypsin clearance in protein-losing enteropathies in pediatrics

El clearance fecal de alfa-1-antitripsina fue realizado en 47 pacientes de edad pediátrica que presentaron diversas enfermedades digestivas: 6 con colitis ulcerosa, 5 con enfermedad celíaca, 6 con intolerancia a la proteína de la leche de vaca, 1 con linfagiectasia intestinal, 1 con giardiasis, 1 con colitis inespecífica, 1 con resección del íleon terminal, y 1 con talasemia mayor y dolor abdominal. Quince pacientes presentaron diarrea crónica inespecífica. Diez niños sin enfermedad digestiva fueron incorporados como grupo control. El 1er. grupo de niños presentó valores significativamente mayores (p < 0.05) del clearance fecal de alfa-1-antitripsina con respecto a los pacientes con diarrea crónica inespecífica y del grupo control. Solo un niño con intolerancia a la proteína de la leche de vaca tuvo un valor inferior a la media + 2 Desvío estandar. Todos los niños con diarrea crónica inespecífica presentaron valores similares a los del grupo control, con excepción de 1 que tuvo un resultado ligeramente aumentado, no hallándose diferencia significativa. El paciente con talasemia mayor y dolor abdominal presentó un valor muy elevado, desconociéndose el motivo de este hallazgo. El clearance fecal de alfa-1-antripsina es un método útil, simple, menos costoso y no invansivo que las técnicas tradicionales para el diagnóstico de enteropatía perdedora de proteínas en la infancia (AU)

[Fecal alpha 1-antitrypsin clearance in protein-losing enteropathies in pediatrics]. / Clearance fecal de alfa-1-antitripsina en enteropatías perdedoras de proteínas en pediatría.

Fecal alpha-1-antitrypsin clearance (A-1-At Cl) was performed on 47 pediatric age patients with various digestive diseases: 6 with ulcerative colitis, 5 with celiac disease, 6 with cow milk protein intolerance, 1 with intestinal lymphangiectasia, 1 with non specific diarrhea and the control group was composed of 10 children without digestive disease. The group of patients with digestive disease showed values of fecal A-1-At Cl significantly higher than the control and non specific diarrhea groups (p less than 0.05). Just 1 child with cow milk intolerance had A-1-At Cl within the range of values of the control group x = 2 S.D. All children with non specific diarrhea excepting one had values falling within the control range. The patient with thalassemia major had a very elevated value of A-1-At Cl. The cause of this finding remains unknown at present. The fecal A-1-At Cl. is a non invasive, cost saving, useful and simpler method than the traditional techniques for the diagnosis of protein losing enteropathy in childhood.

Clearance fecal de alfa-1-antitripsina en enteropatías perdedoras de proteínas en pediatría. / [Fecal alpha 1-antitrypsin clearance in protein-losing enteropathies in pediatrics]

Fecal alpha-1-antitrypsin clearance (A-1-At Cl) was performed on 47 pediatric age patients with various digestive diseases: 6 with ulcerative colitis, 5 with celiac disease, 6 with cow milk protein intolerance, 1 with intestinal lymphangiectasia, 1 with non specific diarrhea and the control group was composed of 10 children without digestive disease. The group of patients with digestive disease showed values of fecal A-1-At Cl significantly higher than the control and non specific diarrhea groups (p less than 0.05). Just 1 child with cow milk intolerance had A-1-At Cl within the range of values of the control group x = 2 S.D. All children with non specific diarrhea excepting one had values falling within the control range. The patient with thalassemia major had a very elevated value of A-1-At Cl. The cause of this finding remains unknown at present. The fecal A-1-At Cl. is a non invasive, cost saving, useful and simpler method than the traditional techniques for the diagnosis of protein losing enteropathy in childhood.

Determinación de clearance de amilasa creatinina en niños y adolescentes / Determination of clearance of amylase creatinine in children and adolescentes

Se estudiaron 24 niños de 10 días a 14 años de edad (x: 5.5.años), 16 varones y 8 mujeres, que fueron internados en nuestro Servicio por afectaciones extradigestivas para control de su cuadro clínico. Se determinó creatinina y amilasa en suero y orina de 24 horas, y lipasa sérica. Los valores del clearance de amilasa-creatinina oscilaron entre 1.3 y 5.8% (x:3 3.1 ñ 1.3). Los resultados de la amilasemia variaron de 36 a 460 U/I (x 123). Cinco pacientes presentaron hiperamilasemia: dos de ellos con parotiditis urliana, 2 se encontraban en control clínico de un post-quirúrgico, y el quinto, una meningitis bacteriana. Todos ellos, presentaron clearance de amilasa-creatinina de hasta 2.5%. La determinación de lipasa fue de 6 a 197 U/I (x 79), siendo todos los valors normales. Conclusiones: La hiperamilasemia no es patognomónica a nivel pediátrico de afectación pancreática; la lipasemia y el clearance de amilasa-creatinina parecen dos parámetros útiles para descartar compromiso pancreático en pacientes con hiperamilasemia