Mannose-binding lectin (MBL) in adult patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) refers to disorders associated with progressive inflammatory processes in the gastrointestinal system. IBD consists of two major forms, Crohn's disease (CD), and ulcerative colitis (UC). IBD became a global disease in the 21st century. Its pathogenesis is still not fully understood. Mannose-binding lectin (MBL) is a pattern-recognising molecule, involved in anti-microbial and anti-cancer immunity. It is able to opsonize microorganisms and abnormal host cells, and to initiate complement activation. The aim of this study was to investigate possible involvement of MBL in inflammatory bowel disease in adults. Forty persons diagnosed with CD and 28 with ulcerative colitis were recruited. The control group consisted of 136 healthy persons. Single nucleotide polymorphisms of the MBL2 gene (localised to both promoter and exon 1) were determined as were serum MBL concentrations. The exon 1 variant alleles and MBL deficiency-associated genotypes were more frequent among patients compared with controls, although this difference was not statistically significant. No differences of MBL levels were found between the major groups. However in MBL2 A/A homozygous IBD patients, the median was significantly higher than in corresponding healthy subjects. That was particularly evident in the case of active Crohn's disease (1493 ng/ml vs. 800 ng/ml, p = 0.021). It may suggest that MBL and MBL-dependent complement activation contributes to excessive inflammation and its adverse effects in the course of CD. It cannot also be excluded that high MBL activity constitutes in some cases part of a multifactorial network conducing to development of CD.

Genetic architecture differences between pediatric and adult-onset inflammatory bowel diseases in the Polish population.

Most inflammatory bowel diseases (IBDs) are classic complex disorders represented by common alleles. Here we aimed to define the genetic architecture of pediatric and adult-onset IBDs for the Polish population. A total of 1495 patients were recruited, including 761 patients with Crohn's disease (CD; 424 pediatric), 734 patients with ulcerative colitis (UC; 390 pediatric), and 934 healthy controls. Allelotyping employed a pooled-DNA genome-wide association study (GWAS) and was validated by individual genotyping. Whole exome sequencing (WES) was performed on 44 IBD patients diagnosed before 6 years of age, 45 patients diagnosed after 40 years of age, and 18 healthy controls. Altogether, out of 88 selected SNPs, 31 SNPs were replicated for association with IBD. A novel BRD2 (rs1049526) association reached significance of P = 5.2 × 10-11 and odds ratio (OR) = 2.43. Twenty SNPs were shared between pediatric and adult patients; 1 and 7 were unique to adult-onset and pediatric-onset IBD, respectively. WES identified numerous rare and potentially deleterious variants in IBD-associated or innate immunity-associated genes. Deleterious alleles in both groups were over-represented among rare variants in affected children. Our GWAS revealed differences in the polygenic architecture of pediatric- and adult-onset IBD. A significant accumulation of rare and deleterious variants in affected children suggests a contribution by yet unexplained genetic components.

Innate immunity components and cytokines in gastric mucosa in children with Helicobacter pylori infection.

PURPOSE. To investigate the expression of innate immunity components and cytokines in the gastric mucosa among H. pylori infected and uninfected children. Materials and Methods. Biopsies of the antral gastric mucosa from children with dyspeptic symptoms were evaluated. Gene expressions of innate immunity receptors and cytokines were measured by quantitative real-time PCR. The protein expression of selected molecules was tested by immunohistochemistry. RESULTS. H. pylori infection did not lead to a significant upregulation of MyD88, TLR2, TLR4, CD14, TREM1, and TREM2 mRNA expression but instead resulted in high mRNA expression of IL-6, IL-10, IFN-γ, TNF-α, and CD163. H. pylori cagA(+) infection was associated with higher IL-6 and IL-10 mRNA expression, as compared to cagA(-) strains. H. pylori infected children showed increased IFN-γ and TNF-α protein levels. IFN-γ mRNA expression correlated with both H. pylori density of colonization and lymphocytic infiltration in the gastric mucosa, whereas TNF-α protein expression correlated with bacterial density. CONCLUSION. H. pylori infection in children was characterized by (a) Th1 expression profile, (b) lack of mRNA overexpression of natural immunity receptors, and (c) strong anti-inflammatory activities in the gastric mucosa, possibly resulting from increased activity of anti-inflammatory M2 macrophages. This may explain the mildly inflammatory gastric inflammation often observed among H. pylori infected children.

Monotherapy with infliximab versus combination therapy in the maintenance of clinical remission in children with moderate to severe Crohn disease.

OBJECTIVES: The aim of the present study was to compare the efficacy and safety of 2 protocols of maintenance therapy with infliximab (IFX) and an immunomodulatory agent in pediatric patients with Crohn disease (CD): withdrawal of immunomodulators versus continuation of immunosuppressants. METHODS: The present multicenter randomized open-label trial included 99 patients with CD (ages 14.5 ±â€Š2.6 years) who were administered IFX (5 mg/kg body weight) along with an immunomodulatory agent (azathioprine 1.5-3 mg/kg body weight per day, methotrexate 10-25 mg/week). After 10 weeks of the induction therapy, 84 responders were centrally randomized into 1 of the following groups: group I (n = 45) in which IFX and an immunomodulatory agent were continued up to week 54 and group II (n = 39) in which the immunomodulatory agent was discontinued after 26 weeks. RESULTS: The induction therapy was reflected by a significant decrease in Pediatric Crohn's Disease Activity Index (PCDAI) and Simplified Endoscopic Activity Score for Crohn's Disease (SES-CD) values. After the maintenance phase, the analyzed groups did not differ significantly in terms of the clinical response loss rates and final PCDAI and SES-CD scores. Furthermore, no significant intragroup differences were documented between mean PCDAI scores determined at the end of induction and maintenance phases. Intensification/modification of the treatment was required in 13 of 45 (29%) and 11 of 39 (28%) patients of groups I and II, respectively. A total of 9 serious adverse events were documented; none of the patients died during the trial. CONCLUSIONS: Twenty-six weeks likely represent the safe duration of combined IFX/immunomodulatory therapy in our sample of pediatric patients with CD.

Expression of adhesion and activation molecules on circulating monocytes in children with Helicobacter pylori infection.

OBJECTIVES: The aim of this study was to assess the cell surface expression of adhesion (CD11a, CD11b, CD11c, CD18, CD54, and CD58) and activation (CD14, HLA-DR, and CD16) molecules on the circulating monocytes in Helicobacter pylori (H. pylori)-infected and noninfected children with gastritis, with the goal of comparing the results with those obtained from the controls. MATERIALS AND METHODS: Ninety-four children were studied: 47 of them with H. pylori infection (of those 25 children after the failure of eradication therapy) and 26 children with gastritis where H. pylori infection was excluded, as well as 21 controls. H. pylori infection status was assessed based on [¹³C] urea breath test, rapid urease test, and histology. Analysis of the monocyte surface molecule expression was carried out by flow cytometry. RESULTS: H. pylori-infected children and children who experienced a failure of the eradication therapy differed significantly in the expression of adhesion and activation molecule on circulating monocytes. A decrease, both in the proportion of CD11c- and CD14-bearing monocytes, and the expression of CD11c and CD14 molecules on circulating monocytes, was found in children in whom the eradication therapy failed (p < .05). Low expression of CD11b (p = .04) and CD18 (p = .02) integrins on monocytes was also observed. Additionally, the percentage of HLA-DR-bearing monocytes was decreased (p = .04), while the CD16 density receptor was increased (p = .02). Compared with the controls, low percentage of CD16-positive monocytes was noted in noninfected children with gastritis (p = .01). CONCLUSION: H. pylori eradication therapy in children causes inhibition of inflammatory response via a reduction in CD11b, CD11c, and CD18 beta2 integrin monocyte expression.

Mannan-binding lectin deficiency in pediatric patients with inflammatory bowel disease.

OBJECTIVE: The incidence of inflammatory bowel disease (IBD) in Europe has increased significantly. At least a fourth of patients are children. Mannan-binding lectin (MBL) is believed to be an important component of innate immunity, acting as an opsonin and activator of the lectin pathway (LP) of complement. The data relating any of the LP factors to IBD are sparse and contradictory and were obtained mainly from adult patients. The aim of this study was to investigate the possible role of MBL in Crohn's disease (CD) and ulcerative colitis (UC) in children. METHODS: MBL2 gene single nucleotide polymorphisms (PCR-RFLP) and MBL concentrations (ELISA) were determined. RESULTS: The frequency of MBL2 gene variants responsible for MBL deficiency (LXPA/O and O/O) is significantly higher in CD patients compared with controls or children with UC. A relatively high frequency of the codon 52 mutation (D allele) was noted in these patients. Practically no difference was found between UC and control (C) groups. Similarly, the average MBL levels as well as the number of MBL-deficient (MBL concentrations < 150 ng/ml) individuals differed between CD patients and controls or children suffering from UC. Again, there was no difference between UC and C groups. CONCLUSIONS: These data suggest that MBL deficiency may be associated with CD but not with UC in pediatric patients. The possible role of MBL in IBD requires confirmation in larger series and further investigation of the mechanisms involved.

Pediatric Helicobacter pylori infection and circulating T-lymphocyte activation and differentiation.

BACKGROUND: In this study, H. pylori-infected and noninfected children with gastritis were compared to a control group with respect to circulating CD4(+) and CD8(+) T lymphocytes expressing activation and differentiation markers. Additionally, the lymphocyte phenotypes of children with gastritis were correlated with the gastric inflammation scores. MATERIALS AND METHODS: H. pylori infection status was assessed based on [¹³C]urea breath test, rapid urease test, and histology. Analysis of the lymphocyte surface molecule expression was carried out by triple-color flow cytometry. RESULTS: The group of H. pylori-infected children showed an elevated proportion of peripheral B cells with CD19(low) , along with a twofold increase in the percentage of memory (CD45RO(+)) CD4(+) and CD8(+) T-cell subsets (p < .05). Moreover, a positive correlation between the age and the percentage of these subsets was seen (r = .38, p = .04 and r = .56, p < .01, respectively). Children with gastritis but without infection had a slightly increased percentage of CD8(+) T cells and CD56(+) NK cells, CD3(high) T cells and CD45RO(high) CD4(+) T-cell subsets (p < .05). Both H. pylori-infected and noninfected children with gastritis were characterized by an increased percentage of memory/effector CD4(+) T cells, the presence of NK cells with CD56(high), memory T-cell subset with CD4(high), and naive, memory, memory/effector, and effector T-cell subsets with CD8(high) (p < .05). Gastric inflammation scores correlated positively with the percentage of CD4(+) T lymphocytes in H. pylori-infected children (r = .42, p = .03). In noninfected children, gastric inflammation scores correlated positively with the percentage of B cells (r = .45, p = .04). CONCLUSION: In H. pylori-negative children, gastritis was associated with an increased percentage of activated NK and T cells, and intermediate-differentiated peripheral blood CD4(+) T cells, which was more pronounced in H. pylori-positive children who also showed an increased B-cell response. However, increased inflammation was only associated with the elevation of CD4(+) T-cell percentage in H. pylori-positive children as well as B-cell percentage in H. pylori-negative children with gastritis.

[The analysis of usefulness different diagnostic methods in children and adolescents with Helicobacter pylori infection]. / Analiza przydatnosci róznych metod diagnostycznych w ocenie zakazenia Helicobacter pylori u dzieci i mlodziezy.

UNLABELLED: A diagnostics of Helicobacter pylori infection in children and adolescents in practice sometimes is still difficult. Qualification to the tests for detecting infection with invasive and noninvasive methods should start from diligent anamnesis. THE AIM OF THE STUDY: Is to present the clinical course and results of diagnostic tests in children and adolescents with suspicion of Helicobacter pylori infection. MATERIAL AND METHODS: One hundred patients aged between 18 months and 18 years who underwent endoscopy with gastric biopsies, histology, culture and 13carbon urea breath test. There were 36 boys and 64 girls in analysed group, 10% of them were preschool children, 42% school children and 48% teenagers older than 12 years RESULTS: Patients were symptomatic and most frequent were dyspeptic symptoms (91%). A symptom duration time was varied from several days to several years. On the basis of endoscopy and histology gastritis and/or duodenitis were found in 92 patients, esophagitis and gastritis in 5 patients, duodenal ulcer in 2 patients, in 1 case gastric and duodenal mucosa was normal. Helicobacter pylori infection was histopathologically confirmed in 37 patients. In 15 cases Helicobacter pylori strains were isolated with full in vitro sensitivity to amoxicillin, claritromycin and metronidazol. Urea breath test was conducted in 85 analyzed patients and 51 of them had abnormal result. CONCLUSIONS: In clinical picture of Helicobacter infection most frequent were dyspepstic symptoms and by endoscopy chronic gastritis and/or duodenitis were shown. Culture of Helicobacter pylori has a limited usefulness in practice especially in patients who underwent antibiotic/eradication therapy. The statistical significant concordance occurred between culture and noninvasive 13carbon urea breath test.

[Adhesion molecules of immunoglobin super family in children and youth with inflammatory bowel disease]. / Czasteczki adhezyjne nadrodziny immunoglobulin w ocenie aktywnosci zapalenia u mlodziezy i dzieci chorych na nieswoiste zapalenia jelit.

UNLABELLED: Chronic inflammation is the common feature of inflammatory bowel disease. Adhesion molecules of immunoglobin super family play a key role in infiltration of leucocytes to place of inflammation. THE AIM OF THIS STUDY: was to investigate the concentrations of slCAM-1, sVCAM-1 i sPECAM-1 in children and youth with Crohn's disease and ulcerative colitis. MATERIAL AND METHODS: The soluble adhesion molecules were studied in the serum of 31 patients with Crohn's disease (CD) and 27 with ulcerative colitis (uc) and 20 healthy controls in age 6-18. Groups of Crohn's disease and ulcerative colitis patients were divided according to Hyams and Truelove-Witts' indexes of disease activity. Serum levels of sICAM-1, sVCAM-1 and sPECAM-1 were measured using an enzyme-linked immunosorbent assay kit of Bender MedSystem. RESULTS: There were no statistical significant differences in the levels of sICAM-1, sVCAM-1 and sPECAM-1 between the Crohn's disease patients and the control group. sICAM-1 level of the patients with ulcerative colitis was statistical significant higher then those of controls (391.28 +/- 134.95 ng/ml vs. 319.91 +/- 77.86 ng/ml, p = 0.022). There were no statistical significant differences in the levels of sVCAM-1 and sPECAM-1 between the patients with ulcerative colitis and the control group. There were no statistical significant differences in the levels of sICAM-1, sVCAM-1 and sPECAM-1 between patients with the active Crohn's disease and with remission and between patients with active ulcerative colitis disease and with remission. CONCLUSION: Determine of sICAM-1, sVCAM-1 and sPECAM-1 in patients with inflammatory bowel disease could not be helpful in estimation of inflammation activity.

[Genetic type of Helicobacter pylori and the efficacy of eradication therapy]. / Typ genetyczny Helicobacter pylori a skutecznosc leczenia eradykacyjnego.

UNLABELLED: Helicobacter pylori is one of the most popular bacteria in the world. The H. pylori infection is an etiological factor of permanent changes in inflammatory of stomach mucous membrane, peptic ulcer of the stomach and duodenum disease and stomach cancer or mucosa associated lymphoid tissue from lymphoid tissue of mucous membrane. The strain bacteria which produce the protein CagA and cytotoxin VacA belong to the more pathogenic strains. The most successful method of treatment for H. pylori infection is an eradication of the bacteria. THE AIM OF THE STUDY: Was an evaluation of the influence which H. pylori genetic type (type I: CagA-positive, CagA-negative, VacA-positive, VacA-negative) has on efficacy of eradication therapy. MATERIAL AND METHODS: 214 of patients over the third year of life with symptoms of dyspepsia, of the upper part of the gastrointestinal tract was performed and H. pylori infection was proved in histopathological or (and) urease test and urea breath test. H. pylori identification was performed using PCR method for biopsy specimens of the gastric mucosa, estimating genetic type of the bacteria (CagA-positive, CagA-negative, VacA-positive, VacA-negative). Triple-drug eradication therapy was introduced. The efficiency of this treatment was checked after 6 weeks with the breath test. RESULTS: The H. pylori infection was found in 101 patients (47.2%), 33 patients were infected with the strain type I (32.7%) and 68 patients (67.3%) with the strain type II. After the treatment the eradication of the infection was found at 71 patients (70.3%), lack of efficacy in H. pylori infection treatment was found at 30 patients (29.7%). Considerably higher percentage of eradicative infection was shown in the group of patients infected with the type II of H. pylori (76.5% vs. 58.8%, p < 0.04). CONCLUSIONS: The effectiveness of eradication can be influenced by the genetic type of H. pylori. The better effects of eradicative treatment can be expected if one is infected with the strains of smaller virulence.

[Adventitious diagnosis of coeliac disease in three family members]. / Przypadkowe rozpoznanie celiakii u trzech czlonków rodziny.

This report presents family that among three of four family members (father, daughter, son) coeliac disease was diagnosed. The first diagnosed person was 11-year-old girl who was included into population screening tests for coeliac disease. Father has been presented chronic diarrhoea since childhood. Son has been suffering from recurrent aphthous stomatitis for many years. The girl was completely asymptomatic. The serum antiendomysial antibodies were positive in a high titre in all three patients. They all also presented macroscopic markers of coeliac disease in form of loss of folds, scalloping or mosaic pattern in the descending part of the duodenum and typical histopathological lesions graded as 3b or 3c according to Marsh classification.

[Twenty-two months old girl with haemorrhagic gastritis as a complication after the nonsteroid anti-inflammatory drugs application--case report]. / Krwotoczne zapalenie blony sluzowej zoladka u 22-miesiecznej dziewczynki jako powiklanie zastosowania niesterydowych leków przeciwzapalnych--opis przypadku.

The aim of case report was to pay attention for possibility of side effects of nonsteroid anti-inflammatory drugs. Child of young and healthy parents was born after normal pregnancy, natural delivery. The disease started in two days before the admission, child had fever, cough and sneezing. Mother gave her two doses of ibuprofen. On the time of admission general state of patient was moderate; girl was apathic. In physical examination features of upper respiratory tract infection were shown. In the course of treatment antibiotic and symptomatic drugs including paracetamol (3x5 ml) were delivered. During the second day of treatment child had no appetite, started to vomit with fresh and haemolized blood. Parenteral hydratation was started. Emergency gastroscopy was done and features of haemorrhagic gastritis were shown. Anti-inflammatory drugs were no more used and delivery of omeprazole was started. Parenteral hydratation was continued. General state of patient was better. In the sixth day after bleeding child was excripted in good general state with order of use of omeprazole. Parents were informed about the restriction of anti-inflammatory drugs use. The aim of case report was to pay attention that haemorrhagic gastritis may be one of side effects of nonsteroid anti-inflammatory drugs used accordingly to actual standards.

[Value of E-selectin and L-selectin determination in children and youth with inflammatory bowel disease]. / Wartosc kliniczna oznaczania selektyny E i L u dzieci i mlodziezy z nieswoistymi zapaleniami jelit.

UNLABELLED: Chronic inflammation is the common feature of inflammatory bowel disease. Infiltration of leucocytes is mediated by definite adhesion molecules expressed on the surface of activated leucocytes, platelets and endothelial cells. AIMS: to investigate the clinical value of determining concentrations of sE-selectin and sL-selectin in children and youth with Crohn's disease and ulcerative colitis. PATIENTS AND METHODS: soluble adhesion molecules were studied in the serum of 31 patients with Crohn's disease (CD) and 27 with ulcerative colitis (UC) and 20 healthy controls aged 6-18. Crohn's disease and ulcerative colitis patients were divided according to Hyams and Truelove-Witts' indeces of disease activity. Serum levels of sE-selectin and sL-selectin were measured using an enzyme-linked immunosorbent assay kit of Bender MedSystem. RESULTS: sE-selectin levels of the inflammatory bowel disease patients were higher then those of controls and sL-selectin levels of the IBD patients were lower than those of controls but without statistical significant differences. The sE-selectin levels of Crohn's disease patients with active disease were statistically significant higher then those with remission of the disease (29,17 + 25,65 ng/ml vs 50,74 + 20,00 ng/ml). There was no statistically significant difference in the levels of L-selectin between patients with active disease and those with remission. There were no statistically significant differences in the levels of sE-selectin and sL-selectin between patients with active ulcerative colitis disease and patients with remission. CONCLUSION: determination of sE-selectin in children with Crohn's disease is of significance in estimation of inflammation activity.

[Impedance-pH analysis in gastroesophageal reflux monitoring]. / Zastosowanie metody pH-impedancji w monitorowaniu refluksu zoladkowo-przelykowego.

Gastroesophageal reflux is defined as regurgitation of the stomach contents into the esophagus due to transient or persistent failure of the lower esophageal sphincter. The measurement of impedance is a new technique used to diagnose gastroesophageal reflux. This technique is devoid of restrictions connected with classical esophageal pH-metry. Multichannel intraluminal impedance depends on changes in resistance to alternating current between two metal ring electrodes (impedance measuring segment) generated by the presence of bolus within that segment. The impedance measuring segments are located at 3, 5, 7, 9 cm (distal esophagus) and at 15 and 17 cm (proximal esophagus) over the proximal margin of the lower esophageal sphincter. The technique allows for classification of gastroesophageal reflux incidents as acid, weakly acidic and non-acid, assessment of reflux contents as liquid, gas or gas-liquid and the height of reflux regurgitation into the esophagus. The usefulness of pH-impedance analysis is still difficult due to the lack of normal values in children.

[Iron status with particular consideration of soluble transferrin receptors in children and youth with gastritis, with or without Helicobacter pylori infection]. / Stan gospodarki zielazem ze szczególnym uwzglidnieniem I osoczowych receptorów transferyny u dzieci i mlodziezy z przewleklym zapaleniem blony sluzowej ioladka ze wspólistniejacym zaka eniem Helicobacter pylori lub bez zakaienia.

UNLABELLED: Role of Helicobacter pylori infection in chronic gastritis and gastric and/or duodenal ulcers is well known. Simultaneously there are some articles in literature considering H. pylori as a cause of extra-gastrointestinal illnesses such as atopic dermatitis, chronic urticaria or acne rosacea, hypotrophy, Schoenlein-Henoch disease, atherosclerosis or hypochromic anaemia. The aim of the study. was to asses iron status in aspect of plasmatic transferrin receptors concentration among children and youth with chronic gastritis with or without Helicobacter pylori infection. MATERIALS AND METHODS: Forty one patients were included as a study group. Range of age was 9-18 years. All patients were diagnosed due to chronic abdominal pains. There were 13 males and 28 females. Blood was collected from every patient for blood cell count, iron, transferrin and transferrin receptors concentration (sTfR) assessment before endoscopy of upper gastrointestinal tract. RESULTS: Concentration of sTfR was higher than age norm among 29 (71%) of patients. Among patients with higher level of sTfR 20 (69%) had normal haemoglobin concentration and in this group 10 patients had H. pylori infection. During analysis of 12 patients with nornal level of sTfR normal haemoglobin concentration was found and among five of them H. pylori infection was stated. Among 21 patients without H. pylori infection 14 had normal level of sTfR and 7 had higher level of sTfR which means that 33% had hidden iron deficiency (involuntary of normal Hb concentrations). Among 15 of 20 patients with H. pylori infection level of sTfR was higher which means that 75% patients with infection had hidden iron deficiency (involuntary of normal Hb concentrations). CONCLUSION: Level of plasmatic transferrin receptors can be good and sensitive indicator of iron deficiency and can be helpful in differential diagnosis of hypochromic anaemia and anaemia caused by chronic illness including chronic gastritis with Helicobacter pylori infection.

[The value of anorectal manometry as differentiated organic and functional disorders in children and youth with chronic constipation]. / Wartosc badania manometrycznego jako róznicujacego zaburzenia organiczne i czynnosciowe dolnego odcinka przewodu pokarmowego u dzieci i mlodziezy z przewleklym zaparciem stolca.

UNLABELLED: Constipation is the most frequent ailment from digestive tract in children and youth. Anorectal manometry is no invasion research, contribute to the explanation of pathomechanisms of defecation disorders. THE AIM: of our study is the value of anorectal manometry in diagnostics organic and functional constipation in children and youth. MATRIAL AND METHOD: The study was comprised 100 patients, in it 35 girls and 65 boys, aged from 3 to 17 years old (median age 7 years), who were diagnosed and treated in Chair and Clinic of Pediatrics, Allergology and Gastroenterology by the reason of constipation. The difficulties with constipation were kept at least by three months. Among of analyzed patients 64 came from city and 36 came from the country environment. Transit time was measured in all patients by Abrahamsson' method in modification Hinton. In all patients was measured also anorectal manometry and rectoscopy with histological research. RESULTS: At age group from 3-6 years old and 7-12 years old near 70% were boys. At the group 13-17 years old frequently constipation were in girls (70%). Majority analyzed with constipation in the three groups came from city (group I - 60%, group /II - 71%, group /1/ - 67%). The total colonic transit time was prolonged in 50 (50%) patients with constipation, in 50 (50%) transit time was normal. In 19 patients was the lack of nerve cells in rectum. In 6 patients with the lack of nerve cells in histological research was the lack of rectoanal inhibitory reflex in anorectal manometry. In all patients with presence of nerve cells was RAIR in anorectal manometry. In 66 (66%) children had normal dynamics of defecation. At 34% patients had disturbance of dynamics of defecation (in 21 patients paradoxical shrink of anorectal sphincter, 13 the lack of sphincters relaxation during straining). The organic lesions in anorectal region were in 16 children with constipation. 84 patients granted criteria of functional disorders defecation from 1999 (so called I1 classification of roman functional disturbance). There were not observed essential statistically differences in frequency paradoxical shrink of sphincter and the lack of sphincters relaxation during straining in the group children with organic and functional constipation (p > 0.05). We were observed strong relationship important statistically between presence nerve cells and presence RAIR (p < or =0.01). CONCLUSION: On the base of conducted analysis may be stated at anorectal manometry is useful research in differentiating the kind of defecation disorders in children and youth, which can limit the range of invasion diagnostic research.

[Analysis of the importance of Helicobacter pylori strains in children with gastric and duodenal mucosal inflammatory changes]. / Analiza wystepowania i wplywu zakazenia szczepami CagA(+) Helicobacter pylori na zmiany zapalne blony sluzowej zoladka i dwunastnicy u dzieci.

UNLABELLED: The role of Helicobacter pylori (H. pylori) infection in etiopathogenesis of gastritis and/or duodenitis is well recognized and proven. H. pylori infection also concerns children and youth. It was proven that CagA(+) strains of H. pylori cause inflammatory changes and can lead to ulcer disease of ventriculum and/or duodenum. AIM: The purpose of the study was to determine the prevalence of urease A and cytotoxicity genes in children with diagnosed H. pylori infection and concomitant gastritis and/or duodenitis as well as to determine the kind and stadium of inflammatory changes in relation to particular strains. MATERIAL AND METHODS: The study was performed in 76 patients aged from 3 to 20 years (average age 12.6), who were qualified for endoscopy of the upper GI tract because of recurrent abdominal pain complaints. The H. pylori infection and accompanying gastritis and/or duodenitis were diagnosed according to the Sydney classification. RESULTS: In 57/76 (75%) of diagnosed patients the H. pylori infection was proven with the PCR method (ureA (+)). The following strains were found: CagA(+) in 19 (33% infected subjects). Gastritis and/or duodenitis occurred in all subjects infected with CagA (+) strains and in 54/57 of those with H. pylori infection ureA (+). In subjects without infection, gastritis and/or duodenitis was found in 12 persons, and this result was significantly lower. CONCLUSIONS: In diagnosis it is important to confirm H. pylori presence by CagA gene typing because it relates to the inflammatory changes of the stomach and/or duodenum.

[Effectiveness of omeprazole therapy in children with gastroesophageal reflux diseases(GERD)]. / Ocena skutecznosci leczenia inhibitorem pompy protonowej choroby refluksowej przelyku u dzieci.

THE AIM: Of the study was retrospective analysis of omeprazole (Polprazol) therapy efficacy in children with GERD. MATERIAL AND METHODS: The analyzed group consisted of 78 children with gastroesophageal reflux disease. GERD was detected on the base of questionnaire, pH-metry and/or endoscopy. The questionnaire was conducted in all patients, 24-hour pH-metric examination in 47% and endoscopy in 53% children. Than omeprazole therapy was introduced (0.5-1.0 mg/kg daily). RESULTS: Before omeprazole therapy rebounding was observed in 94% children, heartburn in 84%, vomits in 38% and abdominal pain in 90% children. After 8 weeks of therapy analyzed symptoms were significantly reduced--rebounding was observed in 31% children, heartburn in 28% vomits in 5% and abdominal pain in 26% children. CONCLUSION: Omeprazole therapy is effective in children with gastroesophageal reflux disease.

[Value of pH-metric examination in diagnosing gastroesophageal reflux in children and youth with typical and atypical clinical symptoms of gastroesophageal reflux disease]. / Wartosc badania pH-metrycznego w rozpoznawaniu refluksu zoladkowo-przelykowego u dzieci i mlodziezy z typowymi i nieswoistymi objawami klinicznymi choroby refluksowej przelyku.

AIM: The aim of work was an estimation of pH-metric examination in diagnosing of gastroesophageal reflux in children with typical and atypical symptoms of the gastroesophageal reflux disease. MATERIAL AND METHODS: 121 children were analysed with suspected to gastroesophageal reflux disease. Depending on reported ailments they were divided into 2 groups. Group I patients with typical symptoms of gastroesophageal reflux disease were including: heartburn, rebounding; while the second group consisted of those with atypical symptoms: nausea, vomiting, chest pain, abdominal pain. 24-hour pH-metric examination was performed in each patient. RESULTS: On the basis of pH-metric examination gastroesophageal reflux was diagnosed in 85.2% patients from I group and 44.8% patients from group II. CONCLUSION: The most important examination determining diagnosis of gastroesophageal reflux in children with both typical and atypical symptoms of this illness should be pH-metric examination of the esophagus. In children with atypical symptoms in consideration of differential diagnosis we should take into account a possibility of gastroesophageal reflux.

An evaluation of the impact of supplementation with antioxidant vitamins on oxidation stress parameters in children with chronic recurrent gastroduodenitis.

BACKGROUND: The purpose of our research was to evaluate the impact of supplementation with antioxidative vitamins in children with chronic recurrent gastroduodenitis on the concentration of malon-dialdehyde (MDA) in plasma and erythrocytes, and on activity of the antioxidant enzymes: dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px). MATERIAL/METHODS: We studied 19 children (age from 13 to 16), diagnosed with chronic recurrent gastroduodenitis. The concentration of MDA was measured by Buege and Aust method, while the antioxidant enzyme activity was measured before and after a two-month course of supplementation with vitamins C and E: SOD by the Misra and Fridovich method, CAT by the Bears and Seizer method, and GSH-Px by the Paglia and Valentine method. RESULTS: The average concentration of MDA in erythrocytes in the studied children was significantly higher (38.59 nM/gHb) than in control group (24.07 nM/gHb), but after supplementation was significantly reduced (p<0.05). The average SOD activity in the experimental group was significantly lower both before (885 U/gHb) and after supplementation (923.3 U/gHb) than in the control group (1240 U/gHb). The activity of the remaining enzymes did not differ significantly in experimental and control groups. CONCLUSIONS: The increased erythrocyte concentration of MDA in children with chronic recurrent gastroduodenitis may point to the generation of active forms of oxygen due to the low activity of the anti-oxidant enzyme SOD. Supplementation with the antioxidant vitamins C and E in children with a low antioxidant potential and chronic recurrent gastroduodenitis reduces the generation of free oxygen radicals.