Is acid gastroesophageal reflux in children with ALTE etiopathogenetic factor of life threatening symptoms?

PURPOSE: Commonly described multiorgan manifestation of acid GER: primary and secondary to cow's milk allergy and/or other food (CMA/FA) sometimes coexists with ALTE (Apparent Life Threatening Events) syndrome symptoms. Among these symptoms are apnea, cyanosis, pallor, hypotonia, non-epileptic seizures, consciousness disorders and bradycardia. MATERIALS AND METHODS: 264 children aged: 4-102 months (x=20.78 +/- 17.23 months) of both sexes, with symptoms suggestive of GER were enrolled into study. 8 children (4.8%) aged up to 2 years (x=10.00 +/- 2.78 months) of both sexes with symptoms suggestive of ALTE were selected from the group. 24-hour esophageal pH monitoring was used for acid GER diagnosis in these children. X-ray of esophagus with barium swallow was performed in order to evaluate the height of GER in infants. Immunoallergologic tests were performed in order to differentiate acid GER: primary and secondary to food allergy in these children. AIMS: (1) Assessment of the prevalence of acid GER in children with symptoms suggestive of ALTE, (2) Clinical evaluation of symptoms in children with ALTE and acid GER, (3) Assessment of efficacy of conservative treatment in children with reflux and ALTE symptoms, (4) Natural regression of the disease in children with ALTE Results: From among 264 examined children who underwent 24-hour esophageal pH monitoring acid GER was confirmed in 170 (64.4%), and ALTE in 8 (4.8%). The causative role of primary acid GER in children with ALTE regarded to 4 children (50.0%) and GER secondary concerned 4 remaining children (50.0%). Mean number of ALTE episodes that appeared before admission to the hospital was similar in both study groups. The presence of typical reflux symptoms in 5 (62.5%) out of 8 children with ALTE symptoms on the basis of primary or secondary acid GER is significant. Mean value of total acid GER index in a subgroup of children with primary GER constituted x = 11.13 +/- 1.45 and was not statistically significant in comparison with mean value x = 12.13 +/- 1.30 of a parameter measured in a subgroup of children with secondary GER. The most common clinical manifestation was apnea and it was of identical prevalence in both study subgroups. Analysis of clinical differentiation of the course of ALTE in children with primary and secondary acid GER under conservative therapy was performed. Under this therapy, gradual regression of ALTE symptoms was achieved in all (8/100.0%) patients, with a tendency to longer time of improvement in children with secondary GER. Typical and atypical symptoms of GER receded in a subgroup with primary GER and were alleviated in a subgroup with secondary GER. In the second half year of clinical observation aggravation of reflux and ALTE symptoms was observed in subgroups. In the second year of clinical observation various typical and atypical symptoms of GER were observed in both subgroups. All these malaises during this period coexisted with ALTE symptoms. In the third year of clinical observation in both subgroups ALTE symptoms connected with acid GER were not observed. CONCLUSION: Primary and secondary GER were defined as the causative factors of ALTE in 8 (4.8%) examined infants.

Oxyuriasis-induced intestinal obstruction in a child--case report.

PURPOSE: The presentation of an unusual case of the tumor of ileum wall induced by pinworm infection in a 5-years-old child. MATERIAL AND METHODS: The record of a 4-years-old boy treated in the department of pediatric surgery was analyzed concerning the diagnostic difficulties. After 6 month from an episode of ileo-cecal intusussception successfully treated with a barium colon enema, the diagnosis of lymphoma was made and the resection of distant segment of small intestine was performed. RESULTS: No clinical and laboratory features of oxyuriasis could be stated before the onset of disease, during hospitalization and in the follow-up period. The hypertrophied and activated lymphatic tissue with a non-specific inflammatory reaction to the pinworms were seen in the wall of ileum, appendix and mesenteric lymph nodes. No neoplastic cells were found in the microscopic study of ileum, appendix, mesenteric lymph nodes and peritoneal lavage fluid. CONCLUSIONS: The proper diagnosis of oxyuriasis may be difficult when the course is atypical. The enterobius vermicularis infestation as an etiologic factor should be taken into account in any case of abdominal pathology. However, the methods routinely used in "acute abdomen" including examinations of blood, urine and stool, repeated ultrasound and CT, are not reliable. As the infestation may mimic neoplasm, the surgical treatment and microscopic examination can be necessary for the final diagnosis in some cases.

A long-term study in children with a recognized gluten intolerance.

A retrospective and prospective study was carried out on 54 children with gluten intolerance recognized 5-10 years ago. Coeliac disease (CD) was confirmed in 44 (81.5%) patients. The clinical picture in the observed children showed an evolution during the period of analysis. Intestinal symptoms are rare in adolescence (33%) while they are always present in the youngest children (initial diagnosis). At the time of the follow-up analysis, 67% of the patients demonstrated parenteral symptoms, mainly in the osteoarticular system, CNS, skin, mucous membranes and in only 33% children were the intestinal symptoms present. Over one third of the patients demonstrated body weight and height deficiency, 73% of boys and 39% of girls in age of pubescence had no maturity features. Neurological disorders were present in almost two thirds of the cases and about 5% of the children showed an evident mental retardation. Disruption of the gluten-free diet, frequent dietary errors and ineffective cooperation of the parents are the most probable reasons for physical and mental disturbances in the studied children. The obtained therapeutic results call for the creating of multi-disciplinary active care for children with gluten intolerance.

The assessment of the therapeutic effectiveness of IRS-19 in allergic children with recurrent or chronic respiratory infections.

The subject of the clinical-laboratory examinations was a group of 36 children aged 1 4/12 - 17 years with recurrent upper (94%) and lower (63%) airway infections, whose condition did not improve after antibiotic therapy, elimination diet and anti-histaminic treatment. In 83% of the examined patients respiratory tract symptoms co-existed with skin (61%), gastrointestinal tract (44%) and OUN (16%) diseases. 75% of examined children, with humoral and/or cellular response disorders, were given an IRS-19 vaccine, which resulted in the regression of the respiratory tract symptoms in 78% of patients. Due to side-effects in the form of high temperature, the treatment was terminated in 14% of children. The obtained therapeutic effects and convenience of administration of the vaccine, justify IRS-19 treatment in children with recurrent lower and upper airway infections, after complex immunological examination.