Characterization of a group of children with eosinophilic esophagitis in Cali, Colombia.

PURPOSE: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic disease of the gastrointestinal tract. The objective of this study was to clinically and demographically describe a child population with EoE diagnosed in a high-complexity hospital in Cali, Colombia. METHODS: A retrospective study was carried out. The clinical histories of patients between 0 and 18 years with clinical suspicion and a histological diagnosis of EoE were analyzed. All patients underwent an allergy study, either by measurement of specific immunoglobulin (Ig) E and/or an intraepidermal skin-prick test. RESULTS: Thirty-five patients were included in the study, of which 21 (60%) women. The median age was 8 years (interquartile range [IQR] 5-12), and the age of onset of symptoms was 5 years (IQR 2-10). Thirty patients (85.7%) reported a history of allergic disease, with rhinitis being the most frequent (n = 25, 71.4%). Only one patient reported with food allergy mediated by IgE. The main symptoms in patients included abdominal pain (17 [48.6%]), refractory gastroesophageal reflux (16 [45.7%]), and choking (9 [25.7%]). Upper gastrointestinal endoscopy was normal in 10 patients (38.5%). The median number of eosinophils in the biopsy was 42 (IQR 31-92). Allergenic sensitization was verified in 25 of 35 patients (71.4%). Of these, dust mite allergy was positive in 21 patients (84%), while the most frequent food allergy was toward cow's milk, in five patients (31.3%). CONCLUSIONS: The majority of patients with EoE were females. The most frequent symptom was abdominal pain. Endoscopic abnormalities were also observed frequently, and the prevalence of other allergic diseases (especially rhinitis) and allergenic sensitization (especially to mites) was high.

Enfoque clínico del niño desnutrido según recomendaciones de la OMS: primera parte / Clinical approach to the malnourished child as recommended by WHO: first part

La desnutrición (DNT) infantil afecta a cerca de una décima parte de los < 5 años de edad en todo el mundo y se asocia con la mitad de todas las muertes en este mismo grupo de edad. La deficiencia de macronutrientes puede ser el resultado de una dieta inadecuada, una mala absorción de los nutrientes ingeridos, o la presencia de una enfermedad inflamatoria crónica, donde se promueve su pérdida y un estado catabólico. El estado nutricional se evalúa con la puntuación z del peso (P) para la talla (T), y se expresa en unidades de desviación estándar (DE) de la media de la población de referencia. La DNT moderada se define como una puntuación z de P/T, entre 2 y 3 DE por debajo de la media (-2 a -3 DE). El compromiso del P/T, indica DNT aguda, la OMS propone su clasificación en moderada y severa, según valores de DE y la presencia de edema. La DNT severa también puede clasificarse como complicada o no complicada, según las comorbilidades asociadas. El kwashiorkor se asocia con una mayor tasa de mortalidad, y la complicación más frecuente es la infección bacteriana sistémica.

Malnutrition (UND) child affects about a tenth of <5 years of age worldwide and is associated with half of all deaths in this age group. Macronutrient deficiency can result from inadequate diet, poor absorption of ingested nutrients, or the presence of a chronic inflammatory disease, where loss and promotes a catabolic state. Nutritional status was evaluated with the weight z score (W) for height (H) and is expressed in units of standard deviation (SD) of the mean reference population. The UND moderate is defined as a z score W/H, between 2 and 3 SD below the mean (-2 to -3 SD). The commitment of the W/H, indicates acute UND, WHOproposed classification in moderate and severe, according to the values of SD and the presence of edema. The UND also be classified as severe or complicated uncomplicated by associated comorbidities. Kwashiorkor is associated with a higher mortality rate, and the most common complication is systemic bacterial infection.

Enfoque clínico del niño desnutrido según recomendaciones de la OMS: segunda parte

La desnutrición (DNT) en niños, afecta cerca de una décima parte de los < 5 años a nivel mundial, y se asocia con la mitad de las muertes en esta misma edad, sobre todo, en poblaciones que viven en circunstancias de pobreza extrema. En algunos casos, según las condiciones sociales de cada paciente, se puede continuar con la fase de rehabilitación de forma ambulatoria, con visitas domiciliarias, suplementosnutricionales y administración de micronutrientes. Se considera que el niño está preparado para entrar en lafase de rehabilitación cuando ha recuperado el apetito, habitualmente una semana después del ingreso. Losniños DNT presentan un retraso del desarrollo mental y del comportamiento, que si no se trata puede convertirse en la secuela más grave a largo plazo de la DNT. Se considera que un niño se ha recuperado si su peso es del 90% del que le correspondería según su talla (equivalente a –1 DE); no obstante, puede seguirteniendo bajo peso para su edad, debido al retraso del crecimiento. Es esencial un seguimiento planificado del niño con intervalos regulares después del alta. Pacientes con DNT moderada y severa sin complicaciones, sin enfermedad crónica, con manejo en casa, alcanzan tasas de recuperación entre el 85-90%.

Malnutrition (UND) in children, affecting about onetenth of <5 years worldwide, and is associated with halfof the deaths in this age, especially in populations living in conditions of extreme poverty. In some cases, depending on the social conditions of each patient can continue the rehabilitation on an outpatient basis, withhome visits, nutritional supplements, and administration of micronutrients. It is believed that the child is ready to enter the rehabilitation phase when it has regained appetite, usually one week after admission. UND children have delayed mental development and behavior, which if untreated can become the worst sequel in the long term UND. It is believed that a child has recovered if its weight is 90% which would correspond by size (equal to -1 SD), however, may still underweight for their age due to growth retardation. Planned follow-up is essential the child at regular intervals after discharge.