Activity of mitogen-activated protein kinases in the esophageal epithelium of patients with Barrett's esophagus.

Barrett's esophagus (BE), a complication of gastroesophageal reflux disease, is associated with an increased risk of esophageal cancer. Mitogen-activated protein kinases may play an important role in the pathogenesis of this process. We aimed to evaluate mitogen-activated protein kinases activity in esophageal mucosa of patients with BE and find possible relationship between reflux type and BE. Twenty-four patients (mean age: 59 years) with gastroesophageal reflux disease symptoms and endoscopically suspected esophageal metaplasia (ESEM) were prospectively enrolled for testing by a multichannel intraluminal impedance monitoring along with a Bilitec 2000. Endoscopic biopsies were taken from methylene blue-positive pit patterns (sites suggesting specialized intestinal metaplasia [SIM]), from 2 cm above the Z-line and from cardial parts of the stomach. The biopsies were analyzed for extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38 activity by Western blot. Seventeen ESEMs had histologically proven metaplasia: eight patients had SIM and nine had gastric-type epithelia (GE). Biliary reflux was more evident in SIM (P = 0.019) but not in GE (P = 0.019); non-biliary reflux was typical for GE (P = 0.005) but not for SIM (P = 0.04). Strong activations of ERK and p38 were found predominantly in SIM, but not in normal esophageal mucosa (NE) (P = 0.01 and P < 0.001 respectively). Strong signals for active JNK and p38 were detected in GE, but not in NE (P = 0.006 and P = 0.02 respectively). ERK activity was significantly higher than p38 activity in ESEM patients only with GE (P = 0.02). The strong activation of ERK, but not JNK is indicative of SIM. The presence of bile in gastroesophageal refluxate is predisposing to SIM, but not to GE in esophageal mucosa.

The natural history of cow's milk allergy in north-eastern Poland.

PURPOSE: The rate of cow's milk allergy diminishes with age. There is not enough information concerning geographical trends in persistent cow's milk allergy in children. The objective of the study was to evaluate the prevalence of persistent cow's milk allergy in children previously diagnosed with IgE-mediated cow's milk allergy (CMA). MATERIAL/METHODS: Diagnosis of cow's milk allergy was established by a medical history of symptoms associated with exposure to cow's milk, positive skin prick tests with cow's milk, the presence of milk-specific IgE, and by a positive double- or single-blind placebo-controlled food challenge with milk confirmed by a positive open-controlled milk challenge. A second oral challenge was performed after at least one year of a milk-free diet and children with a positive oral milk rechallenge were diagnosed as having a persistent CMA. RESULTS: Two hundred ninety-one children, 2-14 years of age (mean 5.30±3.16 years, 95% CI, 5.02-5.62 years) completed the study. Persistent CMA was diagnosed in 79 patients (27.1%). Two hundred twelve children (72.9%) outgrew their allergy to cow's milk at a mean age of 5 years after an average time of 16.4±0.8 months on an elimination diet. Eighty percent of children below 3 years of age became milk tolerant. Milk-specific IgE (p=0.018) and history of paternal bronchial asthma and/or rhinitis (p=0.020) were associated with persistence of cow's milk allergy in regression analysis. CONCLUSIONS: An age above 3 years, as well as features of atopy, individual and familial, may be associated with a risk of delayed tolerance to milk in children.

The evaluation of angiogenesis and matrix metalloproteinase-2 secretion in bone marrow of multiple myeloma patients before and after the treatment.

PURPOSE: Angiogenesis appears to be a prominent feature of many hematological disorders, particularly in multiple myeloma (MM). Progression in MM also involves secretion of the metaloproteinases (MMPs). In this study, the expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and its receptor, in bone marrow trephine biopsy (TB) of thirty six MM patients before and after the treatment or during progression was examined. The MMP-2 secretion was assessed from the same patients. MATERIAL/METHODS: Immunohistochemical staining of bone marrow specimens for angiogenic factors and microvessel density (MVD) and bone marrow aspirates for Western blot analysis of MMP-2 expression was performed. RESULTS: In active, untreated MM patients, we found statistically significant differences in the expression of angiogenic factors according to the patients after the anti-angiogenic treatment. We found statistical differences of the expression of angiogenic factors between the group of patients with a response after the treatment and the patients who had progression during the treatment. The data showed statistically significant decreased MVD after the treatment. The results showed statistically significant differences between initial secretion of MMP-2 in active, untreated MM patients and patients with a response after the treatment and patients with progression during the treatment. CONCLUSIONS: We showed that not only decreased expression of angiogenic cytokines is present after the anti-angiogenic treatment but also activity of MMP-2 in MM patients who responded to the treatment. Combination therapy with the inhibition of the activity of MMPs could represent an interesting therapeutical approach in MM.

Serum interleukin--4 and tumor necrosis factor alpha concentrations in children with primary acid gastroesophageal reflux and acid gastroesophageal reflux secondary to cow's milk allergy.

AIM: The possible role of serum interleukin 4 (IL-4) and tumor necrosis factor alpha (TNF- α) in pathogenesis of the reflux symptoms in children with primary acid gastroesophageal reflux (GER) and acid GER secondary to cow's milk allergy (CMA). MATERIAL AND METHODS: Out of 264 children, 76 (28.8%) patients with primary GER and 62 (23.5%) patients with GER secondary to CMA (pH - monitoring) serum IL-4 and TNF- α concentrations were assessed before treatment, 1 and 2 years after the initiation of the periodically administered pharmacotherapy. RESULTS: Children with primary GER had mean IL-4 concentrations 0.17 ± 0.06 pg/ml before treatment, 0.08 ± 0.07 pg/ ml after 1-year and 0.07 ± 0.06 pg/ml after 2-years of treatment. The mean IL-4 concentrations were 1.07 ± 0.24, 0.5 ± 0.22 and 0.44 ± 0.19 pg/ml respectively in children with GER secondary to CMA. The mean serum TNF- α concentrations was 3.62 ± 1.30 pg/ml before treatment , 2.16 ± 1,35 pg/ ml after 1 year and 1.65 ± 1.16 pg/ml after 2 years of treatment in children with primary GER. In group with GER secondary to CMA mean serum TNF- α concentrations were 4.95 ± 1.88, 2.53 ± 0.80 and 2.02 ± 0.78 pg/ml respectively. Statistical analysis of the concentration of both cytokines showed their differentiation between them and in the study groups. CONCLUSIONS: The highest mean serum IL-4 and TNF-α concentrations were observed in children with GER secondary to CMA and in children in control group (with cow's milk allergy and/or other food allergy diagnosed - CMA/FA) before the treatment administration.

Serum gastrin concentrations in children with primary gastroesophageal reflux and gastroesophageal reflux secondary to cow's milk allergy.

PURPOSE: The assessment of the serum gastrin concentrations and the role of enterohormone in children with primary acid gastroesophageal reflux (GER) and GER secondary to cow's milk allergy (CMA). MATERIALS/METHODS: 138 children were diagnosed with pathological acid GER on the basis of pH-metric examination. 76 (28.8%) patients had primary GER and 62 (23.5%) patients had GER secondary to CMA.Serum gastrin concentration (fasting and postprandial) was assessed before treatment and 1 and 2 years after initiation of the therapy. RESULTS: The children with primary GER had the fasting gastrin concentration 69.46 ± 11.87 µU/ml before treatment, 77.86 ± 26.35 µU/ml after 1 year and 83.78 ± 25.21 µU/ml after 2 years of treatment. The children with GER secondary to CMA had gastrin concentrations 89.61 ± 26.75, 73.17 ± 19.49 and 73.90 ± 20.31 µU/ml respectively. The mean postprandial gastrin concentration after treatment was higher than before treatment in children with both primary and secondary GER. The primary GER group had postprandial gastrin concentration 96.07 ± 33.51 µU/ml before treatment and 116.06 ± 33.95 µU/ml and 118.48 ± 33.96 µU/ml after 1st and 2nd year of therapy respectively. The secondary GER group had postprandial gastrin concentration 85.33 ± 14.12 µU/ml before treatment and 106.55 ± 24.51 µU/ml and 110.36 ± 24.67 µU/ml after 1st and 2nd year of therapy respectively. CONCLUSIONS: The mean fasting serum gastrin concentrations in patients with primary and secondary GER were similar and mean postprandial concentrations were higher than fasting concentrations in both study groups.

Sleep-wake schedules in preschool children who snore.

PURPOSE: The aim of the study was to compare sleep-wake schedules between snoring and nonsnoring preschool age children. MATERIAL AND METHODS: Daytime and nighttime sleep duration, daytime and nighttime symptoms were assessed in 34 children at preschool age who snore (5.38+/-1.21 years) and in 66 age- and sex-matched nonsnorers (5.67+/-1.12 years). The snoring group consisted of children with obstructive sleep apnea (OSA) scores <+3.5 and >-1, the nonsnoring group with OSA score <-1. RESULTS: Children who snore differ from the nonsnorers in daytime sleep duration (51.62+/-28.9 minutes vs. 10.70+/-20.2 minutes; p<0.001), but not in nighttime sleep (10.97+/-0.52 hours vs. 9.83+/-1.34 hours; p>0.05). The percentage of children with daytime napping was higher in the snoring group than in the nonsnorers (47.1% vs. 9.1%; p<0.00004), and parents-reported behavioral problems were more frequent in children who snore (41.2% vs. 19.7%; p<0.02). Multivariate odds ratios, including variables for nighttime (sleep apnea) and daytime symptoms (daytime napping and oral breathing), showed that regular sleep during the day was the most predictive of snoring (OR=6.1; 95%CI 1.76-21.04; p<0.005). CONCLUSION: In preschool age children, when the daytime nap begins to disappear, snoring may have an effect on daytime schedule through an increased need for daytime sleep.

Acid gastroesophageal reflux and intensity of symptoms in children with gastroesophageal reflux disease. Comparison of primary gastroesophageal reflux and gastroesophageal reflux secondary to food allergy.

UNLABELLED: The ability to differentiate between primary and secondary causes of gastroesophageal reflux (GER) is extremely important during the diagnostic procedure. At the same time, the quality of symptoms and the intensity of the course of gastroesophageal reflux disease (GERD) should be estimated. Acid GER is assessed using 24-hour esophageal pH monitoring; the results of this diagnostic test should always be interpreted alongside the clinical picture. PURPOSE: To establish the interdependence between the intensity of the clinical symptoms and the acid reflux index in children with primary GER and GER secondary to cow's milk protein allergy (CMA) and/or other food allergies (FA). MATERIALS AND METHODS: A total of 138 children of various ages with symptoms of GERD were included in the study. The diagnostic procedure included 24-hour pH monitoring of the esophagus with a 2-channel probe (distal and proximal lead). For this purpose, ESPGAN diagnostic criteria were implemented. The type and intensity of typical manifestations of GERD were assessed with the help of our own scoring system. This diagnostic and therapeutic algorithm which includes an oral food challenge test, was applied to 138 children in order to differentiate primary GER from GER secondary to CMA/FA. RESULTS: Primary GERD was diagnosed in 76 patients (55.1%) with a mean age: x=25.20 months+/-27.28 (group 1) and GERD secondary to CMA/FA was confirmed in 62 children (44.9%) with a mean age: x=21.53 months+/-17.79 (group 2). The most important pH-metric parameter analyzed in study groups 1 and 2 was the GER index: total and supine. An assessment of the intensity of symptoms and a comparative analysis of intensity was evaluated against the GER index: total and supine. Among study group 1, the following gradation of symptoms was found: in 31 children (40.8%)-degree 3, in 33 children (43.4%)-degree 4, and in 12 children (15.8%)-degree 5, whereas among the patients in group 2:25 (40.3%) were in degree 3, 27 (43.6%) were in degree 4, and 10 (16.1%) were in degree 5. It was estimated that the higher the GER result in both total and supine positions (for both leads), the higher the level of symptoms noted. This interdependence was demonstrated for both groups. CONCLUSIONS: In seeking to determine any etiopathogenetic connection between primary GER or GER secondary to CMA/FA and their clinical consequences, 24-hour esophageal pH monitoring with a 2-channel probe is recommended, since it provides for better clinical control of GERD and its appropriate treatment.

Manometric study of lower esophageal sphincter in children with primary acid gastroesophageal reflux and acid gastroesophageal reflux secondary to food allergy.

PURPOSE: The comparison of values of selected lower esophageal sphincter (LES) manometric parameters measured in children suspected of gastroesophageal reflux disease (GERD) (preliminary study) and in children with primary acid GER and acid GER secondary to cow's milk allergy and/or other food (CMA/FA) in relation to the duration of the disease (prospective study). MATERIAL AND METHODS: A 24-hour esophageal pH monitoring was performed on 264 children of both sexes suspected of GERD (mean age x=20.78+/-17.23 months). Pathological acid gastroesophageal reflux (GER) was diagnosed and divided into primary and secondary reflux in 138 children (52.3%). 76 patients (28.8%) (x=25.2+/-27.28 months) with primary GER made up Group 1. Group 2 consisted of 62 patients (23.5%) (x=21.53+/-17.79 months) with GER secondary to CMA/FA. 32 patients (12.1%) (x=23.7+/-12.63 months) with CMA/FA symptoms made up Group 3 (reference group). Prospective assessment of LES manometric parameters, i.e. resting LES pressure and LES length, was performed on 138 children with GER. Manometric parameters, resting LES pressure and LES length, measured at the preliminary study (0) and control studies (after 1, 2 and 8 years), were prospectively assessed in 138 children. The assessment resulted from clinical observation and/or conservative treatment. RESULTS: The mean value of resting LES pressure (mm Hg) before treatment was x=11.75+/-3.98 in Group 1, x=11.05+/-3.31 in Group 2, and x=14.17+/-3.86 in Group 3 (reference group). After 2 years of clinical observation, the mean value of resting LES pressure accounted for x=13.71+/-3.88 in Group 1, x=13.01+/-2.94 in Group 2, and x=17.92+/-3.36 in Group 3. The mean LES length (cm) before treatment accounted for x=1.68+/-0.72 in Group 1, x=1.78+/-0.70 in Group 2, and x=2.0+/-0.86 in Group 3. After 2 years of clinical observation, the mean LES length was x=2.80+/-0.40 in Group 1, x=2.76+/-0.40 in Group 2, and x=2.97+/-0.48 in Group 3. 12 children with persistent GERD (Group 1) and 8 children with persistent GERD and food allergy (Group 2) underwent manometric evaluation of LES after 8 years. No statistical differentiation of the mean values of resting LES pressure and LES length were shown in examined children of Groups 1 and 2 during prospective studies. CONCLUSIONS: Manometric studies of LES assessing only resting LES pressure and its length in the examined children with acid GER do not clearly differentiate GER into primary and secondary refluxes to food allergy.

24-hour esophageal pH monitoring in children with pathological acid gastroesophageal reflux: primary and secondary to food allergy. Part I. Intraesophageal pH values in distal channel; preliminary study and control studies--after 1, 2, 4 and 9 years of clinical observation as well as dietary and pharmacological treatment.

PURPOSE: Among 264 children suspected of GERD, acid gastroesophageal reflux (GER) was confirmed in 138 children on the basis of 24-hour pH monitoring. AIMS OF THE STUDY: Comparative analysis of parameters of 24-hour intraesophageal pH monitoring (in distal channel--above cardia) in children with acid GER: primary and secondary to cow milk allergy and/or other food allergy (CMA/FA) diagnosed; comparison of examined values of pH monitoring parameters with regard to duration of the disease (preliminary study and prospective studies--after 1, 2, 4 and 9 years of clinical observation and/or conservative treatment). MATERIAL AND METHODS: 264 children suspected of GERD, of both sexes (140 boys--53.0% and 124 girls--47.0%), aged: 1.5-102 months; x = 20.78 +/- 17.23 months, were enrolled in the study. In order to differentiate acid GER: primary from secondary to CMA/FA in 138 (52.3%) children with GERD immunoallergological tests were performed. Positive result of oral food challenge test confirmed the allergy being the cause of GER. 138 children with pathological acid GER were qualified into two groups: 1 and 2. Group 1--76 patients (55.1%), aged: 4-102 months; x = 25.2 +/- 27.28 months, with pathological primary GER. Group 2--62 patients (44.9%), aged: 4-74 months, mean age x = 21.53+/- 17.79 months, with pathological GER secondary to CMA/FA. RESULTS: Significant differentiation of the mean values of these parameters between preliminary study and control studies within groups was shown in the case of: number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes, duration of the longest episode of acid GER, acid GER index: total and supine (distal channel). Statistical significance (p < 0.05) was higher in group 1, especially during prospective clinical observation and/or conservative treatment. At the same time significant differentiation of the mean values of: number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes and mean values of acid GER index: total and supine was shown between the groups. Statistical significance (p < 0.05) was higher in group 2. CONCLUSIONS: The preliminary study of examined children confirmed that values of pH monitoring in distal channel were comparable and did not contribute to differentiation of GER into primary (group 1) and secondary (group 2). During prospective clinical observation and/or clinical treatment the intensity of reflux in these groups was assessed on the basis of the number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes in distal channel. Acid GER index: total and supine appeared to be important diagnostic parameter but only after the first year of dietary and pharmacological treatment.

24-hour esophageal pH monitoring in children with pathological acid gastroesophageal reflux: primary and secondary to food allergy. Part II. Intraesophageal pH values in proximal channel; preliminary study and control studies--after 1, 2, 4 and 9 years of clinical observation as well as dietary and pharmacological treatment.

PURPOSE: Among 264 children suspected of GERD, acid GER was confirmed in 138 children on the basis of 24-hour pH monitoring. AIMS OF THE STUDY: Comparative analysis of parameters of 24-hour intraesophageal pH monitoring with dual-channel probe (in proximal channel) in children with acid GER: primary and secondary to cow milk allergy and/or other food allergy (CMA/FA) diagnosed; comparison of examined values of pH monitoring parameters with regard to duration of the disease (preliminary study and prospective studies--after 1, 2, 4 and 9 years of clinical observation and/or conservative treatment). MATERIAL AND METHODS: 264 children suspected of GERD, aged: 1.5-102 months; x = 20.78 +/- 17.23 months, were enrolled in a study. In order to differentiate acid primary GER from GER secondary to CMA/FA in 138 (52.3%) children with GERD immunoallergological tests were performed. Positive result of oral food challenge test confirmed the allergy being the cause of GER. 138 children with pathological acid GER were qualified into two groups: 1 and 2. Group 1--76 patients (55.1%), aged: 4-102 months; x = 25.2 +/- 27.28 months, with pathological primary GER. Group 2--62 patients (44.9%), aged: 4-74 months; x = 21.53 +/- 17.79 months, with pathological GER secondary to CMA/FA. RESULTS: Significant differentiation of the mean values of these parameters between preliminary study and control studies within groups was shown in the case of: number of episodes of acid GER and duration of the longest episode of acid GER, acid GER index: total and supine (proximal channel). Statistical significance (p < 0.05) was higher in group 1, especially during prospective clinical observation and/or conservative treatment. At the same time significant differentiation of the mean values of: number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes and mean values of acid GER index: total and supine was shown between the groups. Statistical significance (p < 0.05) was higher in group 2. CONCLUSIONS: The preliminary study of examined children confirmed that values of pH monitoring in proximal channel were comparable to those in distal channel and did not contribute to differentiation of GER into primary and secondary. During prospective clinical observation and/or clinical treatment, on the basis of consecutive measurements, especially the number of episodes of acid GER and episodes of acid GER lasting more than 5 minutes, and also supine acid GER index it was stated that GER secondary to CMA/FA was of wider extent (higher) in comparison with primary GER in these patients.

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.

Gastroesophageal reflux (GER) in children and adolescents with regard to food intolerance.

PURPOSE: The hypothesis put forward in the current study was that food intolerance can be a cause of gastroesophageal reflux (GER) affecting children with this pathology at various age. In order to confirm or exclude this hypothesis, the study objective was to determine the frequency of the cause-and-effect relationship between allergy to cow milk proteins and/or other food products and gastroesophageal reflux found in the study group of patients, and to establish diagnostic differentiation guidelines in GER caused by food intolerance, i.e. secondary vs primary GER. MATERIAL AND METHODS: A total of 735 children (428 boys--58.2% and 307 girls--41.8%; mean age x = 41.12 months +/- 25.03) with symptoms suggesting gastroesophageal reflux disease (GERD) were qualified for the study. The diagnostic procedure included a 24 h pH-metry of the oesophagus, which was performed in all the study children. In 703 patients (411 boys--55.9% and 292 girls--39.7%) upper gastrointestinal endoscopy was carried out. Manometric examination of the oesophagus was performed in 232 children (123 boys--16.7% and 109 girls--14.8%). Allergological and immunological tests were done in 170 children with suspected allergy (91 boys--12.4% and 79 girls--10.7%). Contrast radiography of the upper gastrointestinal tract was performed in 78 children with respiratory symptoms (42 boys--5.7% and 36 girls--4.9%). Oral challenge test was used to differentiate primary GER from GER secondary to cow milk proteins intolerance or other food allergy in 138 children (72 boys--9.8% and 66 girls--8.9%). RESULTS: Based on the 24 h pH-metry of the oesophagus and endoscopic examination of the upper gastrointestinal tract, gastroesophageal reflux disease and/or reflux oesophagitis were diagnosed in 138 study subjects (18.8%); mean age x = 23.36 months +/- 22.53. Positive oral food challenge test confirmed pathological GER secondary to cow milk protein allergy/other food hypersensitivity in 62 children (8.4%). CONCLUSION: The current study revealed the existence of the cause-and-effect relationship between allergy to cow milk protein/ /other food products and GER in the study children at various age.

Gastroesophageal reflux in children and adolescents. clinical aspects with special respect to food hypersensitivity.

PURPOSE: Gastroesophageal reflux (acid GER), primary and secondary, has a wide spectrum of clinical symptoms and occurs at developmental age. The study objective was to elaborate the clinical profile of symptoms and to determine whether there are any differences in clinical manifestations between the two acid GER conditions, i.e. primary and secondary to cow milk allergy and/or other food allergy (CMA/FA). MATERIAL AND METHODS: The study involved 264 children of both genders and at various age, with diverse reflux symptoms from one or many organs and with a positive family history of alimentary tract diseases. Based on preliminary diagnostic tests, the children were divided into groups. In 138 children, pathological acid GER, primary and secondary to CMA/FA, was recognized. RESULTS: The profile of clinical symptoms observed in 264 children with suspected gastroesophageal reflux disease (GERD) was elaborated according to their frequency. Among differentiating symptoms the most common were: vomiting (12.1%), bronchitis (10.9%) and pneumonia (9.6%). In the group of 138 GER children, 32 (23.2%) had monosystemic symptoms, in the other 106 patients (76.8%) many systems were affected. The most frequent reflux symptoms were: in primary GER (group 2)--alimentary tract disorders (28.6%), pneumonia and bronchitis (20.7%) and neurological symptoms with torticollis (7.4%); in secondary GER (group 3)--alimentary tract disorders: vomiting and anxiety/crying (25.2%); pneumonia and bronchitis (19.4%). In 23 children (37%) with secondary GER, typical allergic symptoms were found to coexist. The 138 GER patients underwent allergologic and immunologic tests to confirm the allergic background of symptoms. CONCLUSION: Clinical symptoms caused by the presence of secondary acid GER are non-specific, being identical or similar to those observed in primary acid GER. Allergologic and immunologic tests are useful to confirm or exclude the relationship between GER and CMA/FA in the study children.

Evaluation of the effect of intravenous l-carnitine on quality of life in chronic hemodialysis patients.

AIM: The aim of this study was to determine the effect of l-carnitine on quality of life (QOL) in chronic hemodialysis patients. PATIENTS AND METHODS: This trial used a randomized, prospective, placebo-controlled, double-blind, crossover design. Inclusion criteria were patients who were older than 18 years, had been on dialysis for a minimum of one year, and had at least two of the following symptoms: intradialytic hypotension, muscle cramping, lack of energy, muscle weakness or myopathy, cardiomyopathy, or lack of responsiveness to erythropoietin (EPO). Patients were excluded if they were mentally incompetent to complete a QOL questionnaire. Sixteen patients were randomized to receive either l-carnitine (20 mg/kg) or placebo (normal saline) after each dialysis session for 12 weeks, followed by a 6-week washout, then the crossover therapy for 12 weeks. The Kidney Dialysis Questionnaire was the assessment tool used to evaluate QOL. RESULTS: There was no significant effect of l-carnitine on QOL irrespective of treatment order. There were also no differences found in any of the secondary outcomes including incidence of muscle cramping, intradialytic hypotension, EPO requirements or hemoglobin. Adverse effects consisted of gastrointestinal symptoms, with a similar incidence between l-carnitine and placebo. CONCLUSION: L-carnitine did not have a benefit on QOL in our patient population.

[Congenital megaloblastic anemia in a 22-month-old boy]. / Postac dzieciéca niedokrwistosci megaloblastycznej u 22-miesiecznego chlopca.

A 22-month old boy with the congenital form of megaloblastic anaemia is presented. The child was admitted to hospital with moderate-to-severe hematological and neurological symptoms. Very low serum vitamin B12 concentration and normal gastric secretion were determined. A dramatic recovery after intramuscular injections with vitamin B12 was observed.

The role of free oxygen radicals in children with chronic viral hepatitis B.

Lipid peroxidation of polyunsaturated fatty acids, being important components of cellular membranes, caused by free oxygen radicals is considered to be one of the main causes of hepatocyte injury. The aim of this study is to estimate the malondialdehyde (MDA) level in the red blood cells of children with chronic viral hepatitis B. The decrease of MDA concentration along with the clinical and serological improvement in children with chronic hepatitis B was observed. We also noticed a correlation of MDA with HBeAg-anti HBe seroconversion and obliteration of HBV DNA polimerase activity.

[Clinical aspects of gastro-esophageal reflux in children]. / Aspekty kliniczne odplywu zoladkowo-przelykowego u dzieci.

In 20 children hospitalized in the age range from 2 months to 7 years the clinical manifestations caused by radiologically demonstrated gastro-oesophageal reflux were analysed. The main symptoms were from the digestive tract and respiratory system. In this group of children this reflux was also the cause of deficient body weight and attacks of apnoea with cyanosis.