The significance of increased levels of end nitric oxide metabolites in blood serum of children with celiac disease.

OBJECTIVES: The aim of the study was to determine serum nitric oxide (NO) metabolites and correlate them to gluten-free diet (GFD) compliance, the parameters of morphological and functional condition of the small intestine in patients with celiac disease (CD) in a long-term follow-up. PATIENTS AND METHODS: The study included 35 children (age median 8.0 years) with previously diagnosed CD, among them 15 - on a strict GFD and 20 - on a semistrict GFD. 32 patients (age median 7.5 years) with functional abdominal pain were recruited as controls. Nitrites (NO(2)), nitrates (NO(3)), total content of nitrites and nitrates (NOx) in serum were determined using the Griess reaction. CD patients underwent small intestine morphometry and absorption D-xylose test. RESULTS: Compared to the controls, the CD patients on a strict GFD had no significant differences in NO(2), NO(3), NOx content, while in patients violating GFD these parameters were significantly higher. In comparison with the patients on a strict GFD, the patients on a semistrict GFD had higher median values of NO(3) (p = 0.002) and NOx (p = 0.0000). Serum NOx correlated negatively with the height of villi (p = 0.0001), D-xylose excretion (p = 0.0063), and correlated positively with the depth of crypts (p = 0.0082) and cellular density of villi stroma (p = 0.0067). CONCLUSION: CD patients not keeping to a strict GFD have an increased level of nitric oxide metabolites in serum. NOx content is associated with morphometric parameters of the small intestine that proves the participation of NO in the pathogenesis of histological changes in CD (Tab. 3, Ref. 39).

Duodenal mucosa in children with coeliac disease in catamnesis and varying compliance with the gluten-free diet.

OBJECTIVES: the aim of the study was to identify the characteristic morphometric data changes in the small intestine mucosa in response to varied compliance with gluten-free diet in children with coeliac disease. METHODS: 71 children (47 girls and 24 boys) aged 2.5 to 16.5 (median age=10.6) with coeliac disease diagnosed according to the previously revised ESPGHAN criteria were included in the study. The patients were divided into three groups: 1 - on strict GFD, 2 - on semistrict GFD, 3 - not on GFD. Quantitative morphometric data on biopsies of duodenal mucosa in each group were compared with each other. RESULTS: As compared with group 1, patients from group 2 had a lower villous height (Vh)/crypt depth (Cd) ratio, but a higher Cd, total cell density of lamina propria, plasma cells density in the villi and fibroblasts density in the space between the crypts. In patients from group 3, as compared with group 1, we found a significant reduction in Vh and Vh/Cd ratio, and a significant decrease in the number of goblet cells. At the same time they yielded an increase in Cd, number of intraepithelial lymphocytes (IEL), total cell density and plasma cells density throughout the lamina propria depth, number of macrophages and neutrophils in the villous lamina propria, and number of fibroblasts in the space between crypts. The differences were statistically significant. CONCLUSION: Quantitative morphometric parameters of small intestine mucosa allow revealing statistically significant differences between the groups of children with coeliac disease in response to varied compliance with GFD. This enables us to assess the dynamics of the pathological process and enhance our understanding of its nature, which is very important for improving the therapy and prognosis (Ref. 40).

[Features of mucosal lesions of stomach and duodenum in children with chronic gastroduodenitis with different microflora content].

OBJECTIVE: Our aim was to reveale the features of histological mucosa with different composition of the microflora of stomach and duodenum in children with chronic gastroduodenitis. METHODS: The study included 122 children with chronic gastroduodenitis from 5 to 17 years old. All patients underwent endoscopy with histology of biopsy specimens of gastric and duodenal mucosa in 94 patients and in 48 patients among them with morphometry of biological material. Identification of herpes simplex virus 1, 2 types, cytomegalovirus, human papilloma virus 16, 18 types, Helicobacterpylori was carried out using polymerase chain reaction in biopsies of gastroduodenal mucosa and gastric juice. RESULTS: Children with chronic gastroduodenitis depending on the identified microorganisms were divided into groups: 1st (n = 51)--without detectable microorganisms, 2nd (n = 28)--with associations of H. pylori and viruses, 3rd (n = 15)--only with viruses, 4th (n = 28)--with H. pylori. Thus, in patients with H. pylori inflammation was noted mainly in the antral mucosa and dystrophic changes--in the duodenal mucosa. In the presence of viruses the inflammation was expressed more in the fundal stomach and duodenum. When viral-bacterial associations were observed most pronounced inflammatory-dystrophic process was localized throughout the gastroduodenal mucosa. CONCLUSION: In children with chronic gastroduodenitis in the presence of bacterial, viral and mixed microflora in the stomach and duodenum identified characteristic histological features of the mucosa, manifested in a different localization and severity of inflammatory and dystrophic changes.