Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

A Latin American and Spanish pediatric gastroenterology group's understanding of cow's milk protein allergy diagnosis and treatment: Results of a survey by the Food Allergy Working Group of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica. / Conocimiento sobre el diagnóstico y el tratamiento de la alergia a las proteínas de la leche de vaca por un grupo de gastroenterólogos pediatras en Iberolatinoamérica: resultado de la encuesta del Grupo de Trabajo de Alergia Alimentaria de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica.

INTRODUCTION: There are discrepancies in the diagnosis and management of cow's milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. MATERIAL AND METHODS: Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. RESULTS: The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57, 83 and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. CONCLUSION: CMPA management is diverse and there is poor adherence to the clinical practice guidelines.

Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. / Prevalencia de esofagitis eosinofílica: estudio multicéntrico en población pediátrica evaluada en 36 centros de gastroenterología de América Latina.

INTRODUCTION AND OBJECTIVE: Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS: A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS: Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS: The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.

[Stable auditory evoked potentials in the study of two patients with auditory neuropathy]. / Potenciales evocados auditivos de estado estable en el estudio de dos pacientes con neuropatía auditiva.

INTRODUCTION: We described the results of the auditory multiple steady state response (MSSR) technique in the assessment of two patients with auditory neuropathy (AN). The aim of this study was to corroborate the correspondence between the MSSR generators elicited by amplitude modulated tones ranging between 80-100 Hz, with the generators of auditory brain stem response (ABR). Moreover, we would also try to demonstrate the validity of the MSSR in the diagnosis of AN in children. MATERIAL AND METHODS: Two children diagnosed of hyperbilirrubinemia, aged, 18 months and 10 years have been studied with MSSR (500, 1000, 2000 and 4000Hz); ABR with clicks; OAE; behavioural audiometry; MRI and acoustic reflexes. RESULTS: A difference between electrophysiological and behavioural audiogram in both cases diagnosed with auditory neuropathy have been found. The auditory thresholds were similar using the two types of evoked potentials (MSSR and ABR). Both techniques showed an increment of auditory threshold congruous with a severe auditory impairment, while behavioural audiometry showed only a mild elevation of auditory threshold. We can also see how the threshold differed between frequencies using behavioral audiometry and MSSR. CONCLUSION: It is concluded that our findings are in agreement with previous studies and they sustain the theory about the coincidence of MSSR at fast rate (80-110 Hz) and ABR generators. Also, we demonstrate the usefulness of the MSSR as an objective [corrected] electroaudiometric tool in patients with auditory neuropathy as ABR. This technique is thus a recommendable test to complete the audiological study in infants with AN, to establish a more precise treatment.

[A combined neonatal hearing screening protocol]. / Protocolo combinado de cribado auditivo neonatal.

OBJECTIVE: To analyze a neonatal hearing screening protocol with transient evoked otoacoustic emissions (OAE) and auditory brainstem response (ABR). PATIENTS AND METHODS: We studied 1,532 newborns with a protocol using transient evoked otoacoustic emissions and auditory brainstem response. We also evaluated auditory development until twelve months of age with quarterly questionnaires. RESULTS: A total of 1,485 (97 %) newborns had normal OAE, 185 (12 %) were referred for ABR exploration and only 11 (0.7 %) were referred to the otorhinolaryngology service for auditory study and diagnosis. Four neonates had auditory disjunction. No false negatives were detected in the follow-up. CONCLUSIONS: This hearing screening protocol with OEA and ABR is useful for detecting hearing loss in neonates. The prevalence of hearing loss in this study was 2.6 % of live newborns.

Protocolo combinado de cribado auditivo neonatal / A combined neonatal hearing screening protocol

Objetivo: El objetivo de este estudio es analizar un protocolo de cribado auditivo neonatal en el que se combina el uso de otoemisiones acústicas (OEA) evocadas y potenciales evocados auditivos de tronco cerebral (PEATC). Pacientes y métodos. Se estudiaron 1.532 recién nacidos con un protocolo en el que se realizaron OEA y PEATC. Además, se realizó una evaluación del desarrollo auditivo hasta los 12 meses de edad mediante unos cuestionarios trimestrales. Resultados: Superaron las OEA 1.485 niños (97%), a 185 bebés (12%) fue necesario realizarles PEATC y sólo 11 niños (0,7%) precisaron ser remitidos al servicio de otorrinolaringología para completar el estudio y realizar el diagnóstico definitivo. En 4 niños se detectó enfermedad auditiva. En este estudio no se detectó ningún falso negativo durante el seguimiento. Conclusiones: Este protocolo de estudio en el que se usa OEA y PEATC de forma combinada, demuestra ser útil para la detección de la hipoacusia en recién nacidos. La prevalencia de la hipoacusia detectada en este estudio fue de 2,6 recién nacidos vivos (AU)

Prevencion de caries con fluor. / Caries prevention with fluor

Se enumeran las causas que favorecen la produccion de caries dentarias en especial las correspondientes a los glucidos. Se destaca el papel del fluor y su mecanismo de accion en la formacion dentaria y en la profilaxis de las caries.Se recomienda implementar un programa de prevencion empleando en las cifras de consumo, fluor en la dosis de 0,8 a 1,2 ppm, segun las zonas geograficas

Prevencion de caries con fluor. / Caries prevention with fluor

Se enumeran las causas que favorecen la produccion de caries dentarias en especial las correspondientes a los glucidos. Se destaca el papel del fluor y su mecanismo de accion en la formacion dentaria y en la profilaxis de las caries.Se recomienda implementar un programa de prevencion empleando en las cifras de consumo, fluor en la dosis de 0,8 a 1,2 ppm, segun las zonas geograficas