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The 13C-urea breath test is the most widely applied non-invasive test to diagnose Helicobacter pylori (Hp) infection in children.The fasting time, dose and formulation of labeled urea, type of test meal, time of breath collection, device to detect breath samples, cut-off value of exhaled 13CO 2/ 12CO 2 breath delta value and the interpretation of results have been modified to improve the accuracy.The 13C-urea breath test possesses a good perfor-mance in diagnosing Hp infection and evaluating the eradication of infection after treatment in children.However, the high false-positive results in young children are caused by oral flora, endogenous CO 2 and fixed dose of labeled urea.In addition, taking proton pump inhibitors, antibiotics and bismuth before test, low bacterial density and peptic ulcer bleeding will lead to false negative results.This study aims to review the influencing factors of 13C-urea breath test in the diagnosis of Hp infection in children.
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The polymorphism of CYP2C19 gene constitutes the basis for the difference in enzyme activity and affects the metabolism of many drugs including proton pump inhibitors.The distribution of CYP2C19 gene varies by region and race.The study on the relationship between CYP2C19 genotype and proton pump inhibitors is of great significance for the individualized treatment of Helicobacter pylori (Hp) in children.This paper reviews the effects of CYP2C19 gene polymorphism on proton pump inhibitors and the efficacy of Hp eradication in children.
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Objective:To investigate the distribution of CYP2C19 genotypes in Helicobacter pylori (Hp) infected children in Chongqing and the correlation of genotypes with gender, age and efficacy, and to provide a reasonable plan for Hp eradication in children in Chongqing. Methods:A prospective clinical cohort study was carried out on 156 children who were suspected of Hp infection and underwent gastroscopy in Children′s Hospital of Chongqing Medical University from March to July 2020. 13C-urea breath test ( 13C-UBT), rapid urease test (RUT) and histological examination were made for all the children included.Meanwhile, for Hp-positive children, the CYP2C19 genotypes were detected by using the polymerase chain reaction(PCR)-sequence-specific primer method, and their sensitivity to Clarithromycin and Amoxicillin was assessed.According to the genetic testing results, the CYP2C19 genotypes were divided into homozygous extensive metabolizer (HomEM), heterozygous extensive metabolizer (HetEM) and poor metabolizer (PM). The eradication outcomes of proton pump inhibitor combined with Amoxicillin and Clarithromycin (PAC) in different genotypes were observed.The measurement data that did not conform to the normal distribution were expressed with the median ( M), and the enumeration data were represented by the rate or the constituent ratio.The Chi- square test was used for comparison between groups, and P<0.05 indicated statistically significant difference. Results:(1)A total of 102 children were Hp positive.Positive rates of 13C-UBT, RUT and histologic results were 97.1% (99/102), 99.0% (101/102), and 90.2% (92/102), respectively.(2)Among the 102 Hp-infected children HomEM accounted for 45.1% (46/102), HetEM for 41.2% (42/102), and PM for 13.7% (14/102). (3)There were 50 males and 52 females in 102 Hp-infected children.The age range was 3 years to 17 years and 9 months (median: 9 years and 7 months). There was no significant difference in the distribution of CYP2C19 genotypes between females and males and among children of different ages (all P>0.05). (4)In 87 cases treated with PAC regimen, 36 cases failed to eradicated Hp in the initial treatment, including 18 cases of HomEM, 15 cases of HetEM, and 3 cases of PM.Hp was eradicated successfully in 51 cases, including 21 cases of HomEM, 21 cases of HetEM and 9 cases of PM.There was no statistically significant difference in the Hp eradication efficacy among children with different CYP2C19 genotypes treated by the PAC regimen ( P>0.05). (5) Among the 87 children, 45 children were sensitive to Clarithromycin, and 37 of them achieved successful Hp eradication.About 42 children were resistant to Clarithromycin, and Hp eradication was fulfilled in 14 of them.There was a statistically significant difference in the Hp eradication efficacy among Clarithromycin-resistant children treated by PAC regimen ( P<0.05). Conclusions:The CYP2C19 genotypes have no correlation with gender, age and Hp eradication efficacy of PAC in children with Hp infection in Chongqing.
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The transplantation of human umbilical cord mesenchymal stem cells (hUC-MSCs) can promote hypoxic-ischemic brain damage (HIBD) nerve repair, but finding suitable seed cells to optimize transplantation and improve treatment efficiency is an urgent problem to be solved. In this study, we induced hUC-MSCs into dedifferentiated hUC-MSCs (De-hUC-MSCs), and the morphology, stem cell surface markers, proliferation and tri-directional differentiation ability of the De-hUC-MSCs and hUC-MSCs were detected. A whole-gene chip was utilized for genome cluster, gene ontology and KEGG pathway analyses of differentially expressed genes. De-hUC-MSCs were transplanted into HIBD rats, and behavioral experiments and immunofluorescence assays were used to assess the therapeutic effect. A lentivirus vector for human stromal cell-derived factor-1 (hSDF-1α) was constructed, and the role of hSDF-1α in the neuroprotective effect and mechanism of De-hUC-MSCs was verified. De-hUC-MSCs displayed similar cell morphology, stem cell surface marker expression, cell proliferation and even three-dimensional differentiation ability as hUC-MSCs but exhibited greater treatment potential in vivo. The reprogramming mechanism of hSDF-1α participated in the dedifferentiation process. By successfully constructing a stable hSDF-1α cell line, we found that De-hUC-MSCs might participate in nerve repair through the hSDF-1α/CXCR4/PI3K/Akt pathway. De-hUC-MSCs reprogramming of endogenous hSDF-1α expression may mediate the hSDF-1α/CXCR4/PI3K/Akt pathway involved in nerve repair in HIBD rats.
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Objective:To investigate the clinical features of children with irritable bowel syndrome(IBS), so as to achieve the early diagnosis and treatment, thus avoiding misdiagnosis and mistreatment.Methods:A total of 80 hospitalized IBS patients in the Department of Gastroenterology, Children′s Hospital of Chongqing Medical University from January 2012 to August 2018 were enrolled.Their diagnosis and treatment were analyzed by combining with literature reviews.Results:(1)A total of 80 cases include 53 boys and 27 girls.The mean age at diagnosis was(9.70±2.88)years, and the median duration of disease was 10 months.(2)Abdominal pain was found in all cases, followed by diarrhea in 60 cases, constipation in 31 cases, abdominal distension in 21 cases, vomiting in 19 cases, weight loss in 11 cases, loss of appetite in 9 cases, and headache in 3 cases.Twenty-nine cases had suspected triggers before onset, mostly diet factor.(3)Eighty cases with IBS include 46 cases with irritable bowel syndrome with diarrhea(IBS-D), 17 cases with irritable bowel syndrome with constipation(IBS-C), 13 cases with mixed irritable bowel syndrome(IBS-M) and 4 cases with unsubtyped irritable bowel syndrome(IBS-U). The number of boys with IBS-C and IBS-D was higher than that of girls.IBS-M was on the contrary.IBS-U was equal between them.There were significant differences in gender among the subtypes ( χ2=0.83, P=0.001). Abdominal distension among 4 clinical types was statistically diffe-rent, IBS-M had the highest incidence, followed by were IBS-C, IBS-D, IBS-U.(4)Treatment was aimed at patients education, psychological intervention, dietary management and symptomatic therapy.After the first 6 months visit of 74 cases, 34 cases were sustained relieved, 25 cases were alleviated, and the overall effective rate was 79.73%, but 15 cases were ineffective. Conclusions:IBS is a common functional gastrointestinal disease in children, with more boys than girls.Dietary stimulation is the most common cause.Among the 4 subtypes, the composition ratio of IBS-D is the highest.Most of the cases are effective in symptomatic treatment.There are still some patients with poor curative effect.
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Non-typhoid Salmonella(NTS)is widely distributed around the world, mainly infected children under 5 years of age.Salmonella Enteritidis and Salmonella Typhimurium are the main serotypes.NTS are major cause of acute gastroenteritis, but the invasive diseases such as bacteremia and meningitis are more serious.The antibiotic resis-tance of NTS is severe, and irrational use of antibiotics is ubiquitous.Now, the epidemiology, clinical characteristics, susceptible factor and antibiotic therapy of NTS infection in children were summarized, which helps early diagnose and rational antibiotic therapy.
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Gastrointestinal tuberculosis(GITB)is defined as Mycobacterium tuberculosis involving any region of gastrointestinal tract, mostly in the distal ileum and cecum.Clinical features include abdominal pain, fever and palpable mass in the ileocecal area and so on.China is one of the countries with high tuberculosis burden, and the incidence of GITB remains high.However, the manifestation isn′t specific, so it′s still difficult to diagnose, which causes misdiagnosis and mistreatment.Diagnosis and treatment of GITB in children are more difficult than in adults.It′s often misdiagnosed as Crohn′s disease, increasing treatment expense, leading to unnecessary adverse drug reactions and affecting the physical and mental health of children.Therefore, it′s vital to understand the characteristics and make correct diagnosis, which improves patient′s prognosis and life quality, and reduces tuberculosis transmission.
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Cyclic vomiting syndrome is a functional gastrointestinal disorder.In May 2016, Rome Ⅳ criteria of Functional Gastrointestinal Diseases have been published, it is defined as at least twice paroxysmal vomiting within 6 months, with or without retching, each time lasting for hours to days, every patient has a fixed episode, each episode interval can be several weeks to months, and the interictal period can restore the basic health level.The disease with the corresponding clinical manifestaion, laboratory and imaging examination can be diagnosed after appropriate evaluation.At present, the pathogenesis of the disease is still unclear, most of them are treated according to clinical experience, the purpose is to prevent seizures.The review is mainly focused on the research progress of the diagnosis, pathogenesis and treatment progress of cyclical vomiting syndrome.
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Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, and is also a common cause of recurrent abdominal pain in children.The pathogenesis of IBS has not been completely clarified, and it is currently believed to be related to factors such as gastrointestinal dysmotility, visceral hypersensitivity, and brain-gut axis dysfunction.Pediatric IBS often shows abdominal pain, bloating, accompanied by altered bowel habits, while its clinical manifestations are not specific.The diagnosis of IBS is usually made based on the Rome Ⅳ criteria.The ultimate goal of treatment is to improve the quality of life of children, including alleviating the abdominal pain of children and restoring normal bowel habits.The treatment mainly includes adjusting diet and lifestyle, medicine etc.This review is to investigate the progress of the pathogenesis, diagnosis and treatment of IBS in recent years.
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Cyclic vomiting syndrome is a functional gastrointestinal disorder.In May 2016,Rome Ⅳ criteria of Functional Gastrointestinal Diseases have been published,it is defined as at least twice paroxysmal vomiting within 6 months,with or without retching,each time lasting for hours to days,every patient has a fixed episode,each episode interval can be several weeks to months,and the interictal period can restore the basic health level.The disease with the corresponding clinical manifestaion,laboratory and imaging examination can be diagnosed after appropriate evaluation.At present,the pathogenesis of the disease is still unclear,most of them are treated according to clinical experience,the purpose is to prevent seizures.The review is mainly focused on the research progress of the diagnosis,pathogenesis and treatment progress of cyclical vomiting syndrome.
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Chronic intestinal pseudo-obstruction(CIPO)is an intestinal motility dysfunction caused by intestinal myopathies or neuropathies or mesenchymopathies.The clinical manifestation is almost the same with mechanical intestinal obstruction,but in the absence of any obstruction in the gastrointestinal tract.According to etiology,it can be divided into primary and secondary.While according to gastrointestinal neuromuscular disorders,it can be categorized as myopathy,neuropathy and mesenchymopathy,which have different pathogenesis.The disease with the clinical manifestation,imaging examination or histopathology was diagnosed,but mechanical intestinal obstruction must be excluded.Presently,the therapies of CIPO mainly are stimulating the motility of intestine and ensuring the necessary nutrition of the children.The review is mainly focused on the research progress of the pathogenesis,clinical manifestation,diagnosis,therapy of pediatric CIPO in recent years.
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Systemic multiple organ can be involved in food allergy and the digestive tract is a major involved organ.Food allergy related digestive tract diseases are diversity,most is non-IgE mediated mechanism.The diagnosis methods of IgE mediated and non-IgE mediated food allergy is not the same.The management of digestive food allergies should focus on the establishment of the oral immune tolerance and the rational use of drugs.Combined with the recent guidelines and the progresses of diagnosis and treatment of gastrointestinal food allergy are introduced.
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Food allergy is a common illness in children,which is divided into IgE-mediated,non-IgE mediated and mixed-mediated food allergy.Gastrointestinal tract is the mainly affected organ,mostly mediated by non-IgE mechanism.Gastrointestinal food allergy are lack of unified diagnostic criteria currently,whose mechanism is also elusive.Moreover,the double-blind placebo-controlled food challenge is the gold standard for the diagnosis of food allergy.This review focuses on the procedure for the oral food challenge and its application in the diagnosis of gastrointestinal food allergy.
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Objective To analyze the main clinical manifestations,laboratory features and prognosis of neonatal intrahepatic cholestasis caused by Citrin defiency (NICCD).Methods Twenty-nine NICCD infants were diagnosed by blood tandem mass spectrometry (MS-MS)analysis and/or SLC25A13 mutation analysis from July 2012 to February 2015 in Children's Hospital of Chongqing Medical University.Clinical data of 29 cases were analyzed retrospectively which included manifestations,laboratory features and prognosis.The general situation,feeding,liver function,growth were followed up.Results Twenty-nine infants suffering from NICCD presented jaundice in an early time,and some clinical manifestations were investigated such as hepatomegaly (20/29 cases),splenomegaly (3/29 cases),anemia (14/29 cases),and failure to thrive (9/29 cases).Laboratory data suggested that all of 29 patients had increased conjugated bilirubin,total bile acid,γ-glutamyl transferase and alkaline phosphatase.Some patients also showed abnormal coagulation function (20/22 cases),dyslipidemia (9/20 cases),increased blood lactic acid (22/26 cases) and alpha-fetoprotein (14/14 cases),decreased albumin (24/29 cases),blood glucose (17/22 cases) and ceruloplasmin (4/4 cases).The pathological analysis of one patient's liver indicated the edema and degeneration of liver cells,intrahepatic cholestasis and a small amount of fibrous tissue hyperplasia in portal area.MS-MS analysis of blood samples revealed distinctive increase in methionine,tyrosine,threonine,citrulline,arginine and free carnitine,long chain acyl-carnitine in most patients.Gas chromatography-mass spectrometer (GC-MS) analysis of urine samples mainly showed elevated 4-hydroxyphenyllactic acid and 4-hydroxyphenylpyruvic acid.Prognosis showed that most of the NICCD patients (8/29 cases) could recover in one-year old with a lactose-free,medium chain triglyceride-enriched formula,and one patient died of liver cirrhosis.Three patients at over one-year old had the preference of a high protein and low carbohydrate diet.Conclusions Infants might be considered to have NICCD if they have jaundice in an early time,with the clinical characteristics of hepatomegaly,splenomegaly,abnormal coagulation function,anemia,failure to thrive,dyslipidemia,decresed albumin and blood glucose,increased blood lactic acid and alpha-fetoprotein.After that further tests of MS-MS,GC-MS and gene analysis of this disease are needed to confirm diagnosis.
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Objective To investigate the clinical characteristics and etiology in infants undergoing colonoscopy in order to improve the understandings of lower gastrointestinal tract diseases and their endoscopic manifestations.Methods The clinical and endoscopic data of the infants aged ≤ 3 years old who underwent conoloscopy at the Department of Gastroenterology,Children's Hospital of Chongqing Medical University,from July 2010 to December 2014,were retrospectively analyzed.A total of 223 children were included,148 male and 75 female.The age range was from 26 d to 3 years old(＜6 months:41 cases;6-12 months:68 cases;1-3 years old:114 cases).Results A total of 235 colonoscopies were performed under deep sedation by single or double manipulators.Cecal intubation was successful in 192 colonoscopies and terminal ileal intubation was completed in 29 colonoscopies,with a high success rate of 94.0％ (221/235 colonoscopies).The main symptoms included hematochezia (124 cases,55.6％),persistent/chronic diarrhea (55 cases,24.7％),hematochezia with chronic diarrhea(22 cases,9.5％),and others(22 cases,9.5％).Of the 223 patients,clear diagnosis were established for 215 children (96.4％),with food protein-induced proctocolitis (FPIPC) (78/223 cases,35.0％),colonic polyps (50/223 cases,22.4％),colitis (29/223 cases,13.0％),antibiotic associated diarrhea (AAD) (19/223 cases,8.5％),FPIPC with AAD (10/223 cases,4.5％).Conclusions Colonoscopy serves as a very important tool for the accurate diagnosis of lower gastrointestinal diseases with hematochezia and/or chronic diarrhea.FPIPC and colonic polyps are the most common causes for hematochezia and/or chronic diarrhea.AAD may be another important cause of chronic diarrhea and bloody stool in infants.Moreover,ghe application of colonoscopy in combination with histopathology can also play an important role in the diagnosis of some rare diseases,such as intestinal tuberculosis,primary intestinal lymphangiectasia,Behcet's disease and primary immunodeficiency disease.
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Drug induced liver injury(DILI) is one of the most common factors causing liver damage and liver failure in children.And in most cases,patients' manifestations lack characteristic features.Thus,patients will develop gastrointestinal symptoms such as jaundice,nausea,vomiting and abdominal abstention until serious hepatic dysfunction.Futhermore,some patients are likely to develop acute liver failure,even death,without drug discontinuation and timely intervening measures.Early diagnosis and effective therapies considerably make sense.This review aims to illustrate the mechanism,manifestations,diagnosis and treatment of DILI in children,in order to promote the early treatment of the disease,reduce the serious complications and improve survival rate in clinical work.
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Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract. Most ca-ses are asymptomatic,while it can be symptomatic when complications happened,its complications often expressed as hematochezia,abdominal pain,vomit,fever,and so on. When signs or symptoms arise from a Meckel′s diverticulum, morbidity and mortality will increase. So make a definite diagnosis of the diverticulum play an important role in the treatment of Meckel′s diverticulum. In this essay,now illustrate the meaning of imaging examination about the diagnosis of Meckel′s diverticulum,wish to make a diagnosis as soon as possible.
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Food allergy(FA) seems to be increasing world wide which is roughly divided into IgE mediated or non-IgE mediated FA(NFA).NFA primarily affects the gastrointestinal mucosa which is far less understanding the immunological mechanisms than IgE-mediated FA.Clinicians sometimes experienced confusion due to delayed onset of symptoms and subsequent difficulty in making the clinical association between offending food and clinical symptoms.The lack of easily accessible diagnostic measures also contributes to the problem.The diagnosis of NFA usually is established in the eliminated of food allergen and food challenge test.In this paper,the diagnosis and treatment of NFA is introduced combined with our clinical practice experience.
