Digestive Tract In Children Research Articles

DUPLICATION OF THE GASTROINTESTINAL TRACT IN CHILDREN

Duplication of the gastrointestinal tract (GIT) being a rare malformation can be localized in anywhere of the digestive tube. The incidence of this disease is 1:4,500 newborns. In most cases doubling of the gastrointestinal tract is diagnosed before the age of two years and is found in both girls and boys with a slight predominance of boys. Duplications of the gastrointestinal tract are closely connected cystic or tubular structures possessing a common blood supply with any part of the digestive tract. Signs of doubling are a well-developed layer of smooth muscles in the wall of duplication and the presence of the mucous membrane. The type of mucosa of the formation generally corresponds to the gastrointestinal tract from which it originates but in 29-35% of cases ectopic tissue occurs. The spectrum of clinical symptoms of gastrointestinal redundancies is extremely diverse and often the diagnosis of the disease presents great difficulties for the surgeon. It depends on the type of duplication, location, size, the presence of ectopic mucosa and communication with the lumen of a healthy area of the digestive tract. At present, there is no consensus on the tactics of managing patients with GITduplication. The choice of the method of surgical treatment (enucleation, fenestration, resection) is determined by the following criteria: the localization and size of pathological formation, the mobility of the supporting segment of the digestive tube, the ratio to the lumen segment of the gastrointestinal tract (extra-, intraluminal position), the type of blood supply, the presence or absence of communication with the lumen of a healthy site of the gastrointestinal tract and the age of the patient. In each case of doubling, an individual approach and choice of tactics for surgical treatment are required. This article presents a literature review on the topic “Doubling the digestive tract in children” in details, there are highlighted theories of embryogenesis of this developmental defect, classifications, clinical features, diagnosis and surgical treatment of duplications of different localization.

Clinical analysis of malignant solid tumors in the digestive tract in children and adolescents

Objective To explore the clinical features, treatment and prognosis of malignant solid tumors in the digestive tract in children and adolescents. Methods Sixty-five children and adolescents with malignant solid tumors in the digestive tract from January 1997 to June 2017 were selected, who were treated at the Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital.The tumor site, gender, age, clinical presentations, treatment, follow-up time and their life status by deadline follow-up in 65 children and adolescents were collected respectively, and the clinical features, treatment methods and prognosis were retrospectively analyzed.The follow-up deadline was on December 31, 2017. Results The most frequent sites of tumors were liver tumor(36 cases, 55.38%), followed by rectum tumor(11/65 cases, 16.92%), colon tumor(6/65 cases, 9.23%), pancreas tumor(5/65 cases, 7.69%), gastric(3/65 cases, 4.62%), esophagus(1/65 cases, 1.54%), gallbladder tumor(1/65 cases, 1.54%), ileum tumor(1/65 cases, 1.54%), and appendix tumor(1/65 cases, 1.54%). The prevalence rate in males and females was 1.321.00.The age of embryo tumor incidence was smaller, and the age of epithelium cancer incidence was older.The main symptoms included abdominal distension and pain (66.15%, 43/65 cases). Twenty-seven patients (41.5%, 27/65 cases) was in stage Ⅳ.Radical and palliative surgery were the main treatment in 50 cases (76.92%). The 1-year, 3-year, 5-year overall survival rates were 60.7%, 31.0%, 18.8%, respectively.The overall survival rate of colon and rectal cancer was higher than that of hepatocellular cancer, and the differences were all statistically significant(χ2=6.268, P=0.012; χ2=11.772, P=0.001). The overall survival rate of patients who received surgery combined with chemoradiotherapy was the longest and those undergoing chemotherapy only was the shortest, but the differences had no statistical significance among 4 groups of sheer surgery, chemotherapy alone, surgery combined with chemotherapy and surgery combined with chemoradiotherapy(all P>0.05). Conclusion The malignant solid tumors in the digestive tract in children and adolescents have a poor prognosis.The unspecific presentation makes the diagnosis difficult.It is very important to diagnose early and treat as soon as possible by the combination of surgery, chemotherapy and radiotherapy to improve the overall survival rate. Key words: Child; Adolescent; Digestive tract; Malignant solid tumor; Clinical analysis

A study on radio opaque foreign body in digestive tract of children

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">An estimated 40 percent of foreign body ingestions in children are not witnessed, and in many cases, the child never develops symptoms. Sharp foreign body, button battery must be carefully removed and followed up for any complications. Foreign bodies that have passed the gastroesophageal junction should be assured that the foreign body will probably pass through the GI tract. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A retrospective analysis of the records of the children below 12 years with foreign body ingestions were analysed and the radio-opaque foreign body were included in the study period between March 2012 to March 2015. The x-ray were analysed, type of foreign body, treatment and complications were noted. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There were 45 children included in the study who had ingested foreign body and on radiological evaluation radio opaque foreign body was found. The coin topped the list with 30, button battery- 7 numbers, safety pin- 5 numbers. In 2 children who ingested button battery suffered cricopharyngeal stricture, which was treated with serial dilatation with bougies, while one child with open safety pin ingestion, developed pseudo- aneurysm of arch of aorta and one ear stud developed stridor with sub glottic stenosis. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The radio opaque foreign though is easy to visualise, but in some case it can dangerous complications. Rigid oesophagoscopy and prompt removal of foreign body is the treatment of choice.</span></p>

Инородные тела пищеварительного тракта у детей: новые аспекты известной проблемы

Инородные тела пищеварительного тракта у детей: новые аспекты известной проблемы

No effect of yeast-like fungi on lipid metabolism and vascular endothelial growth factor level in children and adolescents with type 1 diabetes mellitus.

BackgroundThe objective of the research was to investigate vascular endothelial growth factor (VEGF) levels in the context of lipid metabolism and amount of yeast-like fungi colonizing the digestive tract in children and adolescents with type 1 diabetes mellitus (T1DM).MethodsThe study included 45 children with T1DM and 27 age- and sex-matched healthy control subjects. In the study sample 33 T1DM patients were administered insulin pump therapy and 12 T1DM patients were administered multiple daily injections with insulin pen devices. All T1DM patients were free of micro- and macrovascular complications. In T1DM patients and healthy controls biochemical tests were performed and measurements of yeast-like fungi colonizing the alimentary tract were conducted. Moreover all study subjects had their serum VEGF levels measured with ELISA test.ResultsThe subgroup of children and adolescents with T1DM and yeast-like fungus colony number 10^3 CFU/g was shown statistically significantly lower HbA1c levels, and lower but not statistically significantly total cholesterol, LDL cholesterol and VEGF levels versus T1DM patients with the amount of yeast-like fungi 10^6 CFU/g. Moreover higher HDL levels were observed in this subgroup versus T1DM patients with the amount of yeast-like fungi 10^6 CFU/g although the difference was not statistically significant.ConclusionsOur study has shown no influence of yeast-like fungi on lipid metabolism and VEGF level in children and adolescents with T1DM. Comprehensive treatment of T1DM patients and intensive insulin therapy with help of personal insulin pumps can reduce or prevent the development of long-term diabetic complications. Further studies in this field are needed.

Последовательность возникновения эрозивно-язвенных поражений пищеварительного тракта у детей с дисплазией соединительной ткани

Последовательность возникновения эрозивно-язвенных поражений пищеварительного тракта у детей с дисплазией соединительной ткани

Патология верхних отделов пищеварительного тракта у детей как биопсихосоциальная проблема

Патология верхних отделов пищеварительного тракта у детей как биопсихосоциальная проблема

Foreign bodies in digestive tract of children: A tertiary care hospital experience

Introduction: Foreign bodies in the digestive tract are an important cause of morbidity and mortality in paediatric age group and pose diagnostic and therapeutic challenges We performed this study to evaluate our experience of foreign bodies of digestive tract in children over a five year period in a tertiary referral center. Patients and Method: A retrospective study was conducted over a 5-year period between April 2009 and March 2013. All patients who were managed for foreign body in digestive tract up to 12 years of age were included and analysis was performed from case record of patients. Results: Total 97 patients with FB in digestive tract were included in the study FB was most commonly lodged in Upper esophagus in 61 patients, middle esophagus in 12 cases lower third of esophagus in 14 cases and beyond gastro-oesophageal junction in 10 cases. The most common clinical presentations were dull pain. Coins were the most common type of foreign body in the esophagus accounting for 71.1% of patients. Plain neck and chest x-rays antero-posterior and lateral view was diagnostic in all cases, with all FB being opaque. Rigid oesophagoscopy and removal under general anesthesia was the main treatment modality performed in 63 (65.8%) and Magill forceps extraction was done in 20 cases. Conclusion: Foreign bodies in digestive tract of children are a common problem with diverse presentation. Disc battery ingestion is prone for complication and expedient removal is required & associated conditions can pose risk for lodgment of foreign bodies.

Yeast-like fungi in the gastrointestinal tract in children and adolescents with diabetes type 1

In recent years the frequency of fungal infections in human populations has increased considerably. The most common type offungus attacking the human organism is Candida albicans. Yeast-like fungi occur naturally in the oral cavity, intestines, vagina, or skin, however in amounts not dangerous to human health. The studies so far have shown that patients with diabetes type 1 (T1DM) to a large degree are exposed to complications related to fungal infections. A substantial growth of fungi observed in diabetic patients may unfavorably affect metabolic compensation, and lead to increased demand for insulin, as well as to the difficult to cure symptom infections. The weaker the immune resistance in patients with diabetes, the greater the risk of ailments related to candidiasis. The article contains a review of recent literature regarding the problems related to occurrence of yeast-like fungi in digestive tract of children with diabetes type 1.

Management of Foreign Bodies of Upper Digestive Tract

The objective of this study was to determine the management of rigid esophagoscopy for extraction of foreign bodies (FBs) upper digestive tract in a tertiary care hospital. This descriptive study was conducted at the Department of ENT, Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2008 to December 2010. This study included 380 patients. After taking detailed history, thorough examination and investigations, a well informed consent was obtained. Rigid esophagoscopy was performed under general anesthesia. The data was analyzed using the statistical program for social sciences (SPSS version 17). Our study with total duration of 3years included 380 cases constituting 227 male and 153 female, with male:female ratio of 1.48:1. The age of the patients ranged from 1 to 80years with mean age of 39.39±SD 6.81years. The clinical features of these patients were mainly dysphagia for solids (72.89%) followed by throat pain (18.15%). Site of impaction of FBs was that in 303 cases (79.73%) cricopharynx, in 61 cases (16.05%) mid-esophagus and in 16 cases (4.21%) pyriform fossa was involved. Rigid esophagoscopy was performed in all cases and a variety of FB was extracted from upper digestive tract. The commonest FB was coin 58.42% followed by meat bolus 17.10%. It is concluded from this study that the commonest FB upper digestive tract in children is coin while in adults is meat bolus in this part of the world. Rigid esophagoscopy is still the technique of choice for its extraction and its complication can be minimized if performed by expert hands.

Gut Bacteria Help Infants to Digest Milk More Effectively Than Adults

Infants are more efficient at digesting and utilizing nutritional components of milk than adults owing to a difference in the strains of bacteria that dominate their digestive tracts. Researchers from the University of California, Davis, and Utah State University report the genomic analysis of these strains in the November 2010 issue of the journal Applied and Environmental Microbiology, identifying the genes that are most likely responsible for this difference (see http://aem.asm.org/cgi/content/full/76/22/7373). “Human milk provides all the nutrients needed to satisfy the neonate energy expenditure and a cadre of molecules with non-nutritional but biologically relevant functions,” the researchers state. “Neonatal health is likely dependent on the timely and complex interactions among bioactive components in human milk, the mucosal immune system, and specialized gut microbial communities.” In pointing out that human milk oligosaccharides (HMOs) are the third-largest solid component of milk, the authors note that the structural complexity of HMOs renders them nondigestible to the host. “Bifidobacteria and, frequently, Bifidobacterium longum strains often predominate the colonic microbiota of exclusively breast-fed infants. Among the three subspecies of B. longum, only B. longum subsp. infantis grows robustly on human milk oligosaccharides (HMOs)” and is associated with early colonization of the infant gut. In the study, the researchers used whole-genome microarray comparisons to associate genotypic biomarkers among 15 B longum strains exhibiting various HMO utilization patterns. They identified 5 distinct gene clusters on B longum that were conserved across all strains capable of growth on HMOs and which have also diverged in strains incapable of growing on HMOs. The results of this study suggest that B longum has ≥2 distinct subspecies: B longum subsp infantis, adapted to utilize milk carbon and found primarily in the digestive tract of children, and B longum subsp longum, specialized for plant-derived carbon metabolism and associated with the adult digestive tract. “Although early gut colonization is likely dependent on a multitude of dietary and nondietary factors, the delivery of complex oligosaccharides through milk creates an ideal and unique nutrient niche for the establishment of, and colonization by, B. longum subsp. infantis strains,” say the researchers. “During weaning, a gradual transitioning from milk-based to plant-based diets generates a shift in carbon availability in the gastrointestinal tract favorable for the expansion and formation of an adult-like gastrointestinal tract microbiota.”

0541: Ultrasound in the Digestive Tract

US is today an important imaging modality for evaluation of the digestive tract in children. It allows simultaneous non invasive anatomic and homodynamic study. It's of a diagnostic, prognosis, therapeutic and preventive value. It helps the physicians to confirm eventual antenatal diagnosed abnormalities and to treat children in several circumstances, exploring different congenital and acquired disorders. US exam must be carried out by high frequency convex and linear probes in all scan plans. The child is lying in supine position, in general. No premedication is needed and diet is not necessary. Doppler techniques, if available, are helpful. Normal aspect of digestive tract and variants are important to be known. Its main indications are acute and chronic abdominal pain, suspected intussusception or appendicitis, inflammatory bowel diseases, suspected hypertrophic pyloric stenosis or gastro-oesophageal reflux, blunt abdominal trauma mid gut volvulus, Schoenlein Henock purpura syndrome, mesenteric ischemia, and screening for abdominal congenital abnormalities. Checking all the intra abdominal organs must be the gold rule. The observation should include bowel wall thickness, bowel motility, bowel content, free fluid or collection in the abdomen, or any mass related to the bowel. US guided biopsy is very helpful, in particular when abdominal mass is suspected. US is needed during the follow up after medical or surgical treatment of several diseases: abscesses, ascitis, recurrencies of malignant tumors or intussusception.

Role of anorectal manometry in children with severe constipation

Constipation is one of the most frequent disorders of the digestive tract in children and it can be an important problem in paediatric and surgical practice. Most of the time, the cause is psychological or because of a slowing of colonic transit, but it can be a sign of organic gastrointestinal outlet obstruction. Some patients with chronic constipation are resistant to a medical approach and they present with a severe form of constipation that needs recurrent hospital admission. Anorectal manometry (ARM) is a noninvasive procedure and it helps to explain the mechanisms of defecation disorders. The aim of the present study was to evaluate the role of ARM in children with severe constipation. From October 2003 to October 2006, in the Paediatric Surgery Unit, 85 children - aged more than 1 year - with severe constipation were seen. The mean age was 5 years (range, 1-13). At presentation, every child had abdominal and rectal examination in order to identify abdominal distension or faecal masses. Bowel preparation with enemas was performed before ARM in patient with a rectal faecaloma. Myoelectric activity of the internal anal sphincter and resting anal tone was recorded; recto-anal inhibitory reflex (RAIR) was tested to exclude Hirschsprung's disease (HD). Anal tone was considered normal until 50 cm H(2)O. When the RAIR was absent, the patient underwent rectal suction biopsies (RSB) for histology and acetylcholinesterase histochemistry. In cases of normal or high anal tone with the RAIR present, the child had bowel cleaning, medical treatment, 2- and 6-month follow-up. Children with ineffective treatment at follow-up underwent RSB. In case of HD, a laparoscopic-assisted endorectal pull-through (ERPT) according to Georgeson's technique was performed. Seventy per cent of the patients had bowel preparation before ARM. In four patients the ARM was impossible to assess because of crying. In 28 patients, the anal tone result was higher than 50 cm H(2)O and local treatment with anaesthetic agents was used for 8 weeks. Seventeen patients underwent RSB: 11 patients with RAIR absent/unclear, 4 noncooperative children and 2 patients with ineffective medical treatment at follow-up. HD was diagnosed in 2 patients and laparoscopic-assisted ERPT was performed. The remaining patients had good results at 6-month follow-up. ARM is a noninvasive diagnostic tool to study the mechanism of defecation in children with constipation in order to prescribe the appropriate treatment. This procedure can be used in every child - aged more than 1 year - with severe constipation and assessment of the RAIR can select the cases for RSB.

Postmortem Findings and Clinicopathological Correlation in Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a severe life-threatening disease, with an incidence of 3 per 10,000 births, that can occur as an isolated defect or in combination with other congenital anomalies. We reviewed the clinical and autopsy reports of 39 subjects with CDH that were autopsied between 1988 and 2001 to determine whether autopsy had an additional value in the detection of malformations in patients with CDH. We compared the clinical data (including echographic results in some patients) concerning congenital anomalies with the autopsy results. Before autopsy, 6 structural cardiac defects, 3 anomalies of the urogenital system, and 3 anomalies of the digestive tract were observed in 10 patients (clinical and echographic results). However, with postmortem examination, only 4 structural cardiac defects were confirmed, 2 cases showed another cardiac anomaly, and 7 new cardiac defects were found. In the urogenital system, 1 anomaly was confirmed, 1 was not confirmed, and 1 showed another malformation. In addition, in 7 patients new urogenital malformations were found after autopsy. In the digestive tract, all 3 malformations were confirmed, but we found 3 new malformations after postmortem examination. All clinically established dysmorphic features and anomalies of the skeletal system and central nervous system were confirmed by autopsy, and no additional malformations were found. We concluded that postmortem examination has an important additional role in the detection of structural cardiac defects and malformations of the urogenital system and digestive tract in children with CDH.

Postmortem Findings and Clinicopathological Correlation in Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a severe life-threatening disease, with an incidence of 3 per 10,000 births, that can occur as an isolated defect or in combination with other congenital anomalies. We reviewed the clinical and autopsy reports of 39 subjects with CDH that were autopsied between 1988 and 2001 to determine whether autopsy had an additional value in the detection of malformations in patients with CDH. We compared the clinical data (including echographic results in some patients) concerning congenital anomalies with the autopsy results. Before autopsy, 6 structural cardiac defects, 3 anomalies of the urogenital system, and 3 anomalies of the digestive tract were observed in 10 patients (clinical and echographic results). However, with postmortem examination, only 4 structural cardiac defects were confirmed, 2 cases showed another cardiac anomaly, and 7 new cardiac defects were found. In the urogenital system, 1 anomaly was confirmed, 1 was not confirmed, and 1 showed another malformation. In addition, in 7 patients new urogenital malformations were found after autopsy. In the digestive tract, all 3 malformations were confirmed, but we found 3 new malformations after postmortem examination. All clinically established dysmorphic features and anomalies of the skeletal system and central nervous system were confirmed by autopsy, and no additional malformations were found. We concluded that postmortem examination has an important additional role in the detection of structural cardiac defects and malformations of the urogenital system and digestive tract in children with CDH.

Upper endoscopic findings in children with active juvenile chronic arthritis

Aim: To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA) Methods: This was a prospective, open, non‐randomized study. Gastroscopy was performed on 45 children with active JCA in 1996–2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non‐steroidal anti‐inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate. Results: Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n= 24) than in children without symptoms (n= 21) (75% vs 38%, p= 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p= 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p= 0.02). Conclusion: Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.

Cytomegalovirus‐Associated Manifestations Involving the Digestive Tract in Children With Human Immunodeficiency Virus Infection

ABSTRACTObjectiveTo study the clinical manifestations of gastrointestinal cytomegalovirus disease in children with human immunodeficiency virus infection.MethodsReview of clinical records of eight human immunodeficiency virus–infected children and histopathologically confirmed gastrointestinal cytomegalovirus disease from 1995 to 2001.ResultsSix of the eight children were younger than 1 year. The most common clinical presentations were fever and chronic diarrhea. Lower gastrointestinal hemorrhage and bowel perforation were noted in four and three patients, respectively. The colon was the most commonly affected site, followed by the small bowel and esophagus. The diagnosis was established by histopathology, obtained during endoscopy and surgery. Mucosal edema, erythema, and ulcer comprised the most common endoscopic findings. Two patients with fever, chronic diarrhea, and lower gastrointestinal bleeding developed remission after being treated with a 14‐day course of ganciclovir.ConclusionGastrointestinal cytomegalovirus disease can result in serious life‐threatening complications, such as bowel perforation and massive gastrointestinal bleeding. Patients with chronic diarrhea and fever of unidentified cause might benefit from gastrointestinal endoscopy for early diagnosis and treatment. Although ganciclovir does not eradicate the infection and relapses are frequent, this treatment can prevent complications and reduce morbidity.

Cytomegalovirus-associated manifestations involving the digestive tract in children with human immunodeficiency virus infection.

To study the clinical manifestations of gastrointestinal cytomegalovirus disease in children with human immunodeficiency virus infection. Review of clinical records of eight human immunodeficiency virus-infected children and histopathologically confirmed gastrointestinal cytomegalovirus disease from 1995 to 2001. Six of the eight children were younger than 1 year. The most common clinical presentations were fever and chronic diarrhea. Lower gastrointestinal hemorrhage and bowel perforation were noted in four and three patients, respectively. The colon was the most commonly affected site, followed by the small bowel and esophagus. The diagnosis was established by histopathology, obtained during endoscopy and surgery. Mucosal edema, erythema, and ulcer comprised the most common endoscopic findings. Two patients with fever, chronic diarrhea, and lower gastrointestinal bleeding developed remission after being treated with a 14-day course of ganciclovir. Gastrointestinal cytomegalovirus disease can result in serious life-threatening complications, such as bowel perforation and massive gastrointestinal bleeding. Patients with chronic diarrhea and fever of unidentified cause might benefit from gastrointestinal endoscopy for early diagnosis and treatment. Although ganciclovir does not eradicate the infection and relapses are frequent, this treatment can prevent complications and reduce morbidity.

Efficacy of antibody NF2F11 staining in the investigation of severe long-standing constipation

Abstract A retrospective study of 7 adult patients (6 with severe, long-standing constipation and 1 with chronic idiopathic intestinal pseudoobstruction) was carried out to test the diagnostic potential of the antineurofilament monoclonal antibody NF2F11. In 4 of the cases of constipation and in the 1 case of pseudoobstruction, paraffin sections of resected colon revealed an anomaly in that the axon bundles of both plexus systems remained unstained. This picture differed from that found in the control population. The results are discussed in relation to previous studies of congenital neurogenic abnormalities of the digestive tract in children.

Efficacy of antibody NF2F11 staining in the investigation of severe long-standing constipation: A preliminary report

A retrospective study of 7 adult patients (6 with severe, long-standing constipation and 1 with chronic idiopathic intestinal pseudoobstruction) was carried out to test the diagnostic potential of the antineurofilament monoclonal antibody NF2F11. In 4 of the cases of constipation and in the 1 case of pseudoobstruction, paraffin sections of resected colon revealed an anomaly in that the axon bundles of both plexus systems remained unstained. This picture differed from that found in the control population. The results are discussed in relation to previous studies of congenital neurogenic abnormalities of the digestive tract in children.