Gastrointestinal Tract In Children Research Articles

Endoscopic diagnosis and treatment of children foreign bodies of battery in digestive tract: analysis of 13 cases

Objective To summarize the effectiveness and security of endoscopic removal of foreign bodies of battery in the gastrointestinal tract in children. Methods We analyzed retrospectively the clinical data of 13 patients who swallowed foreign bodies including button cell and cylindrical battery.The 13 patients were treated in our hospital between July 2011 and April 2015, aged 19 months to 12 years. Results A total of 9 cases of foreign bodies in esophagus, including embedded in the first the esophageal stenosis in 4 cases, the second the esophageal stenosis in 3 cases, cardia in 1 case, and 4 cases of foreign body in stomach.We successfully removed 16 foreign bodies of the battery in endoscopy.No serious complications such as perforation, hemorrhaging happened during and after operation. Conclusion It is one relatively safe and effective method of diagnosis and treatment of endoscopic removal of foreign bodies of battery in gastrointestinal tract in children. Key words: Battery; Gastrointestinal tract; Endoscopic; Children

Діагностична ефективність методу гідросонографії у виявленні патології верхніх відділів травного тракту в дітей з бронхіальною астмою та рецидивним бронхітом

Діагностична ефективність методу гідросонографії у виявленні патології верхніх відділів травного тракту в дітей з бронхіальною астмою та рецидивним бронхітом

PO-0112 An Assessment On Digestive Pathology In A Paediatric Gastroenterology Unit In North-eastern Romania

<h3>Aim</h3> To assess the five years prevalence of significant diagnoses of gastrointestinal tract in children evaluated by endoscopy. <h3>Method</h3> We analysed the endoscopy records in “St. Mary“ Children’s Emergency Hospital from Jassy, Romania between 2009–2013, excluding follow-up endoscopies. We studied demographic and clinical variables, the indications for gastroeintestinal endoscopy and the endoscopic findings. <h3>Results</h3> The endoscopy unit in our hospital deserves a population of about 1,400,000 paediatric patients (age 0–18) from North Eastern Romania. From 98,123 hospital admissions in the mentioned period with 13, 789 children admitted into the gastroenterology unit, 3439 digestive endoscopies were performed; from these, 88.75% were upper gastrointestinal endoscopies and 11.25% were colonoscopies. The main reasons for performing the endoscopies were: persistent vomits, pirosis, epigastric pain, hematemesis, significant weight loss, clinical suspicion of malabsorbtion, hyposideremic refractory anaemia, rectorhagia, hematochesia, chronic constipation. The incidence of the main diagnoses found at esogastroduodenoscopy represent from all the endoscopies: gastroduodenitis 82.73%, esophageal stenosis 2.94%, gastroduodenal ulcers 1.66%, foreign bodies 1.19%, esophageal varices and diverticula registered each the lowest procent of 0.12%. Analizing the colonoscopies ulcerative colitis were found in 9.74% of patients, while polyps in 1,51%. Gastrointestinal pathology was more frequent in females (62.93%), rural areas (59.00%), age 15–18 years being the most affected (40.39%). <h3>Conclusions</h3> Even if digestive endoscopy in children is indicated in selected patients, it still remains the investigation of choice if symptoms persist for more than six months and the child has a family history of gastrointestinal pathology.

Evaluating the effectiveness of endoscopic treatment of gastroduodenal bleeding in children

Introduction: One of the current problems of emergency abdominal child surgery are gastric (GU) and duodenal ulcer (DU). Thus, domestic and foreign researchers have noted that the prevalence of peptic ulcer disease in the pediatric population in recent years has nearly doubled. GU and duodenal ulcer occurs with frequency 1,6-2,7 cases per 1000 children and is 7-12 % of diseases of the gastrointestinal tract in children. Along with the growing incidence of this disease, there is a tendency of the number of complications increase.One of the major complications that pose a threat to a child's life is gastroduodenal bleeding. InUkraine, the rate for the last five years has increased by 14% and in the structure of hemorrhagic complications of diseases of the gastrointestinal tract up to 60 % .Despite the fact that endoscopic hemostasis is considered the "gold standard" treatment of gastroduodenal ulcer bleeding, their effectiveness in the primary use and application in cases of relapse in childhood actively discussed.Insufficient number of pediatric surgeons work on the effectiveness of the treatment of these complications with the use of modern minimally invasive technologies is largely determined by the relevance and purpose of the present study.Research objective. To analyze the efficacy of endoscopic treatment of bleeding and recurrence of gastric and duodenal ulcers in children.Material and research methods. Results of the treatment of 57children with acute bleeding from gastric and duodenal ulcers in age from 2 to 16 years who were treated in the surgical departments of pediatric surgery clinics Dnepropetrovsk State Medical Academy and Zaporozhye State Medical University were presented. 38 (67 %) were girls, 19 (33 %) - boys.All patients were admitted to the intensive care unit and undergone clinical, laboratory examinations, complex etiopathogenetic treatment (infusion, hemostatic, substitution, antisecretory therapy) and fibrogastroduodenoscopy (EGD) for diagnostic and therapeutic purposes. Activity of the bleeding was defined with scale by Forrest (Forrest-Rosch W., 1986) during endoscopy exam. Endoscopic electrocoagulation monoelektrod using fiberoptic gastroduodenoscopy «Olympus» UES 10 was done. Injection of 0.18% solution of adrenaline with endoscopic injection needle 5Ch in different volumes through the working channel of the endoscope and therapy in combination with electrocautery was done. Treatment effectiveness monitoring was based on clinical, laboratory data and endoscopic studies.Results of research. The study found that duodenal ulcer bleeding substantially prevailed and was found in 44 children, whereas bleeding from gastric ulcer were found in 13 patients. Thus at 52 (91 %) there was no history information of the diagnosed ulcer. Chronic abdominal pain with PUD previously was recorded only in 9% of cases.Bleeding duration up to 6 hours before admission was detected in 39% of children, between 6 and 24 hours – in 45% and more than 24 hours – in 16% of patients. During EGD macroscopic acute ulcers appearance was detected in the majority (86 %) of children, 32% of them in the last month had mentioned nonsteroidal anti-inflammatory drugs intake and 41% of patients noted aggressive and soft products intake. Ulcers size ranged approximately 5-7 mm. Contamination of Helicobacter pylori serological test according to the level of IgG antibodies was detected in 89.8% of children. Variations in the levels of pepsinogen and serum gastrin in 98 % of children do not cross the boundaries of age-reference values. The clinical picture was characterized by vomiting blood 15% of patients, vomiting "coffee grounds" was detected in 72 % of children, melena was observed in 61% of cases.Primary hemostasis using endoscopic electrocautery combinations and epinephrine injection solution was effective in 48 (84 %) children. 9 patients that undergone only electrocoagulation treatment on the 2nd day were diagnosed rebleeding, which required re-EGD using a combined endoscopic hemostasis. According to the results of clinical laboratory and endoscopic control full bleeding stop was observed during the first 2 days of children stay in hospital.Conclusions .1. Study improved predominance of duodenal ulcer bleeding in children.2. History of alcohol and/or nonsteroidal anti-inflammatory drugs intake increases the risk of acute gastric or duodenum ulcers complicated by bleeding.3. Use of surgery endoscopic hemostasis using combined coagulation- injection method on the background of the hemostatic and parenteral antisecretory therapy for primary and preventive stop ulcer bleeding ensures maximum efficiency of complex treatment in the practice.

Clinical Analysis of Foreign Bodies in Gastrointestinal Tract in Children

Foreign body ingestion is a common problem among paediatric populations. Most of the ingested foreign bodies spontaneously pass through the gastrointestinal tract, but approximately less then 10% of them remain without being discharged, and trigger complications. Therefore, proper evaluation and treatment according to the situation is required. In this study, clinical progress and complications were analyzed according to the clinical features and treatment in children who ingested foreign bodies. Among pediatric patients under 18 who were admitted to Chonnam National University Hospital after ingesting foreign bodies between January 2008 to June 2012, only the patients who had their foreign body in the gastrointestinal tract were included in this study. Based on medical records, age, type of foreign body, time spent till admission, and whether the endoscopy was done or not, complication were researched retrospectively. According to symptoms and plain abdomen X-ray findings, treatment was chosen and conducted among endoscopy, observation and emergency operation. Among 273 patients, 9 (3.3%) of them had surgical removal. Seven (2.6%) of them had an emergency operation on the day of admission, and the rest 2 (0.7%) had operation during observation. Removal through initial endoscopic approach was tried in 157 (57.5%) patients. Eleven (70.8%) of them had their foreign body removed at the initial trial, and 5 (4.9%) of them at the second trial. Among 109, who were on observation status, 9 (8.3%) of them needed endoscopic removal, and 2 (1.8%) of them suffered from surgical removal. It is thought to be better to approach slowly considering the type, size and symptoms in foreign body ingestion of pediatric patients, rather than immediate and invasive removal.

SPECIAL CHARACTERISTICS OF CHRONIC GASTRODUODENAL DISORDERS DEVELOPMENT IN CHILDREN FROM A REGION WITH ABNORMAL INTENSITY OF GEOMAGNETIC FIELD

Aim : to assess special characteristics of disease course, development of concomitant diseases and enzymatic status of gastro-intestinal tract in children with chronic gastroduodenitis, living over the territory of Kursk magnetic anomaly. Patients and methods: 120 children with confirmed diagnosis of chronic gastroduodenitis (among them 60 patients from Kursk and 60 patients from Zheleznogorsk) were performed complex clinical examination. Results: the prevalence of gastroduodenal disorders were 2,7 times higher among children from Zheleznogorsk, than among children from Kursk. Early beginning of chronic gastroduodenitis in children of Zheleznogorsk must be mentioned. The mean age of the onset of the disease in Kursk is 6,4±0,4 years, while in Zheleznogorsk — 5,0 ± 0,4 years (p &lt; 0,01). The most common concomitant diseases in Zheleznogorsk children were reactive changes of hepatobiliary system and combination of chronic gastroduodenitis with allergic pathology. On coprological test the majority of Zheleznogorsk patients had significantly higher content of fatty acids in faeces. Conclusions : the above-mentioned changes can be evidence of insufficient enzymatic activity of certain components of digestive juices. Children with chronic gastroduodenitis living over the territory of Kursk magnetic anomaly should be isolated into a separate group of patients. It will allow rational correction of standard schemes of treatment with accordance to established characteristics.

Trefoil Factor 1 as a marker of mucosal damage of the gastrointestinal tract in children with sepsis

Intestinal ischemia and reperfusion is a common pathway for many diseases in children. The objective of our study was an analysis of Trefoil factor 1 levels dynamics in patients with SIRS or septic condition during a 5-day period. Analysis of TFF1 levels dynamics revealed that TFF1 levels kept steady state during the 5-day period. TFF1 levels were similar in patients with SIRS, sepsis and severe sepsis. Significantly higher levels of TFF1 were in patients with septic shock and MODS.

705 Gastrointestinal Hemorrhage in a 21-Month-Old Girl in The Course of Lymphoodular Hyperplasia. Case Report

Gastrointestinal hemorrage is an emergency condition requiring immediate diagnostics. Lymphonodular hyperplasia, as a cause of bleeding from the gastrointestinal tract in children, is a rarely observed pathology of unknown etiology....

Chronic Diarrhea in Children

Chronic Diarrhea in Children

Initial Location Determines Spontaneous Passage of Foreign Bodies From the Gastrointestinal Tract in Children

Initial Location Determines Spontaneous Passage of Foreign Bodies From the Gastrointestinal Tract in Children

Superior Mesenteric Vein Occlusion Causing Severe Gastrointestinal Haemorrhage in Two Paediatric Cases

Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery.

Colonización del tracto digestivo en niños después de infección por gérmenes productores de betalactamasas de espectro extendido y tratamiento con carbapenems, estudio prospectivo

IntroductionGastrointestinal tract colonization seems to be a risk factor for acquiring an infection by extended-spectrum beta-lactamase (ESBL) producing bacteria. Time colonization has not been established yet, this condition has not been analyzed enough, and evidence is poor. ObjectiveThe aim of this study was to determine the incidence of gastrointestinal tract colonization after an antibiotic therapy. Patients and methodsThis was a one-year prospective descriptive study of patients who had cultures with ESBL-producing enterobacteriaceae (Klebsiella pneumonia or Escherichia coli) and received treatment with meropenem. In order to detect potential reservoirs for ESBL producing bacteria, stool cultures were done on days 7, 14 and 30 after initiating the antibiotic treatment. ResultsDuring the study period, we included 80 cases, of which 47 received meropenem, and stool cultures were performed in these cases. There was gastrointestinal tract colonization by ESBL-producing bacteria in 21.3% (10) on day 7 of treatment, 8.5% (4) on day 14, and none on day 30. K. pneumonia, being the most frequent, was found in 60% of cultures. ConclusionsThe gastrointestinal tract in children acts as a temporary reservoir for ESBL-producing bacteria and could be an infection and contamination source to medical staff and other patients during a critical period of at least two weeks. 100% of gastrointestinal tract colonization was eradicated after treatment with meropenem.

Evaluation of gastrointestinal pathology and treatment in children with suspected biliary dyskinesia

Decreased gallbladder ejection fraction (GBEF) was reported in patients who had abdominal pain and gastrointestinal (GI) diseases. The study aims were to review pathology of GI tract in children with acalculous biliary-type abdominal pain and to evaluate the pain improvement after a 2-week trial of proton pump inhibitor (PPI) and laparoscopic cholecystectomy (LC). Children below 18years of age with a history of biliary-type abdominal pain by ROME III criteria were evaluated. All underwent an upper endoscopy and their histologic findings of the proximal GI tract were reviewed. Responses to a 2-week trial of PPI and LC were analyzed. Sixteen were identified with biliary-type abdominal pain with GBEF <35%. Endoscopic and histologic evidence of reflux esophagitis was observed in 11 children those of gastritis in 3 children. A GI pathology of these children is mostly acid-related and four of ten children experienced a complete response to PPIs and did not require LC. Nine children had LC; four had complete and four had partial pain improvement. A trial of PPIs may be cost-effective prior to considering LC in these patients since four of ten children experienced a complete response to PPIs without the requirement of LC, compared with four of nine children who improved completely.

Initial Location Determines Spontaneous Passage of Foreign Bodies From the Gastrointestinal Tract in Children

The purpose of this study was to follow the natural course of spontaneous passage (SP) of ingested foreign bodies (FBs) in children. The medical records of 249 patients who ingested FBs were reviewed. In addition, they were studied by telephone questionnaires to follow up spontaneously passed FB. The factors associated with SP such as age, the type, size, and initial location of the FBs were analyzed. Foreign bodies were spontaneously passed in 145 patients (58.2%), endoscopic removal was performed in 100 patients (40.2%), and operative removal was performed in 4 patients (1.6%). Most SP FBs were passed within 5 days. The SP rates (SPRs) according to the initial location were the following: 12.2% for the esophagus (P<0.0001), 71.4% for the stomach, 85.7% for the small bowel, and 96.4% for the colon. There was no significant difference in the SPR according to age. When coins and disk batteries that required early endoscopic removal were excluded, the SPR was 63.4% for FBs less than 10 mm, 80.4% for FBs 10 to 20 mm, 72.8% for FBs 20 to 30 mm, and 50.0% for FBs more than 30 mm (P=0.091). The initial location of the FB (odds ratio, 33.7; 95% confidence interval, 14.4-79.0) and the size of the FB (odds ratio, 3.5; 95% confidence interval, 1.0-11.6) were independent predictors of SP by multivariate analysis. Most FBs in the gastrointestinal tract are spontaneously passed without complication, and the initial location of FBs was found to be the main determining factor for SPR. Ingested FBs, in children, even sharp or relatively large FBs, can be spontaneously passed when they are located below the esophagus.

Abnormal Gastrointestinal Histopathology in Children With Autism Spectrum Disorders.

OBJECTIVES:: The significance of the association between many gastrointestinal (GI) pathologies and autism has yet to be discovered. The aim of the present study was to review available evidence documenting any link between autism and GI histopathology in children. MATERIALS AND METHODS:: In a systematic review, the following sources were searched: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1980-August week 2, 2009), EMBASE (1980-August week 2, 2009), PubMed (last 180 days), Web of Science, and Scopus, using the terms "autism" or "autistic spectrum disorder" and "intestinal" or "gastrointestinal" or "colitis." In addition, relevant studies were identified through browsing the reference lists of the included articles for relevant citations. All children younger than 18 years old with autistic spectrum disorder who were examined for abnormal GI histopathology were included. Cohort studies published in the English language, reporting GI histopathological examination findings in children with autism, were included. Two independent authors performed data extraction. The methodological quality of each trial was assessed. RESULTS:: Eight studies have reported the histopathological features of the GI tract in children with autism and fulfilled inclusion criteria. In general, none of these trials appeared to be of high quality. Apart from intestinal lymphonodular hyperplasia, the majority of these findings were not consistent. CONCLUSIONS:: GI pathological findings in children with autism have been inconsistent. The present available evidence does not support or refute a link between GI histopathology and autism in children. The significance of intestinal lymphonodular hyperplasia in these children is unknown. Large properly designed prospective controlled trials addressing this issue are required.

Лечебное питание при заболеваниях желудочно-кишечного тракта у детей

Лечебное питание при заболеваниях желудочно-кишечного тракта у детей

Defensin‐mRNA Expression in the Upper Gastrointestinal Tract Is Modulated in Children With Celiac Disease and Helicobacter pylori–positive Gastritis

Defensins are expressed in epithelial cells as cationic peptides with antimicrobial properties. Because of their role as immunologically important effector molecules, their contribution in maintaining a stable microenvironment in the gastrointestinal tract has recently received much attention. The present study was designed to further characterize expression patterns of defensins in diseases of the upper gastrointestinal tract in children, particularly in Helicobacter pylori (Hp)-associated gastritis or celiac disease (CD). Semiquantitative real-time reverse transcriptase-polymerase chain reaction (PCR) was carried out with gene-specific primers for human beta-defensin 1 to 6 (hBD1 to 6) and human alpha-defensin 5 and 6 (hD5 and 6) in mucosal biopsies of children diagnosed as having CD (n = 11; 4.2-16.2 years) or Hp gastritis (n = 18; 3.2-16.7 years). Levels of expression were compared with those of healthy individuals (n = 21; 2.8-14.6 years). Expression levels in Hp-infected specimens were furthermore compared with those with histologic inflammation not associated with Hp infection (n = 30; 3.6-15.7 years). Expression of hBD2 was upregulated in the antrum and corpus of patients with Hp gastritis, whereas inflammation without detection of Hp was not associated with any change in defensin gene expression. In patients with CD, expression of hBD2 was upregulated in the antrum, whereas hBD1 and 4 were downregulated in duodenal biopsies. Different pathological conditions of the upper gastrointestinal tract lead to specific modulations of defensin gene expression in children. Especially the pathophysiological role of hBD2 in Hp infection and hBD1 and 4 in CD warrant further attention.

Gastrointestinal intervention in children

Interventional radiology is a rapidly growing discipline in paediatrics. Many non-vascular interventional techniques may be used in the gastrointestinal tract in children. The technically simpler and more common of these may be adopted by any paediatric radiologist with an interest in interventional radiology. Other rarer and more complex techniques are currently restricted to specialist centres with a higher overall caseload. This review emphasizes the common procedures such as oesophageal dilatation, gastrostomy, insertion of transgastric jejunal feeding tubes and biopsy. Less common salivary, hepatobiliary, pancreatic and intestinal interventions are also described.

Endoscopic removal of 115 foreign bodies from the upper gastrointestinal tract in children

Over the past 25 years (1984–1992 in the Apáthy István and 1992–2002 in Heim Pál Children Hospital, thereafter until 2009 in Pediatric Surgical and Traumatological Department of St. John's Hospital) 115 foreign bodies were removed endoscopically from the esophagus, stomach and duodenum of 115 children. The age of patients was 6 months to 6 years. At older ages only pschycosomatically retarded children swallowed foreign objects intentionally.

Species Distribution and Antibiotic Resistance in Coagulase-negative Staphylococci Colonizing the Gastrointestinal Tract of Children in Ile-Ife, Nigeria

Purpose : The antimicrobial susceptibility of 149 coagulase-negative staphylococci (CoNS) isolates from faecal samples of children in Ile-Ife, Nigeria, was evaluated in order to determine their contribution to antimicrobial resistance in the community. Methods : The isolates were identified to the species level by conventional methods, and their susceptibility to 20 antibiotics was tested by disk diffusion and to vancomycin by agar dilution. Results : The species distribution was as follows: Staphylococcus epidermidis 45 (30.2 %), S. haemolyticus, 26 (17.5 %); S. capitis, 24 (16.1 %); S. xylosus, 11 (7.4 %); S. saprophyticus, 8 (5.4 %); S. warneri, 8 (5.4 %); S. hominis, 6 (4.0 %); S. schleiferi, 5 (3.3 %); S. lugdunensis, 3 (2.0 %) and S. capitis sub ureolyticus, 3 (2.0 %) and isolates from other CoNS species 10 (6.7 %). Resistance to the �lactam antibiotics was in excess of 50 % of the isolates tested whilst there was significant incidence of resistance to cotrimoxazole, chloramphenicol, tetracycline, erythromycin, fusidic acid and norfloxacin. The highest percentage of oxacillin resistance was found among S. haemolyticus (46.2%) while the lowest was in S. capitis (8.3%). Reduced susceptibility (MIC � 4mg/L) to vancomycin was shown by both oxacillin-resistant and susceptible CoNS species. Conclusion : The gastrointestinal tracts of children could serve as a reservoir for antibiotic-resistant CoNS, some of which had reduced susceptibility to vancomycin.