Intestine In Children Research Articles

Hydrogenogenic and methanogenic variants of small intestine bacterial overgrowth in children with gastrointestinal and allergic pathology

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is defined as an overgrowth of microorganisms more than 103 microbial bodies in 1 ml and non-specific symptoms (abdominal pain, flatulence, unstable stool, diarrhea or constipation). AIM: The aim of the study is to based on the study of the prevalence and age characteristics of various variants of the course of the syndrome of excessive bacterial growth of the small intestine in children with gastroenterological and allergic pathology, to increase the quality of diagnosis and therapeutic approaches to this pathological syndrome. MATERIALS AND METHODS: The study included 102 patients (55 female and 47 male), median age: 10.0 [7.2–12.0], with functional dyspepsia (n = 32), functional constipation (n = 20), chronic diseases of the upper digestive tract (n = 13), atopic dermatitis (n = 21) and allergic diseases of the respiratory system (n = 16). All patients underwent gastroenterological and allergological examination including hydrogen breath test on the Lactophan apparatus and hydrogen-methane test on the GastroCheck Gastrolyzer apparatus to diagnose of hydrogenogenic (H2-SIBO) and methanogenic SIBO (CH4-SIBO). RESULTS: Inclusion of methane level in exhaled air into the diagnostic algorithm increased the frequency of SIBO diagnosis depending on pathology by 10–30%. In older age groups, there was a tendency to decrease the frequency of H2-SIBO, with a significant difference between preschool and high school age (18/75% and 12/42.9 %, p = 0.018), and a tendency to increase CH4-SIBO from 4.2 % to 17.9%. The frequency of H2-SIBO was significantly higher in children with functional versus chronic diseases of the upper digestive tract (22/71% и 4/30,8 %, p = 0,02). The highest frequency of SIBO was found in children with functional dyspepsia (89.8 %), functional constipation (87.9%) and atopic dermatitis (94.5%). CH4-SIBO was predominant in children with functional constipation (33%). CONCLUSIONS: Parallel identification of hydrogen and methane in exhaled air increased the frequency of SIBO diagnosis in children of different age groups with gastroenterological and allergic pathology, which is relevant for further examination and therapy. CH4-SIBO flow was more typical for older children and H2-SIBO for younger age groups.

A pilot study on the characterization and correlation of oropharyngeal and intestinal microbiota in children with type 1 diabetes mellitus

BackgroundType 1 Diabetes Mellitus (T1DM) is one of the most common endocrine disorders of childhood and adolescence, showing a rapidly increasing prevalence worldwide. A study indicated that the composition of the oropharyngeal and gut microbiota changed in T1DM. However, no studies have yet associated the changes between the microbiomes of the oropharyngeal and intestinal sites, nor between the flora and clinical indicators. In this study, we examined the composition and characteristics of oropharyngeal and intestinal flora in patients with T1DM in compared to healthy children. We identified correlations between oropharyngeal and intestinal flora and evaluated their association with clinical laboratory tests in patients with T1DM.MethodsThe oropharyngeal and fecal samples from 13 T1DM and 20 healthy children were analyzed by high-throughput sequencing of the V3–V4 region of 16S rRNA. The associations between microbes and microorganisms in oropharyngeal and fecal ecological niches, as well as the correlation between these and clinical indicators were further analyzed.ResultsIt was revealed that T1DM children had distinct microbiological characteristics, and the dominant oropharyngeal microbiota genus included Streptococcus, Prevotella, Leptotrichia, and Neisseria; that of intestinal microbiota included Blautia, Fusicatenibacter, Bacteroides, and Eubacterium_hallii_group. Furthermore, oropharyngeal Staphylococcus was significantly positively correlated with intestinal norank_f__Ruminococcaceae and Ruminococcus_torques_group in TIDM children. Moreover, in these children, differential genes in oropharyngeal and intestinal samples were enriched in metabolic pathways such as amino acid generation, fatty acid metabolism, and nucleotide sugar biosynthesis. Additionally, correlation analysis between the oropharyngeal/intestinal microbiome with laboratory tests showed significant correlations between several bacterial taxa in the oropharynx and intestines and glycated hemoglobin and C-peptide.ConclusionUnique microbial characteristics were found in the oropharynx and intestine in children with T1DM compared to healthy children. Positive correlations were found between changes in the relative abundance of oropharyngeal and gut microbiota in children with T1DM. Associations between the oropharyngeal/intestinal microbiota and laboratory investigations in children with T1DM suggest that the composition of the oropharyngeal and intestinal flora in children with T1DM may have some impact on glycemic control.

Clinical Application and Feasibility of Capsule Endoscopy in Children at a Medical Center in Central Taiwan

Background/PurposeCapsule endoscopy (CE) is a noninvasive examination for excellent visualization of small bowel mucosal lesions. We aimed to evaluate the clinical efficacy and safety of CE in pediatric patients. MethodsFrom April 2014 to December 2022, CE procedures performed in children younger than 18 years of age at Taichung Veteran General Hospital were analyzed retrospectively. ResultsAmong 136 procedures, the completion rate was 95.6% (n=130), with a median age of 14 years old. Suspicion or evaluation of inflammatory bowel diseases (IBD) (41%) was the most common indication for CE. Other common indications of CE were chronic unexplained abdominal pain (35%) and obscure gastrointestinal bleeding or iron deficiency anemia (21%). No procedure-related complications occurred. The diagnosis of those patients with incomplete study were CD with small bowel stricture, graft-versus-host disease and duodenal ulcers. A total of 86 CE procedures showed positive findings, and the overall diagnostic yield rate was 63.2%. Small bowel ulcers (65.12%) were the most common findings. Overall, 26.5% of CE examinations resulted in a new diagnosis and 44.9% of CE exams led to a change in therapy. For patients with IBD, CE findings resulted in an even higher therapeutic change rate of 48.1%. ConclusionsCE is a safe and feasible diagnostic method to study the small intestine in children, especially for IBD. Incomplete study could be an indicator of positive finding and can potentially be a guide to identify the site of possible strictures.

Expression of intestinal drug transporter proteins and metabolic enzymes in neonatal and pediatric patients

The development of pediatric oral drugs is hampered by a lack of predictive simulation tools. These tools, in turn, require data on the physiological variables that influence oral drug absorption, including the expression of drug transporter proteins (DTPs) and drug-metabolizing enzymes (DMEs) in the intestinal tract. The expression of hepatic DTPs and DMEs shows age-related changes, but there are few data on protein levels in the intestine of children. In this study, tissue was collected from different regions of the small and large intestine from neonates (i.e., surgically removed tissue) and from pediatric patients (i.e., gastroscopic duodenal biopsies). The protein expression of clinically relevant DTPs and DMEs was determined using a targeted mass spectrometry approach. The regional distribution of DTPs and DMEs was similar to adults. Most DTPs, with the exception of MRP3, MCT1, and OCT3, and all DMEs showed the highest protein expression in the proximal small intestine. Several proteins (i.e., P-gp, ASBT, CYP3A4, CYP3A5, CYP2C9, CYP2C19, and UGT1A1) showed an increase with age. Such increase appeared to be even more pronounced for DMEs. This exploratory study highlights the developmental changes in DTPs and DMEs in the intestinal tract of the pediatric population. Additional evaluation of protein function in this population would elucidate the implications of the presented changes in protein expression on absorption of orally administered drugs in neonates and pediatric patients.

Irritable bowel syndrome in children: pathogenetic significance of disorders of intestinal microbiota

Irritable bowel syndrome (IBS) is the most common functional disorder of the intestine in children. In recent years, IBS has been defined as functional pathology of the intestine, manifested by visceral recurrent pain that occurs at least once per week, characterized by the following two or more signs: associated with defecation; with changes in the frequency and shape of stools. These symptoms had to be noted in the patient for the last 3 months, with a total duration of at least 6 months, without signs of organic damage to the gastrointestinal tract (GIT). The gut microbiota is of particular importance in the pathogenesis of IBS. In patients with IBS, an increase in Enterobacteriaceae, Ruminococcus, Clostridium, Dorea species and a decrease in the number of Lactobacillus, Bifidobacterium and Faecalibacterium species were found. At the same time, a similar microbial profile was found in patients with different subtypes of IBS. The established patterns of changes in the composition of the microbiota in IBS in children and adults indicate IBS and functional disorders of the GIT to have a pronounced microbial pathogenesis. In this regard, the personalized use of prebiotics, probiotics, synbiotics, and fecal microbiota transplantation can effectively affect the intestinal microbiome in IBS. 
 Conclusion. Correction of disorders of intestinal microbiota is the most important method of treating IBS in children. Determining the patterns of formation of changes in the intestinal microbiome in IBS children creates new opportunities for improving methods of their correction.

Surgical Tactics in Perforations of Stomach and Small Intestine in Children (Literature Review)

INTRODUCTION: Currently, the number of pediatric patients urgently hospitalized with different variants of gastrointestinal perforations complicated with peritonitis, remains high. In the given work, the variants of the surgical treatment depending on the location of the perforation defect (stomach, duodenum, small intestine) are presented, and the most common causes of such conditions encountered in clinical practice, are described (perforation of Meckels diverticulum, spontaneous perforation of small intestine and stomach in children with extremely low body mass, patients with EhlersDanlos syndrome).
 AIM: To determine the most relevant variants of surgical tactics in children with perforations of different parts of the gastrointestinal tract (in particular, stomach, small intestine) in conditions of peritonitis.
 MATERIALS AND METHODS: In the process of studying the literature, 142 scientific publications were analyzed on Google Academy, PubMed, eLIBRARY information resources, published from 2002 to 2022. With this, works describing intestinal perforation with the underlying necrotic enterocolitis, were excluded from the study, since this category of patients requires a separate discussion and description of approaches to treatment.
 CONCLUSION: According to the results of the analysis of scientific literature, variants of surgical tactics used in perforations of the gastric wall include (in the order from the most commonly used to the least common): laparotomy and suturing with excision of the edges of the defect; suturing in conditions of laparoscopy; atypical resection with the formation of a gastric tube on the probe; resection of stomach. In duodenal perforations, the following methods are used: rhomboid duodeno-duodenoanastomosis according to Kimura, intracorporeal suture with endovideosurgical access; laparotomy and suturing of the defect in extensive necrosis. In spontaneous perforation in the small intestine, resection of the part of the intestine is advisable anastomosis according to Santulli in combination with terminal ileostomy, simultaneous end-to-end anastomosis or application of intestinal stomas.

Rebalancing of mitochondrial homeostasis through an NAD+-SIRT1 pathway preserves intestinal barrier function in severe malnutrition

The intestine of children with severe malnutrition (SM) shows structural and functional changes that are linked to increased infection and mortality. SM dysregulates the tryptophan-kynurenine pathway, which may impact processes such as SIRT1- and mTORC1-mediated autophagy and mitochondrial homeostasis. Using a mouse and organoid model of SM, we studied the repercussions of these dysregulations on malnutrition enteropathy and the protective capacity of maintaining autophagy activity and mitochondrial health. SM was induced through feeding male weanling C57BL/6 mice a low protein diet (LPD) for 14-days. Mice were either treated with the NAD+-precursor, nicotinamide; an mTORC1-inhibitor, rapamycin; a SIRT1-activator, resveratrol; or SIRT1-inhibitor, EX-527. Malnutrition enteropathy was induced in enteric organoids through amino-acid deprivation. Features of and pathways to malnutrition enteropathy were examined, including paracellular permeability, nutrient absorption, and autophagic, mitochondrial, and reactive-oxygen-species (ROS) abnormalities. LPD-feeding and ensuing low-tryptophan availability led to villus atrophy, nutrient malabsorption, and intestinal barrier dysfunction. In LPD-fed mice, nicotinamide-supplementation was linked to SIRT1-mediated activation of mitophagy, which reduced damaged mitochondria, and improved intestinal barrier function. Inhibition of mTORC1 reduced intestinal barrier dysfunction and nutrient malabsorption. Findings were validated and extended using an organoid model, demonstrating that resolution of mitochondrial ROS resolved barrier dysfunction. Malnutrition enteropathy arises from a dysregulation of the SIRT1 and mTORC1 pathways, leading to disrupted autophagy, mitochondrial homeostasis, and ROS. Whether nicotinamide-supplementation in children with SM could ameliorate malnutrition enteropathy should be explored in clinical trials. This work was supported by the Bill and Melinda Gates Foundation, the Sickkids Research Institute, the Canadian Institutes of Health Research, and the University Medical Center Groningen.

Adenomyoma of the small intestine in children: a 12-year experience in a tertiary referral center.

Adenomyoma of the small intestine is rare in children and the clinical characteristics is not clear. The study was to document the clinical characteristics and treatment of children with adenomyoma of the small intestine. A retrospective study was conducted in children with intestinal adenomyoma from 2010 to 2022. We recorded age, gender, symptoms, location, tumour size and treatment options. Thirteen patients with adenomyoma of the small bowel were included. The median age was 20 months with a male-to-female ratio of 10:3 and more than half of the patients were younger than 2 years old. The mean tumour size was 2.0 cm. The lesion was found accidentally in one patient, and the others presented with symptoms of intussusception. A pathological lead point was found on ultrasound in seven patients. All tumours were located in the ileum, ranging from 24 to 260 cm proximal to the ileocecal valve. The tumour was found in an antimesenteric site in eight patients. Three patients suffered intestinal necrosis, and segmental resection of the ileum was performed. Three patients without intestinal necrosis underwent tumour rection, while intestinal resection and anastomosis were performed in the remaining seven. All patients recovered well except one, who developed intussusception 7 days after surgery; that patient underwent surgery and recovered uneventfully. Adenomyoma of the small intestine has a male predominance in children and intussusception is a common presentation. The ultrasound feature is a mass of mixed echogenicity containing several small cystic areas. Surgery is the primary treatment option and the procedure should be chosen based on intraoperative findings.

Mechanisms of Lung and Intestinal Microbiota and Innate Immune Changes Caused by Pathogenic Enterococcus Faecalis Promoting the Development of Pediatric Pneumonia.

Bacterial pneumonia is the main cause of illness and death in children under 5 years old. We isolated and cultured pathogenic bacteria LE from the intestines of children with pneumonia and replicated the pediatric pneumonia model using an oral gavage bacterial animal model. Interestingly, based on 16srRNA sequencing, we found that the gut and lung microbiota showed the same imbalance trend, which weakened the natural resistance of this area. Further exploration of its mechanism revealed that the disruption of the intestinal mechanical barrier led to the activation of inflammatory factors IL-6 and IL-17, which promoted the recruitment of ILC-3 and the release of IL-17 and IL-22, leading to lung inflammation. The focus of this study is on the premise that the gut and lung microbiota exhibit similar destructive changes, mediating the innate immune response to promote the occurrence of pneumonia and providing a basis for the development and treatment of new drugs for pediatric pneumonia.

Diagnostics of hamartomal polyps of the deep sections of the small intestine in children with Peutz–Jeghers syndrome and juvenile polyposis

Diagnostics of hamartomal polyps of the deep sections of the small intestine in children with Peutz–Jeghers syndrome and juvenile polyposis

Microbial signature of intestine in children with allergic rhinitis.

Previous studies have found that unique patterns of gut microbial colonization in infancy associated with the development of allergic diseases. However, there is no research on the gut microbiota characteristics of AR children in Chinese Mainland. To investigate the changes of gut microbial of AR children in Chinese Mainland and evaluate the correlation between gut microbial and clinical indexes. In this clinical study, fecal samples from 24 AR children and 25 healthy control children (HCs) were comparative via next generation sequencing of the V3-V4 regions of the 16S rRNA gene. Analyzed the relationship between clinical features and gut microbial using Spearman correlation. Compared to HCs, AR children showed significant decreases in Shannon index and significant increases in Simpson index at both the family and genera levels (all p < 0.05). In terms of bacterial composition, at the phylum level, AR children had higher abundance of Bacteroidetes than that in the HCs group (p < 0.05) and were significantly positively correlated with TNSS (p < 0.05). At the family level, AR children had higher abundance of Prevotellaceae and Enterobacteriaceae higher than that in the HCs group (all p < 0.05) and had a significantly positive correlation with TNSS, eosinophils (EOS) and total immunoglobulin E (tIgE) (all p < 0.05). At the genus level, reduced abundance of Agathobacter, Parasutterella, Roseburia and Subdoligranulum were also observed in the AR cohorts compared to HCs (all p < 0.05) and significantly negatively associated with TNSS, EOS, tIgE, QOL, and FeNO (all p < 0.05). AR children in Chinese Mainland were characterized by reduced microbial diversity and distinguished microbial characteristics in comparison with HCs. The observations of this study offer proof that distinctive gut microbiota profiles were present in AR children and necessitate further investigation in the form of mechanistic studies.

Gut microbiome as predictor of metabolic syndrome in young children born to mothers with gestational diabetes mellitus

Gut microbiome as predictor of metabolic syndrome in young children born to mothers with gestational diabetes mellitus

Role of color Doppler ultrasonography in predicting the viability of bowel loops in children with intussusception

Abstract Background: Intussusception mainly affects infants and toddlers, though it can affect any age of the pediatric population. Intussusception has been successfully diagnosed using B-mode ultrasonography. Once, hydrostatic or pneumatic intussusception reduction under image guidance was used to treat these children. But this needs a critical assessment of the preserved bowel viability before the procedure. There are several criteria based on ultrasonography for predicting bowel reducibility during hydrostatic or pneumatic reduction. Our study aimed to demonstrate the role of color Doppler ultrasound in predicting the viability of the intestine in children with intussusception. Materials and Methods: Thirty children under 14 years of age with clinical symptoms suggestive of intussusception were evaluated on color Doppler and power Doppler ultrasonography to predict the viability of bowel loops in children with intussusception. The compression technique was used for graded compression, and the patients were followed for clinical/surgical outcomes. Sensitivity, specificity, positive predictive value, negative predictive value, the strength of agreement of trapped fluid, vascularity at apex, and power Doppler for predicting viability of bowel loops were statistically analyzed. Results: In 17 (56.67%) children, vascularity at the apex of the intussusceptum loop was absent. Vascularity at the apex was present in only 13 of 30 patients (43.33%). On the final clinical/surgical outcome, 17 (56.67%) of patients had necrosis of the bowel loop. Bowel loops were viable in only 13 of 30 patients (43.33%). Of patients who had viability of bowel loops, 76.92% of patients did not have trapped fluid. If the trapped fluid was absent, there was a 100.00% probability of viability of bowel loops; if trapped fluid was present, there was an 85.00% chance of necrosis. Among patients who had necrosis, 100.00% of patients had trapped fluid. In predicting bowel loops’ viability, vascularity’s sensitivity and specificity at the apex on color Doppler were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%). In predicting the viability of bowel loops, the sensitivity and specificity of power Doppler at the apex of the intussusceptum loop were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%) each. Excellent agreement was seen between final diagnosis and vascularity at the apex with kappa 1 and P value &lt;0.0001. Among 17 patients diagnosed with bowel necrosis, 17 had similar findings in vascularity at the apex. Among 13 patients diagnosed with viable bowel loops, 13 had similar vascularity findings at the apex. The concordance rate was 100.00%, and the discordance rate was 0.00% between the final diagnosis and vascularity at the apex. Conclusion: The presence or absence of blood flow in the intussusceptum loop on color Doppler sonography and power Doppler is a promising predictor of bowel viability. Trapped fluid within the intussusceptum loop emphasizes the possibility of no spontaneous resolution of intussusception. Color Doppler ultrasonography, which detects blood flow in the invaginated bowel, seems to be the most valuable diagnostic modality for predicting the likelihood of bowel reduction.

Bacteriophage sensitivity of opportunistic microbiota in children with gut dysbiosis

Aim.As the activity of bacteriophages is species- and strain-specific, it is necessary to study bacteriophage sensitivity in distinct geographic regions with various disease patterns. Here, we aimed to study the lytic activity of specific commercially available bacteriophages againstKlebsiella spp., Proteus spp., andStaphylococcus aureusisolated from the intestines of children with gut dysbiosis.Materials and Methods.Bacteriophage sensitivity was assessed in 315 opportunistic microorganisms (125Staphylococcus aureusstrains, 120Klebsiella spp.strains, 70Proteus spp.strains) isolated from the intestinal microbiota of 300 children &lt; 4 years of age with gut dysbiosis. Bacteriophage preparations were produced by Microgen (Russian Federation). The lytic activity of bacteriophages was studied by a drip method on a Muller-Hinton medium by calculating the area of bacterial culture lysis.Results.We found low sensitivity ofKlebsiella spp.(37.5% sensitive strains) andProteus spp.(41.4% sensitive strains) to specific bacteriophages, albeit there were considerable differences between distinctKlebsiellaspecies (Klebsiella pneumoniae, 56.7% sensitive strains;Klebsiella oxytoca, 18.3% sensitive strains, p = 0.03) andProteusspecies (Proteus vulgaris, 52.0% strains;Proteus mirabilis, 35.6% strains, p = 0.04). Nevertheless, sensitivity toStaphylococcus aureuswas considerably higher (78.4%). In addition, lytic activity of bacteriophages reduced along with the increasing severity of gut dysbiosis.Conclusion.Klebsiella spp.andProteus spp.isolated from children with dysbiosis have low sensitivity to commercially available bacteriophages. Bacteriophage sensitivity positively correlated with gut dysbiosis.

Показники цитокінового статусу дітей раннього віку з алергічним ураженням шлунково-кишкового тракту залежно від забезпеченості вітаміном D

The rapid growth in the prevalence of allergic diseases among children in the modern world dictates the need for detailed study of pathogenetic mechanisms, the search for new methods of diagnosis, treatment and prevention of this pathology. Recent studies of the important immunological effects of vitamin D in allergic pathology make it important to study its effect on the course of gastrointestinal food allergy (GIFA) in young children. Purpose - to determine the serum concentrations of IL-10 and IL-17 in young children with GIFA, depending on the supply of vitamin D. Materials and methods. We examined 34 children aged from 2 months to 3 years with isolated gastrointestinal symptoms or a combination of gastrointestinal and skin symptoms associated with food. The comparison group consisted of 22 children of the same age with an unencumbered individual and family history of allergies. All examined children had quantified serum cytokine (IL-10, IL-17A) levels by enzyme-linked immunosorbent assays and serum hydroxycalciferol (25(OH)D) levels. Vitamin D deficiency in subjects was considered at a concentration of 25(OH)D in serum &lt;20 ng/ml (or &lt;50 nmol/l), a concentration of 21 ng/ml to 29 ng/ml (or from 50.1 nmol/l up to 74.9 nmol/l) was assessed as vitamin D deficiency. A sufficient concentration of vitamin D was considered to be 25(OH)D serum level &gt;30 ng/ml. Data of clinical and laboratory researches were processed by methods of mathematical statistics accepted in biology and medicine. Results. There was a significantly increase in the average concentrations of IL-17A (180.4±23.0 pg/ml) and IL-10 (113.8±15.0 pg/ml) in children with gastrointestinal food allergy and in the comparison group - 45.7±18.1 pg/ml and 32.1±11.4 pg/ml, respectively, (p&lt;0.05), which reflects the intensity of the allergic inflammatory process in the gastrointestinal tract. In children with allergic gastrointestinal inflammation who were deficient in vitamin D, the mean concentrations of proinflammatory cytokine IL-17A and regulatory cytokine IL-10 were significantly higher than in children with GIFA and optimal supply of vitamin D 244.9±19.7 ng/ml and 49.45±2.14 ng/ml respectively against 135.2±33.3 ng/ml and 26.41±1.81 ng/ml respectively, (p&lt;0,05), which indicates a more intense activity of the inflammatory process in the intestine of children with insufficient supply of vitamin D. Conclusions. Allergic gastrointestinal inflammation in young children is characterized by increased concentrations of serum proinflammatory and regulatory cytokines - IL-10 and IL-17A, that is a protective reaction of the immune system and can be used as a marker of allergic inflammation in GIFA. The study of the regulatory effect of vitamin D on the expression of cytokines (IL-10 and IL-17A) in allergic gastrointestinal inflammation in young children will optimize the pathogenetic treatment of gastrointestinal food allergies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: cytokine status, young children, allergic pathology of the gastrointestinal tract, vitamin D.

Intestinal bacteria flora changes in patients with Mycoplasma pneumoniae pneumonia with or without wheezing

Mycoplasma pneumoniae (MP) infection is a common cause of community-acquired pneumonia in children. Furthermore, many children with Mycoplasma pneumoniae pneumonia (MPP) have recurrent wheezing and reduced small airway function after their clinical symptoms have resolved, eventually leading to asthma. MPP can trigger immune disorders and systemic inflammatory responses. Hence, the intestine is the largest immune organ of the body. Therefore, we sought to investigate whether the alteration of intestinal flora is correlated with the development of wheezing in children with MPP. We collected 30 healthy children as group A, 50 children with nonwheezing MPP as group B, and 50 children with wheezing MPP as group C. We found that the percentage of eosinophil cells (EC) was significantly higher in group C than that in group B for routine blood tests and serum inflammatory factors. The serum cytokines, including IL-4, IL-17, TNF-α, and TGF-β, were significantly higher in group C than in group B. In addition, the level of IL-10 was significantly lower in group C than in group B. The distribution characteristics of intestinal flora strains in children with MPP were detected by sequencing of 16S rRNA gene amplicon sequencing. There were differences in the abundance of intestinal flora between children with MPP and healthy children, with lower abundance of Ruminococcus flavefaciens, Clostridium butyricum, Lactobacillus, and Bifidobacterium in the intestine of children with MPP compared to healthy children. The abundance of Ruminococcus flavefaciens and Clostridium butyricum was significantly lower in the intestine of children with wheezing MPP compared to children without wheezing MPP. In the correlation analysis between children with MPP and inflammatory factors, Ruminococcus flavefaciens was found to be negatively correlated with IL-17. Clostridium butyricum was negatively correlated with L-4, IL-17, TNF-α, and TGF-β; however, it positively correlated with IL-10. Thus, it was concluded that alterations in intestinal flora play a crucial role in the immune response to MPP, where a significant decline in intestinal Ruminococcus flavefaciens and Clostridium butyricum leads to an exacerbation of the inflammatory responses, which may promote the development of children with wheezing MPP.

Clinical justification of small-intestine decompression in children with common appendicular peritonitis

The aim of this work: to evaluate the effectiveness of the developed methods of intestinal decompression in the treatment of spilled appendicular peritonitis in children. Materials and methods. The study was conducted on the basis of the 2nd SamMI clinic in the period from 1990 to 2014. Long-term decompression of the small intestine was carried out through appendicostomy or cecostomy, the technique of which was significantly different in the main group (79 patients) and the comparison group (34 patients). Results. The methods we developed for decompression of the small intestine in children with common appendicular peritonitis (WAP) contributed to an earlier restoration of intestinal motility and the appearance of the first independent stool (on day 4), normalization of body temperature by 4-5 days, and a reduction in the duration of the gastric tube (up to 3 days) and early activation of patients (2-3 days).

A longitudinal study of dominant E. coli lineages and antimicrobial resistance in the gut of children living in an upper middle-income country

Objectives:The gastrointestinal tract constitutes a complex and diverse ecosystem. Escherichia coli is one of the most frequently studied and characterised species in the gut ecosystem; nevertheless, there has been little research to determine their diversity and population dynamics in the intestines of children over time. We analysed the turnover or dominant E. coli isolates in children faecal matter during 1 year.Methods:In this prospective study, a fresh faecal sample was obtained from children longitudinally over one year (30 faecal samples at sampling period 1 and 22 faecal samples at sampling periods 2 and 3). From each stool sample, five E. coli colonies were randomly selected (n = 405 E. coli isolates total) in order to characterize the genotype and phenotypic antimicrobial resistance patterns.Results:We were unable to find same E. coli dominant clone in faecal matter from 30 children in different sampling periods. Whole-genome sequencing of three isolates belonging to ST131 found in one child during the sampling period I and II indicated that isolates were three different ST 131 clones that carried extended-spectrum β-lactamase (ESBL) genes.Conclusion:We found that all numerically dominant E. coli lineages in children’s intestines were transient colonisers, and antimicrobial resistance phenotypes of these strains varied significantly over time without any apparent selective force.

Эозинофильный гастрит у ребенка. Как заподозрить? Критерии диагностики

Objective of the Review: To analyze current data on eosinophilic lesions of the stomach in children with the analysis of a clinical case. Key points. Diseases of the gastrointestinal tract associated with primary tissue eosinophilia are a heterogeneous group of changes characterized by inflammation, with predominantly eosinophilic tissue infiltration in the absence of other known causes. Clinical manifestations of allergic inflammatory diseases of the gastrointestinal tract are most often nonspecific. Depending on the level of the lesion, eosinophils are distinguished: gastritis (EoG), enteritis, and colitis. In recent years, more and more attention of experts has been directed to research in this area, but so far there are no general epidemiological data on the prevalence of this pathology in the population, both adults and children. Conclusion. Currently, there are no clear morphological criteria for diagnosing eosinophilic lesions of the stomach, small and large intestine in children, and clinical manifestations, especially in young children, are nonspecific. When making a diagnosis of EoG, it is necessary to take into account a family allergic history, a set of laboratory diagnostic data (eosinophilia in a clinical blood test and a high level of total IgE) and a morphological study of a biopsy of the gastric mucosa. Keywords: children, eosinophilic gastritis, eosinophilia, tissue eosinophilia, food allergy.

The Impact of Pathological Changes in the Intestinal Microbiocenosis on the Appearance or Intensification of Negative Behavior in Children with ASD

A causal relationship was found to exist between the many manifestations of negative behavior and the pathogenic microflora predominating in the intestines of children with ASD. Elimination of identified bacterial and fungal infections led to a decrease or disappearance of negative behavior, and, in a relapse, to their return.