RESUMEN
Information on solitary rectal ulcer syndrome (SRUS) in children is limited and based on case reports only. This study was undertaken with the objective of describing the clinical history, symptoms, diagnostic work-up, and treatment of a large case series of pediatric patients with SRUS. The study was multi-center and retrospective. All pediatric endoscopists in Poland were invited to participate in the study and were asked to look through their endoscopic databases to identify SRUS cases from the last 10 years. The charts of SRUS patients were reviewed with respect to demographic data, and endoscopic and histological findings. Additionally, treatment methods and outcomes were assessed. In total, 31 patients (18 males, mean age of 13 years, range 5-18 years) were included in the study. All patients reported rectal bleeding. Other common symptoms included: abdominal pain (64.5%), perianal pain (54.8%), and passage of mucus (51.6%). The diagnostic work-up lasted from 1 to 48 months. Colonoscopic findings revealed rectal ulceration in 96.8% of patients. Therapeutic approaches included: high fiber diet (64.5%), laxatives (54.8%), topical corticosteroids (63.3%), 5-aminosalicylates administered orally and topically (29.1% and 96.8%, respectively), sucralfate (9.7%), and a biofeedback training (6.6%). Endoscopic argon plasma coagulation was performed in 2 patients and surgical intervention was necessary in 4 of them. Treatment was unsuccessful in 36% of patients. The findings of this study indicate that SRUS is rare in pediatric population, its diagnosis may be considerably delayed, and the treatment applied is often ineffective.
Asunto(s)
Enfermedades del Recto/diagnóstico , Úlcera/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Hemorragia Gastrointestinal , Humanos , Masculino , Polonia , Enfermedades del Recto/terapia , Estudios Retrospectivos , Úlcera/terapiaRESUMEN
BACKGROUND/OBJECTIVES: To analyse the approach to diagnose gastroesophageal reflux (GER) and the qualification criteria for anti-reflux (AR) procedures in Polish children fed via gastrostomy between 2000 and 2010. SUBJECTS/METHODS: An electronic questionnaire containing questions on the demographic and clinical data of patients with gastrostomies was distributed to six Polish centres of nutritional therapy. The portion pertaining to GER included data on clinical exponents, diagnostic procedures (pH-metry, pH-impedance, scintigraphy and upper gastrointestinal (GI) series) and AR. RESULTS: In total, 348 children (M199/F149; age at gastrostomy 5.78±5.49 years) were included. Data on the diagnosis of GER and the AR criteria were available for 343 and 336 subjects, respectively. Percutaneous endoscopic gastrostomy was performed in 258/348 patients (74.1%), while surgery was performed in 80/348 patients (23%). The data from 10/348 (2.9%) cases were unavailable. At least one of the tests for GER was conducted in 177/343 (51.6%) of patients: pH-metry in 74/343 (21.6%), pH-impedance in 17/343 (5.0%), scintigraphy in 60/343 (17.5%) and upper GI series in 102/343 (29.7%). GER was reported in 114/343 cases (33.2%), and fundoplication was performed in 87 children (76.3% of patients with GER). The highest congruence between a positive test result and the decision to perform fundoplication was documented in cases of scintigraphy and upper GI series (P=0.00000 and P=0.00191, respectively). A significant increase in the prevalence of simultaneous gastrostomy and AR was observed over the decade analysed (r=0.8, P=0.009). This study revealed a centre-specific attitude towards the diagnosis of GER and the assessment of qualifications for fundoplication in Polish gastrostomy-fed children. CONCLUSIONS: The unified diagnostic algorithm of GER and the universal qualification criteria for AR procedures need to be defined for gastrostomy-fed children.
Asunto(s)
Nutrición Enteral/efectos adversos , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/terapia , Gastrostomía/efectos adversos , Complicaciones Posoperatorias/terapia , Niño , Preescolar , Fundoplicación , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/etiología , Gastroscopía , Humanos , Concentración de Iones de Hidrógeno , Lactante , Polonia/epidemiología , Prevalencia , Cintigrafía , Encuestas y CuestionariosRESUMEN
The most important risk factors contributing to the development of atherosclerosis include lipid disorders and the predisposition to early ischaemic heart disease in the family. Atherosclerotic process proceeds with age and it develops as a result of oxide LDL modification at the level of vascular wall. Oxygen-free radicals take part in this process, which may probably be opposed by the antioxidant system of the body. The aim of this study was to compare the intensity of lipid peroxidation and the activity of antioxidant enzymes in children from the families with the risk of early atherosclerosis and in children without such predisposition. The activity of katalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined and the concentration of malonic dialdehyde--a lipid peroxidation marker was established. The study was conducted on 76 children aged 4-17 years, mean age 12 +/- 0.6 years. The risk group consisted of 56 patients with the history of hypercholesterolaemia and early atherosclerosis in the members of their families up to 45 years of age. Control group was formed of 20 subjects without such history. MDA concentration as well as the activity of antioxidant enzymes were determined with the use of adequate methods of spectrophotometry. The results obtained were subject to statistical analysis. The activity of antioxidant enzymes displayed considerable fluctuations in both groups of children, but these differences remained statistically insignificant in all the cases. Higher MDA concentrations in serum and in erythrocytes were observed in the risk group. These differences proved statistically significant (alpha < 0.05). On the basis of the present study and the analysis performed, it was found that the activity of antioxidant enzymes (CAT, SOD, GSH-Px) cannot serve as a parameter differentiating between children from the families with the risk of early atherosclerosis and children without such predisposition. Children with positive family history of hypercholesterolaemia and early atherosclerosis may demonstrate intensive lipid peroxidation, but this hypothesis requires further investigations.