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Objective: To understand the characteristics of the intestinal microbiota after oral tolerance in infants with food protein-induced proctocolitis (FPIAP) treated with amino acid formula and their differences from healthy children, aiming to provide a scientific basis for guiding the application of probiotics during treatment. Methods: FPIAP infants were prospectively enrolled, fecal specimens were obtained, and DNA was extracted for PCR amplification of the bacterial 16S rRNA gene V4 region. Library construction and sequencing were performed, and bioinformatic analysis was performed after obtaining valid data. Results: There were 36 patients in the FPIAP group: 20 males and 16 females, age 21.944 ± 13.277 months. Diarrhea with blood in the stool were the main symptom, with an average course of 14.83 ± 9.33 days. Thirty infants (83.33%) had mucus stool, 11.11% (4/36) of them experiencing vomiting, and 55.56% (20/36) of the infants displaying poor intake and weight gain, 28 (77.78%) patients with moderate eczema, 2 (5.6%) patients with chronic respiratory symptoms. The treatment time with amino acid formula was 5.51 ± 2.88 months. A control group comprising of 25 healthy infants who were full-term, natural delivery, bottle fed, and matched in terms of age (24.840 ± 12.680 months) and gender (15 males and 10 females) was selected. Anaerobic bacteria were less abundant in FPIAP infants than healthy infants (P = 4.811 × 10-5), but potentially pathogenic bacteria were more abundant (P = 0.000). The abundance of Actinobacteria was low in FPIAP infants, the abundance of Proteobacteria was high, and the abundance of Firmicutes was reduced. Bifidobacterium could be used as a bacterial genus to differentiate healthy and FPIAP infants. Both α-and ß-diversity indicators of intestinal microbiota were lower in FPIAP infants. In FPIAP infants, glucose and energy metabolism and amino acid anabolism were decreased, and inflammation-related lipopolysaccharide synthesis pathways were increased. Conclusion: Compared with healthy infants, FPIAP infants with oral tolerance after amino acid formula treatment had differences in the structure and diversity of intestinal microbiota, among which Bifidobacterium was significantly reduced. Trial Registration: This trial was registered on https://register.clinicaltrials.gov/.
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Congenital sodium diarrhea(CSD)refers to a rare and intractable secretory diarrhea of intrauterine onset with high fecal sodium loss which is caused by abnormal intestinal sodium absorption.Congenital sodium diarrhea is a disease with clinical and genetical heterogeneity.It can be classified as non-syndromic congenital sodium diarrhea(non-sCSD)and syndromic congenital sodium diarrhea(sCSD)according to the clinical features.The diagnosis of CSD is made based on the manifestation and genetic analysis.The mutations of CSD include SLC9A3 gene、GUCY2C gene and SPINT2 gene.The main treatment of CSD is symptomatic treatment and some of these patients will develop inflammatory bowel disease(IBD). Lifelong clinical and biological follow-up of patients is necessary.
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Objective To evaluate the application of clinical Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP),and to investigate the nutritional risks of inpatient children with gastroenterological diseases in Sichuan province and their associated clinical characteristics and the features of hygiene economics.Methods STAMP was utilized for nutrition screening of inpatient children with gastroenterological diseases in Chengdu Women and Children's Central Hospital from January 2015 to March 2017.All the enrolled children were divided into 3 groups according to the STAMP scores:low risk group (LR group),moderate risk group (MR group) and high risk group (HR group).Clinical and economic data were compared among 3 groups.Results A total of 3 672 assessments were accomplished,including 2 372 times for males and 1 300 times for females (＜ 2 years old:2 021 times,2-5 years old:803 times,＞5 years old:848 times).Among them,147 children were identified as LR(4.00％),2 296 children as MR (62.53％),and 1 229 children as HR (33.47％).Statistically significant differences were observed among 3 groups in average length of hospital stay (P ＜0.001),the total cost at hospital (P ＜0.001),drug cost (P ＜ 0.001),antibiotic use (x2 =21.66,P ＜ 0.001),parenteral nutrition administration (x2 =46.43,P ＜ 0.001),blood products use (x2 =45.00,P ＜ 0.001),while there was no significant difference in re-admissions for over 3 times (P ＞ 0.05).Malnutrition rate was 4.08％ (6/147 cases) in LR group,2.05％ (47/2 296 cases) in MR group and 31.90％ (392/1 229 cases) in HR group,respectively,and among them 146 patients were diagnosed as severe malnutrition.Digestive tract infections were the most common diseases in MR group(66.33％,1 523/2 296 cases) and HR group(68.27％,839/1 229 cases).Moreover,children with stomatitis,gastrointestinal postoperation,acute pancreatitis,inflammatory bowel disease,esophageal diseases,digestive malformations,cyclic vomiting,malnutrition,and acute intestinal obstruction were all in HR group.Conclusions Nutritional risk is likely to raise the burden of disease.STAMP is applicabile clinically when it is utilized for nutrition risk screening of inpatient children with gastroenterological diseases in Sichuan province and provides evidence for nutrition support treatment.
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Nutrition treatment plays an important role in the treatment and follow - up management of pediatric inflammatory bowel disease (IBD). The theory of specific carbohydrate diet(SCD),first presented in 1951,is a strict diet limitation focused on the sorts of carbohydrate:monosaccharide is the only kind of carbohydrate that is permitted, disaccharide and most complex carbohydrate like polysaccharide and starch are eliminated,intake of protein and fat is not limited,and processed meat and other processed food are cut down appropriately. Currently,mechanism of SCD diet′s treatment efficacy on IBD is not elucidated clearly. The hypothesis of this theory is:(1)Bowel inflammation of IBD patients leads to the decline of disaccharidase′s function,thus glucose,galactose and fructose are the only kinds of car-bohydrate that can be absorbed. (2)Occurrence of IBD is related to the disorder of bowel bacteria. The change of diet may regulate the bowel bacteria,which may be helpful to the symptoms of IBD. Retrospective case studies and case re-ports preliminarily indicated the efficacy of SCD in improving pediatric IBD symptoms and maintenance of clinical re-mission. However,high level evidence is still required to support the hypothesis. The limitation of carbohydrate by SCD would be the clue for the diet of pediatric IBD patients. However,the menu should be formulated according to the eating habits and the available food,as well as the requirement of the growth and development in children.
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Objective@#To identify the epidemiological characteristics of the common diarrhea-related virusesof children under 5 years of age in Chengdu area, and provide the objective evidences for prevention and control of diarrhea.@*Methods@#Fecal specimens collected from children with acute gastroenteritis between March 2006 and June 2015 were sent to Center for Disease Control and Prevention(CDC) of Sichuan province for detection of viral RNA. Clinical data were also documented. Enzyme-linked immunosorbent assay(ELISA) and/or Reverse transcriptase-polymerase chain reaction(RT-PCR) were used to detect and classify rotavirus, human calicivirus, adenovirus and astrovirus.@*Results@#A total of 2 331 fecal specimens from children (1 446 male and 885 female) under 5 were collected. 1 351 were identified as having viral gastroenteritis with the overall positive rate of 58.0%. Children at the age from 7 to 12 months were the susceptible population. Rotavirus was detected in 659 specimens (28.3%) with epidemic time from November to December. Human calicivirus was detected in 542 specimens (23.3%) and September was its epidemic time. Norovirus GII was the main strain of the virus, but no outbreak was observed in our study. Prevalence of rotavirus declined after 2007, while the detection rate of calicivirus was increasing, which led it to be one of the primary pathogens related to viral gastroenteritis in children under 5. Astrovirus was detected in only 35 patients (1.5%) mainly identified from January to March. Adenovirus was detected in 118 patients (5.1%) mainly from May to August with limited epidemic in 2011. Most patients had acute progress(91.2%), none have chronic progress. Mild dehydration was the most common symptom among all the children, followed by moderate dehydration, while none of the patient had severe symptom. Digestive symptoms are usually accompanied by extra-intestinal symptoms in both virus infection. However, extra-intestinal symptoms had higher incidences in rotavirus infection than in calicivirus infection, while the patients with these symptoms recovered during the follow-up period.@*Conclusions@#Virus infection is the common cause of acute gastroenteritis in children under 5. Rotavirus and human calicivirus were the leading pathogens in Chengdu area.