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Celiac disease is a permanent gluten intolerance followed by a variety of symptoms and damage to the enterocite. Forty families of celiac patients were investigated in the period of March 1992 through March 1993. The aim of the study was to utilize a dosage of serum antigliadin antibody (IgA and IgG) as screening method to stablish the frequency of celiac disease in siblings of carriers of the disease and diagnose it in first degree relatives of those patients. The 121 relatives who agreed to take part on the study were submitted to an inquire, evaluation of nutritional status and collecting 3 ml of venous blood for dosage of antigliadin antibody class IgA and IgG. Positive sorology was obtained in seven subjects and a biopsy could be obtained in five. One mother presented a pathologic anatomical picture of celiac disease representing sibling frequency of 0.8% in the group of relatives studied.

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In 1990 a project was performed in Israel in which the authors reported a higher frequency of whorls and a lower frequency of ulnar loops in the dermatoglyphic pattern of children with celiac disease than in children belonging to control group. Based on these findings we carried out a similar study with our local population. Thirty six celiac children, their parents and siblings had their fingerprints analysed and compared to a control group matching for age, sex and race, in order to assess the efficiency of this method for the diagnosis of celiac disease. A statistically significant higher frequency of whorls and arches was found in celiac children than in control group (whorls = 40.6%, arches = 11.7%; whorls = 30.3%, arches = 5.0%, respectively) as well as a strong correlation between the dermatoglyphic pattern of the parents and their celiac children. There was also a statistically higher frequency of whorls > = 4 in celiac children (55.6%) than in controls (30.6%). The conclusion is that the dermatoglyphic pattern analysis can be used as a complementary data. Due to its low sensitivity (55.6%) and specificity (69.4%) considering the presence of four or more whorls, it is not useful as a screening or as a method itself, for the diagnosis of celiac disease.

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The aim of this study was to evaluate the dietary fiber intake and the dietary habits of children with and without functional chronic constipation. We enrolled 58 children with functional chronic constipation and 58 controls without constipation matched for sex and age. Food and fiber intake were evaluated by 24 hour dietary recall and a complete clinical history was performed. The age of onset of constipation occurred during the first year of life in 55.4% of the patients while the median age of evaluation was 78 months. Soiling was found in 41.7% of patients. The median period of exclusive breast feeding was shorter (P = 0.002) in the constipation group (one month) than in the control group (three month). The proportion of constipation was similar for mothers of children of both groups as well as for siblings in both groups. The fathers of children with constipation presented higher frequency of constipation (12.3%) than the fathers of children in control group (1.8%), but the difference did not reach statistical significance (P = 0.06). The amount of food measured by 24 hour recall was similar in both groups. The calorie intake of constipated children (1526 +/- 585 calories/day) was lower (P = 0.07) than in the control group (1712 +/- 513 calories/day) but the difference did not reach statistical significance. The intake of protein, fat and iron was lower in the constipation group than in the control group. The volume of cow's milk intake was similar in both groups. The median of total dietary fiber intake in the constipation group (13.5 g/day) was statistically (P = 0.009) lower than in the control group (16.8 g/day). The daily intake of insoluble dietary fiber was also statistically lower (P = 0.001) in the constipation group (6.3 g) than in the control group (9.4 g). The intake of soluble dietary fiber was similar in both groups. The intake of dietary fiber per 1,000 calories of diet was 10.3 g in the constipation group and 10.4 in the control group (P = 0.41). There was a considerable intersection of individual values in fiber intake of the constipation and control groups, suggesting that low fiber intake acts in association with others factors on the genesis of constipation in children. However, the low intake of insoluble fiber, suggests that it plays an important role on the pathogenesis of chronic constipation in children.

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Between July 1985 and June 1990, we prospectively investigated 236 children suspected of having malabsorption syndrome. Each patient had a xylose absorption test and small intestinal biopsy. Blood samples were collected to AGA assay. The aim of the study was to evaluate the use of antigliadin antibodies test, IgG and IgA, in screening celiac disease for intestinal biopsy and in the monitoring of gluten-free diet and challenge in celiac patients. Twenty patients were diagnosed with celiac disease confirmed by three small intestinal biopsies; 12 patients were suspected of having celiac disease, with two biopsies, before and one year after a gluten-free diet; 106 patients had environmental enteropathy; 45 patients had protracted diarrhea and 56 children had failure to thrive with no gastrointestinal symptoms. The AGA test was considered a reliable test in screening for biopsy and in the differential diagnosis between celiac disease and other causes of malabsorption syndrome. The IgG AGA test had high sensitivity (90.4%) and the IgA AGA test had high specificity (92.1%) in screening for celiac disease. In the follow-up of the celiac patients the antibody levels were significantly higher during gluten containing diet than after gluten avoidance being thus a reliable test to evaluate dietary compliance.

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Examination of fecal specimens for detection of Giardia lamblia cysts is known to produce a high percentage of false negative results while it is generally believed that duodenal juice often contains trophozoites even when the stool examination is negative. The aim of this study was to compare the detection of trophozoites in duodenal aspirate with the findings of cysts in stool samples for the diagnosis of asymptomatic giardiasis. Forty five children with iron deficiency anemia (one to six years of age) were studied, 21 with giardiasis and 24 without giardiasis. For each subject, one to five stool samples were examined for cysts of Giardia lamblia employing the formol-ether concentration method. Duodenal juice from all children were examined for the presence of trophozoites of Giardia lamblia. Fecal excretion of cysts was demonstrated in 20 (95%) of the 21 patients with giardiasis; however, only nine (43%) exhibited the presence of trophozoites in their duodenal aspirates. In one child trophozoites were observed in the duodenal aspirate; but the parasitologic investigation was negative for cysts in the feces. All the children without giardiasis had at least three stool samples and duodenal aspirate negative for Giardia lamblia. In conclusion, fecal examination by formol ether concentration method exhibited a greater number of positive results than did the duodenal aspirate microscopy method in the diagnosis of giardiasis.

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A alta prevalência de Enteropatia Ambiental em nosso meio e em determinados casos, sua semelhança clínica, funcional e histológica com Doença Celíca, näo permite o diagnóstico diferencial entre essas duas patologias. Foram estudadas 12 crianças portadoras de Enteropatia Ambiental, com diarréia crônica, alteraçäo da prova de absorçäo da D-Xilose e atrofia vilositária subtotal da mucosa do intestino delgado. O acompanhamento das crianças com dieta isenta de glúten só permitiu o diagnóstico diferencial em metade dos pacientes. Conclui-se ser necessário o desenvolvimento de técnicas auxiliares para o diagnóstico de Doença Celíaca

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The D-xylose and triglyceride absorption tests have been widely used as screening tests to characterize malabsorption and indicate intestinal biopsy. In this paper we report the efficiency of these tests in the differential diagnosis of the various causes of chronic diarrhea and their possible relationship to jejunal villous atrophy. Two hundred and fifteen children with chronic diarrhea were submitted to the D-xylose and triglyceride absorption tests, and small intestinal biopsy. The patients were divided into 5 groups, that is: I--celiac disease, 53; II--protracted diarrhea, 24; III--environmental enteropathy, 50: IV--celiac disease under gluten free diet, 11; V--irritable bowel syndrome, 77. D-xylose and triglyceride absorption tests were within normal limits in 3.8% and 4.2% patients belonging respectively to groups I and II. On the other hand, only 7.8% of the patients belonging to group V would be included in the group of patients that would have indication for intestinal biopsy, since both tests revealed abnormal results. Moreover, both tests showed an excellent relationship with the intensity of villous atrophy.

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We report the association of diabetes mellitus and celiac disease in one patient, which was confirmed by intestinal biopsy, the withdraw of gluten from the diet, and by a positive challenge test. We emphasize the importance to recognize this association to improve the clinical management of patients with diabetes mellitus.

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Three cases of Ménétrier's disease in childhood are reported and 38 other cases previously described in the literature are reviewed. The disease manifests in children as a protein-losing gastropathy and a characteristic hypertrophic gastric rugae is demonstrated by upper gastrointestinal radiographs or endoscopy. In contrast to the usual chronicity of the disease in adults, the course is usually benign in children and the symptoms resolve spontaneously in weeks or months. The possible etiology and differential diagnosis are discussed. Ménétrier's disease in children may be more common than report.

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Objetivou-se, por ensaio comparativo, avaliar a aceitaçäo, tolerabilidade e ganho de peso, de crianças eutróficas ou com DPC I, com idade de 1 até 12 meses, com síndrome de diarréia aguda, separadas em 2 grupos. O grupo I, de 25 crianças, recebeu a fórmula alimentar com baixo teor de lactose HN-25 MILUPA e o Grupo II, de 24 criancas, recebeu produto a base de soja. O controle clínico foi feito pela anotaçäo diária do peso, volume do alimento ingerido, número de características das evacuaçöes, com determinaçäo do pH e de substâncias redutoras nas fezes. Realizou-se coprocultura com pesquisa de enteropatógenos e rotavírus. Além da hidrataçäo apropriada quando necessária, procedeu-se a realimentaçäo precoce administrando os alimentos em volume e concentraçäo adequados. Os resultados mostraram boa evoluçäo em 18 das 25 criancas do grupo da fórmula alimentar com baixo teor de lactose e 10 das 24 crianças do grupo soja. Houve ganho ponderal médio diário de 25,00 g no Grupo 1 e 12,9 no grupo II da soja. A aceitaçäo média diária por Kg de peso foi de 156,6 ml/dia no grupo I da fórmula alimentar com pouca lactose e de 116,9 ml no grupo II, da soja. Concluiu-se pela melhor evoluçäo da diarréia, melhor aceitaçäo da realimentaçäo e melhor ganho ponderal nas crianças realimentadas com a fórmula com baixo teor de lactose

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Säo analisados 30 pacientes com RGE, com idade compreendida entre 36 dias e 10 anos. Vômitos constituíram a queixa principal em 25/30 (83,3%); em 3/30 (10%) o sintoma predominante foi de origem respiratória (crises de apnéia em dois e pneumonia respirativa em um) e em 2/30 (6,7%) foi referida dor retroesternal em queimaçäo. Os sintomas iniciaram-se no primeiro mês de vida em 28 casos (93,3%), a queixa foi tardia (aos 5 e 1/2 e nove anos). Um grupo de 22 pacientes foi avaliado em estudo prospectivo durante período de três a 16 meses. Após medidas anti-refluxo, 19/22 (86,3%) apresentaram remissäo ou atenuaçäo do sintoma após o sexo a nono mês de vida. Esofagite foi detectada em 3/22 pacientes, os quais referiam persistência da queixa (14%). Além destes, esofagite estava presente em dois pacientes com dor retroesternal. Concluímos que RGE primário é patologia geralmente autolimitada, de evoluçäo favorável na grande maioria dos pacientes. A persistência dos sintomas deve levantar a suspeita de complicaçöes esofágicas associadas. Foi altamente sugestiva a relaçäo entre crises de apnéia e o RGE

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Estudou-se qual a possivel interferencia no desenvolvimento da imunidade antitetanica ativa em cobaias e camundongos, filhos de femeas vacinadas contra o tetano em diferentes epocas durante o periodo da prenhez. Verificou-se que a vacinacao das femeas, em gestacao nao interferiu, negativamente, no desenvolvimento da imunidade ativa dos animais filhos quando submetidos a vacinacao ao redor de 60 dias apos o nascimento. A presenca de baixos niveis de anticorpos circulantes, recebidos congenitamente, parece ter, em determinadas condicoes, estimulado a resposta imunitaria quando, posteriormente, os animais filhos foram vacinados contra o tetano. Sugere-se que o complexo antigeno-anticorpo formado seja capaz de melhorar a resposta imunitaria induzida pelo toxoide

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