RESUMEN
OBJECTIVES: The aim of this multicenter prospective, randomized, double-blind study was to assess the efficacy of the combination of omeprazole, amoxicillin, and clarithromycin (OAC) for the treatment of Helicobacter pylori gastritis in children. STUDY DESIGN: Seventy-three children with dyspeptic symptoms were included in the trial (mean age 10.8 years; range, 3.3 to 15.4). Patients were randomized to receive OAC or amoxicillin and clarithromycin (AC) for 7 days. H pylori status was assessed before and 4 weeks after eradication treatment, by use of the carbon 13-labeled urea breath test. RESULTS: In intent-to-treat analysis (n = 63), eradication rates were 74.2% (95% CI, 58.7 to 89.6) in the OAC group and 9.4% (95% CI, 0 to 19.5) in the AC group. In per-protocol analysis (n = 53), the eradication rate increased to 80% (95% CI, 64.3 to 95.7), remaining significantly higher than in AC group (10.7%; 95% CI, 0 to 22.2). Resistance of strains to clarithromycin was rare (3/39 = 7.7%) and was not associated with failure of treatment. Adverse events were reported in 24.6% of patients and remained mild. CONCLUSION: This study shows that 1-week OAC triple therapy results in successful eradication of H pylori in 75% of children with gastritis.
Asunto(s)
Amoxicilina/uso terapéutico , Claritromicina/uso terapéutico , Gastritis/tratamiento farmacológico , Gastritis/microbiología , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Omeprazol/uso terapéutico , Adolescente , Pruebas Respiratorias , Niño , Preescolar , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: To determine the feasibility and value of transabdominal ultrasonography of the terminal ileum and colon of children with inflammatory bowel disease (IBD) and to compare the findings with those of ileocolonoscopy. STUDY DESIGN: Thirty-eight patients ranging in age from 4 to 18 years who underwent ileocolonoscopy for management of IBD or for diagnosis were studied prospectively. Twenty-one patients had Crohn disease, nine had ulcerative colitis, and eight served as control subjects. Transabdominal ultrasonography was performed on the day before ileocolonoscopy. Ultrasonographic findings were compared with the results of ileocolonoscopy, used as the reference method. RESULTS: Peristalsis was recorded in all segments of the control subjects; the thickness of the terminal ileum was always less than 2.5 mm, and that of the large bowel, 2 mm or less. In the two patient subgroups, the thickness range of affected ileal and colonic segments was similar, but values were significantly different from those of the control subjects (chi-square test, p <0.0001). The overall sensitivity of the method was 88%, and the specificity, 93%. CONCLUSION: Transabdominal ultrasonography should prove to be a useful clinical and investigational technique, although further studies are needed to assess its value in the treatment of children with IBD.
Asunto(s)
Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Adolescente , Niño , Preescolar , Colitis Ulcerosa/diagnóstico por imagen , Colon/diagnóstico por imagen , Colonoscopía , Enfermedad de Crohn/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Íleon/diagnóstico por imagen , Enfermedades Inflamatorias del Intestino/diagnóstico , Estudios Prospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
We describe a form of intractable diarrhea in six children (four girls) with similar clinical histories and identical histopathologic features. The children had watery diarrhea of neonatal onset requiring total parenteral nutrition. Two had siblings who had died of diarrhea in the first year of life; two others are sisters. Repeated duodenal or jejunal biopsies revealed villous atrophy with normal or hyperplastic and regenerative cryptae, normal cellularity of the lamina mesenterii propria, and no signs of T-cell activation. The main histologic features are epithelial dysplasia with focal crowding and disorganization of the surface enterocytes, pseudocystic formation of the glands, and abnormal regenerative cryptae. The basement membrane components were studied with polyclonal antibodies on frozen specimens, and were compared with biopsy specimens from patients with celiac disease or autoimmune enteropathy. Relative to the control subjects, there was faint and irregular deposition of laminin at the epithelium-lamina mesenterii propria interface, whereas deposits of heparan sulfate proteoglycan were large and lamellar. The primary or secondary nature of these modifications of the basement membrane remains to be determined, but the modifications might be related to epithelial abnormalities and to the severity of this neonatal diarrhea, which resisted all treatment and necessitated permanent total parenteral nutrition.
Asunto(s)
Diarrea Infantil/patología , Duodeno/patología , Mucosa Intestinal/patología , Yeyuno/patología , Membrana Basal/patología , Membrana Basal/ultraestructura , Biopsia , Estudios de Casos y Controles , Diagnóstico Diferencial , Diarrea Infantil/genética , Diarrea Infantil/terapia , Epitelio/patología , Epitelio/ultraestructura , Femenino , Humanos , Inmunohistoquímica , Recién Nacido , Mucosa Intestinal/ultraestructura , Masculino , Microscopía Electrónica , Microvellosidades/patología , Microvellosidades/ultraestructura , Nutrición Parenteral Total , Resultado del TratamientoRESUMEN
We report a case of a prenatal esophagitis and gastritis revealed at 33 weeks of gestation by the presence of bloody amniotic fluid and dilated intestinal loops that was confirmed by endoscopy at birth. Complete recovery occurred after treatment with ranitidine.