RESUMEN
Our aims were to compare the specificity and sensitivity of the reflux index (RI), Euler and Byrne score (EBS), and area under the curve (AUC) at pH < 4.0 in infants 1 year old for identifying pathologic gastroesophageal reflux (GER) and to identify new cutoffs on formula feedings. We undertook a prospective investigation of extended pH monitoring (EPM) in 117 infants with symptoms of GER. Infants were categorized as having pathologic reflux by three measures: RI > or = 5%, EBS > or = 50, or AUC pH < 4.0 or < or = 21.3, as determined by receiver operating characteristic (ROC) curve analysis. Using the RI as a criterion, 27 infants (23%) had pathologic reflux. When EBS and AUC were used, 65 (56%), and 67 (57%) respectively, were classified as having pathologic reflux. The specificities of RI, EBS, and AUC were 97.8, 100.0, and 100.0%, respectively, and the sensitivities were 93.0, 91.5, and 94.4, respectively. A new cutoff value for RI of 2.1% was determined using ROC curve analysis to improve the specificity and sensitivity of RI to the above values. The number of infants with pathologic GER is likely to be significantly less using the traditional RI alone on formula feedings, however, the revised RI cutoff value and AUC analysis by computerized pH tracings can enhance the accuracy on formula feedings.
Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Hidrógeno/metabolismo , Monitoreo Fisiológico , Área Bajo la Curva , Femenino , Humanos , Concentración de Iones de Hidrógeno , Lactante , Fórmulas Infantiles , Recién Nacido , Masculino , Curva ROC , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: To determine the presence of Helicobacter species in the liver biopsy specimens from children with various chronic liver diseases as data in adult literature suggests a possible role of these bacteria in their pathogenesis. MATERIALS AND METHODS: Paraffin sections of 61 liver biopsies of pediatric patients with miscellaneous diseases and autopsy liver tissue from 10 control subjects with no evidence of preexisting liver disease were examined for the presence of Helicobacter species by a genus-specific seminested polymerase chain reaction (PCR) assay. PCR-products of positive samples were further characterized by denaturing gradient gel electrophoresis (DGGE) and DNA-sequence analysis. Based on those results, a seminested PCR assay for H. ganmani was developed and applied to the samples. RESULTS: On analysis, 40/61 patient samples were positive in the genus-specific Helicobacter PCR and 4/10 from the control group. The nucleotide sequences of 16S rDNA fragments were 99-100% similar to mainly Helicobacter sp. 'liver' and H. ganmani. PCR-products similar to H. canis and H. bilis were also found. The 16S rDNAs of control specimens showed similarity to Helicobacter sp. 'liver'. In the H. ganmani-specific PCR analysis 19 patients, but none of the controls, were positive. CONCLUSIONS: Amplified Helicobacter 16S rDNAs were related to Helicobacter sp. 'liver' or H. ganmani in liver biopsy specimens of pediatric patients. The possible significance of Helicobacter species in pediatric liver diseases needs to be evaluated further in prospective studies.
Asunto(s)
ADN Bacteriano/análisis , ADN Ribosómico/análisis , Helicobacter/aislamiento & purificación , Hepatopatías/microbiología , ARN Ribosómico 16S/análisis , Adolescente , Biopsia , Niño , Preescolar , Enfermedad Crónica , ADN Espaciador Ribosómico/genética , Femenino , Helicobacter/genética , Humanos , Lactante , Hepatopatías/patología , Masculino , Datos de Secuencia Molecular , Especificidad de la EspecieRESUMEN
We conducted a retrospective review of 342 infants presenting with symptoms suggestive of gastroesophageal reflux disease (GERD) to assess their evaluation, management, and outcome. All infants underwent extended pH monitoring (EPM) for one or more of the following symptoms: regurgitation, choking, irritability, failure to thrive, apparent life-threatening event, or wheezing. EPM was considered abnormal if distal reflux index was > or = 5% and/or if the Euler and Byrne score was > or = 50 and these patients were labeled as having GERD. Those with normal EPM parameters were controls. All infants were < 1 year of age (198 boys, 144 girls). Most received conservative treatment with formula changes and/or thickening and positional management before EPM. Of 342 infants studied, EPM was normal in 169 patients, ie, controls, and GERD was present in 173 children. GERD was more prevalent in Caucasians compared to African Americans (P < 0.045). Although a prokinetic or acid suppression medication or both were given more commonly in infants with GERD, almost half of infants in the control group also needed pharmacotherapy because of persistent symptoms. Mean time to resolution of symptoms in the control group infants with normal EPM was 3.5 months, and in infants with GERD it was 5.4 months (P < 0.001). In conclusion, the majority of infants with symptoms suggestive of GERD resolve their symptoms within 3-6 months of initiating treatment. Day-to-day variability of the spectrum of GERD may contribute towards normal results of EPM in some infants who need pharmacotherapy.
Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/terapia , Preescolar , Femenino , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Lactante , Modelos Logísticos , Masculino , Postura , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Recurrent exposure to gastric acid as in children with bulimia and gastroesophageal reflux disease (GERD) may contribute to dental erosion. We performed a prospective study to evaluate the presence of GERD and dental erosions in children with primary and permanent dentition. Children undergoing elective endoscopy for possible GERD (n = 37) underwent evaluation of their teeth for the presence, severity, and pattern of erosion and stage of dentition: 24 patients had GERD. Dental erosions were identified in 20; all had GERD. Erosion patterns showed more involvement of the posterior teeth. Many affected patients had primary dentition.
Asunto(s)
Reflujo Gastroesofágico/complicaciones , Erosión de los Dientes/complicaciones , Adolescente , Biopsia , Niño , Protección a la Infancia , Preescolar , Atención Odontológica , Ingestión de Alimentos , Esófago/patología , Femenino , Reflujo Gastroesofágico/psicología , Humanos , Masculino , Higiene Bucal , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Erosión de los Dientes/psicologíaRESUMEN
OBJECTIVES: We examined the use of complementary alternative medicine (CAM) in children and young adults with inflammatory bowel disease. METHODS: After validation of a questionnaire and completion of a pilot survey, children and young adults with inflammatory bowel disease were enrolled in three centers of pediatric gastroenterology (Boston, Detroit, and London). RESULTS: Two hundred eight questionnaires were completed in total (Boston, 120; Detroit, 37; London, 51). Ages ranged from 3.8 to 23.0 yr, 58% were male, 57% had Crohn's disease, and 35% had ulcerative colitis. The frequency of CAM use was 41%. The most common CAMs were megavitamin therapy (19%), dietary supplements (17%), and herbal medicine (14%). Parental CAM use and the number of adverse effects from conventional medicines were predictors of CAM use (odds ratio = 1.9, 95% CI = 1.2-3.1, p = 0.02; odds ratio = 1.3, 95% CI = 1.2-1.5, p < 0.001, respectively). The most important reasons respondents gave for using CAM were side effects from prescribed medicines, prescribed medicines not working as well as they had hoped, and hoping for a cure. Fifty-nine percent of respondents not taking CAM were interested in learning more about it. CONCLUSIONS: In our survey over 40% of children with chronic inflammatory bowel disease used complementary medicine in addition to conventional therapies. Parental CAM use and number of adverse effects from conventional therapies were the only independent predictors of CAM use. Some complementary therapies have potential for adverse effects and for drug interactions with conventional treatments. Physicians should take a thorough history of CAM use in children with chronic inflammatory bowel disease.