Expression of adhesion and activation molecules on circulating monocytes in children with Helicobacter pylori infection.

OBJECTIVES: The aim of this study was to assess the cell surface expression of adhesion (CD11a, CD11b, CD11c, CD18, CD54, and CD58) and activation (CD14, HLA-DR, and CD16) molecules on the circulating monocytes in Helicobacter pylori (H. pylori)-infected and noninfected children with gastritis, with the goal of comparing the results with those obtained from the controls. MATERIALS AND METHODS: Ninety-four children were studied: 47 of them with H. pylori infection (of those 25 children after the failure of eradication therapy) and 26 children with gastritis where H. pylori infection was excluded, as well as 21 controls. H. pylori infection status was assessed based on [¹³C] urea breath test, rapid urease test, and histology. Analysis of the monocyte surface molecule expression was carried out by flow cytometry. RESULTS: H. pylori-infected children and children who experienced a failure of the eradication therapy differed significantly in the expression of adhesion and activation molecule on circulating monocytes. A decrease, both in the proportion of CD11c- and CD14-bearing monocytes, and the expression of CD11c and CD14 molecules on circulating monocytes, was found in children in whom the eradication therapy failed (p < .05). Low expression of CD11b (p = .04) and CD18 (p = .02) integrins on monocytes was also observed. Additionally, the percentage of HLA-DR-bearing monocytes was decreased (p = .04), while the CD16 density receptor was increased (p = .02). Compared with the controls, low percentage of CD16-positive monocytes was noted in noninfected children with gastritis (p = .01). CONCLUSION: H. pylori eradication therapy in children causes inhibition of inflammatory response via a reduction in CD11b, CD11c, and CD18 beta2 integrin monocyte expression.

Pediatric Helicobacter pylori infection and circulating T-lymphocyte activation and differentiation.

BACKGROUND: In this study, H. pylori-infected and noninfected children with gastritis were compared to a control group with respect to circulating CD4(+) and CD8(+) T lymphocytes expressing activation and differentiation markers. Additionally, the lymphocyte phenotypes of children with gastritis were correlated with the gastric inflammation scores. MATERIALS AND METHODS: H. pylori infection status was assessed based on [¹³C]urea breath test, rapid urease test, and histology. Analysis of the lymphocyte surface molecule expression was carried out by triple-color flow cytometry. RESULTS: The group of H. pylori-infected children showed an elevated proportion of peripheral B cells with CD19(low) , along with a twofold increase in the percentage of memory (CD45RO(+)) CD4(+) and CD8(+) T-cell subsets (p < .05). Moreover, a positive correlation between the age and the percentage of these subsets was seen (r = .38, p = .04 and r = .56, p < .01, respectively). Children with gastritis but without infection had a slightly increased percentage of CD8(+) T cells and CD56(+) NK cells, CD3(high) T cells and CD45RO(high) CD4(+) T-cell subsets (p < .05). Both H. pylori-infected and noninfected children with gastritis were characterized by an increased percentage of memory/effector CD4(+) T cells, the presence of NK cells with CD56(high), memory T-cell subset with CD4(high), and naive, memory, memory/effector, and effector T-cell subsets with CD8(high) (p < .05). Gastric inflammation scores correlated positively with the percentage of CD4(+) T lymphocytes in H. pylori-infected children (r = .42, p = .03). In noninfected children, gastric inflammation scores correlated positively with the percentage of B cells (r = .45, p = .04). CONCLUSION: In H. pylori-negative children, gastritis was associated with an increased percentage of activated NK and T cells, and intermediate-differentiated peripheral blood CD4(+) T cells, which was more pronounced in H. pylori-positive children who also showed an increased B-cell response. However, increased inflammation was only associated with the elevation of CD4(+) T-cell percentage in H. pylori-positive children as well as B-cell percentage in H. pylori-negative children with gastritis.

[Adhesion molecules of immunoglobin super family in children and youth with inflammatory bowel disease]. / Czasteczki adhezyjne nadrodziny immunoglobulin w ocenie aktywnosci zapalenia u mlodziezy i dzieci chorych na nieswoiste zapalenia jelit.

UNLABELLED: Chronic inflammation is the common feature of inflammatory bowel disease. Adhesion molecules of immunoglobin super family play a key role in infiltration of leucocytes to place of inflammation. THE AIM OF THIS STUDY: was to investigate the concentrations of slCAM-1, sVCAM-1 i sPECAM-1 in children and youth with Crohn's disease and ulcerative colitis. MATERIAL AND METHODS: The soluble adhesion molecules were studied in the serum of 31 patients with Crohn's disease (CD) and 27 with ulcerative colitis (uc) and 20 healthy controls in age 6-18. Groups of Crohn's disease and ulcerative colitis patients were divided according to Hyams and Truelove-Witts' indexes of disease activity. Serum levels of sICAM-1, sVCAM-1 and sPECAM-1 were measured using an enzyme-linked immunosorbent assay kit of Bender MedSystem. RESULTS: There were no statistical significant differences in the levels of sICAM-1, sVCAM-1 and sPECAM-1 between the Crohn's disease patients and the control group. sICAM-1 level of the patients with ulcerative colitis was statistical significant higher then those of controls (391.28 +/- 134.95 ng/ml vs. 319.91 +/- 77.86 ng/ml, p = 0.022). There were no statistical significant differences in the levels of sVCAM-1 and sPECAM-1 between the patients with ulcerative colitis and the control group. There were no statistical significant differences in the levels of sICAM-1, sVCAM-1 and sPECAM-1 between patients with the active Crohn's disease and with remission and between patients with active ulcerative colitis disease and with remission. CONCLUSION: Determine of sICAM-1, sVCAM-1 and sPECAM-1 in patients with inflammatory bowel disease could not be helpful in estimation of inflammation activity.

[The analysis of usefulness different diagnostic methods in children and adolescents with Helicobacter pylori infection]. / Analiza przydatnosci róznych metod diagnostycznych w ocenie zakazenia Helicobacter pylori u dzieci i mlodziezy.

UNLABELLED: A diagnostics of Helicobacter pylori infection in children and adolescents in practice sometimes is still difficult. Qualification to the tests for detecting infection with invasive and noninvasive methods should start from diligent anamnesis. THE AIM OF THE STUDY: Is to present the clinical course and results of diagnostic tests in children and adolescents with suspicion of Helicobacter pylori infection. MATERIAL AND METHODS: One hundred patients aged between 18 months and 18 years who underwent endoscopy with gastric biopsies, histology, culture and 13carbon urea breath test. There were 36 boys and 64 girls in analysed group, 10% of them were preschool children, 42% school children and 48% teenagers older than 12 years RESULTS: Patients were symptomatic and most frequent were dyspeptic symptoms (91%). A symptom duration time was varied from several days to several years. On the basis of endoscopy and histology gastritis and/or duodenitis were found in 92 patients, esophagitis and gastritis in 5 patients, duodenal ulcer in 2 patients, in 1 case gastric and duodenal mucosa was normal. Helicobacter pylori infection was histopathologically confirmed in 37 patients. In 15 cases Helicobacter pylori strains were isolated with full in vitro sensitivity to amoxicillin, claritromycin and metronidazol. Urea breath test was conducted in 85 analyzed patients and 51 of them had abnormal result. CONCLUSIONS: In clinical picture of Helicobacter infection most frequent were dyspepstic symptoms and by endoscopy chronic gastritis and/or duodenitis were shown. Culture of Helicobacter pylori has a limited usefulness in practice especially in patients who underwent antibiotic/eradication therapy. The statistical significant concordance occurred between culture and noninvasive 13carbon urea breath test.

[Value of pH-metric examination in diagnosing gastroesophageal reflux in children and youth with typical and atypical clinical symptoms of gastroesophageal reflux disease]. / Wartosc badania pH-metrycznego w rozpoznawaniu refluksu zoladkowo-przelykowego u dzieci i mlodziezy z typowymi i nieswoistymi objawami klinicznymi choroby refluksowej przelyku.

AIM: The aim of work was an estimation of pH-metric examination in diagnosing of gastroesophageal reflux in children with typical and atypical symptoms of the gastroesophageal reflux disease. MATERIAL AND METHODS: 121 children were analysed with suspected to gastroesophageal reflux disease. Depending on reported ailments they were divided into 2 groups. Group I patients with typical symptoms of gastroesophageal reflux disease were including: heartburn, rebounding; while the second group consisted of those with atypical symptoms: nausea, vomiting, chest pain, abdominal pain. 24-hour pH-metric examination was performed in each patient. RESULTS: On the basis of pH-metric examination gastroesophageal reflux was diagnosed in 85.2% patients from I group and 44.8% patients from group II. CONCLUSION: The most important examination determining diagnosis of gastroesophageal reflux in children with both typical and atypical symptoms of this illness should be pH-metric examination of the esophagus. In children with atypical symptoms in consideration of differential diagnosis we should take into account a possibility of gastroesophageal reflux.

[Value of E-selectin and L-selectin determination in children and youth with inflammatory bowel disease]. / Wartosc kliniczna oznaczania selektyny E i L u dzieci i mlodziezy z nieswoistymi zapaleniami jelit.

UNLABELLED: Chronic inflammation is the common feature of inflammatory bowel disease. Infiltration of leucocytes is mediated by definite adhesion molecules expressed on the surface of activated leucocytes, platelets and endothelial cells. AIMS: to investigate the clinical value of determining concentrations of sE-selectin and sL-selectin in children and youth with Crohn's disease and ulcerative colitis. PATIENTS AND METHODS: soluble adhesion molecules were studied in the serum of 31 patients with Crohn's disease (CD) and 27 with ulcerative colitis (UC) and 20 healthy controls aged 6-18. Crohn's disease and ulcerative colitis patients were divided according to Hyams and Truelove-Witts' indeces of disease activity. Serum levels of sE-selectin and sL-selectin were measured using an enzyme-linked immunosorbent assay kit of Bender MedSystem. RESULTS: sE-selectin levels of the inflammatory bowel disease patients were higher then those of controls and sL-selectin levels of the IBD patients were lower than those of controls but without statistical significant differences. The sE-selectin levels of Crohn's disease patients with active disease were statistically significant higher then those with remission of the disease (29,17 + 25,65 ng/ml vs 50,74 + 20,00 ng/ml). There was no statistically significant difference in the levels of L-selectin between patients with active disease and those with remission. There were no statistically significant differences in the levels of sE-selectin and sL-selectin between patients with active ulcerative colitis disease and patients with remission. CONCLUSION: determination of sE-selectin in children with Crohn's disease is of significance in estimation of inflammation activity.

Fecal pyruvate kinase: a potential new marker for intestinal inflammation in children with inflammatory bowel disease.

OBJECTIVE: Inflammatory bowel disease (IBD) in children creates diagnostic and clinical challenges. Clinical data, endoscopic appearance and the histopathological assessment of biopsies are essential for diagnosis. However, new methods are required for non-invasive follow-up. Recently, we demonstrated that the dimeric isoform of pyruvate kinase (PK) detected in stool might serve as a potential non-invasive screening tool in inflamed pouch mucosa. The aim of this study was to investigate whether this test could be used to detect intestinal inflammation in pediatric IBD patients. MATERIAL AND METHODS: Fecal PK immunoreactivity was assessed in 75 patients with proven ulcerative colitis (UC) and 32 with Crohn's disease (CD). Pediatric Crohn Disease Activity Index (PCDAI) and Truelove-Witts scores were determined in CD and UC patients, respectively. Thirty-five healthy subjects (HS) served as a control group. RESULTS: Increased PK levels were documented in 94.1% and 100% active CD patients with a cut-off level of 5 U/g and a cut-off level of 4 U/g, respectively, and in 94.3% of active UC patients regardless of cut-off level. Enzyme immunoreactivity was significantly higher in all IBD patients than in HS. Abnormal PK results were documented in 71.7% of all IBD patients (65.3% and 84.4 for UC and CD patients, respectively). Enzyme levels in UC remission were significantly lower than in the active phase. Enzyme immunoreactivity significantly correlated to both scoring systems. CONCLUSIONS: The measurement of stool PK could be a potentially useful marker of IBD activity in children. However, its clinical value demands further studies for comparison with other tests.

[Helicobacter pylori infection as a cause of sideropenic anaemia resistant to treatment - own observation]. / Zakazenie Helicobater pyroli przyczna niedokrwistosci niedobarwliwej opornej na leczenie- obserwacje wlasne.

A relationship is described between H. pylori infection and diseases localized beyond the gastrointestinal tract, for example: atherosclerosis, stenocardia, cerebral stroke, chronic urticaria, rosacea, hemicrania and in, children with height deficit or anaemia, caused by iron deficiency. Two cases of sideropenic anaemia in children resistant to oral iron are presented. Gastrointestinal tract symptoms were not observed and most probably the reason for anaemia was H. pylori infection. The first 14 years old patient with normal menstrual periods had been treated for four months by oral iron, without any effect (Hgb 10.2 g%, Fe 36.8%, ferritin < 10.8 mg%). On endoscopy of upper gastrointestinal tract there were macroscopic typical changes of H. pylori infection in antrum part of the stomach. On histological examination of biopsy segments inflammation of stomach mucosa in average intensification and H. pylori infection was confirmed. Recovery caused normalization of iron in the organism and of erythrocyte morphology. There was no recurrence of anaemia in long-term observation of the girl. A 14 years old boy treated without success for severe sideropenic anaemia (Hgb 7.1 g%), with positive family history (father has gastric ulcer). In spite of lack of gastrointestinal tract symptoms, on endoscopy there were features of chronic active hemorrhagic inflammation of stomach mucosa with H. pylori infection. Oral iron and effective eradication (proton pump inhibitor, amoxycillin, clarithromycin), achieved normalization of morphological changes. Recurrence of anaemia has not been observed.

[Non-specific inflammatory bowel disease or allergic colitis in small children - what is the final diagnosis]. / Nieswoiste czy alergiczne zapalenie jelita grubego u malych dzieci-trudnosci diagnostyczne.

The reason of bleeding from alimentary tract in small children - may sometimes be a big problem and we may need a long observation before making the diagnosis. One of the most frequent reasons of bleeding is food allergy, which resembles allergic colitis. However, bleeding can be the first symptom of ulcerative colitis or Crohn's disease, but it is very rare in small children. We present three cases of small children with bleeding from alimentary tract, in which it was difficult to make the final diagnosis. In our cases, the endoscopic and histopathological examination showed changes, which suggested non-specific inflammatory bowel disease. The microabscesses in crypts and inflammatory infiltration in the mucosa indicated ulcerative colitis. Moreover, one child had also inflammatory infiltration in the oesophagus and duodenum, which is typical for Crohn's disease. We conclude that even when the clinical course suggests that the reason of presenting symptoms was food allergy, there is need for longer observation until one can make the final diagnosis.

[Pyoderma gangrenosum, a nonintestinal manifestation of Lesniowski-Crohn's disease in a 15 years old girl]. / Zgorzelinowe zapalenie skóry jako pozajelitowa manifestacja choroby lesniowskiego-crohna u-15 letniej dziewczynki.

In the clinical course of Lesniowski-Crohn's disease in children, gastrointestinal symptoms are predominant. Extraintestinal manifestations are found rarely, contrary to adults. Pyoderma gangrenosum is hardly ever observed but frequently coexists with colon involvement. The aim of the study was a presentation of 15 years old girl with Lesniowski-Crohn's disease and predominant joint and skin symptoms in form of pyoderma gangrenosum. Skin lesions were shaped in solitary ulcerations with cyanotic undermined border localized on legs and buttocks. After steroid therapy these changes were healed with permanent blue scar. Gastrointestinal symptoms though slight were characteristic. The girl had stools with some fresh blood and perianal lesions.

[Analysis of the importance of Helicobacter pylori strains in children with gastric and duodenal mucosal inflammatory changes]. / Analiza wystepowania i wplywu zakazenia szczepami CagA(+) Helicobacter pylori na zmiany zapalne blony sluzowej zoladka i dwunastnicy u dzieci.

UNLABELLED: The role of Helicobacter pylori (H. pylori) infection in etiopathogenesis of gastritis and/or duodenitis is well recognized and proven. H. pylori infection also concerns children and youth. It was proven that CagA(+) strains of H. pylori cause inflammatory changes and can lead to ulcer disease of ventriculum and/or duodenum. AIM: The purpose of the study was to determine the prevalence of urease A and cytotoxicity genes in children with diagnosed H. pylori infection and concomitant gastritis and/or duodenitis as well as to determine the kind and stadium of inflammatory changes in relation to particular strains. MATERIAL AND METHODS: The study was performed in 76 patients aged from 3 to 20 years (average age 12.6), who were qualified for endoscopy of the upper GI tract because of recurrent abdominal pain complaints. The H. pylori infection and accompanying gastritis and/or duodenitis were diagnosed according to the Sydney classification. RESULTS: In 57/76 (75%) of diagnosed patients the H. pylori infection was proven with the PCR method (ureA (+)). The following strains were found: CagA(+) in 19 (33% infected subjects). Gastritis and/or duodenitis occurred in all subjects infected with CagA (+) strains and in 54/57 of those with H. pylori infection ureA (+). In subjects without infection, gastritis and/or duodenitis was found in 12 persons, and this result was significantly lower. CONCLUSIONS: In diagnosis it is important to confirm H. pylori presence by CagA gene typing because it relates to the inflammatory changes of the stomach and/or duodenum.

[Long term analysis of chronic gastritis with Helicobacter pylori infection in children and teenagers with chronic abdominal pain]. / Wieloletnia analiza czestosci wystepowania przewleklego zapalenia blony sluzowej zoladka ze wspólistniejacym zakazeniem Helicobacter pylori u dzieci i mlodziezy z bólami brzucha.

INTRODUCTION: Helicobacter pylori can be the cause of chronic gastritis and gastric ulcer. In children, the infection can be asymptomatic or can be a cause of dyspepsia. THE AIM of the study was to evaluate the incidence of chronic gastritis and H. pylori infection in children and teenagers investigated because of chronic abdominal pain. MATERIAL AND METHODS: From the group of 3762 children and teenagers investigated during 10 years in the Department of Children's Disease, Allergology and Gastroenterology University Medical School in Bydgoszcz, because of abdominal pain, we selected 910 patients (24.2%) with chronic gastritis and coexisting H. pylori infection. RESULTS: We discovered that the highest number of infected children was in the age group 7-14 years (75.8%) then 15-18 (13.2%), 3-6 (10.4 %) and 0-2 (0.6%). The study demonstrated that the number of infected girls (57%) was higher than the number of infected boys. CONCLUSION: In our investigations chronic gastritis with H. pylori infection in children and teenagers diagnosed because of abdominal pain, occurs in about 25% of patients and this fact should be considered in diagnostic procedures and management.

An evaluation of the impact of supplementation with antioxidant vitamins on oxidation stress parameters in children with chronic recurrent gastroduodenitis.

BACKGROUND: The purpose of our research was to evaluate the impact of supplementation with antioxidative vitamins in children with chronic recurrent gastroduodenitis on the concentration of malon-dialdehyde (MDA) in plasma and erythrocytes, and on activity of the antioxidant enzymes: dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px). MATERIAL/METHODS: We studied 19 children (age from 13 to 16), diagnosed with chronic recurrent gastroduodenitis. The concentration of MDA was measured by Buege and Aust method, while the antioxidant enzyme activity was measured before and after a two-month course of supplementation with vitamins C and E: SOD by the Misra and Fridovich method, CAT by the Bears and Seizer method, and GSH-Px by the Paglia and Valentine method. RESULTS: The average concentration of MDA in erythrocytes in the studied children was significantly higher (38.59 nM/gHb) than in control group (24.07 nM/gHb), but after supplementation was significantly reduced (p<0.05). The average SOD activity in the experimental group was significantly lower both before (885 U/gHb) and after supplementation (923.3 U/gHb) than in the control group (1240 U/gHb). The activity of the remaining enzymes did not differ significantly in experimental and control groups. CONCLUSIONS: The increased erythrocyte concentration of MDA in children with chronic recurrent gastroduodenitis may point to the generation of active forms of oxygen due to the low activity of the anti-oxidant enzyme SOD. Supplementation with the antioxidant vitamins C and E in children with a low antioxidant potential and chronic recurrent gastroduodenitis reduces the generation of free oxygen radicals.

[Interleukin 13 and 18 serum concentration in children with cow milk hypersensitivity]. / Badania stezenia interleukiny 13 i 18 w surowicy krwi u dzieci z nadwrazliwoscia na mleko krowie.

UNLABELLED: The aim of the study was the estimation of IL-13 and IL-18 concentration in serum of children with cow milk hypersensitivity and estimation of its usefulness in clinical practice. MATERIAL AND METHODS: 30 children (14 boys, 16 girls) at the age 6-24 months, average 10.5 months. The children were divided into two groups. Group 1 included 18 children with elevated total IgE, group II, 12 children with normal IgE. In all children with suspected cow milk hypersensitivity, a diet based on strong milk hydrolysates or soy-milk formulas was advised. In 10 children IL-13 and IL-18 were examined three times: at the moment of diagnosis and after 3 and 6 months of dietary treatment. In 20 children IL-13 and IL-18 were estimated twice. Total IgE and specific IgE were performed by HYTER 288; IL-13 and IL-18 were measured by Bender Med System. The results were analysed statistically. RESULTS: in children with elevated IgE statistically significant higher IL-13 concentration was found and the mean IL-18 concentration in this group was lower but the difference was not statistically significant. We confirmed a positive correlation between elevated IgE and IL-13 concentration and a negative correlation between IgE and IL-18 before introducing the diet. In children with clinical improvement there was a nonsignificant decrease of IL-13 and increase of IL-18 concentration after diet introduction. In the group without clinical improvement, high IL-13 and low IL-18 concentration during diet were observed (p < 0,01). Highly positive correlation between serum IL-18 after 3 months of elimination diet and clinical improvement was observed. Highly negative correlation between mean IL-13 concentration after 6 months of diet and the clinical condition were observed. CONCLUSIONS: The correlation between IL-13 concentration and elevated IgE, indicates a connection of this cytokine with atopy. Negative correlation between IL-18 concentration and elevated IgE suggests a possibility of inhibiting IgE synthesis by this cytokine. A strong correlation between IL-18 concentration and clinical improvement after 3 months of elimination diet may imply a reduction of the allergic process. High negative correlation between IL-13 concentration and clinical improvement after 6 months of elimination diet may indicate a prolongation of the allergic process.