Helicobacter pylori increases expression of proapoptotic markers Fas and FasL on CD4 lymphocytes in children.

The pathomechanism of Helicobacter pylori action upon gastric mucosa and its role in the pathogenesis of gastritis have not been fully elucidated. The aim of this study was to evaluate the most prevalent lymphocyte subpopulations of the gastric mucosa in gastritis in children, as well as to evaluate the expression of Fas and Fas ligand receptors (FasL), periapoptotic markers of gastric mucosa lymphocytes before and after H. pylori eradication. Forty nine patients aged 6 to 17 years, investigated due to chronic abdominal pain, were studied. The obtained tissue samples were analysed by immunohistochemistry. Different lymphocyte subsets were quantified on the basis of surface antigen expression (CD3, CD4, CD8, CD20), secreted cytokines (IL-4, IL-6, IFNgamma) and Fas and FasL proteins in the gastric mucosa. B and T helper lymphocytes were found to play a major role in the inflammatory infiltration in the gastric mucosa in children during H. pylori infection. Their expression was found to decrease after eradication. The enhanced expression of Fas receptor on lymphocytes before treatment and a decrease of this expression after eradication of H. pylori were shown. It was demonstrated that there is a correlation between CD4 and Fas receptor expression that may induce apoptosis of the helper lymphocytes in infected children.

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.

[Dysphagia and gastroesophageal reflux in children with oesophageal atresia with tracheo-oesophageal fistula after succesful surgery treatment. Own observations]. / Zaburzenia polykania i refluks zoladkowo-przelykowy u dzieci z wrodzonym zarosnieciem przelyku i przetoka przelykowo-tchawicza po skutecznym zabiegu chirurgicznym. Obserwacje wlasne.

BACKGROUND: current succesful surgery of oesophageal atresia with tracheo-oesophageal fistula leads to increased survival of the affected newborns Hence late complications of the defect itself or those due to surgical methods occur more often. AIM OF THE STUDY: was to establish on the base of own observations, the frequency of swallowing problems, gastro-esophageal reflux and oesophagitis after successful surgery of oesophageal atresia. MATERIAL AND METHODS: we investigated 17 patients after successful surgery of oesophageal atresia and tracheo-oesophageal fistula, performed during the first days of life, in the Department of Paediatric Surgery, Medical University of Gdansk (chief prof Czeslaw Stoba). These patients were diagnosed and treated in the Department of Paediatrics, Paediatric Gastroenterology and Oncology, Medical University of Gdansk, during 2005-2006. There were 10 boys and 7 girls, aged from 4 to 14 years (in the - years 2005-2006). In all children, besides obtaining the detailed history concerning dyspeptic symptoms and dysphagia, upper alimentary tract endoscopy, oesophagography and pH-metric examinations were performed RESULTS: gastroesopghageal reflux (GER) was diagnosed in 41.2%, and oesophagitis, by endoscopic examination, in. 17.7% of patients. Disturbed oesophageal motility on radiography was observed in 88.2% of children. CONCLUSIONS: despite the high frequency of gastroesopghageal reflux among this group of patients, their health condition was good, dysphagia and the intensity of the oesophagitis were mild. But it should be remembered that prolonged gastroesopghageal reflux may cause serious complications.

[Inflammatory bowel disease in children--an analysis of the clinical symptoms and selected biochemical parameters]. / Nieswoiste zapalenia jelit u dzieci--analiza obrazu klinicznego i wybranych parametrów biochemicznych.

AIM OF THE STUDY: an analysis of clinical symptoms and laboratory tests in children with inflammatory bowel disease (IBD). PATIENTS AND METHODS: eighty-nine children with IBD (58 with ulcerative colitis (UC) and 31 with Crohn's disease (CD) diagnosed on the basis of clinical symptoms, endoscopic and histopathological examination, were qualified into the studied group. Disease activity was evaluated by using Truelowe-Witts scale for UC and PCDA9 scale for CD cases. Forty-two children without acute or chronic inflammatory diseases constituted the control group. RESULTS: the frequency of such clinical symptoms as: diarrhea, fever, weight loss, abdominal pain, weakness, constipations, anemia, joints pain, vomits, and jaundice was comparable in children with UC and CD while intestinal bleeding was significantly more frequently observed in patients with UC than with CD (P<0.05). There was no statistically significant difference in BMI between patients with UC and CD. Cole's index was significantly higher in children with UC than with CD (P<0.05). Hemoglobin level and serum iron level were statistically significantly lower in patients with CD than in the control group (P<0.05). Mean leukocyte count in children with CD was significantly higher than in the control group (P<0.05). Neutrophils percentage in patients with UC and CD was significantly higher than in the control group (P<0.05). Platelet count was significantly higher in all children with IBD than in the control group (P<0.05). Mean serum CRP level was significantly higher only in children with CD while ESR was significantly higher in both groups of IBD patients. Mean serum gamma-globulin level was statistically significantly higher in children with UC and with CD but no significant differences were observed in serum IgA, IgG, and IgM levels among the analyzed groups. Serum GT level was higher in children with CD than in the control group while serum ALT and AST level did not differ significantly among the analyzed groups of patients. CONCLUSIONS: 1. Serum C-reactive protein level is one of the most valuable markers for monitoring the course of IBD, especially CD, in children. 2. In patients with IBD systematic monitoring of liver function parameters (especially parameters of cholestasis) is necessary as severe hepatic complications may occur. 3. Further search for new sensitive and specific markers monitoring the course of inflammatory bowel diseases is needed.

[Gastroesophageal reflux disease presenting as severe bronchial asthma in an 18 months old child]. / Choroba refluksowa przelyku przebigajaca pod maska astmy oskrzelowej o ciezkim przebiegu u 18-miesiecznego dziecka.

It is known that gastro-esophageal reflux can trigger bronchospasm among children with asthma and cystic fibrosis as well as in children without chronic respiratory tract disorders. In our practice we have met only once with the case of a child misdiagnosed as having severe asthma in whom surgical treatment of gastro-esophageal reflux disease ended with full withdrawal of respiratory symptoms. On the basis of this case we conclude that the diagnostic procedures should be performed in cases of asthma resistant to typical treatment.

Frequency, consequences and pharmacological treatment of gastroesophageal reflux in children with cystic fibrosis.

BACKGROUND: Gastroesophageal reflux (GER) may aggravate chronic bronchopulmonary diseases. The study evaluated GER frequency and characteristics in children with Cystic Fibrosis (CF) as well as its consequences and pharmacological treatment. MATERIAL/METHODS: 40 CF children aged 1.3 to 20 years were examined. The study methodology involved: medical files analysis, anamnesis, physical examination, growth status estimation, esophageal pH-metry and upper gastrointestinal tract endoscopy with histological examination of esophageal biopsies. RESULTS: Based on pH-metry results, the diagnosis of GER was established in 22 children (55%). Mild GER (Index Reflux - IR 5-10%) was found in 12 children (54.5%), moderate GER (IR 10-20%) in 7 (31.8%) and severe GER (IR>20%) in 3 (13.6%). Ten patients with moderate or severe GER underwent endoscopy, which revealed GER-related esophagitis in 8 cases. There was no statistical difference of GER frequency and degree according to: age, sex, growth status, presence of type DF508 mutation in CFTR genome and typical GERD symptoms. According to the ESPGAN proposition, cisapride or cisapride with ranitidine medication was instituted. Treatment analysis was performed in 19 cases after successful follow-up examinations carried out three months later, indicating a significant decrease in reflux index, the longest episode duration and the number of episodes longer than 5 minutes. Improvement of endoscopic picture was noticed after treatment. CONCLUSIONS: High frequency of gastroesophageal reflux and its consequences among children with cystic fibrosis, as well as the possibility of well-tolerated and efficient treatment of GER, indicate that diagnostics of GER among children with CF should be obligatory.

TGF-beta (transforming growth factor-beta) in chronic inflammatory conditions - a new diagnostic and prognostic marker?

TGF-beta is a cytokine with varied properties and pleiotropic activity. It is released in an inactive form. To exhibit its biological activity, it requires binding to extracellular matrix proteins and, after that, proteolytic elimination of LAP (Latent Associated Protein) and LTBP (Latent TGF-beta Binding Protein). The process involves, among others, tissue transglutaminase, thrombin and plasmin. By stimulation of specific receptors, it influences transcription of some genes and translation of formed mRNA. Locally, it demonstrates proinflammatory properties whereas systemically, it has primarily a potent immunosuppressive effect. TGF-beta, by affecting proliferation, differentiation and migration of cells, as well as stimulation of extracellular matrix protein production, plays an important role in tissue regeneration and remodeling, but also in fibrosis. TGF-beta is also indispensable to maintain immune homeostasis of the organism. Reduced TGF-beta activity is considered to be responsible for development of autoimmune disorders in the course of several pathologic conditions. This cytokine plays an important role in the pathogenesis of chronic inflammatory processes taking place, among others, in inflammatory bowel diseases (IBD) and chronic hepatitis B and C. The paper presents a review of literature concerning diagnostic and prognostic value of TGF-beta level determinations in blood and tissue bioptates of patients with chronic non-specific enteritis and chronic hepatitis B and C.