Allergic enteritis in children.

The gastrointestinal form of food allergy is very common in children. The most frequently observed types are allergic proctitis and proctocolitis. In most cases the symptoms subside within the first 2 months of life. The babies seem healthy, and the only abnormality is a small amount of blood in stool. Symptoms can also include small intestine inflammation and colitis. Patients may present with irritability, abdominal pain, flatulence, colic, postprandial vomiting, chronic diarrhoea, and hindered physical development. The diagnosis of allergic enteritis is based on the clinical examination and the results of additional tests including an endoscopy of the lower digestive tract with histopathological assessment. Cow's milk proteins are the most common nutrition proteins responsible for the development of the symptoms of allergic enteritis. The most essential method of treating allergic enteritis is the elimination diet. The symptoms should subside within 1-2 weeks from the beginning of the diet.

The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology.

The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).

Medium chain triglycerides (MCT) formulas in paediatric and allergological practice.

Fats constitute the most significant nutritional source of energy. Their proper use by the body conditions a number of complex mechanisms of digestion, absorption, distribution, and metabolism. These mechanisms are facilitated by fats made of medium chain fatty acids; therefore, they are an easy and quick source of energy. Thus, an increased supply of medium chain triglycerides (MCT) is particularly important in patients with disturbances of digestion and absorption such as disturbed bile secretion, classic coeliac disease, short bowel syndrome, inflammatory diseases of the intestines, disturbed outflow of lymph, some metabolic disease, and severe food allergies, as well as in prematurely born neonates. Use of preparations containing an additive of MCT is limited, especially if they are to be used for a longer period of time. With a large quantity of MCT in a diet, there is a risk of deficiency of necessary unsaturated fatty acids and some fat-soluble vitamins. The caloricity of MTC compared to long-chain triglycerides is lower, and formulas with MCT are characterised by higher osmolality. Medium chain triglycerides is not recommended as an additive to standard formulas for healthy children. The use of MCT should be limited to strictly specified medical indications.

[Evaluation of anger expression, school functioning and a level of anxiety in children and adolescents with functional abdominal pain].

Psychosocial conditions may have influence on the occurrence of functional abdominal pain. Anxiety, school-related difficulties and suppression of emotions negatively impact on the psychosocial condition of a child and could impede its treatment. AIM: The analysis of the psychosocial determinants of functioning of children and adolescents with functional abdominal pain. Meterial and methods: The study group comprised 58 patients (12 boys and 46 girls) from 9 to 17 years of age (av. 13.34±2.14 years) with functional abdominal pain, diagnosed according to the III Roman Criteria, and the control group of 58 healthy children in adequate age, of Bydgoszcz primary and secondary schools. The test method utilised The Anger Regulation and Expression Scale (SEG), The State-Trait Anxiety Inventory for Children (STAIC) and Me and My School Questionnaire. RESULTS: Analysing the results of scale SEG between the group of children with functional abdominal pain and healthy children, significant differences were observed in the scale of external anger (p=0.045). There were no differences between the group of children with functional abdominal pain and the comparative one in terms of Me and My School Inventory scale (p> 0.05). In the group of healthy adolescents, the average of motivation differed significantly from the result of the adolescents with functional abdominal pain (p=0.031). There were no differences between the group of children and adolescents with abdominal pain and the healthy ones in terms of the performance in STAIC scales (p>0.05). CONCLUSIONS: 1. Healthy children compared to children with functional abdominal pain more openly express negative emotions, such as anger and irritation, which can cause reduced tendency to the somatization of symptoms. 2. Symptoms of young people with functional abdominal pain intensify reluctance to fulfill school duties and heighten fear of school, depending on the speed of activation of the autonomic nervous system.

Innate immunity components and cytokines in gastric mucosa in children with Helicobacter pylori infection.

PURPOSE. To investigate the expression of innate immunity components and cytokines in the gastric mucosa among H. pylori infected and uninfected children. Materials and Methods. Biopsies of the antral gastric mucosa from children with dyspeptic symptoms were evaluated. Gene expressions of innate immunity receptors and cytokines were measured by quantitative real-time PCR. The protein expression of selected molecules was tested by immunohistochemistry. RESULTS. H. pylori infection did not lead to a significant upregulation of MyD88, TLR2, TLR4, CD14, TREM1, and TREM2 mRNA expression but instead resulted in high mRNA expression of IL-6, IL-10, IFN-γ, TNF-α, and CD163. H. pylori cagA(+) infection was associated with higher IL-6 and IL-10 mRNA expression, as compared to cagA(-) strains. H. pylori infected children showed increased IFN-γ and TNF-α protein levels. IFN-γ mRNA expression correlated with both H. pylori density of colonization and lymphocytic infiltration in the gastric mucosa, whereas TNF-α protein expression correlated with bacterial density. CONCLUSION. H. pylori infection in children was characterized by (a) Th1 expression profile, (b) lack of mRNA overexpression of natural immunity receptors, and (c) strong anti-inflammatory activities in the gastric mucosa, possibly resulting from increased activity of anti-inflammatory M2 macrophages. This may explain the mildly inflammatory gastric inflammation often observed among H. pylori infected children.

[Nutritional guidelines for healthy children aged 1-3 years - Polish Expert Group statement. Part I- energy and nutritional components demand]. / Normy zywienia zdrowych dzieci w 1-3. Rokuzycia . stanowisko polskiej grupy ekspertów.czesc i - zapotrzebowanie na energiei skladniki odzywcze.

Updating of the nutritional guidelines for the Polish population requires updates of the nutritional norms for children. We present the Polish Expert Group statement (2012) on intake of selected nutrients (protein, lipids, carbohydrates, vitamin D and E) essential in nutrition of children aged 1-3 years. For this purpose the Expert Group reviewed available scientific data: the recent guidelines, nutritional norms and recommendations, systematic reviews and expert opinions as well as original publications, in relation to the specific requirements of the Polish population.

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.

Current management of congenital diaphragmatic hernia.

The treatment of congenital diaphragmatic hernia (CDH) still represents a challenge, even for the specialised multidisciplinary teams in centres that provide treatment for CDH. Despite significant progress in the fields of pathophysiology, prenatal diagnosis, surgical techniques and intensive care, CDH is a disease still burdened with a high mortality. Due to the paucity of randomised studies, there are no standard guidelines for treatment. The present review looks at existing diagnostic and therapeutic principles based on the available literature.

Mannan-binding lectin deficiency in pediatric patients with inflammatory bowel disease.

OBJECTIVE: The incidence of inflammatory bowel disease (IBD) in Europe has increased significantly. At least a fourth of patients are children. Mannan-binding lectin (MBL) is believed to be an important component of innate immunity, acting as an opsonin and activator of the lectin pathway (LP) of complement. The data relating any of the LP factors to IBD are sparse and contradictory and were obtained mainly from adult patients. The aim of this study was to investigate the possible role of MBL in Crohn's disease (CD) and ulcerative colitis (UC) in children. METHODS: MBL2 gene single nucleotide polymorphisms (PCR-RFLP) and MBL concentrations (ELISA) were determined. RESULTS: The frequency of MBL2 gene variants responsible for MBL deficiency (LXPA/O and O/O) is significantly higher in CD patients compared with controls or children with UC. A relatively high frequency of the codon 52 mutation (D allele) was noted in these patients. Practically no difference was found between UC and control (C) groups. Similarly, the average MBL levels as well as the number of MBL-deficient (MBL concentrations < 150 ng/ml) individuals differed between CD patients and controls or children suffering from UC. Again, there was no difference between UC and C groups. CONCLUSIONS: These data suggest that MBL deficiency may be associated with CD but not with UC in pediatric patients. The possible role of MBL in IBD requires confirmation in larger series and further investigation of the mechanisms involved.

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.

Oxidatively damaged DNA/oxidative stress in children with celiac disease.

BACKGROUND: Because patients with celiac disease face increased risk of cancer and there is considerable circumstantial evidence that oxidatively damaged DNA may be used as a marker predictive of cancer development, we decided, for the first time, to characterize oxidative stress/oxidative DNA damage in celiac disease patients. METHODS: Two kinds of oxidatively damaged DNA biomarkers, namely, urinary excretion of 8-oxodG and 8-oxoGua, and the level of oxidatively damaged DNA in the leukocytes, as well as the level of antioxidant vitamins were analyzed using high-performance liquid chromatography (HPLC) and HPLC/gas chromatography with isotope dilution mass detection methods. These parameters were determined in three groups: (a) children with untreated celiac disease, (b) patients with celiac disease on a strict gluten-free diet, and (c) healthy children. RESULTS: The mean level of 8-oxodG in DNA isolated from the leukocytes and in the urine samples of the two groups of celiacs was significantly higher than in controls, irrespective of diet. There was no statistically significant difference in these parameters between treated and untreated celiacs. The mean plasma retinol and alpha-tocopherol concentration in the samples of untreated celiacs was significantly lower than in treated celiacs. CONCLUSION: Our results suggest that although diet can be partially responsible for oxidative stress/oxidatively damaged DNA in celiac patients, there is a factor independent of diet. IMPACT: It is possible that celiac disease patients may be helped by dietary supplementation rich in vitamin A (and E) to minimize the risk of cancer development.

[Meaning of ghrelin and leptin in gastrointestinal tract diseases]. / Znaczenie greliny i leptyny w chorobach przewodu pokarmowego.

Ghrelin and leptin are newly discovered, still very mysterious, hormones. Beside the energy balance, they regulate endocrine and immune system, growth and maturate processes. Fluctuations of both hormones concentration are observed in many gastrointestinal tract diseases. In this publication is presented current knowledge about meaning ghrelin and leptin in choosen diseases, like malabsorption syndromes, inflammatory diseases and tumors of gastrointestinal tract.

[Multiple organ failure in a severely malnourished patient with chromosome aberration]. / Skrajne niedoiywienie jako przyczyna niewydolnosci wielonarzadowej u chorej z aberracja chromosomalna.

BACKGROUND: Pneumonia and malnutrition are two of the biggest killers in childhood, as defined by the World Health Organisation. Although common in the developing world, these conditions can also be observed in more advanced countries, as a result of negligence and lack of proper care in disabled children. We describe a case in which severe malnutrition resulted in multiple organ failure. CASE REPORT: A 16-yr-old retarded girl with +14q chromosome aberration, was admitted to hospital because of severe anaemia and dyspnea. She was extremely malnourished. Her body weight was 32 kg with a height of 152 cm (BMI 13.9). Her Hb concentration was 1.12 mmol L(-1), Ht 7%, and RBC 0.93 T L(-1). RBC transfusion resulted in transfusion-related acute lung injury (TRALI) and multiple organ failure. She was treated with mechanical ventilation, inotropic support and parenteral nutrition, complicated by the refeeding syndrome and gastrointestinal haemorrhage. After recovery, a gastrostomy was performed, but due to gastric retention she required a laparotomy for adhesiolysis.The girl recovered and remains under home care. DISCUSSION: In a case of a girl with retardation, multiple organ failure resulting from ten years of malnutrition was observed. She was especially difficult to treat because of a prolonged dysfunction of homeostasis, hypoproteinemia, hypophosphatemia and SIRS. Such patients require careful treatment in ICU settings.

[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.

[Can obstructive bronchitis be a risk factor of bronchial asthma in infants and small children?]. / Czy obturacyjne zapalenie oskrzeli u niemowlat i malych dzieci moze byc czynnikiem ryzyka astmy oskrzelowej?

One of more frequent reasons for hospitalizations concerning infants and small children are obstructive bronchitis. Great prevalence of bronchial tree obturation during infancy and in small children is a result of anatomical and functional differences of airways and immunological differences that occur in infants and small children. The most frequent cause of bronchial tree obturation is infection induced by viruses, rarely by bacteria. Recurrences of bronchial tree obturation are observed in some patients. Obturation recurrences can be caused by number of diseases that appear during infancy and in small children, for example cystic fibrosis of the pancreas. Also the presence of foreign body in the airways, immotile cilia syndrome, immunological disturbances, innate anomalies of the respiratory system and the circulatory system and bronchial asthma can result in obturation recurrences. Various clinical criteria are established and new markers of allergic inflammation are searched in view of difficulties to diagnose bronchial asthma in the youngest children. There are no unequivocal rules to diagnose bronchial asthma in infants and small children despite these searches.

[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.

[Analysis of L, E, and P selectins concentration in infants and young children with spastic bronchitis]. / Analiza stezenia selektyny L, E i P u niemowlat i malych dzieci chorych na obturacyjne zapalenie oskrzeli.

UNLABELLED: Spastic bronchitis in infants and young children is one of the most frequent causes of hospitalization in this age group. Both infectious and allergic inflammations lead to inflammation cells activation and their flow to the place of inflammation by the activation of adhesive molecules. One of groups of adhesive molecules are L, E and P selectins responsible for leucocytes migration through the vessel wall. The aim of the study was to assess the concentration of solved fractions of L, P and E selectins in infants and young children in the course of spastic bronchitis. MATERIAL AND METHODS: Fifty four patients with spastic bronchitis (group I) including 32 with the first bronchitis (group IA) and 22 patients with recurrent bronchitis (at last the third one--group IB) were included into the study. Comparative group (group II) was consisted of 26 patients hospitalized due to other causes and with no bronchitis in the past. Patients were from 1 to 36 months of age. Among all patients solved fractions of selectins L, E and P were analyzed by ELISA tests. RESULTS: Mean sL-selectin concentration in group I was 4126.3 ng/ml and in group II 4222.31 ng/ml and was not statistically significant. Concentrations of sL-selectin in the group of patients with the first episode of spastic bronchitis was 4099.37 ng/ml and in the group of patients with recurrent bronchitis was 4166 ng/ml and had no statistical difference. Mean sE-selectin concentration in group I was 205.49 ng/ml and in group II 214.50 ng/ml and was not statistically significant. Concentrations of sE-selectin in the group of patients with the first episode of spastic bronchitis was 195.22 ng/ml and in the group of patients with recurrent bronchitis was 220.43 ng/ml and had no statistical difference. Concentration of sP-selectin was assessed among 51 patients with bronchitis and among 26 patients from comparative group. Because of the lack of normal distribution values of sP-selectin concentrations were changed by decimal logarithm. Mean sP-selectin concentration in group I was 235.95 ng/ml and in group II 164.70 ng/ml. After logarithm change values of concentrations were: 2.249 and 2.005 and had statistical difference (p = 0.0221). Concentrations of sP-selectin in the group of patients with the first episode of spastic bronchitis was 234.0 ng/ml and in the group of patients with recurrent bronchitis was 238.20 ng/ml and after logarithm change concentrations were 2.26 in the group of patients with the first episode of spastic bronchitis and 2.24 in the group of patients with recurrent bronchitis and had no statistical difference. CONCLUSION: On the ground of our study in infants and young children with spastic bronchitis increase of sP-selectin concentration was observed and sE-selectin and sL-selectin concentrations were the same.

Epidemiology of inflammatory bowel disease among children in Poland. A prospective, population-based, 2-year study, 2002-2004.

BACKGROUND/AIMS: The incidence of pediatric inflammatory bowel disease (IBD) in Western countries is on the rise. No prospective studies have been conducted on the epidemiology of pediatric IBD in Poland. The aim of the study was to define the characteristics of new pediatric IBD and assess the incidence of new IBD among children in Poland between 2002 and 2004. METHODS: Patient records from 24 pediatric gastroenterology centers servicing the whole population of Poland were collected. IBD diagnosis was based on clinical, radiological, endoscopic and histological features. RESULTS: There were 491 new IBD patients, representing an overall incidence of IBD of 2.7 cases/100,000 children/year. The incidence of Crohn's disease (CD) was 0.6, ulcerative colitis (UC) 1.3, and indeterminate colitis (IC) 0.8. The age-related incidence of IBD was 1.8 in the 0- to 10-year-old age group, rising to 3.7 for the 11- to 18-year age group. CONCLUSIONS: The overall incidence of IBD (as well as CD, UC and IC) in Poland is lower than that in Western countries. The relative contribution of UC and IC to the overall IBD incidence is higher in Poland than in most Western countries. These findings may suggest a tendency towards under- or misdiagnosis.