Value of the atopy patch test in the diagnosis of food allergy in children with gastrointestinal symptoms.

BACKGROUND: In recent years, food allergy, especially in the child population, has become an increasing problem in developed societies. In the youngest children, it is a frequent cause of gastrointestinal disorders. The atopy patch test, applied from several years in clinical practice, is one of the methods used in allergology. OBJECTIVES: The objective of the work was an assessment of the diagnostic value of the atopy patch test in the diagnosis of allergy to cow's milk protein and to wheat proteins in children with gastrointestinal symptoms. MATERIAL AND METHODS: The study was comprised of 61 children (37 boys and 24 girls, aged 3 to 36 months, average age 13.5 months). Their medical history might have indicated a connection between the symptoms and ingested food. In all the children, an atopy patch test and a skin prick test with native food allergens were carried out. Table 1 presents the characteristics of the studied patients. Diagnosis of allergy to cow's milk protein and to wheat was verified in the open food challenge. RESULTS: Sensitivity of APT for milk was 21%, specificity - 91%, PPV - 80%, NPV - 39% and for wheat - 67%, 100%, 100% and 77%, respectively (Table 4). For the skin prick test, sensitivity, specificity, PPV and NPV were 13%, 96%, 83% and 39% for milk and 22%, 80%, 50% and 53% for wheat. CONCLUSIONS: APT demonstrates high sensitivity and high specificity in the diagnosis of allergy to wheat in children with gastrointestinal symptoms. The sensitivity of ATP in the detection of allergy to cow's milk in children with gastrointestinal symptoms was low and therefore the diagnosis should be verified by challenge tests.

[Feeding disorders, ALTE syndrome, Sandifer syndrome and gastroesophageal reflux disease in the course of food hypersensitivity in 8-month old infant]. / Zaburzenia karmienia, zespól ALTE, zespól Sandifera oraz choroba refluksowa przelyku w przebiegu naldwraiwosci pokarmowej u osmiomiesiecznego niemowlecia.

This paper describes the occurrence of feeding disorders, atopic dermatitis, life-threatening symptoms, Sandifer syndrome, and gastroesophageal reflux disease in 8-month old infant in the course of food hypersensitivity. Used in the treatment of cow's milk protein hydrolysates with a considerable degree of hydrolysis, omeprazole, Cisapride. It was not until the introduction of elemental diet based on free amino acids resulted in the withdrawal of life-threatening child's symptoms.

[Distinct clinical characteristics of inflammatory bowel disease in children younger than 5 years]. / Odrebnosci kliniczne nieswoistych zapalen jelit u najmlodszych dzieci do lat 5.

UNLABELLED: In the last decades an increase in morbidity of inflammatory bowel disease, particularly of Crohn disease, in children has been observed. OBJECTIVE: Assessment of clinical course and activity of inflammatory bowel disease in children younger than 5 years was the goal of the study. MATERIAL AND METHODS: The study comprised 21 children aged 2 to 5 years (13 boys and 8 girls) who were diagnosed with: Lesniowski-Crohn disease (7 children), ulcerative colitis (7 children) and indeterminate colitis (remaining 7 children). RESULTS: Among studied children boys prevailed (61.9%). In 6 children the disease started in the first and second year of life; the average age of disease onset was 26.9 months and the time between the onset of the disease and the diagnosis was 16.6 months. 46% of patients came from the cities with population above 100000 when only 23% lived in the country. Autoimmune diseases were diagnosed in the families of 6 children, food or pollen allergy in the families of 11 children. Abdominal pain, diarrhea, presence of blood and mucous in the stool, fever and lack of thrive were most apparent in the clinical picture. The pathological changes were present mainly in the large intestine and only in one case in the upper part of the alimentary tract and jejunum. The observed course of the disease was severe or moderate. In two children aged 3 years colectomy was performed. CONCLUSIONS: In children younger than 5 years severe and moderate course of the Lesniowski-Crohn disease and ulcerative colitis is apparent. Fever, abdominal pain, diarrhea, presence of blood and mucous in the stool and lack of appetite were the most often seen symptoms. Pathological changes in children younger than 5 years were present mainly in the large intestine and only in single cases in the upper part of the alimentary tract and jejunum. In children with inflammatory bowel disease a frequent occurrence of allergy, bronchitis, pneumonia and urinary tract infection, which required antibiotics, was observed.

[Acute pancreatitis as a complication of diagnostic gastroduodenal endoscopy at 10 years old girl--case report]. / Ostre zapalenie trzustki jako powiklanie gastroduodenoskopii diagnostycznej u 10-letniej dziewczynki--opis przypadku.

A 10-years old girl with chronic pancreatitis, in whom the symptoms of acute pancreatitis appeared after gastroduodenal endoscopy is described. One hour after endoscopy the following symptoms appeared: unigastric and epigastric pain, intense vomiting, elevated amylase activity in the serum (2744 micro/l) and in urine (23738 micro/l) as well as serum lipase activity (4350 micro/l). Ultrasound of the abdomen revealed the enlargement of the pancreas with hypodense structure in comparison to the examination conducted couple hours earlier, and trace of fluid around the pancreas. In the treatment intravenous omeprazole, a strict diet and intravenous fluid and electrolytes were administered. After two days vomiting and abdominal pain subsided, biochemical results improved and the reduction of pancreas dimensions in ultrasound study was observed.

[Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel diseases]. / Zmiany endoskopowe w górnym odcinku przewodu pokarmowego u dzieci chorych na nieswoiste zapalenia jelit.

THE AIM OF THIS STUDY: To evaluate the frequency and type of endoscopic and histopathological changes in upper gastrointestinal tract in children with inflammatory bowel diseases. MATERIAL AND METHODS: The study included 97 patients aged from 3 to 18 years (mean age 12.8 years, 45 girls and 52 boys) with inflammatory bowel diseases (IBD), treated in the 2nd Chair and Department of Pediatrics, Gastroenterology and Feeding of Children from 2005 to 2007. These children were divided into 3 groups depending on the clinical diagnosis: group 1: 38 children with ulcerative colitis (UC), group 2: 26 children with Crohn's disease (CD), and group 3: 33 children with indeterminate colitis (IC). In all patients upper gastrointestinal endoscopy was performed. During endoscopy biopsies were routinely taken from the stomach (antral region), the duodenum and all mucosal changes. H. pylori infection was detected by a positive culture. The obtained results were analyzed using 2 test (p<0.05). RESULTS: Esophageal changes were observed in 27.8% children with IBD, most frequently in CD and IC groups, respectively in 34.6% and 36.3% of children. No endoscopic abnormalities in the esophagus were noted in 72.2% of IBD children and the figure rises to 84.3% in UC children (p<0.05). Endoscopic examination of the stomach revealed no changes in 23.7% of IBD children, in 76.3% of these patients inflammatory lesions were observed. Only in 11.5% of the CD patient were no abnormalities in the stomach observed (p<0.05). In the CD group children mild endoscopic changes were observed in 53.8%, and severe in 34.6% of these patients. Ulceration of the duodenum, often in the descending part was revealed in 23.1% of CD children. Helicobacter pylori infection was found in 10.3% of the IBD children, most frequently in the IC group (12.1%). Histopathological examination confirmed esophageal changes in 31.9% of IBD patients, in the stomach and duodenum respectively in 77.3% and 48.4% of these children. Noncaseating granulomas were noted in 3.1% of the CD patients, partial villus atrophy was noted in 1 child with CD. CONCLUSIONS: In the group of IBD children, various inflammatory changes during the upper endoscopy were observed. Endoscopic examination most frequently revealed inflammatory changes of the stomach, less frequently of the duodenum and of the esophagus. Histopathological examination of IBD patients most frequently confirmed stomach changes. Less frequently histopathological changes were observed of the duodenum and of the esophagus, particularly in CD children. In the group of IBD children H. pylori infection was noted in few of the patients. Upper endoscopy in the IBD children is an important diagnostic tool and should be a part of monitoring the activity of the disease and results of the therapy.

[Management of fever without source in children]. / Trudnosci diagnostyczne w rozpoznawaniu goraczki niewiadomego pochodzenia u dzieci.

INTRODUCTION: Infectious diseases are the most common cause of fever in children. Viral and bacterial infections of respiratory, gastrointestinal, central nervous system and urinary tract dominates. In the group of children with chronic fever in some cases inflammatory bowel diseases, immunodeficiency syndromes and infections of rare pathogens are diagnosed. AIM: Authors analysed retrospectively 10 children with chronic fever treated in the II Department of Pediatric Gastroenterology & Nutrition, Medical University of Wroclaw. RESULTS: In those children we diagnosed Crohn's disease (1 case), cat scratch disease (1 case), systemic fungial infection in the child with short bowel syndrome (1 case), severe immunodeficiency syndrome (3 cases), intraperitoneal abscess in a child with Crohn's disease (1 case), severe toxic diarrhoea in the course of treatment with cyclosporin (1 case), Yersinia enterocolitica infection (2 cases). CONCLUSION: In the diagnostics of the prolonged fever in children various conditions and diseases ought to be considered.

[Williams syndrome in 2-year-old boy]. / Zespól Williamsa u 2-letniego chlopca.

In the course of Williams syndrome, in 15% of the cases, transient hypercalcemia is present. Additionally, in patients with this syndrome celiac disease is more frequent than in general population. In present work, a case of 2-years-old boy with hypercalcemia, deficiency of the body mass in whom Williams syndrome had been diagnosed in 15th month of life, was described.

[Genotype and phenotype of gastrointestinal symptoms analysis in children with cystic fibrosis]. / Ocena genotypu i objawów ze strony ukladu trawiennego u dzieci chorych na mukowiscydoze.

UNLABELLED: Cystic fibrosis is the most common autosomal recessive genetic defect of one gene CFTR, where a variety of mutations were revealed. Cystic fibrosis is a variable disease and to date the genotype-phenotype correlation is difficult to clarify. The aim of the study was to analyse retrospectively the genotype and phenotype of children with cystic fibrosis and to search the correlation between type of mutation in CFTR and clinical manifestation of the gastrointestinal tract. MATERIAL AND METHODS: The study group comprised 52 patients. Molecular DNA analyses were performed in 43 cases. Statistical analysis was done by using Fisher test. RESULTS: In 34 (79%) cases two mutations in the CFTR gene were identified. In this group 21 cases were identified as a homozygous for AF508 mutation, in single case other mutations were found. A mutation of one CFTR allel was revealed in 11 patients, cystic fibrosis was not confirmed by genetic test in 9 children. Mean age of diagnosis was 34 months. In 38 children (73%) pancreatic insufficiency in the course of disease was found. Exocrine insufficiency of pancreas was showed significant frequently in homozygous group. Liver dysfunction in 20 children (38.5%) was revealed. In this group 12 patients was identified as a homozygous for deltaF508 mutation. On the base of oral glucose tolerance test the diabetes mellitus and glucose intolerance was diagnosed in 4 cases with homozygous genotype. Seven patients died in the endstage of the illness, in two of them homozygous mutation deltaF508 was found, in next 5 patients genetic analysis was not performed. CONCLUSIONS: The frequency and severity of clinical manifestation of the gastrointestinal tract correlates with deltaF508 mutation. Early genetic test and demonstration of molecular defect in CFTR gene confirms the clinical diagnosis of cystic fibrosis and improves a quality of life and prolongs survival time of cystic fibrosis patients.

[Cryptosporidiosis in children with chronic diarrhea]. / Kryptosporydioza u dzieci z przewlekla biegunka.

The aim of the studies was to establish the prevalence of Cryptosporidium parvum in children hospitalized with diarrhea. The group of 102 children has been examined from 2002-2003. A total of 8 (7.8%) cases of cryptosporidiosis was recorded in this period.

[Susceptibility to antimicrobial agents of enteroaggregative Escherichia coli strains isolated from children with diarrhea]. / Wrazliwosc na antybiotyki i chemioterapeutyki enteroagregacyjnych szczepów Escherichia coli (EAEC) izolowanych od dzieci z biegunka.

Enteroaggregative Escherichia coli (EAEC) are responsible for infant's persistent secretory diarrhea, traveler's diarrhea and outbreaks. Since isolated all over the world EAEC strains show a low to high level of resistance to antimicrobial agents, the aim of the study was to determine antimicrobial susceptibility and beta-lactamases extended spectrum (ESBL) production in vitro among 55 enteroaggregative E. coli strains isolated from children with diarrhea. Among the 17 antimicrobial agents tested, most of them showed good in vitro activity against EAEC isolates examined, apart from ampicylin and piperacylin (about 30% resistant EAEC strains). Three of 55 examined EAEC isolates were ESBL--producing strains. Because of the presence of ESBL--producing as well as resistant to antimicrobial agents EAEC isolates among enteroaggregative E. coli strains examined, treatment with antibiotics should be undertaken according to antibiogram.

[Correlation between the presence of aggregative fibria and a type of Escherichia coli adhesion]. / Korelacja pomiedzy obecnoscia fimbrii agregacyjnych a typem adhezji paleczek Escherichia coli.

Enteroaggregative strains of E. coli (EAEC) are an important agents possessing among many virulence factors, aggregative fimbria AAF hemagglutinating in the presence of mannose human group A or/and rats erythrocytes. The aim of the study was to determine the correlation between the presence of AAF fimbria and pattern of adherence in vitro. Tested strains of E. coli were obtained from children with diarrhea (133 strains) and healthy children (105 strains). Among strains of E. coli from children with diarrhea 81 (61%) showed the presence of AAF fimbria and 19 (23%) were adhering in aggregative pattern. In the group of strains of E. coli isolated from healthy children 31 (30%) were AAF positive and 8 (25.8%) of them presented aggregative adherence. Examination of AAF fimbria only dose not allow to distinguish EAEC strains. The data showed the participation of EAEC strains in diarrhea of children below 3 years old.