Evaluation of treatment in acute gastroenteritis: A comparative study.

OBJECTIVE: To compare the efficacy of only dietary recommendations, zinc, probiotics and combination therapies in children admitted with acute gastroenteritis. METHODS: The comparative, prospective, double-blind, placebo-controlled study was conducted from October 2020 to April 2021 at the Paediatric Emergency Service after approval from the ethics review committee of Diyarbakir Gazi Yasargil Training and Research Hospital, Turkey, and comprised infants with a diagnosis of acute gastroenteritis who were divided into four groups. Only appropriate dietary recommendations were given to the control group 1, while group 2 was given a single probiotic containing bifidobacterium breve, bifidobacterium bifidum, bifidobacterium infantis and bifidobacterium longum strains. Group 3 was given zinc and group 4 was given probiotics and zinc. Demographic data of the patients, admission complaints, physical examination findings, dehydration degrees, and laboratory findings were recorded and analysed. RESULTS: Of the 132 subjects, 79 (59.8%) were males. The overall mean age was 27.5±3.6 months. There were 22 (16.7%) patients in group 1, 34 (25.8%) in group 2, 28 (21.2%) in group 3, and 48 (36.4%) in group 4. The mean duration time to diarrhoea termination was 84.5±10.7 hours (range: 79-89 hours) in group 1, 73.05±6.8 hours (range: 70.5-75.4 hours) in group 2, 80.1±10.3 hours (range: 76-84 hours) in group 3, and 43.5±9.6 hours (range: 46-48 hours) in group 4. Group 4 outcome was statistically significant (p<0.001). CONCLUSIONS: The efficiency of combined treatment with probiotics and zinc was found to be significantly better in the treatment of childhood acute gastroenteritis.

Fecal calprotectin levels used as a noninvasive method for screening for chronic gastritis in pediatric patients. A descriptive study.

BACKGROUND: Gastritis consists of inflammation of the gastric mucosa and is one of the main causes of dyspeptic symptoms in children. OBJECTIVE: To investigate the presence of inflammation by evaluating fecal calprotectin (FC) in children diagnosed with chronic gastritis. DESIGN AND SETTING: Descriptive study in Pediatric Gastroenterology Department of Ondokuz Mayis University Hospital in Turkey. METHODS: Between January 2016 and July 2018, FC levels were compared retrospectively in children with chronic gastritis (histopathology-based diagnosis), patients with inflammatory bowel disease (IBD) and healthy children. RESULTS: A total of 67 chronic gastritis patients (61.2% girls) with a mean age of 13.09 ± 3.5 years were evaluated. The mean FC levels were 153.4 µg/g in the chronic gastritis group, 589.7 µg/g in the IBD group and 43.8 µg/g in the healthy group. These levels were higher in chronic gastritis patients than in healthy individuals (P = 0.001) and higher in IBD patients than in the other two groups (P < 0.001). The FC level in the patients with chronic active gastritis (156.3 µg/g) was higher than in those with chronic inactive gastritis (150.95 µg/g) (P = 0.011). Among the patients with chronic active gastritis, the FC level was significantly higher in Helicobacter pylori-positive individuals than in negative individuals (P = 0.031). CONCLUSION: We confirmed the association between increased FC and chronic gastritis. Elevated FC levels may be seen in patients with chronic active gastritis. In order to be able to use FC as a screening tool for chronic gastritis, further studies in a larger study group are needed.

Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial.

PURPOSE: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. METHODS: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. RESULTS: Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. CONCLUSION: Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.

Pre- and Postgastrostomy Evaluation of Gastroesophageal Reflux in Children Using 24-Hour pH Monitoring.

Background: The aim of this study was to evaluate 24-hour pH monitoring results before and after gastrostomy in neurological impaired (NI) children who underwent gastrostomy or Nissen fundoplication (NF) concurrently with gastrostomy. Materials and Methods: Between March and December 2018, NI patients who had previously received pre- and postgastrostomy (Group 1) or gastrostomy + NF (Group 2) underwent pH monitoring pre- and postoperatively. Results: Twenty patients [12 males (60%) and the median age of 5.6 (14 months-14.7 years) years] with NI were followed up during the study period. When pre- and postgastrostomy weight and BMI z-scores were compared, the results were significantly higher in both groups after procedure (P = .043, P = .040, respectively). The clinical results of the patients after the operation showed improvement in both groups. The pH index of Group 1 (n = 11) was 2.32 (0-3.8) before gastrostomy and 3.18 (2.1-6.9) after gastrostomy (P = .061) and in Group 2 (n = 9) it was 5.85 (4.9-15.8) and 0.61 (0.3-1.3), before and after procedure (P < .001). There was a statistically significant difference in reflux index of each group. This difference was not statistically significant between the groups (P = .072). When the total bolus exposure index was compared, it was 4.01 (2.1-5.2) before gastrostomy and 5.67 (4.6-6.3) after gastrostomy in Group 1 (P = .041). In group 2, that index was found to be 9.8 (8.3-10.2) before and 1.28 (0.5-1.4) after (P < .001). There was a statistically significant difference in index after gastrostomy in Groups 1 and 2 (P = .023). Conclusions: Gastrostomy feeding is an effective and safe option to achieve enteral feeding in NI children. NF concurrent with gastrostomy should be decided according to the individual patient. Clinical trials protocol registration ID number was PRS NCT00445112.

Association of obesity and non-alcoholic fatty liver disease with the fecal calprotectin level in children.

BACKGROUND AND STUDY AIMS: As the prevalence of obesity increased, obesity-related comorbidities such as non-alcoholic fatty liver disease (NAFLD) also increased. The aim of this study is to investigate the presence of intestinal inflammation by evaluating the faecal calprotectin (FC) level in children with obesity and NAFLD and to determine the factors affecting the FC level. PATIENTS AND METHODS: Between August 2018 and November 2018, the FC levels of obese patients (Group 1a = NAFLD (n = 30) and 1b = without NAFLD (n = 30)) were prospectively compared to that of healthy children (Group 2, n = 20). Patients with BMI > 2 z-score were considered obese. NAFLD was identified with liver contrast and brightness on ultrasound. RESULTS: Of the patients included in this study, 50 were male (62.5%), with a mean age of 11.4 ± 3.1 years. The mean FC levels were 121.6 ± 24.8 µg/g (19.5-800) in Group 1 (Group 1a = 128.4 and Group 1b = 84.5) and 43.8 ± 25.4 µg/g (19.5-144) in Group 2. In comparison, the FC levels were higher in Group 1. This difference was more significant when compared with Group 1a than with Group 2 (p = 0.018 and p = 0.007, respectively). When the FC levels of Group 1 (above 50) were compared to lower levels, the weight, BMI, waist circumference and waist circumference/height values were significantly higher (p = 0.006, p = 0.028, p = 0.035 and p = 0.026, respectively). CONCLUSION: The FC level increased as a sign of intestinal inflammation in obese and NAFLD patients. This is directly proportional to the weight, waist circumference and waist-to-height ratio. It is thought that FC, which is easily applicable and an inexpensive biomarker, can be used safely in demonstrating the presence of intestinal inflammation in obese children.

Can Point Shear Wave Elastography Be Used as an Early Indicator of Involvement?: Evaluation of the Pancreas and Liver in Children With Cystic Fibrosis.

OBJECTIVES: The aim of this study was to determine the effect of cystic fibrosis (CF) on pancreas and liver elasticity in young children using point shear wave elastography and to determine the relationship with clinical findings. METHODS: Twenty-two patients with genetically proven CF, who were admitted to our pediatric gastroenterology clinic, and 22 healthy control participants were enrolled in the study. The shear wave velocity (SWV) of the liver and pancreas were measured with point shear wave elastography. RESULTS: The 22 patients with CF included 45.5% girls with a mean age ± SD of 35 ± 35.8 months (range, 5-123 months). The 22 healthy control participants included 41.2% girls with a mean age of 58.9 ± 44.4 months (range, 2-159 months). The mean SWV of the pancreas in the patients with CF (1.06 ± 0.26 m/s) was significantly higher than that of the healthy control participants (0.85 ± 0.23 m/s; P = .01). The mean SWV of the liver in the patients with CF (1.46 ± 0.24 m/s) was significantly higher than that of the healthy control participants (1.12 ± 0.21 m/s; P = .001). The SWV of the pancreas and liver did not show any significant differences depending on ursodeoxycholic acid use, malnutrition status, and the presence of the F508 deletion mutation. CONCLUSIONS: This study showed an increased SWV of the pancreas in children with CF, contrary to the literature. We also found an increased liver SWV even in the absence of CF-related liver disease. Ultrasound elastography may be a useful method of evaluating early changes in the pancreas and liver before the obvious clinical, laboratory, and B-mode ultrasound signs of CF-related involvement.

Fecal calprotectin in children with familial Mediterranean fever in the attack-free period.

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent episodes of fever and serosal inflammation. The aim of this study was to evaluate fecal calprotectin (FC) in children with FMF during the non-attack period. METHODS: A retrospective evaluation was made of the data of a total 66 patients diagnosed with FMF in an attack-free period and without amyloidosis or inflammatory bowel disease (IBD). FC level in the FMF patients was compared with that in the patients with IBD and healthy control subjects. RESULTS: The FMF patients consisted of 37 boys (56.1%) with a mean age of 10.1 ± 3.9 years. Mean FC was 192.5 µg/g (range, 19.5-800 µg/g) in the FMF group, 597.9 µg/g (range, 180-800 µg/g) in the IBD group, and 43.8 µg/g (range, 19.5-144 µg/g) in the control group. The FC level in the children with FMF was higher than in the control group (P < 0.001), and the FC level of the IBD patients was higher than both the FMF and the control groups (P = 0.020, P < 0.001, respectively). CONCLUSIONS: FC was higher in FMF patients compared with healthy children even in the absence of IBD/amyloidosis. Even though colonoscopy is the gold standard in identifying intestinal inflammation in FMF patients, FC, a non-invasive and inexpensive method, can be used for screening. The presence of subclinical intestinal inflammation was also quantitatively identified in children with FMF.

Gallbladder Polyps: Rare Lesions in Childhood.

OBJECTIVE: Unlike adults, gallbladder polyps (GPs) are rare in childhood. The aim of this study was to evaluate patients with a GP diagnosis. METHODS: Patients who were diagnosed with GP via ultrasonography from October 2012 to October 2017 were retrospectively evaluated in terms of sociodemographic characteristics and laboratory findings. RESULTS: The study included 19 patients diagnosed with GP and followed up in our department. The patients comprised 14 (73.6%) girls with a mean age of 13.9 ±â€Š4.1 years and a mean follow-up period of 10.2 ±â€Š5.4 months (range, 3-26 months). The most common presenting symptom of the patients (n = 15, 78.9%) for ultrasonography was abdominal pain without biliary symptoms. Location of the polyps was in the corpus in 55% of patients, and either in the fundus (20%) or the neck of the gallbladder (25%). The average diameter of the polyps was 4.5 ±â€Š1.6 mm (range, 2-9 mm). Multiple polyps were observed in 3 patients. No significant change in the number or size of polyps was noted at the end of the follow-up periods. Cholecystectomy was applied to 1 patient who had >5 polyps with a rapid increase in size, and the pathology report was hamartomatous polyp. There was no remarkable change in the clinical or laboratory findings of other patients during the follow-up period. CONCLUSION: In this study, GPs could be seen in young children as young as 16 months of age and ultrasonography is sufficient for follow-up in stable and asymptomatic patients.

Retrospective analysis of children with α-1 antitrypsin deficiency.

BACKGROUND: α-1 Antitrypsin (AAT) deficiency is the most frequently occurring genetic liver disorder. The association among classical α-1 antitrypsin deficiency (AATD), chronic liver disease, and cirrhosis is common in adult patients but rare in children. AIM: To assess the clinical characteristics of children with AATD and to compare symptoms between homozygous and heterozygous children. MATERIALS AND METHODS: The study included 20 children who were found to have mutant Pi alleles. AAT phenotyping was conducted on patients with a low serum AAT level. The exclusion criteria included infectious, anatomic, and metabolic conditions. Symptoms on presentation, physical examination findings, laboratory values, liver biopsy results, and follow-up periods were recorded for each patient. RESULTS: The patients included six (30%) girls and 14 (70%) boys, with a mean age of 6.3±5.1 (1-16) years. The PiZZ phenotype was present in eight (40%) and PiMZ in 12 (60%) patients. The most frequent symptom was elevated liver function test results. Three patients were referred with neonatal cholestasis and one with compensated cirrhosis. Eight patients underwent liver biopsy; all patients except one had periodic acid-Schiff-positive diastase-resistant globules in the hepatocytes. The mean follow-up period was 34±33 (12-101) months. At the end of follow-up, all patients with PiZZ were found to have chronic hepatitis, and one with cirrhosis. On the contrary, two patients with PiMZ were found to have chronic hepatitis. CONCLUSION: Children with classical AATD commonly have chronic liver disease. In heterozygous (PiMZ) children with AATD, enzyme levels can normalize with occasional fluctuations, sometimes causing delayed diagnosis.