Persistent diarrhea: still a serious public health problem in developing countries.

Diarrhea is still responsible for high rates of morbidity and mortality in children under 5 years of age. The prolongation of the acute episode may cause digestive and absorptive malfunction and, consequently, malnutrition, raising the risk of death. The objective of this review is to supply the most recent knowledge in the field of persistent diarrhea and to contribute to the decrease of its incidence. Some possible etiologic agents may be involved, including viruses, bacteria, and parasites. Treatment must be addressed to avoid malabsorption of the nutrients of the diet, associated with replacement of the hydroelectrolytic losses, to prevent its prolongation. In the great majority of the episodes, antibiotics are not indicated. Breastfeeding, introduction of safe dietary strategies to prevent protein-energy malnutrition, and improvement of sanitary conditions and hygiene are measures to be promoted with the objective of decreasing the morbidity/mortality of the diarrheic disease in children less than 5 years of age.

A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population.

OBJECTIVES: To develop an international consensus on the definition of gastroesophageal reflux disease (GERD) in the pediatric population. METHODS: Using the Delphi process, a set of statements was developed and voted on by an international panel of eight pediatric gastroenterologists. Statements were based on systematic literature searches using Medline, EMBASE, and CINAHL. Voting was conducted using a six-point scale, with consensus defined, a priori, as agreed by 75% of the group. The strength of each statement was assessed using the GRADE system. RESULTS: There were four rounds of voting. In the final vote, consensus was reached on 98% of the 59 statements. In this vote, 95% of the statements were accepted by seven of eight voters. Consensus items of particular note were: (i) GERD is present when reflux of gastric contents causes troublesome symptoms and/or complications, but this definition is complicated by unreliable reporting of symptoms in children under the age of approximately 8 years; (ii) histology has limited use in establishing or excluding a diagnosis of GERD; its primary role is to exclude other conditions; (iii) Barrett's esophagus should be defined as esophageal metaplasia that is intestinal metaplasia positive or negative; and (iv) extraesophageal conditions may be associated with GERD, but for most of these conditions causality remains to be established. CONCLUSIONS: The consensus statements that comprise the Definition of GERD in the Pediatric Population were developed through a rigorous process. These statements are intended to be used for the development of future clinical practice guidelines and as a basis for clinical trials.

Age-specific prevalence of diffusely adherent Escherichia coli in Brazilian children with acute diarrhoea.

In a prospective study between February 2003 and June 2004, stool specimens of children less than 2 years of age with diarrhoea (n=218) and without diarrhoea (n=86), living in Vitória, Espírito Santo, Brazil, were examined for the presence of diarrhoeagenic Escherichia coli. E. coli isolates were tested by colony blot hybridization with specific DNA probes designed to detect EPEC, ETEC, EIEC, EAEC, DAEC and EHEC/STEC. Diarrhoeagenic E. coli strains were detected as the sole pathogen in stools of 92 (30.3 %) children, including 72 (33.0 %) with diarrhoea and 20 (23.2 %) without diarrhoea. DAEC was the most frequent pathotype and was found significantly more often from patients (18.3 %) than from controls (8.1 %) (P<0.05), particularly among children more than 1 year of age (P=0.01). Atypical EPEC and EAEC isolates were isolated from both patients (5.5 % and 4.6 %, respectively) and controls (6.9 % and 6.9 %, respectively). ETEC was more frequently isolated from patients (3.2 %) than controls (1.2 %). Typical EPEC (0.9 %) and EIEC (0.4 %) isolates were detected only in children with diarrhoea. In conclusion, our data suggest that DAEC should be considered potential pathogens in the region of Brazil studied.

Single multiplex assay to identify simultaneously enteropathogenic, enteroaggregative, enterotoxigenic, enteroinvasive and Shiga toxin-producing Escherichia coli strains in Brazilian children.

A multiplex PCR to differentiate typical and atypical enteropathogenic Escherichia coli (EPEC), enteroaggregative E. coli (EAEC), enterotoxigenic (ETEC), enteroinvasive E. coli (EIEC) and Shiga toxin-producing E. coli (STEC) strains was developed and evaluated. The targets selected for each group were eae and bfpA for EPEC, aggR for EAEC, elt and est for ETEC, ipaH for EIEC and stx for STEC isolates. This PCR was specific and sensitive for rapid detection of target isolates in stools. Among 79 children with acute diarrhea, this technique identified 13 (16.4%) with atypical EPEC, four (5%) with EAEC, three (3.8%) with typical EPEC, one (1.3%) with ETEC and one (1.3%) with EIEC.

High prevalence of celiac disease in Brazilian blood donor volunteers based on screening by IgA antitissue transglutaminase antibody.

OBJECTIVE: To study the prevalence of celiac disease among blood donor volunteers based on screening by IgA antitissue transglutaminase antibody, followed by a confirmatory small intestine biopsy. METHODS: The transversal study involved 3000 potential blood donors, residing in the city of Sao Paulo, Brazil. The participants were gender divided into 1500 men and 1500 women, with an average age 34.4+/-10.8 years, and included blood donor volunteers who could be turned down owing to anemia. All participants answered a questionnaire concerning the presence of diarrhea, constipation or abdominal pain during the 3 months before the study. Each participant with human recombinant IgA antitissue transglutaminase antibody level above 10 U/ml was invited to undergo a small intestine biopsy by means of an upper gastrointestinal endoscopy. The presence of villous atrophy and a positive antibody test were suggestive of possible celiac disease. RESULTS: Antitissue transglutaminase antibody was positive in 1.5% (45/3000) of the study population. Among the antibody-positive group, 21 (46.6%) agreed to have a biopsy performed, and within them the histological pattern of villous atrophy was confirmed in 66.7% (14/21). Consequently, the suggestive prevalence of celiac disease was at the minimum, one per 214 of the potential blood donor volunteers. A significant association was found between celiac disease and the symptoms of diarrhea, constipation and abdominal pain. CONCLUSIONS: The prevalence of celiac disease in Sao Paulo city is high and comparable to that observed in European countries. It is possible that in Brazil the prevalence of this disease had previously been underestimated.

[Clinical characteristics of pediatric patients with chronic constipation according to age group]. / Características clínicas de pacientes pediátricos com constipação crônica de acordo com o grupo etário.

BACKGROUND: There was no study evaluating clinical characteristics of constipation according pediatric age groups. AIM: To evaluate the clinical characteristics of patients with chronic constipation according to age group. METHODS: This retrospective study evaluated the demographic data and clinical characteristics of pediatric patients with chronic constipation who had been admitted to an outpatient clinic between May 1995 and December 2000. Data was analyzed according to the followings age groups: infants, pre-school, school age and adolescent. RESULTS: Five hundred and sixty one patients were included in the study. The percentage of patients according to age groups were: infants (19.1%), pre-school (42.9%), school age (26.9%), and adolescents (11.0%). There was no statistical gender difference among the four age groups. Less than three bowel movements per week were observed more frequently in pre-school (65.8%) and school age (59.6%) than in infants (52.4%) and adolescents (43.1%). Fecal escape ("soiling") was found in 75.6% of the pre-school patients aged more than 48 months, in 68.2% of the school age and in 76.7% of the adolescents. Soiling was more frequent in boys (80.7%) than in girls (50.0%) only in school age children. Retentive posture (67.6%, 40.7%, 27.2%), fear for defecation (70.2%, 44.2%, 29.7%) and abdominal pain (80.8%, 69.6%, 73.6%) were observed, respectively, more frequently in pre-school than in school age and adolescents. CONCLUSION: There were differences in clinical characteristics according to age group. However, prolonged duration of constipation and an elevated number of complications were observed in all age groups, especially fecal soiling and abdominal pain.

Partially hydrolyzed guar gum increases intestinal absorption of iron in growing rats with iron deficiency anemia.

OBJECTIVE: The objective of this study was to evaluate the effect of partially hydrolyzed guar gum (PHGG) dietary fiber towards intestinal iron absorption, for dietary intake and on the growth of rats with iron deficiency anemia in comparison to those fed on a diet with cellulose and without dietary fiber. MATERIALS AND METHODS: Male Wistar rats (n=24) weaned at 21 days were fed with AIN93-G diet without iron for 2 weeks in order to induce iron deficiency anemia. At 36 days old, the anemic rats were divided into three groups: (1) PHGG group-100g of PHGG per kg of diet; (2) Cellulose group-100g of cellulose per kg of diet; (3) Control group-diet without dietary fiber. All the diets had 25mg of elemental iron/kg of diet added to lead to recovery from iron deficiency anemia. RESULTS: The final hemoglobin values in g/dl, for the PHGG group, the cellulose group and the control group were, respectively: 11.3+/-1.2, 8.6+/-0.7 and 8.1+/-0.9 (P<0.001). The levels of hepatic iron, in mug/g of dry tissue, in the same order, were: 322.2+/-66.6, 217.2+/-59.1 and 203.7+/-42.4 (P<0.001). Apparent iron intestinal absorption was, respectively: 67.5+/-8.9%, 35.4+/-15.3% and 31.3+/-24.9% (P<0.001). The three groups consumed similar quantities of diet. The changes in weight and in body length were similar in the three groups studied. CONCLUSION: PHGG led to greater intestinal absorption of iron, regeneration of hemoglobin and hepatic levels of iron than diet with cellulose and diet control.

Biochemical profile of coconut water from coconut palms planted in an inland region.

OBJECTIVE: To analyze the biochemical profile of coconut water from dwarf coconut palms planted in non-coastal regions, during the maturation period (sixth to ninth month). METHODS: Eight of 15 coconut palms planted in a non-coastal region were selected by lots and their coconuts sent to a laboratory for extraction and analysis of the coconut water. Coconut water from a total of 45 coconuts, from the sixth to ninth months' maturity, were analyzed to measure glucose, electrolytes, total proteins and osmolarity and to identify the sugars contained. RESULTS: The analysis of coconut water from the sixth to ninth month did not find any differences in the median concentrations of sodium (3 mEq/L; 2 and 3), glucose (0.6 g/L; 0.3 and 17.3) or total proteins (9 g/L; 6 and 12), but detected a reduction in the concentration of potassium (64 mEq/L; 46 and 99), calcium (6.5 mmol/L; 5 and 8.5), magnesium (8 mmol/L; 3.9 and 9.8), chloride (38.5 mEq/L; 30 and 48.7) and osmolarity (419 mOsmol/L; 354 and 472). With relation to the sugars, identified by chromatography on paper, an increase was observed from the sixth to the ninth month in the concentration of fructose (68 mg/microL; 44 and 320) and glucose (299 mg/microL; 262 and 332) and in conjunction with a concentration of sucrose (340 mg/microL; 264 and 390). CONCLUSIONS: The biochemical profile of coconut water varied as the coconuts matured, observing reductions in the concentration of potassium, calcium, magnesium, chloride and osmolarity. Descending paper chromatography revealed an increase in the concentration of fructose and glucose and also a reduction in the concentration of sucrose.

[Prevalence of constipation in adolescents enrolled in São José dos Campos, SP, Brazil, school's and in their parents]. / Prevalência de constipação em adolescentes matriculados em escolas de São José dos Campos, SP, e em seus pais.

BACKGROUND: There is few information concerning constipation in adolescence. AIMS: To evaluate the prevalence of constipation in adolescents enrolled in schools settled down in the city of São José dos Campos, state of São Paulo, Brazil, and in their biological parents. PATIENTS AND METHODS: A transversal study was carried out by analyzing a convenience sample which included adolescents between 9 years and 9 months and 18 years and 7 months old and their parents in five schools situated in São José dos Campos, SP. Data was obtained from an individual and personal questionnaire filled by the father, the mother and the adolescent. Three hundred and seventy two adolescents were studied. Constipation was defined as the elimination of hard stools and the presence of at least one of the following: painful or difficult defecation, soiling or bloody stools. Scybalous feces or dry cracked stools or the defecation frequency equal or minor than two per week were considered criteria for characterization of constipation. Rome II criteria was used for evaluate the prevalence of constipation in the parents. RESULTS: The prevalence of constipation in adolescents was 22.3%, being it more frequent in female (27.4%) than in male (14.9%). Among the fathers, the prevalence of constipation (7.3%; 20/274) was lower than in the mothers. Kappa's coefficient showed a slight concordance in the concomitance of constipation in the adolescent and his/her mother (kappa = 0.12) and in the adolescent and his/her father (kappa = 0.05). CONCLUSIONS: Intestinal constipation is a prevalent disturbance in the studied group of adolescents. However, it was not found relevant concordance between constipation in the adolescents and their parents.

[Functional, microbiological and morphological intestinal findings among human immunodeficiency virus infected children]. / Aspectos funcionais, microbiológicos e morfológicos intestinais em crianças infectadas pelo vírus da imunodeficiência humana.

BACKGROUND: [corrected] Gastrointestinal tract disorders are frequent among human immunodeficiency virus infected children, with important repercussions on nutrition and survival. Most studies related to this subject were restricted to adults, being less investigated the problem in the children. AIMS: To study intestinal digestion, absorption, microbiological and morphological findings among human immunodeficiency virus infected children. MATERIAL AND METHODS: Eleven human immunodeficiency virus infected children under 13 years old, belonging to clinical categories A, B or C, separated in two groups: five patients with current or recent episode of diarrhea and six patients without diarrhea in the last 30 days preceding entering in study. Investigation proposed: microbiological and morphological analysis of small intestine and rectum biopsy; stool exams for bacterium, parasite, rotavirus, Mycobacterium species and Cryptosporidium; D-xylose test RESULTS: All tested subjects (9/11) had low D-xylose absorption (8,4 _ 24,4 mg d/L). Small intestinal mucosa histology findings were nonspecific, represented, in majority, of grade I/II enteropathy (6/10). Increased cellular infiltration of the chorion was observed in all specimens. Rectum histology alterations were also nonspecific, with chorion increased cellular infiltration. Mycobacterim avium intracellulare and Cryptosporidium were the solely microorganisms founded, both in stool CONCLUSIONS: Our study demonstrated high prevalence (100%) of intestinal malabsorption among human immunodeficiency virus infected children, despite the occurrence or not of diarrhea. It was not possible to establish relationships between the presence of microorganisms, intestinal malabsorption, intestinal morphologic findings and the occurrence or not of diarrhea. There was no correlation between D-xylose and intensity of villous atrophy.

Severe protein-calorie malnutrition in two brothers due to abuse by starvation. / Desnutrição proteico­calórica grave em dois irmãos devido ao abuso por privação alimentar.

OBJECTIVE: To describe the case of two siblings with severe protein-calorie malnutrition due to abuse by starvation. CASES DESCRIPTION: The two patients were simultaneously referred from the Municipal Hospital, where they were admitted to the Pediatric Gastroenterology clinic of a university hospital for diagnostic investigation of the cause of severe malnutrition and screening tests for Celiac Disease, Cystic Fibrosis and Environmental enteropathy among others. The exams were all normal, and after detailed research on the interactions of this family, we reached the conclusion that the malnutrition was due to abuse by starvation. The children spent approximately two months in the hospital, receiving a high-protein and high-calorie diet, with significant nutritional recovery. COMMENTS: Abuse by starvation, although rare, should always be considered of as one of the causes of child malnutrition and pediatrician should be aware of the child's development, as well as the family interactions, to prevent more severe nutritional and emotional consequences in the future.

[Nutritional status of Terena indian children from Mato Grosso do Sul, Brazil: follow up of weight and height and current prevalence of anemia]. / Estado nutricional de crianças índias terenas: evolução do peso e estatura e prevalência atual de anemia.

OBJECTIVE: This study of Terena Indian children less than 10 years old was undertaken in order to compare weight and height in 1995 and 2002 and to evaluate anemia prevalence in 2002. METHODS: This was a cross-sectional study of the Limão Verde and Córrego Seco tribes, located in Aquidauana, Mato Gosso do Sul, Brazil. The study enrolled all 253 children who were less than 10 years old in 1995 and 244 who were under 10 in 2002. Their nutritional status was evaluated comparing weight and height with the NCHS (National Center for Health Statistics) reference values (Epi-Info version 6.2). Hemoglobin was assayed using a portable photometer. RESULTS: The percentages of children with weight for age deficit (z score < -2 standard deviations) were 4 and 2.9% in 1995 and 2002 respectively. Percentages of weight for height deficits were 3.6 and 0.8% respectively. Percentages of height for age deficits were 15 and 11.1% respectively. The median z scores for weight, age and weight, and height showed a statistically significant increase during the period between 1995 and 2002 in infants. Between 24 and 60 months, there were increments in median z scores for weight for age and height for age. There was no statistically significant decrease in any of the anthropometric indicators, with reference to z scores. The prevalence rates of anemia were 86.1% for infants 6 to 24 months old (n = 43), 50.8% for those 24 to 60 months (n = 65) and 40.7% for children aged 60 to 120 months (n = 59). CONCLUSION: Weight and height both increased during period from 1995 to 2002. Anemia was highly prevalent, calling for immediate corrective measures.

[Nutritional status and intestinal iron absorption in children with chronic hepatic disease with and without cholestasis]. / Estado nutricional e absorção intestinal de ferro em crianças com doença hepática crônica com e sem colestase.

OBJECTIVE: To evaluate food intake, occurrence of energy-protein malnutrition and anemia, and intestinal iron absorption in children with chronic liver disease. METHODS: The study included 25 children with chronic liver disease, 14 with cholestasis and 11 without cholestasis. The age varied between 6.5 months and 12.1 years. Intestinal iron absorption was evaluated by the increment of serum iron one hour after the ingestion of 1 mg/kg of elemental iron and by the response to oral iron therapy. Iron intestinal absorption was compared to a group with iron deficiency anemia (without liver disease). RESULTS: The mean intake of energy and protein in the cholestatic group was higher than in patients without cholestasis. The nutritional deficit was more severe in cholestatic patients, especially with regard to height-for-age and weight-for-age indices. Anemia was found in both cholestatic group (11/14; 78.6%) and noncholestatic group (7/11; 63.6%). The cholestatic group presented lower (p < 0.05) intestinal iron absorption (90.6+/-42.1 microg/dl) than the iron deficiency anemia group (159.6+/-69.9 microg/dl). However, cholestatic patients responded to oral iron therapy. The noncholestatic group showed intestinal iron absorption similar to the iron deficiency anemia group. CONCLUSION: The cholestatic group showed more severe nutritional deficits. Despite the evidence of lower iron intestinal absorption, cholestatic patients responded to oral iron therapy, probably, due to the coexistence of iron deficiency.

[Effectiveness of anorectal manometry using the balloon method to identify the inhibitory recto-anal reflex for diagnosis of Hirschsprung's disease]. / A manometria anorretal (método do balão) no diagnóstico diferencial da doença de Hirschsprung.

OBJECTIVE: To evaluate results of anorectal manometry performed with equipment made in Brazil for the screening of Hirschsprung's disease in children with chronic constipation. METHODS: Results of 372 anorectal manometries performed consecutively in children with chronic constipation were evaluated. The equipment (Proctosystem Viotti) has two channels for pressure registration by the balloon method and is connected to a computer using specific software. Absence of the inhibitory recto-anal reflex was considered suggestive of Hirschsprung's disease and diagnosis was confirmed by traditional diagnostic methods. RESULTS: Absence of the inhibitory recto-anal reflex was found in 14 (3.8%) of the 372 anorectal manometry examinations. Diagnosis of Hirschsprung disease was confirmed in 9 out of 14 patients by characterization of aganglionosis upon rectal biopsy. In the other 5 patients, rectal biopsy was not performed in view of a satisfactory evolution with the clinical treatment for constipation. In 4 out of the 5 patients the inhibitory recto-anal reflex was demonstrated with a second anorectal manometry examination. CONCLUSIONS: The equipment used for anorectal manometry presented a satisfactory performance. Diagnosis of Hirschsprung disease was discarded in 86.5% of the patients with chronic constipation because the inhibitory recto-anal reflex was detected. Manometric evaluation also made possible the identification of a small group of patients in which more than half had Hirschsprung's disease.

[Nutritional status of indigenous children from the Alto Xingu in 1980 and 1992 and follow-up of weight and height from the first through the fourth years of life]. / Estado nutricional de crianças índias do Alto Xingu em 1980 e 1992 e evolução pondero-estatural entre o primeiro e o quarto anos de vida.

This study focused on the under-five population of the Alto Xingu region in Brazil, with the following objectives: (1) to evaluate height and weight increment from the first through the fourth years of life and (2) to compare nutritional status in 1980 and 1992. Height and weight increases were evaluated in 81 children. Weight and height were measured in 264 children evaluated in 1980 and in 172 in 1992 (< 10 years of age). Median Z-scores in the first and fourth years of life, respectively, showed: (1) a decrease in weight-for-age, (-0.12 in the first year and -0.51 in the fourth year of life; p = 0.002); (2) a decrease in weight-for-height (+1.31 and +0.08; p < 0.001); (3) an increase in height-for-age (-1.50 and -0.94; p < 0.001). Median Z-scores in 1980 and 1992 showed: (1) no change in weight-for-age (-0.61 in 1980 and -0.62 in 1992; p = 0.90); (2) no change in weight-for-height (+0.27 and +0.34; p = 0.10); and (3) a decrease in height-for-age (-1.04 and -1.22; p = 0.02). Height-for-age increased and weight-for-height decreased between the first and fourth years of life. A decrease in height-for-age was observed from 1980 to 1992, demonstrating the importance of nutritional surveillance among the population of the Alto Xingu.

[Dermatoglyphics of children with chronic constipation]. / Dermatóglifos em crianças com constipação crônica.

BACKGROUND: The dermatoglyphics can be used to study the participation of genetic factors in many diseases. There is controversy concerning the association between the dermatoglyphic pattern of digital arches and constipation. AIM: To compare the dermatoglyphic patterns among children with and without chronic constipation in relation to the dermatoglyphic patterns and characteristics of stools of their mothers. METHODS: Three groups of children aged from 2 to 12 years and their mothers were studied: 35 patients with severe chronic constipation, 45 children with mild chronic constipation and 51 children without constipation. The fingerprints were taken and evaluated by a datiloscopy technicist and classified in arch, radial loop, ulnar loop, whorl and others. RESULTS: Digital arches were found in 25.7% of severe constipated patients, 28.9% of mild constipated children and in 23.5% of controls. There was not a statistical significant association. Constipation was found in 51,9% (68/131) of the mothers. Arches were found in 35.3% of the mother with constipation and in 42.9% of mothers without constipation. There was a slight association between constipation in children and in theirs mothers (Kappa coefficient = +0.16). CONCLUSION: The dermatoglyphics were not useful to identify the influence of genetic in constipation. There was not association between the dermatoglyphic pattern of digital arch and constipation both in children and in their mothers. Only a slight concordance was found between constipation in children and in their mothers.

[Evaluation of the nutritional status of Indian children from Alto Xingu, Brazil]. / Avaliação do estado nutricional das crianças índias do Alto Xingu.

OBJECTIVE: To evaluate the nutritional status and estimate body composition of Indian children from Xingu Indigenous Park (XIP), rain forest Amazon region, by using anthropometry and bioelectrical impedance (BI) tests. METHODS: One hundred and sixty-four Indian children (89 girls and 75 boys) of unknown age were evaluated by means of anthropometry and bioelectrical impedance. Weight and height were used to calculate z-score for weight-for-height (W/H) index. Two equations based on the resistance values obtained from the bioelectrical impedance were used to determine body composition. The values obtained were compared to standard reference. RESULTS: Z-score median for weigh-for-height index was 0.59 (boys) and 0.46 (girls) (P=0.27), respectively. Among the children studied only 1.8% showed z-score W/H <-2 standard deviations (SD), and 3% showed z-score W/H >2 SD. Mean resistance values were 625.4 +/- 79.2 Ohms (girls) and 588.8 +/- 68.9 Ohms (boys) (P<0.01). The percentage of body composition values obtained for girls were 14.2% fat mass (FM) and 85.8% fat-free mass (FFM), and 11.7% (FM) and 88.3% (FFM). The values for the boys were 14.9% (FM) and 85.1% (FFM), and 10.3% (FM) and 89.7% (FFM). CONCLUSIONS: There were low rates of obesity and malnutrition, what leads us to believe that the nutritional status among the Indian children from XIP has been kept in good standard along the last three decades, even under some degree of the Western culture influence. The Indians' body composition enhanced the good nutritional status among the studied population. BI played an important role in the estimation of body composition in this field study.

[Allergic colitis: clinical and morphological aspects in infants with rectal bleeding]. / Colite alérgica: características clínicas e morfológicas da mucosa retal em lactentes com enterorragia.

BACKGROUND: Recent studies indicate the importance of eosinophilis infiltrated in the rectal mucous which jointly with the clinical features can serve to establish the diagnostic of allergic colitis. AIM: To describe prospectively, the clinical features and morphological abnormalities of the rectal mucosa in patients with rectal bleeding and clinical diagnosis of cow's milk allergy. METHODS: Clinical features of 20 infants under 6 months of age were described. Morphological findings in rectal mucosa were compared with control group, with suspicion of congenital megacolon. RESULTS: The mean age of the patients was 97 +/- 47 days, rectal bleeding started before 120 days in 85% of them; 40% were breastfed, 60% cow's milk formula or both. The most striking morphological feature, in 18 patients, was eosinophilic infiltration in the rectal mucosa. There was a significant statistical difference when these values were compared with control group. CONCLUSIONS: The increased number of eosinophils in the rectal mucosa represent the most important characteristic of allergic colitis, in patients under 6 months, with rectal bleeding, when breastfed, cow's milk formula or both.

[Breath methane in children with chronic constipation]. / Metano no ar expirado de crianças com constipação crônica functional.

RATIONALE: Methane is an intestinal gas which may be excreted in the expired air of about 10% of children. OBJECTIVE: The aims of this study were to investigate methane production by children with functional chronic constipation and methane concentration in the expired air before and after a bowel movement induced by a phosphate enema. METHODS: Seventy-five patients with functional chronic constipation aged from 3 to 13 years were studied. Methane concentration in the expired air was determined using a gas chromatograph (Quintron, model 12i). Methane production was considered present if the breath methane concentration was equal or greater than 3 ppm. RESULTS: Methane production was present in 44 (86.3%) of 51 patients with constipation and fecal soiling versus only 7 (29.2%) of 24 patients with constipation without fecal soiling. After six weeks of therapy for constipation, the number of methane producers decreased by 65.2%. None of the 10 children with normal intestinal habit produced methane. Expired air methane concentration was determined before and after a bowel movement induced by a phosphate enema in 20 patients with impacted stool. From these 20 patients, 12 were methane producers. The median (percentiles 25 and 75 between parenthesis) of methane concentration decreased from 21.5 (15.0-25.5) ppm before to 11.0 (4.0-12.5) ppm after the bowel movement. CONCLUSION: Methane production was associated with chronic constipation with soiling and decreased when impacted stool decreased.

[Nutritional status and body composition of two South American native populations -- Alto Xingu and Ikpeng]. / Avaliação do estado nutricional e da composição corporal das crianças índias do Alto Xingu e da etnia Ikpeng.

OBJECTIVES: To assess the nutritional and body composition of two Brazilian indigenous populations by comparing their nutritional status. METHODS: 95 children from Alto Xingu and 69 from Ikpeng were evaluated, ages ranged from 24 to 117 months. The study was performed in the Xingu Indigenous Park. Data collected were: age, weight, height, skin folds, arm circumference, resistance and reactance. The z-scores were calculated and classified according to the parameters defined by the National Center for Health Statistics (NCHS 2000). Shortness was defined as length or stature below -2, underweight as body mass index below -2, and overweight as body mass index above 2. RESULTS: Among children from Alto Xingu, the prevalence of shortness was 8.4%, while among Ikpengs the prevalence was 37.7% (p < 0.001). Underweight was diagnosed in 12.5% of Ikpeng s children. Values of fat-free mass were greater for children from Alto Xingu and no case of obesity was found. CONCLUSION: In this study, Ikpeng's children showed higher incidences of short stature and low weight than the Altoxingu's children. Data regarding body composition have greater values among children from Alto Xingu, thus we conclude that nutritional status among children from Alto Xingu is better than the one found among the Ikpeng's children.