Solitary Rectal Ulcer Syndrome in Children: A Case Series Study.

Information on solitary rectal ulcer syndrome (SRUS) in children is limited and based on case reports only. This study was undertaken with the objective of describing the clinical history, symptoms, diagnostic work-up, and treatment of a large case series of pediatric patients with SRUS. The study was multi-center and retrospective. All pediatric endoscopists in Poland were invited to participate in the study and were asked to look through their endoscopic databases to identify SRUS cases from the last 10 years. The charts of SRUS patients were reviewed with respect to demographic data, and endoscopic and histological findings. Additionally, treatment methods and outcomes were assessed. In total, 31 patients (18 males, mean age of 13 years, range 5-18 years) were included in the study. All patients reported rectal bleeding. Other common symptoms included: abdominal pain (64.5%), perianal pain (54.8%), and passage of mucus (51.6%). The diagnostic work-up lasted from 1 to 48 months. Colonoscopic findings revealed rectal ulceration in 96.8% of patients. Therapeutic approaches included: high fiber diet (64.5%), laxatives (54.8%), topical corticosteroids (63.3%), 5-aminosalicylates administered orally and topically (29.1% and 96.8%, respectively), sucralfate (9.7%), and a biofeedback training (6.6%). Endoscopic argon plasma coagulation was performed in 2 patients and surgical intervention was necessary in 4 of them. Treatment was unsuccessful in 36% of patients. The findings of this study indicate that SRUS is rare in pediatric population, its diagnosis may be considerably delayed, and the treatment applied is often ineffective.

IgG subclass distribution of hepatitis B surface antigen antibodies induced in children with chronic hepatitis B infection after interferon-alpha therapy.

The IgG subclass distribution of antibody to hepatitis B surface antigen (anti-HBs) was investigated in 19 children with chronic active hepatitis B infection who showed a complete serological seroconversion after interferon-alpha therapy. Determinations were done 6 and 12 months after treatment. Our results showed no selectivity in anti-HBs synthesis among IgG subclasses. All 4 IgG isotypes were involved in the response, with similar percentage contributions, on average, of IgG1 (35%), IgG3 (27%), and IgG4 (28%), followed by IgG2 (10%). IgG4 became the second most dominant isotype at the end of observation. These results are in contrast to those found after natural seroconversion, in which anti-HBs was highly restricted to neutralizing IgG1 and IgG3, with only a minor contribution from IgG2 and IgG4. It is postulated that analysis of the specific profiles of IgG subclasses may be of value for the estimation of the therapeutic efficacy of recombinant interferon-alpha used and may be helpful in choosing more-effective treatment.

The IgG subclass profile of anti-HBs response in vaccinated children and children seroconverted after natural infection.

The IgG subclass profiles of anti-HBs antibodies were investigated in 30 children who had recovered from acute hepatitis B and 40 children vaccinated against hepatitis B virus (HBV) with Engerix B. After natural seroconversion the mean geometric value of anti-HBs titres was ca 41-fold lower than at the peak of response in vaccinees, and specific antibodies were highly restricted to IgG1 subclass followed by IgG3 with only a minor contribution of IgG2 and IgG4. Conversely, in children immunized with recombinant HBsAg, IgG1 and IgG3 dominated after two doses of vaccine and 1 month after the third injection but the response was less selective and more variable. One year after vaccination IgG4 anti-HBs antibodies became the second dominating isotype. Significant statistical differences in the profiles of IgG anti-HBs were observed when the age and maturity of humoral response were considered. While children vaccinated below 5 years of age responded mainly with IgG1 and IgG3 subclasses, older children (> 5 years) showed a high individual variability in the specific profiles with a high contribution of IgG4. We concluded that vaccination at a younger age leads to the production of antibody subclasses which are more effective for virus neutralization.

[Apoptosis and hepatic cell proliferation in autoimmune hepatitis and chronic viral hepatitis C in children: analysis of APO-1/Fas (CD95), bcl-2 and Ki67 expression]. / Apoptoza i proliferacja komórek watrobowych w autoimmunologicznym zapaleniu watroby i przewleklym wirusowym zapaleniu watroby typu C u dzieci: analiza ekspresji APO-1/Fas (CD95), bcl-2 i Ki67.

Hepatocyte damage in autoimmune hepatitis (AIH) and chronic viral hepatitis C (CVH) is attributed to an immune response. We analysed liver biopsy specimens from 4 children with AIH type I, 3 children with AIH type II and 2 children with CVH, using ApopDetek in situ hybridisation method and Mabs anti CD95, Ki67, bcl-2 by means of APAAP technique. The histological appearance of apoptotic bodies in both conditions was similar. The proliferation activity of the hepatocytes was elevated in cases of CVH and less extensive in AIH. Immunohistochemical analysis suggested that the liver damage in AIH and CVH could be mediated by CD95 system as a mechanism of T-cell mediated cytotoxicity.

[Evaluation of nonspecific inflammatory bowel disease in children using disease activity scoring systems]. / Ocena przebiegu nieswoistych zapalen jelit u dzieci wedlug systemu punktowego.

Scoring systems for assessment of clinical activity of IBD were used to evaluate 62 children with IBD (14 with CD, 35 with CU and 13 with CNS). The PCDAI system was most effective in children with CD. In children with CU, both modified Truelove-Witts and Rachmilewitz indexes are equally effective, however use of the Truelove-Witts scale is simpler. The Rachmilewitz scale is better in distinguishing between UC and CNS.

The value of quantitative measurement of HBeAg and HBsAg before interferon-alpha treatment of chronic hepatitis B in children.

Serum concentrations of HBsAg, HBeAg and hepatitis B virus DNA were measured quantitatively before interferon treatment in 23 children (17 boys, 6 girls) suffering from chronic hepatitis B, and correlated to the outcome of the treatment. Five children remained HBsAg- and HBeAg-positive throughout the treatment and 6 months after the end of the treatment (non-responders), 12 children eliminated HBeAg but not HBsAg (partial responders) and six eliminated HBeAg and HBsAg (complete responders). The five non-responders had significantly higher initial HBsAg and HBeAg concentrations and significantly lower alanine aminotransferase levels than the partial or complete responders. The six complete responders had significantly lower HBsAg concentrations than the partial or non-responders, and seemed to be younger. No significant difference in HBV DNA levels was found in the three response groups. These data suggest that quantitative assays of HBsAg and HBeAg are particularly useful in selecting patients with chronic hepatitis B for interferon therapy.

[Can TNF-alpha and IL-6 be helpful in assessment of chronic hepatitis in children?]. / Czy TNF-alpha i IL-6 moga byc pomocne w ocenie przewleklego zapalenia watroby u dzieci?

The purpose of the work was an assessment of TNF-alpha and Il-6 concentrations in 34 children with diagnosed chronic hepatitis. In all studied patients the values of TNF-alpha and Il-6 concentration were slightly increased. The correlations calculated between TNF-alpha and Il-6 concentrations calculated between TNF-alpha and Il-6 concentrations and laboratory parameters (laboratory indicators of hepatitis activity--AlAT; liver function indicators--prothrombin index, bilirubin concentration, bile acid concentration, alkaline phosphatase activity, anti-pyrin half-life) were non-significant in Spearman non-parametric test (p > 0.005) except for the correlation between albumin and TNF-alpha concentrations. No statistically significant differences of TNF-alpha and Il-6 concentrations were found between groups of patients with active and persistent hepatitis; groups with and without cirrhosis as well as between groups with and without portal hypertension. Normal or slightly increased TNF-alpha and Il-6 concentrations, observed in chronic hepatitis in children should be explained by compensated liver function in such patients.