Foreign Body Ingestion and Management in Children.

OBJECTIVE: The aim of the study is to evaluate of the children who came to our hospital with the complaint of foreign body (FB) ingestion and were treated. METHODS: A retrospective evaluation was made of the records of children who presented at our institution between January 2014 and August 2021 with the complaint of FB ingestion. RESULTS: Evaluation was made of 297 children, comprising 121 female children (40.7%) with a mean age of 61.1 ± 50.3 months (range, 4-202 months). The ingested FB most frequently was coins (n = 88, 29.6%). The most common complaint on presentation was vomiting in 47 cases (15.8%). Endoscopy was applied to 75 cases (25.3%), and most common FB was removed from the upper esophagus in 31 cases (41.3%). The most frequently removed FB was coins at the rate of 40%. Of the 211 cases left to a spontaneous course, 117 were in the intestines, 22 in the stomach, and in 72 cases localization could not be determined on conventional radiography as the FB was not opaque. In 7 cases with a bolus of food caught in the esophagus, 3 had corrosive esophagus stricture (1 case with colon transposition), 2 had operated esophagus atresia, 1 had eosinophilic esophagitis, and 1 had congenital esophagus stricture. CONCLUSIONS: Although there can be serious outcomes, there is spontaneous expulsion in most cases. However, a significant proportion requires a timely endoscopic procedure. Attention must be paid to underlying diseases when FBs, such as a food bolus, are in the esophagus.

Familial Mediterranean Fever Mutation Analysis in Pediatric Patients With Inflammatory Bowel Disease: A Multicenter Study.

BACKGROUND: The aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases has been reported previously. METHODS: Children with IBD (334 ulcerative colitis (UC), 224 Crohn's disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. RESULTS: A total of 597 children (mean age: 10.8 ± 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/ heterozygous) in patients with UC (P < .05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P = .031, P = .045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P = .007). CONCLUSION: Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not have a high impact on inflammatory response and clinical outcome of the disease.

Breakfast habits, dairy product consumption, physical activity, and their associations with body mass index in children aged 6-18.

The purpose of this study was to determine breakfast habits, dairy product consumption, and physical activity and their relations with body mass index (BMI) in schoolchildren and adolescents. This cross-sectional, school-based study was performed with children aged 6-18 years. Height and weight were measured, and a BMI z-score was calculated for each child. Breakfast consumption frequency, intake of milk and other dairy products, physical activity habits, and mothers' employment status were assessed via a self-report questionnaire. Multiple linear regression analysis was used to estimate the association between these habits and BMI z-scores. Seven thousand one hundred sixteen children were included, 3445 (48.4%) female, with a mean age of 11.7 ± 2.7 years (5.8-18.9). Of these, 62.6% had breakfast every day. Boys ate breakfast daily significantly more often than girls (64.5 and 60.7%, respectively; p < 0.001). The percentage of children eating breakfast daily decreased with age (79.1% at 6-11 vs. 52.1% at 12-18 years, p < 0.001). Sixty-four (0.9%) children consumed no dairy products. Milk intake was negatively and significantly associated with BMI z-score (ß = - 0.103, p < 0.001). Cheese consumption and the mother being employed were positively and significantly associated with BMI z-score (ß = 0.517, p < 0.001, and ß = 0.172, p < 0.001, respectively). Children engaging in physical activity had higher BMI z-score values than others (0.22 ± 0.01 vs. 0.12 ± 0.02, p < 0.001). Prevalence of overweight/obese was higher among children of working mothers compared to those of unemployed mothers (respectively, 29.3, 23.3%, p < 0.001). CONCLUSIONS: Skipping breakfast was associated with overweight/obesity in schoolchildren and adolescents, while milk consumption exhibited a protective effect. What is known? • Dietary interventions should be incorporated into a multidisciplinary strategy for obesity prevention. • Most studies of habitual physical activity in children suggest that the overweight and obese children are less active. What is new? • Milk consumption seems to have a protective effect against overweight/obesity, irrespective of yogurt or cheese consumption. • Children engaging in greater physical activity had higher body mass index values than others.

Child with Pancreatic Hydatid Cyst Presenting with Cholestasis.

Although hydatid cysts are often seen in the liver and lungs, they may be present in many organs. Even in countries where hydatid cyst disease is endemic, the occurrence of pancreatic hydatid cysts is rare. Pancreatic hydatid cysts are important for the differential diagnosis of patients with pancreatic pseudocysts and cystic carcinomas. We could not find cystic echinococcosis cases which are kept together pancreas and liver in PubMed. In this article, we highlight the fact that pancreatic cystic echinococcosis may play a role in the etiology of cholestasis and that cysts may not be isolated in the pancreas in a pediatric population.

Peptic Ulcers and Erosions in Children at a Pediatric Unit in Turkey.

OBJECTIVE: To study the characteristics of peptic ulcer and erosion in pediatric patients. METHODS: Over a period of seven years, 1,026 children underwent upper gastrointestinal endoscopy in our pediatric gastroenterology unit. RESULTS: Peptic ulcers and erosions were found in 59 (7.2%) patients [ulcers in 42 (5.1%)and erosions in 17 (2.1%)]. Thirty (50.9%) children presented with acute upper gastrointestinal bleeding. Helicobacter pylori positivity was found in 27 patients (45.8%), and ulcerogenic medication use was found in 13 (22%) patients. CONCLUSION: The main risk factors for childhood peptic ulcer and erosions were H. pylori infection and non-steroidal anti-inflammatory drug use.

Cystic Eechinococcosis in Childhood: Five-Years of Experience From a Single-Center.

OBJECTIVE: To evaluate the clinical data and prognosis of cystic echinococcosis during a 5-year period who were followed by the pediatric clinics. METHODS: Demographic, clinical, laboratory, and prognosis data of 34 patients with cystic echinococcosis obtained between 2009 to 2014 were retrospectively evaluated. Of these, 10 patients were excluded because of incomplete data or failure to follow up. RESULTS: A total of 24 (12 males and 12 females) children were included the study. The mean ages of patients were 11.17 ± 3.71 (range, 5-17) years. The most common symptoms were abdominal pain (41.7%), cough (16.7%), and fatigue (12.5%). Localization of the parasite in the patients was determined to be as follows: liver (54.2%), lung (33.3%), and intraabdominal (4.2%). Multiorgan involvement was observed in 8.3% of the cases. Indirect hemagglutination test was positive in 13 (54.2%) patients at admission. All patients received treatment with albendazole. Seven patients were treated with puncture-aspiration-injection-re-aspiration (PAIR) (29.2%). Open surgery was performed in six patients (24.2%). One patient was treated with both PAIR and open surgery. CONCLUSIONS: Cystic echinococcosis is a serious public health problem in developing countries. Hydatid cyst should be considered in the presence of suspicious radiological and clinical findings in endemic areas.

Gastrointestinal Neuroendocrine Tumors in Two Children.

BACKGROUND: Enterochromaffin-like cell hyperplasia and neuroendocrine tumors are relatively rare in childhood. CASE CHARACTERISTICS: A 15-year-old girl who presented with epigastric pain and a 6-year-old boy who was admitted with hematochezia. Endoscopy revealed nodules in the stomach in Case 1, and polyploidy lesion in the rectum in Case 2. OUTCOME: Enterochromaffin-like cell hyperplasia in Case 1 and neuroendocrine tumor in Case 2. MESSAGE: A low index of suspicion for neuroendocrine tumors in children can result in delay in the detection of these rare but potentially malignant diseases.

Burkitt lymphoma with unusual presentation: Acute pancreatitis.

Pancreatitis due to malignant infiltration is an uncommon condition in childhood. Pancreatic lymphomas constitute <2% of all non-Hodgkin lymphomas. Only six reported cases with various clinical presentation have been documented in the literature. Described herein is the case of a nine-year-old boy with abdominal pain, jaundice, emesis, weight loss, diarrhea, who developed hyperlipidemia and cholestasis. Pancreatitis was suspected due to high amylase and lipase. Computed tomography and magnetic resonance cholangiopancreatography showed diffuse enlargement of the pancreas. This sausage pancreas imaging was suggestive of autoimmune pancreatitis, but the patient was diagnosed with Burkitt lymphoma on bone marrow aspiration, and rapidly improved with chemotherapy. Burkitt lymphoma should be kept in mind when patients present with pancreatitis, especially with diffuse enlarged pancreas.

The nutritional status of hospitalized children: Has this subject been overlooked?

BACKGROUND/AIMS: To determine the nutritional status of hospitalized children at the time of admission and to investigate the relationship between diagnosis and nutritional status. MATERIALS AND METHODS: Body weight, height, triceps skinfold thickness, and mid-arm circumference were measured on admission and percentages of weight-for-age, weight-for-height, body mass index, mid-arm circumference, and triceps skinfold thickness were calculated. The nutritional status was evaluated using the Waterlow, Gomez, and other anthropometric assessments. RESULTS: A total of 511 patients were included in the study with a mean age of 5.8±4.9 years. Malnutrition was determined in 52.7% of patients according to the Waterlow classification. Mild malnutrition was determined in 39%, moderate in 12%, and severe in 1.7%, with the characteristics of acute malnutrition in 23.9%, acute-chronic in 7.3%, and chronic in 21.5%. The highest rate of malnutrition was in the 0-2 years age group (62.3%). According to the Gomez classification, malnutrition rate was determined as 46.8%. The rates of malnutrition in malignant, gastrointestinal, and infectious diseases were 60%, 59.8%, and 54.5%, respectively. CONCLUSION: The prevalence of malnutrition in hospitalized children was noticeably high. The nutritional evaluation of all patients and an early start to nutritional support could provide a significant positive contribution.

Extremely rare cause of congenital diarrhea: enteric anendocrinosis.

Congenital diarrheal disorders consist of a variety of chronic enteropathies. There are approximately 30 different diseases that can be classified into four groups according to the mechanisms involved in pathogenesis: (i) absorption and transport of nutrients and electrolytes; (ii) enterocyte differentiation and polarization; (iii) enteroendocrine cell differentiation; and (iv) modulation of the intestinal immune response. Affected patients often present with life-threatening diarrhea, in the first few weeks of life. A new disorder, enteric anendocrinosis, which is characterized by severe malabsorptive diarrhea and a lack of intestinal enteroendocrine cells has recently been described in six patients with recessively inherited mutations in the Neurogenin-3 gene. In this report we describe a seventh case with a review of the literature.

Percutaneous management of bile-plug syndrome: a case report.

Bile-plug syndrome is defined as an obstruction of the common bile duct by bile sludge in full-term infants. It is a correctable cause of obstructive jaundice in infants and is generally treated surgically. Here, we present a case of a 5-month-old infant with bile-plug syndrome, which was treated by percutaneous biliary interventions. To the best of our knowledge, percutaneous treatment of bile-plug syndrome is reported for the first time in an infant. This minimal invasive treatment modality may be a useful alternative to surgery in infants with bile-plug syndrome.

Therapeutic effect of metformin and vitamin E versus prescriptive diet in obese adolescents with fatty liver.

OBJECTIVE: The aim of the study was to determine whether metformin or vitamin E treatment for six months is effective in reducing body weight, blood pressure, and also ameliorating insulin resistance, adiponectin, and tumor necrosis factor (TNF)-alpha in obese adolescents with non-alcoholic fatty liver disease (NAFLD). METHODS: Sixty-seven obese adolescents with liver steatosis (age range, 9 - 17 years) were included in the study. The metformin group received an 850-mg dose of metformin daily and the vitamin E group received 400 U vitamin E /daily, in capsule form for 6 months, plus an individually tailored diet, exercise, and behavioral therapy. RESULTS: After 6 months later, there was a significant decline in body mass index, and fasting insulin and homeostatic model assessment (HOMA) values in all three groups. Moreover, in comparingson of changes in HOMA among the groups, the metformin- treated group showed significantly improved metabolic control and insulin sensitivity (HOMA) at the end of the study. There were no significant differences for changes of adiponectin, TNF-alpha, in all three groups after 6 months study. CONCLUSION: These data suggest that metformin treatment is more effective than dietary advice and vitamin E treatment in reducing insulin resistance, and also in ameliorating metabolic parameters such as fasting insulin and lipid levels, in obese adolescents having NAFLD.

Adenomyomatosis of the gallbladder resembling honeycomb in a child.

Adenomyomatosis of the gallbladder is believed to be an uncommon pathologic condition of the gallbladder in childhood. Only three pediatric cases have been described in the literature up to now. Honeycomb gallbladder has been described in two adult patients; no patients have been reported in childhood until now. To the best of our knowledge, we report here the first case of adenomyomatosis of the gallbladder which resembled honeycomb, in a 9-year-old girl presented with recurrent abdominal pain. The diagnosis was made by ultrasound, and confirmed by magnetic resonance cholangiopancreatography and finally cholecystectomy. In conclusion, ultrasound scanning performed more generally in children presenting with recurrent abdominal pain might lead to accurate diagnosis of adenomyomotosis of the gallbladder during childhood.

An unusual cause of ascites: hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis is character-ized by fever, hepatosplenomegaly, cytopenia, hyper-triglyceridemia, hypofibrinogenemia, and hemophago-cytosis. Ascites is not mentioned as a symptom of hemophagocytic syndrome. We report a one month-old girl suffering from familial erythrophagocytic lympho-histiocytosis, who presented with ascites.

Long-term aspects of nodular gastritis in children.

BACKGROUND: Close association of nodular gastritis and Helicobacter pylori infection has been initially proved by various studies. There have been some studies reporting microscopic and histologic recovery in a short time after eradication therapy. But there is not enough data about the long-term course of this condition. The aim of this study is to document current clinical conditions, presence of H. pylori and results of endoscopic and histologic examination, after a long-term period, in children with endoscopically diagnosed antral nodularity. METHODS: A total of 35 patients diagnosed as nodular antral gastritis by upper gastrointestinal endoscopy during a 2 year period, were invited for re-evaluation and re-endoscopy after 3 years. Histopathologically, H. pylori detected ones had been treated with standard triple eradication therapy. In total, 27 patients were accepted for enrollment in the study. Repeated endoscopy could be performed in all 27 patients. RESULTS: The persistence of antral nodularity was detected in 18 of 27 patients. Decrease in symptoms, absence of symptoms and presence of H. pylori infection were detected in 6, 8 and 16 (89%) of them, respectively. There was no statistical significance between the first and last endoscopic biopsies when activity, atrophy, intestinal metaplasia and presence of follicles were regarded. Malt lymphoma could not be detected in any of the patients. CONCLUSION: There is a strong association between nodular gastritis and H. pylori. Presence of antral nodularity in the long-term period may be related to H. pylori re-infection. New therapeutic approaches are required for treatment and management of the patients diagnosed as nodular gastritis and living in areas endemic for H. pylori infection.

Biochemical markers of bone metabolism in children with Helicobacter pylori infection.

We investigated the biochemical markers of bone metabolism in children with Helicobacter pylori infection. Biochemical markers of bone metabolism and serum levels of vitamin B12, ferritin and estradiol were measured in 41 H. pylori-positive (+) children (23 girls, 18 boys; aged 11.8+/-3 years). Serum levels of intact parathyroid hormone, ss-collagen I carboxy terminal telopeptide, total alkaline phosphatase (ALP), bone-specific ALP, N-terminal cross-links of human procollagen type I, N-mid-osteocalcin, calcium, phosphate, ferritin, and estradiol did not differ significantly between H. pylori(+) and H. pylori negative (-) children. Vitamin B12 levels were significantly decreased in H. pylori(+) compared to H. pylori(-) children. H. pylori infection was not accompanied by significant changes in markers of bone metabolism in children, although vitamin B12 levels were decreased. Further studies are required to clarify whether H. pylori infection causes time-dependent changes in bone turnover markers during the long course of this inflammatory disease.

Serum ferritin, vitamin B(12), folate, and zinc levels in children infected with Helicobacter pylori.

We sought to explore the relationship between Helicobacter pylori infection and serum ferritin, vitamin B(12), folate, and zinc status among children. Fifty patients aged 5-18 years who underwent upper gastrointestinal endoscopy because of dyspeptic symptoms, were studied, prospectively. Patients were grouped as H. pylori positive (group 1, n=32) or H. pylori negative (group 2, n=18) by histopathologic examination and rapid urease test. Fasting serum ferritin, vitamin B(12), folate, and zinc levels of patients were measured. Both groups were indifferent according to age, gender, height standard deviation score (H(SDS)), and weight standard deviation score (W(SDS)). Serum ferritin levels were 33+/-26 and 50+/-46 ng/mL (P=.098), vitamin B(12) levels were 303+/-135 and 393+/-166 pg/mL (P=.042), folate levels were 9.64+/-3.2 and 9.61+/-2.8 ng/mL (P=.979), and zinc levels were 95+/-48 and 87+/-31 mug/dL (P=.538), in groups 1 and 2, respectively. Ferritin levels of 14 (43.8%) patients in group 1 and 6 (33.3%) patients in group 2 were below the normal range (P=.470). Serum vitamin B(12) levels of 9 children (28%) in group 1 and 2 children (11%) in group 2 were below the normal range (P=.287). The findings of the present study suggest that H. pylori infection has a negative effect on serum ferritin and vitamin B(12) levels in children. This negative effect on vitamin B(12) levels is rather marked in contrast to that on ferritin levels. H. pylori infection has no significant effect on serum folate or zinc levels among children.