The Role of Vitamin D and Vitamin D Receptor Gene Polymorphisms in the Course of Inflammatory Bowel Disease in Children.

Background: The etiopathogenesis of inflammatory bowel disease (IBD) is still unclear. Prior studies suggest genetic components that may influence the incidence and severity of the disease. Additionally, it was shown that low levels of serum vitamin D may have an impact on the clinical course of the disease due to its effect on the immunological system. Methods: We aimed to investigate the correlation between the incidence of vitamin D receptor (VDR) gene polymorphisms (rs11568820, rs10735810, rs1544410, rs7975232, and rs731236, commonly described as Cdx2, FokI, Bsm, ApaI, and TaqI, respectively) and vitamin D concentration with the clinical course of IBD (disease activity, extent of the intestinal lesions). Data were obtained from 62 patients with IBD (34 with Crohn's disease, 28 with ulcerative colitis), aged 3-18 years, and compared with controls (N = 47), aged 8-18 years. Results: Although there was no difference in the incidence of individual genotypes between the study groups (IBD, C) in all the polymorphisms examined, we described a significant increase in the chance of developing IBD for heterozygotes of Cdx2 (OR: 2.3, 95% CI 0.88-6.18, p = 0.04) and BsmI (OR: 2.07, 95% CI 0.89-4.82, p = 0.048) polymorphisms. The mean serum 25OHD level in patients with IBD was significantly higher compared with the controls (19.87 ng/mL vs. 16.07 ng/mL; p = 0.03); however, it was still below optimal (>30 ng/mL). Furthermore, a significant correlation was found between vitamin D level and TaqI in patients with IBD (p = 0.025) and patients with CD (p = 0.03), as well as with the BsmI polymorphism in patients with IBD (p = 0.04) and patients with CD (p = 0.04). A significant correlation was described between the degree of disease activity and genotypes for the FokI polymorphism in patients with UC (p = 0.027) and between the category of endoscopic lesions and genotypes for the Cdx2 polymorphism also in patients with UC (p = 0.046). Conclusions: The results suggest a potential correlation of VDR gene polymorphism with the chance of developing IBD, and the clinical course of the disease requires further studies in larger group of patients. Vitamin D supplementation should be recommended in both children with inflammatory bowel disease and in healthy peers.

Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease.

In the course of inflammatory bowel disease (IBD) malabsorption may lead to a vitamin D deficiency and calcium-phosphate misbalance. However, the reports on the vitamin D status in children with IBD are few and ambiguous. Here, we are presenting complex analyses of multiple factors influencing 25OHD levels in IBD children (N = 62; Crohn's disease n = 34, ulcerative colitis n = 28, mean age 14.4 ± 3.01 years, F/M 23/39) and controls (n = 47, mean age 13.97 ± 2.57, F/M 23/24). Additionally, calcium-phosphate balance parameters and inflammatory markers were obtained. In children with IBD disease, activity and location were defined. Information about therapy, presence of fractures and abdominal surgery were obtained from medical records. All subjects were surveyed on the frequency and extent of exposure to sunlight (forearms, partially legs for at least 30 min a day), physical activity (at least 30 min a day) and diet (3 days diary was analyzed with the program DIETA 5). The mean 25OHD level was higher in IBD patients compared to controls (18.1 ng/mL vs. 15.5 ng/mL; p = 0.03). Only 9.7% of IBD patients and 4.25% of controls had the optimal vitamin D level (30-50 ng/mL). Despite the higher level of 25OHD, young IBD patients showed lower calcium levels in comparison to healthy controls. There was no correlation between the vitamin D level and disease activity or location of gastrointestinal tract lesions. Steroid therapy didn't have much influence on the vitamin D level while vitamin D was supplemented. Regular sun exposure was significantly more common in the control group compared to the IBD group. We found the highest concentration of vitamin D (24.55 ng/mL) with daily sun exposure. There was no significant correlation between the vitamin D level and frequency of physical activity. The analysis of dietary diaries showed low daily intake of vitamin D in both the IBD and the control group (79.63 vs. 85.14 IU/day). Pediatric patients, both IBD and healthy individuals, require regular monitoring of serum vitamin D level and its adequate supplementation.

Enhancement of Circulating and Intestinal T Regulatory Cells and Their Expression of Helios and Neuropilin-1 in Children with Inflammatory Bowel Disease.

BACKGROUND/AIMS: The proportions of intestinal and peripheral regulatory T cells (Tregs) in pediatric inflammatory bowel disease (IBD) were poorly investigated, as well as different subsets of these cells. Helios and Neuropilin-1 were proposed as markers differentiating between thymic and peripheral Tregs. Therefore, the aim of current work was to investigate the proportions of Tregs and expression of Helios and Neuropilin-1 in Tregs in peripheral blood and intestinal mucosa of children with inflammatory bowel disease. MATERIALS AND METHODS: Fifteen patients newly diagnosed with inflammatory bowel disease: ulcerative colitis (n=7) and Crohn's disease (n=8) were included in the study. Nine children who presented with no abnormalities in colonoscopy served as a control group. Quantification of regulatory T cells of the CD4+CD25highFOXP3+ phenotype, as well as Helios+ and Neuropilin-1+ in peripheral blood and bowel mucosa was based on multicolor flow cytometry. RESULTS: The rates of circulating and intestinal Tregs were significantly higher in the studied group than in the control group. The rate of intestinal T regulatory lymphocytes was significantly higher than circulating Tregs in patients with IBD, but not in the control group. The median proportion of circulating FOXP3+Helios+ cells amounted to 24.83% in IBD patients and 15.93% in the controls. The median proportion of circulating FOXP3+Nrp-1+ cells was 34.23% in IBD and 21.01% in the control group. No statistically significant differences were noted for the circulating FOXP3+Helios+ cells and FOXP3+Nrp-1+ cells between the studied and the control group. CONCLUSION: The rates of circulating and intestinal T regulatory cells are increased in naïve pediatric patients with IBD. The rate of Tregs is higher in intestinal mucosa than in peripheral blood in patients with IBD. Flow cytometry is a valuable method assessing the composition of infiltrates in inflamed tissue. Helios and Neuropilin-1 likely cannot serve as markers to differentiate between natural and adaptive Tregs.

Expression of death receptor 3 on peripheral blood mononuclear cells differes in adult IBD patients and children with newly diagnosed IBD.

BACKGROUND: Interaction between TL1A and death receptor 3 (DR3) is associated with the pathogenesis of inflammatory bowel disease (IBD), although their role in the development of this disease remains not fully explained. Some studies showed elevated expression of TL1A and DR3 in inflamed intestinal tissue but currently there are no reports concerning expression of DR3 on peripheral blood mononuclear cells (PBMCs) of IBD patients which was the subject of our study. METHODS: We performed flow cytometry analysis of DR3 expression on CD4(+), CD8(+), CD11c(+), CD14(+) or CD20(+) PBMCs of adults and children with IBD and healthy volunteers with respect to C-reactive protein (CRP) levels in blood. Blood samples were collected from pediatric patients before the beginning of therapy, whereas adults patients were undergoing anti-inflammatory IBD treatment and had much lower CRP levels. RESULTS: With regard to appropriate healthy volunteers, children with IBD had elevated percentage of DR3-expressing CD4(+), CD8(+), CD11c(+) and CD20(+) PBMCs which, with the exception of DR3(+) CD11c(+) cells in children with ulcerative colitis, was correlated with CRP level in blood. Adult patients had increased frequency of DR3(+) CD8(+) and CD20(+) PBMCs and their CRP levels correlated only with DR3(+) CD8(+) cells. CONCLUSIONS: In comparison to healthy volunteers, untreated children with IBD have higher percentage of DR3(+) PBMCs than adults with IBD undergoing anti-inflammatory treatment. In most of the investigated PBMCs populations, the frequency of DR3(+) cells is correlated with the level of CRP. We suggest anti-inflammatory treatment may lead to reduction in the frequency of DR3(+) PBMCs. © 2016 International Clinical Cytometry Society.

Demographic characteristics of children with early clinical manifestation of inflammatory bowel disease.

INTRODUCTION: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition of the colon and small intestine. The disease is common in young people (children and young adults), but it is rare in children younger than five years of age. Therefore, IBD developing during the first years of life (under the age of 5) is known as an early-onset IBD (EO-IBD), and it is considered to be a specific entity with a distinct phenotype. However, the available data on that issue are still insufficient. AIM: To determine the characteristics and clinical course of children with early-onset IBD. MATERIAL AND METHODS: We performed a retrospective database analysis of 47 infants younger than 5 years old diagnosed with IBD. Patient's demographic data, including age, sex, and age at disease onset, were collected in 6 paediatric hospitals in Poland. Disease location was established on the basis of the review of all endoscopic, colonoscopic, histopathological, and radiological records. All possible complications were reported, as well as any treatment and its efficacy. Since the diagnosis was established all patients have been on follow up. RESULTS: Among 47 children registered in the database, 23 (49%) had a diagnosis of CD, 16 (34%) had UC, and 8 (17%) had IC (indeterminate colitis). The mean age at diagnosis was 28.5 ±27.5 months; 57.4% were male. The most common location/type of disease was ileocolonic disease (L3). The most common complication of IBD was anaemia, found in 30 (63.8%) children. The observed course of the disease was either severe or moderate. In 4 children younger than 2 years old, surgery was performed. CONCLUSIONS: Inflammatory bowel disease in children younger than 5 years old includes UC, CD, and a relatively high proportion of IC. In early-onset IBD severe and moderate course of the disease is usually observed. Disease manifestation in these patients is predominantly ileocolonic.

Evaluation of CD40 and CD80 receptors in the colonic mucosal membrane of children with inflammatory bowel disease.

INTRODUCTION: The most prevalent inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD). Immune processes play a vital role in the etiopathogenesis of these conditions, involving both cellular and humoral response mechanisms. The aim of this study was to quantify CD40- and CD80-positive cells in the biopsy specimens of large intestinal mucosa from children with IBD. MATERIALS AND METHOD: The study comprised 38 children aged between 3-17 years (mean 11.5±3.7 years) - 20 boys (52.6 %) and 18 girls (47.4%). Eighteen patients were diagnosed with UC on the basis of clinical manifestation, endoscopic and histopathological findings. Mean age of this subgroup was 11.55±4.07 years. A group of 10 children (mean age 12.30±2.83) diagnosed with CD was also included. The control group comprised 10 IBD-free children (mean age 10.28±4.07 years). The surface expressions of CD40 and CD80 were analyzed in large intestine mucosa biopsy specimens, fixed in formaldehyde, embedded in paraffin, and cut with a microtome into 4 µm slices. RESULTS: The number of CD40- and CD80-positive cells in the large intestinal mucosa of children with Crohn's disease and ulcerative colitis was significantly higher than in the controls. The highest number of CD40+ and CD80+ cells was observed in the caecal mucosal membrane of Crohn's disease patients and in the rectal mucosa of individuals with ulcerative colitis. CONCLUSION: IBD is characterized by elevated, segment-specific, expression of CD40 and CD80.

Evaluation of clinical usefulness of serum neopterin determination in children with bacterial infections.

UNLABELLED: Neopterin (NPT) (6-D-erythro-trihydroxypropyl pteridin) is one of the indicators of the immune system activity. Elevated neopterin concentration occurs in diseases mostly involving stimulation of cellular immunity. The determination of neopterin concentration, usually in blood serum and urine but also in many other bodily fluids, has already been applied in many areas of medicine, such as transfusiology, transplantology, oncology, infectious diseases and autoimmunological diseases. OBJECTIVE: The aim of this work is to evaluate clinical usefulness of serum neopterin determination in children with urinary tract infections of confirmed bacterial etiology. MATERIAL: The study involved 56 children with bacterial urinary tract infections - patients of the Clinic of Paediatrics, Paediatric Gastroenterology, Hepatology & Paediatric Nutrition of Medical University of Gdansk in the years 2012-2013. The control group included 105 healthy children. RESULTS: The values of NPT concentration in blood serum obtained in the group of children with urinary tract infections did not significantly differ from the values obtained in the control group. CONCLUSIONS: The determination of neopterin concentration in children with bacterial urinary tract infections is not a clinically useful parameter.

[Biological treatment of inflammatory bowel diseases in children in the years 2004-2013 in Poland]. / Leczenie biologiczne nieswoistych zapalen jelit u dzieci w latach 2004-2013 w Polsce.

UNLABELLED: In the last years an increase in Crohn's disease morbidity in children is observed together with constant morbidity of ulcerative colitis. The course of these diseases is severe, younger children are affected and the diseases are resistant to conventional treatment. Biological drugs are a chance for a longer remission and healing of the intestinal mucosa. OBJECTIVE OF THE WORK: Assessment of the use of biological drugs in treatment of inflammatory bowel disease in Poland was the objective of the work. MATERIAL AND METHODS: Gastroenterological centers treating inflammatory bowel disease during the years 2004-2013 were invited to a questionnaire retrospective study. RESULTS: The questionnaires of biological treatment of Crohn's disease and ulcerative colitis in children were received from 12 centers. In the years 2004-2013 the number of children aged 4 months to 18 years with Crohn's disease treated with biological drugs was 424. In the years 2004-2008--69 children were treated with infliximab and in the years 2009-2013--299 children, which was a four-fold increase. 56 children were treated with adalimumab in the years 2008-2013. In the years 2005-2013--72 children with ulcerative colitis were treated with infliximab and 11 with adalimumab. The age of the children ranged from 2 years to 18 years. The higher number of children treated was in the years 2009-2013: 59 with infliximab and 10 with adalimumab. CONCLUSIONS: In the last decade a significant increase on the number of children with Crohn's disease and ulcerative colitis treated with biological drugs was observed. It is connected not only to greater morbidity but above all to the introduction of a treatment program by the National Health Insurance Fund for children with Crohn's disease. There is an expectation that the introduction of biological treatment in inflammatory bowel disease will prolong clinical and endoscopic remission and diminish the number of surgeries.

Prevalence and correlates of vitamin K deficiency in children with inflammatory bowel disease.

Although vitamin K deficiency has been implicated in adult inflammatory bowel disease (IBD), its prevalence in pediatric IBD remains unknown. We carried out a cross-sectional study in 63 children with Crohn's disease (CD) and 48 with ulcerative colitis (UC) to assess the prevalence of vitamin K deficiency and to search for potential correlation between vitamin K status and pediatric IBD activity. Vitamin K status was assessed using protein induced by vitamin K absence-II (PIVKA-II; ELISA). Prevalence of vitamin K deficiency was 54.0% in CD and 43.7% in UC. Vitamin K deficiency was more common in patients with higher CD activity, in CD patients with higher mass Z-scores, and less common among children with CD treated with infliximab. Relation of vitamin K deficiency to pediatric IBD clinical course and treatment demand further research.

The Foker technique (FT) and Kimura advancement (KA) for the treatment of children with long-gap esophageal atresia (LGEA): lessons learned at two European centers.

INTRODUCTION: We present the experiences from two European centers performing the Foker technique (FT) of esophageal lengthening by axial traction and the Kimura advancement (KA) method of lengthening the upper pouch by extrathoracic resiting a spit fistula (SF) in children with long-gap esophageal atresia (LGEA, gap length > 5 cm). MATERIALS AND METHODS: A total of 15 children were treated (8 pure EA, 6 lower tracheoesophageal fistula [TEF], and 1 upper TEF). Gaps ranged from 5 to 14 cm. Nine children already had a SF. Patients were grouped according to the presence of a SF and the subsequent surgical strategy: Group A (no SF, n = 6) received FT on both pouches. Group B (with SF, n = 6) received KA of SF and FT of the lower pouch. Group C (with SF, n = 3) received closure of the SF and subsequent Foker traction (CSFT) on both pouches. RESULTS: Group A: Primary repairs for all six children (mean age 3 months, gap length 6.5 cm) after a mean traction time of 3 weeks and a mean of 2.1 thoracotomies (range 2 to 3). Dilations were required in three out of six for anastomotic strictures with one perforation during the second dilation. Group B: All six children (mean age 16.4 months, gap length 9.5 cm) had a primary anastomosis, although for two it was significantly delayed (48 and 143 weeks traction time) because of infections. The number of thoracotomies ranged from 2 to 8 (mean 3.6). Leaks occurred in five out of six anastomoses (responsive to conservative management). Two children developed severe strictures, which required the anastomosis to be redone. In group C (mean age 10.6 months, gap length 6.5 cm), several major complications occurred. The three SF closures leaked (one iatrogenic) causing severe mediastinitis. CSFT was successful in only one case and the other two children had an esophageal replacement (stomach, jejunum). No deaths occurred in the series. CONCLUSION: FT of both pouches (group A) resulted in primary repairs of all six LGEA patients. The combination of KA and FT (group B) resulted in an equivalent rate of primary repairs, but with an increased number of thoracotomies and rate of complications compared with group A. CSFT (group C) resulted in a high failure rate. More data are needed (we propose a multicenter registry) to elucidate the safety and efficacy of each elongation technique and to establish an algorithm with clearer inclusion and exclusion criteria.

Immunohistochemical distribution of cocaine- and amphetamine-regulated transcript peptide - like immunoreactive (CART-LI) nerve fibers and various degree of co-localization with other neuronal factors in the circular muscle layer of human descending colon.

Cocaine- and amphetamine-regulated transcript peptide (CART) is a neuromediator and/or neuromodulator in nerve structures within the gastrointestinal tract, but knowledge about its distribution, functions and co-localisation with other neuronal factors, especially in humans, is very scarce. During the present investigation the distribution and immunohistochemical reaction (IR) of CART - like immunoreactive (CART-LI) nerve fibers in the circular muscle layer of human descending colon were studied. Fragments of human colon were processed for double labelling immunofluorescence using a mixture of anti-CART antibodies with antibodies against vesicular acetylocholine transporter (VAChT), vasoactive intestinal polypeptide (VIP), pituitary adenylate cyclase - activating peptide (PACAP), substance P (SP), galanin (GAL) and nitric oxide synthase (NOS). Thick CART-LI nerve fibers formed a very dense meshwork within the colonic circular muscle layer in all patients studied. The highest number of CART - positive nerves also contained VAChT and/or VIP. A slightly lower level of co-localisation was observed in the case of CART and PACAP or CART and NOS. Only single nerve fibers were concurrently immunoreactive to CART and SP or CART and GAL. The present study reports for the first time a detailed description of the IR of CART-LI nerve fibers in the circular muscle layer within adult human descending colon.

Helicobacter pylori increases expression of proapoptotic markers Fas and FasL on CD4 lymphocytes in children.

The pathomechanism of Helicobacter pylori action upon gastric mucosa and its role in the pathogenesis of gastritis have not been fully elucidated. The aim of this study was to evaluate the most prevalent lymphocyte subpopulations of the gastric mucosa in gastritis in children, as well as to evaluate the expression of Fas and Fas ligand receptors (FasL), periapoptotic markers of gastric mucosa lymphocytes before and after H. pylori eradication. Forty nine patients aged 6 to 17 years, investigated due to chronic abdominal pain, were studied. The obtained tissue samples were analysed by immunohistochemistry. Different lymphocyte subsets were quantified on the basis of surface antigen expression (CD3, CD4, CD8, CD20), secreted cytokines (IL-4, IL-6, IFNgamma) and Fas and FasL proteins in the gastric mucosa. B and T helper lymphocytes were found to play a major role in the inflammatory infiltration in the gastric mucosa in children during H. pylori infection. Their expression was found to decrease after eradication. The enhanced expression of Fas receptor on lymphocytes before treatment and a decrease of this expression after eradication of H. pylori were shown. It was demonstrated that there is a correlation between CD4 and Fas receptor expression that may induce apoptosis of the helper lymphocytes in infected children.

Epidemiology of inflammatory bowel disease among children in Poland. A prospective, population-based, 2-year study, 2002-2004.

BACKGROUND/AIMS: The incidence of pediatric inflammatory bowel disease (IBD) in Western countries is on the rise. No prospective studies have been conducted on the epidemiology of pediatric IBD in Poland. The aim of the study was to define the characteristics of new pediatric IBD and assess the incidence of new IBD among children in Poland between 2002 and 2004. METHODS: Patient records from 24 pediatric gastroenterology centers servicing the whole population of Poland were collected. IBD diagnosis was based on clinical, radiological, endoscopic and histological features. RESULTS: There were 491 new IBD patients, representing an overall incidence of IBD of 2.7 cases/100,000 children/year. The incidence of Crohn's disease (CD) was 0.6, ulcerative colitis (UC) 1.3, and indeterminate colitis (IC) 0.8. The age-related incidence of IBD was 1.8 in the 0- to 10-year-old age group, rising to 3.7 for the 11- to 18-year age group. CONCLUSIONS: The overall incidence of IBD (as well as CD, UC and IC) in Poland is lower than that in Western countries. The relative contribution of UC and IC to the overall IBD incidence is higher in Poland than in most Western countries. These findings may suggest a tendency towards under- or misdiagnosis.

[Posterior gastric wall ulceration as a complication of percutaneous endoscopic gastrostomy. A report of 2 cases]. / Owrzodzenia tylnej sciany zoladka jako powiklania przezskórnej endoskopowej gastronomii. Opis dwóch przypadków.

Two cases of posterior gastric wall ulceration are presented as a rare complication of percutaneous endoscopic gastrostomy (PEG). Percutaneous endoscopic gastrostomy (Flocare, Nutricia) was performed in two boys (aged 2 and 19 months), who were unable to take necessary nutrients by mouth due to neurological disorders concerning swallowing and deficiency of body mass. This status does not allow to cover liquid and caloric requirement. In one case bleeding occurred 12 days after PEG insertion, in the second--6 weeks after PEG insertion. Both patients were treated with parenteral nutrition and omeprazol intravenously, with good result. The described complications are rare, however, the proton pomp inhibitors application in prevention should be considered.

[Analysis of enteral nervous system in children with drug resistant ulcerative colitis]. / Ocena jelitowego ukladu nerwowego u dzieci w przebiegu lekoopornego wrzodziejacego zapalenia jelita grubego.

INTRODUCTION: pathogenesis of inflammatory bowel diseases has been intensively investigated for many years. The role of enteric nervous system (ENS) and neuroprotective transmitters such as galanine (GAL), vasoactive intestinal peptide (VIP) and pituitary adenosine cyclase activating peptide (PACAP) has been underlined recently. Neuroprotective transmitters play a role in the regulation of intestinal contractions, ion transport in the intestinal epithelium and modulation of the proinflammatory cytokine production, which may result in diminuation of inflammation. AIM OF THE STUDY: was to investigate activity of ENS in children with drug resistant ulcerative colitis measured by the density of GAL, VIP and/or PACAP containing nervous fibres in mucosal membrane in course of pharmacological treatment and 12 months after colectomy. MATERIAL AND METHODS: 16 children were included in the study. Group I consisted of 7 children with drug resistant ulcerative colitis. Mucosal biopsy specimen was taken twice: colonoscopy before colectomy during (12 months earlier on average) and from resected colon. Group II (reference group) consisted of 9 children with excluded inflammatory bowel diseases based on colonoscopy and biopsy mucosal specimen assessment. Histology and immunochemistry of mucosal samples were analysed. RESULTS: decreased density of GAL, VIP and/or PACAP containing nervous fibres in colon mucosal membrane of children with ulcerative colitis was found: GAL-IR (3.5 +/- 3.15), VIP-IR (19.7 +/- 2.7), PACAP-IR (6.3+/-2.52) as compared to the reference group: GAL-IR (11.2+/-5.58), VIP-IR (36.1 +/- 16.0) and PACAP-IR (15.7 +/- 9.95). Significant diminuation of the density of GAL, VIP and/or PACAP containing nervous fibres was found in the study. CONCLUSION: 1. The density of VIP, PACAP and GAL containing nerve fibres diminishes in the course of ulcerative colitis, which may be a result of progressive degradation of colon mucosal membrane. 2. The hypothesis that absence of chemotaxis inhibition by low levels of neuroprotective transmitters might be a reason for drug resistance in ulcerative colitis.

[Dysphagia and gastroesophageal reflux in children with oesophageal atresia with tracheo-oesophageal fistula after succesful surgery treatment. Own observations]. / Zaburzenia polykania i refluks zoladkowo-przelykowy u dzieci z wrodzonym zarosnieciem przelyku i przetoka przelykowo-tchawicza po skutecznym zabiegu chirurgicznym. Obserwacje wlasne.

BACKGROUND: current succesful surgery of oesophageal atresia with tracheo-oesophageal fistula leads to increased survival of the affected newborns Hence late complications of the defect itself or those due to surgical methods occur more often. AIM OF THE STUDY: was to establish on the base of own observations, the frequency of swallowing problems, gastro-esophageal reflux and oesophagitis after successful surgery of oesophageal atresia. MATERIAL AND METHODS: we investigated 17 patients after successful surgery of oesophageal atresia and tracheo-oesophageal fistula, performed during the first days of life, in the Department of Paediatric Surgery, Medical University of Gdansk (chief prof Czeslaw Stoba). These patients were diagnosed and treated in the Department of Paediatrics, Paediatric Gastroenterology and Oncology, Medical University of Gdansk, during 2005-2006. There were 10 boys and 7 girls, aged from 4 to 14 years (in the - years 2005-2006). In all children, besides obtaining the detailed history concerning dyspeptic symptoms and dysphagia, upper alimentary tract endoscopy, oesophagography and pH-metric examinations were performed RESULTS: gastroesopghageal reflux (GER) was diagnosed in 41.2%, and oesophagitis, by endoscopic examination, in. 17.7% of patients. Disturbed oesophageal motility on radiography was observed in 88.2% of children. CONCLUSIONS: despite the high frequency of gastroesopghageal reflux among this group of patients, their health condition was good, dysphagia and the intensity of the oesophagitis were mild. But it should be remembered that prolonged gastroesopghageal reflux may cause serious complications.

[Inflammatory bowel disease in children--an analysis of the clinical symptoms and selected biochemical parameters]. / Nieswoiste zapalenia jelit u dzieci--analiza obrazu klinicznego i wybranych parametrów biochemicznych.

AIM OF THE STUDY: an analysis of clinical symptoms and laboratory tests in children with inflammatory bowel disease (IBD). PATIENTS AND METHODS: eighty-nine children with IBD (58 with ulcerative colitis (UC) and 31 with Crohn's disease (CD) diagnosed on the basis of clinical symptoms, endoscopic and histopathological examination, were qualified into the studied group. Disease activity was evaluated by using Truelowe-Witts scale for UC and PCDA9 scale for CD cases. Forty-two children without acute or chronic inflammatory diseases constituted the control group. RESULTS: the frequency of such clinical symptoms as: diarrhea, fever, weight loss, abdominal pain, weakness, constipations, anemia, joints pain, vomits, and jaundice was comparable in children with UC and CD while intestinal bleeding was significantly more frequently observed in patients with UC than with CD (P<0.05). There was no statistically significant difference in BMI between patients with UC and CD. Cole's index was significantly higher in children with UC than with CD (P<0.05). Hemoglobin level and serum iron level were statistically significantly lower in patients with CD than in the control group (P<0.05). Mean leukocyte count in children with CD was significantly higher than in the control group (P<0.05). Neutrophils percentage in patients with UC and CD was significantly higher than in the control group (P<0.05). Platelet count was significantly higher in all children with IBD than in the control group (P<0.05). Mean serum CRP level was significantly higher only in children with CD while ESR was significantly higher in both groups of IBD patients. Mean serum gamma-globulin level was statistically significantly higher in children with UC and with CD but no significant differences were observed in serum IgA, IgG, and IgM levels among the analyzed groups. Serum GT level was higher in children with CD than in the control group while serum ALT and AST level did not differ significantly among the analyzed groups of patients. CONCLUSIONS: 1. Serum C-reactive protein level is one of the most valuable markers for monitoring the course of IBD, especially CD, in children. 2. In patients with IBD systematic monitoring of liver function parameters (especially parameters of cholestasis) is necessary as severe hepatic complications may occur. 3. Further search for new sensitive and specific markers monitoring the course of inflammatory bowel diseases is needed.

[Tryptase activity in colon mucosal samples of children with inflammatory bowel disease]. / Aktywnosc tryptazy w bioptatach blony sluzowej jelita grubego u dzieci z przewleklym nieswoistym zapaleniem jelit.

INTRODUCTION: mast cells are dispersed in many tissues, especially in the digestive and respiratory system mucosal membranes. Tryptase is the most important proteinase released from mast cells after degranulation. It influences strongly the cells and tissues by activating the inflammatory process. THE AIM OF THE STUDY: was to assess the activity of tryptase in colon mucosa samples in children with inflammatory bowel diseases (IBD) and in children with bleedings from lower part of gastrointestinal tract (GTB), without inflammation. MATERIAL AND METHODS: a group of 30 children with IBD was analyzed in the study. IBD is formed by three disease entities: ulcerative colitis (UC) - 14 patients, Crohn's disease (CD) - 9 patients and non-specific colitis (NSC) - 7 patients. Moreover, a group of 18 children with bleeding from lower part of gastrointestinal tract was studied. The activity of tryptase in homogenates of colon mucosal samples was estimated fluoroimmunoenzymatically. RESULTS: the results of our analysis showed no statistically important difference between the mean activity of tryptase in groups of children with IBD and GTB (31442 +/- 1304 vs 31868 +/- 775 ug/l). The study of tryptase activities in different disease entities of IBD group showed, that its value in ulcerative colitis group was 31382 +/- 1170 ug/l, in Crohn's disease group it was 31536 +/- 1120 ug/l; in non-specific colitis group the tryptase activity was 32277 +/- 498 ug/l. The analysis with Kruskal-Wallis Anova test revealed that the differences are statistically significant (p = 0.034). In post hoc test the outstanding value is the tryptase activity in children with NSC. Activity of tryptase in colon in much higher than its activity in plasma (normal range 1-19 ug/l). CONCLUSIONS: the activity of tryptase in mucosal membrane samples is much higher than in blood. The extent of mast cells degranulation may be dependent on the form of IBD.

[Bone mineral density in inflammatory bowel diseases in children]. / Mineralizacja kosci u dzieci z wrzodziejacym zapaleniem jelita gruego i choroba lesniowskiego-crohna.

OBJECTIVE: determination of bone mineral density in children treated because of inflammatory bowel diseases. MATERIAL AND METHODS: 42 patients were included: 21 with ulcerative colitis and 21 with Crohn's disease. The duration of illness was from 2.0-24.0 months. Glucocorticoid therapy was applied in 92.9% of patients with the duration from 4-1680 days. The cumulative doses of glucocorticoids were from 160 to 25900 mg. Bone mineral density (BMD) and z-score of L1-L4 were assessed by dual-energy X-ray absorptiometry (DEXA). The mean BMD of L1-L4 were measured in g/cm2 and compared with referential values for gender and age. Osteopenia (ope) mean z-score from -1 to -2 SD, osteoporosis (opo) < -2 SD were accepted. RESULTS: BMD values varied from 0.531 to 1.301 g/cm. Z-score values varied from 0.9 to -5.6 SD. Bone mineral disturbances occurred in 57.2% of cases and it was equally both in 28.6% of cases osteoporosis and osteopenia. In ulcerative colitis osteopenia was predominant (23.8%), while in Crohn's disease osteoporosis occurred more often (23.8%). There was no significance in the duration time of the disease and BMD and z-score. The significant difference was found in the duration of steroid therapy and z-score. No association was found among cumulative dose of steroids and z-score. No significant differences were found in BMD and z-score of lumbar spine in ulcerative colitis and Crohn's disease. CONCLUSIONS: 1. Bone mineral disturbances often complicate inflammatory bowel diseases in children. 2. The association among the duration time of steroid therapy and bone mineral density was confirmed. 3. No significant differences were found in bone mineral density among colitis ulcerasa and Crohn's disease cases.

[Changes in the number of neuroprotective transmitter containing mucosal nerve fibres in children with ulcerative colitis]. / Zmiany w liczebnosci wlókien nerwowych zawierajacych transsmitery o charakterze neuroprotekcyjnym w blonie sluzowej jelit w przebiegu wrzodziejacego zapalenia jelita grubego u dzieci.

INTRODUCTION: Ulcerative colitis and Crohn's disease are two main disease entities that belong to the group of inflammatory bowel diseases (IBD). Chronic inflammatory process concerning intestinal mucosal membrane causes structural and functional changes of intestinal nervous system. This phenomenon is called the plasticity of the nervous system and is due to the ability of nerve cells to adapt to changing environmental conditions. The resulting alterations of intestinal neurons' chemical code are augmentation, inhibition or initiation of the neurotransmitters' synthesis (synthesis "de novo"). The role of neuroprotective transmitters - galanine (GAL), vasoactive intestinal peptide (VIP) and pituitary adenosine cyclase activating peptide (PACAP) seems to be important in the pathogenesis of inflammatory bowel diseases. They are responsible for the regulation of intestinal contraction and modification of ions' transport in the intestinal epithelium. They also diminuate the inflammation by modulation of the proinflammatory chemokines and cytokines production. THE AIM: of the study was to analyse the changes in the nerve fibres' containing GAL, VIP and/or PACAP, density in the mucosal membrane of children with ulcerative colitis (UC) with different Clinical activity index. MATERIAL AND METHODS: the study included 33 children hospitalised due to UC with different activity and 9 children in the control group, after exclusion of IBD. All the studied patients underwent colonoscopic examination with colon mucosa biopsies. Histology and immunochemistry of mucosal samples were analysed. Those studies helped to assess the changes in the number of nerve fibres containing analysed transmitter substances in the mucosal membrane of the colon. RESULTS: the results showed a statistically significant diminuation of nerve fibres containing analysed neurotransmitters number in colon mucosa samples of children with UC. There were no statistically significant changes in number of nerve fibres dependent on the clinical activity index of UC. CONCLUSIONS: the process of degradation present in UC is accompanied by the important diminuation on neurotransmitter containing fibres number. However, their density is not dependent of the clinical activity of the disease.