Retrospective study of budesonide in children with eosinophilic gastroenteritis.

BACKGROUND: The effectiveness of budesonide (BUD), a locally active steroid, on eosinophilic gastroenteritis (EGE) is not well understood. This study is to retrospectively evaluate the efficacy of BUD in children with EGE. METHODS: Forty-four children, diagnosed with EGE, were enrolled from 2013 to 2017 in our center. According to patients' preference, all the patients were treated with dietary elimination (DE) and montelukast therapy, or combined with prednisone (PRED)/BUD. Patients' clinical manifestations, treatments, and outcomes were reviewed from the medical records. Twenty-four patients (7 PRED, 7 BUD, 10 DE) received therapy for ≥8 weeks, followed by repeat endoscopy and biopsies. Histological response was defined as <20 eos/hpf (eosinophils per high-power field). RESULTS: Significant number of patients in DE+PRED (6/7, 85.7%) and DE+BUD (6/7, 85.7%) groups achieved histological response than in the DE group (3/10.30%) (p = 0.024). Mean post-treatment peak eos/hpf in the DE+PRED group was 16.57 ± 6.85 vs. 10.00 ± 5.07 in the DE+BUD group vs. 36.60 ± 24.57 in the DE group (p = 0.009). Change of eos/hpf from pre- to post-treatment was -49.86 ± 45.02 vs. -34.29 ± 23.44 in the BUD group vs. -0.3 ± 23.95 in the DE group (p = 0.011). There were no significant differences between DE+PRED and DE+BUD groups (p = 0.470, p = 0.363, respectively). CONCLUSION: BUD is effective in the treatment of EGE and has similar effectiveness with PRED.

Recent advances in complementary and replacement therapy with nutraceuticals in combating gastrointestinal illnesses.

The digestive system provides nourishment to the whole body. Disorders in this system would result in many associated illnesses as the body is deprived of essential nutrients. Gastrointestinal diseases, in particular, gastric ulceration, inflammatory bowel diseases and colorectal cancer have become more prevalent in all population age groups. While this can be attributed to diet and lifestyle changes, the measures to combat these illnesses with conventional drugs is losing popularity owing to the harsh side effects, drug resistance and lack of patient compliance. The focus of this review is to endorse promising nutraceutical dietary components such as phytosterols, polyphenols, anthocyanins and polyunsaturated fatty acids and their synergistic value, in combination with conventional management of key gastrointestinal diseases. As most of these nutraceuticals are labile compounds, the need for protection and delivery using a carrier system is stressed and the methods for targeting to specific parts of the gastrointestinal tract are discussed. A section has also been devoted to perspectives on co-encapsulation methods of drugs and nutraceuticals using different particle systems. Multilayered carrier systems like double layered and core shell particles have been proposed as an exemplary system to co-encapsulate both drugs and nutrients while keeping them segregated.

High Prevalence of Eosinophilic Gastrointestinal Disease in Children With Intestinal Failure.

OBJECTIVES: The aim of the present study was to describe the prevalence and clinical features of gastrointestinal (GI) eosinophilic inflammation among pediatric patients with intestinal failure (IF). METHODS: Medical records of all patients studied in our institution's IF program who underwent GI endoscopy over a 15-year period were reviewed, and clinical, pathologic, nutrition, and laboratory data collected. RESULTS: One hundred five patients underwent 208 GI endoscopic procedures with biopsy. The overall prevalence of eosinophilic inflammation, defined as increased eosinophils in at least 1 tissue type on at least 1 endoscopy, was 39 of 105 (37%). The tissue-specific prevalence of eosinophilic inflammation ranged widely, with the colon/rectosigmoid being the most common (18/68, 26%), followed by the esophagus (17/83, 20%), ileum (9/54, 17%), duodenum (4/83, 5%), and stomach (3/83, 4%). Higher peripheral eosinophil count and hematochezia were associated with eosinophilic inflammation in the colon (P = 0.002 and 0.0004, respectively). The use of a strict elemental diet for 3 months before endoscopy was not associated with a decreased frequency of eosinophilic inflammation in any tissue. CONCLUSIONS: Eosinophilic inflammation is a common histopathological finding in patients with IF. Colonic eosinophilic inflammation is associated with clinical symptoms of GI blood loss, and peripheral eosinophilia, and was not abrogated by a strict elemental diet.

Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis.

Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.

Eosinophilic gastrointestinal disease and inflammatory bowel disease in children: is it a disease continuum?

Eosinophilic gastrointestinal disease (EGID) and inflammatory bowel disease (IBD) are two distinct disorders that share some clinical manifestations but have different diagnostic criteria. In this article, we reviewed the clinical data of three children with EGID who later developed IBD. This study is a retrospective case note review that was conducted between 2007 and 2012. EGID seems to precede IBD in some subsets of children in whom the diagnosis of IBD may take a few years to fully develop.

Eosinophilic gastritis in children: clinicopathological correlation, disease course, and response to therapy.

OBJECTIVES: Eosinophilic gastritis (EG), defined by histological criteria as marked eosinophilia in the stomach, is rare, and large studies in children are lacking. We sought to describe the clinical, endoscopic, and histopathological features of EG, assess for any concurrent eosinophilia at other sites of the gastrointestinal (GI) tract, and evaluate response to dietary and pharmacological therapies. METHODS: Pathology files at our medical center were searched for histological eosinophilic gastritis (HEG) with ≥70 gastric eosinophils per high-power field in children from 2005 to 2011. Pathology slides were evaluated for concurrent eosinophilia in the esophagus, duodenum, and colon. Medical records were reviewed for demographic characteristics, symptoms, endoscopic findings, comorbidities, and response to therapy. RESULTS: Thirty children with severe gastric eosinophilia were identified, median age 7.5 years, 14 of whom had both eosinophilia limited to the stomach and clinical symptoms, fulfilling the clinicopathological definition of EG. Symptoms and endoscopic features were highly variable. History of atopy and food allergies was common. A total of 22% had protein-losing enteropathy (PLE). Gastric eosinophilia was limited to the fundus in two patients. Many patients had associated eosinophilic esophagitis (EoE, 43%) and 21% had eosinophilic enteritis. Response to dietary restriction therapy was high (82% clinical response and 78% histological response). Six out of sixteen patients had persistent EoE despite resolution of their gastric eosinophilia; two children with persistent HEG post therapy developed de novo concurrent EoE. CONCLUSIONS: HEG in children can be present in the antrum and/or fundus. Symptoms and endoscopic findings vary, highlighting the importance of biopsies for diagnosis. HEG is associated with PLE, and with eosinophilia elsewhere in the GI tract including the esophagus. The disease is highly responsive to dietary restriction therapies in children, implicating an allergic etiology. Associated EoE is more resistant to therapy.

Dietary sulforaphane-rich broccoli sprouts reduce colonization and attenuate gastritis in Helicobacter pylori-infected mice and humans.

The isothiocyanate sulforaphane [SF; 1-isothiocyanato-4(R)-methylsulfinylbutane] is abundant in broccoli sprouts in the form of its glucosinolate precursor (glucoraphanin). SF is powerfully bactericidal against Helicobacter pylori infections, which are strongly associated with the worldwide pandemic of gastric cancer. Oral treatment with SF-rich broccoli sprouts of C57BL/6 female mice infected with H. pylori Sydney strain 1 and maintained on a high-salt (7.5% NaCl) diet reduced gastric bacterial colonization, attenuated mucosal expression of tumor necrosis factor-alpha and interleukin-1beta, mitigated corpus inflammation, and prevented expression of high salt-induced gastric corpus atrophy. This therapeutic effect was not observed in mice in which the nrf2 gene was deleted, strongly implicating the important role of Nrf2-dependent antioxidant and anti-inflammatory proteins in SF-dependent protection. Forty-eight H. pylori-infected patients were randomly assigned to feeding of broccoli sprouts (70 g/d; containing 420 micromol of SF precursor) for 8 weeks or to consumption of an equal weight of alfalfa sprouts (not containing SF) as placebo. Intervention with broccoli sprouts, but not with placebo, decreased the levels of urease measured by the urea breath test and H. pylori stool antigen (both biomarkers of H. pylori colonization) and serum pepsinogens I and II (biomarkers of gastric inflammation). Values recovered to their original levels 2 months after treatment was discontinued. Daily intake of sulforaphane-rich broccoli sprouts for 2 months reduces H. pylori colonization in mice and improves the sequelae of infection in infected mice and in humans. This treatment seems to enhance chemoprotection of the gastric mucosa against H. pylori-induced oxidative stress.

Study of crib-biting and gastric inflammation and ulceration in young horses.

Nineteen young horses that had recently started to perform the stereotypy of crib-biting were compared with 16 non-stereotypic horses for 14 weeks. After initial observations of their behaviour and an endoscopic examination of the condition of their stomachs, the horses were randomly allocated to a control or an antacid diet At the start of the trial, the stomachs of the crib-biting foals were significantly more ulcerated and inflamed than the stomachs of the normal foals. In addition, the faecal pH of the crib-biting foals (6.05) was significantly lower than that of the normal foals (6.58). The antacid diet resulted in a significant improvement in the condition of the horses' stomachs. The crib-biting behaviour declined in most of the foals, regardless of their diet, but tended to decline to a greater extent in the foals on the antacid diet.

Tromboprofilaxis en cirugía de cadera con Heparina de bajo peso molecular: enoxaparina sódica / Thromboprophylaxis in hip surgery with a low molecular weight heparin: sodium enoxaparin

El objeto del estudio es determinar la seguridad de una heparina de bajo peso molecular (HBPM) Enoxaparina sódica, en cirugía ortopédica mayhor mediante un estudio cánico experimental aleatorizado con 71 pacientes hospitalizados para cirugía de cadera en el Servicio de Ortopedia y Traumatología del Hospital Nacional Guillermo Almenara Irigoyen - IPSS, entre Diciembre 1996 y Marzo 1997. Se incluyeron en el grupo-profilaxis 35 pacientes que recibieron Enoxaparina sódica 40 mg/d desde 12 hrs antes de la operación y 36 pacientes en el grupo-control que siguieron el esquema convencional sin usar anticoagulantes. El volumen de sangrado intra y postoperatorio, sangrado mayor operatorio, y las alteraciones en el perfil de coagulación no mostraron diferencias estadísticamente significativas entre los dos grupos. Tampoco se presentó sangrado extraoperatorio, ni reacciones adversas al fármaco. Eln porcentaje de fallecidos en el grupo-control fue de 2.7 por ciento y cero en el grupo-profilaxis. La profilaxis de tromboembolismo venosos en cirugía de cadera con Enoxaparina sódica, mostró seguridad, tolerancia y facilidad de manejo sin necesidad de monitoreo de laboratorio

Tratamiento dietético con Alicina en la gastritis crónica por Helicobacter pylóri en el Hospital IPSS Tacna / Alicine diethetical therapy for helicobacter pylori chronic gastritis at SSPI Tacna Hospital

Se realizó un estudio prospectivo experimental ciego, en pacientes que acudieron a la consulta gastroenterológica del Hospital II IPSS - Tacna por presentar cuadro clínico de gastritis. Se estudiaron 18 pacientes quiénes tuvieron endoscopía y biopsia antes y después de la administración de alicina (un diente de ajo) por 20 días, con un grupo de control de 15 pacientes. Los resultados mostraron negativización de Helicobacter pylóri en el 71 por ciento de pacientes que recibieron alicina, frente al grupo control que sólo negativizó el 16 por ciento. Este estudio demostroó la influencia dietética de algunos elementos como la alicina en el curso natural de la lenfermedad y una alternativa que debe se considerada como tratamiento en poblaciones grandes con escasos recursos económicos

Lymphocytic gastritis and associated small bowel disease: a diffuse lymphocytic gastroenteropathy?

AIM: To investigate the natural history of lymphocytic gastritis (LG) and its relation to Helicobacter pylori infection and to coeliac disease using serology, duodenal biopsy and a small intestinal permeability test. METHOD: Twenty two patients diagnosed as having LG between 1984 and 1994 were investigated by upper gastrointestinal endoscopy at which gastric and duodenal biopsy specimens were taken for histological assessment and immunohistology. Serum was collected for measurement of anti-H pylori, anti-gliadin and anti-endomysial antibodies. A lactulose/mannitol absorption test was performed within one week of endoscopy. Control groups were studied by histology, serology and permeability tests. RESULTS: Three patients had been recently diagnosed as having LG while 15 still had the condition after a mean of 13.9 (range two to 38) months. LG involved the antrum alone in three patients, antrum and body in seven, body alone in six, and gastric remnant in two. Gastroduodenal intraepithelial lymphocytes (IELs) were T cells and predominantly of T suppressor (CD8) type. Duodenal IELs were increased compared to age/sex matched controls with chronic gastritis. Four patients had duodenal villous atrophy. Four patients no longer had LG after a mean of 29.3 (10-70) months but had increased gastroduodenal IELs. H pylori was present in four (22%) of 18 patients with LG but H pylori serology was positive in 11 (61%) of 18. There was no difference in seropositivity when compared with age/sex matched controls with dyspepsia. Eleven of 20 patients with LG tested had abnormal lactulose/mannitol absorption (v none of 22 controls with chronic gastritis). Four patients with LG, all with villous atrophy, were seropositive for IgA endomysial antibody. CONCLUSIONS: The persistence of LG with time, the association with increased duodenal IELs and abnormal small intestinal permeability suggests LG may be a manifestation of a diffuse lymphocytic gastroenteropathy related to sensitivity to gluten or some other agent.

[Effect of fruit and vegetable juices on the changes in the production of carcinogenic N-nitroso compounds in human gastric juice]. / Modifitsiruiushchee vliianie fruktovykh i ovoshchnykh sokov na obrazovanie kantserogennykh N-nitrozosoedinenii v zheludochnom soke cheloveka.

The study was made of the effect of apple, grapefruit, orange and beet juices on in vitro formation of N-nitrosodimethylamine (NDMA) from sodium nitrite and amidopirin in human gastric juice (GJ). Experimental samples of GJ from outpatients attending the outpatient department of the AMS Cancer Research Center were used. The patients had various forms of gastritis and gastric cancer. It was found that fruit and beet juices may inhibit or enhance NDMA formation depending on the GJ composition, pH in particular. In acid medium (pH-1.3-3.4) there was a trend to inhibition of NDMA synthesis, while in neutral and alkaline (pH = 7.4-8.5) medium NDMA synthesis is activated. Practical implications of the findings are discussed.

[Effect of diet therapy on the changes of vitamin C content in the blood and urine of patients with chronic gastritis and peptic ulcer]. / Izmenenie v soderzhanii vitamina C v krovi i moche bolnykh khronicheskimi gastritami, iazvennoi bolezníu zheludka i dvenadtsatiperstnoi kishki v protsesse dietoterapii.

Estimation and analytical methods were employed to investigate real rations of patients with gastroduodenal ulcer. Chemical composition of diet N 1 was found unsatisfactory both by ascorbic acid and carbohydrates content responsible for low-caloric value of the diet. The ration correction with additional provision of vegetables, fruit, greens raised vitamin C intake by the patients though the deficiency was not abolished.

[Clinico-instrumental studies of the digestive system during diet therapy using culinary products prepared in ultra-high frequency ovens]. / Kliniko-instrumental'nye issledovaniia pishchevaritel'nogo apparata pri ispol'zovanii v lechebnom pitanii kulinarnykh izdelii, prigotovlennykh v SVCh-pechakh.

A total of 148 patients aged 18-66 years were examined. Of these, 86 subjects received an experimental diet, while 62 were placed on the common dietetics. Both single and 10-day nutrition with products manufactured in ultra-high ovens (UHF products) did not produce any adverse effect on the mean estimates of acid-forming function of the stomach and pH in the basal phase of gastric secretion or on the pattern of gastric mucus formation in patients. Histological study of the biopsy specimens of the gastric mucosa in patients who received UHF products did not reveal any specific time course of changes in its morphology and function. The blood flow in the gastric mucosa varied within an insignificant range (10-15 cal/min). Fifty per cent of patients who received UHF products without any additional treatment methods showed moderate positive shifts in the clinical and physiological parameters under study. Based on the data obtained the authors draw the conclusion about the lack of an unfavourable effect of UHF products, thinking it advisable to use such products, particularly in a complex of therapeutic measures.