Características clínicas y manejo de lactantes menores de 1 año con sospecha de alergia a proteína de leche de vaca / Clinical characteristics and management of infants less than 1-year-old suspected with allergy to cow's milk protein

Introducción: La alergia a proteína de leche de vaca (APLV) es frecuente en lactantes (2-5% en < 1 año). Tiene múltiples formas de presentación y un amplio diagnóstico diferencial, por lo que es relevante confirmar el diagnóstico. El estándar de oro del diagnóstico es el test de provocación oral (TPO), que en la práctica no siempre se realiza. En Chile hay escasa literatura respecto a esta entidad. Objetivo: Describir características demográficas, clínicas y manejo de lactantes < 1 año con sospecha de APLV. Pacientes y Método: Estudio retrospectivo en menores de 1 año atendidos por sospecha de APLV entre 2009-2011. Se registraron datos demográficos, historia perinatal, antecedentes de atopia, alimentación al momento del diagnóstico, síntomas de sospecha de APLV, estudios realizados para su confirmación, y respuesta a tratamiento. Se consideró como estándar de diagnóstico la respuesta a la dieta y la contraprueba. Se definió como respuesta a la dieta la ausencia de los síntomas atribuidos a la APLV al menos 4 semanas desde el cambio de leche. Se realizó estadística descriptiva mediante programa Epiinfo™. Resultados: Se incluyeron 106 lactantes, 51% varones, 80% recién nacidos de término, 74% con al menos un progenitor atópico, 34% con alguno de los padres o algún hermano con alergia alimentaria. La mediana de edad al inicio fue 1,5 meses (rango: 1,5-2 m). El 15% recibió fórmula desde el período neonatal y el 50% antes del tercer mes. Los síntomas más frecuentes fueron: vómitos (63%), cólicos (50%) y rectorragia (40%); el 61% presentó ≥ 2 síntomas al comienzo. Solo en el 34% se hizo TPO, en el resto se evaluó la respuesta a la dieta de exclusión y se realizaron exámenes. La realización de exámenes no cambió la conducta. Tratamiento: 43% lactancia materna con dieta de exclusión, 24% solo fórmula extensamente hidrolizada, 26% solo fórmula aminoacídica y 7% otros. Conclusión: Las características demográficas y antecedentes de los pacientes concuerdan con lo descrito en la literatura extranjera. El inicio clínico fue precoz, predominando los síntomas digestivos. Se realizaron exámenes en una proporción alta de pacientes, sin contribuir a un cambio de conducta; el TPO fue subutilizado como herramienta diagnóstica.

Introduction: Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. Objective: To describe the demographic and clinical features of infants with suspected CMPA. Patients and Method: A retrospective study of patients < 1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. Results: The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with ≥ 1 atopic parent, and 34% with ≥ 1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2 m). Almost half (46%) were breast-feeding ≥ 6 m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had ≥ 2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. Conclusion: Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.

Infantile colic--unfolded.

Infantile colic is a common complaint for which mothers bring their babies to pediatricians. Though the condition has been a cause of controversy and a subject of extensive research, no consensus is yet reached on its definition, etio-pathogenesis and management. This article reviews the existing literature on present subject.

Prevalencia de síntomas digestivos en mujeres adultas normales y su asociación a la litiasis biliar / Prevalence ofdigestive symptoms in normal adult women and it association with biliary lithiasis

The aim of this work was to study the prevalence of biliary diseases and digestive symptoms in normal adult women. Four hundred nineteen women were chosen; of these 145 were discarded due to previous gastrointestinal disease (20), previous gastrointestinal complaints (38) and previous cholecystectomy (85). Two hundred seventy six women were subjected to abdominal ultrasound examination; of these, 53 had cholelithiasis and in three a gallbladder cancer was suspected (and confirmed by surgery). Considering women with previous cholecystectomy, cholelithiasis and gallbladder cancer, a 33.6 per cent prevalence of biliary diseases can be inferred. An interrogation about gastrointestinal symptoms was performed to women subjected to ultrasound examinations by 2 professionals unware of ultrasound results. A high frequency of pyrosis, food intolerance and constipation was found, not observing differences between women with or without cholelithiasis. However, these last women had a higher frequency of upper abdominal pain. Both groups had also a high rate of previous surgical procedures

Colicas do lactente: a visao do pediatra / Colics of the infant: the vision of the pediatrician

Os autores realizam um estudo sobre a visao do medico pediatra a respeito de colicas do lactente, baseado em dados obtidos atraves de um questionario distribuido em um congresso de pediatria ambulatorial. Foram avaliados os itens incidencia, criterios diagnosticos, etiologia e tratamento. Os autores procuram demonstrar que a colica e um problema prevalente em nosso meio, evidenciam a falta de conhecimento adequado sobre a etiologia e a pratica de um tratamento questionavel. Alem disso fazem uma discussao sobre o assunto baseada na literatura medica atual .