Fluoroscopic criteria for on-site evaluation of failed intussusception reduction during air enema technique.

Background: There is no reliable fluoroscopic criteria for failed intussusception reduction during air enema technique. Methods: This retrospective case-control study included 373 episodes of ileocolic intussusceptions who had undergone air enema under fluoroscopy. All procedures were initially classified by conventional fluoroscopic criteria: presumptive successful procedures (PSP) vs. presumptive failed procedures (PFP). PFP were divided into true failure, false failure, and undetermined groups. The configuration and size of the residual mass were evaluated on fluoroscopic images. Statistical analyses included Mann-Whitney U-test, Fisher's exact test, receiver operating characteristic (ROC) analysis, logistic regression analyses, and Kruskal-Wallis rank sum test with a post hoc Tukey test. Results: PSP was 264 episodes (71%) and PFP was 109 episodes (29%). The true failure was 40 (37%) and false failure was 48 (44%). The true failure group commonly showed a larger size and round configuration for the residual mass than false failure (P<0.001). Multivariable analysis revealed configuration (P=0.004) and transverse diameter (P=0.007) as significant parameters that differentiated true and false failure. The optimal cut-off value of the transverse diameter of the residual mass was 2.3 cm. The sensitivity and specificity of conventional fluoroscopic criteria for failed reduction was 100% and 85%, respectively. The combination of new fluoroscopic findings and conventional criteria increased the specificity to 100%. Conclusions: Fluoroscopic finding of round-shape and larger size residual mass combined with conventional criteria may be useful for differentiating false failure from truly failed enema reduction in children with intussusception.

The effects of three alternative treatment strategies after 8 weeks of proton pump inhibitor therapy for GERD in children.

OBJECTIVES: The purpose of this 24-week treatment study was to evaluate the effects of three treatment strategies after 8 weeks of lansoprazole therapy for gastroesophageal reflux disease in children. DESIGN: Open-labelled, uncontrolled, prospective study. SETTING: Samsung Medical Center, Seoul, Korea. METHODS: 37 erosive reflux disease (ERD) and 20 non-erosive reflux disease (NERD) patients were divided into three groups by symptom assessment at 8 weeks: (1) observation without treatment in the 'symptoms-resolved' group, (2) 'on-demand' treatment for an additional 16 weeks in the 'symptoms-attenuated' group and (3) continuous treatment in the 'symptoms-persistent' group. RESULTS: For ERD, six (100%) out of six patients in the 'symptoms-resolved' group remained improved at weeks 16 and 24. Sixteen (72.7%) out of 22 patients in the 'symptoms-attenuated' group had improvement of symptoms at 16 weeks, and 18 (81.8%) patients at 24 weeks. Six (66.7%) out of nine patients in the 'symptoms-persistent' group remained improved at weeks 16 and 24. For NERD, seven (100%) out of seven patients in the 'symptoms-resolved' group remained improved at weeks 16 and 24. Eight (80.0%) out of 10 patients in the 'symptoms-attenuated' group remained improved at week 16, and 10 (100.0%) patients at week 24. None out of three patients in the 'symptoms-persistent' group remained improved at weeks 16 and 24. CONCLUSIONS: The selection of each alternative for long-term management according to the results of the assessment of symptoms at week 8 was useful and well tolerated. 'On-demand' therapy was equally effective. The 16-week therapy had the same efficacy as the 24-week therapy with regard to long-term lansoprazole treatment.

Is colonoscopy necessary in children suspected of having colonic polyps?

BACKGROUND/AIMS: The clinical spectrum, histology, and endoscopic features of colonic polyps in the pediatric age group were studied to evaluate the role of colonoscopy in children suspected of having colonic polyps. METHODS: Seventy-six patients with colorectal polyps were studied. Investigations included barium enema (n=6), sigmoidoscopy (n=17), and colonoscopy (n=53) at the initial visit. Colonoscopy was also performed in 23 patients who received barium enema or sigmoidoscopy. Data related to age, gender, family history, signs, symptoms, size, location, polyp types, and associated diseases were collected and analyzed. RESULTS: Among the 76 patients, juvenile polyps were detected in 58 (76.3%), potentially premalignant polyposis in 17 (22.4%), familial adenomatous polyposis in 11 (14.5%), Peutz-Jegher syndrome in 4 (5.3%), and juvenile polyposis syndrome in 2 (2.6%). Twenty-two patients (28.9%) had polyps in the upper colon. All patients with potentially malignant polyps had polyps in both the upper colon and rectosigmoid colon. CONCLUSIONS: Although most of the children with colorectal polyps had juvenile polyps, a significant number of cases showed multiple premalignant and proximally located polyps. This finding emphasizes the need for a colonoscopy in such patients. Thus, the risk of malignant change, particularly in children with multiple polyps, makes surveillance colonoscopy necessary.

The expression of iron-repressible outer membrane proteins in Helicobacter pylori and its association with iron deficiency anemia.

BACKGROUND: Helicobacter pylori infection is known to be a cause of iron deficiency anemia (IDA) that is unresponsive to iron supplements. H. pylori bind iron to a specific receptor by iron-repressible outer membrane proteins (IROMPs) under conditions of restricted iron. MATERIALS AND METHODS: We compared the expression of IROMPs from strains of H. pylori under both iron-restricted and iron-supplemented conditions to determine the difference between strains with and without IDA. One standard strain, two clinical strains, and three IDA strains were cultured; and then the IROMPs were extracted under iron-restricted and iron-supplemented conditions. We used SDS-PAGE to compare the expression of the IROMPs from each strain. RESULTS: IROMPs were found in IDA strains under iron-restricted conditions and their molecular sizes were estimated to be 56, 48, 41, and 37 kDa. In the iron-repleted media, the IROMPs were no longer present. CONCLUSION: In the iron-depleted state, specific H. pylori strains associated with IDA demonstrated an advantage in iron acquisition due to a higher expression of IROMPs. Our results can explain in part why some patients with H. pylori infection are more prone to develop clinical IDA under restricted iron conditions in the host.

Allergic proctitis and abdominal distention mimicking Hirschsprung's disease in infants.

AIM: To determine the incidence and clinical aspects of allergic proctitis (AP) in infants with symptoms that mimic Hirschsprung's disease (HD). METHODS: One hundred and five patients less than 6 months of age, who underwent barium enema, anorectal manometry and rectal suction biopsy due to suspicion of HD, were enrolled. Comparison of the patient characteristics associated with each disease was based on the results of the triple testing. The sensitivity and specificity of the three tests, for the diagnosis of HD, were evaluated. RESULTS: The mean age of enrolled patients was 2.1+/-0.9 months. Based on the three tests, 39 patients (37.1%) were diagnosed with HD, seven patients (6.7%) with AP, and 53 (50.5%) had normal results. Of the 54 patients with transitional zone and a reversed rectosigmoid index on the barium enema, four (7.4%) were patients with AP. The mean age of the AP patients (3.1+/-1.5 months old) was older than the HD children (1.4+/-0.9 months old). The sensitivity of the three tests for HD was 97.4%, 87.2% and 92.3% and the specificity was: 74.2%, 78.8% and 100%, respectively. CONCLUSIONS: In the infants with severe abdominal distention, the incidence of AP mimicking HD was relatively high. Therefore, consideration of AP should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic HD. For differentiation of these disorders, a rectal suction biopsy is very useful.

Hepatocyte transplantation for glycogen storage disease type Ib.

Glycogen storage disease type I (GSD-I) is a group of autosomal recessive disorders with an incidence of 1 in 100,000. The two major subtypes are GSD-Ia, caused by a deficiency of glucose-6-phosphatase (G6Pase), and GSD-Ib, caused by a deficiency of glucose-6-phosphate transporter (G6PT). We report that a substantial improvement was achieved following several infusions of hepatocytes in a patient with GSD-Ib. Hepatocytes were isolated from the unused cadaveric whole livers of two donors. At the first transplantation, approximately 2 x 10(9) cells (2% of the estimated recipient's total hepatocytes) were infused. Seven days later 1 x 10(9) (1% of liver mass) cryopreserved hepatocytes from the same donor were infused, and an additional 3 x 10(9) (3% of liver mass) cells from the second donor were infused 1 month after the second transplantation. After the hepatocyte transplantation, the patient showed no hypoglycemic symptoms despite the discontinuation of cornstarch meals. Liver biopsies on posttransplantation days 20 and 250 showed a normal level of glucose-6-phosphatase activity in presolubilization assay that was very low before transplantation. This was the first and successful clinical hepatocyte transplantation in Korea. In this study, hepatocyte transplantation allowed a normal diet in a patient with GSD-Ib, with substantial improvement in their quality of life. Hepatocyte transplantation might be an alternative to liver transplantation and dietary therapy in GSD-Ib.