Three-dimensional high-resolution anorectal manometry in children after surgery for anorectal disorders.

OBJECTIVE: Three-dimensional high-resolution anorectal manometry (3DHRAM) is the most precise tool for assessing the function of the anal canal. Our aim was to evaluate children after surgery for anorectal disorders using 3DHRAM. PATIENTS AND METHODS: We prospectively enrolled 43 children (30 males; mean age: 7 years) after surgery for Hirschsprung's disease, anal atresia, or after proctocolectomy. Manometric data were compared to raw data obtained from previously studied children without symptoms arising from the lower gastrointestinal tract. Correlations between manometry and symptoms were evaluated. RESULTS: The lowest values of the resting pressure, squeeze pressure, and pressure of the puborectalis muscle were observed in the anal atresia group (55.6 mmHg, 121.7 mmHg, and 44.17 mmHg, respectively). Compared to asymptomatic children, the lowest mean resting pressures were observed in those with non-retentive fecal incontinence (61.3 mmHg, p<0.000). The receiver operating curve cut-off value for the mean resting pressure between asymptomatic children and incontinent patients was 68.5 mmHg. The thresholds of urge were significantly higher in constipated patients compared to asymptomatic patients (87.5 cm³ and 30 cm³, respectively; p=0.003). CONCLUSIONS: 3DHRAM may be a useful tool for assessing the function of the anorectum of children after surgery (NCT02296008).

Effect of omeprazole on symptoms of gastroesophageal reflux disease in children with cystic fibrosis. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: The incidence of gastroesophageal reflux disease (GERD) is higher in patients with cystic fibrosis (CF) than in the general population. While the relationship between GERD and its typical symptom, heartburn, is beyond doubt, its effect on cough or abdominal pain is unclear. In CF patients, in particular, it is often difficult to confirm the causal relationship between GERD and these symptoms. The aim of this trial was to evaluate the effect of omeprazole treatment of GERD on abdominal pain and cough, in children with CF. PATIENTS AND METHODS: This was a multicentre, randomized, double-blind, placebo-controlled trial. All children aged 4-18 years underwent 24-hour multichannel intraluminal pH-impedance monitoring. The patients with diagnosed GERD were randomly assigned to receive omeprazole (20 mg twice daily for 12 weeks) or placebo. The severity of symptoms was assessed on visual analog scale. RESULTS: 22 consecutive patients (median age 11.02± 3,67, range 6.4-17.0) were enrolled. A statistically significant reduction in abdominal pain and typical GERD symptoms, but not cough, was observed in both omeprazole (N=12) and placebo (N=10) groups. However, there were no statistically significant differences between the groups in the degree of reduction. We did not observe any differences between the groups in terms of adverse reactions. CONCLUSIONS: Treatment of GERD in children with CF seems not to have a stronger effect than a placebo on the severity of cough and abdominal pain. Considering this, as well as the previously raised concerns about the impact of chronic proton pump inhibitor treatment on the course of CF, perhaps one should be more careful in intensively treating suspected atypical GERD symptoms in patients with CF.

Gastroesophageal Reflux Disease in Children with Interstitial Lung Disease.

Gastroesophageal reflux disease is common in adult patients with interstitial lung disease. However, no data currently exist regarding the prevalence and characteristics of the disease in pediatric patients with interstitial lung disease. The aim of the present study was to prospectively assess the incidence of gastroesophageal reflux disease and characterize its features in children with interstitial lung disease. Gastroesophageal reflux disease was established based on 24 h pH-impedance monitoring (MII-pH). Gastroesophageal reflux episodes (GERs) were classified according to widely recognized criteria as acid, weakly acid, weakly alkaline, or proximal. Eighteen consecutive patients (15 boys, aged 0.2-11.6 years) were enrolled in the study. Gastroesophageal reflux disease was diagnosed in a half (9/18) of children. A thousand GERs were detected by MII-pH (median 53.5; IQR 39.0-75.5). Of these, 585 (58.5 %) episodes were acidic, 407 (40.7 %) were weakly acidic, and eight (0.8 %) were weakly alkaline. There were 637 (63.7 %) proximal GERs. The patients in whom gastroesophageal reflux disease was diagnosed had a significantly higher number of proximal and total GERs. We conclude that the prevalence of gastroesophageal reflux disease in children with interstitial lung disease is high; thus, the disease should be considered regardless of presenting clinical symptoms. A high frequency of non-acid and proximal GERs makes the MII-pH method a preferable choice for the detection of reflux episodes in this patient population.

Evaluation of laryngopharyngeal reflux in pediatric patients with asthma using a new technique of pharyngeal pH-monitoring.

There is a debate about the association between asthma and gastroesophageal and/or laryngopharyngeal reflux (LPR). Pharyngeal pH-monitoring is a new technique that allows a physician to assess whether reflux passes the upper esophageal sphincter barrier. The aim of the study was to assess the prevalence of LPR in children with difficult-to-treat asthma. The present study was an open, prospective one. A total of 21 subjects of the mean age 12.7 years were enrolled in the study. All children were asked to fill out a Reflux Symptoms Index questionnaire and a 24-h pharyngeal pH monitoring was performed, using the Dx-pH Measurement System. The LPR was diagnosed in 13 (61.9%) children. There was a positive correlation between LPR diagnosis and the degree of asthma control. The LPR was more frequent in children treated with a higher than lower doses of fluticasone (p = 0.019, OR = 17.3) and in those using montelukast compared with non-users (p = 0.008, OR = 19.0). The mean Reflux Symptoms Index score was almost twice greater in children with LPR than in those without it (13.2 vs. 6.8, respectively, p = 0.003). We conclude that the prevalence of laryngopharyngeal reflux in children with difficult-to-treat asthma is substantial.

[Diagnostic and therapeutic problem of infected arteriovenous fistula for hemodialysis-case report]. / Problemy diagnostyki i leczenia zakazonej przetoki tetniczo-zylnej do hemodializy--opis przypadku.

On the case of 48 old patient with chronic renal failure, treated with repeated hemodialyses, we described diagnostic and therapeutic problems of infected arterio-venous fistula of severe clinical course and rare epidemiology (Staphylococcus warneri). Special attention was paid to the difficulties in the confirmation of bacterial etiology of this infection as well as practical usefulness of ultrasonography in the monitoring of clinical course and therapy of infected arteriovenous fistula.

[The role of natural growth stimulators in regulation of regeneration processes in small intestinal epithelium after irradiation]. / Rola naturalnych stymulatorów wzrostu w regulacji procesów odnowy nablonka jelita cienkiego po napromienieniu.

In this paper, basing on recently published data, the influence of growth factors on small intestine epithelium regeneration after irradiation is presented. Our knowledge of growth control in the small intestine mucosa may become an accepted mode of radio-, chemotherapy and the treatment of acute radiation sickness in the future. Results of recent studies suggest that there are different factors which can modulate the process of epithelium regeneration. Some of them such as gastrin, enteroglucagon, CCK, EGF, FGF, TGF and IL-11 are able to enhance this process. In addition, other factor-PGE-2 is responsible for not only stimulation of small intestine epithelium growth but radioprotection as well.