Gastric emptying of solids in children: reference values for the (13) C-octanoic acid breath test.

BACKGROUND: (99m) Technetium scintigraphy ((99m) TS) is the 'gold standard' for measuring gastric emptying (GE), but it is associated with a radiation exposure. For this reason, the (13) C-octanoic acid breath test ((13) C-OBT) was developed for measuring GE of solids. The objective of this study was to determine normal values for gastric half-emptying time (t1/2 GE) of solids in healthy children. METHODS: Gastric emptying of a standardized solid test meal consisting of a pancake evaluated with (99m) TS and (13) C-OBT was compared in 22 children aged between 1 and 15 years with upper gastrointestinal symptoms. Subsequently, the (13) C-OBT was used to determine normal values for GE of the same solid test meal in 120 healthy children aged between 1 and 17 years. KEY RESULTS: The results showed a significant correlation (r = 0.748, p = 0.0001) between t1/2 GE measured with both techniques in the group of children with upper gastrointestinal symptoms. In the group of healthy children, mean t1/2 GE was 157.7 ± 54.0 min (range 71-415 min), but t1/2 GE decreased with age between 1 and 10 years and remained stable afterward. There was no influence of gender, weight, height, body mass index, and body surface area on t1/2 GE. CONCLUSIONS & INFERENCES: Normal values for GE of solids measured with the (13) C-OBT using a standardized methodology were determined in healthy children. We propose to use this method and corresponding reference ranges to study GE of solids in children with gastrointestinal problems.

The use of probiotics in IBD and IBS.

While the role of microflora is well established in the development of inflammatory bowel disease (IBS); data is still emerging regarding IBS as the knowledge on brain-gut interaction grows. For both patient groups multiple efficacious treatments exist, but there are still unmet needs as long term disease control remains an issue. Given the importance of the microbiome on the development of the immune system and the interaction between the microbiome and the host organism, this "route" is being examined increasingly as a therapeutic possibility in both pathologies with variable results. We here provide a short overview on the existing data, meta-analysis and single studies, on probiotic treatment in both diseases.

Hospital-related undernutrition in children: still an often unrecognized and undertreated problem.

AIM: To evaluate the nutritional status of hospitalized children in Belgian hospitals and to analyse the impact of undernutrition on the degree of weight loss and duration of hospitalization. METHODS: In each hospital (one tertiary and three secondary hospitals), 100 consecutively hospitalized children were eligible for inclusion. Of these, 379 were included for analysis. Body weight, length and mid-upper arm circumference were measured at admission and body weight also at discharge. RESULTS: The median (range) age was 2.1 (0.8-17) years. On admission, 29 (7.7%) children were chronically malnourished and, depending on the parameter, between 2.4% and 9.8% acutely undernourished, while 12.1% had at least one subnormal parameter. Median (range) duration of hospitalization was four (1-64) days. Median (range) weight change was 0.0% (-15.6% - +13.9%). Weight loss of >2% was significantly (p < 0.05) more prevalent in tertiary (20.0%) than in secondary (10.2%) hospitals. Median hospital duration was 50% longer for chronically malnourished children (6.0 vs 4.0 days; p < 0.01). Only 36 children received a nutritional intervention. CONCLUSION: Acute undernutrition and chronic undernutrition remain frequent findings in hospitalized children in Belgium. Children with chronic undernutrition had a 50% longer hospital stay. Hospital-related undernutrition is an often unrecognized problem, because only one-third of the acutely malnourished children received nutritional support.

Probiotics and prebiotics in infants and children.

Probiotics and prebiotics have a major influence on gastrointestinal flora composition. This review analyses the relationship between this change in flora composition and health benefits in children. Literature databases were searched for relevant articles. Despite exhaustive research on the subject in different indications, such as prevention and treatment of acute gastroenteritis, antibiotic associated diarrhea (AAD), traveler's diarrhea, inflammatory bowel disease, irritable bowel syndrome, Helicobacter pylori, necrotizing enterocolitis, constipation, allergy and atopic dermatitis, colic and extraintestinal infections, reports of clear benefits for the use of prebiotics and probiotics in pediatric disorders remain scarce. The best evidence has been provided for the use of probiotics in acute gastroenteritis and in prevention of AAD. However, AAD in children is in general mild, and only seldom necessitates additional interventions. Overall, the duration of acute infectious diarrhea is reduced by approximately 24 hours. Evidence for clinically relevant benefit in all other indications (inflammatory bowel disease, irritable bowel syndrome, constipation, allergy) is weak to nonexistent. Selected probiotic strains given during late pregnancy and early infancy decrease atopic dermatitis. Adverse effects have very seldom been reported. Since the risk seems minimal to nonexistent, prebiotics and probiotics may be helpful in the prevention and treatment of some disorders in children, although the evidence for benefit is limited. The best evidence has been accumulated for some lactobacilli strains and for Saccharomyces boulardii in the reduction of the duration of acute diarrhea due to gastroenteritis and prevention of AAD.

A preliminary report on the efficacy of the Multicare AR-Bed in 3-week-3-month-old infants on regurgitation, associated symptoms and acid reflux.

OBJECTIVES: The aim of this preliminary study was to evaluate the efficacy of a 40 degrees supine body position on infant regurgitation, reflux-associated symptoms and acid reflux. INTERVENTION: Thirty of 52 consecutive infants presenting with frequent regurgitation and reflux-associated symptoms occurring mainly during feeding were evaluated in the Multicare AR-Bed (Peos, Ninove, Belgium). The Infant-Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R) and an oesophageal pH monitoring were performed at inclusion and after 1 week. RESULTS: Eight out of 30 (27%) infants did not tolerate the 40 degrees positioning, and had to be taken out of the study within the first 2 days. However, in 22/30 (73%) infants the I-GERQ-R and acid reflux decreased significantly with the Multicare AR-Bed. The mean duration of use of the Multicare AR-Bed was 3.2 months. CONCLUSION: The results of this pilot study suggest that a specially made bed that nurses the infant at 40 degrees supine body position reduces regurgitation, acid reflux and reflux-associated symptoms. However, the intervention was open, the sample size small and the withdrawal rate was substantial. Larger trials are needed.

Esophageal impedance and esophagitis in children: any correlation?

AIM: : The aim of this study was to correlate the data obtained with multiple intraluminal esophageal impedance and pH (MII-pH) recordings in infants and children referred for suspected gastroesophageal reflux disease with esophageal histology. MATERIALS AND METHODS: : In a prospective study, results of esophageal biopsies and MII-pH recording obtained in 45 children (mean age +/- SD: 69 +/- 55 months) were analyzed. Regarding the MII-pH data, an automatic (Autoscan Bioview Analysis Software, version 5.3.4, Sandhill Scientific Inc, Highlands Ranch, CO) and a manual reading were performed; an automatic pH analysis (meal included) was also performed. RESULTS: : Acidic, weakly acidic, and alkaline reflux episodes accounted, respectively, for 48.7%, 49.5%, and 1.8% of the total number of reflux episodes detected by MII-pH. Esophagitis was present in 25 (56%) children. Concordance between classic pH-study analysis (alone) and esophageal histology was found in 19 of 45 (42%) children. According to the MII-pH analysis, the mean and median value of the pH were significantly higher in the group with esophagitis than in the group with normal esophageal histology. A longer clearance time was found in the group with esophagitis than in subjects with normal histology. Gas reflux episodes represented 21% of the total reflux episodes and were comparable in both groups. CONCLUSIONS: : Multiple intraluminal esophageal impedance and pH analysis does not provide a distinct parameter to predict esophageal mucosal injury in children. In our population, MII-pH shows comparable acidic, weakly acidic, alkaline, and gas reflux in children with and without esophagitis. Further research is needed to analyze clearance parameters.

Probiotics in infectious diarrhoea in children: are they indicated?

Infectious gastroenteritis continues to be a leading cause of mortality and morbidity worldwide. The cornerstone of treatment remains replacement of water and electrolyte losses with oral rehydration solution. Until a few years ago, probiotics were discussed primarily in the context of alternative medicine, but they are now entering mainstream medical practice since a decrease of the severity and duration of infectious gastroenteritis in approximately 24 hours has been shown for some strains. Therefore, probiotics are a potential add-on therapy in acute gastro-enteritis. The shortening of the duration of diarrhoea and the reduction in hospital stay result in a social and economic benefit. Evidence found in viral gastroenteritis is more convincing than in bacterial or parasitic infection. Mechanisms of action are strain specific and only those commercial products for which there is evidence of clinical efficacy should be recommended. Timing of administration is also of importance. In acute gastroenteritis, there is evidence for efficacy of some strains of lactobacilli (e.g. Lactobacillus caseii GG and Lactobacillus reuteri) and for Saccharomyces boulardii. Probiotics are "generally regarded as safe", but side effects such as septicaemia and fungaemia have very rarely been reported in high-risk situations. Although most studies conclude in a statistically significant shortening of the duration of diarrhea, the clinical relevance of this finding is limited. In conclusion, selected strains of probiotics result in a statistically significant but clinically moderate benefit in shortening the duration of diarrhoea caused by acute infectious gastroenteritis.

Isolation of Campylobacter concisus from feces of children with and without diarrhea.

A prospective study compared fecal isolation rates of Campylobacter concisus for children with diarrhea and without diarrhea by a filter technique in which media were incubated for 4 days in a microaerobic atmosphere. No statistically significant difference in isolation rates was found (13.2% in patients with diarrhea and 9% in controls). Moreover, 35 of 37 children attending the same day care center harbored different C. concisus strains, as was demonstrated by arbitrary primer PCR DNA fingerprinting. These data suggest a lack of a pathogenic role for C. concisus in enteritis.

Biological risk factors for fatal protein energy malnutrition in hospitalized children in Zaire.

Biological markers were used in an attempt to predict mortality in children admitted to the hospital in Kivu, Zaire, for protein energy malnutrition. Data for 39 children who died (16.4%) showed significantly lower levels of albumin (1.61 vs. 2.53 g/dl; p < 0.001), transferrin (82.1 vs. 167.7 mg/dl; p < 0.001), and transthyretin (6.49 vs. 9.87 mg/dl; p < 0.001), but not or retinol-binding protein, than for the 199 survivors. Since albumin and transferrin were correlated, a Cox model was used to see whether albumin or transferrin has a significant predictive value independent of transthyretin. The relative risk predicted by each indicator was of the same order of magnitude, approximately 4. We conclude that specific biological markers help to discriminate among hospitalized subjects at risk and to identify those in need of more intensive nutritional support to prevent early death.

Contribution of the 13C-urea breath test to the detection of Helicobacter pylori gastritis in children.

Serology, 13C-urea breath test, histology, Campylobacter-like organism testing, and culture were performed in 95 consecutive children to evaluate the contribution of these tests to the detection of Helicobacter pylori infection. In analyses considering any combination of three positive tests as "gold standard" for diagnosing H pylori infection, 26 children were Helicobacter positive (27%), which is only one patient more than the number of children with only a positive culture. The accuracy of culture was excellent when "any combination of three positive tests" was used as the gold standard (sensitivity 96%, specificity 100%, positive predictive value 100% [false positivity 0%], negative predictive value 99% [false-negative results 1%]). The results of invasive and noninvasive tests were comparable. When culture was considered as "gold standard," the sensitivity of serology and 13C-urea breath test was 96%; the specificity was 96% and 93%, respectively; the positive predictive value was 89% and 83% (false-positive results in 11% and 17%); and the negative predictive value for both was 99% (false-negative results in 1%). It is concluded that culture can be used as gold standard, but that non-invasive tests such as serology and/or 13C-urea breath test can be used to diagnose H pylori infection in children, since each has at least 95% sensitivity and 92% specificity.

Use of a urea breath test versus invasive methods to determine the prevalence of Helicobacter pylori in Zaire.

The prevalence of Helicobacter pylori infection in Zaire was determined by means of a [14C] urea breath test in 133 asymptomatic subjects, by culture and histological examination of biopsies in 324 consecutive endoscopy patients with chronic epigastric complaints, and by both the breath test and culture/histology in a subset of 92 patients. Sixty healthy Belgian students or hospital laboratory workers were also included for comparison. The prevalence of Helicobacter pylori was significantly higher in asymptomatic Zairian subjects (77.4%) than in the Belgians (30%; p less than 10(-6)). Infection was also acquired much earlier in life in Africans, 66% of the children aged 5 to 9 years already being infected versus none of the Belgian subjects below the age of 20 years. In Zaire, however, the prevalence of Helicobacter pylori in patients with gastroduodenal disorders (87.5%) was similar to that in the group of asymptomatic subjects (77.5%) after adjustment for age and other epidemiological parameters (gender, place of residency, education level, smoking and drinking habits) in a multivariate analysis. The high rate of acquisition of Helicobacter pylori infection in Zaire emphasizes the need to consider the baseline prevalence of Helicobacter pylori in a defined population when studying its association with various diseases.