Increasing prevalence of celiac disease - where to look for answers?

Celiac disease or gluten-sensitive enteropathy is a relevant health concern in today's world. Three prerequisites need to be met to trigger the disease, namely a genetic predisposition, gluten consumption, and environmental factors. Retrospective studies conducted across all age groups have ruled out the possibility that improved diagnostic methods were behind the increased prevalence. Since the genetic predisposition is more or less constant in the population, it is assumed that external factors may play a major role in this increase. Although it is generally believed that modern wheat varieties are to be blamed for the increase in gluten intolerance-related diseases, this assumption is refuted based on the analysis of the current and 100-year-old varieties. However, the increased prevalence could be related to modern lifestyles, changes in food preparation technology or composition, disruption of the intestinal barrier in viral disease, and other factors leading to intestinal dysbiosis. A possible preventive strategy in predisposed individuals could be the avoidance of gluten from the diet when ill, especially with a viral infection. This article openup a new perspective on the currently common autoimmune disease.

Inflammatory cloacogenic polyp in an adolescent - case report and review of the literature.

Inflammatory cloacogenic polyp is a rare lesion arising in the anal transitional zone. It is usually benign, but rare cases of malignant transformation are known. It is most commonly seen in the adult population from the fourth to the sixth decade of life, but it can be found among children and adolescents as well. The most common clinical symptoms include rectal bleeding and altered bowel habits, although some patients may be asymptomatic. Treatment involves transanal endoscopic microsurgery followed by a bowel regimen with stool softeners. We present the case report of a 14-year-old boy presenting with intermittent rectal bleeding in whom a polypoid lesion was found during digital rectal examination. The patient underwent proctosigmoidoscopy during which the suspicious lesion was removed by transanal endoscopic microsurgery and the histological diagnosis of inflammatory cloacogenic polyp was established. In the postoperative period, the patient was without any further problems. In this case report, we want to raise awareness of this rare diagnosis and emphasize its place in the differential diagnosis of rectal bleeding across all age groups.

Acute kidney injury requiring renal replacement therapy due to Clostridioides difficile infection in a 15-year-old boy

Acute gastroenteritis is commonly seen in pediatric clinical practice. It is a largely self-limited disease with a benign course. We present a case of teenager with gastroenteritis resulting in severe acute kidney injury. The decline in glomerular filtration was so significant that renal replacement therapy had to be initiated. We had to continue in intermitent hemodialysis for seven days until sufficient improvement in renal function. Clostridioides difficile was identified as a cause of vomiting, bloody diarrhea and subsequent dehydration. To our knowledge, this is the first reported case of C. difficile-associated diarrhea accompanied by acute kidney injury requiring renal replacement therapy in a child.

Myofibroblastic tumor of the esophagus - a case report of long-term follow-up and literature review.

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm with intermediate malignant potential. Although most often seen in the lungs, it can occur at multiple anatomical locations, including the gastrointestinal tract. An esophageal lesion is extremely rare, however. IMTs present most commonly in children and young adults. The main therapeutic approach is surgical resection. CASE REPORT: We report on the follow-up of a case in a 13-year-old boy with IMT in the esophagus. He underwent surgical resection in 2013 and is free of disease to date. CONCLUSION: Surgical resection is the most preferred therapy. If the resection is complete, the risk of recurrence is low. Nevertheless, every patient should be carefully followed up after the resection.

COVID-19 associated Paediatric Inflammatory Multisystem Syndrome (PIMS) in children.

The clinical course of the SARS-CoV-2 virus infection (COVID-19 disease) in paediatric patients is predominantly mild. However, in a small percentage of paediatric patients, the COVID-19 could lead to the development of with the Paediatric Inflammatory Multisystem Syndrome (PIMS) presenting as high fever, gastrointestinal symptoms, neurological symptomatology and even as multiorgan dysfunction. These three cases represent the first published report of critically ill paediatric patients with PIMS in the Czech Republic.