ABSTRACT
BACKGROUND/AIMS: Delayed gastric emptying may be an important contributing factor to gastroesophageal reflux disease (GERD) in children, but there are limited data on its evaluation in children with erosive-GERD. This study aims to evaluate the gastric emptying of a solid meal in patients with erosive-GERD. METHODS: Nineteen patients (age range 8.79-17.9 years) with erosive esophagitis and 14 healthy controls (age range from 8.04 to 18.7 years) were compared. Esophagitis was graded according to Los Angeles classification. The gastric emptying was evaluated by (13)C-octanoic breath test, which was performed after a 344 kcal standardized solid test meal. Symptoms were evaluated using a standardized questionnaire. RESULTS: The two most prevalent symptoms were nausea and epigastric pain, which were reported by 12 (63.2%) patients. Irritable bowel syndrome was present in 26.3% (5/19). The median gastric emptying half-time in patients was 160 min (interquartile range [IQR] 140-174 min), which was not different from the controls' figure (median 157 min, IQR 143-170 min). Additionally, the lag time and the gastric emptying coefficient were not significantly different between the study groups. CONCLUSION: Delayed gastric emptying is not associated with erosive esophagitis in children with GERD, when compared to controls.
Subject(s)
Gastric Emptying , Gastroesophageal Reflux/physiopathology , Adolescent , Breath Tests , Case-Control Studies , Chi-Square Distribution , Child , Endoscopy, Digestive System , Female , Humans , Male , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
AIM: To evaluate gastric emptying of solids in children and adolescents with functional dyspepsia with and without Helicobacter pylori infection. PATIENTS AND METHODS: The study included 27 female patients (mean age 13.38 +/- 2.81 y) with functional dyspepsia according to Rome II criteria who were selected after upper gastrointestinal endoscopy found no major mucosal abnormality. Fragments were collected from the esophagus, gastric antrum, and gastric body for histological examination and rapid urease test. H. pylori infection was diagnosed according to the rapid urease test and histological appearance. The histological appearance of the gastric mucosa was evaluated according to modified Sydney criteria. A C-octanoic breath test was performed after a test meal (2 slices of toasted bread, 10 g margarine, and 1 egg with 100 microL of the tracer dipped in the yolk) with 13 points of air collection in 4 hours. RESULTS: Infection with H. pylori was observed in 12 of 27 patients (44.4%). The gastric emptying half-time was shorter in infected patients than in uninfected patients (mean +/- SD 153.4 +/- 20.0 min vs 179.2 +/- 32.2 min; P = 0.019), as was the lag phase (106.3 +/- 22.6 vs 126.6 +/- 22.7 min; P = 0.038). There was no relationship between gastric emptying (half-time and lag phase) and degree of histological abnormality. Vomiting and nausea were associated with slower gastric emptying in patients without H. pylori gastritis more often than in infected patients. CONCLUSIONS: The study suggests that delayed gastric emptying can play an important role in a subgroup of dyspeptic patients, particularly those without H. pylori infection who have nausea and vomiting.
Subject(s)
Dyspepsia/physiopathology , Gastric Emptying/physiology , Helicobacter Infections/physiopathology , Helicobacter pylori , Adolescent , Breath Tests , Caprylates , Carbon Isotopes , Female , HumansABSTRACT
BACKGROUND: Urea breath test is an accurate method for the diagnosis of Helicobacter pylori infection in children. This test could estimate the bacterial load by measuring the urease activity in gastric mucosa. The aim of the study was to correlate the result of 13C-urea breath test (13C-UBT) and histological estimative for bacterial colonization and severity of inflammatory infiltrate. METHODS: Forty-four patients (mean age 8.54 +/- 3.9 years) with dyspeptic symptoms were evaluated. Patients were evaluated through endoscopy and 13C-UBT. Helicobacter pylori infection was defined by histology, rapid urease test and 13C-UBT. Breath test results were expressed by delta over baseline (DOB) and urea hydrolysis rate (UHR). Test results were treated logarithmically for statistical analysis. RESULTS: There was a significant inverse correlation between age and Log DOB (-0.501, P= 0.0005), but there was no relationship between Log UHR and age (-0.148, P= 0.336). The study did not find correlation between the breath test result and histological grades for mononuclear infiltrate, neutrophilic infiltrate and bacterial density. CONCLUSION: The 13C-UBT does not estimate the severity of histological findings in children with Helicobacter pylori infection. The results of the breath test should be interpreted in a qualitative way.
Subject(s)
Breath Tests , Gastritis/diagnosis , Helicobacter Infections/diagnosis , Helicobacter pylori/enzymology , Urease/metabolism , Adolescent , Bacteriological Techniques , Carbon Isotopes , Child , Child, Preschool , Female , Histocytochemistry , Humans , Infant , Male , Pyloric Antrum/pathology , Reproducibility of Results , Severity of Illness Index , UreaABSTRACT
BACKGROUND: The 13C-methacetin breath test is a non-invasive method to evaluate hepatic microsomal function that allows a quantitative assessment of the functional hepatic mass. AIM: To evaluate the clinical usefulness of the 13C-methacetin breath test in patients with hepatitis C chronic liver disease. PATIENTS AND METHODS: Seventy eight patients with chronic hepatitis C and 13 matched healthy controls were studied. HCV patients were classified as having chronic hepatitis (n = 51), cirrhosis (n = 27), being seven with decompensated disease (presence of ascite, jaundice and/or encephalopathy). HbsAg/HIV co-infected patients, chronic alcohol drinker, having other chronic diseases and those using drugs that could interfere with hepatic cytochrome P450, were excluded. The disease stage and activity in biopsy fragments were determined according the Brazilian Society of Hepatology criteria. Breath test was performed with 75 mg of 13C-methacetin, and the 13CO2 in the expired air was measured through a nondispersive infra red spectrometry. The delta over baseline, and the cumulative recovery of 13CO2 at 40 (13C-methacetin breath test 40 min) and 120 minutes (13C-methacetin breath test 120 min) were calculated. RESULTS: 13C-methacetin breath test parameters correlate only with hepatic staging but not with necroinflammatory (activity) parameters, being the best correlation found between hepatic staging and the 13C-methacetin breath test 120 minutes. The mean values for 13C-methacetin breath test 120 min was significantly reduced in the cirrhotic groups (19.2 +/- 7.1% for compensated and 14.7 +/- 4.0% for decompensated cirrhotics) than in control (29.9 +/- 4.5%) and chronic hepatitis (27.8 +/- 6.1%) groups. The best diagnostic accuracy for the diagnosis of cirrhosis among HCV patients was found for 13C-methacetin breath test 120 min with 81% of sensibility and 77% of specificity. CONCLUSION: 13C-methacetin breath test is correlated with structural changes in HCV-related chronic hepatic diseases and the cumulative recovery at 120 minutes is a sensitive parameter to identify the presence of hepatic cirrhosis in these patients.
Subject(s)
Acetamides , Breath Tests/methods , Hepatitis C, Chronic/complications , Liver Cirrhosis/etiology , Liver Function Tests/methods , Adolescent , Adult , Aged , Biopsy , Case-Control Studies , Female , Hepatitis C, Chronic/pathology , Hepatitis C, Chronic/physiopathology , Humans , Liver Cirrhosis/pathology , Liver Cirrhosis/physiopathology , Male , Middle Aged , Sensitivity and Specificity , Severity of Illness Index , Time FactorsABSTRACT
RACIONAL: O teste respiratório da metacetina marcada com carbono 13 (13C-metacetina) é método não-invasivo que permite examinar a função hepática microssomal, permitindo avaliação quantitativa da massa hepática funcional. OBJETIVO: Avaliar a utilidade clinica do teste respiratório da 13C-metacetina na avaliação de pacientes com doença crônica do fígado pelo vírus da hepatite C. CASUíSTICA E MÉTODOS: Setenta e oito pacientes com hepatite crônica C e 13 indivíduos saudáveis pareados por sexo e idade foram estudados. Pacientes infectados cronicamente pelo vírus C foram classificados como portadores de hepatite crônica (n = 51) ou cirrose hepática (n = 27, sendo 7 deles classificados como descompensados pela presença de ascite, icterícia e/ou encefalopatia). Pacientes co-infectados HbsAg/HIV, em uso crônico de álcool, com outras doenças crônicas ou em uso de medicamentos que pudessem interferir com a atividade do citocromo P450, foram excluídos. O estádio e a atividade da doença nos fragmentos de biopsia foram determinados de acordo com os critérios da Sociedade Brasileira de Hepatologia. O teste respiratório da 13C-metacetina foi realizado com 75 mg de 13C-metacetina e a concentração de 13CO2 no ar expirado foi medido através de espectrometria infravermelha não dispersiva. Foram calculados o "delta over baseline" e o percentual de recuperação cumulativo do 13CO2 aos 40 (teste respiratório da 13C-metacetina 40 min) e aos 120 minutos (teste respiratório da 13C-metacetina 120 min). RESULTADOS: Os parâmetros do teste respiratório da 13C-metacetina se correlacionaram com avaliação estrutural histológica, mas não com a atividade necroinflamatória no tecido hepático, sendo que a melhor correlação foi obtida entre o grau de estádio e o teste respiratório da 13C-metacetina 120 min. Os valores médios do teste respiratório da 13C-metacetina 120 min foram significantemente mais reduzidos nos grupos cirróticos (19,2 ± 7,1 por cento para cirróticos compensados e 14,7 ± 4,0 por cento para os cirróticos descompensados) que nos grupos controle (29,9 ± 4,5 por cento) e com hepatite crônica (27,8 ± 6,1 por cento). A melhor acurácia no diagnóstico de cirrose entre os portadores de hepatite crônica C foi encontrada para o teste respiratório da 13C-metacetina 120 min com 81 por cento de sensibilidade e 77 por cento de especificidade...
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Acetamides , Breath Tests/methods , Hepatitis C, Chronic/complications , Liver Cirrhosis/etiology , Liver Function Tests/methods , Biopsy , Case-Control Studies , Hepatitis C, Chronic/pathology , Hepatitis C, Chronic/physiopathology , Liver Cirrhosis/pathology , Liver Cirrhosis/physiopathology , Sensitivity and Specificity , Severity of Illness Index , Time FactorsABSTRACT
BACKGROUND AND OBJECTIVE: Studies support the accuracy of 13C-urea breath test for diagnosing and confirming cure of Helicobacter pylori infection in children. Three methods are used to assess 13CO2 increment in expired air: mass spectrometry, infrared spectroscopy, and laser-assisted ratio analysis. In this study, the 13C-urea breath test performed with infrared spectroscopy in children and adolescents was evaluated. METHODS: Seventy-five patients (6 months to 18 years old) were included. The gold standard for diagnosis was a positive culture or positive histology and a positive rapid urease test. Tests were performed with 50 mg of 13C-urea diluted in 100 mL orange juice in subjects weighing up to 30 kg, or with 75 mg of 13C-urea diluted in 200 mL commercial orange juice for subjects weighing more than 30 kg. Breath samples were collected just before and at 30 minutes after tracer ingestion. The 13C-urea breath test was considered positive when delta over baseline (DOB) was greater than 4.0%. RESULTS: Tests were positive for H. pylori in 31 of 75 patients. Sensitivity was 96.8%, specificity was 93.2%, positive predictive value was 90.9%, negative predictive value was 97.6%, and accuracy was 94.7%. CONCLUSIONS: 13C-urea breath test performed with infrared spectroscopy is a reliable, accurate, and noninvasive diagnostic tool for detecting H. pylori infection.
Subject(s)
Breath Tests , Helicobacter Infections/diagnosis , Helicobacter pylori , Spectrophotometry, Infrared , Urea , Adolescent , Carbon Isotopes , Child , Child, Preschool , Female , Gastritis/microbiology , Gastroscopy , Humans , Infant , Male , Peptic Ulcer/microbiology , Sensitivity and Specificity , Urea/administration & dosage , Urease/analysisABSTRACT
A excreção respiratória da ûüC-metacetina, na dose de 2mg/kg de peso corporal, antes e após a ingestão de etanol (0,3ml/kg de peso), foi avaliada em dez voluntários adultos sadios. O ûüCO2 foi colhido no ar expirado a intervalos regulares durante duas hora e sua concentração medida através de espectrometria infravermelha não dispersiva. Foram calculados o DOB (delta over baseline), a velocidade de metabolização (0/0ûüCdose/hora) e a capacidade de metabolização ou 0/0da dose acumulada aos 40(Ac40) e 120 minutos (Ac120). Após a ingestão de etanol, a metabolização da ûüC-metacetina foi significantemente menor em todos os 10 voluntários testados, para todos os parâmetros analisados (dose acumulada aos 120 minutos de 29,3ñ4,4por cento antes e de 21,2ñ4,8poe cento após etanol, p <0,001). Essa redução foi mais acentuada nos cinco voluntários do sexo feminino nos primeiros 20 minutos do teste, havendo diferenças significantes em relação aos do sexo masculino. Esses resultados demonstram que o estresse oxidativo produzido pelo etanol é capaz de alterar significantemente a metabolização da ûüC-metacetina pelo fígado humano, especialmente nas mulheres, e evidenciamo papel os microssomos hepáticos na oxidação da metacetina e a possibilidade de interferência da ingestão de etanol sobre a sensibilidade do teste