ABSTRACT
Oral rehydration salt (ORS) treatment in young children with acute diarrhoea (AD) has contributed to decrease mortality associated with dehydration although effective strategies to reduce morbidity associated with this disease are required. The aim of this study was to evaluate the diarrhoea duration when using combined colloidal bismuth hydroxide gel (CBHG) and oral rehydration salt treatment compared with ORS therapy in children with AD. We designed a double-blind, randomised prospective study with treatment and control groups. Patients aged one to 12 years, with no prior pathology and with AD of less than 48 h were included. The Chi-squared and Mann-Whitney tests were used, as well as the Cox proportional hazards model and the Kaplan-Meier estimator. Patients were randomised into an ORS and CBHG treatment group and a control group for ORS plus placebo. (Average age: 3.2 years). The result of the post-treatment evaluation with respect to the average duration of AD was 25.5 h for the treated group vs. 41.5 h for the control group (p = 0.015). The average number of stools was 4.8 in the treated group and 8.2 in the control group (p = 0.032). We conclude that the use of CBHG plus ORS significantly reduced the duration of AD, the number of stools and the percentage of children with persistent AD after 24 h of treatment compared to the control group. AD remitted almost twice as fast in patients treated with CBHG and ORS compared to those who received ORS plus placebo.
ABSTRACT
Objetivo: Evaluar las características epidemiológicas de un grupo de pacientes pediátricos con esofagitis eosinofílica (EEo) y las modalidades de tratamiento empleadas en Latinoamérica. Pacientes y métodos: Estudio multicéntrico, observacional, transversal. Se aplicó una encuesta a 36 Centros de Gastroenterología y Endoscopia Pediátrica de 10 países latinoamericanos con la finalidad de obtener información socio-demográfica y datos sobre el tratamiento utilizado para el manejo de los casos evaluados durante el periodo 2014-2016. Resultados: 372 casos de EEo pediátrica fueron evaluados durante el periodo 2014-2016 y 108 casos (29%) correspondieron al trimestre Abril-Junio 2016. 46,72% de los casos pertenecían al grupo de edad escolar y 71,8% consultaron por disfagia. 87,2% de los pacientes fueron manejados con dieta, 55,3% esteroides deglutidos (12,8% en monoterapia) y 6% recibió montelukast. No hubo reporte de pacientes en terapia con agentes biológicos. Conclusiones: los resultados sugieren un predominio del sexo masculino con una mayor incidencia de la enfermedad en la edad escolar y la adolescencia. Las manifestaciones clínicas más frecuentes son disfagia, vómitos y síntomas de reflujo gastroesofágico. El tratamiento más indicado por los especialistas en América Latina es la dieta seguido del uso de esteroides deglutidos. Los IBP también son ampliamente utilizados como terapia coadyuvante. Un estudio de prevalencia a nivel continental es necesario para evaluar el comportamiento de la enfermedad en diferentes regiones de América Latina.
Aims: To evaluate epidemiological features of pediatric patients with eosinophilic esophagitis in Latinamerica and therapeutical options indicated by pediatric gastroenterologists in our continent. Patients and methods: multicenter, observational, transversal study. 36 Centers of Pediatric Gastroenterology and Endoscopy from 10 latinamerican countries participated giving clinical and sociodemographic information about pediatric patients with EoE diagnosed and treated during the last two years (study period). Results: 372 cases of pediatric EoE were evaluated during period 2014-2016 (108 cases were evaluated during trimester April-June 2016). 46,72% of cases were school age children, with dysphagia been the main clinical symptom in 71,8% of patients. 87,2% of patients received diet as a main indication of treatment, 55,3% received swallowed steroids (12,8% as monotherapy) and 6% were treated with montelukast among others. There were no reports of patients under treatment with biological drugs. Conclusions: epidemiological features of our study group suggest a higher prevalence of pediatric EoE in male school age children and adolescents. Most frecuent clinical symptoms are dysphagia, vomiting and gastroesophageal reflux symptoms. Treatment is based mainly on diet and swallowed steroids. A continental prevalence study is necessary to evaluate the behavior of the disease in different regions of Latinamerica.
ABSTRACT
Nutrition in early stages of life is one of the most influential environmental factors for the good development of organs and systems and the wellbeing of the child. Epigenetic mechanisms can explain how prenatal and postnatal nutrition affects genes expression with the subsequent risk of immune and metabolic diseases. The objective of this paper is to update the knowledge of the role the nutritional status and dietary practices of pregnant women and the child's feeding patterns over the first year of life have in the risk of future diseases.
Subject(s)
Infant Nutritional Physiological Phenomena , Nutritional Status , Prenatal Nutritional Physiological Phenomena , Female , Health Status , Humans , Infant , Infant, Newborn , Pregnancy , Time FactorsABSTRACT
During the last twenty years Eosinophilic Esophagitis has become one the most important causes of esophageal disfunction in children, food impactation in adolescents and young adults, therapeutic failure in patients with gastroesophageal reflux disease (GERD) and the most frecuent eosinophilic disease of the gastrointestinal tract. We present recommendations for the diagnosis and treatment of the disease based in a systematic review of the literature.
Subject(s)
Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/therapy , Gastroesophageal Reflux/complications , Child , Eosinophilic Esophagitis/etiology , Esophagoscopy , Evidence-Based Medicine , Humans , Societies, MedicalABSTRACT
INTRODUCTION: No published material on the prevalence of celiac disease (CD) in the pediatric population of Argentina has been found up to date. Objective. To estimate the prevalence of CD in a pediatric population (hospital-based sample) from 5 urban districts of Argentina. METHODS: In a cross-sectional descriptive study, we analyzed serum samples from 2219 children, aged 3-16 years old, which had been requested for pre-surgical tests and for physical aptitude certificates for sports in the province of Buenos Aires, and cities of Buenos Aires, Córdoba, Santa Fe and Salta. Children with a previous and accurate diagnosis of CD were also included. IgA class tissue transglutaminase antibodies were determined using serum samples, and those samples which turned out positive were also tested for IgA class endomysium antibodies. A small intestine biopsy was proposed for those who had a positive serology. RESULTS: Between May 2008 and August 2009, 29 positive serologies were found. A total of 22 duodenum biopsies were performed, and 21 turned out compatible with CD. Out of 2219 children, 7 had a previous diagnosis. A prevalence of 1.26% (1:79 children), with female gender predominance (p < 0.023) was found. Ninety percent of the celiac children were over 6 years old (p < 0.021). Silent celiac disease predominated but there was a 33% of symptomatic cases. CONCLUSIONS: The results of the trial show a higher prevalence of CD than expected. The finding of symptomatic patients (33%) suggests the undertaking of different activities to spread the knowledge on this disease and promote the indication for serology test, to avoid complications by means of an early diagnosis.
Subject(s)
Celiac Disease/epidemiology , Adolescent , Argentina/epidemiology , Celiac Disease/diagnosis , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Prevalence , Urban HealthABSTRACT
Introduction. No published material on the preva lence of celiac disease (CD) in the pediatric population of Argentina has been found up to date. Objective. To estimate the prevalence of CD in a pediatric population (hospital-based sample) from 5 urban districts of Argentina. Methods. In a cross-sectional descriptive study, we analyzed serum samples from 2219 children, aged 3-16 years old, which had been requested for pre-surgical tests and for physical aptitude certifcates for sports in the province of Buenos Aires, and cities of Buenos Aires, Córdoba, Santa Fe and Salta. Children with a previous and accurate diagnosis of CD were also included. IgA class tissue transglu taminase antibodies were determined using serum samples, and those samples which turned out positive were also tested for IgA class endomysium an tibodies. A small intestine biopsy was proposed for those who had a positive serology. Results. Between May 2008 and August 2009, 29 positive serologies were found. A total of 22 duo denum biopsies were performed, and 21 turned out compatible with CD. Out of 2219 children, 7 had a previous diagnosis. A prevalence of 1.26% (1:79 children), with female gender predominance (p < 0.023) was found. Ninety percent of the celiac children were over 6 years old (p < 0.021). Silent celiac disease predominated but there was a 33% of symptomatic cases. Conclusions. The results of the trial show a higher prevalence of CD than expected. The finding of symptomatic patients (33%) suggests the undertak ing of different activities to spread the knowledge on this disease and promote the indication for serology test, to avoid complications by means of an early diagnosis.
Introducción. Hasta la fecha del estudio no se hallaron estudios poblacionales publicados sobre prevalencia de enfermedad celíaca en la población pediátrica argentina. Objetivo. Estimar la prevalencia de la enfermedad celíaca en población pediátrica a partir de una muestra de base hospitalaria de cinco distritos urbanos. Método. Diseño descriptivo de corte transversal. Bajo consentimiento informado, participaron 2219 niños, de 3 a 16 años, que realizaban estudios de laboratorio para exámenes prequirúrgicos o certificados de aptitud física deportiva del Conurbano bonaerense, y ciudades de Buenos Aires, Santa Fe, Córdoba y Salta. Se incluyeron niños con diagnóstico previo y certero de enfermedad celíaca dentro de esa población. Se determinaron anticuerpos antitransglutaminasa y, en las muestras positivas, anticuerpo antiendomisio. Se propuso biopsia de intestino delgado a quienes presentaron ambas serologías positivas. Resultados: 29 serologías fueron positivas. Se realizaron 22 biopsias de duodeno, 21 fueron compatibles con enfermedad celíaca y 7 presentaron diagnóstico previo. La prevalencia fue de 1,26% (1:79) IC 95% 0,84-1,81, con predominio del sexo femenino (p <0,039). El 90% de los niños celíacos hallados fueron mayores de 6 años. Las formas clínicas silentes predominaron, pero hubo un 33% de casos sintomáticos. Conclusión. Los resultados en la población estudiada muestran una prevalencia mayor que la esperada. El hallazgo de formas sintomáticas (33%) sugiere emprender acciones de difusión del conocimiento de la enfermedad y ampliar la indicación de serología para obtener diagnóstico precoz.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Celiac Disease/epidemiology , Argentina/epidemiology , Cross-Sectional Studies , Celiac Disease/diagnosis , Prevalence , Urban HealthABSTRACT
Introduction. No published material on the preva lence of celiac disease (CD) in the pediatric population of Argentina has been found up to date. Objective. To estimate the prevalence of CD in a pediatric population (hospital-based sample) from 5 urban districts of Argentina. Methods. In a cross-sectional descriptive study, we analyzed serum samples from 2219 children, aged 3-16 years old, which had been requested for pre-surgical tests and for physical aptitude certifcates for sports in the province of Buenos Aires, and cities of Buenos Aires, Córdoba, Santa Fe and Salta. Children with a previous and accurate diagnosis of CD were also included. IgA class tissue transglu taminase antibodies were determined using serum samples, and those samples which turned out positive were also tested for IgA class endomysium an tibodies. A small intestine biopsy was proposed for those who had a positive serology. Results. Between May 2008 and August 2009, 29 positive serologies were found. A total of 22 duo denum biopsies were performed, and 21 turned out compatible with CD. Out of 2219 children, 7 had a previous diagnosis. A prevalence of 1.26% (1:79 children), with female gender predominance (p < 0.023) was found. Ninety percent of the celiac children were over 6 years old (p < 0.021). Silent celiac disease predominated but there was a 33% of symptomatic cases. Conclusions. The results of the trial show a higher prevalence of CD than expected. The finding of symptomatic patients (33%) suggests the undertak ing of different activities to spread the knowledge on this disease and promote the indication for serology test, to avoid complications by means of an early diagnosis.(AU)
Introducción. Hasta la fecha del estudio no se hallaron estudios poblacionales publicados sobre prevalencia de enfermedad celíaca en la población pediátrica argentina. Objetivo. Estimar la prevalencia de la enfermedad celíaca en población pediátrica a partir de una muestra de base hospitalaria de cinco distritos urbanos. Método. Diseño descriptivo de corte transversal. Bajo consentimiento informado, participaron 2219 niños, de 3 a 16 años, que realizaban estudios de laboratorio para exámenes prequirúrgicos o certificados de aptitud física deportiva del Conurbano bonaerense, y ciudades de Buenos Aires, Santa Fe, Córdoba y Salta. Se incluyeron niños con diagnóstico previo y certero de enfermedad celíaca dentro de esa población. Se determinaron anticuerpos antitransglutaminasa y, en las muestras positivas, anticuerpo antiendomisio. Se propuso biopsia de intestino delgado a quienes presentaron ambas serologías positivas. Resultados: 29 serologías fueron positivas. Se realizaron 22 biopsias de duodeno, 21 fueron compatibles con enfermedad celíaca y 7 presentaron diagnóstico previo. La prevalencia fue de 1,26% (1:79) IC 95% 0,84-1,81, con predominio del sexo femenino (p <0,039). El 90% de los niños celíacos hallados fueron mayores de 6 años. Las formas clínicas silentes predominaron, pero hubo un 33% de casos sintomáticos. Conclusión. Los resultados en la población estudiada muestran una prevalencia mayor que la esperada. El hallazgo de formas sintomáticas (33%) sugiere emprender acciones de difusión del conocimiento de la enfermedad y ampliar la indicación de serología para obtener diagnóstico precoz.(AU)
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Celiac Disease/epidemiology , Argentina/epidemiology , Celiac Disease/diagnosis , Cross-Sectional Studies , Prevalence , Urban HealthABSTRACT
INTRODUCCIÓN: Hasta la fecha del estudio no se hallaron estudios poblacionales publicados sobre prevalencia de EC en población pediátrica argentina. OBJETIVO: estimar la prevalencia de la EC en población pediátrica de cinco distritos urbanos. MÉTODOS: diseño descriptivo de corte transversal. Se invitó a participar a 2.230 niños, de 3 a 16 años, que realizaban estudios de laboratorio para exámenes prequirúrgicos o certificados de aptitud física deportiva. Se determinaron Anticuerpos Antitransglutaminasa, y en las muestras positivas Anticuerpo Antiendomisio. Se propuso biopsia de intestino delgado a quienes presentaron ambas serologías positivas. Se incluyeron niños con diagnóstico previo de EC que cumplían los criterios de inclusión. La prevalencia se expresó mediante el porcentajey su IC exacto. Las comparaciones entre grupos se efectuaron mediante la prueba exacta de Fisher. RESULTADOS: se testearon los sueros de 2.219 niños, 29 serologías fueron positivas. Se realizaron 22 biopsias de duodeno, 21 fueron compatibles con EC y 7 presentaron diagnóstico previo. La prevalencia fue de 1,26% (1:79)IC 95% 0,84-1.81, con predominio del sexo femenino (p<0,039) e importantes diferencias regionales. El 90% de los niños celíacos hallados fueron > 6 años. Las formas clínicas silentes predominaron pero hubo un 33% de casos sintomáticos. CONCLUSIÓN: los resultados en la población estudiada muestran una prevalencia mayor que estudios previos en adultos. El hallazgo de formas sintomáticas (33%) sugiere emprender acciones de difusión del conocimientode la enfermedad y ampliar la indicación de serología para obtener diagnóstico precoz.
INTRODUCTION: up the date of this study, published material about the prevalence of CD in pediatric population in Argentina has not been found. OBJECTIVE: to estimate CD prevalencein a pediatric population of 5 urban districts. METHODS: descriptive and cross sectional cut design. Were invited 2.230 children, between 3 and 16 years, which had been requested forpre-surgical studies and physical aptitude certificates for sports. IgA class tissue transglutaminase antibodies were determined and to positive samples IgA class endomysium antibodies. A small intestine biopsy was proposed for those who had both positive serology. Children with a previous diagnosis of CD who met the inclusion criteria were included. The prevalence was expressed by means of the percentage and its exact confidence interval and the comparisons between groups were performed using Fisher´s exact test. RESULTS: 2.219 children´s sera were studied. 29 were positive serologies. 22 duodenum biopsies were performed, 21 turned out compatible with CD. 7 children presented a previous diagnosis. A prevalence of 1.26% (1:79) CI 95% (0,84-1,81) was found, with female sex predominance ( p<0.039) and important regional differences as well. Ninety percent of the celiac children found were> 6 years Silent clinical manifestations predominated but there were 33% of symptomatic cases. CONCLUSIONS: the results in the study population showed a higher prevalence than previous studies in adults. The finding of symptomatic manifestations (33%)suggests actions to spread the knowledge of this disease promotingthe indication of serology for early diagnosis.
