ABSTRACT
La fibrosis quística (FQ) es un trastorno hereditario, de las glándulas de secreción exocrina, considerada la causa más frecuente de insuficiencia pancreática exocrina (IPE) en la infancia. Esta revisión resume el panorama del tratamiento de reposición enzimática en la IPE asociada a la FQ, las formulaciones disponibles, su dosificación y modo de administración, así como las limitaciones y desafíos actuales y las posibles áreas del desarrollo futuro
Cystic fibrosis (CF) is an inherited disorder of the exocrine secretion glands, considered the most frequent cause of exocrine pancreatic insufficiency (EPI) in childhood. This review summarizes the landscape of enzyme replacement therapy in PEI associated with CF, the available formulations, their dosage and mode of administration, as well as the current limitations and challenges and potential areas for future development.
Subject(s)
Cystic Fibrosis , Exocrine Pancreatic Insufficiency , Enzyme Replacement TherapyABSTRACT
OBJETIVO: presentar los resultados de una encuesta aplicada a pediatras gastroenterólogos de Latinoamérica para conocer como realizan el abordaje diagnóstico y terapéutico de pancreatitis. MATERIAL Y MÉTODOS: estudio transversal, encuesta exploratoria, multicéntrica. RESULTADOS: el 73,6 % definió los tres tipos de pancreatitis de acuerdo con el grupo INSPPIRE. La enfermedad biliar, trauma abdominal e ingesta de medicamentos fueron la etiología más frecuente. El 80 % fueron pancreatitis leve. El 73 % utilizo soporte nutricional; la nutrición enteral fue la más empleada. CONCLUSIÓN: es el primer estudio exploratorio que permite tener una estimación del abordaje diagnóstico y terapéutico de la pancreatitis por PG en Latinoamérica
No disponible
Subject(s)
Humans , Child , Adolescent , Practice Patterns, Physicians' , Pancreatitis/diagnosis , Pancreatitis/therapy , Severity of Illness Index , Surveys and Questionnaires , Cross-Sectional Studies , Latin AmericaABSTRACT
OBJECTIVE: to present the results of a survey applied to Latin American pediatric gastroenterologists (PGs) to learn how they perform the diagnostic and therapeutic approach to pancreatitis. MATERIAL AND METHODS: a descriptive, exploratory, multicenter study and survey was conducted. RESULTS: 73.6 % defined the three types of pancreatitis according to the INSPPIRE group. Biliary disease, abdominal trauma, and medication intake were the most frequent causes. 80 % of cases were considered mild pancreatitis. 73 % of the PGs utilized nutritional support, with enteral nutrition predominating. CONCLUSION: this is the first exploratory study to describe the diagnostic and therapeutic approach of PGs to pancreatitis in Latin America.
Subject(s)
Pancreatitis , Acute Disease , Adolescent , Child , Enteral Nutrition , Humans , Latin America/epidemiology , Nutritional Support , Pancreatitis/diagnosis , Pancreatitis/epidemiology , Pancreatitis/therapy , Surveys and QuestionnairesABSTRACT
Juvenile polyposis syndrome is a rare autosomal dominant condition characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. Juvenile polyposis of infancy is a generalized severe form of juvenile polyposis syndrome associated with a poor prognosis. A 47-month-old female infant presented initially with gastrointestinal bleeding and protein-losing enteropathy at 4 months of age. At the age of 12 months, the condition worsened, requiring albumin infusions every 24 to 48 hours and red blood cell transfusions every 15 days. Upper gastrointestinal endoscopy, colonoscopy, and small-bowel enteroscopy revealed diffuse polyposis that was treated with multiple endoscopic polypectomies. Despite subtotal colectomy with ileorectal anastomosis, protein-losing enteropathy and bleeding persisted, requiring continued blood transfusions and albumin infusions. A chromosomal microarray revealed a single allele deletion in chromosome 10q23, involving both the PTEN and BMPR1A genes. Loss of PTEN function is associated with an increased activation of the protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway involved in cell proliferation. Treatment with sirolimus, an mTOR inhibitor, was initiated with the aim of inhibiting polyp growth. Soon after initiation of treatment with sirolimus, blood and albumin infusions were no longer needed and resulted in improved patient growth and quality of life. This case represents the first detailed report of successful drug therapy for life-threatening juvenile polyposis of infancy.
Subject(s)
Immunosuppressive Agents/therapeutic use , Intestinal Polyposis/congenital , Neoplastic Syndromes, Hereditary/diagnosis , Neoplastic Syndromes, Hereditary/drug therapy , Sirolimus/therapeutic use , Child, Preschool , Female , Follow-Up Studies , Humans , Intestinal Polyposis/diagnosis , Intestinal Polyposis/drug therapy , Intestinal Polyposis/surgery , Neoplastic Syndromes, Hereditary/surgery , Treatment OutcomeABSTRACT
OBJETIVES: The aim of the study is to investigate the incidence and clinical features of autoimmune hepatitis (AIH) in children from the province of Santa Fe, Argentina, for 10 years. METHODS: From the records of all of the pediatric hepatologists in the province of Santa Fe, Argentina, we reviewed the clinical charts of patients <18 years who were diagnosed with AIH (simplified score >6 points) and followed between January 2003 and December 2013. Population data were extracted from the 2010 national census. Values were expressed as percentages and median ± interquartile range. Mann-Whitney U test was used for comparison between the groups. RESULTS: Sixty-seven patients fulfilled inclusion criteria, from which 11 (16%) were later reclassified as having "autoimmune sclerosing cholangitis" according to biochemical, histological, and radiological findings. A final sample of 56 patients (39 F) with AIH was analyzed, giving an annual incidence of 0.56/100,000. Median age at presentation was 8 (5.7-11) years, and the median follow-up was 4 (2-7) years. Type 1 AIH was diagnosed in 89%. An acute presentation was observed in 53%, while 13 (23%) showed cirrhosis on initial biopsy. Prednisone (87%) and azathioprine (60%) were the most common drugs prescribed. At the end of follow-up, 53/56 (95%) were alive, including 4 patients (7%) who underwent liver transplantation. CONCLUSIONS: AIH has an estimated incidence of 0.56/100,000 per year in children from the province of Santa Fe (Argentina). Overall survival rate was 95%. A subgroup of patients diagnosed as AIH develops predominant biliary disease and should be better classified as autoimmune sclerosing cholangitis.
Subject(s)
Hepatitis, Autoimmune/epidemiology , Argentina/epidemiology , Biopsy , Child , Child, Preschool , Cholangitis, Sclerosing/epidemiology , Cholangitis, Sclerosing/pathology , Female , Hepatitis, Autoimmune/pathology , Humans , Incidence , Liver/pathology , Male , Retrospective Studies , Survival RateABSTRACT
Introducción. La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. Población y métodos. Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. Resultados. Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0, 4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9, 7 años y la demora diagnóstica, de 16, 5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. Conclusiones. La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.
Introduction. Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. Population and methods. Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. Results. Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. Conclusions. The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Inflammatory Bowel Diseases/epidemiology , Argentina/epidemiology , Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Registries , Incidence , Prospective StudiesABSTRACT
INTRODUCTION: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. POPULATION AND METHODS: Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. RESULTS: Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. CONCLUSIONS: The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.
INTRODUCCIÓN: La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. POBLACIÓN Y MÉTODOS: Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. RESULTADOS: Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0,4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9,7 años y la demora diagnóstica, de 16,5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. CONCLUSIONES: La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.
Subject(s)
Inflammatory Bowel Diseases/epidemiology , Adolescent , Argentina/epidemiology , Child , Child, Preschool , Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Female , Humans , Incidence , Male , Prospective Studies , RegistriesABSTRACT
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
BACKGROUND: The Argentinian population is mainly of Caucasian origin, with a small contingent of indigenous descent. The aim of this study is to test the hypothesis that a panel of mutations designed for European countries is not optimal as a first-line molecular diagnosis for routine use in this country of mixed European origin. METHODS: Phenotype analyses combined with a European screening panel of 71 mutations followed by Sanger sequencing and large rearrangement study, were used to characterize the identification and distribution of CFTR mutations in the Santa Fe province of Argentina. RESULTS: Clinical review of 121 subjects suspected of CF during childhood led to selection of 83 unrelated patients. Thirty four different mutations, including two new ones, c.2554dupT and p.Leu49Pro, were detected. The total sensitivity was 91% (n = 151/166 alleles). CONCLUSIONS: Frequencies of CFTR mutations in Argentinian populations differ from those of their European ancestry. A new first line panel of 21 CFTR mutations with a sensitivity of 84% is proposed for routine use in central Argentina.
Subject(s)
Cystic Fibrosis/genetics , Mutation , Argentina , Heterozygote , Homozygote , HumansABSTRACT
Healthy infants during the first year of life often have multiple functional gastrointestinal symptoms such as colic, regurgitation and constipation. The usual fuzziness and/or crying at this stage of life is interpreted as digestive discomfort or pain, and the corresponding concerns result in unsuitable behaviors as overeating, interruption of breastfeeding, multiple changes of formulas, innumerable queries and unnecessary medications. The aim of this paper is to update knowledge on the pathophysiology of the most common functional gastrointestinal dis orders, in order to avoid over diagnosis and select the most appropriate therapeutic approach and convenient nutritional interventions.
Subject(s)
Gastrointestinal Diseases/physiopathology , Gastrointestinal Diseases/therapy , Colic/therapy , Constipation/therapy , Humans , InfantABSTRACT
A magneto immunofluorescence assay for the detection of anti-transglutaminase antibodies (ATG2) in celiac disease was developed. The ATG2 were recognized by transglutaminase enzyme immobilized on the magnetic beads and then the immunological reaction was revealed by antibodies labeled with peroxidase. The fluorescent response of the enzymatic reaction with o-phenylenediamine and H2O2 as substrates was correlated with anti-transglutaminase titer, showing EC50 and LOD values of 1:11,600 and 1:74,500 of antibody titers, respectively. A total number of 29 sera samples from clinically confirmed cases of celiac disease and 19 negative control samples were tested by the novel magneto immunofluorescence assay. The data were submitted to the receiver-operating characteristic plot (ROC) analysis which indicated that 8.1 U was the most effective cut-off value to discriminate correctly between celiac and non-celiac patients. The immunofluorescence assay exhibited a sensitivity of 96.6%, a specificity of 89.5% and an efficiency 93.8% compared with the commercial optical ELISA kit.
Subject(s)
Antibodies/blood , Celiac Disease/diagnosis , Fluorescent Antibody Technique, Indirect , GTP-Binding Proteins/analysis , Magnetics , Transglutaminases/analysis , Antibodies/immunology , Celiac Disease/blood , Enzyme-Linked Immunosorbent Assay , Enzymes, Immobilized/chemistry , Enzymes, Immobilized/immunology , GTP-Binding Proteins/immunology , Humans , Protein Glutamine gamma Glutamyltransferase 2 , ROC Curve , Transglutaminases/immunologyABSTRACT
An electrochemical magneto immunosensor for the detection of anti-transglutaminase antibodies (ATG2) in celiac disease was developed. The immunological reaction is performed on magnetic beads (MBs) as a solid support in which the transglutaminase enzyme (TG2) is covalently immobilized (TG2-MB) and then ATG2 were revealed by an antibody labeled with peroxidase. The electrochemical response of the enzymatic reaction with o-phenilendiamine and H2O2 as substrates by square wave voltammetry was correlated with the ATG2. Graphite-epoxi composite cylindrical electrodes and screen printed electrodes were used as transducers in the immunosensor. A total number of 29 sera from clinically confirmed cases of celiac disease and 19 negative control sera were tested by the electrochemical magneto immunosensor. The data were submitted to the receiver-operating characteristic plot (ROC) analysis which indicated that 16.95 units was the most effective cut-off value (COV) to discriminate correctly between celiac and non-celiac patients. Using this point for prediction, sensitivity was found to be 100%, while specificity was 84%.
Subject(s)
Antibodies/blood , Biosensing Techniques/instrumentation , Celiac Disease/blood , Celiac Disease/immunology , Transglutaminases/immunology , Antibodies/immunology , Celiac Disease/diagnosis , Celiac Disease/enzymology , Electrochemical Techniques/instrumentation , Enzymes, Immobilized/immunology , Equipment Design , Humans , Immunoassay/instrumentation , Magnetics/instrumentation , Sensitivity and SpecificityABSTRACT
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.
Subject(s)
Humans , Child , Adolescent , Data Collection , Celiac Disease/epidemiology , Celiac Disease/immunology , Transglutaminases , Argentina , Cost-Benefit Analysis , Enzyme-Linked Immunosorbent Assay , Epidemiology, DescriptiveABSTRACT
Los marcadores serológicos comúnmente utilizados en el diagnóstico de la enfermedad celíaca son los anticuerpos antigliadina (AG) y antiendomisio (AE). Recientemente (1997) se identificó a la transglutaminasa de tejido (tTG) como el principal autoantígeno de los anticuerpos AE. El objetivo de este trabajo fue determinar la sensibilidad y especificidad de testes de ELISA desarrollados en base a la utilización de estructuras moleculares definidas como antígenos de captura para los anticuerpos AG y AE. Como antígenos inmovilizados para los anticuerpos AG se ensayaron tres péptidos de sínteses correspondientes a la región amino terminal de la alfa gliadina y para los AE, la transglutaminasa de hígado de cobayo. Se examinaron un total de 80 sueros correspondientes a: pacientes celíacos, no tratados y tratados, controles enfermos no celíacos y controles sanos. Rango de edad: 7 meses a 14 años. Se obtuvo una sensibilidad del 97 por ciento y una especificidad 86 por ciento para la IgG determinada utilizando como antígeno uno de los tres péptidos de síntesis (correspondiente a los residuos 31-55 de la alfa gliadina). Este péptido aparece como un antígeno altamente sensible y más específico que la gliadina. El mejor resultado, con un 100 por ciento de especificidad y sensibilidad, se obtuvo en la determinación de la IgA anti-tTG, lo que destaca la relevancia de estos anticuerpos como marcadores serológicos de la enfermedad celíaca.
Subject(s)
Child, Preschool , Child , Infant , Adolescent , Humans , Male , Female , Antibodies/blood , Antigens/blood , Celiac Disease/diagnosis , Gliadin/immunology , Peptides/immunology , Transglutaminases/immunology , Biomarkers , Celiac Disease/enzymology , Enzyme-Linked Immunosorbent Assay , Gliadin/biosynthesis , Immunoglobulin A/blood , Immunoglobulin G/blood , Sensitivity and Specificity , Serologic TestsABSTRACT
Los marcadores serológicos comúnmente utilizados en el diagnóstico de la enfermedad celíaca son los anticuerpos antigliadina (AG) y antiendomisio (AE). Recientemente (1997) se identificó a la transglutaminasa de tejido (tTG) como el principal autoantígeno de los anticuerpos AE. El objetivo de este trabajo fue determinar la sensibilidad y especificidad de testes de ELISA desarrollados en base a la utilización de estructuras moleculares definidas como antígenos de captura para los anticuerpos AG y AE. Como antígenos inmovilizados para los anticuerpos AG se ensayaron tres péptidos de sínteses correspondientes a la región amino terminal de la alfa gliadina y para los AE, la transglutaminasa de hígado de cobayo. Se examinaron un total de 80 sueros correspondientes a: pacientes celíacos, no tratados y tratados, controles enfermos no celíacos y controles sanos. Rango de edad: 7 meses a 14 años. Se obtuvo una sensibilidad del 97 por ciento y una especificidad 86 por ciento para la IgG determinada utilizando como antígeno uno de los tres péptidos de síntesis (correspondiente a los residuos 31-55 de la alfa gliadina). Este péptido aparece como un antígeno altamente sensible y más específico que la gliadina. El mejor resultado, con un 100 por ciento de especificidad y sensibilidad, se obtuvo en la determinación de la IgA anti-tTG, lo que destaca la relevancia de estos anticuerpos como marcadores serológicos de la enfermedad celíaca. (AU)
Subject(s)
Child, Preschool , Child , Infant , Adolescent , Humans , Male , Female , Celiac Disease/diagnosis , Transglutaminases/immunology , Antibodies/blood , Gliadin/immunology , Antigens/blood , Peptides/immunology , Biomarkers , Sensitivity and Specificity , Enzyme-Linked Immunosorbent Assay , Immunoglobulin A/blood , Immunoglobulin G/blood , Gliadin/biosynthesis , Serologic Tests , Celiac Disease/enzymologyABSTRACT
Entre enero de 1978 y diciembre de 1983 fueron asistidos 108 niños por ingestión de sustancias cáusticas. Sólo 86 completaron su seguimiento hasta el alta. En la mitad de los casos el tóxico ingerido fue hidróxido de sodio (soda cáustica). La distribución por edades mostró una mediana de 24 meses. A todos los pacientes se les indicó el mismo esquema de tratamiento. La radiografia contratada de esófago realizada entre el 7- y el 30- día mostró ser pronóstica de las lesiones severas. Se realizó endoscopia esofágica a 31 pacientes durante los primeros días de evolución; 17 tuvieron lesiones de la mucosa esofágica que en 2 de ellos fueron severas y coincidieron con la evolución a la estenosis. Hubo correlación endoscópica/radiológica. Se consideraron pacientes de alto riesgo con probabilidad de desarrolar estenosis, aquellos niños que con el antecedente de ingesta de álcali presenten: a) Retraso mental. b) Lesiones intensas de orofaringe. c) Disfagia inicial que persiste más de 48 horas. Consideramos que la conducta ante todo niño que haya ingerido ese cáustico es: 1) Tratamiento con corticoides durante 15 días. 2) Radiografía contrastada de esófago entre el 7§ y el 10§ día. Si ésta presenta anormalidad, efectuar esofagoscopia y eventual dilatación
Subject(s)
Burns, Chemical , Caustics/adverse effects , Esophagus/injuries , Esophageal Stenosis/chemically induced , Adrenal Cortex Hormones/therapeutic use , Esophageal Stenosis/drug therapyABSTRACT
Entre enero de 1978 y diciembre de 1983 fueron asistidos 108 niños por ingestión de sustancias cáusticas. Sólo 86 completaron su seguimiento hasta el alta. En la mitad de los casos el tóxico ingerido fue hidróxido de sodio (soda cáustica). La distribución por edades mostró una mediana de 24 meses. A todos los pacientes se les indicó el mismo esquema de tratamiento. La radiografia contratada de esófago realizada entre el 7- y el 30- día mostró ser pronóstica de las lesiones severas. Se realizó endoscopia esofágica a 31 pacientes durante los primeros días de evolución; 17 tuvieron lesiones de la mucosa esofágica que en 2 de ellos fueron severas y coincidieron con la evolución a la estenosis. Hubo correlación endoscópica/radiológica. Se consideraron pacientes de alto riesgo con probabilidad de desarrolar estenosis, aquellos niños que con el antecedente de ingesta de álcali presenten: a) Retraso mental. b) Lesiones intensas de orofaringe. c) Disfagia inicial que persiste más de 48 horas. Consideramos que la conducta ante todo niño que haya ingerido ese cáustico es: 1) Tratamiento con corticoides durante 15 días. 2) Radiografía contrastada de esófago entre el 7º y el 10º día. Si ésta presenta anormalidad, efectuar esofagoscopia y eventual dilatación (AU)
