Infection with cagA-positive and cagA-negative types of Helicobacter pylori among children and adolescents with gastrointestinal symptoms in Latvia.

In order to determine the prevalence of concomitant cagA-positive and cagA-negative Helicobacter pylori genotypes in individual subjects, a group of 56 symptomatic patients (aged 8-18 years) was studied. Among 31 patients culture-positive for Helicobacter pylori, only cagA-positive colonies were isolated from 18 patients, both cagA-positive and cagA-negative genotypes were isolated from 4 patients, and in 9 patients all of the individual colonies isolated were cagA-negative, but in seven of them a pool of colonies was positive for cagA. Thus, the presence of both cagA-positive and cagA-negative genotypes in the same individual was identified in 11 of the 31 culture-positive patients tested, and most of the patients predominantly colonized by cagA-negative strains also harbored a small amount of cagA-positive strains. Previous or current infection with cagA-positive strains of Helicobacter pylori was observed in 50 of the 56 patients studied.

Pharmacokinetics of budesonide controlled ileal release capsules in children and adults with active Crohn's disease.

BACKGROUND: Systemic glucocorticosteroid therapy is effective in Crohn's disease, but is associated with side-effects. Budesonide has high topical anti-inflammatory activity, but considerably lower systemic activity than other oral glucocorticosteroids. AIM: To evaluate the systemic exposure to budesonide (controlled ileal release capsules) in children and adults with active Crohn's disease, and to assess the suppression of plasma cortisol. METHODS: In an open label study, patients (eight children and six adults) with active Crohn's disease received 9 mg budesonide (Entocort capsules) orally once daily for 7 days. Plasma concentrations were determined on the seventh day of administration, and pharmacokinetic parameters were calculated. For reference, 0.5 mg budesonide was given intravenously separately. Plasma cortisol levels were compared with the pre-treatment baseline values. RESULTS: Systemic exposure to budesonide (AUC0-24 h) after 1 week of oral administration was 41 +/- 21 nmol/L x h (mean +/- s.d.) in children and 35 +/- 20 nmol/L x h in adults. The estimated systemic availability in children was 9 +/- 5% and in adults 11 +/- 7%. The mean plasma cortisol (AUC0-24 h) decreased by 64 +/- 18% in children and by 50 +/- 27% in adults. CONCLUSIONS: The systemic exposure, systemic availability and cortisol suppression after oral administration of 9 mg budesonide were similar in children and adults with active Crohn's disease. Budesonide was well tolerated and no clinically important safety-related findings were identified.

A relatively low prevalence of Helicobacter pylori infection in a healthy paediatric population in Riga, Latvia: a cross-sectional study.

UNLABELLED: The aim of this study was to investigate the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) among asymptomatic children. 13C-urea breath tests and questionnaires were obtained from 142 children and 40 parents. The prevalence of H. pylori was 19%. H. pylori positivity was higher in children with a positive parent (p=0.003) and independently inversely related to antibiotic treatment during the previous year in preschool children (p = 0.045). CONCLUSION: The prevalence of H. pylori in children in Riga is higher than that in Western countries, but lower than that in Eastern European countries. H. pylori is present during the second year of life and is influenced by parental H. pylori status and previous treatment with antibiotics.

Diagnostic test meal in childhood enteropathy using simultaneous carbohydrate and fat loading.

UNLABELLED: The diagnostic value of a combined test meal consisting of glucose, D-xylose and dairy cream was studied in 230 infants and children with gastrointestinal symptoms. The simultaneous absorption of the three compounds was rated according to their serum concentrations at different times 0-240 min after intake and compared to the histological changes of jejunal biopsy specimens. CONCLUSION: The results showed that the simultaneous loading test had higher specificity and sensitivity than D-xylose alone in patients with subtotal villous atrophy.

[Help to children and adolescents with malnutrition or eating disorders. Percutaneous endoscopic gastrostomy with button: simple, safe and cost-effective]. / Hjälp för barn och ungdomar med malnutrition eller ätstörning. Perkutan endoskopisk gastrostomi och knapp enkelt, säkert och billigt.

Percutaneous endoscopic gastrostomy (PEG) has gained great popularity for children with malnutrition and eating disorders secondary to chronic illness. However, the procedure is not without risks. We report on 62 infants and children, median age 4 years (1 month-20 years), who underwent PEG placement. Cerebral palsy with or without mental retardation was the most common diagnosis (50%). No complications related to the PEG procedure itself occurred, but postoperative pneumonia was seen in 10%. Late complications were few: intraperitoneal migration of the button in one child and prolapse of the stoma in another. At the time of button placement, after median 14 weeks, mean weight had increased from a standard deviation score of -2.7 to -2.2 (P < 0.001). We consider PEG to be a safe procedure for children with malnutrition requiring enteral feeding. Due to potential risks and complications related to this method, a multidisciplinary approach, as found in a "nutritional support team", is recommended.

Detection of Helicobacter pylori antibodies in a pediatric population: comparison of three commercially available serological tests and one in-house enzyme immunoassay.

A serum immunoglobulin G enzyme immunoassay (EIA) for Helicobacter pylori antibodies already in use in adults was evaluated with 99 pediatric serum samples to determine its usefulness for the study of H. pylori disease in children. The reference method used was either the (13)C-urea breath test or a biopsy culture of gastric mucosa. In children, an EIA cutoff of 0.35 absorbancy unit yielded sensitivity, specificity, and positive and negative predictive values of 93, 97, 93, and 97%, respectively. The cutoff recommended when this EIA was published for use in adults was 0.70 absorbancy unit (H. Gnarpe, P. Unge, C. Blomqvist, and S. Mäkitalo, APMIS 96:128-132, 1988). Another subset of 169 serum samples taken from children was analyzed by four serological tests in order to compare the performance of the in-house EIA with the Pyloriset, HM-CAP, and Helico-G kits. For the 169 samples, 10 (5.9%) false-positives and no false-negatives occurred with the Helico-G, 3 (1.8%) false-positives and no false-negatives occurred with the Pyloriset, and 3 (1.8%) false-positives and 1 (0.6%) false-negative occurred with the HM-CAP. For the 169 samples, 1 (0.6%) false-positive and no false-negatives occurred with the in-house EIA. Serological detection of H. pylori antibodies with our EIA seems to be valuable in diagnosing H. pylori infection in children, but only if a lowered, specific pediatric cutoff is established. The commercial kits, particularly the Helico-G, seem to overdiagnose pediatric H. pylori infection. A positive serological test for H. pylori infection, particularly for children, needs to be confirmed by a reference method because of the possibility of spontaneous eradication of infection, with a lingering serological response.

[Intestinal transplantation. The first Swedish transplantation of the small intestine in an adult patient with pseudoobstruction]. / Tarmtransplantation. Första svenska tunntarmstransplantationen till en vuxen patient med pseudoobstruktion.

Recent advances, first and foremost the development of new immunosuppressive agents, have markedly improved the outcome of intestinal transplantation, which is a treatment option for patients with serious intestinal diseases who have become dependent on total parenteral nutrition. The first small bowel transplantation in Sweden was performed at Huddinge Hospital in 1997, in the adult patient with intestinal pseudo-obstruction. The article reports the course of this patient and an update of international progress in intestinal transplantation.

Long-term double-blind study on the influence of dietary fibres on faecal bile acid excretion in juvenile ulcerative colitis.

A double-blind cross-over long-term trial (18 months) with randomized supplementation with wheat fibre or ispaghula for two periods of six months, separated by a six-month wash-out period with placebo, was performed in ten patients with juvenile ulcerative colitis to study the effect on faecal bile acid (BA) excretion. All patients were in remission since 0.5-2 years and orally treated with sulphasalazine. The average intake of either fibres was 16 g day-1. Faecal samples were collected (72 h) before and after each fibre period. Faecal water were prepared by centrifugation of faeces at 15,000 g for 2 h. BA in faeces and faecal water were studied using capillary column gas-liquid chromatography-mass spectrometry. Faecal excretion of total BA were not significantly changed by the two fibres. Supplementation with wheat fibre, but not with ispaghula, decreased the faecal concentration of total BA by 43% (p < 0.05), unconjugated BA by 41% (p < 0.01), and taurine conjugated BA by 58% (p < 0.05). Addition of wheat fibre decreased the concentration of chenodeoxycholic acid by 66% (p < 0.05) and isomers of cholic acid by 51% (p < 0.05) in faeces. The mean faecal water concentration of taurine-conjugated BA decreased by 55% when wheat fibre was added (p < 0.05) and the concentration of isomers of deoxycholic acid increased by 39% when ispaghula was supplemented (p < 0.05). The ratio isomeric deoxycholic acid to deoxycholic acid in faecal water increased significantly when wheat fibre was added (p < 0.05). The percentage distribution of secondary and ketonic BA was not influenced by the dietary fibre supplementation. The concentration of BA in faeces and faecal water decreased only by wheat fibre, suggesting that it is superior in obtaining an affect on faecal BA concentration.

Serum primary bile acids in the course of celiac disease in children.

Serum concentrations of primary bile acids (BAs) were determined in the course of celiac disease and in healthy age-matched controls. Determinations of BAs were made by radioimmunoassays after an overnight fasting and for 4 h postprandially after intake of a standardized test meal. In untreated celiac disease presenting with subtotal villous atrophy, peak concentrations of primary BAs were significantly delayed and serum levels were significantly higher than in controls. Small but significant abnormalities persisted after a period of gluten-free diet despite a normalization of mucosal morphology. Slightly pathological standard liver function tests in five patients were related to increased fasting levels but not to the postprandial pattern of BAs, indicating that the observed abnormalities postprandially were not related to liver disease. Further studies simultaneously focusing on deconjugation mechanisms, absorption, and pool sizes of BAs are required to explain the postprandial BA pattern under the course of celiac disease.

Faecal bile acid excretion in children with inflammatory bowel disease.

Faecal bile acid excretion and intestinal transit time were studied in 18 children with inflammatory bowel disease in clinical remission and with normal stools: 16 with ulcerative colitis, two with Crohn's colitis, mean age 14 years (range 10-17 years). Five healthy children, mean age 12.4 years (range 10-17 years), were studied as control subjects. Most patients were taking sulphasalazine, but none were taking steroids. Transit time was determined by carmine and did not differ between groups. Faeces were collected for 72 hours, and faecal water was prepared by centrifugation of faeces at 15,000 x g for two hours. Bile acids in total faeces and faecal water were studied using capillary gas-liquid chromatography-mass spectrometry. Faecal excretion of total bile acids, unconjugated bile acids, and glycine and taurine conjugates were significantly increased in patients as was faecal water excretion of total bile acids, particularly the taurine conjugates and cholic and chenodeoxycholic acids. Total concentrations of bile acids in faeces and faecal water were two to five times higher in patients. The children with inflammatory bowel disease in clinical remission had high excretion and concentration rates of bile acids, especially taurine conjugates, in both total faeces and faecal water, a finding of considerable interest in the pathogenesis of malignancy in these diseases.

Serum bile acids in relation to disease activity and intake of dietary fibers in juvenile ulcerative colitis.

Serum concentrations of primary bile acids were determined at different disease activities in juvenile ulcerative colitis and in healthy age-matched controls. In patients with ulcerative colitis in clinical remission, serum levels of bile acids were also studied after long-term intake (6 months) of dietary fibers (wheat fiber and ispaghula, respectively) in a double-blind randomized cross-over study. Blood samples were taken in the morning after an overnight fasting and for 4 h postprandially after a standardized test meal. Determinations of bile acids were made by radioimmunoassays. Patients with total colitis in the active phase had significantly higher serum levels of cholic and chenodeoxycholic acids 4 h postprandially compared with control children. After long-term intake of ispaghula, significantly higher (although not different from controls) serum levels of cholic acid were found 2 and 3 h postprandially, whereas wheat fibers did not affect serum bile acid concentrations. These results may suggest an increased absorption of unconjugated bile acids in the diseased colon and a minimal influence of dietary fibers on serum bile acid concentrations.

Absence of effect on faecal microflora of long-term supplementation of dietary fibres in juvenile ulcerative colitis.

In a long-term double-blind cross-over study, ten patients aged 10-18 years with juvenile ulcerative colitis were studied before and after six months supplementation of dietary fibre (wheat fibre and ispaghula). All patients had been in remission for 0.5 to 2 years and orally treated with sulfasalazine, but none were taking steroids. The type of fibre intake was randomized and the periods separated by a 6-month wash-out period with placebo. The average intake of both wheat fibre and ispaghula was 16 g per day. Faecal samples were collected before and after each fibre period and analysed by quantitative and qualitative microbiological techniques. No significant changes in bacterial species were found in the faecal microflora. The results indicate that effects of fibre on human metabolism in patients with ulcerative colitis treated with sulfasalazine are not mediated by changes in the intestinal microflora.

Liver damage in juvenile inflammatory bowel disease.

During a 12-year period, 46 children and adolescents with inflammatory bowel disease were followed from the time of diagnosis with regular biochemical tests of liver function. Thirty-four patients had ulcerative colitis and 12 had Crohn's disease. Mean age at the time of diagnosis was 10.2 years (range 7 months-17 years) and the mean follow-up period was 5.2 years (range 1-11 years). Pathological liver function tests were found in 60% of the 34 patients with ulcerative colitis: 9 of these 20 patients demonstrated more severe disturbance, usually at the time of diagnosis. Liver damage was most frequent in patients with total colitis. Liver biopsy was performed in eight patients, demonstrating "pericholangitis", fibrosis and in one case cirrhosis. Morphometry of electron microscopical pictures revealed a significantly increased number of lysosomes and dilated cisternae of the rough endoplasmic reticulum. ERCP was performed in two patients, verifying primary sclerosing cholangitis in one. Four of the 12 patients with Crohn's disease had mildly pathological liver function tests. No correlation was found to the extent, duration or treatment of bowel disease. In our series of juvenile inflammatory bowel disease, liver damage occurred frequently, especially in ulcerative colitis. The more severe changes tended to coincide with the onset of bowel disease.

Na,K-ATPase activity in rectal mucosa of children with ulcerative colitis and Crohn's disease.

Mucosal Na,K-ATPase activity was studied in rectal biopsy specimens from 19 children with ulcerative colitis (UC) (mean age, 13 years) and 4 children with Crohn's colitis (mean age, 14 years) and compared with biopsy specimens from 12 control children (mean age, 12 years). The Na,K-ATPase activity was significantly decreased in UC with severe rectal inflammation compared with UC in remission or with children with unspecific symptoms and normal mucosa (p less than 0.001, respectively). A higher enzyme activity was shown with age in the group with normal rectal mucosa and no evidence of inflammatory bowel disease (n = 17). The decreased Na,K-ATPase in UC with severe rectal inflammation might contribute to the diarrhoea by impairment of sodium transport.

High dose intravenous IgG reduces platelet associated immunoglobulins and complement in idiopathic thrombocytopenic purpura.

4 children with idiopathic thrombocytopenic purpura were treated with high dose i.v. IgG. Platelet associated immunoproteins were determined with an Elisa technique. Platelet counts increased in all patients, while simultaneously platelet associated IgG, IgA, IgM, C3 and C4 decreased. Serum antiplatelet antibody increased during treatment suggesting that administration of high doses of IgG interferes with the binding of antiplatelet antibody.

Pyridoxal phosphate concentration in blood in newborn infants and their mothers compared with the amount of extra pyridoxol taken during pregnancy and breast feeding.

The concentrations of pyridoxal phosphate have been estimated in cord blood and capillary blood samples taken at 3 hours, 2 days, 4 days, 7 days and 6 weeks of age, from eleven full-term infants. Pyridoxal phosphate concentrations were also determined in venous blood samples taken from the mothers at delivery. A highly significant correlation between pyridoxal phosphate in cord whole blood and venous whole blood taken from the mothers at delivery was found. Infants whose mothers had taken extra pyridoxol during pregnancy had a higher concentration of pyridoxal phosphate at 3 hours of age compared with infants whose mothers had not taken extra pyridoxol. During the first week of life the concentrations of pyridoxal phosphate in capillary blood decreases strikingly. At 6 weeks of age the concentration of pyridoxal phosphate is in the same range as that of normal adults. Findings are also discussed which indicates that: 1) Vitamin B6 is transported in breast milk; 2) The giving of supplemental pyridoxol during pregnancy in ordinary doses (2-6 mg/day) does not have an antilactogenic effect. No correlation between the erythrocyte aspartate aminotransferase activation with pyridoxal phosphate in vitro and pyridoxal phosphate concentration in plasma was found during the first 6 weeks of life.