RESUMEN
Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0-18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2-258) h. All children were ≤ 5 (median 1.4; IQR 0.9-2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%). CONCLUSION: Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required. What is Known: ⢠Button battery ingestion may result in serious and fatal complications. ⢠Serious and fatal complications after button battery ingestion are increasing worldwide. What is New: ⢠Sixteen serious complications after button battery ingestion occurred during 2008-2016 in children in the Netherlands. ⢠Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.
Asunto(s)
Suministros de Energía Eléctrica/efectos adversos , Esófago/lesiones , Cuerpos Extraños/complicaciones , Preescolar , Ingestión de Alimentos , Endoscopía/estadística & datos numéricos , Cuerpos Extraños/mortalidad , Humanos , Lactante , Países Bajos , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To assess incidence and clinical course of Dutch patients with achalasia diagnosed before 18 years of age as well as their current symptoms and quality of life (QoL). STUDY DESIGN: Retrospective medical chart review and a cross-sectional study assessing current clinical status using the Eckardt score and reflux disease questionnaire. General QoL was measured using Kidscreen-52 for patients <18 years of age or to 36-Item Short Form Health Survey for patients ≥18 years of age. RESULTS: Between 1990 and 2013, 87 children (mean age 11.4 ± 3.4 years, 60% male) diagnosed with achalasia in the Netherlands were included. Mean incidence was 0.1/100,000/y (range 0.03-0.21). Initial treatment was pneumodilation (PD) in 68 (79%) patients and Heller myotomy (HM) in 18 (21%) patients. Retreatment was required more often after initial PD compared with initial HM (88% vs 22%; P < .0001). More complications of initial treatment occurred after HM compared with PD (55.6% vs 1.5%; P < .0001). Three esophageal perforations were seen after HM (16.7%), 1 after PD (1.5%). Sixty-three of 87 (72%) patients were prospectively contacted. Median Eckardt score was 3 (IQR 2-5), with 32 patients (44.5%) having positive scores suggesting active disease. Reflux disease questionnaire scores were higher after initial HM vs PD (1.71 [0.96-2.90] vs 0.58 [0-1.56]; P = .005). The 36-Item Short Form Health Survey (n = 52) was lower compared with healthy population norms for 7/8 domains. Kidscreen-52 (n = 20) was similar to population norms. CONCLUSIONS: Pediatric achalasia is rare and relapse rates are high after initial treatment, especially after pneumodilation, but with more complications after HM. Symptoms often persist into adulthood, without any clinical follow-up. QoL in adulthood was decreased.
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Acalasia del Esófago/diagnóstico , Acalasia del Esófago/epidemiología , Calidad de Vida , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Países Bajos/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Previous studies have suggested the existence of enteropathy in cystic fibrosis (CF), which may contribute to intestinal function impairment, a poor nutritional status and decline in lung function. This study evaluated enterocyte damage and intestinal inflammation in CF and studied its associations with nutritional status, CF-related morbidities such as impaired lung function and diabetes, and medication use. METHODS: Sixty-eight CF patients and 107 controls were studied. Levels of serum intestinal-fatty acid binding protein (I-FABP), a specific marker for enterocyte damage, were retrospectively determined. The faecal intestinal inflammation marker calprotectin was prospectively studied. Nutritional status, lung function (FEV1), exocrine pancreatic insufficiency (EPI), CF-related diabetes (CFRD) and use of proton pump inhibitors (PPI) were obtained from the medical charts. RESULTS: Serum I-FABP levels were elevated in CF patients as compared with controls (p<0.001), and correlated negatively with FEV1 predicted value in children (r-.734, p<0.05). Faecal calprotectin level was elevated in 93% of CF patients, and correlated negatively with FEV1 predicted value in adults (r-.484, p<0.05). No correlation was found between calprotectin levels in faeces and sputum. Faecal calprotectin level was significantly associated with the presence of CFRD, EPI, and PPI use. CONCLUSION: This study demonstrated enterocyte damage and intestinal inflammation in CF patients, and provides evidence for an inverse correlation between enteropathy and lung function. The presented associations of enteropathy with important CF-related morbidities further emphasize the clinical relevance.
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Fibrosis Quística/complicaciones , Enfermedades Intestinales/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Fibrosis Quística/metabolismo , Fibrosis Quística/patología , Proteínas de Unión a Ácidos Grasos/sangre , Heces/química , Femenino , Humanos , Lactante , Inflamación/complicaciones , Inflamación/metabolismo , Inflamación/patología , Enfermedades Intestinales/metabolismo , Enfermedades Intestinales/patología , Complejo de Antígeno L1 de Leucocito/análisis , Masculino , Persona de Mediana Edad , Estado Nutricional , Adulto JovenRESUMEN
OBJECTIVES: Adalimumab, a humanised anti-tumour necrosis factor antibody, is an effective treatment in adult patients with refractory Crohn disease (CD). The available literature on its efficacy in children remains limited. We aimed to evaluate the real-world efficacy in paediatric patients with CD and compare the efficacy between infliximab (IFX) nonresponders and patients who lost response to IFX. METHODS: All Dutch patients with CD receiving adalimumab before the age of 18 years after previous IFX therapy were identified. We analysed longitudinal disease activity, assessed by the mathematically weighted Pediatric Crohn's Disease Activity Index (wPCDAI) or the physician global assessment (PGA), and adverse events (AEs). RESULTS: Fifty-three patients with CD were included. Twelve patients received monotherapy and the others received combination treatment with thiopurines (nâ=â21), methotrexate (nâ=â11), steroids (nâ=â7), or exclusive enteral nutrition (nâ=â2). Median follow-up was 12 months (interquartile range 5-23). Remission was reached in 34 patients (64%, wPCDAIâ<â12.5 or PGAâ=â0) after a median of 3.3 months, and maintained by 50% for 2 years. Eleven patients (21%) reached response but not remission (decrease in wPCDAIâ≥â17.5 or decrease in PGA). Eighteen patients (34%) failed adalimumab treatment because of nonresponse (nâ=â4), lost response (nâ=â11), or AEs (nâ=â3). More IFX nonresponders failed adalimumab treatment than patients who lost response to IFX (2/3 vs 8/34, hazard ratio 18.8, 95% confidence interval 1.1-303.6). Only 1 patient encountered a serious AE, a severe but nonfatal infection. CONCLUSIONS: In clinical practice, adalimumab induces remission in two-thirds of children with IFX refractory CD.
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Antiinflamatorios no Esteroideos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Adalimumab , Adolescente , Antiinflamatorios no Esteroideos/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Niño , Resistencia a Medicamentos , Quimioterapia Combinada , Tolerancia a Medicamentos , Femenino , Humanos , Infliximab , Masculino , Retratamiento , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: Addition of a non-invasive marker for intestinal damage to the currently used parameters for celiac disease activity (symptoms, serologic tests and biopsy) might further improve clinical management of celiac disease (CD). Intestinal fatty acid binding protein (I-FABP) is a cytosolic enterocyte protein and sensitive marker for enterocyte damage in the small intestine. We investigated whether serum I-FABP levels can reliably identify villous atrophy in children with a positive CD antibody screening. Moreover, the recovery of I-FABP levels after gluten free diet (GFD) was studied. METHODS: I-FABP levels were analyzed retrospectively in 49 children with biopsy proven CD and in 19 patients with a positive screening but without histological confirmation of CD. Blood was collected before biopsy and repeatedly after the onset of GFD. RESULTS: Initial I-FABP concentrations in CD (median 458 pg/ml) were significantly (p < 0.001) elevated compared to controls (median 20 pg/ml). In the control group, only two of 19 children were found to have elevated I-FABP levels, of which one was subsequently diagnosed with CD after gluten challenge. I-FABP concentrations correlated with severity of villous atrophy. In all CD patients, I-FABP levels decreased quickly after GFD and normalized in 80% of patients within 12 weeks. CONCLUSIONS: Elevated I-FABP levels accurately predict villous atrophy in children with a positive serologic test for CD (positive predictive value 98%). In addition, measurement of I-FABP enables monitoring the response to GFD.
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Enfermedad Celíaca/sangre , Enfermedad Celíaca/patología , Enterocitos/patología , Enterocitos/ultraestructura , Proteínas de Unión a Ácidos Grasos/sangre , Mucosa Intestinal/patología , Adolescente , Área Bajo la Curva , Atrofia/patología , Biopsia , Enfermedad Celíaca/dietoterapia , Niño , Preescolar , Dieta Sin Gluten , Femenino , Humanos , Lactante , Masculino , Microvellosidades/patología , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND AND GOALS: In the clinical management of celiac disease, new noninvasive tools for evaluation of intestinal damage are needed for diagnosis and for follow-up of diet effects. Fatty acid binding proteins (FABP) are potentially useful for this purpose as these are small cytosolic proteins present in enterocytes and sensitive markers for intestinal mucosal damage. First, the distribution and microscopic localization of FABP in the healthy human intestine was examined. Second, levels of circulating FABP were measured in patients with celiac disease before and after introducing a gluten-free diet (GFD) and in healthy controls. STUDY: The distribution and microscopic localization of FABP in normal human intestinal tissue was assessed using surgical intestinal specimens of 39 patients. Circulating levels of intestinal (I)-FABP and liver (L)-FABP were determined in 26 healthy volunteers and 13 patients with biopsy proven celiac disease. Ten of these patients were reevaluated within 1 year after starting GFD. RESULTS: I-FABP and L-FABP are predominantly present in the small intestine, mainly the jejunum. Moreover, FABP are expressed in cells on the upper part of the villi, the initial site of destruction in celiac disease. Circulating levels of FABP are significantly elevated in untreated patients with biopsy proven celiac disease compared with healthy controls (I-FABP: 784.7 pg/mL vs. 172.7 pg/mL, P<0.001; L-FABP: 48.4 ng/mL vs. 10.4 ng/mL, P<0.001). In response to GFD, these concentrations normalize. CONCLUSIONS: Results of this pilot study strongly suggest that FABP can be used as a noninvasive method for assessment of intestinal damage in celiac disease. Besides an additional role in the diagnosis of celiac disease, FABP potentially enable noninvasive monitoring of the GFD effects.
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Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/patología , Proteínas de Unión a Ácidos Grasos/análisis , Mucosa Intestinal/patología , Adolescente , Adulto , Enfermedad Celíaca/dietoterapia , Niño , Preescolar , Dieta Sin Gluten/estadística & datos numéricos , Enterocitos/metabolismo , Enterocitos/patología , Proteínas de Unión a Ácidos Grasos/sangre , Femenino , Humanos , Lactante , Recién Nacido , Mucosa Intestinal/metabolismo , Masculino , Persona de Mediana Edad , Proyectos Piloto , Adulto JovenRESUMEN
Anaemia due to obscure gastrointestinal blood loss remains a challenge to the clinician, especially when blood loss is severe enough to result in profound anaemia while further investigations fail to identify the cause of bleeding. A description of how wireless capsule endoscopy revealed a bleeding jejunal haemangioma in a 2.5-year-old boy with recurrent anaemia is given. New techniques such as wireless capsule endoscopy and double balloon enteroscopy are feasible and provide a valuable adjunct to the diagnostic investigation of children with obscure enteral blood loss.
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Enterocolitis Necrotizante/diagnóstico , Heces/química , Complejo de Antígeno L1 de Leucocito/análisis , Adolescente , Biomarcadores/análisis , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades Inflamatorias del Intestino/diagnóstico , Complejo de Antígeno L1 de Leucocito/inmunologíaRESUMEN
Massive small bowel resection often leads to long-term parenteral nutrition. The authors present a term-born, 3-day-old boy with midgut volvulus in whom only 17 cm of small bowel was left after resection. This patient was weaned from parenteral nutrition after 7 months. Temporary parenteral nutrition-associated cholestasis was treated with ursodeoxycholic acid.
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Vólvulo Intestinal/congénito , Síndrome del Intestino Corto/etiología , Anastomosis Quirúrgica , Lactancia Materna , Colagogos y Coleréticos/uso terapéutico , Colestasis/tratamiento farmacológico , Colestasis/etiología , Diarrea Infantil/etiología , Humanos , Recién Nacido , Vólvulo Intestinal/cirugía , Intestinos/patología , Intestinos/cirugía , Pruebas de Función Hepática , Masculino , Necrosis , Nutrición Parenteral/efectos adversos , Síndrome del Intestino Corto/terapia , Esteatorrea/etiología , Ácido Ursodesoxicólico/uso terapéuticoRESUMEN
UNLABELLED: To evaluate the usefulness of "single stool sample" analysis in the investigation of steatorrhoea instead of 72-h stool collection, we examined 57 stool samples of patients with cystic fibrosis (CF) while on pancreatic enzyme therapy and 29 stool samples of healthy children. We compared results of fat, nitrogen, water and energy content. Fat was determined by the method of Van de Kamer et al. and the Acid Steatocrit (AS) method, water by vacuum drying, nitrogen by the Dumas method and energy was obtained using a bomb calorimeter. Results (median) for CF patients and healthy controls were significantly different (P< or =0.0001) for fat respectively: 8.90 and 4.75/100 g wet weight (ww) stool as measured by the method of Van de Kamer et al. and 28.6% and 7.2% by the AS method. Energy results for energy were also significantly (P< or =0.0001) different: 742.96 and 549.32 kJ/100 g ww stool for CF patients and healthy controls respectively. Results of single stool sample water and nitrogen were similar in both groups. These results were comparable to those of a 3-day stool collection, as reported in the literature. CONCLUSION: Results from single stool samples yield clinically useful information concerning fat and energy. Single stool sample analysis is therefore useful for frequent monitoring of faecal fat and energy.