[Eosinophilic esophagitis in children: Evaluation of practices through a multicenter study]. / L'œsophagite à éosinophiles chez l'enfant : évaluation des pratiques.

Eosinophilic esophagitis (EE) is a recent pathology defined by abnormal immune response of the esophageal mucosa to exogenous allergens, leading to chronic mucosa infiltration by 15 eosinophils per High-Power-Field (Eos/HPF). The present retrospective study was designed to assess the hospital care for children suffering from EE in several hospitals in western France in order to highlight discrepancies and improve future care. Twenty-eight children ranging from 1.5 months to 17 years old were included in the study. Episodes of food blockage were the most frequently reported symptoms (46 %). A ratio of 29 % of EE patients reported macroscopically normal endoscopy; diagnosis was then established upon histological anomalies found in biopsies. The mean eosinophil count was 72.4 Eos/HPF. Centralized immunohistochemical staining revealed the presence of IgG4-responding plasma cells in 76.5 % of patients, as well as IgG4 intraepithelial degranulation in 14 % of them. The evaluation of the treatment plan showed important inter-center discrepancies with only 43 % of patients receiving endoscopic reevaluation. This study objectively highlights heterogeneities in diagnosis and care provided to children suffering from EE. Therefore, improving the consistency of practices seems to be crucial to optimize the patients' outcome. The role of IgG4 as a new diagnosis marker remains to be clarified.

[Knowledge of adolescents with inflammatory bowel disease: Results of a multicenter cross-sectional survey]. / Connaissances des adolescents atteints de maladie inflammatoire chronique intestinale : résultats d'une enquête transversale multicentrique.

AIM: To assess knowledge acquired by adolescents about their inflammatory bowel disease (IBD). METHODS: An anonymous questionnaire was given during consultation to adolescents followed for IBD by pediatricians from 13 hospitals between 1 September 2012 and 1 July 2013. After parental consent, these physicians completed a form at the inclusion of each patient, in which the characteristics of IBD were detailed. The patients mailed back their questionnaire. RESULTS: A total of 124 patients from 12 to 19 years of age were included with a response rate of 82% (all anonymous); 23% of the patients thought that diet was a possible cause of IBD and 22% that one of the targets of their treatment was to cure their disease for good. Of the patients reported having Crohn disease, 46% knew the anoperineal location and 14% knew that Crohn disease can affect the entire digestive tract. Twenty-five percent of the patients were able to name one side effect of azathioprine (88% had already received this treatment), 24% were able to name one side effect of infliximab (54% had already received this treatment), 70% of the adolescents knew that smoking worsens Crohn disease, 68% declared they had learned about their IBD from their pediatrician, and 81% said they would like to receive more information. CONCLUSION: Adolescents with IBD have gaps in their general knowledge and the different treatments of their disease. Their main source of information is their pediatrician, warranting the implementation of customized patient education sessions.

[Congenital portosystemic shunts: experience of the western region of France over 5 years]. / Shunts porto-systémiques congénitaux : expérience du Grand-Ouest sur cinq ans.

INTRODUCTION: Congenital portosystemic shunts (CPS) are rare vascular malformations that lead to liver metabolic modifications. The aim of this study was to describe the management and outcome of CPS in children who were followed in the western region of France and to compare our experience to a literature review. PATIENTS AND METHODS: This retrospective study reports nine children with CPS who were followed in the western region of France between 2008 and 2013. RESULTS: Among these nine children, six were detected by prenatal ultrasonography, one had cholestatic jaundice during the postoperative period, one had cholestatic jaundice during the first days of life, and one had dyspnea and fatigue. Two children had liver tumors. The CPS was intrahepatic for four children and extrahepatic for two children. Three others had a patent ductus venosus. Among the intrahepatic shunts that were discovered before the age of 2 years, three closed spontaneously. The five other shunts were closed surgically or by interventional radiology techniques, after angiography for four children. After closure of eight shunts, the outcome was favorable for six children. Two children presented complications after surgery: portal hypertension and portal thrombus. CONCLUSION: When CPS is suspected, the diagnosis should be confirmed and complications should be investigated. Shunt closure restores portal flow and prevents complications.

Nerve growth factor content is increased in the rectal mucosa of children with diarrhea-predominant irritable bowel syndrome.

BACKGROUND: The enteric nervous system is a complex network that includes, in the digestive mucosa, neuronal bodies and fibers interacting with the immune system and mucosal mast cells (MC). These interactions involve the secretion of messengers, such as the neurotrophin nerve growth factor (NGF), which influence colonic motility and sensitivity, both affected in irritable bowel syndrome (IBS). This study was designed to test the hypothesis that, in children with IBS, colonic mucosal innervation, NGF content, and MC infiltration are altered. We aimed to measure MC infiltration, number of neuronal bodies, distance from MC to nerve fibers, inflammation, and NGF content in rectal mucosa of pediatric patients with IBS as compared with controls. METHODS: Rectal biopsies from children (median age: 14 years) with diarrhea-predominant IBS (n = 11) and controls (n = 14) were studied. MC and neuronal mucosal structures were identified by tryptase, CD117 and PGP9.5 immunoreactivity. Inflammatory cells (neutrophils, eosinophils, and lymphocytes) were counted. NGF was quantified in situ by ELISA. KEY RESULTS: No mucosal inflammation was detected in IBS. MC infiltration and number of neuronal bodies were not significantly different between IBS and controls. The distance between MC and nerve fibers was not different in IBS compared with controls (5.2 ± 0.3 vs 5.0 ± 0.3 µm). Number of MC in close proximity to nerve fibers (<5 µm) was not different in the two groups. However, in IBS, NGF content was higher than controls (0.93 ± 0.3 vs 0.62 ± 0.3 pg mg(-1) protein, P < 0.05) and significantly correlated with MC number. CONCLUSIONS & INFERENCES: Regardless of inflammation, NGF content is increased in rectal mucosa of diarrhea-predominant IBS children.

[Rectal prolapse in a 3-year-8-month-old child]. / Prolapsus rectal chez un enfant de 3 ans 8 mois.

INTRODUCTION: Starting from a recent clinical case, we present the different causes of rectal prolapse and their specific treatments. In this case, the relation to infectious colitis was questionable. OBSERVATION: This 3-year-8-month-old boy had repetitive rectal prolapses with phlegmy and bloody diarrhea, with reduction increasingly difficult. Stool analysis was negative but pseudomembranous colitis was found with coloscopy and was confirmed by biopsy. DISCUSSION: Hygienic and dietary measures are the first steps in the treatment rectal prolapse. Pseudomembranous colitis, often related to Clostridium difficile toxins; is a severe form of postantibiotic diarrhea. Its treatment is based on oral antibiotic therapy with metronidazole or vancomycin for 10 days. Rectal prolapsus in children is cured without recurrence in 98% of cases. CONCLUSION: In the case reported herein, rectal prolapse did not recur after diarrhea recovery with antibiotic therapy, suggesting a causative link with pseudomembranous colitis.