Longitudinal evaluation of glucose tolerance and insulin secretion in non-diabetic children and adolescents with cystic fibrosis: results of a two-year follow-up.

Thirty-two patients with cystic fibrosis and repeatedly normal fasting blood glucose underwent oral glucose tests and islet-cell antibody assessments on two occasions approximately two years apart. Fourteen patients underwent two iv glucose tolerance tests also. Although in the group as a whole mean glucose areas in response to the oral test remained substantially unmodified over the two-year period, the prevalence of glucose tolerance abnormalities increased from 37.5 to 50%. Insulin output in response to both oral and iv tolerance tests decreased over time. Worsening of insulin secretion and/or of glucose tolerance was never accompanied by deteriorating clinical status. Islet-cell antibodies were detected in no patients, even in those who developed a diabetic glucose tolerance. These results support, on a longitudinal basis, the view of a progressive impairment of B-cell function in cystic fibrosis, which may precede the onset of metabolic abnormalities and is not triggered by autoimmunity.

Insulin secretion, glycosylated haemoglobin and islet cell antibodies in cystic fibrosis children and adolescents with different degrees of glucose tolerance.

In comparison with 12 weight-matched controls, 39 children and adolescents with cystic fibrosis (CF) showed higher fasting glycaemic levels and both delayed and enhanced blood glucose responses to OGTT. Glycaemic response was normal in 30/39 patients (76.9%), impaired in other 7 cases (18%) and diabetic in the remnant two (5.1%). Fasting insulin levels and total insulin output during OGTT did not differ in patients and controls, but insulin peak in CF group was delayed and sustained. In the whole CF series mean HbA1c was higher than in controls but no difference was found between patients with normal and those with impaired glucose tolerance. Islet cell antibodies were absent in the entire CF group. In conclusion, our results confirm the raised prevalence in CF of glucose tolerance abnormalities, which do not seem to depend on auto-immune factor involvement. Delayed insulin response to OGTT can be considered a very early expression of beta cell impairment in the course of CF. In our experience HbA1c assay did not constitute a sensitive and specific screening test for detection of the C patients with glucose intolerance.

Helicobacter pylori infection: a simplified diagnostic approach.

We evaluated the diagnostic accuracy of endoscopic finding of nodular antritis and rapid urease test (RUT) in order to simplify the approach to the diagnosis of Helicobacter pylori (H. pylori) infection. Forty-four consecutive patients (mean age 7.9 yr, range 6-13 yr) referred because of recurrent abdominal pain as the main symptom, were prospectively investigated for the presence of H. pylori. H. pylori positivity or negativity was defined as the concordance of two of the following tests: RUT, microbiologic culture, and histologic examination on bioptic samples. RUT sensitivity was 100%, whereas specificity was 87.5%. The presence of nodular antritis had a sensitivity of 96.4% and specificity of 87.5% in H. pylori infection diagnosis. The predictivity value of combined RUT and nodular antritis, whether positive or negative, was 100%. Only in case of discordance do we suggest the utilization of other expensive tools for diagnosis of H. pylori infection.

Ranitidine in children with peptic ulcer and patients with pancreatic cystic fibrosis.

This article describes experience of the use of ranitidine in children with peptic ulcer and patients with pancreatic cystic fibrosis. Ranitidine proved to be efficacious and well tolerated, the percentage of healing being 89.4%. Ranitidine was also used in subjects with gastritis from Campylobacter pylori, obtaining rapid regression of subjective symptoms. Administration of ranitidine to cystic fibrosis patients improved the efficacy of the pancreatic extract, with consequent enhancement of digestive compensation.

Beta cell function, peripheral sensitivity to insulin and islet cell autoimmunity in cystic fibrosis patients with normal glucose tolerance.

Beta cell function, peripheral sensitivity to insulin and specific pancreatic autoimmunity were studied in 30 youngsters with cystic fibrosis (CF) accurately selected in order to fulfill the criteria for normal glucose tolerance. With respect to weight-matched controls, patients with CF exhibited a significantly lower glucose tolerance and a globally preserved, although delayed, insulin response to oral glucose tolerance test, while first-phase insulin secretion after i.v. glucose was blunted. Peripheral sensitivity to insulin, assessed in vivo by both the euglycemic clamp technique and the number of insulin receptors, directly measured in circulating monocytes, was superimposable in patients and controls. Serum islet-cell antibodies were not found in any of the patients. In conclusion, disorders of beta cell function may be observed in CF patients even when glucose tolerance is within the normal range. Such abnormalities are not associated with changes in peripheral sensitivity to insulin and do not seem to depend on specific autoimmune events.

Bowel frequency in healthy children.

Bowel frequency was recorded, on a diary sheet basis, in 662 children from six Italian cities. There is a wide interindividual variability, showing a sharp decrease with age; we report the distribution of the percentiles in the different age groups. Among infants, the breast-fed ones pass significantly more stools than the formula-fed.

Cimetidine treatment of reflux esophagitis in children: an Italian multicentric study.

The effectiveness of cimetidine (30-40 mg/kg/day) was evaluated in 32 children with gastroesophageal reflux disease complicated by esophagitis who entered a random double-blind trial for 12 weeks. Esophagitis was diagnosed in all patients by endoscopy with biopsy. Seventeen patients (age, mean +/- SD: 21.7 +/- 37.65 months) received cimetidine (c-pts), and 15 (age, mean +/- SD: 29.03 +/- 39.73 months) received a placebo (p-pts). All patients received intensive postural therapy. Based on clinical and endoscopic (and histologic) data, 12 c-pts and three p-pts were healed (p less than 0.01), the condition of four c-pts and three p-pts had improved (not statistically significant), and the condition of one c-pt and nine p-pts had worsened (p less than 0.01). Both clinical and esophagitis scores significantly decreased only in the c-pt group, as compared with p-pts. Improvement of esophagitis was seen in all (100%) of c-pts with mild or moderate esophagitis versus 57.14% of p-pts (p less than 0.01) and in 87.5% of c-pts with severe esophagitis as compared with 25% of the p-pt group (p less than 0.01). We conclude that cimetidine is an effective agent for treatment of reflux esophagitis in children. Although gastroesophageal reflux disease in infancy has a naturally self-limited course with conservative care (thickened feedings and posture adjustment), extensive pharmacologic therapy is needed in the presence of esophagitis.

Barrett's esophagus in an infant: a long standing history with final postsurgical regression.

Data on the frequency of regression of Barrett's esophagus after medical therapy or antireflux surgery in adult patients are conflicting; these data, with regard to pediatric age, where Barrett's esophagus is considered rare, are scarce and disappointing after antireflux surgery. We report a 4-month-old infant affected by severe reflux esophagitis who developed a junctional-type Barrett's epithelium. Histochemical procedures to detect mucin pattern were also carried out. The regression of Barrett's esophagus was observed 4 months after antireflux surgery whereas medical therapy had been unsuccessful. We suggest that esophageal biopsy should also be performed in the presence of severe esophagitis. Longer follow-up observations of other patients may clarify the role of antireflux surgery when Barrett's esophagus complicates gastroesophageal reflux (GER).

Gastrin 17 and gastrin 34, before and after a meal, in newborn infants.

In 89 healthy full-term newborn infants, we studied the different contribution of gastrin 17 (G17) and gastrin 34 (G34) to neonatal hypergastrinemia and the G17 and G34 response to a meal in the first days of life. Serum concentrations of G17 and G34 were measured by radioimmunoassay specific for the NH2-terminus of G17 and G34 in 23 newborn infants in the cord blood and in 66 newborn infants before or 20 min after bottle-feeding. Basal serum G17 and G34 values were also obtained in 38 healthy fasting adults. Mean (+/- SEM) G17 levels in the cord blood were not different from those of the adult controls (29.28 +/- 4.16 versus 31.00 +/- 2.62 pg/ml) and increased significantly either at 12 h (48.06 +/- 7.32 pg/ml, p less than 0.025) or on the 4th day of life (80.56 +/- 9.99 pg/ml, p less than 0.01). Serum G34 levels in the cord blood were significantly higher than in adult controls (163.22 +/- 11.19 versus 126.68 +/- 5.57 pg/ml, p less than 0.005) and increased at 12 h of life (225.22 +/- 25.95 pg/ml, p less than 0.02), but no increase was found on the 4th day of life (204.87 +/- 18.08 pg/ml). Neither postprandial G17 nor G34 increases were found on the 1st or on the 4th day of postnatal life. The study supports the following conclusions: (a) neonatal hypergastrinemia is mainly due to G34 fraction; (b) the increased levels of gastrin on the 4th day of life are due to G17 fraction; (c) bottle-feeding does not stimulate either G17 or G34 release in the first 4 days of life.

Obesity in a child with untreated coeliac disease.

This is the first report of obesity in an untreated coeliac patient diagnosed at the age of 5.1 years according to the criteria of the European Society for Paediatric Gastroenterology. Diagnosis of coeliac disease was suspected on the basis of recurrent episodes of abdominal pain and of family history. Gluten-free diet induced evident acceleration of both length and weight velocity and increase of weight excess, apart from resolution of the abdominal symptoms. The present case report demonstrates that obesity in a child does not exclude the diagnosis of coeliac disease.

[Scintigraphic study of gastric emptying in children with common obesity]. / Etude scintigraphique de la vidange gastrique chez des enfants avec obésité commune.

Quantitative gastric emptying essay by a single radio-nuclide technique (Tc99m), utilizing a fluid/solid meal, were performed in 2 groups of age-matched children: (a) 15 males with non-endocrine obesity; (b) 6 males and 3 females affected by gastroesophageal reflux, arbitrarily used as controls. Mean (+/- SD) gastric emptying rates, expressed as emptying half-time (T/2 in min) in the group a and b were superimposable (102.0 +/- 60.6 vs 97.3 +/- 43.1). Our data do not support the existence of an abnormally rapid gastric emptying rate in obesity, at least in pediatric age. This finding is even more striking if one considers that our control group was at high risk for delayed gastric emptying.