Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003).

BACKGROUND: The purpose was to assess in Italy the clinical features at diagnosis of inflammatory bowel disease (IBD) in children. METHODS: In 1996 an IBD register of disease onset was established on a national scale. RESULTS: Up to the end of 2003, 1576 cases of pediatric IBD were recorded: 810 (52%) ulcerative colitis (UC), 635 (40%) Crohn's disease (CD), and 131 (8%) indeterminate colitis (IC). In the period 1996-2003 an increase of IBD incidence from 0.89 to 1.39/10(5) inhabitants aged <18 years was observed. IBD was more frequent among children aged between 6 and 12 years (57%) but 20% of patients had onset of the disease under 6 years of age; 28 patients were <1 year of age. Overall, 11% had 1 or more family members with IBD. The mean interval between onset of symptoms and diagnosis was higher in CD (10.1 months) and IC (9 months) versus UC (5.8 months). Extended colitis was the most frequent form in UC and ileocolic involvement the most frequent in CD. Upper intestinal tract involvement was present in 11% of CD patients. IC locations were similar to those of UC. Bloody diarrhea and abdominal pain were the most frequent symptoms in UC and IC, and abdominal pain and diarrhea in CD. Extraintestinal symptoms were more frequent in CD than in UC. CONCLUSIONS: The IBD incidence in children and adolescents in Italy shows an increasing trend for all 3 pathologies. UC diagnoses exceeded CD.

Intraduodenal lipase activity in celiac disease assessed by means of 13C mixed-triglyceride breath test.

BACKGROUND: In patients with celiac disease, the occurrence of exocrine pancreatic insufficiency has been related to an impairment of the gut-mediated stimulatory effect of the meal on the pancreas. The purpose of this study was to assess the intraduodenal lipase activity in patients with celiac disease by means of the 13C mixed-triglyceride breath test and to monitor pancreatic function after the institution of a gluten-free diet. METHODS: Seventeen untreated patients with celiac disease (mean age, 17.4 +/- 10.5 years) were studied. After an overnight fast, patients were given a standard test meal consisting of 100 g of white bread and 0.25 g of butter per kilogram of body weight, to which 16 mg di-stearyl-13C-octanoyl-glyceride (mixed triglyceride) had been added. Breath samples were taken twice at baseline and at 30-minute intervals for 6 hours after the meal. 13C enrichment in breath was determined by means of Isotope Ratio Mass Spectrometer (IRMS) (ANCA-NT; Europa Scientific, Crewe, UK). Results were expressed as the maximum percentage of 13C recovery per hour at any time, the time to reach peak excretion of 13C, and the percentage of 13C cumulative dose over 6 hours. RESULTS: Mixed-triglyceride breath test results were pathologic in three patients and at the lower limit of the normal range in another patient. In the remaining 13 patients, the results were within normal values. At the 6- and 12-month follow-ups, all patients showed normal intraduodenal lipase activity. CONCLUSIONS: In approximately 24% of patients with celiac disease, the intraduodenal pancreatic lipolytic activity is impaired. The mixed-triglyceride breath test could be used to assess fat maldigestion and to monitor the need for enzyme replacement therapy in such patients.

[Pancreatitis associated with salmonella]. / Pancreatite in corso di salmonellosi maggiore.

There is no general agreement about the possibility that pancreatitis could be regarded as a clinical complication of Salmonella infection. We report 2 cases of salmonellosis WHO were admitted to our Department for clinical and biological signs of pancreatitis. Our observation agrees with other reported cases, suggesting that patients affected by salmonellosis with upper abdominal pain should be investigated for concomitant pancreatitis; on the other hand in patients suffering from diarrhea with hyperamylasaemia, salmonellosis should be considered as a likely explanation for their clinical condition.

[Melkersson-Rosenthal syndrome. A case report]. / La sindrome di Melkersson-Rosenthal. Descrizione di un caso.

The Melkersson-Rosenthal syndrome is a rare disease of unknown pathogenesis. Classical signs include recurrent facial palsy, lingua plicata and orofacial edema. The diagnosis is often difficult when all features are not present at the same time: in the literature complete triads occurred in 25-30% of the patients. We report a case of Melkersson-Rosenthal syndrome with classical triad of signs in a 13 year old boy. The pathology, clinical features and management of this disease are discussed: the possible role of food allergy or additives intolerance is also examined.

[Chronic inflammatory bowel diseases in childhood. Case contribution and critical considerations]. / Le malattie infiammatorie croniche intestinali in età pediatrica. Contributo casistico e considerazioni critiche.

The term "inflammatory bowel disease" describes 2 major categories of chronic disease: Crohn's disease and ulcerative colitis. Non specific chronic colitis and allergic colitis in childhood can usually be distinguished by clinical and histopathologic criteria. This study regards a retrospective analysis of 23 patients suffering from chronic inflammatory bowel disease. Clinical manifestations began between 4 and 18 years of age. The Authors report remarkable frequency in pediatric age and common diagnostic delay, especially in Crohn's disease. The possibility of extraintestinal symptoms (erythema nodosum, arthritis, iridocyclitis) is also showed. Moreover they analyse present diagnostic proceedings: in childhood the employ of 99 mTc-HmPAO-labelled granulocytes is a new and non invasive test useful in the follow-up of the patients. In the treatment corticosteroids and sulfasalazine are used in various combinations associated with general supportive measures. Finally the Authors confirm that chronic inflammatory bowel disease may cause, especially in childhood, remarkable involvement on the growth and several psychological disorders.

[Achalasic megaesophagus with onset in the 1st year of life. A case report]. / Megaesofago acalasico ad insorgenza nel I anno di vita. Descrizione di un caso.

We report a case of esophageal achalasia in a nine months old baby. Recurrent cough and cyanosis were the most important clinical findings. Esophagomyotomy remarkably improved the clinical symptoms. Disorders of esophageal motility may be an important cause of respiratory emergencies in the first year of life.