[Treatment of chronic functional constipation in children by administration of vegetable fiber (Dicoman 5)]. / Trattamento della stipsi cronica funzionale del bambino con somministrazione di fibre vegetali ("Dicoman 5").

Chronic functional constipation is a common clinical disorder in pediatric age. Thirteen children with functional constipation were treated by administration of vegetable fibres together with a toilet training program, for two months. In each patient anorectal manometry showed presence of inhibitory anal reflex and diagnosis of constipation was confirmed by a prolonged gastrointestinal transit time measured by radio-opaque markers. In all patients there was a significant improvement in both stool frequency and intestinal transit time; furthermore, a normalization of anorectal motility variables was observed at rectal manometry. No changes in the blood levels of nutritional parameters were seen in any patient. It is concluded that vegetable fibres represent an effective treatment of functional chronic constipation in children.

Effect of dietary calcium on metabolic balance of normal infants.

Metabolic balance studies were performed with six normal infants fed in a balanced cross-over design three formulas differing only in calcium concentration: 389, 659, and 1024 mg/liter. Absorption of phosphorus was significantly affected by increasing calcium intake decreasing from 68 to 63 to 52% of intake. However, since urinary excretion of phosphorus also decreased, there was no significant effect on retention of phosphorus. Absorption of fat was slightly (but significantly) depressed by calcium, decreasing from 97.5 to 95.5 to 92.1% as calcium intake increased. The level of dietary calcium had no significant effect on absorption or retention of nitrogen, magnesium, copper, and zinc. One of the subjects had consistently lower absorption of calcium and fat than the other subjects, suggesting an absorptive defect. The decrease in fractional absorption of calcium (57 to 47 to 39% of intake) with increasing intake of calcium is compatible with adaptive regulation. On the other hand, the observation that absorbed calcium (mg/kg/day) was linearly related to intake of calcium with a slope of 0.373 suggests an alternative explanation: constant passive, concentration-dependent (slope), and constant active (y-intercept) transport of calcium over the range of calcium intakes. Thus, the findings are explainable in more than one way and do not necessarily demonstrate regulatory changes.

Sigmoidoscopy, colonoscopy, and radiology in the evaluation of children with rectal bleeding.

The authors evaluated the diagnostic role of sigmoidoscopy, colonoscopy, and double contrast radiology in 103 children with rectal bleeding, with or without other gastrointestinal symptoms. The children's mean age was 44 months, with a range from 1 month to 12 years. In 74.5% of the subjects investigated, visual inspection of the anus and sigmoidoscopy with rectal biopsy disclosed a positive diagnosis. Of the remaining patients, a conclusive diagnosis was reached by either colonoscopy or double contrast radiology in all but six patients. These six, with mild painless hematochezia, remained without a diagnosis. The diagnostic procedure in pediatric patients with rectal bleeding should include an initial visual inspection of the anus, and sigmoidoscopy; air contrast enema and colonoscopy should be performed only in children whose sigmoidoscopy is negative, in diagnostic assessment of inflammatory bowel disease, and in cases of recurrent bleeding after removal of rectal polyps. Colonoscopy is important also in the follow-up examination of children with inflammatory bowel disease and allows the removal of polyps located in the proximal colon.