Risk of gastrointestinal bleeding during adolescence and early adulthood in children with portal vein obstruction.

OBJECTIVE: To estimate the risk of bleeding during adolescence and early adulthood in a group of children with portal vein obstruction who had not undergone an effective treatment beforehand. STUDY DESIGN: Children (n = 44) were followed up from age 12 years to a mean age of 20 years (range, 15-34 years). Actuarial risk of bleeding, related to previous occurrence of gastrointestinal bleeding and to pattern of varices at age 12, was calculated yearly. RESULTS: Twenty-four children presented with gastrointestinal bleeding after age 12, and 20 did not bleed. The overall actuarial probability of bleeding was 49% at age 16 and 76% at age 24. Probability of bleeding at age 23 was higher in children who had bled before age 12 than in children who had not bled (93% vs 56%; P =.007). Probabilities of bleeding at age 18 and at age 23 were 60% and 85%, respectively, in patients who had grade II or III esophageal varices at age 12. The 9 children without varices or with grade I varices only on endoscopy did not bleed between the ages of 12 and 20 years. CONCLUSIONS: Children with portal vein obstruction have a >50% risk of bleeding during adolescence; the pattern of varices on endoscopy at age 12 may have a prognostic value.

Percutaneous endoscopic gastrostomy for continuous feeding in children with chronic cholestasis.

BACKGROUND: Malnutrition associated with chronic cholestasis in children often requires continuous enteral feeding through a nasogastric tube, which may be poorly tolerated. METHOD: Percutaneous endoscopic gastrostomy was performed in five children (age range, 20 months to 13 years) with severe cholestasis (Alagille syndrome in four; biliary atresia in one) and severe malnutrition (mean weight, -2.6 standard deviations; mean height, -2.7 standard deviations) who were awaiting liver transplantation. The pull-through technique was used in patients under general anesthesia, and the button was set within 2 months. RESULTS: Minor wound infection required antibiotic therapy in one patient. In the four children with Alagille syndrome, enteral feeding by means of percutaneous endoscopic gastrostomy was used until liver transplantation for a mean period of 14 months with a mean weight gain of 350 g/mo and a mean height gain of 0.53 cm/mo. Seventeen months to 3 years, 3 months after liver transplantation, all four children were alive and in good clinical condition with normal readings in liver function tests. The technique had to be discontinued in the child with biliary atresia because of secondary occurrence of ascites, gastric intolerance, and refractory wound infection. CONCLUSION: Percutaneous endoscopic gastrostomy may be a valuable alternative to nasogastric tube for nutritional support in children with cholestasis and mild portal hypertension.

[Ambulatory 24-hour home pH-metry: parental and familial reactions. Prospective study of 100 cases]. / La pHmétrie de 24 heures en ambulatoire à domicile: vécu parental et familial. Etude prospective de 100 cas.

BACKGROUND: The ambulatory twenty-four hour esophageal pHmetry is nowadays a common mode of assessment of gastro-esophageal reflux in children. The aim of this study was to evaluate the impact of the test on child and family's ordinary daily life. MATERIAL AND METHODS: One-hundred children (64 boys, 36 girls) were included in this study during a 10-month period from August 1992 until May 1993. Mean age was 2 years 9 months (range: 22 days--12 years). Forms with a list of questions concerning parental understanding of the test, child's reaction after introduction of the pH-electrode, general reactions in the household, and eventual disturbance of the child's temper and appetite, were given to the parents. Six months later, 81 families were contacted by telephone and asked the same questions. Children were divided into three groups: those under 1 year of age (n = 38), from 1 to 4 years (n = 35), and more than 4 years (n = 27). RESULTS: One child aged 2 months had to be admitted to hospital due to the mother's overanxiety. The majority of parents (80%) assumed they knew about the principles of the test, with little change once the test was over. Those whose child had previously been submitted to the test were less apprehensive. When the test was first initiated, 81% of parents feared it would cause some discomfort, either due to pain (69%), or to poor acceptance at home (25%) with the risk of having the catheter accidently removed. Once the catheter had been positioned with the parents close to the child at that time, its presence was judged by them tolerable in 88.9% of cases. Once at home, 84.8% of the parents were not worried, as the child was calm (83.8%) and also due to the possibility for them to get in touch with the physician if necessary (86.9%). No change in routine daily life was reported by 80.8% of the families; in only 19.2% was the child reported to be overwhelmed with the test. When asked if the test should be undertaken another time, 91.9% would still prefer it as a home procedure, the only families requesting it be done in hospital being those with a history of sudden death syndrome. CONCLUSION: pHmetry test as a 24-hour procedure done at home may be the source of some discomfort and anxiety both to the child and parents; yet it appears to be generally well-accepted, both for its non-aggressive and diagnostic value.

[Small intestine ulcers 12 years after ileosigmoid anastomosis for neonatal necrotizing enterocolitis]. / Ulcérations du grêle 12 ans après une anastomose iléosigmoïdienne pour entérocolite ulcéronécrosante néonatale.

BACKGROUND: Ileal ulcers can be seen several years after surgery for neonatal necrotizing enterocolitis. They may be due to chronic bacterial colonisation of the intestine. CASE REPORT: A 12 year-old boy admitted suffering from chronic severe anemia (hemoglobin 6.5 g/dl), hypochromic and microcytic. Digestive bleeding was negative and the patient was successfully given iron for 6 months. Anemia was found again several months after cessation of treatment. Rectosigmoidoscopy showed several ulcers with inflammatory mucosa, near anastomosis secondary to an extensive bowel resection due to necrotizing enterocolitis. Ulcers of the distal small bowel persisted despite mesalazine and iron therapy and required resection of the intestine on both sides of the anastomosis. A few months later, recurrence of both ulcers and anemia led to the search for bacterial overgrowth which was confirmed by breath hydrogen testing. The patient was then given metronidazole plus amoxicillin by alternate courses and is well one year later. CONCLUSIONS: Chronic bacterial colonization can be responsible for ileal ulcers several years after intestinal resection, requiring a prolonged controlled follow-up.

[Budd-Chiari syndrome and membranous obstruction of the suprahepatic inferior vena cava. Treatment by percutaneous intraluminal angioplasty]. / Syndrome de Budd-Chiari et obstruction membraneuse de la veine cave inférieure sus-hépatique. Traitement par angioplastie intra-luminale percutanée.

A 38-year-old woman, suffering from a Budd-Chiari syndrome due to membranous obstruction of the inferior vena cava, has been treated by percutaneous trans-luminal angioplasty. The result is excellent six months after. The permeability of the vena cava has been studied by manometry and cavography. This innocuous procedure seems worth while in the treatment of Budd-Chiari syndrome with membranous obstruction of the inferior vena cava.