[New recommendations on the diagnosis and treatment of eosinophilic esophagitis in children and adults].

Besides gastro-esophageal reflux, eosinophilic esophagitis (EoE), is the most frequently diagnosed chronic inflammatory disease both in children and adults. Clinical symptoms depend on the age of the patient and the time of the disease. In infants and younger children feeding disturbances, physical development retardation, vomiting and abdominal pain are most frequent. Difficulty in solid food swallowing, food impaction in the esophagus and chest pain are the most frequent symptoms in older children and adults. In the endoscopic study of the esophagus, esophagitis, rings and esophageal stricture may be visible. Traits of chronic inflammation and eosinophilic infiltration are present in histologic examination. In the year 2017, an international experts' working group, headed by A.J. Lucendo, under the auspices of UEG - United European Gastroenterology, ESPGHAN - European Society of Pediatric Gastroenterology, Hepatology and Nutrition, EAACI - European Academy of Allergy and Clinical Immunology, EUREOS - European Society of Eosinophilic Oesophagitis, elaborated diagnostic and therapeutic recommendations for eosinophilic esophagitis using the GRADE method (Grading of Recommendations Assessment, Development and Evaluation). The international experts' group included gastroenterologists, aerologists, pediatricians, laryngologists, pathologists and epidemiologists. The wide spectrum of specialists in various fields made it possible to consider various aspects of the disease in their recommendations.

Clinical differences of Helicobacter pylori infection in children.

Helicobacter pylori infection is widely spread all over the world. The prevalence of H. pylori infection in the world varies and depends on numerous factors such as age, ethnicity, geographical and socioeconomic status. Humans have been in a symbiotic relationship with this bacterium for thousands of years. However 10-20% of people infected with H. pylori are likely to develop gastroduodenal diseases such as peptic ulcer disease, iron deficiency anemia, gastric mucosal atrophy, metaplasia, dysplasia, MALT lymphoma, or gastric adenocarcinoma. Most of these diseases develop as the infection progresses and they are likely to occur later in life among the elderly. In the following years, the use of modern molecular techniques has led to the discovery of new Helicobacter strains and their genotypic differentiation. Newly discovered Helicobacter microorganisms can colonize human gastrointestinal tract and bile ducts. This article summarizes the distinct features of H. pylori infection in children including its prevalence, clinical manifestation, indications for treatment and recommended schemes of eradication.

[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]. / Zaburzenia czynnosciowe przewodu pokarmowego u dzieci i mlodziezy. IV Kryteria Rzymskie.

In the work diagnostic criteria of functional disorders of the gastrointestinal tract in children and adolescents aged 4 to 18 years are presented. The criteria were elaborated by experienced experts in pediatrics and gastroenterology and were presented on Digestive Disease Week in San Diego in 2016 as modified IV Rome Criteria. In the work the following functional disorders are discussed: cyclic vomiting syndrome, functional nausea and vomiting, rumination syndrome, aerophagia, functional dyspepsia, irritable bowel syndrome, abdominal migraine, functional abdominal pain - not otherwise specified, functional constipation, nonretentive fecal incontinence.

[Functional gastrointestinal disorders in neonate and toddler. The Rome IV criteria]. / Zaburzenia czynnosciowe przewodu pokarmowego u niemowlat i malych dzieci. IV Kryteria Rzymskie.

Functional disorders of the gastrointestinal tract in infants and children are very frequent. To the most common belong: infant colic, regurgitation and functional constipation. In the year 2016 modified IV Rome criteria of functional gastrointestinal disorders were published. In the current work the authors discuss diagnostic criteria and therapy in regurgitation, rumination syndrome in infants, cyclic vomiting syndrome, infant colic, infant dyschezia and functional constipation in children younger than four years.

Evaluation of the infliximab therapy of severe form of pediatric Crohn's disease in Poland: Retrospective, multicenter studies.

BACKGROUND: Registration of infliximab in Poland has increased chances to induce clinical remission and mucosal healing in the severe form of pediatric Crohn's disease. OBJECTIVES: The aim of this retrospective study was to assess the results and safety of infliximab therapy in the severe form of pediatric Crohn's disease. MATERIAL AND METHODS: The study included 153 children with severe form of non-fistulizing Crohn's disease treated with infliximab. The clinical activity of Crohn's disease was assessed according to PCDAI scale, endoscopic scoring was graded according to SES-CD, body mass was measured with body mass index (BMI). Infliximab was administered at the dose 5 mg/kg body mass in the 0.2 and 6th week, and then, after clinical response, every 8 for the period of 12 months. RESULTS: One hundred thirty-six children (88.89%) achieved clinical response after induction therapy and 75.21% of children after the maintenance therapy. 39.68% of children achieved remission as graded with endoscopic scoring SES-CD. There was a statistically significant increase in body weight following the treatment. Side effects such as anaphylaxis, rash, and the activation of EBV infection appeared in 9 children at the time of infliximab injection. In other children the drug was well tolerated. CONCLUSIONS: Induction and maintenance therapy with infliximab resulted in clinical remission of Crohn's disease in 75.21% of children, and in the intestinal mucosa healing in 39.68% of children.

Induction and maintenance infliximab therapy in children with moderate to severe ulcerative colitis: Retrospective, multicenter study.

BACKGROUND: Pediatric ulcerative colitis (UC) is a severe disease characterised by the presence of extensive inflammatory lesions in the colon. The administration of intravenous corticosteroids is recommended in patients with acute relapse of the disease, whereas early treatment with cyclosporine, tacrolimus or infliximab is recommended if there is no improvement. OBJECTIVES: The aim of this study was to retrospectively evaluate the efficacy and safety of infliximab therapy in the treatment of moderate-to-severe and severe relapse of pediatric UC. MATERIAL AND METHODS: The analysis included 42 children aged 4-18 years (23 girls, 19 boys) treated in 7 pediatric gastroenterology departments in Poland during the past 4 years. The disease duration ranged from 2 to 100 months. The clinical activity of UC ranged from 35 to 85 points according to the PUCAI scale. Twenty-one children were diagnosed with pancolitis, 10 children with extensive UC, and the remaining with the left-sided UC. In the induction therapy infliximab was administered at doses of 5 mg/kg in the 0.2 and 6 weeks, and after the clinical response every 8 weeks to 12 months. Treatment results were assessed in 10 and 54 weeks. RESULTS: After the induction therapy the clinical response was achieved in 14 children (33.33%) and clinical remission in 11 children (26.19%). Two children required surgical treatment, and the remaining 2 suffered from anaphylactic shock. After the maintenance therapy clinical remission was maintained in 12 children (57.14%), whereas 3 children required surgery (colectomy). CONCLUSIONS: Infliximab therapy in children with moderate-to-severe UC induces remission and, in some children, proves to be effective in preventing early colectomy.

[Indicators of inflammatory process in stool in diagnostics and monitoring of inflammatory bowel diseases]. / Wskazniki stanu zapalnego badane w stolcu w diagnostyce i monitorowaniu leczenia nieswoistych chorób zapalnych jelit.

In the recent decades the rapid development of the studies on new methods used in diagnosis, differential diagnosis, and monitoring the treatment of inflammatory bowel diseases has been observed. To the diagnostics of gastrointestinal disorders new methods such as endoscopic capsule and imaging methods including magnetic resonance have been introduced. Markers of inflammation detected in stool play significant role in the diagnostics. To the best known belong calprotectine and lactoferrin, which are produced by neutral granulocytes. In the present review we have presented the clinical usefulness of detection in the stool of calprotectin, lectoferrin, S100A12 protein and pyruvate kinase. Clinical usefulness of these markers were used in diagnosis, assessment of the treatment results, disease relapse and mucosal healing in inflammatory bowel disease. Determination of fecal calprotectin and lactoferrin in the process of mucosal healing in ulcerative colitis or Crohn's disease are of particular value. Confirmation of these results in multicenter prospective trials will enable in the future to reduce the number of control colonoscopies, which in children are performer under general anesthesia.

Seroprevalence of Helicobacter pylori infection in Polish children and adults depending on socioeconomic status and living conditions.

PURPOSE: Helicobacter pylori (H. pylori) is one of the causes of gastritis, peptic ulcer disease, gastric cancer and MALT-lymphoma. The frequency of H. pylori infection is different in various regions of the world and dependent on age, socioeconomic and hygiene status. The objective of this study was to assess seroprevalence and the associated socioeconomic and sociodemographic characteristics influencing H. pylori infection in children and adults in Polish population. MATERIAL/METHODS: In multicenter epidemiological studies, H. pylori infection occurrence was assessed in Poland in the years 2002 and 2003. The seroprevalence of H. pylori infection diagnosis was based on IgG anti-H. pylori antibodies concentration above 24 UI/ml, which was measured using ELISA test. The study included 6565 subjects: 3307 adults (50.37%) and 3258 children (49.63%). RESULTS: Positive result was observed in 3827 subjects (58.29%), i.e. 1043 children (32.01%) and 2784 adults (84.19%). H. pylori infection prevalence was greater in children of poor economic status, who were born in a rural area, lived in crowded houses with no running tap water and with toilet outside the house, and who did not observe hygiene rules. In adults, the factors predisposing to higher probability of being H. pylori infected included: being born in a rural area, having low family income and elementary education, smoking tobacco, drinking high proof alcohols as well as not observing of hygiene rules. CONCLUSIONS: Improvement of socioeconomic status, sanitary and hygienic conditions and the education of the society might decrease H. pylori infection prevalence in children and in adults.

[H. pylori infections in children: clinical, diagnostic and treatment implications]. / Zakazenie Helicobacter pylori u dzieci: implikacje kliniczne, diagnostyczne i lecznicze.

Helicobacter pylori is the most widespread infection all over the Word. The rate of this infection varies, depending on age, geographic region, socioeconomic and hygienic conditions. Most infected children live in the poor, developing countries without adequate living and hygienic conditions. Prevalence of H. pylori infections in children in Poland was 32.01%. The course of infection in children depends on individual predisposition, environmental factors and virulence of H. pylori. In children in Poland infection with cagA+s1m1 genotype occurs most frequently. In children, a connection of H. pylori infection to ulcer disease of the duodenum was demonstrated. Additionally, the diagnostic tests of infection and diagnostic assessing eradication were discussed in the work. Recommendations on the treatment of H. pylori taking into account the necessity of the assessment of bacteria sensitivity to antibiotics were outlined. It is particularly important in the regions with high resistance of H. pylori to clarythromycin, which in children can exceed 20%.

Clinical picture of classical, atypical and silent celiac disease in children and adolescents.

BACKGROUND: Celiac disease is a frequent disease of the alimentary tract in children. Clinical presentation of the disease is variable and depends on type of the disease. OBJECTIVES: The aim of the study was an analysis of clinical findings, selected laboratory features and coexisting diseases in children and adolescents with celiac disease. MATERIAL AND METHODS: Material of the study comprised a series of 78 children aged 8 months - 13 years. Celiac disease was diagnosed basing on clinical symptoms, histological studies of intestinal specimens and positive serologic tests (EmA, TG2). RESULTS: Classical celiac disease was diagnosed in 40 children (51.3%), atypical celiac disease in 26 children (33.3%) and silent celiac disease in 12 children (15.4%). The most frequent clinical symptoms of classical form of celiac disease were chronic diarrhea (90.0%), recurrent abdominal pain (70.0%), development retardation (65%), hypocholesterolemia (35.0%) and IgA deficiency (22.5%). In atypical form of the disease dominated the following symptoms: recurrent abdominal pain (76.9%), failure to thrive (38.4%), short stature (42.3%), anemia (15.3%), hypertransaminasemia (11.5%), food allergy (19.2%) and thyroid diseases (11.5%). In silent celiac disease hypercholesterolemia was present in 33.3%, hypertriglycerydemia in 16.6%, type 1 diabetes in 50%, and celiac disease in parents or siblings in 33.3%. CONCLUSIONS: Classical celiac disease is the most frequently diagnosed clinical form of the disease. Silent celiac disease occurs frequently in children with type 1 diabetes mellitus whose parents or siblings have celiac disease. Frequent diagnosis of atypical and silent forms of celiac disease is an indication to serological examination in children with unclear clinical picture and genetic predisposition.

[Gallbladder contractility in children with functional abdominal pain or irritable bowel syndrome]. / Ocena kurczliwosci pecherzyka zólciowego w czynnosciowych bólach brzucha oraz w zespole jelita nadwrazliwego u dzieci.

UNLABELLED: III Rome Criteria of functional gastrointestinal disorders in children, distinguished the disturbances with abdominal pain, to which irritable bowel syndrome, functional abdominal pains, functional dyspepsia and abdominal migraine were included. THE AIM OF THE STUDY was sonographic assessment of the gallbladder and its contractility in functional abdominal pain and irritable bowel syndrome in children. MATERIAL AND METHODS: The study comprised 96 children aged 6 to 18 years, 59 girls and 37 boys. Depending on diagnosis, the children were divided into three groups. 38 children with functional abdominal pain constituted the first group, 26 children with irritable bowel syndrome were included to the second group, the third group consisted of 32 healthy children (control group). Diagnosis of functional abdominal pain and irritable bowel syndrome was made based on the III Rome Criteria. In irritable bowel syndrome both forms with diarrhea (13) and with constipation (13) were observed. Anatomy and contractility of the gallbladder were assessed by ultrasound examination. The presence of septum, wall thickness, thick bile, vesicle volume in fasting state and 30th and 60th minute after test meal were taken into consideration. Test meal comprised about 15% of caloric requirement of moderate metabolism. Children with bile stones and organic diseases were excluded from the study. RESULTS: Thickened vesicle wall and thick bile were present more frequently in children with irritable bowel syndrome and functional abdominal pain than in control group (p < 0.02). Fasting vesicle volume was significantly greater in children with functional abdominal pain than in irritable bowel syndrome and control group (p = 0.003, p = 0.05). Vesicle contractility after test meal was greatest in children with functional abdominal pain. Evaluation of diminished (smaller than 30%) and enlarged (greater then 80%) gallbladder contractility at 30th and 60th minute after test meal demonstrated disturbances of contractility in children with irritable bowel syndrome and functional abdominal pain. CONCLUSIONS: In children with functional abdominal pain and irritable bowel syndrome disturbances of gallbladder anatomy, fasting volume and contractility after test meal were demonstrated. The observed disturbances require further studies for explanation of their role in functional gastrointestinal disturbances with abdominal pain in children.

[Refractory celiac disease]. / Choroba trzewna oporna na leczenie.

Refractory celiac disease is characterized by the persistence or recurrence of symptoms connected with enteropathy, presence of specific antibodies in the serum: EMA, tTG2 and DPG, and (or) intestinal villous atrophy despite strict adherence to gluten-free diet for 6 to 12 months. Correct initial diagnosis of celiac disease, exclusion of other causes of the lack of response to gluten-free diet and persistence of villous atrophy are necessary conditions of diagnosis of refractory celiac disease. Options of the treatment, depending on the patient condition are: gluten-free diet, elementary diet, parenteral nutrition, immunosuppression and biological therapy.

[The frequency of anemia in children with newly diagnosed Crohn's disease in children]. / Czestosc wystepowania niedokrwistosci u dzieci z nowo rozpoznana choroba Lesniowskiego-Crohna.

UNLABELLED: The aim of the study was to analyze the occurrence of anemia in children with newly diagnosed Crohn's disease and 3 months after the initiation of treatment depending on location and activity of the disease. MATERIALS AND METHODS: 36 children aged from 2 to 18 years with newly diagnosed Crohn's disease treated in the years 2005-2011. According to the classification of Paris children were divided into 2 groups: II - 9 children (0-10 years); II - 27 children (11-17 years). We analyzed RBC, Hb, HCT, MCV, Fe, PCDAI at diagnosis and 3 months after the treatment, depending on the location and phenotype of the disease. Anemia was defined according to WHO criteria. Children were treated in accordance with the standards and activity of the disease. During the observation period supplementation of iron was not used. We analyzed the potential factors that could affect on the incidence of anemia. RESULTS: In the group I mean activity of the disease was lower than in group II in both observed periods. No statistically significant differences in hemoglobin, red blood cell count, hematocrit and volume of erythrocytes at diagnosis and after 3 months were noted. The average iron concentration increased from 6.98 microg/dl to 9.95 microg/dl (p < 0.05) after the treatment. A statistically significant higher incidence of iron deficit in group II in both analyzed periods was observed, respectively, 66.7% vs 92.59% and 55.5% vs 77.77% (p < 0.05). Anemia was more frequent in group II (p > 0.05). After 3 months of treatment the incidence of anemia reduced from 63.88% to 44.4% (p < 0.05) and iron deficit from 83.3% to 72.2% (p > 0.05). Inflammatory changes in upper gastrointestinal tract were found in 61.1% of children with Helicobacter pylori infection in 8.3% of cases. Ileal location was observed in 52.7% of children, more often in group II than I, 62.9% vs 22.22% (p < 0.05). Isolated location of inflammatory lesions in the colon more frequently observed in group I than II, respectively 55.5% vs 29.6% (p < 0.05). Thiopurine were used in 38.8% of children more often in group II than I, respectively 48.1% vs 11.1% (p < 0.05). Corticosteroids were used in 50.0% of children, often in group II than I, respectively 55.5% vs. 33.3% (p > 0.05). CONCLUSIONS: In children with newly diagnosed Crohn's disease anemia was diagnosed in 63.88% of the children and in 47.2% of children after 3 months of treatment (p < 0.05), iron deficiencies, respectively, in 83.3% and 72.2% of children (p > 0.05). 3-month treatment period of Crohn's disease has increased the iron concentration from 6.98 microg/dl to 9.95 mg/dl although the absence of supplementation (p < 0.05). In group II more often than in group I risk factors of anemia like changes in the upper gastrointestinal tract, the location of the ileum, intestinal villous atrophy and the use of immunosuppressive drugs were observed (p < 0.05). Anemia and iron deficiency were more often observed in the ileocolonic location than when the upper gastrointestinal tract was involved (adquately 55.5% vs 30.5%; p < 0.05 and 75.0% vs 41.6%; p < 0.05).

[Galbladder contractility in children with functional dyspepsia]. / Ocena kurczliwosci pEcherzyka zólciowego w niestrawnosci czynnosciowej u drieci.

UNLABELLED: Disturbances of the gallbladder and biliary tract in children, contrary to those in adults, were not included in Ill Rome Criteria of functional disorders of the alimentary tract. The aim of the work was sonographic assessment of gallbladder function in functional dyspepsia in children. MATERIAL AND METHODS: The study included 45 children, aged 6 to 18 years (28 girls and 17 boys) with functional dyspepsia and 32 healthy children without symptoms form the alimentary tract of the same age, who were regarded as the control group. Diagnosis of functional dyspepsia was made based on Ill Rome Criteria. Anatomy and contractility of the gallbladder were assessed sonographically taking into consideration its volume in fasting state, than 30 and 60 minutes after the test meal. In anatomy assessment the presence of septum, thickness of the wall and the presence of thickened bile were taken into account. RESULTS: Anatomical anomalies and wall thickness changes were observed statistically significantly more frequently in children with functional dyspepsia. There was no statistical difference in the volume of the gallbladder in fasting state and its contractility after test meal. CONCLUSIONS: Anatomical anomalies of the gallbladder were more frequent in children with functional dyspepsia in comparison to healthy children, however, there were no statistical differences in its volume in fasting state and contractility after test meal.

Treatment of Helicobacter pylori infection in the aspect of increasing antibiotic resistance.

In the present work, the problem of Helicobacter pylori infection in the world and its increasing antibiotic resistance are analyzed. The authors discuss the efficacy of treatment, noting that the clarithromycin--and metronidazole-resistance of H. pylori is the main cause of this treatment failure. Because of this phenomenon, a quadruple therapy is being introduced and clarithromycin is being replaced by new antibiotics. The authors also present various schemes of triple and quadruple therapy as well as sequential therapy. Attention is directed to the fact that, in order to obtain better results of the eradication, the treatment should be prolonged from 7 to 10 or even 14 days, and that the doses of the drugs should be increased.

[Feeding disorders, ALTE syndrome, Sandifer syndrome and gastroesophageal reflux disease in the course of food hypersensitivity in 8-month old infant]. / Zaburzenia karmienia, zespól ALTE, zespól Sandifera oraz choroba refluksowa przelyku w przebiegu naldwraiwosci pokarmowej u osmiomiesiecznego niemowlecia.

This paper describes the occurrence of feeding disorders, atopic dermatitis, life-threatening symptoms, Sandifer syndrome, and gastroesophageal reflux disease in 8-month old infant in the course of food hypersensitivity. Used in the treatment of cow's milk protein hydrolysates with a considerable degree of hydrolysis, omeprazole, Cisapride. It was not until the introduction of elemental diet based on free amino acids resulted in the withdrawal of life-threatening child's symptoms.

[Ascites and extreme lipid abnormalities as initial symptoms of cystic fibrosis in a 5-years-old girl--case report]. / Wodobrzusze, obrzeki oraz skrajne zaburzenia gospodarki lipidowej jako pierwsze objawy mukowiscydozy u piecioletniej dziewczynki--opis przypadku.

UNLABELLED: Cystic fibrosis is the most common, multiorgan inherited autosomal recessive disorder. The gene associated with this disease encodes the CF transmembrane conductance regulator (CFTR). The aim of this article is a presentation of 5-years-old girl with cystic fibrosis and associated liver disease as the only manifestation of CF. CASE REPORT: We described the case of a 5.5-years-old girl with ascites and peripheral edema without of the symptoms. Laboratory tests revealed hepatic cell damage with cholestasis, extreme lipid abnormalities and hypocholesterolemia. Based on positive sweat test (CI: 122 mEq/l) and genetic analysis (homozygote deltaF508) the diagnosis of cystic fibrosis was confirmed. Patient was successfully treated with nutritional treatment and pancreatic enzymes.

[Acute pancreatitis as a complication of diagnostic gastroduodenal endoscopy at 10 years old girl--case report]. / Ostre zapalenie trzustki jako powiklanie gastroduodenoskopii diagnostycznej u 10-letniej dziewczynki--opis przypadku.

A 10-years old girl with chronic pancreatitis, in whom the symptoms of acute pancreatitis appeared after gastroduodenal endoscopy is described. One hour after endoscopy the following symptoms appeared: unigastric and epigastric pain, intense vomiting, elevated amylase activity in the serum (2744 micro/l) and in urine (23738 micro/l) as well as serum lipase activity (4350 micro/l). Ultrasound of the abdomen revealed the enlargement of the pancreas with hypodense structure in comparison to the examination conducted couple hours earlier, and trace of fluid around the pancreas. In the treatment intravenous omeprazole, a strict diet and intravenous fluid and electrolytes were administered. After two days vomiting and abdominal pain subsided, biochemical results improved and the reduction of pancreas dimensions in ultrasound study was observed.

[Nodular lymphoid hyperplasia--underestimated problem of gastrointestinal tract pathology in children]. / Guzkowy przerost limfoidalny--niedoceniony problem w patologii przewodu pokarmowego u dzieci.

Nodular lymphoid hyperplasia (NLH) is a rare condition with unknown etiology frequently associated with common variable immunodeficiency (CVID) and selective immunoglobulin A deficiency. NLH is a common cause of gastrointestinal bleeding. The risk of malignancy has been well recognized in subjects with NLH. The present knowledge about the nodular lymphoid hyperplasia (NLH) was described.

[Severe toxic diarrhoea in cyclosporin treated 11-years old girl with nephrotic syndrome]. / Ciezka biegunka toksyczna w przebiegu leczenia cyclosporyna A u jedenastoletniej dziewczynki z zespolem nerczycowym.

A 11-years old cyclosporin-treated girl with nephrotic syndrome, complicated by severe toxic diarrhoea with excessive metabolic alkalosis and dyselektrolitemia (hyponatremia, hypokaliemia, hypochloremia) and transient immunoglobulin deficiency is reported. Ultrasonography shows thickeness of the colonic wall as a symptom of colonic inflammation. After discontinuation of cyclosporin therapy, excluding infectious origin of diarrhoea (bacterial, viral and fungal infection), partial parenteral nutrition, enteral nutrition (Peptisorb), probiotics and antidiarrhoeal drugs were used in the treatment. After introducing steroids orally (Entocort) complete resolution of symptoms were observed.