Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study.

OBJECTIVES: Beneficial therapeutic effect of probiotics has been reported in children with the irritable bowel syndrome (IBS) but not consistently in other functional abdominal pain-related disorders. The aim of the present study was to investigate the effect of Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain (FAP) and IBS in children. METHODS: Children (age 4-18 years) referred to pediatric gastroenterologist at Children's Hospital Zagreb from May 2012 to December 2014, diagnosed as FAP or IBS, were randomized to receive L reuteri DSM 17938 108 CFU daily or placebo. The study was a prospective, randomized, double-blind, placebo-controlled parallel study. Symptoms were evaluated using Wong-Baker FACES pain rating scale for pain and Bristol scale for stool shape and consistence. RESULTS: Data were analyzed for 55 children (26 in the intervention group and 29 in the placebo group). Children in the intervention group had significantly more days without pain (median 89.5 vs 51 days, P = 0.029). Abdominal pain was less severe in children taking probiotics during the second month (P < 0.05) and fourth month (P < 0.01). The 2 groups did not differ in the duration of abdominal pain, stool type, or absence from school. Both groups experienced significant reduction in the severity of abdominal pain from first to fourth month, with the reduction more prominent in the intervention group (P < 0.001 vs P = 0.004). CONCLUSIONS: Administration of L reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.

Diagnosis of coeliac disease in children younger than 2 years.

BACKGROUND AND AIM: To diagnose coeliac disease (CD) in children younger than 2 years, the old ESPGHAN criteria based on 3 small bowel biopsies were recommended until recently. The aim of the present study was to investigate the applicability of only 1 small intestinal biopsy plus positive serology for the diagnosis of CD in children younger than 2 years. METHODS: A prospective cohort study included 81 patients younger than 2 years with symptoms suggestive of CD, who all completed the diagnostic procedure based on 3 small bowel biopsies. According to the finding of the third biopsy, patients were divided into group A-CD confirmed (N = 44), and group B-CD not confirmed, after the gluten challenge (N = 37). RESULTS: At the time of the first biopsy, total villous atrophy (Marsh IIIc) was found more often in group A than in group B (77% vs 27%, P < 0.01). Also, all of the studied antibodies were more frequently positive in group A than in group B (P < 0.01 for all of the tested antibodies). Positive anti-endomysial antibodies and Marsh IIIc finding were the best discriminators between the group A and the group B and considerably contributed to the prediction of CD. CONCLUSIONS: The second and the third biopsies (before and after the gluten challenge) may also be avoided when diagnosing CD in children younger than 2 years provided that the child, at the time of presentation, has positive anti-endomysial antibodies and Marsh IIIc on the small bowel biopsy. A gluten challenge should be still considered in all other children younger than 2 years.

[Viralhepatitis. Croatian Consensus Statement 2013]. / Virusni hepatitis. Hrvatska konsenzus konferencija 2013.

Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fibrosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treatment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects.

[Treatment of viral hepatitis in children]. / Terapija virusnog hepatitisa u djece.

In children, the natural history of chronic hepatitis B and C is different from that in adults. There are also different guidelines on therapy. So far, only conventional interferon alfa and lamivudine have been approved for the treatment of children with chronic hepatitis B before the age of twelve. For the older ones, tenofovir and adefovir are also an option. All of them are used as monotherapy. Treatment should be carried out only in certain indications, provided by predictors that favor a positive outcome. Therapeutic goal is to stop the progression of the disease in order to reduce the risk of complications (cirrhosis and hepatocellular carcinoma) later in life. There is also no urgency to start treatment in children with chronic hepatitis C, as the disease in children generally has slow progression. Therefore, therapy is indicated in those with progressive liver disease (with a significant degree of fibrosis). The recommended treatment is a combination of pegylated interferon alfa 2b and ribavirin. For all children with chronic viral hepatitis, annual screening for hepatocellular carcinoma must also be conducted, as it has been shown that the risk is higher here than in healthy children.

[Viral hepatitis: Croatian consensus statement]. / Virusni hepatitis: Hrvatska konsenzus konferencija.

There has been a dramatic improvement in diagnostic procedures and therapy of viral hepatitis in the last 20 years. Improvements in therapy caused an increase in actual cost, however, with significant long-term savings through a decreased cost of treatment of advanced liver disease including liver transplantation. The Croatian National Board for Viral Hepatitis has decided to initiate the organization of consensus conference on viral hepatitis enabling the leading experts in the country to give the best possible recommendations for the diagnosis, prophylaxis and therapy in our circumstances. The Consensus Conference took place in Zagreb in June 2004, with update in March 2005, organized by the Croatian National Board for Viral Hepatitis, Reference Centers of the Ministry of Health for Chronic Liver Diseases, Infectious Diseases and AIDS, Croatian Society of Gastroenterology--Hepatology Section, Croatian Society for Nephrology, Dialysis and Transplantation, and Croatian Institute for Health Insurance. Invited experts provided written reports on the respective subjects that appear in this issue and their recommendations resulting in this consensus statement.

[Treatment of viral hepatitis in children]. / Terapija virusnog hepatitisa u djece.

The goal of treating children with chronic hepatitis B is the prevention of complications rather than the urgency of stopping the disease. Candidates for treatment are HBV DNA and HBeAg positive children, older than 2 years, with elevated transaminases for at least 6 months and histologic evidence for chronic hepatitis. Treatment can be carried out with interferon alfa or lamivudine, however, interferon is preferred for higher efficacy. The combined therapy has been currently studied. No consensus has yet been attained on the necessity to treat chronic hepatitis C in children. Candidates for treatment are HCV RNA positive children, older than 3 years, having persistently elevated transaminases, with histologic evidence for chronic hepatitis and significant fibrosis. Until recently, treatment was carried out with interferon alfa, but now, due to better results, a combined therapy with interferon alfa and ribavirin is recommended. New controlled trials are expected as a basis for general recommendations.