Questionnaire and nocturnal oxymetry in children with adenotonsillar hypertrophy.

OBJECTIVES: Draw up an evaluative approach to the diagnostic contribution of nocturnal oximetry associated with a parental questionnaire in children with adenotonsillar hypertrophy (ATH). PATIENTS AND METHODS: Analysis of a parental questionnaire on sleep patterns and oximetry recording made in children with ATH. The results of the oximetry were compared to the data gathered from the questionnaire. RESULTS: Of the 342 children (age range, 3 months to 14 years), 209 permanent snorers, 115 occasional snorers, and 18 non-snorers were identified. The proportion of positive oximetry readings varied from 31.6 to 0% and the difference was significant between the first group and the two others (p<0.001). The data were correlated for four symptoms, including snoring and sleep apnea. The absence of snoring always gave a negative oximetry reading. CONCLUSIONS: In cases of ATH, a negative questionnaire can predict that oximetry will not be useful and if necessary advise for a polysomnography for an exclusion diagnosis. In contrast, a positive questionnaire followed by a positive oximetry argues in favor of the polysomnography not being useful.

Role of pancreatic impairment in growth recovery during gluten-free diet in childhood celiac disease.

BACKGROUND & AIMS: Clinical significance and duration of insufficient release of pancreatic enzymes in childhood celiac disease have not been clarified. The aim of this study was to evaluate the role that pancreatic impairment plays in growth recovery and the duration of this impairment. METHODS: Forty-six patients with celiac disease who had a median age of 2.5 years were enrolled. Fecal chymotrypsin level was determined at diagnosis and then every 15 days after the beginning of a gluten-free diet in all patients. RESULTS: At diagnosis, 17 of 46 patients with celiac disease had subnormal fecal chymotrypsin values. During the gluten-free diet, a progressive reduction in the percentage of patients with subnormal fecal chymotrypsin values was observed: 12 of 46 patients after 30 days and 2 of 46 patients after 60 days. Weight increase after 2 months of gluten-free diet was significantly greater in patients with normal fecal chymotrypsin values at diagnosis than in patients with subnormal values, and a positive correlation was found between fecal chymotrypsin at diagnosis and weight increase (r = 0.56). CONCLUSIONS: A small percentage of patients with celiac disease still had subnormal chymotrypsin concentrations after 60 days of gluten-free diet. Fecal chymotrypsin is a predictive index of weight recovery in the first months after diagnosis of celiac disease; it could be used to select patients for enzyme supplementation therapy.

Quality control study of H2 breath testing for the diagnosis of carbohydrate malabsorption in Italy. The "Tenue Club" Group.

BACKGROUND AND AIMS: H2 breath testing is increasingly used in Italy. The aim of this multicenter study was to assess the accuracy of this technique in the diagnosis of carbohydrate malabsorption. METHODS: An anonymous questionnaire was used to collect information about H2 breath testing methods and to design the quality control study. Fifteen out of 23 laboratories responded to the questionnaire and 12/23 completed the entire study. RESULTS: The survey revealed that a large variety of H2 testing methods are employed in Italy, but none have been previously tested for accuracy. This prospective study showed that these tests fail to identify > 20% of patients with malabsorption. In contrast, a new method based on single H2 breath measurement at 6 hours after lactulose ingestion and a cutoff value of greater than 5 ppm, had a sensitivity of 92% +/- 4% and a specificity of 94% +/- 0.5%. Increasing the cut-off to 10 ppm resulted in a sensitivity of 88% +/- 9% and a specificity of 100%. This improved accuracy was obtained with a much simpler testing procedure in which only one breath sample is analyzed, in contrast to the baseline and multiple subsequent samples that are analyzed using the currently employed techniques. CONCLUSIONS: A great improvement in the accuracy of the H2 breath test, as well as a considerable saving in terms of time and costs, may be possible through the use of a new, simplified H2 breath test followed by careful H2 analysis.

[Rare causes of gastrointestinal bleeding in childhood. A clinical case of von Willebrand's disease]. / Cause rare di emorragia gastrointestinale in età pediatrica. Un caso clinico di malattia di von Willebrand.

von Willebrand type I disease is an hereditary coagulation disorder characterized by a deficiency of the factor VIII complex: VIII: C, vWF:Ag, vWF:RCoF. The clinical features of this disease are spontaneous bleeding and mucosal or cutaneous bleeding following minimal injuries. The authors describe a case of a 4-year girl with recurrent episodes of gastrointestinal bleeding due to von Willebrand disease.

[What do celiac children eat? Dietary analysis of a group of children with celiac disease on a diet]. / Che cosa mangiano i bambini celiaci? Analisi dietologica su un gruppo di celiaci a dieta.

A diagnosis of Coeliac Disease (CD) indicates a lifelong compliance to a gluten-free diet (GFD), which implies a change in deeply ingrained dietary habits and may cause dietary imbalances. We studied the dietary intake in a group of children with CD on GFD. CD was diagnosed according to Espgan criteria. Strict compliance to GFD was ascertained by Hydrogen breath-test. For each patient a thorough dietary history was obtained; the Recommended Dietary Allowances (RDA) 1986/1987--Istituto Nazionale della Nutrizione were used as reference measurements. 71.3% of our patients had a daily calorie intake lower than recommended (mean +/- 1SD = -110 +/- 389 kcal/day). Calorie deficiency was mainly due to a low carbohydrate intake (50.2 +/- 7% of daily calorie intake vs. 59% RDA; difference = -4.7 +/- 7%). Fast absorbed simple carbohydrates exceeded by 46% the recommended 10% ratio to complex carbohydrates. Daily fat intake was higher than RDA (+7.7%) in 94.1% of our patients, who obtained from fat 35.7 +/- 5.2% of their daily calorie intake vs 28% recommended. Saturated to unsaturated fat ratio was unbalanced towards saturated fat intake (2.3 +/- 1.1 vs 0.33 recommended). Coeliac children on a GFD have low caloric and carbohydrate intakes and a high fat intake. An unbalance towards simple sugar and saturated fat ingestion was detected. A lifelong protraction of these dietary habits may favour the onset of metabolic diseases in mature age.

[Hydrogen breath test in celiac disease: relationship to histological changes in jejunal mucosa]. / Breath-test all'idrogeno nella malattia celiaca: alterazioni in rapporto alle modificazioni istologiche della mucosa digiunale.

Hydrogen concentration in expired breath depends on the fraction of ingested carbohydrates unabsorbed by the small intestinal mucosa which reach the large intestine and are fermented by the colonic flora. The aim of this study is to assess whether in coeliac children breath hydrogen excretion reflects the histological changes in the jejunal mucosa. Hydrogen breath test was performed on 40 children (15 males 25 females) divided into three groups. Group I (controls): 9 children with symptoms suggestive of coeliac disease who, after the appropriate workup, were found to suffer from other gastrointestinal disorders and had abnormal jejunal mucosa. Group II: 14 children who had been diagnosed as coeliacs according to the ESPGAN criteria, were kept on a gluten free diet for a minimum of 6 months and had a normal jejunal mucosa. Group III: 17 coeliac children who ate small quantities of gluten or were on a normal diet. At histology, 10 of them showed a total and 7 a partial atrophy of the jejunal mucosa. Breath hydrogen levels were measured both at baseline and after ingestion of a 2% sorbitol solution in water, at 30 minute intervals for four hours. The peak hydrogen level and the total surface area under the hydrogen excretion curve were also assessed. Coeliac children on a gluten containing diet excrete significantly more H2 than controls or coeliacs on a gluten free diet. Patients with more severe histological lesions had higher peak H2 levels and greater total excretion areas. In coeliac children, sorbitol breath H2 test represents a simple noninvasive technique to detect impaired jejunal function and it should have an important role as a screening test and in assessing dietary compliance.