Correlation between biomarkers (calprotectin, seromucoid, metalloproteinase-3 and CRP) and clinical and endoscopic activity of ulcerative colitis in children.

PURPOSE: The aim of the study was to compare the clinical activity and inflammatory markers with the endoscopic activity of ulcerative colitis (UC) and mucosal healing. PATIENTS AND METHODS: The study included 50 children aged 2-18 years (27 girls, 23 boys) diagnosed with UC at various stages of the disease; 8 children were assessed twice. In 20 children, colonoscopy revealed pancolitis, in 24 - left-sided colitis, and in 6 - ulcerative proctitis. The clinical activity of UC was assessed according to the Pediatric Ulcerative Colitis Activity Index (PUCAI). Endoscopic index of the colon inflammation was assessed according to the Rachmilewitz scoring. We assessed the clinical activity of UC, the concentration of fecal calprotectin (FC), seromucoid, metalloproteinase-3 (MMP-3) and C-reactive protein (CRP). RESULTS: The study demonstrated significant decrease in the clinical activity, FC, seromucoid and MMP-3 in endoscopic remission. We found a strong positive correlation between PUCAI, FC, serum seromucoid and serum MMP-3 with the endoscopic activity. However, we found no relationship between the concentration of CRP and the endoscopic activity of the disease. Among the studied markers, seromucoid exhibited the best performance in distinguishing between patients with endoscopic remission and endoscopically active disease. CONCLUSIONS: The examined inflammatory markers such as FC, as well as serum seromucoid and MMP-3 levels may be helpful in the assessment of large intestine mucosal healing.

Th9 lymphocytes and functions of interleukin 9 with the focus on IBD pathology.

The work presents the newest knowledge on a new phenotype of T helper lymphocytes (Th9) and on Interleukin 9 (IL-9). Processes leading to transformation of naïve T lymphocyte into Th9 lymphocytes are presented, including the role of IL-4 and TGFß signaling. Involvement of transcription factor network in production of IL-9 is described. Other cells capable of expressing IL-9 and secreting IL-9 are portrayed. Diversity of IL-9 effects caused by activation of IL-9 receptors on various types of cells is presented. Principal effects of the activation of IL-9 receptor on T-cells seem to be antiapoptotic and stimulatory which leads to enhanced defense against parasitic infection and cancer development but, from the other side, it perpetuate chronic inflammation in autoimmune diseases and allergic processes. In the last years the role of IL-9 in autoimmune diseases such as rheumatic diseases and inflammatory bowel disease gained importance since the increased expression of this cytokine has been observed in animal models of intestinal inflammation and in groups of patients with ulcerative colitis. It was also noted that neutralization of IL-9 in animal models of ulcerative colitis leads to amelioration of inflammatory process, what could have significance in the treatment of this disease in humans in the future.

Campylobacter concisus as the etiologic agent of gastrointestinal diseases.

A number of reports on the pathogenic influence of Campylobacter concisus on the human body and its role in many diseases of the gastrointestinal system, including gastroesophageal reflux disease, Barrett's esophagus and inflammatory bowel disease, have appeared lately. Campylobacter concisus is a Gram negative bacteria which requires an anaerobic environment or microaerophilic environment with hydrogen for growth and is therefore difficult to culture. Due to this difficulty, the rate of infections in epidemiological data are underestimated. There are reports that C. concisus was the only pathogen isolated from the stool of patients with acute diarrhea, which could indicate that it is an etiologic factor of acute gastrointestinal infections in humans. Moreover, the results of some studies suggest that infection with C. concisus is a factor predisposing to the development of gastroesophageal reflux disease and Barrett's esophagus, conditions which may be present before the development of cancer. There are also studies which indicate C. concisus infection as a trigger of inflammatory bowel disease, since it has been demonstrated that C. concisus is present more frequently in patients with newly diagnosed Crohn's disease than in a control group.

Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula.

BACKGROUND: Motility disturbances of the esophagus and gastroesophageal reflux disease (GERD) are observed frequently in children after repair of congenital esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Recently, in many pediatric surgical centers, thoracoscopic repair was introduced, which theoretically would change the postoperative course. OBJECTIVES: The goal of the study was to assess physical development, disease symptoms, and GERD symptom frequency in children who underwent thoracoscopic surgery of congenital EA/TEF. MATERIAL AND METHODS: The study comprised 22 children (14 boys and 8 girls), aged 16 to 79 months (average age 47.3 months) after surgery of EA/TEF. Clinical symptoms and physical development were analyzed. In 19 children, multichannel intraluminal esophageal impedance connected with pH-metry (MII/pH) was performed. In 11 patients, esophagogastroduodenoscopy with a histological study of mucosa samples was done. RESULTS: The most frequent symptoms were dysphagia, belching, cough and recurrent bronchitis. In 31.5% of the children, body mass deficiency was observed and in 28.6%, low body mass and short stature. Prematurity was present in half of the patients. Depending on the result of the MII/pH study, the children were divided into two groups: 10 children with GERD and 9 children without diagnosis of gastroesophageal reflux. In the 10 with GERD, acid reflux was diagnosed in 9 and non-acid reflux was diagnosed in one. MII/pH demonstrated statistically significant differences in the number of reflux episodes, reflux index, bolus exposure index, mean time of esophageal exposure and acid exposure and mean acid clearance time in children with GERD in comparison to children without this disease. In 36.4% of children who underwent endoscopy, esophagitis was diagnosed, esophageal stricture in 18% and gastric metaplasia in 9.1%. CONCLUSIONS: In children who underwent corrective thoracoscopic surgery of EA/TEF, GERD caused by motility disorders of the esophagus was frequently observed. These children require constant monitoring and early treatment of the complication.

Value of the atopy patch test in the diagnosis of food allergy in children with gastrointestinal symptoms.

BACKGROUND: In recent years, food allergy, especially in the child population, has become an increasing problem in developed societies. In the youngest children, it is a frequent cause of gastrointestinal disorders. The atopy patch test, applied from several years in clinical practice, is one of the methods used in allergology. OBJECTIVES: The objective of the work was an assessment of the diagnostic value of the atopy patch test in the diagnosis of allergy to cow's milk protein and to wheat proteins in children with gastrointestinal symptoms. MATERIAL AND METHODS: The study was comprised of 61 children (37 boys and 24 girls, aged 3 to 36 months, average age 13.5 months). Their medical history might have indicated a connection between the symptoms and ingested food. In all the children, an atopy patch test and a skin prick test with native food allergens were carried out. Table 1 presents the characteristics of the studied patients. Diagnosis of allergy to cow's milk protein and to wheat was verified in the open food challenge. RESULTS: Sensitivity of APT for milk was 21%, specificity - 91%, PPV - 80%, NPV - 39% and for wheat - 67%, 100%, 100% and 77%, respectively (Table 4). For the skin prick test, sensitivity, specificity, PPV and NPV were 13%, 96%, 83% and 39% for milk and 22%, 80%, 50% and 53% for wheat. CONCLUSIONS: APT demonstrates high sensitivity and high specificity in the diagnosis of allergy to wheat in children with gastrointestinal symptoms. The sensitivity of ATP in the detection of allergy to cow's milk in children with gastrointestinal symptoms was low and therefore the diagnosis should be verified by challenge tests.

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.

[Diagnostic validity of anti-tissue transglutaminase and anti-endomysium antibodies in children with celiac disease]. / Ocena miana przeciwcial przeciwko transglutaminazie tkankowej i przeciwko endomyzjum w diagnostyce choroby trzewnej u dzieci.

UNLABELLED: Tissue transglutaminase (tTG) plays a decisive role in the pathomechanism of celiac disease. Unchanged gliadin peptides bind to HLA-DQ2 with a week affinity, after that they are recognized by gliadin specific T-lymphocytes and the whole immune reaction is started which damages intestine mucous and causes the release of tTG. Tissue transglutaminase deaminates gliadin peptides enhancing the whole process. The aim of this study was determination of correlation between antiendomysial antibodies and anti-tissue transglutaminase antibodies in children with celiac disease, and the assessment of their usefulness in the diagnosis of celiac disease. MATERIAL AND METHODS: 109 children, aged 6 moths to 16 years (average 8.8 years) were included into the study. In all children an intestine biopsy was performed and/or antiendomysial antibodies were determined. In all children tissue transglutaminase antibodies were measured. Antibodies against tissue transglutaminase were determined using ELISA method. Antiendomysial antibodies were determined using the immunofluorescence method. RESULTS: In patients with normal mucous with lack of lymphocyte infiltration no IgAEmA were present in the blood. In the groups with subtotal and total villous atrophy all IgAEmA titres were positive. A positive titre of IgAEmA was observed only in childrerl with villous atrophy, which yields specificity of the test of 100%, sensitivity was 81%. Sensitivity of the anti-tTG antibodies test for detecting villous atrophy was 83% for IgA and 52% for IgG. There is a positive correlation between IgAEmA and anti-tTG antibodies. CONCLUSIONS: High sensitivity and specificity of determination of antibodies against tTG in IgA class causes that these tests may serve as a screening test in diagnosis and monitoring of celiac disease in children.