Faecal calprotectin concentration in children with coeliac disease.

INTRODUCTION: It is still unknown whether faecal calprotectin elevation may be caused by active untreated coeliac disease (CD) itself or whether it indicates the coexistence of CD and another disease associated with gastrointestinal inflammation. AIM: To assess faecal calprotectin concentration (FCC) and its correlation with the clinical form and histopathological picture of the small intestine in children with CD. MATERIAL AND METHODS: Fifty-five children with newly recognised CD (mean age: 9.1 years) and 17 children with CD diagnosed at least year before and on a strict gluten-free diet (mean age: 12.3 years) were accepted for the study. Classical (n = 27), non-classical (n = 17), and asymptomatic form (n = 11) were distinguished in children with newly diagnosed CD based on the clinical picture. The histopathological small intestinal lesions were classified as Marsh 1 (n = 4), 3a (n = 5), 3b (n = 20), and 3c (n = 26). FCC was assessed using ELISA method with 50 µg/g as the upper limit of the normal. RESULTS: FCC was abnormal for 21 patients with newly diagnosed CD (38.2%) and for six patients from the treated group (35.3%). Mean FCC for the analysed group of patients was 91.7 ±144.8 µg/g, in the group with newly diagnosed CD - 100.9 ±154.4 µg/g, and in the treated group - 61.8 ±106.2 µg/g (Z = -1.333; p = 0.183). In the group of patients with recently diagnosed CD a statistically significant relationship was not observed for FCC and both clinical picture (χ2 = 0.319, p = 0.852) and severity of small intestinal lesions according to the Marsh classification (rho = 0.136). CONCLUSIONS: Assessment of FCC seems to have no use as a marker for diagnostics and monitoring of CD irrespective of clinical form of the disease and severity of the inflammatory lesions within the small intestine.

Correction to: A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview.

AN was the most frequent cause of hospitalization within all ED and suicide attempt-related hospitalizations were most common among patients with AN [9].

Correction to: A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview.

The original article can be found online.

A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview.

PURPOSE: Anorexia nervosa is a chronic disease which may result in various complications. In pediatric clinical practice, it is common to observe complications related to progressive cachexia caused by malnutrition; however, cases of severe complications, like electrolyte disorders, which represent a direct threat to life, due to polydipsia, are rarely observed. The purpose of this study is to highlight that excessive drinking is of primary importance in anorexia nervosa patients, as it can result in severe medical complications, including increased risk of death. METHODS: We report the case of a 13-year-old girl with anorexia nervosa, who was referred to hospital with seizures, disorders of consciousness, and cardiorespiratory failure. RESULTS: The unstable condition of the patient was attributed to hyponatremia (119 mmol/l), decreased serum osmolality (248 mmol/kg), and decreased urine osmolality (95 mmol/kg) caused by polydipsia (water intoxication) and persistent vomiting. The presented girl was drinking large amounts of water prior to a weigh-in to falsify her low body weight. CONCLUSIONS: Polydipsia is a common problem reported by patients with eating disorders, but one which rarely leads to serious clinical complications, due to severe hyponatremia. This case underscores the importance of careful evaluation of fluid intake and the need for regular monitoring of serum electrolytes in patients with anorexia nervosa. All clinicians treating patients with such disease, as well as the parents of sick children, should be familiar with this life-threatening condition. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Endoscopic removal of a battery that was lodged in the oesophagus of a two-year-old boy for an extremely long time.

In the present work we describe a 2-year-old boy whose battery ingestion was overlooked, and who had the battery endoscopically removed from the upper part of his oesophagus after several months. This is the only described case of such a long impaction of a lithium battery in the oesophagus, without development of severe complications. We stress the necessity to take into account ingestion of a dangerous foreign body by children demonstrating unspecific clinical signs.

The range of lesions in the small intestine of children with celiac disease determined by capsule endoscopy.

BACKGROUND: Celiac disease is a chronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution. OBJECTIVES: The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease. MATERIAL AND METHODS: A total of nine patients aged from 15 to 18 years (average age: 16 years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following a bowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan). RESULTS: The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in a short section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients a significant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients a mosaic mucosal pattern was noted. CONCLUSIONS: The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment.

[Polymorphism of helicobacter pylori and the presence of genes babA2 and sabA and endoscopic and histopathological changes in patients infected with Heicobacter pylori]. / Polimorfizm Helicobacter pylori i obecnoss genów babA2 i sabA a obraz endoskopowy i histopatologiczny u chorych zakazonych Helicobacter pylori.

UNLABELLED: The infection of Helicobacter pylori is the main reason of a duodenal and gastric ulcer disease. Among other virulence factors of Helicobacter pylori, there are outer membrane proteins (OMPs), such as babA2 and sabA. THE AIM OF THE STUDY: An assessment of a relationship between the presence of genes babA2 and sabA and endoscopic and histopathologic changes during gastritis, duodenitis and an ulcer disease. MATERIAL AND METHODS: We included 119 patients aged from 3 to 17 (average 13.6) with gastritis and duodenitis and the infection of Helicobacter pylori. The endoscopy was conducted with taking samples of the mucosa for the histopathologic and genetic examination. The degree of endoscopic and histopatologic changes were determined according to Sydney's classification. The patients were devided in the extra groups with a small level (without erosion) and with a large level (with erosion) of endoscopic changes. To identify the infection of Helicobacter pylori, the PCR technique was used and then the presence of the babA2 and sabA genes of Helicobacter pylori was verified. The genetic confirmation of Helicobacter pylori infection was obtained in 88 patients and material was directed to the further examination. RESULTS: Not statistically significant differences were determined between endoscopic and histopathologic pictures and either the presence or absence of the genes babA2 and sabA. CONCLUSION: The presence of the genes babA2 and sabA is not related with level of endoscopic and histopathologic changes in pediatrics patients.

[The prevalence of dupA (duodenal ulcer-promoting gene) of Helicobacter pylori in children and adolescents--own observation]. / Czestosc wystepowania genu dupA (duodenal ulcer-promoting gene) Helicobacter pylori u dzieci i mlodziezy--obserwacje wlasne.

UNLABELLED: The strains of Helicobacter pylori are described by many common features which determine their virulence. The genes which are connected with much higher virulence of some strains are vacA, cagA, oipA, dupA. Duodenal Ulcer Promoting Gene--dupA is the new virulence factor coexisting with a duodenum ulcer. There is a rationale that shows a protective character of dupA with reference to a stomach cancer. The dupA gene probably causes increasingly higher releasing of pro-infectious IL-8 via stomach cells and it influences the production of IL-12 and other cytokines. The aim of the study was to determine the frequency of dupA gene's appearance in the Polish children's group and in the Polish teenagers' group infected with H. pylori. The research was also aimed to determine the coexistence of dupA gene and duodenum ulcer disease or erosion infection of duodenum's mucous membrane. MATERIAL AND METHODS: The endoscopic examination of the upper part of digestive duct was performed in 119 qualified patients with dyspeptic symptoms and with suspicion of stomach and duodenum's mucous membrane infection. The segments were taken for histopathological identification of H. pylori and for genetic indicating via PCR method. To confirm the presence of H. pylori in the extract the amplification of DNA fragment sized 860 pz was used. The presence of dupA gene was detected by PCR reaction with using the starters which include the fragment of jhp0917-jhp0918 sequence in the plastic H. pylori's genome area. To confirm the infection the urea breathing test was taken. RESULTS: 88 patients confirm the infection of H. pylori. The presence of dupA gene was found in 20 patients--a group A (22.7%), whereas in 68 patients dupA gene was not found--a group B (77.2%). Pathological changes in duodenum was found in 20 patients infected with H. pylori (22.7%), included 4 patients in the group A (20%) and 16 in the group B (23.5%). There was an infection (swelling, redness, congestion) in duodenum was found in the group A in all cases and there was an erosion presented in 3 patients. In the group B in 2 patients the duodenum ulcer disease was diagnosed. The infectious changes in duodenum were found in 7 patients but they were not infected with H. pylori; 1 patient was diagnosed with the duodenum ulcer disease. CONCLUSION: The presence of dupA gene in the Polish children population infected with H. pylori is quite frequent but there is no clinical correlation with the duodenum ulcer disease.

[The analysis of usefulness different diagnostic methods in children and adolescents with Helicobacter pylori infection]. / Analiza przydatnosci róznych metod diagnostycznych w ocenie zakazenia Helicobacter pylori u dzieci i mlodziezy.

UNLABELLED: A diagnostics of Helicobacter pylori infection in children and adolescents in practice sometimes is still difficult. Qualification to the tests for detecting infection with invasive and noninvasive methods should start from diligent anamnesis. THE AIM OF THE STUDY: Is to present the clinical course and results of diagnostic tests in children and adolescents with suspicion of Helicobacter pylori infection. MATERIAL AND METHODS: One hundred patients aged between 18 months and 18 years who underwent endoscopy with gastric biopsies, histology, culture and 13carbon urea breath test. There were 36 boys and 64 girls in analysed group, 10% of them were preschool children, 42% school children and 48% teenagers older than 12 years RESULTS: Patients were symptomatic and most frequent were dyspeptic symptoms (91%). A symptom duration time was varied from several days to several years. On the basis of endoscopy and histology gastritis and/or duodenitis were found in 92 patients, esophagitis and gastritis in 5 patients, duodenal ulcer in 2 patients, in 1 case gastric and duodenal mucosa was normal. Helicobacter pylori infection was histopathologically confirmed in 37 patients. In 15 cases Helicobacter pylori strains were isolated with full in vitro sensitivity to amoxicillin, claritromycin and metronidazol. Urea breath test was conducted in 85 analyzed patients and 51 of them had abnormal result. CONCLUSIONS: In clinical picture of Helicobacter infection most frequent were dyspepstic symptoms and by endoscopy chronic gastritis and/or duodenitis were shown. Culture of Helicobacter pylori has a limited usefulness in practice especially in patients who underwent antibiotic/eradication therapy. The statistical significant concordance occurred between culture and noninvasive 13carbon urea breath test.

[Genetic type of Helicobacter pylori and the efficacy of eradication therapy]. / Typ genetyczny Helicobacter pylori a skutecznosc leczenia eradykacyjnego.

UNLABELLED: Helicobacter pylori is one of the most popular bacteria in the world. The H. pylori infection is an etiological factor of permanent changes in inflammatory of stomach mucous membrane, peptic ulcer of the stomach and duodenum disease and stomach cancer or mucosa associated lymphoid tissue from lymphoid tissue of mucous membrane. The strain bacteria which produce the protein CagA and cytotoxin VacA belong to the more pathogenic strains. The most successful method of treatment for H. pylori infection is an eradication of the bacteria. THE AIM OF THE STUDY: Was an evaluation of the influence which H. pylori genetic type (type I: CagA-positive, CagA-negative, VacA-positive, VacA-negative) has on efficacy of eradication therapy. MATERIAL AND METHODS: 214 of patients over the third year of life with symptoms of dyspepsia, of the upper part of the gastrointestinal tract was performed and H. pylori infection was proved in histopathological or (and) urease test and urea breath test. H. pylori identification was performed using PCR method for biopsy specimens of the gastric mucosa, estimating genetic type of the bacteria (CagA-positive, CagA-negative, VacA-positive, VacA-negative). Triple-drug eradication therapy was introduced. The efficiency of this treatment was checked after 6 weeks with the breath test. RESULTS: The H. pylori infection was found in 101 patients (47.2%), 33 patients were infected with the strain type I (32.7%) and 68 patients (67.3%) with the strain type II. After the treatment the eradication of the infection was found at 71 patients (70.3%), lack of efficacy in H. pylori infection treatment was found at 30 patients (29.7%). Considerably higher percentage of eradicative infection was shown in the group of patients infected with the type II of H. pylori (76.5% vs. 58.8%, p < 0.04). CONCLUSIONS: The effectiveness of eradication can be influenced by the genetic type of H. pylori. The better effects of eradicative treatment can be expected if one is infected with the strains of smaller virulence.

Screening for celiac disease in Poland.

BACKGROUND: Epidemiologic studies of celiac disease in Poland have been performed only within selected regions of the country and involve mainly symptomatic patients or groups at risk. The aim of this study was to assess the prevalence of celiac disease among children in Poland. MATERIAL/METHODS: Screening for the presence of antiendomysial antibodies IgA endomysium (EmA) and IgG EmA was performed in 3235 children born between 1994 and 1997 and living in Bydgoszcz. Small-bowel biopsy was proposed for patients with a positive IgA EmA and/or IgG EmA titer. RESULTS: A positive IgA EmA and/or IgG EmA titer was found in 25 patients (0.8%). Histopathologic features of celiac disease (Marsh stage III-B or III-C) were found in small-bowel biopsy specimens from 7 children, normal histologic features were found in 4 children, and 14 children did not undergo small-bowel biopsy. Celiac disease occurred more frequently among girls than boys (P<0.0001) and showed an asymptomatic (2/7 children) or oligosymptomatic (5/7 children) course. The prevalence of histologically confirmed celiac disease was estimated at 1 in 404 children, but the prevalence of serologically identified celiac disease was 1 in 124 children. CONCLUSIONS: The prevalence of celiac disease in a population of Polish children was slightly lower than that in other countries and showed an asymptomatic or oligosymptomatic course, despite findings of advanced histopathologic lesions in the small bowel.

[Twenty-two months old girl with haemorrhagic gastritis as a complication after the nonsteroid anti-inflammatory drugs application--case report]. / Krwotoczne zapalenie blony sluzowej zoladka u 22-miesiecznej dziewczynki jako powiklanie zastosowania niesterydowych leków przeciwzapalnych--opis przypadku.

The aim of case report was to pay attention for possibility of side effects of nonsteroid anti-inflammatory drugs. Child of young and healthy parents was born after normal pregnancy, natural delivery. The disease started in two days before the admission, child had fever, cough and sneezing. Mother gave her two doses of ibuprofen. On the time of admission general state of patient was moderate; girl was apathic. In physical examination features of upper respiratory tract infection were shown. In the course of treatment antibiotic and symptomatic drugs including paracetamol (3x5 ml) were delivered. During the second day of treatment child had no appetite, started to vomit with fresh and haemolized blood. Parenteral hydratation was started. Emergency gastroscopy was done and features of haemorrhagic gastritis were shown. Anti-inflammatory drugs were no more used and delivery of omeprazole was started. Parenteral hydratation was continued. General state of patient was better. In the sixth day after bleeding child was excripted in good general state with order of use of omeprazole. Parents were informed about the restriction of anti-inflammatory drugs use. The aim of case report was to pay attention that haemorrhagic gastritis may be one of side effects of nonsteroid anti-inflammatory drugs used accordingly to actual standards.

[Gastric myoelectrical activity in children and youth with dyspeptic symptoms]. / Zaburzenia czynnosci mioelektrycznej zoladka u dzieci i mlodziezy z objawami dyspeptycznymi.

THE AIM: of the study was to analyze gastric myoelectrical activity in children and youth with dyspeptic symptoms. MATERIAL AND METHODS: 113 children and youth aged 4.5 to 18 years (mean age 13.4 years) with dyspeptic symptoms were enrolled into the study. They were divided into 4 groups: group I--30 patients--without gastrooesophageal acid reflux GER (-) and Helicobacter pylori infection Hp (-), group II--35 patients, GER (+) Hp (-); group III--20 patients, GER (-) Hp (+); group IV --28 patients, GER (+) Hp (+). Gastrooesophageal acid reflux was recognized using 24-hour pH-metry. Helicobacter pylori infection was diagnosed based on histopathological examination of gastric body and/or antrum specimens, urease test and (or) C13 urea breath test. Gastric myoelectrical activity was performed using multichannel electrogastrography (Medtronic POLYGRAM NETTM). Six EGG electrodes were fixed on the subject's abdomen in standard places. Fasting EGG was recorded for 30 minutes followed by one hour postprandial recording after an ingestion of standard meal. Variables assessed were: dominant frequency (DF), the power of the dominant frequency (DP), percentage of bradygastria, normal, tachygastria and arrhythmia frequency, dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC) recorded from each channel (C1, C2, C3, C4) and average percentage slow wave coupling (%SWC) among channels. Comparisons were performed using Kruskal-Wallis's test. RESULTS: In comparison to group II GER (+) Hp (-) in group I GER (-) Hp (-) were recorded significantly higher percentage of bradygastria frequency in C1 and C2 (5% vs 2% and 4% vs. 1%) and postprandialy significantly higher percentage of arrhythmia in C4 (18% vs 13%). In comparison to group Ill GER (-) Hp (+) in group I GER (-) Hp (-) fasting were observed significantly lower dominant frequency (2.89 vs 3.07 cpm), higher percentage of tachygastria frequency in C1 (3% vs. 1%), lower percentage of arrhythmia frequency in C2 (20% vs 29%), higher DPIC in C4 (1.46 vs 1.27), higher average percentage %SWC 2-3 (70% vs 59%) and postprandialy lower DFIC in C4 (0.45 vs 0.54). In comparison to group IV GER (+) Hp (+) in group I GER (-) Hp (-) fasting were recorded lower percentage of arrhythmia frequency in C1 and C2 (18% vs 27% and 20% vs 30%) and postprandialy lower percentage of arrhythmia frequency in C2 (11% vs 17%) and lower DFIC in C2 (0.37 vs 0.48). In comparison to group Ill GER (-) Hp (+) in group II GER (+) Hp (-) fasting were observed significantly lower percentage of bradygastria frequency in C1 (2% vs 4%), higher DPIC in C2 (1.87 vs 1.28), higher average percentage %SWC 1-3 and 2-3 (71% vs 63% and 71% vs 59%) and postprandialy higher percentage of bradygastria frequency in C1 (5% vs 3%) and higher average percentage %SWC 3-4 (68% vs 58%). In comparison to group IV GER (+) Hp (+) in group II GER (+) Hp (-) fasting were recorded significantly higher percentage of normal frequency in C1 and C2 (76% vs 68% and 75% vs 67%) and higher average percentage %SWC 1-2 (77% vs 69%) and postprandialy significantly lower percentage of arrhythmia frequency in C1 (12% vs 18%). In comparison to group IV GER (+) Hp (+) in group Ill GER (-) Hp (+) fasting were observed significantly higher dominant frequency (3.07 vs. 2.87 cpm, p < or = 0.01) and lower percentage of tachygastria frequency in C1 (1% vs 2%) and postprandialy lower percentage of bradygastria frequency in C1 and C2 (3% vs 5% and 3% vs 5%) and lower DFIC in C2 (0.33 vs 0.48). CONCLUSION: In dyspeptic children and youth Helicobacter pylori infection and/ or gastrooesophageal acid reflux have influence on the gastric myoelectrical activity EGG abnormalities in patients with these diseases are varied, mostly preprandialy and recorded from proximal part of the stomach.

[Use of transcutaneous electrogastrography in the diagnostics of digestive tract diseases]. / Zastosowanie przezskórnej elektrogastrografii w diagnostyce chorób przewodu pokarmowego.

Transcutaneous electrogastrography (EGG) is the only non-invasive method of gastric myoelectric activity assessment which allows to evaluate slow wave activity and peak potentials of gastric contractions. During single channel analysis dominant frequency of slow waves (DF) is assessed, dominant power (DP), difference of DF and DP before and after the meal, percentage of normo-, brady- and tachygastry, ratio of dominant postprandial activity to preprandial acivity (power ratio--PR) and dominant frequency instability coefficient--DFIC). Multichannel EGG let us to assess myoelectric activity of different parts of stomach during one analysis. Transcutaneous electogastrography allows only for indirect evaluation of motoric disorders and needs many more studies to more precise assessment of its clinical use in gastroenterological diagnostics.

[Role of procalcitonin concentration in clinical diagnosis]. / Znaczenie oznaczania stezeniac prokalcytoniny w diagnostyce klinicznej.

UNLABELLED: Procalcytonin (PCT) is a prohormon of calcitonin. It is made in thyroid structures. Level of procalcitonin is related from actual calcium concentration in blood. It is shown that procalcitonin level increases in bacterial, fungus and parasite infections, in systematic inflammatory response syndrome (SIRS), burn and multiple organ dysfunction syndrome (MODS). We wanted to conclude the actual knowledge about the role of procalcitonin used in acute infection. Level of PCT is compatible with the etiology of infection. The procalcitonin is a fast infection marker with a longer semi-loose time than CRP. A mechanism of secretion of procalcitonin to blood circulation is still enigmatic. The determination method (immunoluminometric assay) is easy and inexpensive and results are credible and can be used to differentiating and moni-toring of disease. CONCLUSIONS: It is possible that PCT could be an important marker in fast diagnosis and differentiating of bacterial infections, also could be used in treatment monitoring and prognosis.