Utility of a stool antigen test to detect the incidence of helicobacter pylori infection and familial and community enviromental risk factors for this infection in pediatric age.

BACKGROUND: Helicobacter pylori (Hp) infection is mainly acquired during childhood; it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by World Health Organization. The exact mode of transmission is as yet, not known. Aim of our study has been to identify risk factors associated with Helicobacter pylori infection in a preschool and school population and to confirm if Hp antigen in faeces is useful as screening in epidemiological studies. METHODS: We interviewed, with questionnaire, 400 children (203 male; age range 3-10 years; mean age 6 years) of 3 different schools and stool samples were collected of all children too. 35 of 400 (8%) children underwent to upper gastrointestinal endoscopy because of a suspect of upper gastrointestinal disease. RESULTS: stool were collected from 400 school children and 35 of them shown positivity of Hp antigen test. A questionnaire about presence of nausea, vomit, recurrent abdominal pain, family size, parent's occupations and education, use of antibiotics, country of birth of child and parents, personal hygiene, breast feeding, presence of the animals was completed. 35 children with positive Hp stool antigen test and a suspicious of upper gastrointestinal disease (recurrent abdominal pain, diurnal or nocturnal abdominal pain, nausea, vomiting, iron deficiency) underwent to esophagogastroduodenoscopy (EGDS) that demonstrated antral gastritis and positive histology and urease rapid test. CONCLUSIONS: the results of this study suggest that risk factors for Hp infection are low socioeconomics factors, hygiene and living conditions and that Hp antigen in faeces is useful as screening test.

Short review about Helicobacter pylori infection in pediatric age: epidemiological and clinical findings, diagnosis, therapy and role of probiotics.

Helicobacterpylori (Hp) is mainly acquired during childhood and causes one of the most widespread infections worldwide; it is recognised as a cause of gastritis and peptic ulcer and it has been classified as a group A carcinogen by World Health Organization. This infection can be diagnosed by invasive techniques requiring endoscopy and biopsy (histological examination, rapid urease test, culture) and by non invasive tests (serology, urea breath test, detection of Hp antigen stool specimen). The gold standard in the eradication of Hp is one-week triple therapy: one proton pump inhibitor (PPI) and two antibiotics (mainly nitromidazoles, macrolides and beta-lactames). It is possible the use of probiotics during this therapy to reduce the adverse effects, to improve tolerability and compliance of multiple antibiotics regimens.

Eosinophilic esophagitis: management and pharmacotherapy.

Eosinophilic esophagitis represents the most debated disease of the last 10 years, too often speculated or overestimated and certainly well known and examined. The aim of this study was to summarize the recent therapeutic trends in order to show persistent doubts regarding several debated therapies. The study combined the most recent international literature and the authors' daily experience to define the scope of the review, with limits caused by a lack of available randomized studies between dietetic and pharmacological treatment. It was concluded that eosinophilic esophagitis is an immunoallergic disease that is generally caused by identifiable food and environmental allergens although, in a minority of cases, the etiological trigger remains undetermined. Therapy usually fights the responsible agents, but sometimes they are not resolved. A need for more pathogenetically driven treatments is invoked.

Reflux oesophagitis in children; the role of endoscopy. A multicentric Italian survey.

BACKGROUND: The decision whether to perform endoscopy in children with suspected reflux oesophagitis is not a straightforward one. Few symptoms are specific for oesophagitis and the diagnosis is not always correlated even to visual findings on endoscopy. AIM: The aim of this study was to define the role of endoscopy and especially of histology in the diagnosis of reflux oesophagitis and to examine the correlations between symptoms, endoscopic findings and histology in children with suspected gastroesophageal reflux disease. PATIENTS AND METHODS: One hundred and thirty-six patients with a clinical diagnosis of reflux oesophagitis, aged 1-18 years (mean 8.43; standard deviation +/-4.4), were enrolled from 12 Italian Paediatrics Gastroenterology Centres; symptom score, endoscopic and histologic oesophagitis scores were observed before and after therapy with proton pump inhibitors. RESULTS: Before therapy, a high correlation between the prevailing symptom score and endoscopic score was demonstrated, but not with histologic score: there was a significant tendency for histologic grade to exceed visual findings. After therapy, endoscopic score and histologic score were significantly improved. CONCLUSIONS: Oesophageal biopsies increase the diagnostic accuracy of upper endoscopy. Histologic grading is often much more important than the endoscopic appearance, so that endoscopic oesophageal biopsies are very important aids in the diagnosis of oesophagitis. Appropriate clinical evaluation of symptoms must occur before endoscopic examination.

Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders.

BACKGROUND: Patients with eating disorders can refer to a variety of gastrointestinal symptoms, sometimes to justify reduced food intake and vomiting. The authors investigated whether adolescent patients with eating disorders and dyspeptic symptoms have altered gastric electric activity and abnormal gastric emptying as assessed respectively by electrogastrography and scintigraphy. METHODS: Twenty-eight patients (18 with anorexia and 10 with bulimia) and 16 healthy volunteers underwent electrogastrography; 20 of the 28 patients (14 with anorexia and 6 with bulimia) underwent gastric emptying scintigraphy. Electrogastrography with bipolar recording lasted 1 hour, 30 minutes before and after a standard meal. Before gastric emptying scintigraphy, patients fasted overnight; during testing, they ingested a solid meal labeled with technetium-99m sulfur colloid. The ratio of fasting to postprandial electrogastrographic variables was evaluated using the Wilcoxon matched-pair test. The Mann- Whitney test was used to compare absolute values for electrogastrographic data in each group. The Student paired t test was used to compare scintigraphic results expressed as percentage of gastric emptying at 60 minutes and as the gastric emptying time (T(1/2)). RESULTS: Patients with bulimia significantly differed from those with anorexia and control subjects regarding the amount of normal gastric electric activity and bradygastria, and from patients with anorexia only regarding tachygastria. These electrogastrographic variables did not differ significantly between patients with anorexia and control subjects. Gastric emptying time (T(1/2)) was significantly longer in patients with bulimia than in those with anorexia. CONCLUSIONS: Adolescent patients with bulimia who complain of dyspeptic symptoms have documentable abnormalities of gastric electric activity and emptying, whereas their counterparts with anorexia, probably owing to their shorter disease duration, do not.

[Disseminated intravascular coagulation in chickenpox. Report of a case in a child]. / CID in corso di varicella. Descrizione di un caso in un bambino.

The case of a healthy and immunocompetent five-year-old boy, who developed a disseminated intravascular coagulation during chickenpox is described. Disseminated intravascular coagulation manifestations were extremely severe and included macroscopic hematuria, necrotic purpura and cerebrovascular thrombosis. The outcome in this patient was a complete recovery. Nevertheless, the possibility of a seriously complicated course of chickenpox even in low-risk children subgroups suggests that the Varicella-Zoster virus infection should not be underestimated. More accurate information about the impact of chickenpox and its complications on the population is needed, in order to provide a contribution for the debate about the costs associated with this disease and the potential benefits of both the early antiviral therapy and the vaccinal prophylaxis.

[Rapid recovery from optic papillitis secondary to oto-mastoiditis in pediatric age]. / Rapida guarigione di una papillite ottica secondaria ad otomastoidite in paziente pediatrico.

In this paper we report the case of an acute papillitis of the right optic nerve secundary to a mastoiditis and sinusitis of the same site in a 10-year old boy. At onset the child presented a painful movement of the ocular globe, monolateral amaurosis and papillary oedema. The exams have confirmed the correlation among mastoiditis, sinusitis and papillitis. At the same time, we were able to exclude the presence of endocranial tumours and alteration of the other side. The child underwent a steroid therapy with a complete recovery within 30 days.

[The follow-up of a child with a syndrome due to partial deletion of chromosome 3 (p25-pter)]. / Follow-up di un bambino affetto da sindrome da delezione parziale del cromosoma 3 (p25-pter).

A case of del(3) p25-pter syndrome in a four-year-old boy whose clinical manifestations were followed and studied since birth, is described. Diagnosis was made by means of karyotype analysis. The parental chromosomes were normal. So far, only about twenty cases of this syndrome have been described in living individuals. Comparison with previously reported cases confirms that the phenotype exhibits an identifiable pattern of malformation, consisting of pre- and postnatal growth delay, typical craniofacial dysmorphisms and limb abnormalities. No severe visceral anomalies were detected in this patient. Nevertheless, the follow-up revealed a progressive decay of the psychomotor and neurosensory functions.

[Orbital cellulitis. A case report]. / Cellulite orbitaria. Descrizione di un caso clinico.

This study describes the case of a 6 years old child, male, with orbital cellulitis and underlines the importance of an early diagnosis and therapy to avoid severe complications often present in this disease. Swelling and redness of the eyelid, pain and ophthalmoplegia are the first sign of an orbital cellulitis and they require rapid diagnostic procedure such as ultrasound and TC scan of the orbital region to evaluate the integrity of the profound orbital tissues. The child was admitted at the Department of Pediatrics, University "La Sapienza" of Rome and underwent an ultrasound, TC scan and serum exams which demonstrated the elevation of the sedimentation rate, reactive C protein and WBC plus the interesting of the profound orbital tissues. The child was treated with antibiotic and antiinflammatory therapy showing a complete recovery within 7 days. An ultrasound performed 7 days later demonstrated a complete resolution of the inflammatory process. In summary, this study would like to stress the necessity of an early diagnosis and an appropriate therapy in order to avoid the severe complications often present in children with orbital cellulitis.

[Colles' fracture in a girl after fulguration]. / Frattura di Colles in una bambina in seguito a folgorazione.

In the present study we describe the case of a 11 years old child, female, who was accidentally fulgurated by the left arm and after has presented an episode of pallor, shaking, confusion, throbbing and tingle of the arms. For this reason she was admitted in our Department of Pediatrics, University of Rome "La Sapienza". The child presented also a moderate pain at the left wrist. For this reason was performed a wrist X Ray which showed an incomplete fracture of the distal extremity of the radial diaphysis, with a small ulnar infraction of the same side. Life parameters and the ECG were normal so as the blood exams, in particular the CPK and the LDH (in fact, they can be indication of muscular necrosis). In summary the Authors with this study would like to remark the necessity of to suspect a fracture in the place of admittance of the electric current, even if not immediately appear clean signs of oedema, pain and functional impotence.

[Pseudotumor cerebri: a pediatric case report]. / Pseudotumor cerebri: descrizione di un caso pediatrico.

We describe a case of pseudotumor cerebri (PTC) in a five years old child. Pseudotumor cerebri is a not very common syndrome in the pediatric age. The incidence rate in about 1:100.000. The prognosis of PTC is usually good. Sometimes however, PTC could be complicated by eye diseases such as reduction of visual field. Our case is a child with diplopia and with a bilateral oedema of the papilla. The diagnosis of PTC was possible after the physical examination and the instrumental exams (EEG, brain NMR and others). During the staying in the hospital the child performed a therapy with betamethasone and acetazolamide; the diplopia improved and the bilateral oedema of the papilla started to be less evident. The child was discharged in good health and with a planned ocular follow-up. We think that the Pediatrician must considered the possibility of the presence of a PTC; that is an important syndrome not only for the Neurologist.

[Anterior scalenus syndrome in pediatric age. Report of a case]. / Sindrome dello scaleno anteriore in età pediatrica. Descrizione di un caso.

This paper aims to describe a case of a twelve-year-old girl affected by "scalenus syndrome" and who, at its outbreak, suffered great pain, cyanosis hyperhydrosis in the affected arm. The patient's follow-up took place at the Children's Hospital of the University of Rome "La Sapienza". The diagnosis, already clear from the anamnesis as well as from both the onset of the symptoms and the general conditions of the patient herself, was then confirmed by a local MR-angiography (MRA), the only test that gave us a positive result. No medical treatment was given the girl; she was only recommended to rest and avoid putting too much weight on the scapular girdle. The outcome of our study is mainly represented by the singling out and recognition of a syndrome which on the one hand is rare, but on the other is gaining more and more social significance, especially because of the so frequent use of often too heavy school bags, weighing on the scapular girdle. The description of this case, therefore, aims also to awake not only medical people, but also teachers and parents to the problem.