The complete picture of changing pediatric inflammatory bowel disease incidence in Spain in 25 years (1985-2009): the EXPERIENCE registry.

OBJECTIVES: A growing incidence of pediatric IBD (PIBD) in southern Europe has been recently reported. The SPIRIT registry (1996-2009) confirmed these tendencies in Spain. Our aim is to obtain data from 1985 to 1995 and describe the complete picture of PIBD presentation changes in Spain in the last 25years. METHODS: A retrospective survey of incident PIBD in the period 1985-1995 was performed. Patients' data were obtained from the hospitals' databases and compared with the published data from the 1996 to 2009 period. Seventy-eight IBD reference centers took part in this survey. RESULTS: Data from 495 patients were obtained: 278 CD (56.2%), 198 UC (40%), and 19 IBDU (3.8%); 51.7% were female, with higher predominance both in UC (58.6%) and in IBDU (57.9%), but not in CD (46.4%). Median (IQR) age at diagnosis was 12.9 (10.0-15.7) years, with significant differences among IBD subtypes: CD: 13.1 (10.8-16.0) vs UC: 12.4 (9.4-15.1) vs IBDU: 7.5 (3.0-13.0) (p≤0.001). These results are significantly different to the ones in the SPIRIT registry, with a higher proportion of IBDU, younger age and male predominance. The data from both periods taken together give a complete picture of a 25-year period. An annual increase of incident patients was observed, with a ten-fold increase over this period. CONCLUSION: These data extend the epidemiological trends to a full 25-year period (1985-2009). PIBD incidence in Spain has experienced a sixteen-fold increase. The IBD subtype, localization of the affected segment, age- and sex distribution observed are in accordance with our previously published ones of 1996-2009.

Líneas de trabajo e investigación de la Sección de Gastroenterología del H. Infantil Universitario Niño Jesús / Lines of work and research Section of Gastroenterology H. Infantil Universitario Niño Jesús

La actividad asistencial e investigadora se centra preferentemente en la enfermedad celíaca, la enfermedad inflamatoria intestinal y la infección por Helicobacter pylori. Se desarrollan los proyectos de investigación en cada área y se citan las publicaciones más relevantes (AU)

Care and investigator activity is preferentially focused on celiac disease, inflammatory bowel disease and Helicobacter pylori infection. Research project are developed in each area and the most relevant publications are cited (AU)

Eosinophilic esophagitis, celiac disease, and immunoglobulin E-mediated allergy in a 2-year-old child.

Celiac disease, eosinophilic esophagitis, and urticaria are 3 manifestations of food allergy with different pathogenic mechanisms. We report the case of a 2-year-old child with digestive symptoms, slow growth, and severe asthma. The results of skin prick tests were positive to several foods. Endoscopy revealed eosinophilic esophagitis and celiac disease. Treatment consisted of a gluten-free diet and a 1-month course of oral corticosteroids. Endoscopy and biopsy findings were normal at 5 years of age. A gluten-free diet is the basis of treatment of celiac disease, but the role of an elimination diet in eosinophilic esophagitis is not well established. Our patient also developed urticaria when exposed to milk and egg.We present, to our knowledge, the first report of a patient with celiac disease, eosinophilic esophagitis, and immediate-type immunoglobulin E-mediated food allergy.

Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe.

AIM: To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe. METHODS: During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested. RESULTS: A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother's birth-country; 13% were <6 years of age, 43% 6-11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p = 0.001). CONCLUSION: The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance.

Cólico del lactante, reflujo gastroesofágico y estreñimiento en la hipersensibilidad a proteínas vacunas. ¿Dónde están los límites? / Infant colic, gastroesophageal reflux and constipations in hypersensitivity to cow proteins. Where are the limits?

El diagnóstico de alergia o intolerancia a proteínas de leche de vaca es sencillo cuando las manifestaciones clínicas se corresponden con los cuadros típicos de las mismas, entre los que se incluyen las gastroenteritis o enterocolitis. En estos casos la eliminación de las proteínas de leche de vaca de la alimentación se sigue en todos los casos de desaparición de la sintomatología. El problema lo suponen aquellos cuadros clínicos en los que las proteínas de leche de vaca (PLV) pueden estar implicadas en su patogenia, pero no existe clara evidencia de su papel etiológico. El cólico del lactante, el reflujo gastroesofágico y el estreñimiento, constituyen tres ejemplos de esta situación. En los tres exige implicación de las proteínas de leche de vaca en su etiopatogenia, aunque con diferente grado de evidencia. La dieta de exclusión de proteínas vacunas tiene valor diagnóstico

The diagnosis of Cow´s milk allergy is not difficult in patients with clinical manifestatiuons of IgE mediated hypersensitivity and avoidance of the offending proteins resolves the symptoms of allergy. Recently additional disorders have been attributed to cow milk allergy: infant colic, gastroesophageal reflux, and constitpation. Immunological basis of these are not well established and the diagnosis requires differentiating these disorders from other causes of similar symptoms. Trials elimination diets have diagnostic value

La microflora bacteriana

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Microflora bacteriana e inmunidad intestinal / Bacterial microflora and intestinal immunity

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