Dietary fiber mixture in pediatric patients with controlled chronic constipation.

OBJECTIVES: The aim of the study was to test the clinical efficacy and effect on colonic transit time (CTT) of a dietary fiber mixture given to children with controlled chronic constipation (CC) after the withdrawal of stool softeners and enemas. METHODS: This randomized, placebo-controlled, double-blind clinical trial involved 54 patients aged 4 to 12 years and had CC that was controlled by the use of low-dose stool softeners. The use of these softeners was discontinued when the patients were admitted to the clinical trial. The patients were randomized into 2 groups for the 4-week study period. One group received a dietary fiber mixture and the other group received a placebo (maltodextrin). The primary outcome was therapeutic failure (oral stool softeners or enemas was required to prescribe during the trial). Secondary outcomes included defecation frequency, stool consistency (measured using the Bristol Stool Form Scale), and CTT. RESULTS: Therapeutic failure was observed in 34.6% (9/26) of the patients in the dietary fiber mixture group and in 35.7% (10/28) in the control group (P = 0.933). The mean increase in daily bowel movements was 0.53 in the dietary fiber mixture group and 0.23 in the control group (P = 0.014). The patients in the dietary fiber mixture group (60.0%) passed nonhardened stools more frequently than did those in the control group (16.7%, P = 0.003). The CTT was similar for both groups. CONCLUSIONS: The fiber mixture did not prevent the suspension of stool softeners or lead to reduced CTT; however, the mixture promoted an increased frequency of defecation and an improvement in the stool consistency.

DGAT1 mutation is linked to a congenital diarrheal disorder.

Congenital diarrheal disorders (CDDs) are a collection of rare, heterogeneous enteropathies with early onset and often severe outcomes. Here, we report a family of Ashkenazi Jewish descent, with 2 out of 3 children affected by CDD. Both affected children presented 3 days after birth with severe, intractable diarrhea. One child died from complications at age 17 months. The second child showed marked improvement, with resolution of most symptoms at 10 to 12 months of age. Using exome sequencing, we identified a rare splice site mutation in the DGAT1 gene and found that both affected children were homozygous carriers. Molecular analysis of the mutant allele indicated a total loss of function, with no detectable DGAT1 protein or activity produced. The precise cause of diarrhea is unknown, but we speculate that it relates to abnormal fat absorption and buildup of DGAT substrates in the intestinal mucosa. Our results identify DGAT1 loss-of-function mutations as a rare cause of CDDs. These findings prompt concern for DGAT1 inhibition in humans, which is being assessed for treating metabolic and other diseases.

A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy.

BACKGROUND: Cow's milk is the most common food allergen in infants and the diagnosis of cow's milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow's milk allergy. METHODS: An observational cross-sectional study was performed among 9,478 patients evaluated by 30 pediatric gastroenterologists for 40 days in 5 different geographical regions in Brazil. Clinical data were collected from patients with symptoms suggestive of cow's milk allergy. The nutritional status of infants (age < or = 24 months) seen for the first time was evaluated according to z-scores for weight-for-age, weight-for-height, and height-for-age. Epi-Info (CDC-NCHS, 2000) software was used to calculate z-scores. RESULTS: The prevalence of suspected cow's milk allergy in the study population was 5.4% (513/9,478), and the incidence was 2.2% (211/9,478). Among 159 infants seen at first evaluation, 15.1% presented with a low weight-for-age z score (< -2.0 standard deviation - SD), 8.7% with a low weight-for-height z score (< -2.0 SD), and 23.9% with a low height-for-age z score (< -2.0 SD). CONCLUSION: The high prevalence of nutritional deficits among infants with symptoms suggestive of cow's milk allergy indicates that effective elimination diets should be prescribed to control allergy symptoms and to prevent or treat malnutrition.

Doença péptica: estudo comparativo entre crianças e adolescentes / Peptic disease: comparative study between children and adolescents

Objetivo: Analisar comparativamente os dados clínicos e endoscópicos concernentes à doença péptica em grupo de crianças (CR) e adolescentes (AD). Material e Métodos: Foram estudadas 30 crianças e 76 adolescentes, no período de agosto de 1992 a novembro de 1994, portadores de doença péptica. O diagnóstico foi firmado mediante exame endoscópico e histológico em todos os casos. Pesquisou-se a colonizaçäo pelo H. pylori (biópsia gástrica corada pelo Giensa). Foram tomados e comparados dados clínicos quanto a dor abdominal (localizaçäo, intensidade, cronicidade e sintomas acompanhantes) em ambos os grupos. A análise estatística foi efetuada pelo teste exato de Fisher (valor de significância p<0,05). Resultados: os resultados foram similares quanto à predominância do sexo feminino (66 por cento grupo CR x 70 por cento grupo AD), cronicidade da dor entre 2 a 6 meses (40 por cento CR x 38 por cento AD), dor de intensidade forte (70 por cento CR x 83 por cento AD), presença de vômitos e náuseas (42 por cento CR x 55 por cento AD). Epigastralgia foi predominante nos AD (87 por cento x CR 63 por cento), sendo este estado significativo (p=0,012). A endoscopia foi normal em 30 por cento das CR e 14 por cento dos AD (p=0,052). A presença de gastrite leve e moderada foi significativamente mais encontrada no AD (72 por cento) que em crianças (37 por cento) (p<0,01). Nas CR houve nítida predominância de gastrite antral de aspesto nodular, enquanto nos AD prevaleceu gastrite de caráter difuso. A Bulboduodenite foi constatada nas CR (10 por cento) e nos AD (12 por cento),...