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1.
Artigo em Inglês | MEDLINE | ID: mdl-32740538

RESUMO

OBJECTIVES: Crohn disease (CD) can affect patient's quality of life (QOL) with physical, social, and psychological impacts. This study aimed to investigate the QOL of children with CD and its relationship with patient and disease characteristics. METHODS: Children ages from 10 to 17 years with diagnosed CD for more than 6 months were eligible to this cross-sectional study conducted in 35 French pediatric centers. QOL was assessed by the IMPACT-III questionnaire. Patient and disease characteristics were collected. RESULTS: A total of 218 children (42% of girls) were included at a median age of 14 years (interquartile range [IQR]: 13--16). Median duration of CD was 3.2 years (IQR: 1.7-5.1) and 63% of children were in clinical remission assessed by wPCDAI. Total IMPACT-III score was 62.8 (±11.0). The lowest score was in "emotional functioning" subdomain (mean: 42.8 ±â€Š11.2). Clinical remission was the main independent factor associated with QOL of children with CD (5.74 points higher compared with those "with active disease", 95% confidence interval [CI] 2.77--8.70, P < 0.001). Age of patient at the evaluation was found negatively correlated with QOL (-0.76 per year, 95% CI: -1.47 to -0.06, P = 0.009). Presence of psychological disorders was associated with a lower QOL (-9.6 points lower to those without, 95% CI: -13.34 to -5.86, P < 0.0001). Total IMPACT-III and its subdomains scores were not related to sex, disease duration, or treatments. CONCLUSIONS: These results not only confirm that clinical remission is a major issue for the QOL of patients, but also highlights the importance of psychological care.

2.
Surg Endosc ; 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32833100

RESUMO

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) and gastrostomy tube (GT) placement may be performed concomitantly in children with gastro-esophageal reflux disease (GERD) and failure to thrive. We aimed to evaluate the rate and risk factors for LNF failure in children undergoing concomitant LNF/GT. METHODS: A retrospective multi-institutional cohort study was conducted, reviewing patients that underwent LNF (2005-2014). Data collected included patient demographics, comorbidities, and type of GT (laparoscopy- or endoscopy-assisted). The primary outcome measure was LNF failure. Data was compared using contingency tables or Mann-Whitney tests, when appropriate. An exploratory analysis by Kaplan-Meier survival and Cox proportional hazards analysis was performed to determine predictors of time to LNF failure after LNF/GT. RESULTS: Of 189 children that underwent LNF, 99 (52%) had a concomitant GT (55% laparoscopy-, 45% endoscopy-assisted). LNF failed in 15% after LNF/GT and in 17% after LNF alone (p = 0.84), at a median age of 23 months (IQR 8-41). Using univariate analysis, we found that a younger age at the time of surgery (p = 0.05), prematurity (p = 0.0018), esophageal atresia (p = 0.01), and endoscopy-assisted GT (p = 0.02) were potential predictors of LNF failure after LNF/GT. After multivariate regression analysis, prematurity (p = 0.007) remained significantly associated with LNF failure after LNF/GT. No predictive factors for LNF failure after LNF alone were identified. CONCLUSIONS: Concomitant GT insertion and LNF is a common practice, as half of the children that undergo LNF also received GT insertion. Children born preterm or with esophageal atresia comprise a fragile population at high-risk of LNF failure after LNF/GT. Prospective, multicentric studies are needed to evaluate the best GT technique to use in children undergoing LNF.

3.
Endosc Int Open ; 8(7): E969-E973, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32617400

RESUMO

Background and study aims The real burden of urgent endoscopy in children has not been studied yet. Our aim was to evaluate the need for urgent endoscopy in children. Patients and methods Information was collected about all the calls that were received during the 24 hour on-call shift for pediatric endoscopy in the region of Ile-de-France (12.1 million inhabitants) during a 6 months period (February-July 2017). Results A total of 237 calls (19 calls/y/100,000 children) were collected regarding children of an average age of 3.2 years (range 2 days-18 years). Most of the calls (68 %) were for foreign body ingestions. Gastroscopy was required in 32 % of children: 24 % of those calling for foreign body ingestion, 48 % for gastrointestinal bleeding, 63 % for caustic ingestions ( P  = 0.01). The average time between the call and the urgent endoscopy were below the international recommendations for each situation. Conclusions Calling the endoscopist seems to have become a recurrent practice, although in most cases, urgent endoscopy did not appear necessary, especially for foreign body ingestion. This organization of pediatric endoscopy on call was able to guarantee the performance of urgent endoscopy in adequate timing for a highly populated region.

4.
BMJ Open ; 10(5): e036929, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32398339

RESUMO

OBJECTIVE: Inflammatory bowel diseases (IBDs) are chronic relapsing remitting diseases which potentially result in hospitalisation, requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice and support.The aim of this study was to assess the impact of introduction of an IBD nurse position on healthcare use and costs in a tertiary IBD centre. METHODS: An IBD nurse was instituted in September 2017 in our multidisciplinary IBD team. We compared differences in healthcare use 1 year before and 1 year after the introduction of an IBD nurse position for all the patients with a confirmed diagnosis of IBD attending the Robert Debre Hospital via two information sources: Programme de Médicalisation des Systèmes d'Information and Centre des Maladies Rares. RESULTS: 252 patients (78.5% of patients with IBD followed up in our centre) were included in the patient education programme. After the introduction of an IBD nurse position, fewer patients were hospitalised for a flare, with less hospital stays: 56 before vs 28 after (p=0.002). An estimated saving of €35 070 was achieved through the decrease of hospitalisations for flare.More patients were also hospitalised for diagnosis: 32 hospitalisations before vs 54 hospitalisations after (p=0.001). All other hospitalisation categories were comparable, and the same reasons for hospitalisation were found before and after. CONCLUSION: This study demonstrates that the IBD nurse position reduces hospital admissions. Instead of the traditional model, the IBD nurse provides accessible advice and allows patients to be outpatients.

5.
Pediatr Emerg Care ; 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32118832

RESUMO

An 8-year-old child experienced abdominal pain and melena due to duodenal and ileal ulcerations throughout antiretroviral prophylactic treatment after a needlestick injury. Mild to moderate adverse effects often occur with lamivudine and zidovudine, but more severe adverse effects such as intestinal ulcers resulting in melena after a prophylactic antiretroviral treatment may question the safety of the current guidelines.

6.
J Pediatr Gastroenterol Nutr ; 70(3): 310-317, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31651668

RESUMO

OBJECTIVE: Infliximab (IFX) is a frequent therapeutic option for Crohn disease (CD) patients. Early detection of responders to IFX is critical for the management of CD in order to avoid long-term exposure to the drug without benefit. This retrospective study aimed at analysing which early parameters recorded during the induction period are able to predict response to IFX during the maintenance period in pediatric CD. PATIENTS AND METHODS: Medical records of all CD patients ages from 2 to 18 years who received IFX at a tertiary IBD center were retrospectively analyzed. Children were classified in 3 groups according to their response at week 14 (W14) remission, clinical response or , no response. The factors recorded at W0, W2, and W6, which were associated with remission at W14 were analyzed using a logistic regression. RESULTS: Among the 111 patients included, 74.8% patients were responders to IFX at W14, including 38.7% in clinical remission and 36% with partial clinical response. Clinical remission at W14 was associated with normal growth (P < 0.01), and normal albuminemia (P = 0.01) at baseline, It was also associated with trough levels to IFX >8.3 µg/ml at week 6 (P < 0.01). CONCLUSION: Trough levels to IFX >8.3 µg/ml at week 6 are predictive of remission at W14 for luminal disease.

7.
J Pediatr Gastroenterol Nutr ; 69(5): 528-532, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31436711

RESUMO

OBJECTIVES: Research on long-term use of mitomycin C (MC) for recurrent esophageal stenoses is limited. We assessed the long-term efficacy and safety of local application of MC for recurrent esophageal stenoses in children. METHODS: This was a retrospective study of 39 patients (17 girls) with a median age of 19.5 months (range: 2.4-196.0) at the time of MC application. The etiologies of stenosis were esophageal atresia (n = 25), caustic ingestion (n = 9), congenital esophageal stenosis (n = 3), and other causes (n = 2). Stenosis was single in 35 (90%) patients and multiple in 4 (10%). Before MC, patients underwent multiple repeated dilations (median: 3 dilations per child [range: 2-26]) over a median period of 7 months (range: 2.6-49.3). Treatment success was defined a priori as a reduction in the number of dilations over the same period from before to after the application of MC. RESULTS: For 26 (67%) patients, the application of MC was considered a success: 102 versus 17 dilatations (P < 0.0001). Sixteen (41%) patients never required additional dilation during the follow-up after MC application (median: 3.1 years [range: 0.6-8.5]). No complication related to MC was observed. Biopsies at the site of MC application were performed at maximal follow-up in 16 patients and revealed no dysplasia. Three factors were associated with success of MC: single stenosis, short stenosis, and esophageal atresia type III. CONCLUSIONS: This study is the largest series reported showing that topical application of MC is an efficient and safe treatment for recurrent esophageal stenosis in children.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Estenose Esofágica/tratamento farmacológico , Mitomicina/uso terapêutico , Administração através da Mucosa , Adolescente , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Esofagoscopia , Feminino , Humanos , Lactente , Masculino , Mitomicina/administração & dosagem , Mitomicina/efeitos adversos , Complicações Pós-Operatórias , Estudos Retrospectivos
8.
J Pediatr Gastroenterol Nutr ; 69(2): 189-193, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30921262

RESUMO

OBJECTIVES: In adult inflammatory bowel disease (IBD) treated by anti-TNF antibodies, paradoxical psoriasis has an estimated prevalence of 1.6 to 22%, especially in infliximab (IFX)-treated patients. Little is known in the pediatric IBD (PIBD) populations. METHODS: All patients ages from 2 to 18 years with Crohn disease (CD) or ulcerative colitis (UC) and treated for the first time by IFX between January 2002 and March 2014, were considered for inclusion in this retrospective study performed in a tertiary PIBD centre. Paradoxical psoriasis events together with clinical and biological data were collected in all patients. Comparisons between psoriasis and control groups were performed using univariate statistical analyses. RESULTS: One hundred and twenty-three CD patients and 24 UC patients were treated with IFX. Twenty patients (13.6%) experienced a paradoxical psoriasis. All of them were affected by CD. Perianal CD was more frequent in the psoriasis group (P = 0.033). Fourteen patients (70%) were in remission when skin lesions occurred. Paradoxical psoriasis was diagnosed 355 days (median, interquartile range [IQR] 239; 532) after the initiation of IFX corresponding to the eighth injection (median, IQR: 6; 15). Psoriasis lesions were controlled by local steroids in all cases and no patients discontinued IFX therapy. CONCLUSIONS: 13.6% of our IBD patients treated with IFX developed psoriasis during a median follow-up of 23.9 months (IQR: 11.6; 36.5). Crohn disease patients with perianal disease were at a higher risk to develop this common side effect.


Assuntos
Fármacos Dermatológicos/efeitos adversos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/efeitos adversos , Psoríase/induzido quimicamente , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Psoríase/epidemiologia , Estudos Retrospectivos
10.
Endoscopy ; 51(1): 10-17, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30184608

RESUMO

BACKGROUND: Esophagogastroduodenoscopy (EGD) is the standard method for diagnosis of esophageal and gastric varices in children. In this prospective study we evaluated the use of PillCam esophageal capsule endoscopy (ECE) in pediatric patients. METHODS: Patients aged 7 to 18 years presenting with portal hypertension and/or cirrhosis underwent ECE (PillCam ESO 2, Given Imaging Ltd.) followed by EGD. RESULTS: 102 patients were screened, 81 (52 boys; mean age 13.96 ±â€Š0.25 years) were included and 21 were excluded (16 for "candy test" failure). Esophageal varices were identified by EGD in 62 patients (77 %) and by ECE in 57 patients (70 %) using the de Franchis classification (DFC). The sensitivity of ECE for esophageal varices was 92 % and the specificity was 100 % using DFC. Based upon 57/81 patients with small, medium, and large varices on both ECE and EGD, using DFC, the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were 55 %, 92 %, 89 %, and 63 %, respectively, giving a total overall accuracy of 72 %. To improve sensitivity and specificity in classification of esophageal varices, we propose using a modified score. This score detected esophageal varices with 100 % sensitivity, 93 % specificity, 94 % PPV, and 100 % NPV, giving a total overall accuracy of 97 %. All patients preferred ECE over EGD. No capsule retention was recorded. CONCLUSIONS: ECE is a well-tolerated and safe procedure in children. Using the modified score, the sensitivity of ECE is currently sufficient to detect esophageal varices and replace EGD in infants with suspicion of esophageal varices or when EGD is refused.


Assuntos
Endoscopia por Cápsula/métodos , Varizes Esofágicas e Gástricas/diagnóstico , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Adolescente , Criança , Endoscopia do Sistema Digestório/métodos , Varizes Esofágicas e Gástricas/etiologia , Feminino , França , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
11.
J Crohns Colitis ; 13(5): 578-584, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-30541021

RESUMO

BACKGROUND: Ustekinumab [UST] is effective in the treatment of adults with moderate to severe Crohn's disease [CD]. There is a paucity of data on its use in children. AIM: To evaluate the response to UST in children with moderate to severe CD. METHODS: This multicentre retrospective cohort study identified children under 18 years old with CD, who received open-labelled subcutaneous UST. The primary outcome was changes in mean abbreviated Paediatric Crohn's Disease Activity Index [aPCDAI] between baseline and 3 and 12 months, and rate of clinical remission at 3 and 12 months. Secondary outcomes were clinical response at the same time points, changes in C-reactive protein [CRP] and albumin, improvement in growth parameters, and rate of adverse events. RESULTS: A total of 44 patients who failed at least one biological treatment were identified. Linear mixed model [LMM] analysis revealed a statistically significant effect of UST (χ2[1] = 42.7, p = 1.2 × 10-8) which lowered the aPCDAI scores by about 16 ± 2.7 at 3 months, and 19.6 ± 2.9 at 12 months. At 12 months, 38.6% of the patients achieved clinical remission and 47.8% achieved clinical response. There was a significant increase in mean weight z-score of 0.48 [±0.13] [p <0.001] and in mean body mass index [BMI] z score of 0.66 [±0.16] [p <0.001]. The probability of remaining on UST at 12 months was 76.9%. The rate of adverse events was 12.4 per 1000 patient-months. CONCLUSIONS: Subcutaneous UST should be considered a viable therapeutic option for paediatric patients who are refractory to other biological agents. Prospective randomised trials are needed.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doença de Crohn/tratamento farmacológico , Ustekinumab/uso terapêutico , Adolescente , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Proteína C-Reativa/análise , Criança , Feminino , Humanos , Injeções Subcutâneas , Masculino , Estudos Retrospectivos , Albumina Sérica/análise , Resultado do Tratamento , Ustekinumab/administração & dosagem , Ustekinumab/efeitos adversos
12.
J Pediatr Gastroenterol Nutr ; 68(3): 442-452, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30585892

RESUMO

Peutz-Jeghers syndrome (PJS) is a well-described inherited syndrome, characterized by the development of gastrointestinal polyps, and characteristic mucocutaneous freckling. Development of small bowel intestinal polyps may lead to intussusception in children may require emergency laparotomy with potential loss of bowel. Gastrointestinal polyps may lead to bleeding and anemia. This European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper provides a guide for diagnosis, assessment, and management of PJS in children and adolescents and guidance on avoiding complications from PJS or from the endoscopic procedures performed on these patients.This is the first position paper regarding PJS published by European Society for Paediatric Gastroenterology Hepatology and Nutrition. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of pediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, some of the recommendations are based on expert opinion. This position paper will be helpful in the appropriate management and timing of procedures in children and adolescents with PJS.


Assuntos
Programas de Rastreamento/normas , Síndrome de Peutz-Jeghers/diagnóstico , Síndrome de Peutz-Jeghers/terapia , Criança , Pré-Escolar , Colonoscopia/normas , Consenso , Medicina Baseada em Evidências , Testes Genéticos/normas , Humanos , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/etiologia , Pólipos Intestinais/cirurgia , Intussuscepção/etiologia , Programas de Rastreamento/métodos , Neoplasias/etiologia , Neoplasias/genética , Neoplasias/prevenção & controle , Síndrome de Peutz-Jeghers/complicações , Síndrome de Peutz-Jeghers/genética , Medição de Risco
13.
Artigo em Inglês | MEDLINE | ID: mdl-30298122

RESUMO

Yersinia are common contaminants of food products, but their prevalence in the human gut is poorly documented. Yersinia have been implicated in Crohn's Disease (CD, an inflammatory bowel disease) however their role in CD is controversial. We performed highly sensitive PCR assays of specific sequences for the gyrB gene of Y. aldovae, Y. bercovieri, Y. enterocolitica, Y. intermedia, Y. mollaretii and the inv gene of Y. pseudotuberculosis. We analyzed a total of 470 ileal samples taken from 338 participants (262 CD patients and 76 controls) belonging to three independent cohorts. All patients and controls were phenotyped and genotyped for the main CD susceptibility variants: NOD2, ATG16L1, and IRGM. Yersinia were found in 7.7% of ileal samples (respectively 7.9 and 7.6% in controls and CD patients) corresponding to 10% of participants (respectively 11.8 and 9.5% in controls and CD patients). Y. enterocolitica, Y. pseudotuberculosis and Y. intermedia were the most frequently identified species. The bacteria were more frequent in resected specimens, lymph nodes and Peyer's patches. Yersinia were no more likely to be detected in CD tissues than tissues from inflammatory and non-inflammatory controls. CD patients treated with immunosuppressants were less likely to be Yersinia carriers. In conclusion, this work shows that Yersinia species are frequently found at low levels in the human ileum in health and disease. The role of Yersinia species in this ecosystem should now be explored.


Assuntos
Doença de Crohn/complicações , Doença de Crohn/microbiologia , Íleo/microbiologia , Yersiniose/epidemiologia , Yersiniose/microbiologia , Yersinia/isolamento & purificação , DNA Girase/genética , Humanos , Reação em Cadeia da Polimerase , Prevalência , Yersinia/classificação , Yersinia/genética
14.
Inflamm Bowel Dis ; 24(11): 2423-2430, 2018 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-29788152

RESUMO

Background: Crohn's disease (CD) is a chronic relapsing inflammatory disease. To optimize therapeutic decision making, it is essential to identify parameters that allow early prediction of a severe disease course. The aim of this study was to assess the link between arthritis and medium-term therapeutic failure in pediatric CD. Methods: We conducted a population-based cohort study with prospectively collected electronic data. To be included, patients must be younger than 17 years and have a confirmed CD diagnosed between 2005 and 2014. The primary outcome was the percentage of patients with at least 1 therapeutic failure of immunosuppressive drugs during the 2 years after the CD diagnosis, with a propensity score analysis. Results: We included 272 patients with CD. The median age was 12.1 years (interquartile [10.1-14.2]). Sixty-five patients (23.9%) developed arthritis, which predominantly occurred during the first year after CD diagnosis. We found a highly significant association between arthritis and therapeutic failure of immunosuppressive drugs after 2 years (OR = 6.9; 95% confidence interval [CI], 2.7-18.0; P < 0.0001; propensity score matching analysis). Arthritis was also significantly associated with introduction of biotherapy due to luminal disease 2 years after diagnosis (OR = 3.2, 95% CI, 1.8-6.0; P = 0.0001). Similar results were obtained after 4 years, and arthritis was significantly associated with a higher number of hospitalizations for luminal flare-up or complications after 4 years (OR = 2.2; 95% CI, 1.2-3.9; P = 0.007). Conclusions: Arthritis was strongly associated with medium-term therapeutic failure of pediatric CD. Occurrence of arthritis early in the disease may justify closer follow-up visits or specific therapeutic management.


Assuntos
Artrite/induzido quimicamente , Doença de Crohn/tratamento farmacológico , Imunossupressores/efeitos adversos , Índice de Gravidade de Doença , Adolescente , Artrite/patologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Falha de Tratamento
15.
Hum Pathol ; 72: 174-179, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28899741

RESUMO

Digestive graft-versus-host disease (GVHD) is a frequent complication after bone marrow transplantation, but small bowel obstruction is an extremely rare event. We present herein the first pediatric series of 4 cases of small bowel obstruction after bone marrow transplantation with detailed gross, histological data and their genetic status of the NOD2 gene. All patients had a history of severe acute GVHD treated by immunosuppressive agents and/or infliximab (in 3 cases). Acute or progressively worsening abdominal pain accompanied by small bowel occlusion occurred 5-16 months after graft, and computed tomographic scan revealed multiple small intestinal stenoses. Failure of intensive medical treatment led to surgical resection of affected loops. Stigmata of acute (apoptosis of crypts and satellitosis) and chronic GVHD features (submucosal fibrosis and serosae sclerolipomatosis), as well as extensive ulcerations, were observed in all ileal specimens. NOD2 mutation was found in only 1 patient. The follow-up showed successful outcome after surgery.


Assuntos
Doença Enxerto-Hospedeiro/patologia , Obstrução Intestinal/patologia , Intestino Delgado/patologia , Adolescente , Transplante de Medula Óssea/métodos , Pré-Escolar , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/cirurgia , Humanos , Imunossupressores/uso terapêutico , Obstrução Intestinal/cirurgia , Masculino , Mutação/genética , Proteína Adaptadora de Sinalização NOD2/genética , Resultado do Tratamento
16.
J Laparoendosc Adv Surg Tech A ; 27(10): 1085-1090, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28877001

RESUMO

BACKGROUND: Esophageal repair after caustic injury is a surgical challenge in children. The aim of this study was to report the first results of a total laparoscopic approach in transhiatal esophagectomy and esophageal replacement by an anisoperistaltic gastric tube. PATIENTS AND METHODS: A retrospective review of data from children operated on with a laparoscopic approach for transhiatal esophagectomy and Gavriliu's esophagoplasty between 2011 and 2015 was performed. Surgical techniques were related with variations for 2 cases, 1 case with robotic assistance and 1 with thoracoscopic assistance. RESULTS: Seven patients were operated on. The median weight was 16 kg. Median duration of mechanical ventilation was 2 days. Total esophagectomy was achieved in all cases. Two patients could eat after a barium swallow 7 days after surgery. The most frequent immediate complication (57%) was anastomotic or gastric tube leakage treated successfully in 100% of the cases with self-expanding metallic stent placement. Seventy-one percent of children presented with stenosis, which responded to pneumatic dilatation in 67% of the cases. Redo surgery was required in 43%, either for anastomosis revision or nonfunctioning gastric tube. With an average follow-up of 51 months, 85.7% of children achieved oral feeding. CONCLUSIONS: Total laparoscopic approach for esophagectomy and esophageal replacement by Gavriliu's anisoperistaltic gastric tube is a feasible technique allowing to shorten the postoperative mechanical ventilation duration and save parietal damage often present in these patients requiring multiple surgery. It appears to have a good long-term tolerance, although the immediate postoperative complication rate remains as high as the open technique.


Assuntos
Queimaduras Químicas/cirurgia , Esofagectomia/métodos , Esofagoplastia/métodos , Laparoscopia/métodos , Cáusticos/efeitos adversos , Criança , Pré-Escolar , Doenças do Esôfago/cirurgia , Esofagectomia/efeitos adversos , Esofagoplastia/efeitos adversos , Esôfago/lesões , Esôfago/cirurgia , Feminino , Humanos , Lactente , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/cirurgia , Reimplante , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis
17.
Int J Gen Med ; 10: 61-68, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28293116

RESUMO

BACKGROUND: Recurrent respiratory tract infections (RRTIs) are the most common reason for children's visits to primary care physicians in France; however, little is known about general practitioners' (GPs) opinions and expectations concerning the management and prevention of these common and recurrent pathologies. PURPOSE: To describe French GPs' daily practice in the management of respiratory infections and the prevention of their recurrence in children. METHODS: A sample group of French GPs answered a structured questionnaire on risk factors, RRTI management, antibiotic use and prevention measures. RESULTS: A total of 358 GPs participated in the survey. Rhinopharyngitis, the most frequent respiratory infection, was considered to be recurrent if six or more episodes occurred in a year. Four risk factors were acknowledged as substantial: living in communities, passive smoking, pollution and allergies. Around 63% of GPs said that RRTIs are too often treated with antibiotics. More than 85% thought that prevention of RRTIs is possible. Smoking cessation, vaccination, allergen avoidance and hygiene were identified as the main preventive measures. A large majority of GPs (84%) prescribed products for prevention and ~90% would prescribe a product stimulating immunity if the efficacy and tolerability of these agents was proven and confirmed in their daily practice. CONCLUSIONS: French GPs are well aware of the health and socioeconomic burdens resulting from RRTIs, as well as the risk of antibiotic overuse. They have a prevention-oriented approach, implement preventive measures when possible and prescribe products for prevention.

18.
Nat Commun ; 8: 13998, 2017 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-28084299

RESUMO

Monolayered epithelia are composed of tight cell assemblies that ensure polarized exchanges. EpCAM, an unconventional epithelial-specific cell adhesion molecule, is assumed to modulate epithelial morphogenesis in animal models, but little is known regarding its cellular functions. Inspired by the characterization of cellular defects in a rare EpCAM-related human intestinal disease, we find that the absence of EpCAM in enterocytes results in an aberrant apical domain. In the course of this pathological state, apical translocation towards tricellular contacts (TCs) occurs with striking tight junction belt displacement. These unusual cell organization and intestinal tissue defects are driven by the loss of actomyosin network homoeostasis and contractile activity clustering at TCs, yet is reversed by myosin-II inhibitor treatment. This study reveals that adequate distribution of cortical tension is crucial for individual cell organization, but also for epithelial monolayer maintenance. Our data suggest that EpCAM modulation protects against epithelial dysplasia and stabilizes human tissue architecture.


Assuntos
Células Epiteliais/química , Epitélio/química , Actomiosina/química , Actomiosina/genética , Actomiosina/metabolismo , Adolescente , Fenômenos Biomecânicos , Células CACO-2 , Polaridade Celular , Criança , Pré-Escolar , Diarreia Infantil/genética , Diarreia Infantil/metabolismo , Enterócitos/química , Enterócitos/metabolismo , Molécula de Adesão da Célula Epitelial/química , Molécula de Adesão da Célula Epitelial/genética , Molécula de Adesão da Célula Epitelial/metabolismo , Células Epiteliais/citologia , Células Epiteliais/metabolismo , Epitélio/metabolismo , Feminino , Humanos , Lactente , Síndromes de Malabsorção/genética , Síndromes de Malabsorção/metabolismo , Masculino , Junções Íntimas/química , Junções Íntimas/genética , Junções Íntimas/metabolismo
19.
J Pediatr Gastroenterol Nutr ; 64(2): e38-e43, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28107284

RESUMO

OBJECTIVES: Surgery and conservative treatment of esophageal or gastric perforations are both often associated with poor results and carry a high morbidity and mortality rate. The aim of the present study was to evaluate the effectiveness and safety of using fully covered self-expending metallic stents (SEMS) in children with upper digestive leaks. METHODS: This retrospective study reviewed all children with esophageal or gastric perforation who were treated with placement of an SEMS from January 2011 to January 2015. Closure of the perforation was the primary outcome measured. Secondary outcomes were the duration of antibiotic therapy and parenteral nutrition, adverse events, and length of hospitalization. RESULTS: A total of 19 SEMS were placed in 10 patients (median age: 5.5 years; 5 girls) treated for postanastomotic leaks of esophageal atresia (n = 3), esophagogastroplasty (n = 4), resection of esophageal duplication (n = 1) or perforation during Toupet surgical dismantling (n = 1), and gastric rupture after Nissen surgery (n = 1). The perforation closed in 9 out of 10 patients in a mean of 36 days after stenting (range: 13-158 days). All patients received antibiotic therapy for an average of 17.5 days (3-109 days) and parenteral nutrition for 49 days (17-266 days). During a median follow-up of 8.9 months, 4 out of 9 sealed perforations developed stenosis, which was efficiently treated by endoscopic dilations in 2 patients and surgical redo in 2 patients with dilation-resistant stenosis. CONCLUSIONS: Covered stents appear to be beneficial in closing esophageal perforations in children and can avoid the high morbidity of a surgical repair. Stenosis, however, occurred frequently after larger leakages.


Assuntos
Perfuração Esofágica/terapia , Complicações Pós-Operatórias/terapia , Stents Metálicos Autoexpansíveis , Adolescente , Fístula Anastomótica/terapia , Criança , Pré-Escolar , Perfuração Esofágica/etiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
20.
J Pediatr Gastroenterol Nutr ; 64(1): 133-153, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27622898

RESUMO

This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.


Assuntos
Endoscopia Gastrointestinal/normas , Gastroenteropatias/terapia , Adolescente , Cáusticos , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica , Colonoscopia , Endoscopia do Sistema Digestório , Endossonografia , Europa (Continente) , Feminino , Corpos Estranhos , Gastroenterologia , Gastroenteropatias/diagnóstico , Hemorragia Gastrointestinal , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Sociedades
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