Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis

Gastroesophageal reflux (GER) disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males) was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2 percent); total number of acid episodes (<50 episodes); number of reflux episodes longer than 5 min (3 or less), and duration of the longest reflux episode (<9.2 min). One patient (1/10, 10 percent) presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10 percent of chronic rhinosinusitis surgeries can be eliminated.

Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation

The present prospective study was carried out to determine dietary fiber and energy intake and nutritional status of children during the treatment of chronic constipation. Twenty-five patients aged 2 to 12 years with chronic constipation were submitted to clinical evaluation, assessment of dietary patterns, and anthropometry before and after 45 and 90 days of treatment. The treatment of chronic constipation included rectal disimpaction, ingestion of mineral oil and diet therapy. The standardized diet prescribed consisted of regular food without a fiber supplement and met the nutrient requirements according to the recommended daily allowance. The fiber content was 9.0 to 11.9 g for patients aged less than 6 years and 12.0 to 18.0 g for patients older than 6 years. Sixteen patients completed the 90-day follow-up and all presented clinical improvement. The anthropometric variables did not change, except midarm circumference and triceps skinfold thickness which were significantly increased. Statistically significant increases were also found in percent calorie intake adequacy in terms of recommended daily allowance (55.5 to 76.5 percent on day 45 and to 68.5 percent on day 90; P = 0.047). Percent adequacy of minimum recommended daily intake of dietary fiber (age + 5 g) increased during treatment (from 46.8 to 52.8 percent on day 45 and to 56.3 percent on day 90; P = 0.009). Food and dietary fiber intake and triceps skinfold thickness increased during follow-up. We conclude that the therapeutic program provided a good clinical outcome

Morfometria do intestino delgado em crianças com diarréia por Escherichia coli enteropatogênica clássica e enteropatia ambiental assintomática / Morphometrics of the small bowel in children with diarrhea due to classical enteropathogenic Escherichia coli and to environmental asymptomatic enteropathy

Infecçäo entérica por Escherichia coli enteropatogênica clássica (EPEC) pode causar diferentes graus de alteraçöes das vilosidades do intestino delgado.OBJETIVOS. Este estudo teve por objetivo: 1) avaliar as alteraçöes morfológicas da mucosa intestinal na diarréia aguda por EPEC, por meio da morfometria linear, e compará-la a um grupo controle; 2) comparar o número de LIE encontrado na diarréia aguda e/ou persistente por EPEC com aqueles encontrados no grupo controle; 3) pesquisar a presença de E. coli aderida à mucosa do intestinodelgado naquelas crianças que apresentaram diarréia com coprocultura positiva para EPEC. PACIENTES E MÉTODOS. Foram analisados 30 biópsias da mucosa do intestino delgado de crianças com diarréia aguda e/ou persistente, com coprocultura positiva para EPEC e 16 biópsias obtidas da mucosa do intestino delgado de crianças portadoras de enteropatia ambiental assintomática, que constituíram nosso grupo controle. Foram realizadas as seguintes análises morfométricas: RESULTADOS: Espessura total mucosa µ EPEC=279,6 EAA=445,1 p<0,001; Altura vilosidade µ EPEC 134,3 EAA 248,0 p<0,001; Extensäo da zona críptica µ EPEC 145,2 EAA 197,1 p<0,02; linfócitos intra-epiteliais EPEC 11,6 EAA 15,5 p<0,005. CONCLUSÄO. Presença de bactéria gram-negativa, portanto, provavelmente, EPEC, foi constatada em três dos 30 pacientes com diarréia, apresentando coprocultura positiva para EPEC. As alteraçöes morfométricas ocorrem, principalmente, às custas da diminuiçäo das visolidades intestinais.

Doença celíaca e enteropatia ambiental: diagnósticos diferencial em crianças de baixo nível sócio-econômico / Celiac diseases and environmental bowel diseases: differential diagnosis in children of low socioeconomic status

A alta prevalência de Enteropatia Ambiental em nosso meio e em determinados casos, sua semelhança clínica, funcional e histológica com Doença Celíca, näo permite o diagnóstico diferencial entre essas duas patologias. Foram estudadas 12 crianças portadoras de Enteropatia Ambiental, com diarréia crônica, alteraçäo da prova de absorçäo da D-Xilose e atrofia vilositária subtotal da mucosa do intestino delgado. O acompanhamento das crianças com dieta isenta de glúten só permitiu o diagnóstico diferencial em metade dos pacientes. Conclui-se ser necessário o desenvolvimento de técnicas auxiliares para o diagnóstico de Doença Celíaca