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A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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Gastroenterologia , Hipersensibilidade a Leite , Animais , Bovinos , Feminino , Humanos , Lactente , Aleitamento Materno , Leite/efeitos adversos , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/prevenção & controle , Qualidade de Vida , Revisões Sistemáticas como Assunto , Metanálise como AssuntoRESUMO
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 1 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost and quality of life.
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ABSTRACT: Octreotide, a somatostatin analogue, has been used for more than 20âyears in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".
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Gastroenteropatias , Pancreatite , Preparações Farmacêuticas , Doença Aguda , Criança , Fármacos Gastrointestinais/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Humanos , Octreotida/uso terapêutico , Pancreatite/tratamento farmacológicoRESUMO
OBJECTIVES: Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety. METHODS: Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors. RESULTS: A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2-lactose breath testing, H2-fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro-caecal transit time (OCTT) or to diagnose and follow-up on celiac disease. CONCLUSIONS: Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.
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Gastroenterologia , Infecções por Helicobacter , Testes Respiratórios/métodos , Criança , Consenso , Gastroenterologia/métodos , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Revisões Sistemáticas como AssuntoRESUMO
ABSTRACT: Button batteries (BB) remain a health hazard to children as ingestion might lead to life-threatening complications, especially if the battery is impacted in the esophagus. Worldwide initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably <2âhours). Honey and sucralfate can be considered in ingestions ≤12âhours while waiting for endoscopic removal but should not delay it. In case of delayed diagnosis (first confirmation of the BB on X-ray >12âhours after ingestion or time point of removal >12âhours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (≤12âhours after ingestion) and position of the BB beyond the esophagus, one can monitor with repeat X-ray (if not already evacuated in stool) in 7 to 14âdays, which is different from previous guidelines where repeat X-ray and removal is recommended after 2-4âdays and is also based on age. Finally, prevention strategies are discussed in this paper.
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Corpos Estranhos , Gastroenterologia , Criança , Ingestão de Alimentos , Fontes de Energia Elétrica , Esôfago , Corpos Estranhos/diagnóstico , Corpos Estranhos/prevenção & controle , HumanosRESUMO
OBJECTIVES: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. METHODS: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. RESULTS: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. CONCLUSIONS: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.
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Gastroenterologia , Gastroenteropatias , Infecções por Helicobacter , Helicobacter pylori , Criança , Fezes , Gastroenteropatias/diagnóstico , Humanos , Recém-Nascido , Complexo Antígeno L1 LeucocitárioRESUMO
Thiopurines, alone or in combination with other agents, have a pivotal role in the treatment of specific gastrointestinal and hepatological disorders. In inflammatory bowel disease and autoimmune hepatitis thiopurines have proven their value as steroid sparing agents for the maintenance of remission and may be considered for preventing postoperative Crohn disease recurrence where there is moderate risk of this occurring. Their use with infliximab therapy reduces antibody formation and increases biologic drug levels. The routine clinical use of thiopurines has, however, been questioned due to a number of potential adverse effects. The aim of this article is to provide information regarding the use, and in particular, safety of these agents in clinical practice in the light of such potentially severe, albeit rare, effects.
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Doença de Crohn , Doenças Inflamatórias Intestinais , Azatioprina/efeitos adversos , Criança , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/efeitos adversos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Mercaptopurina/efeitos adversos , RecidivaRESUMO
Acute diarrhoea is a leading cause of morbidity and mortality in the paediatric population. Racecadotril is an antisecretory drug recommended as an adjuvant antidiarrhoeal treatment.In the small bowel, the enzyme neutral endopeptidase (NEP) inhibits the action of enkephalins, which prevent water and electrolyte hypersecretion. By inhibiting NEP, racecadotril allows enkephalins to exhibit their antisecretory effects. Consequently, racecadotril reduces the secretion of water and electrolytes in the small intestine, without having an effect on intestinal motility. No serious adverse events related to racecadotril have been reported.Racecadotril has proven its efficacy as an adjuvant antidiarrhoeal drug with a good safety profile. Its addition to oral rehydration solution (ORS) appears clinically beneficial and potentially leads to health care savings.
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Gastroenteropatias , Preparações Farmacêuticas , Antidiarreicos/uso terapêutico , Criança , Diarreia/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Humanos , Tiorfano/análogos & derivados , Tiorfano/uso terapêuticoRESUMO
Familial adenomatous polyposis (FAP) is a well-described inherited syndrome, characterized by the development of hundreds to thousands of adenomas in the colorectum, with implications in children and adolescents. Almost all adult patients will develop colorectal cancer if they are not identified and treated early enough. Identifying and screening for FAP commences in adolescence. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the adenomatous polyposis (APC) gene. This European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper provides a guide for diagnosis, assessment, and management of FAP in children and adolescents.This is the first position paper regarding FAP published by ESPGHAN. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of paediatric 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, these of the recommendations are supported on expert opinion. This position paper will instruct on the appropriate management and timing of procedures in children and adolescents with FAP.
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Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/terapia , Programas de Rastreamento/normas , Adenoma/diagnóstico , Adenoma/genética , Adenoma/prevenção & controle , Polipose Adenomatosa do Colo/complicações , Adolescente , Criança , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Neoplasias Colorretais/prevenção & controle , Consenso , Medicina Baseada em Evidências , Gastroenterologia/normas , Testes Genéticos/métodos , Hepatoblastoma/diagnóstico , Hepatoblastoma/genética , Hepatoblastoma/prevenção & controle , Humanos , Programas de Rastreamento/métodos , Pediatria/normasRESUMO
AIM: To describe the current prevalence of paediatric hypertension and the relationships between body mass index, gender, place of residence, and blood pressure in a population of school-aged children from western Romania. MATERIAL AND METHOD: A total of 3626 children from Timisoara and the surrounding regions were examined by medical students from February, 2010 to June, 2011. Children's body mass index was interpreted on the basis of reference guidelines from Centers for Disease Control and Prevention. Blood pressure measurements were taken by the auscultation method. For defining elevated blood pressure, we used the standards published in the Fourth Report. RESULTS: Overall, the prevalence of overweight was 14% and 11.8% for obesity. Boys had a higher prevalence of both overweight and obesity compared with girls. The prevalence of hypertension on our screening was 9.1% higher in boys and urban residence. The prevalence of pre-hypertension was 6.5%. With regard to body mass index, 21.1% of obese, 12.8% of overweight, and 7.1% of normal weight children presented hypertension. The strongest determinant of hypertension was body mass index percentile. Significant odds ratio was found for obesity (3.93; confidence interval: 3.114.95), urban residence (1.68; confidence interval: 1.352.1), and male gender (1.34; confidence interval: 1.121.6). CONCLUSIONS: The results confirm a worrisome prevalence of overweight and obesity among children in Romania, accompanied by an alarming prevalence of hypertension. Overweight and obesity, male gender, and urban residence were the major contributing factors for the overall high prevalence of hypertension found. Our results point to the urgent need to adopt strategies aimed at preventing hypertension and obesity in children in Romania.
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Hipertensão/epidemiologia , Obesidade Infantil/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Índice de Massa Corporal , Criança , Feminino , Humanos , Masculino , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Romênia/epidemiologia , Distribuição por SexoRESUMO
BACKGROUND: Primary lactose intolerance (PLI) is characterized by the inability to digest lactose. Homozygotes for the lactase gene polymorphisms (CC or GG) are considered to be genetically predisposed to PLI. Still, symptoms may only be present later in life. The evidence supporting a link between PLI, dairy intake, and quality of life (QoL) is limited in children. AIM: This study investigates the link between LCT polymorphisms and suggestive symptoms and the influence of the genetic predisposition to PLI on dairy intake and QoL in Romanian children. MATERIALS AND METHODS: We recruited consecutive children evaluated in our ambulatory clinic. We asked all participants to complete a visual-analog symptoms scale, a dairy intake, and a QoL questionnaire. We used strip genotyping to identify genetic predisposition to PLI. RESULTS: 51.7% of children had a CC genotype, and 34.5% also had a GG genotype. Most children reported no or mild symptoms. Dairy intake and QoL were similar across study groups. CONCLUSIONS: Our study shows that genetic predisposition does not necessarily assume the presence of specific symptoms. Genetic predisposition to PLI did not lead to dairy avoidance, nor did it negatively influence our children's QoL.
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Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favourable acoustic windows in children makes US the first line of investigation for evaluation of pleural and chest wall abnormalities.In the first part of the topic the technical requirements were explained and the use of ultrasound in the lung and pleura in paediatric patients were discussed. In the second part lung parenchymal diseases with their subpleural consolidations are reflected. In the third part, the use of ultrasound for chest wall, mediastinum, diaphragmatic diseases, trachea, interventions and artifacts in paediatric patients are summarized.
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Pneumopatias , Parede Torácica , Artefatos , Criança , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Ultrassonografia/métodosRESUMO
Primary lactose intolerance is caused by a genetically programmed loss in lactase production after 5-6 years of age. Milk and dairy products are often incriminated as a cause of gastrointestinal symptoms. Recent studies show that lactase persistence in adult life correlates with higher anthropometric indexes and an altered metabolic profile. We aimed to assess whether the presence of gene polymorphisms for primary lactose intolerance has an influence on the anthropometric and metabolic profile of children. We conducted a cross-sectional study, recruiting consecutive children evaluated at the 2nd Pediatric Clinic, Timisoara from May to August 2016. We enrolled 87 children aged 6-17 years [mean age 10.64±3.51 years; 45 (51.72%) girls]. Subjects were asked to complete an analogue visual scale of symptoms. We measured weight, height, blood pressure and calculated body mass index. The metabolic profile included fasting blood glucose, triglycerides and HDL cholesterol levels. We used strip genotyping to identify gene polymorphisms for primary lactose intolerance. According to the results, our study population was grouped into lactose tolerant (n=42) and lactose intolerant (n=45) groups. No differences were found in regards to weight, height, body mass index and blood pressure between the two study groups. Glucose, triglycerides and HDL cholesterol were similar in the lactose intolerant and lactose tolerant children. The presence of gene polymorphisms for primary lactose intolerance did not influence the children's anthropometric and metabolic profile.
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BACKGROUND: Coeliac disease is one of the most prevalent immune-mediated gastrointestinal disorders in children. AIM: To review the incidence and prevalence of paediatric coeliac disease, and their trends, regionally across Europe, overall and according to age at diagnosis. METHODS: Systematic review and meta-analysis from January 1, 1950 to December 31, 2019, based on PubMed, CINAHL and the Cochrane Library, searches of grey literature and websites and hand searching of reference lists. A total of 127 eligible studies were included. RESULTS: The prevalence of previously undiagnosed coeliac disease from screening surveys (histology based) ranged from 0.10% to 3.03% (median = 0.70%), with a significantly increasing annual trend (P = 0.029). Prevalence since 2000 was significantly higher in northern Europe (1.60%) than in eastern (0.98%), southern (0.69%) and western (0.60%) Europe. Large increases in the incidence of diagnosed coeliac disease across Europe have reached 50 per 100 000 person-years in Scandinavia, Finland and Spain. The median age at diagnosis increased from 1.9 years before 1990 to 7.6 since 2000. Larger increases in incidence were found in older age groups than in infants and ages <5 years. CONCLUSIONS: Paediatric coeliac disease incidence and prevalence have risen across Europe and appear highest in Scandinavia, Finland and Spain. The most recent evidence shows large increases in incidence in most regions, but stabilisation in some (notably Sweden and Finland). Sharp increases in the age at diagnosis may reflect increases in milder and asymptomatic cases diagnosed since reliable serology testing became widely used, through endomysial antibodies after 1990 and tissue transglutaminase antibodies around 2000.
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Doença Celíaca , Idoso , Autoanticorpos , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Humanos , Incidência , Lactente , PrevalênciaRESUMO
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favorable acoustic windows in children makes US the first line of investigation for the evaluation of pleural and chest wall abnormali-ties. Lung parenchyma was previously thought to be inaccessible to ultrasound due to the presence of the air and bony thorax. The change in attitude and growing awareness of the diagnostic possibilities has led to lung ultrasound (LUS) being accepted as a valuable point of care method. In addition, the application of LUS has widened with improvements in technology such as higher resolution transducers, harmonic imaging and contrast-enhanced ultrasound. In the current World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) paper series the topic will be introduced, the technical requirements explained and the use of ultrasound in the lung and pleura in pediatric patients are discussed.
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Pleura , Criança , Humanos , Pulmão/diagnóstico por imagem , Pleura/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , UltrassonografiaRESUMO
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. In the current World Federation of Societies for Ultra-sound in Medicine and Biology (WFUMB) paper series so far (part I) the topic has been introduced and the technical require-ments explained. In the present paper the use of US in the lung in paediatric patients is analysed. Lung diseases including the interstitial syndrome, bacterial pneumonia and viral infections, CoViD findings, atelectasis, lung consolidation, bronchiolitis and congenital diseases of the respiratory system including congenital pulmonary airway malformation (CPAM) and sequester but also pneumothorax are discussed.
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COVID-19 , Malformação Adenomatoide Cística Congênita do Pulmão , Criança , Humanos , Pulmão/diagnóstico por imagem , SARS-CoV-2 , UltrassonografiaRESUMO
The aim of the study described here was to evaluate the reproducibility of a new shear-wave elastography (SWE) technique, 2-D SWE.GE, and the impact of ultrasound experience in acquiring reliable measurements, as no official recommendations are available for this system. Elastographic measurements (EMs) were obtained in 60 patients using 2-D-SWE with the GE Logiq E9. Three examiners with different levels of experience in ultrasound-based elastography performed 10 valid EMs on each subject: a novice (C.P.) who had no experience in liver elastography and had performed fewer than 50 ultrasound examinations; an elastography expert (A.M.S.) who had more than 1 y of liver elastographic experience in four elastographic methods and had performed more than 1000 ultrasonography examinations; and an ultrasound expert (T.M.) who had no experience in liver elastography and had performed more than 1000 ultrasound examinations. Medians and interquartile ranges were calculated (m/s). We used the inter-class correlation coefficient and Bland-Altman plots with 95% lower and upper limits of agreement to assess the inter- and intra-observer reproducibility of 2-D-SWE.GE measurements. The final study group included 60 patients, 56.7% women and 43.3% men, with a mean age of 33.08 ± 13.83 y and mean body mass index of 22.85 ± 4.04 kg/m2. In this group, 73.3% were healthy volunteers and 26.7% had compensated liver cirrhosis. We did not find significant differences between EMs taken by the examiners overall and across study groups. The overall agreement between examiners was excellent: 0.915 (95% confidence interval [CI]: 0.870-0.946). The agreement between the novice and the experienced examiners, respectively, was good to excellent (novice and ultrasound expert: 0.908, 95% CI: 0.846-0.945; novice and elastography expert: 0.885, 95% CI: 0.808-0.931). The intra-observer reproducibility for each of the examiners was excellent; however, the inter-class correlation coefficients were higher for the examiners more experienced in elastography: 0.936 (95% CI: 0.896-0.963) versus 0.966 (95% CI: 0.943-0.980) versus 0.984 (95% CI: 0. 973-0.991). The good ICCs for the median values indicate that 2-D-SWE.GE is a reproducible method. Ultrasound experience did not significantly influence the results.
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Técnicas de Imagem por Elasticidade/métodos , Cirrose Hepática/diagnóstico por imagem , Adulto , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , UltrassonografiaRESUMO
The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with B and C chronic hepatopathies, using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment. SUBJECTS AND METHODS: the study included 228 consecutive subjects with chronic hepatopathies (26% HBV, 74% HCV) from whom 51% had liver cirrhosis. Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. For TE 10 valid LS measurements were performed for each patient and the median value was calculated. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10LS measurements with a success rate ≥60% and an interquartile range <30%. For ElastPQ we calculated the median value of 10LS measurements in the liver parenchyma, at least 1cm below the capsule, avoiding large vessels. For differentiating between stages of liver fibrosis we used the TE cut-off values published in the Tsochatzis meta-analysis: significant fibrosis (F≥2)- 7.0kPa, severe fibrosis (F≥3)- 9.5kPa and for liver cirrhosis (F=4)-12kPa (Tsochatzis et al., 2011). The areas under the receiver operating characteristic curve (AUROCs) were used to assess the diagnostic performance of ElastPQ, correlations between ElastPQ and TE were evaluated. RESULTS: Valid LS measurements were obtained in 90.7% (207/228) cases by means of TE and in 98.7% (225/228) cases with ElastPQ. In the final analysis 205 patients were included. The ElastPQ values ranged from 2.32 to 44.07kPa (median=10.42kPa). Based on TE cut-off values (Tsochatzis et al., 2011) we divided our cohort into 4 groups: F0-F1:61/205 (29.8%); F2: 14/205 (6.8%); F3: 15/205 (7.3%); F=4: 115/205 (56.1%). The best cut-off values for discriminating, significant, severe fibrosis and cirrhosis were 7.2, 8.5 and 8.9kPa, respectively. The AUROCs were calculated considering TE as the reference method: 0.94 for significant fibrosis (F≥2), 0.97 for severe fibrosis (F≥3) and 0.97 for cirrhosis (F=4). In our cohort there was a strong correlation between measurements obtained by Transient Elastography and ElastPQ (r=0.85, p<0.001). CONCLUSIONS: ElastPQ seems to have a good diagnostic accuracy for staging liver fibrosis.
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Técnicas de Imagem por Elasticidade , Hepatite B Crônica/diagnóstico por imagem , Hepatite B Crônica/patologia , Hepatite C Crônica/diagnóstico por imagem , Hepatite C Crônica/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/virologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
AIM: To evaluate the performance of 2D shear-wave elastography from General Electric (2D-SWE.GE) for the noninvasiveassessment of liver fibrosis and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosisusing Transient Elastography (TE) as the reference method. MATERIAL AND METHOD: We included 331 consecutive subjectswith or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastographic techniques:TE and 2D-SWE.GE. Reliable LS measurements were defined for TE as the median value of 10 measurements with a successrate of ≥60% and an interquartile range (IQR)<30% and for 2D-SWE.GE as the median value of 10 measurements acquiredin a homogenous area and an IQR<30%. To discriminate between TE fibrosis stages we used the following cut-offs: F2- 7;F3- 9.5 and F4- 12kPa. RESULTS: Reliable LS measurements were obtained in 95.8% subjects by 2D-SWE.GE, and 94.2%by TE (p=0.44). Based on TE cut-off values we divided our cohort into four groups: F<2: 30.1%; F=2: 10.2%; F=3: 12.2%;F=4: 47.5%. A strong correlation was found between the LS values obtained by the 2 methods: r=0.83, p<0.0001.LS valuesobtained by 2D-SWE.GE were significantly lower than those obtained by TE: 10.14±4.24 kPa vs. 16.72±13.4 kPa (p<0.0001).The best cut-off value for F≥2, F≥3 and for F=4 were 6.7, 8.2 and 9.3 kPa. CONCLUSIONS: The best 2D-SWE.GE cut-off valuesfor predicting F≥2, F≥3 and F=4 were 6.7, 8.2 and 9.3kPa.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador/métodos , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/fisiopatologia , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Módulo de Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resistência ao Cisalhamento , Adulto JovemRESUMO
UNLABELLED: Obesity prevalence in both adults and children has reached epidemic proportions worldwide. Romania seems to follow the same trend, but studies proving this fact are scarce. Our aim was to determine the prevalence of overweight and obesity and to find correlations to certain health-risk behaviors in children from western Romania. MATERIAL AND METHODS: In this cross-sectional study, a total of 3626 children aged 7-18 years were examined by medical students (February 2010- June 2011). Children were classified by their body mass index using International Obesity Task Force (IOTF) reference. The children were asked to complete a short questionnaire inquiring about 5 health-risk behaviors: consumption of fast-food, sweetened beverages, sweets and fruits and about physical exercise. RESULTS: The overall prevalence of overweight was 18.2% (16.2% in girls and 20.7% in boys) and 7.2% for obesity (5.8% in girls and 9.0% in boys). The prevalence of both overweight and obesity was higher in boys versus girls and rural versus urban. Overweight and obesity was correlated with the consumption of sweetened beverages and sweets and also with sedentary behavior. CONCLUSIONS: The prevalence of overweight and obesity children is alarming, particularly in boys, higher in rural versus urban. The findings confirm the urgent need for national preventive strategy for childhood obesity and targeted interventions tailored to local circumstances.