Functional Gastrointestinal Disorders, Autonomic Nervous System Dysfunction, and Joint Hypermobility in Children: Are They Related?

OBJECTIVES: To evaluate the prevalence of orthostatic intolerance and joint hypermobility in schoolchildren with and without functional gastrointestinal disorders (FGIDs) and to assess autonomic nervous system dysfunction in children with FGIDs and joint hypermobility. STUDY DESIGN: Schoolchildren (10-18 years) attending public schools from 3 Colombian cities (Cali, Palmira, and Bucaramanga) completed validated questionnaires for FGIDs and underwent testing for hypermobility and autonomic nervous system dysfunction. Heart rate and blood pressure were assessed in recumbency and upright position at regular intervals. The differences in characteristics between schoolchildren with and without FGIDs were compared with a t-test for continuous variables and with a Fisher exact test (2 × 2 contingency tables) for categorical variables. RESULTS: In total, 155 children with FGIDs were matched with 151 healthy controls. Children with FGIDs had historically significant greater frequency of 10 of 12 symptoms of orthostatic intolerance, no significant difference in any symptoms of orthostatic intolerance during recumbency, significantly greater frequency in 6 of 12 symptoms of orthostatic intolerance during orthostasis, trend toward statistical significance for orthostatic intolerance (P = .0509), and no significant difference in prevalence of orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). There was no significant difference in prevalence of orthostatic intolerance, OH, and POTS between those with joint hypermobility and those without. CONCLUSIONS: Children with FGIDs have a greater prevalence of symptoms of orthostatic intolerance but were not more likely to have OH and POTS as compared with children without FGIDs. Children with joint hypermobility did not have a greater prevalence of orthostatic intolerance, OH, and POTS.

The prevalence of functional constipation in children was unchanged after the Rome IV criteria halved the diagnosis period in Rome III.

AIM: The Rome IV criteria for the diagnosis of functional constipation are one month, compared with two months in the Rome III criteria. Our aim was to see whether this altered the prevalence in Ecuador by surveying school children and comparing the results to our previous study. METHODS: A cross-sectional study was conducted in Quito, Ecuador, in 2013 two randomly selected schools: one private and one public. Children aged 8-15 completed the Spanish version of the Questionnaire of Paediatric Gastrointestinal Symptoms based on the Rome IV criteria. We compared our findings with our previous 2013 study based on the Rome III criteria. RESULTS: A total of 951 children (61% male) completed the Rome IV questionnaire from June to July 2017 at a mean age of 11.2 ± 1.8 years, and 417 children (52% male) completed the Rome III questionnaire in June 2013 at a mean age of 12.0 ± 1.8 years. We found that 14.4% met the Rome IV criteria for functional constipation compared with 11.8% for the Rome III criteria (p = 0.11). CONCLUSION: Modifying the time required for a diagnosis functional constipation from two months to one month did not result in a significant difference in the prevalence.

Celiac disease in children with Down syndrome. / Enfermedad celíaca en niños con síndrome de Down.

INTRODUCTION: Celiac disease (CD) in children with Down syndrome (DS) has been published by several countries, without available data for Colombia. OBJECTIVE: To determine the frequency and related factors of CD in children with DS, compared with a group of children without DS, analyzing the clinical, im munological, and genetic manifestations. PATIENTS AND METHOD: A total of 209 children between 1-18 years of age (8.4 ± 4.1 years, 55.5% female) were studied, 97 with DS and 112 without DS, using anti-transglutaminase antibodies as serological marker (tTG2). Variables of age, gender, race, ori gin, weight, height, and digestive symptoms were studied. Children with positive tTG2 underwent duodenal biopsy and genotype. The proportion of children with DS, without DS, and CD was esti mated and their 95% CI; measures of central tendency, univariate and bivariate analysis, considering a p < 0.05 significant. RESULTS: Eight children with DS (8.2%) and five children without DS (4.5%) were tTG2 positive (p = 0.200). None presented serum IgA deficiency. One child with DS presented CD with Marsh II (1.0%), and two children with DS (2.1%) and two without DS (1.8%), presen ted potential CD (p = 0.432). Three children were HLA-DQ2. CD was more likely in the preschool group (OR = 6.14 95%CI = 0.41-87.35 p = 0.0462). CONCLUSIONS: The CD frequency due to intestinal biopsy in children with DS is much lower than that reported in the literature, being associated with preschool, and having DQ2 as its main allele. These findings are similar to those described worldwide.

Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents: Comparison Between Rome III and Rome IV Criteria.

OBJECTIVES: To assess the prevalence of functional gastrointestinal disorders (FGIDs) in children using Rome IV criteria and to compare the prevalence of FGIDs using Rome IV with Rome III criteria. STUDY DESIGN: This was a cross-sectional study using the same methods as our previous study on FGIDs in Colombia. The Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV version was translated into Spanish, followed by reverse translation. Terms were adjusted to children's language by using focus groups of children. School children aged 8-18 years completed the Spanish version of the Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV. Data were compared with Rome III data. RESULTS: In total, there were 3567 children (from 6 cities): 1071 preadolescents (8-12 years) and 2496 adolescents (13-18 years). Average age 13.7 ± 2.4 years (56.5% girls). A total of 21.2% of children had at least 1 FGID. Prevalence was significantly lower than Rome III (P = .004). Similar to Rome III, disorders of defecation were the most common, followed by abdominal pain, and disorders of nausea and vomiting. Prevalence of abdominal migraine decreased (P = .000) and functional dyspepsia increased (P = .000). The new diagnoses functional vomiting and functional nausea were present in 0.7% of all children. CONCLUSIONS: The application of the Rome IV criteria resulted in a significantly lower prevalence of FGIDs; however, the relative frequency of each subgroup of disorders did not change. New diagnoses of the Rome IV criteria were present in a small percentage of children.

[Irritable bowel syndrome subtypes and characteristics in children from Panama, Ecuador,El Salvador, Nicaragua and Mexico]. / Caracterización y subtipos del síndrome de intestino irritable en niños de Panamá, Ecuador, El Salvador, Nicaragua y México.

INTRODUCTION: Few pediatric studies classify the irritable bowel syndrome (IBS) subtypes. OBJECTIVE: To describe the characteristics and subtypes of IBS in children from Panama, Ecuador, El Salvador, Nicaragua and Mexico. MATERIAL AND METHODS: Prevalence study performed in children between 8 and 18 years of age with a diagnosis of IBS. The children answered the Questionnaire for Pediatric Gastrointestinal Symptoms Roma III for Schoolchildren and Adolescents (QPGS-III) to identify functional gastrointestinal disorders. Variables such as age and sex were taken into account. The subtypes of IBS were classified in IBS with constipation (IBS-c), with diarrhea (IBS-d), mixed (IBS-m) and without subtype (IBS-ss). Statistical analysis included measures of central tendency, two-tailed student t-test, chi-square test, and Fisher's exact test, with a significant p<0.05. RESULTS: We included 79 children (54.4% female, 12.1±2.1 years) presenting IBS-ss in 55.7%, IBS-c in 15.2%, IBS-m in 15.2% and SII-d in 13.9%. Severe pain predominated most of the day and with mucous stools; possible associations for IBS-d school and sex. CONCLUSION: After IBS-ss, the IBS-e, IBS-d and IBS-m are similar, being the possible risk factors for IBS-d, the public school and the female gender.

[Overlapping of functional gastrointestinal disorders in latinamerican schoolchildren and adolescents]. / Superposición de desórdenes gastrointestinales funcionales en escolares y adolescentes latinoamericanos.

INTRODUCTION: There are few studies on overlapping Functional Gastrointestinal Disorders (FGIDs). OBJECTIVE: To describe the prevalence and possible risk factors in Latin American children (Latam) to present overlapping FGIDs. PATIENTS AND METHOD: Prevalence study in Latam schoolchildren bet ween 8-18 years of age. Sociodemographic variables were included; the Rome III Criteria in Spanish were used, and overlapping FGIDs were considered when two, three or four and more FGIDs were presented in the same child. The statistical analysis included Student's T-test, chi-square test, Fisher's exact test, univariate and multivariate analysis, and calculation of ORs and 95% CI, being considered a significant p < 0.05. RESULTS: 6,193 Latam children were analyzed (11.8 ± 2.2 years, 62.2% between 8-12 years of age, 50.4% girls, 68.0% public school), and 23.4% with a diagnosis of some kind of FGIDs. There was overlap of FGIDs in the same child, in 8.4% (5.5% with 2 FGIDs, 2.1% with 3 FGIDs and 0.9% with 4 or more FGIDs), the main overlaps were irritable bowel syndrome (IBS) + functional abdominal pain (FAP) (2.6%), and IBS + FAP + functional constipation (1.1%). There was predominance of the female gender. CONCLUSION: There is a low prevalence of overlapping FGIDs in Latam schoolchildren and adolescents, with a predominance in females and of very variable pre sentation.

Prevalence of functional gastrointestinal disorders in Colombian school children.

OBJECTIVES: To determine prevalence for functional gastrointestinal disorders (FGIDs) in Colombian school children using the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) and to determine possible risk factors. STUDY DESIGN: The QPGS-III was translated into Spanish then reverse translated by a team of bilingual physicians. Focus groups of Colombian children were conducted to assure understanding of the Spanish version. Children at 1 public school and 2 private schools in Pasto, Colombia were invited to participate in a prevalence study using the translated questionnaire. RESULTS: A total of 373 children (95 private school, 278 public school), with mean age 9.9 years completed the QPGS-III. Twenty-nine percent of children were diagnosed with FGIDs. FGIDs were more common in females (OR, 1.63; 95% CI, 1.04-2.56). Functional constipation (14%) was the most common FGID. Irritable bowel syndrome was the most common abdominal pain-related FGID (5.4%). Abdominal migraine (1%) and cyclic vomiting syndrome (0.3%) were the least common FGIDs. CONCLUSION: FGIDs are common in Colombian school children.

Psychological distress and coping efficacy in children with disorders of gut-brain interaction.

BACKGROUND: Multiple psychological factors influence disorders of gut-brain interaction (DGBIs). We aimed to evaluate psychological distress in Colombian schoolchildren with and without DGBIs. METHODS: We included children ages 8-18 years without organic medical conditions from largest regional public schools in Colombia. Children completed Spanish versions of Rome III diagnostic questionnaire for DGBIs, State Trait Anxiety Inventory for Children (STAIC), Children's Somatization Inventory (CSI), and a measure of coping efficacy. These data, demographic and socioeconomic characteristics, were compared between children with DGBIs and healthy peers. Exploratory analyses investigated differences between youth with symptoms of functional abdominal pain disorders (FAPDs) compared with healthy peers. KEY RESULTS: Of 1496 children, 281 (mean age 12.9 ± 2.2 years, 49.8% females) self-reported criteria for DGBIs and 125 reported (44.5%) FAPDs. Children with DGBIs had higher trait anxiety, emotional sensitivity, somatization including GI, non-GI, pain-related, and non-pain-related subscales (p < 0.001 each) and lower coping efficacy (p = 0.02) compared to healthy peers. Females had higher trait anxiety and somatization (p = 0.04 and p = 0.005, respectively). State and trait anxiety and coping efficacy differed based on location in children with DGBIs (p = 0.02, p = 0.03, and p < 0.001, respectively). Children with FAPDs had higher trait anxiety (p = 0.02) and somatization (p < 0.001) compared to healthy youth. CONCLUSIONS & INFERENCES: Children with DGBIs had higher anxiety, emotional sensitivity, and somatization, and lower coping efficacy compared with healthy youth. This highlights the importance of appraising psychological distress characteristics as well as incorporating conflict resolution, assertiveness training, and resilience building during the treatment of DGBIs.

Gastrointestinal Symptoms and Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Sources in Schoolchildren-A Pilot Study.

Bothersome gastrointestinal (GI) signs/symptoms, including abdominal pain, distension, nausea, and flatulence, are common in children. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) is frequently recommended for children with GI symptoms. Currently, there are no studies on the effect of FODMAPs in healthy schoolchildren. In this cross-sectional study, schoolchildren reported an association between FODMAPs and GI symptoms through a standardized questionnaire and images of 20 common staples known to be rich in FODMAPs. A total of 208 schoolchildren aged 8-18 years old participated. A proportion of 38.0% of children reported GI symptoms, with abdominal pain (33%) being the most common complaint followed by abdominal distension (24%) and nausea (23%). The majority of children who reported intolerances to FODMAP-containing foods were intolerant to less than two food groups (76%). While vegetables and legumes (26%), particularly black beans (11%) and onions (7%), emerged as the most common group of triggers, milk (12%) stood out as the single food most frequently associated with GI symptoms. In conclusion, there was a high prevalence of FODMAPs intolerance among schoolchildren. Larger studies are recommended to confirm these findings and to inform possible dietary interventions to reduce the effect of FODMAPs on schoolchildren.

Prevalence of joint hypermobility, postural orthostatic tachycardia syndrome (POTS), and orthostatic hypotension in school-children. / Prevalencia de la hipermovilidad articular, el síndrome de taquicardia postural (POTS) y la hipotensión ortostática en escolares.

INTRODUCTION: Children with joint hypermobility, postural orthostatic tachycardia syndrome, and orthostatic hypotension report autonomic symptoms such as dizziness, nausea, headaches, and palpitations. It is unclear if there is a pathophysiological link between connective tissue disorders and autonomic symptoms. There is no published data on the prevalence of disorder at the community level. PRIMARY OBJECTIVE: To assess the prevalence of joint hypermobility, orthostatic hypotension, and postural or thostatic tachycardia syndrome in children. SECONDARY OBJECTIVE: To determine the relationship bet ween joint hypermobility, orthostatic hypotension, and postural orthostatic tachycardia syndrome. PATIENTS AND METHOD: Participants aged 10 to 18 years were selected from public schools in three Colombian cities. The surveys included historical questions on the incidence of dizziness, nausea, headache, tremor, blurred vision, vertigo, anxiety, near syncope and syncope, sweating, palpitations triggered by standing in the two months prior to the investigation. Each of these signs and symptoms was also assessed during the recumbency (10 minutes) and standing (2, 5 and 10 minutes) phases of the investigation. HR and BP measurements were obtained at the same intervals. Joint mobility was measured with a mechanical goniometer and assessed with the Beighton score. RESULTS: Prevalence of joint hyperlaxity: 87 of 306 (28.4%). Prevalence of orthostatic hypotension: 5 of 306 (1.6%). Prevalen ce of postural orthostatic tachycardia syndrome: 6 of 306 (2.0%). Of 87 children with joint hyperlaxi ty, only 1 child had joint hyperlaxity at the same time as postural hypotension (1.2%) (p = 0.6735), and 1 child had joint hyperlaxity and postural orthostatic tachycardia syndrome simultaneously (1.2%) (p = 0.5188). CONCLUSION: Children with joint hyperlaxity did not have a higher prevalence of postural orthostatic tachycardia syndrome and orthostatic hypotension. It seems unlikely that con nective tissue disorders are responsible for most cases of postural orthostatic tachycardia syndrome and orthostatic hypotension in the community. Of note, the pathophysiology of postural orthostatic tachycardia syndrome and orthostatic hypotension requires further investigation.

A SYSTEMATIC REVIEW AND META-ANALYSIS IN SCHOOLCHILDREN AND ADOLESCENTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS ACCORDING TO ROME IV CRITERIA.

OBJECTIVE: To determine the prevalence of functional gastrointestinal disorders (FGIDs) in children according to Rome IV criteria. METHODS: We included cohorts and observational descriptive studies, including information for the prevalence of FGIDs according to Rome IV criteria in children 4 to 18 years old. We searched the MEDLINE (Ovid), EMBASE, LILACS, and CENTRAL databases from May 2016 to nowadays. Gray literature and other databases were also consulted. The risk of bias was assessed using the STROBE Statement. The results were reported in forest plots of the estimated effects of the included studies with a 95% confidence interval (95%CI). RESULTS: We included 14 studies involving a total of 17427 participants. Three studies were conducted in Europe, two in North America, and nine in Latin America. Most studies were school-based (n=14670, 84.18%), participants were mostly female (55.49%), white (51.73%), 8 to 18 years old (77.64%), and assisted to a public school (81.53%). Thirteen studies used the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS-RIV) to assess FGIDs. We found a global prevalence for FGIDs of 23% (95%CI 21-25%, I2 99%). Main disorders were functional constipation (FC) with 12% (95%CI 11-15%) followed by functional dyspepsia (FD) (5%, 95%CI 11-15%) and irritable bowel syndrome (IBS) (3%, 95%CI 2-4%). The prevalence of FGIDs was higher in the Americas, representing 23.67% (95%CI 21.2-26.2%, I2 91.3%). CONCLUSION: FGIDs are present in one of four children and adolescents, representing a common condition in this age group the central disorders were FC, FD, and IBS.

Functional Gastrointestinal Disorders in Neonates and Toddlers According to the Rome IV Criteria: A Systematic Review and Meta-Analysis.

Functional gastrointestinal disorders (FGIDs) are classified as a combination of persistent gastrointestinal symptoms. The Rome IV criteria can elucidate several factors in the pathogenesis of FGIDs. The frequency of FGIDs can differ between clinical and nonclinical settings and between geographic regions. To determine the global prevalence of FGIDs in neonates and toddlers according to the Rome IV criteria. We included cohort and descriptive observational studies reporting the prevalence of FGIDs according to the Rome IV criteria in children aged 0-48 months. We searched the Medline, Embase, Lilacs, and CENTRAL databases from May 2016 to the present day. Furthermore, unpublished literature was searched to supplement this information. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to evaluate the risk of bias. A meta-analysis of the proportions was performed using MetaProp in R. The results are reported in forest plots. We identified and analyzed 15 studies comprising 48,325 participants. Six studies were conducted in Europe, three in Latin America, two in North America, and four in Asia. Most participants were 12-48 months old (61.0%) and were recruited from the community. The global prevalence of FGIDs was 22.0% (95% confidence interval, 15-31%). The most common disorder was functional constipation (9.0%), followed by infant regurgitation syndrome (8.0%). Its prevalence was higher in the Americas (28.0%). FGIDs, as defined by the Rome IV criteria, are present in 22% of children, and the most common primary disorder is functional constipation. A higher prevalence of FGIDs has been reported in America.

The impact of incorporating toilet-training status in the pediatric Rome IV criteria for functional constipation in infant and toddlers.

BACKGROUND: The diagnosis of functional constipation (FC) is based on the Rome criteria. The last edition of the criteria (Rome IV) for infants and toddlers modified the criteria to differentiate toilet-trained (TT) and non-toilet-trained (NTT) children. These changes have not been validated. We aimed to understand the impact of adding toilet training to the diagnostic criteria and to assess the prevalence of FC. METHODS: Parents of infants and toddlers from six outpatient clinics (four public, two private) located in three geographically dispersed cities in Colombia completed validated questionnaires to diagnose functional gastrointestinal disorders according to Spanish version of Rome IV criteria (QPGS-IV). RESULTS: A total of 1334 children (24.4 months ±15.0) participated: 482 (36%) TT and 852 (64%) NTT. The prevalence of FC was 21.1%. The prevalence increased with age, 0-1 years 7.7%; 2 years 18.2%; 3 years 23.7%; and 4 years 37.2%. TT vs NTT for FC 41.9% vs 9.3%, respectively (OR 7.06, 95% CI 5.26-9.47, P < .0001). TT more likely to report ≥ 3 criteria (OR = 2.43, 95% CI 1.41-4.21, P = .0015). 18.3% of TT had episodes of fecal incontinence that met the frequency required by Rome for FC (≤1 episode/week). However, 87.1% had fecal incontinence less often. 7.4% of them characterized as large quantity. CONCLUSION: We found no changes in the prevalence of FC using the Rome IV criteria vs Rome III. TT children are more likely to have FC. Study suggests that changes in Rome IV criteria were potentially clinically relevant and to have adequate face validity. Future studies should confirm our findings.

[Case-Control Study On Generalised Joint Hypermobility In Schoolchildren With Functional Gastrointestinal Disorders According To Rome IV Criteria In Spanish]. / Estudio de casos y controles sobre hiperlaxitud articular generalizada en escolares con trastornos digestivos funcionales según los criterios de roma IV en español.

INTRODUCTION: Although results show an association between the presence of generalised joint hypermobility (GJH) and functional gastrointestinal disorders (FGIDs) in children, they are limited and controversial. OBJECTIVE: To determine the association between GJH and FGIDs and the search for risk factors for GJH in girls from a Public Educational Institution of Tuluá, Colombia. PATIENTS AND METHODS: The students completed the Rome IV Questionnaire to identify FGIDs. Each girl with a diagnosis of some FGIDs was matched with a healthy control of the same age. Joint laxity was assessed according to the Beighton score and was considered as GJH when it was ≥ 4. The prevalence of GJH was compared in girls with and without FGIDs. RESULTS: Out of a total of 921 girls between 10 and 18 years of age that participated in the study, 219 (23.8%) of them had some FGIDs. The analysis was performed on a total of 169 girls with FGIDs and 169 healthy control girls. There were no significant differences in GJH between girls with and without a diagnosis of some FGIDs (OR=1.12: 95% CI; 0.71-1.77, P=.5838), nor were there any risk factors. CONCLUSION: In this study, no relationship or any risk factor was found between GJH and the presence of FGIDs.

Post-infectious functional gastrointestinal disorders in children after a non-severe dengue episode without warning signs / Trastornos gastrointestinales funcionales después de un episodio de dengue no grave sin signos de alarma

Introduction: The pathogenesis of functional gastrointestinal disorders involves infectious agents such as viruses. Objective: To study the development of functional gastrointestinal disorders 3, 6, 9 and 12 months after an episode of non-severe dengue without warning signs in children. Materials and methods: We conducted a cohort study in 73 children diagnosed with non-severe dengue without warning signs at Hospital Universitario del Valle "Evaristo García" and 62 healthy children from Cali, Colombia. Using the Questionnaire for Pediatric Gastrointestinal Symptoms Rome III (QPGS-III) in Spanish we identified functional gastrointestinal disorders 3, 6, 9, and 12 months after non-severe dengue without warning signs. Measurements of central tendency, relative risk, chi square, and Fisher's exact test were performed, with p<0.05 being significant. Results: We included 135 children who were 10.7±1.9 years old; 51.1% of them were male and 19.3% had a functional gastrointestinal disorder (9.6% of them had abdominal pain related to functional gastrointestinal disorders). There was a greater risk to present a functional gastrointestinal disorder and related abdominal pain in children after non-severe dengue without warning signs at 3, 6, 9, and 12 months of follow-up, but without significant differences. Conclusion: Our study suggests that non-severe dengue without warning signs does not increase the risk of functional gastrointestinal disorders and related abdominal pain for up to 12 months of follow-up.

Introducción. La patogenia de los trastornos funcionales gastrointestinales involucra agentes infecciosos como los virus. Objetivo. Investigar el desarrollo de trastornos funcionales gastrointestinales en niños, a los 3, 6, 9 y 12 meses después de un episodio de dengue no grave sin signos de alarma. Materiales y métodos. Se hizo un estudio de cohorte de 73 niños con diagnóstico de dengue no grave sin signos de alarma atendidos en el Hospital Universitario del Valle "Evaristo García" y de 62 niños sanos de Cali, Colombia. Mediante el 'Cuestionario para síntomas gastrointestinales pediátricos Roma III' (Questionnaire for Pediatric Gastrointestinal Symptoms Rome III, QPGS-III), se determinaron los trastornos gastrointestinales funcionales a los 3, 6, 9 y 12 meses de seguimiento después de un episodio de dengue no grave sin signos de alarma. Se calcularon las medidas de tendencia central, riesgo relativo y prueba de ji al cuadrado, y se usó la prueba exacta de Fisher con un nivel de significación (p) menor de 0,05. Resultados. Se incluyeron 135 niños de 10,7±1,9 años; 51,1 % de ellos correspondía al sexo masculino y 19,3 % presentaba algún trastorno funcional gastrointestinal (9,6 % con dolor abdominal relacionado). El riesgo de presentar algún trastorno funcional gastrointestinal con dolor abdominal relacionado a los 3, 6, 9 y 12 meses de seguimiento en niños con dengue no grave sin signos de alarma fue mayor que sin dicho antecedente, pero sin diferencias significativas. Conclusión. Los resultados del estudio sugieren que el dengue no grave sin signos de alarma no incrementó el riesgo de trastornos gastrointestinales funcionales y dolor abdominal relacionado a lo largo de 12 meses de seguimiento.

Occurrence and molecular characterization of Giardia duodenalis in child population from Colombia.

Giardia duodenalis is one of the most prevalent human intestinal parasite, with children living in developing countries being particularly at risk of infection. The occurrence and molecular diversity of G. duodenalis was investigated in stools specimens from 307 individuals aged one to nineteen years in Colombia. Samples were collected in three educational establishments (n: 163) and two hospital laboratories (n: 144) from urban and rural areas. Feces were concentrated using a biphasic sedimentation method and wet mounts of the sediment were examined by light microscopy. G. duodenalis assemblages and sub-assemblages were determined on positive samples by PCR of the triose phosphate isomerase (tpi), ß-giardin (bg) and small-subunit (ssu) rRNA genes. G. duodenalis infection was detected by microscopy in 23 individuals (7.5%). The protozoan was more prevalent among specimens collected in educational establishments (11.6%) than in those obtained from hospital laboratories (2.8%). Infection was most common in individuals from urban areas and children aged 1-5 years. No significant association between diarrhea and infection could be demonstrated. Twenty Giardia-positive samples were successfully allocated to assemblage B (n: 11), sub-assemblage AII (n: 7), and assemblage A (n: 2). Results indicate the potential for transmission of G. duodenalis infection in children attending educational establishments and individuals from urban areas, where transmission seems to be primarily anthroponotic.

Digestive, hepatic, and nutritional manifestations in Latin American children with HIV/AIDS.

The HIV/AIDS infection is increasing in Latin America and the Caribbean regions, according to the World Health Organization (WHO). In Latin America, most cases are in Brasil, Mexico, and Colombia. Some causes of the HIV/AIDS infection in Latin America are poverty, limitations on the access to antiretroviral drugs, poor response from governmental and health authorities, migration, and scantiness of research resources. In the pediatric population, perinatal transmission is the main contact mechanism. Several digestive, hepatic, and nutritional manifestations allow the classification of HIV infection in children, according to the Centers for Disease Control and Prevention. Improvement in knowledge of the epidemiology, pathogenesis, physiopathology; and management of HIV enteropathy and on nutritional care practices of infected HIV children is recommended.

Prevalence of markers of celiac disease in Colombian children with diabetes mellitus type 1.

INTRODUCTION: Although the association between diabetes mellitus type 1 (T1DM) and celiac disease (CD) is well established; there are only a few studies that focus on South American children, haplotypes and their possible associations. OBJECTIVE: To determine the prevalence of CD markers in a group of children with T1DM and to analyze the associated clinical, immunological and genetic manifestations. METHODS: A prevalence study focusing on children with T1DM who were assessed based on variables including sociodemographics, anthropometric information, disease characteristics, laboratory results and family medical history. In partitipants a positive tTG2 (Ig A anti-transglutaminase), a duodenal biopsy and genotype were performed. The proportion of children with T1DM and CD was estimated (CI 95%). Determinations of central tendency, univariate and bivariate analysis, were also performed; p <0.05 was considered significant. RESULTS: Thirteen (8.4%) of the 155 children (53.6% girls, 11.0 ±3.6 years, 2-18 years) with T1DM were tTG2 positive, four had CD (2.6%), seven had potential CD (4.5%) and nine were HLA DQ2/DQ8 positive (5.8%). Children with T1DM and CD had their last ketoacidotic episode (21.5 ±30.4 months versus 69.5 ±38.8 months, p= 0.0260) earlier than children with T1DM and potential CD. There were no differences with anthropometry or with the laboratory results regarding glycemic control. CONCLUSIONS: The prevalence of CD in these children with T1DM is higher than that reported in other South American countries. The prevalence of CD was found to be associated with the time of presentation of T1DM and its main allele, the DQ2/DQ8. These findings are different from what has been described in other places around the world.

INTRODUCCIÓN: A pesar que la asociación entre diabetes mellitus tipo 1 (DMT1) y enfermedad celíaca (EC) está bien establecida; hay pocos estudios en niños suramericanos sobre haplotipos y sus posibles asociaciones. OBJETIVO: Determinar la prevalencia de marcadores de EC en un grupo de niños con DMT1, analizando las manifestaciones clínicas, inmunológicas y genéticas. MÉTODOS: Estudio de prevalencia en niños con DMT1 a quienes se les tomaron variables sociodemográficas, antropométricas, de la enfermedad, paraclínicas y familiares metabólicas. A los niños con IgA anti-transglutaminasa (tTG2) positivos, se les realizó biopsia duodenal y genotipo. Se estimó la proporción de niños con DMT1 y EC y su IC 95%; medidas de tendencia central, análisis univariado y bivariado, siendo significativa una p <0.05. RESULTADOS: Trece (8.4%) de los 155 niños (53.6% niñas, de 11.0 ±3.6 años, 2-18 años) con DMT1 fueron tTG2 positivos, cuatro presentaron EC (2.6%), siete EC potencial (4.5%) y nueve HLA DQ2/DQ8 (5.8%). Los niños con DMT1 y EC presentaron más pronto su último episodio cetoacidótico (21.5 ±30.4 meses versus 69.5 ±38.8 meses, p= 0.0260) que los niños con DMT1 y EC potencial. No hubo diferencias con la antropometría ni con los paraclínicos del control glicémico. CONCLUSIONES: La prevalencia de EC en estos niños con DMT1 es superior a la de otros países suramericanos; estando asociada al tiempo de presentación de la DMT1 y su principal alelo el DQ2/DQ8, hallazgos diferentes a lo descrito a nivel mundial.