Allan J. Rosenberg

The seroprevalence of Helicobacter pylori in a referral population of children in the United States

OBJECTIVES:The purpose of this study was to determine the prevalence of serum antibodies directed against Helicobacter pylori (H. pylori) in children referred to childrens hospitals or medical centers throughout the United States.METHODS:This multisite cross-sectional prospective study involved 992 children from 12 states using a validated anti–H. pylori IgG enzyme immunoassay. The children were recruited into two groups: those without any GI complaints (non–GI referral, n = 619) and those who were referred for endoscopy because of abdominal pain (GI referral, n = 373).RESULTS:GI referral children had a higher rate of seropositivity (22.5%) than non–GI referral children (14.1%) from the same geographic regions. In both groups, older children were more likely to be seropositive for H. pylori, as were nonwhite children and those with lower socioeconomic status. H. pylori seropositivity rates were higher in GI referral children with four or more household members (relative risk [RR] = 1.47; CI 1.01–2.14). Multivariate analysis controlling for age, ethnicity, and household income, showed that presence of GI symptoms were associated with a nearly 2-fold risk for H. pylori seropositivity (odds ratio = 1.77, CI 1.27–2.47). Epigastric pain (RR = 2.21; CI = 1.33–3.66) and having three or more episodes of abdominal pain in the last 3 months (RR = 0.59, CI = 0.35–0.99) were the only specific symptoms significantly associated with H. pylori seropositivity.CONCLUSIONS:The H. pylori seropositivity rate of GI referral children with symptoms of abdominal pain was significantly higher. H. pylori infection in early childhood was found to be associated primarily with the childs household size and socioeconomic status.

The Use of an Oral Fluid Immunoglobulin G ELISA for the Detection of Helicobacter pylori Infection in Children

Background. Enzyme linked immunosorbent assay (ELISA) evaluation of oral fluid immunoglobulin G (IgG) antibodies to Helicobacter pylori is a unique approach for both epidemiological studies and the diagnosis of infection, especially in children. The use of oral fluid sampling to evaluate specific H. pylori IgG antibodies has advantages over serum, including reduced biohazard risk and noninvasive collection. Oral fluid sampling is fast and involves minimal patient discomfort. Since children facilitate transmission of H. pylori infection, a simple, accurate, noninvasive diagnostic test is necessary for large epidemiologic studies. The aim of our study was to evaluate a new oral fluid ELISA for detection of IgG antibodies to H. pylori in children.

Chylous ascites: a case of child abuse and an overview of a rare condition

A 7-month-old female infant was transferred to our institution from a local hospital for suspected child abuse and abdominal distention. She was reportedly in good health until 2 days before admission, when her mother noted periorbital bruising and conjunctival hemorrhages. The infant was also noted to have abdominal distention. Medical history was significant for two episodes of “spontaneous bleeding.” On one occasion the infant was noted to have bleeding from her mouth with no apparent source and on another occasion she had a circular bruise on her face. Bleeding parameters obtained by her pediatrician during those times yielded normal results. Family history for bleeding disorders was negative. The child had no prior surgeries, hospital admissions, or chronic illnesses. On physical examination she was afebrile and vital signs were within normal limits. Her weight and height placed her in the seventy-fifth percentile and twentieth percentile, respectively. The child appeared apprehensive and clung to her mother. She had bilateral periorbital bruising and conjunctival hemorrhages. There were small bruises on her forehead and left cheek. Her abdomen was tight and distended with shifting dullness to percussion. Bowel sounds were present. Abdominal girth was 50 cm. No organomegaly was noted and stool hemoccult was negative. The rest of the physical examination was unremarkable. Abdominal computed tomography (CT) showed accumulation of a large amount of ascites in the peritoneal cavity without evidence of bowel injury (Fig. 1). Diagnostic paracentesis yielded 135 mL of cloudy white fluid with a specific gravity of 1.025 and a pH of 7.61. Analysis of the fluid showed red blood count 11,000/mm, white blood count 8000/mm, polymorphonuclear leukocyte 1%, lymphs 97%, eosinophil 1%, protein 2.9 g/dL, glucose 96 mg/dL, triglycerides 1307 mg/dL, and lactic dehydrogenase 140 U/L. Gram stain and cultures were negative. Peripheral blood studies revealed lymphopenia (1930/mm, 37%), albumin 3.2g/dL, and total protein 4.8g/dL. A skeletal survey, as part of child abuse work-up at our institution, showed a right femur fracture and a left distal tibial fracture in varying stages of healing. Head magnetic resonance imaging revealed no abnormalities. Ophthalmology consult found no retinal hemorrhages. The child was admitted to the general pediatric service and started on total parenteral nutrition (TPN). On day 5 of TPN patient was started on quarter-strength Portagen (Bristol-Myers Squibb, Princeton, NJ) orally which she tolerated well. Portagen was increased in strength gradually, reaching full-strength 4 days later. Parenteral nutrition was discontinued on day 14 and Portagen use was continued. The infant’s health gradually improved with softening of her abdomen, decreased abdominal girth (39 cm at discharge), and resolution of her other injuries. Serial abdominal ultrasonography confirmed resolution of the ascites. The patient was subsequently discharged in the custody of her grandparents after 21 days of hospital stay.

Crohn's Disease of the Prepuce in a 12-Year-Old Boy: A Case Report and Review of the Literature

We report a case of Crohns disease with involvement of the foreskin in a 12-year-old boy. One year previously, on the basis of clinical features (diarrhea with blood, perianal fissures) and histologic examination, a diagnosis of Crohns disease was made. Subsequently, he developed phimosis and balanitis and underwent circumcision. Sections submitted from the foreskin revealed noncaseating granulomatous inflammation consistent with Crohns disease. Crohns disease with involvement of the genitalia is unusual. Only 26 cases including our case have been reported in the scientific literature. We have analyzed these cases with emphasis on gender, age, clinical features, duration of Crohns disease, and probable mode of spread to the genitalia. Careful examination of sections from genital lesions, including those submitted from the foreskin, is essential to detect small isolated granulomas that may then lead to the diagnosis of inflammatory bowel disease.

Age of Onset of Functional Constipation

ABSTRACT In a review of 538 children with functional constipation, we analyzed ages of presentation and onset, symptom duration, and behavioral/developmental problems. We divided the subjects into quartiles (Q1–Q4) based on age of onset. Median onset age was 2.3 years. The oldest group had the shortest symptom duration before referral at 1.8 ± 1.8 years (compared with Q3 to Q1, P = 0.039, P = 0.001, P < 0.001, respectively). Of the Q4 subjects, 22% had a behavioral/developmental problem (P < 0.001 compared with Q1–Q3). We conclude that most children develop functional constipation as infants and toddlers, but those with later onset are more likely to have behavioral/developmental issues and see a specialist sooner.

Prospective Comparison of Rapid Urease Tests (Pyloritek, Clo-test) for the Diagnosis of H. Pylori Infection in Symptomatic Children: A Pediatric Multicenter Study. 480

Rapid urease tests have been routinely used in the Gastrointestinal endoscopy suites. PyloriTek is a new rapid (1 hour) urease test which is comparable to standard CLO-test in adults. Limited data are available on the sensitivity of PyloriTek in the pediatric population. Aim: To compare the performance of two rapid urease tests (PyloriTek; Serim Corp. and CLO-test; Delta West) using histologic examination as a gold standard.Methods: In a prospective study, children were enrolled by four pediatric GI clinics. Children with previous history of Hp infection or recent antibiotic treatment were excluded. Gastric antral biopsies were tested for both rapid tests and histology. Results: 144 patients (M/F=70/74) with the mean age of 11.6 years were investigated. PyloriTek and CLO-test had a concordance of 139/144(96.5%) and discordance of 05/144(3.5%). Comparison between histology and both tests are seen in Table: