Bruce Taubman

Overflow encopresis and stool toileting refusal during toilet training: A prospective study on the effect of therapeutic efficacy

We determined the incidence of stool toileting refusal in 53 children with overflow encopresis; 24 (45%) experienced difficulty toilet training for bowel movements. One-year follow-up data were obtained for 43 children, 31 with secondary encopresis and 12 with primary encopresis. Among the children with secondary encopresis, no difference was observed in response to treatment between children with and without difficulty toilet training. Ninety-one percent (11 of 12) of the children who had been soiling for less than 1 year at the time of presentation were free of soiling and no longer required therapeutic medication, compared with 55% (10 of 18) of the children who had been soiling for a longer period. Only 1 of 12 children with primary encopresis was free of soiling and no longer receiving therapeutic medication at 1 year, compared with 21 of 37 with secondary encopresis (p = 0.003). We concluded that children with primary encopresis who demonstrated stool toileting refusal during toilet training were resistant to medical treatment.

Slipping Rib Syndrome as a Cause of Chest Pain in Children

Four patients with the slipping rib syndrome presenting as chest pain are described, and the appropriate literature is reviewed. In two of the patients the physicians caring for the children were initially concerned that a cardiac condition was the cause of the chest pain, and a cardiac evaluation was done. In one patient an emotional cause for the pain was first considered and then a cardiac cause was pursued. In the last patient esophagitis was thought to be the cause and the child was referred to a gastroenterologist. It is suggested that slipping rib syndrome should be considered by physicians when evaluating children with a complaint of chest pain. The condition can be easily diagnosed on physical examination and therefore may save some patients from an unnecessary cardiac or gastroentestinal evaluation.

Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study

BackgroundThe objective of this study was to prospectively determine the prevalence of asymptomatic celiac disease among children presenting with fibromyalgia. The secondary objective was to investigate if their symptoms resolved on a gluten free diet.FindingsAll children seen in the Amplified Musculoskeletal Pain clinic between the ages of 12 and 17 years of age who fulfilled the 1990 American College of Rheumatology diagnostic criteria for fibromyalgia were invited to participate. A total immunoglobulin A (IgA) level, IgA antiendomysial (EMA) and IgA anti-TTG antibodies was obtained on all study subjects. A visual analog scale for pain and a functional disability inventory were obtained on all patients. If a patient had elevated EMA or TTG a small bowel biopsy was done. Patients with celiac disease were placed on a gluten-free diet and observed to see if their symptoms resolved.50 patients, 45 females, completed the study. Only one patient was found to have celiac disease. On a gluten-free diet her tissue transglutaminase antibody level returned to normal but her visual analog scale scores increased and her functional disability inventory was 40 initially and 21 at follow up.ConclusionsIn this pilot, single center study at a tertiary childrens hospital patients with fibromyalgia do not seem to have occult celiac disease at an increased rate over the population as a whole.