C. De Giacomo

Helicobacter pylori infection and chronic gastritis: clinical, serological, and histologic correlations in children treated with amoxicillin and colloidal bismuth subcitrate.

Twenty-three children with Helicobacter (Campylobacter) pylori-associated chronic gastritis are reported. Family history of peptic disease, previous digestive procedures, and nonspecific epigastric pain were the most frequently encountered clinical features. Antral nodularity at endoscopy and histologic evidence of follicular gastritis were characteristic morphological aspects. Rapid urease tests suggested the diagnosis in 90% of patients. Significant increases of serum IgG and IgA against Helicobacter pylori allowed the identification of infected children with 95% cumulative sensitivity. Treatment with amoxicillin and bismuth subcitrate eradicated the infection and improved gastritis in 13 of 19 children. These findings provide further evidence for the etiologic role of Helicobacter pylori in chronic antral gastritis in children.

Serum immune response to Helicobacter pylori in children: Epidemiologic and clinical applications*

Antibody responses to Helicobacter pylori were measured by a solid-phase whole-cell enzyme-linked immunosorbent assay in 150 children and adolescents; in 47 consecutive children undergoing upper gastrointestinal endoscopy, including 17 with H. pylori infection before and after antimicrobial treatment; and in 46 family members of the infected children. Abnormal levels of either IgG or IgA were found in 6% of the 150 children. In the latter group the prevalence of H. pylori seropositivity increased with age. Parents and siblings of the infected children had 94% and 71% seropositivity, respectively, suggesting intrafamilial spread. Abnormal levels of IgG or IgA against H. pylori identified infected children with 95% sensitivity and 84% specificity. Eradication of the infection was accompanied by a significant decrease in IgG and IgA titers, with normalization in 10 cured patients in 12 months or less. We conclude that the method described for evaluation of H. pylori-specific IgG and IgA antibodies gives helpful information on the epidemiology of the infection and represents a useful adjunct to diagnosis and management of chronic gastritis in children.

MEMBRANOUS GLOMERULOPATHY AND CHRONIC SMALL‐INTESTINAL ENTEROPATHY ASSOCIATED WITH AUTOANTIBODIES DIRECTED AGAINST RENAL TUBULAR BASEMENT MEMBRANE AND THE CYTOPLASM OF INTESTINAL EPITHELIAL CELLS

ABSTRACT. A child with an immune‐mediated disease is described, who presented two very rare clinical manifestations, a membranous glomerulopathy with circulating anti‐renal tubular basement membrane antibody and a small‐intestinal enteropathy with circulating antibody directed against the cytoplasm of intestinal epithelial cells. Steroid treatment was followed by complete resolution of the renal but not the intestinal manifestations.

Letter: lymphocytic gastritis and coeliac disease

SIRS; We appreciate the commentary by Philpott et al. regarding our study. 2 Regarding repeated oesophageal food bolus impaction for patients with eosinophilic oesophagitis (EoE), our database only captured information during the first impaction to present at our centre during the study period. This rationale was based on our primary aims, which were to report aetiologies of impaction, as well as general outcomes. Patients with EoE who had a prior impaction all had episodes prior to 2004, or presented elsewhere prior to their index impaction at our centre. For those with recurrent impaction presenting to our centre during the study period, data regarding aetiology and season were not collected. Regarding regional pollen counts, we suspect that such a study would be valuable, as recent data demonstrate a consistent seasonal variation in EoE diagnosis, with cases occurring more in the summer. Furthermore, we acknowledge that studies reporting seasonal variation in pollen counts, and whether these correlate to increased rates of impaction, are necessary. We did not collect this information, as an analysis of seasonal variation of EoErelated food bolus impaction was not our primary aim. We did note a low frequency of erosive oesophagitis, which was a rare cause of food bolus impaction in the absence of an oesophageal stricture. Increasing the biopsy rate would likely further increase the proportion of EoE-related food bolus impaction, as the majority of non-EoE food bolus impactions do not typically require histology to establish a diagnosis. Finally, they suggest that mandatory general anaesthesia (GA) should be employed. It is noteworthy that GA was associated with a higher risk of complications (OR 5.0). While this is confounded by indication, it demonstrates that GA does not completely mitigate periprocedural risk. Further data are necessary before imposing a practice mandating GA for oesophageal food bolus impaction, given that conscious sedation appears to be safe and effective in selected patients.

Treatment with Amoxicillin and Colloidal Bismuth Subcitrate in Children with Helicobacter pylori-Associated Peptic Disease

In children Helicobacter pylori infection is strikingly associated with peptic disease [1]. Family history of peptic disease, previous digestive procedures, and nonspecific epigastric pain are the most frequently encountered clinical features [2]. Isolated vomiting and more severe symptoms such as hematemesis are rarely described. At endoscopy antral nodularity, and gastric and duodenal ulcers are the typical lesions [2]. The infection is almost invariably associated with histologic evidence of chronic gastritis [2, 3]. Serum immune response against the bacterium with production of specific immunoglobulin G (IgG) and IgA is found in the majority of infected children [4, 5]. An increase in the level of serum pepsinogen I usually occurs [5].