Carlos H. Lifschitz

Lactobacillus GG improves recovery in infants with blood in the stools and presumptive allergic colitis compared with extensively hydrolyzed formula alone.

OBJECTIVES To determine the benefits of Lactobacillus rhamnosus GG (LGG) in an extensively hydrolyzed casein formula (EHCF) in improving hematochezia and fecal calprotectin over EHCF alone. STUDY DESIGN Fecal calprotectin was compared in 30 infants with hematochezia and 4 weeks after milk elimination with that of a healthy group. We also compared fecal calprotectin and hematochezia on 26 formula-fed infants randomly assigned to EHCF with LGG (Nutramigen LGG) (EHCF + LGG) or without (Nutramigen) (EHCF - LGG) and on 4 breastfed infants whose mothers eliminated dairy. RESULTS Fecal calprotectin in those with hematochezia was significantly higher than in comparisons (mean +/- SD 325.89 +/- 152.31 vs 131.97 +/- 37.98 microg/g stool, t = 6.79, P < .0001). At 4 weeks, fecal calprotectin decreased to 50% of baseline but was still significantly higher than in comparisons (157.5 +/- 149.13 vs 93.72 +/- 36.65 microg/g, P = .03). Fecal calprotectin mean decrease was significantly larger among EHCF + LGG compared with EHCF - LGG (-214.5 +/- 107.93 vs -112.7 +/- 105.27 microg/g, t = 2.43, P = .02). At 4 weeks, none of the EHCF + LGG had blood in stools, and 5/14 on EHCF - LGG did (P = .002). CONCLUSION Fecal calprotectin is elevated in infants with hematochezia and possible allergic colitis. EHCF + LGG resulted in significant improvement of hematochezia and fecal calprotectin compared with the EHCF alone.

Effect of Resistant and Digestible Starch on Intestinal Absorption of Calcium, Iron, and Zinc in Infant Pigs

The first nonmilk foods that are given to infants contain high levels of starch, a fraction of which is resistant to enzyme hydrolysis. Incomplete digestion of starch may interfere with the absorption of certain minerals. A fraction of dietary starch which is resistant to in vitro enzymatic hydrolysis has been termed resistant starch. The aim of this study was to compare the intestinal apparent absorption of calcium, phosphorus, iron, and zinc in the presence of either resistant or digestible starch. Twelve 7-10-d-old piglets were fitted with a T-tube inserted into the intestine approximately 3 m distal to the duodenum. Animals received in random order 200 mL of a test meal of cooked, cooled, high amylose corn starch (16.4% resistant starch), or cooked rice starch (digestible starch) administered by an orogastric tube. Both meals contained the same amount of calcium, phosphorus, iron, and zinc. The test meal also contained tracer amounts of 59Fe and65 Zn, as well as polyethylene glycol 3350, as a nonabsorbable marker. Intestinal apparent absorption of starch was greater after the meal with digestible starch (71.0 ± 17.0%) than after the meal with resistant starch (49.2 ± 10.3) (p < 0.001). After feeding the meals with resistant and digestible starch, mineral apparent absorption was, respectively: calcium, 40.2 ± 11.8% versus 28.1 ± 16.4% (p < 0.05); phosphorus, 73.2 ± 14.0%versus 67.8 ± 18% (NS); iron, 24.1 ± 12.2%versus 12.6 ± 10.6% (p < 0.01), and zinc, 35.0± 13.0% versus 30.6 ± 8.22% (NS). In conclusion, a meal containing 16.4% resistant starch resulted in a greater apparent absorption of calcium and iron compared with a completely digestible starch meal. If this finding holds true for the whole bowel, administration of resistant starches could have a positive effect on intestinal calcium and iron absorption.

Infants Fed Docosahexaenoic Acid- and Arachidonic Acid-Supplemented Formula Have Decreased Incidence of Bronchiolitis/Bronchitis the First Year of Life

To assess the effect of docosahexaenoic acid and arachidonic acid supplementation in infant formula on the incidence of respiratory illnesses, pediatricians assigned infants to receive docosahexaenoic acid/arachinonic acid-supplemented formula or control formula. Anthropometrics, medical history, and illnesses were reported. Among 1342 infants, there was a higher incidence of bronchiolitis in control versus docosahexaenoic acid/arachinonic acid-supplemented groups at 5, 7, and 9 months (P < .01). Weight, length, and head circumference were similar for both groups. Infants fed formula supplemented with 0.32% docosahexaenoic acid and 0.64% arachidonic acid experienced a lower incidence of bronchiolitis compared with infants fed formula supplemented with no docosahexaenoic acid/arachidonic acid or lower levels of docosahexaenoic acid/arachidonic acid in the first year of life.

Addition of rice cereal to formula does not impair mineral bioavailability

BACKGROUND The effect of adding rice cereal to formula on calcium and iron bioavailability was studied. METHODS Fourteen healthy infants were studied at 2-week intervals to assess the absorption of calcium and iron from formula or formula mixed with rice cereal. Infants were randomly assigned to initiate the study either on a lactose-containing formula (F) or the same formula mixed with 6.5 g/dl of rice cereal (F + R). Calcium and iron absorption were determined using a multiple tracer approach in which calcium and iron isotopes were given orally mixed with either F or F + R and a different tracer of calcium given intravenously. Nine infants underwent calcium and iron studies and five underwent calcium studies only. A tracer amount of 46Ca was administered intravenously. Calcium absorption was determined as the ratio of the recovered oral versus intravenous tracer in the urine during the 24 hr after tracer administration. Iron incorporation into red blood cells (RBCs) was determined from the enrichment of the iron isotopes in the RBCs at 14 days after dosing. RESULTS Mean (+/- SD) percent absorption of calcium from F was 58% (+/- 13) and from F + R 57% (+/- 18). Absorption of iron from F was 5.8% (+/- 7) and from F + R 6.3% (+/- 4) (p = 0.06). Analyses of variance for repeated measures indicated no significant correlation between amount of calories, calcium, or iron ingested, and calcium or iron absorbed. CONCLUSIONS Adding rice cereal to formula does not impair bioavailability of calcium or iron from infant formulas. Because of the increased total calcium and iron in the mixture of formula and cereal, the overall amount of minerals absorbed from F + R may be greater than from formula alone.

Carbohydrate Absorption From Fruit Juices in Infants

Objective. To compare the absorption of carbohydrate in particular from a lower (10 mL/kg−1) quantity than that previously tested, of white grape juice and pear juice after a single feeding and after ingestion twice daily for 2 weeks, and determine their respective effects on stool water content, in healthy infants. Study Participants. Twelve healthy, well-nourished infants, 5 to 9 months of age, who were recruited from the general population. Design/Methods. Infants underwent a breath hydrogen test after a serving of pear juice. Three to 5 days later, the test was repeated after a serving of white grape juice. Infants were randomly assigned to receive a 10 mL/kg−1 serving of grape juice or pear juice twice daily for 2 weeks. The breath tests were repeated after the ingestion of the juices in the same sequence. With the second breath test with pear juice, a charcoal marker and 20 mg13C fructose, a stable, nonradioactive isotope, were mixed with the juice. Water content of the stools was compared before and after the 2-week feeding of the juice, and fecal samples were analyzed for 13C enrichment by mass spectrometry. Results. After the ingestion of the fruit juices, only 1 infant had an abnormal peak hydrogen (H2; ≥10 ppm), which followed the pear juice. That same infant was the only one who had H2 levels ≥10 ppm after grape juice. There was no significant difference in the peak breath H2 levels after grape juice and pear juice either at the beginning of the study or 2 weeks after taking the juice assigned (2.8 ppm ± 2.9 vs 6.2 ppm ± 9, respectively). The difference in breath H2response before and after the 2 weeks of fruit juice intake was not significant. Mean (±standard deviation) fecal 13C enrichment at baseline was 3.0 Δ%o (±2.4), which was not significantly different from after 2 weeks of juice intake (2.4 Δ%o [±1.5]), regardless of the juice assigned: 2.7 Δ%o (±1.6) for grape juice and 2.2 Δ%o (±1.5) for pear juice. Mean (±standard deviation) percentage of fecal water at baseline was 24.1% (±5.1), which was not significantly different from after 2 weeks of juice (22.5% [±6]), regardless of the juice received: 21.8% (±5.8) for grape juice and 23.2% (±6.7) for pear juice. Conclusion. When either grape or pear juice is administered in a dosage of 10 mL/kg/day, the carbohydrate is well absorbed, produces no adverse gastrointestinal symptoms, and has no effect on stool water in healthy infants.

Effect of a simethicone-containing tablet on colonic gas elimination in breath

The effect of a tablet containing the antiflatulent, simethicone, on intestinal hydrogen (H2) elimination in breath was studied. In three trials, normal subjects (age 12–52 years) received, on subsequent days, lactulose or lactulose with two tablets of either simethicone or placebo in randomized order. Breath samples were collected over 210 min and analyzed by gas chromatography for H2. The time course of H2 expiration above baseline levels was calculated and compared for the three tests. No significant differences in transit time were found. Cumulative H2 expiration was significantly lower after simethicone compared to placebo. H2 production from stool incubated with simethicone or placebo indicated that the drug had no effect in reducing the fermentative production of H2in vitro. Interestingly, the vehicle present in the tablets could be fermented by intestinal bacteria. Simethicone reduced the amount of H2 eliminated in breath, but this effect was offset partially by H2 production from the fermentation of unabsorbable substances used in the formulation of the tablets.

Intestinal permeability to lactulose and mannitol in growing rats with iron-deficiency anemia

Iron deficiency can have nonhematological manifestations, some of which may affect the gastrointestinal tract. The aim of this study was to determine if iron-deficiency anemia in growing rats affected small-bowel permeability as assessed by the urinary ratio of lactulose and mannitol. Thirty-seven male Harlan Sprague-Dawley rats (21 d of age) were randomly divided into two groups and fed either an iron-deficient (n=19) or an iron-sufficient diet (n=18) that contained either 13.5 or 43.8 mg of iron/kg diet, respectively. Animals were evaluated between 25 and 38 d of dietary treatment. Intestinal permeability was assessed by measuring the lactulose/mannitol urinary ratio following administration of a solution that contained the two sugars. At the end of the study, the mean body weight of rats fed the low-iron diet was approx 95% that of the controls. The mean hemoglobin (g/dL) was significantly lower in the low-iron diet group (11.2±1.4) than in the control group (16.9±0.8) (p=0.001). The liver iron concentration (µg/g) of the anemic group (41.4±4.7) was also statistically (p=0.001) lower than in the control group (116.6±18.2). The lactulose/mannitol ratio was lower in the anemic rats (2.0±0.7) than in the control group (2.6±0.7) (p=0.008), a finding that is not suggestive of intestinal mucosal atrophy, previously described in anemic children.

Indications de l’endoscopie du tractus digestif supérieur chez le nourrisson, l’enfant et l’adolescent

RésuméCet article présente une revue des indications de l’endoscopie du tractus digestif supérieur et des considérations relatives à son exécution chez les enfants et les adolescents.Le développement de l’endoscopie a permis de mettre en évidence certaines différences relatives à l’incidence et la morbidité de certains problèmes gastroentérologiques pédiatriques par rapport aux connaissances acquises avant l’endoscopie. En outre, exécutée par des praticiens expérimentés, l’endoscopie se révèle d’une grande valeur diagnostique et thérapeutique.SummaryThis article presents a brief review of the indications for upper intestinal endoscopy in infants, children, and adolescents. The advent of endoscopy has made us aware of certain differences regarding incidence and morbidity of particular gastrointestinal problems compared to our beliefs in the pre-endoscopic era as well as to the existence of certain pathologies which also exist in the pediatric population. Endoscopy in children, when performed by experienced hands, is a safe and helpful diagnostic tool.

High-performance size-exclusion chromatography of porcine colonic mucins : Comparison of Bio-Gel® TSK 40XL and Sepharose® 4B columns

A high-performance size-exclusion chromatography (HPSEC) method was developed for the separation of porcine colonic mucins using a Bio-Gel TSK 40XL HPSEC column (300 mm x 75 mm). In addition, porcine gastric and bovine submaxillary mucin preparations were used to describe more fully the separation characteristics of the HPSEC column. For comparison, the same preparations were also separated using a Sepharose 4B column (100 cm x 2.6 cm). The colonic and gastric mucins eluted in the void volume (V0) of both columns. Bovine submaxillary mucin was in the elution volume (Ve) of both columns. Analytical HPSEC of fractions (V0 and Ve) of the various preparations obtained by Sepharose 4B chromatography exhibited retention times identical to those for fractions obtained by HPSEC. After separation by both methods, purified mucins were obtained by CsCl2 density gradient ultracentrifugation; analytical HPSEC profiles, protein contents, and monosaccharide compositions of both gastric and colonic mucins from either column were similar. The HPSEC method, however, is ideally suited to separate microgram to milligram quantities of colonic mucin preparations quickly: 2 to 4 h, compared with 24 to 30 h for the Sepharose 4B method.