Federica Gaiani

Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

There are many causes of gastrointestinal bleeding (GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the “Gastro-Ped Bleed Team” of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) carried out a systematic search on MEDLINE via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: “upper GIB” and “pediatric” [all fields]; “lower GIB” and “pediatric” [all fields]; “obscure GIB” and “pediatric” [all fields]; “GIB” and “endoscopy” [all fields]; “GIB” and “therapy” [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, case-control studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

Cancer and Dysplasia Surveillance

Colorectal cancer (CRC) and dysplasia surveillance are of paramount importance in the long-term management of inflammatory bowel disease (IBD). Chronic inflammation and immunosuppressive therapy represent risk factors. It has not yet been established which are the treatments at major risk; therefore, studies on long-term surveillance are awaited. Specific genetic mutations seem to have a role too. Although dysplastic lesions usually develop in the adult age, they must be taken into account by pediatricians. The risk to develop dysplastic lesions is mainly related to ulcerative colitis (UC), but also Crohn’s disease (CD) has to be strictly followed up.

Helicobacter Pylori Infection: We Should Always Verify the Intrafamilial Transmission

Background and Aims: Helicobacter pylori infection is one of the most common gastrointestinal infections in humans; it affects about 30% of people in developed countries and about 80% in developing ones. The majority of patients acquire the infection during childhood and the intrafamilial transmission is considered one of the most important routes of infection. The aim of this study was to assess the intrafamilial transmission rate among family members of index subjects. Methods: We have suggested all patients H. pylori-positive (99 patients, symptomatic index subjects) diagnosed during 18 months (Sep 2011-Dec 2012) to screen their family members by stool antigen test (SAT) and, when positive, to perform upper gastrointestinal endoscopy. Results: Through SAT we identified 126 patients belonging to 41 households of 99 initial index subjects, therefore 41 index subjects (41.4%) had at least one family member affected. The entire population studied included 225 H. pylori-positive patients: 99 index subjects (symptomatic) and 126 family members diagnosed by SAT screening and histological examination by gastroscopy. Of these, 103 patients (81.7%) were considered slightly symptomatic (mild clinical history until then not important enough to perform further diagnostic study) and 23 patients (18.3%) were totally asymptomatic. Conclusions: In the spread of H. pylori infection, the intrafamilial transmission is an important route of contamination; besides the known mother-to-child dyad, also the transmission among family members plays a considerable role and it should be always verified.

P93 Situs viscerum inversus and apple peel atresia: a rare association. case report

Background and aims Duodenal atresia is a relatively common anomaly and its frequency ranges from 1 in 3000 to 5000 live births. Association of duodenal atresia with situs viscerum inversus is rare and fewer than 20 patients have been reported in literature. Methods We present a sub-Saharan 1 years old female baby, born at 31 weeks with prenatal diagnosis of situs viscerum inversus with dextrocardia, ventricular septal defect, ductus venous agenesis, duodenal atresia and intestinal malrotation. We considered risk factors, clinical and surgical management, complications and evolution of this rare association. Results A 31 weeks female baby was born by emergency caesarean section for cardiotocographic changes. Her mother history was positive for pre-gestational diabetes on insulin therapy and for Streptococcus beta-haemolytic infection. Incomplete intrapartum amplicillin prophylaxis was made. The baby weighed 2300 g and her Apgar scores were 5 and 5, needing non-invasive ventilation with nCPAP. Because of suspected intestinal obstruction, parental nutrition was started one day after birth and a radiological examination was performed showing the mirror image of a double-bubble configuration of duodenal atresia. She underwent laparotomy at 6 days of life, confirming situs inversus and intestinal necrosis secondary to volvulus on common mesentery (apple peel type 3b): duodeno-cecal anastomosis with saving the ileocecal valve was performed. Histology of the surgical specimen confirmed the transmural necrosis. Six days after, enteral nutrition was progressively introduced with good tolerance and weight gain; parental nutrition was continued with subsequent cholestasis needing the modification of the lipid composition. At 3 months of age, she underwent a Bianchi intestinal lengthening procedure and cholecystectomy. The onset of post-surgical duodenal stenosis two months after required one endoscopic pneumatic dilation (8–10 mm) and a gastrostomy button was placed too. Upper endoscopies performed 1 month and 6 months later were normal. Enteral and parental nutrition was continued and the oral feeding was gradually introduced. Conclusions Duodenal atresia and situs inversus are rare combinations. Outcome is good with appropriate multidisciplinary management and follow-up. Maternal diabetes could be factor risk of laterality, as suggested in literature.

A Giant Congenital Lobular Capillary Haemangioma

Lobular capillary haemangioma is a relatively common benign mucocutaneous lesion in paediatric age. The etiopathogenesis is not very clear, but it seems that lesions originate de novo from a process of lobular vascular proliferation that appears to be neoplastic. Congenital onset is usually very rare; it happens only in 1.1% in literature. We report a case of a newborn with a giant congenital lobular capillary haemangioma of the head (left occipital region) which increased rapidly with superficial ulcers in the early days of life. The baby was operated on by full-thickness excision using the linear closure technique; this treatment allows histological examination, ensures the most efficacy aesthetic results and gives the lowest recurrence rate.