Gönül Çaltepe

Impact of laryngopharyngeal and gastroesophageal reflux on asthma control in children

OBJECTIVE A prospective study was carried out to determine the sensitivity and specificity of reflux symptoms and laryngeal findings to diagnose laryngopharyngeal reflux (LPR) and gastro-esophageal reflux (GER) in children with asthma by comparing the results of double probe pH monitorization and to determine the difference between controlled and uncontrolled asthma in terms of GER and LPR coexistence. METHODS A total of 50 patients (23 girls, mean age 10.8±0.4 years) with mild to moderate persistent asthma were included in this study. The patients were divided in two groups according to the asthma control status as controlled (n=27) vs. uncontrolled asthma (n=23). All patients completed the reflux symptom questionnaire and then they underwent flexible fiberoptic laryngoscopy and 24h double probe (pharyngeal and esophageal) pH monitorization. Laryngopharyngeal and gastroesophageal reflux were defined according to the double probe pH meter results. RESULTS The prevalences of LPR and GER were 70% and 46% in asthmatic patients, respectively. The reflux symptom score and LPR disease index were not useful to predict LPR or GER. There was no association between asthma control status and LPR and GER. Vocal nodule seems to be a valuable sign to evaluate LPR in asthmatic children. CONCLUSIONS The reflux symptom score and LPR disease index do not seem reliable to diagnose LPR and GER in children with asthma. The frequency of LPR and GER are independent of asthma control, atopy and long acting beta agonist usage.

Different techniques for biliary diversion in progressive familial intrahepatic cholestasis

BACKGROUND Progressive familial intrahepatic cholestasis (PFIC) is a cholestatic liver disease of childhood. Pruritus resulting from increased bile salts in serum might not respond to medical treatment, and internal or external biliary drainage methods have been described. In this study, we aimed to evaluate different internal drainage techniques in patients with PFIC. PATIENTS AND METHODS Between 2009 and 2014, seven children (4 male, 3 female, 3months-5years old), (median 2years of age) with PFIC were evaluated. The patients were reviewed according to age, gender, complaints, surgical technique, laboratory findings and outcome. In each two patients, cholecystoileocolonic anastomosis, cholecystojejunocolonic anastomosis and cholecystocolostomy were performed. Cholecysto-appendico-colonic anastomosis was the technique used in one patient. RESULTS Jaundice and excessive pruritus were the main complaints. One of the patients with cholecystoileocolonic anastomosis died of comorbid pathologies (cirrhosis, adhesive obstruction and severe sepsis). Temporary rectal bleeding was observed in all the patients postoperatively. Regardless of the surgical technique, pruritus was dramatically decreased in all the patients in the postoperative period. CONCLUSION Regardless of the technique, internal biliary diversion methods are beneficial for the relief of pruritus in PFIC patients. Selection of the surgical method might vary depending on the surgeons preference and the surgical anatomy of the gastrointestinal system of the patient.

Role of Point Shear Wave Elastography in the Determination of the Severity of Fibrosis in Pediatric Liver Diseases With Pathologic Correlations

Our aims in this study were as follows: (1) to determine the cutoff value that can distinguish between advanced liver fibrosis and normal liver tissue for two different elastographic techniques; (2) to determine the cutoff value that can distinguish mild liver fibrosis from normal liver tissue for the techniques; and (3) to assess tissue stiffness in nonalcoholic fatty liver disease (NAFLD).

Lactose and fructose intolerance in Turkish children with chronic abdominal pain

ObjectiveTo investigate the prevalence of lactose and fructose intolerance in children with chronic abdominal pain.MethodsHydrogen breath tests were done to detect lactose and fructose malabsorption in 86 children with chronic abdominal pain (44 irritable bowel syndrome, 24 functional abdominal pain and 17 functional abdominal pain syndrome as per Rome III criteria) presenting to a Pediatric Gastroentreology department.Results14 (16.3%) of patients were diagnosed with lactose intolerance and 11 (12.8%) with fructose intolerance.ConclusionsLactose and fructose intolerance in children can lead to chronic abdominal pain and symptoms improve with dietary modifications.

A case of tuberculous peritonitis in childhood.

Currently, tuberculosis remains a major public health problem worldwide. Peritoneal tuberculosis occurs in approximately 1% of all of tuberculosis cases and is rarely observed in children. Diagnosis and treatment delays caused by mimicking many other intra-abdominal diseases can lead to increases in morbidity and mortality. Here, we present a case of a four-year-old child with tuberculosis peritonitis who was diagnosed by laparoscopic biopsy and histopathological examination and recovered with antituberculosis therapy. Peritoneal tuberculosis should be considered in younger patients and adults with fever, abdominal pain and weight loss in endemic areas.

Detection of gastroesophageal reflux in children with cerebral palsy using combined multichannel intraluminal impedance–ph procedure

Gastroesophageal reflux (GER) is a very common condition in children with neurological impairment and this can influence nutritional and respiratory outcomes. The aim of this study was to investigate the presence of GER in children with cerebral palsy (CP) using multiple intraluminal impedance (MII)-pH monitoring. The use of combined MII-pH allows for the detection of both acid and non-acid reflux episodes. A total of 29 CP patients with symptoms suggesting GER, aged 2 to 10 years old, underwent 24-hour combined MII-pH monitoring. There were a total of 3899 reflux episodes, of which 29% were acid, 60% were weakly acid and 11% were alkaline. The number of non-acid reflux episodes was statistically significantly greater (p < 0.01). These findings confirm that GER disease is seen frequently in children with cerebral palsy and most of the reflux episodes are not acidic. Non-acid reflux can also influence the morbidity in patients with cerebral palsy. It can be concluded that 70% of the reflux episodes would not have been recognized by pH measurement alone.

Diagnostic accuracy of point shear wave elastography in the detection of portal hypertension in pediatric patients

PURPOSE The purpose of this study was to determine the usefulness of point shear wave elastography (p-SWE) of the liver and spleen for the detection of portal hypertension in pediatric patients. MATERIALS AND METHODS The study consisted of 38 healthy children and 56 pediatric patients with biopsy-proven liver disease who underwent splenic and liver p-SWE. The diagnostic performance of p-SWE in detecting clinically significant portal hypertension was assessed using receiver operating characteristic (ROC) curves. RESULTS Reliable measurements of splenic and liver stiffness with p-SWE were obtained in 76/94 (81%) and 80/94 patients (85%), respectively. The splenic stiffness was highest in the portal hypertension group (P<0.01). At ROC curve analysis, the area under the curve in the detection of portal hypertension was lower for splenic p-SWE than for liver p-SWE (0.906 vs. 0.746; P=0.0239). The cut-off value of splenic p-SWE for portal hypertension was 3.14m/s, with a specificity of 98.59% and a sensitivity of 68.18%. The cut-off value of liver p-SWE for portal hypertension was 2.09m/s, with a specificity of 80.28% and a sensitivity of 77.27%. CONCLUSION In pediatric patients, p-SWE is a reliable method for detecting portal hypertension. However, splenic p-SWE is less accurate than liver p-SWE for the diagnosis of portal hypertension.

The hidden danger: Silent celiac disease

Celiac disease (CD) is a permanent immune-mediated inflammatory disease of the small intestine, which is induced by gluten. It was considered to be highly prevalent primarily in populations of European descent; however, currently, it is known that CD is a global disease, and the overall frequency of incidence is increasing throughout the world. It is estimated that 1% of the world population has this disease (1,2). The pathogenic mechanism of CD involves both genetic and environmental factors. It is known that genetic predisposition, observed as human leukocyte antigen (HLA) DQ2 or DQ8 positivity, for the disease is the most important, and almost all patients with CD exhibit these molecules (3). In fact, the absence of either of these two molecules has a negative predictive value in terms of excluding the diagnosis of CD. Therefore, these two HLA haplotypes are considered to be necessary but not sufficient. Serological tests are important to screen for and diagnose CD. Over the years, serological tests have improved with better availability. Currently, the determination of serum anti-tissue transglutaminase immunoglobulin A antibodies seems to be the most sensitive and specific test for the primary diagnosis of CD. Because recent tests are more sensitive than those in the past, the current prevalence of CD may be higher. However, when the current screening methods are applied to stored sera, the prevalence is still observed to have increased during the course of time. In two serological studies from US and Europe, the prevalence of CD has been shown to increase four and two times, respectively, over the years (1,4). Although there are still some geographic differences, currently, the frequency of CD is increasing in Asia and Africa also (2). This increase is attributed to available and improved serological tests or increased awareness of the physicians. There are also some environmental factors that influence the prevalence of CD, the most important being the consumption of gluten. One reason for the increased prevalence of CD may also be the increased amounts of gluten in the diet worldwide. Especially in developing countries, wheat consumption has increased at a faster rate than all other regional cereals. This can be attributed to changes in global dietary habits, westernization of diet to contain a large amount of wheat (including gluten), and changes in the processing of cereals (5). Currently, wheat-containing foods comprise as much as up to 50% of energy intake worldwide. In addition, the wheat available now is not the same as the wheat available thousands of years ago that contained smaller amounts of the highly toxic peptide 33-mer gliadin (6,7).

Akut pankreatit ile başvuran bir duodenal duplikasyon kisti olgusu

Duodenal duplication cyst is a rare congenital anomaly of the gastrointestinal tract. In this article, a 14-year-old male patient with abdominal pain and vomiting is presented. While investigating the etiology of acute pancreatitis, the cystic mass was found in the duodenum. After surgical removal of the cyst, histopathologic examination demonstrated duplication cyst. Duodenal duplication cyst should be remembered as a rare cause of acute pancreatitis.

A rare cause of nephrotic syndrome in a 14-year-old boy: questions.

A previously healthy 14-year-old boy was presented with a 10-day history of progressive periorbital and bilateral lower extremity edema. He also noted that the frequency and amount of his urine had decreased. He had no gross hematuria, no recent sore throat, or upper respiratory tract infections. His medical history was unremarkable, with no known history of kidney disease. Physical examination on admission was unremarkable except for moderate edema on bilateral eyelids and lower extremities. His cardiovascular, respiratory, neurological, and genitourinary exams were all normal. Blood pressure was 130/80 mmHg. His height was 151 cm (25–50 p) andweight was 44.5 kg. Laboratory findings revealed that he had marked hypoalbuminemia (2.1 g/dl) with heavy proteinuria (5167 mg/dl, or 20 mg/mg creatinine) and microscopic hematuria (ten red blood cells/HPFwith no red blood cell casts). Hyperlipidemia (T-Chol 225 mg/dl, TG 263 mg/dl) was also noted. Serum complements were normal (C3 0. 8 g/L, C4 0. 4 g/L), and anti-nuclear antibody was negative. Renal function was intact (creatinine 0.7 mg/dl, BUN 20 mg/dl). HBs antigen, HCVantibody, and human immunodeficiency virus (HIV) were all negative. There was no evidence of streptococcal infection. Based on his clinical and laboratory findings, he was diagnosed as having nephrotic syndrome. The patient was hospitalized and investigated for the etiology of the nephrotic syndrome. During the work-up for a renal biopsy, a cystic mass in the right upper abdomenwas found by ultrasonography and confirmed by computed tomography (CT) scan (Fig. 1).