Harohalli Shashidhar

Expert pediatric opinion on the Report of the Baveno IV Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension

Abstract:  Portal hypertension leads to a wide variety of complications, which lead to significant morbidity and mortality and are some of the leading reasons for liver transplantation in children with chronic liver disease. Evidence‐based approaches to the management of adults with portal hypertension exist and have been comprehensively reviewed in a series of international meetings, including the Baveno meetings. Similar evidence‐based approaches for the management of portal hypertension in children do not exist and as such international meetings on portal hypertension have not focused on this problem in children. On October 7, 2005 at The Mount Sinai School of Medicine, a panel of pediatric experts reviewed the most recent Baveno statement and crafted a statement modified with their opinions vis a vis approaches to the management of portal hypertension in children.

Investigating the effect of antibiotics on quorum sensing with whole-cell biosensing systems

Quorum sensing (QS) allows bacteria to communicate with one another by means of QS signaling molecules and control certain behaviors in a group-based manner, including pathogenicity and biofilm formation. Bacterial gut microflora may play a role in inflammatory bowel disease pathogenesis, and antibiotics are one of the available therapeutic options for Crohn’s disease. In the present study, we employed genetically engineered bioluminescent bacterial whole-cell sensing systems as a tool to evaluate the ability of antibiotics commonly employed in the treatment of chronic inflammatory conditions to interfere with QS. We investigated the effect of ciprofloxacin, metronidazole, and tinidazole on quorum sensing. Several concentrations of individual antibiotics were allowed to interact with two different types of bacterial sensing cells, in both the presence and absence of a fixed concentration of N-acylhomoserine lactone (AHL) QS molecules. The antibiotic effect was then determined by monitoring the biosensor’s bioluminescence response. Ciprofloxacin, metronidazole, and tinidazole exhibited a dose-dependent augmentation in the response of both bacterial sensing systems, thus showing an AHL-like effect. Additionally, such an augmentation was observed, in both the presence and absence of AHL. The data obtained indicate that ciprofloxacin, metronidazole, and tinidazole may interfere with bacterial communication systems. The results suggest that these antibiotics, at the concentrations tested, may themselves act as bacterial signaling molecules. The beneficial effect of these antibiotics in the treatment of intestinal inflammation may be due, at least in part, to their effect on QS-related bacterial behavior in the gut.

Atypical Clinical and Diagnostic Features in Ménétrier's Disease in a Child

Ménétriers disease is one of the rarest protein-losing gastropathies in childhood. It is characterized clinically by non-specific gastrointestinal symptoms and edema, biochemically by hypoalbuminemia, and pathologically by enlarged gastric folds. In adults, this disease can be devastating with significant morbidity and mortality. In childhood, it is a self-limiting, transient and benign illness. Its treatment is largely supportive with total parenteral nutrition (TPN) while oral intake is encouraged. Acute onset of vomiting in healthy school age children can be initially explained by acute viral gastroenteritis. However, persistent vomiting associated with hematemesis and severe abdominal pain should warrant further work-up. This case report illustrates a self-limiting and rare cause of protein-losing enteropathy called Ménétriers disease that presented with several variant clinical features not typically described in association with this entity.

Helicobacter pylori & beyond: pediatric peptic ulcer disease

The word peptic implies ‘gastric-, pepsin- or acid-related’. Peptic ulcer disease (PUD) denotes the presence of gastric and/or duodenal ulceration or erosion. In clinical practice, the term encompasses gastric or duodenal infl ammation due to any etiology, and may be more common in childhood than ulcerative disease. PUD occurs across the pediatric age group. Although etiopathology of PUD is typically related to that of Helicobacter pylori infection, other etiology for PUD is not uncommon in children and requires a different approach in evaluation and therapeutic decisions. Evaluation of PUD includes endoscopy with mucosal biopsy. Noninvasive testing, such as urea breath test, has a role in the follow-up of H. pylori eradication following therapy. Better understanding of pathogenic factors innate to H. pylori infection has enhanced our understanding of associated PUD. This review describes the management of both H. pylori and non-H. pylori PUD.

Recurrent Lower Abdominal Pain in Older Children and Adolescents: Revised Clinical Approach

Pelvic and lower abdominal pain constitutes more than 30% of the referrals to our adolescent medicine and gastroenterology clinics. These cases are responsible for numerous school absences and significant cost to the healthcare system. This article will review the most common causes of lower abdominal and pelvic pain in adolescents, diagnostic and management issues, as well as prevention.

Surgical Complications of Salmonella Enteritis

Infection with Salmonella species can present as a surgical emergency in children.1-6 In the United States, Salmonella spp. infections are uncommonly encountered by surgeons.6 However, infections with both Salmonella typhi and nontyphoidal Salmonella can result in mesenteric lymphadenitis mimicking appendicitis, cholecystitis, salphingitis, peritonitis, intestinal perforation, intussusception, or rarely, complete intestinal obstruction.1-7 Surgical emergencies may present with coexistent infectious enteritis caused by Salmonella. Appropriate diagnosis and management of these emergencies requires a high index of suspicion for presence of other etiologies despite documented Salmonella infection. We discuss 2 such patients with emergent surgical diagnoses coexistent with Salmonella infection that required intervention, along with a review of the literature.