Konrad Siala

Epidemiology of Helicobacter pylori infection in asymptomatic children: a prospective population-based study from the Czech Republic. Application of a monoclonal-based antigen-in-stool enzyme immunoassay.

Background:  Acquisition of Helicobacter pylori occurs mainly in childhood and is significantly influenced by geographical variations. The aim of this study is to evaluate the prevalence of H. pylori infection in a population‐based sample of asymptomatic children in the Czech Republic. Furthermore, this study aims to identify potential risk factors associated with this infection.

Cytokine tumor necrosis factor-alpha a promoter gene polymorphism at position -308 G→A and pediatric inflammatory bowel disease : Implications in ulcerative colitis and crohn's disease

Objectives: Our pilot study aimed to determine the effect of tumor necrosis factor-alpha (TNF-&agr;) 308 G→A promoter single-nucleotide polymorphism in pediatric inflammatory bowel disease (IBD), its influence on inflammatory activity and the clinical manifestations. Methods: We obtained genomic DNA from 164 subjects, 82 with long-standing IBD aged 8 to 18 years: 46 with Crohn disease (CD) and 36 with ulcerative colitis (UC). Eighty-two healthy children served as the control population. Genotyping was determined by using a restriction enzyme-based assay. TNF-&agr; 308 G→A polymorphism was assessed in terms of inflammatory (C-reactive protein [CRP]) and disease activity. The latter was assessed by the Pediatric Crohns Disease Activity Index (PCDAI) and the Truelove index for CD and UC, respectively. Results: Significant differences in TNF-&agr; 308 A polymorphism were found between the IBD group and controls (P < 0.05) and the UC group and controls (P < 0.001). No differences were noted between TNF-&agr; 308 A polymorphism and clinical characteristics in UC. The frequency of the −308 A allele of TNF was not different in CD compared with that in the control group. The frequency of TNF-&agr; 308 A genotype was significantly higher in CD patients with predominantly stenosing/penetrating disease compared with patients without complications (P < 0.001) and healthy controls (P < 0.01). In CD patients, those carrying TNF −308 A had a significant increase in CRP (P < 0.05) and the PCDAI (P < 0.05). In CD, CRP levels strongly correlated with the PCDAI (r = 0.6150, P < 0.001). In UC, significant differences among the mean levels of CRP (P < 0.05) and disease activity (P < 0.001) related to TNF-&agr; 308 A polymorphism were found. Allele distribution (odds ratio, 12.9; CI, 1.18-140.81, P < 0.001) and CRP serum levels (odds ratio, 1.020; CI, 1.00-1.04, P < 0.001) were independently associated with CD complications. Conclusions: Although not necessarily dictating IBD initiation, the TNF-&agr; 308 A polymorphism may play a role in modifying the CD phenotype. The polymorphism may influence disease activity as well as more intense inflammatory activity in both forms of IBD and may modify the progression of chronic digestive tract inflammation.

Evaluation of faecal calprotectin as a valuable non-invasive marker in distinguishing gut pathogens in young children with acute gastroenteritis

Aim:  The aim of the study is to evaluate faecal calprotectin (f‐CP) in children ≤3 years of age with acute gastroenteritis (AG) as an early predictor of bacterial inflammation.

Helicobacter heilmannii-related gastric ulcer in childhood

Helicobacter pylori (H. pylori) occurs worldwide. H. pylori infection is associated with chronic gastritis and peptic ulcer disease both in adults and children (1,2). Non-steroidal anti-inflammatory drugs (NSAIDs) have also been recognized as an important cause of peptic ulcer disease. Some authors have reported an increased rate of nonH. pylori, non-NSAID duodenal and gastric ulcer disease in adults (3,4). Similar to the adult population, data regarding duodenal or gastric ulcers in children unrelated to H. pylori or other risk factors such as Crohn disease or drugs, are also available (5,6,7). However, the prevalence of non-H. pylori, non-NSAID peptic ulcer disease in children is unknown. On the basis of published trials, it appears plausible that other unknown factors must be taken into account. However, H. pylori is not the only bacterial pathogen that colonizes the gastric mucosa. Helicobacter heilmannii (H. heilmannii), formerly Gastrospirillum hominis, similar to H. pylori, has been described in gastric biopsies in humans and has been strongly associated with gastritis both in children and adults (8,9,10). To the best of our knowledge, there are no published studies regarding the association of gastric ulcer disease and H. heilmannii infection in children. We describe here a 14-year-old girl with gastric ulcer disease in association with H. heilmannii infection. The purpose of this study is to alert the clinician to the possible etiologic role of H. heilmannii in gastric ulcer disease in children.

Gastric emptying of solids in children with H. pylori-positive and H. pylori-negative non-ulcer dyspepsia.

Objective: There is currently no data available in children on possible relationships among Helicobacter pylori, gastric motility and gastric inflammation. This is a prospective study of gastric emptying (GE) in symptomatic children with and without H. pylori who met symptom-based criteria for non-ulcer dyspepsia (NUD). Methods: 47 consecutive dyspeptic patients (23 males; age range, 7 to 18 years) were enrolled. All patients had extensive negative diagnostic investigations. Scintigraphic solid-phase gastric emptying was assessed. Results: 21 H. pylori-positive and 26 H. pylori-negative patients were identified with non-ulcer dyspepsia. The groups were not different in clinical symptoms except that pain related to feeding was more frequent in infected children (P < 0.03). Nodular antral gastritis was found more frequently in the H. pylori positive group (P < 0.0001). The gastritis score was more severe in H. pylori infected than H. pylori negative patients in both fundic and body mucosa (P < 0.001). Within the H. pylori-positive NUD group, the mean half-time GE of a solid meal was significantly accelerated compared to the non-infected group (P < 0.05). There was no difference in the intragastric food distribution and curves of gastric emptying of both groups. A significant relationship was found between the degree of gastric body inflammation gastric emptying, but not antral inflammation. Gastric emptying rate did not differ by sex or age of the subjects in either group. Conclusions: In dyspeptic children with H. pylori, gastric emptying of a solid was significantly accelerated compared with symptomatic H. pylori uninfected patients. This suggests that H. pylori is able to induce gastric emptying acceleration. Our findings add more information on H. pylori infection and gastroduodenal disease.

Helicobacter heilmannii gastroduodenal disease and clinical aspects in children with dyspeptic symptoms

Aim: To evaluate the occurrence and clinical characteristics of Heliobacter heilmannii infection among children presenting with dyspeptic symptoms. Method: Prospective cohort study of 580 patients. Results: Of all examined dyspeptic children, 26.4% were infected with spiral‐shaped organisms, and 0.9% of patients were found to be infected with spiral H. heilmannii‐like organisms.

Paediatric Rome III Criteria-Related Abdominal Pain Is Associated With Helicobacter pylori and Not With Calprotectin.

Objectives: Abdominal pain–related functional gastrointestinal disorders in children include functional dyspepsia, functional abdominal pain, irritable bowel syndrome, and abdominal migraine. We aimed to evaluate a possible association between functional abdominal pain disorders and Helicobacter pylori infection and faecal calprotectin level. Methods: Prospective observational study including consecutive children with functional gastrointestinal disorders fulfilling Rome III criteria (cases) and age/sex-matched healthy controls. H pylori has been detected by biopsy-based tests and stool-antigen detection, faecal calprotectin by enzyme-linked immunosorbent assay. Results: A total of 56 cases (27 with functional dyspepsia) and 56 controls were enrolled. H pylori being detected in 17 of 56 cases (30.4%) and 4 of 56 controls (7.1%, odds ratio: 5.7; 95% confidence interval [CI]: 1.8–18.2, P = 0.003). H pylori was detected significantly more frequently in cases with functional dyspepsia (14/27, 51.9% odds ratio: 14.0; 95% CI: 3.9–49.7, P = 0.00001) than in controls and not in cases with other well-recognized functional gastrointestinal complaints (3/29, 10.3%). The median faecal calprotectin level was similar in cases (7.8 &mgr;g/g, 95% CI: 7.8–8.4) including those with gastritis, and controls (9.1 &mgr;g/g, 95% CI: 7.8–11.3). Gastritis features were more frequent in H pylori–infected and noninfected cases with functional dyspepsia (27/27, 100%) than in cases with other abdominal functional complaints (15/29, 51.7%, P = 0.007). Conclusions: H pylori gastritis and noninfectious gastritis were associated with functional dyspepsia in children referred for abdominal pain–related functional gastrointestinal disorders while faecal calprotectin is not a predictor of gastritis and is similar in children with functional abdominal pain symptoms and in controls.

Treatment of encapsulated pleural effusions in children: A prospective trial

Background:  The aim of this study was to improve the efficacy of treatment of complicated pleural effusions.

Adolescent herpes simplex viral infection related Ludwig's angina in ulcerative colitis.

Ludwig’s angina (LA) was described for the first time in 1836 by Wilhelm Frederick von Ludwig (1). This rare infectious condition is clinically characterized by dyspnea, severe dysphagia, symmetrical neck swelling, and fever. LA is a cellulitis of the submandibular and sublingual spaces which can be fatal as a result of respiratory failure. LA spreads by continuity along fascial planes, rather than by lymphatics, and rarely involves the glandular structures (2,3). LA is uncommon in childhood but carries the potential for lethal complications, especially in immunocompromised patients (4). Bacterial infection has been recognized as a risk factor for LA. In children, bacteriology usually reveals a predominance of Streptococcus species in addition to gram negative rods, anaerobes, and mixed flora (4). However, to the best of our knowledge, no published reports have implicated a role for viral infections in LA in childhood. Ulcerative colitis (UC) and Crohn disease (CD) are characterized by chronic digestive tract inflammation. Immunologic, environmental, infectious, and genetic factors have been postulated to play a significant role in their development (5,6,7,8). Treatment is effective but has limitations due to side effects. This paper reports a 15-year-old boy with UC on immunosuppresive therapy and herpes simplex virus type l (HSV)-1 related LA which was successfully treated with acyclovir.

Fistulizing Anorectal Crohn Disease in a Child With Severe HLA-B27-associated Enthesitis-related Arthritis

Juvenile idiopathic arthritis (JIA) represents a family of childhood arthropathies characterized by chronic synovial inflammation. Enthesitis-related arthritis (ERA), a subgroup of JIA and formerly known as juvenile ankylosing spondylitis, is frequently associated with inflammatory bowel disease (IBD). ERA represents the pediatric form of spondyloarthropathy (SA) in adults. The typical presentations of ERA are seronegative oligoarthritis associated with enthesitis affecting the joints of the lower extremities. Abnormalities of the axial skeleton, including sacroiliitis, are absent in the early stages of the disease (1). The histocompatibility antigen HLA-B27 is strongly linked with adult ankylosing spondylitis (AS) (90%) and with the risk for the development of AS in IBD (2). This antigen is associated with 25% of cases of IBD and is present in 70% of patients with IBD having inflammation of the axial skeleton (3). The prevalence of the HLA-B27 antigen in adult patients with Crohn disease (CD) has been found to be 12%, although it is 78% in patients with CD and AS (4). The prevalence of IBD is increased in adults with other autoimmune diseases, particularly AS, and in those with reactive and psoriatic arthritis (5). Indeed, in 1 study, ileocolonoscopies confirmed gut inflammation in 57% of adults with SA (6). Another study also reported the eventual development of CD in patients with SA (7). Conversely, arthritic manifestations are common extraintestinal symptoms of CD in children (8). In another study, 35% of patients with CD fulfilled criteria consistent with the European Spondyloarthropathy Study Group for SA (1). To our best knowledge, this is the