Maiko Tatsuki

Serum magnesium concentration in children with functional constipation treated with magnesium oxide

AIM To determine whether hypermagnesemia recently reported in adult patients possibly develops in children with functional constipation taking daily magnesium oxide. METHODS We enrolled 120 patients (57 male and 63 female) aged 1-14 years old (median: 4.7 years) with functional constipation from 13 hospitals and two private clinics. All patients fulfilled the Rome III criteria for functional constipation and were treated with daily oral magnesium oxide for at least 1 mo. The median treatment dose was 600 (500-800) mg/d. Patients were assessed by an interview and laboratory examination to determine possible hypermagnesemia. Serum magnesium concentration was also measured in sex- and age-matched control subjects (n = 38). RESULTS In the constipation group, serum magnesium concentration [2.4 (2.3-2.5) mg/dL, median and interquartile range] was significantly greater than that of the control group [2.2 (2.0-2.2) mg/dL] (P < 0.001). The highest value was 3.2 mg/dL. Renal magnesium clearance was significantly increased in the constipation group. Serum magnesium concentration in the constipation group decreased significantly with age (P < 0.01). There was no significant correlation between the serum level of magnesium and the duration of treatment with magnesium oxide or the daily dose. None of the patients had side effects associated with hypermagnesemia. CONCLUSION Serum magnesium concentration increased significantly, but not critically, after daily treatment with magnesium oxide in constipated children with normal renal function.

Endoscopic findings in the acute phase of food protein-induced enterocolitis syndromae

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Temporal Trend of Pediatric Inflammatory Bowel Disease: Analysis of National Registry Data 2004 to 2013 in Japan

Increased incidence and prevalence of pediatric inflammatory bowel disease (IBD) have been reported in Western countries. Changes in the prevalence of pediatric IBD in Asian countries, however, remain unclear. We evaluated the changes in the prevalence of IBD among Japanese adults and children from 2004 to 2013, by using the Japanese national registry data of patients receiving financial aid. Data from children (ages 0-19 years) were compared with those from young adults (ages 20-39 years). In 2004, age-standardized prevalences of Crohn disease (CD) and ulcerative colitis (UC) among children were 4.2 of 100,000 and 11.0 of 100,000, respectively. The corresponding prevalences among young adults were 41.0 of 100,000 and 89.8 of 100,000, respectively. In 2013, age-standardized prevalences of pediatric CD and UC were 7.2 of 100,000 and 15.0 of 100,000, respectively. During this period, prevalence of pediatric CD increased by 73.8% among children and by 49.0% in young adults. The prevalence of UC increased by 45.0% among children, and by 73.7% among young adults.

IL-10RA Mutation as a Risk Factor of Severe Influenza-Associated Encephalopathy: A Case Report

With this report, we describe the first case of IAE in a patient with IL-10RA mutation. Changes in cytokines before and after influenza are evaluated. Influenza-associated encephalitis and encephalopathy (IAE) is a severe complication of influenza infection with high morbidity and mortality. We present the case of a patient with IL-10RA mutation who developed encephalopathy after influenza infection. A 10-day-old boy developed recurrent fever and anal fistula. Growth failure gradually became apparent. He had been treated with antibiotics and elemental nutrition. However, the patient did not respond to the treatments. At 11 months, he suddenly developed shock with encephalopathy and multiple organ failures. He was then diagnosed with IAE. A cytokine study revealed elevated levels of IL-1 receptor antagonist, IL-2, IL-6, IL-8, IP-10, eotaxin, G-CSF, MCP-1, and IL-10. These cytokines are normally downregulated by IL-10. Genetic testing revealed a IL-10RA mutation at the 3′ end of exon 4 (c.537G→A). These findings might reflect an increased risk of severe IAE in patients with IL-10RA mutation.

Severity scales of non-IgE-mediated gastrointestinal food allergies in neonates and infants

BACKGROUND Non-IgE-mediated gastrointestinal food allergies (non-IgE-GI-FAs) are one type of food allergy found in neonates and infants. Few reports have defined the severity of non-IgE-GI-FAs in these populations. METHODS Grading scales of the severity of non-IgE-GI-FAs according to extra-GI symptoms, such as poor weight gain, as well as systemic symptoms, including fever and shock, were developed and retrospectively applied to patients with non-IgE-GI-FAs. The relationship between the severity of non-IgE-GI-FAs and both clinical and laboratory findings were examined. RESULTS Elevation of C-reactive protein levels and a decrease in total protein and albumin were observed in accordance with allergy severity. In an endoscopic examination, inflammatory findings were confirmed in large areas of the colonic mucosa in case of higher severity levels, and infiltration of inflammatory cells other than eosinophils was found in the severest grade. Extensively hydrolyzed milk or amino acid-based milk was required for all patients with the severest grade. In addition, the timing of acquiring tolerance tended to be late for this grade. CONCLUSIONS Classification and determination of the severity of non-IgE-GI-FAs in neonates and infants may not only contribute to elucidation of the pathogenesis but may also be useful in the clinical setting.

Fecal retention in childhood: Evaluation on ultrasonography

To assess the usefulness of rectal diameter measurement on ultrasonography as a diagnostic tool for fecal retention in children.

P-070: Height at the time of diagnosis of inflammatory bowel disease in Japanese children: an analysis of Japanese national registry data

O-23 Effectiveness of nutritional and anti-TNF therapy in North American children with active Crohn’s disease D.Y. Lee1 *, R.N. Baldassano1, C.W. Compher2, A.M. Griffiths3, A.R. Otley4, L.G. Albenberg1, G.D. Wu2, F.D. Bushman2, J.D. Lewis2. 1Children’s Hospital of Philadelphia, Philadelphia, United States of America, 2University of Pennsylvania, Philadelphia, United States of America, 3The Hospital for Sick Children, Toronto, Canada, 4IWK Health Centre, Halifax, Canada