Marcin Banasiuk

Value of Antral Nodularity for the Diagnosis of Helicobacter pylori Infection in Children

Background The aim of this study was to confirm the role of antral nodularity in the diagnosis of Helicobacter pylori (H. pylori) infection in children. Material/Methods This prospective study included 107 children (58 male; 54.2%), between the ages of 3 and 18 years, infected with H. pylori, which was confirmed if the patient had at least 2 of 4 positive test results (urea breath test, urease test in gastric biopsy, histopathology – positive hematoxylin and eosin and Giemsa staining, and/or monoclonal stool ELISA test – Amplified IDEIA™ Hp StAR™). The control group consisted of 234 children with abdominal pain, of similar age, in whom urease test in gastric tissue and histopathology were negative. In both groups, photographs of the gastric antrum taken during endoscopy were evaluated for nodularity by 3 independent endoscopists, blinded to the results of other tests. Sensitivity, specificity, and negative and positive predictive value of nodularity were assessed. Indication for upper endoscopy was chronic abdominal pain not considered to be functional. Results There were no statistical differences between groups regarding sex (chi-square test with Yates’s correction: p=0.8763) or age (mean ±SD) 11.77±3.49 and 12.43±3.32, study and control groups, respectively (Mann-Whitney test: p=0.1352). The sensitivity of the presence of nodularity as an indication of H. pylori infection was 91.6% and specificity was 91%. PPV of gastric nodularity was 81% and NPV was 96%. Conclusions Antral nodularity is reliable test. Physicians could start treatment of H. pylori infection whenever gastric nodularity is observed and the urease test result is positive, without waiting for histopathology results.

Metronidazole or Rifaximin for Treatment of Clostridium difficile in Pediatric Patients with Inflammatory Bowel Disease A Randomized Clinical Trial

Background: Interestingly, Clostridium difficile infection (CDI) worsens the course of inflammatory bowel disease (IBD); however, there is a paucity of data regarding the treatment of CDI in this group of patients. Methods: This was a prospective, single-blind trial. Children with flare of IBD and CDI were randomly assigned to receive metronidazole or rifaximin orally for 14 days. CDI was diagnosed based on a positive well-type enzyme immunoassay (EIA) toxins A/B stool test for C. difficile toxins A and/or B. The cure rate was defined as the percentage of patients with a negative EIA stool test for C. difficile toxins A/B measured 4 weeks after the end of treatment. Recurrence was defined as a repeat CDI within 2 to 8 weeks. Results: In total, we included 31 patients with IBD including 12 patients with Crohns disease and 19 with ulcerative colitis. Of them, 17 received metronidazole and 14 received rifaximin. There were no statistically significant differences between the 2 study groups including age, type of treatment, and disease activity. There was no statistically significant difference in the cure rate between patients treated with metronidazole and rifaximin (70.6% versus 78.6%, respectively, P = 0.5). We found no difference in recurrence rate between the 2 study treatment types (17% versus 0%, respectively, P = 0.3). We did not find an association between immunosuppressive therapy and CDI cure rate or CDI recurrence rate. Conclusions: Metronidazole and rifaximin were similarly effective treatments for CDI in pediatric patients with IBD.

3D high-definition manometry in evaluation of children after surgery for Hirschsprung's disease: A pilot study

PURPOSE Anorectal 3-dimensional high definition manometry (3D HRM) could be the best tool for postoperative assessment of restorative surgical procedures for Hirschsprungs disease. The aim of our study was to evaluate patients after surgery for Hirschsprungs disease using 3D HRM. MATERIALS AND METHODS Anorectal function was evaluated using solid state 3D HRM. We measured the length of the anal canal, mean resting squeeze pressures, the presence of rectoanal inhibitory reflex, cough reflex, ano-anal reflex and the bear down manoeuvre. RESULTS We studied 14 children operated on for Hirschsprungs disease. The mean values of pressure asymmetry were higher in patients after the Duhamel procedure than after the TEPT procedure (29.58% vs. 22.26% during resting and 26.1% vs. 14.01% during squeeze, respectively). No difference between the groups was observed in the measurement of all the manometric parameters except the presence of rectoanal inhibitory reflex (87.5% after TEPT vs. 33% after Duhamel). CONCLUSIONS Anorectal 3D HRM evaluation of patients with Hirschsprungs disease demonstrated that the asymmetry of the anal canal occurred in a similar percentage after both procedures.

Letter: gastritis in paediatric patients with coeliac disease

fatty liver in our HIV-infected subjects. This finding was similar to that observed in the Multicenter AIDS Cohort Study. In our multivariate model (in which various metabolic conditions and intrahepatic triglyceride content were adjusted), both HIV infection and central obesity were independent predictors of liver fibrosis. Of note, while only 4.1% and 6.1% of those with HIV infection and central obesity alone respectively had significant liver fibrosis, significant liver fibrosis was observed in 32.1% when both conditions were present, implying a possible synergistic interaction between HIV infection and components of metabolic syndrome in producing excessive liver fibrosis. The role and mechanism of obesity on chronic liver disease and other comorbidities in HIV-infected subjects deserve further evaluation. We acknowledge the high prevalence of metabolic comorbidities in our HIV-infected cohort, and the results of our study should be interpreted within this context. As metabolic syndrome and other metabolic complications are prevalent in up to >30% of the HIV-infected population receiving anti-retroviral therapy, we hope that our results would contribute to optimising care of this group of individuals.

PP-9 NORMAL VALUES OF 3D HIGH-RESOLUTION ANORECTAL MANOMETRY IN CHIDREN.

Background and Aims: 3D high-resolution anorectal manometry (3D HRAM) provides a 3D topographic image of pressure along the anal canal. The aim of the study was to determine normal values of 3D HRAM in children. Methods: Children without any symptoms arising from the lower gastrointestinal tract were prospectively enrolled in the study. Manometry procedures were performed using a rigid probe (Covidien/Medtronic, Ireland) without premedication. Pressure within the anal canal and 3D images of sphincters were measured. If possible, defecation dynamics and thresholds of sensation were evaluated. Data were expressed as the mean (±SD). Results: A total of 61 children (34 males; age: 2–17 years, mean: 8.28 years) were studied. The mean resting and squeeze sphincter pressures were 83.43 (±23.23) mmHg and 191 (±64.21) mmHg, respectively. The mean length of the anal canal was 2.62 (±0.68) cm and correlated with age (r = 0.49, p < 0.0001). The mean rectal balloon volume to elicit recto-anal inhibitory reflex was 15.66 (±10.9) cc. The first sensation, urge and discomfort were observed at 24.42 (±23.98) cc, 45.91 (±34.55) cc and 91.58 (±50.17) cc of the balloon volume, respectively. The mean resting pressure of the puborectalis muscle was 71.54 (±14.58) mmHg while the mean squeeze pressure was 134.10 (±35.2) mmHg. A positive correlation between age and balloon volume needed to elicit discomfort was determined (r = 0.49, p < 0.001). Conclusion: Normative data of 3D HRAM in children without symptoms arising from the lower gastrointestinal tract were established. There were no significant differences in pressure results between males and females.

Immunization Coverage in Children with Inflammatory Bowel Disease

Patients suffering from inflammatory bowel diseases (IBD) are at increased risk of infections, mainly due to immunosuppressive treatment. Moreover, infections may cause flares of IBD. Vaccination is the most effective way of preventing many infections. The aim of this study was to evaluate the vaccination status of Polish children with IBD. Individual immunization cards of children with IBD and healthy controls were reviewed. Demographic data such as age, sex, and IBD history, including therapy type, were collected. We enrolled 267 children into the study, including 214 children with IBD and 53 controls. None of the children had completed the full up-to-date routine childhood immunization schedule recommended in Poland. Controls were more than 4 times more likely to be vaccinated than the IBD patients, with the vaccines that enjoy the insurance reimbursed (OR 4.1, 95% CI 2.2-7.9). In conclusion, the study demonstrates a poor vaccination status in children suffering from IBD.