Michal Huml

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.

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.

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.

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

Autoimmune disease, familial clustering and thyroid carcinoma coexistent with autoimmune thyroiditis in children and adolescence: A cross-sectional study from the Czech Republic

BACKGROUND The prevalence of autoimmune thyroiditis (AIT), as the most common autoimmune disease (AD) and papillary thyroid cancer (PTC) is steadily rising in children. The aim of this study was to determine the coexistence of other AD and thyroid carcinoma (TC) in AIT. METHODS The cross-sectional study conducted at a tertiary center comprised AIT children (< 19 years). Data on age/sex, thyroid function and ultrasound, autoantibodies, associated AD, familial occurence of AD and the occurence of TC for each child were collected. RESULTS In total, 231 eligible patients (77% females) were included. The most common onset (66%) was during adolescence. At onset, hypothyroidism was detected in 59.3%; hashitoxicosis in 1.3%. The positivity of both autoantibodies was present in 60.6%, the negativity was in 3,5%. We confirmed a high frequency (44.6%) of AD with AIT predominance in parents and/or grandparents of patients and in siblings (7.4%). 15.2% had at least 1 comorbid AD, of which type 1 diabetes mellitus was the most common (8.5%). Over a period of 7 years TC was diagnosed in 16 patients (mean age 13.5 years) with predominance of PTC in 15 (94%) patients. AIT had concurrently 69% patients. 56% of patients had metastases (89% in AIT subjects). An invasive PTC was present in 44% (86% in AIT subjects). CONCLUSIONS The prevalence rate of AD in AIT and first-degree relatives is high, and several new associations have been reported. Providers should be aware of comorbidities and TC in AIT as this would help in early diagnoses and timely interventions.