S Van Biervliet

Severe Gastritis in an Insulin-dependent Child With an IPEX Syndrome

Gastric mucosal atrophy is a rare finding in children and it is seldom seen even in association with Helicobacter pylori infection (1). Atrophic gastritis predisposing to gastric tumours is observed in 20% of patients with autoimmune type 1 insulin-dependent diabetes mellitus (IDDM) patients with parietal cell antibodies (2). Evidence for type 1 diabetes being an autoimmune process is based on the presence of ‘‘diabetes autoantibodies’’ (3). The role of CD4þCD25þ regulatory T cells in protecting against a variety of autoimmune diseases is admitted (4). Autoimmune gastritis is a disease caused by a CD4þT cell response to the gastric Hþ/Kþ-ATPase encoded by Atp4a and Atp4b Hþ/Kþ-ATPase. In recent experimental work on mice, it is proposed that prevention of autoimmune gastritis requires extrathymic T cell deletion and suppression by regulatory T cells (5). We report the case of a boy with early IDDM who developed an extensive exfoliative gastritis progressing toward mucosal atrophy with intestinal and malpighian metaplasia. An attenuated form of immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) was eventually confirmed by FoxP3 mutation.

Profile of pediatric Crohn's disease in Belgium

AIMnA Belgian registry for pediatric Crohns disease, BELCRO, was created. This first report aims at describing disease presentation and phenotype and determining associations between variables at diagnosis and registration in the database.nnnMETHODSnThrough a collaborative network, children with previously established Crohns disease and newly diagnosed children and adolescents (under 18 y of age) were recruited over a 2 year period. Data were collected by 23 centers and entered in a database. Statistical association tests analyzed relationships between variables of interest at diagnosis.nnnRESULTSnTwo hundred fifty-five patients were included. Median age at diagnosis was 12.5 y (range: 1.6-18 y); median duration of symptoms prior to diagnosis was 3 m (range: 1-12 m). Neonatal history and previous medical history did not influence disease onset nor disease behavior. Fifty three % of these patients presented with a BMI z-score < -1. CRP was an independent predictor of disease severity. Steroids were widely used as initial treatment in moderate to severe and extensive disease. Over time, immunomodulators and biological were prescribed more frequently, reflecting a lower prescription rate for steroids and 5-ASA. A positive family history was the sole significant determinant for earlier use of immunosuppression.nnnCONCLUSIONnIn Belgium, the median age of children presenting with Crohns disease is 12.5 y. Faltering growth, extensive disease and upper GI involvement are frequent. CRP is an independent predictive factor of disease activity. A positive family history appears to be the main determinant for initial treatment choice.

Improvement of the eradication rate of Helicobacter pylori gastritis in children is by adjunction of omeprazole to a dual antibiotherapy

Aim: The possible improvement of efficacy and tolerability of a 7‐day dual antibiotherapy amoxicillin‐clarithromycin (AC) on the eradication of Helicobacter pylori (H. pylori) gastritis in children by the adjunction of omeprazole (OAC) was studied.

COMBINED IMPACT OF MUCOSAL DAMAGE AND OF CYSTIC FIBROSIS ON THE SMALL INTESTINAL BRUSH BORDER ENZYME ACTIVITIES

Abstract In 61 cystic fibrosis (CF) patients, the small intestinal mucosa was studied at the time of diagnosis before starting therapy. In 19 out of 61 patients, partial villous atrophy on light microscopy and shortened villi on stereomicroscopic examination were seen. On the biopsy specimens, maltase, sucrase, lactase and alkaline phosphatase activities were studied. Comparison of the enzymatic activities in CF patients having damaged mucosa and a group of patients having similar mucosal lesions of unspecified origin (UTID), reveals a significantly more pronounced decrease of the alkaline phosphatase activity (p<0.005) in the CF patients. This is in agreement with previous reported results in CF patients with normal mucosa. The abnormal mucosal findings could be due to the decreased neutralization of the gastric content delivered into the duodenum, the early inflammatory reaction present in the CF mucosa and/or to the impaired synthesis of membrane glycoproteins and enzymes secondary to the CFTR mutation.

Colon transit time in healthy children and adolescents

PurposeThe aims of this study are to describe normal colon transit time (CTT) in healthy children, correlate results with age, the Bristol stool scale, and stool frequency, and to evaluate intra- and interobserver variability.MethodsInclusion criteria were as follows: healthy children between 3 and 18xa0years old with a normal defecation pattern, no history of abdominal surgery, and no medication use. Total and segmental CTT is measured by taking ten polythene radiopaque markers during six consecutive days followed by a single abdominal X-ray on day 7. Total and segmental CTT are calculated by multiplying the number of markers by 2.4 (Abrahamsson et al. Scand J Gastroenterol 32:72–80, 1988).ResultsFifty-four children and adolescents have participated: 30 boys and 24 girls (median age 10xa0years (3–18xa0years)). Median total CTT is 36xa0h (<2.4–86.4xa0h). There is no significant difference for age category (toddlers 31.2xa0h (<2.4–74.4xa0h), elementary school 36xa0h (2.4–79.2xa0h), and adolescents 43.2xa0h (14.4–86.4xa0h)). Segmental CTT reveals a median right colon CTT of 4.8xa0h (0–28.8xa0h); a median left colon CTT of 2.4xa0h (0–31.2xa0h); and a median rectosigmoidal CTT of 24xa0h (0–64.8xa0h). The Bristol stool scale correlates with total CTT (pu2009=u20090.031). The intra- and interobserver variability displays an ICC of 0.999 for the total CTT.ConclusionThe CTT of normal healthy children is not sex- or age-related (above the age of 3xa0years). The Abrahamson method for CTT measurement by using bony landmarks for the determination of colon segments is easy to perform and well tolerated with a virtual inexistent rating difference between different observers.

Raised immunoglobulin A and circulating T follicular helper cells are linked to the development of food allergy in paediatric liver transplant patients

Post‐transplant food allergy (LTFA) is increasingly observed after paediatric liver transplantation (LT). Although the immunopathology of LTFA remains unclear, immunoglobulin (Ig) E seems to be implicated.

Safety And Cost Of Infliximab For The Treatment Of Belgian Pediatric Patients With Crohn’s Disease

Biologicals have become an important component in the treatment of Crohns disease in children. Their increased and long term use raises safety concerns. We describe safety and cost of infliximab in Belgian pediatric Crohns disease patients. All patients on infliximab as part of the present or past treatment for Crohns Disease until January 1st 2011 were selected from an existing database. Information on disease phenotype, medication and adverse events were extracted. Adverse events occurred in 25.9% of patients exposed to infliximab of which 29.6% were severe. In total 31.7% of patients stopped infliximab therapy. The main reasons for discontinuation were adverse events in 45.4% and loss of response in 30.3%. No malignancies or lethal complications occurred over this 241 patient year observation period. Immunomodulators were concomitant medication in 75% of patients and were discontinued subsequently in 38.4% of them. The cost of infliximab infusions per treated patient per year in the Belgian health care setting is approximately 9 474 euro, including only medication and hospital related costs. Even though infliximab is relatively safe in pediatric CD on the short term, close follow-up and an increased awareness of the possible adverse reactions is highly recommended. Adverse reactions appeared in 25.9% of all patients and were the main reason for discontinuation. Treatment cost has to be balanced against efficacy and modifications in disease course. In the Belgian health care system, the medication is available to all patients with moderate to severe CD.

Nutritional intake evolution in adolescent sporting boys over the last two decades.

Abstract The AIM of the study was to evaluate the nutritional trends in young elite male soccer players, attending national soccer league at RFC Bruges over the last two decades. At the start of each season, players and parents are instructed about normal healthy nutrition and fluid intake by dieticians. METHODS: Since1983, dieticians perform dietary habit surveys in the adolescent player groups. They instruct players and parents how to record all food and fluid intake during 3 days, a training-day, a match-day and an off-day. It is asked to do the recordings when players and parents are together and parents are asked to supervise the recording. Intakes are calculated using the Becel institute nutrition software (BINS), Becel®, 2003. RESULTS: A significant decrease of energy intake/m2 is observed over the last 20 years. Body composition, measured as age-matched body mass index remained at median levels for the population during this period. An important modification of dietary content towards the recommended daily intakes is observed. Fat, saturated fat and cholesterol intake decreased dramatically. Carbohydrate intake increased. CONCLUSIONS: A positive evolution towards the recommended dietary composition is observed over the years. However, the decrease in caloric intake without influence on the body mass index could suggest that these elite male footballers have a decreased physical activity as compared to 20 years ago.

THORACIC DUCT LIGATION AS TREATMENT OF CHYLOTHORAX DUE TO VENA CAVA SUPERIOR THROMBOSIS

Abstract Thrombosis is a well known complication of subclavian vein catheterization. As collateral circulation develops, consequences are usually limited to the fact that this vein is no longer usable as an access route. However, one of the possible complications of a superior vena cava thrombosis is the development of a chylothorax. We describe an infant developing a chylothorax caused by a SVC thrombosis after subclavian vein catheterization for parenteral nutrition. The chylothorax did not resolve following conservative management, but was successfully treated by surgical ligation of the thoracic duct.

Anal Canal Duplication in an 11-Year-Old-Child

Anal canal duplication (ACD) is the least frequent digestive duplication. Symptoms are often absent but tend to increase with age. Recognition is, however, important as almost half of the patients with ACD have concomitant malformations. We present the clinical history of an eleven-year-old girl with ACD followed by a review of symptoms, diagnosis, treatment, and prognosis based on all the reported cases in English literature.