Shoma Dutt

Detection and isolation of Campylobacter species other than C. jejuni from children with Crohn's disease.

ABSTRACT The presence of Campylobacter species other than Campylobacter jejuni and antibodies to Campylobacter concisus in children were investigated. A significantly greater presence of C. concisus and higher levels of antibodies to C. concisus were detected in children with Crohns disease (CD) than in controls. Campylobacter species other than C. jejuni were isolated from intestinal biopsy specimens of children with CD.

Detection of Helicobacteraceae in intestinal biopsies of children with Crohn's disease.

Background:  Given that members of Helicobacteraceae family colonize the intestinal mucus layer, it has been hypothesized that they may play a role in Crohn’s disease. This study investigated the presence of Helicobacteraceae DNA in biopsies collected from children with Crohn’s disease and controls.

Prospective peer-review audit of paediatric upper gastrointestinal endoscopy.

Aim:  To describe the findings of paediatric upper gastrointestinal endoscopy (UGE) and to reduce the rate of normal findings in children undergoing diagnostic UGE.

Are We Overdoing Pediatric Lower Gastrointestinal Endoscopy

Introduction: Lower gastrointestinal endoscopy (LGIE)/colonoscopy is frequently performed for rectal bleeding, recurrent abdominal pain, and the diagnosis of inflammatory bowel disease (IBD). Although these are common indications, the causes of isolated rectal bleeding and recurrent abdominal pain in the otherwise well child have not been described. Methods: A retrospective analysis of patients who had had an LGIE/colonoscopy from January 2001 to December 2010 was performed. The following data were collected: demographic data, indication, distance reached, macroscopic findings, microscopic findings, diagnosis, additional procedures, and complications. Results: There were a total of 999 colonoscopies. The colonoscopy was normal in 390 of 999 (39%). The commonest indication for colonoscopy was a diagnosis of suspected IBD, 449 of 999 (45%). IBD was confirmed in 282 of 449 (63%), but colonoscopy was normal in 143 of 449 (32%) of suspected IBD. Colonoscopy was performed for rectal bleeding in 197 of 999 (20%) of whom 141 of 197 (72%) were normal. There were 46 (5%) colonoscopies performed for recurrent abdominal pain, which were all normal. Our completion rate to the cecum and beyond was 521 of 999 (52%). Our perforation rate during the 10 years was 0.2%. Conclusions: Colonoscopy is a safe procedure in pediatrics; however, 39% of colonoscopies in this series were normal. Many of these could have been avoided by eliminating colonoscopy in patients with recurrent abdominal pain in the absence of other clinical features, conservative management with laxatives for those with fresh blood per rectum typical of anal fissures, and fecal calprotectin screening before endoscopy in patients with suspected IBD.

Recombinant parathyroid hormone therapy for severe neonatal hypoparathyroidism.

Hypoparathyroidism-retardation-dysmorphism (HRD) syndrome (OMIM 241410), also known as SanjadSakati syndrome, is a rare autosomal recessive disorder characterized by hypoparathyroidism, growth failure, developmental delay, and characteristic facies. We describe the effective short-term use (tapered over 12 days) of recombinant parathyroid hormone (PTH) (teriparatide) in an unusual genetic condition characterized by hypoparathyroidism. Standard treatment for hypoparathyroidism involves oral vitamin D analogues and calcium, often in large doses to achieve sufficient intestinal calcium transport to overcome the hypercalciuria and concomitant malabsorption. 1 Despite its known physiological benefits, 2 recombinant PTH is not usually considered in the treatment algorithm for hypoparathyroidism in the pediatric population. Case Report Approval for this case report was obtained from the Human Research Ethics Committee of The Children’s Hospital at Westmead. Informed consent was obtained from the family. A female infant was born to first-cousin Iraqi parents at 31 weeks gestation, after an antenatal course that included oligohydramnios and fetal growth restriction. The parents had previously experienced 2 first-trimester miscarriages and fetal death at 30 weeks, and the current pregnancy was conceived after in vitro fertilization. She had a birth weight of 1190 g (SDS, 1.02), length of 36.5 cm (SDS, 1.77), and head circumference of 25.4 cm (SDS, 1.61). Dysmorphic features included deep-set eyes, large ears with hypoplastic posterior helices, and a thin nose (Figure 1). The newborn period was complicated by respiratory distress syndrome, treated with surfactant, mechanical ventilation, and continuous positive airway pressure. Significant feeding intolerance and vomiting were present from the first week of life. Upper gastrointestinal studies showed gastric hypomotility and delayed passage into the duodenum with no mechanical obstruction. Transpyloric tube feeding was started at 4 weeks after birth. Fat malabsorption was confirmed by fecal fat analysis and low serum vitamin A and E levels. Results of a sweat test were normal. Pancreatic enzyme replacement and fat-soluble

Campylobacter concisus: a New Character in the Crohn's Disease Story?

I read with extreme interest the article by Zhang et al. ([7][1]) about a high prevalence of Campylobacter concisus DNA as well as of immunoglobulin G antibodies to C. concisus in children with Crohns disease. The role of bacteria in the pathogenesis of inflammatory bowel disease is well recognized

Pediatric-to-adult Transition and Medication Adherence in Patients with Inflammatory Bowel Disease

Background: Medication nonadherence is common in inflammatory bowel disease and is associated with poor outcomes. There has been no study on pediatric-to-adult transition as a risk factor for nonadherence in inflammatory bowel disease, which has been demonstrated in other diseases. We aimed to assess whether transitioned (TR) patients have higher nonadherence rates than young adults (YAs) diagnosed in adulthood. Methods: Consecutive ambulatory subjects were prospectively recruited and completed the validated Medication Adherence Reporting Scale (MARS), with the primary outcome being adherence differences between group age-matched TR and YA groups. Pediatric subjects were taken as the control group. Perceptions of medication-related necessity and concerns were assessed with the Beliefs about Medicines Questionnaire (BMQ). Nonadherers (defined as MARS ⩽16) received the Inflammatory Bowel Diseases Pharmacist Adherence Counselling (IPAC) intervention and adherence change was reassessed after 6 months as a secondary outcome. Results: Adherence in TR patients (n = 38, mean age 20.4, 13.2% nonadherent) was noninferior to and numerically better than YAs diagnosed in adulthood (n = 41, mean age 21.2, 24.4%). Nonadherence in the pediatric control group (n = 50, mean age 14.7) was 8.0%. YAs had significantly higher medication-related concerns (14.6 versus 11.9, P = 0.02) than the pediatric group. The IPAC intervention reduced nonadherence rates by 60% (P = 0.004). Conclusions: TR patients did not have worse adherence than YAs diagnosed in adulthood. Protective factors may include previous treatment in pediatric centers and the salient symptomatology of inflammatory bowel disease, whereas increasing concerns over medications contribute to nonadherence in YAs. Pharmacist-led counselling improves adherence in these patients.

Bile salt stimulated lipase: Inhibition by phospholipids and relief by phospholipase A2

INTRODUCTION Bile salt stimulated lipase (BSSL; Enzyme Commission (EC) number 3.1.1.13) has been a candidate triglyceridase for improving enzyme therapy for pancreatic insufficiency; however, its efficacy is near absent. We hypothesise that similarly to pancreatic lipase, BSSL is inhibited by phospholipids and this inhibition is relieved by Phospholipase A2 (PLA2; EC 3.1.1.4), and the present study was undertaken to explore this possibility. MATERIALS AND METHODS Synthetic emulsions of triglyceride and phosphatidylcholine (PC) or lysophosphatidylcholine (LPC)/bile salt mixed micelles were used as a model of intestinal digestion-media. The effect of PLA2 treatment of systems containing PC on BSSL activity was also explored. Automatic titration at constant pH (pH-stat) and nuclear magnetic resonance (NMR) spectroscopy were used to measure the rate and identify products of lipolysis. RESULTS PC was inhibitory to BSSL activity, while LPC became inhibitory only above an LPC/bile salt concentration ratio of 0.3. PLA2 treatment relieved the inhibition only below this ratio, despite its complete phospholipid-hydrolysing action. Thus, LPC had an inhibitory effect at higher concentrations. CONCLUSIONS These results may implicate a change in the design of enzyme therapy in patients with pancreatic exocrine insufficiency. Supplementation of BSSL with PLA2 could improve patient health with adequate manipulation of phospholipid and lysophospholipid concentrations in the intestinal fluid.

An unusual case of haemolytic anaemia and failure to thrive in a Burmese refugee baby

An unusual case of haemolytic anaemia and failure to thrive in a Burmese refugee baby Sandra Y-C Chuang, Louise Sealy, Hiran Selvadurai, Shoma Dutt and Chee Y Ooi 1,6 Discipline of Paediatrics, School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Respiratory Department, and Department of Gastroenterology, Sydney Children’s Hospital, Respiratory Department, and Department of Gastroenterology, Children’s Hospital at Westmead, Sydney Medical School, Discipline of Paediatric and Child Helath, University of Sydney, Sydney, New South Wales, Australia

Raised tacrolimus level and acute renal injury associated with acute gastroenteritis in a child receiving local rectal tacrolimus

Local rectal application of tacrolimus in distal colitis, pouchitis and perianal Crohn’s disease has previously been reported to be both effective and safe. We report a patient treated with per rectum local application of tacrolimus, who developed toxic levels of tacrolimus and acute renal injury during an episode of acute gastroenteritis. This case illustrates that local application of tacrolimus, although usually safe, may be associated with significantly raised tacrolimus levels and acute renal injury during acute gastroenteritis. It is important for physicians to be aware of this association when prescribing local rectal tacrolimus.