Association of gastroesophageal reflux with obstructive lung disease in children after allogeneic bone marrow transplantation.
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Adolescent↗
Biomedical subjects
D M Israel
Publications and source records attributed to D M Israel.
Prolonged use of gastrostomy for enteral hyperalimentation in children with Crohn's disease.
OBJECTIVES: To evaluate the safety of gastrostomy tube (G-tube) placement in children with Crohn's disease and the efficacy of prolonged enteral hyperalimentation in children with growth failure complicating Crohn's disease. METHODS: Twenty children with Crohn's disease and growth failure were offered enteral hyperalimentation via nasogastric tube (NG-tube) for treatment of growth arrest, with follow-up for complications, compliance, and response to nutritional support. The use of a G-tube was offered to children who refused to use the NG-tube. Medical and surgical management were provided as dictated by the disease activity. RESULTS: Thirteen children were started on NG-tube feeds, and five were started on G-tube feeds after refusal to use an NG-tube at the outset. Two children required surgery at the time of diagnosis and had a G-tube placed during the operation. Nine of 13 children found the use of an NG-tube too disruptive and were later changed to a percutaneous endoscopic gastrostomy (PEG) or surgically-placed G-tube. A total of 16 children had a percutaneous endoscopic gastrostomy (eight children) or a surgically-placed G-tube (eight children) for 6-29 months. Two of those children had endoscopic evidence of gastroduodenal Crohn's disease, and six had microscopic patchy chronic gastritis. Minor complications occurred in five of the 16, including external leakage, button dislodgement, local pain, and local wound infection. At this time, the G-tube has been removed from 13 children, 12 of whom had prompt and complete healing of the G-tube site and one of whom had a small gastrocutaneous fistula that required suture for successful closure. Poor compliance with G-tube feeds was observed in four of 16 children. During the period of nutritional support, there was resumption of normal growth rates for all; in addition, eight of 16 had catch-up growth. CONCLUSION: Nutritional therapy is important in the management of children with growth failure due to Crohn's disease, though it may not be the only factor affecting growth. G-tubes are safe and well tolerated by children with Crohn's disease and should be offered to those children who do not tolerate prolonged use of an NG-tube.
Adolescent↗
Partial splenic embolization in children with hypersplenism.
As an alternative to surgical splenectomy, partial splenic embolization was performed in seven children for hypersplenism manifested by splenomegaly, thrombocytopenia, leukopenia, and erythrocyte hemolysis. Within a few days, platelet and leukocyte counts rose significantly in all patients and were maintained in six of seven patients during a follow-up period of 9 to 69 months. Spleen size and abdominal distention also decreased significantly in all children. There were no infectious complications.
Adolescent↗
Successful pancolonoscopy and ileoscopy in children.
The purpose of this study was to collect prospective data regarding the quality, extent, and duration of pediatric pancolonoscopy performed by pediatric gastroenterology attending physicians and a fellow in training. Over 7 months, data were prospectively collected on 40 colonoscopic procedures. The cecum was reached in 37 cases (92.5%) and the terminal ileum in 35 cases (87.5%). When cases of stricture and equipment failure were excluded, these completion rates were 97 and 95%, respectively. The overall average duration for pancolonoscopy, ileoscopy, multiple biopsies, and polypectomy (where necessary) was 38 min. When attending physicians performed the procedure, the duration was 31 min; the duration was 37 min when the fellow completed the procedure and 45 min when the fellow required the attending physician to complete it. The average time taken to reach the cecum by the attending physician was 19 min (range, 8-32); by the fellow it was 25 min (range, 17-32), and by the combination it was 37 min (range, 11-59). The average time from cecum to terminal ileum was 3 min for all, with ranges of 1-12 min for the attending physician and 1-23 min for the fellow. The fellow initiated 24 procedures, of which the attending physician was required to complete 12, including all five procedures performed in the initial 2 months of the study, 7 of 13 in the next 3 months, and none of the six procedures in the last 2 months. Of the 40 examinations, the colon was normal in five (12.5%), and a specific diagnosis was made in 35.(ABSTRACT TRUNCATED AT 250 WORDS)
Biopsy↗
Oral pemphigus vulgaris associated with inflammatory bowel disease and herpetic gingivostomatitis in an 11-year-old girl.
An 11-year-old girl with recently diagnosed oral pemphigus vulgaris developed a severe exacerbation of mouth ulceration due to superinfection with herpes simplex virus type I. A concurrent diagnosis of chronic inflammatory bowel disease was established to explain symptoms of weight loss and intermittent bloody diarrhea that predated the oral ulceration by several years. Herpes simplex infection is a recognized complication of pemphigus vulgaris that may be mistaken for a recrudescence of the disease. The association of pemphigus with chronic inflammatory bowel disease has been documented in a small number of adults. Its relationship to pyostomatitis vegetans, an acknowledged marker for ulcerative colitis and Crohn disease, remains unclear.
Child↗
Treatment and long-term follow-up of Helicobacter pylori-associated duodenal ulcer disease in children.
In a 7-year period, 33 children had endoscopically documented duodenal ulcer disease. Of the 33 children, 29 had Helicobacter pylori antral gastritis. All children with H. pylori-associated duodenal ulcer disease were treated with antibiotics but no H2-receptor blocking agents. For the first 3 years of the study, initial treatment was with bismuth subsalicylate or amoxicillin for 6 weeks. For the latter 4 years, therapy with both bismuth subsalicylate and amoxicillin for 6 weeks was used initially; those in whom treatment failed received bismuth subsalicylate and amoxicillin for 6 weeks, and metronidazole for 4 weeks. Follow-up with endoscopic biopsies was performed immediately after each treatment course and at a mean of 6.5 months after clearance of H. pylori from antral biopsy specimens. Data for noncompliant patients and those receiving nonsteroidal antiinflammatory drugs were analyzed separately. For compliant patients, the rates of H. pylori clearance from antral biopsy specimens immediately after each treatment were as follows: bismuth subsalicylate, 6 of 12 children; amoxicillin, 1 of 5 children; double therapy, 9 of 9 children; and triple therapy, 3 of 3 children. At long-term follow-up, the number of children with no H. pylori in antral biopsy specimens were as follows: monotherapy, 1 of 5; double therapy, 4 of 4; and triple therapy, 3 of 3. Of the noncompliant patients, only 1 of 5 had H. pylori eradication with combination therapy and none had H. pylori eradication with monotherapy. Duodenal ulcer disease had healed in all children with H. pylori-negative antral biopsy specimens at follow-up; duodenal ulcers recurred in all children with persistent or recurrent H. pylori infection. We conclude that therapy with two drugs for 6 weeks is the treatment of choice for endoscopically proved duodenal ulcer and histologically proved H. pylori antral gastritis, and that poor patient compliance reduces the rate of success. Our data strongly support a causal relationship between H. pylori and duodenal ulcer disease.
Adolescent↗
Barrett's esophagus in children with cystic fibrosis: not a coincidental association.
Barrett's esophagus (BE) is a premalignant condition, and a recognized complication of severe gastroesophageal (GE) reflux. Children with cystic fibrosis (CF) have a marked predilection to develop GE reflux, but Barrett's esophagus is one complication of GE reflux not previously described in CF. We describe in detail two adolescents with CF who were found to have Barrett's esophagus, and mention three other cases. The presence of Barrett's esophagus in CF patients may be missed because GE reflux is often relatively silent in CF, because patients may consider mild upper gastrointestinal (GI) symptoms as "part of CF," and because of the nature of Barrett's epithelium itself. Upper gastrointestinal (GI) endoscopy with documentation of landmarks and multiple targeted biopsies should be performed in children with CF with even mild symptoms of GE reflux or an abnormal 24 h intra-esophageal pH study. Any biopsies containing columnar epithelium should be stained with Alcian blue at pH 2.5 to look for goblet cell metaplasia, i.e., Barrett's esophagus. Children with CF may be a high-risk group for development of Barrett's esophagus and its complications, especially given the increased survival in CF.
Adolescent↗
Halothane hepatitis in children.
Halothane hepatitis is now a well-recognized distinct entity in adults, but there prevails an often-taught "axiom" that halothane hepatitis "does not occur" in children. We describe 2 children who developed cholestatic hepatitis following halothane anesthesia. The first patient had no antecedent liver disease, and presented with anorexia, abdominal pain and delayed onset of jaundice after multiple halothane exposures. Halothane-specific antibodies were positive, and liver tests resolved completely. The second patient had antecedent liver disease and presented with delayed onset of unexplained high fevers for 10 days following a single halothane exposure. Gradually increasing cholestasis ensued in the absence of other causes of liver disease. Halothane antibodies were negative. These cases illustrate different clinical presentations of halothane hepatitis, such as delayed onset of jaundice or fever following halothane exposure. The difficulties in making a definitive diagnosis and the need to exclude other causes of liver disease are detailed. Risk factors and other presentations are discussed. While halothane hepatitis appears to be an uncommon entity in children, it does occur, and may present with manifestations less than fulminant hepatic failure. A high index of suspicion and a detailed history of the time sequence of events are necessary as the diagnosis is primarily clinical. Halothane-specific antibodies are helpful if positive. In any child developing unexplained jaundice or high fevers following halothane anesthesia, further exposures should be avoided and halothane-specific antibodies obtained.
Chemical and Drug Induced Liver Injury↗
Arthritis as the initial manifestation of inflammatory bowel disease in early infancy.
We report a 10-month-old infant who had arthritis as the initial clinical manifestation of ulcerative colitis. Arthritis is considered to be the most common extraintestinal manifestation of IBD in adults and children. This case emphasizes that arthritis may be the earliest manifestation of IBD even in the very young infant.
Arthritis↗