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S Cadranel

Publications and source records attributed to S Cadranel.

At least 37 records · Page 2Linked to original sources
PubMed1993

A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: a report from a working group on gastro-oesophageal reflux disease. Working Group of the European Society of Paediatric Gastro-enterology and Nutrition (ESPGAN).

In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux can be safely treated before performing (expensive and often unnecessary) complementary investigations. However, the latter are mandatory if symptoms persist despite appropriate treatment. Oesophageal pH monitoring of long duration (18-24 h) is recommended as the investigation technique of choice in infants and children with atypical presentations of gastro-oesophageal reflux. Upper gastro-intestinal endoscopy in a specialised centre is the technique of choice in infants and children presenting with symptoms suggestive of peptic oesophagitis. Prokinetics, still a relatively new drug family, have already obtained a definitive place in the treatment of gastro-oesophageal reflux disease in infants and children, especially if "non-drug" treatment (positional therapy, dietary recommendations, etc.) was unsuccessful. It was the aim of the Working Group to help the paediatrician with this consensus statement and guide-lines to establish a standardised management of gastro-oesophageal reflux disease in infants and children.

Child↗
PubMed1993

Measurement of urinary sugars by HPLC in the estimation of intestinal permeability: evaluation in pediatric clinical practice.

Determinations of the permeability of the intestine to various sugars have been used to assess intestinal mucosal abnormalities, but the widespread application of such tests has been prohibited by the complexity of most classically used techniques. In this study, we evaluated the sensitivity and practicability of using HPLC to estimate intestinal permeability, with mannitol and lactulose as mono- and disaccharides, respectively. The results of the permeability tests were compared with those of intestinal biopsy in 20 children. All patients with an abnormal intestinal biopsy showed a low mannitol recovery, and the patients with allergic symptoms showed a high lactulose recovery. Our preliminary data suggest that HPLC is reliable, gives results comparable with those of other methods, and is a practical way to determine intestinal permeability noninvasively.

Adolescent↗
PubMed1992

Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants.

We studied sleeping infants in order to investigate whether a temporal relation exists between acid reflux extending to the proximal portion of the oesophagus and cardiorespiratory events. One hundred infants with occasional regurgitations were studied: 50 infants admitted after an apparently life-threatening event (ALTE) that occurred during sleep and that remained unexplained despite medical investigation, and 50 asymptomatic infants (non-ALTE). The infants had a median age of 8 weeks (range 4-26 weeks); 54 were boys. In each child a pH probe was placed in the proximal portion of the thoracic oesophagus, under radiological control. Polygraphic monitoring of state of alertness, cardiorespiratory activity, and proximal oesophageal pH changes was conducted continuously during 1 night. The data were analysed blind. In 80 infants a total of 186 decreases in oesophageal pH below 4 units were seen; 37% occurred during wakefulness, and 40% during rapid eye movement (REM) sleep. A total of 7029 central and 61 obstructive apnoeas were monitored, mainly during REM sleep. Within 5 min before, and 5 min after the drops in pH, there was no difference in the number, or the duration of bradycardia, central, mixed, or obstructive apnoea. The infants with an ALTE could not be differentiated from the non-ALTE infants for any of the variables studied. It is concluded that spontaneous acid refluxes extending to the proximal portion of the oesophagus during sleep are usually not temporally related with the development of apnoeas or bradycardias.

Female↗
PubMed1992

Midgut malrotation, the reliability of sonographic diagnosis.

We are unaware of any other anatomical study which deals with normal variations in the relationship between the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV). In our investigation in the majority of cases, the SMV lies to the right of the SMA. It has been suggested that ultrasonographic demonstration of a left sided SMV, is characteristic of midgut malrotation so a prospective study was undertaken in order to try to correlate the position of the mesenteric vessels on Ultrasound with the radiological diagnosis of midgut malrotation on upper GI series. 427 children (95% infants) who were planned for upper GI investigation, have had color Doppler U.S. of the mesenteric vessels before the barium study. In 67 cases, the mesenteric vessels were obscured by intestinal gas. Among them, there were 2 cases of malrotation. Three different positions of the mesenteric vessels were found in the 360 remaining cases. 1) A left sided SMV was found in 4% of the cases, all had midgut malrotation on X-rays and at surgery. 2) A mesenteric vein anterior to the SMA was found in 5% of the cases, 28% had midgut malrotation. 3) A normal right sided SMV was found in 91% of the cases. However 3% of these had midgut malrotation. There are anatomical variations in the position of the mesenteric vessels and a normal relationship between SMA and SMV does not exclude the possibility of intestinal malrotation. Nevertheless, ultrasound remains a useful noninvasive screening technique for the diagnosis of midgut malrotation.

Cecal Diseases↗
PubMed1992

Contribution of the 13C-urea breath test to the detection of Helicobacter pylori gastritis in children.

Serology, 13C-urea breath test, histology, Campylobacter-like organism testing, and culture were performed in 95 consecutive children to evaluate the contribution of these tests to the detection of Helicobacter pylori infection. In analyses considering any combination of three positive tests as "gold standard" for diagnosing H pylori infection, 26 children were Helicobacter positive (27%), which is only one patient more than the number of children with only a positive culture. The accuracy of culture was excellent when "any combination of three positive tests" was used as the gold standard (sensitivity 96%, specificity 100%, positive predictive value 100% [false positivity 0%], negative predictive value 99% [false-negative results 1%]). The results of invasive and noninvasive tests were comparable. When culture was considered as "gold standard," the sensitivity of serology and 13C-urea breath test was 96%; the specificity was 96% and 93%, respectively; the positive predictive value was 89% and 83% (false-positive results in 11% and 17%); and the negative predictive value for both was 99% (false-negative results in 1%). It is concluded that culture can be used as gold standard, but that non-invasive tests such as serology and/or 13C-urea breath test can be used to diagnose H pylori infection in children, since each has at least 95% sensitivity and 92% specificity.

Adolescent↗
PubMed1991

Measurement of colonic transit time in children.

Transit times through the whole colon and its segments were measured in 10 healthy children and 14 children suffering constipation secondary to myelomeningocele. The subjects ingested radio-opaque markers on three successive days, and on the fourth a plain abdominal roentgenogram was taken using fast film. In the healthy children, total colonic transit time (mean +/- SD) was 37.8 +/- 6.2 h, with segmental times of 10.8 +/- 3.5 h for the right colon, 12.2 +/- 2.7 h for the left, and 14.7 +/- 2.1 h for the rectosigmoid; upper normal limits of 17.8 h for the right colon, 17.6 h for the left, 19.1 h for the rectosigmoid, and 50.2 h for the total colonic transit time were established. In the constipated children, the total transit time was 59.9 +/- 5.4 h, with segmental times of 15.9 +/- 2.3 h for the right colon, 18.9 +/- 2.3 h for the left, and 25.0 +/- 2.6 h for the rectosigmoid. The technique described is simple, is easy to use in clinical practice, and involves a lower radiation dose than other methods. It may prove useful for measurement of colonic transit time in suitable patients.

Adolescent↗
PubMed1991

Arousals induced by proximal esophageal reflux in infants.

We investigated whether acid reflux in the proximal esophagus can induce arousal from sleep in infants. Fifty normal infants with occasional regurgitations were studied at the age of 8 weeks (range 4-26 weeks). In each child a pH probe was placed in the proximal portion of the thoracic esophagus, in front of the third vertebra, under radiologic control. Polygraphic monitoring of state of alertness and of proximal esophageal pH changes was recorded continuously during one night. The data were analyzed blind. For 41 of the 50 infants, a total of 97 drops below pH 4 was computed. Reflux was more frequently associated with wakefulness (41% of the episodes), or rapid eye movement (REM) sleep (39%), than with nonREM (19%) or indeterminate sleep (1%). Comparing the fifth and the last minutes preceding the pH drops, a significant increase in the number of behavioral arousals was observed (p = 0.003). In comparison with the minute before the drop in esophageal pH, a further significant increase in the number of arousals occurred during the first minutes following the pH drop (p = 0.001). Although the first minutes following the 97 episodes of reflux represented only 0.4% of the total sleep time, 76% of all arousals (74 out of 97) took place during this time period (p = 0.001). Five minutes after the pH drops, the behavioral changes tended to return to prereflux values. It is concluded that in infants, during sleep, proximal gastroesophageal reflux can act as a strong arousal stimulus.

Arousal↗
PubMed1990

Post-necrotising enterocolitis pseudo-obstruction treated with Cisapride.

We report on one patient in whom segmental colic intestinal pseudo-obstruction (IPO) following the surgical treatment of a grade III necrotising enterocolitis (NEC) was responsible for a severe failure to thrive. Further intestinal resection in an already short gut was avoided by using Cisapride, a new intestinal prokinetic agent (1 mg/kg/d in 4 doses, orally), which dramatically improved the symptoms and allowed weight gain and intestinal adaptation. After 6 months, Cisapride was withdrawn. IPO did not recur after 2 years of follow-up, although proximal distention persisted.

Cisapride↗
PubMed1990

Caustic ingestion and esophageal function.

The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

Accidents, Home↗
PubMed1988

IgA immune response patterns to gliadin in serum.

The incidence, titer and molecular size of anti-gliadin (GL) IgA were analyzed in sera from children with celiac disease (CD, n = 66), hospitalized control children (n = 64) and children with other malabsorption disorders (n = 103). Anti-GL IgA was assessed by solid-phase radioimmunoassay, and its molecular size was analyzed by sucrose density gradient ultracentrifugation. The median anti-GL IgA titer was significantly higher in untreated CD than in the other groups, with some overlap. Whereas 57% of anti-GL IgA were polymeric IgA (pIgA) in acute CD, only 17% were pIgA in children with other malabsorption disorders. These anti-GL pIgA consisted mainly of dimers with in some children, a low proportion of anti-GL secretory IgA (SIgA). A large proportion of anti-GL pIgA was associated with high total serum IgA. After the onset of a gluten-free diet (GFD), anti-GL pIgA disappeared more quickly from serum than mIgA. During the gluten challenge test, anti-GL IgA comprised 20% pIgA when they reappeared in serum, but 59% pIgA at the end of the test. The presence of anti-GL pIgA in serum seems related to chronic exposure to gluten of CD patients with a flat intestinal mucosa. These serum pIgA antibodies could result from a spillover from the intestinal mucosal synthesis into the circulation.

Antibodies, Anti-Idiotypic↗
PubMed1987

Gastric emptying with gastro-oesophageal reflux.

The time taken for gastric emptying of a liquid (milk) or a semi-liquid (pudding) meal was evaluated in 477 infants and children. These patients were referred for suspected gastro-oesophageal reflux and underwent gastro-oesophageal scintigraphy, prolonged oesophageal pH study, manometric evaluation of the lower oesophageal sphincter pressure, and fibreoptic endoscopy. No difference in gastric emptying was observed in children aged under 3 years, regardless of the presence or absence of the gastro-oesophageal reflux, the pressure of the lower oesophageal sphincter, or the presence of oesophagitis. In children over 6 years, however, gastric emptying was significantly delayed in those presenting with reflux compared with those without reflux; in children over 3 years there was slower gastric emptying in those with a decreased lower oesophageal sphincter pressure compared with those with higher pressure and in those with overt oesophagitis compared with those without oesophagitis. This study suggests that gastro-oesophageal reflux is more severe in childhood than in infancy, probably due to more complex motor disorders affecting the gastric fundus as well as lower oesophageal sphincter function.

Adolescent↗
PubMed1987

Vaccination of newborns of HBsAg-positive carrier mothers with a recombinant DNA hepatitis B vaccine.

Thirty neonates born to HBsAg-positive mothers were vaccinated with a 20 microgram dose of the SmithKline Biologicals recombinant DNA yeast-derived vaccine within 24 hours after birth, with similar inoculations repeated 1 and 2 months later. Preliminary results indicate that the recombinant vaccine was well tolerated and immunogenic. A 100% seroconversion rate was achieved 4 months after the first vaccine dose and the anti-HBs geometric mean titres progressively rose from 14 to 31,279 and 361 IU/l at months 1, 2, 4, and 6, respectively. Although a longer period of observation and comparison with a historical control group are needed to evaluate its protective efficacy in this high-risk population, the fact that no vaccinated newborns have been infected is encouraging.

Antigens↗
PubMed1987

Gastro-oesophageal reflux in paediatric patients: studies with alizapride.

A series of studies was carried out in infants and children suffering from gastro-oesophageal reflux to assess the therapeutic efficacy and tolerability of alizapride, a recently developed dopaminergic-receptor blocker. Investigational techniques such as manometry, pH monitoring, endoscopy and scintigraphy were used to evaluate a prokinetic activity of the drug and its effects on oesophageal and gastric motility when given by the intravenous and oral routes. Preliminary findings indicate that alizapride had a significant effect on lower oesophageal sphincter pressure and peristaltic wave amplitude, but the evidence for an effect on gastric motility was less clear. Long-term treatment with oral alizapride (usually in a dosage of 5 mg/kg/day) suggests that it produced marked symptomatic improvement and was very well tolerated in the majority of the patients studied. A double-blind controlled trial is now in progress to provide more objective evidence of the usefulness of alizapride in the management of digestive tract motor disorders in paediatric patients.

Adolescent↗