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Biomedical subjects

S Cucchiara

Publications and source records attributed to S Cucchiara.

At least 91 records · Page 5Linked to original sources
PubMed1990

Value of the 24 hour intraoesophageal pH monitoring in children.

Twenty four hour oesophageal intraluminal pH probe studies were performed in 114 children (range age: one month-12 years) referred for symptoms or signs compatible with gastroesophageal reflux. Forty five patients had reflux disease alone, 69 had evidence of oesophagitis which was assessed endoscopically and histologically. Recordings were also performed in 63 control patients. The occurrence of reflux was analysed for the total study period and particularly while awake, asleep, fasting, and during postcibal periods. Oesophageal acid exposure time and the number of reflux episodes lasting greater than five minutes during the total study period provided the best discrimination between patients and controls; however, 20% and 30% of all reflux patients had both normal (with 2 SD of control) acid exposure time and number of long lasting reflux episodes, respectively. Patients with oesophagitis had significantly more acid reflux than those with simple uncomplicated disease during postcibal, fasting, awake periods, but not during sleep; however, increasing severity of oesophagitis was not associated with increasing acid exposure. The ability of the intraluminal oesophageal pH test to discriminate patients with various degrees of reflux disease decreased if only postprandial pH variables were taken into account. We conclude that: (1) the 24 hour intraoesophageal pH monitoring may present false negative results that limit overall sensitivity of the test; (2) the presence of oesophagitis does not seem to be associated with increased oesophageal acid exposure during sleep; (3) limiting the pH recording to postprandial periods reduces the discriminatory power of the test.

Child↗
PubMed1989

Cimetidine treatment of reflux esophagitis in children: an Italian multicentric study.

The effectiveness of cimetidine (30-40 mg/kg/day) was evaluated in 32 children with gastroesophageal reflux disease complicated by esophagitis who entered a random double-blind trial for 12 weeks. Esophagitis was diagnosed in all patients by endoscopy with biopsy. Seventeen patients (age, mean +/- SD: 21.7 +/- 37.65 months) received cimetidine (c-pts), and 15 (age, mean +/- SD: 29.03 +/- 39.73 months) received a placebo (p-pts). All patients received intensive postural therapy. Based on clinical and endoscopic (and histologic) data, 12 c-pts and three p-pts were healed (p less than 0.01), the condition of four c-pts and three p-pts had improved (not statistically significant), and the condition of one c-pt and nine p-pts had worsened (p less than 0.01). Both clinical and esophagitis scores significantly decreased only in the c-pt group, as compared with p-pts. Improvement of esophagitis was seen in all (100%) of c-pts with mild or moderate esophagitis versus 57.14% of p-pts (p less than 0.01) and in 87.5% of c-pts with severe esophagitis as compared with 25% of the p-pt group (p less than 0.01). We conclude that cimetidine is an effective agent for treatment of reflux esophagitis in children. Although gastroesophageal reflux disease in infancy has a naturally self-limited course with conservative care (thickened feedings and posture adjustment), extensive pharmacologic therapy is needed in the presence of esophagitis.

Adolescent↗
PubMed1989

Esophageal aperistalsis due to reflux esophagitis: a report of two cases.

Two small infants with gastroesophageal reflux disease and esophagitis are reported. Esophageal manometry revealed in both patients severe abnormalities consisting of aperistalsis and simultaneous low-amplitude motor waves. In one of the patients, defective relaxation of lower esophageal sphincter was also noted. Short-term intensive treatment with H2 antagonists resulted in symptomatic and endoscopic improvement as well as in manometric normalization. It is suggested that severe esophagitis may affect control mechanisms of esophageal motility, resulting in loss of coordination and decreased amplitude of contractions.

Deglutition↗
PubMed1989

Bowel frequency in healthy children.

Bowel frequency was recorded, on a diary sheet basis, in 662 children from six Italian cities. There is a wide interindividual variability, showing a sharp decrease with age; we report the distribution of the percentiles in the different age groups. Among infants, the breast-fed ones pass significantly more stools than the formula-fed.

Child↗
PubMed1989

[Treatment of chronic functional constipation in children by administration of vegetable fiber (Dicoman 5)].

Chronic functional constipation is a common clinical disorder in pediatric age. Thirteen children with functional constipation were treated by administration of vegetable fibres together with a toilet training program, for two months. In each patient anorectal manometry showed presence of inhibitory anal reflex and diagnosis of constipation was confirmed by a prolonged gastrointestinal transit time measured by radio-opaque markers. In all patients there was a significant improvement in both stool frequency and intestinal transit time; furthermore, a normalization of anorectal motility variables was observed at rectal manometry. No changes in the blood levels of nutritional parameters were seen in any patient. It is concluded that vegetable fibres represent an effective treatment of functional chronic constipation in children.

Child↗
PubMed1988

Cisapride restores the decreased lower oesophageal sphincter pressure in reflux patients.

The effect of the new prokinetic drug cisapride on the resting lower oesophageal sphincter pressure and on the strength of peristaltic contractions was studied in 10 healthy controls and in 10 reflux patients with abnormally low (less than 10 mm Hg) basal lower oesophageal sphincter pressure. A slow intravenous injection of cisapride 10 mg significantly increased the sphincter pressure in the controls but even more in the patients in whom it almost doubled the resting lower oesophageal sphincter pressure of 8.7 (0.5) mm Hg to between 15 and 20 mm Hg for at least 90 min. Results are expressed as mean (SE). Cisapride also significantly increased the amplitude of peristaltic contractions in controls and reflux patients. Therefore, cisapride might be useful in the treatment of reflux.

Adult↗
PubMed1987

Cisapride for gastro-oesophageal reflux and peptic oesophagitis.

Twenty children (age range 75 days-47 months) with reflux oesophagitis entered a random double blind trial in which they received either Cisapride (Janssen Pharmaceutical Ltd), a new prokinetic agent, or an identical placebo syrup. Diagnosis of gastro-oesophageal reflux was made by measurement of intraluminal oesophageal pH combined with manometry. Oesophagitis was assessed in all patients by histological examination of mucosal specimens taken during oesophagogastroduodenoscopy. Manometry, pH test, and endoscopy with biopsy examination were repeated at the end of the treatment period. Seventeen patients completed the trial, eight of whom were taking the drug and nine the placebo. Mean total clinical score and post-prandial reflux time (% of reflux) significantly improved in patients in the group given Cisapride but not in the group given placebo. Furthermore, there was a significant improvement of the histological oesophagitis score only in the children in the group given Cisapride, whereas placebo was ineffective. It is concluded that Cisapride is a useful agent both for the relief of symptoms of gastro-oesophageal reflux and for the healing of peptic oesophagitis in infancy.

Child, Preschool↗
PubMed1986

Esophageal motor abnormalities in children with gastroesophageal reflux and peptic esophagitis.

Esophageal motility was studied in 26 children with gastroesophageal reflux. In 11 patients (group A), esophagitis was severe; in the remaining 15 (group B), either mild or no microscopic changes were found. Lower esophageal sphincter pressure and amplitude, as well as velocity and duration of esophageal pressure waves, were manometrically measured. All patients underwent a 12-week intensive antacid course. Manometric tracings, blindly read, were compared with those of 16 age-matched children with emesis without proven reflux (group C). Among the variables analyzed, amplitude of the motor waves was significantly lower in patients with severe esophagitis than in group B and C patients (P less than 0.01). Nonspecific motor defects (simultaneous, broad-based, double-peaked waves) were more commonly present in group A. At the end of therapy, symptoms had either disappeared or significantly improved. Endoscopic and histologic studies showed disappearance of the severe inflammatory changes. Manometry, repeated in patients with cured severe esophagitis, showed normalization of the amplitude and significant decrease of the nonspecific motility abnormalities. We conclude that severe gastroesophageal reflux disease in children causes esophageal motor dysfunction, resulting from esophageal inflammation. The occurrence of esophageal motility disorders only in patients with severe esophagitis and its disappearance after therapy may account for the favorable course of reflux disease in infancy.

Antacids↗
PubMed1985

Iron malabsorption in giardiasis.

Among 10 children with giardiasis, eight had iron deficiency; iron deficiency anemia was the main complaint in three. Evaluation of iron absorption by the oral iron load test demonstrated a subnormal response (i.e., increase in serum iron levels of less than 100 micrograms/dl) in all eight patients with iron deficiency. In contrast, in two iron-sufficient patients with giardiasis the response to an oral iron load was normal. Xylose absorption was abnormal in five of the 10 patients. After metronidazole dosing, iron absorption became normal in seven patients but remained abnormal in one patient, who also had IgA deficiency. Xylose absorption became normal in all five patients who underwent a second test, but remained abnormal in the patient with IgA deficiency. Concomitant morphologic-studies of jejunal biopsy material from these patients revealed moderate changes in the intestinal mucosa of two patients. We conclude that malabsorption of iron is a complication of giardiasis.

Anemia, Hypochromic↗
PubMed1985

Gastrointestinal transit time, frequency of defecation, and anorectal manometry in healthy and constipated children.

Total gastrointestinal transit time (TGITT), frequency of defecation, and anorectal manometry were evaluated in 63 pediatric patients referred for chronic nonorganic constipation; in 39, segmental transit times of the right and left colon and rectum were also measured. TGITT was significantly longer in chronically constipated children than in matched normal controls. Although bowel frequency was highly significantly correlated with TGITT in patients with prolonged transit time, not all children with prolonged TGITT had reduced bowel frequency. Moreover, not all children with constipation had prolonged TGITT. In children with idiopathic chronic constipation, slowing of intestinal transit occurred most frequently at the level of the distal colon and rectum. Anorectal motility variables were not significantly different in children with functional chronic constipation and in normal children. Maximal resting and pressure and mean intrarectal distending volume causing threshold inhibition in constipated patients did not significantly differ from the control values. Therefore, anorectal manometry did not detect relevant motor abnormalities in constipated children.

Anal Canal↗
PubMed1985

[Radiology in chronic constipation in childhood].

One hundred thirteen children referred for chronic constipation were examined by means of diagnostic work-up including anal inspection, rectal exploration, weekly bowel frequency evaluation, measurement of total and segmental intestinal transit times (TITT, SITT), contrast enema, anorectal manometry (ARM), suction rectal biopsy for histochemistry. Final diagnosis were: chronic functional "simple" constipation in 53 children; chronic functional constipation and soiling in 32; Hirschsprung's disease in 18. In 10 children, initially referred for constipation, TITT was in the normal range so they underwent no further examination. Conclusions are that bowel frequency identifies a real gastrointestinal problem, but definite diagnosis of constipation is relied on TITT. In the assessment of chronic constipation nature, ARM is more sensitive than radiology. Suction rectal biopsy is reliable in detection of aganglionosis: its accuracy can be improved by histochemical or biochemical determination of Acetylcholinoesterase.

Acetylcholinesterase↗
PubMed1984

Gastrointestinal transit time and anorectal manometry in children with fecal soiling.

Fifty-three children with chronic idiopathic constipation, 32 with fecal soiling and 21 without soiling, were investigated by total gastrointestinal transit time (TGITT) and anorectal manometry (ARM). TGITT and ARM were also performed, respectively, in 46 and 32 healthy subjects. Twenty-two of the 32 children with soiling were successfully managed by medical treatment and toilet training. TGITT was significantly longer in all constipated children than in normal children. Furthermore, some parameters of anorectal motility (threshold volume, amplitude of threshold inhibitory anal reflex) of the patients differed markedly from those measured in controls. Rectal compliance was significantly higher in children with fecal soiling than in children with constipation without soiling and healthy controls. In the successfully treated children, soiling disappeared, TGITT normalized, and anorectal variables changed significantly. It is concluded that TGITT is useful in assessing the degree of constipation. Electromanometry of the anorectum is of great help in the diagnosis of functional constipation by excluding aganglionosis; furthermore, it provides additional information allowing better understanding of the mechanisms involved in functional constipation in children.

Anal Canal↗
PubMed1984

Antacids and cimetidine treatment for gastro-oesophageal reflux and peptic oesophagitis.

Thirty three children aged 2 to 42 months (mean 9 months) with gastro-oesophageal reflux and peptic oesophagitis took part in a treatment trial comparing cimetidine (20 mg/kg/day) with an intensive regimen of antacids (Maalox, 700 mmol (mEq)/1 X 73 m2/day). All children were evaluated clinically and by radiology, acid reflux test, and endoscopy. After 12 weeks of treatment all were again evaluated clinically, by pH measurement, and endoscopy. Twenty nine children, 15 on antacid and 14 on cimetidine, completed the trial. Eight patients on antacid and seven on cimetidine were cured; five on antacid and six on cimetidine improved; and two patients on antacid and one on cimetidine underwent surgery. Both groups of children showed a statistically significant reduction in the score of clinical, pH, and endoscopic variables after treatment. Lower oesophageal sphincter pressure before treatment did not correlate significantly with the final total score. Antacids in large quantities are as effective as cimetidine in medical treatment of gastro-oesophageal reflux and peptic oesophagitis.

Aluminum Hydroxide↗