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Y Vandenplas

Publications and source records attributed to Y Vandenplas.

At least 19 recordsLinked to original sources
PubMed2007

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. METHODS: Forty-six children presenting with H. pylori gastritis, assessed at inclusion by endoscopy, H. pylori urease test, histology and/or culture were randomised to a twice-daily regimen of AC or OAC. A (13)C-urease breath test was performed 4-6 weeks after the end of the treatment period to evaluate H. pylori eradication. RESULTS: A larger proportion of patients was H. pylori negative (69%) in the OAC regimen treatment 4-6 weeks after eradication treatment compared with those who received dual AC therapy (15%). A total of seven patients (three in the OAC and four in the AC group) reported adverse events (AEs). Only vomiting was reported in more than one patient (one in each treatment regimen) and only one AE was severe (urticaria: in the OAC group, but considered not related to treatment). CONCLUSION: A larger eradication rate of H. pylori was obtained in the triple OAC group than in the dual AC group. Both therapy regimens can be safely administered to children for 7 days.

Adolescent↗
PubMed2006

Variability of the 13C-octanoic acid breath test for gastric emptying of solids in healthy children.

AIM: To assess the intra-individual variability of the 13C-octanoic acid breath test using non-dispersive infrared spectrometry for gastric emptying of solids in healthy children. METHODS: A 13C-octanoic acid breath test was performed at least two times in 19 healthy children (age 12.4 +/- 2.7 years) 2-7 days apart to measure gastric emptying of solids. Breath samples were taken before eating a 13C-octanoic acid-labelled pancake and at 15-min intervals for the following 240 min. Breath samples were analysed using non-dispersive infrared spectrometry; 13C-recovery was used to calculate values for gastric half-emptying time (t(1/2)), gastric lag phase (t(lag)) and gastric emptying coefficient. Intra-individual variability of the parameters t(1/2), t(lag) and gastric emptying coefficient were expressed as coefficient of intrasubject variation. RESULTS: The mean coefficient of intrasubject variation of t(1/2) was 13.3 +/- 7.9% (range 2.5-29.6%; interindividual range 99-204 min; intra-individual range 5-84 min for t(1/2)). The mean coefficient of intrasubject variation of t(lag) was 13.6 +/- 7.5% (range 0.8-27.8%) (interindividual range 65-146 min; intra-individual range 1-50 min for t(lag)). The mean coefficient of intrasubject variation of gastric emptying coefficient was 12.5 +/- 6.8% (range 3.4-30.2%; interindividual range 2.3-3.9; intra-individual range 0.17-1.4 for gastric emptying coefficient). The coefficient of intrasubject variations of t(1/2), t(lag) and gastric emptying coefficient were independent of the values of t(1/2), t(lag) and gastric emptying coefficient. CONCLUSIONS: Gastric emptying in healthy children is characterized by a large inter- and intra-individual variability and is concordant with the results obtained with other techniques.

Adolescent↗
PubMed2006

[Medical end-of-life decisions in neonates and infants in Flanders, Belgium; 1999/2000].

OBJECTIVE: To determine the number of medical end-of-life decisions in critically ill neonates and infants in Flanders, Belgium. DESIGN: Retrospective. METHOD: A death certificate study on all deaths of neonates and infants in the whole of Flanders was carried out over a i2-month period (August 1999-July 2000). An anonymous questionnaire was sent by mail to the attending physician of each of the 292 children who died under the age of 1 year. All physicians who had attended at least one death during the study period were included in an attitude study. RESULTS: A total of 253 (87%) of the 292 questionnaires were returned and 121 (69%) of the 175 physicians involved completed the questions on attitude. An end-of-life decision had been possible in 194 (77%; 95% CI: 70.4-82.4) of the 253 deaths for which questionnaires were returned, and such a decision was actually made in 143 cases (57%; 95% CI: 48.9-64.0). Lethal drugs were administered in 15 of 117 early neonatal deaths and in 2 of 77 later deaths (13% versus 3%; p = 0.018). The attitude study showed that 69 (58%; 95% CI: 48.1-66.5) of the 120 physicians supported a change in the law making life-termination possible in some well-defined cases. CONCLUSION: The death of neonates and infants was commonly preceded by an end-of-life decision in Flanders. The type of decision varied substantially according to the age of the child. The majority of physicians involved, favoured legalization of the use of lethal drugs in some well-defined cases.

Attitude of Health Personnel↗
PubMed2006

Variability of the 13C-acetate breath test for gastric emptying of liquids in healthy children.

PURPOSE: Scintigraphy is considered as the "gold standard" for measuring gastric emptying (GE). The C-acetate breath test (C-ABT) offers an attractive alternative to measure GE of liquids as it is nonradioactive. The aim of this study was to assess the variability of the C-ABT for GE of liquids in healthy children using nondispersive infrared spectrometry (NDIRS). METHODS: The C-ABT was repeated at least 2 times in 21 healthy children (6 girls and 15 boys), aged between 6.2 and 16.4 years, 2 to 7 days apart. After an overnight fast, a standardized milk drink, labeled with 50 or 100 mg C-acetate according to weight, was administered. Breath samples were taken before feeding, at 5-minute intervals for the first 40 minutes and at 10-minute intervals for the following 140 minutes after feeding. Breath samples were analyzed using NDIRS, and C recovery was used to calculate values for gastric half-emptying time (t1/2), time of peak C exhalation, or gastric lag phase (tlag) and gastric emptying coefficient (GEC). Intraindividual variabilities of the parameters t1/2, tlag, and GEC were expressed as coefficient of intrasubject variation (CV). RESULTS: The median CV of t1/2 was 8.3% (CV range, 1.6%-16.2%; t1/2 interindividual range, 65-112 minutes; and t1/2 intraindividual range, 4-33 minutes). The median CV of tlag was 16.6% (CV range, 2.0%-26.6%; tlag interindividual range, 31-76 minutes; and tlag intraindividual range, 1-35 minutes). The median CV of GEC was 4.3% (CV range, 0.8%-15.7%; GEC interindividual range, 3.81-4.89; GEC intraindividual range, 0.08-1.31). The CVs of t1/2, tlag, and GEC were independent of age, sex, weight, height, and measured values of t1/2, tlag, and GEC. CONCLUSIONS: The C-ABT using NDIRS is an easy, noninvasive, and nonradioactive procedure with a large intraindividual variation for measuring GE of liquids in healthy children, but comparable to the variation reported with other techniques.

Adolescent↗
PubMed2005

Cornstarch thickened formula reduces oesophageal acid exposure time in infants.

BACKGROUND: Infant regurgitation is a phenomenon causing worldwide parental distress and anxiety. Parental reassurance and dietary advices regarding feeding techniques and volumes are helpful in the management. Guidelines also recommend the use of thickened formula. However, the impact of thickened feeding on the frequency of acid reflux is still a matter of debate. Therefore, we evaluated the effect of a casein predominant formula thickened with a specifically selected and treated cornstarch on the frequency and duration of acid reflux episodes. METHODS: Ninety-six formula-fed infants with a mean age of 93 days, presenting with episodes of regurgitation and vomiting occurring more than five times a day and with an abnormal oesophageal pH monitoring, were randomised to a regular infant formula (n = 45) or cornstarch thickened casein predominant formula (n = 51) for 28 days. A second pH monitoring was performed at the end of the study period (26+/-5 days). Symptoms were daily recorded in a diary by the parents for 28 days. RESULTS: At inclusion, the pH-metric parameters did not differ between the control and the intervention group. Results of pH monitoring at baseline and at the end of the study did not differ in the control group on the regular infant formula. However, in the group with the casein dominant cornstarch thickened formula, all pH-metric parameters (reflux index (% of the investigation time with a pH < 4.0), number of reflux episodes >5 min, duration of the longest reflux episode) decreased significantly. The frequency of vomiting and regurgitation did not differ between both groups at baseline, remained unchanged in the control group, but decreased significantly in the intervention group. CONCLUSION: A casein dominant formula thickened with a specifically treated cornstarch reduces oesophageal acid exposure, and reduces the frequency of clinical symptoms.

Caseins↗
PubMed2005

Intervention during pregnancy and allergic disease in the offspring.

The etiology of allergy is multifactorial, with many variables contributing to the final expression of atopic disease. Three breeding grounds are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s) and environmental factors. Timing and dosing of allergen(s) are of major importance. Contact with (dietary) allergens and various agents such as tobacco smoke and infections occur not only during post-natal life, but also perinatally and even pre-natally. A critical review of published evidence regarding the impact of maternal exposure to antigens during pregnancy on later development of allergy in the offspring can only conclude that more research is urgently needed. Contact with multiple dietary allergens should be in general of benefit to the fetus to develop tolerance. Current knowledge suggests that pregnant women should have a normal diversified diet, avoiding toxic agents such as tobacco and alcohol. The role of maternal intake of poly-unsaturated fatty acids on the development of atopy in the infants needs to be further evaluated. If parental history would be insufficient to determine the fetal risk, preventive measurements would be advisable for all fetuses.

Allergens↗
PubMed2004

Current pharmacological treatment of gastroparesis.

The aetiology of gastroparesis differs between children and adults. During childhood, gastroparesis is quite rare, and is mostly seen in preterm infants, with either immaturity of the gastrointestinal tract, or when allergic to cow's milk protein. Acute, delayed gastric emptying may be observed following viral infections. In adults, most patients with gastroparesis are either idiopathic or of diabetic origin. As a consequence, approaches in the treatment of children and adults differ. Metoclopramide, domperidone, cisapride and erythromycin have all been studied. Evidence for benefit is strongest for the latter two drugs, although most studies have methodological shortcomings. From a paediatric perspective, it seems astonishing that more trials with erythromycin analogues have not been performed, as the few data available suggests that these analogues are more powerful, without the side effects of long-term, low-dose administration of antibiotics. Gastric electrical stimulation seems the most promising therapeutic option available at present.

Adult↗
PubMed2004

A classification of end-of-life decisions in neonates and infants.

AIM: Valid and reliable data are needed to gain insight into the decisions of paediatricians concerning the end of life of newborns and infants. Such data could throw light on the poorly documented aspects of medical practice regarding these end-of-life decisions (ELDs). In this article a classification of ELDs is developed. METHODS: The classification is developed from knowledge generated from large-scale epidemiological studies on ELDs. RESULTS: This classification sets out from considerations of the various possible medical end-of-life procedures for newborns and infants and from important ethical aspects of the decision-making process. From both ethical and legal viewpoints the life-shortening intention of the physician is a significant factor for the qualification of ELDs. Furthermore, the consultation of the parents is an important factor in absence of the possibility of the patient's self-determination. CONCLUSION: This classification has been devised with the aim of making reliable and valid descriptions of both the incidence and nature of ELDs in this specific population of newborns and infants.

Decision Making↗
PubMed2004

The natural course of gastro-oesophageal reflux.

UNLABELLED: Gastro-oesophageal reflux disease is a common phenomenon usually consistent with a benign prognosis. But alarm symptoms and complications occur at any age, and may be difficult to recognize clinically although requiring prompt and adequate intervention. Many unsettled issues in gastro-oesophageal reflux (disease) are encountered in its natural course and clinical presentation. Severity of reflux is much more related to complications than to the amount of reflux. Current medical reflux treatment with H2-receptor antagonists and preferably with proton pump inhibitors is efficient in controlling symptoms and healing oesophagitis. Whether early treatment of mild reflux significantly changes the incidence or severity of symptoms and complications in adulthood is uncertain. Atopic disease is now recognized to cause reflux-like symptoms. Paediatricians should adequately consider the impact on the quality of life of repetitive regurgitation. CONCLUSION: Further research is needed to define more clearly how many, which and why some children with reflux disease progress to persisting chronic disease and others do not.

Adult↗
PubMed2003

Disaccharidase activities in Belgian children: reference intervals and comparison with non-Belgian Caucasian children.

AIM: To establish reference values for disaccharidase activities in Belgian children and to compare enzyme activities with those of non-Belgian Caucasian children. METHODS: Data from Belgian children who had undergone endoscopic jejunal biopsies (1994-2000) for suspected malabsorption were reviewed. The patients were divided into three groups based on histology: (A) normal (n = 201), (B) moderate changes (n = 58) and (C) (sub)total atrophy (n = 14). The 95% reference limits for disaccharidase activities (U/g protein) were calculated for group A after exclusion of patients with a positive hydrogen breath test, a history of lactose intolerance or coeliac disease (final population: n = 151, 0.1-12 y). Values were compared with those of 34 non-Belgian Caucasian children with normal histology (28 of Mediterranean origin). RESULTS: The reference limits (90% confidence interval) were 86 (65-111)-423 (366-494) for maltase, 9 (6-12)-91 (78-122) for lactase and 24 (18-30)-155 (120-184) for sucrase. No gender-related differences in enzyme activities were found. Lactase levels showed a slight decrease with increasing age. Disaccharidase activities of children with histologically confirmed mucosal injury were significantly lower than those of children with normal histology: median values for groups A, B and C were 208, 181 and 96, respectively, for maltase, 40, 28 and 7, respectively, for lactase and 69, 54 and 25, respectively, for sucrase. Median disaccharidase activities in biopsies with normal histology were lower in non-Belgian children, the difference being only statistically significant for lactase, 33 versus 40. CONCLUSION: The reference values for Belgian children are well in line with other reported values from Caucasian children. Although enzyme activities are lower in children with histologically confirmed mucosal damage, they do not allow differentiation between histology groups. Lower lactase values were found in non-Belgian children.

Atrophy↗
PubMed2003

Oesophageal pH monitoring in children: how is it perceived by the parents and does the technique change feeding and daily activity?

AIM: To determine whether oesophageal pH monitoring in infants induces changes in daily activity and feeding, and with the help of a questionnaire to evaluate how parents perceive pH monitoring. METHODS: The parents of 100 children, consecutively referred for oesophageal pH monitoring, were asked by one of the authors (A.A.) to respond to a standardized questionnaire immediately after the end of the procedure. Twenty questions were asked, concerning five topics: feeding (4 questions), activity (6 questions), perception of the parents (6 questions), accuracy of the provided information (3 questions), and previous experience with oesophageal pH-metry (1 question). For statistical analysis, every variable was qualified as "no change" and "change" for feeding and activity, as "positive" or "negative" regarding the perception of the test, and as "sufficient" or "insufficient" regarding the information provided. The answers to the questions were also analysed according to the result of the oesophageal pH monitoring (normal vs abnormal), and according to whether or not there was previous experience of oesophageal pH-metry in a first degree relative. RESULTS: Changes in feeding occurred in 28% of cases and changes in activity in 30%, but did not differ according to the oesophageal pH-metry result. Equally, the perception of the parents regarding the test (37% negative), the acceptability of a second pH-metry test (refusal in 52%) and previous experience with oesophageal pH-metry (positive in 25%) were not influenced by the result of the pH monitoring. Parents of infants with abnormal oesophageal pH monitoring were more frequently dissatisfied with the information about the nature of the test provided before the test and also the results than parents of infants with normal results (52% vs 19%, respectively; p < 0.05). CONCLUSION: According to the perception of the parents, pH monitoring induces changes in feeding and activity in 28% and 30%%, respectively; 63% of the parents considered pH monitoring to be well tolerated. Parents of infants with abnormal pH monitoring results need more attention.

Attitude↗
PubMed2002

Oligosaccharides in infant formula.

Breast-feeding is the golden standard for infant feeding. However, the majority of a few week old infants are fed with a second choice infant feeding, cow's milk based formula. Amongst the multiple differences between human and cow's milk regards the development of the gastro-intestinal flora: the flora of the breast-fed infant being richer in bifidobacteria and lactobacilli. Both species are known to be potentially beneficial for the health of the host. The absence of oligosaccharides, the third largest component in human milk, in cow's milk is likely to account for the differences in colonic flora. The oligosaccharide content and concentration in breast milk is - just as for the other macronutrients - a dynamic process, making it impossible for industry to mimic nature. However, if the composition cannot be mimicked, the effect and function can be imitated. The addition of two oligosaccharides, galacto-oligosaccharides and inulin, to cow's milk based infant formula has been shown to have a bifidogenic effect, and to stimulate the growth of bifidi and lactobacilli. In conclusion, the addition of oligosaccharides to cow's milk based infant formula brings this alternative, second choice infant feeding one step closer to the golden standard of human milk. But, prolonged breast-feeding should still be promoted with maximum effort.

Animals↗
PubMed2001

Management of ingested foreign bodies in childhood and review of the literature.

UNLABELLED: The management of ingested foreign bodies in children is not standardised. During a 15-year period, we recorded 325 consecutive paediatric cases of accidental ingestion of foreign bodies or with symptoms suggesting oesophageal obstruction presented at the emergency department or the paediatric gastroenterology unit. The foreign bodies that had to be removed were, in decreasing order of frequency: coins, toy parts, jewels, batteries, sharp materials such as needles and pins, fish and chicken bones, and "large" amounts of food. Only 54% of the patients had transient symptoms at the moment of ingestion, such as retrosternal pain, cyanosis and dysphagia. A minority (28, 9%) of foreign bodies could be removed with a McGill forceps; 65 (20%) were removed with a magnet probe. Endoscopic removal was performed in 82 cases (25%). In the majority of cases (150, 46%) natural elimination occurred. The outcome of all patients was uneventful. CONCLUSION: Recommendations for management of children presenting with a history of suspected accidental ingestion of a foreign body for the community paediatrician are proposed.

Adolescent↗
PubMed2001

The role of Helicobacter pylori in paediatrics.

Helicobacter pylori is a bacterium that colonizes the human stomach, especially during childhood. Although it has been studied intensively during the past decade, many controversies still exist on many important issues, including the clinical relevance of virulence factors, indications for treatment, recommended procedures for diagnosis and the typical symptom profile, among others. The lack of double-blind, placebo-controlled studies in children illustrates the paucity of hard scientific data, and is the major reason for differences in opinion. Therefore, the present review of literature published during the past 2 years raises many questions.

Adolescent↗