Aplicación racional de los nuevos criterios de la European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2020 para el diagnóstico de la enfermedad celíaca

Coeliac disease is a systemic immune-mediated disorder triggered by the ingestion of gluten, which is given in genetically predisposed subjects. It manifests with a wide variety of clinical symptoms, specific serological markers, HLA-DQ2/DQ8 haplotype, and enteropathy. The criteria followed for this have usually been those established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) since 1969. These criteria have advanced from the need of several intestinal biopsies to, thanks to the development of serological tests of high sensitivity and specificity, considering the enteropathy as one more element in this diagnosis and makes it possible to perform a diagnosis without the need of an intestinal biopsy in certain circumstances. The updated review of the 2012 criteria in 2019 provides new evidence on some aspects, such as the role of HLA, the diagnosis of asymptomatic patients, and the effectiveness of the serological markers. These aspects are reviewed in detail, with the aim of facilitating the rational application of the new 2020 criteria at all care levels. In this sense, Paediatric Primary Care is fundamental in the search for active cases and to perform a first serological study, being recommended that the diagnosis is always establishedby a Paediatric GastroenterologistLa enfermedad celíaca es un proceso sistémico de carácter inmunológico, desen-cadenado por el consumo de gluten, que se da en sujetos genéticamente predispuestos. Se expresa con una gran variedad de síntomas clínicos, marcadores serológicos específicos, hap-lotipo HLA-DQ2/DQ8 y enteropatía. El tratamiento consiste en eliminar de por vida el gluten de la dieta, por lo que es fundamental un diagnóstico adecuado. Los criterios seguidos para ello han sido habitualmente los establecidos por la European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) desde 1969. Estos criterios han ido evolucionando desde la necesidad de varias biopsias intestinales para el diagnóstico a, gracias al desarrollo de pruebas serológicas de alta sensibilidad y especificidad, considerar la enteropatía como un elemento más en este diagnóstico y posibilitar en determinadas circunstancias realizarlo sin necesidad de biopsia intestinal. La revisión actualizada en 2019 de los criterios 2012 aporta nueva evidencia sobre algunos aspectos, como el papel del HLA, el diagnóstico de los pacientes asintomáticos y la eficacia de los marcadores serológicos. Estos aspectos se revisan en detalle,con el objetivo de facilitar la aplicación de los nuevos criterios 2020 de una forma racional en todos los niveles asistenciales. En este sentido el pediatra de Atención Primaria es fundamental para la búsqueda activa de casos y realizar un primer estudio serológico, recomendándose que el diagnóstico sea siempre establecido por un pediatra gastroenterólog

Non-IgE-mediated cow’s milk allergy: Consensus document of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP), the Spanish Association of Paediatric Primary Care (AEPAP), the Spanish Society of Extra-hospital Paediatrics and Primary Health Care (SEPEAP), and the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP)

Non-IgE-mediated cow's milk allergy is a frequent disorder in paediatrics. As patients might be seen by professionals from different specialties and levels of expertise, a great variability in diagnostic procedures and disease monitoring is commonly observed. Therefore, four scientific societies involved in its management have developed a consensus document providing specific recommendations related to its prevention, diagnosis, treatment and follow up.La alergia a las proteínas de leche de vaca no mediada por IgE es una patología frecuente, en cuyo manejo están implicados profesionales de diferentes áreas existiendo a día de hoy una gran variabilidad en la forma de abordar su diagnóstico, tratamiento, seguimiento y prevención. Con el objetivo de unificar pautas de actuación se ha elaborado un documento de consenso entre cuatro de las sociedades científicas implicadas en el abordaje de niños con dicha patologí

Aplicación conjunta de diversas herramientas de calidad en la reanimación neonatal

Introduction: In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates. Material and methods: Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods. Results: 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P <.001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period. Conclusions: The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparationIntroducción: Es importante conocer si en la reanimación neonatal el uso de diversas herramientas de calidad tiene impacto en la preparación del puesto de estabilización, correcto desarrollo del procedimiento y evolución clínica de aquellos neonatos más vulnerables. Material y métodos: Estudio de intervención cuasiexperimental, prospectivo y multicéntrico en 5 unidades neonatales iii-A. En las fases pre y postintervención, ambas de un año de duración, se realizaron auditorías aleatorias semanales de los puestos de estabilización en el paritorio para comprobar su preparación. En la fase postintervención se usaron checklists, briefings y debriefings en las reanimaciones de los neonatos menores de 32 semanas. Se compararon el desarrollo del procedimiento y la evolución inicial posreanimación entre ambos periodos. Resultados: Se realizaron 852 auditorías en el periodo preintervención y 877 en el postintervención. El porcentaje de auditorías sin defecto fue superior en la segunda fase (63% vs. 81% p < 0,001). Se incluyeron 75 reanimaciones en la fase inicial y 48 en la segunda, de las cuales en 36 (75%) se habían utilizado todas las herramientas de calidad. No existieron diferencias en las principales variables clínicas durante la estabilización, aunque se objetivó una tendencia a menores problemas técnicos durante el procedimiento en el segundo periodo. Conclusiones: La utilización de auditorías aleatorias, checklists, briefings y debriefings en la reanimación de los menores de 32 semanas es factible, pero no tiene impacto en los resultados clínicos a corto plazo ni en la correcta ejecución del procedimiento. Las auditorías de los puestos de reanimación neonatal mejoran significativamente su preparació

Clínica y diagnostica de las gastroenteritis virales infantiles en el área IX de la Comunidad de Madrid

Tesis doctoral inédita leída en la Universidad Autonoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 31 de Octubre de 200

Modificaciones de las Fórmulas infantiles para lactantes : preparados especiales.

La leche materna (LM), es el alimento ideal en el primer año de vida, pero en determinados casos es necesario suplirla, para lo que se han empleado diversos sucedáneos y han surgido las leches de fórmula. Se llaman así a los productos industriales que, utilizando como materia prima principalmente la leche de vaca (LV), han seguido en su elaboración varios procesos para hacerlos semejantes a la LM. Diversos organismos se han encargado de establecer normas sobre la composición de estas leches, con el fin de asegurar su semejanza a la LM y de evitar al máximo los problemas por una mala reconstitución del producto. La industria ha desarrollado además de los sustitutivos de la LM para lactantes sanos, otro tipo de preparados especiales para niños con problemas de digestión, absorción o intolerancia, o casos de alergia a determinadas proteínas. Son fórmulas con modificaciones en uno o varios de los principios inmediatos (proteínas, grasas o hidratos de carbono) y distintas indicaciones. Todas cubren las necesidades de los lactantes durante los primeros meses de vida. Es fundamental, dado que pueden ser consideradas como un tratamiento, el conocimiento de las indicaciones específicas de cada una de ellas. Se pueden considerar cuatro grupos: fórmulas sin lactosa, fórmulas de soya, fórmulas con hidrolizados de proteínas de LV y fórmulas elementales o monoméricas

Virus productores de gastroenteritis. Vacunación frente a Rotavirus.

Desde el descubrimiento del virus Norwalk como causa de gastroenteritis, los virus son reconocidos como una importante causa de enfermedad diarreica en humanos en todo el mundo, y ha aumentado de forma consistente el número de agentes virales asociados con esta enfermedad. Rotavirus es la principal causa de diarrea grave en niños menores de 5 años y se estima que hasta uno de cada 58 niños precisará hospitalización por diarrea por rotavirus del grupo A durante los primeros 5 años de vida. Norovirus (antiguo virus Norwalk-like) y Sapovirus (antiguo virus Sapporo-like) pertenecen a la familia Caliciviridae y están emergiendo como causa de gastroenteritis esporádica en la infancia; esta infección se ha encontrado en diversos países en 3.5% a 20% de casos esporádicos. Astrovirus se ha asociado con 4% a 12% de episodios de diarrea en niños y estudios recientes utilizando técnicas de diagnóstico molecular han descrito que en algunos medios los astrovirus es la segunda causa de diarrea en niños. Finalmente, los datos sobre la incidencia de adenovirus entéricos en la diarrea infantil son variados y en países industrializados oscila entre 1% y 8%. La gravedad de la enfermedad, así como la necesidad de hospitalización, han sido descritas como mayores en la gastroenteritis asociada con rotavirus del grupo A. El objeto de esta revisión es actualizar los conocimientos sobre la taxonomía, morbilidad y epidemiología molecular de estos virus, incluyendo la vacunación frente a rotavirus. SUMMARY Since the Norwalk virus was identified as a cause of gastroenteritis, viruses are recognized as an important cause of diarrheal disease in humans worldwide and the number of viral agents associated with gastroenteritis has steadily increased. Rotavirus is the most common cause of severe diarrhea in children under 5 years of age and it has been estimated that up to one in every 58 children will have been hospitalised because of diarrhea due to group A rotavirus during the first 5 years of life. Norovirus (former Norwalk-like virus) and sapovirus (former Sapporo-like virus) are members of the family Caliciviridae and are emerging as a cause of sporadic gastroenteritis in young children and in several countries this infection has been detected in 3.5-20% of sporadic cases. Astroviruses have been associated with 4% to 12% of diarrheal episodes in children and recent studies using immune and molecular diagnostics have established that in some settings astrovirus is the second most common cause of diarrhea in children. Finally, data on the incidence of enteric adenoviruses in childhood diarrhea are variable and in industrialized countries this incidence varies from 1% to 8%. The severity of disease, together with the need for hospitalisation, has been described greater with gastroenteritis caused by group A rotavirus. This review will focus on the epidemiology of these viruses, their taxonomy, morbidity, molecular epidemiology data and it will include an update on rotavirus vaccines

Management of small intestinal bacterial overgrowth by pediatric gastroenterologists in Spain.

small intestinal bacterial overgrowth (SIBO) is a heterogeneous condition with nonspecific symptoms. This study aimed to report its management by pediatric gastroenterologists in Spain. a descriptive study was performed by means of a survey sent to 184 active members of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP). one hundred and forty-eight responses (80.4 %) were received. Forty-four patients had no predisposing condition, 31.1 % used antibiotics followed by probiotics, 33.1 % antibiotherapy concomitant with probiotics, 24.3 % only antibiotics and 10.8 % only probiotics. The diagnosis was established via clinical parameters in 73.8 % of participants and the therapeutic response was checked only by clinical data in 90 %. there is high variability in the management of SIBO among pediatric population in Spain

A randomized placebo controlled clinical trial to evaluate the efficacy and safety of minocycline in patients with Angelman syndrome (A-MANECE study)

Background: Minocycline is an old tetracycline antibiotic that has shown antiinflammatory and antiapoptotic properties in different neurological disease mouse models. Previous single arm study in humans demonstrated benefits in individuals with Angelman Syndrome (AS); however, its efficacy in patients with Angelman Syndrome has not been assessed in a controlled trial. This was a randomized, double-blind, placebo-controlled, crossover trial in individuals with AS, aged 6 years to 30 years (n = 32, mean age 12 [SD 6·29] years). Participants were randomized to minocycline or placebo for 8 weeks and then switched to the other treatment (a subset of 22 patients) or to receive minocycline for up to 16 weeks (10 patients). After week 16, all patients entered a wash-out 8-week follow-up period. Results: Thirty-six subjects were screened and 34 were randomized. Thirty two subjects (94·1%) completed at least the first period and all of them completed the full trial. Intention-to-treat analysis demonstrated the lack of significantly greater improvements in the primary outcome, mean changes in age equivalent of the development index of the Merrill-Palmer Revised Scale after minocycline compared with placebo (1·90 ± 3·16 and 2·00 ± 3·28, respectively, p = 0·937). Longer treatment duration up to 16 weeks did not result in better treatment outcomes (1·86 ± 3·35 for 8 weeks treatment vs 1·20 ± 5·53 for 16 weeks treatment, p = 0·667). Side effects were not significantly different during minocycline and placebo treatments. No serious adverse events occurred on minocycline. Conclusions: Minocycline treatment for up to 16 weeks in children and young adults with AS resulted in lack of significant improvements in development indexes compared to placebo treatment. Treatment with minocycline appears safe and well tolerated; even if it cannot be completely ruled out that longer trials might be required for a potential minocycline effect to be expressed, available results and lack of knowledge on the actual mechanism of action do not support this hypothesis. Trial registration: European Clinical Trial database (EudraCT 2013-002154-67), registered 16th September 2013; US Clinical trials database (NCT02056665), registered 6th February 2014.Depto. de Psicología Experimental, Procesos Cognitivos y LogopediaFac. de PsicologíaTRUEpu

A randomized placebo controlled clinical trial to evaluate the efficacy and safety of minocycline in patients with Angelman syndrome (A-MANECE study)

Abstract Background Minocycline is an old tetracycline antibiotic that has shown antiinflammatory and antiapoptotic properties in different neurological disease mouse models. Previous single arm study in humans demonstrated benefits in individuals with Angelman Syndrome (AS); however, its efficacy in patients with Angelman Syndrome has not been assessed in a controlled trial. This was a randomized, double-blind, placebo-controlled, crossover trial in individuals with AS, aged 6 years to 30 years (n = 32, mean age 12 [SD 6·29] years). Participants were randomized to minocycline or placebo for 8 weeks and then switched to the other treatment (a subset of 22 patients) or to receive minocycline for up to 16 weeks (10 patients). After week 16, all patients entered a wash-out 8-week follow-up period. Results Thirty-six subjects were screened and 34 were randomized. Thirty two subjects (94·1%) completed at least the first period and all of them completed the full trial. Intention-to-treat analysis demonstrated the lack of significantly greater improvements in the primary outcome, mean changes in age equivalent of the development index of the Merrill-Palmer Revised Scale after minocycline compared with placebo (1·90 ± 3·16 and 2·00 ± 3·28, respectively, p = 0·937). Longer treatment duration up to 16 weeks did not result in better treatment outcomes (1·86 ± 3·35 for 8 weeks treatment vs 1·20 ± 5·53 for 16 weeks treatment, p = 0·667). Side effects were not significantly different during minocycline and placebo treatments. No serious adverse events occurred on minocycline. Conclusions Minocycline treatment for up to 16 weeks in children and young adults with AS resulted in lack of significant improvements in development indexes compared to placebo treatment. Treatment with minocycline appears safe and well tolerated; even if it cannot be completely ruled out that longer trials might be required for a potential minocycline effect to be expressed, available results and lack of knowledge on the actual mechanism of action do not support this hypothesis. Trial registration European Clinical Trial database (EudraCT 2013-002154-67), registered 16th September 2013; US Clinical trials database (NCT02056665), registered 6th February 2014