Helicobacter Pylori Infection in Children with Recurrent Abdominal Pain

Recurrent abdominal pain (RAP) is a very common presenting complaint in pediatric population. There is still a debate regarding the role of Helicobacter pylori (H. pylori) infection as an etiology of RAP. Typically, the inflammatory process in the gastric mucosa of infected individuals is chronic gastritis. Serologic and histologic examination are widely used for the diagnosis. This study was aimed to determine the role of H. pylori infection in Indonesian children with RAP. The presence of serum IgG antibody to H. pylori and upper gastrointestinal endoscopy were performed on the 101 children with RAP. Mucosal biopsies were obtained for histologic analysis. The prevalence of H. pylori infection indicated by serology was 32.7% and by histology was 27.7%. Histologic evidence of gastritis was present in 94.1% children and 45% of them had chronic atrophic and active gastritis. Seventy percent children with H. pylori positive were found abnormal through endoscopy and all of the infected children were revealed abnormal through histological examination. Forty eight percent of seropositive children were found H. pylori positive and 80% of seronegative\u27s children were found to be H. pylori negative through histologic examination. Conclusion: H. pylori infection can be a cause of RAP in children. Work up for H. pylori infection should be performed when symptoms are suggestive of organic disease. Larger prospective studies are needed to be performed for a longer time of period to clarify this issue

Biliary Atresia in Infants with Cholestasis

Background: Cholestasis is a pathological condition due to impaired secretion and excretion of bile into the duodenum. The etiology should be found within golden period age (< 10 weeks of life) in order to get better outcome. Biliary atresia is characterized by total obstruction of extrahepatic biliary system. The cause is unknown. The only effective treatment is Kasai procedure, which should be done at 8 weeks age or less. The aim of this study was to observe the pattern of cholestasis cases in infants. Method: A descriptive study was conducted on 63 patients with cholestasis at the Harapan Kita Woman and Children Hospital, Jakarta between January 2008 and December 2009. Data was obtained from the computerized medical record database system. Statistical analysis was performed using SPSS program. Results: There were 63 infants, include of 40 (63.5%) boys. Age at admission were 80.2 (30-207) days. The laboratory findings included mean serum levels of hemoglobin 8.9 g/dL, conjugated bilirubin 12 mg/dL, alanine transaminase 149 u/L, aspartate transaminase 236 u/L, alkaline phospatase 582 u/L and gamma-glutamyl transpeptidase level 326 u/L. Biliary atresia was diagnosed in 8 (12.7%) infants by abdominal ultrasonography examination, cholangiography and liver biopsy. Kasai procedure (portoenterostomy) was performed to all those infants. Two of those infants died. Conclusion: Cholestasis has become one of the most common problem found in infants. Biliary atresia should always be considered as one of the cause, since early diagnosis and immediate treatment are needed to provide a good outcome

Intestinal Amebiasis in Children with Bloody Diarrhea

Background: Amebiasis affects more than 50 million people each year, resulting in 100,000 deaths. Entamoeba histolytica (E. histolytica) is clearly pathogenic causing intestinal infection that varies from asymptomatic to fulminant colitis. Appropriate diagnosis and treatment of amebiasis in children is important to avoid serious complication, such as hepatic abscesses. Bloody diarrhea is a classic symptom, which is often used as screening for intestinal amebiasis. This study aimed to know the prevalence of intestinal amebiasis and other clinical and laboratory characteristics in children with bloody diarrhea who visited Harapan Kita Women and Children Hospital, Jakarta. Method: This was a retrospective descriptive study. Data was obtained by evaluating medical records at Harapan Kita Women and Children Hospital Jakarta, from January 2009 to December 2010. The data included age, sex, morphology of E. histolytica, blood hemoglobin level and leukocyte count, as well as fecal leukocytes and erythrocytes. Diagnosis was confirmed by finding trophozoites in 3 consecutive stool specimens. Statistical analysis was performed using SPSS program. Results: Trophozoite forms were found in 58/889 (6.5%) children with bloody diarrhea. There were 40 (58.8%) boys, and 27 (39.7%) children were ≤ 1 years old. Fourteen (20.6%) children had anemia, 49 (72.1%) children had fecal leukocytes > 10 and 51 (75%) children had fecal erythrocytes > 5; however, only 21 (30.9%) children with blood leukocytes count > 14,000 u/L. Conclusion: Intestinal amebiasis is common in children with bloody diarrhea, especially infants. Increased fecal leukocytes and erythrocytes are often found in intestinal amebiasis; however, blood leukocyte count may not increase

Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children

Background: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy' infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration > 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux > 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy' infants and children were not significantly different; however reflux index > 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER

Zinc Supplementation in Children with Acute Diarrhea of Invasive Bacterial and Non-bacterial Infection

Background: Diarrhea is one of the manifestations of gastrointestinal disorder. In Indonesia, diarrhea is still one of the leading causes of death in infants and children. Diarrhea requires a rational and comprehensive management to deliver an optimal result. This study was aimed to assess the effectiveness of zinc supplementation in children with acute diarrhea of invasive bacterial infection. Method: A cross-sectional study was performed in 74 children aged 2-14 years with acute diarrhea, who visited the Outpatient Clinic, Pasar Rebo Hospital Jakarta, between January and June 2011. The inclusion criteria were patients had suffered diarrhea for 1-7 days. Based on fecal analysis Results, subjects were divided into group A (non-infectious) and group B (infectious). All children received zinc supplementation. Results: The mean value of subject age was 46.6 months in group A and 81.3 months in group B. The mean frequency of diarrhea prior to zinc supplementation was 7.5 times/day in group A and 7.8 times/day in group B. Duration of diarrhea before zinc supplementation was 52.6 hours in group A and 45.4 hours in group B. On the seventh day, there was no subject of both groups who still suffered from diarrhea. Although the duration of diarrhea in group A was shorter than group B, no significant difference was found (62.4 hours vs 66.8 hours, p = 0.07). Conclusion: Zinc supplementation shows similar efficacy in children with acute diarrhea caused by invasive bacterial infection and those without bacterial infection as well

Recurrent Abdominal Pain in Children

Recurrent abdominal pain is one of the most common symptoms found in children. Description of abdominal pain is important in determining the etiologic cause. Organic pain must be ruled out first before suspecting psychogenic cause of pain. However, Children and infant are likely having difficulties in describing abdominal pain. Referred pain may lead to misdiagnosis. Alarm symptoms of abdominal pain are important indices and must be recognized. Careful and complete anamnesis and physical examination play critical role in management approach of recurrent abdominal pain in children and determine whether medical therapy only or combination with surgical intervention is considered necessary

Soy Infant and Extensively Hydrolyzed Formula as Therapeutic Formula for Cow's Milk Protein Allergy

Cow's milk protein allergy (CMPA) is a food allergy mostly suffered by children aged < 3 years that can be mediated by IgE or non-IgE or both. The prevalence of CMPA in children is heterogeneous between populations. Meta-analysis study showed that the prevalence was 2-3% in infants and < 1% in children aged < 6 years. Although the prevalence is quite small but proper management is very important because it affects the quality of life of children and to avoid the risk of anaphylactic reaction that threatens life. Therapy for CMPA is to avoid cow's milk protein and its derivatives; it is also recommended for breast-feeding mothers to do the same. Therapeutic milk formulas that can be given is extensively hydrolyzed formula (eHF) or soy infant formula (SIF). The selection of formula became adebate, especially about the safety, effectiveness and cost