Caustic Ingestion in Children

Caustic ingestion (CI) is an unfortunate event that occurs in families with a poor prevention culture. Its prevalence is unknown in developing countries; it occurs mainly in children < 5 years and is more common in boys. The chemical caustic agents are alkaline (85%) or acid products stored in food or beverage containers without warning labels and safety caps. The immediate symptoms include salivation, oropharyngeal burns, vomiting and oropharyngeal/retrosternal pain. Upper endoscopy is the first‐line tool to identify the type and extension of oesophageal and gastric damage. A barium swallow performed 2–3 weeks after the CI may identify oesophageal stricture. Dysphagia occurs in about one‐third of cases. Regarding the nutritional status, children with dysphagia and/or oesophageal strictures may have lower fat reserves or muscle mass than the cases without these complications, meaning impaired nutritional status. All patients should be hospitalized for evaluation and treatment. Hemodynamic stabilization and adequacy of the patient’s airway are priorities; vomiting induction and gastric lavage are contraindicated. Methylprednisolone in II-b oesophageal burns for 3 days diminishes the risk of stricture. Selected cases will require oesophageal dilatations, gastrostomy or oesophageal replacement by colon or stomach. There are other promising agents in the management of caustic oesophageal strictures

The Importance of Lactose in the Human Diet:Outcomes of a Mexican Consensus Meeting

Lactose is a unique component of breast milk, many infant formulas and dairy products, and is widely used in pharmaceutical products. In spite of that, its role in human nutrition or lactose intolerance is generally not well-understood. For that reason, a 2-day-long lactose consensus meeting with health care professionals was organized in Mexico to come to a set of statements for which consensus could be gathered. Topics ranging from lactase expression to potential health benefits of lactose were introduced by experts, and that was followed by a discussion on concept statements. Interestingly, lactose does not seem to induce a neurological reward response when consumed. Although lactose digestion is optimal, it supplies galactose for liver glycogen synthesis. In infants, it cannot be ignored that lactose-derived galactose is needed for the synthesis of glycosylated macromolecules. At least beyond infancy, the low glycemic index of lactose might be metabolically beneficial. When lactase expression decreases, lactose maldigestion may lead to lactose intolerance symptoms. In infancy, the temporary replacing of lactose by other carbohydrates is only justified in case of severe intolerance symptoms. In those who show an (epi)genetic decrease or absence of lactase expression, a certain amount (for adults mostly up to 12 g per portion) of lactose can still be consumed. In these cases, lactose shows beneficial intestinal-microbiota-shaping effects. Avoiding lactose-containing products may imply a lower intake of other important nutrients, such as calcium and vitamin B-12 from dairy products, as well as an increased intake of less beneficial carbohydrates

Diagnostic and prognostic value of antibodies against chimeric fibrin/filaggrin citrullinated synthetic peptides in rheumatoid arthritis

Introduction: Evidence suggests that citrullinated fibrin(ogen) may be a potential in vivo target of anticitrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis (RA). We compared the diagnostic yield of three enzyme-linked immunosorbent assay (ELISA) tests by using chimeric fibrin/filaggrin citrullinated synthetic peptides (CFFCP1, CFFCP2, CFFCP3) with a commercial CCP2-based test in RA and analyzed their prognostic values in early RA. Methods: Samples from 307 blood donors and patients with RA (322), psoriatic arthritis (133), systemic lupus erythematosus (119), and hepatitis C infection (84) were assayed by using CFFCP- and CCP2-based tests. Autoantibodies also were analyzed at baseline and during a 2-year follow-up in 98 early RA patients to determine their prognostic value. Results: With cutoffs giving 98% specificity for RA versus blood donors, the sensitivity was 72.1% for CFFCP1, 78.0% for CFFCP2, 71.4% for CFFCP3, and 73.9% for CCP2, with positive predictive values greater than 97% in all cases. CFFCP sensitivity in RA increased to 80.4% without losing specificity when positivity was considered as any positive anti-CFFCP status. Specificity of the three CFFCP tests versus other rheumatic populations was high (> 90%) and similar to those for the CCP2. In early RA, CFFCP1 best identified patients with a poor radiographic outcome. Radiographic progression was faster in the small subgroup of CCP2-negative and CFFCP1-positive patients than in those negative for both autoantibodies. CFFCP antibodies decreased after 1 year, but without any correlation with changes in disease activity. Conclusions: CFFCP-based assays are highly sensitive and specific for RA. Early RA patients with anti-CFFCP1 antibodies, including CCP2-negative patients, show greater radiographic progression

Consenso mexicano sobre probióticos en gastroenterología

Introducción: El uso de los probióticos es común en la práctica clínica. Existe un número signi-ficativo de estudios que apoyan la eficacia de los probióticos en algunos trastornos digestivos.Sin embargo, el desconocimiento de la evidencia científica y las diferentes presentaciones ycomposiciones microbianas de los probióticos disponibles dificultan su prescripción.Objetivo: Proveer al clínico de una revisión consensuada sobre los probióticos y recomendacio-nes de su uso en gastroenterología.Material y métodos: Se seleccionaron los ensayos clínicos controlados, metaanálisis y revisio-nes sistemáticas publicados hasta 2015, usando los términos MESH: probiotics, gastrointestinaldiseases, humans, adults and children. Se utilizó la metodología Delphi. Diecisiete gastroente-rólogos de adultos y 12 de ni˜nos elaboraron enunciados los cuales fueron votados hasta obteneracuerdo > 70%. Para cada enunciado se evaluó el nivel de evidencia basado en el sistema GRADE.Resultados y conclusiones: Se generaron 11 enunciados sobre conceptos generales de probió-ticos y 27 enunciados sobre uso de probióticos en enfermedades gastrointestinales tanto enni˜nos como en adultos. El grupo de consenso recomienda el uso de probióticos en las siguientescondiciones clínicas: prevención de la diarrea asociada a antibióticos, tratamiento de la diarreaaguda infecciosa, prevención de infección por Clostridium difficile y enterocolitis necrosante,para disminuir los eventos adversos de la terapia de erradicación del Helicobacter pylori, elalivio de los síntomas del síndrome de intestino irritable, en el estre˜nimiento funcional deladulto, para inducir y mantener la remisión en pacientes con colitis ulcerosa crónica idiopáticay pouchitis, y en la encefalopatía hepática oculta y manifiesta.© 2016 Asociaci´on Mexicana de Gastroenterolog´ıa. Publicado por Masson Doyma M´exico S.A.Este es un art´ıculo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). ASTRACT Introduction: Probiotics are frequently prescribed in clinical practice. Their efficacy in treatinggastrointestinal disorders is supported by a significant number of clinical trials. However, thecorrect prescription of these agents is hampered due to a lack of knowledge of the scientificevidence and to the different presentations and microbial compositions of the probiotics thatare currently available.Aim: To provide the clinician with a consensus review of probiotics and recommendations fortheir use in gastroenterology.Materials and methods: Controlled clinical trials, meta-analyses, and systematic reviewspublished up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases,humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologiststreating adult patients and 14 pediatric gastroenterologists formulated statements that werevoted on until agreement > 70% was reached. The level of evidence based on the GRADE systemwas evaluated for each statement.Results and conclusions: Eleven statements on the general concepts of probiotics and 27 sta-tements on the use of probiotics in gastrointestinal diseases in both adults and children wereformulated. The consensus group recommends the use of probiotics under the following clini-cal conditions: the prevention of diarrhea associated with antibiotics, the treatment of acuteinfectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enteroco-litis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief fromirritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis,and the treatment of covert and overt hepatic encephalopathy.© 2016 Asociaci´on Mexicana de Gastroenterolog´ıa. Published by Masson Doyma M´exico S.A. Thisis an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

[Gastroesophageal reflux disease]. [Reflujo gastroesof�gico en ni�os.]

Physiological gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and occurs up 2/3 of normal infants; and, it resolves spontaneously around 9-12 months of age. When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment, anemia, apnea, wheezing or other chronic respiratory symptoms, asthma, recurrent pneumonia or sleeping problems. Diagnosis of GERD implies studies as upper gastrointestinal series, upper endoscopy and 24 h esophageal pH monitoring; special cases may require motility and nuclear medicine studies. GER may be successfully treated with prone elevated position (30-45 degrees), shortening the feeding intervals to 3 h and anti-GER high-viscosity formulas. The regular use of prokinetic drugs is not recommended. The efficacy of proton pump inhibitors and H2 histamine receptor antagonists in the treatment of GERD has been demonstrated in children by diminishing de acid secretion of parietal cells, lowering the gastric contents and decreasing its ability to cause peptic-acid damage to the esophagus or to the respiratory tract. Surgical treatment is indicated in chronic recurrent GERD, usually in children 5 years or older with dependent proton pump inhibitor erosive esophagitis, chronic respiratory disease and in risk-selected cases

[Gastroesophageal reflux disease]. [Reflujo gastroesofágico en niños.]

Physiological gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and occurs up 2/3 of normal infants; and, it resolves spontaneously around 9-12 months of age. When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment, anemia, apnea, wheezing or other chronic respiratory symptoms, asthma, recurrent pneumonia or sleeping problems. Diagnosis of GERD implies studies as upper gastrointestinal series, upper endoscopy and 24 h esophageal pH monitoring; special cases may require motility and nuclear medicine studies. GER may be successfully treated with prone elevated position (30-45 degrees), shortening the feeding intervals to 3 h and anti-GER high-viscosity formulas. The regular use of prokinetic drugs is not recommended. The efficacy of proton pump inhibitors and H2 histamine receptor antagonists in the treatment of GERD has been demonstrated in children by diminishing de acid secretion of parietal cells, lowering the gastric contents and decreasing its ability to cause peptic-acid damage to the esophagus or to the respiratory tract. Surgical treatment is indicated in chronic recurrent GERD, usually in children 5 years or older with dependent proton pump inhibitor erosive esophagitis, chronic respiratory disease and in risk-selected cases

Caustic ingestion and oesophageal damage in children: Clinical spectrum and feeding practices

Aim: The study aims to evaluate the association of oesophageal damage with clinical data and feeding practices in children who suffered a caustic substance ingestion (CSI). Methods: Cross-sectional design was used in this study. The setting was at a paediatric referral hospital in 2006. Ninety-four children with CSI were used as study samples, with mean age of 38.4 months, and 37.2% were females. The independent variable was oesophageal damage; the dependent variables were clinical data and feeding practices. Results: Main symptoms included salivation, oropharyngeal burns and vomiting. On endoscopy, 84.6% had second- or third-degree burns. Oesophageal stricture occurred in 48.9%. Severe burns were associated with oesophageal stricture and ingestion of alkaline products; dysphagia was associated with oesophageal stricture. In about one fourth of the cases, a nutritional intervention with complete and balanced liquid diets was required to maintain the adequate daily recommended intake (DRI). Conclusions: Alkali ingestion was associated with severe burns and oesophageal stricture. The presence of oesophageal strictures and dysphagia required changes in the feeding practices in order to maintain an adequate nutritional status and/or to complete their DRI. " 2011 The Authors Journal of Paediatrics and Child Health " 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

Short-Term Effects on Substance Use of the Keeping It REAL Pilot Prevention Program: Linguistically Adapted for Youth in Jalisco, Mexico

Background/Aims: Alagille syndrome, a dominant inherited disorder, is characterized by cholestatic liver disease, associated to interlobular bile duct paucity combined with; cardiac, skeletal, ocular and facial abnormalities. Increased levels of serum lipids are present in more than 80% of probands. Parents and siblings of children with Alagille syndrome are often found to have a mild expression of this probable disease gene; it is not known if dyslipidemia occurs in parents and siblings of children with Alagille syndrome. The aim of the study was to investigate the lipid profile in sibs and parents of children with Alagille syndrome. Methodology: Four children with Alagille syndrome and 21 first-degree relatives were studied. Setting: A pediatric referral hospital. Period: July-October 2005. Design: cross-sectional. Variables: Total, low-density, high-density cholesterol and triglyceride. Statistics: ?2, Mann-Whitney U and Kruskal-Wallis. Results: Probands had higher levels of total cholesterol, low-density cholesterol and triglycerides than their siblings (p&lt;0.05); however, no differences with their parents were observed (p&gt;0.05). Conclusions: Dyslipidemia does not seem to be a phenotypic expression in first degree relatives of children with Alagille syndrome. The increased level of serum lipids observed in some of the parents is similar to the expected prevalence of hypercholesterolemia in the adult Mexican population. " H.G.E. Update Medical Publishing S.A.",,,,,,,,,"http://hdl.handle.net/20.500.12104/44499","http://www.scopus.com/inward/record.url?eid=2-s2.0-41549105363&partnerID=40&md5=47e0af19fa7fc383fc5cb74d60316182",,,,,,"81",,"Hepato-Gastroenterology",,"