New developments in the diagnostics of celiac disease in children

Gluten enteropathy (or celiac disease) is the most common genetically related nutritional intolerance worldwide. Celiac disease is a multifactorial, autoimmune disease, which is observed in genetically predisposed individuals. It affects both children and adults leading to an atrophy of the small bowel mucosa of a varying degree. The article outlines the conclusion of the last guidelines on the topic. Finally, a summary and a conclusion on the topic are presented

Potentialities of the Multichannel Intraluminal pH-metry with Impedance in Diagnostics and Treatment of Gastroesophageal Reflux Disease in Infant Age /// Възможностите на мултиканалната интралуменна рН-метрия с импеданс при диагностика и лечение на гастроезофагеалната рефлуксна болест в кърмаческа възраст

[EN] Diagnosing infants and children with GERD is often a challenge. The suspected symptoms of GERD are non-specific at this age. The investigated breastfed infants are 0 to 12 months old with clinical presentation of GERD; they meet the criteria of reflux according to Orenstein’s questionnaire and those of an additional questionnaire that we have developed to assess the extra-oesophageal symptoms. We have performed a pre- and post-treatment pH-monitoring. The sooner the diagnosis of GERD is made, the faster the troublesome symptoms resolve and the severity of the components of the pH-monitoring is alleviated. Following the establishment of GERD is the question of treatment options. Using thickened milk formula resolves symptoms such as apnoea and cyanosis as well as part of the oesophageal symptoms. However milk formulas can’t affect the number of acid refluxes and reflux episodes, as well as their duration. There is a significant reduction in the number of postprandial refluxes. The use of alginate and PPI relieves symptoms such as apnoea and cyanosis, burping, Sandifer syndrome and remarkably alleviates the regurgitation and vomiting. When analysing the results of MII pH monitoring after treatment with the aforementioned drugs, we established a significant improvement in Boix Ochoa score, SI, SSI, SAP as well as the number of clinically relevant refluxes. There is a marked reduction of the postprandial refluxes when applying combined therapy. The treatment strategy requires patient-oriented approach, sometimes using combined treatment.[BG] Диагнозата на ГЕРБ често е трудна. Предполагаемите симптоми на ГЕРБ при кърмачета и деца са често неспецифични. Обследвани са кърмачета от 0- до 12-месечна възраст с клинични симптоми на ГЕРБ, покриващи данните за рефлукс според въпросника на Orenstein и допълнително разработен от нас въпросник, покриващ екстраезофагеалните симптоми. На пациентите са направени по две рН-метрии преди и след лечението. Колкото по-рано се постави диагнозата ГЕРБ и се започне адекватно лечение, толкова по-бързо отзвучават тревожещите родителите симптоми и подобряване в показателите на рН-метрията. След диагностицирането на ГЕРБ стои въпросът как да се лекува кърмачето. При използването на гъсти млечни формули е налице подобряване на симптомите като апнея с цианоза и част от езофагеалните. Млечните формули обаче не повлияват броя на киселите рефлукси, рефлуксните епизоди, както и тяхната продължителност значимо. Но значително подобрение е налице в броя на постпрандиалните рефлукси. При лечението с алгинат и ИПП са налице подобрения по отношение на симптомите като апнея с цианоза, хълцане, синдром на Sandifer, значително намалели симптоми като регургитация и повръщане. При анализа на показателите от ММИ рН-метрия след лечението с двата препарата е налице значимо повлияване на Boix Ochoa score, SI, SSI, SAP като и броя на значимите рефлукси. Налице е значимо подобрение на постпрандиалните рефлукси при лечението и с двата препарата. Изборът на лечение е строго индивидуален, понякога се налага и комбинирано лечение

Non-alcoholic fatty liver disease and microRNA expression in children

With the rise of the obesity epidemic in recent decades, non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease, not only in adults but in children as well. At present, the gold standard in diagnosing pediatric NAFLD is liver biopsy – an invasive procedure associated with potentially severe complications. Therefore, the current efforts are directed towards the development of new non-invasive and accessible methods for the early diagnosis of NAFLD. Among the potential biomarkers are the micro-ribonucleic acids (miRNAs) – small molecules made up of 20-25 nucleotides, which exert their biological effect as regulators of protein synthesis. The aim of the present article is to provide a short description of miRNA function in hepatic metabolism and their possible use in diagnosing pediatric NAFLD

Fulminant clostridiosis in ulcerative colitis

Introduction: Ulcerative colitis is an inflammatory bowel disease of the colon. It presents itself with ulcers and pus, damaged mucosa and a continual course. It usually starts from the rectum and affects other parts of the colon. The histological findings include chronic inflammation of the mucosa, poly­morphonuclear neutrophilic infiltration of the crypts of the colon, presence of crypt abscesses and disturbance of mucosal glands structure. Clostridium difficile is a bacterium which causes colitis by producing toxins that further damage the lining of the colon. These conditions have several forms-acute, sub-chronic, chronic and fulminant. The latter leads to toxic megacolon.Materials and Methods: A 15-year-old girl was hospitalized due to hematemesis and diarrhoea. Her skin was pale, her face and limbs were oedemic. Blood analysis and microbiology tests, radiographies, CT and MRI scans, sonography, esophagogastroduodenoscopy and colonoscopy were all performed. The results showed various laboratory index deviations, anaemic syndrome, hypoproteinaemia, hy­poalbuminemia, mushy stool mixed with mucus, but no blood. However, only a few days later the pa­tient started bleeding, blood clots and colon mucous were also observed. The bleeding would go on for two days and another colonoscopy was performed while blood infusions were ongoing. On both oc­casions histological samples were taken. The final diagnosis was fulminant clostridiosis in ulcerative colitis. An unanimous decision for colostomy was taken and carried out. An ileostoma was then cre­ated and the surgical intervention was terminated.Results: Her post-operative period was about a month long. There were complications such as epilep­tic seizures, hypovolemic shock, ascites and pleural effusion. Another bleeding did not occur. Thera­py for both ulcerative colitis and clostridium difficile infection was appointed.Conclusion: Fulminant ulcerative colitis is a serious condition with high mortality rates by itself, let alone being complicated by clostridium difficile. Histological remission is what is mandatory for a bowel transplant to be placed

Wilson`s Diseаse in Childhood- the Hereditary Factor: a Case Report

Introduction: Wilson`s disease is a rare genetic disorder characterized by excess copper, stored in various body tissues. It usually begins by six years of age, but in most cases presents clinically in the teenage years or early twenties. The disease normally affects the liver, the brain and the corneas of the eyes. Wilson`s disease is progressive and, if left untreated, may cause hepatic or central nervous system dysfunction, and even death. Early diagnosis and treatment may prevent serious long-term disability and life-threatening complications. Treatment is aimed at reducing the amount of copper that has accumulated in the body and maintaining normal copper levels thereafter.Materials and Methods: A girl at the age of 11 was hospitalized with complaints of fatigue, abdominal pain and oedema of the lower limbs. A physical examination revealed ascites in the abdomen and enlargement of the liver. Her laboratory results showed high levels of liver enzymes and low levels of ceruloplasmin. She had been hospitalized 6 times in 4 years. Her brother, age 9, was admitted to hospital due to epigastric pain, vomiting and dark faeces. He underwent a fibrogastroscopy, which diagnosed him with chronic gastritis and enteritis. His lab results showed low hemoglobin, high levels of ASAT and ALAT, and low ceruloplasmin. The youngest sister was hospitalized because of a paresis of the right facial nerve, vomiting and epigastric pain. Her examination lead to the diagnosis of her siblings.Results: All three kids were diagnosed with Wilson`s disease, despite their various presentation. There is a 25 % chance for all three of them to inherit the defective genes from both of their parents.Conclusion:  In conclusion, Wilson`s disease is a great imitator - it can be mistaken for many illnesses and the key to its diagnosis is an enzyme called ceruloplasmin

USE OF THE PROBIOTIC Lactobacillus reuteri DSM 17938 IN THE PREVENTION OF ANTIBIOTIC-ASSOCIATED INFECTIONS IN HOSPITALIZED BULGARIAN CHILDREN: A RANDOMIZED, CONTROLLED TRIAL

Objective: To evaluate the effectiveness of Lactobacillus reuteri DSM 17938 for the prevention of antibiotic-associated diarrhoea and Clostridium difficile-related infections in hospitalized children in a Bulgarian hospital. Study design: Children (n=100, aged 3 to 12 years) admitted to the hospital for acute infections were enrolled in a randomized, double- blind, placebo-controlled trial. They were assigned to receive either a probiotic supplement containing 1 x 108 CFU Lactobacillus reuteri DSM 17938 in the form of one chewable tablet once per day (n=49) (BioGaia AB, Stockholm, Sweden) or placebo (n=48). The probiotic or placebo was taken 2 hours after lunch each day, during the entire period of antibiotic treatment at the hospital and for additional 7 days. Results: Data from 97 children were included in the final analysis. The incidence of diarrhoea (defined as at least 3 loose or watery stools per day in a 48-hour period that occurred during or up to 21 days after cessation of antibiotic treatment) was unexpectedly low in both groups - L. reuteri (n=1) versus placebo (n=1): 2,04 vs. 2,1 per 100 (p>0,05, risk ratio 1,02, 95% CI 0,7-1,4). L reuteri DSM 17938 did not significantly affect the incidence or severity of AAD diarrhoea and Clostridium difficile infection. We found unusually high colonisation rate of non-symptomatic C. difficile measured by toxin-specific ELISA. There was no difference between the probiotic and placebo groups for any of the other secondary outcomes (i.e., incidence of mild diarrhoea, frequency of stool samples positive for C. difficile toxin A and B at the beginning and at the end of study period, frequencies of other gastrointestinal symptoms in the same study period) (p<0,05). No adverse events were reported. Conclusion: Due to the low incidence of antibiotic-associated diarrhoea in both groups, no conclusion can be made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children. The probiotic did not affect the non-symptomatic high rate of C. difficile colonisation (33.3% in the placebo and 38.8% in the L. reuteri group at baseline) in this population. There was also no difference between groups regarding different gastrointestinal side effects