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Consequences of Helicobacter pylori infection in children

World Journal of Gastroenterology 2010年第41期16卷 5181-5194页

作者： Lucia Pacifico Caterina Anania John F Osborn flavia ferraro Claudio Chiesa Department of Pediatrics Sapienza University of Rome 324 I-00161 Rome Italy Department of Public Health Sciences Sapienza University of Rome I-00185 Rome Italy Department of Molecular Medicine National Research Council I-00133 Rome Italy

Although evidence is emerging that the prevalence of Helicobacter pylori (H. pylori) is declining in all age groups, the understanding of its disease spectrum continues to evolve. If untreated, H. pylori infection is lifelong. Although H. pylori typically colonizes the hu-man stomach for many decades without adverse con-sequences, children infected with H. pylori can manifest gastrointestinal diseases. Controversy persists regarding testing (and treating) for H. pylori infection in children with recurrent abdominal pain, chronic idiopathic thrombocytopenia, and poor growth. There is evidence of the role of H. pylori in childhood iron deficiency anemia, but the results are not conclusive. The possibility of an inverse relationship between H. pylori and gastroesophageal reflux disease, as well as childhood asthma, remains a controversial question. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae.

关键词： Helicobacter pylori Children Gastrointestinal diseases Epigastric pain Anemia Growth retardation Chronic idiopathic thrombocytopenic pupura

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Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2013年第25期19卷 4007-4014页

作者： Lucia Pacifico Mario Bezzi Concetta Valentina Lombardo Sara Romaggioli flavia ferraro Stefano Bascetta Claudio Chiesa Department of Pediatrics Sapienza University of Rome Department of Radiological Sciences Sapienza University of Rome Department of Radiological Sciences Sapienza University of Rome 00161 Rome Italy Institute of Translational Pharmacology National Research Council

AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP). METHODS: A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1-to 1-basis) with thecases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMDZ-scores were calcu- lated using race and gender specific LMS curves. RESULTS: Obese children with NAFLD had a significantly lower LS BMDZ-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis,

关键词： Bone mineralization Dual energy X-ray absorptiometry Adipokines C-reactive protein Nonalcoholic fatty liver disease Children

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Pediatric nonalcoholic fatty liver disease:A clinical and laboratory challenge

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World Journal of Hepatology 2010年第7期2卷 275-288页

作者： Lucia Pacifico Eleonora Poggiogalle Vito Cantisani Guendalina Menichini Paolo Ricci flavia ferraro Claudio Chiesa Departments of 1 Pediatrics Sapienza University of Rome National Research Council Institute of Neurobiology and Molecular Medicine Departments of Radiological Sciences Sapienza University of Rome

The true prevalence of pediatric nonalcoholic fatty liver disease (NAFLD) is unknown. Challenges in determin ing the population prevalence of NAFLD include the type of test (and the reference intervals used to define normal and abnormal), the type of population (general population, hospital series), the demographic characteristics of the population sampled, and the nat ure of the study design. The natural history of pediat ric NAFLD remains uncertain. The issue of when to perform a liver biopsy in children with suspected NAFLD remains controversial. Children with NAFLD but normal alanine aminotransferase are rarely investigated. However, evidence of alterations in glucose metabolism parameters should prompt a better understanding of the natural history of pediatric NAFLD not only in terms of the progression of liver disease but also regarding its potential relationship with other health outcomes such as type 2 diabetes mellitus and cardiovascular disease. This evidence could make liver biopsy mandatory in the majority of cases at risk of progressive and severe hepatic and extrahepatic disease. This conclusion, however, raises the question of the feasibility of liver biopsy assessment in an extremely large at risk popul ation, and of the cost/effectiveness of this policy. There is a considerable, continuous interest in reliable, noninv asive alternatives that will allow the prognosis of pediat ric NAFLD to be followed in large community or populat ionbased studies.

关键词： Nonalcoholic fatty liver disease Children Insulin resistance Ultrasound Magnetic resonance imaging

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