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Use of Probiotic Yogurt in the Management of Acute Diarrhoea in Children. Randomized, Double-Blind, Controlled Study

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Open Journal of Pediatrics 2014年第1期4卷 54-61页

作者： Giuseppe Grandy Zdenka Jose Richard Soria Jennifer Castelú Anelisse Perez Jose P. Ribera Oscar Brunser Albina Patino Foundation Cochabamba Bolivia Institute of Nutrition and Food Technology University of Chile Santiago Chile paediatric Centre Albina Patino Department of Gastroenterology and Nutrition Cochabamba Bolivia

Background: In Bolivia there are few probiotic preparations available in the market, practically without alternatives to the use of freeze-dried products. An alternative used as a good alternative in other parts of the world is yogurt with a probiotic strain added. In this study we report the use of a locally prepared yogurt with a lyophilized probiotic added. Methods: This is randomized, double-blind and controlled clinical trial in children hospitalized with acute diarrhoea carried out at the paediatric Centre Albina Pati?o in Cochabamba, Bolivia with children 10 to 35 months participating. Children were randomly assigned to receive an oral rehydration solution and Saccharomyces boulardii (positive control) or the same solution plus yogurt preparation containing Lactobacillus rhamnosus (yogurt group). The primary outcome was the duration of diarrhoea. Secondary outcomes were the duration of fever, vomiting and hospitalization. Results: Of the 74 children incorporated 42 completed the protocol;baseline characteristics were similar in both groups. The median duration of diarrhoea was similar in children who received yogurt (71 hours) and controls (79 hours) (p = 0.3). The mean duration of fever was also similar in both groups: S. boulardii (24 hours) or yogurt (11 hours) (p = 1.02), as was the duration of vomiting: 17 hours vs. 32 hours in the control group (p = 0.37). A significant difference in the numbers of daily bowel movements was observed in the third day, the probiotic group was lower (p = 0.01). There was no effect on the duration of hospitalization (p = 0.26). Conclusions: The use of a yogurt containing L. rhamnosus has an effect comparable to S. boulardii. Introduction of yoghurt with a probiotic in the diet of patients hospitalized with acute diarrhoea may help reduce its duration, regardless of its aetiology.

关键词： Probiotics Yogurt Diarrhoea and Children

Nutritional therapy for active Crohn’s disease

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World Journal of gastroenterology 2008年第27期14卷 4420-4423页

作者： Paul A Smith Specialist Registrar in gastroenterology North Manchester General Hospital Gastroenterology Department Delaunays Road Crumpsall Manchester

Nutritional therapy for active Crohn’s disease (CD) is an underutilised form of treatment in adult patients, though its use is common in the paediatric population. There is evidence that nutritional therapy can effectively induce remission of CD in adult patients. Enteral nutrition therapy is safe and generally well tolerated. Meta-analysis data suggest that corticosteroids are superior to nutritional treatment for induction of remission in active CD. However, the potential side effects of such pharmacotherapy must be taken into consideration. This review examines the evidence for the efficacy of elemental and polymeric diets, and the use of total parenteral nutrition in active CD.

关键词：克罗恩氏病节段性回肠炎营养学类固醇

Surgical strategies in paediatric inflammatory bowel disease

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World Journal of gastroenterology 2015年第20期21卷 6101-6116页

作者： Colin T Baillie Jennifer A Smith Department of paediatric Surgery Royal Liverpool Childrens Hospital

Inflammatory bowel disease(IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn's disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid(distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum(pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice.

关键词： Inflammatory bowel disease Ulcerativecolitis Crohn's disease paediatric Surgery

Growth and bone health in paediatric patients with Crohn's disease receiving subcutaneous tumor necrosis factor antibody

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World Journal of gastroenterology 2015年第21期21卷 6613-6620页

作者： Judith Pichler Wolf Dietrich Huber Christoph Aufricht Bettina Bidmon-Fliegenschnee Department of paediatric and Adolescent Medicine Medical University Vienna

AIM:To study whether adalimumab(ADA) was associated with improvement in growth,bone mineraldensity(BMD) and bone metabolism.METHODS:In children with Crohn's disease(CD) there is a high prevalence of growth failure and reduced BMD.Treatment with infliximab is associated with an improvement in growth.Anthropometry,paediatric CD activity index(PCDAI),bone markers and BMD was measured in 18 patients(72% females) one year before and after start of ADA with a median age of 14.4 years(range:5-19 years) at treatment start.Outcomes were indicators of growth with treatment as well as interval growth.RESULTS:Eleven(61%) children experienced catchup growth after ADA.PCDAI significantly decreased from 52.1 ± 16 to 30.4 ± 23(P ≤ 0.001).Post ADA,body mass index(BMI) standard deviation score(SDS) 0.1[range:2.7-(-0.8)] vs-1 [range:0.1-(-3.6)],P = 0.04 and △BMI SDS in children 0.3 [range:0.7-(-0.2)] vs-1.1 [range:1.2-(-2.3)],P = 0.01 in remission were significantly higher compared to those with moderate to severe inflammation.The main predictors for growth were 25-hydroxycholecalciferol and for bone mineralisation weight and height SDS.ADA had no significant influence on bone markers and BMD.CONCLUSION:Next to improvement of PCDAI,half of the children achieved a positive catch-up growth.A better nutritional status with improvement in BMI and weight is positive predictor for improved growth and bone mineralisation.

关键词： Crohn's disease Adalimumab Growth Bone health paediatrics

Detection of reflux-symptom association in children with esophageal atresia by video-pH-impedance study

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World Journal of gastroenterology 2020年第28期26卷 4159-4169页

作者： Settachote Maholarnkij Anapat Sanpavat Katawaetee Decharun Termpong Dumrisilp Chomchanat Tubjareon Benjawan Kanghom Tanisa Patcharatrakul Nataruks Chaijitraruch Voranush Chongsrisawat Palittiya Sintusek Department of Pediatrics King Chulalongkorn Memorial Hospital and Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Division of Pathology King Chulalongkorn Memorial HospitalFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Division of Pediatric Surgery King Chulalongkorn Memorial HospitalFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Division of gastroenterology and Pediatric Gastroenterology and Hepatology STAR(Special Task Force for Activating Research)Department of PediatricsKing Chulalongkorn Memorial Hospital and Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Division of gastroenterology Department of PediatricsKing Chulalongkorn Memorial HospitalFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Neurogastroenterology and Motility Department of GastroenterologyFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Division of gastroenterology Department of MedicineFaculty of MedicineKing Chulalongkorn Memorial HospitalBangkok 10330Thailand

BACKGROUND Children with esophageal atresia(EA)have risk of gastroesophageal reflux disease(GERD),suggesting reflux monitoring for prompt management.AIM To evaluate GERD in children with EA and specific symptom association from combined Video with Multichannel Intraluminal Impedance and pH(MII-pH)study.METHODS Children diagnosed with EA with suspected GERD and followed up at King Chulalongkorn Memorial Hospital between January 2000 and December 2018 were prospectively studied.All underwent esophagogastroduodenoscopy with esophageal biopsy and Video MII-pH study on the same day.Symptoms of GERD which included both esophageal and extra-esophageal symptom were recorded from video monitoring and abnormal reflux from MII-pH study based on the statement from the European paediatric Impedance Group.Prevalence of GERD was also reported by using histopathology as a gold standard.Endoscopic appearance was recorded using Los Angeles Classification and esophagitis severity was graded using Esohisto criteria.RESULTS Fifteen children were recruited with age of 3.1(2.2,9.8)years(40%,male)and the common type was C(93.3%).The symptoms recorded were cough(75.2%),vomiting(15.2%),irritability or unexplained crying(7.6%)and dysphagia(1.9%)with the symptom-reflux association of 45.7%,89%,71%and 0%,respectively.There were abnormal endoscopic appearance in 52.9%,esophagitis in 64.7%and high reflux score in 47.1%.Video MII-pH study has high diagnostic value with the sensitivity,specificity and accuracy of 72.7%,100%and 82.4%,respectively.CONCLUSION Prevalence of GERD in children with EA was high.Video MII-pH study to detect GERD in children with EA had high diagnostic value with the trend of specific symptom association.

关键词： Gastroesophageal reflux disease Esophageal atresia Children Impedance pH study Video Symptom association

Demographic determinants of risk,colon distribution and density scores of diverticular disease

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World Journal of gastroenterology 2011年第8期17卷 1009-1017页

作者： Mark Golder Irina Chis Ster Pratusha Babu Amita Sharma Muhammad Bayat Abdulkadir Farah Centre for Academic Surgery Institute of Cell and Molecular Science Barts and the London School of Medi-cine and Dentistry Queen Mary University MRC centre for paediatric Epidemiology and Biostatistics University College Department of Radiology University Hospital Lewisham

AIM:To investigate associations between ethnicity,age and sex and the risk,colon distribution and density scores of diverticular disease(DD).METHODS:Barium enemas were examined in 1000 patients:410 male,590 female;760 whites,62 Asians,44 black africans(BAs),and 134 other blacks(OBs).Risks and diverticula density of left-sided DD(LSDD) and rightsided-component DD(RSCDD = right-sided DD + right and left DD + Pan-DD) were compared using logistic regression.RESULTS:Four hundred and forty-seven patients had DD(322 LSDD and 125 RSCDD).Adjusted risks:(1) LSDD:each year increase in age increased the odds by 6%(95% CI:5-8,SE:0.8%,P < 0.001);Asians:odds ratio(OR):0.23(95% CI:0.10-0.53,SE:0.1,P ≤ 0.001) and OBs:OR:0.25(95% CI:0.14-0.43,SE:0.07,P ≤ 0.001) appeared protected vs Whites;(2) RSCDD:each year increase in age increased the odds by 4%(95% CI:2-6,SE:1%,P < 0.001);females were 0.60 times(95% CI:0.40-0.90,SE:0.12,P = 0.01) less likely than males to have RSCDD;BAs were 3.51 times(95% CI:1.70-7.24,SE:1.30,P < 0.001) more likely than Whites to have RSCDD;and(3) DD density scores:each year increase in age increased the odds of highdensity scores by 4%(95% CI:1-6,SE:1%,P < 0.001);RSCDD was 2.77 times(95% CI:1.39-3.32,SE:0.67,P < 0.001) more likely to be of high density than LSDD.No further signif icant differences were found in the adjusted models.CONCLUSION:Right colonic DD might be more common and has higher diverticula density in the west than previously reported.BAs appear predisposed to DD,whereas other ethnic differences appear conserved following migration.

关键词：高密度风险分数结肠 logistic回归人口种族差异 BAS

Therapeutic upper gastrointestinal tract endoscopy in paediatric gastroenterology

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World Journal of Gastrointestinal Endoscopy 2015年第3期7卷 169-182页

作者： Imdadur Rahman Praful Patel Philip Boger Shahnawaz Rasheed Mike Thomson Nadeem Ahmad Afzal Department of gastroenterology University Hospital Southampton SO16 6YD Southampton United Kingdom Department of paediatrics University Hospital Southampton SO16 6YD Southampton United Kingdom Department of Surgery the Royal Marsden Hospital SW3 6JJ London United Kingdom Department of paediatric gastroenterology the Children's Hospital Sheffield Western Bank S10 2TH Sheffield United Kingdom

Since the first report of use of endoscopy in children in the 1970 s, there has seen an exponential growthin published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract.

关键词： Child Pediatrics Endoscopy Gastroscopy Intestinal polyps Hemorrhage Caustics Gastrostomy Mitomycin Gastroesophageal reflux

Utilisation of magnets to enhance gastrointestinal endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第19期7卷 1306-1310页

作者： Imdadur Rahman Praful Patel Philip Boger Mike Thomson Nadeem Ahmad AfzalImdadur Department of gastroenterology University Hospital Southampton Department of paediatric gastroenterology the Children’s Hospital Sheffield Department of paediatrics University Hospital Southampton

Methods to assess, access and treat pathology within the gastrointestinal tract continue to evolve with video endoscopy replacing radiology as the gold standard. Whilst endoscope technology develops further with the advent of newer higher resolution chips, an array of adjuncts has been developed to enhance endoscopy in other ways; most notable is the use of magnets. Magnets are utilised in many areas, ranging from endoscopic training, lesion resection, aiding manoeuvrability of capsule endoscopes, to assisting in easy placement of tubes for nutritional feeding. Some of these are still at an experimental stage, whilst others are being increasingly incorporated in our everyday practice.

关键词： Magnet Endoscopy Training Therapeutic Capsule Nutrition Child paediatric Colonoscopy Imaging

Generic and disease-specific health-related quality of life in patients with Hirschsprung disease:A systematic review and meta-analysis

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World Journal of gastroenterology 2022年第13期28卷 1362-1376页

作者： Veerle Huizer Naveen Wijekoon Daniëlle Roorda Jaap Oosterlaan Marc A Benninga LW Ernest van Heurn Shaman Rajindrajith Joep PM Derikx Department of Pediatric Surgery Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdam Reproduction and DevelopmentAmsterdam 1105 AZNetherlands Department of Surgery University of Colombo and Department of Paediatric SurgeryLady Ridgeway Hospital for ChildrenColombo 00800Sri Lanka Department of Pediatrics Emma Children's HospitalAmsterdam UMCUniversity of AmsterdamEmma Neuroscience GroupAmsterdam Reproduction and DevelopmentAmsterdam 1105 AZNetherlands Department of Pediatrics Lady Ridgeway Hospital for ChildrenColombo 00800Sri Lanka

BACKGROUND Patients with Hirschsprung disease(HD)are at risk of persistent constipation,fecal incontinence or recurrent enterocolitis after surgical treatment,which in turn may impact physical and psychosocial functioning.Generic health-related quality of life(HRQoL)and disease-specific health-related quality of life are relevant outcome measures to assess the impact of HD on the QoL of these patients.AIM To summarize all available evidence on HRQoL of patients with HD after surgery and the impact of possible moderating factors.METHODS Pubmed,Web of Sciences,Psyc Info and Embase were searched with search terms related to’Hirschsprung disease’,’Pediatrics’and’Quality of life’.Mean and standard deviation of generic HRQoL overall and domain scores were extracted from each study,as well as data describing potential factors associated with QoL.Random effect models were used for meta-analytic aggregation of generic HRQoL scores.Meta-regression was used to assess the relationship between patient and clinical characteristics and generic HRQoL.Disease-specific HRQoL outcomes of patients with HD were systematically reviewed.RESULTS Seventeen articles were included in the systematic review(n=1137 patients)and 15 in the quantitative meta-analysis(n=1024 patients).Four studies reported disease-specific HRQoL.Patient’s age ranged between 0 and 21 years.Meta-analytic aggregation showed a nonsignificantly impaired generic HRQoL(d=-0.168[95%CI:-0.481;0.145],P=0.293,I^(2)=94.9)in patients with HD compared to healthy controls.Physical(d=-0.042[95%CI:-0.419;0.335],P=0.829,I^(2)=95.1),psychosocial(d=-0.159[95%CI:-0.458;0.141],P=0.299,I^(2)=93.6)and social HRQoL(d=-0.092[95%CI:-0.642;0.457],P=0.742,I^(2)=92.3)were also not significantly lower compared to healthy controls.There was no relation between health-related outcomes and the sex of the patients and whether generic HRQoL was measured by parental proxy or self-report.Disease-specific complaints of patients with HD impaired physical HRQoL,but not psychosocial and social HRQoL.CONC

关键词： Hirschsprung disease Health-related quality of life Meta-analysis Systematic review Pediatrics