Pediatrics Subject Collection: Gastrointestinal Tract

Care of the Child Assisted by Technology [ARTICLES]

Glader, L. J. — 2009-11-01

Objectives Objectives Introduction Who Are Technology-dependent... Specific Technologies Psychosocial Issues General Management Principles Prognosis Websites for Families References After completing this article, readers should be able to: Describe children who are dependent on technology. List common indications for and complications of gastrostomy tubes. Define invasive and noninvasive mechanical ventilation. Recognize the psychosocial effects of having a child dependent on technology. Introduction Objectives Introduction Who Are Techn ...

Recommendations for Screening, Monitoring, and Referral of Pediatric Chronic Hepatitis B [SPECIAL ARTICLES]

Haber, B. A. — 2009-11-01

Most children with chronic hepatitis B virus infection (persistent hepatitis B surface antigen-positive for >6 months) are asymptomatic and do not generally require treatment. These children are, however, at increased risk for severe complications later in life, including advanced liver disease and liver cancer. On November 11, 2008, the Hepatitis B Foundation, a nonprofit research and disease advocacy organization, convened a panel of nationally recognized North American pediatric liver specialists to consider and recommend an approach for the screening, monitoring, initial management, and referral of children with chronic hepatitis B. The panel developed recommendations to provide guidance to practitioners on determining what additional tests to conduct, how often to monitor on the basis of test results, and when to refer to a pediatric liver specialist to build a partnership between the practitioner and liver specialist to enhance the success of management of children with this lifelong infection.

Research and Statistics: Systematic Reviews and Meta-Analyses [ARTICLES]

Bair-Merritt, M. H. — 2009-10-01

Case Studies Case Studies Introduction Systematic Review Meta-analysis Advantages and Limitations The Cochrane Library References Suggested Reading You are seeing an 11-month-old infant who has bronchiolitis. A medical student rotating through your practice asks you if the empiric evidence supports prescribing albuterol. In between patients, you search the medical literature and find hundreds of articles written on this topic. You would like one article that summarizes the existing evidence regarding the effectiveness of beta2-agonists for treating bronchiolitis. You are seeing an otherwise healthy 3-year-old boy w ...

Hypernatremia [IN BRIEF]

Goff, D. A. — 2009-10-01

Common Electrolyte Problems in Pediatrics--Hypernatremia. Perkin R, Swift J. In: Pediatric Hospital Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008:89 -90 Disorders of Sodium and Water Homeostasis. Skorecki K, Ausiello D. In: Cecil's Medicine. 23rd ed. Philadelphia, Pa: Saunders, Inc; 2007 The Changing Pattern of Hypernatremia in Hospitalized Children. Moritz ML, Ayus JC. Pediatrics. 1999;104 :435 -439 Urine Sodium Concentration in Ambulatory Heal ...

Dimenhydrinate in Children With Infectious Gastroenteritis: A Prospective, RCT [ARTICLES]

Uhlig, U. — 2009-10-01

OBJECTIVE: Vomiting is a common symptom in children with infectious gastroenteritis. It contributes to fluid loss and is a limiting factor for oral rehydration therapy. Dimenhydrinate has traditionally been used for children with gastroenteritis in countries such as Canada and Germany. We investigated the efficacy and safety of dimenhydrinate in children with acute gastroenteritis. METHODS: We performed a prospective, randomized, placebo-controlled, multicenter trial. We randomly assigned 243 children with presumed gastroenteritis and vomiting to rectal dimenhydrinate or placebo. Children with no or mild dehydration were included. All children received oral rehydration therapy. Primary outcome was defined as weight gain within 18 to 24 hours after randomization. Secondary outcomes were number of vomiting episodes, fluid intake, parents' assessment of well-being, number of diarrheal episodes, and admission rate to hospital. We recorded potential adverse effects. RESULTS: Change of weight did not differ between children who received dimenhydrinate or placebo. The mean number of vomiting episodes between randomization and follow-up visit was 0.64 in the dimenhydrinate group and 1.36 in the placebo group. In total, 69.6% of the children in the dimenhydrinate group versus 47.4% in the placebo group were free of vomiting between randomization and the follow-up visit. Hospital admission rate, fluid intake, general well-being of the children, and potential adverse effects, including the number of diarrhea episodes, were similar in both groups. CONCLUSIONS: Dimenhydrinate reduces the frequency of vomiting in children with mild dehydration; however, the overall benefit is low, because it does not improve oral rehydration and clinical outcome.

Cholelithiasis and Cholecystitis [IN BRIEF]

Guralnick, S. — 2009-09-01

Biliary Tract Disease in Children. McEvoy CF, Suchy FJ. Pediatr Clin North Am. 1996; 42: 75-98 Cholelithiasis. Friedman JR, Crawford Kennedy M. eMedicine Specialties, Pediatrics: General Medicine, Gastroenterology. 2009. Available at: http://www.emedicine.com/ped/topic381.htm. Accessed June 2009 Cholecystitis. Hebra A, Miller M. eMedicine Specialties, Pediatrics: General Medicine, Gastroenterology. 2008. Available at: http://emedicine.medscape.com/article/927340-overview. Accessed June 2009 ...

Gastrointestinal Symptoms in Children With Type 1 Diabetes Screened for Celiac Disease [ARTICLES]

Narula, P. — 2009-09-01

BACKGROUND: The association between celiac disease (CD) and type 1 diabetes mellitus (DM) is recognized. Most cases of CD in patients with DM are reported to be asymptomatic. OBJECTIVES: The objectives of this study were to (1) compare and audit our practice with the published standards for screening for CD in children with DM, (2) characterize the children with DM and biopsy-confirmed CD, in terms of growth and gastrointestinal symptoms, and compare them with children with DM and negative celiac serology, and (3) document the effects of a gluten-free diet (GFD) after 1 year of gastrointestinal symptoms, growth, and insulin requirement. METHOD: We performed a retrospective case-note review of 22 children with DM, positive celiac serology {+/-} biopsy-confirmed CD, and 50 children with DM and negative celiac serology. RESULTS: Twenty-two children (3.9% of the total diabetic population) had positive celiac serology on screening, with 17 (3%) having biopsy-confirmed CD. Ninety-four percent of the children had standardized celiac serology testing. At diagnosis of CD, 13 of the 17 biopsy-positive children (76.4%) had [≥]1 gastrointestinal symptom. The frequency of gastrointestinal symptoms in negative celiac serology diabetic children was 6% (3 of 50) (P < .0005). Symptoms resolved in all children after introduction of a GFD. A significant improvement in weight SD score (P = .008) and BMI SD score (P = .02) was noted in those compliant with a GFD after 1 year. CONCLUSIONS: Children with DM and CD have a higher frequency of gastrointestinal symptoms than their diabetic peers with negative celiac serology and are not truly asymptomatic. Institution of a GFD has a positive effect on nutritional status and symptom resolution in the short-term.

Foreign Body Ingestion and Aspiration [ARTICLES]

Louie, M. C. — 2009-08-01

Objectives Objectives Case Studies Foreign Body Ingestions Foreign Body Aspiration Suggested Reading After completing this article, readers should be able to: Recognize the presenting history, signs, and symptoms of patients who have swallowed or inhaled foreign bodies. Discuss the long-term complications of gastrointestinal and airway foreign bodies. Describe appropriate management strategies for patients who have common esophageal and gastric foreign bodies. Identify the risks associated with ingestion of button batteries and recognize when emergent removal is necessary. Maintain a high level of suspicion for aspirated foreign bodies, recognizing that de ...

Cystic Fibrosis [ARTICLES]

Montgomery, G. S. — 2009-08-01

Objectives Objectives Introduction Genetics and Epidemiology Diagnosis Lung Disease Pulmonary Therapies Pancreatic Disease Intestinal Disease Hepatobiliary Disease Upper Airway Disease Fertility Issues Prognosis Conclusion Suggested Reading After completing this article, readers should be able to: Describe the underlying genetic disruption that leads to the pathophysiologic changes seen in cystic fibrosis (CF). Interpret newborn screening results and other tests used to diagnose CF. Recognize the complications that may arise in various organ systems of p ...

13C-Sucrose Breath Test: Novel Use of a Noninvasive Biomarker of Environmental Gut Health [ARTICLES]

Ritchie, B. K. — 2009-08-01

OBJECTIVE: Environmental enteropathy syndrome may compromise growth and predispose to infectious diseases in children in the developing world, including Australian Aboriginal children from remote communities of the Northern Territory. In this study, we described the use of a biomarker 13C-sucrose breath test (SBT) to measure enterocyte sucrase activity as a marker of small intestinal villus integrity and function. METHODS: This was a hospital-based prospective case-control study of Aboriginal and non-Aboriginal children with and without acute diarrheal disease. Using the SBT, we compared 36 Aboriginal case subjects admitted to a hospital (18 diarrheal and 18 nondiarrheal disease), with 7 healthy non-Aboriginal control subjects. Intestinal permeability using the lactulose/rhamnose (L/R) ratio on a timed 90-minute blood test was performed simultaneously with the SBT. The SBT results are expressed as a cumulative percentage of the dose recovered at 90 minutes. RESULTS: Aboriginal children with acute diarrheal disease have a significantly decreased absorptive capacity, as determined by the SBT, with a mean of 1.9% compared with either Aboriginal children without diarrhea (4.1%) or non-Aboriginal (6.1%) control subjects. The mean L/R ratio in the diarrhea group was 31.8 compared with 11.4 in Aboriginal children without diarrhea. There was a significant inverse correlation between the SBT and the L/R ratio. CONCLUSIONS: The SBT was able to discriminate among Aboriginal children with diarrhea, asymptomatic Aboriginal children with an underlying environmental enteropathy, and healthy non-Aboriginal controls. This test provides a noninvasive, easy-to-use, integrated marker of the absorptive capacity and integrity of the small intestine and could be a valuable tool in evaluating the efficacy of interventions aimed at improving gut health.