Publications (37) View all
-
Article: Phlegmonous Gastritis: A Rare Cause of Abdominal Pain.
Journal of pediatric gastroenterology and nutrition 03/2013; · 2.18 Impact Factor -
Article: Celiac disease in first degree relatives of celiac children.
[show abstract] [hide abstract]
ABSTRACT: CONTEXT - The first degree relatives of celiac patients represent a high risk group for the development of this disorder, so their screening may be crucial in the prevention of long-term complications. OBJECTIVE - In order to determine the prevalence of celiac disease in a group of first degree relatives of children with proven gluten intolerance, we conducted a prospective study that consisted in the screening of celiac disease, using a capillary immunoassay rapid test that allows a qualitative detection of IgA antibody to human recombinant tissue transglutaminase (IgA-TTG). METHODS - When the screening test was positive subjects were advised to proceed with further investigation. The screening test was performed in 268 first degree relatives (143 mothers, 89 fathers, 36 siblings) corresponding to 163 children with celiac disease. RESULTS - Screening test was positive in 12 relatives (4.5%), of which 1 refused to continue the investigation. In the remaining 11 relatives celiac disease was diagnosed in 7 cases (2.6%, 5 mothers, 2 fathers) who had a median age of 39 years (27-56 years), mild gastrointestinal symptoms, high titre of IgA-TTG and histology abnormalities confirming the diagnosis. All these patients are currently on a gluten-free diet. CONCLUSION - The prevalence of celiac disease among first degree relatives (2.6%) was 5 times higher than that in the general population. Although the recommendations for screening asymptomatic high risk groups, such as first degree relatives, are not unanimous the early diagnosis is crucial in preventing complications, including nutritional deficiency and cancer.Arquivos de gastroenterologia 09/2012; 49(3):204-7. -
Article: Management of pediatric ulcerative colitis: joint ECCO and ESPGHAN evidence-based consensus guidelines.
[show abstract] [hide abstract]
ABSTRACT: Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). A group of 27 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to ESPGHAN and ECCO members. A list of 23 predefined questions were addressed by working subgroups based on a SR of the literature. A total of 40 formal recommendations and 68 practice points were endorsed with a consensus rate of at least 89% regarding initial evaluation, how to monitor disease activity, the role of endoscopic evaluation, medical and surgical therapy, timing and choice of each medication, the role of combined therapy, and when to stop medications. A management flowchart, based on the Pediatric Ulcerative Colitis Activity Index (PUCAI), is presented. These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.Journal of pediatric gastroenterology and nutrition 07/2012; 55(3):340-61. · 2.18 Impact Factor -
Article: Risk of infection and prevention in pediatric patients with IBD: ESPGHAN IBD Porto Group commentary.
[show abstract] [hide abstract]
ABSTRACT: Combined immunosuppression by immunomodulators and biological therapy has become standard in the medical management of moderate-to-severe inflammatory bowel disease (IBD) because of clearly demonstrated efficacy. Clinical studies, registries, and case reports warn of the increased risk of infections, particularly opportunistic infections; however, already in the steroid monotherapy era, patients are at risk because it is accepted that a patient should be considered immunosuppressed when receiving a daily dose of 20 mg of prednisone for 2 weeks. Prescriptions increasingly involve azathioprine, methotrexate, and various biological agents. The TREAT registry evaluated safety in >6000 adult patients, half of them treated with infliximab (IFX) for about 1.9 years. IFX-treated patients had an increased risk of infections and this was associated with disease severity and concomitant prednisone use. The REACH study, evaluating the efficacy of IFX in children with moderate-to-severe Crohn disease, refractory to immunomodulatory treatment, reports serious infections as the major adverse events and their frequency is higher with shorter treatment intervals. The combination of immunosuppressive medications is a risk factor for opportunistic infections. Exhaustive guidelines on prophylaxis, diagnosis, and management of opportunistic infections in adult patients with IBD have been published by a European Crohn's and Colitis Organization working group, including clear evidence-based statements. We have reviewed the literature on infections in pediatric IBD as well as the European Crohn's and Colitis Organization guidelines to present a commentary on infection prophylaxis for the pediatric age group.Journal of pediatric gastroenterology and nutrition 06/2012; 54(6):830-7. · 2.18 Impact Factor -
Article: Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome.
[show abstract] [hide abstract]
ABSTRACT: Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the recent description of serial transverse enteroplasty (STEP). We reviewed the patients who underwent the STEP operation for short bowel syndrome in our hospital in order to evaluate medium-term outcome. Between April 2006 and December 2008, three children were submitted to STEP without postoperative complications directly related to the procedure. In two cases the autonomy for oral/enteric feeding was obtained within 3 and 7 months after surgery with sustained growth, persisting at 5 years of follow-up after STEP. One child remained dependent of parenteral nutrition and was submitted to intestinal transplantation 30 months after STEP. However, since STEP until transplantation, it was possible to increase enteric volume and decrease intestinal dilation and the frequency of occlusive episodes. STEP is an effective and safe technique for intestinal lengthening that may allow increased tolerance to oral/enteric feeding or at least alleviate some complications of short bowel syndrome.European Journal of Pediatrics 04/2012; 171(8):1265-8. · 1.88 Impact Factor
