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ABSTRACT: Eosinophilic oesophagitis is an emerging disease, well known also in paediatric age, probably caused by both IgE and non-IgE mediated food allergies, diagnosed by upper endoscopy with biopsy. The most severe complication is oesophageal stenosis. The identification of the offending allergens is often difficult; therapy is focused to eliminate the supposed antigenic stimulus, to control the acute symptoms and to induce long-term remission.
We report the clinical outcome and the typical endoscopic findings of children and adolescents affected by eosinophilic oesophagitis, referring a proposal of diagnostic and treatment protocol.
Twelve patients, affected by eosinophilic oesophagitis with a histological diagnosis, underwent radiographic upper gastro-intestinal series, 24 h pH-probe and standardised allergic testing; they were treated with steroids (oral prednisone and swallowed aerosolised fluticasone) and elimination diet. Dilations were performed when eosinophilic oesophagitis was not yet diagnosed, or in patients resistant to conventional treatment.
Two patients were lost to follow up (mean follow up: 1 year 11 months); seven patients have no symptoms and normal histology, five of them on restricted diet (without cow's milk protein) and two patients on elemental diet (amino acid formula). In two patients (no allergens identified), mild dysphagia and eosinophilic infiltration persist; one patients underwent Nissen fundoplication for Barrett's oesophagus: he has no symptoms and normal oesophagus, on restricted diet (without cow's milk/eggs protein and wheat).
The recognition of typical endoscopic picture with careful biopsies extended to the whole oesophagus, even in emergency, could more quickly lead to the correct diagnosis and avoid severe complications of eosinophilic oesophagitis in children, as stricture and failure to growth. Elimination diet is the key of resolution when the allergens are identified. A great challenge remains the relation between gastro-oesophageal reflux disease and eosinophilic oesophagitis, which should however be explained.
Digestive and Liver Disease 05/2006; 38(4):245-51. · 3.05 Impact Factor
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ABSTRACT: Patients with eating disorders can refer to a variety of gastrointestinal symptoms, sometimes to justify reduced food intake and vomiting. The authors investigated whether adolescent patients with eating disorders and dyspeptic symptoms have altered gastric electric activity and abnormal gastric emptying as assessed respectively by electrogastrography and scintigraphy.
Twenty-eight patients (18 with anorexia and 10 with bulimia) and 16 healthy volunteers underwent electrogastrography; 20 of the 28 patients (14 with anorexia and 6 with bulimia) underwent gastric emptying scintigraphy. Electrogastrography with bipolar recording lasted 1 hour, 30 minutes before and after a standard meal. Before gastric emptying scintigraphy, patients fasted overnight; during testing, they ingested a solid meal labeled with technetium-99m sulfur colloid. The ratio of fasting to postprandial electrogastrographic variables was evaluated using the Wilcoxon matched-pair test. The Mann- Whitney test was used to compare absolute values for electrogastrographic data in each group. The Student paired t test was used to compare scintigraphic results expressed as percentage of gastric emptying at 60 minutes and as the gastric emptying time (T(1/2)).
Patients with bulimia significantly differed from those with anorexia and control subjects regarding the amount of normal gastric electric activity and bradygastria, and from patients with anorexia only regarding tachygastria. These electrogastrographic variables did not differ significantly between patients with anorexia and control subjects. Gastric emptying time (T(1/2)) was significantly longer in patients with bulimia than in those with anorexia.
Adolescent patients with bulimia who complain of dyspeptic symptoms have documentable abnormalities of gastric electric activity and emptying, whereas their counterparts with anorexia, probably owing to their shorter disease duration, do not.
Journal of Pediatric Gastroenterology and Nutrition 08/2003; 37(1):35-41. · 2.30 Impact Factor
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ABSTRACT: Gastrointestinal motility disorders are frequently found in several pathologies. The aim of this study was to assess, by means of electrogastrography, the presence of gastrointestinal motility abnormalities in children affected by Crohn's disease (CD) or Chronic Intestinal Pseudo-Obstruction (CIPO). Patients and Methods. We studied 34 subjects; 20 control subjects (M = 15, mean age = 10 +/- 3.5 yrs), 8 patients (M = 4, mean age = 18 +/- 7 yrs) with Crohn's disease in a quiescent phase and 6 patients (M = 6, mean age = 10 +/- 3.5 yrs) with Chronic Intestinal Pseudo-Obstruction. Results. Analysis of gastric electrical activity (GEA) parameters demonstrated that in the control group physiological post-prandial changes are represented by an increase of 3 Cycles Per Minute (3 CPM) activity, Period Dominant Power (PDP) and Period Dominant Frequency (PDF) and by the reduction of bradygastria. Crohn patients showed an insignificant increase of 3 CPM and PDP; CIPO patients showed an abnormal variation of 3 CPM, PDP and post-prandial bradygastria. Moreover, CD patients showed a significant difference in post-prandial values of PDP compared to normal subjects. CIPO patients revealed a significant difference in the values of either preprandial PDF with tachygastria or the post-prandial value of 3 CPM, compared to normal subjects. Conclusions. EEG is a non-invasive method to study gut motility related to GEA alterations present in CIPO as well as in CD patients.
European Journal of Pediatric Surgery 03/2003; 13(1):31-4. · 0.81 Impact Factor
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ABSTRACT: Gastric resection is an infrequent surgical procedure in childhood. However, the use of the stomach for bladder augmentation and substitution is well documented. Partial gastrectomy performed in gastrocystoplasty (GCP) involves the greater curvature of the stomach, the same area in which gastric pace-maker cells are known to be placed. The aim of this study was to assess, by electrogastrography (EGG), if subtotal gastric resection can alter gastric motility in children submitted to partial gastrectomy for GCP.
Gastric electrical activity (GEA) was evaluated in 25 children using EGG: 10 patients (4 boys, 6 girls; mean age, 11.6 years) previously submitted to GCP, and 15 normal subjects (12 boys, 3 girls; mean age, 8.62 +/- 2.77 years) as controls. All patients were submitted to cutaneous EGG; recording GEA for 30 minutes before and after a standard test meal. The percentage of 3 cycles per minute (3CPM), bradygastria, tachygastria, DFIC (dominant frequency instability coefficient), DPIC (dominant power instability coefficient), PDP (period dominant power), PDF (period dominant frequency) were recorded and analyzed using Wilcoxon matched-pair test. Data were considered statistically significant if P <.05.
Normal subjects as well as operated patients showed a statistically significant difference in bradygastria (P =.05), PDP and PDF (P =.05) percentage, comparing pre versus postprandial period. In the normal group, 3CPM (P =.0012) and DFIC (P =.0008) were statistically different between the pre- and postprandial period. Patients who underwent GCP did not show any statistically significant difference in 3CPM and DFIC pre- and postprandial.
In normal subjects, GEA showed a complete variation after the meal, whereas in operated patients GEA was impaired and only partially modified after the meal. This observation suggests that in patients with gastric resection, adaptation of the stomach to food ingestion is present but incomplete with respect to normal subjects; it can be caused by surgical removal of the pace-maker cells of the greater curvature. For this reason a follow-up analysis of gastric function is recommended for all patients undergoing GCP.
Journal of Pediatric Surgery 09/2001; 36(8):1157-9. · 1.45 Impact Factor
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ABSTRACT: To quantify colorectal neurogenic dysfunction in children with spina bifida and to evaluate the clinical efficacy of appropriate rehabilitation performed by the coloproctologist in the spina bifida team.
The bowel function of 73 patients with congenital (67) and acquired (six) spinal lesions (age 7-25 years) was evaluated by one physician. Evacuation habit was classified as full bowel control, mild and severe constipation or incontinence. Fifty-two children had mild or severe incontinence or constipation, 22 of whom were treated by the coloproctologist using biofeedback or conventional therapy; 30 were not treated. The outcome was compared between the groups
Bowel constipation remained stable in 90% and was complicated in 10% of the untreated patients, while it ameliorated in 59% of patients who received specialist treatment.
Neurogenic bowel dysfunction needs specialist management to achieve better results, using the concept of controlled incontinence. There was no significant difference between conventional therapy and biofeedback methods.
British Journal of Urology 06/1998; 81 Suppl 3:117-9.
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ABSTRACT: From 1983 to 1996, 31 children with caustic esophageal strictures were seen at Bambino Gesù Children's Hospital; they were all treated conservatively except for two cases complicated by tracheoesophageal fistula. The remaining 29 patients were divided into three groups depending on the treatment, which was modified over the years. Group A (1983 to 1987) consisted of seven patients treated by periodic dilatations; group B (1988 to 1992) consisted of 10 children treated by 40 days of esophageal stenting plus dexamethasone, 0.5 mg/kg/d plus ranitidine plus no oral feeding for 7 to 10 days; group C (1993 to 1996) consisted of 12 cases treated by 40 days of esophageal stenting plus dexamethasone, 1 mg/kg/d plus omeprazole plus early oral feeding resumption.
No differences were observed between the three groups of patients with regard to the mean age and to the ingested substance, whereas a significant difference (P = .007) was observed in the mean length of the stricture between group A and C (3.4+/-1.3 and 5.6+/-1.6 cm, respectively). In all but one of the patients (96.5%) complete healing of the stenosis was achieved by conservative treatment, with definitive relief of dysphagia. One patient in group C did not improve after a repeated stenting procedure and was surgically treated. However, in group A, resolution of the stricture was obtained after an average of 19.9+/-14.8 dilatations in a mean period of 25.3+/-17.2 months. In group B, a mean of 12+/-11.3 dilatations were required in a mean period of treatment of 14.1+/-10.6 months. In patients in group C, a mean of 3.5+/-3.2 dilatations were necessary in a mean of 5.8+/-4.8 months. A statistically significant difference was observed both with regard to the number of dilatations and to the duration of treatment, between group A and group C (P = .002) and group B and C (P = .03).
Esophageal replacement should be considered only in cases complicated by tracheoesophageal fistula or in the rare patients who do not respond to repeated esophageal stenting.
Journal of Pediatric Surgery 02/1998; 33(1):54-7. · 1.45 Impact Factor
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ABSTRACT: Ulcerative colitis is seen with increasing frequency in paediatric age and its diagnosis is made more difficult by atypical cases. Sixty-five patients with UC were seen at our institute and all of them underwent medical treatment. In all patients the disease extended to the whole colon (pancolitis). Eleven patients (average age 9 yrs) underwent surgical correction by Endorectal Pull Through (EPT) 8 straight and 3 with ileal reservoir. One straight EPT had to be converted to Brooke ileostomy because of unacceptable stool frequency. In the rest of the patients the disease is well controlled with medical treatment. After 2 years of follow up surgical complications, continence, stool frequency and quality of life were evaluated: results indicate that surgical complications rate is the same as in other reported series; furthermore, continence and stool frequency are good with all surgical techniques eve though straight pull-through may require a period of adaptation the length of which varies considerably. Our results confirm that children with pancolitis and severe symptoms should be offered prolonged medical treatment prior to undertake surgical correction.
Acta chirurgica Belgica 07/1996; 96(3):104-7. · 0.43 Impact Factor
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ABSTRACT: The authors report their experience in the treatment of the chronic constipation in paediatric age. During the last 3 years (1991-1994), 230 children presenting chronic constipation have been studied at the Strumental Gastroenterologic Department of Children Hospital Bambino Gesù; 19 of them (8%), 10 male and 9 female, were studied with anorectal manometry, defecography and Intestinal Transit test. All the patients had a overtone (high squeeze) of the anal sphincter and the medical treatment was unsuccessful. They underwent sphincteromyectomy by posterior approach. In 17 patients it has been obtained a notable improvement of the symptomatology with regularization of the evacuations. The simplicity of the surgical technique, the absence of complications and the obtained results confirm the validity of sphinteromyectomy in the therapy of the chronic constipation in paediatric age. Interoperating anorectal manometry proved to be essential both in modulating sphincteromyectomy and in its eventual complications.
Minerva pediatrica 06/1996; 48(5):217-20.
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ABSTRACT: From 1982 to 1990, 222 children (mean age 2.5 years, range 1–11 years) were admitted to Bambino Gesu' Children's Hospital
for suspected caustic ingestion. In 126 cases (56.7%) esophageal injuries were evidenced on endoscopy, which was always performed
within 24 h of the injestion. Eighteen children (8.1%) developed an esophageal stricture; 4 of these were treated surgically
and the remaining 14 were included in two different protocols of conservative treatment: up to 1987, 7 patients (group 1)
underwent periodic esophageal dilatations; from 1988 to 1990, 7 (group 2) were treated by esophageal stenting. In group 1,
a mean of 25.1 ± 17.8 months and 19.3 ± 15.8 dilatations were necessary for the stenosis to heal completely. In group 2, disappearance
of the stricture was achieved within 12.8 ± 9 months with a mean of 9.4 ± 11 dilatations. Esophageal stenting appeared to
reduce by half both the duration of treatment and the number of dilatations required to obtain complete healing of corrosive
stenoses. Moreover, the scars softened after stent placement, allowing safer dilatation of recurrent strictures.
Pediatric Surgery International 12/1992; 8(1):2-7. · 1.25 Impact Factor
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ABSTRACT: Sigmoid volvulus is a rare disease of childhood, which requires surgery. The case of a 12-year-old boy is reported. The main aetiopathogenetic causes and the proper surgical approach are also described with particular reference to the so-called mesosigmoidoplasty, which consists of shortening the mesosigmoid by incision along its axis and transverse suture.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 08/1989; 27(3):105-7. · 0.29 Impact Factor
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ABSTRACT: From January 1976 to October 1986, 107 cases of esophageal atresia (EA) were admitted to the Neonatal Surgical Unit of the Bambino Ges Hospital of Rome; 86% of the children had a type III EA. Associated anomalies were present in 47%; they were multiple in 18%. Cardiological malformations were the most frequent followed by digestive, skeletal, urological, and chromosomal aberrations. Surgical treatment was attempted in all children except 3, who died before surgical correction, in an effort to perform an end-to-end anastomosis in a single layer through a transpleural approach. According to the results, children were divided into two groups of 50 patients each: group 1 (1976–1981); and group 2 (1981–1986). Anastomosis was possible in 69% of children (68.7% in group 1, 69.3% in group 2). After 1983, gastrostomy fell into gradual disrepute and a transanastomotic tube was used. Immediate complications were seen in 36.6% of cases; in no case did recurrence of the tracheoesophageal fistula occur. The overall mortality decreased from 50% (group 1) to 30% (group 2). In the two periods considered, the mortality according to Waterston's risk classes was 28.5% 5,8% (class A), 42.1% 11.7% (class B), 82.3% 68.7% (class C). Of a total of 41 deaths, 47% were due to severe associated malformations: bronchopneumopathy or prematurity seemed to have less importance in establishing the prognosis.
Pediatric Surgery International 01/1989; 4(2):95-100. · 1.25 Impact Factor
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ABSTRACT: Endoscopic injection sclerosis (EIS) of oesophageal varices is a valuable alternative treatment of recurrent variceal haemorrhage in childhood, since derivative treatment is not always possible; the spontaneous regression of varices occurring in some cases could also be promoted by EIS. A modified technique using a specially designed silicone rubber tube around the pediatric-type fiberscope in order to compress the injected varix is described. Eight children aged between 15 months and 12 years were treated with this method and 2 to 4 varices were sclerosed at each procedure using the Olympus NM3K injector. A constant reduction of the volume of the treated varices was observed, and the risks of variceal bleeding diminished significantly.
Endoscopy 06/1984; 16(3):98-100. · 5.21 Impact Factor
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ABSTRACT: The authors report 6 cases of colonic stenosis (three males and three females, range of age 9 days-4 months) observed from 1982 to 1985 in the Department of Pediatric Surgery in Bambino Gesù Hospital. Three out of six have been admitted with the diagnosis of necrotizing enterocolitis soon after birth. The authors have observed 2 cases of colonic stenosis in neonatal age, 1 case aged month, both suffering from Hirschsprung's disease. A file for the diagnosis has been performed for all patients. Stenosis have been observed in the descending colon, sigmoid colon, rectosigmoid tract, multiple stenosis were present in 2 patients. In 5 patients the surgical treatment has been the removal of stenotic tract. In three patients a colostomy on transverse colon has been performed followed by abdominal perineal intestinal lowering. The authors stress the importance of anorectal manometry among investigations usually performed to exclude Hirschsprung's disease.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 8(6):895-8.
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ABSTRACT: Considering the clinical and statistical data about injured children coming to the emergency department in the years between 1990 and 1995, the Authors hope better information, identification of risks, use of safety devices in order to successfully implement precautionary measures and the assistance in accidents which still are the first reason for death in children.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 18(2):187-9.
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ABSTRACT: The gastro-esophageal reflux (GER) usually causes digestive symptoms, failure to trive and/or respiratory symptoms. Furthemore the association between GER and asthma is well known. Nevertheless, the relationship between two pathologies and role of GER in aggravation of asthma are not well known. The aims of our study is to identify the peculiar pH-metric caracteristics of GER may be responsable of asthmatic symptoms in children. The study was conducted in 32 children. The patients were divided into two groups: Group A composed of 16 children suffering from non-allergic asthma characterized by prevalent nocturnal manifestation; Group B composed of 16 children suffering from GER, without respiratory symptoms. All patients underwent to 21 pH-monitoring. The pH-metric data collected in two groups are submitted to statistic analysis using the Student's "t" Test.
La Pediatria medica e chirurgica: Medical and surgical pediatrics 17(6):513-4.
