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Peña-Vélez R, Toro-Monjaraz E, Imbett-Yepez S, Ramírez Mayans JA. Prevalence of dyssynergic defecation in children with constipation evaluated by high-resolution anorectal manometry. Rev Esp Enferm Dig 2024. [PMID: 38235682 DOI: 10.17235/reed.2024.10173/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Dyssynergic defecation, defined as the incoordination of rectoanal and abdominal muscles and the pelvic floor which are necessary for the appropriate relaxation, is characterized by paradoxical anal contraction, inadequate anal relaxation, or abnormal rectal propulsion; it is considered a cause of refractory primary constipation. The prevalence of dyssynergic defecation in the pediatric age is still little known. The studies that have evaluated the defecation dynamics through anorectal manometry suggest that 36.8% to 80.9% of children with functional constipation (FC) present dyssynergic defecation. High-resolution Anorectal Manometry (HRAM) is a tool for the evaluation of the sensitivity and defecation dynamics; it allows to establish the diagnosis of dyssynergia and its classification. The objective of this study was to determine the prevalence of dyssynergic defecation in children with FC and characterize the most common type of dyssynergia evaluated through a HRAM. In this study, 63 files of pediatric patients with FC diagnoses were included. Of these, 41.3% (n=26) were female and 58.7% (n=37) were male. The median age in the group of dyssynergia was 8 years, while for the FC group it was 9 years; the distribution by sex was similar. Of the included patients, 41.3% (n=26) showed dyssynergic defecation, and 58.7% (n=37) showed normal anorectal manometry. Regarding the type, 84.6% (n=22) were of type I, 7.7% (n=2) was the percentage for both types III and IV, and no patients were reported for type II.
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Affiliation(s)
- Rubén Peña-Vélez
- Gastroenterology and Nutrition, Instituto Nacional de Pediatría, México
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Peña-Vélez R, Toro-Monjaraz E, Avelar-Rodríguez D, Zárate-Mondragón F, Ramírez-Mayans J. Alterations in the Rectal Sensitivity of Children With Chronic Constipation Evaluated by High-Resolution Anorectal Manometry. Cureus 2022; 14:e28835. [PMID: 36225479 PMCID: PMC9536238 DOI: 10.7759/cureus.28835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Constipation is one of the most frequent chronic disorders in children and is almost always of functional etiology. Manometric alterations in anorectal sensitivity in children with chronic constipation are described in the literature; nevertheless, the impact of the duration of constipation on the parameters of anorectal manometry sensitivity is unknown. Objective To compare the parameters of sensitivity of high-resolution anorectal manometry (first sensation, threshold volume for urgency, and maximal tolerability) in children with chronic constipation, related to the time of evolution from the beginning of the symptoms. Methods This was a retrospective observational analytic study. The data of 39 children with functional constipation who were subjected to high-resolution anorectal manometry were included to evaluate constipation. The patients were divided into three groups according to the duration of constipation: <1 year; from 1 to 2 years; and >2 years. The parameters of sensitivity of the anorectal manometry were compared between the three groups and correlation tests were performed with the duration in months from the beginning of the symptoms of constipation. Results There was no difference between the sensitivity parameters of high-resolution anorectal manometry of the three groups; no correlation of these parameters with the time of evolution of the symptoms was found. Conclusions Alterations in the anorectal distensibility could develop early in the course of the disease, even from the first year of the beginning of the symptoms.
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Muhardi L, Aw MM, Hasosah M, Ng RT, Chong SY, Hegar B, Toro-Monjaraz E, Darma A, Cetinkaya M, Chow CM, Kudla U, Vandenplas Y. A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria. Front Pediatr 2021; 9:778747. [PMID: 35071132 PMCID: PMC8767117 DOI: 10.3389/fped.2021.778747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/24/2021] [Indexed: 12/27/2022] Open
Abstract
Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0-5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0-6 months, the reported prevalence of colic ranged between 10-15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0-12 months, the reported prevalence of regurgitation and constipation were 3.4-25.9% and 1.3-17.7%, respectively. The reported prevalence of constipation was 1.3-26% among children aged 13-48 months and 13% among children aged 4-18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.
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Affiliation(s)
| | - Marion M Aw
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mohammed Hasosah
- Department of Pediatric, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Ruey Terng Ng
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze Yee Chong
- Department of Pediatrics, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Badriul Hegar
- Department of Pediatrics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erick Toro-Monjaraz
- Unit of Physiology and Gastrointestinal Motility, Department of Gastroenterology and Nutrition, National Institute of Pediatrics, Mexico City, Mexico
| | - Andy Darma
- Department of Pediatrics, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Merih Cetinkaya
- Department of Neonatology, Health Sciences University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Chung Mo Chow
- Virtus Medical Group, Hong Kong, Hong Kong SAR, China
| | | | - Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Peña-Vélez R, Toro-Monjaraz E, Avelar-Rodríguez D, Cadena-León J, Ignorosa-Arellano K, Loredo-Mayer A, Zárate-Mondragón F, Cervantes-Bustamante R, Ramírez-Mayans J. Esophageal motility disorders in children with dysphagia: the utility of the Chicago classification. Rev Esp Enferm Dig 2020; 112:850-853. [PMID: 33054306 DOI: 10.17235/reed.2020.6735/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND esophageal manometry is the standard criterion for the evaluation of dysphagia and the diagnosis of a primary motor disorder of the esophagus in adults and children. AIMS to describe the diagnosis according to the Chicago classification (CC) v3.0 in children with dysphagia, in whom an esophageal motility disorder was documented. The associated comorbidities were also determined. METHODS an observational retrospective study was performed of 54 patients evaluated for dysphagia, who had undergone a high-resolution manometry (HREM). RESULTS a normal HREM was found in 52 % (n = 28) of the children, whereas 48 % (n = 26) had some esophageal motility disorder. The most frequent diagnosis was ineffective esophageal motility and achalasia. Excluding previously healthy children, most children had a history of autoimmune disease and intellectual disability. CONCLUSIONS an esophageal motor disorder can be diagnosed in nearly half of infants and children with dysphagia. In this study, all esophageal diseases could be classified according to the CC v3.0. HREM should be considered for the evaluation of children with dysphagia, in addition to other studies.
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Affiliation(s)
- Rubén Peña-Vélez
- Gastroenterología y Nutrición, Instituto Nacional de Pediatría, México
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Peña-Vélez R, Toro-Monjaraz E, Avelar-Rodríguez D, Ignorosa-Arellano K, Zárate-Mondragón F, Cervantes-Bustamante R, Montijo-Barrios E, Cadena-León J, Ramírez-Mayans J. Small intestinal bacterial overgrowth: could it be associated with chronic abdominal pain in children with allergic diseases? Rev Esp Enferm Dig 2020; 111:927-930. [PMID: 31617366 DOI: 10.17235/reed.2019.6321/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS small intestinal bacterial overgrowth (SIBO) is a well-known cause of chronic abdominal pain (CAP) during the pediatric age. On the other hand, children with a history of some allergic disorder present CAP more frequently. The aim of this study was to determine the association between the presence of allergic diseases and SIBO in patients diagnosed with CAP. MATERIALS AND METHODS this was an observational, analytical, retrospective study. Children with CAP who had undergone a lactulose hydrogen breath test to determine the presence of SIBO were included in the study. All patients underwent an evaluation for allergies by means of a skin prick test or the determination of specific IgE, according to clinical diagnosis. The study groups were established according to the presence of SIBO and the results of the allergic evaluation were statistically compared between the groups. RESULTS seventy patients were included (41 females and 29 males) and SIBO was diagnosed in 35 patients. In addition, 71.4% of children with SIBO were found to have an allergic disease, in contrast with 28.6% of children without SIBO (p = 0.001). The odds ratio for having any type of allergy in patients with SIBO was 5.45 (95% CI, 1.96-15.17; p = 0.001). CONCLUSIONS we found an association between SIBO and allergic disease, especially allergic rhinitis, cow's milk protein allergy and asthma. Thus, SIBO should be ruled out in pediatric patients with CAP and allergic disease.
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Affiliation(s)
- Rubén Peña-Vélez
- Gastroenterología y Nutrición, Instituto Nacional de Pediatría (INP), México
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Montijo-Barrios E, López-Ugalde MV, Ramírez-Mayans J, Anaya-Flórez MS, Arredondo-García JL, Azevedo-Tenorio I, Bacarreza-Nogales D, Bautista-Silva MG, Cáceres-Cano PA, Cáceres-Mendoza CA, Cadena-León JF, Cadranel S, Carbajal-Rodríguez L, Castillo-de-León YA, Cázares-Méndez JM, Cervantes-Bustamante R, Colindres-C E, Cossío-Ochoa EA, Chanis-Águila R, Chávez-Barrera JA, Escobar-Castro H, Fernández-Aragón M, Fernández-Carrocera LA, Flores A, Flores-Calderón J, Galaz-Pantoja ME, García-Dávila M, Heller-Rouassant S, Hernández-Bautista VM, Higuera-Benítez J, Huerta-Hernández RE, Huerta-López JG, Jovel-Banegas LE, Larrosa-Haro A, Leal-Quevedo FJ, León-Ramírez C, Limón-Rojas AE, Lozano-Sáenz JS, Mariño-Forero ÁE, Márquez-Aguirre MP, Maruy-Saito A, Méndez-Nieto CM, Menéndez-Sandoval JF, Merlos-Fernández IG, Michel-Aceves RDJ, Michel-Penichet F, Munguía-Venegas P, Murillo-Márquez P, Navarro-A DC, Noronha-Spolidoro JV, Núñez-Barrera I, Ordaz-Ortiz CR, Ortega-Martell JA, Ortiz-López-de-Wyss AC, Ovando-Fonseca JE, Oyervides-García CI, Palacios-Rosales J, Pinzón-Navarro AB, Quevedo-B R, Quito-Riera B, Ramírez-Ortiz FDM, Rivera-Medina J, Romero-Trujillo JO, Sabra A, Sáez-de-Ocariz-Gutiérrez MDM, Sánchez-Ortega A, Sánchez-Pérez MP, Sarmiento-Quintero F, Serrano-Sierra A, Suárez-Cortina L, Tormo-Carnicé R, Toro-Monjaraz E, Urquidi-Rivera ME, Vásconez F, Vera F, Worona-Dibner LB, Zablah-Córdova R, Zamora-Dávila E, Zárate-Mondragón F. [Guía latinoamericana para el diagnóstico y tratamiento de alergia a las proteínas de la leche de vaca (GL-APLV)]. Rev Invest Clin 2014; 66 Suppl 2:S9-S72. [PMID: 25706585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 06/04/2023]
Abstract
Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.
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Valdovinos-Oregón D, Ramírez-Mayans J, Cervantes-Bustamante R, Toro-Monjaraz E, Cázares-Méndez M, Cadena-León J, Zárate-Mondragón F, Montijo-Barrios E. [Primary intestinal lymphangiectasia: twenty years of experience at a Mexican tertiary care hospital]. Rev Gastroenterol Mex 2014; 79:7-12. [PMID: 24655928 DOI: 10.1016/j.rgmx.2013.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/27/2013] [Accepted: 07/31/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary intestinal lymphangiectasia is a rare congenital disease described by Waldmann in 1961 that is a consequence of obstruction of the lymphatic drainage of the small bowel with secondary lymph vessel dilation. This distorts the architecture of the villi and causes a leakage of lymph into the intestinal lumen, resulting in protein-losing enteropathy and malabsorption. AIM To describe the clinical, biochemical, radiologic, endoscopic, and histologic characteristics in children with primary intestinal lymphangiectasia. METHOD A retrospective observational, descriptive, cross-sectional study was conducted that reviewed the case records of children diagnosed with primary intestinal lymphangiectasia that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 1, 1992 to September 30, 2012. RESULTS Four patients were found that presented with primary intestinal lymphangiectasia. Three of them had been diagnosed before 3 years of age. All the patients presented with chronic diarrhea, edema, lymphopenia, hypocalcemia, and hypogammaglobulinemia, and 3 patients presented with hypocholesterolemia. Bowel transit time, endoscopy, and intestinal biopsies were characteristic of this pathology. CONCLUSIONS Intestinal lymphangiectasia should be suspected when there is a clinical picture of chronic diarrhea and protein-losing enteropathy accompanied with edema at any level, as well as hypoalbuminemia, hypocalcemia, lymphopenia, hypogammaglobulinemia, and hypocholesterolemia, which are the main biochemical findings of this pathology. All children presenting with intestinal lymphangiectasia should undergo an upper gastrointestinal series with bowel transit time and endoscopy with biopsies taken at the level of the duodenum. Treatment includes diet and the periodic administration of albumin and gamma globulin.
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Affiliation(s)
- D Valdovinos-Oregón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México.
| | - J Ramírez-Mayans
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - R Cervantes-Bustamante
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - E Toro-Monjaraz
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - M Cázares-Méndez
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - J Cadena-León
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - F Zárate-Mondragón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - E Montijo-Barrios
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
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Valdovinos-Oregón D, Ramírez-Mayans J, Cervantes-Bustamante R, Toro-Monjaraz E, Cázares-Méndez M, Cadena-León J, Zárate-Mondragón F, Montijo-Barrios E. Primary intestinal lymphangiectasia: twenty years of experience at a Mexican tertiary care hospital. Revista de Gastroenterología de México (English Edition) 2014. [DOI: 10.1016/j.rgmxen.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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