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Moriczi M, Pujol-Muncunill G, Martín-Masot R, Jiménez Treviño S, Segarra Cantón O, Ochoa Sangrador C, Peña Quintana L, González Santana D, Rodríguez Martínez A, Rosell Camps A, Armas H, Barrio J, González de Caldas R, Rodríguez Salas M, Balmaseda Serrano E, Donat Aliaga E, Bodas Pinedo A, Vaquero Sosa E, Vecino López R, Solar Boga A, Moreno Álvarez A, Sánchez Sánchez C, Tolín Hernani M, Gutiérrez Junquera C, Martinón Torres N, Leis Trabazo MR, Eizaguirre FJ, García Peris M, Medina Benítez E, Fernández Caamaño B, Vegas Álvarez AM, Crespo Valderrábano L, Alonso Vicente C, Rubio Santiago J, Galera-Martínez R, García-Romero R, Ros Arnal I, Fernández Cebrián S, Lorenzo Garrido H, Viada Bris JF, Velasco Rodríguez-Belvis M, Bartolomé Porro JM, Blanco Rodríguez M, Barros García P, Botija G, Chicano Marín FJ, La Orden Izquierdo E, Crehuá-Gaudiza E, Navas-López VM, Martín-de-Carpi J. Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP. Nutrients 2020; 12:nu12041012. [PMID: 32272604 PMCID: PMC7231252 DOI: 10.3390/nu12041012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/21/2022] Open
Abstract
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.
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Affiliation(s)
- Melinda Moriczi
- Paediatric Gastroenterology and Nutrition Unit, Hospital Complex Torrecárdenas, 04009 Almeria, Spain; (M.M.); (R.G.-M.)
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Esplugues del Llobregat, 08950 Barcelona, Spain; (G.P.-M.); (J.M.-d.-C.)
| | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Malaga, 29011 Málaga, Spain;
| | - Santiago Jiménez Treviño
- Gastroenterology Unit, Hepatology and Nutrition, Central University Hospital of Asturias, 33011 Oviedo, Spain;
| | - Oscar Segarra Cantón
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carlos Ochoa Sangrador
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Virgen de la Concha, 49022 Zamora, Spain;
| | - Luis Peña Quintana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital, 35016 Las Palmas of Gran Canaria, Spain; (L.P.Q.); (D.G.S.)
| | - Daniel González Santana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital, 35016 Las Palmas of Gran Canaria, Spain; (L.P.Q.); (D.G.S.)
| | | | - Antonio Rosell Camps
- Paediatric Gastroenterology and Nutrition Unit, University Hospital Son Espases, 07010 Palma de Mallorca, Spain;
| | - Honorio Armas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital of the Canary Islands, 38320 Tenerife, Spain;
| | - Josefa Barrio
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Fuenlabrada, Fuenlabrada, 28942 Madrid, Spain;
| | - Rafael González de Caldas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Reina Sofía, 14004 Cordoba, Spain; (R.G.d.C.); (M.R.S.)
| | - Mónica Rodríguez Salas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Reina Sofía, 14004 Cordoba, Spain; (R.G.d.C.); (M.R.S.)
| | - Elena Balmaseda Serrano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Complex, University of Albacete, 02008 Albacete, Spain;
| | - Ester Donat Aliaga
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital La Fe, 46009 Valencia, Spain;
| | - Andrés Bodas Pinedo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Esther Vaquero Sosa
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Raquel Vecino López
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Alfonso Solar Boga
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital Teresa Herrera, 15004 A Coruña, Spain; (A.S.B.); (A.M.Á.)
| | - Ana Moreno Álvarez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital Teresa Herrera, 15004 A Coruña, Spain; (A.S.B.); (A.M.Á.)
| | - César Sánchez Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, General University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.S.S.); (M.T.H.)
| | - Mar Tolín Hernani
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, General University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.S.S.); (M.T.H.)
| | - Carolina Gutiérrez Junquera
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Puerta de Hierro, 28220 Majadahonda, Madrid, Spain;
| | - Nazareth Martinón Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Clinic of Santiago, 15706 Santiago de Compostela, Spain; (N.M.T.); (M.R.L.T.)
| | - María Rosaura Leis Trabazo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Clinic of Santiago, 15706 Santiago de Compostela, Spain; (N.M.T.); (M.R.L.T.)
| | - Francisco Javier Eizaguirre
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital of Donostia, 20006 San Sebastian, Spain;
| | - Mónica García Peris
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Lluís Alcanyís, Xátiva, 46800 Valencia, Spain;
| | - Enrique Medina Benítez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Beatriz Fernández Caamaño
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain;
| | - Ana María Vegas Álvarez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Laura Crespo Valderrábano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Carmen Alonso Vicente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Javier Rubio Santiago
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Jerez, 11408 Jerez de la Frontera, Cádiz, Spain;
| | - Rafael Galera-Martínez
- Paediatric Gastroenterology and Nutrition Unit, Hospital Complex Torrecárdenas, 04009 Almeria, Spain; (M.M.); (R.G.-M.)
| | - Ruth García-Romero
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Paediatric Hospital Miguel Servet, 50009 Zaragoza, Spain; (R.G.-R.); (I.R.A.)
| | - Ignacio Ros Arnal
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Paediatric Hospital Miguel Servet, 50009 Zaragoza, Spain; (R.G.-R.); (I.R.A.)
| | - Santiago Fernández Cebrián
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Complex Ourense, 32616 Ourense, Spain;
| | - Helena Lorenzo Garrido
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Basurto, Bilbao, 48013 Vizcaya, Spain;
| | - Javier Francisco Viada Bris
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Niño Jesús, 28009 Madrid, Spain; (J.F.V.B.); (M.V.R.-B.)
| | - Marta Velasco Rodríguez-Belvis
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Niño Jesús, 28009 Madrid, Spain; (J.F.V.B.); (M.V.R.-B.)
| | | | - Miriam Blanco Rodríguez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Jiménez Díaz Foundation, 28040 Madrid, Spain;
| | - Patricia Barros García
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital San Pedro de Alcántara, 10003 Cáceres, Spain;
| | - Gonzalo Botija
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Alcorcón Foundation, 28922 Alcorcón, Madrid, Spain;
| | - Francisco José Chicano Marín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Los Arcos del Mar Menor, 30739 Pozo Aledo, Murcia, Spain;
| | - Enrique La Orden Izquierdo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Infanta Sofía, 28709 San Sebastián de los Reyes, Madrid, Spain;
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Clinical Hospital, 46010 Valencia, Spain;
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Malaga, 29011 Málaga, Spain;
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-292-191
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Esplugues del Llobregat, 08950 Barcelona, Spain; (G.P.-M.); (J.M.-d.-C.)
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Jiménez Treviño S, Pujol Muncunill G, Martín-Masot R, Rodríguez Martínez A, Segarra Cantón O, Peña Quintana L, Armas Ramos H, Eizaguirre Arocena FJ, Barrio Torres J, García Burriel JI, Ortigosa Castillo L, Donat Aliaga E, Crujeiras Martínez V, Barros García P, Botija Arcos G, Bartolomé Porro JM, Juste Ruiz M, Ochoa Sangrador C, García Casales Z, Galicia Poblet G, Oliver Goicolea P, Lorenzo Garrido H, García Romero R, La Orden Izquierdo E, Pérez Solis D, Navas-López VM, Díaz Martin JJ, Martín de Carpi J. Spanish Pediatric Inflammatory Bowel Disease Diagnostic Delay Registry: SPIDER Study From Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica. Front Pediatr 2020; 8:584278. [PMID: 33178654 PMCID: PMC7593447 DOI: 10.3389/fped.2020.584278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/16/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Aims: Diagnostic delay (DD) is especially relevant in children with inflammatory bowel disease, leading to potential complications. We examined the intervals and factors for DD in the pediatric population of Spain. Methods: We conducted a multicentric prospective study, including 149 pediatric inflammatory bowel disease patients, obtaining clinical, anthropometric, and biochemical data. Time to diagnosis (TD) was divided into several intervals to identify those where the DD was longer and find the variables that prolonged those intervals. Missed opportunities for diagnosis (MODs) were also identified. Results: Overall TD was 4.4 months (interquartile range [IQR] 2.6-10.4), being significantly higher in Crohn's disease (CD) than in ulcerative colitis (UC) (6.3 [IQR 3.3-12.3] vs. 3 [IQR 1.6-5.6] months, p = 0.0001). Time from the visit to the first physician until referral to a pediatric gastroenterologist was the main contributor to TD (2.4 months [IQR 1.03-7.17] in CD vs. 0.83 months [IQR 0.30-2.50] in UC, p = 0.0001). One hundred and ten patients (78.3%) visited more than one physician (29.9% to 4 or more), and 16.3% visited the same physician more than six times before being assessed by the pediatric gastroenterologist. The number of MODs was significantly higher in CD than that in UC patients: 4 MODs (IQR 2-7) vs. 2 MODs ([IQR 1-5], p = 0.003). Referral by pediatricians from hospital care allowed earlier IBD diagnosis (odds ratio 3.2 [95% confidence interval 1.1-8.9], p = 0.025). Conclusions: TD and DD were significantly higher in CD than those in UC. IBD patients (especially those with CD) undergo a large number of medical visits until the final diagnosis.
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Affiliation(s)
| | - Gemma Pujol Muncunill
- Unit for the Comprehensive Care of Paediatric Inflammatory Bowel Disease, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Rafael Martín-Masot
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Oscar Segarra Cantón
- Pediatric Gastroenterology and Nutrition Unit, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Luis Peña Quintana
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Materno Infantil de Canarias, Las Palmas Gran Canaria, Spain
| | - Honorio Armas Ramos
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Josefa Barrio Torres
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | - Luis Ortigosa Castillo
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Ester Donat Aliaga
- Pediatric Gastroenterology and Nutrition Unit, Hospital La Fe, Valencia, Spain
| | - Vanesa Crujeiras Martínez
- Pediatric Gastroenterology and Nutrition Unit, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Barros García
- Pediatric Gastroenterology and Nutrition Unit, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Gonzalo Botija Arcos
- Pediatric Gastroenterology and Nutrition Unit, San Rafael Hospital, Madrid, Spain
| | | | - Mercedes Juste Ruiz
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitari San Juan de Alicante, Sant Joan d'Alacant, Spain
| | - Carlos Ochoa Sangrador
- Pediatric Gastroenterology and Nutrition Unit, Hospital Virgen de la Concha, Zamora, Spain
| | - Zuriñe García Casales
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Araba Sede Txagorritxu, Vitoria-Gasteiz, Spain
| | - Gonzalo Galicia Poblet
- Pediatric Gastroenterology and Nutrition Unit, Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - Ruth García Romero
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - David Pérez Solis
- Pediatric Gastroenterology and Nutrition Unit, Hospital San Agustín de Avilés, Avilés, Spain
| | - Víctor Manuel Navas-López
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Javier Martín de Carpi
- Unit for the Comprehensive Care of Paediatric Inflammatory Bowel Disease, Hospital Sant Joan de Deu, Barcelona, Spain
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Ferreira H, Ramos RN, Quan CF, Ferreiro SR, Ruiz VC, Juampérez Goñi J, Quintero Bernabeu J, Segarra Cantón O, Álvarez Beltran M. Chylomicron Retention Disease: a Description of a New Mutation in a Very Rare Disease. Pediatr Gastroenterol Hepatol Nutr 2018; 21:134-140. [PMID: 29713611 PMCID: PMC5915691 DOI: 10.5223/pghn.2018.21.2.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/18/2017] [Revised: 09/24/2017] [Accepted: 10/14/2017] [Indexed: 11/14/2022] Open
Abstract
Chylomicron retention disease, also known as Anderson's disease, is a rare hereditary hypocholesterolemic disorder, recessive inherited, characterized by nonspecific symptoms as abdominal distension, steatorrhea, and vomiting associated with failure to thrive. We describe a patient with failure to thrive, chronic diarrhea and steatorrhea who the diagnosis of chylomicron retention disease was established after several months of disease progression. The genetic study confirmed a homozygosity mutation in SAR1B gene, identifying a mutation never previous described [c.83_84delTG(p.Leu28Argfs*7)]. With this case report the authors aim to highlight for this very rare cause of failure to thrive and for the importance of an attempting diagnosis, in order to start adequate management with low fat diet supplemented with fat-soluble vitamins, reverting the state of malnutrition and avoiding possible irreversible and desvantating complications.
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Affiliation(s)
- Helena Ferreira
- Department of Pediatric, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Raquel Nuñez Ramos
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Cinthia Flores Quan
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Susana Redecillas Ferreiro
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Vanessa Cabello Ruiz
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Javi Juampérez Goñi
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Jesus Quintero Bernabeu
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Oscar Segarra Cantón
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
| | - Marina Álvarez Beltran
- Department of Pediatric and Gastroenterology, Hepatology, Nutritional Support and Liver Transplant Unit, Hospital Universitário Vall d'Hebron, Barcelona, Spain
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Flores Quan C, Redecillas Ferreiro S, Segarra Cantón O. Gluten-Free Diet: Always as Easy, Useful, and Healthy as People Think? JCS 2018. [DOI: 10.1055/s-0038-1669381] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractA diet free of wheat and other gluten-containing foods is followed by individuals with celiac disease and by unaffected persons. Although the evidence and pathophysiology of gluten-induced symptoms are well established in celiac disease, they are still limited in non-celiac patients. At present, a gluten-free diet is often seen as a healthy lifestyle change instead of an adequate dietary therapy required for a specific condition. Consequently, the market for gluten-free products is steadily growing and improving; in fact, pseudocereals and genetically modified foods and crops are gaining importance in attempts to cover the dietary and nutritional needs of a population that demands it. There is currently interest not only in modifying crops to improve their agronomic traits and product flavor and appearance, but also to improve the nutritional content of crops and/or to silence certain genes with greater risk of allergenicity. However, the gluten-free diet trend is not hazard free, and many people can end up struggling with dietary disorders after making this decision. Therefore, we should be familiar with and take into account the potential shortage of certain nutrients in some of the gluten-free alternative products, which are now being fortified to prevent nutrient deficiencies and their consequences.
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Affiliation(s)
- Cinthia Flores Quan
- Gastroenterology, Hepatology, Nutritional Support and Pediatric Liver Transplantation Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Susana Redecillas Ferreiro
- Gastroenterology, Hepatology, Nutritional Support and Pediatric Liver Transplantation Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Segarra Cantón
- Gastroenterology, Hepatology, Nutritional Support and Pediatric Liver Transplantation Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Giménez Casado A, López Liñán MJ, Barba Orozco E, Accarino Garaventa A, Álvarez Beltrán M, Azpiroz Vidaur F, Segarra Cantón O. [Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder]. An Pediatr (Barc) 2017; 88:100-105. [PMID: 28460821 DOI: 10.1016/j.anpedi.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/20/2017] [Accepted: 03/17/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Rumination syndrome is an uncommon gastrointestinal functional disorder that may be difficult to diagnose, as not many physicians are aware of this condition. In many cases, patients undergo numerous tests and are prescribed several treatments based on erroneous diagnoses. When the correct diagnosis is eventually made, therapy for the syndrome can be difficult and complex because of its multifactorial nature. The aim of this study was to present our experience with this condition, by presenting an analysis of the clinical, diagnostic, and therapeutic data of our patients. PATIENTS AND METHOD A prospective and retrospective study was conducted on all cases of rumination syndrome diagnosed between January 2010 and May 2016 in patients attending the Paediatric Gastroenterology Departments of two hospitals: Consorci Sanitari de Terrassa and Hospital Materno-Infantil Vall d'Hebron (Barcelona, Spain). RESULTS The analysis included 12 patients, with a mean age at the onset of symptoms of 9 years and 1 month, and the mean time period to make the diagnosis was 2 years and 3 months. A mean of 8.1 complementary tests were carried out before establishing the diagnosis. In 10 of the 12 patients, some type of treatment had been given before the diagnosis of rumination syndrome, but was unsuccessful in all cases. Ten of our patients underwent the novel, experimental biofeedback therapy. CONCLUSIONS Due to the limited knowledge of this condition among attending professionals in terms of the clinical presentation, diagnosis, and treatment, patients with rumination syndrome are often misdiagnosed and undergo numerous avoidable complementary tests, and invasive, costly treatments.
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Affiliation(s)
- Aida Giménez Casado
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
| | - María José López Liñán
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - Elisabeth Barba Orozco
- Unidad de Motilidad Digestiva, Servicio de Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Anna Accarino Garaventa
- Unidad de Motilidad Digestiva, Servicio de Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Marina Álvarez Beltrán
- Unidad de Gastroenterología, Hepatología, Soporte Nutricional y Trasplante Hepático Pediátrico, Servicio de Pediatría, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Fernando Azpiroz Vidaur
- Unidad de Motilidad Digestiva, Servicio de Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Oscar Segarra Cantón
- Unidad de Gastroenterología, Hepatología, Soporte Nutricional y Trasplante Hepático Pediátrico, Servicio de Pediatría, Hospital Universitario Vall d'Hebron, Barcelona, España
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