1
|
Quitadamo P, Tambucci R, Mancini V, Campanozzi A, Caldaro T, Giorgio V, Pensabene L, Isoldi S, Mallardo S, Fusaro F, Staiano A, Salvatore S, Borrelli O. Diagnostic and therapeutic approach to children with chronic refractory constipation: Consensus report by the SIGENP motility working group. Dig Liver Dis 2024; 56:406-420. [PMID: 38104028 DOI: 10.1016/j.dld.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, San Carlo Hospital, Milan, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Giorgio
- UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Fabio Fusaro
- Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Digestive and Endoscopic Surgery, Gastroenterology and Nutrition, Intestinal Failure Rehabilitation Research Group, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| |
Collapse
|
2
|
Isoldi S, Mallardo S, Quitadamo P, Leter B, Cucchiara S. Review on Advances in Pediatric Endoscopy in the Management of Inflammatory Bowel Disease. Curr Pediatr Rev 2024; 20:CPR-EPUB-137673. [PMID: 38265388 DOI: 10.2174/0115733963268547231128101929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/26/2023] [Accepted: 10/19/2023] [Indexed: 01/25/2024]
Abstract
Over the past decades, an increased importance has been given to gastrointestinal (GI) endoscopy in the management of children with inflammatory bowel diseases (IBD), considering that mucosal healing has been recognized as the optimal endpoint in the treat-to-target paradigm. The recent advances in technology and anesthesia have facilitated the comprehensive evaluation of the GI tract. In this review, we will discuss the role of ileocolonoscopy, upper GI endoscopy, and device-assisted enteroscopy in the work-up and management of pediatric Crohn’s disease (CD) and ulcerative colitis, with particular attention on non-invasive endoscopic techniques, such as wireless capsule endoscopy. We will also analyze the most commonly used endoscopic scoring systems, including small bowel scoring systems and endoscopic recurrence grading of neo-terminal ileum CD. Moreover, we will focus on the endoscopic management of complications, such as strictures, that commonly require surgery. Lastly, we will discuss cancer surveillance in children with IBD, with particular consideration of the role of high-definition endoscopic equipment and chromoendoscopy in dysplasia detection rates.
Collapse
Affiliation(s)
- Sara Isoldi
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Paolo Quitadamo
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Beatrice Leter
- Sapienza University of Rome, Department of Women’s and Children’s Health
| | | |
Collapse
|
3
|
Quitadamo P, Isoldi S, Mallardo S, Zenzeri L, Ceccanti S, Battagliere I, Del Bene M, Di Nardo G. Rectal Bleeding in Infants: Diagnostic Work-up and Management. Curr Pediatr Rev 2024; 20:286-295. [PMID: 36809947 DOI: 10.2174/1573396319666230210111048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 02/17/2023]
Abstract
Lower gastrointestinal bleeding is an alarming symptom in pediatrics, especially in infancy. However, it is commonly secondary to benign and self-limiting conditions, such as anal fissures, infections, and allergies; more rarely it is caused by more serious disorders, such as necrotizing enterocolitis, very early onset inflammatory bowel diseases, and vascular malformations. The present review aims at summarizing the different clinical conditions presenting with rectal bleeding in infancy and provides an evidence-based diagnostic work-up for the clinical management of patients with this occurrence.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Letizia Zenzeri
- Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Ilaria Battagliere
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Margherita Del Bene
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Pediatric Gastroenterology and Endoscopy Unit, NESMOS Department, Faculty School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| |
Collapse
|
4
|
Isoldi S, Viola F, Cucchiara S, Dilillo A, Iorfida D, Testi AM, Fiorentino F, Mallardo S. Management of collagenous gastritis in children: Case series and literature review. Indian J Gastroenterol 2023:10.1007/s12664-023-01472-3. [PMID: 37971571 DOI: 10.1007/s12664-023-01472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
Collagenous gastritis (CG) is a rare histopathological finding on gastric biopsies in children. It is associated with abdominal pain and iron deficiency anemia, usually not respondent to oral iron supplements. The aim of this study was to describe our experience in the management of pediatric patients with CG. Moreover, we propose to review the literature on this topic. We retrospectively reviewed all pediatric patients diagnosed with CG at our centre from January 2014 to January 2019. Three pediatric patients (2 F, mean age 12.3) were diagnosed with CG during the study period. Two presented with moderate and one with severe anemia. Symptoms were abdominal pain, asthenia and headache in two and asthenia and abdominal pain in one. All underwent upper and lower gastrointestinal endoscopy. All were firstly started with oral iron supplements with no benefit, principally due to poor compliance secondary to the worsening of the epigastric pain and proton pump inhibitor resistance. Therefore, they underwent ferric carboxymaltose (FCM) infusion with good clinical and laboratory response. Patients received a mean of two infusions/year, with stable hemoglobin levels and no adverse outcomes. Our review failed to identify a consistent response to specific treatments. Considering the apparent benign nature of the disease, symptomatic and supportive treatments are advisable. Iron deficiency anemia is largely present and therapy with oral iron supplements is not always successful. In our study, FCM infusion was effective in increasing the key blood indices in patients who poorly tolerated oral supplements.
Collapse
Affiliation(s)
- Sara Isoldi
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy.
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy.
- Santa Maria Goretti Hospital, Latina, Italy.
| | - Franca Viola
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy
| | - Salvatore Cucchiara
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy
| | - Anna Dilillo
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy
| | - Donatella Iorfida
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Francesco Fiorentino
- Pathology Unit, Sapienza - University of Rome, Polo Pontino, Santa Maria Goretti Hospital, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Polo Pontino, Latina, Italy
| |
Collapse
|
5
|
Di Nardo G, Cremon C, Staiano A, Stanghellini V, Borrelli O, Strisciuglio C, Romano C, Mallardo S, Scarpato E, Marasco G, Salvatore S, Zenzeri L, Felici E, Pensabene L, Sestito S, Francavilla R, Quitadamo P, Baldassarre M, Giorgio V, Tambucci R, Ziparo C, Parisi P, Barbaro MR, Barbara G. Role of inflammation in pediatric irritable bowel syndrome. Neurogastroenterol Motil 2023; 35:e14365. [PMID: 35340083 DOI: 10.1111/nmo.14365] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/09/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND IBS affects a large number of children throughout the world and is thought to be the result of disturbed neuroimmune function along with the brain-gut axis. Although the underlying pathophysiologic mechanisms are not clear, the role of low-grade inflammation and mucosal immune activation in IBS symptom generation has become evident also in subsets of pediatric patients. Animal models provided meaningful insight in the causal relationship between abnormal mucosal immune activation and changes in gastrointestinal (GI) sensory-motor function. Likewise, the development of long-standing GI symptoms fulfilling the current criteria for functional GI disorders after infection gastroenteritis and in patients with IBD or celiac disease in remission further supports this hypothesis. Immune activation, its impact on gut sensory-motor function, and potential implications for symptom generation emerged in both children and adults with IBS. PURPOSE The aim of this review is to summarize the main evidence on the presence of low-grade inflammation and immune activation in children with IBS, its possible role in symptom generation, and its potential implication for new therapeutic strategies.
Collapse
Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, "Federico II", University of Naples, Naples, Italy
| | | | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Elena Scarpato
- Department of Translational Medical Science, "Federico II", University of Naples, Naples, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.,Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ruggiero Francavilla
- Pediatric Section, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Mariella Baldassarre
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Ziparo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | |
Collapse
|
6
|
Isoldi S, Di Nardo G, Mallardo S, Parisi P, Raucci U, Tambucci R, Quitadamo P, Salvatore S, Felici E, Cisarò F, Pensabene L, Banzato C, Strisciuglio C, Romano C, Fusco P, Rigotti F, Sansotta N, Caimmi S, Savasta S, Zuin G, Di Stefano M, Provera S, Campanozzi A, Rossi P, Gatti S, Corpino M, Alvisi P, Martelossi S, Suppiej A, Gandullia P, Verrotti A, Terrin G, Pacenza C, Fornaroli F, Comito D, D'Arrigo S, Striano P, Raviglione F, Carotenuto M, Orsini A, Belcastro V, Di Corcia G, Raieli V, Ferilli MAN, Ruscitto C, Spadoni E, Grosso S, D'Alonzo R, Papa A, Pavone P, Meli M, Velardita M, Mainetti M, Vanacore N, Borrelli O. Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Ital J Pediatr 2022; 48:156. [PMID: 36042474 PMCID: PMC9429644 DOI: 10.1186/s13052-022-01346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/16/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment. Methods Cross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Results A total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians. Conclusion In conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01346-y.
Collapse
Affiliation(s)
- Sara Isoldi
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Giovanni Di Nardo
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Lazio, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Lazio, Italy.
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Claudia Banzato
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Patrizia Fusco
- Pediatric Unit, Montis Regalis Hospital, Mondovì, Cuneo, Italy
| | | | - Naire Sansotta
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Savasta
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanna Zuin
- Pediatric Department, University of Milano Bicocca, FMBBM, San Gerardo Hospital, Monza, Italy
| | - Marina Di Stefano
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Provera
- Department of Pediatrics, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, Pediatric Unit, University of Foggia, Foggia, Italy
| | - Paolo Rossi
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Simona Gatti
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | - Mara Corpino
- Gastroenterologia Pediatrica, Clinica Pediatrica e Malattie Rare, Ospedale Pediatrico Microcitemico A. Cao, ARNAS Brotzu, Cagliari, Italy
| | - Patrizia Alvisi
- Department of Paediatrics, Ospedale Maggiore, Azienda USL, Bologna, Italy
| | | | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Gandullia
- UOC Gastroenterologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Caterina Pacenza
- Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy
| | - Fabiola Fornaroli
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Stefano D'Arrigo
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Pasquale Striano
- Pediatric Neurology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health and Physical and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alessandro Orsini
- Paediatric Neurology Section, Paediatric Department, Pisa University Hospital, University of Pisa, Pisa, Italy
| | | | | | - Vincenzo Raieli
- Child Neuropsychiatry Unit - ISMEP- ARNAS CIVICO, Palermo, Italy
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Elisabetta Spadoni
- Pediatric Department, Azienda Ospedaliera Nord-Ovest of Tuscany, San Luca Hospital of Lucca, Lucca, Italy
| | - Salvatore Grosso
- Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Renato D'Alonzo
- Pediatric and Neonatological Unit, Maternal and Child Department, Nuovo Ospedale San Giovanni Battista, Foligno, Italy
| | - Amanda Papa
- Infantile Neuropsychiatry Departement Maggiore della Carità University Hospital, Novara, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mariaclaudia Meli
- Azienda Policlinico, "Rodolico-San Marco Hospital", University of Catania, Catania, Italy
| | - Mario Velardita
- Department of Pediatrics, Hospital "Salvatore e Saverio Gravina", Caltagirone, Italy
| | - Martina Mainetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, UK
| |
Collapse
|
7
|
Bramanti SM, Manippa V, Babore A, Dilillo A, Marcellino A, Martucci V, Mallardo S, Isoldi S, Bloise S, Sanseviero M, Iorfida D, De Luca E, Trumello C, D’Alleva F, Ventriglia F, Lubrano R, Del Giudice E. Comparing parental distress and children's difficulties between parents of children with rheumatic diseases and parents of healthy children in families facing the COVID-19 pandemic. Curr Psychol 2022; 42:1-10. [PMID: 35967493 PMCID: PMC9361970 DOI: 10.1007/s12144-022-03589-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/03/2022]
Abstract
The COVID-19 pandemic could be a threat for the health status of children with a chronic condition. The present study aimed to explore parents' and children's psychological adjustment during the current pandemic, pursuing a triple objective: to compare the psychological adjustment of parents of children with pediatric rheumatic diseases (PRDs) and parents of healthy children; to analyze children's psychological symptoms (emotional problems and hyperactivity) before and during the COVID-19 pandemic, and with or without a PRDs diagnosis; to explore the associations of children's emotional problems and hyperactivity with parents' psychological adjustment, parent-child interactions and belonging or not to families with PRDs. This cross-sectional study involved 56 parents of children with PRDs and 53 parents of healthy children. Self-report questionnaires about parents' depression, anxiety, parenting stress, and children's emotional symptoms and hyperactivity-inattention were administered. No differences were detected on psychological adjustment between parents of children with PRDs and parents of healthy children. Parents of children with PRDs reported statistically significant higher levels of children's emotional problems and hyperactivity before the pandemic, compared to parents of healthy children; during COVID-19 pandemic, emotional symptoms increased for both groups, while hyperactivity-inattention symptoms increased only in the group of healthy children. Children's emotional difficulties were associated with higher levels of parental anxiety, worse parent-child interaction and having PRDs; children's hyperactivity symptoms were related to parent-child difficult interaction and higher levels of parental depression. Findings suggest the importance to target the children in relation to their parents, when approaching the psychological aspects of PRDs.
Collapse
Affiliation(s)
- Sonia M. Bramanti
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Valerio Manippa
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Babore
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Anna Dilillo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Alessia Marcellino
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Vanessa Martucci
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Sara Isoldi
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Silvia Bloise
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Mariateresa Sanseviero
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Donatella Iorfida
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Enrica De Luca
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Carmen Trumello
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Francesca D’Alleva
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy
| | - Flavia Ventriglia
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Riccardo Lubrano
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Emanuela Del Giudice
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| |
Collapse
|
8
|
Bloise S, Isoldi S, Marcellino A, De Luca E, Dilillo A, Mallardo S, Martucci V, Sanseviero M, Del Giudice E, Iorfida D, Leone R, Testa A, Frasacco B, Gizzone P, Proietti Ciolli C, Sinceri A, Zuliani F, Zanardi E, Gambarotto A, Lisa Grandinetti A, Ventriglia F, Lubrano R. Clinical picture and long-term symptoms of SARS-CoV-2 infection in an Italian pediatric population. Ital J Pediatr 2022; 48:79. [PMID: 35598023 PMCID: PMC9123625 DOI: 10.1186/s13052-022-01270-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 10/06/2021] [Accepted: 05/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background SARS-CoV-2 infection in the pediatric age group has a milder course than in adults, but in some cases even children may present with severe forms or develop long-term consequences. The aim of this study was to analyze the clinical features, long-term effects, lifestyle changes and psychological effects of SARS-CoV-2 infection in a pediatric sample of the Italian population. Methods We conducted a telephone survey among 3075 children infected with SARS-CoV-2 in the Latina Local Health Authority. Outcomes included: clinical features of infection, long-term symptoms, lifestyle changes and emotional symptoms during the illness. The information obtained was automatically linked to a spreadsheet and analyzed. Results One thousand four hundred thirteen children agreed to participate in the study; the mean age was 112.8 ± 21.9 months. Children were infected mainly inside familial clusters (59.6%; n = 842); 99% (n = 1399) of children were asymptomatic or exhibited mild symptoms. 20% (n = 259) of children experienced long-term symptoms; risk factors were: older age, higher body mass index and longer duration of infection. Throughout the period of infection, children spent most of the time on devices like tv-video, social media and mobile phone for non-educational activities. 58.8% (n = 620) of parents expressed a negative opinion about distance learning. Finally, we observed that 49,6% (n = 532) of children experienced psychological symptoms during quarantine period. Conclusion Despite a lower susceptibility to COVID-19 in children, it is important to keep the focus high in children, both because of the possible long symptoms after infection and the impact on a children’s mental and physical health due to pandemic. We believe that the return to school or other extracurricular activities are important to correct some of the risk factors for the long COVID syndrome, as obesity, and to limit the cultural damage generated by distance learning and psychological effects related to restrictive measures.
Collapse
Affiliation(s)
- Silvia Bloise
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy.
| | - Sara Isoldi
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Alessia Marcellino
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Enrica De Luca
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Anna Dilillo
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Saverio Mallardo
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Vanessa Martucci
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Mariateresa Sanseviero
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Emanuela Del Giudice
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Donatella Iorfida
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Rita Leone
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Alessia Testa
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Beatrice Frasacco
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Pietro Gizzone
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Claudia Proietti Ciolli
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Alessandro Sinceri
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Francesca Zuliani
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Elena Zanardi
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Anna Gambarotto
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | | | - Flavia Ventriglia
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| | - Riccardo Lubrano
- Dipartimento Materno Infantile E Di Scienze Urologiche, Sapienza Università Di Roma, UOC Di Pediatria e NeonatologiaOspedale Santa Maria Goretti, Polo Pontino, Rome, Lazio, Italy
| |
Collapse
|
9
|
Dilillo A, Del Giudice E, Cucchiara S, Viola F, Mallardo S, Isoldi S, Iorfida D, Bloise S, Marcellino A, Martucci V, Sanseviero M, De Luca E, Protano C, Marotta D, Ventriglia F, Lubrano R. Evaluation of Risk for Thromboembolic Events in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2022; 74:599-604. [PMID: 35129153 DOI: 10.1097/mpg.0000000000003398] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The occurrence of thrombotic events in adult patients with inflammatory bowel disease (IBD) is linked to multiple interactions between hereditary and acquired risk factors. There are few published data concerning children with iBD. The aim of this study was to investigate the presence of thromboembolic risk factors also in children with iBD. METHODS We enrolled three groups of children: one with Crohn disease (cD), one with ulcerative colitis (Uc), and a control group of healthy subjects. For all the participants the potential thromboembolic risk was evaluated clinically and with laboratory tests. RESULTS We studied: 30 children (25.6%) with CD, 28 (23.9%) with UC, and 59 (50.4%) healthy control subjects. Regarding Pediatric Crohn Disease Activity Index, no significant differences between thromboembolic risk factors and disease activity were detected. Instead, in the patients with UC, stratified with the Pediatric Ulcerative Colitis Activity Index, there was a statistically significant difference in serum fibrinogen levels between patients with mild and moderate/severe disease [3.8 (3.2-4.5) g/L vs 5.7 (4.8-6.2) g/L, P < 0.0032]. serum homocysteine levels were lower in healthy controls than in CD (P = 0.176) and UC (P = 0.026). An increased level ofhomocysteine in UC with a homozygous mutation in the methylene tetrahydrofolate reductase C677T gene was also observed. CONCLUSIONS Our study showed that children with IBD have clinical features, acquired and congenital factors that can increase thrombotic risk, similarly to adults.
Collapse
Affiliation(s)
- Anna Dilillo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Emanuela Del Giudice
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Salvatore Cucchiara
- Maternal Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome
| | - Franca Viola
- Maternal Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome
| | - Saverio Mallardo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Sara Isoldi
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Donatella Iorfida
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Silvia Bloise
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Alessia Marcellino
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Vanessa Martucci
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Mariateresa Sanseviero
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Enrica De Luca
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Daniela Marotta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Flavia Ventriglia
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| | - Riccardo Lubrano
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina
| |
Collapse
|
10
|
Lubrano R, Bloise S, Marcellino A, Proietti Ciolli C, Testa A, De Luca E, Dilillo A, Mallardo S, Isoldi S, Martucci V, Sanseviero M, Del Giudice E, Malvaso C, Iacovelli C, Leone R, Iorfida D, Ventriglia F. Assessment of respiratory function in children wearing a N95 mask with or without an exhalation valve: Data compared. Data Brief 2021; 39:107550. [PMID: 34778496 PMCID: PMC8572147 DOI: 10.1016/j.dib.2021.107550] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
In response to the current COVID-19 pandemic, universal face masking represents one of the most important strategies to limit the spread of infection. However, their use in children is still highly debated (Esposito and Principi, 2020; Esposito et al., 2020) and there are few data (Lubrano et al., 2021a, 2021b) describing their possible effects on respiratory function in children. A dataset in this paper presents a comparison of the data related to the effects on respiratory function of children wearing a filtering facepiece 2 (N95 mask) with or without exhalation valve. 22 healthy children were randomly assigned to two groups, both groups wearing an N95 mask: one without an exhalation valve (group A), another with an exhalation valve (group B). Children were subjected to a 72 min test: the first 30 min without mask, then 30 min wearing face mask while practiced their usual play activity; finally, 12 min, with face mask in place, while they walked as in a walking test. They were monitored through to microstream capnography system (Rad-97TM with Nomo-Line Capnography, Masimo, Irvine, CA, USA) to log oxygen saturation (SpO2) and respiratory rate (RR). We use the Wilcoxon test to analyzed the differences between the parameters recorded during the study in group A and B. Data analysis was performed using JMP14.3.0 program for Mac by SAS Institute inc.
Collapse
Affiliation(s)
- Riccardo Lubrano
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Silvia Bloise
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Alessia Marcellino
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Claudia Proietti Ciolli
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Alessia Testa
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Enrica De Luca
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Anna Dilillo
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Saverio Mallardo
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Sara Isoldi
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Vanessa Martucci
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Mariateresa Sanseviero
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Emanuela Del Giudice
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Concetta Malvaso
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Claudio Iacovelli
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Rita Leone
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Donatella Iorfida
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| | - Flavia Ventriglia
- Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia - Polo Pontino, Italy
| |
Collapse
|
11
|
Bloise S, Martucci V, Marcellino A, Mallardo S, Lubrano R. Possible Role of Thoracic Ultrasound in the Diagnostic Pathway of Infant Abuse in the Pediatric Emergency Department. J Ultrasound Med 2021; 40:1705-1707. [PMID: 33098578 DOI: 10.1002/jum.15546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Silvia Bloise
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| | - Vanessa Martucci
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| | - Alessia Marcellino
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| | - Saverio Mallardo
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| | - Riccardo Lubrano
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| |
Collapse
|
12
|
Paparella R, Mallardo S, Lubrano R. Letter to the editor: Response to the letter of Ozcan et al. "Supraventricular tachycardia induced vomiting and abdominal contractions: Do we need further explanations?". J Electrocardiol 2021; 68:6. [PMID: 34246861 DOI: 10.1016/j.jelectrocard.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Roberto Paparella
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy.
| | - Saverio Mallardo
- Department of Maternal and Child Health, "Santa Maria Goretti" Hospital, Sapienza University of Rome, Latina, Italy
| | - Riccardo Lubrano
- Department of Maternal and Child Health, "Santa Maria Goretti" Hospital, Sapienza University of Rome, Latina, Italy
| |
Collapse
|
13
|
Paparella R, Mallardo S, Lubrano R. Projectile vomiting and Valsalva-like abdominal contractions as an uncommon presentation of supraventricular tachycardia in an infant. J Electrocardiol 2021; 66:136-138. [PMID: 33957501 DOI: 10.1016/j.jelectrocard.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/25/2020] [Revised: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 02/09/2023]
Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential diagnosis essential in not delaying crucial intervention. We here describe the case of an undetected PSVT in an infant performing repeated abdominal contractions, thus presenting with projectile vomiting. At an early stage of tachycardia, infants are probably able to unconsciously attempt and succeed to terminate acute episodes by strengthening vagal stimulation in the form of Valsalva-like abdominal contractions, but only up to a point. As PSVT progresses, heart failure may develop. Early recognition and treatment are therefore required to minimize negative outcomes.
Collapse
Affiliation(s)
- Roberto Paparella
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy.
| | - Saverio Mallardo
- Department of Maternal and Child Health, "Santa Maria Goretti" Hospital, Sapienza University of Rome, Latina, Italy
| | - Riccardo Lubrano
- Department of Maternal and Child Health, "Santa Maria Goretti" Hospital, Sapienza University of Rome, Latina, Italy
| |
Collapse
|
14
|
Lubrano R, Bloise S, Testa A, Marcellino A, Dilillo A, Mallardo S, Isoldi S, Martucci V, Sanseviero M, Del Giudice E, Malvaso C, Iorfida D, Ventriglia F. Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e210414. [PMID: 33651109 PMCID: PMC7926283 DOI: 10.1001/jamanetworkopen.2021.0414] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. OBJECTIVE To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020. INTERVENTIONS All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes. MAIN OUTCOMES AND MEASURES Changes in respiratory parameters during the use of surgical masks were evaluated. RESULTS Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05). CONCLUSIONS AND RELEVANCE This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.
Collapse
Affiliation(s)
- Riccardo Lubrano
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Silvia Bloise
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Alessia Testa
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Alessia Marcellino
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Anna Dilillo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Saverio Mallardo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Sara Isoldi
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Vanessa Martucci
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Maria Sanseviero
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Emanuela Del Giudice
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Concetta Malvaso
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Donatella Iorfida
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Flavia Ventriglia
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| |
Collapse
|
15
|
Isoldi S, Mallardo S, Marcellino A, Bloise S, Dilillo A, Iorfida D, Testa A, Del Giudice E, Martucci V, Sanseviero M, Barberi A, Raponi M, Ventriglia F, Lubrano R. The comprehensive clinic, laboratory, and instrumental evaluation of children with COVID-19: A 6-months prospective study. J Med Virol 2021; 93:3122-3132. [PMID: 33570199 PMCID: PMC8014060 DOI: 10.1002/jmv.26871] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
Objectives To perform a comprehensive clinic, laboratory, and instrumental evaluation of children affected by coronavirus disease (COVID‐19). Methods Children with a positive result of nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) underwent laboratory tests, anal and conjunctival swab, electrocardiography, lung, abdomen, and cardiac ultrasound. Twenty‐four‐hour ambulatory blood pressure monitoring was performed if abnormal basal blood pressure. Patients were followed‐up for 6 months. Results Three hundred and sixteen children were evaluated; 15 were finally included. Confirmed family member SARS‐CoV‐2 infection was present in all. Twenty‐seven percent were asymptomatic. Anal and conjunctival swabs tests resulted negative in all. Patients with lower body mass index (BMI) presented significantly higher viral loads. Main laboratory abnormalities were: lactate dehydrogenase increasing (73%), low vitamin D levels (87%), hematuria (33%), proteinuria (26%), renal hyperfiltration (33%), and hypofiltration (13%). Two of the patients with hyperfiltration exhibited high blood pressure levels at diagnosis, and persistence of prehypertension at 6‐month follow‐up. No abnormalities were seen at ultrasound, excepting for one patient who exhibited B‐lines at lung sonography. Immunoglobulin G seroconversion was observed in all at 1‐month. Conclusions Our study confirm that intra‐family transmission is important. The significant higher viral loads recorded among patients with lower BMI, together with low vitamin D levels, support the impact of nutritional status on immune system. Renal involvement is frequent even among children with mild COVID‐19, therefore prompt evaluation and identification of patients with reduced renal function reserve would allow a better stratification and management of patients. Seroconversion occurs also in asymptomatic children, with no differences in antibodies titer according to age, sex and clinical manifestations.
Collapse
Affiliation(s)
- Sara Isoldi
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy.,Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza-University of Rome, Rome, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Alessia Marcellino
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Silvia Bloise
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Anna Dilillo
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Donatella Iorfida
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Alessia Testa
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Emanuela Del Giudice
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Vanessa Martucci
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Mariateresa Sanseviero
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Antonio Barberi
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Massimo Raponi
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Flavia Ventriglia
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Riccardo Lubrano
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| |
Collapse
|
16
|
Quitadamo P, Isoldi S, Mallardo S, Zenzeri L, Di Nardo G. Scientific Evidence for the Treatment of Children with Irritable Bowel Syndrome. Curr Pediatr Rev 2021; 17:92-102. [PMID: 33504308 DOI: 10.2174/1573396317666210127123330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
Irritable bowel syndrome (IBS) is one of the most common functional gastro-intestinal disorders which significantly impacts the quality of life of affected children. Abdominal pain improved by defecation, associated with a change in stool form and frequency, represents its specific clinical marker. Even if a number of potential patho-physiological mechanisms have been described, the exact underlying etiology of IBS is so far unclear. Likewise, no optimal treatment has ever been found neither for adult nor for pediatric patients. Current therapeutic options include drugs, dietary interventions and biopsychosocial therapies. The present review aims at evaluating the scientific evidence supporting the efficacy of these treatments for children with IBS.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Letizia Zenzeri
- Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, Pediatric Gastroenterology and Endoscopy Unit, NESMOS Department, Faculty School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| |
Collapse
|
17
|
Bloise S, Marcellino A, Testa A, Dilillo A, Mallardo S, Isoldi S, Martucci V, Sanseviero MT, Del Giudice E, Iorfida D, Ventriglia F, Lubrano R. Serum IgG levels in children 6 months after SARS-CoV-2 infection and comparison with adults. Eur J Pediatr 2021; 180:3335-3342. [PMID: 34023936 PMCID: PMC8140562 DOI: 10.1007/s00431-021-04124-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/16/2020] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
Since the outbreak of SARS-CoV-2 among the population has occurred quite recently, there is a lack of evidence on the long-term duration of antibody response, especially in children. It is therefore crucial to clarify this aspect, considering its implications in the development of successful surveillance strategies, therapies, and vaccinations. The aim of this study was to assess the antibody response in a children group after SARS-CoV-2 infection, and to compare it with that of their parents affected by SARS-CoV-2 infection. We enrolled 12 children and their parents, both groups being affected by COVID-19 in April 2020. In the children's group, we collected real-time RT-PCR cycle threshold (Ct) values and gene characterization of first nasal-throat swab at the time of diagnosis (T0); 30 days after the diagnosis (T30), we performed blood tests to detect anti-SARS-CoV-2 IgM and IgG. Finally, 180 days after the diagnosis (T180), we measured anti-SARS-CoV-2 IgG in both children and parents. In children, antibody levels declined significantly at 180 days (T180) after first measurement (T30). There were no significant differences in IgG level related to age, sex, and clinical manifestations. We found a significant correlation between IgG titers at T30 and Ct value of gene N. Children showed a lower level of antibodies against SARS-CoV-2 at T180 compared to their parents.Conclusion: Antibody responses in children waned 180 days after SARS-CoV-2 infection, and at the same time, their parents showed a different antibody response to the virus. These results highlight that serological tests should be used with caution in surveillance strategies among the general population. What is known: • Currently is not known how long antibody response will be maintained or if it protects from reinfection. • Recent reports in adults suggest that antibodies to SARS-CoV-2 declined several months after infection, but data are missing in pediatric age. What is new: • We showed that antibody responses to SARS-CoV-2 wane several months after infection also in children with quantitative differences in antibody levels between children and adults. • In this context, serological tests should be used with caution in surveillance strategies.
Collapse
Affiliation(s)
- Silvia Bloise
- Dipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy.
| | - Alessia Marcellino
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Alessia Testa
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Anna Dilillo
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Saverio Mallardo
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Sara Isoldi
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Vanessa Martucci
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Maria Teresa Sanseviero
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Emanuela Del Giudice
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Donatella Iorfida
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Flavia Ventriglia
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| | - Riccardo Lubrano
- grid.7841.aDipartimento Materno Infantile, UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti, Polo Pontino, Sapienza Università di Roma, Latina, Italy
| |
Collapse
|
18
|
Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S, Baldassarre ME, Cordelli DM, Falsaperla R, Felici E, Ferilli MAN, Grosso S, Mallardo S, Martinelli D, Quitadamo P, Pensabene L, Romano C, Savasta S, Spalice A, Strisciuglio C, Suppiej A, Valeriani M, Zenzeri L, Verrotti A, Staiano A, Villa MP, Ruggieri M, Striano P, Parisi P. Cyclic Vomiting Syndrome in Children. Front Neurol 2020; 11:583425. [PMID: 33224097 PMCID: PMC7667239 DOI: 10.3389/fneur.2020.583425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy. Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) to identify relevant current issues and to propose future research directions on pediatric CVS.
Collapse
Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Giovanni Di Nardo
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale “F. Del Ponte,” University of Insubria, Varese, Italy
| | | | | | - Raffaele Falsaperla
- Neonatal Intensive Care and Pediatric Units, S. Marco Hospital, Vittorio Emanuele Hospital, Catania, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Ada Noris Ferilli
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Diego Martinelli
- Division of Metabolism, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, “Sapienza,” University of Rome, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Annamaria Staiano
- Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Naples, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- Institute for Research, Hospitalization and Health Care (IRCCS) “G. Gaslini” Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
19
|
Mantegazza C, Mallardo S, Rossano M, Meneghin F, Ricci M, Rossi P, Capra G, Latorre P, Schindler A, Isoldi S, Agosti M, Zuccotti GV, Salvatore S. Laryngeal signs and pH-multichannel intraluminal impedance in infants and children: The missing ring: LPR and MII-pH in children. Dig Liver Dis 2020; 52:1011-1016. [PMID: 32553701 DOI: 10.1016/j.dld.2020.05.001] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/04/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE to investigate the reliability of laryngeal reflux finding score (RFS) and symptom index (RSI) in assessing gastroesophageal reflux (GER) in children and infants. METHODS patients with laryngeal or respiratory symptoms, who underwent laryngoscopy and esophageal pH-impedance (MII-pH) were recruited. RSI and RFS were correlated to MII-pH results. A RSI>13, RFS>7, acid exposure index>7%, total reflux episodes>100/24 h in infants or>70/24 h in children, or a positive symptom index or association probability, were considered pathological. Analysis considering age (</>12 months) was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the laryngeal scores were calculated. RESULTS 197 children (median 53 months, 61 infants) were enrolled. MII-pH was pathological in 5/10 patients with RFS>7, and in 17/31 with RSI>13. RFS>7 had 3.9% sensitivity, 93% specificity, a PPV of 50 and a NPV of 34 in predicting GER disease. RFS was inversely associated to weakly acidic and proximal GER. RSI>13 had 13% sensitivity, 83% specificity, and a PPV and NPV similar to RFS. RSI was significantly associated with the number of acid reflux episodes, and, in infants, with bolus exposure index. CONCLUSIONS RSI and RFS aren't accurate in predicting GER in infants and children. Acid reflux relates to laryngeal symptoms, but neither acid, nor proximal and weakly acidic GER relate to laryngeal alterations.
Collapse
Affiliation(s)
| | - Saverio Mallardo
- Gastroenterology and Hepatology Pediatric Department, Università La Sapienza, Roma; Italy
| | - Martina Rossano
- Pediatric Department, Ospedale "F. Del Ponte", Università dell'Insubria, Varese, Italy
| | - Fabio Meneghin
- Pediatric Department, Ospedale Buzzi, Università di Milano, Italy
| | - Michela Ricci
- Pediatric Department, Ospedale Buzzi, Università di Milano, Italy
| | - Paolo Rossi
- Gastroenterology and Hepatology Pediatric Department, Università La Sapienza, Roma; Italy
| | | | | | | | - Sara Isoldi
- Gastroenterology and Hepatology Pediatric Department, Università La Sapienza, Roma; Italy
| | - Massimo Agosti
- Pediatric Department, Ospedale "F. Del Ponte", Università dell'Insubria, Varese, Italy
| | | | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", Università dell'Insubria, Varese, Italy.
| |
Collapse
|
20
|
Quitadamo P, Tambucci R, Mancini V, Cristofori F, Baldassarre M, Pensabene L, Francavilla R, Di Nardo G, Caldaro T, Rossi P, Mallardo S, Maggiora E, Staiano A, Cresi F, Salvatore S, Borrelli O. Esophageal pH-impedance monitoring in children: position paper on indications, methodology and interpretation by the SIGENP working group. Dig Liver Dis 2019; 51:1522-1536. [PMID: 31526716 DOI: 10.1016/j.dld.2019.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Abstract
Multichannel intraluminal impedance pH (MII-pH) monitoring currently represents the gold standard diagnostic technique for the detection of gastro-esophageal reflux (GER), since it allows to quantify and characterize all reflux events and their possible relation with symptoms. Over the last ten years, thanks to its strengths and along with the publication of several clinical studies, its worldwide use has gradually increased, particularly in infants and children. Nevertheless, factors such as the limited pediatric reference values and limited therapeutic options still weaken its current clinical impact. Through an up-to-date review of the available scientific evidence, our aim was to produce a position paper on behalf of the working group on neurogastroenterology and acid-related disorders of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) on MII-pH monitoring technique, indications and interpretation in pediatric age, in order to standardise its use and to help clinicians in the diagnostic approach to children with GER symptoms.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy; Department of Translational Medical Science,"Federico II", University of Naples, Italy.
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, Saronno Hospital, Saronno, Italy
| | - Fernanda Cristofori
- Department of Pediatrics, Giovanni XXIII Hospital, Aldo MoroUniversity of Bari, Bari, Italy
| | - Mariella Baldassarre
- Department of Biomedical Science and Human Oncology-neonatology and Nicu section, University "Aldo Moro", Bari, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, Giovanni XXIII Hospital, Aldo MoroUniversity of Bari, Bari, Italy
| | - Giovanni Di Nardo
- NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Rossi
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Saverio Mallardo
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Elena Maggiora
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science,"Federico II", University of Naples, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute ofChild Health and Great OrmondStreet Hospital, London, UK
| |
Collapse
|
21
|
Oliva S, Aloi M, Viola F, Mallardo S, Civitelli F, Maccioni F, Hassan C, Papoff P, Cucchiara S, Cohen SA. A Treat to Target Strategy Using Panenteric Capsule Endoscopy in Pediatric Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2019; 17:2060-2067.e1. [PMID: 30326301 DOI: 10.1016/j.cgh.2018.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/23/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Pan-enteric capsule endoscopy (PCE) is effective for assessment of small intestinal and colonic Crohn's disease (CD) in pediatric patients. We aimed to determine whether PCE can be used to monitor mucosal healing and deep remission, in a treat to target strategy for pediatric patients with CD. METHODS We performed a prospective study of 48 children with a diagnosis of CD at a tertiary care pediatric gastroenterology unit; 46 patients were included in the final analysis. Biomarker, imaging, and PCE analyses were performed at baseline and after 24 and 52 weeks. Small bowel and colonic mucosal healing were defined by Lewis scores <135 and simple endoscopic score for CD ≤1, respectively. Clinical remission was defined as defined as a pediatric CD activity index score <10 and biomarker-based remission based on normal levels of biomarkers; deep remission was defined as a combination of clinical remission, biomarker-based remission, and mucosal healing. Treatments were adjusted based on findings from PCE (imaging was considered only for patients with negative findings from PCE). Therapies were introduced, optimized, switched, or combined at the discretion of treating clinicians. The primary outcome was the ability of PCE to assess mucosal healing and deep remission at 3 timepoints and to guide a treat to target strategy. RESULTS PCE detected inflammation in 34 patients (71%) at baseline, 22 patients (46%) at week 24, and 18 patients (39%) at week 52 (P for comparison among timepoints <.05). Findings from PCE led to a change in therapy for 34 patients (71%) at baseline and 11 patients (23%) at 24 weeks, whereas only 2 patients with negative results from PCE (4%) changed therapies based on findings from imaging. When the treat to target strategy was applied, proportions of patients with mucosal healing and deep remission increased from 21% at baseline, to 54% at week 24, to 58% at week 52 (P for comparison among timepoints <.05); 2 patients (4%) did not respond to treatment. CONCLUSION In a prospective study of 48 children with CD, we found a treat to target strategy, based on findings from PCE, to significantly increase the proportions of patients with mucosal healing and deep remission. CLINICAL TRIAL gov no: NCT03161886.
Collapse
Affiliation(s)
- Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Franca Viola
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Saverio Mallardo
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Fortunata Civitelli
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Francesca Maccioni
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Paola Papoff
- Department of Pediatrics PICU, Sapienza University of Rome, Rome, Italy
| | - Salvatore Cucchiara
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Stanley A Cohen
- Children's Centre for Digestive Health Care, Atlanta, Georgia
| |
Collapse
|
22
|
Oliva S, Rossetti D, Papoff P, Tiberti A, Mallardo S, Volpe D, Ruggiero C, Russo G, Vezzoli D, Isoldi S, Cucchiara S. A 12-Week Maintenance Therapy with a New Prepared Viscous Budesonide in Pediatric Eosinophilic Esophagitis. Dig Dis Sci 2019; 64:1571-1578. [PMID: 30659470 PMCID: PMC6522447 DOI: 10.1007/s10620-018-5449-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/10/2018] [Accepted: 12/29/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND A new prepared oral viscous budesonide (PVB) has been effective in inducing clinical and histological remission in pediatric eosinophilic esophagitis (EoE). AIMS To evaluate the efficacy of a 12-week maintenance therapy on clinical, endoscopic, and histological remission using half of the dose used in the induction therapy. METHODS We prospectively enrolled pediatric patients with active EoE. After 12 weeks of induction therapy with PVB (< 150 cm: 2 mg/day; ≥ 150 cm: 4 mg/day) patients received a maintenance dose of half of the dose used in the induction therapy (1 mg or 2 mg) for another 12 weeks. A 12-week follow-up was then performed in all patients after the end of therapy. Endoscopy was performed at weeks 0, 12, 24, and 36. Symptoms, endoscopy, and histology scores were also calculated. Serum cortisol was evaluated during the treatment period. RESULTS We enrolled 20 children (15 males; median age 10 years; range 4-17). After the 12-week induction therapy 18 patients (90%) were in remission, with a significant decrease in the median peak of eosinophil count/HPF as well as a marked reduction in clinical, endoscopic, and histological scores (p < 0.01). At the end of the maintenance therapy (week 24), 17 patients (85%) were still in remission, while there were only 9 at week 36 (45%). No significant changes in cortisol levels were observed during the study period. CONCLUSIONS The 12-week maintenance treatment with the half the dose of PVB was effective in sustaining remission at week 24; however, no reduction in the rate of relapse after suspension of treatment occurred.
Collapse
Affiliation(s)
- Salvatore Oliva
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Danilo Rossetti
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Paola Papoff
- Department of Paediatrics, PICU, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Tiberti
- Department of Radiological Sciences, Oncology, and Anatomical Pathology, Sapienza – University of Rome, Rome, Italy
| | - Saverio Mallardo
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Danila Volpe
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Cosimo Ruggiero
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Giusy Russo
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Debora Vezzoli
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Sara Isoldi
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Salvatore Cucchiara
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| |
Collapse
|
23
|
Palone F, Vitali R, Trovato CM, Montuori M, Negroni A, Mallardo S, Stronati L. Faecal high mobility group box 1 in children with celiac disease: A pilot study. Dig Liver Dis 2018; 50:916-919. [PMID: 29709462 DOI: 10.1016/j.dld.2018.04.003] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Celiac disease (CD) is a gluten-related immunological disorder resulting in inflammatory enteropathy. AIMS We assessed a stool marker of intestinal inflammation, the HMGB1 protein, in children with CD on a gluten free diet (GFD) at baseline and at follow up (FU). METHODS Thirty-nine children were investigated at diagnosis and at FU. Traditional serum markers of CD (anti-transglutaminase and anti-endomysial antibodies) and faecal HMGB1 (by enzyme-linked immunosorbent assay and immunoblotting) were tested. RESULTS There was a marked increase at baseline in both serum anti-transglutaminase IgA (anti-tTGAs) and faecal HMGB1; the latter being undetectable in controls. A strong correlation occurred between the two markers. At 12-month FU in 24 patients on GFD, HMGB1 decreased in all subjects, yet still being detectable in six children: high anti-tTGAs where evident in three, while the three with normal anti-tTGAs were complaining of intestinal symptoms and reported a low GFD adherence. CONCLUSIONS Faecal HMGB1 is a valuable marker of intestinal inflammation and may have a role in complementing serology in the management of CD children. Future studies including larger patient cohorts and small bowel mucosa histology will be designed to assess the relationship between faecal HMGB1 levels and duodeno-jejunal histopathology.
Collapse
Affiliation(s)
| | - Roberta Vitali
- Department of Radiation Biology and Human Health, ENEA, Rome, Italy
| | | | - Monica Montuori
- Department of Paediatrics, Sapienza University of Rome, Italy
| | - Anna Negroni
- Department of Radiation Biology and Human Health, ENEA, Rome, Italy
| | | | - Laura Stronati
- Department of Cellular Biotechnology and Haematology, Sapienza University of Rome, Italy.
| |
Collapse
|
24
|
Di Nardo G, Oliva S, Ferrari F, Mallardo S, Barbara G, Cremon C, Aloi M, Cucchiara S. Efficacy and tolerability of α-galactosidase in treating gas-related symptoms in children: a randomized, double-blind, placebo controlled trial. BMC Gastroenterol 2013; 13:142. [PMID: 24063420 PMCID: PMC3849317 DOI: 10.1186/1471-230x-13-142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 09/18/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gas-related symptoms represent very common complaints in children. The reduction of gas production can be considered as a valuable target in controlling symptoms. α-galactosidase has been shown to reduce gas production and related symptoms in adults. To evaluate the efficacy and tolerability of α-galactosidase in the treatment of gas-related symptoms in pediatric patients. METHODS Single center, randomized, double-blind, placebo-controlled, parallel group study performed in tertiary care setting. Fifty-two pediatric patients (32 female, age range 4-17) with chronic or recurrent gas-related symptoms were randomized to receive placebo (n = 25) or α-galactosidase (n = 27). Both treatments were given as drops or tablets, according to body weight for 2 weeks. The primary endpoint was the reduction in global distress measured by the Faces Pain Scale-Revised (FPS-R) at the end of treatment compared to baseline. Secondary endpoints were the reduction in severity and frequency of gas-related symptoms as recorded by parents and/or children. RESULTS α-galactosidase significantly reduced global distress (p = 0.02) compared to placebo. The digestive enzyme decreased the number of days with moderate to severe bloating (p = 0.03) and the proportion of patients with flatulence (p = 0.02). No significant differences were found for abdominal spasms and abdominal distension. No adverse events were reported during treatment. CONCLUSIONS Although larger and longer trials are needed to confirm this result, α-galactosidase seems to be a safe, well tolerated and effective treatment for gas-related symptoms in the pediatric population. TRIAL REGISTRATION ClinicalTrials.gov, NCT01595932.
Collapse
Affiliation(s)
- Giovanni Di Nardo
- Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Oliva S, Di Nardo G, Ferrari F, Mallardo S, Rossi P, Patrizi G, Cucchiara S, Stronati L. Randomised clinical trial: the effectiveness of Lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis. Aliment Pharmacol Ther 2012; 35:327-34. [PMID: 22150569 DOI: 10.1111/j.1365-2036.2011.04939.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intestinal microbiota manipulation, one of the pathogenetic components of inflammatory bowel disease (IBD), has become an attractive therapy for ulcerative colitis (UC). AIM To assess in children with active distal UC the effectiveness of Lactobacillus (L) reuteri ATCC 55730 enema on inflammation and cytokine expression of rectal mucosa. METHODS A total of 40 patients (median age: 7.2 years range 6-18) with mild to moderate UC were enrolled in a prospective, randomised, placebo-controlled study. They received an enema solution containing 10(10) CFU of L. reuteri ATCC 55730 or placebo for 8 weeks, in addition to oral mesalazine. Clinical endoscopic and histological scores as well as rectal mucosal expression levels of IL-10, IL-1β, TNFα and IL-8 were evaluated at the beginning and at the end of the trial. RESULTS Thirty-one patients accomplished the trial (17 males, median age 13 year, range 7-18). Mayo score (including clinical and endoscopic features) decreased significantly in the L. reuteri group (3.2 ± 1.3 vs. 8.6 ± 0.8, P < 0.01) compared with placebo (7.1 ± 1.1 vs. 8.7 ± 0.7, NS); furthermore, histological score significantly decrease only in the L. reuteri group (0.6 ± 0.5 vs. 4.5 ± 0.6, P < 0.01) (placebo: 2.9 ± 0.8 vs. 4.6 ± 0.6, NS). At the post-trial evaluation of cytokine mucosal expression levels, IL-10 significantly increased (P < 0.01) whereas IL-1β, TNFα and IL-8 significantly decreased (P < 0.01) only in the L. reuteri group. CONCLUSIONS In children with active distal ulcerative colitis, rectal infusion of L. reuteri is effective in improving mucosal inflammation and changing mucosal expression levels of some cytokines involved in the mechanisms of inflammatory bowel disease.
Collapse
Affiliation(s)
- S Oliva
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Di Nardo G, Oliva S, Aloi M, Rossi P, Casciani E, Masselli G, Ferrari F, Mallardo S, Stronati L, Cucchiara S. Usefulness of single-balloon enteroscopy in pediatric Crohn's disease. Gastrointest Endosc 2012; 75:80-6. [PMID: 21855873 DOI: 10.1016/j.gie.2011.06.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 06/15/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single-balloon enteroscopy (SBE) has not been reported in pediatric Crohn's disease (CD). OBJECTIVE To determine technical performance, yield, safety, and clinical impact of SBE in pediatric patients with suspected and established CD. DESIGN Prospective, cohort study. SETTING Academic tertiary-care referral center. PATIENTS This study involved 16 patients (group A) with suspected CD and unspecific upper and lower GI endoscopy results and 14 patients (group B) with longstanding CD with previous surgery and showing signs unaccountable by conventional endoscopy. All underwent magnetic resonance imaging, and 14 patients in group A also underwent wireless capsule endoscopy. INTERVENTION SBE. MAIN OUTCOME MEASUREMENTS SBE diagnostic and therapeutic yield, technical performance, clinical impact, and safety. RESULTS In group A, SBE aided diagnosis of CD in 12 patients and eosinophilic enteropathy in 2 patients, whereas no lesions were found in 2 patients. WCE was diagnostic of CD in 3 patients, suggestive of CD in 7 patients, and unspecific in the remaining patients. In group B, SBE revealed moderate-to-severe disease activity in most patients, leading to the introduction of or change in biological therapy, with a marked decrease in the pediatric Crohn's disease activity index scores. SBE allowed successful dilation of small-bowel strictures in 2 patients in group A and 3 in group B. No complications occurred. LIMITATIONS Small sample size, no direct comparison with imaging or other endoscopic techniques. CONCLUSION SBE is a useful and safe endoscopic procedure for evaluating the small bowel in pediatric patients with suspected or established CD. Not only does it allow a definite diagnosis of CD when the latter is uncertain, but it is also very effective in the management of small-bowel strictures, thus avoiding surgery. It may be helpful in redirecting therapy in selected CD patients.
Collapse
|
27
|
Di Nardo G, Oliva S, Passariello M, Pallotta N, Civitelli F, Frediani S, Gualdi G, Gandullia P, Mallardo S, Cucchiara S. Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn's disease with stricture: a prospective, randomized, double-blind, controlled trial. Gastrointest Endosc 2010; 72:1201-8. [PMID: 20951986 DOI: 10.1016/j.gie.2010.08.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 08/05/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic balloon dilation (EBD) is an attractive conservative therapy for Crohn's disease (CD) with stricture; however, its long-term efficacy has been questioned because many patients require more dilations or postdilation surgery. Most reports are retrospective, and no pediatric data are available. OBJECTIVE To assess the effectiveness of corticosteroid intralesional injection after EBD in preventing stricture recurrence. DESIGN Single-center prospective, randomized, double-blind, controlled trial. SETTING Tertiary-referral university hospital. PATIENTS Between November 2005 and January 2009, 29 pediatric patients with stricturing CD were enrolled. INTERVENTIONS Enrolled patients were randomized to receive intrastricture injection of corticosteroid (CS) (n = 15) or placebo (n = 14) after EBD. Patients were followed clinically via small intestine contrast US and intestinal magnetic resonance imaging at 1, 3, 6, and 12 months; all underwent colonoscopy 12 months after dilation. MAIN OUTCOME MEASUREMENTS Time free of repeat dilation and time free of surgery in the 2 groups. RESULTS One of the 15 patients receiving CS required redilation, whereas the latter was needed in 5 of the 14 placebo patients; surgery was needed in 4 of the placebo patients, but in none of those receiving CS. The 2 groups statistically differed in the time free of redilation (P = .04) as well as for time free of surgery after EBD (P = .02), which were worse in the placebo group compared with the CS group. There were no significant differences in baseline demographics between the 2 groups. LIMITATIONS Sample size, participation bias, and short-term follow-up. CONCLUSION In pediatric CD with stricture, intralesional CS injection after EBD is an effective strategy for reducing the need both for redilation and surgery.
Collapse
Affiliation(s)
- Giovanni Di Nardo
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|