1
|
Peña-Vélez R, Toro-Monjaraz E, Avelar-Rodríguez D, Cadena-León J, Ignorosa-Arellano K, Loredo-Mayer A, Zárate-Mondragón F, Cervantes-Bustamante R, Ramírez-Mayans J. Esophageal motility disorders in children with dysphagia: the utility of the Chicago classification. Rev Esp Enferm Dig 2020; 112:850-853. [PMID: 33054306 DOI: 10.17235/reed.2020.6735/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND esophageal manometry is the standard criterion for the evaluation of dysphagia and the diagnosis of a primary motor disorder of the esophagus in adults and children. AIMS to describe the diagnosis according to the Chicago classification (CC) v3.0 in children with dysphagia, in whom an esophageal motility disorder was documented. The associated comorbidities were also determined. METHODS an observational retrospective study was performed of 54 patients evaluated for dysphagia, who had undergone a high-resolution manometry (HREM). RESULTS a normal HREM was found in 52 % (n = 28) of the children, whereas 48 % (n = 26) had some esophageal motility disorder. The most frequent diagnosis was ineffective esophageal motility and achalasia. Excluding previously healthy children, most children had a history of autoimmune disease and intellectual disability. CONCLUSIONS an esophageal motor disorder can be diagnosed in nearly half of infants and children with dysphagia. In this study, all esophageal diseases could be classified according to the CC v3.0. HREM should be considered for the evaluation of children with dysphagia, in addition to other studies.
Collapse
Affiliation(s)
- Rubén Peña-Vélez
- Gastroenterología y Nutrición, Instituto Nacional de Pediatría, México
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Peña-Vélez R, Toro-Monjaraz E, Avelar-Rodríguez D, Ignorosa-Arellano K, Zárate-Mondragón F, Cervantes-Bustamante R, Montijo-Barrios E, Cadena-León J, Ramírez-Mayans J. Small intestinal bacterial overgrowth: could it be associated with chronic abdominal pain in children with allergic diseases? Rev Esp Enferm Dig 2020; 111:927-930. [PMID: 31617366 DOI: 10.17235/reed.2019.6321/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS small intestinal bacterial overgrowth (SIBO) is a well-known cause of chronic abdominal pain (CAP) during the pediatric age. On the other hand, children with a history of some allergic disorder present CAP more frequently. The aim of this study was to determine the association between the presence of allergic diseases and SIBO in patients diagnosed with CAP. MATERIALS AND METHODS this was an observational, analytical, retrospective study. Children with CAP who had undergone a lactulose hydrogen breath test to determine the presence of SIBO were included in the study. All patients underwent an evaluation for allergies by means of a skin prick test or the determination of specific IgE, according to clinical diagnosis. The study groups were established according to the presence of SIBO and the results of the allergic evaluation were statistically compared between the groups. RESULTS seventy patients were included (41 females and 29 males) and SIBO was diagnosed in 35 patients. In addition, 71.4% of children with SIBO were found to have an allergic disease, in contrast with 28.6% of children without SIBO (p = 0.001). The odds ratio for having any type of allergy in patients with SIBO was 5.45 (95% CI, 1.96-15.17; p = 0.001). CONCLUSIONS we found an association between SIBO and allergic disease, especially allergic rhinitis, cow's milk protein allergy and asthma. Thus, SIBO should be ruled out in pediatric patients with CAP and allergic disease.
Collapse
Affiliation(s)
- Rubén Peña-Vélez
- Gastroenterología y Nutrición, Instituto Nacional de Pediatría (INP), México
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Cervantes-Bustamante R, Pedrero-Olivares I, Toro-Monjaraz EM, Murillo-Márquez P, Ramírez-Mayans JA, Montijo-Barrios E, Zárate-Mondragón F, Cadena-León J, Cazares-Méndez M, López-Ugalde M. Histopathologic findings in children diagnosed with cow's milk protein allergy. Rev Gastroenterol Mex 2015; 80:130-4. [PMID: 26024572 DOI: 10.1016/j.rgmx.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cow's milk protein allergy is the most common cause of food allergy. The challenge test, either open or doubled-blind with a placebo control, is regarded as the criterion standard. Endoscopy and histologic findings are considered a method that can aid in the diagnosis of this entity. AIMS The aim of this study was to describe the histopathologic findings in children suspected of cow's milk protein allergy that were seen at our hospital. MATERIAL AND METHODS A descriptive, observational study was conducted on 116 children clinically suspected of presenting with cow's milk protein allergy that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría. Upper endoscopy and rectosigmoidoscopy with biopsies were performed and the findings were described. RESULTS Of the 116 patients, 64 (55.17%) were girls and 52 (44.83%) were boys. The rectum was the site with the greatest presence of eosinophils per field in both groups, followed by the duodenum. In general, more than 15 eosinophils were found in 46% of the patients. CONCLUSIONS Between 40 and 45% of the cases had the histologic criterion of more than 15 to 20 eosinophils per field and the rectosigmoid colon was the most affected site. Therefore, panendoscopy and rectosigmoidoscopy with biopsy and eosinophil count are suggested.
Collapse
Affiliation(s)
- R Cervantes-Bustamante
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - I Pedrero-Olivares
- Servicio de Gastroenterología y Nutrición Pediátrica, Hospital de Alta Especialidad de Ixtapaluca, Secretaría de Salud,, Ixtapaluca, Estado de México, México
| | - E M Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México.
| | - P Murillo-Márquez
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - J A Ramírez-Mayans
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - E Montijo-Barrios
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - F Zárate-Mondragón
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - J Cadena-León
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - M Cazares-Méndez
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - M López-Ugalde
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| |
Collapse
|
4
|
Valdovinos-Oregón D, Ramírez-Mayans J, Cervantes-Bustamante R, Toro-Monjaraz E, Cázares-Méndez M, Cadena-León J, Zárate-Mondragón F, Montijo-Barrios E. [Primary intestinal lymphangiectasia: twenty years of experience at a Mexican tertiary care hospital]. Rev Gastroenterol Mex 2014; 79:7-12. [PMID: 24655928 DOI: 10.1016/j.rgmx.2013.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/27/2013] [Accepted: 07/31/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary intestinal lymphangiectasia is a rare congenital disease described by Waldmann in 1961 that is a consequence of obstruction of the lymphatic drainage of the small bowel with secondary lymph vessel dilation. This distorts the architecture of the villi and causes a leakage of lymph into the intestinal lumen, resulting in protein-losing enteropathy and malabsorption. AIM To describe the clinical, biochemical, radiologic, endoscopic, and histologic characteristics in children with primary intestinal lymphangiectasia. METHOD A retrospective observational, descriptive, cross-sectional study was conducted that reviewed the case records of children diagnosed with primary intestinal lymphangiectasia that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 1, 1992 to September 30, 2012. RESULTS Four patients were found that presented with primary intestinal lymphangiectasia. Three of them had been diagnosed before 3 years of age. All the patients presented with chronic diarrhea, edema, lymphopenia, hypocalcemia, and hypogammaglobulinemia, and 3 patients presented with hypocholesterolemia. Bowel transit time, endoscopy, and intestinal biopsies were characteristic of this pathology. CONCLUSIONS Intestinal lymphangiectasia should be suspected when there is a clinical picture of chronic diarrhea and protein-losing enteropathy accompanied with edema at any level, as well as hypoalbuminemia, hypocalcemia, lymphopenia, hypogammaglobulinemia, and hypocholesterolemia, which are the main biochemical findings of this pathology. All children presenting with intestinal lymphangiectasia should undergo an upper gastrointestinal series with bowel transit time and endoscopy with biopsies taken at the level of the duodenum. Treatment includes diet and the periodic administration of albumin and gamma globulin.
Collapse
Affiliation(s)
- D Valdovinos-Oregón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México.
| | - J Ramírez-Mayans
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - R Cervantes-Bustamante
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - E Toro-Monjaraz
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - M Cázares-Méndez
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - J Cadena-León
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - F Zárate-Mondragón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| | - E Montijo-Barrios
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Secretaría de Salud, México, D.F., México
| |
Collapse
|
5
|
Valdovinos-Oregón D, Ramírez-Mayans J, Cervantes-Bustamante R, Toro-Monjaraz E, Cázares-Méndez M, Cadena-León J, Zárate-Mondragón F, Montijo-Barrios E. Primary intestinal lymphangiectasia: twenty years of experience at a Mexican tertiary care hospital. Revista de Gastroenterología de México (English Edition) 2014. [DOI: 10.1016/j.rgmxen.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
6
|
Ramírez-Mayans J, Toro-Monjaraz E, Romero-Trujillo J, Cervantes-Bustamante R, Zárate-Mondragón F, Montijo-Barrios E, Cadena-León J, Cazares-Méndez M. 24-h intraesophageal pH determination in children allergic to cow's milk protein at a tertiary care hospital. Revista de Gastroenterología de México (English Edition) 2014. [DOI: 10.1016/j.rgmxen.2014.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
7
|
Ramírez-Mayans JA, Toro-Monjaraz EM, Romero-Trujillo J, Cervantes-Bustamante R, Zárate-Mondragón F, Montijo-Barrios E, Cadena-León J, Cazares-Méndez M. [24-h intraesophageal pH determination in children allergic to cow's milk protein at a tertiary care hospital]. Rev Gastroenterol Mex 2014; 79:3-6. [PMID: 24656514 DOI: 10.1016/j.rgmx.2013.09.002] [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] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/13/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Cow's milk protein allergy (CMPA) is being seen more frequently on a daily basis in pediatric consultations. It shares symptoms with gastroesophageal reflux (GER), which can complicate the differential diagnosis. AIMS To attempt to corroborate the presence of acid GER in children with CMPA, as well as to find a characteristic profile through the 24-hour pH monitoring study in children with GER and CMPA METHODS: The intraesophageal pH monitoring studies performed on 47 children with CMPA were reviewed. The measurements in all the studies were carried out within a 24-hour period using Digitrapper® equipment with a multi-use GeroFlex® catheter, after calibration with pH 7 and pH 1 buffer solutions. RESULTS Of the 47 children, 23 were boys (32.4%) and 24 were girls (33.8%) and the mean age was 5±3.7 years. Fourteen of the 47 children (29%) presented with GER, according to the result of the 24-hour intraesophageal measurement. Only 2 of the 47 patients studied fit the phasic profile. CONCLUSIONS The findings show the existing relation between the two pathologies. Nevertheless, it is important to determine the presence of non-acid or weak acid reflux, because their existence can increase this association.
Collapse
|