Collagenous gastritis : about two paediatric cases and literature review

BACKGROUND AND STUDY AIMS

Collagenous gastritis is a rare entity divided in two subgroups (paediatric and adult). In the paediatric population, it often causes anaemia and abdominal pain. Therapy remains the most challenging part as no randomized clinical trial exists and long-term outcome is not well established.

PATIENTS AND METHODS

We reviewed the 43 paediatric patients with diagnosis of collagenous gastritis reported in Pubmed from 1989 to mid 2019 to analyse clinical and histological response depending on the treatment choice.

RESULTS

In 43 patients (M/F ratio 1:2), a clinical response was observed in 85.7% of patients and a histological response in 20.8% of patients. PPI treatment associated with oral iron supplement was the most frequent choice with clinical improvement in 78.5% of patients. Other treatments such as gluten-free diet or corticoids showed relatively good rates of clinical improvement. Histological remission seems difficult to achieve and recurrence of symptoms after treatment interruption was often reported.

CONCLUSIONS

Collagenous gastritis in children is mainly characterized by symptoms of anaemia, abdominal pain or diarrhea. Gastroscopy with fundic biopsies helps to confirm diagnosis and treatment with PPI's (associated with oral iron supplement in case of anaemia) seems to be the most efficient choice to achieve clinical and sometimes histological remission. Long-term outcome of these young patients is unknown. A better understanding of the pathogenesis could lead to new medications focusing on this histological remission.

Numerical study and theoretical performance limit of interconnected multi-capillary gas chromatography columns with perfectly ordered pillar patterns

We present the results of a theoretical and numerical study of the chromatographic performance of a novel type of microfabricated GC column. The column consists of an array of rectangular flow diverters (pillars), creating a network of perfectly ordered, interconnected and tortuous flow-through paths. Using van Deemter and kinetic plots of simulated band broadening data, we could demonstrate that the proposed column structure performs as a bundle of parallel open-tubular capillaries with rectangular cross-section, connected by a regular pattern of channel-intermixing points that allow compensating for inevitable channel-to-channel differences in migration velocity without adding any significant dispersion themselves. The established kinetic plots also allowed to propose design rules for the optimal distance between the pillars as a function of the desired separation efficiency and the available column pressure. The simulations also allowed establishing an expression for the plate height as a function of the velocity of the carrier gas. Results are also compared to the results of a recent experimental study.

Design and performance evaluation of a microfluidic ion-suppression module for anion-exchange chromatography

A microfluidic membrane suppressor has been constructed to suppress ions of alkaline mobile-phases via an acid-base reaction across a sulfonated poly(tetrafluoroethylene)-based membrane and was evaluated for anion-exchange separations using conductivity detection. The membrane was clamped between two chip substrates, accommodating rectangular microchannels for the eluent and regenerant flow, respectively. Additionally, a clamp-on chip holder has been constructed which allows the alignment and stacking of different chip modules. The response and efficacy of the microfluidic chip suppressor was assessed for a wide range of eluent (KOH) concentrations, using 127 and 183μm thick membranes, while optimizing the flow rate and concentration of the regenerant solution (H2SO4). The optimal operating eluent flow rate was determined at 5μL/min, corresponding to the optimal van-Deemter flow velocity of commercially-available column technology, i.e. a 0.4mm i.d.×250mm long column packed with 7.5μm anion-exchange particles. When equilibrated at 10mM KOH, a 99% decrease in conductivity signal could be obtained within 5min when applying 10mM H2SO4 regenerant at 75μL/min. A background signal as low as 1.2μS/cm was obtained, which equals the performance of a commercially-available electrolytic hollow-fiber suppressor. When increasing the temperature of the membrane suppressor from 15 to 20°C, ion suppression was significantly improved allowing the application of 75mM KOH. The applicability of the chip suppressor has been demonstrated with an isocratic baseline separation of a mixture of seven inorganic ions, yielding plate numbers between 5300 and 10,600 and with a gradient separation of a complex ion mixture.

[A clinical case of spontaneous involution of systemic cat scratch disease]

Typical Cat-scratch disease (CSD) manifests as regional lymphadenopathy following cat scratch and sometimes associated with mild fever. There is a lot of atypical manifestations and some of those have systemic involvement. Hepatosplenic CSD is a systemic presentation associating fever of unknown origin with nodules in the liver and/or the spleen. Ultrasound abdominal examination shows nodules (3-30 mm) in the spleen and/or in the liver. Diagnostic is based on serology for B henselae (always IgG + and sometimes IgM +), or polymerase chain reaction (PCR) on the liver to test for the presence of B henselae. Hepatosplenic CSD is rare and therefore underdiagnosed. There is no consensus about the treatment but most of the authors suggest to treat with rifampicine. We report a case of a 4-years-old girl presenting with fever of unknown origin (FUO), high inflammatory markers with normal leukocytosis and hepatosplenic nodules. The diagnosis of CSD was made retrospectively. Evolution was favourable even though no specific antibiotic treatment for Bartonella henselae was administrated.