In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux can be safely treated before performing (expensive and often unnecessary) complementary investigations. However, the latter are mandatory if symptoms persist despite appropriate treatment. Oesophageal pH monitoring of long duration (18-24 h) is recommended as the investigation technique of choice in infants and children with atypical presentations of gastro-oesophageal reflux. Upper gastro-intestinal endoscopy in a specialised centre is the technique of choice in infants and children presenting with symptoms suggestive of peptic oesophagitis. Prokinetics, still a relatively new drug family, have already obtained a definitive place in the treatment of gastro-oesophageal reflux disease in infants and children, especially if "non-drug" treatment (positional therapy, dietary recommendations, etc.) was unsuccessful. It was the aim of the Working Group to help the paediatrician with this consensus statement and guide-lines to establish a standardised management of gastro-oesophageal reflux disease in infants and children.

Iron plays a role in the regulation of dopaminergic activity. In the present study, nonanemic children with attention deficit hyperactivity disorder (ADHD) were evaluated with regard to heme and nonheme iron metabolism and the effect of short-term iron administration on behavior. The study group consisted of 14 boys aged 7–11 years. All first underwent testing to rule out other psychiatric and medical problems. The severity of the ADHD symptoms was determined by parent and teacher scores on the Connors Rating Scale. Thereafter, each patient received an iron preparation (Ferrocal), 5 mg/kg/day for 30 days. Blood samples were taken before and after drug administration. Results showed a significant increase in serum ferritin levels (from 25.9 ± 9.2 to 44.6 ±18 ng/ml) and a significant decrease on the parents’ Connors Rating Scale scores (from 17.6 ± 4.5 to 12.7 ± 5.4). There were no changes in other blood parameters or in the teachers’ scores on the rating scale. The effect of iron supplementation on the behavioral and cognitive symptoms in noniron-deficient ADHD children merits further investigation using a placebo-controlled study.

For the isolation of coeliac active peptide fractions the peptic tryptic digest of whole gliadin was successively separated by ultrafiltration, gel filtration, cation-exchange chromatography, anion exchange chromatography and high-performance liquid chromatography. After each separation step the peptide fractions obtained were characterized by amino acid analysis and examined for coeliac activity in an immunological test (LIF test) and in an organ-culture test. The most active fractions have molecular weights ranging from 7,000 to 14,000 daltons, high contents of Glx (greater than 40 mol-%), Pro (greater than 20 mol-%) and Phe (greater than 5 mol-%) and low contents of S-containing and basic amino acids (0 and less than 2.0 mol-%, respectively). The peptide fraction B3142 obtained after five separation steps seems to be a pure peptide, which shows activity in the immunological test for all coeliac patients examined in very low concentrations. This peptide consists of 53 amino acid residues and has the composition Glx24, Pro15, Val4, Phe3, Ser2, Leu2, Asx1, Gly1, Tyr1.

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The coeliac active peptide B 3142, which has been isolated from a peptic-tryptic digest of gliadin and which consists of 53 amino-acid sequences, was partially hydrolyzed with alpha-chymotrypsin. The two fragment peptides CT-1 (positions 1-22 of B 3142) and CT-2 (positions 23-53) were separated by high-performance liquid chromatography on octadecyl silica gel and purified by gel filtration on Biogel P2. The examination in the organ-culture test including 18 coeliac patients on normal diet and 7 control persons have shown that the toxicity is preserved after the chymotryptic treatment and that the peptides B 3142, CT-1 and CT-2 do not significantly differ from one another according to their coeliac-specific effect.

Peptide B 3142, which has been isolated from a peptic tryptic digest of whole gliadin by several separation steps [1], was examined for coeliac activity in an immunological test and in an organ-culture test, comparing enlarged groups of coeliac patients and control persons. In both test systems the peptide shows a coeliac specific effect. The N-terminal sequence analysis (EDMAN degradation), the C-terminal sequence analysis (incubation with carboxypeptidase Y) and the sequence determination of peptides, obtained from B 3142 by digestion with papain and chymotrypsin, result in the following total amino-acid sequence: H-Val-Pro-Val-Pro-Gln-Leu-Gln-Pro-Gln-Asn-Pro-Ser-Gln-Gln- Gln-Pro-Gln-Glu-Gln-Val-Pro-Leu-Val-Gln-Gln-Gln-Gln-Phe-Pro-Gly-Gln-Gln- Gln-Pro-Phe-Pro-Pro-Gln-Gln-Pro-Tyr-Pro-Gln-Pro-Gln-Pro-Phe-Pro-Ser-Gln- Gln-Pro-Tyr-OH. The 53 amino-acid residues correspond to a molecular mass of 6,129 g/mol.

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SUMMARY The data from a large group of children with biopsy proved coeliac disease born in the Rehovot-Ashdod region of Israel and treated in a regional hospital provided us with the basis for the determination of the annual birth cohort incidence of coeliac disease for the period 1968-81. The findings show a minimum birth cohort incidence of 1*71/1000 live births. The highest incidence rate was in children of Asian origin and the lowest in second generation Israel born. The incidence of coeliac disease rose sharply during the study period.