Administration of L reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.
The aim of this study was to assess the pattern of evolution of resistance to antibiotics in Helicobacter pylori isolated from children who underwent upper endoscopy with antral biopsy during a 10-year period (2001-2010). We retrospectively analyzed data of all children (n = 3,008) who underwent upper endoscopy during the observed period at the Children's Hospital Zagreb, a university tertiary medical center. We calculated the rate, antibiotic susceptibility and risk factors for the H. pylori infection in our cohort. Antral biopsy was performed in 2,313 (76.89%) patients. Altogether, 382 (16.51%) children had positive biopsy for H. pylori (histology and/or culture). There was no significant difference in the incidence of H. pylori during 10 years of observation (p = 0.21). Infected children compared to non-infected group were older (p = 0.005), and had more often antral nodularity (p < 0.0001), and duodenal ulcer (p = 0.002). Altogether, 22.4% of treatment-naïve patients had strains resistant to tested antibiotics: majority to azithromycin (17.9%), followed by clarithromycin (11.9%), metronidazole (10.1%) and amoxicillin (0.6%). In the eradication failure group, 9/11 of children had strains resistant to tested antibiotics, mostly to metronidazole (7/11), followed by azithromycin (3/11) and clarithromycin (1/11). No correlation was found between age or gender and antibiotic resistance (p = 0.32, for both). In conclusion, our data strongly support current guidelines which recommend antibiotic susceptibility testing prior to eradication therapy. Based on our results we recommend the use of amoxicillin-metronidazole-based regimen as the first-line therapy in our study population.
The second and the third biopsies (before and after the gluten challenge) may also be avoided when diagnosing CD in children younger than 2 years provided that the child, at the time of presentation, has positive anti-endomysial antibodies and Marsh IIIc on the small bowel biopsy. A gluten challenge should be still considered in all other children younger than 2 years.
T o the Editor: We provided care to a 10-year-old girl who had placed 2 Buckyballs magnets in her mouth as a makeshift tongue ring, and accidentally swallowed both magnets. An emergent esophagogastroduodenoscopy revealed that the magnets had passed beyond the duodenum. After 48 hours of conservative management, the magnets appeared to remain in a static position in the right lower quadrant. A limited noncontrast computed tomography scan of the abdomen showed both magnets attached to each other in the appendix. A diagnostic laparotomy was performed and under direct visualization, the magnets were manipulated into the appendix and retrieved via an appendectomy (Fig. 1). Her postoperative course was uneventful. After discharge from the hospital, this case received wide media coverage and was published on the front page of The Washington Post (1). During the same time, 2 other preteens were hospitalized at Inova Fairfax Hospital for Children with similar complaints. Both of them passed the objects spontaneously.Between 10% and 20% of cases require endoscopic retrieval, and approximately 1% of cases require operative management for intestinal obstruction or perforation (2,3) Reports from the Centers for Disease Control and Prevention and the US Consumer Product Safety Commission have described the risks of multiple magnet ingestion and have highlighted the dangers of using magnets as simulated jewelry, particularly around the lips and tongue (4,5). We urge the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition to assume a leadership role and take the initiative in educating and creating awareness among pediatricians, pediatric gastroenterologists, and other subspecialists about this emerging pediatric health concern.
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