In Sweden, a precipitous rise in the incidence of celiac disease (CD) in children below two years of age occurred during 1985-1995 in Sweden. The period is well suited for investigating the socioeconomic and geographical distribution of CD in Sweden. Previous research on the importance of socioeconomic position (SEP) in CD has produced conflicting results. All singleton children born in Sweden 1987Sweden -1993 were identified in the Swedish Medical Birth Record. We linked several other national registries to obtain socioeconomic, medical, and demographic information. We applied multilevel (counties, municipalities, and individuals) logistic regression methods to quantify a possible geographical clustering of CD cases and to investigate the association between SEP and CD. Using equalized family income quintile groups as a measure of SEP, we found that in the lowest quintile group the association with CD was for boys OR 1.18 (95 % CI 0.90-1.55) and for girls OR 0.82 (95 % CI 0.67-1.00). Using the Median Odds Ratio (MOR) as a measure of geographical variation clustering, we found that for boys the MOR was 1.76 (95 % CrI 1.46-2.00) and for girls 1.92 (95 % CrI 1.49-2.30). We also identified a reduced odds of CD in offspring having a mother born outside Sweden, boys OR 0.75 (95 % CI 0.57-0.98) and girls OR 0.64 (95 % CI 0.51-0.79). The study show that SEP is of minor importance in the distribution of CD among small children. However, we identified a significant geographical clustering of CD in Sweden during 1987-1993. VARYING PREDICTIVE VALUES DICTATE THE NEED TO STANDARISE COMMERICAL KITS FOR TTG TESTING D. Kesavelu Paediatric Gastroenterology, Alder Hey Childrens NHS Foundation Trust, Liverpool, UKBackground: Over the previous several months we have noticed an increased false positive coeliac serology rate in patients referred from a particular catchment area of our centre. We investigated serologic methods employed and compared it to methods used at our centre and other hospitals in our catchment.
This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Evidence-based recommendations and randomized controlled trials in the region are included. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by utilizing a modified Delphi process and applying the Likert scale in an electronic voting process. Bacillus clausii was recommended as an adjunct treatment with oral rehydration solution for acute viral diarrhea. B. clausii may also be considered for prevention of antibiotic-associated diarrhea, Clostridium difficile-induced diarrhea, and as adjunct treatment of Helicobacter pylori. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations currently apply to most Asia-Pacific countries. Ideally, these need to be validated with local randomized-controlled trials.
Objectives Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer health benefits to the host. Probiotics are currently being recommended and considered for many medical conditions. The Asia-Pacific region contributes to more than 40% of the global industry. Quality of commercial probiotics remains a challenge globally and has been a major concern in various countries in Europe, South Africa, Taiwan, India, Pakistan, and the USA. Research from these countries indicate that the contents do not correspond to the label information in terms of identity, viability, number of microorganisms or purity. The objective of this study is to assess the commercial probiotic bacterial contents and their label accuracy in India. No previous research has been done in this area in India, on commercial probiotics that are sold as “pharmaceuticals”. Methods A random selection of the most prescribed probiotics for various clinical indications were chosen with a minimum shelf life of 12 months. The probiotics were single and multiple strains and these were evaluated by culture, viable plate count, DNA isolation and targeted metagenomics. Our study is the first step in scrutinizing probiotics in terms of quality and quantity analysis which are used across various age groups for multiple indications. Results Out of the 20 chosen probiotics eight products were single strain and 12 products were multiple strains. These probiotics showed very poor correlation between the declared contents on the pack and lab values in viable cell count colonies, the genus and species strain identification, presence of contaminants and these were confirmed with 16s RNA and next generation sequencing. Conclusion Poor correlation in the quality and quantity of probiotics proves that the label claim and actual claim of these “drugs” show exceptionally poor correlation and raises safety concerns in clinical use, especially in vulnerable age groups such as neonates, children and the elderly. Our study shows that “policing” of these probiotics is essential in protecting these patients who are at risk and ensuring quality control and helping clinicians making the right choice.
Increased exposure to antibiotics during early childhood increases the risk of antibiotic-associated dysbiosis, which is associated with reduced diversity of gut microbial species and abundance of certain taxa, disruption of host immunity, and the emergence of antibiotic-resistant microbes. The disruption of gut microbiota and host immunity in early life is linked to the development of immune-related and metabolic disorders later in life. Antibiotic administration in populations predisposed to gut microbiota dysbiosis, such as newborns, obese children, and children with allergic rhinitis and recurrent infections; changes microbial composition and diversity; exacerbating dysbiosis and resulting in negative health outcomes. Antibiotic-associated diarrhea (AAD), Clostridiodes difficile-associated diarrhea (CDAD), and Helicobacter pylori infection are all short-term consequences of antibiotic treatment that persist from a few weeks to months. Changes in gut microbiota, which persist even 2 years after antibiotic exposure, and the development of obesity, allergies, and asthma are among the long-term consequences. Probiotic bacteria and dietary supplements can potentially prevent or reverse antibiotic-associated gut microbiota dysbiosis. Probiotics have been demonstrated in clinical studies to help prevent AAD and, to a lesser extent, CDAD, as well as to improve H pylori eradication rates. In the Indian setting, probiotics ( Saccharomyces boulardii and Bacillus clausii) have been shown to reduce the duration and frequency of acute diarrhea in children. Antibiotics may exaggerate the consequences of gut microbiota dysbiosis in vulnerable populations already affected by the condition. Therefore, prudent use of antibiotics among neonates and young children is critical to prevent the detrimental effects on gut health.
The immature gastrointestinal (GI) tract makes infants vulnerable to transient disorders including colic, gastro-oesophageal reflux (GER) and constipation. These conditions cause a significant distress to infants and caregivers, and are among the most common reasons for the paediatrician referral. In addition, these conditions are associated with a significant morbidity, hospitalisations and high healthcare costs, adding to the burden of the disease. Although they are additions to the ongoing physiological development or arise from maladaptive behavioural responses, the evidence remains limited. The vague aetiology and the self-limiting nature, has devoid these conditions of robust clinical attention, both in the research and clinical practice. Frequent early-life intestinal insults may translate as a risk factor in the development of chronic GI disorders and psychological problems later in life. Emerging evidence suggests that providing an optimal nutritional intervention closer to the breast milk can be a path breaking approach to manage these frequently encountered conditions and aid the growth and development of infants.
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