We conducted an observational study over a 1-year period, including 234 children aged 4–18 years and their caregivers and a matching control group. 60.73% of the children from the study group were males. Average age for the onset of constipation was 26.39 months. The frequency of defecation was 1/4.59 days (1/1.13 days in the control group). 38.49% of the patients in the sample group had a positive family history of functional constipation. The majority of children with functional constipation come from single-parent families, are raised by relatives, or come from orphanages. Constipated subjects had their last meal of the day at later hours and consumed fast foods more frequently than the children in the control sample. We found a statistically significant difference between groups regarding obesity/overweight and constipation (χ 2 = 104.94, df = 2, p < 0.001) and regarding physical activity and constipation (χ 2 = 18.419; df = 3; p < 0.001). There was a positive correlation between the number of hours spent watching television/using the computer and the occurrence of the disease (F = 92.162, p < 0.001, and 95% Cl). Children from broken families, with positive family history, defective dietary habits, obesity and sedentary behavior, are at higher risk to develop chronic functional constipation.

Functional constipation is an issue for both the patient and his/her family, affecting the patient's psychoemotional balance, social relations, and their harmonious integration in the school environment. We aimed to highlight the connection between chronic constipation and encopresis and the patient's psychosocial and family-related situation. Material and Method. 57 patients with ages spanning from 6 to 15 were assessed within the pediatric gastroenterology ward. Sociodemographic, medical, and psychological data was recorded. The collected data was processed using the SPSS 20 software. Results. The study group consisted of 57 children diagnosed with encopresis (43 boys (75.44%) and 14 girls (24.56%)), M = 10.82 years. It was determined that most of the children came from urban families with a poor socioeducational status. We identified a level of studies of 11.23 ± 5.56 years in mothers, while fathers had an average number of 9.35 ± 4.53 years of study. We also found a complex relationship between encopretic episodes and school performances (F = 7.968, p = 0.001, 95% Cl). Children with encopresis were found to have more anxiety/depression symptoms, greater social problems, more disruptive behavior, and poorer school performance. Conclusions. The study highlights the importance of the family environment and socioeconomic factors in manifestations of chronic constipation and encopresis.

Some studies suggest that Helicobacter pylori (H. pylori) infection would be a protective factor for the gastroesophageal reflux. The aim of this study was to explore this fact. A group of 72 children, admitted in a pediatric gastroenterology regional center in Northeast Romania, diagnosed with gastroesophageal reflux by 24-hour continuous esophageal pH monitoring (results were interpreted using the Boix-Ochoa score), underwent upper endoscopy with gastric biopsy to detect the presence of H. pylori by the rapid urease testing and for bacteriological and histologic examination. 19 children (26.39%) had H. pylori infection, while 53 (73.61%) did not. The grade of esophagitis was classified according to the Los Angeles classification system. Out of 47 children with esophagitis A, 16 (34.04%) had H. pylori infection, while out of the 25 children with esophagitis B, only 3 (12%) had H. pylori infection, with statistic significance (χ = 54.69, P << 0.05, 95% confidence interval [CI]). Regarding the value of the Boix-Ochoa score, it appears that the presence of the H. pylori determines lower pH-metry scores (F = 8.13, P = 0.0015, 95% CI). The presence of the H. pylori was not an important factor in the gastroesophageal reflux. On the other hand its relationship with esophagitis appears to be inverse ratio. The fact that the H. pylori presence is statistically greater in the grade A esophagitis could confirm the hypothesis that the bacteria would slow down the development of the esophagitis.

În ultimul deceniu constipaţia a devenit o problemă actuală de adresabilitate în serviciile de gastroenterologie pediatrică. Obiective. Ne-am propus un studiu pentru a identifica prevalenţa constipaţiei şi stabilirea unor corelaţii între dietă şi mediul socio-familial la copii cu vârste cuprinse între 1 şi 17 ani, internaţi în serviciul de Gastroenterologie, Spitalul Clinic de Urgenţă pentru Copii „Sfânta Maria“ Iaşi, în perioada 1 ianuarie 2012 – 1 ianuarie 2014. Rezultate. Grupul de studiu a constat dintr-un lot de 994 de pacienţi, reprezentând 9,6% din totalul copiilor spitalizaţi. În ceea ce priveşte prevalenţa constipaţiei nu am observat o diferenţă semnifi cativă între sexe, raportul F/M a fost de 1,3/1, dar am remarcat o proporţie semnificativă de pacienţi provenind din mediul urban 68% (676) faţă de 32% (318) din mediul rural. În ceea ce priveşte mediul socio-familial: 34% (338) dintre copii trăiesc cu bunicii, 13,9% (139) provin din familii monoparentale, 6,7% (67) sunt în grija unui asistent maternal şi 2,6% (26) vin din centrele de plasament. În lotul studiat un procent mic de copii au fost alăptaţi, respectiv, 26,2% (261), în prima lună, 10,7% (107) timp de 3 luni în timp ce la 6 luni 98,1% (976) dintre copii au primit o formulă de lapte. Diversificarea a fost făcută incorect în cazul a 41% (408) dintre pacienţi. Doar 14,6% (145) au raportat consumul zilnic de fructe şi legume, în timp ce 51,1% (508) au luat masa cel puţin o dată pe săptămână la restaurante de tip fast-food. 21,6% (214) practică sport cel puţin 2 ore/săptămână, în timp ce 48,7% (484) petrec cel puţin 3 ore/zi la televizor. 12,8% (128) dintre pacienţi sunt supraponderali şi 5,7% (57) obezi. Concluzii. Constipaţia este o boala care afectează copiii de toate vârstele. Nu sunt diferenţe notabile între sexe. Se remarcă o pondere crescută a pacienţilor din mediu urban cu predominanţa unui regim alimentar inadecvat, lipsa activităţii fi zice, precum şi o pondere crescută a pacienţilor supraponderali. Un rol important în modificările psihologice îl deţine mediul socio-familial.

Informed consent has become a major, but also mandatory component in medical praxis nowadays. A great number of forums and publications emphasize its ethical and psychological commands, the most adequate way to obtain it and especially its legal implications. In pediatrics, the implications of this procedure are complex, sometimes confusing or not well understood. Thus, in clinical consultations or simple medical acts, the consent could be seen as implicit; when we talk about maneuvers that lead to psychological or physical discomfort, invasive investigations, including endoscopy or therapeutic acts with possible risks or complications, informed consent from parents or legal tutors, respectively an intellectually, psychologically and socially evolved, educated child’s consent (acceptance) becomes mandatory. We must, however, clarify the nuances between consent and acceptance, not only from the semantic point of view, the proportion of either of the two terms in the final decision, the minor patient’s ability to discern at different age stages and finally the role and the importance of the doctor in such decision makings.

Departajarea refluxului gastro-esofagian (RGE) fiziologic (cel mai frecvent) de boala de reflux gastro-esofagian (BRGE) în primul an de viaţă este obligatorie pentru a evita farmacoterapia agresivă. La toate vârstele copilăriei se aplică criterii moderne de evaluare clinică, sumând simptome digestive şi/sau extradigestive şi rezultatele unor investigaţii moderne. Tratamentul igieno-dietetic (suficient in RGE fiziologic), obligatoriu în toate cazurile, şi inhibitorii de pompă protonică dupa vârsta de un an induc remisiune în majoritatea cazurilor de RGE. Evoluţia cronică/recidivantă şi rezistenţa la tratamentul comun impun intervenţia chirurgicală, domeniu îmbogaţit recent la copil cu miotomia perorală endoscopică (POEM).

Ulcerative colitis (UC) is a chronic inflammatory disease of non-infectious and plurifactorial etiology, exclusively affecting the colon, with variable expansion. The selective deficiency of immunoglobulin A (IgA) can be frequently associated with UC, as well as with recurrent respiratory tract infections, autoimmune diseases, atopy. The incidence of vitiligo among UC patients is significantly higher compared to the general population. At the same time, recent studies proved a higher incidence of Clostridium difficile infections in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis) compared to the general population. We are presenting the case of a 9 year old girl, where UC associated with selective deficiency of IgA and vitiligo hampered the diagnosis and therapeutic approach, particularly in the conditions of a preexisting Clostridium difficile infection. The association of these entities is rare in the pediatric population and a multidisciplinary team approach (gastroenterology, dermatology and immunology) can ensure an effective therapeutic management in the case of such patients.

In children’s first year of life it is mandatory to make a difference between physiological gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), in order to avoid an aggressive pharmacologic therapy. All ages of childhood benefit from modern criteria of clinical evaluation, by corroborating the digestive or extra digestive symptoms with the results of modern investigations. The dietary measures (sufficient in GER but mandatory in all cases) together with proton pump inhibitors administration after one year of age induce remission in majority of GER cases. The chronic and recurrent evolution of the disease or failure of the common treatment require surgical intervention, recently enriched in children with peroral endoscopic myotomy (POEM).