Understanding the epidemiology and risk factors for GERD in a region is the first step in designing prevention and treatment strategies.
There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co-morbidity between RAP and obesity could have important implications on RAP management and treatment.
ABSTRACT. Objective. Recurrent abdominal pain (RAP) is a common problem in children and adolescents. Evaluation and treatment of children with RAP continue to challenge physicians because of the lack of a psychometrically sound measure for RAP. A major obstacle to progress in research on RAP has been the lack of a biological marker for RAP and the lack of a reliable and valid clinical measure for RAP. The objectives of this study were (1) to develop and test a multidimensional measure for RAP (MM-RAP) in children to serve as a primary outcome measure for clinical trials, (2) to evaluate the reliability of the measure and compare its responses across different populations, and (3) to examine the reliabilities of the measure scales in relation to the demographic variables of the studied population.Methods. We conducted 3 cross-sectional studies. Two studies were clinic-based studies that enrolled children with RAP from 1 pediatric gastroenterology clinic and 6 primary care clinics. The third study was a community-based study in which children from 1 elementary and 2 middle schools were screened for frequent episodes of abdominal pain. The 3 studies were conducted in Houston, Texas. Inclusion criteria for the clinic-based studies were (1) age of 4 to 18 years; (2) abdominal pain that had persisted for 3 or more months; (3) abdominal pain that was moderate to severe and interfered with some or all regular activities; (4) abdominal pain that may or may not be accompanied by upper-gastrointestinal symptoms; and (5) children were accompanied by a parent or guardian who was capable of giving informed consent, and children over the age of 10 years were capable of giving informed assent. The community-based study used standardized questionnaires that were offered to 1080 children/parents from the 3 participating schools; 700 completed and returned the questionnaires (65% response rate). The questionnaire was designed to elicit data concerning the history of abdominal pain or discomfort. A total of 160 children met Apley's criteria and were classified as having RAP. Inclusion criteria were identical to those criteria for the clinic-based studies. Participating children in the 3 studies received a standardized questionnaire that asked about socioeconomic variables, abdominal pain (intensity; frequency; duration; nature of abdominal pain, if present, and possible relationships with school activities; and other upper gastrointestinal symptoms). We used 4 scales for the MM-RAP: pain intensity scale (3 items), nonpain symptoms scale (12 items), disability scale (3 items), and satisfaction scale (2 items). Age 7 was used as a cutoff point for the analysis as the 7-year-olds have been shown to exhibit more sophisticated knowledge of illness than younger children.Results. A total of 295 children who were aged 4 to 18 years participated in the study: 155 children from the pediatric gastroenterology clinics, 82 from the primary care clinics, and 58 from the schools. The interitem consistency (Cronbach's coefficient ␣) for the pain i...
' 566 Texas MedicalgBranch Hospitals, Department of Pediatr i c s , Galveston, Texas.Although pancreatic insufficiency i s t h e major f a c t o r i n t h e non-absorption of c y s t i c fibrosis(CF), many p a t i e n t s continue t o have steatorrhea despite often excessive amounts of exogenous enzyme. Stool collections from 7 unsupplemented CF patients were analyzed f o r f r e e f a t t y a c i d s ( F F~) and t o t a l fat(T.F). FFA averaged 60% of TF i n comparison t o analyses from 15 enzyme sugplemented CF p a t i e n t s with FFA >90$ TF despite f a t absorption coeff i c i e n t s from 45 t o 95%. This implies correction of digestion with continuing f a t malabsorption. Intraluminal f a t processing was evaluated over consecutive 30 minute periods following a standard meal ( JCI 43:247,1964) i n 4 CF patients. Mean intralumin a l b i l e acid c o n c~t r a t i o n s ( m M ) f o r t h e four were 14.4 f 2.7, 8.9 + 1 . 4 , 7.0 i: .9 and 5.5 t .7 compared t o nonCF controls(N=7.7 2 2.1). The f r a c t i o n of luminal FFA incorporated i n t o micelles (%MI) was 38, 33, 27 and 19 respectively i n comparison t o N with %MI=51 f 12. Intraluminal pH was below 5 . 1 (~= 6 . 1 i: 0.5) i n 20/43 meal f r a c t i o n s from CF p a t i e n t s with steatorrhea. 90% of t h e acidic f r a c t i o n s came from t h e l a s t p a r t s of t h e 2 hour study. Only 3/16 meal f r a c t i o n s were (pH5.1 i n non-steatorrheic CF pat i e n t s . Cimetidine plus enzymes restored pH and improved lipolys i s (luminal FFA/luminal TF) toward normal l e v e l s but had l e s s impact on %MI. These findings suggest t h a t some p a t i e n t s with CF may have a defect i n micellar incorporation despite t h e presence of adequate b i l e acid concentrations and normal intraluminal pH. o n s t r a t e~p r e s e n c e i n processed, C containing foods. I n t h i s study abdominal aorta obtained from 8 adolescent trauma victims a t autopsy was chemi c a l l y analysed f o r the presence o f these compounds. A l l aortas contained atherosclerotic lesions which were dissected out, freed o f a d v e n t i t i a l f a t , minced, extracted i n cho1orform:methan01 2:l then saponified i n 15% KOH. The non-saponifiable l i p i d ( s t e r o l ) was separated i n a two stage t h i n l a y e r chromatography system using Ether:Benzene:Ethyl Acetate then Ether:Heptane on S i l i c a Gel G plates. Bands corresponding t o known standards were then scraped and e l u t e d i n chloroform, converted t o trifluoro-acetates, and q u a n t i f i e d by gas 1 i q u i d chromatography. S i g n i f i c a n t l e v e l s o f two oxygenated C derivatives known t o be cytotoxic were found. These were ( i 2 S.D. This studv was desicmed t o i d e n t i f v t h e n u t r i t i o n a l s t a t u s i n i n f a n t s admiEted with acute diarrhea< syndmn? (ADS) . ADS is defined a s diarrhea which l a s t s f o r a period of 2 w e k s o r less. 110 ADS p a t i e n t s , 9 m n t h s o l d o r less, were alhnitted to Ben Taub General Hospital i n 1978. The hydrated...
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