Objectives:The aim of the study was to review published evidence and the opinion of practising clinicians on the prevalence and long-term health consequences of functional gastrointestinal symptoms in infants younger than 12 months.Methods:PubMed was searched from inception to November 2014 to find articles reporting the prevalence and long-term health outcomes of infantile colic, regurgitation, functional constipation, functional diarrhoea, and dyschezia in infants younger than <12 months. A questionnaire was sent to practising clinicians worldwide, and a group of 15 international experts met to discuss the likely frequency and longer-term consequences of these symptoms.Results:The literature search identified 30 studies reporting the prevalence of infantile colic (2%–73%), 13 that of regurgitation (3%–87%), 8 that of functional constipation (0.05%–39.3%), 2 that of functional diarrhoea (2%–4.1%), and 3 that of dyschezia (0.9%–5.6%). The studies varied in design, populations investigated, and definition of the symptoms. Questionnaires were received from 369 respondents. The experts agreed that the likely prevalences for colic, regurgitation, and functional constipation were 20%, 30%, and 15%, respectively. The limited data in the literature for functional diarrhoea and dyschezia suggest prevalences <10%. Infantile colic may be associated with future health problems in a subset of infants.Conclusions:Functional gastrointestinal symptoms appear to occur in a significant proportion of infants younger than 12 months and may have an impact on future health outcomes. Prospective collection of data according to agreed criteria is needed to obtain more accurate estimates of the prevalence and consequences of these symptoms.

The nature of gastroesophageal reflux in Thai infants differs from that in Western infants. The prevalence of reflux regurgitation in Thai infants was very high at 1 to 2 months of age; however, many infants became symptom-free by 6 months. The type of feeding (breast milk vs. bottle milk) had no influence on the prevalence of reflux regurgitation.

Objectives: The Bristol Stool Form Scale (BSFS) is inadequate for non-toilet trained children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed, consisting of 7 photographs of diapers containing stools of infants and toddlers. We aimed to evaluate interobserver reliability of stool consistency assessment among parents, nurses, and medical doctors (MDs) using the BITSS. Methods: In this multicenter cross-sectional study (2016–2017), BITSS photographs were rated according to the BSFS. The reliability of the BITSS was evaluated using the overall proportion of perfect agreement and the linearly weighted κ statistic. Results: A total of 2462 observers participated: 1181 parents (48.0%), 624 nurses (25.3%), and 657 MDs (26.7%). The best-performing BITSS photographs corresponded with BSFS type 7 (87.5%) and type 4 (87.6%), followed by the BITSS photographs representing BSFS type 6 (75.0%), BSFS type 5 (68.0%), BSFS type 1 (64.8%), and BSFS type 3 (64.6%). The weakest performing BITSS photograph corresponded with BSFS type 2 (49.7%). The overall weighted κ-value was 0.72 (95% CI 0.59–0.85; good agreement). Based on these results, photographs were categorized per stool group as hard (BSFS type 1–3), formed (BSFS type 4), loose (BSFS types 5 and 6), or watery (BSFS type 7) stools. According to this new categorization system, correct allocation for each photograph ranged from 83 to 96% (average: 90%). The overall proportion of correct allocations was 72.8%. Conclusions: BITSS showed good agreement with BSFS. Using the newly categorized BITSS photographs, the BITSS is reliable for the assessment of stools of non-toilet trained children in clinical practice and research. A multilanguage translated version of the BITSS can be downloaded at https://bitss-stoolscale.com/ .

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BackgroundVisceral leishmaniasis (VL) caused by Leishmania siamensis is an emerging disease continuously reported in six southern provinces of Thailand. To date, the phylogenetic relationships among Leishmania isolates from Thai patients and other Leishmania species are still unclear and the taxonomic diversity needs to be established. In this study, the phylogenetic inference trees were constructed based on four genetic loci (i.e., SSU-rRNA, ITS1, hsp70, and cyt b), using DNA sequences obtained from autochthonous VL patients from southern Thailand and reference sequences of reported Leishmania isolates from other studies deposited in GenBank.ResultsPhylogenetic analyses of hsp70 and cyt b loci supported a clade comprised of L. siamensis isolates, which is independent to the other members in the genus Leishmania. In combination with genetic distance analysis, sequence polymorphisms were observed among L. siamensis isolates and two different lineages could be differentiated, lineages PG and TR. Phylogenetic analysis of the cyt b gene further showed that L. siamensis lineage TR is closely related to L. enrietti, a parasite of guinea pigs.ConclusionThe finding of this study sheds further light on the relationships of L. siamensis, both in intra- and inter-species aspects. This information would be useful for further in-depth studies on the biological properties of this important parasite.

IntroductionThe Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed. Our aim is to develop a paediatric stool scale, the Brussels Infant and Toddler Stool Scale (‘BITSS’), and to evaluate the interobserver agreement of stool assessment with the BITSS between the patient's parent and healthcare providers (physicians and nurses).Methods and analysisThis study has two phases. In the first phase, 11 key-opinion leaders in the field of paediatric gastroenterology representing different areas of the world selected seven coloured photographs of infants and/or young children wearing diapers to match the original descriptors of the BSS. The selected photographs were used to create a new scale in which the drawings of stools of the BSS were replaced by infant/toddlers stool photographs. In phase II, we aim at demonstrating that parents, nurses and primary healthcare physicians interpret the stool-pictures of the BITSS with a high degree of consensus and that the agreement is independent of whether it is a parent or a healthcare provider. Interobserver variability of stool assessment with the BITSS between the patient's parent and healthcare providers will be assessed.Ethics and disseminationThe study will be approved by the Ethics Committee of the participating centres. The findings of this study will be submitted to a peer-reviewed journal. Abstracts will be submitted to national and international conferences.Trial registration numberNCT02913950.

Abstract. We report the first case of visceral leishmaniasis caused by Leishmania siamensis in a seronegative child. She was treated with amphotericin B at 1 mg/kg/day for 3 weeks; however, recurrences occurred twice. The patient was cured after the administration of amphotericin B for 5 weeks and monthly prophylaxis for 6 months. CASE REPORTIn 2008, a 5-year-old girl living in a rural area of Satun Province, southern Thailand came to a provincial hospital because of abdominal enlargement for 2 months. Her condition was investigated; thalassemia and human immunodeficiency virus (HIV) infection were ruled out. After failure of diagnosis for 2 years with increased abdominal enlargement, she was referred to Songklanagarind Hospital, Prince of Songkla University, for further investigation in 2010. She was living with her parents and had no history of traveling to other areas. Her house was an untidy one-story house surrounded by trees and the rubber plantation where her parents worked as rubber tappers. Her parents had three cows and raised them nearby the house. On examination, she was an undernourished girl having good consciousness, normal vital signs, but pale, underweight by 13 kg, and had a height of 94 cm. She had abdominal distension, the liver was 2 cm below the right costal margin with soft consistency, and the spleen was 9 cm below the left costal margin. Laboratory findings showed anemia and thrombocytopenia (Hb 8.3 g/dL and Hct 27.3%, white blood cell [WBC] 6,000/μL; PMN 53%, Lymph 41%, Mono 4%, Eo 2%, and platelets 98,000/μL). Liver function test showed total bilirubin 0.6 mg/dL (normal range: 0.2-1.2 mg/dL), direct bilirubin 0.06 mg/dL (normal range: 0-0.2 mg/dL), aspartate aminotransferase (AST) 50 U/L (normal range: 0-32 U/L), alanine aminotransferase (ALT) 29 U/L (normal range: 0-33 U/L), Alkaline phosphatase 130 U/L (normal range: 167-577 U/L), Albumin 3.4 g% (normal range: 3.9-5.1 g%), globulin 7.2 g% (normal range: 2.6-3.0 g%). Coagulogram was normal. Abdominal ultrasonography revealed hepatomegaly without focal lesion and marked splenomegaly (12 + 4 cm.) without focal lesion. Liver biopsy showed portal inflammation with much mononuclear cell infiltration. Accumulation of inflammatory cells was seen in some areas of intrahepatic lobules. Amastigotes were seen in liver histiocytes. Bone marrow aspirates were positive for amastigotes of Leishmania. Serological and molecular diagnoses were performed at the

The prevalence of FC in young Thai children is low. For unselected young children, the Rome II criteria for FC are still appropriate for diagnosis of FC.