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CMA constitutes a risk factor for the development of FGIDs in children.

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AP was common in community children. FAP was the most common FGID among healthy community children. The prevalence of AP by parental report is lower than the previously published prevalence of AP reported by children. Lack of awareness of children's symptoms may play a role in the low ratio of consultation for AP in symptomatic children. Future prospective studies should confirm our findings and investigate the factors influencing the medical consultation decision including parental awareness of children's symptoms.

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Early events may play an important role in the complex pathogenesis of functional gastrointestinal conditions. Timely intervention may have a critical impact on the prevention of this group of chronic incapacitating conditions.

Objective: The possible effect of obesity in the outcome of treated children with abdominal pain-related functional gastrointestinal disorders (FGIDs) has not yet been studied. We hypothesized that obesity is associated with a poor long-term prognosis in children with FGIDs. Study design: Prospective cohort study in an outpatient clinic-based sample of patients diagnosed with abdominal pain-related FGIDs. Principal outcome measured was persistence of pain at long-term follow-up (12-15 months). Frequency of pain, intensity of pain, school absenteeism and disruption of daily activities were compared between obese and non-obese subjects. Results: The group mean age was 13.27 ± 3.84 years, distribution of diagnosis was 32% (functional abdominal pain), 42.5% (irritable bowel syndrome) and 25.5% (functional dyspepsia). Overall, 20.2% of patients were obese. A total of 116 patients (61.7%) reported abdominal pain and 72 (38.3%) were asymptomatic at long-term follow-up. Obese patients were more likely to have abdominal pain (Po0.0001), higher intensity of pain (P ¼ 0.0002), higher frequency of pain (P ¼ 0.0032), school absenteeism (Po0.0001) and disruption of daily activities (Po0.0001) at follow-up than non-obese patients. Conclusion: Obesity is associated with poor outcome and disability at long-term follow-up in children with abdominal pain-related FGIDs. Our novel findings could have important implications in the prognosis and management of FGIDs.

Renal tubular dysgenesis has been reported in isolated cases of neonatal hemochromatosis (NH). We hypothesized that fetal liver injury in NH impairs proximal renal tubular development via impaired hepatic angiotensinogen (AGT) elaboration. Morphometric analyses were performed of postmortem liver and kidney sections of cases of proven NH and postconception age-matched controls for renal proximal tubule density, hepatocyte mass, and hepatic AGT expression. Proximal tubule density was markedly reduced in NH cases, although they showed a spectrum from mild to severe paucity. Hepatic AGT expression was markedly reduced in NH cases and correlated closely with reduced hepatocyte mass. A linear relationship was established between hepatic AGT expression and the degree of renal tubular dysgenesis suggesting that there is a relationship between them. Our results demonstrate that there is a spectrum of kidney pathology in patients with NH including a large proportion of cases with severe proximal tubular dysgenesis. Hepatic synthetic failure resulting in insufficient production of AGT to support renal tubular development is the likely mechanism of kidney disease in NH. (Pediatr Res 67: [188][189][190][191][192][193] 2010) N eonatal hemochromatosis (NH) is defined by the presence in newborns of liver disease in association with pathologic siderosis of various organs and tissues in a pattern similar to hereditary hemochromatosis (1). NH has also been called "neonatal iron storage disease" and "perinatal hemochromatosis" on the basis of these unique pathologic findings. NH is invariably associated with severe liver injury, which evidently is initiated during fetal life (2). Current thinking is that gestational alloimmune hepatocyte injury is involved in the pathogenesis of most or all cases of NH (3,4).Several clinical observations date the onset of liver injury in NH to midgestation. One such observation is the postmortem finding of renal tubular dysgenesis reported in five neonates with NH (5-7). The hallmark histopathologic findings of renal tubular dysgenesis are paucity or absence of proximal tubules and the absence of necroinflammatory disease that could otherwise account for tubular loss. The proximal tubules in this condition appear short and poorly developed, with reduced convolution leading to reduced number of tubular profiles in histologic sections (8). These findings suggest that renal development has been arrested at 20-to 25-wk gestation. Assuming that failed renal development in renal tubular dysgenesis associated with NH is the result of or a complication of fetal liver injury, the finding dates the liver injury in these cases to around 20-wk gestation (9). That raises the question of whether renal development is affected in more cases of NH than is reflected in the meager case reports. In addition, the mechanism by which fetal liver injury leads to a rather specific pattern of failed development in the kidney deserves to be addressed. Renal tubular development is dependent on an intact renin-ang...