In 30 children presenting with complaints characteristic of malabsorption in whom congenital enzy... more In 30 children presenting with complaints characteristic of malabsorption in whom congenital enzyme deficiency could be excluded, determination of the enzymes lactase, saccharase and maltase was performed in the tissue sample obtained by jejunal biopsy; histology was also carried out in all cases. In 23 cases the diagnosis of coeliac disease could subsequently be confirmed, in the other 7 cases the diagnosis could neither be rejected nor established with certainty. All three enzymes had a decreased activity in cases displaying subtotal or total villous atrophy, the most sensitive among them being lactase: in 69% of cases no lactase activity could be shown while saccharase and maltase were absent in 29 respectively 4% of the cases. No close correlation exists between the light-microscopic findings and the activity of enzymes since total absence of enzyme activity may be associated with only moderate villous atrophy. Lack of disaccharidase activity in the upper section of the small bowel does not necessarily mean disaccharide malabsorption exhibiting clinical symptoms, it only indicates a reduced capacity of disaccharide splitting. It has been concluded that routine determination of disaccharidase activities is not justified within the diagnostic procedure of coeliac disease.
Jejunal biopsy and hydrogen breath test were performed in 57 children, 34 having coeliac disease ... more Jejunal biopsy and hydrogen breath test were performed in 57 children, 34 having coeliac disease and 23 with other forms of malabsorption. In children affected by coeliac disease there was a gradually increasing incidence of positive findings with the H2 breath test as villous damage progressed. In the group of subtotal villous atrophy age dependence was also observed, the majority of positive results occurring below three years of age. In the non-coeliac group the most frequent cause of the positive finding was Giardia lamblia infestation. Among 27 cases with lactose malabsorption confirmed by a positive hydrogen breath test only 11 had diarrhoea. The test proved to be useful in differentiating between the contaminated intestine syndrome and malabsorption due to reduced absorptive surface.
Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat,... more Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat, barley, and rye.Reliable serological tests are available for both mass and risk group screening and recent epidemiological studies on celiac disease suggest that the prevalence varies between 1:100-300 in different .continents. The clinical manifestations of the disease has changed in the West and the classical symptomatic cases represent only approximately 1/7th of all diagnosed cases. Symptoms such as, anemia, short stature, dental enamel defect or osteoporosis can be the only manifestations of the atypical disease. There is an increased prevalence of celiac disease in patients with autoimmune diseases. Recent data suggest that there is a correlation between the prevalence of autoimmune diseases and the number of years that an individual consumes gluten-containing foods. Genetic studies revealed a high prevalence of certain HLA antigens in celiac patients, however, there is likelihood that non-HIA genes are also important in the pathomechanism. An interesting new development is the recognition of tissue transglutaminase (tTG), an enzyme that probably forms an autoantigen with gluten. It is generally accepted that antibodies to tTG are identical to the previously described antiendomysium antibodies. Whether or not tTG is responsible for the initiation of an immunoreaction against prolamines or just exacerbates the immune response is a subject of further investigations. [Indian J Pediatr 2000; 67 (10): 757-763]
Preterm human infants demonstrate high fecal K+/Na+ ratio that is inversely related to maturation... more Preterm human infants demonstrate high fecal K+/Na+ ratio that is inversely related to maturation. Renal and colonic basolateral membrane-located Na+,K(+)-adenosine triphosphatase (Na+,K(+)-ATPase) governs K+ excretion and is enhanced by both steroid administration and K+ loading. However, the response of premature kidney or colon to these stimuli is not well studied. We measured basal as well as stimulated levels of renal and colonic Na+,K(+)-ATPase activity in response to betamethasone and K+ load given separately and betamethasone given after K+ load in premature, mature, and 4-day-old Sprague-Dawley rats. Although preterm rats showed a higher basal level in the kidneys (p < 0.004), an increase in enzyme activity in response to the stimuli was achieved only in the colon (p < 0.001 for betamethasone, p < 0.0001 for K+ load, and p < 0.0007 for the combination). At term and at 4 days of postnatal age, however, the kidneys showed much higher levels than the colon in respo...
Journal of pediatric gastroenterology and nutrition, Jan 22, 2015
The purpose of this clinical report is to discuss several recent advances in assessing exocrine p... more The purpose of this clinical report is to discuss several recent advances in assessing exocrine pancreatic insufficiency (EPI) and pancreatitis in children, to review the array of pancreatic function tests (PFTs), to provide an update on the inherited causes of EPI, with special emphasis on newly available genetic testing, and to review newer methods for evaluating pancreatitis.
The Authors examined 515 children with abdominal pain in the outpatient clinics for a period of t... more The Authors examined 515 children with abdominal pain in the outpatient clinics for a period of two years. The pain was frequently periumbilical or mid epigastric with a history of more than two months. Persistent lactose malabsorption was found in 252 children (48,9%), which justifies the use of Breath Hydrogen Test as a first diagnostic procedure for assessing recurrent abdominal pain. Putative pathogens were identified in the stool specimens of 21 patients. Oesophagitis was diagnosed in 18 children and duodenal ulcer in one. 91 patients (less than 6 years old) improved after successful treatment of the chronic upper respiratory inflammations. The authors did not find any causes in 18.1 per cent of the children examined and they think that the abdominal pain in these children may be psychogenic. The use of high-fiber diet is proposed for the later group.
Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat,... more Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat, barley, and rye. Reliable serological tests are available for both mass and risk group screening and recent epidemiological studies on celiac disease suggest that the prevalence varies between 1:100-300 in different continents. The clinical manifestations of the disease has changed in the West and the classical symptomatic cases represent only approximately 1/7th of all diagnosed cases. Symptoms such as, anemia, short stature, dental enamel defect or osteoporosis can be the only manifestations of the atypical disease. There is an increased prevalence of celiac disease in patients with autoimmune diseases. Recent data suggest that there is a correlation between the prevalence of autoimmune diseases and the number of years that an individual consumes gluten-containing foods. Genetic studies revealed a high prevalence of certain HLA antigens in celiac patients, however, there is likelihood that non-HIA genes are also important in the pathomechanism. An interesting new development is the recognition of tissue transglutaminase (tTG), an enzyme that probably forms an autoantigen with gluten. It is generally accepted that antibodies to tTG are identical to the previously described antiendomysium antibodies. Whether or not tTG is responsible for the initiation of an immunoreaction against prolamines or just exacerbates the immune response is a subject of further investigations.
Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder of preterm infants. Other ... more Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder of preterm infants. Other than an association with prematurity and gastrointestinal feeding, no single factor or mechanism has been consistently linked to this disease. We have previously demonstrated that Escherichia coli isolates obtained from the stool of infants with NEC caused NEC-like injury in a weanling rabbit ileal loop model; this injury, in turn, could be blocked by coinfection with selected Gram(+) bacteria (Enterococcus faecium) isolated from asymptomatic controls. Using Caco-2 cells in a trans-well system, we now demonstrate that the same E. coli isolates can cross epithelial cell monolayers in the absence of ultrastructural change or damage. These results with E. coli contrast with those seen with Salmonella typhimurium, which passed through the monolayer at a higher rate and were associated with striking ultrastructural damage. Transcytosis of E. coli was reduced 3-5-fold in the presence of E. faecium previously shown to block NEC-like injury in the loop model. There was a mild increase in the rate of E. coli transcytosis when studies were conducted with younger, undifferentiated cells; these immature cells had no brush border, had decreased production of brush border-specific enzymes, but retained well defined tight junctions, as demonstrated by transepithelial electrical resistance and electron microscopy. A further reduction/ complete blockage of E. coli transcytosis was observed when E. faecium was used as the coinfectant in studies with these undifferentiated cells. We hypothesize that the ability of E. coli to cross epithelial cell layer is a critical initial step in the cascade of events which lead ultimately to NEC; blockage or reduction in E. coli transcytosis in the presence of certain Gram(+) organisms may play a significant role in prevention of NEC.
Objectives To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane p... more Objectives To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis.
Journal of Pediatric Gastroenterology and Nutrition, 1989
The number of one subtype of mast cells (formalin fixation, toluidine blue staining), cells of th... more The number of one subtype of mast cells (formalin fixation, toluidine blue staining), cells of the lamina propria, and intraepithelial lymphocytes were counted in the intestinal biopsy specimens of 14 children with treated celiac disease following a single challenge with gluten. The serum neutrophil chemotactic activity was measured at 0, 1, 3, 5, and 24 h after challenge. There was no significant change in the number of intraepithelial lymphocytes, but the biopsy samples obtained at 5 h showed a marked increase in the inflammatory cells of the lamina propria and a significant decrease in the number of mast cells. A pronounced decrease was present at 3-5 h in the number of eosinophil cells in the blood. The neutrophil chemotactic activity of sera showed a significant increment in 10 of 14 patients. The intestinal permeability of patients became abnormal, as detected by the increased absorption of lactulose. These findings suggest that degranulation of mast cells may be involved in the pathogenesis of the small intestinal mucosal injury in children with celiac disease.
Journal of Pediatric Gastroenterology and Nutrition, 2006
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting, ... more North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting, October 19-22, 2006, Orlando, Florida: Abstracts: POSTER SESSION I, THURSDAY, OCTOBER 19, 2006, 5 pm-7 pm: Pancreas/Cystic Fibrosis: 59
In 30 children presenting with complaints characteristic of malabsorption in whom congenital enzy... more In 30 children presenting with complaints characteristic of malabsorption in whom congenital enzyme deficiency could be excluded, determination of the enzymes lactase, saccharase and maltase was performed in the tissue sample obtained by jejunal biopsy; histology was also carried out in all cases. In 23 cases the diagnosis of coeliac disease could subsequently be confirmed, in the other 7 cases the diagnosis could neither be rejected nor established with certainty. All three enzymes had a decreased activity in cases displaying subtotal or total villous atrophy, the most sensitive among them being lactase: in 69% of cases no lactase activity could be shown while saccharase and maltase were absent in 29 respectively 4% of the cases. No close correlation exists between the light-microscopic findings and the activity of enzymes since total absence of enzyme activity may be associated with only moderate villous atrophy. Lack of disaccharidase activity in the upper section of the small bowel does not necessarily mean disaccharide malabsorption exhibiting clinical symptoms, it only indicates a reduced capacity of disaccharide splitting. It has been concluded that routine determination of disaccharidase activities is not justified within the diagnostic procedure of coeliac disease.
Jejunal biopsy and hydrogen breath test were performed in 57 children, 34 having coeliac disease ... more Jejunal biopsy and hydrogen breath test were performed in 57 children, 34 having coeliac disease and 23 with other forms of malabsorption. In children affected by coeliac disease there was a gradually increasing incidence of positive findings with the H2 breath test as villous damage progressed. In the group of subtotal villous atrophy age dependence was also observed, the majority of positive results occurring below three years of age. In the non-coeliac group the most frequent cause of the positive finding was Giardia lamblia infestation. Among 27 cases with lactose malabsorption confirmed by a positive hydrogen breath test only 11 had diarrhoea. The test proved to be useful in differentiating between the contaminated intestine syndrome and malabsorption due to reduced absorptive surface.
Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat,... more Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat, barley, and rye.Reliable serological tests are available for both mass and risk group screening and recent epidemiological studies on celiac disease suggest that the prevalence varies between 1:100-300 in different .continents. The clinical manifestations of the disease has changed in the West and the classical symptomatic cases represent only approximately 1/7th of all diagnosed cases. Symptoms such as, anemia, short stature, dental enamel defect or osteoporosis can be the only manifestations of the atypical disease. There is an increased prevalence of celiac disease in patients with autoimmune diseases. Recent data suggest that there is a correlation between the prevalence of autoimmune diseases and the number of years that an individual consumes gluten-containing foods. Genetic studies revealed a high prevalence of certain HLA antigens in celiac patients, however, there is likelihood that non-HIA genes are also important in the pathomechanism. An interesting new development is the recognition of tissue transglutaminase (tTG), an enzyme that probably forms an autoantigen with gluten. It is generally accepted that antibodies to tTG are identical to the previously described antiendomysium antibodies. Whether or not tTG is responsible for the initiation of an immunoreaction against prolamines or just exacerbates the immune response is a subject of further investigations. [Indian J Pediatr 2000; 67 (10): 757-763]
Preterm human infants demonstrate high fecal K+/Na+ ratio that is inversely related to maturation... more Preterm human infants demonstrate high fecal K+/Na+ ratio that is inversely related to maturation. Renal and colonic basolateral membrane-located Na+,K(+)-adenosine triphosphatase (Na+,K(+)-ATPase) governs K+ excretion and is enhanced by both steroid administration and K+ loading. However, the response of premature kidney or colon to these stimuli is not well studied. We measured basal as well as stimulated levels of renal and colonic Na+,K(+)-ATPase activity in response to betamethasone and K+ load given separately and betamethasone given after K+ load in premature, mature, and 4-day-old Sprague-Dawley rats. Although preterm rats showed a higher basal level in the kidneys (p < 0.004), an increase in enzyme activity in response to the stimuli was achieved only in the colon (p < 0.001 for betamethasone, p < 0.0001 for K+ load, and p < 0.0007 for the combination). At term and at 4 days of postnatal age, however, the kidneys showed much higher levels than the colon in respo...
Journal of pediatric gastroenterology and nutrition, Jan 22, 2015
The purpose of this clinical report is to discuss several recent advances in assessing exocrine p... more The purpose of this clinical report is to discuss several recent advances in assessing exocrine pancreatic insufficiency (EPI) and pancreatitis in children, to review the array of pancreatic function tests (PFTs), to provide an update on the inherited causes of EPI, with special emphasis on newly available genetic testing, and to review newer methods for evaluating pancreatitis.
The Authors examined 515 children with abdominal pain in the outpatient clinics for a period of t... more The Authors examined 515 children with abdominal pain in the outpatient clinics for a period of two years. The pain was frequently periumbilical or mid epigastric with a history of more than two months. Persistent lactose malabsorption was found in 252 children (48,9%), which justifies the use of Breath Hydrogen Test as a first diagnostic procedure for assessing recurrent abdominal pain. Putative pathogens were identified in the stool specimens of 21 patients. Oesophagitis was diagnosed in 18 children and duodenal ulcer in one. 91 patients (less than 6 years old) improved after successful treatment of the chronic upper respiratory inflammations. The authors did not find any causes in 18.1 per cent of the children examined and they think that the abdominal pain in these children may be psychogenic. The use of high-fiber diet is proposed for the later group.
Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat,... more Celiac disease and dermatitis herpetiformis are caused by the alcohol soluble fractions of wheat, barley, and rye. Reliable serological tests are available for both mass and risk group screening and recent epidemiological studies on celiac disease suggest that the prevalence varies between 1:100-300 in different continents. The clinical manifestations of the disease has changed in the West and the classical symptomatic cases represent only approximately 1/7th of all diagnosed cases. Symptoms such as, anemia, short stature, dental enamel defect or osteoporosis can be the only manifestations of the atypical disease. There is an increased prevalence of celiac disease in patients with autoimmune diseases. Recent data suggest that there is a correlation between the prevalence of autoimmune diseases and the number of years that an individual consumes gluten-containing foods. Genetic studies revealed a high prevalence of certain HLA antigens in celiac patients, however, there is likelihood that non-HIA genes are also important in the pathomechanism. An interesting new development is the recognition of tissue transglutaminase (tTG), an enzyme that probably forms an autoantigen with gluten. It is generally accepted that antibodies to tTG are identical to the previously described antiendomysium antibodies. Whether or not tTG is responsible for the initiation of an immunoreaction against prolamines or just exacerbates the immune response is a subject of further investigations.
Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder of preterm infants. Other ... more Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder of preterm infants. Other than an association with prematurity and gastrointestinal feeding, no single factor or mechanism has been consistently linked to this disease. We have previously demonstrated that Escherichia coli isolates obtained from the stool of infants with NEC caused NEC-like injury in a weanling rabbit ileal loop model; this injury, in turn, could be blocked by coinfection with selected Gram(+) bacteria (Enterococcus faecium) isolated from asymptomatic controls. Using Caco-2 cells in a trans-well system, we now demonstrate that the same E. coli isolates can cross epithelial cell monolayers in the absence of ultrastructural change or damage. These results with E. coli contrast with those seen with Salmonella typhimurium, which passed through the monolayer at a higher rate and were associated with striking ultrastructural damage. Transcytosis of E. coli was reduced 3-5-fold in the presence of E. faecium previously shown to block NEC-like injury in the loop model. There was a mild increase in the rate of E. coli transcytosis when studies were conducted with younger, undifferentiated cells; these immature cells had no brush border, had decreased production of brush border-specific enzymes, but retained well defined tight junctions, as demonstrated by transepithelial electrical resistance and electron microscopy. A further reduction/ complete blockage of E. coli transcytosis was observed when E. faecium was used as the coinfectant in studies with these undifferentiated cells. We hypothesize that the ability of E. coli to cross epithelial cell layer is a critical initial step in the cascade of events which lead ultimately to NEC; blockage or reduction in E. coli transcytosis in the presence of certain Gram(+) organisms may play a significant role in prevention of NEC.
Objectives To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane p... more Objectives To assess the prevalence of small intestinal bacterial overgrowth (SIBO) and methane production in children with encopresis.
Journal of Pediatric Gastroenterology and Nutrition, 1989
The number of one subtype of mast cells (formalin fixation, toluidine blue staining), cells of th... more The number of one subtype of mast cells (formalin fixation, toluidine blue staining), cells of the lamina propria, and intraepithelial lymphocytes were counted in the intestinal biopsy specimens of 14 children with treated celiac disease following a single challenge with gluten. The serum neutrophil chemotactic activity was measured at 0, 1, 3, 5, and 24 h after challenge. There was no significant change in the number of intraepithelial lymphocytes, but the biopsy samples obtained at 5 h showed a marked increase in the inflammatory cells of the lamina propria and a significant decrease in the number of mast cells. A pronounced decrease was present at 3-5 h in the number of eosinophil cells in the blood. The neutrophil chemotactic activity of sera showed a significant increment in 10 of 14 patients. The intestinal permeability of patients became abnormal, as detected by the increased absorption of lactulose. These findings suggest that degranulation of mast cells may be involved in the pathogenesis of the small intestinal mucosal injury in children with celiac disease.
Journal of Pediatric Gastroenterology and Nutrition, 2006
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting, ... more North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting, October 19-22, 2006, Orlando, Florida: Abstracts: POSTER SESSION I, THURSDAY, OCTOBER 19, 2006, 5 pm-7 pm: Pancreas/Cystic Fibrosis: 59
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