Citations

SummaryRecent studies suggest that cyclosporine may be an alternative to colectomy in children with severe ulcerative colitis who fail traditional therapy with bowel rest and high‐dose corticosteroids. We report the clinical course of two such children. Patient I received oral cyclosporine at 15 mg/kg/day for 1 week followed by 8 mg/kg/day for 6 weeks. Clinical remission occurred within 5 days and has been sustained for 24 weeks after azathioprine was substituted for cyclosporine. Patient 2 received oral cyclosporine at 7–8 mg/kg/day for 7 days after which colectomy was performed due to lack of clinical improvement. Blood cyclosporine levels for patient 1 ranged from 95 to 406 ng/ml and for patient 2 from 36 to 65 ng/ml. Sigmoid colonic tissue cyclosporine concentrations for patients 1 and 2 were 10,058 and 3,205 ng/g, respectively. The patient who responded had significantly higher blood and colonic tissue cyclosporine concentrations than the patient who did not respond. Further studies with larger numbers of patients are needed to determine if there is a correlation between blood and colonic tissue cyclosporine concentrations and clinical response.

SummaryAt our institution, proctocolectomy with rectal mucosectomy and ileoanal anastomosis with endorectal pull‐through is now the procedure of choice for young patients with chronic ulcerative colitis and familial polyposis. We have followed up 66 patients (37 male and 29 female, with a median age of 16 years) for at least 6 months after closure of the temporary ileostomy. The patients were seen regularly in follow‐up or were sent a comprehensive questionnaire to assess their condition. Twenty‐two patients had the construction of a J‐pouch. and 44 had a straight ileo‐anal pull‐through. Stool frequency, day (median 4 to 7 stools) and night (median 1 to 3 stools), was similar in the two groups. Voluntary continence was excellent in both groups during waking hours. Occasional night‐time incontinence in small volumes, mild perianal itching, and minimal bleeding from irritation were similar in both groups. Most of the patients could distinguish gas from stool. When medication was used, bulk agents were usually chosen, with a nonspecific anti‐diarrheal agent taken occasionally. A few patients with the straight ileo‐anal pull‐through expressed some dissatisfaction early during the follow‐up period: however, all but two patients expressed satisfaction later. Of the 66 patients, 41 had at least one complication during the postoperative period; however, in 26 the complications were minor. The more severe complications included small bowel obstruction (11 patients requiring surgical decompression), infection (one patient requiring surgery), and transient neuropathy (three patients).

SummaryPrevious studies have shown that orally administered epidermal growth factor (EGF) enhances neonatal intestinal growth and that it may be absorbed in the intestine and bound by other organs. This study investigated whether the ingestion of EGF would be associated with growth of nonintestinal organs. In short‐term studies, 87 newborn rat pups were fed artificial formula containing various concentrations of EGF for 39 h. In long‐term studies, suckling newborn pups were fed EGF or an equal volume of distilled water for 5 days. The pups fed formula containing EGF for 39 h had a significant increase in hepatic incorporation of [3H]thymidine into DNA compared with pups not fed EGF. By 5 days of age, 13 pups fed EGF had heavier livers that contained more DNA and RNA compared with 14 control pups. Moreover, EGF‐fed pups had heavier hearts and kidneys than pups fed no EGF. These data suggested that ingestion of EGF is associated with the growth of nonintestinal organs.

ABSTRACTObjectiveMost Helicobacter pylori infections are acquired during childhood. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) recently published practice guidelines for managing pediatric H. pylori infection. Before this publication, the authors conducted a survey to assess pediatric gastroenterologists' knowledge and practices regarding H. pylori.MethodsOne hundred nine of 514 NASPGHAN members completed an Internet‐based questionnaire on H. pylori infection.ResultsEighty‐two percent of respondents performed outpatient testing for H. pylori. Of these, only 31% restricted testing to children aged >5 years. Most recommended testing for H. pylori in guideline‐recommended conditions; some would not treat infected patients. Ninety‐seven percent would test for H. pylori in a child with new duodenal ulcer (DU), 79% in a child with a history of DU, and 91% in a child with new gastric ulcer. However, only 86%, 60%, and 91%, respectively, would treat H. pylori infection in those conditions. A proton pump inhibitor (PPI)‐based triple regimen was the first‐choice therapy for 78% of respondents. Correct estimates of rates of resistance to amoxicillin, clarithromycin, metronidazole, and tetracycline were 10%, 17%, 43%, and 12%, respectively. Eighty‐six percent believed there was insufficient research on H. pylori in children.ConclusionsNorth American pediatric gastroenterologists seem well informed about H. pylori infection in children despite the lack of published guidelines at the time of survey. Knowledge about antibiotic resistance rates was deficient. Most offered some outpatient testing for H. pylori and would test children with ulcer disease. However, some would not treat patients based on a positive result.