Helicobacter pylori in children Sustmann, Andrea; Okuda, Masumi; Koletzko, Sibylle
Helicobacter (Cambridge, Mass.),
September 2016, Letnik:
21, Številka:
S1
Journal Article
Recenzirano
Helicobacter pylori infection in early childhood may differ in many aspects compared to infection in adulthood: the immune response in the gut, the type and prevalence of complications within and ...outside the stomach, and the impact on long‐term health. In high prevalence countries, transient infections seem to be common in infants and toddlers, and the consequences of this phenomenon on the short‐ and long‐term immune response are still unclear. Other controversial issues are related to the question of which H. pylori‐infected children benefit from treatment and which is the best regimen to eradicate the infection in the presence of a worldwide increasing antibiotic resistance. The first large‐scale randomized placebo‐controlled vaccination trial in schoolchildren indicates that prevention of the infection may be possible.
Importantly, and in addition to reduction of proinflammatory responses, EEN enhanced the capacity of antiinflammatory IL-10 to suppress LPS-induced IL-6 in PBMCs (Fig 1, E). Because suppression of ...inflammatory mediators did not result from numeric changes in peripheral blood monocytes or total lymphocytes (Table E2), we assessed changes in TH-cell subsets directly after isolation from peripheral blood during EEN.
Objectives To examine predictors of delayed diagnosis of inflammatory bowel disease in children and adolescents. Study design A total of 2436 patients (age 0–18 years) with Crohn’s disease, ...ulcerative colitis, or unclassified colitis were included from 53 pediatric gastroenterologists. Predictors were examined with the proportional hazards model, presented as hazard ratios (HR) with 95% confidence intervals. HR < 1.0 represent factors associated with late diagnosis. Results Median time to diagnosis was 4 (2-8) months. Crohn’s disease (HR 0.62; 0.56–0.68), and within Crohn’s disease, ileal disease (HR 0.77, 95% confidence interval 0.67 to 0.89) were associated with delayed diagnosis. Chances for early diagnosis increased with increasing age (HR 1.07 per year of age; 1.06 to 1.08). There was also an effect by center (HR 0.63, 0.52 to 0.67), but not by sex or country (Austria vs Germany). Growth failure was more common in those cases with delayed diagnosis. Conclusions There is still concern about delays in the diagnosis of inflammatory bowel disease in the very young and in children with small bowel disease. Inequalities of care by region require further investigation.
Pulmonary rehabilitation, including aerobic exercise and strength training, improves function, such as spirometric indices, in lung disease. However, we found spirometry did not correlate with ...physical activity (PA) in healthy adolescents (Smith ERJ: 42(4), 2016). To address whether muscle strength did, we measured these adolescents' handgrip strength and correlated it with spirometry.
In 1846 non-smoking, non-asthmatic Germans (age 15.2 years, 47% male), we modeled spirometric indices as functions of handgrip strength by linear regression in each sex, corrected for factors including age, height, and lean body mass.
Handgrip averaged 35.4 (SD 7.3) kg in boys, 26.6 (4.2) in girls. Spirometric volumes and flows increased linearly with handgrip. In boys each kg handgrip was associated with about 28 mL greater FEV1 and FVC; 60 mL/sec faster PEF; and 38 mL/sec faster FEF2575. Effects were 10-30% smaller in girls (all p<0.0001) and stable when Z-scores for spirometry and grip were modeled, after further correction for environment and/or other exposures, and consistent across stages of puberty.
Grip strength was associated with spirometry in a cohort of healthy adolescents whose PA was not. Thus, research into PA's relationship with lung function should consider strength as well as total PA. Strength training may benefit healthy lungs; interventions are needed to prove causality.
Celiac disease has an increasing incidence worldwide and is treated with lifelong adherence to a gluten-free diet. We aimed to describe gluten-free diet adherence rates in children with ...screening-identified celiac disease, determine adherence-related factors, and compare adherence to food records in a multinational prospective birth cohort study.
Children in The Environmental Determinants of Diabetes in the Young study with celiac disease were included. Subjects had at least annual measurement of adherence (parent-report) and completed 3-day food records. Descriptive statistics, t-tests, Kruskal-Wallis tests and multivariable logistic and linear regression were employed.
Two hundred ninety (73%) and 199 (67%) of subjects were always adherent to a gluten-free diet at 2 and 5 years post celiac disease diagnosis respectively. The percentage of children with variable adherence increased from 1% at 2 years to 15% at 5 years. Children with a first-degree relative with celiac disease were more likely to be adherent to the gluten-free diet. Gluten intake on food records could not differentiate adherent from nonadherent subjects. Adherent children from the United States had more gluten intake based on food records than European children (P < .001 and P = .007 at 2 and 5 years respectively).
Approximately three-quarters of children with screening-identified celiac disease remain strictly adherent to a gluten-free diet over time. There are no identifiable features associated with adherence aside from having a first-degree relative with celiac disease. Despite good parent-reported adherence, children from the United States have more gluten intake when assessed by food records. Studies on markers of gluten-free diet adherence, sources of gluten exposure (particularly in the United States), and effects of adherence on mucosal healing are needed.
Objective To assess the association between the introduction of solid foods in the first 12 months and the occurrence of eczema during the first 4 years of life in a prospective study of newborns. ...Study design Data were taken from annually administered questionnaires from a large birth cohort (recruited 1995–1998) comprised of an intervention and a nonintervention group. Outcomes were doctor-diagnosed and symptomatic eczema. Multiple generalized estimation equation models were performed for the 2 study groups. Results From the 5991 recruited infants, 4753 (79%) were followed up. The 2 study groups were different in their family risk of allergies and feeding practices. No association was found between the time of introduction of solids or the diversity of solids and eczema. In the nonintervention group, a decreased risk was observed for avoidance of soybean/nuts, but an increased risk was seen in doctor-diagnosed eczema for the avoidance of egg in the first year. Conclusion The evidence from this study supports neither a delayed introduction of solids beyond the fourth month nor a delayed introduction of the most potentially allergenic solids beyond the sixth month of life for the prevention of eczema. However, effects under more extreme conditions cannot be ruled out.
BACKGROUND:Maternal diet during pregnancy might be one of the factors that influences fetal immune responses associated with childhood allergy. OBJECTIVE:We analyzed the association between maternal ...diet during the last 4 wk of pregnancy and allergic sensitization and eczema in the offspring at 2 y of age. DESIGN:Data from 2641 children at 2 y of age were analyzed within a German prospective birth cohort study (LISA). Maternal diet during the last 4 wk of pregnancy was assessed with a semiquantitative food-frequency questionnaire, which was administered shortly after childbirth. RESULTS:High maternal intake of margarine adjusted odds ratio (aOR): 1. 49; 95% CI: 1.08, 2.04 and vegetable oils (aOR: 1.48; 95% CI: 1.14, 1.91) during the last 4 wk of pregnancy was positively associated and high maternal fish intake (aOR: 0.75; 95% CI: 0.57, 0.98) was inversely associated with eczema during the first 2 y in the offspring. High celery (aOR: 1.85; 95% CI: 1.18, 2.89) and citrus fruit (aOR: 1.73; 95% CI: 1.18, 2.53) intakes increased the risk of sensitization against food allergens. In turn, sensitization against inhalant allergens was positively related to a high maternal intake of deep-frying vegetable fat (aOR: 1.61; 95% CI: 1.02, 2.54), raw sweet pepper (aOR: 2.16; 95% CI: 1.20, 3.90), and citrus fruit (aOR: 1.72; 95% CI: 1.02, 2.92). CONCLUSIONS:We suggest that the intake of allergenic foods and foods rich in n-6 polyunsaturated fatty acids during pregnancy may increase and foods rich in n-3 polyunsaturated fatty acids may decrease the risk of allergic diseases in the offspring.
Celiac disease (CeD) is a conditional autoimmune disorder with T cell-mediated immune response to gluten coupled with antibody production to gliadin and the self-protein tissue transglutaminase ...(TG2). TG2 contributes to the CeD pathomechanism by deamidating gliadin, thereby generating more immunogenic peptides. Anti-gliadin antibodies may appear before the autoantibody production. The scope of this study was to dissect these early antibody responses by investigating serum samples collected during the PreventCD prospective double-blind study, where infants with high CeD risk were randomized to 200 mg daily gluten intake or placebo from 4 to 6 months of age, followed by frequent blood testing on regular gluten consumption in both groups. After primary gluten intake, children with or without later CeD produced IgA and IgG antibodies which preferentially recognized non-deamidated gliadin peptides. At CeD development with anti-TG2 seroconversion, there was a significant increase in the antibody reaction toward deamidated gliadin peptides (DGP), with maturation in the binding strength for the PEQPFP gamma-gliadin core peptide. The earliest produced autoantibodies targeted TG2's celiac epitope 2. Our results reveal a qualitative change in the gliadin-directed humoral immune response at the time when anti-TG2 antibodies appear, but anti-DGP antibodies in the absence of anti-TG2 antibodies are not disease-predictive.
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