•Performance of ElastPQ as compared to TE for liver fibrosis assessment is evaluated.•A strong correlation was found between ElastPQ and TE measurements.•ElastPQ seems to be a good tool to predict ...liver fibrosis severity in chronic hepatitis.
The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with B and C chronic hepatopathies, using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment.
Subjects and methods: the study included 228 consecutive subjects with chronic hepatopathies (26% HBV, 74% HCV) from whom 51% had liver cirrhosis. Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. For TE 10 valid LS measurements were performed for each patient and the median value was calculated. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10LS measurements with a success rate ≥60% and an interquartile range <30%. For ElastPQ we calculated the median value of 10LS measurements in the liver parenchyma, at least 1cm below the capsule, avoiding large vessels. For differentiating between stages of liver fibrosis we used the TE cut-off values published in the Tsochatzis meta-analysis: significant fibrosis (F≥2)- 7.0kPa, severe fibrosis (F≥3)- 9.5kPa and for liver cirrhosis (F=4)-12kPa (Tsochatzis et al., 2011). The areas under the receiver operating characteristic curve (AUROCs) were used to assess the diagnostic performance of ElastPQ, correlations between ElastPQ and TE were evaluated.
Results: Valid LS measurements were obtained in 90.7% (207/228) cases by means of TE and in 98.7% (225/228) cases with ElastPQ. In the final analysis 205 patients were included. The ElastPQ values ranged from 2.32 to 44.07kPa (median=10.42kPa). Based on TE cut-off values (Tsochatzis et al., 2011) we divided our cohort into 4 groups: F0-F1:61/205 (29.8%); F2: 14/205 (6.8%); F3: 15/205 (7.3%); F=4: 115/205 (56.1%). The best cut-off values for discriminating, significant, severe fibrosis and cirrhosis were 7.2, 8.5 and 8.9kPa, respectively. The AUROCs were calculated considering TE as the reference method: 0.94 for significant fibrosis (F≥2), 0.97 for severe fibrosis (F≥3) and 0.97 for cirrhosis (F=4). In our cohort there was a strong correlation between measurements obtained by Transient Elastography and ElastPQ (r=0.85, p<0.001).
Conclusions: ElastPQ seems to have a good diagnostic accuracy for staging liver fibrosis.
Primary lactose intolerance is caused by a genetically programmed loss in lactase production after 5-6 years of age. Milk and dairy products are often incriminated as a cause of gastrointestinal ...symptoms. Recent studies show that lactase persistence in adult life correlates with higher anthropometric indexes and an altered metabolic profile. We aimed to assess whether the presence of gene polymorphisms for primary lactose intolerance has an influence on the anthropometric and metabolic profile of children. We conducted a cross-sectional study, recruiting consecutive children evaluated at the 2nd Pediatric Clinic, Timisoara from May to August 2016. We enrolled 87 children aged 6-17 years mean age 10.64 + or - 3.51 years; 45 (51.72%) girls. Subjects were asked to complete an analogue visual scale of symptoms. We measured weight, height, blood pressure and calculated body mass index. The metabolic profile included fasting blood glucose, triglycerides and HDL cholesterol levels. We used strip genotyping to identify gene polymorphisms for primary lactose intolerance. According to the results, our study population was grouped into lactose tolerant (n=42) and lactose intolerant (n=45) groups. No differences were found in regards to weight, height, body mass index and blood pressure between the two study groups. Glucose, triglycerides and HDL cholesterol were similar in the lactose intolerant and lactose tolerant children. The presence of gene polymorphisms for primary lactose intolerance did not influence the children's anthropometric and metabolic profile. Key words: lactose intolerance, polymorphisms, anthropometric profile, metabolic profile, children
ABSTRACT
Button batteries (BB) remain a health hazard to children as ingestion might lead to life‐threatening complications, especially if the battery is impacted in the esophagus. Worldwide ...initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably <2 hours). Honey and sucralfate can be considered in ingestions ⩽12 hours while waiting for endoscopic removal but should not delay it. In case of delayed diagnosis (first confirmation of the BB on X‐ray >12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (⩽12 hours after ingestion) and position of the BB beyond the esophagus, one can monitor with repeat X‐ray (if not already evacuated in stool) in 7 to 14 days, which is different from previous guidelines where repeat X‐ray and removal is recommended after 2–4 days and is also based on age. Finally, prevention strategies are discussed in this paper.
Ultrasound elastography including transient elastography (TE), point shear wave elastography, (pSWE) and two (three)- dimensional shear wave elastography (2D-SWE) have been introduced mainly for the ...evaluation of the liver. All the techniques are also feasible for the examination of spleen, whereas pSWE and 2D-SWE can be used for the assessment of the pancreas, kidney, gastrointestinal tract and other organs. Strain elastography also plays a role for non-liver applications. The aim of the current report is to highlight unique features and techniques for the elastographic examinations in children and to report initial results in non-liver applications.
Drugs in Focus Mas, Emmanuel; Borrelli, Osvaldo; Broekaert, Ilse ...
Journal of pediatric gastroenterology and nutrition,
January 2022, Letnik:
74, Številka:
1
Journal Article
Recenzirano
ABSTRACT
Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, ...pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms “octreotide” and “children” and “bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility”.
Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, ...intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".
BackgroundCystic fibrosis (CF) is the most frequent monogenic autosomal recessive disease with lethal potential, manifested by a great clinical polymorphism. Cystic fibrosis associated liver ...disease(CFLD) is the second non-pulmonary cause of death in cystic fibrosis, witch, beside pulmonary disease, became on of the most important management issue. Lung function and CFLD is influenced by the nutritional status, being well known that a positive correlation between increase body mass index (BMI) and respiratory disease exists; therefore the effect of the nutritional grade would be important to be assessed.ObjectivesThe aim of this study is to evaluate the effect of the nutritional status on the cystic fibrosis associated liver disease-CFLD evolution.MethodsStudy included fifty-nine patients with cystic fibrosis prospectively monitored for seven years. They were routinely followed-up by clinical assessment, liver biochemical tests, ultrasound examinations and in several cases elastography. CFLD was diagnosed using ECFS criteria. All patients with CFLD received ursodeoxycholic acid and enzymes supplementation according to our guideline. Body mass index was used to evaluate the nutritional status expressed by percentages and z -scores. Results 62.7% were diagnosed with CFLD and weight deficit, without significant gender gap. About 7% of patients leave the study. Underweighted children associated various vitamins deficiency and the reduced BMI was a significant risk factor for the development of CF severe liver disease (p<0.01). Severe CFLD, with portal hypertension was frequent in underweight children, in a 81.06% of patients/ConclusionMost of our children with cystic fibrosis liver disease associated an important percent of weight deficit. If the malabsorbtion is the main cause of poor nutritional status or if other features like CF liver disease are more important remain to be studied in the future. The eternal question of’ the egg or hen’ as CFLD associates low BMI or if the weight deficit determine the CFLD rate is still disputable. Further measures should be taken for the improvement of nutrition of the CF children and the prolongation of a good life for these cystic fibrosis children.
BackgroundThe evaluation of liver fibrosis is of utmost importance in managing paediatric liver diseases. Currently, liver biopsy remains the golden standard for assessing liver fibrosis in children. ...Still, new non-invasive tools for liver fibrosis evaluation are emerging.AimTo compare the measurements acquired with the linear and convex probe and to assess the intra-observer reproducibility of a two dimensional shear wave elastography (2D-SWE GE) technique.Material and methods:We conducted a prospective study that included 70 children (age range: 3-17 years, 37.1% girls, mean body mass index 24.73 plus or minus 7.2 kg/m2). Our study population consisted of obese children (n=35) and a control group: normal weight children without liver disease (n=35). Liver stiffness measurements were performed using 2D-SWE.GE (Logiq E9, GE Healthcare, Chalfont St Giles- UK). For each child one examiner performed 10 liver stiffness measurements with both a linear and a convex probe. To assess the intra-observer reproducibility, we calculated, for each probe, the medians for the first five and the last five measurements, respectively. We then calculated the interclass correlation coefficients (ICCs) for the two medians.ResultsOverall, we found significantly higher measurement values for the linear probe: 7.8 plus or minus 5.1 kPa vs 4.1 plus or minus 0.9 kPa, p=0.001. The measurements were also higher for the linear probe, both in obese and controls: 9.9 plus or minus 6.1 kPa vs 4.2 plus or minus 0.8 kPa, p=0.01 and 6.5 plus or minus 4 kPa vs 3.9 plus or minus 1 kPa, p=0.235. As for the intraobserver reproducibility, we found no differences between the two sets of measurements for both the linear (8.2 plus or minus 5.8 kPa vs 8.1 plus or minus 5.6 kPa, p=0.25) and the convex probe (4.2 plus or minus 0.9 kPa vs 4.3 plus or minus 0.9 kPa, p=0.33). The agreement between measurements was excellent for both probes: ICC=0.956 (95% CI: 0.922-0.975) and ICC=0.927 (95% CI: 0.883-0.955).ConclusionMeasurements acquired with the linear and convex probe are not superimposable. 2D-SWE GE is a reproducible method for liver stiffness measurements in children.
BackgroundCystic fibrosis (CF) is the most frequent monogenic autosomal recessive disease with lethal potential, manifested by a great clinical polymorphism. Cystic fibrosis associated liver ...disease(CFLD) is the second non-pulmonary cause of death in cystic fibrosis, witch, beside pulmonary disease, became on of the most important management issue. Lung function and CFLD is influenced by the nutritional status, being well known that a positive correlation between increase body mass index (BMI) and respiratory disease exists; therefore the effect of the nutritional grade would be important to be assessed.ObjectivesThe aim of this study is to evaluate the effect of the nutritional status on the cystic fibrosis associated liver disease-CFLD evolution.MethodsStudy included fifty-nine patients with cystic fibrosis prospectively monitored for seven years. They were routinely followed-up by clinical assessment, liver biochemical tests, ultrasound examinations and in several cases elastography. CFLD was diagnosed using ECFS criteria. All patients with CFLD received ursodeoxycholic acid and enzymes supplementation according to our guideline. Body mass index was used to evaluate the nutritional status expressed by percentages and z -scores. Results 62.7% were diagnosed with CFLD and weight deficit, without significant gender gap. About 7% of patients leave the study. Underweighted children associated various vitamins deficiency and the reduced BMI was a significant risk factor for the development of CF severe liver disease (p<0.01). Severe CFLD, with portal hypertension was frequent in underweight children, in a 81.06% of patients/ConclusionMost of our children with cystic fibrosis liver disease associated an important percent of weight deficit. If the malabsorbtion is the main cause of poor nutritional status or if other features like CF liver disease are more important remain to be studied in the future. The eternal question of' the egg or hen' as CFLD associates low BMI or if the weight deficit determine the CFLD rate is still disputable. Further measures should be taken for the improvement of nutrition of the CF children and the prolongation of a good life for these cystic fibrosis children.
IntroductionEsophageal atresia(AE) is the most frequent congenital anomaly of the oesophagus. Although the survival rate of patients with AE has increased significantly in recent decades, ...postoperative morbidity is still high, anastomotic stenosis being the most common complication.ObjectiveEndoscopic management in a case with esophageal anastomotic stenosis following surgical intervention for AE.Case presentationWe present the case of a 9 year old girl, diagnosed on the first day of life with AE (distal esophageal-tracheal fistula - Vogt III B). The patient underwent a surgical procedure with the ligation of the fistula and end-to-end esophageal anastomosis, the immediate postoperative evolution being favourable. 4 months later,during a hospitalisation for aspiration pneumonia, the diagnosis of post-operative oesophageal stenosis is established, the patient being guided towards II nd Paediatrics Clinic Cluj-Napoca where one session of dilation of the oesophageal stenosis was performed(5 mm Savary dilator). The family didn't comply with medical recommendations, further endoscopic treatment being cancelled. After another 9 months she is again hospitalised for an episode of aspiration pneumonia. The infant presented dysphagia for liquids and solids, being fed exclusively with formula milk. The underlying condition and the respiratory morbidities negatively influenced the nutritional status. Endoscopic dilatation of the post-operative esophageal stenosis was reinitiated. We performed 4 sessions of dilatation, 7-10 days apart, gradually increasing the diameter of the Savary dilators. Endoscopic passage at the level of stenosis was achieved and the infant tolerates now 2 soft meals/day.ConclusionsThe endoscopic management of anastomotic stenosis after AE surgery requires consistency and interdisciplinary collaboration.
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