以反复腹痛为主要表现的慢性胃炎的临床特点和治疗

目的 探讨以反复腹痛为主要表现的小儿慢性胃炎的临床特点和治疗方法.方法 对本院以反复腹痛为主要表现的186例慢性胃炎患儿的临床表现、胃镜结果进行分析及总结,对幽门]螺杆菌(Hp)感染组与非Hp感染组患儿的临床资料和胃镜结果进行统计学分析,并随机随访84例病例的治疗措施及转归.结果 186例慢性胃炎患儿中,141例(75.8％)存在不合理的饮食习惯.腹痛病程:1 d～2周36例(19.4％),＞2周～3个月51例(27.4％)、＞3个月～10 a99例(53.2％);疼痛部位:腹中上区85例(45.7％)、脐区52例(28.0％)、部位不固定23例(12.4％);伴随症状:恶心呕吐55例(29.6％)、纳差46例(24.7％)、嗳气31例(16.7％)、口臭21例(11.3％)、反酸12例(6.5％).Hp感染17例,Hp相关性胃炎与非Hp相关性胃炎患儿临床表现比较差异均无统计学意义(Pa＞0.05),而胃镜镜下病变特点差异有统计学意义(P＜0.05);Hp相关性胃炎进行规范根除治疗后腹痛基本缓解;在非Hp相关性慢性胃炎中使用抗生素组与不使用抗生素组间疗效的差异无统计学意义(P＞0.05).结论 小儿慢性胃炎的腹痛病程相对较长,多为无明显规律的上腹部疼痛,可伴暖气、恶心、呕吐、纳差、口臭等症状;Hp相关性胃炎的临床症状无特异性,镜下改变以结节为主,规范根除治疗效果好;非Hp相关性慢性胃炎治疗效果与使用抗生素无关,仅需给予保护胃黏膜、通便、饮食调理等综合治疗.     

Malrotation in Children with Symptoms of Gastrointestinal Allergy and Psychosomatic Abdominal Pain

Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritabile and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.     

Fructose breath hydrogen tests in infants with chronic non-specific diarrhoea

Clear fluids high in fructose (e.g., apple juice) have been incriminated for symptoms of chronic non-specific diarrhoea (CNSD), in particular in children 1–4 years of age. H₂ breath tests were performed, after ingestion of fructose (1 g/kg), in 15 patients referred with CNSD and 35 controls. All 15 CNSD children (100%) had breath peak H₂ of 20 ppm versus 49% of the 35 controls (P=0.0005). Median peak H₂ in CNSD (90 ppm, range 31–136) was significantly higher than in controls (20 ppm, range 1–139) (P<0.001). Orocoecal transit time in children with positive tests was similar in both groups. Similary, median H₂ increases during the test period had the same distribution. We demonstrated fructose malabsorption in CNSD, but found a great overlap with the control group. Our results strongly discourage the use of fructose breath H₂ tests in children suspected of CNSD. A positive test has no diagnostic value and a negative test has no clinical implications.Conclusion For clinical practice, we suggest a dietary history and a trial of appropriate measures in infants with chronic nonspecific diarrhoea, instead of performing the fructose H₂ breath test.     

小儿反复发作性腹痛病因分析

目的探讨反复发作性腹痛(RAP)小儿胃镜表现,并分析RAP胃肠病因。方法对313例RAP患儿,男145例,女168例行胃镜检查,并取胃窦黏膜活组织行病理检查及快速尿素酶检测。根据镜检结果判断上消化道疾病,胃黏膜炎症程度与Hp关系。结果胃镜下病变检出率99.68%,其中单纯慢性浅表性胃炎(CGS)118例,CGS伴胆汁返流56例,CGS伴十二指肠球炎44例,CGS伴十二指肠溃疡33例,Hp感染率分别为31.36%、25%、38.64%、60.61%。活动性胃炎与非活动性胃炎Hp感染率分别为92%、23.19%,两组比较有较显著性差异(P<0.0001);中度胃炎与轻度胃炎Hp感染率分别为76.47%、25.96%,两组比较非常显著性差异(P<0.0001)。结论上消化道疾病是小儿RAP的主要病因,Hp感染是引起RAP的重要原因。Hp感染者胃黏膜病理变化较非Hp感染者严重,Hp感染阴性而组织学改变为中度炎症活动性者,需随访排除Hp检查的假阴性。     

抗幽门螺杆菌治疗再发性腹痛与慢性浅表性胃炎的疗效

目的探讨抗幽门螺杆菌(Hp)治疗再发性腹痛(RAP)和慢性浅表性胃炎(CSG)的疗效及其必要性。方法选择本院符合RAP诊断的患儿118例,其中Hp感染52例;胃镜检查后确诊CSG120例,其中Hp感染58例。分别将其分为3组(Hp阴性组、抗Hp治疗组、未抗Hp治疗组),所有患儿治疗3个月,分别行胃镜检查、Hp检测和临床疗效判断,应用SPSS11.0软件进行统计学分析。结果CSG和RAP的发病与Hp感染与否均无关(Pa>0.05)。RAP抗Hp治疗组治疗前后疗效比较差异有统计学意义(χ2=6.74,P<0.05);CSG抗Hp治疗组治疗前后疗效比较差异有统计学意义(χ2=6.16,P<0.05)。结论CSG和RAP的发病与Hp感染无明确相关性,但CSG和RAP的患儿一旦明确有Hp感染,仍应予Hp根除治疗。     

Increased Faecal Alpha-1 -Antitrypsin Excretion in Children with Persistent Diarrhoea Associated with Enteric Pathogens

ABSTRACT. The random faecal alpha-1-antitrypsin (AT) excretion (mg/g dry weight of stool) was measured in 30 infants and children (mean age 10.8±8 mo.) with protracted diarrhoea (duration ≥21 days) and failure to thrive and 27 normally nourished children (mean age 13±4.5 mo.) without any gastrointestinal symptoms in the preceding 12 weeks. The associated factors in patients with protracted diarrhoea and their mean faecal AT during active disease and 3–4 weeks after recovery were as follows: Enteropathogenic E. coli 5 (7.9±5.5; 3.2±0.6), Giardia lamblia 4 (3.9±1.8; 2.5±0.7), Salmonella typhimurium 3 (4.0±0.2; 3.8±0), secondary carbohydrate intolerance 11 (2.5±0.9; 2.4±0.8), and others 7 (3.4±0.7; 3.0±0.5), respectively. Of all the patients with protracted diarrhoea the mean AT in the E. coli , Giardia and Salmonella groups were significantly higher than the mean in the control group (2.1±0.8) and following treatment and recovery the values were comparable to that in the controls. All the 6 patients with very high faecal AT (> mean + 3 SD of controls) were associated with an enteric pathogen.     

再发性腹痛患儿幽门螺杆菌粪便抗原检测分析

目的　探讨儿童再发性腹痛与幽门螺杆菌 (Hp)的关系。方法　再发性腹痛 78例患儿分为学龄前组、学龄组 ,采用ELISA法测定粪便幽门螺杆菌抗原 (HpSA)。结果　再发性腹痛HpSA总阳性率 52 .2 % ,学龄前组阳性率 38.7% ,学龄组阳性率59.6 % ,两组比较差异显著性 ,性别、病程、症状比较差异无显著性。结论　儿童再发性腹痛与Hp感染关系密切 ,随年龄增长有上升趋势     

乳果糖氢呼气试验诊断儿童小肠细菌过度生长

目的评价乳果糖氢呼气试验(BHT)诊断儿童小肠细菌过度生长的有效性。方法选择慢性腹泻、腹痛和腹胀的患儿35例。男18例,女17例;年龄(7.72±3.06)(3～13)岁。均行乳果糖BHT:按0.5g·kg-1口服100g·L-1乳果糖溶液,乳果糖的最大剂量为10g。之后每隔20min测试1次,总测试时间为3h,共测试8次。试验期间任何1次气体标本>20mg.m-3为阳性。结果35例患儿乳果糖BHT阳性18例,阴性17例,阳性率为51.43%,其中8例(22.86%)患儿表现为典型的双峰改变。引起小肠细菌过度生长的病因为慢性浅表性胃炎、慢性细菌性肠炎(各4例),营养不良伴厌食症(2例),胃扭转、小肠大部切除术及脂肪泻(各1例),原因不明5例。使用抗生素治疗的慢性细菌性肠炎患儿均缓解;使用微生态制剂和对症治疗的患儿7例临床症状基本消失,3例临床症状明显改善,4例无效。结论乳果糖BHT是诊断小肠细菌过度生长简单有效的方法,使用抗生素和微生态制剂治疗小肠细菌过度生长有效。     

肾病综合征患儿的腹痛问题

腹痛是肾病综合征患儿经常主诉的症状之一,多数情况下主要是由于肾病导致迅速产生大量腹水及肠壁水肿引起,但有些患儿腹痛明显,很可能是某些严重并发症的临床表现。该文就几种引起肾病患儿严重腹痛的病因如低血容量发作、原发性腹膜炎、血栓栓塞及胃肠道并发症进行简述,以加强对肾病患儿腹痛的重视,从而达到早期诊断、早期治疗,改善预后。     

反复腹痛患儿幽门螺杆菌感染率变迁

目的探讨反复腹痛儿童幽门螺杆菌(Hp)感染变迁规律。方法对1998年1月~2004年12月收集反复腹痛1676例患儿病例资料,男808例,女868例进行13C尿素呼吸试验(13C-UBT)检测Hp感染状况,探讨反复腹痛患儿Hp感染规律变迁。结果Hp感染儿童438例,感染率26.13%,其中2~5岁、5~10岁、10~14岁3组平均感染率分别为23.66%(84/355)、26.31%(286/1087)、29.06%(68/234)。1998~2004年每年平均感染率分别为29.33%(83/283)、28.90%(76/263)、25.76%(51/198)、26.01%(56/215)、25.81%(48/186)、24.45%(67/274)、22.18%(57/257)。结论1.反复腹痛儿童Hp感染率随年龄增加而增加;2.反复腹痛儿童Hp感染率呈逐年下降趋势。     

Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double-blinded testing

Aim: To investigate malabsorption of lactose and fructose as causes of recurrent abdominal pain (RAP). Methods: In 220 children (128 girls, mean age 8,8 [4.1–16.0] years) with RAP, hydrogen breath tests (H₂BT; abnormal if ΔH₂ > 30 ppm) were performed with lactose and fructose. Disappearance of RAP with elimination, recurrence with provocation and disappearance with re‐elimination, followed by a 6‐month pain‐free follow‐up, were considered indicative of a causal relation with RAP. For definite proof, a double‐blinded placebo‐controlled (DBPC) provocation was performed. Results: Malabsorption of lactose was found in 57 of 210, of fructose in 79 of 121 patients. Pain disappeared upon elimination in 24/38 patients with lactose malabsorption, and in 32/49 with fructose malabsorption. Open provocation with lactose and fructose was positive in 7/23 and 13/31 patients. DBPC provocation in 6/7 and 8/13 patients was negative in all. However, several children continued to report abdominal symptoms upon intake of milk or fructose. Conclusion: Lactose intolerance nor fructose intolerance could be established as causes of RAP, according to preset criteria including elimination, open provocation and DBPC provocation. However, in clinical practice, persistent feeling of intolerance in some patients should be taken seriously and could warrant extended elimination with repeated challenges.     

阿奇霉素对急性上呼吸道感染患儿氢呼气试验的影响

目的探讨阿奇霉素(AZM)对急性上呼吸道感染(AURI)患儿氢呼气试验(BHT)的影响。方法采用HD-1型测氢仪对38例AURI患儿应用AZM前后进行空腹BHT及乳果糖BHT,并与健康儿童空腹BHT作对照。结果应用AZM前AURI患儿空腹BHT值明显高于健康对照儿童(P<0.01);应用AZM3d后AURI患儿空腹BHT值明显降低(P<0.01);应用AZM前后AURI患儿口服乳果糖后呼气氢值无明显变化。结论AURI等感染性疾病影响氢的产生和利用;AZM等抗生素能明显抑制肠道产氢,BHT测定并动态观察小儿感染性疾病抗生素对其影响,具有快速、简便、无创、患儿易接受等优点。     

Small Bowel Permeability to 51Cr-EDTA in Children with Recurrent Abdominal Pain

ABSTRACT. Small bowel permeability was investigated in 87 children with recurrent abdominal pain by measuring the 24-h urinary excretion of orally administered ⁵¹Cr-EDTA. The mean excretion was 3.64%± 1. 49% per 24 h. The difference between the mean urinary excretion in children with recurrent abdominal pain and control children (2.51 %± 0.70 %), was significant (p<0.01, two sample t-test). The increased small bowel permeability in children with recurrent abdominal pain might indicate an intestinal etiology for the patients' complaints.     

Intestinal Permeability in Small Children during and after Rotavirus Diarrhoea Assessed with Different-Size Polyethyleneglycols (PEG 400 and PEG 1000)

ABSTRACT. The permeability properties of the small intestinal mucosa was investigated in nine previously healthy children with acute diarrhoea due to rotavirus. The investigation was performed after intake of a mixture in water of polyethyleneglycol molecules (PEG 400 and 1000) ranging from 282 to 1250 dalton in molecular weight. The 6-h urinary recovery of the PEGs was determined with high performance liquid chromatography and used to assess the permeability characteristics of the intestine. The patients served as their own controls and were investigated in the same manner after recovery 3-5 weeks later. A significantly lower urinary recovery of PEG was noted for all molecular sizes (326-1206 dalton) during acute diarrhoea in comparison with the results obtained after recovery ( p <0.001-0.1). There was also a relatively lesser change in the urinary recovery of larger PEG molecules during infection, as reflected by a higher recovery ratio between 1074 and 370 dalton PEGs. The results indicate profound changes in the permeability characteristics of the intestine during acute rotavirus diarrhoea.     

Lactose absorption and malabsorption in healthy German children: Improved phenotypic resolution by simultaneous determination of breath hydrogen and carbon dioxide

A total of 124 apparently healthy German children aged 8 to 10 years were examined for lactose absorption employing the breath hydrogen test with multiple breath collection. Analysis of the maximal change of breath hydrogen concentration (maxH₂) 110 and 150 min after a lactose load of 30 g failed to yield a bimodal distribution separating lactose absorbers and malabsorbers as observed in adults. Comparison with an adult control group of 120 subjects showed that the mean CO₂ concentration was significantly lower and the coefficient of variation was considerably higher in the breath samples of the children. The difference between the highest and the lowest CO₂ concentration in the three samples obtained from each individual was also significantly higher in the group of children. Normalizing the children's H₂ concen tration values to the mean CO₂ concentration in the total group (3.04%) yielded a bimodal distribution of the maxH₂ values. Of 124 children, 18 were identified as lactose malabsorbers. The 14.5% frequency is similar to that observed in German adults.Supported by Stiftung Volkswagenwerk, Hannover     

The status of lactose absorption in Hong Kong Chinese children

Lactose malabsorption was investigated in 169 Chinese children aged between two and 16 years using the breath hydrogen test. The challenge was either lactose solution (1 g/kg) or cow's milk (10 ml/kg). Overall, 68% of the children showed a significant increase in breath hydrogen following the lactose challenge while only 17% showed an increase after the cow's milk challenge and 13% after both challenges. The number of malabsorbers increased significantly (p less than 0.001) with age and no associated gastrointestinal symptoms or signs were found in any of the children following the challenges, suggesting a gradual and partial loss of intestinal lactase activity. We conclude that the prevalence of lactose malabsorption in Hong Kong children is very high using the standard lactose tolerance test but when a more realistic amount of lactose and a natural medium such as a glass of milk is used as the challenge, the number of malabsorbers becomes small and clinically insignificant.     

幽门螺杆菌感染与6岁以上儿童再发性腹痛的关系及其治疗

目的探讨幽门螺杆菌(Hp)感染与6岁以上儿童再发性腹痛(RAP)的关系及Hp感染的相关性治疗。方法选择2007年3月-2009年2月在本院就诊的符合RAP诊断的6岁以上患儿180例,同期选择无RAP的健康儿童30例作为健康对照组,采用14C-尿素呼气试验(14C-UBT)检测Hp感染情况;对Hp阳性的RAP患儿予根除Hp治疗,观察腹痛缓解率、Hp转阴率。结果RAP组Hp感染阳性率为58.33%,较健康对照组Hp感染率(20.00%)显著升高(P<0.01)。RAP组的3个年龄组中,12～14岁组Hp阳性率(69.35%)显著高于6～8岁组(46.51%)和9～11岁组(56.00%)(Pa<0.05)。RAP组中男、女的Hp阳性率分别为55.26%、60.58%,二者比较差异无统计学意义(P>0.05)。有无不良饮食习惯,家族中有无胃病史者Hp感染阳性率分别是45.56%、12.78%,49.44%、8.89%,二组比较差异均有统计学意义(Pa<0.01)。三联疗法根除Hp采用与否腹痛的缓解率、Hp转阴率分别为92.39%、15.38%,89.13%、7.69%,二组比较差异有统计学意义(Pa<0.01)。结...     

Zinc and Copper in Hair and Plasma of Children with Chronic Diarrhea

ABSTRACT. Zinc and copper status was evaluated in nineteen children with chronic diarrhea. An intestinal biopsy suggested that eight of these patients had celiac disease and eleven suffered chronic diarrhea without malabsorption and had normal villi or minimal changes. They were studied for malabsorption and compared with two control groups consisting of nineteen healthy and eleven malnourished children. Plasma zinc was depressed in the celiac disease group when compared with the normal children, but was similar to that of the malnourished children. Hair zinc was also depressed for the chronic diarrhea groups (23.2± 15.2 and 34.4±21.9 μg/g for those with or without malabsorption respectively, vs. 97.9± 15.2 for the healthy group). Plasma and hair copper values were diminished in both groups with chronic diarrhea. A significant correlation was found between plasma carotene levels after oral carotene overload, and both plasma zinc and hair copper values ( r =0.62, P <0.01 and r =0.56, p <0.05, respectively). There was also a significant correlation between plasma zinc and plasma protein ( r =0.54, p <0.05). Hair determinations seem to be more sensitive than plasma values to changes in zinc or copper status in chronic diarrhea. Chronic diarrhea in children is associated with lower levels of zinc and copper, especially when accompanied by malabsorption.     

Safety and Efficacy of Three Oral Rehydration Solutions for Children with Diarrhoea (Edinburgh 1984–85)

ABSTRACT. Of 357 children with acute diarrhoea admitted to the City Hospital, Edinburgh, over a 12-month period, only 5 (1.4%) required IV infusions. Three hundred and nineteen were treated with oral rehydration (OR). Of these 269 were studied in detail and 43% had signs of dehydration, but in none of them was it severe. There were no fatalities. Patients were randomly allocated to treatment with one of three OR solutions in a double blind trial. The solutions had sodium concentrations of 35, 50 and 90 mmol (mEq)/l, and dextrose of 200 (36 g/l), 111 (20 g/l) and 110 (19.8 g/l) mmol/l, respectively. Hypematraemia was not a clinical problem and only 5 children (2%) were biochemically hypematraemic on admission. Treatment did not cause clinical hypematraemia. At the second assessment only 3 children were biochemically hypematraemic, one from each treatment group, and no one had clinical signs. All three solutions were safe and effective in the relatively mildly dehydrated patients currently seen in the UK.