Évaluer l’incidence et analyser les facteurs de risques des ulcères et des érosions gastroduodénales chez l’enfant. Étude prospective réalisée simultanément pendant 1 mois dans 20 centres de 14 pays Européens. Les indications, la présence des ulcères et des érosions gastroduodénales avec leurs facteurs de risques ont été rapportés chez tous les enfants bénéficiant d’une endoscopie digestive haute. Parmi les 1443 enfants inclus 638 filles, âge médian 8,1 ans, 1 mois – 18 ans, des ulcères ou des érosions ont été observés chez 153 enfants 10,6 % variant de 0–22 % dans les différents centres. Les indications principales ont été ; douleurs épigastriques et abdominales 24 % ou suspicion de reflux gastro-œsophagien 15 %. Les enfants ayant des ulcères ou des érosions sont significativement plus âgés que ceux sans lésions (10,5 + 5,4 vs 7,9 + 5,7 ans, p 0.002). La distribution est identique dans les deux groupes pour : sexe, manifestations cliniques, infection à H. pylori, histoire familiale d’ulcère, pays d’origine de l’enfant ou de sa mère, niveau d’éducation du père ou de la mère, prise médicamenteuse, alcool et drogues. Cependant, l’infection à H. pylori, a été fréquemment rencontrée chez les enfants institutionnalisés par rapport à ceux non institutionnalisés : 98,9 % vs 25,4 %, p < 0,001. L’incidence des ulcères ou des érosions gastroduodénales dans cette large étude Européenne pilote a été retrouvée chez 10,6 % des enfants, survenant principalement dans la deuxième décade de la vie. Une prévalence élevé d’infection à H. pylori a été retrouvée chez les enfants institutionnalisés contrasté avec une incidence élevé des ulcères/ érosions H. pylori-négatives chez les enfants non institutionnalisés. Il n’a pas été trouvé de corrélation significative entre les ulcère/érosions et les différents facteurs de risques étudiés.

Aim: The aim of this study was to report single centre experience with cyclosporine (CSA) used in treatment of children with inflammatory bowel disease in concern of safety and efficacy. Estimation included short- and long-term outcome of treatment, obtained remission and maintaining remission, modifications of treatment and necessity of surgical intervention. Methods: Retrospective analysis included 23 patients, 21 with ulcerative colitis and 2 with Crohn's disease, aged 2,75 to 18,5 years, who were treated with cyclosporine during last 5 years. Before CSA therapy was started they received steroids and azathioprine. CSA treatment was included in case of acute exacerbation of disease with steroid-resistance (n=10) and steroid-dependence (n=13). CSA dose was set to obtain theraputic levels (serum concentration> 100 ng/ml and <200 ng/ml). Results: Cyclosporine treatment lasted 2 months in 6 cases, 2 to 6 months- in 8 patients and more than 6 months- in 9 patients. Complications were reported in 2 patients: hirsutism and gingival hypertrophy. CSA treatment was stopped in the second case. Neither of two patients with Crohn's disease improved during the treatment. Short-term improvement was observed in 5 patients with UC. Long term recovery (>6 months) was obtained in 6 cases. 10 patients with ulcerative colitis did not respond to treatment. In 10 patients with severe exacerbation of ulcerative colitis colectomy was performed as an elective surgery when the clinical status improved. Conclusion: Cyclosporine appears as a safe and effective treatment of ulcerative colitis in children in short term. CSA is less effective in maintaining remission, still controlled studies are needed to show efficacy of this treatment.

AIM:To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe. METHODS:During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested. RESULTS:A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother's birth-country; 13% were <6 years of age, 43% 6-11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p = 0.001). CONCLUSION:The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance.

Objective. Children with inflammatory bowel disease (IBD) suffer from malabsorption and malnutrition and therefore may be at risk of developing polyunsaturated fatty acid (PUFA) deficiency. The aim of this study was to investigate PUFA status in children with IBD and the possible relationship to disease activity and nutritional status. Material and methods. We assessed the fatty acid composition of plasma phospholipids (% wt/ wt) of 21 children aged 5.5 - 18 years with IBD ( ulcerative colitis, 15; Crohn's disease, 6) with mild or moderate disease activity. The clinical symptoms and biochemical indices of disease activity and nutritional status ( lean and fat body mass, Hb, albumin serum conc.) were also determined. Results. The patients had lower phospholipid PUFAs than 13 healthy, aged-matched controls (25.8 +/- 5.2 versus 34.2 +/- 5.7, M +/- SD, p< 0.001), mainly due to lower values of linoleic acid ( 18: 2n - 6, 14.0 +/- 3.8 versus 18.3 +/- 4.3, p< 0.01) and its major metabolite arachidonic acid ( 20: 4n - 6, 5.3 +/- 2.0 versus 9.3 +/- 1.9, p< 0.0001). There were also higher values of alpha-linolenic acid ( 18: 3n - 3, 0.3 +/- 0.4 versus 0.2 +/- 0.1, p< 0.01) while the long-chain n - 3 PUFA-eicosapentaenoic and docosahexaenoic acids were normal. Total n - 6 PUFA correlated inversely to erythrocyte sedimentation rate ( p< 0.01), seromucoid ( p< 0.05) and positively to Hb concentration ( p< 0.01). Conclusions. Children inflammatory bowel disease have a high risk of n - 6 PUFA depletion, which is related to disease activity.

The resistance of Helicobacter pylori to antimicrobials, known to be increasing in many countries, is an important factor compromising the efficacy of eradication therapy. Therefore, our study aimed at analysing the current susceptibility status of H. pylori in Poland. A total of 337 H. pylori isolates were cultured from children (N=179) and adults (N=158) from various regions of the country from January 2001 to December 2004. All strains were susceptible to amoxicillin and tetracycline. The overall resistance to clarithromycin (CL) was 28%, but there were significant differences between the centres (ranging from 0% to 33%) and between child and adult isolates (28% versus 15%, respectively; P=0.01) for primary a resistance. Altogether, 46% of H. pylori isolates were resistant to metronidazole (MTZ) and 20% of isolates were simultaneously resistant to CL and MTZ.

Introduction: Triple therapy using a proton pump inhibitor with two antibiotics (amoxicillin, clarithromycin or metronidazole) is recommended for treatment of H. pylori infection in children. Success of therapy highly depends on the susceptibility to the antibiotics used. Aim: To prospectively assess the resistance rate to clarithromycin and metronidazole in H. pylori strains obtained from symptomatic children in Europe. Methods: During a 4-year period (1999–2002) 16 pediatric centers from 14 European countries were ask to report all consecutive H. pylori infected patients with successful antibiotic susceptibility testing. A questionnaire was filled at the time of endoscopy including the following information: age, sex, country of birth of patient and of patient’s mother, endoscopic findings, previous anti-H. pylori therapy, and results of antibiotic susceptibility testing. Results: A total of 1233 patients (47% males) were reported, coming from centers in Northern (3%), Western (70%), Eastern (9%), and Southern Europe (18%). However, 41% of the children originated from non-European countries (from Africa 26.9% and Middle East 10.8%). Age distribution showed 13% were <6 yrs, 43% >6-<12 yrs, and 44% >12 yrs of age. Culture was performed in 1037 patients before first therapy (group A) and in 196 after at least one treatment failure (group B). Resistance to metronidazole was found in 25% of isolates (group A: 23%, B: 35%)and was higher in children born outside Europe (Group A: OR 2.34, 95% CI: 1.59–3.45, p<0.001). Resistance to clarithromycin was detected in 24% (group A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (OR 1.51, 95% CI: 1.10–2.07, p<0.01), in children <6 years of age compared to >12 years (OR 1.62, 95% CI 1.02–2.58, p=0.041), and in patients living in Southern compared to Northern Europe (OR 15.5, 95% CI: 2.1–115.8, p=0.008). Double resistance occurred in 6.9% (group A: 5.3%, B: 15.3%). Over the 4 year period no consistent change of the resistance rate was observed. Children with peptic ulcer disease (n=80, 6.8% of total, age range: 1.7–18.0 yrs) were older compared to nonulcer patients (12.5 vs. 11.9 years, p=0.0013). Conclusion: The primary resistance rate of H. pylori strains obtained from unselected children living in Europe is high (20% for clarithromycin, 23% for metronidazole). Differences with respect to age, country of living and country of mother’s birth indicate that the way of using antibiotics for other indications may have a major impact on the development of primary resistance.

Background/Purpose: Endoscopic variceal ligation (EVL) is effective in controlling rebleeding from esophageal varices in children, but there is no data on the use of EVL to prevent initial bleeding. The objective of this study was to prospectively evaluate the efficacy of EVL in preventing the first hemorrhage from esophageal varices in children.Methods: Thirty-seven children with portal hypertension (22 liver cirrhosis, 15 portal vein thrombosis), aged 4 to 17 years (M = 9.5 +/- 4.4 years) were included in the study. The criteria for inclusion were (1) no previous variceal bleeding; (2) the presence of esophageal varices classified grade 11 or more, and (3) their enlargement by at least I grade after 6 months of observation without endoscopic treatment or appearance of endoscopic signs of high bleeding risk. A Multi-Band Ligator was used, and 2 to 6 bands were fixed under general anesthesia during one procedure depending on the number and size of varices. Follow-up examinations were performed every 3 months, repeating the procedure if necessary. In total, 75 procedures of EVL were performed, from one to 5 in each patientResults: Four patients underwent liver transplantation before eradication of varices. Two others were excluded from the observation because of lack of compliance to the protocol. Of the remaining 31 patients, eradication of varices was achieved in 28 children (90.3%) after 2.0 EVL sessions performed at 3-month intervals. The average time of follow-up after cessation of treatment is 16 months. No bleeding from varices occurred in any child during or after treatment. There were no differences in results between children with liver cirrhosis and portal vein thrombosis. Development of hypertensive gastropathy was observed in 2 children with one episode of bleeding. Recurrence of varices without bleeding occurred in 3 children after 12, 13, and 28 months from eradication.Conclusions: The study results confirmed that endoscopic variceal ligation is a safe and highly effective procedure in children with portal hypertension, regardless of its etiology. Eradication of esophageal varices was followed by 16 months free of bleeding. Prolonged observation is mandatory to conclude if preventive EVL influences the natural history of disease and diminishes the risk of first bleeding onset. (C) 2003 Elsevier Inc. All rights reserved.

Specific serum IgG subclass antibodies against Helicobacter pylori antigens and recombinant CagA were analysed in 75 symptomatic children with histologically confirmed H. pylori infection. H. pylori stimulated an IgG1 predominant response, and IgG3 titres showed a positive association with peptic ulcer disease, chronicity of antral inflammation and density of H. pylori colonization. Two methods used for assessing serum IgG CagA antibody status, i.e. Western blotting and enzyme-linked immunosorbent assay (ELISA), were concordant. CagA stimulated an IgG1 and IgG3 predominant humoral response. Total CagA IgG titres were higher in children with active and more severe chronic antral inflammation. These findings suggest that in children the systemic humoral immune response to H. pylori infection may reflect gastroduodenal pathology.

Objective To assess the relationship between Helicobacter pylori density determined by quantitative culture, H. pylori cagA status, and gastric histology in children.Methods Children with clinical symptoms indicating pathology in the upper gastrointestinal tract were referred for endoscopy. From each child blood was taken for serology, and antral biopsies were obtained for quantitative culture of H. pylori and histology. Histological assessment was performed according to the updated Sydney System. The cagA status of cultured H. pylori was determined by polymerase chain reaction (PCR) and serum IgG response to CagA by western blotting.Results Adequate antral biopsies were obtained from 41 children with positive H. pylori cultures. CagA IgG antibodies were found in 27 patients (66%), 25 of whom were also cagA positive by the PCR. Two children infected with cagA+ strains as determined by the PCR were CagA seronegative. Infection with cagA+ strains was associated with significantly higher activity of inflammation and denser bacterial colonization in the antrum compared to cagA-negative strains. No correlation was observed between the density of colonization and chronic antral inflammation.Conclusions This study shows that infection of children with cagA+ strains of H. pylori is associated with enhanced activity of antral inflammation and higher density of colonization. There is a good correlation between serum western blot and bacterial PCR cagA positivity in determining cagA status and a positive relationship between histology and quantitative culture in assessing H. pylori density in paediatric patients.

Helicobacter pylori resistance to clarithromycin is an important factor in the failure of eradication therapy. The resistance results from point mutations in the 23S rRNA gene of H. pylori. The prevalence of primary resistance of H. pylori to clarithromycin in children and mutations associated with resistance were studied and it was found that 23.5% (23/98) of H. pylori strains isolated in our hospital during 1998-2000 were resistant to clarithromycin. The primary resistance was mainly caused by an A2143G mutation, but the isolates with an A2142G mutation had higher MICs for clarithromycin compared with those with an A2143G mutation: median MIC 256 versus 16 mg/l. Comparison of our data with previous results showed that the prevalence of H. pylori resistance to clarithromycin in children has increased in Poland over the last three years, however the difference was not significant (23.5 vs. 17%, P=0.22).