IntroductionPain is an unpleasant sensory and emotional experience, influenced by various factors. Paroxysmal extreme pain disorder (PEPD) is a rare genetic condition characterized by sudden bouts of pain accompanied by autonomic symptoms.Material, methods and aimThis manuscript presents the case of a 9-year-old boy with paroxysmal extreme pain syndrome and provides a review of the literature. Additionally, a genealogical analysis of the boy’s family was conducted to determine the total number of affected family members. The clinical data included an analysis of genetic tests to identify the mutation confirming PEPD.Result and conclusionA mutation in the SCN9A gene causes the disease, and due to the small number of patients worldwide (around 500, according to literature reports), an effective method of preventing extreme pain attacks had not been established at the time of writing this manuscript. Based on information from scientific sources and the authors’ experiences, it can be firmly stated that various, often difficult-to-identify factors cause paroxysmal extreme pain. This syndrome necessitates further research and the exploration of effective treatment methods.

The pathomechanism of Helicobacter pylori action upon gastric mucosa and its role in the pathogenesis of gastritis have not been fully elucidated. The aim of this study was to evaluate the most prevalent lymphocyte subpopulations of the gastric mucosa in gastritis in children, as well as to evaluate the expression of Fas and Fas ligand receptors (FasL), periapoptotic markers of gastric mucosa lymphocytes before and after H. pylori eradication. Forty nine patients aged 6 to 17 years, investigated due to chronic abdominal pain, were studied. The obtained tissue samples were analysed by immunohistochemistry. Different lymphocyte subsets were quantified on the basis of surface antigen expression (CD3, CD4, CD8, CD20), secreted cytokines (IL-4, IL-6, IFNgamma) and Fas and FasL proteins in the gastric mucosa. B and T helper lymphocytes were found to play a major role in the inflammatory infiltration in the gastric mucosa in children during H. pylori infection. Their expression was found to decrease after eradication. The enhanced expression of Fas receptor on lymphocytes before treatment and a decrease of this expression after eradication of H. pylori were shown. It was demonstrated that there is a correlation between CD4 and Fas receptor expression that may induce apoptosis of the helper lymphocytes in infected children.

Two cases of posterior gastric wall ulceration are presented as a rare complication of percutaneous endoscopic gastrostomy (PEG). Percutaneous endoscopic gastrostomy (Flocare, Nutricia) was performed in two boys (aged 2 and 19 months), who were unable to take necessary nutrients by mouth due to neurological disorders concerning swallowing and deficiency of body mass. This status does not allow to cover liquid and caloric requirement. In one case bleeding occurred 12 days after PEG insertion, in the second--6 weeks after PEG insertion. Both patients were treated with parenteral nutrition and omeprazol intravenously, with good result. The described complications are rare, however, the proton pomp inhibitors application in prevention should be considered.

An intestinal microflora and its metabolism is the object of interest in number of investigations worldwide. Microflora presents in bowels is suspected to have a role in ethiopathogenesis of inflammatory and neoplasm bowel diseases. The assessment of bacterial fermentation processes in 40 children with inflammatory bowel syndrome (IBS), irritable bowel disease (IBD) and constipation (C) was introduced in paper. The hydrogen breath test (HBT) was used to asses the presence of hydrogen and methane in expired air. The utilisation process of free hydrogen and time of intestinal passage were determined. The prolongation of intestinal passage enhances a development of methane synthetising microflora what was observed in most of the patients with IBD and C. Methanogenesis increases with age undependent to gender. In IBD and IBS with predominating diarrhoea patients the increase of hydrogen was observed in the beginning, then its normalisation occurred with no methanogenesis at all. However the HBT enhanced the clinical symptoms of the disease what can be combined with the development of sulphate-reducing bacteria (SRB). They have affinity to hydrogen, and hydrogene sulpide, the end product of their metabolism is responsible for the occurrence and clinical course of IBD. The obtained results suggests that further research on bowel microflora should be continued.

AIM OF THE STUDY an analysis of clinical symptoms and laboratory tests in children with inflammatory bowel disease (IBD). PATIENTS AND METHODS eighty-nine children with IBD (58 with ulcerative colitis (UC) and 31 with Crohn's disease (CD) diagnosed on the basis of clinical symptoms, endoscopic and histopathological examination, were qualified into the studied group. Disease activity was evaluated by using Truelowe-Witts scale for UC and PCDA9 scale for CD cases. Forty-two children without acute or chronic inflammatory diseases constituted the control group. RESULTS the frequency of such clinical symptoms as: diarrhea, fever, weight loss, abdominal pain, weakness, constipations, anemia, joints pain, vomits, and jaundice was comparable in children with UC and CD while intestinal bleeding was significantly more frequently observed in patients with UC than with CD (P<0.05). There was no statistically significant difference in BMI between patients with UC and CD. Cole's index was significantly higher in children with UC than with CD (P<0.05). Hemoglobin level and serum iron level were statistically significantly lower in patients with CD than in the control group (P<0.05). Mean leukocyte count in children with CD was significantly higher than in the control group (P<0.05). Neutrophils percentage in patients with UC and CD was significantly higher than in the control group (P<0.05). Platelet count was significantly higher in all children with IBD than in the control group (P<0.05). Mean serum CRP level was significantly higher only in children with CD while ESR was significantly higher in both groups of IBD patients. Mean serum gamma-globulin level was statistically significantly higher in children with UC and with CD but no significant differences were observed in serum IgA, IgG, and IgM levels among the analyzed groups. Serum GT level was higher in children with CD than in the control group while serum ALT and AST level did not differ significantly among the analyzed groups of patients. CONCLUSIONS 1. Serum C-reactive protein level is one of the most valuable markers for monitoring the course of IBD, especially CD, in children. 2. In patients with IBD systematic monitoring of liver function parameters (especially parameters of cholestasis) is necessary as severe hepatic complications may occur. 3. Further search for new sensitive and specific markers monitoring the course of inflammatory bowel diseases is needed.

BACKGROUND:current succesful surgery of oesophageal atresia with tracheo-oesophageal fistula leads to increased survival of the affected newborns Hence late complications of the defect itself or those due to surgical methods occur more often.AIM OF THE STUDY:was to establish on the base of own observations, the frequency of swallowing problems, gastro-esophageal reflux and oesophagitis after successful surgery of oesophageal atresia.MATERIAL AND METHODS:we investigated 17 patients after successful surgery of oesophageal atresia and tracheo-oesophageal fistula, performed during the first days of life, in the Department of Paediatric Surgery, Medical University of Gdańsk (chief prof Czesław Stoba). These patients were diagnosed and treated in the Department of Paediatrics, Paediatric Gastroenterology and Oncology, Medical University of Gdańsk, during 2005-2006. There were 10 boys and 7 girls, aged from 4 to 14 years (in the - years 2005-2006). In all children, besides obtaining the detailed history concerning dyspeptic symptoms and dysphagia, upper alimentary tract endoscopy, oesophagography and pH-metric examinations were performedRESULTS:gastroesopghageal reflux (GER) was diagnosed in 41.2%, and oesophagitis, by endoscopic examination, in. 17.7% of patients. Disturbed oesophageal motility on radiography was observed in 88.2% of children.CONCLUSIONS:despite the high frequency of gastroesopghageal reflux among this group of patients, their health condition was good, dysphagia and the intensity of the oesophagitis were mild. But it should be remembered that prolonged gastroesopghageal reflux may cause serious complications.

AIM OF THE WORK:Long-term observation of children previously infected with Helicobacter pylori (HP) and evaluation of the reinfection rate after successful therapy. 29 children were included in the study: 16 girls and 13 boys, aged 9-20 years, who in 1998 were diagnosed as having gastritis and/or duodenitis and being infected with Helicobacter pylori. After the treatment, Urea Breath Test (UBT) was performed to evaluate eradication of HP. The test was repeated after 3 and 5 years. In 1998, UBT was negative in 24 of 29 patients, confirming eradication of HP. Three years after treatment, UBT revealed the presence of HP in 7 patients (24.1%) - 5 of them were children in whom eradicative therapy was unsuccessful; in the other two the result of UBT confirmed reinfection. RESULTS:Results of UBT performed after next 2 years remained the same. CONCLUSIONS:HP reinfection rate after successful therapy is low among children and adolescents even in the environment where the bacteria is widely spread. Elimination of HP diminishes the rate of recurrence of gastric symptoms; only in some patients remission is complete.

excluded if tbey were < 65 years Diagnosis codes were used to exclude procedures being perthrmed tor signs or symptoms or for surveillance (histo D' of polyp, IBD, or cancer).Results: FS-SCR increased in all subgroups, ranging from 16% (65-69 years African American male [AAM]) to 82% (85+ years White female [WF]), with the most dramatic increases in the ->80 years age group.Changes in FOBT-SCR ranged from -9% (80-84 years AAM) to 36% (85 + WF), the largest incremem in older ages.The use of BE-SCR declined in almost all snbgroups, ranging from -31% (80-84 years AAM) to 12% (85 + ~VF).CY-SCR increased in virtually all subgroups with most of the increase occurring in the 65-69 years age group (from 7% in AAM to 27% in WF).Conch6tons: in general, increased CRC screening was seen in all age, race, and gender groups wath most of the COL-SCR increases occurring in younger patients.However, in the older age groups, particularly 85 +, dramatic increases in both FS-SCR and FOBT-SCR were noted.Thus, changes in reimbursement were most often associated w'ith large increases in the oldest age groups, which are least likely to benefit from these procedures in terms of prolonging life expeztancy.