Showing posts with label gastrointestinal. Show all posts
Showing posts with label gastrointestinal. Show all posts

Friday, July 11, 2014

Which Colonoscopy Cleanout Preparation Works Best in Children?

By: Lewis First, MD, MS -- Editor-in-Chief

Photo by cheryl via Flickr
Preparing a child’s bowel for a colonoscopy is easier said than done, since available bowel preparation solutions often don’t taste good, require children to consume a high volume of the solution, and necessitate compliance with tricky dietary restrictions.

Multiple preparations for colonoscopy do exist, but have not been compared with each other for efficacy, safety, tolerability and acceptance—at least not until Di Nardo et al. (doi: 10.1542/peds.2014-0131) performed a randomized controlled trial using four different bowel preparation methods.

The study does a nice job of coming clean with some useful results that will flush out what you need to know and consider using (if you’re not using them already) the next time you need to have one of your patients undergo colonoscopy.

Related Reading: 

Tuesday, June 24, 2014

Saccharomyces boulardii in Treating Childhood Diarrhea: Another Victory for Probiotics

By: Lewis First, MD, MS

Saccharomyces. Photo by Bob Blaylock
We have published several studies recently on probiotics and their benefits, but this week, we focus on Saccharomyces boulardii—one organism of the yeast family—and share its benefits courtesy of Feizizadeh et al. (doi: 10.1542/peds.2013-3950), who have done a systematic review of its effectiveness in treating acute diarrhea in children.

According to the authors, S. boulardii has been shown to  prevent and manage diarrhea effectively (especially antibiotic-associated diarrhea), which is potentially very helpful since nearly 760,000 children die from diarrhea every year, especially in developing countries.

To see if S. boulardii really is an effective treatment for childhood diarrhea, Feizizadeh et al. specifically focused on randomized and non-randomized controlled trials, of which 22 out of 1,248 articles met study criteria. The bottom line of this systematic review is that this probiotic appears safe and beneficial, although dosages vary in these studies and the optimal dosing regimen has yet to be determined.

So are you using probiotics to help treat your patients’ diarrheal illnesses? Does it work? Share your thoughts by responding below, sending us an eLetter or via Facebook or Twitter.

Related Reading:

Wednesday, June 18, 2014

A Pediatric Learning Health System & the Search for an Effective IBD Treatment

By: Lewis First, MD, MS

TNF α, (Public Domain)
Children with inflammatory bowel disease (IBD) are commonly seen by both primary care providers and gastrointestinal specialists but never with high enough numbers to really know if a specific approach to IBD is better than others—that is until the arrival of ImproveCareNow (ICN), a network of practices linked together as a pediatric learning health system, which allows standardized data-gathering across sites at multiple children’s hospitals in real time to best determine methods to improve the quality of outcomes in these chronically ill children, teens, and young adults.

This week, Forrest et al. (doi: 10.1542/peds.2013-4103) share with us the result of how the ICN network can be used for high-quality clinical research by looking at data across 35 pediatric gastrointestinal practices as a sequence of non-randomized trials. The study question was whether anti-TNFα therapy was effective at achieving clinical and steroid-free remission rates when compared to children not getting this treatment. The results involve more than 1,800 of 4,130 patients with Crohn’s disease getting this therapy who were then compared to those not receiving TNFα. The results will bowel (I mean bowl) you over and herald this type of network as a valuable research tool for improvement.

To help further highlight the value of learning health systems like ICN, read the accompanying commentary by Abernethy (doi: 10.1542/peds.2014-1182), which further explores the what learning health systems are, how they are put into practice (or not) and the kinds of research opportunities they present.

Both study and commentary will make your helping families with inflammatory bowel disease far less painful than you might imagine dealing with this illness might be, so read on and learn more!

Monday, April 28, 2014

GI Symptoms and Autism: A Meta-Analysis Worth Digesting

Photo by Hey Paul Studios via Flickr
Patients with an autism spectrum disorder (ASD) often complain of gastrointestinal (GI) symptoms, or so it appears, yet just what are those symptoms, how common are they, and are they part of an underlying common pathophysiologic mechanism that links ASD with a gastrointestinal problem?

McElhanon et al. (doi: 10.1542/peds. 2013-3995) have performed a thorough meta-analysis of studies involving GI symptoms and children with ASD. The results may confirm your suspicions. They may also leave you wanting more in regard to specific GI disorders responsible for those symptoms, whether the symptoms are the result of an ASD, and how they can happen pathophysiologically. If anything, this study will show an increased prevalence of GI symptoms—and hopefully lead to even better studies to further define the causal nature of these symptoms in ASD patients.

What’s your opinion on GI symptoms in your ASD patients? Do you see them more often that you might expect? Are there some symptoms more common than others (e.g. abdominal pain)? It would be great if you did a gut check on this topic and share your thoughts via a response to this blog, an eLetter, or through Facebook or Twitter.

Related Reading:

Wednesday, March 19, 2014

A Gut Check on Prophylactic Probiotics and Diarrhea

We have been publishing more and more studies on the effects (positive, negative, or neutral) of probiotics in children. This week, we have another probiotic study that warrants your attention.

Lactobacillus. Photo by  Janice Carr via the CDC
This time the study performed by Gutierrex-Castrellon et al. (doi: 10.1542/ peds.2013-0652) involves the prophylactic daily administering of lactobacillus reuteri for three months in a randomized controlled
trial to more than 160 infants and toddlers in day care centers as well as an equal number of controls. The outcome measure was the frequency and duration of diarrheal episodes up to three months after the medication was stopped. Respiratory tract infections were also monitored along with the number of doctor visits, antibiotics used and absenteeism from school for the child or work for the parents. The authors even performed a cost-benefit analysis.

With so much data to report, one would hope the findings would be well-worth reading about—and they are. Would you consider using lactobacillus reuteri in your practice? Why or why not? Share your comments with us below or via an eLetter on our website or commenting on Facebook or Twitter.

Related Reading:

Monday, January 13, 2014

Celiac Disease: How Well Does a Symptom-Based Screening Questionnaire Detect It?

We recognize that the definitive test for celiac disease is an intestinal biopsy, but who needs that test, and can those who might benefit the most be identified simply by their symptoms?

Photo by Samir via Wikimedia Commons
Rosen et al. (doi: 10.1542/peds.2012-3765) investigated this question by looking at the frequency of symptoms and associated conditions unique to those with biopsy confirmed celiac disease and those without the disease. The authors used a population-based screening of 12-year-olds, who along with their parents, filled out a questionnaire asking about celiac disease-associated conditions.

Unfortunately, the sensitivity and specificity of symptoms for those who screened positive leaves much more to be desired—suggesting that the ability to diagnose celiac purely by symptomatology is not the gold standard and will miss a number of patients who also have this disorder without the classic symptoms.

The study results are tough to digest if one has previously considered celiac screening solely on the basis of classic symptoms and raise the question of whether or not a different set of questions might be needed to not miss as many cases as were missed in this study by the use of the questionnaire. Learn more about diagnosing children with celiac disease by reading this article.

Friday, January 3, 2014

Using the White Blood Cell Count to Reduce Negative Appendectomies: A Retrospective Study

Yesterday, we blogged about using a clinical pathway to predict suspected appendicitis, and today, we continue our discussion of appendicitis and ways to minimize negative appendectomies.

While surgeons may tell you they need to operate on a presumptive appendix even if that appendix may not be inflamed, so as not to miss a potential perforation, they will also want to minimize the negative appendectomy rate. Yet how can they do this?

Bates et al. (doi: 10.1542/peds.2013-2418) decided to see if the magnitude of the white blood cell count (in this case a lower one) could defer surgery and increase observation before automatically operating on a child with a presumptive acute abdomen. The authors did a retrospective review of all appendectomies performed over a 42 month period of time and looked at pre-op lab and radiographic data for all patients in this study. The authors compared this data for normal and abnormal appendices and found normal white blood cell counts (below 8,000 - 9,000) meant a reduction in negative appendectomies.

Just how much of a reduction requires you to cut into this study and decide how much you trust the results to stop surgery or at least observe longer in the setting of a low- normal white blood cell count.

Related Reading:

Thursday, January 2, 2014

Using a Clinical Pathway to Predict Accurately a Suspected Appendicitis: A Prospective Study

In a quest to figure out the most accurate way to diagnose an acute appendix, Saucier et al. (doi: 10.1542/peds.2013-2208) designed a clinical pathway that used a known pediatric appendix score and an ultrasound study to classify patients as low-, middle-, and high-risk for appendicitis –with the low-risk being sent home in this prospective cohort, the middle- group getting an ultrasound, and the high-risk getting operated upon.

So how good is this new guideline? Good enough to carry a high sensitivity and specificity for accurate diagnosis of appendicitis. Just thinking that an ultrasound can be used in place of a CT scan to make this diagnosis is a concept that is certain to radiate positively within all of us.

Stay tuned-- tomorrow we continue our discussion on the appendix with a look at a study that uses white blood cell count to reduce the rate of negative appendectomies.

Friday, September 27, 2013

A Glance Into the Future: Fecal Transplants for Weight Loss

Associate Editor Dr. William V. Raszka offers insight into topics in the news. This week, he reflects on fecal transplants reported to assist with weight loss: 

Each day I am bombarded with information about how to lose weight. There seems to be an almost endless array of diet or exercise recommendations and oodles of gadgets “guaranteed” to work. In the past few months, one of my relatives has tried to lose weight following the South Beach diet, then a Paleolithic diet, and most recently using a smart phone application. Maybe she should try a fecal transplant.

As reported in The New York Times (Health: March 28, 2013), the bacterial flora in our guts may be at least partially responsible for weight loss or gain. Researchers have never quite understood all the reasons why people lose weight following gastric bypass surgery. However, in a recent study conducted in mice, researchers concluded that approximately 20% of the weight loss is most likely due to a change in bacterial flora.

Fattened mice that underwent gastric bypass surgery lost weight and had altered intestinal flora. Mice that underwent a sham surgery where the intestine was simply severed and re-anastomosed did not lose weight and the microbiota did not change.

Next, intestinal contents from each group were transplanted into mice lacking intestinal flora. The mice that received material from the bypass surgery group lost weight while the mice receiving material from the sham group did not.

In a study conducted in adults with potential gastrointestinal disorders, researchers found that indirect evidence of the presence of Methanobrevibacter smithii in the gut was directly related to body mass. The individuals with the highest levels of methane and hydrogen on breath tests were more likely to have more body fat. One possible explanation for this finding is that M. smithii may contribute to the breakdown of foodstuffs, making more calories available.

The general dieter may not be ready for a fecal transplant to help increase weight loss, but the more we learn about our gut and the bacteria that inhabit it, the more we realize how intertwined we are.

*This filler excerpt can be found in the July 2013 Pediatrics print journal p. 71, or online here.

Wednesday, September 11, 2013

A Gut Check on the Rising Incidence of Celiac Disease

Every so often we receive an article noting the increasing incidence of celiac disease, and this week we are sharing a most convincing one that helps sort out whether the increased incidence is a result of improved case ascertainment or a true rise in cases.  White et al. (doi: 10.1542/peds.2013-0932) reviewed all new cases of celiac disease in southeast Scotland over a 20 year period (1990-2009) to determine if cases were diagnosed due to a classical presentation, non-classical presentation, or simply due to targeted screening.  The results are interesting in all three diagnostic categories and seal the deal on suggesting that there is a true rise occurring with this disorder.

You really need to read this study to absorb all it has to offer. In turn, perhaps, you may consider celiac even higher in your differential diagnostic compendium for a variety of symptom complaints.