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OBJECTIVES: The association between GERD and obesity has been frequently reported in adults. Data in children are scarce and inconclusive, evaluating only general obesity. Central adiposity has never been investigated in children as a possible risk factor for GERD. The aims of the present study were to evaluate the prevalence of gastroesophageal reflux disease (GERD) symptoms in overweight and obese children in comparison with a general normal-weight population and whether the GERD symptoms are associated with waist circumference (WC). METHODS: The study population consisted of 153 healthy children. A detailed clinical history and a physical examination were obtained from each patient. A questionnaire on reflux symptoms was completed by caregivers. RESULTS: The reflux symptomatic score resulted significantly higher in obese than in normal-weight children and in children with WC >90th percentile compared with those with WC

Objectives To evaluate the beneficial effects of Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation. Study design A double-blind, placebo-controlled, randomized study was conducted from January 2008 to December 2008 in 44 consecutive infants at least 6 months old (mean age ± SD, 8.2 ± 2.4 SD; male/female, 24/20) admitted to the Gastrointestinal Endoscopy and Motility Unit of the Department of Pediatrics, University "Federico II" of Naples, with a diagnosis of functional chronic constipation. The 44 infants with chronic constipation were randomly assigned to 2 groups: group A (n = 22) received supplementation with the probiotic L reuteri (DSM 17938) and group B (n = 22) received an identical placebo. Primary outcome measures were frequency of bowel movements per week, stool consistency, and presence of inconsolable crying episodes, recorded in a daily diary by parents. Results Infants receiving L reuteri (DSM 17938) had a significantly higher frequency of bowel movements than infants receiving a placebo at week 2 ( P = .042), week 4 ( P = .008), and week 8 ( P = .027) of supplementation. In the L reuteri group, the stool consistency was reported as hard in 19 infants (86.4%) at baseline, in 11 infants (50%) at week 2, and in 4 infants (18.2%) at weeks 4 and 8. However, there was no significant difference between L reuteri and placebo groups in the stool consistency at all weeks ( P = .63, week 2; P = .38, week 4; P = .48, week 8). Similarly, there was no statistically difference in the 2 groups in the presence of inconsolable crying episodes. No adverse effects were reported. Conclusions The administration of L reuteri (DSM 17938) in infants with chronic constipation had a positive effect on bowel frequency, even when there was no improvement in stool consistency and episodes of inconsolable crying episodes. Because of their safety profile, probiotics may be an attractive option in the treatment of functional constipation.

Patients with constipation frequently complain of dyspeptic symptoms that may be explained by reflex inhibition of upper-gastrointestinal motor activity by colonic stimuli. We sought to evaluate the following: (1) the prevalence of functional constipation (FC) and gastric emptying characteristics in children with functional dyspepsia (FD), and (2) the efficacy of osmotic laxatives on constipation, dyspeptic symptoms, and gastric motility.We recruited 42 children (males/females, 22/20; mean age, 80.5 mo) affected by FD (Rome II criteria). All subjects underwent ultrasonographic measurement of the total gastric emptying time (TGEt) at baseline (T0) and after 3 months (T3). Children's bowel habits and the dyspeptic symptomatic score were evaluated at entry and after 1 (T1), 2 (T2), and 3(T3) months. Constipated patients were treated with osmotic laxatives for 3 months. Dyspeptic children without constipation represented the comparison group.FC was present in 28 of 42 (66.6%) patients. Constipated dyspeptic children had significantly more prolonged TGEt than subjects without constipation (median value [interquartile range], 180 (50) vs 150 (28) min, respectively; P = .004). Patients on osmotic laxatives had a significant decrease in TGEt at 3 months (P.001). The median dyspeptic symptomatic score as well as the number and consistency of evacuations per week significantly improved at T1 in comparison with T0 and even more at T2 and T3 (P.001, for each).In our study group, the majority of children with FD were affected by FC associated with delayed gastric emptying. Normalization of bowel habit may improve gastric emptying as well as dyspeptic symptoms.

Objectives To evaluate the clinical validity and applicability of the Paris Consensus on Childhood Constipation Terminology (PACCT) versus the Rome II criteria for pediatric functional defecation disorders (FDDs). Study design Children from infancy to 17 years who had been referred to a tertiary center for chronic constipation were recruited for the study. A prospective longitudinal design was used. The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) for parents of children age 0 to 4 and 4 to 17 years and for children age 10 to 17 years was used for diagnosis of FDDs. Results Children (n = 128; mean age, 67.2 months; 62 males) were screened consecutively. FDDs were diagnosed significantly more often by PACCT than by the Rome II criteria (112 [88.9%] vs 60 [47.6%]; P = .001). The agreement Cohen’s kappa test showed κ = .173. A statistically significant difference was reported between Rome II and PACCT in the 4- to 17-year-old group (P = .001). Scybalous, pebble-like stools and defecation with straining were the main symptoms reported (80%), followed by painful defecation (66%). Conclusions The PACCT criteria show greater applicability than the Rome II criteria for FDDs. The poor agreement implies that they do not identify the same types of patients. Because such a high percentage of constipated children reported the symptoms of defecation with straining, scybalous pebble-like stools, and painful defecation, including these symptoms in any revised criteria should be taken into consideration.