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Fructose is a highly abundant carbohydrate in western diet and may induce bowel symptoms in children as in adults. The main objective of this study is to describe the frequency of fructose malabsorption (FM) in symptomatic patients 18 years or younger undergoing fructose breath test in a single tertiary center between 2013 and 2018, and to evaluate whether certain symptoms are related to positivity of the test. Out of 273 tests 183 (67%) were compatible with FM. The most frequent pretest symptom in the overall study population was bloating (83%), followed by abdominal pain (73%). Patients with positive test were younger than those with a negative test (median 5 vs 8 years, P

Objectives The aim of the study was to compare the cow's milk protein allergy (CMPA) prevalence in 2 cohorts of children from different socioeconomic strata. Methods Prospective birth cohort that included patients from 2 hospitals providing care for a low- and high-income population, respectively. Healthy newborns ≥34 gestational weeks were recruited and followed up to 12 months by a monthly telephone survey. If ≥2 predefined symptoms/signs suggestive of CMPA were detected, the patient was evaluated by a pediatric gastroenterologist. Diagnosis was confirmed by exclusion diet followed by open oral food challenge. Results Overall the prevalence of CMPA was 5.2%, with a 6 times higher prevalence in the high income cohort (9.2%) compared with the low-income group (1.5%; relative risk 6.2; 95% confidence interval 1.8-20.7; P = 0.0005). All the cases were non-immunoglobulin E-mediated with predominantly gastrointestinal symptoms. High-income cohort did have higher frequency of C-section, mother's previous chronic disease, mother's history of atopy/food allergy, older age, and higher educational level of parents. Parent smoking and presence of pets at home were more frequent in the low-income cohort. Multiple logistic regression showed that the high-income cohort did have older age and higher educational level of both parents. Conclusion In these cohorts the prevalence of CMPA was higher than reported previously in other developing countries and significantly higher in the high-income group. Our findings were associated with sociodemographic characteristics of the parents.

Lactase nonpersistence (LNP) in humans is a genetically determined trait. This age-dependent decrease of lactase expression is most frequently caused by single nucleotide polymorphisms in the regulatory region of the lactase (LCT) gene. The homozygous LCT-13,910C/C genotype (rs 4988235) predominates in Caucasian adults with LNP, and is useful for its diagnosis in this population. The accuracy of this genetic test (GT) has not been completely established in children or in a Latin-American population.The aim of the study was to determine diagnostic accuracy of GT for LNP in Chilean children using the lactose breath test (BT) as a reference, and to compare diagnostic yield in preschool- (6 years) and in school-age (≥6 years) children.Children referred for BT for diagnosis of lactose malabsorption to the Gastroenterology Laboratory at Clínica Alemana, Santiago, from October 2011 to March 2012 were invited to participate. After informed consent, symptom questionnaires, both historic and post lactose ingestion were completed. H2 and CH4 in expired air and -13,910 CT single nucleotide polymorphism by polymerase chain reaction, restriction enzyme analysis, and/or Sanger sequencing were determined. GT accuracy was calculated compared to BT as reference method. Diagnostic yield of GT in preschool- and school-age children was compared.Lactose malabsorption was detected by BT in 42 of 60 children (70%). Genotype -13,910C/C was identified in 41 of 60 patients (68%). GT showed 80% sensitivity, 63% specificity, and 74% accuracy for LNP in the preschool population. In school-age children values were higher, 85%, 80%, and 84%, respectively.GT results were significantly concordant with BT results for hypolactasia detection in Chilean children, particularly in those of age 6 years and older.

Background Ingested button batteries (BB) can cause corrosive damage of digestive mucosa within minutes. Immediate endoscopic removal of esophageal BB has been clearly established, but the management of BB located in the stomach is still controversial. Aim To describe demographic, clinical, radiologic, and endoscopic characteristics of a series of pediatric patients evaluated for BB ingestion. Methods Retrospective analysis of clinical charts belonging to children younger than 15 years, who underwent endoscopic removal of BB at Clinica Alemana of Santiago, between November 2007 and November 2011. Results Twenty-five patients subjected to upper endoscopy were analyzed; median age, 31 months; 15 were male (60%), and 11 patients (46%) were symptomatic after ingestion. The BB ingestion was confirmed by radiograph. Endoscopy revealed 10 patients with BB in the esophagus, 12 patients in the stomach and 3 distal to duodenum. Range time between ingestion and endoscopy was 2 to 10 hours for esophageal BB and 2 hours to 3 days for gastric BB. Eight of the 22 BBs removed had a diameter of 20 mm or greater, 6 of them were located in the esophagus and 2 in stomach. The BB color changes were observed in 14 of the 22 BBs. Breakage of battery edges was present in 11 of the 22 batteries. All patients with esophageal BB and 6 of those 12 with gastric BB presented mucosal damage. Conclusion Esophageal BB cause damage within hours. The BB located in the stomach may also cause damage early. Extraction of gastric BB before 48 hours should be considered.

Endoscopic extraction of digestive foreign bodies Introduction: The ingestion of a foreign body (FB) is very common in childhood, 10 to 20% of the cases require endoscopic removal. The aim of this study is to analyze the demographic, clinical and endoscopic characteristic of patients with FB ingestion requiring endoscopic management. Patients and Methods: The design corresponded to a Prospective Cohort Study. It included patients referred to the Clinica Alemana ER in Santiago in order to remove foreign bodies from their digestive systems between November 2007 and No-vember 2011. Demographic, clinical and endoscopic characteristics were recorded, classifying the symptoms as respiratory, digestive and other manifestations. Risk factors and complications were evaluated. Results: 170 patients, 52.4 % male with average age of four years and three months old. In 78.5 % of the cases, the FB ingestion occurred at home, 82.1% sought medical attention within two hours from the ingestion. Digestive, respiratory and local pain were among the most common symptoms. The location of the FB took place using simple x-ray in 87.6 % of the cases. 91.8% of the FBs were extracted. Location: retropharyngeal 1.3%, 69.3% esophagus, stomach 23 %, duodenum 1.9 % and 3.8 % distal duodenum. Round FB were the most frequent (56.4%) like coins, sharp objects (24.1%), batteries (14.7%), magnets (2.9%) and other large items (1.8%). Mucosal lesion was found in 53.5% of the cases and 9.8% required hospitalization Conclusions: The ingestion of FB occurred at home, and it is most frequent in preschool children. The most common FB was a coin. The location of the FB was through x-ray and no failure or complications were described during the endoscopic removal.(Key words: Foreign body, endoscopic extraction, pediatric age, accidents).Rev Chil Pediatr 2013; 84 (5): 505-512RESUMENIntroduccion: La ingestion de cuerpo extrano (CE) es frecuente en la infancia, requiriendo en el 10-20% de los casos extraccion endoscopica. El objetivo de este trabajo fue analizar las caracteristicas demograficas, clinicas y endoscopicas de los pacientes con ingesta de CE que requieren manejo endoscopico. Pacientes y

ResumenIntroducciónLa adecuada limpieza intestinal (LI) es fundamental para lograr el máximo rendimiento diagnóstico durante una colonoscopia. Existen diversos esquemas de LI, y en pediatría aún no hay consenso respecto al más adecuado.ObjetivoDescribir la efectividad, adherencia y efectos adversos de protocolos de LI diferenciados por edad en pacientes pediátricos sometidos a colonoscopia.Pacientes y métodoEstudio descriptivo que incluyó pacientes

Adequate intestinal cleanliness is crucial to achieve optimal colonoscopy performance. Several bowel preparation (BP) schemes have been proposed, but there is still no consensus as regards which is the most suitable in paediatric patients.To describe the effectiveness, adherence, and adverse effects of BP protocols differentiated by age group in paediatric patients subjected to colonoscopy.Prospective, study that included patients18 years subjected to colonoscopy. BP protocols differentiated by age group were indicated as follows:6 m (glycerine suppository); 6 m-3y 11 m (poly-ethylene-glycol (PEG 3350 without electrolytes); 4y-9y 11 m (PEG 3350 without electrolytes + bisacodyl); 10 y-18 y (PEG 3350 with electrolytes). Demographic, clinical information, adherence and adverse effects were registered. Effectiveness was determined using a validated scale (Boston modified) during colonoscopy.A total of 159 patients were included, of which 87 (55%) were males, and with a median age of 4 years (range 1 m-17 years). Seventy eight percent of patients achieved successful BP. The higher effectiveness was observed in the groups of6 m (96%) and 10-18 y (91%). Constipation was significantly more frequent (29%) in the 4 yo-9 yo 11 m in which lower effectiveness was observed (69%). Good adherence was observed in 87% of patients. Adverse effects were observed in a third of patients, although they were mild and did not lead to the suspension of the BP.Satisfactory results were achieved with the BP schemes used, with a successful BP being obtained in 4 out of 5 patients. Results were different between groups, which is probably related to previous bowel transit and indicated medication.

La Diarrea Crónica, definida como aquella que se prolonga por más de 4 semanas, es motivo común de consulta al Pediatra y Gastroenterólogo infantil. Las causas son muy variadas y dependen principalmente de la edad del paciente. En menores de 6 meses, predominan las anomalías congénitas y las alergias alimentarias; en preescolares aparecen las intolerancias a disacáridos, giardiasis, diarrea inespecífica y tumores; en escolares se agrega la Enfermedad inflamatoria intestinal. A cualquier edad debe considerarse además, la etiología infecciosa y en ciertas circunstancias la Enfermedad celíaca. El estudio debe ser sistemático y progresivo, orientado por la historia clínica. Se inicia con una evaluación del estado nutricional y con exámenes generales destinados a descartar infección y evaluación de las funciones digestivas y absortivas. Luego, en algunos casos, se requerirá de estudios más específicos a cargo del especialista. El tratamiento debe enfocarse en preservar un adecuado estado nutricional del paciente, mientras se toman medidas terapéuticas específicas cuando corresponda. La Diarrea crónica debe inicialmente ser manejada por el Pediatra general y cuando sea necesario se requerirá de la participación del Gastroenterólogo infantil en Centros de Salud de mayor complejidad.

Background: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed (Rev Med Chile 2008; 136: 296-303).

To investigate the efects of copper-deficiency on spontaneous closure of ductus arteriosus in newborn rats,an experimental model consisting in three groups of ten female Sprague-Dowley rats each was used. Group I rats,copper-deficient, were fed a copper-free diet from 35 days before pregnancy until birth. Group II, control rats,were given a diet containing appropriate amounts of copper [6 ppm) and energy. Group III, the pair-fed rats, receiv-ed a diet that was adecuate in copper content but restricted in energy to the same caloric ingestion previouslyshown by copper deprived rats. The ductus arteriosus of 10 newborn rats of each group were studied by hystologicalmethods at sometime between the third and twelfth hour of life, and it was patent in 100%, 20% and 40% of thecases of copper deprived, control and pair fed rats respectively (Chi square test, p — 0-0009)- The wall thickness ofpatent ductus from copper deprived rats were significantly lower than those from rats of the other two groups(Kruskall-Wallis Test; p = 0.0079). Our results suggest that materno-fetal copper deficiency significantly affects thespontaneous closure rate of the ductus arteriosus in the rat. The mechanism of this abnormal response probablyincludes structural changes in the ductal wall, alterations in the energy yield process or abnormal regulation ofprostaglandins E2 and F2 —asynthesis,(Key words: Patent ductus arteriosus, copper-deficiency, rats.)

Nitrogen, fat and energy retention were measured in 10 male infants (mean age = 6.8 mo) recovering from marasmic malnutrition while they were fed with either cow's milk based formula (LP) or a modified cow's milk formula (LPM). Their mean weight for age ratio was 72% and their weight for length ratio was 95% (NCHS standards). They went through two consecutive balance periods of 6 days each (3 d. for adaptation and 3 d. for urine and feces collection) beginning with either formula randomly. Both formulas had 85 kcal/dl with 11% protein calories in LPM and 13% in LP. Energy intake, absorption and relative retention were slightly greater with LPM than LP. Fat intake was greater under LPM than LP (5.4 vs. 4.5 g-kg-d, p < 0.025), which resulted in significant differences in fat absorption (LPM 4.3 vs. LP 3 g-kg-d, p < 0.025). Nitrogen intake was significantly lower under LPM than LP (487 vs. 571 mg-kg-d, p < 0.025) with lower urinary nitrogen excretion for LPM than for LP (304 vs. 417 mg-kg-d, p < 0.001). Apparent nitrogen retention averaged 115 mg-kg-d for LPM and only 69 mg-kg-d for LP (NS). A significant correlation was observed between nitrogen intake and nitrogen retention: r = 0.70 (y = 0.57x -167; p < 0.05) with LPM, and r = 0.77 (y = 0.63x -291, p < 0.01) with LP. A correlation was also found between energy intake and weight gain: r = 0.55 (NS) with LPM, and r = 0.88 (y = 0.26x -26; p < 0.001) with LP.(ABSTRACT TRUNCATED AT 250 WORDS)