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The infection with Helicobacter pylori (H pylori) represents an important issue of public health. Aim. Establishing the prevalence of H. pylori infection in children and presenting the cases according to the gastritis type by performing upper digestive endoscopies. Material and method. The retrospective study referred to a period of 5 years and included 1269 children evaluated by upper endoscopy to establish the H. pylori infection rate. Results. The frequency of H. pylori in the case of acute gastritis was signifi cantly more reduced (34.78%) than in the case of chronic gastritis (54.94%). Referring to the 10 types of gastritis, the most frequent ones are purpuric (43.66%), nodular purpuric (25.93%) and nodular antral (15.84%). At the other end, atrophic and hypertrophic gastritis were positioned. The most frequent associations pointed out endoscopically are those with 1st degree esophagitis - 51.6%, duodenitis – 45.07% and purpuric duodenitis – 24.74%. Conclusions. The H. pylori infection is the most frequent etiologic factor for chronic gastritis (54.94%). The early identifi cation of the infection is essential to destroy the bacteria and to prevent the development of various types of gastritis that are later on endoscopically identifi ed.

Constipation is a common symptom in clinical practice. Defi nition include abnormal transit diffi culty during defecation and abnormal stool consistency. Limited diagnostic methods and the many diseases that lead to symptoms, leading to more cases of drug resistance. Treatment includes dietary and behavioral approaches, pharmacological therapy and surgery in carefully selected cases. Surgery is recommended in patients with severe constipation resistant to conservative treatment. Confi rmation of indication for surgical treatment requires colonic transit studies, defecation function and conducting anorectal manometry. Therefore, a close collaboration between pediatric gastroenterologists and surgeon pediatricians is essential for the careful preoperative evaluation and gastrointestinal function. Postoperative complications include intestinal obstruction, abdominal pain, flatulence and diarrhea. The effectiveness of surgery and prevalence of postoperative complications are determined by a careful preoperative evaluation of the gastrointestinal function.

In the last decade constipation has become a current problem addressed in the pediatric gastroenterology departments. Objectives. We propose a study to establish the prevalence of constipation and the correlations between diet and the socio-familial environment in children aged from 1 to 17 years old, hospitalized in the Gastroenterology Department, „Saint Mary“ Emergency Hospital for Children of Iasi, between 1 January 2012 and 1 January 2014 Results. The study group consisted of 994 patients, representing 9.6% of all hospitalized children. Regarding the prevalence of constipation, we did not notice a signifi cant difference between the sexes, the ratio F/M was 1.3/1, but we found a signifi cantly higher proportion of patients from urban areas 68% (676) versus 32% (318) from rural areas. In terms of social and family environment: 34% (338) of children live with grandparents, 13.9% (139) come from single-parent families, 6.7% (67) are in the care of a foster parent and 2.6% (26) come from orphanages. In the group studied a low percentage of children were breastfeed, respectively 26.2% (261) in the first month, 10.7% (107) for 3 months, while at 6 months 98.1% (976) of children received a milk formula. Diversifi cation was done incorrectly in the case of 41% (408) patients. Only 14.6% (145) reported daily consumption of fruits and vegetables, while 51.1% (508) had dinner at least once a week at fast food restaurants. 21.6% (214) practice sport at least 2 hours/week, while 48.7% (484) spend at least 3 hours/day watching television. 12.8% (128) of patients are overweight and 5.7% (57) obese. Conclusions. Constipation is a condition that affects children of all ages. There are not notable differences between the sexes. An increased proportion of urban patients with predominance of inadequate diet, physical inactivity and an increased proportion of overweight patients was found. The socio-familial environment has an important role in the psychological changes.

Primary peptic ulcer still remains highly quoted in children from developing countries, the infection with H. pylori having a high incidence among this cases. Between 2007 and 2012 a retrospective study was performed, involving 84 children who were hospitalized in our clinic, ulcer disease being the main diagnosis.The study’s inclusion criteria were suggestive clinical symptoms and positive endoscopy. The studied group consisted by 79 children with primary ulcer and 5 with secondary ulcer. Reporting data for 1,400,000 children population in North – Eastern Romania an incidence of 5.64/100.000 of primitive ulcer disease has been found, the frequency being 2.58% compared with the overall 3052 upper digestive endoscopies done in the years mentioned above. Male to female ratio was 1.46:1. 77.41% of the patients originated in urban areas. The onset was by functional digestive syndrome in 70,89% of the cases or by complications in 29.11% of the cases. By upper digestive endoscopy 62 duodenal ulcers (DU) and 10 gastric ulcers (GU) were identifi ed. Perforation allowed intraoperative diagnosis of ulcerative lesions in 7 children. 70.89% were H. pylori infection – related ulcers. The contributing factors for developing this condition were unproper diet (63.16%), smoking (57.89), alcohol consumption (15.78), psychological stress (27.27%). We obtained a signifi cant correlation between the high number of a family members, (r = 0.63%; p = 0.002), the low socio-economical status (r = 0.87, p = 0.0003) and H.pylori infection. We used the standard triple therapy on 73.33% of the patients, the qvadruple therapy, based on bismuth on 16.66% of the children, and the sequential therapy in 10% of the cases. The global eradication rate was 66.66% therefore we considered this as being an indirect proof for the high claritromycine resistance in children from our region.

Mycotic gastritis is still an open chapter in specialized research due to the small number of cases described in literature, to its incompletely known complications and prognosis, which creates therapeutic diffi culties. The authors report the case of an immune-competent 5 years and 4 months old male child, in whom upper digestive endoscopy revealed eso-gastro-duodenitis caused by Aspergillus.

Nonsteroidal anti-inflammatory agents (NSAIDs) produce gastric lesions through two mechanisms: local irritation and systemic action. A 2 year and 10 months old female received NSAID for acute upper respiratory infection for 2 days and she developed coffee ground vomitus one day later. Upper gastrointestinal endoscopy revealed a gastric ulcer. She was negative for H. pylori infection, and she was diagnosed with NSAID – induced acute gastric ulcer in the absence of other causes of gastric ulcer. Gastric ulcers develop very rarely after a short-term administration of NSAIDs, which prompted us to report this case. Balancing the risk and the benefit of eradication therapy, it is indicated, for every patient who must follow a chronic treatment with anti-inflammatory drugs, to look for possible associated risk factors.

Helicobacter pylori (H. pylori) is a microaerophilic gram-negative bacterium infecting approximately one half of the world’s population. The oral cavity and dental plaque may be a reservoir for H. pylori infection. Diagnosis of H. pylori infection in children differs from that of adults. Although H. pylori has long been known to be detected in the oral cavity, the significance of such findings are controversial. Oral H. pylori may play an important role in re-infection of the gastric mucosa. The gold standard for eradicating H. pylori infection is standard triple therapy. The studies have shown promising results in the management of both oral and gastric H. pylori.

Irritable bowel syndrome (IBS) is not a disease. It is a group of symptoms that occur together, symptoms as: chronic or recurrent abdominal pain, altered bowel habits, and bloating, with the absence of structural or biochemical abnormalities. Irritable bowel syndrome is a functional gastrointestinal disorder. The causes of IBS are poorly understood. Limited information is available about the number of children with IBS. IBS affects boys and girls equally, but affects each person differently. IBS can be very difficult to diagnose. IBS is diagnosed by exclusion. To diagnose IBS, a health care provider will conduct a physical exam and take a complete medical history. The main objective of treatment for IBS is to restore normal daily function. Diet and lifestyle changes are important in decreasing the frequency and severity of IBS symptoms. Irritable bowel syndrome is a long-term disease and symptoms usually recur. This may be influenced by factors such as stress, diet or other environmental causes. Avoiding triggers is the best way to prevent symptoms of IBS. However, based on the symptoms, this disease can be confused with other organic bowel diseases.

Osteogenesis imperfecta (OI) is a group of rare congenital conditions characterized mainly by bone brittleness secondary to mutations in the genes encoding collagen. The medical history together with a clinical examination in detail of the fractures is highly important in directing the diagnosis towards OI. The authors present an OI case diagnosed in an 11-years old patient with a history of multiple fractures, with bone deformations, which associates a rare congenital malformation – bilateral radioulnar synostosis. This case needs multidisciplinary monitoring (pediatric, orthopaedic, genetic, psychologic).

The oral cavity represents an important source of information about the health of a child. Oral lesions may manifest early, sometimes concomitant with a systemic disease, disappearing with general health improvement or later persisting in spite of the disease’s remission. Also, these can present developmental abnormalities. Oral mucosal lesions are commonly found in patients with liver cirrhosis. We present the case of a 12 years old boy with liver transplant since he was 9 years old, for the biliary cirrhosis secondary to the biliary hypoplasia. The patient had also very low height and weight prior to liver transplant, advanced osteomalacia and many oro-dental manifestations. Severe growth delay and osteomalacia have multiple causes, due to the primary hepatic pathology and to the chronic malabsorption syndrome, also due to the post-transplant immunosuppressant medication. Orodental lesion type and severity depends on the age of the child. It is important to know when the systemic disorders started, their duration and type, as well as their impact. The oral cavity can be significantly affected by immunodeficiency, cholestasis, malnutrition and coagulopathy

Down syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. Megacolon is an abnormal dilation of the colon, often accompanied by a paralysis of the peristaltic movements of the bowel. Congenital megacolon occurs in 1 in 5000 births. The incidence increased with the presence of Down syndrome. Congenital megacolon usually becomes manifest in early childhood. The diagnosis is usually made at birth because of meconium ileus or constipation. Plain X-ray shows a caracteristically narrowed distal segment and a dilated proximal colon. The authors present the case of a four months old child hospitalized at the 5th Pediatric Clinics of “St. Mary” Children's Emergency Hospital who was diagnosed with Down syndrome and congenital megacolon. Removal of the functionally abnormal bowel has relieved the patients' symptoms.