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Abstract. The association of lactase deficiency with recurrent abdominal pain was investigated. One hundred three white children between the ages of 6 to 14 years with recurrent abdominal pain were evaluated. Sixty-nine underwent lactose tolerance tests and 26 had intestinal biopsies with lactase determinations; 21 of 69 (30.4%) had abnormal lactose tolerance tests and eight of 26 (31%) were lactase deficient. However, 16 of 61 (26.4%) control subjects matched for age and ethnic background exhibited lactase deficiency. Thus, a similar prevalence of lactase deficiency was found in the control and the recurrent abdominal pain groups. Thirty-eight patients with recurrent abdominal pain completed three successive six-week diet trials conducted in a double-blind fashion. An increase above base line value in pain frequency was seen in ten of 21 (48%) lactose malabsorbers and four of 17 (24%) lactose absorbers. After a 12-month milk elimination diet, six of 15 (40%) malabsorbers and five of 13 (38%) absorbers had elimination of their pain. This result compared with improvement occurring in five of 12 (42%) absorbers with recurrent abdominal pain who received a regular diet for one year and suggests that the elimination of lactose will not affect the overall frequency of improvement in recurrent abdominal pain. In addition, the recovery rate from recurrent abdominal pain is similar in both lactose absorbers and nonabsorbers independent of dietary restrictions. Pediatrics 67:828-832, 1981; recurrent abdominal pain, lactase deficiency, lactose malabsorption, lactose intolerance. [ABSTRACT FROM AUTHOR]

Abstract. Thirty infants with intractable diarrhea of infancy (IDI) underwent small bowel biopsies in order to determine the extent and duration of small intestinal mucosal injury. The onset of the persistent diarrhea occurred prior to 3 months of age and continued for an average of 48 days prior to investigation. In 18 cases, no associated entities were found. Mucosal injury was invariably found in all 30 infants: grade IV injury in 11, grade III in eight, grade II in nine, and grade I atrophy in one. Disaccharidase activities were diminished and corresponded to the degree of atrophy. Lactase activity was diminished to a greater extent than sucrase and maltase. Significant, persistent mucosal injury existed for an average of six months in 16 of the 23 (70%) repeat biopsies. All infants were given an elemental diet (ED). Twelve of the 30 infants required parenteral nutrition (PN). These infants were gradually advanced to an oral elemental diet and maintained on this diet until histologic findings and disaccharidase levels were normal. Eighteen infants were fed and maintained on an elemental diet by mouth from time of admission until normal histologic findings and disaccharidases were found. No mortality occurred during management and follow-up. Twenty-two of the 28 infants in whom follow-up growth data were available excelled in weight and height velocity. The data suggest that prolonged injury to the small intestinal mucosa is a common finding in many cases of intractable diarrhea of infancy. Elemental diets should be started early in the course of protracted diarrhea in young infants, and may need to be continued for several months since histologic and enzymatic changes of the small intestine may persist for extended periods. Pediatrics 66:730-735, 1980. [ABSTRACT FROM AUTHOR]

Presents information on groin pain and the factors that cause this problem. Causes of this problem; Diagonosis of this problem; Treament of this problem. INSETS: Case study: Hip pain in a young football player;Case Study: A surprising cause of groin pain in a female....

Thirty-two children with ulcer disease were seen over a four-year period. Twenty-seven children had a primary ulcer and five had an ulcer associated with an acute or chronic illness (secondary ulcer). Antral ulcer was diagnosed most commonly, followed by duodenal ulcer and gastric body ulcer. The ratio of gastric ulcer to duodenal ulcer was 17:11. Diagnosis of ulcer was accomplished by endoscopy in 97% of the patients and by radiography in 70% of those studied. Radiologic accuracy was obtained in 89% with duodenal ulcer but in only 50% of those with gastric ulcer. Children with primary gastric ulcer presented with no evidence of chronicity and 12% had persistence or recurrence of ulcer during follow-up. Eighty-two per cent of the children with primary duodenal ulcer presented with chronic symptoms consisting of abdominal pain, nausea, vomiting or recurrent bleeding and 45% had persistence or recurrence of ulcer during follow-up. Children with secondary ulcer all presented with acute symptoms and none had persistence or recurrence. Twenty children were treated prospectively with cimetidine and 11 were treated with antacids. Repeat endoscopy was employed in 16 as a measure of healing. All children with isolated antral ulcer did well clinically, regardless of mode of therapy and of those studied by re-endoscopy all showed complete or substantial healing at six to eight weeks. Treatment of a small group of children with primary duodenal ulcer using cimetidine was initially efficacious, although recurrence of ulcer was noted after cessation of treatment in four of six children given cimetidine. In addition, cimetidine appears to offer no advantage compared to antacids in the treatment of uncomplicated antral ulcer in children. [ABSTRACT FROM AUTHOR]