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The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with an actual or potential tissue injury that is described as such, emphasizing the subjective nature. The cognitive-behavioural therapy has begun to be applied for psychosomatic problems in dental problems. There are several types of techniques: relaxation, biofeedback, exposure and cognitive restructuring. In general, therapists may combine several of the above techniques to treat patients with dental anxiety.

The malabsorption syndrome includes numerous clinical entities accompanied by chronic diarrhoea, abdominal distension and failure to grow. The malabsorption of micronutrients may also have an effect on the tissues of the oral cavity. Lesions at this level can be important in detecting and monitoring diseases. The carefully established case history, family history, serological tests, and interclinical consultation can help give a correct diagnosis in a timely manner and can help prevent complications in these patients. Oral tissues can also provide a readily accessible place for Crohn’s disease biopsies. Sometimes, the severity or prognosis of the disease can be monitored by the presence or extent of the manifestations in the oral cavity.

Gastroesophageal reflux (GER) is a condition characterized by the retrograde passage of the gastric contents into the esophagus and subsequently into the oral cavity. Dentists can frequently diagnose a systemic disease by analysing the oral cavity – especially GERD with a minimal expression of digestive symptoms. Typical oral manifestations in GERD are dental erosions, burning sensation, mucosal erythema of the palate and uvula, and bruxism. Late diagnosis and, implicitly, late treatment of GERD can lead to significant deterioration of the teeth and mastication system. The successful treatment of GERD requires a multidisciplinary approach involving gastroenterologists, ENT specialists and dentists.

Human Cytomegalovirus is known to be the most common cause of congenital and perinatal infection in developed countries. The gastrointestinal involvement is not usually found among its’ most frequent clinical presentations. We present the case of a male infant, aged 1 month and 2 weeks, admitted in our clinic presenting abdominal meteorism, with progressive intensification from the age of 3 weeks old, but normal passage of gas and feces. Laboratory tests revealed cholestasis syndrome, discrete hepatocitolysis syndrome and positive Ig M and Ig G levels for Cytomegalovirus. The imagistic investigations and surgical examination excluded the surgical origin of the symptoms. It was established the diagnosis of gastrointestinal pseudo-obstruction associated with perinatal Cytomegalovirus infection. During a second admission in our clinic, to exclude the possible complications of the Cytomegalovirus infection, a cranio-cerebral CT was performed which identified bilateral modification of otomastoiditis and raised the suspicion of moderate cerebral atrophy. Our case adds to the limited existing information on the clinical picture of Cytomegalovirus infection and supports the idea that the gastrointestinal manifestations of the infection are more common than known.

Gastroesophageal reflux in newborns and infants is particularized by pathogeny, diagnosis and therapeutical approach, functional immaturity of the digestive tract, the anatomic immaturity of the Hiss lower esophageal sphincter and lower gastric acidity. In infants, the low compliance with the laborious procedures such as pHmetry, impedance – pH-metry and digestive endoscopy is also considered. The border between regurgitations, physiological gastroesophageal reflux and the reflux disease is sometimes hard to establish. Changing the lifestyle of infants (feeding and position changes) based on the mother’s compliance with the medical recommendations is a first step in the treatment of GER, followed in non-responsive cases by pharmacological therapy and surgery.

Rett syndrome is a childhood neurodevelopmental disorder that affects girls almostt exclusively. It is a genetic mutation (on the X chromosome) characterized by normal early growth and development followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability. Children with Rett syndrome display a wide variety of symptoms. They have many different health issues that require various treatments. This syndrome does not affect the normal pubertal development of the child. The authors present the case of a 17 years old child hospitalized at the 5th Pediatric Clinics of “St. Mary” Children’s Emergency Hospital who was diagnosed with Rett syndrome.

Gastroesophageal reflux in newborns and infants is particularized by pathogeny, diagnosis and therapeutical approach. The situation is much more complex for them due to the functional immaturity of the digestive tract, to the anatomic immaturity of the Hiss lower esophageal sphincter and to the lower gastric acidity. In infants, the low compliance with the laborious procedures such as pH-metry, impedance – pH-metry and digestive endoscopy is also considered. The border between regurgitations, physiological gastroesophageal reflux and the reflux disease is sometimes hard to establish. Changing the life style of infants (feeding and position changes) based on the mother’s compliance with the medical recommendations is a first step in the treatment of GER, followed in non-responsive cases by pharmacological therapy and surgery.

In both adults and pediatric population, depression is a major disability cause; suicide is the third death cause among children and adolescents. Whereas depression and depression with associated anxiety are among the most common psychiatric pathologies in children and adolescents (with strong impact on their global functionality and with a significant influence on their development process), they are far from studied thoroughly. This study aims to highlight certain demographic and clinical patterns associated to depression of anxiety in children and adolescents, which may represent premises for broader future research and for the consolidation of primary, secondary, and tertiary prevention methods.

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.

Objectives. Identifi cation of clinical, endoscopic, etiological characteristic of children diagnosed with upper and lower gastrointestinal bleeding. Material and methods. It was conducted a descriptive retrospective study over a 3 year period (January 2010 to December 2012) on 107 children aged 1-18 years hospitalized for gastrointestinal bleeding in ”St. Mary” Children’s Emergency Hospital, Iasi. The study group does not include gastrointestinal bleeding from surgical emergencies, infectious diseases, intestinal diseases with immunological or toxic mechanism. Individualized retrospective analysis included historical data, clinical, endoscopic and histological targeted for etiologic diagnosis of gastrointestinal bleeding. All patients were investigated by upper gastrointestinal endoscopy/colonoscopy after the procedure was explained and informed consent was obtained. Results. From the batch of 107 children, 39 (36.4%) presented with upper gastrointestinal bleeding (UGIB) 6 (5.1%) was variceal, non-variceal in 33 (94.4%) cases, and 68 (63.5%) presented with lower gastrointestinal bleeding (LGIB) The main etiologycal aspect of UGB was erosive gastritis 30.8%, esophagitis in 15.4%, duodenitis in 15.4%, gastric and duodenal ulcers 5,1% and respectivily 10.3% of cases, Mallory-Weiss syndrome in 2.6%, multiple etiology in 10 cases 15.4%. Causes of LGIB were colorectal polyps in 41.2.%, ulcerative colitis 20.6%, non specifi c lessions in 17.6% anal fi ssures 13.2%, intestinal polyposis 4.4 %,rectal diverticula 1.5% and vascular malformations 1.5%. It was practiced concomitent endoscopic surgery for rectal polyps. Conclusions. Lower gastrointestinal bleeding was the most common causes related to minor conditions: colorectal polyps, anal fi ssures, nonspecifi c lesions. Non-variceal gastrointestinal bleeding the most common form associated with erosive gastritis, esophagitis, duodenal ulcer, gastric ulcer. Endoscopy proved to be a useful investigation in the diagnosis of gastrointestinal bleeding and a therapeutic useful tool in certain cases.

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.

Very rare in children, the brown tumor, or osteoclastoma, is an understudied ectopic entity that causes severe debilitation in patients with chronic renal insufficiency. We report two cases who developed particular forms with different evolutions of severe renal osteodystrophy.

The growth and development of children is influenced by multiple factors like genetics, general health, physical activity, sedentary, sleep quality and proper nutrition. The disturbance of these factors during the pre-school period can negatively influence the health of the older child and later of the adult. An essential part of pediatrics is prevention. Pre-school care should provide opportunities for promoting healthy behaviours for appropriate physical and psychosocial development.

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.

Celiac disease is an autoimmune disorder of the gastrointestinal tract. The condition may develop at any age, triggered by exposure to dietary gluten in genetically susceptible individuals. The most frequent intestinal manifestations include diarrhea and weight loss. Common extradigestive manifestations include iron deficiency anemia, dermatitis herpetiformis. The authors presents a clinical case diagnosed with celiac disease expressed with gastrointestinal and extradigestive symptoms, such as abdominal pain, flatulence, anemia, impaired hepatic function and dermatitis herpetiformis.

Refluxul gastroesofagian la nou-născut şi sugar se particularizează prin patogenie, încadrare diagnostică şi abordare terapeutică, imaturitatea funcţională a aparatului digestiv, imaturitatea anatomică a sfincterului esofagian inferior Hiss şi aciditatea gastrică mai mică. În cazul sugarilor se ţine cont şi de complianţa redusă la procedurile laborioase cum sunt pH-metria, impedanţ-pH-metria şi endoscopia degestivă. Graniţa dintre regurgitaţii, reflux gastroesofagian fiziologic şi boală de reflux este uneori dificil de trasat. Modificarea stilului de viaţă la sugari (alimentaţia şi modificările poziţionale), prin obţinerea aderenţei mamei la recomandările medicale reprezintă un prim pas în tratamentul RGE, fiind urmat în cazurile non-responsive de terapia farmacologică şi intervenţia chirurgicală.

Erythema nodosum is the most frequent clinicopathologic variant of panniculitis. Triggers are represented by infections, sarcoidosis, rheumatologic diseases, inflammatory bowel disease, medications, autoimmune disorders, pregnancy and malignancy. Erythema nodosum typically manifests by the sudden onset of symmetrical, erythematous, warm nodules, usually located on the lower limbs. Often the lesions are bilaterally distributed. Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Nonsteroidal antiinflammatory drugs and potassium iodide may be helpful drugs to enhance analgesia and resolution. Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered, an underlying infection should be ruled out.

Introduction and aim. Acute diarrhea is the most common gastrointestinal disease in infants and young children. It is defined as an increase in the number of stools, watery, as a result of disruption of water and electrolytes transport in the gastrointestinal lumen and of the accelerated transit. Our study was retrospective, case-control type and tried to determine the cumulative risk factors underlying the emergence and evolution of diarrheal disease in infants and small children. Material and method. We studied a group of 197 children, with the age between 0-4 years, from „Sf. Maria“ Emergency Children’s Hospital from Iasi, which presented with acute diarrhea. Results. The bacterial etiology was confirmed in 44 cases. The most common germ involved was Campylobacter jejuni (27 cases). 31% of children had different degrees of dystrophy. In most cases (76%), the dehydration was isonatremic. Conclusions. In the acute diarrheal disease, dehydration remains the worst to fear consequence of this disease, but with an adequate attitude that includes restoring fluid and electrolyte balance and proper nutrition, diarrheal episode limits itself to an interval approximately of 72 hours.

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

Refluxul gastro-esofagian (RGE) la nou-născut şi sugar se particularizează prin patogenie, încadrare diagnostică şi abordare terapeutică. La aceştia situaţia este mai complexă dacă avem în vedere imaturitatea funcţională a aparatului digestiv, imaturitatea anatomică a sfincterului esofagian inferior Hiss şi aciditatea gastrică mai mică. În cazul sugarilor se ţine cont şi de complianţa redusă la procedurile laborioase cum sunt pH-metria, impedanţpH-metria şi endoscopia digestivă. Graniţa dintre regurgitaţii, reflux gastro-esofagian fiziologic şi boală de reflux este uneori dificil de trasat. Modificarea stilului de viaţă la sugari (alimentaţia şi modificările poziţionale), prin obţinerea aderenţei mamei la recomandările medicale, reprezintă un prim pas în tratamentul RGE, fiind urmat în cazurile non-responsive de terapia farmacologică şi intervenţia chirurgicală.

Atât la adulţi cât şi în cazul populaţiei pediatrice, depresia constituie o cauză majoră de dizabilitate, suicidul fiind a treia cauză de deces în rândul copiilor şi adolescenţilor. Cu toate că depresia şi depresia asociată cu anxietate sunt unele dintre cele mai frecvente patologii psihiatrice în rândul copiilor şi adolescenţilor, având un impact puternic asupra funcţionalităţii globale a acestora şi punând o amprentă remarcabilă asupra procesului lor de dezvoltare, rămân un domeniu insuficient explorat. Studiul de faţă îşi propune evidenţierea unor pattern-uri demografice şi clinice asociate depresiei şi anxietăţii la copii şi adolescenţi, care pot constitui premise pentru cercetări viitoare mai ample, dar şi pentru consolidarea unor metode de prevenţie primară, secundară şi terţiară.

Infecţia cu Helicobacter pylori (H. pylori) este o problemă comună şi semnifi cativă de sănătate publică. Obiectiv. Determinarea prevalenţei infecţiei cu H. pylori la copiii cu simptomatologie sugestivă şi conturarea cazurilor în funcţie de tipul şi felul gastritei prin efectuarea de endoscopii digestive superioare. Material şi metodă. Studiu retrospectiv realizat pe o perioadă de 5 ani pe 1.269 de copii cu simptomatologie gastrică, la care s-au efectuat endoscopii cu biopsie, stabilindu-se rata de infecţie cu H. pylori prin examen direct sau testul ureazei. Rezultate. Frecvenţa H. pylori în cazul gastritei acute a fost semnifi cativ mai mică (34,78%) comparativ cu frecvenţa acesteia în cazul gastritei cronice (54,94%). În cadrul celor 10 tipuri de gastrită, cele mai frecvente sunt formele purpurice (43,66%), nodular purpurică (25,93%) şi nodular antrală (15,84%), la polul opus situându-se gastrita atrofi că şi hipertrofi că. Asocierile cele mai frecvente decelate endoscopic sunt cu esofagita gr I în 51,6%, duodenita în 45,07% şi forma purpurică în 24,74%. Concluzii. Infecţia cu H. pylori este cel mai frecvent asociată gastritei cronice (54,94%). Identifi carea precoce a infecţiei este esenţială pentru eradicarea bacteriei şi prevenirea apariţiei diferitelor tipuri de gastrită identifi cate endoscopic.

Constipaţia este un simptom comun în practica clinică. Defi niţia include frecvenţa anormală a tranzitului, difi cultate în timpul defecării şi consistenţă anormală a scaunului. Metodele de diagnostic limitate precum şi numeroasele afecţiuni care conduc la apariţia simptomatologiei, duc la creşterea numărului de cazuri cu rezistenţa la tratament. Tratamentul include abordări dietetice şi comportamentale, terapie farmacologică şi în cazuri atent selectate intervenţie chirurgicală. Tratamentul chirurgical este recomandat la pacienţii cu constipaţie severă rezistentă la tratamentul conservator. Confi rmarea indicaţiei pentru tratament chirurgical necesită studii privind tranzitul colonic, funcţia de defecare, precum şi efectuarea manometriei anorectale. De aceea, colaborarea strânsă între pediatru, gastroenterolog şi chirurgul pediatru este absolut necesară pentru o evaluare preoperatorie atentă şi corectă a funcţiei gastro-intestinale. Complicaţiile postoperatorii includ obstrucţie intestinală, dureri abdominale, meteorism şi diaree. Eficacitatea intervenţiei chirurgicale şi prevalenţa complicaţiilor postoperatorii sunt determinate de evaluarea atentă preoperatorie a funcţiei gastro-intestinale.