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Introduction and Aim: Abdominal pain in children is a frequent cause of emergency room consultation. An important group of those patients presents with chronic constipation and fecal impaction. Plain abdominal x-ray is widely used for making a diagnosis and ruling out the need for surgical treatment. The present study examined the association between pain intensity and fecal impaction grade., Materials and Methods: An analytic cross-sectional study was conducted that compared 2 radiographic scales to determine the association between the grade of fecal impaction observed and abdominal pain intensity in patients that sought medical attention at an emergency service within a 7-month period. The analysis was carried out by 2 different observers, utilizing 2 different radiographic scales to confirm their reproducibility. The degree of interobserver agreement was measured using the Kappa coefficient and the association between abdominal pain and fecal impaction grade was measured through the Spearman correlation coefficient., Results: There was a significant association between pain intensity and the radiographic grade of fecal impaction (P<.05) for the radiographic scale by segments and its interobserver agreement was high, compared with the scale by percentage., Conclusions: Radiographic scales may be useful in the evaluation and treatment of patients with abdominal pain and constipation. The segmental scale showed less interobserver variability, suggesting its proposal as an alternative in the evaluation and follow-up of patients with chronic constipation., (Copyright © 2019 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

The frequency of gastroesophageal reflux disease in pediatrics has increased. There is not a clear explanation, some believe there is more awareness of the disease, others believe that new formulas, which are richer in nutrients, may irritate the gastrointestinal tract of the infant. Clinically, children present with regurgitation-malnutrition, respiratory disease, and esophagitis. The medical treatment aims to improve the eating techniques, to decrease the gastric acid output, and to improve the motility function of the esophago-gastrointestinal tract. Surgical treatment is rarely needed.

Traditional methods for collecting duodenal fluid are time consuming and technically difficult. A simple endoscopic method is proposed in this report as a means of collecting duodenal fluid to perform exocrine pancreatic function tests. Thirty-five patients between 24 and 36 months of age were studied for pancreatic exocrine function. Twenty-seven presented with chronic diarrhea and 8 with failure to thrive. In 20 patients (group 1), duodenal fluid was collected by means of a double-lumen tube and sequential administration of pancreozymin (PZN) and secretin (SEC). The rest (group 2) had duodenal aspiration from the level of the papilla of Vater through a fiberoptic endoscope following administration of SEC only. The procedure took approximately 3 h in group 1 and 45 min in group 2. Secretin administration produced comparable levels of enzymes in both groups. Pancreozymin produced the highest enzyme levels, but this was only significantly higher than SEC-induced levels in the case of lipase. Endoscopic collection of duodenal fluid following SEC administration is a safe, quick, and reliable method of collecting pancreatic secretion.

The long-term effect of adrenalectomy (Adx) on the exocrine pancreas was examined in female adult rats. Pancreatic amylase concentration decrease to 50% of the control level starting 10 days after Adx, whereas the levels of trypsinogen and lipase remained unchanged. Replacement studies beginning 24 h after surgery with corticosterone (B, 1 mg/100 g body wt) or aldosterone (ALDO, 8 micrograms/100 g body wt) alone did not prevent the decline in amylase after Adx. However, when both hormones were administered together, pancreatic amylase concentration was maintained at a level similar to that of the control group. Serum corticosterone levels in the rats receiving B alone or B + ALDO were not different, and were comparable to levels found in normal rats. Both ALDO and B, given for 5 days starting 10 days after Adx, were required to restore amylase concentrations toward control values. When spironolactone (SPIRO, 3 mg/100 g body wt), a specific mineralocorticoid receptor blocker was administered bid together with ALDO + B, it blocked the increase in pancreatic amylase seen in ALDO + B treated rats but did not affect the serum corticosterone levels. These results suggest that mineralocorticoids are also involved in modulating the level of amylase in the rat exocrine pancreas.