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The offices of pediatric gastroenterologists are filled with infants whose pediatricians have diagnosed gastroesophageal reflux disease. Infants with arching, crying, spitting, and food refusal are being diagnosed with GERD. Although [...]

An approach is presented for treating infants who develop 'short gut colitis', or inflammation of the small intestine in babies who have already developed short bowel syndrome. This is a condition in which digestion and absorption of nutrients is impaired because a significant amount of intestine has been lost due to disease or abnormal development. Total parenteral nutrition (TPN; the delivery of nutrients intravenously), a relatively recent therapeutic approach, has dramatically improved the outcome for most infants with short bowel syndrome. Some, however, develop short gut colitis. Sixteen infants (aged 2 to 20 months) with an average small intestine length of approximately 24 centimeters were studied. They had bloody diarrhea, which was not obviously the result of infection, as well as signs of poor carbohydrate absorption. All patients were fed both parenterally (via a thin tube inserted into a major vein) and enterally (by mouth) with formula. Their symptoms had begun when enteral feeding was being introduced. Examinations of the bowel (by sigmoidoscope) and biopsies were performed in several cases; the histopathological results (of tissue examination under a microscope) are presented. The infants' symptoms improved when enteral nutrition was given at less than full strength or stopped, implying that the colitis may have been a result of malabsorption of nutrients in the formulas. Suggestions are presented concerning the management of these patients and the medications that seemed most beneficial. Sulfasalazine appeared to be most effective in decreasing bowel inflammation. Short gut colitis is best treated soon after symptoms appear, and early treatment ultimately makes it easier to wean infants from TPN. (Consumer Summary produced by Reliance Medical Information, Inc.)

Resolving chronic constipation in children EXPRESS STOP Chronic constipation in children: Boys develop chronic retentive constipation with soiling more often than girls. The child is unaware of and unable to [...]

Gastroesophageal reflux is common among young infants and may cause significant morbidity in a minority of affected patients. Recent clinical research has changed early assumptions about pathogenesis, and refinement in diagnostic techniques have improved the ability to identify and treat these patients.

Thirty infants < 12 mo old (19 with pathologic gastroesophageal reflux and 11 symptomatic controls) underwent continuous monitoring of distal esophageal pH with simultaneous pharyngeal and multiple-site esophageal manometry to compare acid clearance times of awake and asleep reflux episodes. While awake, acid clearance times of the two groups were equivalent. While asleep, mean acid clearance time increased in subjects with pathologic reflux > 500% while remaining essentially unchanged in symptomatic controls. No difference in minimum pH attained during sleep reflux, in percentage of swallows resulting in esophageal peristalsis, or in the frequency of secondary peristaltic waves was found to explain the difference in sleeping acid clearance times in the two groups. However, there was a significant difference between the groups with respect to swallowing rate (p < 0.01). During sleeping reflux episodes, subjects with pathologic reflux swallowed 0.5 ± 0.1 times per minute (mean ± SEM), whereas controls who refluxed swallowed 3.5 ± 1.3 times per minute. During awake reflux episodes the swallowing rates were equivalent in the two groups, 4.1 ± 0.4 and 4.7 ± 0.7 per minute, respectively. We conclude that low swallowing rate during sleeping reflux episodes is primary to the delayed clearance of sleeping reflux in these infants.