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Purpose: Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease of intestines. The high cost of second line drugs along with the need for lifelong therapy are the most distressing factors demanding innovative therapy for treating this disease. Fecal microbial transplantation (FMT) can be used as an adjunct for treating UC. We performed FMT in a six year old male child who was being treated for ulcerative colitis with conventional therapy for the last two years with variable response to therapy. This therapy also has good potential as salvage therapy for refractory multidrug resistant Gram negative organisms and Clostridium difficile infection. Methods: After taking appropriate informed consent, a healthy adult donor from the family was thoroughly screened for various infections (as per protocol). Donor fecal preparation was done taking strict aseptic precautions and FMT was given as retention enema for 1 h (60 ml enema every 15 min) daily for 5 days. Patient was monitored for adverse event (as per protocol). Results: The patient tolerated the enema well. The Paediatric Ulcerative Colitis Activity Index (PUCAI) reduced from 35 to 15 after completion of five days of therapy. There has been no relapse since FMT and the child continues to be asymptomatic with a stable low PUCAI score 6 months post therapy. Conclusion: Our study is a step and encouragement towards the usage of FMT for pediatric patients with ulcerative colitis showing variable response to conventional treatment. However, more future studies are required to authenticate this treatment modality. [ABSTRACT FROM AUTHOR]

Objective: To document the prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic parameters among normalweight and overweight schoolchildren. Design: Cross-sectional study. Setting: Thirteen private schools in urban Faridabad, Haryana. Participants: 961 school children aged 5-10 years. Methods: Ultrasound testing was done, and 215 with fatty liver on ultrasound underwent further clinical, biochemical and virological testing. Outcome measures: Prevalence of fatty liver on ultrasound, and NAFLD and its association with biochemical abnormalities and demographic risk factors. Results: On ultrasound, 215 (22.4%) children had fatty liver; 18.9% in normal-weight and 45.6% in overweight category. Presence and severity of fatty liver disease increased with body mass index (BMI) and age. Among the children with NAFLD, elevated SGOT and SGPT was observed in 21.5% and 10.4% children, respectively. Liver enzyme derangement was significantly higher in overweight children (27% vs 19.4% in normal-weight) and severity of fatty liver (28% vs 20% in mild fatty liver cases). Eleven (8.1%) children with NAFLD had metabolic syndrome. Higher BMI (OR 35.9), severe fatty liver disease (OR 1.7) and female sex (OR 1.9) had strong association with metabolic syndrome. Conclusions: 22.4% of normal-weight and overweight children aged 5-10 years had fatty liver. A high proportion (18.9%) of normal-weight children with fatty liver on ultrasound indicates the silent burden in the population. [ABSTRACT FROM AUTHOR]

Background: The incidence of inflammatory bowel disease is increasing in the pediatric population worldwide. Need and purpose of review: There is paucity of high quality scientific data regarding pediatric inflammatory bowel disease. Most of the guidelines are offshoots of work done in adults, which have been adapted over time to diagnose and treat pediatric patients. This is in part related to the small numbers in pediatric inflammatory bowel disease and less extensive collaboration for multicentric trials both nationally and internationally. Methods: A literature search was performed using electronic databases i.e. Pubmed and OVID, using keywords: pediatric, inflammatory bowel disease, Crohn's disease, Ulcerative colitis, epidemiology and guidelines. This article amalgamates the broad principles of diagnosing and managing a child with suspected inflammatory bowel disease. Main conclusions: 25% of the patients with inflammatory bowel disease are children and and young adolescents. The primary concern is its impact on growth velocity, puberty and quality of life, including psychosocial issues. Treatment guidelines are being re-defined as the drug armamentarium is increasing. The emphasis will be to achieve mucosal healing and normal growth velocity with minimal drug toxicity. [ABSTRACT FROM AUTHOR]

Background: To study the functional aspects of the transposed stomach in the thoracic cavity and its effects on other organ systems. Patients and Methods: Children who had undergone gastric transposition more than 5 years ago were evaluated for symptoms, anthropometry, anaemia, duodenogastric refl ux, pulmonary function, gastric emptying, gastric pH, gastroesophageal refl ux and stricture, gastric motility, and gastritis and atrophy on histological examination of gastric mucosa. Results: Ten children were evaluated at a median follow-up of 90.5 months. On evaluation of symptoms, nine children were satisfi ed with the overall outcome. All patients had their weight and 7 patients had height less than 3rd percentile for their respective age. Anaemia was present in 7/10 children. On evaluation with hepatobiliary scintigraphy, duodenogastric refl ux was present in only 1 patient. Mass contractions of the transposed stomach were present in two thirds of the children. The mean gastric emptying t1/2 was 39.1 minutes. Pulmonary function tests were suggestive of restrictive lung disease in all the patients. Forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were worse in children who underwent transposition or diversion following oesophageal anastomotic leak. Acid secretion was preserved in most patients with episodes of high gastric pH during sleep in nearly half. Mild gastritis was present in all patients where as mild atrophy of the gastric mucosa was observed in only 1child. Helicobacter pylori were positive in 3/8 children. Barium swallow demonstrated refl ux in 2 children. Conclusions: Most children with transposed stomach remain asymptomatic on follow up. However, subclinical abnormalities are detected on investigations, which need close observation as they can manifest later in life. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding is a life threatening condition in children. Common sources of upper gastrointestinal bleeding in children include variceal hemorrhage (most commonly extra-hepatic portal venous obstruction in our settings) and mucosal lesions (gastric erosions and ulcers secondary to drug intake). While most gastrointestinal bleeding may not be life threatening, it is necessary to determine the source, degree and possible cause of the bleeding. A complete and thorough history and physical examination is therefore vital. Esophagogastroduodenoscopy and colonoscopy are currently considered the first-line diagnostic procedures of choice for upper and lower GI bleeding, respectively. The goals of therapy in a child with GI bleeding should involve hemodynamic resuscitation, cessation of bleeding from source and prevention of future episodes of GI bleeding. Antacids supplemented by H2- receptor antagonists and proton pump inhibitors are the mainstay in the treatment of bleeding from mucosal lesion. For variceal bleeds, therapeutic emergency endoscopy is the treatment of choice after initial hemodynamic stabilization of the patient. Independent prognostic factors are presence of shock and co-morbidities. Underlying diagnosis, coagulation disorder, failure to identify the bleeding site, anemia and excessive blood loss are other factors associated with poor prognosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article on severe thrombocytopenia with bleeding manifestations in two children secondary to Plasmodium vivax that was published in a previous issue.

The article offers information on a study that investigated the difference in donor demographics pertaining to liver transplantation carried out in a retrospective review.