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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Antibiotics are prescribed frequently for common childhood infections and Antibiotic-Associated Diarrhea (AAD) appear often in this children. AAD is unexplained diarrhea occurring between 2 hours to 2 months after starting antibiotics, where diarrhea is defined as more than 2 unformed stools for ≥2 days. Children younger than 6 years and type of antibiotics are the two risk factors identified for AAD. The antibiotics with which AAD was associated were: amoxycillin-clavulanate, cephalosporins, macrolides, trimethoprim-sulphamethoxazole and penicillin G and V. The most commonly mechanism for AAD is intestinal overgrowth with pathogenic microorganisms, especially Clostridium difficile, following alterations to the normal intestinal flora induced by antibiotics. Symptoms may range from a mild form of liquid diarrhea to a severe form of pseudomembranous colitis with abdominal pain, local, and systemic inflammation and a typical history of diarrhea that is chronologically related with antibiotic administration. Most of the AAD would respond to only discontinuation or change of the antibiotic, but in Clostridium difficile infection oral metronidazole or oral vancomycin are drugs of choice. Probiotics are increasingly used for prevention and treatment of diarrhea associated antibiotics in children. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (HP) infection is a very important pathogenic link in children with gastroduodenal pathologies. The bacterial implication, in the pathogeny of the digestive diseases and in the development of some extradigestive diseases, is very well known nowadays. The prevalence of the infection differs between geografic areas, it is declining in the developed countries and it is high in the population of the countries in development. It is a fact that there are bacteria which affect specifi cally an organ, but in the same time, can lead to systemic alterations throughout the entire body. The chronic infection with H. Pylori is associated with anaemia, weight and height loss. The increase of the quality and accuracy inidentifying the H. Pylori infection leads to a low rate of complications of the infection by applying the correct and early treatment. [ABSTRACT FROM AUTHOR]

Bolile inflamatorii intestinale (boala Crohn şi rectocolita ulcero-hemoragică) rămân un capitol deschis cercetării din cauza frecvenţei (în creştere în ultimele decade), particularităţilor clinico-evolutive a suferinţei digestive şi extradigestive, a enigmelor patogenetice, sursă a dificultăţilor terapeutice. Tipare genetice specifice, mutaţii genice favorizează răspuns imun aberant la antigeni din mediu sau la autoantigeni provocând o inflamaţie intestinală cu potenţial înalt de cronicizare; citokinele eliberate şi alte mecanisme încă necunoscute pot firesponsabile de manifestările extradigestive. Autorii sistematizează date recente privind patogeneza formelor clinico-evolutive, posibilităţi moderne de diagnostic, posibilităţile şi limitele măsurilor terapeutice moderne în artropatiile care însoţesc boala inflamatorie intestinală. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (Crohn disease and ulcero-hemorrhagic rectocolitis) remains a chapter open to research due to its frequency (higher in the last decades), the clinical and evolutive particularities of digestive and extra digestive disorders, pathogenic enigma which represents a source of therapeutic difficulties. Specific genetic patterns and gene mutations favour the aberrant immune response to the antigens in the environment or the autoantigens causing bowel inflammations with high chronicization potential; the cytokines released and other still unknown mechanisms can be responsible for extra digestive disorders. The authors systematize recent data related to the pathogenesis of clinical evolutive types, modern diagnosis possibilities, the limits and the possibilities of modern therapeutic measures in arthropathies accompanying the inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Hemoragia digestivă la copil poate evolua de la forma ocultă până la manifestări majore cu risc vital. Etiologia cuprinde boli extradigestive (patologia acută a sistemului nervos, coagulopatii, hipertensiune portală etc.) sau digestive (infecţioase, malformative, inflamatorii etc.) cu o frecvenţă nuanţată de vârstă. Anamneza grevată de numeroase posibilităţi de eroare se completează cu o explorare sistematizată abordându-se: gravitatea pierderii de sânge, reflectarea acesteia asupra funcţiei organelor vitale, depistarea unei cauze medicale sau a unei cauze chirurgicale preexistente (malformativă) sau dobândite. Tratamentul este nuanţat de severitatea pierderii de sânge, de necesarul de medicamente cu impact etiopatogenetic. Endoscopia digestivă, pe lângă rolul ei important ca metodă de diagnostic, reprezintă uneori şi o metodă terapeutică. [ABSTRACT FROM AUTHOR]

Digestive hemorrhage in children can evolve from the occult form up to major manifestations with vital risk. The etiology comprises extra-digestive (acute pathology of the nervous system, coagulopathies, portal hypertension, etc.) or digestive (infectious, malformative, inflammatory etc.) diseases with a frequency which depends on the age. The medical history encumbered by multiple error possibilities is supplemented with a synthesized exploration, which approaches: the seriousness of the blood loss, its reflection on the function of the vital organs, depicting a medical cause or a preexisting (malformative) or acquired surgical cause. The treatment depends on the seriousness of the blood loss, on the necessary drugs with ethiopathogenetic impact. Besides its important role as diagnostic method, the digestive endoscopy sometimes represents a therapeutic method. [ABSTRACT FROM AUTHOR]

Gastritele micotice rămân un capitol deschis cercetării din cauza cazurilor puţine citate în literatură, a complicaţiilor şi prognosticului incomplet cunoscute, sursă a dificultăţilor terapeutice. Autorii raportează cazul unui copil de sex masculin, în vârstă de 5 ani şi 4 luni, imunocompetent, la care endoscopia digestivă superioară a obiectivat o eso-gastro-duodenită cu Aspergillus. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Psychosomatic diseases refer to those medical affections whose appearance and/or evolution is signifi cantly infl uenced by psychological factors. The main digestive disorders in which the psychosomatic factor is prevalent are: gastroduodenal affections, corrosive esophagitis, constipation, encopresis, emotional diarrhoea, irritable bowel syndrome, ulcerative rectocolitis and Crohn's disease. The management is based on collaboration between the psychologist and the pediatric gastroenterologist. Supportive psychotherapy is necessary for completing medication. Child should receive emotional support and be helped to understand their feelings about the situation of the disease. The doctor must create a relationship based on trust, develop an attitude that shows empathy, honesty and openness towards children. [ABSTRACT FROM AUTHOR]

Bolile psihosomatice sunt acele afecţiuni medicale a căror apariţie şi/sau evoluţie este determinată, în mod semnifi cativ, de factori psihologici. Principalele tulburări digestive în care factorul psihosomatic este prevalent sunt: afecţiunile gastroduodenale, esofagitele corozive, constipaţia, encompresis, diareea emoţională, sindromul colonului iritabil, rectocolita ulceroasă şi boala Crohn. Conduita terapeutică se bazează pe strânsa colaborare dintre psiholog şi pediatrul gastroenterolog. Psihoterapia de susţinere este necesară pentru completarea medicaţiei. Copilul trebuie să primească suport emoţional şi ajutat să îşi înţeleagă sentimentele faţă de situaţia de boală traversată. Medicul trebuie să realizeze o relaţie de încredere, să dezvolte o atitudine empatică, onestă şi deschisă în relaţiile cu copiii. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) is a microaerophilic gram-negative bacterium infecting approximately onehalf 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. [ABSTRACT FROM AUTHOR]

Obiective. Identificarea caracterelor clinice, endoscopice, etiologice la copiii diagnosticaţi cu hemoragie digestivă superioară şi inferioară. Material şi metodă. S-a efectuat un studiu retrospectiv descriptiv pe o perioadă de 3 ani (ianuarie 2010- decembrie 2012) pe 107 copiii cu vârsta între 1 şi 18 ani, internaţi pentru hemoragii digestive în Spitalului Clinic de Copii „Sf. Maria“ Iaşi. Lotul de studiu nu cuprinde hemoragii digestive din urgenţe chirurgicale, boli infecţioase, boli intestinale cu mecanism imunologic sau toxic. Analiza retrospectivă individualizată prin studiul foii de observaţie a cuprins date anamnestice, clinice, endoscopice şi histologice orientate pentru diagnosticul etiologic al hemoragiilor digestive. Toţi pacienţii au fost investigaţi prin endoscopie digestivă superioară/colonoscopie după ce procedura a fost explicată şi s-a obţinut consimţământul informat. Rezultate. Din lotul de 107 copii luaţi în studiu 39 (36,4%) au reprezentat hemoragia digestivă superioară (HDS), dintre care 6 cazuri (5,1% ) de cauza variceală iar 33 (94,8%) de cauză non variceală; şi 68 (63,5%) au prezentat hemoragia digestivă inferioară (HDI). În etiologia HDS gastrita erozivă a reprezentat 12 (30,8%) cazuri, esofagita 6 (15,4%), duodenita 6 (15,4%), ulcerul duodenal 4 (10,3%), ulcerul gastric 2 (5,1%), sindrom Mallory Weiss 1 (2,6%), etiologie multiplă 6 (15,4%) cazuri. Principalele aspecte etiologice ale HDI au fost poli colo-rectal în 28 (41,2%) cazuri, colită ulcerativă 14 (20,6%), leziuni nespecifi ce 12 (17,6%) fisuri anale 9 (13,4%), sindroame de polipoză intestinală 3 (4,4%), malformaţie vasculară 1 (1,5%), diverticul rectal 1 (1,5%) caz. S-au practicat intervenţii endoscopice concomitente în cazul polipilor colo-rectali. Concluzii. Hemoragia digestivă inferioară a fost cea mai frecventă, corelată cu cauze minore: polipi colorectali, fi suri anale, leziuni nespecifice. Hemoragia digestivă non-variceală forma cea mai frecventă s-a asociat cu gastrita erozivă, esofagita, duodenita, ulcerul gastric. Endoscopia digestivă s-a dovedit a fi o investigaţie utilă în diagnosticul hemoragiilor digestive şi cu aport terapeutic în anumite cazuri. [ABSTRACT FROM AUTHOR]

Constipaţia este un simptom comun în practica clinică. Definiţia include frecvenţa anormală a tranzitului, dificultate 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 re zistentă la tratamentul conservator. Confirmarea 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. [ABSTRACT FROM AUTHOR]

Hemoragia digestivă, o urgenţă majoră şi frecventă în gastroenterologia pediatrică, poate evolua autolimitat (75-85% cazuri) sau sever cu compromiterea hemodinamicii, când se impune o evaluare clinică, reanimare şi endoscopie în scop diagnostic şi eventual terapeutic. Aplicarea parametrilor endoscopici (clasificarea Forrest) pentru evaluarea recurenţei şi prognosticului unei hemoragii digestive jalonează atitudinea ulterioară. Endoscopia terapeutică în limitele circumstanţelor stabilite de declaraţia Societăţii Nord Americane de Gastroenterologie, Hepatologie şi Nutriţie Pediatrică, alegând una dintre tehnicile de injectare, coagulare sau mecanice, într-o manieră individualizată etiopatogeniei hemoragiei digestive, scade numărul intervenţiilor chi rurgicale şi frecvenţa deceselor. Diagnosticul endoscopic precoce împreună cu terapia hemostatică endoscopică şi administrarea endovenoasă de înhibitori ai pompei protonice, sunt măsuri care reduc sângerarea şi recurenţa hemoragiei în proporţie de 80-90%. Experienţa endoscopistului va influenţa promptitudinea recomandării intervenţiei chirurgicale în formele grave, cu risc vital. [ABSTRACT FROM AUTHOR]

Gastrointestinal bleeding, a major and frequent urgency in pediatric gastroenterology can develop self-limited (75- 85% of cases) or severe, with hemodynamic compromised, when require clinical assessment, resuscitation and digestive endoscopy for diagnosis and possible treatment. Application of endoscopic parameters (Forrest classification) to assess recurrence and prognosis of gastrointestinal bleeding peg subsequent attitude. Therapeutic endoscopy within circumstances established by The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition choosing one of the techniques of injection, or mechanical coagulation in an individualized manner to etiopathogeny of gastrointestinal bleeding, it decreases the number of surgical intervention and frequency of deaths. Both early endoscopic diagnosis and endoscopic haemostatic therapy with endovenous administration of proton pump inhibitors, are measures that reduce bleeding and hemorrhage recurrence rate of 80-90%. Endoscopist experience will influence the readiness of surgical recommendation in serious, life-threatening cases. [ABSTRACT FROM AUTHOR]

Human cytomegalovirus (CMV) is a herpesvirus, a member of the beta-herpesvirus subfamily. Infection with CMV represents a major cause of congenital infection, and also a cause of perinatal infection. We present the case of a 3 months-old sugar with breast milk jaundice and hepatic cytolysis, in our evidence from one month. At the age of 6 weeks, at the second evaluation, the laboratory tests showed a mild increase of lymphocytes and monocytes, minimum hepatic cytolysis and positive CMV immunoglobulin M (IgM) assays. Our decision was to follow up the case, without antiviral therapy, because the acute CMV infection was asymptomatic. Therefore, the hepatic cytolysis may precede the presence of CMV in blood, because the immune mediated response to CMV involve specific antibodies type IgM few weeks after the moment of infection. [ABSTRACT FROM AUTHOR]

Acute tonsillitis is an infection of the tonsils caused by one or more types of bacteria or viruses. We describe a case of acute tonsillitis, in a 8 year-old girl, with beta-hemolytic streptococcus group A, in pharyngeal exudate and staphylococcal methicillin-sensitive nasal swab, together with Epstein-Barr virus' IgM antibodies. The incidence of infectious mononucleosis concomitant with angina group A beta-hemolytic streptococcal (GABHS) and methicillin sensitive Staphylococcus aureus is much lower, but not exceptional, representing complications of infectious mononucleosis. Amazing is the association of these bacteria in the infectious mononucleosis. Therefore, we face with a possible initial viral infection with secondary bacterial superinfection. In cases like this, a joint venture of the two bacterial infections, antibiotic treatment is recommended in order to prevent complications, especially those that can occur after an untreated strep infection. [ABSTRACT FROM AUTHOR]